Content
Successful adaptation can improve a psychosocial intervention’s fit with the target group and service system. In addition, adaptation can enhance implementation of an intervention, and it can potentially also promote its effectiveness.
Adaptation involves not only benefits but also potential risks. It is advisable to evaluate the risks at an early stage, when planning the adaptation.
Risks related to adaptation
The need for adaptation is not identified
- The need for the intervention’s adaptation is not identified even though the context in which the intervention is used has changed significantly over time.
- Intervention will be applied with new clients or in a new context.
Excessive or incomplete modification
- The intervention cannot be adapted due to licence restrictions or because the intervention is insufficiently documented.
- It is not possible to make the necessary modifications to the intervention due to an excessive adherence to fidelity in spite of a substantial change in the target group or context.
- The intervention’s core components and key mechanisms of change are modified, which may reduce the effectiveness of the intervention.
- The intervention has been modified to such an extent that it is no longer a matter of adaptation but rather an entirely new intervention.
Deficiencies in documentation
- Modifications made to the intervention have not been documented, which makes it impossible to evaluate them in terms of effectiveness.
- The intervention’s manual and other materials do not adequately specify which of the intervention’s components are flexible and which components are key to its effectiveness and therefore not adaptable.
Reduced effectiveness of the intervention
- Transferability refers to the extent to which the intervention and its effects can be replicated in a context other than the one it was developed in. Not all interventions are transferable, and their effectiveness may be reduced in a new context in spite of high-quality adaptation.
Inconsistencies in training
- Training on the intervention is not modified even though the content of the intervention has been adapted.
- Intervention supervision does not address uncontrolled modification of the intervention in practical work.
Balance between fidelity and adaptation?
Fidelity refers to the intervention being used as intended with children, adolescents and families. Fidelity and its assessment are especially important during intervention training. Nevertheless, implementing an intervention entirely unchanged over time is not realistic.
From the perspective of professionals who use the intervention, it is important to know which components of the intervention are flexible and can be tailored to the needs of individual clients, and which components must be kept unchanged. Distinguishing between these is key to maintaining the effectiveness of the intervention.
In some cases, the use of interventions may involve strict licence requirements, and the adaptation of interventions is restricted. In such cases, the intervention owner’s intention of maintaining strict fidelity may significantly limit the possibilities for adaptation.
Learn more about fidelity and adaptation.
What do we mean when we talk about unplanned modification of an intervention?
The unplanned modification of an intervention refers to a situation where the actual mechanism of action of the intervention ends up being changed. This means the modification of the intervention’s core components or functions, which may reduce its effectiveness. Core components refer to the features or components of an intervention that are essential for achieving desired results.
However, the unplanned modification of interventions is common in real life. The most common reasons for uncontrolled modification include professionals not having enough time, limited resources, and difficulties in getting participants for the intervention.
Practical examples of the unplanned modification of an intervention include reducing the frequency of sessions or omitting some of the content of the intervention.
In some cases, the original intervention that was implemented has been modified to such an extent that it has become an entirely new intervention. In such cases, the effectiveness of the intervention cannot be evaluated without new effectiveness study.