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2. Selection and Adaptation of Materials to Address ARA

Who should use this section:

  • APP programs that have never worked on ARA prevention;
  • APP programs that would like to use different materials to address ARA than they have in the past; and
  • APP programs that want to adapt existing ARA prevention approaches to better fit their needs.

APP programs vary widely in their implementation structures, available resources, settings, and partners. Therefore, it is important that programs that have chosen to address ARA are thoughtful in selecting an approach and materials that are appropriate. This section offers tools and practical guidance about how to select materials as well as registries that list programs addressing ARA, including individual- and multi-lesson programs. APP programs may choose to select specific lessons or activities to best meet their needs, rather than implementing an entire ARA prevention program.  Involving partners in choosing programs and materials before staff selection and training begins is highly recommended.

Programs will likely want to make adaptations to the selected materials to best suit their unique needs and the needs of their communities. This section provides resources to inform the adaptation process, which may involve adapting existing evidence-based APP programs to integrate ARA prevention content or tailoring existing ARA prevention programs to meet the needs of the target population, project structure, or implementation setting.

2.1. Consider Relevant Selection Criteria

APP programs may want to consider selection criteria for materials to address ARA. Youth workers should use the tools in this section to determine which criteria are important to their project so that they can assess ARA prevention activities against these criteria.

  • Vision for Healthy Relationships Education (PDF, 322KB)
    Futures Without Violence. (n.d.). 
    Using the National Health Education Standards, the National Sexuality Education Standards, and expertise in the area of ARA, Futures Without Violence developed this brief checklist of criteria for healthy relationships content. The checklist can be used to determine whether materials address important risk and protective factors for ARA.
     
  • Training Professionals in the Primary Prevention of Sexual and Intimate Partner Violence: A Planning Guide (page 62) (PDF, 1.6MB) 
    Fisher D., Lang, K. S., & Wheaton, J. (2010). Atlanta, GA: Centers for Disease Control and Prevention.
    This document includes a tool on page 62 that offers a broader perspective, distilled from a large literature review on characteristics of effective prevention programs that target a variety of problem behaviors. This tip sheet on nine principles of effective prevention programs may be helpful to APP projects considering the pros and cons of various programs or activities to address ARA. It provides an at-a-glance summary of each characteristic that programs may want to learn more about and then prioritize among their options.
     
  • An Evaluation of Safe Dates, an Adolescent Dating Violence Prevention Program (PDF, 1.5MB)
    Foshee, V. A., Bauman, K. E., Arriaga, X. B., Helms, R. W., Koch, G. G., & Linder, G. F. (1998). American Journal of Public Health, 88, 45-50.
    Another element to consider when selecting ARA prevention materials is whether they address mediators, or the risk and protective factors that have been shown to account for changes in ARA behavior. In this article, researchers reported that exposure to an ARA prevention curriculum resulted in less psychological abuse, sexual violence, and violence perpetrated against a current dating partner. They determined that changes in ARA norms (changing youth norms or acceptance that ARA is okay), gender stereotyping (changing youth beliefs about roles that boys and girls should have), and awareness of services for helping youth who are victims in abusive and violent relationships accounted for most program effects. To best impact behavior change, APP programs addressing ARA should include activities or approaches that address one or more of these risk and protective factors. Sections 2.3 and 2.4 of this toolkit provide information about programs, and Sections 3.3 and 3.4 include resources that address these mediators.  

    Programs addressing ARA should also consider materials that address the risk and protective factors or abusive behaviors that are salient in their communities and target populations. Staff should use needs assessment or other data to identify which factors are important to address. For instance, an organization might find that alcohol use is a common precursor to abusive behavior among youth in their community. This organization could then choose at least one ARA prevention activity that addresses alcohol use.
     
  • Organize and Match Information Tool (PDF, 1.8MB) in “The Adaptation Guide: Adapting HIV Behavior Change Interventions for Gay and Bisexual Latino and Black Men”
    Centers for Disease Control and Prevention. (2010). Atlanta, GA: Centers for Disease Control and Prevention.
    This tool, found on page 119 of this guide, may help APP programs organize needs assessment data and match potential interventions to this information. Although this tool was originally developed to help organizations select HIV behavior change interventions for another population, it provides a format that could be used by APP programs to match their own needs assessment data to potential ARA interventions. This tool could be used early in a planning stage when selecting an ARA intervention or when adapting an intervention to better fit a project or target population.

2.2. Identify Potential Materials

During the planning stage for ARA prevention activities, and through review of relevant criteria, APP projects may decide that implementing an ARA prevention program is (or possibly is) a suitable approach to meeting their goals. An important next step is to review existing programs to determine which might be appropriate to implement. Some governmental and nonprofit organizations maintain lists of programs that have been proven effective in preventing risk behaviors, including ARA. APP projects can use these lists to learn more about whether programs and approaches are suitable for the project’s target population; whether programs have been effective at addressing the risk and protective factors or outcomes that are important to the project; and whether programs can be implemented with available resources. Several of these lists are included below.

  • National Registry of Evidence-Based Programs and Practices (NREPP) 
    Substance Abuse and Mental Health Services Administration. (n.d.).
    This tool provides a summary for every intervention it reviews and includes a research description of outcomes reviewed, ratings of the quality of the research, ratings of readiness for dissemination, information about studies and materials reviewed, information about program costs, and contact information.  
     
  • Prevention Strategies Guide (PDF, 7.7MB)
    Communities That Care. (n.d.). 
    To identify the programs that fit the target community needs, pages 16-34 of the introduction summarize programs, along with the risk and protective factors addressed, domain(s) in which the program operates (family, school, community, or individual), the target age range of youth served, and the target audience.  Additional information about the programs is found in the Tested Programs (PDF, 195MB) section of this guide, which includes references, contact information, detailed information about how each program works, and information about program effectiveness. 
     
  • FindYouthInfo Substance Abuse, Violence, and Other Risk Behavior Program Directory  
    Interagency Working Group on Youth Programs. (n.d.). 
    This database reflects input from 18 federal agencies. Each program has a quality rating based on the conceptual framework, program fidelity, evaluation design, and empirical evidence. Details provided about each program include target population ages, a brief description of the intervention, evaluation specifications and findings, targeted risk and protective factors, references, and contact information. A page about Preventing Teen Dating Violence also provides brief descriptions of selected ARA prevention programs that have been evaluated.
     
  • Model Programs Guide 
    Office of Juvenile Justice and Delinquency Prevention. (n.d.). 
    This tool categorizes programs based on evidence of effectiveness. The database provides a brief description of each curriculum, the evaluation methodology, the findings, other information (such as cost), and references. Selection of programs can be made by filtering by various characteristics, including program type, ethnicity, gender, age, problem behaviors, target setting, and risk and protective factors. 
     
  • Blueprints for Healthy Youth Development Program Search 
    Center for the Study and Prevention of Violence at the University of Colorado. (n.d.). 
    This tool can be used to search for effective programs by keyword or by selecting among categories of program outcomes, target population, program type and setting, and risk and protective factors. Programs in this database are classified according to the strength of evidence of effectiveness.
     
  • What Works  
    Child Trends. (n.d.). 
    This database allows searches for evidence-based programs based on target population, program characteristics, and outcomes (“dating violence” is one option). The program descriptions provide an overview of the program, target population, detailed description of the program, evaluation approach and findings, and additional sources of information.

Students reading study materials with a teacher.2.3. Choose Materials: Individual Modules or Lessons

Identified below are individual lessons on various topics related to ARA prevention. Each lesson is approximately 45-60 minutes in length. APP programs addressing ARA should consider sequencing of activities and how each lesson is related to the existing APP curriculum or project activities being implemented. For instance, the lessons on gender stereotypes could be implemented early in an APP project because they provide a foundation for thinking about sexuality, sexual decision-making, and relationships.  Programs addressing ARA should choose lessons based on their fit with the target population and planned implementation context (e.g., classroom subject).

Gender Stereotypes

Gender stereotypes are beliefs about roles that boys and girls should have. Beliefs in gender equality are important for youth to prevent ARA. The following tools offer different approaches to this important subject.

  • High School FLASH: Family Life and Sexual Health Grades 9-12, Second Edition 
    Reis, B. Aby, C., Casey, E., Gerber, A., Kesler, K., Lewis, M., et al. (2011). Public Health – Seattle & King County. 
    Lesson 4 (Gender Stereotypes) is a 45-minute lesson in which students learn to define and identify gender stereotypes and how stereotypes impact healthy decision-making and relationships, including the potential for ARA. The session is mapped to the National Health Education Standards and the Washington State Health Education Standards; it is therefore ideal for programs that want to address gender stereotypes in health classes. The lesson provides individual and family homework assignments to encourage thoughtful reflection. It also provides ideas for related activities in other subjects such as art and humanities. 
     
  • The Hunger Games: Gender Empowerment Lesson Plan (PDF, 667KB)
    Idaho Coalition Against Sexual & Domestic Violence Center for Healthy Teen Relationships. (2012).
    This lesson plan uses the popular young adult novel “The Hunger Games”  to provide an engaging method for exploring concepts of gender, gender stereotypes, and gender equality.  
     
  • It’s All One Curriculum, Volume 2: Activities for a Unified Approach to Sexuality, Gender, HIV, and Human Rights Education (PDF, 2.2MB)
    International Sexuality and HIV Curriculum Working Group (2009). New York: The Population Council, Inc.
    For programs that want a lesson or lessons that delve deeper into the topic of gender, Unit 2 (pages 32-53) is an excellent resource from which to develop an effective unit geared toward local settings or target populations. This curriculum uses a human rights framework and focuses on fostering critical thinking skills. It is intentionally comprehensive, so youth workers can select the content and activities that meet the needs of their project and time constraints. 

Relationship Violence

The lessons below provide in-depth exploration of the dynamics of various forms of ARA, including physical, sexual, and psychological abuse. The modules rely heavily on scenarios to help participants understand how various forms of abuse manifest in relationships.

  • High School FLASH: Family Life and Sexual Health Grades 9-12, Second Edition   
    Reis, B. Aby, C., Casey, E., Gerber, A., Kesler, K., Lewis, M., et al. (2011). Public Health – Seattle & King County.
    Lesson 6 (Sexual Violence) teaches youth to recognize sexual violence, including rape, sexual assault, child sexual abuse, voyeurism, child pornography and exploitation, sexual harassment, and sexting (i.e., using text messages to share sexual content). It devotes considerable time to the issue of consent.  Through scenarios, the lesson explores the impact of alcohol and other drugs, body language, and force. The session is mapped to the National Health Education Standards and the Washington State Health Education Standards and is therefore ideal for APP programs that want to address ARA in health classes. The lesson provides individual and family homework assignments to encourage thoughtful reflection. 
     
  • Safe Dates: An Adolescent Dating Abuse Prevention Curriculum (Lesson 2) (PDF, 797KB)
    Foshee, V., & Langwick, S. (2010). Center City, MN: Hazelden Publishing.
    Lesson 2 (Defining Dating Abuse) explores the issue of ARA by having students list physically and emotionally harmful behaviors, discuss scenarios, and review statistics. As described in Section 2.4, Safe Dates is an evidence-based ARA prevention program designed for 8th and 9th grade students. This lesson is available for free through Hazelden Publishing. 
     
  • Dating Violence 101 Single Day Lesson Plan (PDF, 565KB)
    Break The Cycle. (n.d.). 
    This lesson uses a series of videos (available on YouTube) as the basis for group discussion about different forms of ARA. It provides participants with strategies for safely ending a relationship and for seeking resources for themselves or friends. 

Digital and Electronic Abuse

Digital abuse is a growing form of ARA, particularly among youth. Such abuse can include unwanted, repeated calls or text messages, privacy violations such as breaking into e-mail or social networking accounts, and pressure to send nude or private pictures or videos.

Youth workers should select modules that will resonate with their target populations. Knowledge about which technologies youth are using—and how—will help youth workers to select appropriate lessons.

  • Digital Technology & Teen Relationships – High School Curriculum (PDF, 756KB) 
    Idaho Coalition Against Sexual & Domestic Violence Center for Healthy Teen Relationships. (n.d.). 
    This lesson helps participants identify digital abuse, provides strategies for coping with abusive or inappropriate digital behaviors, and supports helping others who may be in an abusive relationship
     
  • High School FLASH: Family Life and Sexual Health Grades 9-12, Second Edition 
    Reis, B. Aby, C., Casey, E., Gerber, A., Kesler, K., Lewis, M., et al. (2011). Public Health – Seattle & King County.
    Lesson 19 (Sexual Violence: Digital Communication and Safety) primarily utilizes written scenarios to help youth identify online behaviors that can put them at risk of experiencing sexual abuse. The session is mapped to the National Health Education Standards and the Washington State Health Education Standards and is therefore ideal for APP programs that want to address ARA and technology in health classes. The lesson provides individual and family homework assignments to encourage thoughtful reflection.  

If programs do not have time to address digital or electronic abuse with project participants, they should consider sending participants to That’s Not Cool, a national public education campaign to prevent ARA. That’s Not Cool uses digital examples of controlling behavior online and by cell phone to encourage youth to set boundaries about what is, or is not, acceptable relationship behavior.

Other Lessons and Activities

  • Teacher’s guide: Interesting, Fun, and Effective Classroom Activities to Influence Teen Dating Violence Awareness and Prevention (PDF, 53KB)Logo, that's not cool dot com
    American Bar Association. (2006).
    This guide provides suggestions for class activities that increase awareness of ARA and are appropriate for each school subject. It provides ideas for interesting projects and ways to extend an APP program’s efforts to address ARA. 
     
  • Start Relating Before They Start Dating: A Workshop For Parents and Caregivers, and their Teens (PDF, 1.3MB)
    Start Strong Idaho: Building Healthy Teen Relationships. (n.d.).
    This is a 2.5-hour family dinner model where youth and parents separately learn about ARA and strategies for improving parent/caregiver-youth communication, including communication about ARA. Youth and parents then share a meal and practice communication skills. Targeted to parents and youth in middle school, it can be adapted for older audiences.  APP projects may want to use this program if they are interested in engaging parents in ARA prevention efforts but have had or anticipate difficulties in recruiting parents to attend activities in a group setting.  
     
  • Moving from a Relationship Bystander to a Relationship Upstander Workshop Guide (PDF, 1.3MB)
    Start Strong Boston—Boston Public Health Commission and Futures Without Violence. (n.d.). 
    This guide is geared toward parents of middle school youth but is also appropriate for parents of older teens. The goal of the 80-minute workshop is to help parents and caregivers encourage youth to respond to ARA and promote non-violent relationships among their peers. APP programs that already involve parents and caregivers in group activities or are seeking a way to engage parents in a one-time session may be interested in adding this workshop.

2.4. Choose Materials: Multi-session Programs

This section summarizes multi-session ARA prevention programs, including several evidence-based programs. These programs are designed to be implemented through a variety of methods for specific populations and in various settings. They each focus on particular risk and protective factors for ARA. APP programs may not be able to use entire multi-session programs, but may decide to incorporate select sessions or activities from a program. Youth workers should consider the fit of the program with the target population, implementation setting and resources, and community needs; the ease of integration of the program with APP project activities; and whether the program has evidence of effectiveness for the population(s) targeted.

Name Target audience Targeted domains Number of sessions/time Cost and training information Evidence of effectiveness

 

Safe Dates: An Adolescent Dating Abuse Prevention Curriculum
 HTML(2nd ed.) 
Foshee, V., & Langwick, S. (2010).
Center City, MN: Hazelden Publishing.

 

Male and female middle and high school students

Evaluated with 8th and 9th graders

 

Defining healthy relationships and ARA

Understanding and reducing acceptance of ARA

Helping friends, including awareness of available services

Gender stereotypes

Understanding emotions and managing anger

Communication skills

Preventing sexual assault

10 50-minute sessions, poster contest, play

$225 per curriculum manual with CD-ROM

Training not required, but recommended to maintain fidelity of the program; training costs vary by region

Randomized controlled trial over 4 years (2) demonstrated:

Reduced psychological, physical, and sexual ARA perpetration

Reduced physical ARA victimization

Same effects regardless of prior ARA involvement

Same effects for males and females, and for white and non-white youth

 

Families for Safe Dates
 PDF (2 p.)
Hazelden Foundation. (2010).

 

Male and female teens and their caregivers

Evaluated with families of 13- to 15-year-olds

 

Understanding and reducing acceptance of ARA

Comfort and skills communicating about dating and ARA

Anger and conflict management

Recognizing and responding to ARA

Recognizing and preventing date rape

Planning for safe and healthy relationships

6 booklets for teens and parents to complete together at home

Sold as part of Safe Dates curriculum (see box above)

Training not required, but may be included in Safe Dates training

Randomized controlled trial over 3 months (3) demonstrated:

Reduced beliefs that ARA is acceptable

Increased caregiver engagement in ARA prevention

Reduced physical ARA victimization

 

The Fourth R: A Relationships-Based Program for Students
 HTML
Wolfe et al. (2008).

 

Male and female students in 7th through 12th grades

Evaluated with 9th graders

Alternative versions of curriculum are available to meet the needs of different populations

 

The 9th grade curriculum includes:

Personal safety and injury prevention

Healthy growth and sexuality

Substance use and abuse

Varies per grade level. For example:

7th grade: 4 units totaling 27 lessons

8th grade: 4 7-lesson units

9th grade: 3 7-lesson units

Each lesson is 75 minutes long

 

The cost varies by curriculum

9th grade Comprehensive Kit is $695 Canadian, approximately $675 U.S.

Training not required, but available through the developers

Randomized controlled trial over 2.5 years (4) demonstrated:

Reduced ARA perpetration among boys

Higher condom use among sexually active boys

 

The Youth Relationships Manual: A Group Approach with Adolescents for the Prevention of Woman Abuse and the Promotion of Healthy Relationships
 HTML 
Wolfe, D.A., Wekerle, C., Gough, R., Reitzel-Jaffe, D., Grasley, C. et al. (1996).
Sage Publications, Inc. 

 

14- to 16-year-olds with histories of child maltreatment

Information about healthy relationships, power dynamics, and ARA

Communication skills

Conflict resolution skills

Community resources

Social action

18 2-hour sessions delivered in a community-based setting

Curriculum manual available for $118.

Training is not required; the manual includes implementation instructions.

Randomized controlled trial over 2 years (5) demonstrated:

Reduced physical ARA perpetration

Reduced emotional ARA victimization and (for boys) physical ARA victimization

Reduced symptoms of emotional distress

 

Coaching Boys into Men
 HTML
Futures Without Violence. (2008).

 

Male athletes in grades 9 to 11

 

Recognizing and responding to ARA

Gender stereotypes

Personal responsibility for intervening when ARA is witnessed

Weekly, 10 to 15-minute discussions implemented by coaches throughout the sports season

 

Free for download; no training requirements

Randomized controlled trial over 1 year (6) demonstrated:

Reduced ARA perpetration

Reduced negative bystander behaviors (i.e., laughing and going along with peers’ abusive behaviors)

 

Building A Lasting Love
HTML
Langhinrichsen-Rohling, J., & Turner, L. A. (2012). Prevention Science, 13(4), 384-394.

 

The full text of this article is available for purchase through the publisher’s website.

Inner-city, expectant adolescents

Developed and evaluated with African American youth from disadvantaged neighborhoods

Understanding healthy relationships and ARA

Safety planning

Anger and emotion management

Communication and conflict management skills

Stress management skills

4 90-minute sessions

Contact program developer

Randomized controlled trial over 6 weeks (7) demonstrated:

Reduced perpetration of psychological ARA perpetration

Reduced physical ARA victimization

 

Love U2®: Relationship Smarts PLUS
 HTML
Pearson, M. (2008). Berkeley, CA: Dibble Institute. 

 

Male and female students in grades 9 through 12

Healthy relationships, including love and intimacy

Personal values and identity

Peer pressure

Recognizing ARA

Communication skills

Conflict management skills

Parent-teen relationships

Personal responsibility

 

13 1-hour sessions

Instructor’s manual costs $360

Student workbooks cost $75/pack of 10

Training is recommended but not required; training can be customized to staff needs

Quasi-experimental evaluation (8) demonstrated:

Increased relationship knowledge

Reduced verbal aggression

Increased realistic relationship beliefs

Randomized controlled trial over 1 year (9), (10) demonstrated:

Improved relationship beliefs

Increased conflict management skills

 

Expect Respect: A School-Based Program for Preventing Teen Dating Violence and Promoting Safe and Healthy Relationships
 PDF (32 p.)
Ball, B., & Rosenbluth, B. (2010).
Austin, TX: SafePlace. 

 

Male and female middle and high school students

Vulnerable youth who have experienced ARA or violence in their homes

Understanding healthy relationships and ARA

Recognizing and responding to ARA

Gender stereotypes

Expressing and managing emotions

Communication and conflict management skills

Personal responsibility

Youth leadership and peer education

School-wide awareness of ARA and responsibility for ARA prevention

 

Program for vulnerable youth includes 24 sessions in a support group format

Program for youth leadership includes 8 1-hour sessions 

School-wide strategies include a school climate survey, school policies addressing interpersonal violence, and an awareness campaign.

$160 for four books and a CD of resources

No training requirements; training is available and can be customized to staff needs

 

Qualitative data (11) showed:

Increased knowledge about abuse warning signs and abusive behaviors;

Improved skills in building healthy relationships

Single group pre-post evaluation (12) demonstrated:

Increased healthy relationship skills

Reduced ARA perpetration and victimization among a subgroup of students who reported high pre-program levels of ARA perpetration and victimization

 

Love Is Not Abuse: High School Edition
 PDF (80 p.)

 

Male and female high school students

A version for college students is also available

Understanding and reducing acceptance of ARA

Helping friends and family members, including awareness of resources

Help seeking for ARA

Promoting healthy relationships

Digital abuse

 

4 45-minute lessons

Free for download

No training requirements

Not evaluated

 

Lessons from Literature
 HTML
Futures Without Violence, formerly Family Violence Prevention Fund.

 

Male and female middle and high school students

Understanding and reducing acceptance of ARA

Power and control in relationships

Responding to ARA

Personal boundaries and respectful behavior

Integrating ARA into Literature curricula

 

2 lessons are included in the manual, and teachers are encouraged to develop their own lessons using the provided template.

The 2 lesson plans included with the manual each take 3 weeks to complete using daily 55-minute sessions.

Free for download

Not evaluated



For projects that are hoping to implement ARA prevention programming in schools, a document that maps a program to national, state, or district educational standards can be a persuasive school recruitment tool.

Mapping Safe Dates to GA Education Standards
This tool shows how one ARA prevention program, Safe Dates, corresponds to six different Georgia state educational standards.

Projects that are interested in creating a similar document for their school district and ARA prevention program of choice should do the following:

  • Identify relevant educational standards.
  • Standards may exist at multiple levels (national, state, or district).
  • Standards may cover a variety of topics: health, social-emotional learning (e.g., communication, decision-making, conflict resolution), or core academic subjects.
  • Review curriculum manual session by session and page by page to identify goals, objectives, and content that corresponds with educational standards.
  • Create document that summarizes correspondence between educational standards and program.

Share document with school administrators, school prevention and health education coordinators, teachers, or any other individuals whose buy-in is essential for program adoption and success.

2.5. Adapt Materials as Needed

It is unlikely that any one ARA prevention program will be the perfect fit for incorporation into APP programming. A project may not have the resources to implement an ARA prevention curriculum as designed, or program content may overlook or contradict important cultural or logistical considerations for the APP target population. In these situations, APP projects may need to make program adaptations.

Even if ARA prevention programming itself does not need to be adapted, it is possible that the implementation of ARA prevention programming will constitute an adaptation to APP programming. For example, a project might want to implement an ARA prevention lesson between two lessons of an evidence-based APP curriculum. 

Regardless of whether it is an APP or ARA prevention program that is being adapted, adaptations should be made without compromising core components (i.e., key messages, content, and implementation requirements). Core components are not always made explicit in program materials, so youth workers should strive to learn as much as they can about the intent of activities or programs they are using.

The tools in this section will guide APP programs through the process of assessing the need for adaptation, planning for adaptation, implementing and evaluating adapted programming, and refining adaptations if needed.

  • The Adaptation Guide (PDF, 1.8MB)
    Centers for Disease Control and Prevention. (2010). Atlanta, GA: Centers for Disease Control and Prevention. 
    This adaptation guide was designed to help organizations adapt HIV behavior change interventions for another population. However, it provides a number of tools that can be useful for adapting virtually any type of health intervention for any target population, including ARA interventions.
    • The adaptation process diagram on page 16 of the guide graphically represents how a project moves through the process of program selection, adaptation, testing, revision, implementation, and evaluation. It provides a useful overview of the steps that should be included in adaptation work plans and timelines.
    • The chart on page 121 can be used as a template to document the characteristics of a particular program, compare those with project needs, and describe any necessary adaptations. Most of the fields in this chart can be applied to ARA prevention programs, with the exception of the “HIV Transmission Behavior” row, which could be changed to “ARA Behavior.” The checklist on pages 100-101 provides additional suggestions for the kinds of information that can be included in the adaptation chart.
    • The adaptation decision tool (pages 62, 63, 125, and 137) can help projects document the characteristics of specific intervention activities, describe adaptations that will take place, and provide justification for the adaptations, all while maintaining the intent of activities. This can be a useful template not only for planning adaptations, but also for describing adaptations in a process evaluation.
    • Pages 102-105 present various methods to collect data, for instance, on population needs or on outcomes of adapted programs. This section describes surveys, in-depth interviews, focus groups, and observations; it presents the advantages and disadvantages of each.
    • The monitoring and evaluation decision tree (page 73) provides a framework for thinking through, and acting on, monitoring and evaluation data. If a program or adaptation was not effective, the decision tree suggests a series of actions that may improve effectiveness.
  • The ADAPT-ITT Model: A Novel Method of Adapting Evidence-Based HIV Interventions
    Wingood, G. M., & DiClemente,  R. J. (2008). Journal of Acquired Immune Deficiency Syndromes, 47(Suppl 1), S40-S46.
    This article describes the Assessment Decision Adaptation Production Topical experts Integration Training Test (ADAPT-ITT) model phases and methodology. A graphic representation is available in a table on page S42. This adaptation process involves using an innovative pretesting methodology known as theater testing to adapt evidence-based interventions. Theater testing is a type of pretesting methodology that is commonly used to test products such as television advertisements. 

    Using this methodology, participants who are typical of the intended audience (the new target population) are invited to a central location to respond to a product demonstration (i.e., the adapted intervention activities). At the end of the demonstration, participants receive a questionnaire and answer questions designed to gauge their reaction to the product. 

    An example application of ADAPT-ITT to the Sisters Informing, Healing, Living, and Empowering (SIHLE) evidence-based APP program is shown on page S44, and an example adaptation plan for SIHLE is shown on page S45. Regardless of the adaptation process APP programs use, they may need to complete similar tables for their projects to help with planning the adaptation process.  

An APP project may be interested in implementing an ARA prevention program with a racial/ethnic group for whom that program has never been used or evaluated; the project may choose to make cultural adaptations prior to widespread implementation.

Several complementary frameworks are useful in planning cultural adaptations. First, cultural adaptation can involve modification to both surface structure(incorporating the observable characteristics of the target culture, like language or clothing) and deep structure (considering the unique ways that social forces impact health behavior within a particular culture).(13) Second, cultural adaptation comes in two basic forms: modifying program content and modifying the source, mode, or location of program delivery.(14) In order to take a balanced and complete approach to cultural adaptation, projects should consider all of these possible types of adaptations; examples are shown in chart below.

Form of adaptation
Structural level of adaptation Content Source, mode, location
Surface structure Present ARA statistics specific to the target population.
Re-create visual aids (e.g., handouts, posters, videos) to include images of representatives from the target population.
Revise program text to use terms commonly used by the target population.
Tailor program for delivery in a setting that is easily accessible for the target population.
Deep structure Discuss cultural values that may relate to ARA (e.g., related to masculinity/femininity, dating, helping and help-seeking).
Incorporate stories, analogies, and traditions from the target population.
Target population may be more receptive to receiving ARA prevention messages from individuals with particular demographic characteristics, backgrounds, or professions; hire these individuals as implementers.


  • The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit 
    Castro, F. G., Barrera, J., M., & Martinez, J., C. R. (2004). Prevention Science, 5, 41-45.
    This journal article discusses key challenges in implementing evidence-based programming within various cultural contexts. Table 1 (page 42) lists a variety of ways that program participants, program delivery staff, and target communities may differ from those in which programs were originally tested; APP programs could identify their adaptation needs by filling in information about their “program validation group(s)” (found in research literature about the ARA prevention program that they have selected) and “current consumer group” (i.e., APP project target population). The authors also discuss the dimensions and forms of cultural adaptation, which can be a source of ideas for ways to adapt an ARA prevention program to better align with target population characteristics.

  • Finding the Balance: Program Fidelity and Adaptation in Substance Abuse Prevention: A State-Of-The-Art Review (PDF, 593KB)
    Backer, T. E. (2002). Rockville, MD: Center for Substance Abuse Prevention.
    This report reviews research evidence on how fidelity and adaptation relate to program effectiveness. Several sections of this report can serve as useful tools for APP programs planning to adapt ARA prevention programming. Pages 45-46 present six key steps for adapting programs while maintaining fidelity. Page 50 presents unresolved issues in adaptation/fidelity for program implementers; this list can help to make APP program staff aware of challenges that they may face, so that they can be proactive in securing the resources and support that will promote ARA prevention program success.

 

The Adolescent Pregnancy Prevention Program’s Training and Technical Assistance and Meeting Logistical Support project led by RTI International for the U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Family and Youth Services Bureau, under Contract No. HHSP23320035651WC developed this toolkit.

 
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