How can an educator implement an evidence-based practice or program with fidelity?
Page 5: Risks of Adapting Evidence-Based Practices
Recall that fidelity of implementation refers to the implementation of a practice or program as intended by its researchers or developers. When educators adapt a practice or program with proven success by omitting or changing any of its components, they may well render it ineffective. Whenever a change is made to a core component—what is taught, how it is taught, or the amount of time it is taught—you significantly increases the risk of not achieving the expected outcomes.
For example, a teacher is planning to use an EBP that should be implemented two times per week for 45 minutes each session for 10 weeks. He realizes that, realistically, he can spare only 35 minutes per session and only has 9 weeks left in the semester. He believes that the changes that he needs to make to implement the EBP with his class are insignificant. However, the cumulative effect of his changes is that the students receive 30% less intervention time than if he had implemented the EBP as intended.
Oftentimes, educators like the one in the example above make seemingly small changes to core components of a practice or program, not realizing that even minor changes can decrease the effectiveness of the EBP. They are often tempted to make adaptations to an EBP to make it less complicated or to make it fit within their time and budget constraints. Although the teacher thought he was making a relatively small change, in fact he made a major adaptation by changing a core component. In this case, he changed the amount of time it is taught (i.e., exposure/duration), decreasing the length of sessions as well as the number of sessions.
Considerations When Adapting
Given the risks associated with making adaptations to an EBP, nevertheless there are times when you might feel it necessary to adapt an EBP. For example, you might find that no EBP matches your criteria (i.e., student and setting, resources, and evidence level), that your children or students are not engaged, or that they are not making the expected gains. If considering making changes to an EBP, you should do so with caution and keep in mind that research indicates that adaptations are more successful when:
- They are made after first implementing the EBP with fidelity. This allows the educator to practice implementing the EBP correctly and allows him or her to assess the children or students’ responses when it is implemented as intended.
- Changes are made to one component at a time. This allows the educator to assess the children or students’ responses to that change before making others. If multiple components are adapted at the same time, and learner performance changes, it is difficult to determine which adaptation affected the performance.
- Changes are made to non-core components (i.e., minor adaptations) as opposed to core components (i.e., major adaptations).
| Examples of Changes to Non-Core Components (Minor Adaptations) |
Examples of Changes to Core Components (Major Adaptations*) |
|
|
* Adaptations to core components are not recommended.
Bryan Cook describes the balance between implementing a practice or program with fidelity and adapting to meet one’s unique needs. (time: 3:02).
Transcript: Bryan Cook, PhD
I do think it’s okay to adapt sometimes. I’ll preface that, though, with the comment that we do have to be very careful about adaptation. It is one threat to implementation fidelity. We need to be very careful about when we adapt so that we don’t change the practice and make an EBP ineffective through our adaptation. That being said, teaching is more than following a recipe. It’s more than checking off boxes. If we don’t do more than try to just check off all the boxes then we’re really not owning a practice. We’re really not making it work for our students. And so we have to integrate the idea of implementation fidelity with our expertise as instructors with our specific knowledge of the students and the learners that we teach. And this is, I think, part of the art of teaching, is that we have to balance fidelity with some level of flexibility and fit. We have to make it work for our students within our context, but that doesn’t give you carte blanche to change the practice and make it something it’s not, because when you change the critical elements of a practice you risk making it ineffective.
And so we have to look for areas that we can tweak or make kind of minor modifications to an intervention to an evidence-based practice in ways that it still maintains the critical components of the intervention that make it effective, and yet adapt it in ways that make it an especially good fit for our learners and to our learning environment, and that can be really hard to do. And it is a little bit of guesswork. There aren’t clear guidelines, at least as of yet, about how to do that. And so when we do that, I think it’s important to not do that too early. Before we really understand how something is working, we don’t want to start changing it. So not doing that right away, but only adapting it after you really kind of understand how the program or practice works, and then you can figure out how to adapt it without really changing it. And whenever we make changes, it becomes doubly important to take good reliable frequent assessment data and do good progress monitoring so that we can readily measure the effects of that adaptation. We’re hoping that we’re able to potentially improve the effectiveness of the practice but at least maintain the effectiveness of the practice. But we want to be very careful that we closely monitor and make sure that, when we have made a change or an adaptation, that we haven’t decreased the effectiveness of the practice, and the only way to really tell that reliably is to look at reliable progress monitoring of student outcomes.
For Your Information
When an adaption is made to an EBP, the effectiveness of the practice or program might be changed—learner outcomes might be better, worse, or the same than if the EBP were implemented as designed. It is important to monitor progress to determine how the young children or students are responding. This will be discussed in greater detail in the next Module in this series:
