Adapting models from other contexts

Many of the social challenges faced in Australia are not unique.

Many of the challenges communities face — such as youth unemployment or increasing substance use — have, to some degree, been tackled in other contexts. Whilst solutions are unlikely to exist in a ‘ready to implement’ form, learning more about the thinking behind programs and initiatives with similar intent can have enormous value for our own problem solving. The adoption of effective non-local models into our contexts is an obvious way to maximise impact whilst saving time and money. However, it needs to be done with a degree of caution.

Whilst at the high level problems and situations are not unique, at the local level they are very unique. What has been designed for one context may not be readily applicable to another. It is also a possibility that something that ‘works’ in one context may be entirely unsuitable for another.

Services might not fit with local populations they aim to support. Something that is particularly relevant to in-community solutions where what makes programs and services ‘work’ can be very nuanced and intentionally designed for unique community needs. Seemingly minor factors such as branding, key messages, referral sources, or staff training time and techniques can be determining factors of success (or failure).

Services may not fit well into the local service system – with approaches to funding, performance management and local capability.

When program elements are not adapted but need to be, and other components are altered but shouldn’t be, the potential for success is undermined: University of South Australia found that when evidence-based interventions are implemented in other contexts, they often are “quickly adapted or changed, resulting in interventions potentially losing the key ingredients that were critical for effectiveness.” (Fiona Arney, Kerry Lewig, Robyn Mildon, Aron Shlonsky, Christine Gibson and Leah Bromfield, “Spreading and implementing promising approaches in child and family services” )

Research highlights that adaptation efforts struggle when “the links between service activities, their intended target group, the issue they are intended to address and their anticipated outcomes are not always clear.” Critical to a successful adoption is the integrity and soundness of a theory of change; research suggests that in a study of 52 child protection programs, successful programs demonstrated “integrity between target population, theory of change and program components.” (L Segal, K Dalziel & K Papandrea, Where to invest to reduce child maltreatment – a decision framework and evidence from the international literature, in Taking Responsibility: A Roadmap for Queensland Child Protection, 2013 (p 625))

Planning for adoption and adaption

The following questions are aimed to support initiatives to effectively adapt adopt and/or adapt programs, or elements of programs, into their own context. The questions aim to support teams to determine if adoption is a viable option and, if so, to identify what modifications are needed.

Nine questions to answer to support effective adoption and adaption.

  • What is it that makes an intervention work in its original context?
  • What is the core of the theory of change? What activities contribute to that theory of change and cannot be modified?
  • What is the explicit objective of the program (e.g. what problem is it trying to solve)?
  • Who is the intended target population and how is the new population similar or different that of the initial program?
  • What are allowable modifications?
  • What conditions need to be in place for an intervention to ‘work’?
  • Are those conditions in place in the new context? How are conditions similar and different between the contexts?
  • What allowable adaptions could be made to make the program fit in its new context?
  • How can we minimise the risk, and maximise the learning associated with getting something working in a new context?

Practically this may play out over a number of stages:

  1. Understanding the intervention in the original context (including cultural considerations at each level of the implementation context from beneficiaries to staff and management)
  2. Understanding the new context and how it does and does not fit with the original context (i.e. characteristics, needs and preferences of target population)
  3. Deciding and designing adaptions for the new context (i.e. which also includes the implementing agency’s practitioners, organisation and wider service environment)
  4. Prototyping a modified intervention in the new context to contain risk, refine design, and surface further adaptation needs for optimal efficacy.
  5. Full implementation of adapted model in new context (i.e. including staff section, training, coaching and supervision, performance evaluation and assessment, data systems to support decision-making, and facilitating adaptive leadership)
  6. Oversee and monitor program drift and implementers’ responsive revisions

The process described above is clearly relevant for the adaption of models from overseas into Australia, but similar principles, at a smaller scale, can be applied to adaptions for different communities within Australia.

A TACSI example

TACSI’s own program Family by Family, underwent a series of intentional adapts to make it work in the North of Adelaide, after being initially developed in the South. Following research with communities in the Northern Suburbs we identified the need to change the language used in the recruitment of families and to change how the families came together as groups. The later because of a very different transport situation. Had the model been delivered identically in the North as it was in the south we are confident it would have failed. Even thought the two communities are only 45 minutes apart. Now the program in the North regularly out-performs the program in the South.

Fundamentally, solutions need to work within the context for which they are delivered, which requires a careful acknowledgement of cultural and behavioural nuances. Any attempt to move to another context should follow a rigorous process of adaption which both respects the core of what makes the service ‘work,’ and utilises ‘allowable adaptions’ to ensure that it is effective and maintains fidelity in its new context.