This is the second of a series of group reflections on the study tour. Today we visited the Olweus bullying program and Multisystemic Therapy (MST).

Prevention Action talks to Celia Arriaga, Seattle coordinator of the Olweus Bullying Program

One question concerns fidelity and the extent to which flexibility in implementation, to take account of local context, loses the evidence base. Fidelity sounds like a rigid formula but programs based on individual responses to complex problems, such as MST, require practitioners to engage with families reflexively but, critically, to be methodological in how they go about it.

Another issue is how to ensure that programs are not seen as standalone projects but linked together to form a coherent multi-component package. MST in Washington State is delivered as part of a menu, but the idea of first identifying need and then selecting from a menu of programs required a significant cultural shift.

Lastly, if the quality of the practitioner is key to quality implementation, is there a danger of suggesting that the content of what is delivered doesn’t matter? Other seemingly universal features of effective programs include light caseload, strong quality control, high intensity and seeing things through. Chris Robinson, Chief Executive of the Mayor’s Fund for London, captured the sentiment using a line from a song originally recorded by the Swallows in 1951: ‘It ain’t the meat, it’s the motion’.

Meera Spillett, Deputy Director, Norfolk Children's Services, UK
The question that comes up for me, having visited the Olweus and MST programs today, is how to ensure fidelity, and how much adaptation is permitted. Also, how much is the success of these programs related to individuals and to the psychology, motivation and leadership of teams? And what if staff are lost through turnover?

Julie Anderson, Information Sharing and Assessment Programme Manager, Norfolk Children's Services, UK
On the question of fidelity, you can't legislate against changes because people are people. Where programs are modified it seems to me the key is to focus on relationships, values and principles, to keep families at the center of everything we do.

• For about the fidelity question, see also an interview with Jason Medina, a consultant implementing Functional Family Therapy in Seattle,