The faithful implementation of policies and practice and a sense of ownership among the communities they have been designed to help are fundamental aspects of effective prevention. The worry is that they pull in different directions and may be just as fundamentally incompatible.

But Abigail Fagan and colleagues from the Social Development Research Group (SRDG) in Seattle argue that if prevention programs are organized in the right way as part of a carefully constructed routine, the difficulties evaporate. They back up their claims with findings from a large US study.

SRDG have been studying the contribution of the Communities that Care (CtC) prevention framework has made to the thorny issue of fidelity. Described by its creators as an “operating system that empowers communities to use advances in prevention science to guide their prevention efforts”, the CtC framework comprises five phases which together provide a road map for getting from a good idea to the successful roll out of a number of evidence based prevention programs.

The phases can be summarized as:

• getting started
• organizing and involving
• developing a community profile
• creating a community action plan
• implementing and evaluating the community action plan.

The fifth step was the focus of the Seattle study.

The researchers acknowledge that fidelity – the delivery of programs in accordance with the guidelines and methods of delivery specified by the developers – does not happen naturally. But on the other side of equation it is known that low fidelity implementation can wipe out the anticipated effects. So efforts to plan and deliver evidence-based programs need to include steps to counter the “drift” that will inevitably take place.

The CtC method incorporates three activities that guard against ‘drift’: monitoring, training and technical assistance.

Monitoring takes the form of annual surveys conducted with CtC trainers, SRDG staff and local CtC co-ordinators. It captures information about adherence to the program components and content, dosage (number, length, and frequency of sessions), quality of delivery and participant responsiveness.

The very act of monitoring was found to encourage people to do things properly. It also meant that adjustments to delivery could be made immediately rather than being picked up when it was too late.

Training gives people the knowledge and skills they need to deliver the interventions and approaches and to follow the CtC method. It fosters understanding not only of the what to do but also why.

Technical assistance is designed to help communities with the day-to-day challenges of using the methods and programs, helping to identify barriers to implementation and working out strategies for overcoming them. The CtC method relies on weekly phone calls, emails and site visits.

Used in concert monitoring, training and technical assistance enabled 12 different communities in the study successfully to implement 13 prevention programs.

The Seattle authors observe that it is an odd oversight on the part of some program developers not to include fidelity monitoring tools. Of the 13 programs in the study, monitoring tools were available for nine and not all of those had been tested for validity or reliability.

Their study shows that people generally want to deliver programs with fidelity but need help in the form of monitoring, training and technical assistance to do so. That apart, the findings indicate that local ownership and fidelity are entirely compatible.

[For more about Communities that Care and its creator David Hawkins, see Communities that Care under US spotlight and Giving the power of prevention to the people]

• Summary of: Fagan A A, Hanson K, Hawkins J D and Arthur M W. (2008) “Bridging Science to Practice: Achieving Prevention Program Implementation Fidelity in the Community Youth Development Study”, American Journal of Community Psychology 41:235-249

[For more about Communities that Care and its creator David Hawkins, see Communities that Care under US spotlight and Giving the power of prevention to the people]