Skip to main content


"The SPF Process" by Center on the Family. All rights reserved.


After a community has carefully chosen and planned their prevention strategy, it is then time to implement the prevention program or programs. Implementation is the next step in the SPF process. At this stage it is important to think about the prevention program’s ‘active ingredients,’ or its goals, objectives, timeline, and protocols. It is likely that a program will need to be adapted to fit local conditions so as to be a good match for the cultural norms, values, and beliefs of a community. If an intervention is not seen as relevant to the target population, it is not likely to be effective. However, communities and organizations should be thoughtful and purposeful about the changes they make to their prevention programs. When making cultural adaptations to a program, changes need to be recorded and should not alter the features of the program that are thought to be the key ingredients for change.

When implementing culturally appropriate programs, service providers and planners often have to strike a balance between fidelity to the original program design and cultural adaption.

  • Adaptation: Any change a prevention program undergoes in order to meet specific needs. Two types of adaptation include changes to program:
  • Content: Making changes or additions to program manuals, tasks, and tools so that the content is more relevant to the target population. In order to be effective these changes should reflect the use of both culturally relevant names, terms, and examples (surface structure) and culturally relevant concepts, themes, and issues (deep structure).
  • Delivery: Making changes to the way programs are carried out (e.g., online vs. in the classroom)
  • Fidelity: The degree that an implemented prevention program stays ‘true’ to what its designers intended. Fidelity can be described along 4 dimensions:
  • Adherence: How much did your program stick to the original design? It is not always possible or even desirable (in the case of cultural adaptations) to administer a program exactly as designed. However, it is important to note any deviations from the design to see if these have impacted your outcomes in some way.
  • Dose: How much of the program did your target population receive? This refers to the number of classes or meetings participants actually attended, as well as the length and intensity of the program activities. It is important to keep track of the dose because it is quite possible that participants who attended more activities will show more change than those who left the program early.
  • Quality of delivery: In the end, how high was the quality of your program delivery? This refers to the level of staffing and training as well as the resources deployed during program activities. It is possible to follow a program manual precisely but without a focus on the quality of the delivery. This is often the result of poor planning, inadequate training, or lack of enthusiasm on the part of program staff.
  • Participant responsiveness: How did your target population respond to the program? A successful prevention program is not only well implemented with a high-level of quality, but it is also relevant to your participants. If your program is not meaningful and useful to your target audience, than even high-quality implementation will result in disappointing outcomes. Therefore, measuring the level of participant engagement is critical to understanding whether a program is effective.

SPF in Hawai‘i: Implementation

The SPF-SIG project funded a total of 17 evidence-based prevention programs in the state of Hawai‘i. These included activities which targeted individual-level change by using programs intended to increase the prevention knowledge and skills of teens (prevention education programs). Altogether the prevention education programs reached 10,048 youth participants statewide. Each county also implemented what are known as environmental strategies. These prevention programs target community-level change such as advocating for changes in public policy and increasing community awareness around issues of substance abuse.




Castro, F., Barrera, M., and Martinez, C. (2004). The cultural adaptation of prevention interventions: resolving tension between fidelity and fit. Prevention Science, 5(1), 41-45.
Dusenbury, L., Brannigan, R., Falco, M., and Hansen, W. (2003). A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Education Research Theory & Practice, 18(2), 237-256. 
Moncher, F., and Prinz, R. (1991). Treatment fidelity in outcome studies. Clinical Psychology Review, 11, 247-266.
SAMHSA. (2015, October 1). Step 4: Implement. Retrieved from

March 2020

Mar 06 Fri
ADAD Training: Effective Case Management Practices

This training will provide an overview of the role of the human service worker focusing on the application of theory and skills necessary for providing interventions and effective direct service. Participants will increase their competence in professional skills such as case management, client intake and interviewing, and basic group and individual counseling techniques.


Kakuhihewa Building ADAD Building Room 111 A/B 601 Kamokila Blvd. Kapolei, HI 96707

Mar 09 Mon
ADAD Training: Advanced Ethics

The purpose of the session is to gain an understanding of ethical guidelines in an advanced setting. Participants will be better equipped to resolve ethical dilemmas in Substance abuse and Mental Health field. This will be beneficial for those that have already completed Ethic's the Basic.


Department of Health State Lab 2725 Waimano Home Road Pearl City, HI 96782

Mar 23 Mon
ADAD Training: The Assessment and Treatment of Dual Diagnosis

The following Assessment and Treatment of Dual Diagnosis Workshop is intended to provide advanced training in working with the range of psychiatric co-occurring conditions among substance use populations. This workshop will provide additional support for assessing psychiatric conditions, the common treatment for dual substance users with SPMI, and common malingering/feigning symptoms used by SUD populations. In addition, various treatment modalities will help understand and direct the course of treatment toward referral needs, ongoing treatment, and discharge planning.


Kakuhihewa Building ADAD - Room 111 A/B 601 Kamokila Blvd. Kapolei, HI 96707

Mar 25 Wed
Forgive for Good Workshop

Participants at this workshop will learn the basics of forgiveness methods developed by the Stanford Forgiveness Projects.  


Oahu Veterans Center - Sullivan Hall 1298 Kukila Street Honolulu, HI 96818