tion of existing prevention programs, as well as a number of challenges to implementation. The chapter then describes strategies that can complement the implementation of evidence-based interventions. Next is a discussion of research needed to increase understanding of and support successful implementation. The final section presents conclusions and recommendations for moving implementation forward.

A major implementation issue is the balance between delivering an evidence-based program as developed and adapting a program to meet the specific needs of the community. This section describes three alternative implementation approaches: (1) direct adoption of a specific evidence-based prevention program, (2) adaptation of an evidence-based intervention to community needs, and (3) community-driven implementation. Table 11-1 summarizes the advantages and disadvantages of each. These three approaches are not mutually exclusive or exhaustive of all potential approaches. Each requires an active partnership among community leaders, organizations and institutions, and researchers and must address issues of trust, power, priority, and action. The appropriate approach in a given community will depend on its characteristics and priorities and the availability of an existing evidence-based program that matches its needs. Ideally, evaluation is a component of all three approaches to shed light on why a specific approach works in a particular community or how to generalize knowledge about successful implementation to other programs, communities, or institutional settings.

A community’s adoption of a specific prevention program involves delivering the program with high fidelity, increasing the likelihood that its impact will be similar to that found in the original studies. Typically, programs have met a specific standard of evidence, often articulated by federal, state, or other external funding sources (Halfors, Pankratz, and Hartman, 2007). Standardized curricula, teaching manuals, or taped media help deliver the program in a manner similar to that used by the original researchers. Generally, there is limited adaptation of the program to the cultural or historical characteristics or the particular interests of the community.

Sites typically need sufficient local capacity and resources and technical assistance from the program developers or other certified trainers to ensure fidelity, monitoring, supervision, and sustainability (Elliott and Mihalic, 2004). Both the Nurse-Family Partnership Program and Life Skills Training, considered strong evidence-based programs backed by research findings