Innovative Approaches for Prevention Practice with Immigrant and Refugee Families: Balancing Fidelity and Fit

Background: Ensuring the healthy development of immigrant/refugee youth requires access to evidence-based prevention programs (EBPs). However, establishing cultural relevance of such programs while maintaining efficacy necessitates an implementation process that addresses the adherence and adaptation dilemma (Hasson et. al, 2020). This community based participatory research project uses innovative processes to adapt, deliver, and evaluate the Strengthening Families 10-14 program (SFP), a Blueprints for Healthy Youth Development Certified Promising Program. Our project was done in partnership with the City of Seattle Office of Immigrant and Refugee Affairs after immigrant/refugee community members expressed a desire for programs to strengthen their parenting skills and prevent their children from becoming involved in unhealthy behaviors. SFP developers met with the implementation team in Seattle to collaboratively address adapting SFP while maintaining fidelity. A detailed review of the curriculum for cultural relevance was conducted. When areas of discrepancy were identified, adaptations were made without changing essential components. This mixed-methods study of that process was guided by two questions: 1) Was the adapted version of SFP successful in achieving original curriculum learning outcomes?, and 2) What adaptation processes contributed most to program success?

Methods: Two cohorts of the adapted SFP are included in this analysis (parents n=15, youth n=21). Participating families originated from Vietnam, Somalia, Eritrea, Ethiopia, Mexico, and Paraguay, and spoke six languages (English, Somali, Vietnamese, Amharic, Tigrinya, and Spanish). To answer our first research question, participants were given the retrospective pre-post test included in the SFP curriculum (Molegaard et. al, 1993), a single-administration self-report survey. It measures curriculum learning outcomes through participant-reported use of tools and skills covered in the curriculum, which are central to SFPs positive impact on risk and protective factors (Spoth et. al, 2000). The survey was translated into 6 languages, youth and parents were surveyed separately, and interpretation was provided. To answer our second research question, weekly focus groups with the facilitation/interpretation team (n=12) were held during program implementation to reflect on, identify, and record effective adaptation processes.

Results: The adapted SFP successfully achieved curriculum learning outcomes. Parents reported increased use of all twenty parenting effectiveness tools and youth reported increased use of 13/15 social/emotional skills taught in the curriculum. Focus group participants identified several aspects of the implementation process that contributed most to success: 1) a strong partnership between the curriculum developer and delivery agency, 2) a collaborative and participatory approach to adaptation, delivery, and evaluation which included developers, facilitators, interpreters, and potential participants, 3) an expanded role of interpreters to include them as adaptation specialists and in program delivery, and 4) addressing unique challenges of multilingual program delivery.

Conclusions and Implications: Cross-generational immigrant and refugee families face unique challenges to accessing effective prevention programs. Despite adaptations done to tailor SFP for immigrant/refugee families, outcomes show that the program had similar results to non-adapted implementations (Hockaday, 2018). Lessons learned from this pilot program may be useful when adapting evidence-based prevention programs for efficacy in immigrant and refugee families.