Local adaptation during implementation: A case study of the Fussy Baby Network® New Orleans and Gulf Coast initiative

- Local adaptation coexists with implementation fidelity.
- Framework of who, what, how, when, and why explains adaptation process.
- Adaptations developed from collaboration between local program staff and model developer.
- Adaptations were on-going during implementation process.
- Adaptations were cultural, in response to community, program participants, and institution.

Scholars and practitioners recognize that adaptation is necessary, and can enhance program outcomes, when scaling early interventions. This study used a framework for implementation that identified critical elements for understanding the adaptation process including: a) who made the adaptations, such as model developers and staff members, b) what elements were adapted, c) how adaptations occurred, such as adding or removing elements, d) when adaptations took place, such as at the beginning of implementation or as an on-going process, and e) why the adaptations occurred. Erikson Institute's Fussy Baby Network ® (FBN) service program has been implemented in seven cities across the United States. Implementation of FBN in the New Orleans and Gulf Coast (NOGC) region began in 2012. Using a longitudinal phenomenological study design, FBNNOGC program and institutional staff were interviewed over three years at ten time points. This study identified five adaptations of FBN to NOGC: a) increasing length and intensity of services, b) adding a family advocate, c) integrating academic and clinical contexts, d) changing the program name, branding, and outreach materials, and e) networking with other providers. No adaptations were made to the program model or training, which ensured program fidelity.