When Evidence Meets Community: 

What the 2025 SAMHSA Prevention Fellows discovered about fidelity, adaptation, and becoming prevention professionals

By Steve Miller, CRPS

An evidence-based prevention program comes with something of a blueprint. Research has helped determine what works, which components matter, and how those pieces contribute to desired outcomes. Then the program leaves the research stage and enters a community. There, the people, the community, and the context are difference; resources, language, age, accessibility, staffing, geography, and lived experience all influence how a program will actually be received.

So, what happens to the blueprint?

That question sits at the heart of a research project undertaken by a group of the PTTC Network's 2025 Prevention Fellows. The cohort examined 19 widely used prevention curricula and programs, looking at fidelity tools, guidance for adaptations, community-specific evaluations, curriculum updates, and the experiences of program developers and administrators.

At its core, fidelity asks whether a program is being implemented as designed. Adaptation recognizes that sometimes a program must change to work effectively within a particular community, but as the Fellows discovered, the professional skill isn't choosing fidelity or adaptation - It's learning how to navigate between them intentionally.

When the Blueprint Meets the Neighborhood

Imani Conway entered the project understanding fidelity as following the original evidence-based program and adaptation as making changes to the program to better fit a population. The research added an important layer. “Fidelity does not mean that every part of a program remains unchanged,” she explained. What matters is identifying and protecting core components while recognizing that some adaptations may be necessary across different communities.

The Fellows' research supported that distinction. Their review found evidence that community relevant adaptations can improve fit while maintaining effectiveness when core theoretical components remain intact. Unplanned changes to program structure, however, can undermine fidelity and potentially weaken outcomes.

“A program can have strong evidence, but it still has to

make sense for the people for whom it is intended.”
— Imani Conway

ZamZam Abdirahman was surprised by how creatively communities could adapt programs to their circumstances while preserving what made those programs effective.

Shavanne Lambert came away with an equally practical lesson: Do your homework. Don't choose a program simply because it's familiar, popular, or affordable. Understand the research behind it. Know why particular components are there, what can change, and what needs to remain. “You don't need to make up things on your own,” she reminded practitioners. Ask questions. Consult the research. Contact developers when possible. Understand the intention behind the intervention before changing it.

Imani puts the challenge plainly: “A program can have strong evidence, but it still has to make sense for the people for whom it is intended.”

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Recovery is transforming lives in communities across America. Through the Great American Recovery, SAMHSA is bringing together states, tribes, local leaders, faith groups, employers, families, care providers, recovery organizations, and people with lived experience to strengthen the support systems that make recovery possible.

National Recovery Month is a time to celebrate progress, recognize the people who support recovery, and invite every American to help build communities where individuals can lead healthy, fulfilling lives.

The Great American Recovery Toolkit makes it easy to get involved. Organizations, families, employers, peers, and community leaders can copy, download, and share resources tailored to their audiences.

Recovery grows through partnership. By advancing research, making it easier to seek help, prioritizing whole-person care, and creating meaningful community connections, we can strengthen recovery—and save lives.

Every September, SAMHSA joins organizations and communities nationwide in observing Suicide Prevention Awareness Month. It is a time to raise awareness, encourage open conversations, support those who may be struggling, and remind everyone that help and hope are available.

SAMHSA’s Suicide Prevention Awareness Month Toolkit helps state behavioral health authorities, community organizations, employers, families, and advocates share this vital message. Resources can be copied, downloaded, and adapted for different audiences and communication channels.

Suicide prevention is a shared responsibility. By advancing research, making help-seeking easier, prioritizing whole-person care, and strengthening connections within our communities, we can create environments where people feel supported and valued.

When we work together, we can inspire hope—and help save lives.

The PTTC Network, along with our partner the Prevention Research Center, a center in the Pacific Institute for Research and Evaluation has published three new Prevention Research Briefs recently.

Prevention Research Briefs are a resource for busy prevention professionals that provide insights and critical research information in a short format.

Did you know that for every $1 spent enforcing laws against alcohol over-service there is a cost savings of $35, and a cost savings of $46 for each $1 spent on enforcement of underage drinking laws? 

In survey results from 2024, 13% of adults over 60 report past month binge drinking. Tobacco use or nicotine vaping, cannabis use, and illicit drug use (including cannabis) were also prevalent among this age group.

RBS training helps to increase servers’ knowledge of state laws prohibiting over-service, alcohol’s effects on cognition and risk of harm, identifying signs of intoxication, and skills to refuse service to intoxicated customers.

Science helps us understand why prevention works. Communities help us recognize what prevention looks like. In the next edition of the PTTC Post, we will examine why creative approaches like Photovoice, murals, storytelling, podcasts, music, and zines have become so compelling in community work. They're not simply artistic projects; they're windows which help communities recognize the relationships, strengths, and possibilities that often go unnoticed in the busyness of everyday life. In many ways, they help make the invisible visible.

Funding for this initiative was made possible by grant no. 1H79SP084314 from SAMHSA. The views expressed do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.