*5.1. Models Have to Be Adaptable*

Some implementers have looked for ways to work with different cultures and countries. Baumann and colleagues [50] conducted a systematic review of the literature for four evidence-based parent-training interventions, involving 610 articles. Only eight reported a cultural adaptation, and only two tested the efficacy with rigorous research methods. In addition to needing more implementation studies, we need to include cultural adaptations, especially for models used internationally. Practices developed in one country inevitably have to be adapted for implementation in other countries. With the current rigid approach to implementation fidelity, we can expect little international replication. Seeking the balance is the key.

Obsession with evidence is an American preoccupation, and the RBM is no exception [51–53]. One of our tenets in the model is to eschew non-evidence-based practices, which means we have to discard bogus practices overseas (which abound) and in the U.S. [54].

However adaptable a model is to local customs and preferences, implementers might still move on to other models. Many implementers have trouble with sticking with a model over a 5 year implementation plan and having the courage to stay away from other bright shiny objects that come along and divert attention and resources from the model.
