Implementing for success in school-based mental health promotion: The role of quality in resolving the tension between fidelity and adaptation

Research in implementation science has shown that interventions are rarely implemented as designed, and that variability in implementation is associated with variability in outcomes. Lack of programme fidelity has been seen as the prime cause of poor outcomes, though it has also been suggested that this must be balanced against adaptation. In this chapter, we argue that what is required is a focus on quality, of both fidelity and adaptation. This reframing has implications for programme development processes, research and evaluation, and the training and support of practitioners in the field.