Adapting a Very Early Social Communication Program for Health Service Delivery

Abstract iBASIS Inklings (hereafter Inklings) is an evidence-based early childhood support program for infants aged 6–18 months who show early differences in social communication and connection. The program builds caregiver capacity to sensitively recognise and respond to their baby’s unique communication style to support development. With Inklings now funded for widespread delivery in Australia, this study aimed to systematically document developer-led modifications made as the program moved from a research trial through to health service delivery. A retrospective mapping of modifications was conducted using the Framework for Reporting Adaptations and Modifications-Enhanced (Wiltsey Stirman et al., 2019b). Four manual versions published between 2016 and 2025, along with associated practitioner training materials, were reviewed and coded. Seventy-six modifications were identified across program versions. Most were content-related (83%), primarily aimed at improving program acceptability, contextual fit, and implementation fidelity. Fewer changes related to delivery context (10%), such as provisions for telehealth, and practitioner training (8%), including the introduction of certification and supervision requirements. Most modifications (82%) were directly aligned with the core functions of the original program. However, 5% of modifications were identified as fidelity inconsistent according to the framework used, for 13% impact on fidelity or core functions was unclear. These modifications are explored in detail. Program adaptation is an expected and necessary component of scaling evidence-based supports into real-world settings. Systematically identifying how and why modifications occur during scale-up strengthens understanding of their relationship to program mechanisms and outcomes and supports continued delivery of evidence-informed services for infants and families.