This article updates the pipeline paradigm for evidence building with a cyclical paradigm that encompasses evidence building, implementation, and adaptation. A cyclical paradigm for evidence-based policy and practice assumes that an intervention will be adapted over time, across settings, and across populations. These innovations and adaptations are encouraged and tested, with periodic review of the need for impact assessment. The cyclical paradigm also emphasizes service contrast at every stage, not just in the evidence-building stage where it has traditionally been a focus. A continuous cycle of evidence building, implementation, and adaptation—looping back to further evidence building—can help to ensure that the impacts of evidence-based policies and programs are sustained and grow in new settings.
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