 The process and results of a refinement of a framework for assessing modifications to evidence-based interventions are described. The updated frame includes additional components, when and how in the implementation process the modification was made, whether it was planned or proactive, whether it was unplanned or reactive, and whether the modification is fidelity consistent with the original intent or goal. These additional components will allow for a more precise understanding of modifications, the process of modifying or adapting, and the relationship between different forms of modification and subsequent health and implementation outcomes. This article was authored by Shannon Wiltsi-Sturman, Anna A. Bowman, and Christopher J. Miller.