A New Hampshire law, enacted in 2003, requires that state-funded illness management and recovery services be delivered with fidelity to their original models. That means any service or intervention should adhere to the protocol or initial program model. In the past 15 years, these fidelity reviews have become a key element for ensuring that programs in the state achieve their intended outcomes.
The state Department of Health and Human Services conducts annual fidelity reviews for two specific services—known as assertive community treatment and supported employment—delivered by 10 community mental health centers across the state. This process has helped to standardize monitoring and fostered collaboration on improving behavioral health services. And that has enabled the department to have constructive and supportive conversations with community health centers about their programs.
Fidelity review teams made up of at least three officials from the department’s Bureau of Mental Health Services score a program’s implementation—and how that aligns with its original mission—based on about 25 criteria that affect service delivery, such as intake rates and contact hours.
Lauren Quann, the bureau’s administrator of operations, noted recently that “conducting fidelity reviews provides a clear and consistent message regarding the expectation to provide a high-quality service, and gives the centers objective feedback and support regarding service quality, including guidance for improvement.” For instance, when service providers for one program received a low score on intensity of service—the average duration of face-to-face service time per client—the bureau set a minimum contact requirement for program providers.
In the 30 days after a center receives its scores, department contractors work with program staff to develop an improvement plan that addresses any deficiencies. The bureau then reviews progress quarterly on action items identified in the plan. Contractors also provide ongoing trainings to ensure that any corrective actions undertaken by program administrators are appropriate and effective.
Fidelity reviews help educate agency staff and providers on what helps improve service delivery. Making the process a routine part of operations also can increase staff capacity, in part by taking advantage of ready-to-use materials that save time and effort. Regular reviews also can boost staff’s ability to manage mental health disorders, utilize motivational and educational strategies, and implement cognitive behavioral approaches. And New Hampshire is seeing the results. Using the review process, the state has improved program outcomes, including reductions in mental health-related relapses and hospitalizations and improved progress in clients meeting their recovery goals.
Sara Dube is a director and Mariel McLeod is an associate with the Pew-MacArthur Results First Initiative.