Program 'Fidelity' Reviews Help New Hampshire Improve Mental Health Outcomes

State requirement designed to ensure services are delivered as intended

Navigate to:

Program 'Fidelity' Reviews Help New Hampshire Improve Mental Health Outcomes
New Hampshire

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.

For more information:

Sara Dube is a director and Mariel McLeod is an associate with the Pew-MacArthur Results First Initiative.

Spotlight on Mental Health


Implementation Oversight

Quick View

Implementation Oversight

Jurisdictions can achieve the benefits of evidence-based programs by building capacity to support effective implementation, what Results First calls evidence-based implementation oversight. Included below are links to briefs, fact sheets, and other resources. Along with explanatory documents, this section highlights how select states and counties approach this type of oversight.

Composite image of modern city network communication concept

Learn the Basics of Broadband from Our Limited Series

Sign up for our four-week email course on Broadband Basics

Quick View

How does broadband internet reach our homes, phones, and tablets? What kind of infrastructure connects us all together? What are the major barriers to broadband access for American communities?

What Is Antibiotic Resistance—and How Can We Fight It?

Sign up for our four-week email series The Race Against Resistance.

Quick View

Antibiotic-resistant bacteria, also known as “superbugs,” are a major threat to modern medicine. But how does resistance work, and what can we do to slow the spread? Read personal stories, expert accounts, and more for the answers to those questions in our four-week email series: Slowing Superbugs.

Explore Pew’s new and improved
Fiscal 50 interactive

Your state's stats are more accessible than ever with our new and improved Fiscal 50 interactive:

  • Maps, trends, and customizable charts
  • 50-state rankings
  • Analysis of what it all means
  • Shareable graphics and downloadable data
  • Proven fiscal policy strategies


Welcome to the new Fiscal 50

Key changes include:

  • State pages that help you keep track of trends in your home state and provide national and regional context.
  • Interactive indicator pages with highly customizable and shareable data visualizations.
  • A Budget Threads feature that offers Pew’s read on the latest state fiscal news.

Learn more about the new and improved Fiscal 50.