Strategies to implement evidence-based practices are critical to improve services. There are many barriers to their implementation, despite all available knowledge. Even geographically small countries like Portugal (92.152 km2)can have substantial regional variations in evidence-based practices implementation.

Evaluate the regional variation of mental health case management fidelity during a systematic implementation process, according to the measurement of techniques and resources used by mental health professionals.

The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a case management course, in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009).

Mental health professional’s assessment in 26 mental health public and private services (n=71) showed that there are significant differences in the proportion of case management adequate implementation between country regions (North = 35,7% / Centre = 57,5 / Lisbon and Tagus Valley = 65,3%, Alentejo 72,7% and Algarve = 50%).

The results show that even in a geographically small country there are big differences in the quality and degree of effective practices implementation. This happens despite the fact that the implementation process was developed nationwide by the same training and implementation team, working with regional groups.

Locally and regionally designed implementation programs are needed to balance the unevenness of evidence based practices fidelity and quality.