Introduction: The purpose of this study is to describe how Coordinated Specialty Care program clinicians and decision-makers experience fidelity monitoring and what components of the fidelity model are most relevant to them. Methods: Using an instrumental case study design informed by the Exploration Preparation Implementation Sustainment framework, data were collected using semi-structured interviews. A constant comparison approach with both inductive and deductive coding was used. Results: Fourteen participants representing 3 regions of the United States were interviewed. The analysis resulted in 22 codes and 5 themes, (1) the fidelity review process, (2) facilitators and barriers to fidelity monitoring, (3) the impact of monitoring fidelity, (4) pros and cons of fidelity monitoring, and (5) shared decision making and flexibility. Across participants, flexible implementation of the model components and shared decision-making were considered central to implementation. Fidelity monitoring conflicted with these goals in some experiences. Clinicians and program decision-makers varied in the experience of facilitators and barriers to fidelity, yet lack of training and education was an important barrier. Conclusion: Although participants shared prioritization of flexibility and shared decision-making as core needs, the role of fidelity in achieving the goals of coordinated specialty care was unclear and potentially conflicting. Better alignment of fidelity monitoring with coordinated specialty care central tenants could improve the experience of both implementers and clients.