Chapter 5 114 The principal researcher and one of the two co-auditors assessed IMR fidelity in 15 IMR groups within one-day site visits near the end of the treatment course. Both assessors performed independent scoring following a standard procedure (54). In the case of differences or disagreements, the assessors established a consensus score. The principal investigator was trained on how to use the IMR fidelity scale by two American specialists (6). The two trained co-auditors were a psychologist and an advanced nurse practitioner. In addition to semi-structured interviews with participants and trainers, assessments involved one observation session and checking forms, such as anonymized IMR Goal Tracking Sheets (6). All IMR elements were reviewed with all respondents during the interviews. This included questioning about elements that were not used during the observed session. Thus, we were able to obtain a good overall picture of the fidelity within each group and we were able to assess all 13 items of the IMR fidelity scale. Periodically, the researchers provided feedback regarding the assessment results in the supervision groups. To assess the impact of fidelity, patients who received IMR were assigned the fidelity score of their group. This score indicates the fidelity level of the IMR model as applied to the participant. IMR Content and Services All study participants received CAU comprising standard outpatient psychiatric care (including case management, multidisciplinary psychiatric and psychological treatment, and rehabilitation services). The treatment contacts for individual case management involved face-to-face meetings with a mental health nurse, a social worker, or another psychiatric counselor at two-week intervals. Additionally, a psychiatrist was consulted at least once a year as appropriate. Typical contacts with case managers involved individualized recovery support and structuring conversations on all life domains. In the intervention group, these usual services were provided together with IMR, a comprehensive structured training program for people with SMI. IMR was provided in a group format in weekly 90-min sessions. In accordance with the IMR fidelity scale, these groups included up to eight people. However, the exact group size varied per group and per session. The IMR intervention comprised eleven modules as well as practitioner guides and handouts for the participants. The eleven modules included Recovery Strategies, Basic Facts about Mental Illness, the Stress-Vulnerability Model, Building Social Support, Using Medication Effectively, Drug and Alcohol Use, Reducing Relapses,
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