Chapter 6 144 differences in patient population, sample size, type of control group, duration of IMR, levels of IMR exposure, and also differences in model fidelity (17-19). Adequate dissemination and efficacy of research on EBPs for people with an SMI require clear and precise specification of the quality of implementation (20-22). Quality of implementation can be assessed by measuring the fidelity of interventions. Fidelity is the degree of adherence to standards and principles of a program model (20, 22). Therefore, a primary reason why fidelity scales are developed is to evaluate whether an intervention is being implemented following the treatment model or program (model integrity). Relevant uses of assessing fidelity in research include determining whether the lack of effects of an intervention may be due to failure of proper implementation, comparing studies executed by different research groups and evaluating the same intervention, measuring differences in compliance to program standards over all sites in multisite trials, and identifying critical ingredients of an intervention (Bond & Drake, 2020). The major relevance of fidelity lies in the assumption that “higher fidelity to an EBP predicts better outcomes for clients” (23). There is evidence of this predictive validity from some programs in the National EBPs Project in the US (24), including Assertive Community Treatment (25-29), Individual Placement and Support (30), and IMR (9, 17, 31). The National EBPs Project aimed at evaluating the implementation of several different EBPs in typical mental health treatment programs in the U.S. Each EBP had a fidelity scale designed to evaluate the quality of implementation of that practice (24). One of the programs in this project was IMR (4), for which the IMR Fidelity Scale was developed (22, 24). Later, another IMR fidelity scale was developed: the IMR Treatment Integrity Scale (IT-IS), which was meant to complement and extend the IMR Fidelity Scale by providing a more in-depth assessment of the trainer’s competence in applying IMR elements (32). In this study, in 15 IMR groups of two mental health institutes for both scales, fidelity assessments were executed using the assessment procedure based on the IMR Fidelity Scale (24). In this study, we aimed to: (1) establish the level of implementation of all IMR elements, especially to identify targets for improvement; and (2) explore the complementary value of the IT-IS to the standard IMR Fidelity Scale. To the best of our knowledge, this is the first study in which the IMR Fidelity Scale and the IT-IS are compared at an item level.
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