Fidelity and clinical competence in providing IMR 145 Methods Setting This study was embedded in an RCT to test the effectiveness of IMR in people with SMI. This RCT was executed at two mental health organizations in the Rotterdam region of the Netherlands. Eligible participants were outpatients between 18 and 65 years of age who had been diagnosed with an SMI. IMR was provided in groups in weekly 90-minute sessions (17, 19). Initially, based on knowledge obtained during a study tour to the US, an implementation plan was drafted for IMR implementation in both institutions. As part of this plan, a steering committee, implementation group, and education group were formed in each institution. The US handouts and IMR workbooks were translated into Dutch and edited for cultural relevancy. Moreover, in the larger of the two organizations, IMR implementation began with a pilot study that yielded positive results; an RCT seemed feasible (33). After this pilot, IMR was integrated into the institutions’ standard care. All IMR trainers participating in the RCT received two days of training in teaching IMR from two professional trainers who had extensive experience in teaching rehabilitation and recovery support as well as providing IMR. The IMR trainers received a two-hour group supervision from a senior counselor once every two weeks. Supervision groups were composed of a mix of IMR trainers from different IMR groups, teams, and locations. Twice a year, an additional four-hour training session was provided. Two master classes were held for trainers and counselors, each led by a US IMR creator. A total of 35 IMR trainers were involved, who were experienced clinicians and had the following professional backgrounds: 15 community mental health nurses, four nurses, 13 social workers (four of whom were also peer support specialists), two psychologists, and one peer support specialist with a professional peer support education. In this study, the IMR Fidelity Scale as well as the IT-IS were applied to 15 IMR groups. Ten groups had two IMR trainers, and five groups had three IMR trainers, one of whom was always a peer support specialist and also had a professional background as a clinician. On average, IMR groups with three trainers had more participants (M = 7.8, SD = 0.84) than those with two trainers (M = 6.2, SD = 1.48). However, this difference was statistically nonsignificant (U = 41, p = 0.06, r = 0.52).
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