Chapter 6 146 Measures The IMR Fidelity Scale is a scale used to assess the degree of implementation of the IMR model. It was part of the original IMR toolkit (34). It consists of 13 behaviorally anchored items that assess critical structural and clinical elements of IMR (24). Structural elements include group size and program length, whereas clinical elements include the use of cognitive-behavioral techniques and coping skills training. Each item is rated on a five-point scale; a score of five indicates full implementation of the IMR element (35). The total group score is the mean of all item scores. Scores of ≥ 4.0 are considered to reflect high fidelity, scores of ≥ 3.0 to < 4.0 reflect moderate fidelity, and scores of < 3 reflect low fidelity (24). The IMR Fidelity Scale has shown excellent psychometric properties (22). The IT-IS assesses trainer competence in conducting IMR elements displayed in a particular session and is also behaviorally anchored; treatment integrity is considered to include not only competence but also adherence to the IMR program and differentiation, that is, the flexible use of interventions (7, 31, 32, 36). Competence—defined as IMR trainers’ level of skill shown in delivering the treatment—includes both understanding the program model and having the skills to implement it (32). The IT-IS was meant to complement and extend the IMR Fidelity Scale by assessing individual clinicians. It provides researchers with a more precise assessment of the IMR process by evaluating competence at the clinical interaction level (32). The IT-IS consists of 16 items scored on a five-point scale, with higher scores indicating better performance. Guidelines for interpreting the scores are as follows: 1 to < 2 = unsatisfactory: clinician fails to use methods; ≥ 2 to < 3 = needs improvement: clinician applies either insufficient or inappropriate methods and/or with limited skill and flexibility; ≥ 3 to < 4 = satisfactory: clinician applies a sufficient range of methods with skill and flexibility, some difficulties evident; ≥ 4 to < 5 = very good: clinician systematically applies an appropriate range of methods in a creative, resourceful, and effective manner; 5 = excellent: clinician uses an excellent range of application or successful application in the face of difficulties. The total group score is the mean of all item scores (7, 36). Each of the IT-IS items corresponds to a critical element of IMR (32). Four items are general, meaning that they are not specific to IMR but are critical to the quality of the intervention and include a therapeutic relationship, recovery orientation, involving all members of the group, and enlisting support among group members (7). The other 12 items are IMR-specific (32). The IT-IS has 13 mandatory items and three optional items, which are only scored if the applicable part of the IMR
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