Fidelity and clinical competence in providing IMR 153 items (range of mean scores: 2.07–2.83), and one unsatisfactory scoring item (M = 1.73). The seven needs improvement and unsatisfactory scoring IT-IS items all involved clinical elements of IMR. Out of these seven elements, five were poorly implemented by between eight and ten IMR groups (53.3%–66.7%), including behavioral tailoring for medication, weekly action planning, relapse prevention training, action plan review, and coping skills training. Two elements—the involvement of significant others and cognitive-behavioral techniques—were poorly implemented by 13 groups (86.7%). Results on the indicators of excellence of the poorly implemented elements To better comprehend and clarify the poor application of the seven needs improvement and unsatisfactory scoring competency elements, we investigated the results of the application of the indicators of excellence, which provided direction to the rating of these elements (36). IMR trainers did not make individual relapse prevention plans with all the participants, nor did they check existing plans. In addition, they did not succeed in persuading participants to try out components of the plan or ensuring that all people involved were familiar with it. For behavioral tailoring for medication, after thorough discussion, IMR trainers should help participants find individual ways to incorporate taking medication into their daily lives and discuss medication use with their physician. However, this element was often misunderstood as only promoting the exchange of experiences with different types of medication and their side effects. For coping skills training, none of the IMR groups systematically used an appropriate set of methods, including role-play, modeling, or shaping. In addition, encouraging significant others to participate in coping strategies was rare. Cognitive-behavioral technique reinforcement was often used. However, only some groups used relaxation training and occasionally modeling. Role-play, shaping, cognitive restructuring, and behavioral experiments were not applied. Most IMR trainers only gave general assignments to the group instead of weekly individual action planning and review. Weekly action planning refers to assignments to help client(s) transfer skills presented during the session to their daily lives and also includes steps to be taken to attain measurable benchmarks of goal progress (7). However, the trainers rarely helped individual participants’ tailor their planned activities for their goals, preferences, and personal situations. Consequently, there were few reviews of personal action plans. Finally, the lowest average score was on significant other involvement competence. In almost no group did IMR trainers have
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