Chapter 6 154 a plan to systematically increase the involvement of significant others, for example, in homework or in working on recovery goals or by having them attend an IMR session. Two examples of successful implementation of the most poorly scored element Although a total of eight elements scored poorly on average, some IMR groups managed to implement these elements with high or satisfactory scores. Generally, scores ranged from 2–3 points on the five-point-scales (Tables 2 and 3). Two examples of successful implementation of the element of significant other involvement that had the lowest score on both scales are as follows. One IMR trainer elicited involvement by explaining IMR to the families of two of her clients, who were also in the IMR group. Consequently, one participant had a goal of reading to her children. In the highest-scoring group for this element, trainers frequently asked to involve significant others in IMR activities based on a specific plan. In this group, some participants and their partners completed home assignments together. When the social support module was discussed in this group, each participant was invited to bring someone with some success, such as a housing support worker, sister, wife, and so on. Therefore, in this IMR group, the trainers managed to meet the IT-IS excellence indicator of having a family member physically present at a session. Discussion Study relevance and main results To the best of our knowledge, this study is the first to use both the IMR Fidelity Scale and the IT-IS to identify the degree of IMR implementation per group and at the item level. In addition, this study evaluated the complementary value of the ITIS to the IMR Fidelity Scale, including the shared and separate elements covered by the two scales. For use in this study, the IT-IS rating procedure was adapted so it could be used in a way similar to the IMR Fidelity Scale. Results showed that 12 of the 20 IMR elements of both scales (60%) were wellimplemented (use of a structured IMR curriculum, educational strategies, motivation-based strategies (all three assessed with both scales), provision of educational handouts, comprehensiveness of the curriculum, number of people in a session or group, IMR goal-setting (all four assessed with the IMR Fidelity Scale), therapeutic relationship involving all members of the group, recovery orientation, enlisting support between group members, and structure/efficient use of time (all five assessed with the IT-IS)). Eight IMR elements were insufficiently implemented
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