A naturalistic pilot study 37 We considered the support base for implementing IMR on a broader scale to be important to the feasibility of an RCT, as this would affect the number of participants who could be recruited for the RCT and because it would be executed in the same institute. This support base would be affected by participants’ and clinicians’ satisfaction with IMR and by its perceived effectiveness. As the feasibility of such an RCT would also depend on the quality with which IMR was implemented, we chose to investigate aspects of implementation on which the earlier RCTs had differed, such as fidelity, trainers’ education and supervision, dropout from IMR, and IMR duration. Our pilot study was designed as a program-evaluation that included a process evaluation and an outcome evaluation. As there have recently been calls for increased scientific rigor in pilot and feasibility studies (17), our reporting of this study is based on “Checklist: Items to include when reporting a pilot study” (16) adopted from the CONSORT format (18). Methods Participants and setting In the pilot study we included adult outpatient clients aged between 18 and 65 with severe and persistent mental illnesses (SMI), i.e., those entailing serious limitations in social functioning and requiring coordinated professional care (19). As well as behavior that would be likely to seriously disrupt the group, the exclusion criteria were having severe cognitive impairments and having insufficient knowledge of the Dutch language. Participants were recruited from six Community Mental Health Teams (CMHTs) serving people with severe and persistent mental illness at Bavo Europoort, a mental health institution in the greater Rotterdam area in the Netherlands, a conurbation with approximately 1.2 million inhabitants. Each sub-region of about 150,000 inhabitants was served by a Community Mental Health Team and an Assertive Community Treatment Team (ACT). Clients of the CMHTs who met the eligibility criteria were identified and asked by their clinicians to participate in IMR. From the start, most participants in IMR also participated in the pilot study. The following activities were undertaken to prepare for the implementation of IMR in this institution: to visit Prof. Mueser and colleagues and to see IMR in practice, a
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