A naturalistic pilot study 51 “Involvement of Significant Others,” “Coping-Skills Training,” “Relapse-Prevention Training” and “Behavioral Tailoring for Medication.” The greatest variance was on item 7 regarding “IMR Goal Follow-up,” which was implemented well in 3 groups and not implemented well in 3 groups; the items score ranged from 1-5, see Table 4. Due to a ceiling effect, the differences between groups perceived for some items in the quality of implementation during observation of one session per team were reflected only partly in the scores of the fidelity scale. In particular, this concerned items 8 (motivation-based strategies), 9 (educational techniques), and 10 (cognitive-behavioral techniques). Variance in fidelity appeared to be related to differences in the trainers’ skills and their experience in guiding groups. This was reflected particularly in their ability to practice social and coping-skills training, roleplay, relapse-prevention training, and motivational strategies. Infrastructure for education and supervision By setting up a system for the supervision and training of the trainers, the institute successfully created an infrastructure for implementing IMR on a broader scale. The trainers were experienced clinicians (mostly psychiatric nurses, but also a psychologist and a psychiatrist), who 1.) all received a two-day course in teaching IMR before the start of the pilot and 2.) attended supervision once every two weeks for two hours. Twice a year since the start of the pilot, all IMR trainers have come together for a morning or afternoon of additional booster training. TABLE 4 Fidelity-scores on the IMR-fidelity scale of the six IMR groups Group Item A B C D E F M (SD) Mdn (IQR) 1 # of people in a Session or Group 4 5 5 5 4 5 4.7 (.52) 5 (.75) 2 Program Length 5 5 5 5 5 5 5 (0) 5 (0) 3 Comprehensiveness of Curriculum 5 5 5 5 5 5 5 (0) 5 (0) 4 Provision of Educational Handouts 5 5 5 5 5 5 5 (0) 5 (0) 5 Involvement of Significant Others 3 1 3 3 3 3 2.7 (.82) 3 (0) 6 IMR Goal Setting 5 5 5 5 5 5 5 (0) 5 (0) 7 IMR Goal Follow-up 5 4 2 5 1 2 3.2 (1.72) 3 (2.75) 8 Motivation-Based Strategies 5 4 4 5 5 5 4.7 (.52) 5 (.75) 9 Educational Techniques 5 5 5 5 5 5 5 (0) 5 (0) 10 Cognitive-Behavioral Techniques 5 4 4 5 4 4 4.3 (.52) 4 (.75) 11 Coping Skills Training 3 2 2 4 3 2 2.7 (.82) 2.5 (1) 12 Relapse-Prevention Training 2 2 3 1 3 3 2.3 (.82) 2.5 (1) 13 Behavioral Tailoring for Medication 2 2 2 2 1 3 2 (.63) 2 (0) Mean fidelity score per group 4.2 3.8 3.8 4.2 3.8 4.0 4.0 (.20) 3.9 (.35) Median fidelity score (IQR) 5 (2) 4 (3) 4 (2) 5 (1) 4 (2) 5 (2)
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