Table 3.

Illness Management and Recovery (IMR) Fidelity scale rev. 3-24-05

	1	2	3	4	5
1. # People in a session or group IMR is taught individually or in groups of 8 or less consumers	Some sessions taught with over 15 consumers	Some sessions taught with 13–15 consumers	Some sessions taught with 11 or 12 consumers	Some sessions taught with 9 or 10 consumers	All IMR sessions taught individually or in groups of 8 or less
2. Program length Consumers receive at least 6 months of weekly IMR sessions or equivalent (e.g., biweekly for at least 12 months)	< 20% of IMR clients receive at least 6 months of weekly sessions	20–39% of IMR clients receive at least 6 months of weekly sessions	40–69% of IMR clients receive at least 6 months of weekly sessions	70–89% of IMR clients receive at least 6 months of weekly sessions	≥ 90% of IMR clients receive at least 6 months of weekly sessions
3. Comprehensiveness of the curriculum • Recovery strategies • Mental illness facts • Stress-vulnerability model • Social support • Using medication • Preventing relapse • Stress management • Coping symptoms • Mental health system	Curriculum materials include only 1 topic, or educational handouts are not available	Curriculum materials include 2 or 3 topic areas	Curriculum materials include 4 or 5 topic areas	Curriculum materials include 6 or 7 topic areas	Curriculum materials include 8 or 9 topic areas
4. Provision of educational handouts All consumers participating in IMR receive IMR handouts	< 20% of IMR clients receive educational handouts	20–39% of IMR clients receive educational handouts	40–69% of IMR clients receive educational handouts	70–89% of IMR clients receive educational handouts	≥ 90% of IMR clients receive educational handouts
5. Involvement of significant others At least one IMR-related contact by IMR practitioner in the last month OR significant other has involvement with the consumer in pursuit of goals (e.g., assisting with homework assignments)	< 20% of IMR clients have significant other(s) involved	20–29% of IMR clients have significant other(s) involved	30–39% of IMR clients have significant other(s) involved	40–49% of IMR clients have significant other(s) involved	≥ 50% of IMR clients have significant other(s) involved
6. IMR goal setting • Realistic and measurable (ambitious goals are broken down into smaller steps) • Individualized • Pertinent to recovery process • Linked to IMR plan	< 20% of IMR clients have at least 1 personal goal in chart	20–39% of IMR clients have at least 1 personal goal in chart and interviews verify IMR goal setting process	40–69% of IMR clients have at least 1 personal goal in chart and interviews verify IMR goal setting process	70–89% of IMR clients have at least 1 personal goal in chart and interviews verify IMR goal setting process	≥ 90% of IMR clients have at least 1 personal goal in chart and consumer and clinician interviews verify IMR goal setting process
7. IMR goal follow-up Practitioners and consumers collaboratively follow up on goal(s) (see examples in the IMR Practitioner Workbook)	< 20% of IMR clients have follow-up on goal(s) documented in chart	20–39% of IMR clients have follow-up on goal(s) documented in chart and interviews verify IMR goal follow-up	40–69% of IMR clients have follow-up on goal(s) documented in chart and interviews verify IMR goal follow-up	70–89% of IMR clients have follow-up on goal(s) documented in chart and interviews verify IMR goal follow-up	≥ 90% of IMR clients have follow-up on the goal(s) documented in their chart and consumer and clinician interviews verify IMR goal follow-up
8. Motivation-based strategies • New info & skills linked to personal goals • Positive perspectives • Pros & cons of change • Hope & self-efficacy	Few or none of the practitioners are familiar with the use of motivation-based strategies (e.g., < 20% of IMR sessions use at least 2 motivation-based strategy)	Some of the practitioners are familiar, with a low level of use (e.g., 20–29% of IMR sessions use at least 2 motivation-based strategy)	Some of the practitioners are familiar, with a moderate level of use (e.g., 30–39% of IMR sessions use at least 2 motivation-based strategy)	The majority of the practitioners are familiar and use it regularly (e.g., 40–49% of IMR sessions use at least 2 motivation-based strategy)	All practitioners are familiar with the use of motivation-based strategies and use it regularly (e.g., ≥ 50% of IMR sessions use at least 2 motivation-based strategy
9. Educational techniques • Interactive teaching • Checking for understanding • Breaking down info • Reviewing info	Few or none of the practitioners are familiar with the use of educational strategies (e.g., < 20% of IMR sessions use at least 2 educational strategies)	Some of the practitioners are familiar, with a low level of use (e.g., 20–29% of IMR sessions use at least 2 educational strategies)	Some of the practitioners are familiar, with a moderate level of use (e.g., 30–39% of IMR sessions use at least 1 educational strategies)	The majority of the practitioners are familiar and use it regularly (e.g., 40–49% of IMR sessions use at least 2 educational strategies)	All practitioners are familiar with the use of educational strategies and use it regularly (e.g., ≥50% of IMR sessions use at least 2 educational strategies
10. Cognitive-behavioral techniques • Reinforcement • Shaping • Modeling • Role playing • Cognitive restructuring • Relaxation training	Few or none of the practitioners are familiar with the use of cognitive-behavioral strategies (e.g., < 20% of IMR sessions use at least 2 cognitive-behavioral strategies)	Some of the practitioners are familiar, with a low level of use (e.g., 20–29% of IMR sessions use at least 2 cognitive-behavioral strategies)	Some of the practitioners are familiar, with a moderate level of use (e.g., 30–39% of IMR sessions use at least 1 cognitive-behavioral strategy)	The majority of the practitioners are familiar and use it regularly (e.g., 40–49% of IMR sessions use at least 2 cognitive-behavioral strategies)	All practitioners are familiar with the use of cognitive-behavioral strategies and use them regularly (e.g., ≥ 50% of IMR sessions use at least 2 cognitive-behavioral strategies
11. Coping skills training • Review current coping • Amplify current coping or develop new coping skills • Behavioral rehearsal • Review effectiveness • Modify as necessary	Few or none of the practitioners are familiar with the principles of coping skills training	Some of the practitioners are familiar with the principles of coping skills training, with a low level of use	Some of the practitioners are familiar with the principles of coping skills training, with a moderate level of use	The majority of the practitioners are familiar with the principles of coping skills training and use them regularly	All practitioners are familiar with the principles of coping skills training and use them regularly
12. Relapse prevention training • Identify triggers • Identify early warning signs • Stress management • Ongoing monitoring • Rapid intervention as needed	Few or none of the practitioners are familiar with the principles of relapse prevention training	Some of the practitioners are familiar with the principles of relapse prevention training, with a low level of use	Some of the practitioners are familiar with the principles of relapse prevention training, with a moderate level of use	The majority of the practitioners are familiar with the principles of relapse prevention training and use them regularly	All practitioners are familiar with the principles of relapse prevention training and use them regularly, as documented by relapse prevention plans in clients’ charts
13. Behavioral tailoring for medication Behavioral tailoring includes developing strategies tailored to each individual’s needs, motives and resources (e.g., choosing medication that requires less frequent dosing, placing medication next to one’s toothbrush)	Few or none of the practitioners are familiar with the principles of behavioral tailoring for medication	Some of the practitioners are familiar with the principles of behavioral tailoring for medication, with a low level of use	Some of the practitioners are familiar with the principles of behavioral tailoring for medication, with a moderate level of use	The majority of the practitioners are familiar with the principles of behavioral tailoring for medication and use them regularly	All practitioners are familiar with the principles of behavioral tailoring for medication and use them regularly

Score all items based on information gathered through interviews with consumers and clinicians, as well as review of IMR documentation in consumers’ charts