How to implement Illness Management and Recovery (IMR) in mental health service settings: evaluation of the implementation strategy

Abstract

BackgroundThe purpose of this study was to evaluate the implementation strategy used in the first-phase of implementation of the Illness Management and Recovery (IMR) programme, an intervention for adults with severe mental illnesses, in nine mental health service settings in Norway.MethodsA total of 9 clinical leaders, 31 clinicians, and 44 consumers at 9 service settings participated in the implementation of IMR. Implementation was conducted by an external team of researchers and an experienced trainer. Data were gathered on fidelity to the intervention and implementation strategy, feasibility, and consumer outcomes.ResultsAlthough the majority of clinicians scored within the acceptable range of high intervention fidelity, their participation in the implementation strategy appeared to moderate anticipated future use of IMR. No service settings reached high intervention fidelity scores for organizational quality improvement after 12 months of implementation. IMR implementation seemed feasible, albeit with some challenges. Consumer outcomes indicated significant improvements in illness self-management, severity of problems, functioning, and hope. There were nonsignificant positive changes in symptoms and quality of life.ConclusionsThe implementation strategy appeared adequate to build clinician competence over time, enabling clinicians to provide treatment that increased functioning and hope for consumers. Additional efficient strategies should be incorporated to facilitate organizational change and thus secure the sustainability of the implemented practice. Trial registration ClinicalTrials.gov NCT02077829. Registered 25 February 2014

Fidelity Evaluation of the Compared Procedures for Conducting the PREDIAPS Implementation Strategy to Optimize Diabetes Prevention in Primary Care

“…It is also possible that these strategies were not strong enough to be detectable. In any case, differential participation or exposure to the strategy could compromise the future implementation of the clinical intervention that we are seeking to promote [31]. Therefore, future analysis and interpretation of the main outcomes of interest should be adjusted for the degree of participation of professionals in general and/or exposure to the actions of the implementation strategy as a function of study arm and professional group [11,30].…”

Psychometric Properties of a Fidelity Scale for Illness Management and Recovery

“…Although some studies have shown that core principles predict outcomes (Bartholomew and Kensler 2010 ; Hasson-Ohayon et al 2007 ; McGuire et al 2012 ), no published study has thus far examined the predictive validity of the IMR Fidelity scale. Experts recommend regular fidelity monitoring (Bond et al 2009 ), which is always difficult to implement (Bond et al 2014 ; Egeland et al 2017 ; Rychener et al 2009 ). The widespread use of Fidelity scales awaits electronic health records designed to facilitate quality measurement.…”

“…Two of the authors (KME and KSH) reviewed the translation in detail, repeatedly comparing it with the original version. A prior implementation project tested the translated version (Egeland et al 2017 ).…”

“…The practitioners teach these strategies using a combination of educational, motivational, and cognitive-behavioural techniques, following an accompanying workbook with educational handouts in weekly sessions over 10–12 months, either individually or in groups. The IMR program has spread world-wide (Egeland et al 2017 ; Garber-Epstein et al 2013 ; Pratt et al 2011 ; Roosenschoon et al 2016 ), including strong endorsement in Sweden (The National Board of Health and Welfare 2017 ). A 2014 review concluded that IMR had superior outcomes to treatment as usual, according to observer ratings of psychiatric symptoms, as well as patient and practitioner ratings (McGuire et al 2014 ).…”

Psychometric Properties of the General Organizational Index (GOI): A Measure of Individualization and Quality Improvement to Complement Program Fidelity

“…Researchers have rarely reported the psychometric properties of the GOI scale, despite wide usage (Egeland et al 2017 ; McHugo et al 2007 ; Salyers et al 2009 ). One previous psychometric study of the GOI found acceptable interrater reliability, internal consistency, and sensitivity to change across several evidence-based practices (Bond et al 2009a , b ).…”