Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Illness Management and Recovery Fidelity Scale

Date: ________________________________________________

Rater(s): _________________________________________________

_________________________________________________________

Program Name: ____________________________________________

Address: _________________________________________________

Contact Person: ___________________ (Title: ) __________________

Phone: ___________________________ Fax: ___________________

E-mail: __________________________________

Names of the IMR Practitioners: _________________________________________________________

_________________________________________________________

Number of consumers identified as receiving IMR services: _____________________
(The IMR questions refer to these consumers.)

Sources Used:

_____ Progress notes

_____ Chart review

_____ IMR curriculum review

_____ Interview with IMR Program Director/Coordinator

_____ Interview with IMR Program leader

_____ Interview with IMR practitioners

_____ Interview with consumers

Number of IMR practitioners: ______________

Number of IMR consumers served in preceding year: ______________

Date program was started: ___________________________________