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Barriers Associated with the Implementation of Homework in Youth Mental Health Treatment and Potential Mobile Health Solutions

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Abstract

Background

Homework, or between-session practice of skills learned during therapy, is integral to effective youth mental health TREATMENTS. However, homework is often under-utilized by providers and patients due to many barriers, which might be mitigated via mHealth solutions.

Methods

Semi-structured qualitative interviews were conducted with nationally certified trainers in Trauma Focused Cognitive Behavioral Therapy (TF-CBT; n = 21) and youth TF-CBT patients ages 8–17 (n = 15) and their caregivers (n = 12) to examine barriers to the successful implementation of homework in youth mental health treatment and potential mHealth solutions to those barriers.

Results

The results indicated that many providers struggle to consistently develop, assign, and assess homework exercises with their patients. Patients are often difficult to engage and either avoid or have difficulty remembering to practice exercises, especially given their busy/chaotic home lives. Trainers and families had positive views and useful suggestions for mHealth solutions to these barriers in terms of functionality (e.g., reminders, tracking, pre-made homework exercises, rewards) and user interface (e.g., easy navigation, clear instructions, engaging activities).

Conclusions

This study adds to the literature on homework barriers and potential mHealth solutions to those barriers, which is largely based on recommendations from experts in the field. The results aligned well with this literature, providing additional support for existing recommendations, particularly as they relate to treatment with youth and caregivers.

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Funding

Dr. Bunnell was supported by the National Institute of Mental Health (Grant Numbers F32 MH108250 and K23 MH118482).

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL, 33613, USA

    Brian E. Bunnell

  2. Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Brian E. Bunnell, Leslie A. Lenert & Kristen A. Higgins

  3. Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, SC, USA

    Lynne S. Nemeth

  4. Cognitive Behavior Therapy Research Unit and School of Psychological Sciences, Monash University, Clayton, VIC, Australia

    Nikolaos Kazantzis

  5. Child Abuse Research Education & Service (CARES) Institute, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA

    Esther Deblinger

  6. Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, USA

    Kenneth J. Ruggiero

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  1. Brian E. Bunnell
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  2. Lynne S. Nemeth
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  3. Leslie A. Lenert
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  4. Nikolaos Kazantzis
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  5. Esther Deblinger
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  6. Kristen A. Higgins
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  7. Kenneth J. Ruggiero
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by BB, LN, KR, and KH. The first draft of the manuscript was written by BB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Brian E. Bunnell.

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Conflict of Interest

Brian E. Bunnell, Lynne S. Nemeth, Leslie A. Lenert, Nikolaos Kazantzis, Esther Deblinger, Kristen A. Higgins and Kenneth J. Ruggiero declares that they have no conflict of interest.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at the Medical University of South Carolina (Pro00047774) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual subjects participating in the study.

Research Involving Human Participants and/or Animals

No animal studies were carried out by the authors for this article.

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Bunnell, B.E., Nemeth, L.S., Lenert, L.A. et al. Barriers Associated with the Implementation of Homework in Youth Mental Health Treatment and Potential Mobile Health Solutions. Cogn Ther Res 45, 272–286 (2021). https://doi.org/10.1007/s10608-020-10090-8

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