Component 4
Collaborative Task Striving and Monitoring

Between session task setting or “homework” is essential to this component, and integrates with the goals and vision of personal recovery. While homework assignments have been used effectively within psychological treatments for a wide range of problems for some time, only recently has their role been explicitly assessed within interventions for schizophrenia (Glaser, et al., 2000). This development provides great promise, given that generalisation from psychosocial rehabilitation settings to the natural environment has provided a significant challenge in the past. By definition, homework provides the opportunity to generalise skills learned to naturalistic settings. CRM includes three major stages for systematic homework administration: review, design and assignment, along with a range of strategies for identifying and overcoming obstacles to successful implementation.

What is Homework?

• Any purposeful and meaningful activity that a client may complete outside of treatment e.g.
  • Engaging in a specific behavior
  • Daily recording of cognitions
• It provides an opportunity for clients to transfer skills developed with the case manager to other environments
• The use of homework (as a procedure by itself) receives little emphasis in clinical training. It is often assumed practitioners know how to use homework.

Is Homework effective?

Meta-analysis

Kazantzis, N., & Deane, F. P. & Ronan, K. (2000).

• Examined 28 studies reported between 1980 and 1998 looking at the effects of homework and homework compliance therapeutic outcome.

Findings

• Homework assignments produced a positive mean effect size in the medium range ( r = .36).
• 68% of clients would improve when therapy involved HW compared to only 32% when therapy involved not HW
• Correlational research shows that homework compliance is associated with positive treatment outcome
• CBT with HW produced significantly better outcomes than CBT without HW

Review, Design, Assign

Review

• Always discuss homework completion with your client
• Reinforce/praise all attempts
• Examine reasons for any homework not completed
• Problem solve barriers to homework completion

Design

• Discuss treatment goals
• Consider the client’s ability and potential barriers
• Negotiate relevant homework tasks
• Present rationale and how homework will help attain goals
• Provide a choice of homework activities

Assign

• Complete the homework assignment form
• Consider alternatives for potential barriers
• Ask how confident the client is about completing the homework

If the client’s confidence is less than 70% collaboratively modify or adjust the task

Key references

Library resources