Undergraduate Research Hub

Assigning and reviewing homework as a strategy to help clients gain therapeutic skills is a common technique used across a variety of evidence-based practices (EBPs) and has been shown to improve therapy outcomes for children and youth. However, in studies characterizing routine psychotherapy delivered in community mental health settings, homework is rarely used in sessions. While some therapist and client level predictors of EBP strategy use have been identified in routine psychotherapy (e.g. client stressors, therapists’ attitudes towards EBPs) it is unknown what is associated with community mental health therapists using homework in the increasingly common context of system-driven implementation of multiple EBPs. To identify predictors of therapists’ use of homework, 680 videos of sessions with 274 clients were collected from 103 therapists (of which 55% were Hispanic) providing children’s mental health services through the Los Angeles County Department of Mental Health (LACDMH). The current study uses a multilevel logistic regression analysis model to identify which factors are associated with therapist use of homework in therapy sessions when there is system-driven implementation support for the use of multiple EBPs in community mental health settings. After controlling for the EBP delivered in session and the number of EBPs therapists were trained in, having a caregiver present in the therapy session, older child age, and being an unlicensed therapist were associated with a higher likelihood of therapists assigning and reviewing homework during a specific session. Therapist race/ethnicity, perceptions of the EBP being delivered, their report of emotional exhaustion, and direct hours with clients, as well as emergent unexpected stressful client life events within a session were not significantly associated with therapists’ delivery of homework. These findings underscore the need to provide explicit attention during therapist training on the use of homework with younger clients when caregivers are absent from sessions and the need to facilitate the use of homework among licensed therapists.