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16-03-2020 | Original Article

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

Cognitive Therapy and Research
Brian E. Bunnell, Lynne S. Nemeth, Leslie A. Lenert, Nikolaos Kazantzis, Esther Deblinger, Kristen A. Higgins, Kenneth J. Ruggiero
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The online version of this article (https://​doi.​org/​10.​1007/​s10608-020-10090-8) contains supplementary material, which is available to authorized users.

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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.


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.


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).


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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