Doctor of Philosophy
School of Psychology - Faculty of Health and Behavioural Sciences
Kelly, Peter James, Does homework improve outcomes for individuals diagnosed with severe mental illness? PhD thesis, School of Psychology, University of Wollongong, 2007. http://ro.uow.edu.au/theses/729
Homework refers to activities completed by individuals between therapeutic sessions which are designed to help them make progress toward their treatment goals (Deane, Glaser, Oades, & Kazantzis, 2005; Kazantzis & Lampropoulos, 2002b; Shelton & Ackerman, 1974). Homework has been recommended for use by mental health case managers to help clients with severe mental illness (SMI; Glaser, Kazantzis, Deane, & Oades, 2000; Turkington, Dudley, Warman, & Beck, 2004). Research has not previously examined whether case managers routinely use homework or if homework improves outcomes for individuals with SMI. The aim of the current study was to examine case managers' homework practices and describe their attitudes towards the use of homework. It also examined the relationship between homework and client outcome. The research consisted of two related studies. Study 1 involved the distribution of a homework practices survey to 122 mental health case managers. Results indicated that 93% of case managers implemented homework, but only 15% regularly used a systematic approach to homework administration where they clearly specified the task and provided a written note for the client. On average case managers reported positive attitudes towards homework, predominately using a range of behaviourally based homework tasks. Study 2 was conducted as an effectiveness study and examined the actual use of homework by case managers working in clinical practice. Case managers were trained in a systematic approach to homework administration and were provided with carbonised Homework Administration Pads to assist with homework implementation. A Hierarchical Linear Modelling (HLM) approach was used to examine the relationship between homework and outcome for all participants in the study (N = 242). The total number of homework assignments administered to each client and the quality of homework completion predicted improvement on the Health of Nation Outcome Measure (HoNOS). When examining just those individuals who were assigned homework (n = 129), the total number of homework assignments administered also predicted improvements on the Kessler 10 (K10). These results are supportive of the use of systematic homework administration procedures with individuals diagnosed with SMI. However, during the course of the 12-month study, 113 clients (47%) were not assigned homework using the Homework Assignment Pad. This suggests that promoting the consistent use of systematic homework procedures by case managers represents a considerable challenge. It is likely that there are a range of factors that influence case managers' use of homework. For example, current results suggest that case manager attitudes towards homework and the importance case managers' place on homework for SMI are likely to influence their implementation of systematic homework administration procedures. Additionally, attitudes represent just one aspect of social cognitive models of behaviour (e.g., Theory of Planned Behaviour; Ajzen, 1991). It is likely that homework administration is also influenced by beliefs case managers hold regarding subjective norms (e.g., managerial, supervisory or peer expectations) and perceived behavioural control with implementing the task (e.g., client acceptance of homework, sufficient time to administer homework). With homework offering considerable promise in supporting the recovery of people diagnosed with SMI, future work would benefit from examining strategies to promote the regular use of systematic homework administration procedures by mental health case managers.
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