7 tips for assigning home programs that actually get done!
Coaching clients (or their caregivers) on home programs is often a futile task. Therapists and clients alike go through the motions with little impact on what really happens beyond the session. Though for many therapeutic interventions, a well-executed home program can be the difference between achieving therapy goals and going to therapy sessions. Not that going to sessions isn’t nice, but therapists and clients aim for more…
Coaching, which is a nicer way for saying homework assignment, is common across a wide range of disciplines: occupational therapy, speech and language therapy, psychotherapy, behavior therapy and more. Research has shown there are several recommendations that can lead to significantly higher compliance (reference below). Here is my integrated view of these approaches and interviews with over 60 therapists over the last 3 years:
- Be clear about the relevancy of the home program to the client’s problems and goals. Compliance hinges on clients’ and caregivers’ motivation, which stems from the desire to solve a pain. Hence, home programs should come after SMART goals are determined and be directly linked to these goals.
- Communicate the importance of adherence to home programs by sharing research findings. A simple way is to use the old adage: “the more effort you put in the more you get out.” The point is to establish the relationship between the effort exerted and achieving therapy goals.
- Shoot for quick wins. The digital era we live in makes us all impatient. We seek immediate gratification. Therapy home programs are no difference. By starting with goals that can be achieved quickly you are building the clients / caregivers confidence in the process.
- Describe and model the home program in the most concrete way possible. Make sure you go through the check list of: what, when, where, who, how often and for how long. Remember that clients are not trained professional and might be embarrassed to ask. Practicing the assignments in-session is good practice.
- Hand out the home program in a tangible way. Your client / caregivers need to have this info accessible to them when needed. They need to walk away from the session with something in their hand. For most people today, this means to have it on their smartphones.
- Begin sessions by following up on adherence since previous session. Otherwise the home program may be perceived as not being very important. Following up will also give you visibility to what’s going on beyond the session, and the opportunity to reinforce progress.
- Give ample feedback with positive reinforcements for adherence and work through barriers. Help your clients and their caregivers see the relationship between adherence to home programs and therapy goals. Reassure them when they comply and help them get over barriers that hinder compliance.
Broder, M.S. (2000). Making optimal use of homework to enhance your therapeutic effectiveness. Journal of Rational-Emotive and Cognitive Behavior Therapy, 18, 3-18.
Kazantzis, N., & L’Abate, L. (2007). Handbook of Homework Assignments in Psychotherapy Research, Practice, and Prevention. Springer US.
Shelton, J. L., & Levy, R. L. (1981b). Behavioral assignments and treatment compliance: a handbook of clinical strategies. Champaign, IL: Research Press.
Oren Steinberg is co-founder of SensoryTreat, providing a carryover empowerment platform for pediatric therapists and caregivers of children with Autism and other developmental disabilities.