Pediatric traumatic brain injury (TBI) often results in new child behavior problems, parental distress, and increased family dysfunction. Interventions to address psychosocial difficulties following pediatric TBI are rare, and access to skilled therapists can be restricted by distance and finances. Recent studies provide evidence that problem-solving interventions can reduce caregiver distress and improve child adjustment following TBI. The current project builds upon these investigations by comparing counselor-assisted problem-solving (CAPS) to an internet resource comparison group (IRC). In CAPS, a trained counselor guides families through a 6-month structured online problem-solving and skill-building program via one-on- one videoconference sessions. Families in the IRC group receive computers, high speed internet access and links to brain injury information and resources, but not the CAPS website content. We will examine the efficacy and cost effectiveness of CAPS in a randomized trial comparing the effects of CAPS versus IRC. Primary outcomes, to be assessed pre- and post treatment and at 6- and 12- month follow-up assessments, include problem-solving skills and parent-child communication. Secondary outcomes include child functioning and behavior problems and parent psychological distress. Additional family outcomes include parenting efficacy, parent stress, and family functioning. Participants will include families of 120 children, aged 12-16 years, who experienced a moderate to severe TBI 1-6 months prior to study participation. Families will be randomly assigned to one of two conditions. Group differences will be examined using mixed linear models for continuous outcomes and Generalized Estimation Equations (GEE) for dichotomous outcomes. We hypothesize that the CAPS group will exhibit better problem solving and communication skills as well as better child functioning and lower levels of parental distress compared with the IRC group. Families with greater pre-injury problems and fewer resources will derive greater benefit from the CAPS intervention. The proposed project has clear public health implications. Our overarching goal is to ameliorate psychological problems among children with TBI and their parents by equipping both with increased coping and problem-solving skills. Findings will shed light on treatment processes and mechanisms by identifying factors that mediate and moderate treatment response.
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