A Trial of Online Problem Solving for Pediatric TBI

描述（由申请人提供）：儿童创伤性脑损伤（TBI）通常会导致新的儿童行为问题，父母痛苦和家庭功能障碍增加。解决儿童脑外伤后心理社会困难的干预措施很少，而且由于距离和经济条件的限制，获得熟练治疗师的机会也受到限制。最近的研究提供的证据表明，解决问题的干预措施可以减少照顾者的痛苦，提高儿童适应创伤性脑损伤。目前的项目建立在这些调查的基础上，将辅导员协助解决问题（CAPS）与互联网资源比较小组（IRC）进行比较。在CAPS项目中，一名训练有素的咨询师通过一对一的视频会议，指导家庭完成为期6个月的结构化在线问题解决和技能培养项目。IRC组的家庭可以获得电脑、高速互联网接入和脑损伤信息和资源的链接，但不能获得CAPS网站的内容。我们将在一项比较CAPS与IRC疗效的随机试验中检验CAPS的疗效和成本效益。治疗前后以及6个月和12个月随访评估的主要结果包括解决问题的能力和亲子沟通。次要结果包括儿童功能和行为问题以及父母心理困扰。其他的家庭结果包括养育效能、父母压力和家庭功能。参与者将包括120名儿童的家庭，年龄在12-16岁之间，在参与研究前1-6个月经历过中度至重度TBI。家庭将被随机分配到两种情况中的一种。将使用混合线性模型对连续结果和广义估计方程（GEE）对二分类结果进行组差异检查。我们假设，与IRC组相比，CAPS组将表现出更好的解决问题和沟通技巧，以及更好的儿童功能和更低的父母痛苦水平。伤害前问题更严重、资源更少的家庭将从CAPS干预中获得更大的好处。拟议的项目有明显的公共卫生影响。我们的首要目标是通过提高应对和解决问题的能力来改善创伤性脑损伤儿童及其父母的心理问题。研究结果将通过确定介导和调节治疗反应的因素来阐明治疗过程和机制。

DESCRIPTION (provided by applicant): 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.