A Trial of Online Problem Solving for Pediatric TBI

描述（由申请人提供）：小儿创伤性脑损伤（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。针对儿童TBI后心理社会困难的干预措施很少见，而且获得熟练治疗师的机会可能受到距离和财务的限制。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和改善儿童调整后TBI。目前的项目建立在这些调查比较辅导员协助解决问题（CAPS）的互联网资源比较组（IRC）。在CAPS，一名训练有素的顾问通过一对一的视频会议指导家庭完成为期6个月的结构化在线解决问题和技能建设计划。IRC组中的家庭收到电脑，高速互联网接入和链接到脑损伤信息和资源，但没有CAPS网站的内容。我们将在一项比较CAPS与IRC效果的随机试验中检查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技能和亲子沟通。次要结果包括儿童功能和行为问题以及父母的心理困扰。其他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12- 1 - 6岁儿童的家庭，这些儿童在参与研究前1-6个月经历了中度至重度TBI。家庭将被随机分配到两个条件之一。将使用连续结局的混合线性模型和二分结局的广义估计方程（GEE）检查组间差异。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水平的父母痛苦。有更大的伤前问题和更少的资源的家庭将从CAPS干预中获得更大的好处。拟议的项目对公共卫生有明显的影响。我们的总体目标是通过提高应对和解决问题的技能来改善TBI儿童及其父母的心理问题。研究结果将阐明治疗过程和机制，确定因素，介导和适度的治疗反应。

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.