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、父母痛苦和增加的家庭功能障碍。解决儿童脑外伤后的心理社会困难的干预措施很少见，而且获得熟练的治疗师可能会受到距离和经济状况的限制。最近的研究提供了证据表明，解决问题的干预措施可以减少照顾者的痛苦，并改善脑外伤后儿童的适应能力。目前的项目建立在这些调查的基础上，将辅导员协助的问题解决(CAPS)与互联网资源比较小组(IRC)进行比较。在CAPS中，一名训练有素的辅导员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计划。IRC组的家庭会收到电脑、高速互联网接入以及脑损伤信息和资源的链接，但不会收到CAPS网站的内容。我们将在一项随机试验中检查CAPS的疗效和成本效益，比较CAPS和IRC的效果。主要结果将在治疗前和治疗后以及在6个月和12个月的后续评估中进行评估，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。其他家庭结果包括父母教养效能、父母压力和家庭功能。参与者将包括120名12-16岁儿童的家庭，他们在参与研究前1-6个月经历了中度至严重的脑外伤。家庭将被随机分配到两种情况之一。将使用连续结果的混合线性模型和二分结果的通用估计方程(GEE)来检查组内差异。我们假设，与IRC组相比，CAPS组将表现出更好的问题解决和沟通技能，以及更好的儿童功能和更低的父母痛苦水平。伤害前问题较多和资源较少的家庭将从上限干预中获得更大好处。拟议的项目具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技能来改善脑外伤儿童及其父母的心理问题。研究结果将通过确定调节和缓和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.