A Randomized Trial of Teen Online Problem Solving: Efficacy in Improving Caregiver Outcomes After Brain Injury
ABSTRACT Objective: To examine the results of a randomized clinical trial (RCT) of Teen Online Problem Solving (TOPS), an online problem solving therapy model, in increasing problem-solving skills and decreasing depressive symptoms and global distress for caregivers of adolescents with traumatic brain injury (TBI). Method: Families of adolescents aged 11-18 who sustained a moderate to severe TBI between 3 and 19 months earlier were recruited from hospital trauma registries. Participants were assigned to receive a web-based, problem-solving intervention (TOPS, n = 20), or access to online resources pertaining to TBI (Internet Resource Comparison; IRC; n = 21). Parent report of problem solving skills, depressive symptoms, global distress, utilization, and satisfaction were assessed pre- and posttreatment. Groups were compared on follow-up scores after controlling for pretreatment levels. Family income was examined as a potential moderator of treatment efficacy. Improvement in problem solving was examined as a mediator of reductions in depression and distress. Results: Forty-one participants provided consent and completed baseline assessments, with follow-up assessments completed on 35 participants (16 TOPS and 19 IRC). Parents in both groups reported a high level of satisfaction with both interventions. Improvements in problem solving skills and depression were moderated by family income, with caregivers of lower income in TOPS reporting greater improvements. Increases in problem solving partially mediated reductions in global distress. Conclusions: Findings suggest that TOPS may be effective in improving problem solving skills and reducing depressive symptoms for certain subsets of caregivers in families of adolescents with TBI. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
SourceAvailable from: Emily LawJournal of Pediatric Psychology 05/2014; DOI:10.1093/jpepsy/jsu032 · 2.91 Impact Factor
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ABSTRACT: Background Parents caring for a child with Cystic Fibrosis (CF) are at high risk for psychological distress and have limited access to psychological care. Therefore, a web-based psychological support program for severely distressed parents of children with CF (WEP-CARE) was developed and evaluated for its feasibility and efficacy.MethodsA clinical expert panel developed WEP-CARE based on principles of cognitive-behavioral therapy. This web-based writing therapy comprises nine sessions, tailored for the specific needs of caregivers. The pilot study was conducted as a single-group intervention with pre-post-follow-up design. Out of 31 participants, 23 parents completed the intervention (21 female; mean age 37 years; SD¿=¿6.2 years, range 25 ¿ 48 years). Psychological symptoms and quality of life were assessed online by self-report measures at pre and post treatment and followed up 3 month later.ResultsOn average, the caregivers¿ symptoms of anxiety decreased statistically significant and clinical relevant about five points from an elevated (M¿=¿11.4; SD =2.6) to a normal level (M¿=¿6.7; SD¿=¿2.6; p¿<¿0.001) between pre and post treatment. Fear of disease progression (p¿<¿0.001) and symptoms of depression (p¿=¿0.02) significantly decreased as well. Quality of life significantly improved (p¿=¿0.01). The effects were maintained at the 3-months follow-up assessment.ConclusionsWEP-CARE is feasible and promising regarding its efficacy to improve parental mental health and quality of life.Health and Quality of Life Outcomes 02/2015; 13(1):11. DOI:10.1186/s12955-015-0211-y · 2.10 Impact Factor
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ABSTRACT: Pediatric traumatic brain injury (TBI) contributes to impairments in functioning in everyday settings. Evidence suggests that online family problem-solving therapy (FPST) may be effective in reducing adolescent behavioral morbidity. This article examines the efficacy of Counselor-Assisted Problem Solving (CAPS), a form of online FPST in improving long-term functional outcomes of adolescents with TBI relative to Internet resources only. Children, aged 12 to 17 years, who were hospitalized in the previous 7 months for TBI were enrolled in a multisite, assessor-blinded randomized controlled trial. Consented participants were randomly assigned to CAPS or an Internet resource comparison (IRC) condition. Outcomes were assessed at baseline and at follow-ups 6, 12, and 18 months postbaseline. The Child and Functional Assessment Scale and the Iowa Family Interaction Rating Scale (IFIRS) served as primary outcomes of child and family functioning respectively. For the Child and Functional Assessment Scale total, we found a significant group × time interaction, with less impaired functioning for the CAPS group than for the IRC group at the final follow-up. Parent education moderated the efficacy of CAPS on overall rates of impairment and school/work functioning, with the advantage of CAPS over IRC evident at the final follow-up only for participants with less-educated parents. Neither group differences nor group × time interactions were found for the IFIRS. Relatively brief, online treatment shortly after injury may result in long-term improvements in child functioning, particularly among families of lower socioeconomic status. Clinical implementation of CAPS during the initial months postinjury should be considered. Copyright © 2015 by the American Academy of Pediatrics.Pediatrics 01/2015; DOI:10.1542/peds.2014-1386 · 5.30 Impact Factor