A Trial of Online Problem Solving for Pediatric TBI

儿童创伤性脑损伤在线问题解决的尝试

• 批准号: 7148365
• 负责人: SHARI L WADE
• 金额: $ 65.31万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7148365
• 关键词: Internet; adolescence (12-20); anxiety; behavior disorders; behavior therapy; behavioral /social science research tag; brain injury; caregivers; clinical research; clinical trials; communication; coping; cost effectiveness; depression; family structure /dynamics; functional ability; human subject; human therapy evaluation; interview; longitudinal human study; parent offspring interaction; patient /disease registry; patient oriented research; problem solving; psychological stressor; questionnaires; socioeconomics; telemedicine

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.

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。解决儿科创伤性脑损伤后心理社会困难的干预措施很少，而且获得熟练治疗师的机会可能会受到距离和经济的限制。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护理人员的痛苦并改善 TBI 后儿童的适应能力。当前的项目建立在这些调查的基础上，通过将顾问辅助问题解决（CAPS）与互联网资源比较组（IRC）进行比较。在 CAPS 中，训练有素的顾问通过一对一的视频会议课程指导家庭完成为期 6 个月的结构化在线问题解决和技能培养计划。 IRC 小组的家庭可以获得电脑、高速互联网接入以及脑损​​伤信息和资源的链接，但没有 CAPS 网站内容。我们将在一项随机试验中检查 CAPS 的功效和成本效益，比较 CAPS 与 IRC 的效果。主要结局将在治疗前和治疗后以及 6 个月和 12 个月的随访评估中进行评估，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家长心理困扰。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 12-16 岁儿童的家庭，他们在参与研究前 1-6 个月经历过中度至重度 TBI。家庭将被随机分配到以下两种情况之一。将使用连续结果的混合线性模型和二分结果的广义估计方程（GEE）来检查组间差异。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巧，以及更好的儿童功能和更低的父母痛苦水平。受伤前问题较多且资源较少的家庭将从 CAPS 干预中获得更大收益。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 TBI 儿童及其父母的应对和解决问题的能力来改善他们的心理问题。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。