Effects of a Web-Based Intervention on Family Functioning Following Pediatric Traumatic Brain Injury

Abstract

Objective: Investigate effectiveness of an online Counselor-Assisted Problem-Solving (CAPS) intervention on family functioning after traumatic brain injury.

Methods: Participants were randomized to CAPS (n = 65) or Internet resource comparison (IRC; n = 67). CAPS is a counselor-assisted web-based program. IRC was given access to online resources. Outcomes were examined at 6, 12, and 18 months after baseline. Injury severity, age, and socioeconomic status were examined as moderators.

Results: A main effect of time was noted for teen-reported conflict and parent-reported problem solving. CAPS had decreased parent-reported conflict and a reduction in parental effective communication. Effects were specific to subsets of the sample.

Conclusion: CAPS, a family-based problem-solving intervention designed to address problem behaviors, had modest effects on some aspects of family functioning compared with IRC. Effects were generally limited to subsets of the families and were not evident across all follow-up assessments.

Trial registration: ClinicalTrials.gov NCT00409448.

Figures

Figure 1

Consort diagram

Figure 2

Plot of the treatment*time*TBI severity interaction for parent reported conflict. For teens with severe TBI, conflict for the CAPS group was lower at the 18-month follow-up (M = 1.76, SE = .13) relative to both baseline (M = 1.97, SE = .12), t(298) = 2.02, p = .04, and the 12-month follow-up (M = 2.04 SE = .12), t(294) =2.66, p = .008, whereas conflict for the IRC group was lower at the 12-month follow-up (Mean = 2.17, SE = .12) relative to the 6-month follow-up (Mean = 2.37, SE = .11), t(294) = 2.25, p = .03, but did not differ from baseline at any of the follow-up time points. For teens with moderate TBI, conflict was lower in the CAPS group at the 6-month follow-up (Mean = 1.95, SE = .09) relative to baseline (Mean = 2.14, SE = .09), t(298) = 2.59, p = .01, but not thereafter. A similar pattern was evident for teens with moderate TBI in the IRC group, except that conflict was significantly lower relative to baseline only at the 18-month follow-up (baseline: Mean = 2.16, SE = .09; 18-month: Mean = 1.94, SE = .10), t(298) = 2.92, p = .004. Effect sizes were small (d = .18–.23).

Figure 3

Plot of the trend for a treatment*time*grade level interaction for teen reported conflict. For older teens, the CAPS group reported similar levels of conflict at baseline (M = 2.19, SE = .12) and the 6-month follow-up (M = 2.09, SE = .12) but lower conflict relative to baseline at both the 12-month follow-up (M = 1.93, SE = .13), t(302) = 2.04, p = .04, and 18-month follow-up (M = 1.75, SE = .14), t(305) = 3.14, p = .002, whereas no changes across assessments were evident for the IRC group. For younger adolescents, significant changes in conflict across assessments were not evident for the CAPS group, but for the IRC group conflict was lower relative to baseline (M = 2.29 SE = .12) at both the 12-month follow-up ( M = 2.01 SE = .13; t(294) = 2.17, p = .03 and 18-month follow-up (M = 2.01 SE = .14), t(298) = 1.97, p <.05. Effect sizes were small (d = .18–.27).

Figure 4

Plot of the treatment*time*TBI severity interaction for teen effective communication. For teens with severe TBI, effective communication declined significantly for both the CAPS and IRC groups from baseline (MCAPS = 14.63 SECAPS = 1.06; MIRC= 13.88 SEIRC = 1.01) to the 6-month follow-up (MCAPS = 11.55, SECAPS = 1.08,), t(210) = 2.96, p <.01; MIRC= 11.81 SEIRC = 1.00, t(203) = 2.16, p = .03 for IRC. For the CAPS group only, this decline from baseline was maintained at the 12-months follow-up, (M= 10.19, SE = 1.22, t(216) = 3.80, p < .01), while the IRC group returned to baseline levels by the 12-month follow up. For teens with moderate TBI, effective communication did not differ significantly across assessments for the CAPS group but declined for the IRC group from baseline (M = 13.84, SE = .82) to the 12-month follow-up (M = 11.70, SE = .87), t(216) = 2.50, p = .01. Effect sizes were small (d= .21–.33)

Figure 5

Plot of the trend for a treatment*time*SES interaction for teen reported family problem solving skills. For teens of lower SES, family problem solving skills improved from baseline to the 6-month follow-up for the CAPS group (baseline: M = 2.17, SE = .07; 6-month: M=1.99, SE= .07), t(297) = 2.50, p = .01, although this improvement was not maintained at later follow-ups. Effect size was small (d = .22).