title: 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).
  
  
  METHODS
  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.
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. shari.wade@cchmc.org
authors: Shari L
authors: SL
authors: Wade
authors: Nicolay C
authors: NC
authors: Walz
authors: JoAnne
authors: J
authors: Carey
authors: Kendra M
authors: KM
authors: McMullen
authors: Jennifer
authors: J
authors: Cass
authors: Erin
authors: E
authors: Mark
authors: Keith Owen
authors: KO
authors: Yeates
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000523:psychology* / Q000628:therapy*; D002648:Child; D003863:Depression / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011340:Problem Solving; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000517:prevention & control*; D015599:Trauma Severity Indices; D016896:Treatment Outcome