title: Online problem-solving therapy after traumatic brain injury: a randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Divisions of Physical Medicine and Rehabilitation and shari.wade@cchmc.org.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Wade
authors.affiliation: Divisions of Physical Medicine and Rehabilitation and.
authors.forename: Brad G
authors.initials: BG
authors.lastname: Kurowski
authors.affiliation: Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kirkwood
authors.affiliation: Epidemiology and Biostatistics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio;
authors.forename: Nanhua
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Epidemiology and Biostatistics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio;
authors.forename: Amy
authors.initials: A
authors.lastname: Cassedy
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota;
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Brown
authors.affiliation: Division of Pediatric Psychology, Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio; and.
authors.forename: Britt
authors.initials: B
authors.lastname: Nielsen
authors.affiliation: Division of Pediatric Psychology, Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio; and.
authors.forename: Terry
authors.initials: T
authors.lastname: Stancin
authors.affiliation: Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D002653:Child Behavior Disorders / Q000517:prevention & control*; D005196:Family Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D011340:Problem Solving; D011614:Psychotherapy, Brief; D012959:Socioeconomic Factors; D013813:Therapy, Computer-Assisted
keywords: RCT; adolescent; brain injury; child; online; therapy