A telehealth intervention for families caring for a child with traumatic brain injury (TBI)

A Parenting Program to Reduce Disruptive Behavior in Hispanic Children with Acquired Brain Injury: A Randomized Controlled Trial Conducted in Mexico

Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disruptive behavior. We aimed to investigate the effectiveness of the Signposts program to reduce disruptive behavior and improve self-regulation in Hispanic children with ABI, and reduce parental stress and improve parenting practices. Using a randomized controlled trial design, we assigned children (n = 71) and their parents to Signposts or generic telephone support. Blinded assessors conducted assessments at pre-intervention, immediately post-intervention, and at 3 months post-intervention. Signposts was effective in reducing dysfunctional parenting practices. Further, when analyzing participants at risk of behavioral disturbance (n = 46), Signposts was effective in reducing child disruptive behavior in the home environment and emotional self-regulation. No differences were found for parental stress, parent sense of competence, child disruptive behaviors at school, and child cognitive and behavioral self-regulation. The reduction in disruptive behavior was associated with the implementation of authoritative parenting practices (external regulation), and not associated with child self-regulation.

Online Family Problem Solving for Pediatric Traumatic Brain Injury: Influences of Parental Marital Status and Participation on Adolescent Outcomes

OBJECTIVE

To examine the moderating effects of parent marital status and participation on efficacy of an online family problem-solving intervention for pediatric traumatic brain injury (TBI).

METHODS

Participants were 132 adolescents (12-17 years) who had sustained a recent (<6 months) TBI and their parents. Participants were randomly assigned to the intervention (Counselor-Assisted Problem Solving, CAPS) or an Internet resource comparison (IRC) condition. CAPS was designed to support families in the initial phase following TBI, by teaching problem-solving skills and addressing common challenges. To examine the moderating effect of parent marital status, participants were divided into 4 groups (ie, CAPS married household, CAPS unmarried household, IRC married household, and IRC unmarried household). Family income and caregiver education were controlled in analyses.

RESULTS

Parent marital status moderated treatment effects on adolescent externalizing behavior problems. Adolescents from married households in CAPS displayed fewer behavior problems at 6 and 18 months postbaseline compared with adolescents from unmarried households in CAPS. Among married CAPS families, there were no differences in outcomes among families where 1 or 2 parents actively participated.

CONCLUSIONS

Web-based interventions for pediatric TBI, such as CAPS, are a viable option for some although not all families. Further research is needed to investigate factors that influence efficacy to match families to the most beneficial treatments.

How Do Parents Influence Child Disruptive Behavior After Acquired Brain Injury? Evidence From a Mediation Model and Path Analysis

OBJECTIVES

Children with acquired brain injury (ABI) can present with disruptive behavior, which is often a consequence of injury and parent factors. Parent factors are associated with child disruptive behavior. Furthermore, disinhibition in the child also leads to disruptive behavior. However, it is unclear how these factors interact. We investigated whether parental factors influence child disruptive behavior following ABI and how these factors interact.

METHODS

Parents of 77 children with ABI participated in the study. Parent factors (executive dysfunction, trait-anxiety), potential intervention targets (dysfunctional parenting practices, parental stress, child disinhibition), and child disruptive behavior were assessed. A hypothetical model based on the literature was tested using mediation and path analysis.

RESULTS

Mediation analysis revealed that child disinhibition and dysfunctional parenting practices mediated the association of parent factors and child disruptive behavior. Parents' executive dysfunction mediated the association of dysfunctional parenting practices, parental stress and parent trait-anxiety. Parenting practices mediated the association of executive dysfunction and child disruptive behavior. Path analysis indices indicated good model adjustment. Comparative and Tucker-Lewis Index were &gt;0.95, and the root mean square error of approximation was 0.059, with a chi-square of 0.25.

CONCLUSIONS

A low level of parental trait-anxiety may be required to reduce dysfunctional parenting practices and child disinhibition. Impairments in child disinhibition can be exacerbated when parents present with high trait-anxiety. Child disinhibition is the major contributor of disruptive behavior reported by parents and teachers. The current study provides evidence of parent anxiety and child disinhibition as possible modifiable intervention targets for reducing child disruptive behavior. (JINS, 2019, 25, 237-248).

Internet-based Interacting Together Everyday, Recovery After Childhood TBI (I-InTERACT): Protocol for a multi-site randomized controlled trial of an internet-based parenting intervention

Objectives

We discuss the rationale and description of the Internet-Based Interacting Together Everyday, Recovery After Childhood TBI (I-InTERACT), a telehealth intervention designed to promote positive parenting skills through live in-session skills practice and coaching. A second objective is to describe the protocol of a three-armed (Internet Resource Comparison, I-InTERACT, and I-InTERACT Express) multi-site randomized controlled trial (RCT) designed to examine intervention effectiveness.

Method

Participants included parents of children ages 3–9 who sustained a moderate or severe traumatic brain injury (TBI) any time since birth. Measures assessing parenting behaviors, parent–child interaction, parent/family factors, and child factors were collected prior to intervention, 3 months after enrollment and 6-months after enrollment.

Results

This protocol manuscript was submitted before the completion of data collection and prior to any data analysis. It is expected that the I-InTERACT and I-InTERACT Express interventions will be associated with an increase in positive parenting behaviors, and a decrease in negative parenting behaviors, parental distress, and child behavior problems. Finally it is expected that socioeconomic status, life stressors, and social resources will moderate treatment effects.

Conclusions

The study described in this protocol paper represents one of the first large multi-site RCTs of a parenting intervention designed to promote positive parenting skills in families with young children who sustained a TBI. We plan to disseminate findings to patients and families as well as clinical and research professionals, and begin to develop a research base for this telehealth intervention.

Parenting program versus telephone support for Mexican parents of children with acquired brain injury: A blind randomized controlled trial

Introduction

Acquired brain injury (ABI) during childhood typically causes behavior problems in the child and high levels of stress in the family. The aims of this study are: (1) to investigate the effectiveness and feasibility of a parenting intervention in improving behavior and self-regulation in Mexican children with ABI compared to telephone support; (2) to investigate the effectiveness and feasibility of a parenting intervention in improving parenting skills, parent self-efficacy and decreasing parental stress in parents of children with ABI compared to telephone support. Our secondary aims are (1) to explore the impact that parent characteristics have on the intervention outcomes; (2) to investigate if changes are maintained 3 months after the intervention.

Methods

The research design is a blind randomized controlled trial (RCT). Eligible participants include children with a diagnosis of ABI, between 6 and 12 years of age, and their parents. Sixty-six children and their parents will be randomly allocated to either a parenting program group or telephone support group. The parenting program involves six face-to-face weekly group sessions of 2.5 h each. Participants in the control group receive an information sheet with behavioral strategies, and six weekly phone calls, in which strategies to improve academic skills are provided. Children and their parents are evaluated by blind assessors before the intervention, immediately after the intervention and 3-months post-intervention.

Discussion

This study will be the first to evaluate the efficacy and feasibility of a parenting program for Mexican parents of children with ABI.

Trial identifier

ACTRN12617000360314.

Managing challenging behaviour in preschool children post-traumatic brain injury with online clinician support: protocol for a pilot study

BACKGROUND

Traumatic brain injury (TBI) in children is associated with a range of poor long-term outcomes, including behavioural disturbances. Parents can experience high levels of stress and injury-related burden, and evidence suggests that distressed parents are less likely to adopt positive parenting styles to manage their child's behaviour. The 'Signposts for Building Better Behaviour' program is a parenting programme that was originally developed to assist parents of children with an intellectual disability in managing their child's behaviour. More recently, it has been adapted to include a TBI module, to assist parents in managing post-TBI behaviour. However, geographical and financial barriers remain, preventing many parents from accessing the programme in the standard face-to-face modality. This project aims to investigate the feasibility and acceptability of the programme when delivered with clinician support via videoconferencing.

METHODS/DESIGN

The sample for this feasibility study will be recruited from the Royal Children's Hospital, Melbourne, and the Victorian Paediatric Rehabilitation Service. Participants will be the parents of a child who sustained a TBI between the ages of 2.0 and 6.11, within the previous 2 years. The parents of 15 children will complete the programme, with clinician support via videoconferencing, while the parents of a further 15 children will form a treatment as usual wait-list control group. Parents complete questionnaires assessing their child's behaviour, as well as assessing their own mental health, sense of parenting competency, disciplinary style, and family functioning. These will be completed upon enrolment in the study regarding their child's pre-injury behaviour and then again pre-intervention, immediately post-intervention, and 4 months post-intervention. Parents who complete the intervention will also complete questionnaires assessing their satisfaction with the programme and its delivery. Information will be collected on the feasibility, clinical practicality, and acceptability of the programme when delivered through this medium.

DISCUSSION

This study is the first to investigate the feasibility of delivering post-child TBI behavioural intervention via videoconferencing in Australia. Preliminary findings from this study may support the development of a larger randomised controlled trial. It is hoped that programme delivery through this medium would facilitate better access to the programme, enabling improved long-term outcomes for families.

TRIAL REGISTRATION

ANZCTR, ACTRN12616001574437.

Environmental Contributions to Social and Mental Health Outcomes Following Pediatric Stroke

Mental health and social outcomes following acquired brain injury (ABI) in children are often considered to be due to brain insult, but other factors, such as environment, may also play a role. We assessed mental health and social function in children with chronic illness, with and without stroke (a form of ABI), and typically developing (TD) controls to examine environmental influences on these outcomes. We recruited 36 children diagnosed with stroke, 15 with chronic asthma, and 43 TD controls. Children and parents completed questionnaires rating child mental health and social function and distal and proximal environment. TD children had significantly less internalizing and social problems than stroke and asthma groups, and engaged in more social activities than children with stroke. Poorer parent mental health predicted more internalizing and social problems and lower social participation. Family dysfunction was associated with internalizing problems. Lower parent education contributed to children's social function. Children with chronic illness are at elevated risk of poorer mental health and social function. Addition of brain insult leads to poorer social participation. Quality of home environment contributes to children's outcomes, suggesting that supporting parent and family function provides an opportunity to optimize child mental health and social outcomes.

Anderson V. Long-term maintenance of treatment effects following intervention for families with children who have acquired brain injury

Purpose

– Where no psychosocial or interventional support is provided, children with acquired brain injury (ABI) are at significant risk of serious long-term behavioural and social difficulties. The purpose of this paper is to report the six- and 18-month long-term treatment effects of a family centred behavioural intervention to help families manage and prevent challenging behaviours in children following ABI.

Design/methodology/approach

– In total, 31 parents were followed up at three time points (post-intervention, 6 and 18 months) after participating in an ABI adapted manualised “Signposts for Building Better Behaviour” programme (Hudson et al., 2003).

Findings

– Attrition rates were highest amongst families caring for a child with mild ABI. The maintenance of treatment effects were detailed for those families who reported a reduction in challenging behaviour immediately post-intervention. There were no significant elevations in challenging child behaviour, maladaptive parenting, or family dysfunction for any participants over the long-term follow-up. Irrespective of injury severity, parents reported high levels of satisfaction and efficacy in the parenting role at 18 months post-intervention.

Originality/value

– “Signposts” has further demonstrated its clinical viability by meeting the needs of parents who have a child with ABI in both the short- and longer-term.