Rehabilitation Research and Training Center for Traumatic Brain Injury Interventions--Teen Online Problem Solving Study
Condition: Traumatic Brain Injury
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Wounds and Injuries
Study type: Interventional

Summary: 
      This study will evaluate the effectiveness of an Internet-based psychosocial treatment in
      improving problem-solving, communication skills, stress management strategies, and coping
      among teens who have had a traumatic brain injury and their families.
    

Detailed description: 
      Traumatic brain injury (TBI) in adolescents is a significant stressor for both the teen and
      his or her family. Existing interventions are rare and access to treatment can be restricted
      by distance and finances. Based on previous findings and participant feedback, we propose to
      expand the previously developed TOPS intervention by conducting a multi-site study comparing
      the efficacy of TOPS to that of TOPS-Teen Only (TOPS-TO) in improving child behavior and
      functioning, parental depression and distress and family functioning. The efficacy of both
      active treatments would be examined in relation to an internet resource comparison group
      (IRC). During years 1-3, we will recruit 165 children between the ages of 11 and 18 with
      moderate to severe TBI and randomly assign them to receive TOPS, TOPS-TO, or IRC. We
      anticipate that TOPS will result in improvements in child, caregiver, and family functioning
      relative to IRC; but that TOPS-TO will only result in improvements in child behavior and
      adjustment. Based on prior research, we anticipate that the family-level treatment model of
      TOPS may be more effective than TOPS-TO in improving child behavior for children/adolescents
      with fewer social resources. Given these expectations, we will test the following hypotheses:
      1) Children with TBI receiving either TOPS or TOPS-TO will have fewer behavior problems,
      greater social competence, and better functioning than those receiving IRC at both
      post-treatment and at a 6-month follow-up assessment. 2) Caregivers of children receiving
      TOPS will report less depression and psychological distress, less parent-child conflict, and
      better family functioning than those receiving TOPS-TO or IRC at both post-treatment and at a
      6-month follow-up assessment. 3) Social resources will moderate treatment efficacy, such that
      children with limited social and economic resources will show greater improvements in the
      more comprehensive TOPS intervention. We hypothesize better teen problem solving and
      communication skills, fewer teen emotional/behavioral problems, less parental burden and
      distress, and less parent-teen conflict at follow-up among the TOPS group compared to the IRC
      group. TOPS makes use of emerging technology to address the multifaceted needs of teens
      following TBI with the goal of improving the teen's social and emotional functioning, thereby
      enabling him or her to better negotiate the complex transition to adulthood and independent
      functioning.
    

Intervention name(s): Teen Online Problem Solving (TOPS); Teen Online Problem Solving--Teen Only (TOPS-TO); Internet Resources Comparison (IRC)
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The TOPS program has 10 sessions that provide training in stress management, problem solving, communication, and social skills to all enrolled families, while the remaining 6 sessions address content related to the stressors and burdens of individual families. Each self-guided online session includes real adolescents talking about how TBI affected them, content regarding the skill, video clips showing adolescents and/or families modeling the skill, and exercises giving the family an opportunity to practice the skill. After the completion of the self-guided web pages, the family will meet with the therapist via videoconference; the therapist will review the exercises and help the family implement the problem-solving process with a problem or goal identified by the family.; TOPS-TO targets the same skills as TOPS and includes largely the same website and intervention content. However, it differs with respect to the extent of family involvement in the sessions. In TOPS-TO, sessions will be conducted with the child or adolescent alone, rather than with the family as whole. Parents will be given access to the TOPS-TO website content via their own password protected site so they will understand the skills that their child is learning. However, only the adolescent, and not the parents, will participate in the synchronous videoconferences with the therapist.; Families in the IRC group will also receive a computer, printer, and high-speed internet access if they do not currently have these. Additionally, IRC families receive access to a home page of brain injury resources and links (identical to those given on the TOPS and TOPS-TO homepage) but will not be able to access specific session content. This will enable us to equate the groups with respect to access to the information and resources available on the Web.
Other intervention name(s): TOPS; TOPS-TO; IRC
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: TBI; intracranial edema; brain edema; craniocerebral trauma; head injury; brain hemorrhage, traumatic; subdural hematoma; brain concussion; head injuries, closed; epidural hematoma; extra-axial hemorrhage; cortical contusion; wounds and injuries; disorders of environmental origin; trauma, nervous system; brain injuries