Brief Report: Description of Feasibility and Satisfaction Findings from an Innovative Online Family Problem-solving Intervention for Adolescents following Traumatic Brain Injury

Traumatic brain injury (TBI) is the most common cause of acquired disability in children and adolescents. The highest peak in incidence of TBI is during the adolescent and young adult years (Langlois, 2006). Long-term follow-up suggests that behavioral changes represent the most persistent sequelae of pediatric TBI (Bloom et al., 2001). The social and emotional sequelae of brain injury may be particularly salient for teens given the adolescent developmental challenges of increasing autonomy and responsibility. Deficits in executive function skills (EF), problem solving, and social communication following TBI may limit the teen's ability to negotiate important social tasks and developmental transitions (Janusz et al., 2002) and intensify the effects of life stress on adjustment (Goodman, Gravit, & Kaslow, 1995). These deficits may have a lifelong impact on the teen's academic and vocational pursuits and lead to social isolation and emotional difficulties. Little effort has been made to design interventions to enhance functional outcomes following pediatric TBI (Laatsch et al., 2007). However, problem-solving interventions have been used successfully to reduce depressive symptoms and behavior problems in children and adolescents with other problems (Spence, Sheffield, & Donovan, 2003). Collaborative parent–teen problem solving may provide necessary scaffolding, thereby enabling adolescents to function more effectively. Converging evidence suggests that a problem-solving approach emphasizing EF and social competence may provide functional skills necessary to facilitate the injured adolescent's transition into adult independence and have the potential to enhance behavioral and social outcomes of adolescents following TBI. Treatment for TBI often occurs at urban trauma centers with discharge to home communities, where access to psychosocial follow-up is limited. Complex contemporary lifestyles make weekly in-office therapy sessions burdensome. Increasingly, the internet is being used to meet the mental health needs of individuals who have difficulty accessing traditional care (Norman, 2006). Given these time and access constraints, the web may provide an invaluable tool for linking families with state-of-the-art psychosocial care by reducing potential physical and psychological barriers. Given that 94% of typically developing teens spend time online, a web-based mode of treatment delivery may be particularly feasible and beneficial for them (Pew Internet and American Life Survey, 2007). This project built upon a previous online family problem-solving (OFPS) intervention for children with TBI and their families addressing cognitive appraisals, problem solving, and family communication (Wade, Carey, & Wolfe, 2006a, 2006b). To our knowledge, OFPS represents one of only a handful of web-based interventions designed to be used by members of a family together, requiring responses from both individual family members and the family as a group (Ritterband et al., 2003). OFPS successfully reduced parent-reported child behavior problems and self-reported parental burden and distress in a sample of 5- to 16-year-olds with TBI, with adolescents exhibiting greater improvements than younger children (Wade et al., 2006b). However, the content was not designed to address the specific needs of adolescents. Session content emphasized positive behavioral supports to facilitate child functioning rather than self-monitoring and management. Qualitative feedback revealed a desire for more developmentally appropriate materials, as opposed to the multimedia examples and session content that featured younger school-aged children. We adapted OFPS for adolescents (Teen Online Problem Solving, TOPS) by making three major changes. First, we added two sessions (7 and 8) to address the social challenges of adolescents and the social skills deficits that often accompany moderate to severe TBI. Second, we updated all the homework, session content, interactive skill-building exercises, animations, and video examples so that they were specific to and relevant for adolescents. Finally, we revised the sessions to reflect the emerging independence and self-monitoring skills of adolescence. This report describes TOPS and provides preliminary feasibility and satisfaction data based on a pilot sample of nine adolescents with TBI and their families. Our primary research question was whether teens and parents would find the program easy to use and helpful.