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Counselor-assisted problem solving (CAPS) improves behavioral outcomes in older adolescents with complicated mild to severe TBI.

ABSTRACT: To test the efficacy of Counselor-Assisted Problem Solving (CAPS) versus an Internet resource comparison (IRC) condition in reducing behavior problems in adolescents following traumatic brain injury (TBI).Randomized clinical trial with interviewers naive to treatment condition.Three large tertiary children's hospitals and 2 general hospitals with pediatric commitment.A total of 132 children and adolescents aged 12 to 17 years hospitalized during the previous 6 months for moderate to severe TBI.Participants in CAPS (n = 65) completed 8 to 12 online modules providing training in problem solving, communication skills, and self-regulation and subsequent synchronous videoconferencing with a therapist. Participants in the IRC group (n = 67) received links to Internet resources about pediatric TBI.Child Behavior Checklist administered before and after completion of treatment (ie, approximately 6 months after treatment initiation).Post hoc analysis of covariance, controlling for pretreatment scores, was used to examine group differences in behavior problems in the entire sample and among older (n = 59) and younger adolescents (n = 53). Among older but not younger adolescents, CAPS resulted in greater improvements on multiple dimensions of externalizing behavior problems than IRC.Online problem-solving therapy may be effective in reducing behavior problems in older adolescent survivors of moderate-severe TBI.

SUBMITTER: Wade SL

PROVIDER: S-EPMC3840164 | biostudies-literature | 2014 May-Jun

REPOSITORIES: biostudies-literature

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Counselor-assisted problem solving (CAPS) improves behavioral outcomes in older adolescents with complicated mild to severe TBI.

Wade Shari L SL Stancin Terry T Kirkwood Michael M Brown Tanya Maines TM McMullen Kendra M KM Taylor H Gerry HG

The Journal of head trauma rehabilitation 20140501 3

<h4>Objective</h4>To test the efficacy of Counselor-Assisted Problem Solving (CAPS) versus an Internet resource comparison (IRC) condition in reducing behavior problems in adolescents following traumatic brain injury (TBI).<h4>Design</h4>Randomized clinical trial with interviewers naive to treatment condition.<h4>Setting</h4>Three large tertiary children's hospitals and 2 general hospitals with pediatric commitment.<h4>Participants</h4>A total of 132 children and adolescents aged 12 to 17 years ...[more]

PMID: 23640543

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Project description:BackgroundDespite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury.MethodsPatients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale - Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury - Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles.ResultsOverall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL.ConclusionsPatients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach.Trial registrationClinicalTrials.gov NCT02210221.

Project description:In this paper we argue that a synthesis of findings across the various sub-areas of research in complex problem solving and consequently progress in theory building is hampered by an insufficient differentiation of complexity and difficulty. In the proposed framework of person, task, and situation (PTS), complexity is conceptualized as a quality that is determined by the cognitive demands that the characteristics of the task and the situation impose. Difficulty represents the quantifiable level of a person's success in dealing with such demands. We use the well-documented "semantic effect" as an exemplar for testing some of the conceptual assumptions derived from the PTS framework. We demonstrate how a differentiation between complexity and difficulty can help take beyond a potentially too narrowly defined psychometric perspective and subsequently gain a better understanding of the cognitive mechanisms behind this effect. In an empirical study a total of 240 university students were randomly allocated to one of four conditions. The four conditions resulted from contrasting the semanticity level of the variable labels used in the CPS system (high vs. low) and two instruction conditions for how to explore the CPS system's causal structure (starting with the assumption that all relationships between variables existed vs. starting with the assumption that none of the relationships existed). The variation in the instruction aimed at inducing knowledge acquisition processes of either (1) systematic elimination of presumptions, or (2) systematic compilation of a mental representation of the causal structure underpinning the system. Results indicate that (a) it is more complex to adopt a "blank slate" perspective under high semanticity as it requires processes of inhibiting prior assumptions, and (b) it seems more difficult to employ a systematic heuristic when testing against presumptions. In combination, situational characteristics, such as the semanticity of variable labels, have the potential to trigger qualitatively different tasks. Failing to differentiate between 'task' and 'situation' as independent sources of complexity and treating complexity and difficulty synonymously threaten the validity of performance scores obtained in CPS research.

Dataset Information

Counselor-assisted problem solving (CAPS) improves behavioral outcomes in older adolescents with complicated mild to severe TBI.

Publications

Counselor-assisted problem solving (CAPS) improves behavioral outcomes in older adolescents with complicated mild to severe TBI.

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