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Counselor-Assisted Problem Solving (CAPS) Improves Behavioral Outcomes in Older Adolescents With Complicated Mild to Severe TBI

Wade, Shari L. PhD; Stancin, Terry PhD; Kirkwood, Michael PhD; Brown, Tanya Maines PhD; McMullen, Kendra M. MA; Taylor, H. Gerry PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: May/June 2014 - Volume 29 - Issue 3 - p 198–207
doi: 10.1097/HTR.0b013e31828f9fe8
Original Articles

Objective: 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).

Design: Randomized clinical trial with interviewers naive to treatment condition.

Setting: Three large tertiary children's hospitals and 2 general hospitals with pediatric commitment.

Participants: A total of 132 children and adolescents aged 12 to 17 years hospitalized during the previous 6 months for moderate to severe TBI.

Interventions: 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.

Main Outcome Measures: Child Behavior Checklist administered before and after completion of treatment (ie, approximately 6 months after treatment initiation).

Results: 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.

Conclusion: Online problem-solving therapy may be effective in reducing behavior problems in older adolescent survivors of moderate-severe TBI.

Supplemental Digital Content is Available in the Text.

Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (Dr Wade and Ms McMullen), Cincinnati, Ohio; MetroHealth Medical Center (Dr Stancin) and Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center (Dr Taylor), Case Western Reserve University, Cleveland, Ohio; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (Dr Kirkwood); and Mayo Clinic, Rochester, Minnesota (Dr Brown).

Corresponding Author: Shari L. Wade, PhD, Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (

This work was supported in part by (1) NIH grant R01-MH073764 from the National Institute of Mental Health and (2) a grant from the Colorado Traumatic Brain Injury Trust Fund Research Program, Colorado Department of Human Services, Division of Vocational Rehabilitation, Traumatic Brain Injury Program. The authors acknowledge the contributions of Robert Blaha, Elizabeth Hagesfeld, Michelle Jacobs, Daniel Maier, and Nina Fox in data collection and entry, Amy Cassedy in data management, and John Stullenberger in Web site support. The authors also acknowledge the contributions of the therapists JoAnne Carey, PsyD, Britt Nielsen, PsyD, and Brad Jackson, PhD.

We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated and, if applicable, we certify that all financial and material support for this research (eg, NIH or NHS grants) and work is clearly identified in the title page of the manuscript. This clinical trial was registered with (assigned identifier: NCT00409448).

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins