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Effects of Web-Based Parent Training on Caregiver Functioning Following Pediatric Traumatic Brain Injury

A Randomized Control Trial

Raj, Stacey P., PhD; Shultz, Emily L., BS; Zang, Huaiyu, MS; Zhang, Nanhua, PhD; Kirkwood, Michael W., PhD; Taylor, H. Gerry, PhD; Stancin, Terry, PhD; Yeates, Keith Owen, PhD; Wade, Shari L., PhD

The Journal of Head Trauma Rehabilitation: November/December 2018 - Volume 33 - Issue 6 - p E19–E29
doi: 10.1097/HTR.0000000000000388
Focus on Clinical Research and Practice

Objective: To examine the effects of a Web-based parenting intervention (I-InTERACT), and an abbreviated version (Express), on caregiver depression, psychological distress, parenting stress, and parenting efficacy following pediatric traumatic brain injury (TBI).

Setting: Four children's hospitals and 1 general hospital in the United States.

Participants: 148 caregivers of 113 children aged 3 to 9 years with a moderate to severe TBI.

Design: Multicenter randomized controlled trial. Participants were randomly assigned to I-InTERACT, Express, or an active control condition. Caregiver data were collected at baseline and postintervention (6 months later).

Intervention: I-InTERACT (10-14 sessions) and Express (7 sessions) combine live coaching of parenting skills and positive parenting strategies.

Main Measures: Center for Epidemiologic Studies Depression Scale (CES-D); Global Severity Index of the Symptom Checklist-90-R (GSI), Parenting Stress Index (PSI), and Caregiver Self-Efficacy Scale (CSES).

Results: Analyses revealed no main effects of treatment on caregiver distress (GSI), parenting stress (PSI), or parenting efficacy (CSES). However, analyses examining baseline severity as a moderator found that caregivers with elevated levels of depression in I-InTERACT experienced significantly greater reductions in CES-D scores compared with caregivers in the active control condition.

Conclusions: I-InTERACT reduced caregiver depression but no other facets of caregiver psychological functioning. Modifications to the treatment content may be necessary to reduce parenting stress and improve caregiver efficacy.

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Drs Raj, Zhang, and Wade, Ms Shultz, and Mr Zang); Xavier University, Cincinnati, Ohio (Dr Raj); University of Cincinnati, Cincinnati, Ohio (Ms Shultz, Mr Zang, and Dr Wade); Children's Hospital Colorado and University of Colorado School of Medicine, Aurora (Dr Kirkwood); Case Western Reserve University, Cleveland, Ohio (Drs Taylor and Stancin); Biobehavioral Health Center, Nationwide Children's Hospital Research Institute and Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); and MetroHealth Medical Center, Cleveland, Ohio (Dr Stancin); and University of Calgary, Calgary, Alberta, Canada (Dr Yeates).

Corresponding Author: Shari L. Wade, PhD, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 4009, Cincinnati, OH 45229 (

This study was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research, formerly known as the National Institute on Disability and Rehabilitation Research (grant number: H133B090010).

The authors declare no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.