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A Randomized Comparative Effectiveness Trial of Family-Problem–Solving Treatment for Adolescent Brain Injury

Parent Outcomes From the Coping with Head Injury through Problem Solving (CHIPS) Study

Wade, Shari L. PhD; Cassedy, Amy E. PhD; McNally, Kelly A. PhD; Kurowski, Brad G. MD, MS; Kirkwood, Michael W. PhD; Stancin, Terry PhD; Taylor, H. Gerry PhD

The Journal of Head Trauma Rehabilitation: April 25, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/HTR.0000000000000487
Original Article: PDF Only

Objective: To examine changes in depression and distress in parents of adolescents receiving family-problem–solving therapy (F-PST) following traumatic brain injury.

Method: Families of adolescents hospitalized for moderate to severe traumatic brain injury were randomized to face-to-face F-PST (34), therapist-guided online F-PST (56), or self-guided online F-PST (60). Outcomes were assessed pretreatment and 6 and 9 months later. Parents rated depression and distress on the Center for Epidemiological Studies Depression Scale and the Brief Symptom Inventory, respectively. Mixed modeling was used to examine changes over time and treatment moderators.

Results: The therapist-guided online group had significant reductions in parental depression over time. Analyses of slopes of recovery revealed differential improvement on the Center for Epidemiological Studies Depression Scale between the 2 online groups, with no significant change in depressive symptoms following self-guided F-PST. On the Brief Symptom Inventory Global Severity Index, the therapist-guided online group reported significant improvement from baseline to 6 months that was maintained at 9 months. The face-to-face and self-guided online groups reported significant reductions in distress between 6 and 9 months with corresponding large effect sizes. Differences on the Center for Epidemiological Studies Depression Scale between therapist-guided and self-guided online groups at the 9-month follow-up were more pronounced in families of lower socioeconomic status, t103 = −2.87; P = .005.

Conclusions: Findings provide further support for the utility of therapist-guided online F-PST in reducing parental depression and distress following pediatric traumatic brain injury and offer limited evidence of the efficacy of self-guided online treatment for these outcomes. Families of lower socioeconomic status may benefit more from therapist involvement.

Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center and Departments of Pediatrics and Psychology, University of Cincinnati, Cincinnati, Ohio (Dr Wade); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Cassedy); Division of Psychiatry and Behavioral Health, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio (Dr McNally); Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Departments of Pediatrics, Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio (Dr Kurowski); Department of Rehabilitation Psychology/Neuropsychology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado (Dr Kirkwood); Department of Psychiatry, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio (Dr Stancin); Center for Biobehavioral Health, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); and Division of Developmental/Behavioral Pediatrics and Psychology, Case Western Reserve University and Rainbow Babies & Children's University Hospital Cleveland Medical Center, Cleveland, Ohio (Dr Taylor).

Corresponding Author: Shari L. Wade, PhD, Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center MLC 4009, 3333 Burnet Ave, Cincinnati, OH 45229 (

The authors acknowledge the contributions of the study therapists, Megan Narad, PhD; Nicole Eberle, PhD; Britt Nielsen, PhD; Kristin Robinson, PhD; Cynthia Austen, PhD; and Heather Yardley, PhD. The authors also acknowledge the contributions of the research coordinators, McKenna Sklut, BA; Jennifer Taylor, BA; Hanna Schultz, MA; Katherine Atkinson, BA; Anne Birnbaum, BA; Jacob LaFleur, BA; Robert Blaha, MA; and Maria Crossland, BS, in recruitment, data collection, and entry; Donyielle Godfrey, BA; Adriane Davis-Jordan, BS; and Nori Minich, BS, in data management.

Research reported in this work/publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (PCORI-CER-1306-02435). The views in this work/publication are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee.

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.

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