A pilot study of a teleheath intervention (Teen Online Problem Solving -TOPS) aimed at improving adolescent behavioural outcomes and family functioning following traumatic brain injury (TBI)

INTERVENTION: The intervention known as 'Teen Online Problem Solving' (TOPS) is a family online cognitive behavioural therapy for teenagers s who have experienced traumatic brain injury and their families. Developed in the USA, TOPS has been evaluated and adapted for use in New Zealand. Participants identified via existing TBI rehabilitation service providers will be randomly allocated to either TOPS and usual care (n=10), or usual care only. The TOPS program consists of 10 (approximately 1‐hour) core online sessions that provide training in the topics of stress management, problem solving, communication and self regulation. Using a cognitive behavioural therapy approach, training and education is delivered in the form of online written exercises (i.e., goal setting), videos of adolescents sharing their experiences and strategies, and videos of role play examples. There is an emphasis on self‐monitoring by the adolescent, and parental monitoring and support. The sessions are completed by the adolescent with TBI and, if possible, at least one immediate family member such as their main parent/caregiver. Each topic is explored in various ways, such as videos of adolescents discussing how TBI affected them and the coping strategies they use; video scenarios that the participant anaylses and reports on (e.g. how the actor used techniques taught in the online session to behave more appropriately); and question‐and‐answer tasks/activities that provide an opportunity to practice the skills taught in that session (e.g. re‐writing statements so they are less likely to lead to anger). Each online session is accompanied by an online therapy session using Skype (or similar). Each of the 10 core sessions has an accompanying online session with a TOPS trained therapist, the adolescent with TBI and a parent/caregiver. Ideally, each accompanying Skype session will be conducted within the same week as completion of the related online session. Each online session is expected to run for approximately 1 hour, depending on the needs of each participating adolescent and their family (i.e., some sessions may be more relevant and therefore warrant more time). During this time the therapist will review educational content and assist the family in setting, revisiting and developing strategies to achieving identified goals. Adherence to intervention will be discussed with the family during each online session, with notes recorded by the TOPS therapist. The treatment time‐frame will be approximately 8 hours per participant, spread over an 10‐12 week period. Follow‐up assessment 1 will be administered within 7 days after treatment completion. Follow‐up assessment 2 (final) will take place 4 weeks later to assess any maintenance of preliminary treatment effects and overall satisfaction ratings. CONDITION: Traumatic Brain Injury PRIMARY OUTCOME: To examine the feasibility of using TOPS in NZ. Feasibility will be assessed by examining the following processes and/or study data ‐ establishment of recruitment site/s, participant referrals, eligibility checks, recruitment rate, randomisation, participant adherence to study processes (i.e., completion of homework, engagement with online materials, etc), online therapy delivery (i.e., number of sessions completed), technical difficulties, monitoring of any participant withdrawals, completion of baseline and follow‐up assessments. SECONDARY OUTCOME: To examine adolescent satisfaction with TOPS and usual OR usual care alone. This outcome will be assessed at 4‐weeks after completion of treatment. Satisfaction with TOPS will be assessed using an online satisfaction survey questionnaire, and study‐specific program and technology questionnaires. Information concerning each participant's prior experience with technology will also be collected. Satisfaction with usual care will be assessed using a study specific questionnaire. To examine parent/caregiver satisfaction with TOPS and usual OR usual care alone. This outcome will be assessed at 4‐weeks after completion of treatment. Satisfaction with TOPS will be assessed using an online satisfaction survey questionnaire, and study‐specific program and technology questionnaires. Information concerning each participant's prior experience with technology will also be collected. Satisfaction with usual care will be assessed using a study specific questionnaire. To examine the preliminary efficacy of TOPS for teens with TBI and their families. This will be assessed by examining pre and post scores on a range of standardised measures to assess child behaviour, executive function, and family functioning. Study measures include the Hospital Anxiety and Depression Scale, Symptoms Checklist‐90‐Revised, Strengths and Difficulties Questionnaire, Behaviour Rating Inventory of Executive Function, and Conflict Behaviour Questionnaire. Multi‐informant data will be collected from children with TBI and one of their parents. INCLUSION CRITERIA: Adolescents (11‐18 years at injury) with a mild to moderate traumatic brain injury (TBI) sustained within the last 24 months; teen must reside with a parent with high speed internet access; and parent‐reported behavioural difficulties post‐TBI.