ABSTRACT
OBJECTIVE: To examine changes in parent depression, psychological distress, parenting stress, and self-efficacy among participants in a randomized trial of a Web-based parent training program for pediatric traumatic brain injury (TBI). METHODS: Primary caregivers of 37 children aged 3 to 9 years who sustained a moderate/complicated mild to severe TBI were randomly assigned to the intervention or control group, and both groups were equipped with home Internet access. The online parent training program was designed to increase positive parenting skills and improve caregiver stress management. It consisted of 10 core sessions and up to 4 supplemental sessions. Each session included self-guided Web content, followed by a videoconference call with a therapist to discuss content and practice parenting skills with live feedback. Families in the control group received links to TBI Web resources. RESULTS: Parent income moderated treatment effects on parent functioning. Specifically, lower-income parents in the parenting skills group reported significant reductions in psychological distress compared with lower-income parents in the control group. No differences were found among higher-income parents for depression, parenting stress, or caregiver efficacy. CONCLUSIONS: Parent training interventions post-TBI may be particularly valuable for lower-income parents who are vulnerable to both environmental and injury-related stresses.
Subject(s)
Brain Injuries/rehabilitation , Caregivers/education , Education, Nonprofessional/organization & administration , Internet , Parenting/psychology , Anxiety/prevention & control , Brain Injuries/diagnosis , Caregivers/psychology , Child , Child, Preschool , Depression/prevention & control , Female , Humans , Male , Parent-Child Relations , Parents/education , Poverty , Program Evaluation , Reference Values , Self Efficacy , Stress, Psychological/prevention & control , Treatment Outcome , VideoconferencingABSTRACT
This pilot study examined changes in parenting skills and child behavior following participation in an online positive parenting skills program designed for young children with traumatic brain injury (TBI). Thirty-seven families with a child between 3 and 9 years of age who sustained a moderate to severe TBI were randomly assigned to one of two interventions: online parenting skills training (n=20) or access to Internet resources on managing brain injury (n=17). Parent-child interaction observations and parent ratings of child behavior were collected pre- and post-treatment. Generalized estimating equations and mixed models were used to examine changes in parenting skills and child behavior problems as well as the moderating role of family income on treatment response. Participants in the parenting skills group displayed significant improvements in observed positive parenting skills relative to participants in the Internet resource group. Income moderated improvements in parent ratings of child behavior, with participants in the low-income parenting skills group and high-income Internet resource group reporting the greatest improvements in behavior. This is the first randomized controlled trial examining online parenting skills training for families of young children with TBI. Improvements in positive parenting skills and child behavior support the utility of this intervention, particularly for families from lower socioeconomic backgrounds.
Subject(s)
Brain Injuries/psychology , Child Behavior/psychology , Parent-Child Relations , Parenting/psychology , Parents/education , Child , Child, Preschool , Female , Humans , Internet , Male , Pilot Projects , Socioeconomic Factors , Treatment OutcomeABSTRACT
Pediatric abusive head trauma causes significant cognitive and behavioral morbidity, yet very few post-acute interventions exist to facilitate long-term recovery. To meet the needs of this vulnerable population, we piloted a web-based intervention with live coaching designed to improve positive parenting and child behavior. The efficacy of this parenting skills intervention was compared with access to Internet resources on brain injury. Participants included seven families (four randomized to the parenting intervention and three randomized to receive Internet resources). Parenting skills were observed and child behavior was rated at baseline and intervention completion. At completion, parents who received the parenting skills intervention showed significantly more positive parenting behaviors and fewer undesirable behaviors during play than parents who received access to Internet resources. Additionally, during play, children in the parenting skills intervention group were more compliant following parent commands than children in the Internet resources group. Lastly, parents who received the parenting intervention reported less intense oppositional and conduct behavior problems in their children post-intervention than did parents in the Internet resources group. These findings provide preliminary evidence for the use of this web-based positive parenting skills intervention to improve parenting skills and child behavior following abusive head trauma.
Subject(s)
Child Abuse/rehabilitation , Child Behavior Disorders/rehabilitation , Craniocerebral Trauma/rehabilitation , Internet , Parenting/psychology , Parents/psychology , Child , Child, Preschool , Female , Humans , Male , Parent-Child Relations , Pilot Projects , Treatment OutcomeABSTRACT
We examined the feasibility of and parental satisfaction with a training programme for parents with children who had suffered traumatic brain injury (TBI). Families who did not have a home computer and/or webcam were loaned the necessary equipment. Skype was used for videoconferencing. After the initial treatment session in the family's home, the remaining nine sessions were conducted online. Each session had two parts: (1) a self-guided web session with information about a particular skill; (2) a videoconference session with the therapist. Three of the 20 families (15%) dropped out prior to the final 6-month follow-up visit. Of the remaining 17 families, 13 (65% of those enrolled) completed 9-14 sessions. Almost all of the caregivers (87%) said that the Skype sessions were helpful compared to a conventional office visit. Almost all parents were satisfied with the programme and the technology that was used. Parental satisfaction with the programme was not influenced by prior computer ownership or comfort with technology. The programme appears to be feasible for a wide range of parents of children with TBI and provides an alternative to conventional office-based sessions that may not be accessible to all families.
Subject(s)
Brain Injuries/complications , Child Behavior Disorders/therapy , Internet , Parenting , Patient Education as Topic/methods , Adult , Child , Child Behavior Disorders/etiology , Consumer Behavior , Feasibility Studies , Female , Humans , Male , Middle Aged , Parent-Child Relations , Parents/psychology , Videoconferencing , Young AdultABSTRACT
OBJECTIVE: To report the feasibility and preliminary efficacy of a Web-based parenting skills program to reduce behavior problems following traumatic brain injury (TBI) in young children. METHODS: Families of 9 children between the ages of 3 and 8 years with TBI, injured less than 24 months earlier, participated in a pilot study of a Web-based parenting skills program designed to increase positive parenting skills and to improve caregiver stress management and coping. The program consisted of 10 core sessions and up to 4 supplemental sessions. Each session consisted of self-guided didactic information, video modeling skills, and exercises. Online sessions were followed by synchronous sessions providing in vivo coaching of target skills. RESULTS: Caregivers completed an average of 12 sessions (range 5-24). Ratings of ease of use and satisfaction were high. Paired t tests revealed significant improvements in target parenting behaviors between baseline and session 2 and between sessions 2 and 4. These improvements were maintained at follow-up. Among the 5 families who completed the follow-up assessment, there were trends for reductions in the overall number of behavior problems. CONCLUSIONS: This study provides preliminary evidence of the potential feasibility and efficacy of an online parenting skills intervention for improving positive parenting skills and for reducing child behavior problems following early TBI.
Subject(s)
Brain Injuries/complications , Child Behavior Disorders/therapy , Internet , Parenting , Patient Education as Topic/methods , Adaptation, Psychological , Child , Child Behavior Disorders/etiology , Child, Preschool , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Parent-Child Relations , Patient Satisfaction , Pilot Projects , VideoconferencingABSTRACT
OBJECTIVE: To understand how traumatic brain injury (TBI) affects parent-child interactions acutely following injury. PARTICIPANTS: Young children hospitalized for TBI (n = 80) and orthopedic injuries (OI; n = 113). METHOD: Raters coded videotaped interactions during free play and structured tasks for parental warmth/responsiveness and negativity and child warmth, behavior regulation, and cooperation. Raters also counted parental directives, critical/restricting statements, and scaffolds. RESULTS: Parents of children with TBI exhibited less warm responsiveness and made more directive statements during a structured task than parents in the OI group. Children with TBI displayed less behavior regulation than children with OI. Parental warm responsiveness was more strongly related to child cooperativeness in the OI group than in the TBI group. Child behavior also mediated group differences in parental responsiveness and directiveness. TBI accounted for as much variance in parental behaviors as or more than did sociodemographic factors. CONCLUSION: TBI-related changes in child behavior may negatively influence parent-child interactions and disrupt the reciprocity between parent and child.
