Changes in daily life created by the novel coronavirus (COVID-19) pandemic have resulted in a largely unprecedented situation for millions of families worldwide. Families are under considerable stress, and parents may experience greater psychological distress and disruptions in the parent-child relationship. Some parents may be particularly vulnerable to recent stressors, including those with preexisting psychological disorders and family dysfunction. In the United States, military veterans are one such at-risk population. Recent challenges may exacerbate preexisting conditions and heighten parenting stress, thereby negatively impacting child and family functioning. In this article, we share our experiences developing and piloting a telepsychotherapy parenting skills program for military veterans. The intervention, Online Parenting Pro-Tips (OPPT), combined web-based educational modules addressing child development and positive parenting with live coaching (via videoconferencing link) of parenting skills. Forty-one veterans with a child between the ages of 3 and 9 years enrolled in this trial and 22 completed the 6-session intervention. Veterans who completed the intervention experienced significant reductions in depression, parenting stress, and family dysfunction, with medium to large effect sizes (Cohen's d ranged from .53 to .98). Veterans also reported significant improvements in their child's behaviors. These findings have important implications pertaining to the feasibility and Editor's Note. This article received rapid review due to the time-sensitive nature of the content, but our standard high-quality peer review process was upheld.

The novel coronavirus, COVID-19, has led to sweeping changes in psychological practice and the concomitant rapid uptake of telepsychotherapy. Although telepsychotherapy is new to many clinical psychologists, there is considerable research on telepsychotherapy treatments. Nearly two decades of clinical research on telepsychotherapy treatments with children with neurological conditions has the potential to inform emerging clinical practice in the age of COVID-19.Toward that end, we synthesized findings from 14 clinical trials of telepsychotherapy problemsolving and parent training interventions involving more than 800 children and families with diverse diagnoses including traumatic brain injury, epilepsy, brain tumors, congenital heart disease, and perinatal stroke. We summarize efficacy across studies and clinical populations and report feasibility and acceptability data from the perspectives of parents, children, and therapists.We describe adaptation for international contexts and strategies for troubleshooting technological challenges and working with families of varying socioeconomic strata. The extensive research literature reviewed and synthesized provides considerable support for the utility of telepsychotherapy with children with neurological conditions and their families and underscores its high level of acceptability with both diverse clinical populations and providers. During this period of heightened vulnerability and stress and reduced access to usual supports and services, telepsychotherapy approaches such as online family problem-solving treatment and online parenting skills training may allow psychologists to deliver traditional evidence-based treatments virtually while preserving fidelity and efficacy.

BackgroundAlthough pediatric brain tumor survivors are at high risk for a variety of psychosocial and neurocognitive late effects, there are few evidence‐based interventions to address their needs. The purpose of this study was to test the efficacy of an online problem‐solving intervention on improving the quality of life and executive dysfunction among adolescent and young adult brain tumor survivors.ProcedureA Survivor's Journey was adapted from a similar intervention for survivors of traumatic brain injuries, and involved self‐guided web modules providing training in problem‐solving as a tool for coping with everyday challenges, as well as weekly teleconferences with a trained therapist. Survivors (n = 19) between the ages of 13 and 25, and their caregivers, completed standardized measures of their emotional and behavioral functioning, executive functioning, and quality of life before and after the 12‐ to 16‐week intervention.ResultsParticipation in the intervention led to significant improvements in self‐reported overall (Mpre = 62.03, SDpre = 17.67, Mpost = 71.97, SDpost = 16.75; d = 0.58, P = 0.01) and physical quality of life (Mpre = 63.13, SDpre = 21.88, Mpost = 75.00, SDpost = 21.33; d = 0.55, P < 0.01) as well as parent‐reported emotional quality of life (Mpre = 65.00, SDpre = 28.72, Mpost = 76.15, SDpost = 23.47; d = 0.43, P = 0.03). Greater improvement was noted in those who were diagnosed before the age of seven and those with average or above average estimated IQs. Current age did not moderate outcomes.ConclusionsOnline problem‐solving therapy may be efficacious in improving pediatric brain tumor survivors’ quality of life; however, further research with a comparison group is needed. Online interventions such as Survivor's Journey may decrease barriers to evidence‐based psychosocial care for brain tumor survivors.

Purpose: Technological advances have made the delivery of psychological interventions via web-based platforms increasingly feasible. In recent years, there has been growth in the delivery of psychological interventions through web-based modalities, that is, telepsychology. Although there is evidence supporting the usability and feasibility of telepsychology for a range of populations, there is limited literature on clinician perceptions delivering telepsychology, particularly to pediatric rehabilitation populations. In this mixedmethods study, we report on clinician perspectives and experiences delivering telepsychology to children/ families impacted by pediatric traumatic brain injury. Method: Seventeen clinicians (psychologists and advanced psychology doctoral students) who delivered telepsychology interventions to children/families impacted by pediatric brain injuries completed surveys and interviews. Results: Overall, clinicians reported that telepsychology was equivalent to face-to-face treatment in many regards (e.g., therapeutic alliance, weekly progress, child/family engagement, and establishing rapport). Clinicians reported a number of advantages of telepsychology over face-to-face interventions for this pediatric population including greater ease of scheduling, increased understanding of the family and home environments, and less caregiver stigma of behavioral health care. Disadvantages of telepsychology included difficulties reading nonverbal cues, logistical/technological issues, and greater disruptions during sessions. Conclusions: Findings provide an important foundation for future investigations examining the merits of telepsychology versus traditional treatment for both pediatric rehabilitation populations. Impact and ImplicationsThis study elucidates several advantages and disadvantages of utilizing telepsychology in comparison with face-to-face therapy for family-centered treatment of pediatric traumatic brain injury from a clinician perspective. Overall, clinicians reported that telepsychology was superior to face-to-face therapy in terms of scheduling/attendance, understanding the family and home environments, and reducing behavioral health stigma. Clinicians reported several challenges with utilizing telepsychology; the most prominent including distractions and reading nonverbal cues. Findings from this study provide an important foundation for future investigations examining the merits of telepsychology versus traditional treatment for pediatric populations.

Objective: To examine the frequency of behavioral problems after childhood traumatic brain injury (TBI) and their associations with injury severity, sex, and social environmental factors. Setting: Children's hospitals in the Midwestern/Western United States. Participants: 381 boys and 210 girls with moderate (n = 359) and severe (n = 227) TBI, with an average age at injury of 11.7 years (range 0.3-18) who were injured ≤3 years ago. Design: Secondary data analysis of a multistudy cohort. Main Measures: Child Behavior Checklist (CBCL) administered pretreatment. Results: Thirty-seven percent had borderline/clinical elevations on the CBCL Total Problem Scale, with comparable rates of Internalizing and Externalizing problems (33% and 31%, respectively). Less parental education was associated with higher rates of internalizing, externalizing, and total problems. Time since injury had a linear association with internalizing symptoms, with greater symptoms at longer postinjury intervals. Younger boys had significantly higher levels of oppositional defiant symptoms than girls, whereas older girls had significantly greater attention-deficit hyperactivity disorder symptoms than boys. Conclusions: Pediatric TBI is associated with high rates of behavior problems, with lower socioeconomic status predicting substantially elevated risk. Associations of higher levels of internalizing symptoms with greater time since injury highlight the importance of tracking children over time.

To describe the preliminary feasibility and acceptability of a web-based, problem-solving intervention for adolescent and young adult pediatric brain tumor survivors. Methods: With feedback from survivors and stakeholders, we created "A Survivor's Journey" by modifying an existing problem-solving intervention for traumatic brain injury. Survivors (ages 13-25) were recruited from a pediatric survivorship clinic and were eligible if they had self or caregiver-reported psychosocial difficulties. A Survivor's Journey has four core sessions (i.e., introduction, problem-solving, positive thinking, memory) and up to seven supplemental sessions. Each session involved web content and videoconferencing with a doctoral-level therapist. We analyzed postintervention data related to feasibility (i.e., enrollment and completion rates), as well as survivor's ratings of satisfaction and usability of the intervention. Results: Nineteen survivors (M age ϭ 17.57), half of eligible participants, agreed to

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Objective: We examine need for behavioral health services, service utilization, and predictors of utilization in children with moderate-severe traumatic brain injury (TBI) relative to a comparison group of children with orthopedic injury (OI) 6.8 years after injury. Method: A total of 130 children hospitalized for a moderate-severe TBI (16 severe, 42 moderate) or OI (72) between the ages of three-seven years and completed a long-term follow-up 6.8 years after injury were enrolled at three tertiary care children's hospitals and one general hospital in Ohio. Results: Adolescents with TBI (moderate [38%] and severe [69%]) had significantly greater rates of need than OI (17%). Behavioral health services were utilized by 10% of the sample with no injury group differences (OI: 6%; Moderate: 17%; Severe: 13%). Early treatment and white race were associated with less service utilization. 77% had an unmet need, with no injury group differences (OI: 75%; Moderate: 75%; Severe: 82%). Rate of unmet need greater among white than non-white children. Conclusions: Children who sustain a TBI in early childhood experience persistent and clinically significant impairments even years after injury. Rates of unmet need were high for all injury