Road-to-recovery-TBI: Pilot trial of an eHealth intervention for caregivers after pediatric brain injury.

Abstract

Objective: Traumatic brain injury (TBI) is a leading cause of acquired disability in childhood, impacting long-term health and functioning. Caregivers of children with TBI report worsening psychological health-and caregiver functioning and behaviors directly impact child recovery and outcomes. We developed and pilot tested road-torecovery-TBI (R2R-TBI), a self-guided, eHealth intervention to support caregivers during the acute phase following pediatric TBI and equip families with skills to promote a positive path to recovery. Method: Caregivers of children hospitalized for moderate-to-severe TBI were recruited within 3 months postinjury. Twenty primary caregivers completed measures assessing caregiver psychological functioning, family functioning, and child behavior prior to accessing the intervention and at follow-up 1 month later. Caregivers also completed postintervention satisfaction and usability surveys. Results: Thirty of 42 eligible caregivers consented to participate. Caregivers were diverse with regard to race/ethnicity (45% non-White), income (65% receiving public assistance), and child age (1 month to 15 years). All caregivers rated the intervention as helpful and 90% reported making positive changes. While average scores were in the nonclinical range at baseline and follow-up, percentages of caregivers reporting clinically elevated challenges across all measures (15% to 50%) were higher than instrument norms. There were no significant changes in caregiver, family, or child outcomes from baseline to follow-up. Conclusions: Given challenges that caregivers experience accessing in-office interventions that target their well-being and/or parenting, the R2R-TBI program may be a cost-effective and accessible approach to supporting families during a challenging phase of recovery. Further research is needed to examine the efficacy of the intervention. Implications for Impact StatementWe developed and pilot tested road-to-recovery-traumatic brain injury (R2R-TBI), a self-guided, eHealh intervention to support caregivers during the stressful and challenging acute phase following pediatric TBI and equip families with skills to promote a positive path to recovery. Caregivers in this pilot trial reported good satisfaction with intervention, though no overall changes in caregiver, family, or child functioning were noted between baseline and 1-month follow-up. With further efficacy trials, the R2R-TBI intervention may have promise as a form of preventative behavioral health care for children and families in the acute phase of pediatric TBI.

Introduction to the special interest issue on parent/guardian interventions in pediatric psychology: The role of the pediatric psychologist working with caregivers as the target of intervention.

“…Of particular relevance as we recognize how behavioral health care practices rapidly shifted to telehealth delivery systems during the past year, articles included examine ways in which parent intervention can be applied using online methodologies, across a variety of formats (via a mobile application providing parent training for common sleep behaviors in Jemcov et al, 2021; via a self-guided e-health application to support parents in the acute phase after their child has experienced a TBI in Raj et al, 2021; and, via a video conferencing group intervention for parents of children with congenital heart disease in Goertz et al, 2021). These innovative delivery systems can allow pediatric psychologists to overcome access barriers (such as the attendance barriers described by Harris et al, 2021), which can lead to increased development, uptake and use of evidence-based interventions for parents.…”