Counselor-assisted problem solving (CAPS) improves behavioral outcomes in older adolescents with complicated mild to severe TBI

Objective: To test the efficacy of Counselor-Assisted Problem Solving (CAPS) versus an Internet resource comparison (IRC) condition in reducing behavior problems in adolescents following traumatic brain injury (TBI). Design: Randomized clinical trial with interviewers naive to treatment condition. Setting: Three large tertiary children's hospitals and 2 general hospitals with pediatric commitment. Participants: A total of 132 children and adolescents aged 12 to 17 years hospitalized during the previous 6 months for moderate to severe TBI. Interventions: Participants in CAPS (n = 65) completed 8 to 12 online modules providing training in problem solving, communication skills, and self-regulation and subsequent synchronous videoconferencing with a therapist. Participants in the IRC group (n = 67) received links to Internet resources about pediatric TBI. Main Outcome Measures: Child Behavior Checklist administered before and after completion of treatment (ie, approximately 6 months after treatment initiation). Results: Post hoc analysis of covariance, controlling for pretreatment scores, was used to examine group differences in behavior problems in the entire sample and among older (n = 59) and younger adolescents (n = 53). Among older but not younger adolescents, CAPS resulted in greater improvements on multiple dimensions of externalizing behavior problems than IRC. Conclusion: Online problem-solving therapy may be effective in reducing behavior problems in older adolescent survivors of moderate-severe TBI.