Brown et al.

(2015)

Australia

RCT

PEDro=5

N=59

Population: ABI: TBI=34, Tumor=10, Encephalitis=9, Cardiovascular Accident=4, Hypoxia=2; Acceptance and Commitment Therapy + Stepping Stones Triple P (ACT+SSTP, n=30): Mean Age=7.1yr; Gender: Male=17, Female=13; Mean Time Post Injury=3.1 yr. Care As Usual (CAU, n=29): Mean Age=6.9yr; Gender: Male=18, Female-11; Mean Time Post Injury=3.6yr.

Intervention: Families were randomized to either the ACT+SSTP workshop or to CAU. SSTP involves 6 group sessions to educate on skills and 3 individual sessions to assist in refining learned skills. ACT aspect involves 2 sessions aimed to improve experiential avoidance and psychological flexibility. The interventions were both provided for 10wk lasting approximately 16hr in total. Assessments were conducted at baseline, post-intervention and 6mo follow-up.

Outcome Measure: Parenting Tasks Checklist (PTC), Depression Anxiety and Stress Scale (DASS), Parenting Problem Checklist (PPC), McMaster Family Assessment Device (FAD), Relationship Quality Index (RQI), Acceptance and Action for ABI Questionnaire (AAABIQ).

1.        Parents in the ACT+SSTP group demonstrated an increase in confidence in managing challenging behaviours on PTC (p<0.001), and a decrease in number of inter-parental disagreements on PPC (p=0.021) from baseline to post-intervention. The CAU group had no significant change on either (p=0.340 and p=0.714, respectively).

2.        Family functioning on FAD and psychological flexibility on AAABIQ significantly improved for the ACT+SSTP group from baseline to post-intervention (p<0.001 for both), whereas the CAU group demonstrated no change (p=0.440 for both).

3.        No significant differences between groups for parental distress or relationship satisfaction according to the DASS and RQI respectively were found.

Brown et al.

(2014)

Australia

RCT

PEDro=5

N=59

Population: ABI: TBI=34, Tumor=10, Encephalitis=9, Cardiovascular Accident=4, Hypoxia=2; Acceptance and Commitment Therapy + Stepping Stones Triple P (ACT+SSTP, n=30): Mean Age=7.1 yr; Gender: Male=17, Female=13; Mean Time Post Injury=3.1 yr. Care As Usual (CAU, n=29): Mean Age=6.9 yr; Gender: Male=18, Female-11; Mean Time Post Injury=3.6 yr.

Intervention: Families were randomized to either the ACT+SSTP workshop or to CAU. SSTP involves 6 group sessions to educate on skills and 3 individual sessions to assist in refining learned skills. ACT aspect involves 2 sessions aimed to improve experiential avoidance and psychological flexibility. The interventions were both provided for 10wk and lasted approximately 16hr in total. Assessments were conducted at baseline, post-intervention and 6mo follow-up.

Outcome Measure: The Parenting Scale (PS), Eyberg Child Behavior Inventory (ECBI), Strengths and Difficulties Questionnaire (SDQ).

1.        The ACT+SSTP group demonstrated significant decreases in over-reactivity (p=0.001) and laxness (p<0.001) on the PS while the CAU group showed no change.

2.        There was a large, significant decrease in problem behaviours amongst children in the ACT+SSP group from pre- to post-intervention (p<0.001) but no such change was reported in the CAU group. However, improvements for children in the ACT+SSP group returned to baseline levels at follow-up.

3.        There were significantly fewer ACT+SSTP participants in the clinical range on ECBI-Intensity (p=0.030), SDQ-Emotional (p=0.030), SDQ-Laxness (p=0.027) and SDQ-Over-reactivity (p=0.002) than CAU participants at follow-up.

Wade et al.

(2006b)

USA

RCT

PEDro=5

N_I=37, N_F=32

Population: TBI: Family Problem-Solving Group (FPS, n=16): Mean Age=10.9yr; Gender: Male=10, Female=6; Mean Time Post Injury=8.7mo; Mean Lowest GCS=10.8. Control Group (n=16): Mean Age=10.7yr; Gender: Male=11, Female=5; Mean Time Post Injury=8.8 mo; Mean Lowest GCS=11.1.

Intervention: Patients were randomly assigned to receive either the FPS intervention or standard care. Those in the FPS group were provided with face-to-face problem-solving skills training with 7 biweekly sessions followed by an additional 4 individualized sessions to address unresolved stressors over a 6 mo period. Each session consisted of a didactic portion (30-40min) and a problem-solving portion (45-60min). The control group received standard medical care for TBI. Assessments were conducted at baseline and post-treatment.

Outcome Measure: Child Behavior Checklist (CBCL), Brief Symptom Inventory-Global Severity Index (BSI-GSI), Conflict Behavior Questionnaire (CBQ), satisfaction survey.

1.        The FPS group demonstrated significantly greater reductions on the CBCL Internalizing, Anxious/Depressed, and Withdrawn subscales compared to the control group from baseline to post-treatment (all p<0.050).

2.        No significant differences were found between the FPS group and the control group on the BSI-GSI or CBQ from baseline to post-treatment.

3.        Patients and parents in the FPS group reported high levels of satisfaction with ratings of 9/10 and 8.8/10 respectively at post-treatment.

4.        According to the satisfaction survey, more than 90% of parents in the FPS group reported that they now knew strategies for improving their child’s attention and had developed a plan for handling future behavioural problems.

Braga et al.

(2005)

Brazil

RCT

PEDro=5

N_I=87, N_F=72

Population: TBI: Indirect Family Support Group (IFS, n=38): Mean Age=8.1yr; Gender: Male=10, Female=6; Mean Time Post Injury=1.3yr; Mean GCS=6.7. Direct Clinician Delivered Group (DCD, n=34): Mean Age=8.1yr; Gender: Male=19, Female=15; Mean Time Post Injury=1.1yr; Mean GCS=7.5.

Intervention:  Patients were randomly assigned to either the IFS or DCD group. The IFS group received an integrated support and intervention program consisting of simple home activities and visits from two case managers to educate and support the patient and their family. Patients in the DCD received conventional rehabilitation from health professionals for 2 hr/day, 5 day/wk. Both interventions were provided for 12 mo. Assessments were conducted at baseline, every 3 mo (IFS only), and post-treatment.

Outcome Measure: SARAH Motor Functional Scale (SARAH), Wechsler Intelligence Scale for Children Third Edition (WISC-III), number of activities performed by parents.

1.        The IFS group revealed significantly higher IQ on WISC-III (p=0.050) and motor development and functional independence on SARAH scores (p=0.0180) compared to the DCD group post-treatment.

2.        Higher injury severity (based on GCS) was positively correlated with motor/functional improvements on SARAH classification (p=0.000), but not with IQ scores on WISC-III (p=0.757).

3.        Parents of patients in the IFS group consistently learned the procedures and activities of the intervention over the course of the 12 mo study with no drop in performance despite the treatment changing as the patient demonstrated progress (p=0.999).

Hickey et al.

(2018a)

Australia

PCT

N=47

Population:  Family Forward (FF) Group (N=25): Mean Age of child=10.1yr (5.2); Gender: Male=56%, Female=44%; Mean time post injury=Acute; GCS=N/A. Usual Care (UC) Group (N=22): Mean Age of child=8.5yr (5.6); Gender: Male=59.1%, Female=40.9%; Mean time post injury=Acute; GCS=N/A.

Intervention: Families of children with ABI participated in either a UC or family forward (FF) social work program. Sessions for both occurred twice a week. The FF intervention consisted of a more tailored approach of monitoring the family for post-trauma symptoms in addition to regular social work. Measures taken at baseline, inpatient discharge, and at a 6-week follow-up.

Outcomes: Impact of Events scale – revised (IES-R), parent experience of child illness (PECI), Brief Illness perception questionnaire (Brief IPQ).

Hickey et al.

(2018b)

Australia

PCT

N=47

Population:  Family Forward (FF) Group (N=25): Mean Age of child=10.1yr (5.2); Gender: Male=56%, Female=44%; Mean time post injury=Acute; GCS=N/A. Usual Care (UC) Group (N=22): Mean Age of child=8.5yr (5.6); Gender: Male=59.1%, Female=40.9%; Mean time post injury=Acute; GCS=N/A.

Intervention: Families of children with ABI participated in either a UC or family forward (FF) social work program. The cohorts were recruited sequentially from the inpatient ABI unit and sessions for both occurred twice a week. The FF intervention consisted of a more tailored approach of monitoring the family for post-trauma symptoms in addition to regular social work. Measures taken at baseline, inpatient discharge, and at a 6-week follow-up.

Outcomes: Family Assessment Device-General Functioning (FAD-GF), Family Management Measure (FAMM), Psychosocial assessment tool (PAT2.0), Social work activity form (SWAF),

1.        No significant difference between groups at any time point on the FAD-GF (p>0.05)

2.        The condition management ability subscale of the FAMM was found to be significantly different between groups at 6-weeks post-discharge (p=0.029) showing higher scores in the FF group. No other subscales of the FAMM showed between-groups significance (p>0.05).

3.        There were no significant between-group differences found on the PAT2.0 at any time points (p>0.05).

4.        The three subscales of the SWAF (supportive counselling, family resources, and medical care issues) showed a significant between-groups difference at inpatient discharge (p<0.05) showing higher scores in the FF group.