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.