A Web-based family problem-solving intervention for families of children with traumatic brain injury

  • Shari L. WadeEmail author
  • Christopher R. Wolfe
  • John P. Pestian


We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.


Traumatic Brain Injury Target Behavior Acquire Brain Injury Audio Quality Pediatric Traumatic Brain Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Agnew-Davies, R., Stiles, W. B., Hardy, G. E., Barkham, M., &Shapiro, D. A. (1998). Alliance structure assessed by the Agnew Relationship Measure (ARM).British Journal of Clinical Psychology,37,155–172.PubMedGoogle Scholar
  2. Brooks, D. (1991). The head-injury family.Journal of Clinical & Experimental Neuropsychology,13,155–188.CrossRefGoogle Scholar
  3. Brown, G., Chadwick, O., Shaffer, D., Rutter, M., &Traub, M. (1981). A prospective study of children with head injuries: III. Psychiatric sequelae.Psychological Medicine,11,63–78.PubMedCrossRefGoogle Scholar
  4. Farmer, J. E., &Muhlenbruck, L. (2001). Telehealth for children with special health care needs: Promoting comprehensive systems of care.Clinical Pediatrics,40, 93–98.PubMedCrossRefGoogle Scholar
  5. Fay, G. C., Jaffe, K. M., Polissar, N. L., Liao, S., Rivara, J. B., &Martin, K. M. (1994). Outcome of pediatric traumatic brain injury at three years: A cohort study.Archives of Physical Medicine & Rehabilitation,75,733–741.Google Scholar
  6. Fletcher, J., Ewing-Cobbs, L., Miner, M., Levin, H., &Eisenberg, H. (1990). Behavioral changes after closed head injury in children.Journal of Consulting & Clinical Psychology,58,93–98.CrossRefGoogle Scholar
  7. Gega, L., Marks, I., &Mataix-Cols, D. (2004). Computer-aided CBT self-help for anxiety and depressive disorders: Experience of a London clinic and future directions.Journal of Clinical Psychology,60,147–157.PubMedCrossRefGoogle Scholar
  8. Glueckauf, R. L., Fritz, S. P., Ecklund-Johnson, E. P., Liss, H. J., Dages, P., &Carney, P. (2002). Videoconferencing-based family counseling for rural teenagers with epilepsy: Phase 1 findings.Rehabilitation Psychology,47,49–72.CrossRefGoogle Scholar
  9. Greist, J. H. (1998). Treatment for all: The computer as patient assistant.Psychiatric Services,49,887–889.PubMedGoogle Scholar
  10. Greist, J. H., Gustafson, D. H., Stauss, F. F., Rowse, G. L., Laughren, T. P., &Chiles, J. A. (1973). Computer interview for suicide-risk prediction.American Journal of Psychiatry,130,1327–1332.PubMedGoogle Scholar
  11. Hawley, C. A., Ward, A. B., Magnay, A. R., &Long, J. (2002). Children’s brain injury: A postal follow-up of 525 children from one health region in the UK.Brain Injury,16,969–985.PubMedCrossRefGoogle Scholar
  12. Hewson, C. M., Laurent, D., &Vogel, C. M. (1996). Proper methodologies for psychological and sociological studies conducted via the Internet.Behavior Research Methods, Instruments, & Computers,28,186–191.CrossRefGoogle Scholar
  13. Joinson, A. N. (1998). Causes and implications of disinhibited behavior on the Net. In J. Gackenbach (Ed.),Psychology of the Internet (pp. 43–60). New York: Academic Press.Google Scholar
  14. Kinsella, G., Ong, B., Murtaugh, D., Prior, M., &Sawyer, M. (1999). The role of the family for behavioral outcome in children and adolescents following traumatic brain injury.Journal of Consulting & Clinical Psychology,67,116–123.CrossRefGoogle Scholar
  15. Kleiner, K. D., Akers, R., Burke, B. L., &Werner, E. J. (2002). Parent and physician attitudes regarding electronic communication in pediatric practices.Pediatrics,109,740–744.PubMedCrossRefGoogle Scholar
  16. Maheu, M. M. (2000). Delivering behavioral telehealth via the Internet: E-health.TelehealthNet. Scholar
  17. Maheu, M. M. (2003). The online clinical practice management model.Psychotherapy: Theory, Research, Practice, Training,40, 20–32.CrossRefGoogle Scholar
  18. Marks, I., Shaw, S., &Parkin, R. (1998). Computer-aided treatments of mental health problems.Clinical Psychology: Science & Practice,5, 151–170.CrossRefGoogle Scholar
  19. Marks, M., Sliwinski, M., &Gordon, W. A. (1993). An examination of the needs of families with a brain injured child.NeuroRehabilitation,3, 1–12.Google Scholar
  20. Max, J. E., Castillo, C. S., Robin, D. A., Lindgren, S. D., Smith, W. L., Jr.,Sato, Y., Mattheis, P. J., &Stierwalt, J. A. G. (1998). Predictors of family functioning after traumatic brain injury in children and adolescents.Journal of the American Academy of Child & Adolescent Psychiatry,37,83–90.CrossRefGoogle Scholar
  21. Max, J. E., Koele, S. L., Smith, W. L., Jr.,Sato, Y., Lindgren, S. D., Robin, D. A., &Arndt, S. (1998). Psychiatric disorders in children and adolescents after severe traumatic brain injury: A controlled study.Journal of the American Academy of Child & Adolescent Psychiatry,37,832–840.CrossRefGoogle Scholar
  22. Rabasca, L. (2000). Self-help sites: A blessing or a bane?Monitor on Psychology,31, 28–30.Google Scholar
  23. Ritterband, L. M., Cox, D. J., Walker, L. S., Kovatchev, B., McKnight, L., Patel, K., Borowitz, S., &Sutphen, J. (2003). An Internet intervention as adjunctive therapy for pediatric encopresis.Journal of Consulting & Clinical Psychology,71,910–917.CrossRefGoogle Scholar
  24. Rivara, J. B., Fay, G. C., Jaffe, K. M., Polissar, N. L., Shurtleff, H. A., &Martin, K. M. (1992). Predictors of family functioning one year following traumatic brain injury in children.Archives of Physical Medicine & Rehabilitation,73,899–910.Google Scholar
  25. Rivara, J. B., Jaffe, K. M., Polissar, N. L., Fay, G. C., Liao, S., &Martin, K. M. (1996). Predictors of family functioning and change 3 years after traumatic brain injury in children.Archives of Physical Medicine & Rehabilitation,77,754–764.CrossRefGoogle Scholar
  26. Rotondi, A. J., Sinkule, J., & Spring, M. (in press). An interactive Web-based intervention for persons with TBI and their families: Use and evaluation by female significant others.Journal of Head Trauma Rehabilitation.Google Scholar
  27. Rutter, M. (1981). Psychological sequelae of brain damage in children.American Journal of Psychiatry,138,1533–1543.PubMedGoogle Scholar
  28. Schopp, L. H., Johnstone, B. J., &Merrell, D. (2000). Telehealth and neuropsychological assessment: New opportunities for psychologists.Professional Psychology: Research & Practice,31,179–183.CrossRefGoogle Scholar
  29. Schwartz, L., Taylor, H. G., Drotar, D., Yeates, K. O., Wade, S. L., &Stancin, T. (2003). Long-term behavior problems following pediatric traumatic brain injury: Prevalence, predictors, and correlates.Journal of Pediatric Psychology,28,251 -263.PubMedCrossRefGoogle Scholar
  30. Singer, G. H. S., Glang, A., Nixon, C., Cooley, E., Kerns, K. A., Williams, D., &Powers, L. E. (1994). A comparison of two psychosocial interventions for parents of children with acquired brain injury: An exploratory study.Journal of Head Trauma Rehabilitation,9, 38–49.CrossRefGoogle Scholar
  31. Singer, G. H. S., &Powers, L. E. (1997). Stress management training to help parents adapt to a child’s ABI. In G. H. S. Singer, A. Glang, & J. M. Williams (Eds.),Children with acquired brain injury: Educating and supporting families (pp. 235–251). Baltimore: Brookes.Google Scholar
  32. Sturges, J. W. (1998). Practical use of technology in professional practice.Professional Psychology: Research & Practice,29,183–188.CrossRefGoogle Scholar
  33. Taylor, H. G., Yeates, K. O., Wade, S. L., Drotar, D., Klein, S., &Stancin, T. (1999). Influences on first-year recovery from traumatic brain injury in children.Neuropsychology,13,76–89.PubMedCrossRefGoogle Scholar
  34. Taylor, H. G., Yeates, K. O., Wade, S. L., Drotar, D., Stancin, T., Taylor, H. G., Yeates, K. O., Wade, S. L., Drotar, D., Stancin, T., &Minich, N. (2002). A prospective study of short- and long-term outcomes after traumatic brain injury in children: Behavior and achievement.Neuropsychology,16,15–27.PubMedCrossRefGoogle Scholar
  35. Wade, S. L. (2004). Commentary: Computer-based interventions in pediatric psychology.Journal of Pediatric Psychology,29,269–272.PubMedCrossRefGoogle Scholar
  36. Wade, S. L., Drotar, D., Taylor, H. G., &Stancin, T. (1995). Assessing the effects of traumatic brain injury (TBI) on family functioning: Conceptual and methodological issues.Journal of Pediatric Psychology,20,737–752.PubMedCrossRefGoogle Scholar
  37. Wade, S. L., Michaud, L., & Brown, T. M. (2004).A family intervention to improve child outcomes following traumatic brain injury (TBI). Manuscript submitted for publication.Google Scholar
  38. Wade, S. L., Taylor, H. G., Drotar, D., Stancin, T., &Yeates, K. O. (1996). Childhood traumatic brain injury: Initial impact on the family.Journal of Learning Disabilities,29,652–661.PubMedCrossRefGoogle Scholar
  39. Wade, S. L., Taylor, H. G., Drotar, D., Stancin, T., &Yeates, K. O. (1998). Family burden and adaptation following traumatic brain injury (TBI) in children.Pediatrics,102,110–116.PubMedCrossRefGoogle Scholar
  40. Wade, S. L., Taylor, H. G., Drotar, D., Stancin, T., Yeates, K. O., &Minich, N. M. (2002). A prospective study of long-term caregiver and family adaptation following brain injury in children.Journal of Head Trauma Rehabilitation,17,96–111.PubMedCrossRefGoogle Scholar
  41. Wolfe, C. R. (2001).Learning and teaching on the World Wide Web. San Diego: Academic Press.Google Scholar
  42. Yeates, K. O., Taylor, H. G., Drotar, D., Wade, S. L., Klein, S., Stancin, T., &Schatschneider, C. (1997). Pre-injury family environment as a determinant of recovery from traumatic brain injuries in school-age children.Journal of the International Neuropsychological Society,3,617–630.PubMedGoogle Scholar
  43. Yeates, K. O., Taylor, H. G., Wade, S. L., Drotar, D., Stancin, T., &Minich, N. (2002). A prospective study of short- and long-term neuropsychological outcomes after traumatic brain injury in children.Neuropsychology,16,514–523.PubMedCrossRefGoogle Scholar

Copyright information

© Psychonomic Society, Inc. 2004

Authors and Affiliations

  • Shari L. Wade
    • 1
    • 2
    Email author
  • Christopher R. Wolfe
    • 3
  • John P. Pestian
    • 1
    • 2
  1. 1.Division of Pediatric Physical Medicine and RehabilitationCincinnati Children’s Hospital Medical CenterCincinnati
  2. 2.College of MedicineUniversity of CincinnatiCincinnati
  3. 3.Miami UniversityOxford

Personalised recommendations