Pilot evaluation of a virtual training program for child injury prevention

Unintentional injuries are a leading cause of child death. The present study evaluated the effectiveness of a behavioral injury prevention program for children aged 3-18 years and their caregivers. To accommodate families during the Coronavirus-19 pandemic, training was modified to be delivered virtually. Forty-one children aged 3-18 years and 14 parents/caregivers of children aged 3-5 years attended one of several 4-hour online injury prevention training sessions directed toward residents of Washington state. Training was targeted to three different developmental stages (ages 3-5, 6-12 and 13-18 years). Study outcomes included knowledge about injury prevention strategies, perceived vulnerability for injury, self-efficacy to engage in safety behaviors and behavioral intentions to be safe. Following training, participants showed improved self-efficacy to stay safe, excellent knowledge about the learned material and increased behavioral intention to engage safely. There was minimal change in perceived vulnerability to injury among children; caregivers of young children felt their children were somewhat less vulnerable to injury following the training. Almost all participants said they would recommend the program to others. Results suggest that a virtual behavioral training program delivered remotely is feasible and may be effective to create behavior change and reduce child injury risk. Given its scalability and reach, such programs are recommended for further study, refinement and, if demonstrated effective in larger-scale controlled trials, dissemination to address the leading cause of child mortality in the United States, unintentional injury.

TEACH-M: A pilot study evaluating an instructional sequence for persons with impaired memory and executive functions

PRIMARY OBJECTIVE

The purpose of this pilot study was to evaluate an instructional package that facilitates learning and retention of multi-step procedures for persons with severe memory and executive function impairments resulting from traumatic brain injury.

RESEARCH DESIGN

The study used a multiple baseline across participants design.

METHODS AND PROCEDURES

Four participants, two males and two females, ranging in age from 36-58 years, were taught a 7-step e-mail task. The instructional package (TEACH-M) was the experimental intervention and the number of correct e-mail steps learned was the dependent variable.

MAIN OUTCOMES AND RESULTS

Treatment effects were replicated across the four participants and maintained at 30 days post-treatment. Generalization and social validity data further supported the treatment programme.

CONCLUSIONS

The results suggest that individuals with severe cognitive impairments are capable of learning new skills. Directions for future research include application of the instructional package to other multi-step procedures.

What does it take to collaborate with families affected by brain injury? A preliminary model

BACKGROUND

Collaboration refers to a process in which family expertise is acknowledged and used to direct selection, implementation, and evaluation of treatment plans. Although the skills required to create collaborative partnerships with families are a mainstay of practice for certain rehabilitation disciplines, others have traditionally worked in client-clinician dyads that emphasize the role of the professional as responsible for client change. In addition, the existing collaborative models for working with families affected by brain injury require intensive resources and supports, making collaborative partnerships difficult to create within today's clinical and educational service delivery environments.

RESULT

In this article, we report our efforts to create an accessible set of collaboration procedures for rehabilitation professionals working in clinical and educational settings with individuals with brain injury and their families. A 2-year, qualitative study with eight families led to the development of a preliminary model and prescriptive manual for applying collaborative principles to practice.

CONCLUSION

We review the components of the model and implications for practice.

Educating students with TBI: themes and recommendations

Ten educational consultants and researchers, each with extensive experience working with children with traumatic brain injury (TBI) in school settings, identified seven themes related to serving this population in public schools. These themes are discussed under the headings (1) incidence of TBI and prevalence of persistent educational disability, (2) diversity and central tendencies within the population, (3) assessment, (4) intervention and support in school settings, (5) training and support for educators, (6) intervention and support for families, and (7) systems change and flexibility. For each theme, a set of recommendations is provided, forming an educational research and policy agenda for pediatric TBI.

Awareness intervention: who needs it?

It is widely accepted that awareness deficits present challenges to recovery and should be addressed as part of rehabilitation programming. Response to awareness intervention is commonly inferred from measurements that rely on reports by subjects and significant others. This article describes the findings from a pilot study that examined the relationship among a variety of awareness indicators in three individuals with brain damage over a 9-month period. Results suggest a dissociation between behavioral and perceptual indices of awareness. Changes in behavioral indicators of awareness selected by caregivers were not related to changes in self- or caregiver ratings. The clinical and research implications of the findings are discussed.

Improvement during baseline: three case studies encouraging collaborative research when evaluating caregiver training

The trend in cognitive rehabilitation toward reduced services, which provide more functionally relevant outcomes and the recognition of limited maintenance and generalization with many existing interventions, challenges current research models. There is a need to develop and evaluate interventions that can be implemented by persons other than rehabilitation professionals and that are well suited to naturalistic settings. The researchers responded to these challenges by designing a series of single subject experiments evaluating the effectiveness of training caregivers to provide appropriate cognitive support to persons with brain injury within their own natural living environments. The goal of the original research project included evaluating a collaborative mode of interaction with the subjects and their support persons (as opposed to traditional directive treatment models) where the caregivers and subjects were instrumental in designing the intervention and collective performance data. This paper presents the data from the initial three subject/caregiver groups all of whom demonstrated improvement in the target behaviours during the baseline period. It appeared that the act of measuring client performance changed the behaviours of the support persons and resulted in positive changes in baseline levels. The research and clinical implications of these findings are discussed.