‘Family first’ – feasibility and pilot outcomes of a community intervention for families of children in recovery following brain injury

Figures & data

Table 1. Outline of the family first intervention.

What interventions?
Psychoeducation with respect to the impact of an ABI in childhood – for parents, siblings and the injured child. Core element. Narrative meaning making with respect to personal familial difficulties and experiences (8,22). This involved helping parents gain an understanding of how the child’s ABI and their own/system responses were contributing to challenging behaviors or difficulties etc. Core element. Training in taking a problem-solving approach to difficulties – reframing problems as goals, brainstorming solutions, weighing pros and cons for each and, with appropriate support and guidance where necessary, implementing such solutions and reviewing goal attainment. Core element. Within this problem-solving framework parents and children engaged in coaching in specific strategies relevant to goal attainment. This typically involved shaping appraisal and coping skills related to compensating for cognitive difficulties, managing challenging behaviors, interpersonal difficulties, sleep difficulties, managing medical procedures etc. These interventions were informed by existing evidence bases for these strategies (27–29). Specific interventions varied and were tailored to the specific needs and goals of the family. Advocacy and capacity building with education and healthcare agencies supporting the child and family. The relevance of this varied and was delivered as appropriate.
How were interventions delivered, tailored and modified?
Interventions were primarily delivered within a home visiting context, which pivoted to teletherapy (using a video conferencing platform) from March 2020, and during the COVID-19 restrictions which prevented in-person therapy sessions. The latter remained the key delivery medium to the end of the reporting period in this paper (April 2022). A small number of family workshops (3), involving 10 families, were conducted in the first year of the project and related to specific topics as outlined above. These were conducted at the project base, in a community setting geographically close to groups of families, and online. Difficulties coordinating suitable times and access for groups meant that the interventions became almost wholly delivered to individual families, in a home visiting format, as noted above. Advocacy and consultancy to schools and healthcare agencies were also conducted via in-person sessions and/or online platforms as deemed relevant to need. Approximately half received school input and almost all received healthcare agency consultation. Further details on sessions attended are outlined in Results section.
Additional materials
Online informational resources were available to all to access. These were psychoeducational in nature and related to specific topics as outlined above.
Who delivered the interventions and treatment fidelity?
Interventions were delivered by 3 project therapists with professional qualifications in Counselling, Psychology and Social Work, and who were experienced in work with children with disabilities. A Consultant Clinical Psychologist (EMC), involved in the design of the intervention, and with extensive experience in working with children with ABI and their families, provided training in the delivery of the interventions. Fortnightly consultation and supervision were conducted to maximize intervention fidelity.

Table 2. Family characteristics and child clinical features.

Demographic/Clinical Features	%	Means (SD)	Range
Child birth sex (male/female)	57%/43%
Mean age of child		7.7 years (3.5)	5 months − 15 years
Mean Age Child at Injury		3.6 years (3.5)	0 months − 12 years
Lone parent family	38%
Siblings in family	80%
Parental unemployment	32%
Deprivation index
1st quartile	37%
2nd quartile	7%
3rd quartile	40%
4th quartile	16%
Severity Injury (KOSCHI)
Severe Disability	11%
Moderate Disability	76%
Mild Disability	13%
Mechanism of Injury
Traumatic Brain Injury	46%
Brain Infection	17%
Tumour	9%
Stroke/Bleed	11%
Hypoxia	3%
Other/Combination	14%
Co-morbid Diagnoses
Epilepsy	18%
Visual Impairment	16%
Hearing Impairment	4%
Autistic Spectrum Disorder	3%
Attention Deficit Hyperactivity Disorder	2%
Learning Disability	21%
Cerebral Palsy	7%
Educational Statement Stage
No Statement	17%
Extra Support by School	17%
Statementing Occurred/In progress	47%
Not Known	19%

Figure 1. Thematic synthesis.

Table 3. Pre- and post-scores on standardized outcome measures.

Outcome Measure	Pairs (n)	Pre-Intervention Mean (SD)	Post-Intervention Mean (SD)	t (df) Difference Confidence Interval (CI)	Effect size (p)
Child Behavior Checklist
Competence Index	19	30.8 (7.4)	35.5 (9.4)	−2.35 (18) CI: −8.9/-5.0	0.54 (0.015)
Internalizing Index	22	67.4 (10.6)	67.8 (12.4)	− 0.22 (21) CI: −3.8/3.0	0.05 (0.41)
Externalizing Index	22	70.1 (7.8)	64.9 (10.7)	3.74 (21) CI: 2.3/8.1	0.78 (< 0.001)
Pediatric Quality of Life
Psychosocial Scale	30	51.0 (16.3)	61.7 (18.6)	− 4.81 (29) CI: − 15.1/- 6.1	0.88 (< 0.001)
Physical Health Scale	30	56.4 (24.1)	66.4 (24.5)	−3.42 (29) CI: −16.1/-4.0	0.62 (< 0.001)
Family Functioning	55	52.0 (21.8)	58.1 (21.1)	−2.74 (54) CI: −10.6/-2.7	0.37 (0.004)
Goal Attainment
Proximity to Goal	155 Goals 50 Parents	2.2 (1.6)	6.5 (2.3)	−24.3 (154) CI: −4.6/-3.9	1.9 (< 0.001)

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