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Background: The current study examined the relation between therapeutic processes and child outcomes in the context of Online Family Problem-Solving therapy (OFPST) following pediatric traumatic brain injury. OFPST represents a promising therapy to address common challenges families face following a child’s injury such as communication, behavior problems, and stress management. Although previous studies have identified an association between therapeutic processes and child outcomes in family-based therapy, no studies have examined this in the context of OFPST. Method: The sample for the current study was derived from 4 randomized controlled trials of OFPST for children ages 5 to 18 and their families. We included a total of 118 participants in the sample. We used mixed model analyses to examine the association between therapeutic processes and child treatment outcomes following OFPST. Therapeutic processes included therapist-reported caregiver and child within-session engagement, family homework participation, and child- and caregiver-reported therapeutic alliance. We controlled for study as a random effect and the baseline score of each outcome measure, child age at baseline, caregiver education, and site (a proxy for therapist) as fixed effects. Results: We found that as children were more engaged in the therapy, both children and caregivers reported greater perceived treatment benefits. Greater caregiver- and child-reported therapeutic alliance were associated with greater caregiver-reported perceived treatment benefits. In addition, higher levels of child-reported therapeutic alliance and homework participation were associated with fewer child externalizing problems. Therapeutic processes did not contribute to child social competence, internalizing problems, or executive functioning posttreatment. Discussion: In total, we found limited support that therapeutic processes contribute to treatment outcomes following OFPST. This study contributes to the growing literature on the importance of therapeutic processes to outcomes in telehealth family-based therapy. Future studies could examine the efficacy of efforts to increase engagement and therapeutic alliance in OFPST. |
