Research In Focus: A Weekly Digest of New Research from the NIDILRR Community

For Lower-Income Families Dealing with Childhood TBI, a Web-Based Parent Training Program Shows Promise

A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Traumatic brain injury (TBI) is an injury to the brain from an external force. When a child experiences a TBI, it impacts the whole family, especially the parents. Dealing with new medical needs, changes in mood and behavior, and all the associated costs can ratchet up parental distress. For lower-income families, adding financial issues and poor access to care and services can be a recipe for crisis. One program is showing promise to help parents learn the positive parenting skills they will need to help their child manage life with a TBI as well reducing their own psychological distress.

Researchers from the NIDILRR-funded Rehabilitation Research and Training Center on Interventions for Children and Youth with TBI at Cincinnati Children’s Hospital Medical Center studied a web-based parenting skills program called I-InTERACT to see whether it would help parents of young children with TBI increase positive parenting behaviors and improve the parent-child relationship. I-InTERACT stands for Internet-based Interacting Together Everyday: Recovery After Childhood TBI. A unique feature of the I-InTERACT program is live parent coaching with a therapist, using videoconferencing to help parents practice positive parenting skills with therapist support. In this study, the program provided a combined training in positive parent skills with training in parent stress management and anger control as well as education about TBI and its impact. Therapists coached parents in using positive responses to challenging behavior and taught parents to recognize and address things that might trigger their child’s problem behaviors, setting their children up for success.

Among all the participants, parents from lower-income families reported significant reductions in psychological distress after completing the program. In addition, they experienced less distress than lower-income parents who did not go through the I-InTERACT program. Why was the program effective for these parents? According to the authors, there may be several reasons:

  • Parents in lower-income communities may not have easy access to support, information, and resources they need such as brain injury specialists, counselors, and therapists.
  • Parents’ stress levels may go up as they worry about finances, insurance, and missing work, all while meeting their child’s increasingly complex health and behavioral needs.
  • Parents from lower-income backgrounds who have less education may not recognize their child’s need for services following TBI, along with supports to manage their own well-being.

Because of these factors, lower-income parents of children with TBI may experience greater barriers to accessing traditional in-office therapy and support programs, and hence benefited more from what the web-based program had to offer. The findings suggested that a web-based program could be a viable, beneficial option for these lower-income families, providing access to the training, tools, and information they can use to manage their child’s changing health needs and reduce their own levels of distress.

To learn more:

Families of children with TBI can find information and support online and in their community through the following organizations:

The Brain Injury Association of America and its state chapters offer a wealth of resources, including basic information about brain injury and its diagnosis and treatment, frequently asked questions and personal stories, support for caregivers and families, and webinars on timely topics. See the section focused on children and TBI: is a comprehensive support and information website for understanding TBI. BrainLineKids is specifically designed to help families understand how TBI impacts the everyday lives of children, from family concerns to school issues:

The Center for Parent Information and Resources connects parents to Parent Training Information Centers and Community Parent Resource Centers. These centers provide information and training to help parents of children with disabilities learn about special education and parent rights. Find your local centers at .

To learn more about this study and the I-InTERACT program:

Read the original article: Raj, S.P., Antonini, T.N., Oberjohn, K.S., Cassedy, A., Makoroff, K. L., and Wade, S.L. (2015) Web-based parenting skills program for pediatric traumatic brain injury reduces psychological distress among lower-income parents . Journal of Head Trauma Rehabilitation, 30(5), 347-356. A free abstract is available online. The full text may be purchased from the publisher or ordered through our document delivery service as Article J72657.

To learn more about the I-InTERACT program, visit

Date published: