Widespread clinical implementation of the teen online problem-solving program: Progress, barriers, and lessons learned

Shari L Wade; Kathleen Walsh; Beth S Slomine; Kimberly C Davis; Cherish Heard; Brianna Maggard; Melissa Sutcliffe; Marie Van Tubbergen; Kelly McNally; Kathleen Deidrick; Michael W Kirkwood; Ann Lantagne; Sharon Ashman; Shannon Scratch; Gayle Chesley; Bethany Johnson-Kerner; Abigail Johnson; Lindsay Cirincione; Cynthia Austin

doi:10.3389/fresc.2022.1089079

Widespread clinical implementation of the teen online problem-solving program: Progress, barriers, and lessons learned

Front Rehabil Sci. 2023 Feb 7:3:1089079. doi: 10.3389/fresc.2022.1089079. eCollection 2022.

Authors

Shari L Wade¹, Kathleen Walsh², Beth S Slomine³, Kimberly C Davis⁴, Cherish Heard⁵, Brianna Maggard⁶, Melissa Sutcliffe⁷, Marie Van Tubbergen⁸, Kelly McNally⁹, Kathleen Deidrick¹⁰, Michael W Kirkwood¹¹, Ann Lantagne¹¹, Sharon Ashman¹², Shannon Scratch¹³, Gayle Chesley¹⁴, Bethany Johnson-Kerner¹⁵, Abigail Johnson⁸, Lindsay Cirincione³, Cynthia Austin¹⁶

Affiliations

¹ Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States.
² Department of General Pediatrics, Boston Children's Hospital, Harvard University, Boston, MA, United States.
³ Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
⁴ Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
⁵ Department of Psychology University of Cincinnati Cincinnati, OH, United States.
⁶ Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
⁷ Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States.
⁸ Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States.
⁹ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States.
¹⁰ Neurology and Behavioral Psychology, Pediatrics Neurophysiology, St. Luke's Children's Hospital, Boise, ID, United States.
¹¹ Department of Rehabilitation Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States.
¹² Department of Rehabilitation Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.
¹³ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
¹⁴ The Department of Child & Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
¹⁵ Pediatric Neurology, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, United States.
¹⁶ Department of Neurology, Dell Children's Medical Center, University of Texas at Austin Dell Medical School, Austin, TX, United States.

Abstract

Objective: We describe the clinical implementation in North America of Teen Online Problem Solving (TOPS), a 10+ session, evidence-based telehealth intervention providing training in problem-solving, emotion regulation, and communication skills.

Methods: Twelve children's hospitals and three rehabilitation hospitals participated, agreeing to train a minimum of five therapists to deliver the program and to enroll two patients with traumatic brain injuries (TBI) per month. Barriers to reach and adoption were addressed during monthly calls, resulting in expansion of the program to other neurological conditions and extending training to speech therapists.

Results: Over 26 months, 381 patients were enrolled (199 TBI, 182 other brain conditions), and 101 completed the program. A total of 307 therapists were trained, and 58 went on to deliver the program. Institutional, provider, and patient barriers and strategies to address them are discussed.

Conclusions: The TOPS implementation process highlights the challenges of implementing complex pediatric neurorehabilitation programs while underscoring potential avenues for improving reach and adoption.

Keywords: acquired brain injury; implementation; pediatric injury; problem solving; telehealth; traumatic brain injury.

Grants and funding

This research was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Dissemination and Implementation Award (DI-2018C3-14566). Additional funding came from the State of Ohio, Ohio Development Services Agency, Ohio Third Frontier, Grant Control No. TECG2019-0159 and Cincinnati Children's Hospital Medical Center's Innovation Fund.The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.