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The purpose of this paper is to review and summarise a small but growing body of literature demonstrating that by embedding intervention within a family context offers the greatest promise of success in working with families caring for a child with traumatic brain injury (TBI).

The approach takes the form of a literature review.

The current family-centred evidence-based research indicates the potential benefits for the delivery of family focused interventions following childhood TBI.

The paper adds to the paediatric TBI literature as being of the few papers to incorporate a number of novel family-centred behavioural interventions into the one review paper.

Children with acquired brain injury (ABI) are at significant risk of serious behavioural and social difficulties. The burgeoning growth of research documenting behavioural sequelae after paediatric ABI has not been met with a concomitant level of research aimed at treating the problem. The purpose of this paper is to investigate whether a manualised behavioural intervention support programme could reduce challenging behaviours in children with ABI and improve family-parental well-being and functioning.

A total of 61 parents (48 mothers and 13 fathers) of 48 children aged between three and 12 years with mild, moderate, or severe ABI received an ABI adapted “Signposts for Building Better Behaviour” programme (Hudson et al., 2001) in group-support (GS) or telephone-support (TS) format. Trained “Signposts” practitioners delivered the programme over a five-month period. The programme consisted of nine information booklets, a DVD, and workbook. All families completed pre-intervention and post-intervention evaluations.

On an average parents completed 7.92 out of a possible nine intervention sessions (range 7-9). Parents in both TS and GS formats reported significant reductions in challenging child behaviours irrespective of injury severity. They also reported significant reductions in dysfunctional parenting practices, stress and family burden.

Overall, the current research provides support for Signposts to be used with families of children with ABI in an attempt to ameliorate negative outcomes for family, parent, and child.

The purpose of this paper is to determine the preliminary clinical utility of a telephone-support format of the “Signposts” (Hudson et al., 2003) behavioural intervention programme to be used with a paediatric traumatic brain injury (TBI) population.

Nine families caring for a child with moderate or severe TBI, participated in a pilot study of a TBI adapted “Signposts for Building Better Behaviour” manualised programme. The programme is designed to help parents learn positive parenting skills and strategies that empower them to successfully manage their child's challenging behaviour post-TBI. The programme consists of seven core sessions and two supplemental sessions. Parents work through the sessions with an accompaniment of guiding information booklets, a DVD with scenes modelling positive parenting strategies, and a workbook containing written exercises. At the completion of each session parents receive a telephone-support call from a trained Signposts practitioner who provides assistance and feedback on programme content.

On average parents completed eight sessions (range seven to nine) and every family completed the seven core sessions. Participation in the telephone-support calls was high with 96 per cent of calls having been successfully received by families. All parents agreed that the telephone calls were a useful part of the programme and felt that the materials were helpful for managing challenging behaviour. Paired-samples t-tests showed significant reductions for challenging behaviour from pre- to post-intervention. Parenting practices also significantly improved over the course of the intervention. In general, parents rated a high level of consumer satisfaction with the Signposts programme and its content.

Overall, these preliminary findings support the potential clinical utility of a telephone-support version of the Signposts programme to improve parenting skills and to reduce challenging child behaviour following TBI. This study has provided the impetus for a larger clinical research trial to be conducted.

Where no psychosocial or interventional support is provided, children with acquired brain injury (ABI) are at significant risk of serious long-term behavioural and social difficulties. The purpose of this paper is to report the six- and 18-month long-term treatment effects of a family centred behavioural intervention to help families manage and prevent challenging behaviours in children following ABI.

In total, 31 parents were followed up at three time points (post-intervention, 6 and 18 months) after participating in an ABI adapted manualised “Signposts for Building Better Behaviour” programme (Hudson et al., 2003).

Attrition rates were highest amongst families caring for a child with mild ABI. The maintenance of treatment effects were detailed for those families who reported a reduction in challenging behaviour immediately post-intervention. There were no significant elevations in challenging child behaviour, maladaptive parenting, or family dysfunction for any participants over the long-term follow-up. Irrespective of injury severity, parents reported high levels of satisfaction and efficacy in the parenting role at 18 months post-intervention.

“Signposts” has further demonstrated its clinical viability by meeting the needs of parents who have a child with ABI in both the short- and longer-term.