A natural setting behavior management program for persons with acquired brain injury: a randomized controlled trial.

OBJECTIVE: To investigate the efficacy of a behavior management program delivered in the natural community setting for persons with brain injury and their caregivers. DESIGN: Three-group randomized controlled trial. SETTING: Homes and other community settings. PARTICIPANTS: Thirty-seven persons with traumatic and other acquired brain injury and their caregivers. INTERVENTIONS: Natural Setting Behavior Management (NSBM) involving education and individualized behavior modification program versus education only versus control group. MAIN OUTCOME MEASURES: Changes in frequency of targeted problematic behaviors. Subscale in Questionnaire on Resources and Stress, Maslach Burnout Inventory, and the Neurobehavioral Functioning Inventory. RESULTS: While no significant effects were detected at termination of education only (P<.075) or of NSBM (P<.56), significant treatment effects were found at the main outcome point 3 months after termination of services (P<.002). Rates of disruptive or aggressive behaviors declined significantly in the NSBM group. Differences in caregiver-rated stress, burden, and aggression were not statistically significant. CONCLUSIONS: A program of caregiver education and individualized behavior management in natural settings can decrease the frequency of disruptive behavioral challenges. Larger studies are needed to clarify the duration and intensity of education and individualized treatment required to diminish behavioral challenges and to understand relationships with general stress and burden experienced by caregivers.

Changes in ratings of caregiver burden following a community-based behavior management program for persons with traumatic brain injury.

OBJECTIVE: This study examines the use of a community-delivered behavior management program for persons with traumatic brain injury and their caregivers and its effect on reduction of ratings of caregiver burden. DESIGN: A control group was compared with an education only and education plus behavior management group with random assignment to conditions. PARTICIPANTS: Total number of participants was 27 persons with brain injury and their caregivers. MAIN OUTCOME MEASURES: Dependent measures were subscales of the Questionnaire on Resources and Stress (QRS) and an adapted version of the Maslach Burnout Inventory (MBI). RESULTS: An analysis of covariance adjusting for baseline burden and stress ratings showed no significant change in these measures associated with treatment. CONCLUSIONS: The results are discussed in terms of the potential modifiability of caregiver burden, the small sample size, and the sensitivity of current measures of caregiver stress and burden to detect clinically meaningful change.