The Friends Project: A randomised trial of the Program for the Education and Enrichment of Relational Skills (PEERS) for teenagers with acquired brain injury and cerebral palsy.

The Program for the Education and Enrichment of Relational Skills (PEERS) (R) is a commercially available manualised intervention that uses a small group format of 8-10 teenagers. It comprises didactic instruction, parent-assistance (social coaching), role-playing and modeling, perspective taking questions, behavioural rehearsal, social coaching and in vivo homework assignments. The program comprises once per week 90 minute sessions for 14 weeks. The structure of each 90 minute teen session includes homework review (30 mins), didactic lesson using role play/exercise (30 mins), socialization activity (20 mins); reunification with parents (10 mins). Concurrent 90 minute parent sessions consist of homework review (60 mins), review of adolescent didactic lesson (10 mins); homework assignment (10 mins); reunification with teens (10 mins). The parent program covers the same topics as the teenage group. The program content includes: Session 1: Introduction and conversational skills I – Trading Information Session 2: Conversational Skills II – two way conversations Session 3: Conversational Skills III – electronic communication (voicemail, email, text messaging, social networking, online safety); Session 4: Choosing appropriate friends (identifying a peer group/crowd, identifying extracurricular activities) Session 5: Appropriate use of humour (e.g. paying attention to humour feedback) Session 6: Peer Entry I – entering a conversation (starting and entering conversations with potential friends); Session 7: Peer Entry II – exiting a conversation Session 8: Get togethers Session 9 : Good sportsmanship (being a good host or guest during get-togethers); Session 10: Rejection 1 – teasing and embarrassing feedback (handling teasing, physical bullying, managing rumours and gossip, minimizing cyber bullying, changing a bad reputation); Session 11: Rejection II – Bullying and bad reputations Session 12: Handling disagreements Session 13: Rumours and gossip Session 14: Graduation and termination (final review, graduation party and ceremony). Weekly homework tasks will take approximately 30 minutes for teenagers and parents to arrange and carry out, depending on the week of the program. An example is for a teenager to identify someone from the group to call outside of group time and practise conversation skills with them. The parent would be expected to support the teenager in identifying the person, arranging, monitoring success of the call and troubleshooting difficulties. Another example is to have a get together with a friend and practise being a good sport during board games or computer games. In this week, the teen also needs to practise handling teasing if the opportunity comes up at school. This week’s homework can take up to two hours considering that it involves a social get together which could be also viewed as a regular adolescent activity for a weekend. The teen and parent sessions will be run by experienced occupational therapists, speech pathologists and psychologists. Sessions will be run at a community therapy centre or research centre depending on the site. Fidelity monitoring: Fidelity monitoring will be conducted at each site by the research assistant who will be trained by the therapists to complete weekly fidelity checks, alternating between parent and teen groups. The checklist was developed specifically for the PEERS program to ensure that the main content points in the manual are delivered for each session and has been used in previous studies.