PEERS® Plus: A pilot mixed methods randomised trial of the Program for the Education and Enrichment of Relational Skills (PEERS®) adapted for primary and early high school children with acquired brain injury and cerebral palsy.

The Program for the Education and Enrichment of Relational Skills (PEERS® PLUS) for primary school aged children (8-13 years) is a face to face group delivered and parent assisted social skills program. The manualised program is delivered consecutively across 12 weeks. Participants randomised to block 1 of PEERS® PLUS will commence their involvement in the intervention. PEERS® PLUS comprises 12 weekly sessions of 90-minute duration, delivered in face-to-face groups of up to 8 participants. A concurrent parent group will run in a separate room for the same duration. Group sessions will be held outside typical school hours (estimated 4 pm-5:30 pm). All sessions will run consecutively across 12 weeks. However, in the event of a school or public holiday, sessions will be paused. Any sessions missed due to timetabling conflicts will be rescheduled. Participants will be made aware of session dates/times before commencing their participation in their allocated block. It should be noted the program will not run or extend into extended periods of school holidays, i.e., 6–8-week summer holidays. Participants opting to complete individual dyad sessions over school holiday timeframes will be permitted to, pending staff availability. The content of the sessions will include: (a) facial expression, emotions and body language; (b) focusing attention and active listening; (c) trading information and using your voice; (d) two-way conversations; (e) choosing appropriate friends and humour; (f) entering and exiting a conversation; (g) entering and exiting a game; (h) get-togethers; (i) good sports; (j) handling disagreements and regulating emotions; (k) teasing and embarrassing feedback; (l) Optional: Online communications. Content will be delivered by means of didactic instruction, role-playing and modelling, perspective-taking questions, behavioural rehearsal, parent-assistance (social coaching), and allocation and review of homework tasks to support the transition of learnt skills to home and community environments. The use of sociodramatic and creative and performing arts-based activities will be embedded within the program to maximise engagement of motivation of a younger age group and allow for additional behavioural rehearsal and social coaching opportunities. All activities are easily adapted to meet the needs of participants' skill levels and preferences. The content of caregiver sessions will include: (a) social coaching; (b) reflection opportunities; (c) group discussion opportunities reflecting on topics covered in primary school sessions and individual needs. Two therapists will lead each group session: • Two for the child group (i.e., Occupational therapist (OT), or a combination of OT/Speech Pathologist (SP) • Two for the caregiver group (i.e., OTs, or a combination of OT/Social Worker (SW)). Homework: Time spent on homework tasks will vary throughout the duration of the program dependant on the weekly topic and allocated task. Examples: o Session 4: Children will participate an in-group call (Facetime or Zoom) and reflect on their experience with their caregiver (approximately 20 mins in total) o Session 9: Children will attend or host a get-together with a peer (up to 2 hrs in duration) Note: Estimated duration of homework tasks is expected to take between 10 mins to 2hrs per week dependent on the allocated task. Adherence to intervention will be monitored by weekly fidelity checks - eg. attendance at in-person sessions (yes/no), checklist completion of subject areas (yes/no), checklist completion of homework tasks (yes/no/partially completed) Alongside group sessions, individual dyad sessions will be held at three-time points. Dyad sessions will occur via virtual meeting (or on-site). It is envisaged that dyad sessions will occur between 8 am-7 pm on weekdays at a time convenient to each dyad; dyads should allow approximately 1 hour for their involvement in each session. The first session will focus on collaborative goal setting of 2-3 social participation goals, and the remaining two will be offered around the mid and endpoint of the program. The specific timing of dyad sessions will be flexible and reflect the needs of each family. One or two OTs will be involved in completing dyad sessions. Therapists who will deliver the intervention have completed certified training to deliver PEERS® PLUS in its original formats. All other therapists have extensive experience working with children and youth with brain injuries and their families in both clinical and research contexts. Focus groups using semi-structured interviews will be conducted separately with children and caregivers at the end of the program to explore experiences of participation in PEERS® PLUS. Interviews will be conducted by a researcher not involved in the delivery of the intervention, audiotaped and transcribed. Transcripts will be thematically coded using Nvivo software. All participants in the trial will be invited to participate in the focus groups.