Family-to-Family: Psychoeducation to Improve Children’s Outcomes in HIV+ Families

Abstract:HIV has a negative intergenerational impact on families, particularly children with HIV+ parents (Rotheram-Borus et al., 1997). In order to improve the social, behavioral and mental health outcomes for children affected by HIV, we have designed the Family-to-Family (F2F) intervention that includes the critical, universal, program components identified by the NIMH Intervention Workgroup (in revision). All efficacious intervention programs: frame the problem by providing information and shaping beliefs; enhance skills; establish supportive relationships; and remove environmental barriers to behavior change (e.g, HIV testing, ARV). We aim to evaluate a generic intervention approach that is culturally-tailored to families affected by HIV in a specific country, Thailand. The intervention builds on previous efficacious HIV family interventions, adapted to be sustainable in a developing country context. The F2F intervention for HIV+ parents and their family caregivers will assist families to cope with HIV-related stressors (disclosure, stigma, transmission, & custody), build skills for improving their own and their children’s adjustment, and establish supportive community relationships with other families affected by HIV. Families in Thailand need such an intervention: 1 in 4 elderly adults in Thailand will raise an AIDS orphan, even with a relatively low national seroprevalence rate (1.2%). The study will proceed in 2 phases. In Phase 1, we will pilot and finalize the intervention, assessments, and procedures with 40 families, 10 of whom are “positive models.” In Phase 2, families with HIV+ parents (400 HIV+ parents, 600 family caregivers) from 4 district hospitals in Chang Rai & Nakhon Ratchasima Provinces will be recruited to an intervention to benefit their 960 school-aged children aged 6-17 years. At their clinical care site, we will randomly assign families to either: 1) F2F, a psychoeducational intervention for HIV+ parents and family caregivers delivered in drop-in groups by healthcare providers (not including their children); or 2) a Standard Care intervention. The impact of the F2F intervention will be monitored over 24 months (baseline, 3, 6, 12, 18, & 24 months). The primary outcomes are school-age children’s social, behavioral and mental health status. HIV+ parent’s and family caregivers’ health mental health, parenting skills, and family bonds are intermediate outcomes.

Project Number: 5R01NR009922-03

https://reporter.nih.gov/search/Ur1W-rNiD0eaQlqtw2pwjQ/project-details/7255412

Contact PI/ Project Leader

LI, LI,  (lililili@ucla.edu)

Organization

This project aims to support adults in HIV-affected families in order to improve their children’s well-being. UCLA’s Center for Community Health (CCH) , in collaboration with the Thai Ministry of Public Health, Bureau of Epidemiology, will develop the Family-to-Family (F2F) intervention in order to improve the social, behavioral and mental health outcomes for children affected by HIV.

In Phase 1, we pilot tested the current intervention contents and activities by collecting qualitative data (focus groups and in-depth qualitative interviews) from HIV+ families in the four district hospitals in Chiang Rai and Nakohn Ratchasima provinces selected for the proposed study. We tested the assessment measures with the same 40 families. The findings from Phase was used to develop intervention content, as well as the format and style of the intervention for Phase 2. In addition, the findings from Phase 1 was used to finalize the assessment measures we will use in Phase 2. Phase 1 was completed in September, 2006.

In Phase 2, 400 families with HIV+ parents from 4 district hospitals in Chiang Rai & Nakhon Ratchasima Provinces will be recruited to an intervention to benefit their school-aged children aged 6-17 years. At their clinical care site, we will randomly assign families to either: 1) F2F, a psychoeducational intervention for HIV+ parents and family caregivers delivered in drop-in groups by healthcare providers; or 2) a Standard Care condition. The impact of the F2F intervention will be monitored over 24 months.

Published Journal Articles :

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Interventions, Training Manuals, etc. : 

Surveys and Scales Used: 

Geographical location:

Chiang Rai and Nakhon Ratchasima provinces, Thailand

Targeted risk group: 

HIV-affected families, including PLH, family members, and children

Intervention model:

Cognitive behavioral therapy consisting of 4 Modules and 12 sessions.

Local significance:

The intervention improved the social, behavioral and mental health outcomes for HIV-affected families over 24 months.   The intervention was successfully incorporated into the existing healthcare infrastructure.

The local teams are currently disseminating the intervention and training other healthcare workers in other district hospitals to provide the intervention.

International significance:

It provides a multi-level intervention model for families affected by HIV.

It provides a feasible intervention that can be implemented and incorporated into the existing healthcare infrastructure in other developing countries impacted by HIV.