Posts classified under: Families

Enhancing the Role of Commune health Workers in HIV and Drug control in Vietnam

Abstract: This 5-year project aims to enhance the role of commune health workers (CHWs) in HIV and drug use prevention and treatment. We demonstrate the process of development, implementation, and evaluation of an integrated intervention for CHWs, IDUs, and their family members (FMs) in Vietnam. In Phase 1, intervention topics, format, delivery procedures, and supporting materials are developed through a series of focus group discussions. In Phase 2, implementation pilot and process evaluation are conducted to collect feedback from participating CHWs, IDUs, and their FMs by in-depth interviews in two commune health centers. In Phase 3, we conduct an intervention trial (CHW CARE intervention) in 60 commune health centers (5 CHWs, 15 IDUs and 10 FMs from each commune center), totaling 300 CHWs; 900 IDUs and 600 FMs. Randomization occurs at the commune level (30 communes assigned to the intervention group; 30 communes assigned to the control group). At each commune assigned to the intervention, the intervention is delivered to CHWs first, and the participating CHWs are required to conduct individual and group sessions with IDUs and FMs in their communes. The efficacy of the intervention is assessed at baseline, 3, 6, 9, and 12-month follow-ups by comparing outcome measures of CHWs, IDUs and FMs in the intervention group to those in the control group. Relationships between the intervention outcomes of CHWs, IDUs, and FMs are explored.

Project number: 4R01DA03360-05

Teens and Adults Learning to Communicate (TALC: LA)

Project TALC was funded by the National Institute of Mental Health (NIMH) to evaluate the efficacy of a family-based intervention over time and to contrast the life adjustments of HIV-affected families and their non-HIV-affected neighbors in the current treatment era. Mothers living with HIV (MLH; n = 339) and their school-age children (n = 259) were randomly assigned to receive a behavioral intervention or standard care as the control condition. MLH and their children were compared to non-HIV-affected families recruited at neighborhood shopping markets.

Targeted Risk Group: 

HIV-positive mothers and their adolescent children

Published Journal Articles:

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Links to Interventions, Training Manuals, etc. : 

 Phase 1 – Taking Care Of Myself

Parents’ Curriculum

Phase 2 – Illness

Parents’ Curriculum

  1. TALC LA- Parents Phase 2, Sess 1: What Are My Children's Needs?
  2. TALC LA- Parents Phase 2, Sess 2: Who Will Take Care of My Children?
  3. TALC LA- Parents Phase 2, Sess 3: What Kind of Arrangements Can I Make?
  4. TALC LA- Parents Phase 2, Sess 4: How Do I Start My Plan?
  5. TALC LA- Parents Phase 2, Sess 5: How Can I Really Listen To My Children?
  6. TALC LA- Parents Phase 2, Sess 6: How Can I Tell My Children What I Feel?
  7. TALC LA- Parents Phase 2, Sess 7: How Should I Deal with Problem Behavior?
  8. TALC LA- Parents Phase 2, Sess 8: How Can We Create a Positive Atmosphere at Home?
  9. TALC LA- Parents Phase 2, Sess 9: How Can We Resolve Conflicts at Home? (Part 1)
  10. TALC LA- Parents Phase 2, Sess 10: How Can We Resolve Conflicts at Home? (Part 2)
  11. TALC LA- Parents Phase 2, Sess 11: How Can We Work Together on Selecting a Custodian?
  12. TALC LA- Parents Phase 2, Sess 12: How Can We Deal with Drugs and Alcohol?
  13. TALC LA- Parents Phase 2, Sess 13: How Do I Prevent Pregnancy and Fatherhood?
  14. TALC LA- Parents Phase 2, Sess 14: Where Am I in Making a Custody Plan?
  15. TALC LA- Parents Phase 2, Sess 15: How Can Mothers Encourage Safer Sex?
  16. TALC LA- Parents Phase 2, Sess 16: What is the Mother's Legacy and the Youth's Goals?

 Adolescents’ Curriculum

Phase 3 – Adjustment

New Caregivers and Teens’ Curriculum

  1. TALC LA- New Caregivers and Teens Phase 3, Sess 1: What Do Adolescents and Caregivers/Parents Need from Each Other?
  2. TALC LA- New Caregivers and Teens Phase 3, Sess 3: Dealing with Loss and Grief - Part I
  3. TALC LA- New Caregivers and Teens Phase 3, Sess 4 (Caregivers): Raising an Adolescent
  4. TALC LA- New Caregivers and Teens Phase 3, Sess 4 (Youths): Planning for My Future - Part I
  5. TALC LA- New Caregivers and Teens Phase 3, Sess 5: Dealing with Loss and Grief - Part II
  6. TALC LA- New Caregivers and Teens Phase 3, Sess 6: How Can We Improve Communication - Part I (Effective Expressing)
  7. TALC LA- New Caregivers and Teens Phase 3, Sess 7: Ways of Helping Someone Cope with Loss and Grief
  8. TALC LA- New Caregivers and Teens Phase 3, Sess 8: How Can We Improve Communication - Part II (Active Listening and Responding)
  9. TALC LA- New Caregivers and Teens Phase 3, Sess 9 (Caregivers): Caregiver Support
  10. TALC LA- New Caregivers and Teens Phase 3, Sess 9 (Youths): How Do I Achieve My Goals?
  11. TALC LA- New Caregivers and Teens Phase 3, Sess 10: (Joint) How Can We Deal With Anger in the Relationship?
  12. TALC LA- New Caregivers and Teens Phase 3, Sess 11: How Can I Cope with Sadness?
  13. TALC LA- New Caregivers and Teens Phase 3, Sess 12 (Caregivers): How Should I Deal with Problem Behavior?
  14. TALC LA- New Caregivers and Teens Phase 3, Sess 12 (Youths): How Do I Deal with Fear?
  15. TALC LA- New Caregivers and Teens Phase 3, Sess 13: How Do We Practice Safer Sex, Prevent Pregnancy, and Reduce Alcohol and Drug Use?
  16. TALC LA- New Caregivers and Teens Phase 3, Sess 14: How Can We Resolve Conflicts at Home?
  17. TALC LA- New Caregivers and Teens Phase 3, Sess 15: How Can We Create a Positive Atmosphere at Home?
  18. TALC LA- New Caregivers and Teens Phase 3, Sess 16: Looking to the Future Together, What Can We Do?

Young Adults’ Curriculum

  1. TALC LA- Young Adults Phase 3, Sess 1: How Are Things Going?
  2. TALC LA- Young Adults Phase 3, Sess 2: Planning for My Future - Part I
  3. TALC LA- Young Adults Phase 3, Sess 3: Dealing with Loss and Grief - Part I
  4. TALC- Young Adults Phase 3, Sess 4: Where and How Can Young People Get Support?
  5. TALC LA- Young Adults Phase 3, Sess 5: Dealing with Loss and Grief - Part II
  6. TALC LA- Young Adults Phase 3, Sess 6: Ways of Coping with Loss and Grief
  7. TALC LA- Young Adults Phase 3, Sess 7: Planning for My Future (Part II) - How Do I Achieve My Goals?
  8. TALC LA- Young Adults Phase 3, Sess 8: Hearing and Getting Heard
  9. TALC LA- Young Adults Phase 3, Sess 9: How Can We Deal with Anger?
  10. TALC LA- Young Adults Phase 3, Sess 10: Relationships and Sex (Part 1)
  11. TALC LA- Young Adults Phase 3, Sess 11: Relationships and Sex (Part 2)
  12. TALC LA- Young Adults Phase 3, Sess 12: How Can I Cope with Sadness?
  13. TALC LA- Young Adults Phase 3, Sess 13: Pregnancy and Parenthood
  14. TALC LA- Young Adults Phase 3, Sess 14: How Do I Deal with Fear?
  15. TALC LA- Young Adults Phase 3, Sess 15: How Can I Reduce Substance Use?
  16. TALC LA- Young Adults Phase 3, Sess 16: Looking to the Future

Intervention Model: 

Mothers and their adolescents attended a 16-session cognitive behavioral intervention over eight weeks. For MLH, intervention goals aimed to: 1) improve parenting while ill (i.e., reduce family conflict, improve communication, clarify family roles); 2) reduce mental health symptoms; 3) reduce sexual and drug transmission acts; and 4) increase medical adherence and assertiveness with medical providers. For adolescents, the intervention goals were to: 1) improve family relationships; 2) reduce mental health symptoms; 3) reduce multiple problem behaviors (e.g., drug use, criminal justice acts, school problems, teenage pregnancy); and 4) school retention.

Research Methods:

In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a control group on mental health and health behaviors, including sexual behavior and substance use. Both intervention and control families were compared to a neighborhood cohort, matched on sociodemographics. Because study participants were followed over two years, longitudinal random effect regression models were used to test the efficacy of the intervention.

Surveys and Scales Used:

  1. Living Situation, Including Neighborhood Problems - Scale
  2. Religion: Attendance and Experience
  3. Financial, Labor, and Educational Experience - Scale
  4. Loss and Grief - Scale
  5. Treatment History - Survey
  6. Social Support - Survey
  7. Romantic Relationships - Survey
  8. Needle Use and Sharing - Survey
  9. Reproductive Health - Survey
  10. Parentification - Survey
  11. Goals Scale
  12. Natural Mentors
  13. Dealing with Mother's Illness - Survey
  14. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
  15. Sexually Transmitted Disease - Survey
  16. Medication Adherence - Survey
  17. Educational (Academic) Experience Assessment
  18. Family Functioning - Scale
  19. Family Composition - Scale
  20. Employment and Labor Experience Assessment - Survey
  21. World Health Organization Quality of Life (WHOQOL) - Survey
  22. Self Harm: Suicide History - Survey
  23. CDC Sexual Behavior Questions (CSBQ)
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  25. Detention and Jail History Assessment - Survey
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  27. Alcohol and Other Drug Abuse (AOD) - Scale
  28. Adolescent Substance Use - Survey
  29. PTSD Index for DSM IV (Adolescent version) - UCLA
  30. Parker Parental Bonding Instrument
  31. Positive and Negative Affect Scale (PANAS)
  32. Network Assessment
  33. Janis Self-Esteem - Scale
  34. Medical Outcomes Study (MOS) Social Support - Survey
  35. Living Situation for Adolescents - Survey
  36. Life Outcome Expectancies Assessment - Survey
  37. Life Goals Assessment - Survey
  38. Life Events Assessment - Survey
  39. House Rules - Scale
  40. HIV Related Incidents - Survey
  41. Healthcare Utilization, Providers, and General Health Assessment: Including STD and Pregnancy - Survey
  42. HIV Testing Assessment - Survey
  43. General Medical History Assessment
  44. Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder
  45. Conflict Resolution - Conflict Tactics Scale (CTS)
  46. Adult Adolescent Parenting Inventory (AAPI) - Survey
  47. Nutrition and Exercise - Survey
  48. Rosenberg Self-Esteem (RSE) - Scale
  49. Dealing with Illness - Scale

Local Significance: 

There was a lack of significant findings for an intervention effect on HIV-transmission behaviors and mental health. HIV-transmission behaviors were low to begin with and participants had little room for improvement. The populations affected by the HIV epidemic in the U.S. have shifted over the past number of years since a similarly mounted intervention in New York City led to improvements. HIV interventions in the U.S. need to shift their focus to persons living with HIV who are experiencing substantial problems.

International Significance:

While the focus of U.S.-based HIV interventions need to shift, interventions for the general HIV population may be effective outside the U.S.

Family-Focused HIV Disclosure Intervention in Thailand

This is a Mentored Research Scientist Development Award (K01). HIV disclosure is a key stressor among HIV-affected families in Thailand, and the impact radiates throughout the family. By addressing HIV disclosure as a family matter, the proposed study aims to develop and pilot a culturally tailored intervention in Northeastern Thailand in Nakhon Ratchasima Province.

In Phase 1, formative research will be conducted using in-depth interviews with 20 People Living with HIV (PLH), 20 family members, and 10 healthcare providers to explore the concerns, barriers and motivators around HIV disclosure.  In Phase 2, we will develop a culturally tailored HIV disclosure intervention by engaging 20 PLH through a series of focus groups.  In Phase 3, we will pilot test the intervention with 40 PLH and compare their physical, psychological and social outcomes with the outcomes of 40 PLH in the standard care group. Follow-up assessments with PLH will be conducted at 6 months.

 

Recruiting and Engaging Adolescents in Creating Hope (Project REACH)

Project REACH aims to create an effective recruitment and retention method for family interventions for substance abuse and adapt culturally-appropriate substance abuse programs targeting African American adolescents who are enrolled in Los Angeles County Office of Education (LACOE) schools and their parents (parents includes an adult guardian).
Targeted Risk Group: 
Probation youth and their families in Los Angeles
Research Methods: 
The project has two phases. The first phase is to develop an effective way to recruit families into a family intervention for substance abuse and determine how to make the intervention culturally appropriate. The family intervention that will be adapted for this project is Families that Care: Guiding Good Choices ((aka “Preparing for the Drug Free Years”) (GGC). GGC has been proven to reduce substance abuse, address family conflict through problem solving and communication techniques, and finally increase family connectedness. These activities will be done in collaboration with school administrators, probation officials, teachers, students and parents through key informant interviews and focus groups. The second phase will pilot test the adaptation of GGC in a sample of 60 African American from LACOE schools and their parents.
Local Significance: 
Expect to improve recruitment and retention in GGC, and GGC will improve family functioning and mental health, and decrease problem behaviors (HIV risk behaviors, school performance and recidivism).

Vietnam – Development of a Family Intervention to Address Drug Use and HIV in Vietnam

This two-year study will be conducted in Phu Tho Province, Vietnam in collaboration with the Vietnam National Institute of Hygiene & Epidemiology (NIHE). This study will develop and pilot an intervention aimed at increasing family support for IDU’s behavior change and family capacities to effectively cope with the impact of IDUs and HIV.

Targeted Risk Group: 

IDUs, family members

Intervention model: 

Planned behavior change, Stages of change, and Psych-education

Research Methods: 

• Focus group to develop the content, format and delivery plan for the intervention
• Intervention will be delivered to 40 IDUs and 40 their family members
• Assessments will be conducted with 80 IDUs and 80 Family members at baseline, 3-month and 6-month follow-ups.

Local Significance: 

The findings from the study will inform the design of the full-scale intervention trial for families coping with IDU and/or HIV in Vietnam. By addressing HIV and IDUs, this intervention could potentially reduce the psychological, physical and emotional demands of living with chronic HIV, coping with drug use, and improve the safety of society. A dissemination of the intervention design to district hospitals in Vietnam can improve the lives of families in dealing HIV and IDUs.

International Significance: 

This study demonstrates a model to combine traditional drug use treatment with psychosocial and behavioral intervention. This can be applied to other countries with different cultures.

Grief Interventions for PLAs, Adolescents and Guardians

By the year two thousand, 80,000 children will be orphaned by AIDS in the U.S. and this number will continue to rise. Parental death during one’s childhood has been consistently associated with negative outcomes for children, however, there have been no prospective studies of adolescent bereavement from any type of parental death, including death from AIDS. This continuation study is aimed at delivering and evaluating an intervention to alleviate grief associated with the death of a parent. These results are likely to have implications for millions of AIDS orphans internationally and for the 550,000 US adolescents bereaved annually by parental death.

Scope:

Over the last two and a half years, 310 parents living with AIDS (PLAs) and their 498 adolescent children, age 12-18 were recruited. They were randomly assigned to receive: (1) a standard care condition in which extensive social welfare services are provided; or (2) an enhanced care condition in which three modules of coping skills intervention (Project TALC: Teens and Adults Learning to Communicate) plus social services are provided. Linked to the phases of parental illness, PLAs, their adolescents, and new custodial guardians are schedule to meet individually and jointly in over 32 sessions. Because the life span of women with AIDS extended from 14.3 months to 27 months over the last two years, about two thirds of the sample of PLAs continue to live longer than anticipated, delaying the delivery of the final intervention module. Over the next 18 months, the investigator anticipates that the PLAs will die, and the final, post-death module of the intervention will be delivered. The present continuation study will allow the investigator to complete the delivery and the evaluation of the intervention, and in addition, pursue the following activities: (1) follow youths of PLAs prospectively and longitudinally for four additional years to evaluate their mental health, behavioral, and social outcomes; (2) complete the delivery and evaluation of the enhanced coping skills intervention, particularly of Module 3 to new custodial guardians and youths; and (3) develop new measures of grief to describe the bereavement process over time.

Parents living with AIDS reported a mean of 3.3 (SD=1.3) areas of conflict with their adolescents and 1.5 (SD=1.7) stressful parenting events over the previous three months. The parents were very ill, with many physical symptoms and diseases. Simultaneously, substance use was common (17% used daily), but not injection drug use (3.3%). Half had a sexual partner (63% protected partners by using condoms consistently). Regression analysis revealed that parent-adolescent conflict was significantly associated with high parental drug use: stressful parent events were significantly related to the lifestyle (high drug use and frequent sex acts) of Latino and African-American parents, but not white parents. In contrast to parents with other illnesses, parent-adolescent conflict and stressful parenting events were not influenced by parents’ health status, but were significantly influenced by substance use and sexual lifestyles. Both mothers (87%) and fathers were significantly more likely to disclose their serostatus to adolescents (73%), compared to younger children (23%). Only 44% disclosed to all their children; 11% disclosed to none. Most PLAs (80%) discussed custody plans; however, only 30% initiated legal plans, typically for younger children. Adolescents informed of their PLA’s serostatus engaged in more sexual risk acts, smoked more cigarettes, reported more severe substance use, and greater emotional distress than did uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or followup.

National Institute of Mental Health, grant 2R01MH49958-06

IMAGE Program

The incidence of HIV is high among women of childbearing age in the U.S., and mothers living with HIV (MLH) report their greatest source of stress is combining the maternal role with the psychological and medical demands of coping with a chronic, life-threatening condition.

The purpose of this R01 pilot study is to develop and then test the feasibility of implementing a parenting intervention for HIV-infected mothers with well children age 6–14 years old.  The intervention is designed to improve parenting skills and maternal self-care skills in order to improve child and maternal outcomes.  The basis for development of this intervention is work from two previous R01s (MH # 5R01MH057207, currently Yr. 12) designed to longitudinally assess HIV-positive mothers and their children.

MLH (n = 60) and their children (total N = 120) will be recruited, randomized to a theory-based, skills training intervention or a control condition, and assessed at baseline and 3, 6, and 12-month follow-ups.  The intervention (“Improving Mothers’ parenting Abilities, Growth, & Effectiveness”—the IMAGE program) will consist of 5 sessions, and will be based on the Information – Motivation – Behavioral Skills (IMB) model of health behavior change, with specific skills selected based on our 10-year observational study of MLH and their children, which is on-going at UCLA.  A random subset of 40% of the intervention mothers (n = 12) will be asked to participate in an in-depth qualitative interview after their last follow-up, to obtain detailed process information on their experiences in the intervention.

The main aims of this randomized pilot trial are to:

  1. Develop the intervention and then evaluate the feasibility and acceptability of implementing the 5-week, theory based, individual behavior intervention to enhance positive parenting skills of MLH; and
  2. Conduct preliminary evaluation of the data for effect sizes and investigate trends in the data for
      • Parenting practices outcomes (utilizing the parent practices scale), and secondary outcomes of parenting efficacy
      • Parenting behaviors targeted (parent-child communication, parental monitoring, family routines, and appropriate parentification) and the self-care skills targeted (social support, disclosure, dealing with perceived stigma)
      • Maternal outcomes for mental health indicators and physical health indicators
      • Child outcomes of mental health indicators, behavioral problems, and self-concept and coping
      • Family outcomes (family functioning, parent-child relationship)

We are now in the third decade of the HIV epidemic, and few interventions, other than for prevention or medication adherence, are available for women living with HIV; this study will be the first step in the evaluation an intervention that will assist HIV-positive mothers in dealing with the stress of parenting while coping with HIV. The pilot data will lead to a future application for a full-scale trial of the intervention to test efficacy.

Teens and Adults Learning to Communicate (TALC: NYC)

Teens and Adults Learning to Communicate

Project TALC was funded by the National Institute of Mental Health (NIMH) and is an intervention designed to improve behavior and mental health outcomes among parents with AIDS and their adolescent children. The study sample was comprised of 307 financially-needy, AIDS-infected parents in New York City and 412 adolescent children. The majority (80%) of the parents were mothers. Approximately one-half of the study participants were Latino and over one-third were African American.

Targeted Risk Group: 

AIDS-infected parents and their children

 Intervention model:

Cognitive behavioral intervention comprised of two modules. The first module was for parents only (8 sessions) and focused on coping with the HIV illness and disclosure. The second module was for parents and their adolescents (16 sessions) and focused on ways to plan a legacy, e.g. making custody arrangements.

 Research Methods: 

In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a control group on mental health and health behaviors, including sexual behavior and substance use. Because participants were followed over time, longitudinal random effect regression models were used to test the efficacy of the intervention.

 Local Significance: 

Over the two-year follow-up period, adolescents assigned to take part in the intervention reported significantly and substantially lower levels of emotional distress, conduct problems, and family-related stressors and higher levels of self-esteem than did control group adolescents.

 International Significance: 

Project TALC provided a behavioral intervention that can be adapted for other countries and cultures to improve behavior and mental health outcomes among parents with AIDS and their adolescent children.

Published Journal Articles:

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Please see TALC LA for the up-to-date intervention manuals.

Surveys and Scales Used: 

  1. Needle Use and Sharing - Survey
  2. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
  3. Medication Adherence - Survey
  4. Self Harm: Suicide History - Survey
  5. CDC Sexual Behavior Questions (CSBQ)
  6. Health Belief Model: Self-Efficacy for Sexual Discussion (HBMSD) - Scale
  7. Self-Efficacy to Refuse Sexual Behavior (RSB) - Scale
  8. Self-Efficacy for Limiting Substance Use - Scale
  9. Self-Efficacy for Negotiating Condom Use - Scale
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  11. Detention and Jail History Assessment - Survey
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  13. Alcohol and Other Drug Abuse (AOD) - Scale
  14. Dealing with Illness - Scale
  15. Rosenberg Self-Esteem (RSE) - Scale
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  17. Parker Parental Bonding Instrument
  18. Network Assessment
  19. Life Events Assessment - Survey
  20. HIV Related Incidents - Survey
  21. Healthcare Utilization, Providers, and General Health Assessment: Including STD and Pregnancy - Survey
  22. HIV Testing Assessment - Survey
  23. Global HIV Competence Assessment - Scale
  24. Getting Services Assessment - Survey
  25. General Medical History Assessment
  26. Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder
  27. Composite International Diagnostic Interview (CIDI)

Support To Reunite, Involve and Value Each Other (STRIVE)

The STRIVE program aimed to improve residential stability and the quality of residential life, reduce the number of runaway episodes, as well as reduce HIV-related sexual and substance use risk acts. Family conflict is found to cause runaway episodes for youth. Targeting newly homeless youth, this study developed and implemented a 5-session family-based intervention. STRIVE sessions take place with families while youth are still in shelters and/or being served by community agencies, and as they transition back to the home.

Surveys and Scales Used: 

  1. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
  2. AIDS Knowledge and Attitude - Survey
  3. Adult Attachment Scale (AAS)
  4. Educational (Academic) Experience Assessment
  5. Family Interdependence - Scale
  6. Family Functioning - Scale
  7. Family Assessment Measure III - Scale
  8. Employment and Labor Experience Assessment - Survey
  9. University of Rhode Island Change Assessment (URICA)
  10. Teaming African American Parents with Survival Skills (TAAPSS) - Survey
  11. Spiritual Intuition Inventory (Religion) - Survey
  12. Self Harm: Suicide History - Survey
  13. Social Support Microsystem Scale (SOC)
  14. Health Belief Model: Intentions for Safer Sex (HBMI) - Scale
  15. Michigan Alcoholism Screening Test (MAST) - Survey
  16. Alcohol/Drug: Drug Abuse Screening Test (DAST) - Adolescent Version
  17. Alcohol/Drug: Drug Abuse Screening Test (DAST) - Parent Version
  18. Runaway Episodes - Survey
  19. Residential Stability (RS) - Survey
  20. Reasons for Leaving Home (RLH) - Survey
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  22. Proactive Attitude Scale (PAS)
  23. Health Belief Model: Perceived Susceptibility (HMBP) - Scale
  24. Parental Monitoring Assessment (PMA)
  25. Parker Parental Bonding Instrument
  26. Parent Involvement & Supervision - Scale
  27. NSBA Religious Involvement - Survey
  28. Multiple Problem Behavior: Sex Work - Survey
  29. The Mini-Mental State Exam (MMSE) - Scale
  30. McMaster Family Assessment Device (FAD) - Scale
  31. Inventory of Parent and Peer Attachment (IPPA)
  32. House Rules - Scale
  33. Getting Services Assessment - Survey
  34. Difficulties in Emotion Regulation Scale (DERS)
  35. Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder
  36. Conflict Resolution - Conflict Tactics Scale (CTS)
  37. Autonomy Self Report: Adolescent Autonomy - Scale
  38. AIDS Risk Behavior Assessment (ARBA) - Scale
  39. PTSD Index for DSM IV (Adolescent version) - UCLA
  40. Positive Attitudes Toward Living at Home - Survey

Targeted Risk Group: 

Newly homeless youth in Los Angeles

Intervention model: 

A behavioral family-based intervention model was used to address family conflict and promote positive family-child interactions.

Research Methods: 

This study consisted of two phases Phase 1 was focus groups and key informant interviews to develop research design, measures, an intervention activities. Phase 2 implemented family intervention sessions with baseline and 3, 6, 12, 18, 24 month follow ups.

Local Significance: 

Positive outcomes for reducing HIV risk behaviors and improving mental health.

International Significance: 

N/A
 

Teaching, Raising, and Communicating with Kids (TRACK)

The purpose of this 3-year R01 is to test the preliminary efficacy of an intervention to assist HIV-infected mothers to disclose their serostatus to their young (age 6 – 12 year old), well children.

The basis for development of this intervention is work from two R01s (MH # 5R01MH057207, currently Yr. 09) designed to longitudinally assess HIV-positive mothers and their children, which included studies on maternal disclosure (e.g., Murphy, Marelich, & Hoffman, 2002; Murphy, Marelich, Hoffman, & Schuster, 2006; Murphy, Roberts, & Hoffman, 2002; Murphy, Roberts, & Hoffman, 2003; Murphy, Roberts, & Hoffman, 2006; Murphy, Steers, & Dello Stritto, 2001).  This research suggests disclosure is difficult for mothers living with HIV (MLWHs), and that outcomes for both mothers and children could be improved by the proposed intervention.

Information gathered in the previous two R01s will be used to develop a brief disclosure intervention.  MLWHs (N = 80) will be randomly assigned to the intervention or control condition.  MLWHs and children (N = 160) will be assessed at baseline, 3, 6, and 9-month follow-ups. A random subset of intervention mothers (n = 12) will be asked to participate in an in-depth qualitative interview after their last follow-up, to obtain detailed process information on their experiences in the study.

The aims of the intervention are to:  improve mother-child communication and parenting skills—particularly as they relate to disclosure.  As a result of the intervention aims, other primary and secondary outcomes include:  increasing readiness to disclose, and disclosure itself; improving both MLWH and child mental health indicators; reducing child behavioral problems, and improving the parent-child relationship and family functioning.

This study will provide important prospective, longitudinal data on MLWHs’ adjustment to having disclosed their serostatus, and their children’s adjustment to the disclosure. Previous research indicates that for some families, maternal and child psychological distress may increase immediately following disclosure, but will decrease over time; the longitudinal design of this study will allow us to follow mothers and children throughout the disclosure process.

The study will allow evaluation of maternal and child characteristics that may moderate or mediate the impact of disclosure. Finally, process evaluations for each intervention session as well as in-depth qualitative interviews with a subset of MLWHs who attended the intervention will provide information on issues that need to be addressed prior to a full-scale trial of the disclosure intervention.  Few interventions, other than for prevention or medication adherence, are available for women living with HIV; this study will evaluate an intervention that will help HIV-positive mothers deal with a serious family issue.

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