Youth and Adolescents – Page 2 – CHIPTS – Center for HIV Identification, Prevention and Treatment Services

20Jan

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:

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

20Jan

Street Smart (US)

Runaway and homeless youth have a national seroprevalence rate of 2.3%, a rate about six times higher than adolescents in the major AIDS epicenters.

Links to Interventions, Training Manuals, etc. :

Targeted at homeless and runaway youth, the Street Smart intervention was designed to reduce high-risk sex and drug using behaviors that can lead to HIV infection. However, 12 months after the original intervention, relapse occurred in approximately 15% of those who had previously changed their behavior, and long-term effects were only found in girls. Street Smart: Skills Maintenance addressed the problem of relapse by delivering an additional intervention post-Street Smart, Stayin’ Street Smart. Stayin’ Street Smart was a website that provided skill training, social support, informational updates, and access to an expert for consultation, including problem solving for emerging crises.

In addition to measuring the effectiveness of the maintenance intervention, Street Smart: Skills Maintenance examined the program’s effect over time on multiple problem behaviors (sex work, conduct problems, delinquency, school/employment, violence, chronic homelessness), examined the acceptability of the strategies by youth, and documented patterns of maintenance over time.

Participants:

Approximately 474 homeless and runaway youth between the ages of 12-24 were recruited through community-based agencies and homeless shelters in Los Angeles, CA.

Targeted Risk Group:

Homeless and runaway youth between the ages of 12-24

Local Significance:

Research on the use of Street Smart documented positive outcomes in reducing sexual risk behaviors among females and substance use among both male and female runaways over 2 years (Rotheram-Borus et al. 2003). Outcomes from Street Smart: Maintenance have not been published.

International Significance:

Globally, there are approximately 100 million homeless youth (UNICEF 1989). Strategies to maintain reductions in sexual risk behaviors and substance use found to be effective in homeless and runaway youth in the United Stated could be adapted to help homeless and runaway youth in other countries

20Jan

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.

20Jan

CLEAR Uganda; SUUBI Project

Choosing Life Empowerment Action Results is a behavioral change research project being implemented by Uganda Youth development Link (UYDEL) in collaboration with support from University of California, Los-Angeles. It is a result project known as CLEAR tried in the USA in the cities of Los Angeles and New York by the Center for Community Health (CHIPTS) to assist young people living with HIV/AIDS. Uganda and Kampala in particular, face increasing numbers of HIV/AIDS infections among young people living on the streets and slums. This project targets street and slum youth, 13-23 years living with HIV/AIDS in Rubaga and Kawempe Divisions of Kampala district.

Interventions, Training Manuals, etc. :

Original RCT Protocol 1998-2002

Module 1

Module 2

Module 3

Workbooks

20Jan

Choosing Life: Empowerment, Action, Results! (CLEAR) for Comprehensive Risk Counseling and Services (CRCS)

CLEAR-CRCS is an evidence based HIV prevention and health promotion intervention developed for people living with HIV enrolled in Comprehensive Risk Counseling and Services (CRCS). It is a client-centered program delivered one-on-one with clients who are having difficulty initiating or sustaining behaviors that prevent HIV transmission and reinfection. The program teaches clients cognitive-behavioral strategies to cope with triggers and other stressful situations that lead to risky behaviors and unhealthy choices. The goal of CLEAR-CRCS is to help these people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. CLEAR-CRCS is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.

CLEAR-CRCS is structured such that the CRCS provider can individually tailor the program to address the unique needs of each client. The program consists of six foundational sessions that teach the core behavioral strategies of the program. Within these initial sessions, the client also develops a personal life goal and his or her prevention plan which will direct the focus of subsequent sessions. The provider then has a menu of 21 sessions to choose from in which the client can practice and apply the core strategies to realize his or her goals. The sessions in the menu address five domains: sexual behavior, substance use, treatment adherence, mental health, and successful disclosures.

Research on the original CLEAR Intervention: The original CLEAR study was conducted from 1999-2003 with an ethnically and culturally diverse group of substance using young people living with HIV/AIDS. The intervention was conducted as a multi-site trial in Los Angeles, San Francisco, and New York. The study demonstrated a significant increase in protected sexual acts, such as using condoms, with all partners and with HIV-negative partners.

Underlying Theory and Principles: The intervention was developed based on the social action theory. Social action theory stresses the importance of social interactions and environmental factors in a person’s ability to control behaviors that may endanger his or her health. It incorporates the principles that are expressed in traditional social-cognitive models of health-behavior change, including social-cognitive theory, the health belief model, and the transtheoretical model (stages of change). CLEAR-CRCS is predicated on the notion that behavior change depends both on a person’s belief that he or she can change a behavior (self-efficacy) and the beliefs that changing the behavior will result in a desired outcome (response efficacy).

Interventions, Training Manuals, etc. :

For the most current CDC manuals please CLICK HERE visit the DEBI website.

CURRENT Manuals from CDC funded work for DEBI:

Original RCT Protocol 1998-2002

Module 1

Module 2

Module 3

Workbooks

Telephone Conference Call Groups

NOTE: The original randomized controlled trial had a telephone group format that was not feasible for youth at that time. Only the 1st module was completed, but it is in included here for reference. The activities can be adapted and used for more current interventions.

Surveys and Scales Used:

20Jan

Youth LIGHT

Youth LIGHT was a study to address critical gaps in research on HIV/AIDS prevention with high risk youth, offering an opportunity to shift patterns of sexual risk behaviors among delinquent youth at risk of becoming HIV seropositive adults. An intervention with established efficacy for high risk adults, Project LIGHT, was adapted for high risk adolescents. Youth LIGHT tested the hypothesis that a computerized version of Project LIGHT would be as efficacious as the interpersonal, small-group delivery of the intervention in reducing the sexual risk behaviors of delinquent youths. Youth LIGHT was intended to appeal to youth by changing the traditional methods for teaching and sharing information while getting them to think about their HIV and STI risk behaviors. The study was conducted in partnership with the Los Angeles County Office of Education, and the Juvenile Division of the Superior Court for the County of Los Angeles.

Targeted Risk Group:

Male and female at-risk youth between 14-21 years old, attending LA County alternative education high schools located in the community and in juvenile hall camps.

Interventions, Training Manuals, etc. :

Youth Light Workbook

Session 1: Introductory education/preparedness – basic information about HIV/AIDS; motivation for self-protection
Know one another, and begin to learn each other’s names.v Learn about the project (schedule, ground rules, payment). Begin to develop a sense of group cohesion, identity and ownership by participating in group activities and developing group rules and rituals. Group activity to distinguish facts and myths about AIDS. Identify personal values and positive reasons to stay healthy through group brainstorm. Identify one personal risk factor for AIDS. Identify positive changes they have already made in their lives. Begin to learn about AIDS prevention strategies including condom use and HIV testing.	Meet the animated characters featured throughout the programv Learn about the project Introduce and explain the workbook Identify personal values and positive reasons to stay healthy by computer activity and workbook Play game to distinguish facts and myths about AIDS. Complete computerized personal risk assessment and receive feedback regarding likely risk of contracting HIV or other STD. Learn facts and statistics regarding HIV transmission and infection Complete quiz regarding HIV transmission
Session 2: Identifying triggers – personal vulnerability; identifying personal antecedents to risk behavior
Relate one example of HIV/AIDS content encountered since the last session.v Watch video of persons living HIV Verbalize one personalizing comment indicating heightened vulnerability. Learn to define and identify “trigger” through a group brainstorm. Identify one past incident of personal risk behavior on worksheet. Identify one personal risk trigger on worksheet. Identify one personal goal for the coming session. Read and seriously consider signing a Contract of Commitment given by facilitators.	Watch video of young people living with HIVv Record in workbook one personalizing comment indicating heightened vulnerability. Learn to define and identify “trigger” through computer interaction. Record in workbook one past incident of personal risk behavior. Record in workbook one personal risk trigger. Choose one personal goal from a list to try before logging on again. Read and seriously consider signing the Contract of Commitment contained in the workbook. Complete quiz regarding triggers
Session 3: Controlling triggers – problem solving and cognitive self-instruction
Learn the basic steps of problem solving related to HIV risk reduction through a group exercise. Apply the problem-solving steps to a variety of hypothetical situations generated by the group that require the handling of risk triggers. Generate ask a group a personal list of self-statements to guide behavior change efforts. Set personal goal for handling at least one personally relevant trigger for next session.	Learn the basic steps of problem solving related to HIV risk reduction through interacting with animated character.v Apply the problem-solving steps through modeling from animated character and computer guided workbook exercise. Play game about strength of self-statements to guide behavior and record personal list of self-statements in workbook. Choose a goal related to handling a common and relevant trigger to try before logging on again. Complete quiz regarding steps to problem solving
Session 4: Condom skills – practice use of male and female condom; needle cleaning skills
Sort sexual activities by their safety level as a group.v Identify the safest condom and lubricant types available. Demonstrate the proper way to place and remove a male condom. Demonstrate the proper way to place and remove a female condom. Describe the proper way to clean needles.	Sort sexual activities by their safety level in a game.v Watch a demonstration of the proper way to place and remove a male condom Watch a demonstration of the proper way to place and remove a female condom Choose one personal goal from a list related to proper condom choice and use to try before logging on again Complete quiz regarding steps to proper use of male and female condoms
Session 5/6: Protecting myself– assertive communication
Identify “unwritten rules” of social behavior that can influence people to be unsafe.v Learn the three types of communication: assertive, aggressive, passive. Apply the TALK tools for refusing unsafe sex and/or requesting safe sex through role-play with other group members.	Learn how “unwritten rules” of social behavior can influence people to be unsafe.v Learn the three types of communication: assertive, aggressive, passive. Watch video of youth negotiating for condom use Apply the TALK tolls for requesting safe sex through interaction with avatar that is recorded and played back.
Session 6: Maintenance and relapse prevention – reinforcement of previous skills and advocacy
Identify situations that might lead to relapse.v Learn to deal effectively with potential relapse situations. Identify self-rewards for maintaining safer sex behavior Identify ways to make safer sex more enjoyable. Learn ways in which to “spread the word” about what was learned in the group	Learn how skills of problem solving and self talk can help one effectively deal with relapse through interacting with animated character.v Watch as animated characters identify self-rewards maintaining safer sex behavior. Watch as animated characters identify ways to make safer sex more enjoyable Learn steps with modeling from animated characters about ways to “spread the word” about what was learned from the program

Intervention model:

To illustrate the operations of the computer intervention, we have constructed a table which illustrates the parallel structure between the small group Project Light, and Project Light delivered via computer.

Research Methods:

Students aged 14 to 18 years attending 22 alternative education high schools located in the community and in juvenile hall camps were assessed at baseline and 3, 6 and 12 months. The baseline and follow-up assessments required about 1.5-hour to complete. Each recruitment school was randomized into one of three study conditions: 1) Interpersonal Intervention, 2) Computerized Intervention or, 3) Control. Students attending the same school received the same intervention condition.

Local Significance:

Results from the pilot of this study support the use of computers as a tool for HIV prevention. Youths receiving the computerized intervention were successful in reducing their sexual risk behaviors.

International Significance:

Computerized interventions, which are relatively easy to implement and sustain, appear to be a potentially effective means of promoting reductions in HIV-related sexual risk behaviors. Interactive computer programs may help youths learn skills to prevent HIV infection and instill in these youths the self-efficacy to apply these new skills. These attributes may be particularly useful in international settings where concerns of cost-effectiveness and ease in dissemination are of paramount importance.

Start of Project:

January 1, 2002

Previous page 1 2

Posts classified under: Youth and Adolescents

CURRENT Manuals from CDC funded work for DEBI: