Posts classified under: Youth and Adolescents

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.

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
  1.   CLEAR- Mod 1, Sess 1: Identifying My Strengths: Creating A Vision for the Future. (1.5 hrs)
  2.   CLEAR- Mod 1, Sess 2: I'm HIV-Positive: Attitudes as Barriers to Future Goals. (1.5 hrs)
  3.   CLEAR- Mod 1, Sess 3: Making Commitments: Evaluating and Changing Substance Use. (1.5 hrs)
  4.   CLEAR- Mod 1, Sess 4: Seeing the Patterns: Why Do I Use Drugs and Alcohol? (1.5 hrs)
  5.   CLEAR- Mod 1, Sess 5: Beliefs: Thoughts That Influence My Substance Use Patterns. (1.5 hrs)
  6.   CLEAR- Mod 1, Sess 6: Future Goals: The Impact of Using Drugs and Alcohol. (1.5 hrs)
  • Module 2
  1.   CLEAR- Mod 2, Sess 7: Higher Self and Sexual Decisions: Facing the Challenges. (1.5 hrs)
  2.   CLEAR- Mod 2, Sess 8: Higher Self and Sexual Decisions: Changing Risk Behaviors. (1.5 hrs)
  3.   CLEAR- Mod 2, Sess 9: Making Sexual Decisions: Having Safety and Pleasure. (1.5 hrs)
  4.   CLEAR- Mod 2, Sess 10: Making Sexual Decisions: Can I Use Condoms (Correctly)? (1.5 hrs)
  5.   CLEAR- Mod 2, Sess 11: Making Sexual Decisions: Can I Influence My Partner To Use Condoms? (1.5 hrs)
  6.   CLEAR- Mod 2, Sess 12: Making Sexual Decisions: How Do I Refuse Unprotected Sex? (1.5 hrs)
  • Module 3
  1.   CLEAR- Mod 3, Sess 13: Motivation for Change: Wanting to Stay Healthy (1.5 hrs)
  2.   CLEAR- Mod 3, Sess 14: Attending Health Care Appointments (1.5 hrs)
  3.   CLEAR- Mod 3, Sess 15: Participating In Medical Care: Communication and Decision-making Skills (1.5 hrs)
  4.   CLEAR- Mod 3, Sess 16: Medication Schedules: Can I Stay on Track? (1.5 hrs.)
  5.   CLEAR- Mod 3, Sess 17: Medication Schedules: More Tools to Stay on Track (1.5 hrs)
  6.   CLEAR- Mod 3, Sess 18: Maintaining My Progress: Focus on the Future. (1.5 hrs)
  •  Workbooks
  1. CLEAR Individual Workbook I (Prevention for HIV Positive Adult and Youths)
  2. CLEAR Individual Workbook II (Prevention for HIV Positive Adult and Youths)
  3. CLEAR Individual Workbook III (Prevention for HIV Positive Adult and Youths)

 

 

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.

Original RCT Protocol 1998-2002

  • Module 1
  1.   CLEAR- Mod 1, Sess 1: Identifying My Strengths: Creating A Vision for the Future. (1.5 hrs)
  2.   CLEAR- Mod 1, Sess 2: I'm HIV-Positive: Attitudes as Barriers to Future Goals. (1.5 hrs)
  3.   CLEAR- Mod 1, Sess 3: Making Commitments: Evaluating and Changing Substance Use. (1.5 hrs)
  4.   CLEAR- Mod 1, Sess 4: Seeing the Patterns: Why Do I Use Drugs and Alcohol? (1.5 hrs)
  5.   CLEAR- Mod 1, Sess 5: Beliefs: Thoughts That Influence My Substance Use Patterns. (1.5 hrs)
  6.   CLEAR- Mod 1, Sess 6: Future Goals: The Impact of Using Drugs and Alcohol. (1.5 hrs)
  • Module 2
  1.   CLEAR- Mod 2, Sess 7: Higher Self and Sexual Decisions: Facing the Challenges. (1.5 hrs)
  2.   CLEAR- Mod 2, Sess 8: Higher Self and Sexual Decisions: Changing Risk Behaviors. (1.5 hrs)
  3.   CLEAR- Mod 2, Sess 9: Making Sexual Decisions: Having Safety and Pleasure. (1.5 hrs)
  4.   CLEAR- Mod 2, Sess 10: Making Sexual Decisions: Can I Use Condoms (Correctly)? (1.5 hrs)
  5.   CLEAR- Mod 2, Sess 11: Making Sexual Decisions: Can I Influence My Partner To Use Condoms? (1.5 hrs)
  6.   CLEAR- Mod 2, Sess 12: Making Sexual Decisions: How Do I Refuse Unprotected Sex? (1.5 hrs)
  • Module 3
  1.   CLEAR- Mod 3, Sess 13: Motivation for Change: Wanting to Stay Healthy (1.5 hrs)
  2.   CLEAR- Mod 3, Sess 14: Attending Health Care Appointments (1.5 hrs)
  3.   CLEAR- Mod 3, Sess 15: Participating In Medical Care: Communication and Decision-making Skills (1.5 hrs)
  4.   CLEAR- Mod 3, Sess 16: Medication Schedules: Can I Stay on Track? (1.5 hrs.)
  5.   CLEAR- Mod 3, Sess 17: Medication Schedules: More Tools to Stay on Track (1.5 hrs)
  6.   CLEAR- Mod 3, Sess 18: Maintaining My Progress: Focus on the Future. (1.5 hrs)
  •  Workbooks
  1. CLEAR Individual Workbook I (Prevention for HIV Positive Adult and Youths)
  2. CLEAR Individual Workbook II (Prevention for HIV Positive Adult and Youths)
  3. CLEAR Individual Workbook III (Prevention for HIV Positive Adult and Youths)

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:

 

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

 

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

UNIVERSITY OF CALIFORNIA LOS ANGELES

 

PUBLIC HEALTH RELEVANCE: Unavailable

 

FOA: RFA-MH-05-008/ Study Section: ZMH1-ERB-N(03)

 

Project Start Date: 23-September-2005

Project End Date: 30-June-2010

Budget Start Date: 01-July-2007

Budget End Date: 30-June-2008

 

NIH Categorical Spending

Funding IC:  NATIONAL INSTITUTE OF NURSING RESEARCH / FY Total Cost by IC:  $579,263

 

 

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. : 

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

 

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.

 

 
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