Posts classified under: Mental Health

Community Health Study

There have been few attempts to monitor the risk behaviors and HIV seroprevalence among the general population.

Understanding the HIV epidemic in Los Angeles requires establishing an integrated, multilevel surveillance system for HIV, sexually transmitted diseases (STDs), and the Hepatitis C virus (HCV). Information about sexual and substance use risk behaviors, HIV seroprevalence, and public knowledge, attitudes, and norms regarding HIV are needed for public health planning. A surveillance system will be required in order for Los Angeles to maintain funding for Ryan White and other federal and state funding sources. To begin to develop a method for mounting a comprehensive surveillance system, the City of Los Angeles is planning a study examining the acceptability of anonymous HIV testing and volunteering information about one’s risk behaviors in order to allow planning for HIV-related services.

Most studies of HIV seroprevalence and risk behaviors have been conducted with subgroups identified at high risk for HIV: young gay men, injecting drug users, homeless adolescents, or seriously mentally ill adults. There have been few attempts to monitor the risk behaviors and HIV seroprevalence among the general population (not necessarily from identified high-risk groups). Before any comprehensive surveillance system can be established, the ability to monitor HIV in community settings and among households in neighborhoods with high rates of AIDS cases must be established. To fill this gap, a two-phase project is being initiated by the city in order to assess the acceptability of HIV testing and reporting one’s risk behaviors when approached: 1) in a household survey; or 2) in a neighborhood setting such as a shopping mall, grocery center, theater, or church.

First, the acceptability of gathering HIV-related information from a household will be examined by conducting a supplement to the Los Angeles Health Survey that will be mounted this summer. An anonymous telephone interview will be conducted with random digit dialing of households within the City of Los Angeles. Randomly selected telephone numbers (n=100) will be surveyed on knowledge of transmission of HIV, attitudes and norms towards members of high-risk groups (e.g., gay men) and infected persons, and willingness to anonymously be tested for HIV. All responses will be recorded unlinked from telephone numbers selected by random digit dialing; therefore the identify of all respondents will be unknown and can never be traced. From gathering this information, the acceptability of a household approach as a method of gathering information about HIV-related information will be assessed.

Second, a community with a high rate of AIDS cases will be selected. In this neighborhood, local leaders will be consulted to identify a strategy for sampling community members anonymously and in settings accessible to all community members. In shopping malls in both communities, adults will be asked to anonymously volunteer to participate in a survey of attitudes and norms regarding HIV prevention activities, recent sexual and substance use risks acts, and consent to a saliva-based HIV test. The results of any individual test results will not be available; unmarked samples will be collected in order to indicate a community seroprevalence rate. Interested individuals will be offered an incentive for participating in the survey and test. The willingness of adult members of the community to participate in a study anonymously will be evaluated. Similar to the telephone household survey, no identity of any participant will be obtained. Overall, community rates will be obtained, but no individual information regarding risk or infection status.

The results of these two activities will be used to inform the Los Angeles County Board of Supervisor’s decisions regarding the best method for establishing surveillance methods for HIV infection and predictions regarding the future routes and subgroups for HIV infection. Currently, the County is considering adopting a method of practitioners informing public health officials of all persons testing seropositive for HIV or for a system of unique identifiers for persons who test seropositive for HIV. Both of these systems rely on the identification of seropositive persons, an event that typically occurs about 10 years after a person has become infected. Alternative strategies for monitoring the epidemic, especially among communities with an emerging epidemic must be identified. These studies will inform the strategy selected by the County and may become a national model.

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.

Los Angeles County Methamphetamine Prevention Initiative

There is a significant unmet need in Los Angeles County for methamphetamine-specific training, and community service agencies and outreach workers need education and training on effective approaches to engage and serve persons in the community at risk. Training and technical assistance is also needed for service providers on the latest evidence-based methamphetamine treatment approaches.

More specifically, trainings are needed that cover methamphetamine-specific issues crucial for the development of skills by medical providers, clinicians and outreach workers serving clients who use methamphetamine and address specific concerns around providing culturally appropriate care for specific populations. These trainings address issues such as: mental health considerations, psychological complications, sexual and cybersex addiction and current evidence based treatments.

This training project included the following activities:

  • Providing consultation and technical assistance to the Los Angeles County Alcohol and Drug Program Administration (ADPA) and the Office of AIDS Programs and Policy (OAPP)
  • Developing training curricula and module for ADPA or OAPP-funded substance abuse or HIV/AIDS treatment providers
  • Developing and disseminating web-based training module
  • Providing in-service trainings for Los Angeles County Methamphetamine Task Forces
  • Providing in-service trainings for ADPA and OAPP-funded Drug Abuse and HIV prevention agencies serving young women
  • Providing tailored technical assistance

Mamekhaya

In South Africa, where a large portion of pregnant women are HIV positive, prevention of mother-to-child transmission of HIV (PMTCT) is an important endeavor. To improve the effectiveness of the standard PMTCT programs, the Mamekhaya program used peer mentoring and a culturally adapted cognitive behavioral intervention (CBI).
Research Methods:
HIV-positive pregnant women at the Gugulethu Midwife Obstetric Unit and at the Vanguard Community Health Center in Cape Town were invited to participate in the study. Participants at both sites received the standard PMTCT care; however, participants at the Gugulethu site received the Mamekhaya intervention.The first part of the intervention consisted of assigning a participant with a mentor mother through Mothers2mothers. The mentor mother was a woman who was HIV-positive, had recently had a child, and had received PMTCT and was doing well. Participants also attended group sessions of a cognitive-behavioral intervention. The sessions included information on living with HIV, preventing HIV transmission, parenting, social support, and mental health.
Local Significance: 
Participants in the Mamekhaya intervention had increased HIV knowledge scores, significantly increased social support, and significantly decreased depression scores compared to women in the control group.

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.

Los Angeles County HIV Needs Assessment

The Los Angeles Commission on HIV (COH), in conjunction with the Department of Public Health Office of AIDS Programs and Policy (OAPP) and the Prevention Planning Committee (PPC), developed the Los Angeles County HIV Needs Assessment (LACHNA). This comprehensive survey combined the PPC’s annual prevention survey with the COH’s assessment of service needs and gaps of persons living with HIV/AIDS. Key survey domains included: demographic information, benefit services, Medicare Part D, living situation, substance, psychological symptoms/complaints, medical care, medication adherence, oral health care, unmet need. The project was to conduct an analysis of the LACHNA data for the purpose of planning of HIV/AIDS care and treatment services in Los Angeles, CA.

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)

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:

 
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