Between 26,000 - 36,000 adolescent children of Parents Living With AIDS (PLWA) in New York City are at high risk for a cluster of negative outcomes, both during the stressful illness of their parent, as well as in the year following the parent's death. The numbers of adolescents surviving the death of their PLWA will increase exponentially each year, heightening the need for effective preventive interventions for these adolescents. The goal of this project will be to compare the effectiveness of two different intervention programs aimed at enhancing coping skills (interpersonal problem solving, self-instructions, and increasing pleasant activities): one that targets the adolescent alone and links the adolescent to peers through a computer network; and one that encourages the teens and mothers to collaboratively enhance their coping skills together in a workshop format. Regardless of the strategy adopted, the coping skills will be practiced on the tasks that are associated with different stages of AIDS illness (e.g., newly ill; ill, plan for death), including those following the death of the PLWA (e.g., custody plans and legacies). To evaluate the effectiveness of the interventions, 360 mothers with AIDS (PLWAs) with an adolescent aged 12-18 newly registered with the Division of AIDS Services in New York city will be randomly assigned to one of three conditions (n=120 each): 1) a computerized coping condition where adolescents are paid to utilize an interactive computer network with peers, with the computers located at 14 community-based agencies in New York City; 2) teen-mother coping condition in which a series of workshops are provided aimed at increasing the skills of the PLWA and the adolescent; or 3) a no treatment control condition. Assessed every three months over two years, the primary outcome measures are the adolescent's mental health (psychiatric distress, particularly depression and suicide, and self-esteem), risk behaviors (HIV-related sexual and substance use risk acts, trouble at school and with the criminal justice system, stability of living situation), and social adjustment (peer & family relationships and relationships with new guardians). The success of the intervention conditions at changing the adolescents' coping skills and the PLWAs' health status, and completion of illness-related tasks will be assessed as intermediate outcomes that will impact the adjustment of the adolescent at two years. Finally, differential effectiveness of the intervention will be examined based on the ethnicity, gender and age of the adolescent and initial health status of their mother. It is hypothesized that adolescents in both intervention conditions will show more positive mental health, fewer behavioral problems, and better social adjustment than the no-treatment control. The relative benefit of each of the active interventions is likely to be in different domains (e.g., less depression versus accomplishment of tasks), and the overall benefit will be demonstrated empirically over two years.
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| Milburn, Norweeta G; Rosenthal, Doreen; Rotheram-Borus, Mary Jane et al. (2007) Newly homeless youth typically return home. J Adolesc Health 40:574-6 |
| Rotheram-Borus, Mary Jane; Klosinski, Lee E; Etzel, Mark A (2007) Differences between proof-of-concept studies and effective implementation: routine, opt-out HIV testing in emergency departments. J Acquir Immune Defic Syndr 46:381-3 |
| Stein, Judith A; Rotheram-Borus, Mary Jane; Lester, Patricia (2007) Impact of parentification on long-term outcomes among children of parents with HIV/AIDS. Fam Process 46:317-33 |
| Rotheram-Borus, Mary Jane; Lester, Patricia; Song, Juwon et al. (2006) Intergenerational benefits of family-based HIV interventions. J Consult Clin Psychol 74:622-7 |
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