By the year 2000, 80,000 children will be orphaned by AIDS in the U.S. (58,000 in New York City) and this number will continue to rise. Parental death during childhood has consistently been 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. Over the last 2.5 years, 287 Parents Living with AIDS (PLAs) and their 349 adolescent children aged 12 to 18 years were recruited and randomly assigned to receive: 1) a standard care condition where extensive social welfare services are provided; or 2) an enhanced care condition that provides three modules of coping skills intervention (Project TALC: Teens and Adults learning to Communicate) plus social services. Linked to the phases of parental illness, PLAs, their adolescents, and new custodial guardians are scheduled to individually and jointly meet over 32 sessions. Because the life span of women with AIDS extended from 14.3 months to 27 months over the last 2 years, about 2/3 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 investigators anticipate that the PLAs will die and the final, post-death module of the intervention can be delivered. This competing renewal will allow the investigators to complete the delivery and the evaluation of the intervention. In addition, however, the proposed project aims: 1) to prospectively follow youths of PLAs longitudinally for 4 additional years to evaluate their mental health (including psychiatric disorder), behavioral, and social outcomes; 2) to compare the adjustment of youths of PLAs compared to two contrast groups of youths of the same socioeconomic status (SES) and age: 120 youths who are not bereaved and 120 youths whose parents have died of lung cancer, with an additional goal of documenting the adolescent bereavement process; 3) to complete the delivery and evaluation of the enhanced coping skills intervention, particularly of Module 3 to new custodial guardians and youths; 4) to develop, write a treatment manual, and pilot an intervention designed for fathers living with AIDS (now 27 percent of cases, formerly, 5 percent) that includes more cost-efficient strategies for implementing these interventions (e.g., peer leaders, in-home settings, telephone groups); and 5) to develop new measures of grief to describe the bereavement process over time. These results are likely to have implications for millions of AIDS orphans internationally and for the 550,000 adolescents bereaved annually by parental death.
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