PROJECT TALC (Teens and Adults Learning to Communicate)

FOR PARENTS WITH AIDS AND THEIR ADOLESCENT CHILDREN

OVERVIEW

Project TALC is an intervention designed to improve behavior and mental health outcomes among parents with AIDS and their adolescent children. In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a standard care control group. 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, as well as higher levels of self-esteem than control group adolescents. However, at the four-year follow-up, adolescents in the intervention condition reported significantly higher levels of problem behaviors and conduct problems than the control group. No significant differences in emotional distress or self-esteem were found. A follow-up experimental evaluation found that adolescents in the intervention group reported less substance use at three and six-year follow-ups compared with adolescents in the control group.

DESCRIPTION OF PROGRAM

Target population: Parents with AIDS and their adolescent children

Project TALC (Teens and Adults Learning to Communicate) is designed to improve behavioral, social, and mental health outcomes among parents with AIDS and their adolescent children. The intervention, based on social learning theory, includes 24 sessions spaced out over a period of 12 Saturdays. The first eight sessions are delivered only to AIDS-infected parents. These sessions address issues of disclosure, emotional reaction to AIDS, and coping with stigma. The remaining 16 sessions are delivered to both parents and adolescents. These sessions address issues such as making custody plans, expressing love and affection, and maintaining positive family routines with a very ill parent. Each of these sessions involves some activities for which parents and children are separated and some activities for which parents and children meet together. All sessions include goal-setting and problem-solving activities.

EVALUATION(S) OF PROGRAM

Study 1

Rotheram-Borus, M. J., Lee, M. B., Gwadz, M., & Draiman, B. (2001). An intervention for parents with AIDS and their adolescent children. American Journal of Public Health, 91(8), 1294-1302.

Evaluated population: A total of 307 financially-needy, AIDS-infected parents and 412 adolescent children constituted the study sample for this investigation. The majority (80%) of the parents were mothers. Approximately one-half of the study participants were Latino and over one-third were African-American.

Approach: The Division of AIDS Services in New York City provided researchers with a list of financially needy people with AIDS. People on this list who were parents of adolescent children were recruited to participate in the study. Families (the parents and all adolescent children) who consented to participate were randomly assigned to either the treatment group or the control group. Families assigned to the treatment group were given the opportunity to participate in Project TALC. Project TALC sessions were led by social workers and graduate students in clinical psychology who had completed a 5-day training program and received ongoing supervision. Families assigned to the control group did not receive an intervention. Among parents in the treatment group, three-quarters attended at least one session.

All study participants were interviewed at baseline. Interviews assessed emotional well-being, problem behaviors, and self-esteem. Follow-up interviews occurred every three months for a period of two years.

Over the course of the two-year follow-up period, 134 of the AIDS-infected parents died – 62 from the intervention group and 52 from the control group.

Results: Among adolescents at the 3-month follow-up, no impacts were found on emotional well-being, problem behaviors, conduct problems, family events, and self-esteem. During the first 15 months after baseline, adolescents assigned to the treatment group experienced a reduction in emotional distress that was significantly greater than that experienced by adolescents assigned to the control group. Treatment adolescents also experienced a significantly greater decrease in anxiety. However, reductions in emotional distress and anxiety did not differ significantly between groups after the 15-month follow-up, however.

At the 15-month and 24-month follow-up, adolescents assigned to the treatment group decreased their problem behaviors and conduct problems to a greater extent than did adolescents assigned to the control group. Specifically, adolescents in the treatment group had four times fewer behavior problems and 2.4 times fewer conduct problems. Treatment adolescents also experienced significantly fewer family life stressors and experienced significant gains in self-esteem.

No impacts were found among parents at the 3-month follow-up. However parents benefited from Project TALC at the 15-month follow-up. Compared with control parents, treatment parents reported lower levels of emotional distress (both depression and anxiety) and a decrease of problem behaviors. However, only impacts on decreased problem behaviors among parents occurred at the 24-month follow-up. Three-quarters of parents had disclosed their health status to their children before the program; however, the intervention did not have an impact on parents’ willingness to disclose their HIV-positive status to their children or on their formation of custody plans for their children.

Study 2

Rotheram-Borus, M. J., Lee, M., Leonard, N., Lin, Y. Y., Franzke, L., Turner, E.,…, & Gwadz, M. (2003). Four-year behavioral outcomes of an intervention for parents living with HIV and their adolescent children. AIDS, 17, 1217-1225.

Evaluated population: In total, 307 financially-needy, AIDS-infected parents and 412 adolescent children were evaluated. Forty-eight percent of the adolescents were male and most were students with a mean age of 14.7 years. A majority of the parents living with HIV (PLH) were Latino or African American mothers with a mean age of 38.1 years.

Approach: See approach section of Study 1.

Results: Over the four years following the intervention, teenage parenthood was significantly more common in the standard care condition. From 3 to 21 months, the intervention group demonstrated a significant decreased in problems behaviors. Though the intervention group showed increased problem behaviors from 21 to 48 months, it was not statistically significant. Conduct problems decreased from 3 to 21 months among the intervention group. Though the adolescents in the intervention group demonstrated an increase in conduct problems from 21 to 48 months, the findings did not reach significance. Emotional distress decreased significantly from 3 to 15 months for the intervention group. However, there was no significant difference between the standard care and intervention groups in emotional distress from 15 to 48 months. From 3 to 24 months, self-esteem increased significantly among the adolescents in the intervention group. However, there was no significant difference between standard care and intervention groups in self-esteem reported at 48 months. Negative family life events decreased significantly more in the intervention group compared to the standard care group from 3 to 21 months. However, this rate of change did not reach significance from 21 to 48 months.

Significantly more PLH in the standard care group reported drug dependency over the 48 months than in the intervention group. From 3 to 21 months, parents in the intervention group reported significantly fewer problem behaviors. Though problem behaviors for PLH increased more in the intervention group than standard care group from 21 to 48 months, the finding did not reach significance. Emotional distress decreased for PLH from 3 to 15 months and remained at a similar rate from 15 to 24 months and 24 to 48 months but did not reach significance. No impacts on positive coping style were found from 3 to 21 months. However, positive coping style increased significantly more in the standard care group than intervention group from 21 to 48 months and was significantly higher at 48 months in the standard care group. Social support coping significantly decreased for both groups over the 48 months but was higher for the intervention group. Passive problem solving was significantly less common at 48 months and decreased more in the intervention group. No impacts on relapse into substance use were found.

Study 3

Rotheram-Borus, M. J., Stein, J. A., & Lester, P., (2006). Adolescent adjustment over six years in HIV-affected families. Journal of Adoelscent Health, 39, 174-182.

Evaluated population: The same families from Study 1 (this is a follow-up study)

Approach: See Study 1 for recruitment and randomization procedures. One child was randomly chosen from each family to be assessed for emotional distress, sexual risk acts, substance use, future expectations, and parental bonds at three and six-year follow-ups.

Results: Adolescents who received the intervention reported less substance use at both the three- and six-year follow-ups, compared with those in the control group. There were no impacts of the intervention on emotional distress, sexual risk acts, future expectations, or parental bonds.

SOURCES FOR MORE INFORMATION

Program manual available at:

http://chipts.ucla.edu/interventions/manuals/intervhra1.html

References:

Rotheram-Borus, M. J., Lee, M. B., Gwadz, M., & Draiman, B. (2001). An intervention for parents with AIDS and their adolescent children. American Journal of Public Health, 91, 8, 1294-1302.

Rotheram-Borus, M. J., Stein, J. A., & Lester, P., (2006). Adolescent adjustment over six years in HIV-affected families. Journal of Adoelscent Health, 39, 174-182.

Rotheram-Borus, M. J., Lee, M., Leonard, N., Lin, Y. Y., Franzke, L., Turner, E… , & Gwadz, M. (2003). Four-year behavioral outcomes of an intervention for parents living with HIV and their adolescent children. AIDS, 17, 1217-1225.

KEYWORDS: Adolescence (12-17), Young Adulthood (18-24), Youth (16+), Self-Esteem/Self-Concept, Other Behavioral Problems, Conduct/Disruptive Disorders, Other Social/Emotional Health, Anxiety, Other Substance Use, Parent-Child Relationship, Other Reproductive Health, Clinic-based, Parent of Family Component, Hispanic or Latino, Black or African-American,

Program information last updated on 2/16/12.

		© Child Trends 2003