Program

Feb 16, 2012

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

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.

Program manual available at:

http://chipts.ucla.edu/projects/talc-nyc/

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.