Resilience-based Psychosocial Intervention Among Children Affected by HIV/AIDS
Condition: Emotional Adjustment; Aids/Hiv Problem
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      Parental illness and death from HIV/AIDS has a profound and lasting impact on a child's
      psychosocial well-being, potentially challenging the basic needs for survival and
      compromising the child's future. Therefore, the impact of parental HIV/AIDS on children needs
      to be treated from both a public health and a developmental perspective. However, to date the
      role of a resilience-based approach among children affected by HIV is hypothesized but not
      evidence-based. In this application, we propose to develop a theory-guided, resilience-based,
      multimodal intervention by culturally adapting and integrating components from three SAMHSA
      model programs which show strong evidence in promoting protective factors among young
      children. The multimodal intervention will include three approach levels: the individual
      child (peer-group activities), the family (caregiver parenting skill training), and the local
      community (community advocacy). The short, medium, and long-term efficacy of the
      Child-Caregiver-Advocacy-Resilience [ChildCARE] intervention to improve health and
      psychosocial well-being of children will be evaluated over 36 months through a cluster
      randomized controlled trial. About 800 HIV/AIDS-affected children (8 to 11 years of age) and
      their primary caregivers will be recruited from central China where we have built a strong
      research infrastructure and community collaboration during our previous study. The primary
      outcome measures for the children will include physical health, mental health, growth and
      development, school performance, and a biological indicator of neurobiological stress
      response (salivary cortisol). The outcome measures at caregiver level will include parenting
      style, parental engagement, and mental health well-being. The changes at the community level
      will be measured using children's and caregivers' perceptions of social support and
      HIV-related public stigma. We will also examine the potential mechanism through which the
      ChildCARE intervention is exerting its impact by identifying improvement in protective
      factors and other individual and contextual factors that potentially mediate or moderate the
      intervention effect. This proposed project will examine whether the multilevel protective
      factors we identified in our initial project are amenable to intervention and whether their
      hypothesized changes explain improvement in children outcomes.
    

Detailed description: 
      During the past five years (09/05-08/10) we were funded by R01MH76488 to study the
      psychosocial needs of children affected by HIV including both orphans (children under 18 who
      lost one or both of their parents to HIV/AIDS) and vulnerable children (children with one or
      both parents infected with HIV) in rural China. The overarching goal of our previous study
      was to inform the development of effective, culturally appropriate, and sustainable
      psychosocial interventions for these children. Guided by a developmental psychopathology
      perspective, we constructed an assessment model that integrated research findings from the
      literatures on bereavement, attachment, risk and resilience to delineate the children's
      psychosocial needs following HIV-related parental death or illness1. We incorporated both
      individual and environmental factors that potentially could moderate or mediate the negative
      effects of parental HIV/AIDS on these children. The comprehensive qualitative and
      quantitative data we collected and reported in 29 peer-reviewed publications during the past
      five years have provided the critical foundation for a cultural adaptation of theory-driven
      psychosocial prevention programs among children affected by HIV. The main findings from this
      body of research included 1) children affected by HIV experienced greater mental and
      developmental challenges (e.g., trauma symptoms, depression, social isolation, poor school
      performance) than comparison children who were from the same community but did not experience
      HIV-related illness and death in their families; 2) some children demonstrated tremendous
      resilience reflected in good school performances and the absence of elevated levels of
      psychosocial problems despite parental HIV/AIDS and other traumatic events in their lives;
      and, 3) key protective factors exist within the child and the social environment (e.g.,
      positive future orientation, trusted caregivers, and supportive community) which could
      contribute to resilience in these children, and hence buffer the children from the
      detrimental effects of parental HIV/AIDS. The proposed project will examine whether the
      protective factors identified in our previous study are amenable to intervention and whether
      their hypothesized changes can indeed explain improvement in mental and developmental
      outcomes among participating children.

      From research on early childhood development, compelling evidence has revealed the critical
      importance of successful adaptation in the face of adversity ("resilience") for laying the
      foundation for successful adjustment later in life2-4. However, to date the utility of a
      resilience-based intervention approach among children affected by HIV is hypothesized but not
      evidence-based5-6.Therefore, in this application, we propose to adapt three evidence-based
      programs to produce a theory-driven resilience-based intervention to improve the well-being
      of children affected by HIV in rural China. The proposed multimodal "Child
      Caregiver-Advocacy-Resilience" intervention (ChildCARE) will include three integrated
      components: the individual child (peer-group activities), family (caregiver parenting skill
      training), and the local community (community advocacy). The short, medium, and long-term
      efficacy of the ChildCARe intervention will be evaluated over 36 months through a cluster
      randomized controlled trial (RCT). The primary outcome measures for the children will include
      physical health, mental health, growth and development, school performance, and a biological
      indicator of neurobiological stress response (i.e., salivary cortisol). There are three
      specific aims and four hypotheses in our application:

      AIM #1: Develop a theory-guided, resilience-based, multimodal intervention [ChildCARe] by
      culturally adapting and integrating components from three SAMHSA model programs which show
      strong evidence in promoting protective factors among children; the adaptation process will
      be informed by 1) the data collected from our previous study; 2) our 18 years' experience in
      developing and adapting effective HIV behavioral prevention programs in various cultural
      settings including China; and 3) input from the local collaborators and communities (e.g.,
      community advisory board and research participants); AIM #2: Test the efficacy of the
      ChildCARe intervention through a cluster RCT involving 800 HIV-affected children (8 to 11
      years of age) and their primary caregivers from 80 villages in central China where we have
      built a strong research infrastructure and community collaboration during our previous study;
      AIM #3: Examine the potential mechanism of the intervention by identifying improvement in
      protective factors and other individual and contextual factors that potentially mediate or
      moderate the intervention effect;

      Hypothesis #1: The ChildCARe intervention will demonstrate short, medium, and long-term
      efficacy in improving children's primary outcomes and biological indicator (salivary
      cortisol); Hypothesis #2: The ChildCARE intervention will demonstrate short, medium, and
      long-term efficacy in improving children's intermediate outcomes (e.g., social-emotional
      competence, positive future orientation, and trusting relationship with current caregivers),
      caregiver's outcomes (e.g., parenting skills, mental health well-being), and community-level
      outcomes (e.g., children's and caregivers' perceptions of social support); Hypothesis #3:
      Improvement in intermediate outcomes at levels of child, family, and community will mediate
      the effect of the ChildCARE intervention on the children's primary outcomes and biological
      indicator; Hypothesis #4: Some contextual factors (e.g., care arrangement, household
      socioeconomic status [SES], caregiver's physical health status, disease progression for
      caregivers living with HIV) will moderate the effect of ChildCARE intervention on the
      children's primary outcomes and biological indicator.
    

Intervention name(s): Child-Caregiver-Advocacy-Resilience [ChildCARE] intervention
Intervention type(s): Behavioral
Intervention description(s): The proposed multimodal "Child Caregiver-Advocacy-Resilience" intervention (ChildCARE) will include three integrated components: the individual child (peer-group activities), family (caregiver parenting skill training), and the local community (community advocacy).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The proposed multimodal "Child Caregiver-Advocacy-Resilience" intervention (ChildCARE) will include three integrated components: the individual child (peer-group activities), family (caregiver parenting skill training), and the local community (community advocacy).
Masking: None (Open Label)
Primary purpose: Prevention