The development and implementation of theory-driven programs capable of addressing poverty-impacted children's health, mental health, and prevention needs: CHAMP and CHAMP+, evidence-informed, family-based interventions to address HIV risk and care.

This article describes a program of prevention and intervention research conducted by the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project; McKay & Paikoff, 2007 ) investigative team. CHAMP refers to a set of theory-driven, evidence-informed, collaboratively designed, family-based approaches meant to address the prevention, health, and mental health needs of poverty-impacted African American and Latino urban youth who are either at risk for HIV exposure or perinatally infected and at high risk for reinfection and possible transmission. CHAMP approaches are informed by theoretical frameworks that incorporate an understanding of the critical influences of multilevel contextual factors on youth risk taking and engagement in protective health behaviors. Highly influential theories include the triadic theory of influence, social action theory, and ecological developmental perspectives. CHAMP program delivery strategies were developed via a highly collaborative process drawing upon community-based participatory research methods in order to enhance cultural and contextual sensitivity of program content and format. The development and preliminary outcomes associated with a family-based intervention for a new population, perinatally HIV-infected youth and their adult caregivers, referred to as CHAMP+, is described to illustrate the integration of theory, existing evidence, and intensive input from consumers and healthcare providers.

The VUKA family program: piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa.

An increasing number of adolescents born with HIV in South Africa are on antiretroviral treatment and have to confront complex issues related to coping with a chronic, stigmatizing and transmittable illness. Very few evidence-based mental health and health promotion programs for this population exist in South Africa. This study builds on a previous collaboratively designed and developmentally timed family-based intervention for early adolescents (CHAMP). The study uses community-based participatory approach as part of formative research to evaluate a pilot randomized control trial at two hospitals. The paper reports on the development, feasibility, and acceptability of the VUKA family-based program and its short-term impact on a range of psychosocial variables for HIV + preadolescents and their caregivers. A 10-session intervention of approximately 3-month duration was delivered to 65 preadolescents aged 10-13 years and their families. VUKA participants were noted to improve on all dimensions, including mental health, youth behavior, HIV treatment knowledge, stigma, communication, and adherence to medication. VUKA shows promise as a family-based mental and HIV prevention program for HIV + preadolescents and which could be delivered by trained lay staff.

Adapting Evidence-Based Interventions to Meet the Needs of Adolescents Growing Up with HIV in South Africa: The VUKA Case Example.

The VUKA family program is one of the only evidence-based interventions to promote positive psychosocial outcomes in South African HIV-infected pre- and early adolescents and their families. In this paper, we discuss the collaborative process by which a multidisciplinary team of clinicians, researchers, counselors, and artists/educators and families adapted and developed VUKA for this population using community-based participatory research methods. We describe the intervention and explore lessons learned that may be applicable across contexts related to international collaboration and adapting evidence-based interventions so that they are likely to be acceptable, feasible, and effective in a given setting and country context.

Collaboration With Urban Parents to Deliver a Community-Based Youth HIV Prevention Program.

This article draws on the unified theory of behavior change to examine adult community members' participation in a collaborative, community-based HIV prevention program for inner-city youth. Specifically, the impact of a training and mentorship process is examined with a sample of parent facilitators hired to deliver an evidence-based HIV prevention program in Bronx, New York. Findings indicate that the training program impacted four of five key constructs (environmental constraints, habitual behavior, social norms, and self-concept) expected to be related to parents' ability to deliver the program constructs significantly beyond any increase evidenced by the control group (HIV knowledge increased in both groups). Community-level training programs may therefore be an effective medium for increasing caregivers' intention to collaborate in community-based prevention programs.

Effects of Sexual Expectancies on Early Sexualized Behavior Among Urban Minority Youth.

This study examines the effects of different types of sexual expectancies on early sexual behavior among racial/ethnic minority young adolescents. African American and Latino participants between 11 and 13 years old were recruited through schools and community-based agencies in the South Bronx, New York (N = 223). Multiple logistic regression analyses were used to predict early sexual behavior outcomes, which include engagement in sexual possibility situations, kissing, and sexual touching. The moderating effect of gender was examined using multiplicative interaction terms. Higher expectations categorized as personal/parental and romantic/peer expectancies related to the negative consequences of sexual intercourse decreased the odds of engagement in early sexual behavior; whereas higher academic/career and sexual health expectancies did not. Gender moderated the relationships between personal/parental expectancies and engagement in sexual possibility situations and romantic/peer expectancies and kissing. Social workers formulating sexual health promotion and HIV prevention programs for racial/ethnic minority young adolescents should focus on personal/parental and romantic/peer expectancies in favor of negative expectancies regarding academic/career achievement, pregnancy, and HIV. Social work interventions to delay sexual debut should include a family-based component and should be sensitive to gender differences in sexual expectancies.

Academic adjustment across middle school: the role of public regard and parenting.

In the current longitudinal study, we examined associations between Black and Latino youths' perceptions of the public's opinion of their racial/ethnic group (i.e., public regard) and changes in academic adjustment outcomes across middle school. We also tested combinations of racial/ethnic socialization and parent involvement in academic activities as moderators of this association. We used a 2nd-order latent trajectory model to test changes in academic adjustment outcomes in a sample of 345 Black and Latino urban youth across 6th, 7th, and 8th grades (51% female). Results revealed a significant average linear decline in academic adjustment from 6th to 8th grade, as well as significant variation around this decline. We found that parenting moderated the association between public regard and the latent trajectory of academic adjustment. Specifically, for youth who reported high racial/ethnic socialization and low parent academic involvement, lower public regard predicted lower academic adjustment in 6th grade. For youth who reported both low racial/ethnic socialization and low parent academic involvement, lower public regard predicted a steeper decline in academic adjustment over time. Finally, among youth who reported high racial/ethnic socialization and high parent academic involvement, public regard was not associated with either the intercept or the slope of academic adjustment. Thus, the combination of high racial/ethnic socialization and parent academic involvement may protect youths' academic motivation and performance from the negative effects of believing the public has low opinions of one's racial/ethnic group. Implications for protecting Black and Latino youths' academic outcomes from decline during middle school are discussed.

Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools.

African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.

Adapting A Family-Based HIV Prevention Program for Homeless Youth and Their Families: The HOPE (HIV prevention Outreach for Parents and Early adolescents) Family Program.

As rates of HIV infection increase in adolescents, it is important to provide prevention programs targeting this population. Homeless adolescents living with their families in shelters are at greater risk of participating in risky sexual behavior and incurring negative health outcomes. A family based HIV-prevention pilot study was conducted with eight homeless families in a New York City shelter to explore: 1) the perceived impact of family communication, parental monitoring, family understanding of puberty, STD's and HIV on preventing risky behavior for the participating youth, and 2) the feasibility of conducting such a program within the shelter system. Qualitative and quantitative results indicate increased family communication, parental monitoring and decreased parental depressive symptoms.

Gender and the effects of an economic empowerment program on attitudes toward sexual risk-taking among AIDS-orphaned adolescent youth in Uganda.

PURPOSE: This article examines gender differences in attitudes toward sexual risk-taking behaviors of acquired immune deficiency syndrome (AIDS)-orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda. METHODS: Adolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n=135) or a control condition (n=142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education. RESULTS: Findings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk-taking behavior, in a different way and to a lesser extent than boys. CONCLUSIONS: Future research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms.

A novel economic intervention to reduce HIV risks among school-going AIDS orphans in rural Uganda.

This study tested an economic intervention to reduce HIV risks among AIDS-orphaned adolescents. Adolescents (n = 96) were randomly assigned to receive the intervention or usual care for orphans in Uganda. Data obtained at baseline and 12-month follow-up revealed significant differences between the treatment and control groups in HIV prevention attitudes and educational planning.