Dorian E. Traube

A national study of the impact of outpatient mental health services for children in long-term foster care

Despite the tremendous mental health need evidenced by children in foster care and high rates of use of mental health services among children in foster care, little is known about the impact of outpatient mental health services on the behavioral health of this population. This study utilizes data from the National Survey of Child and Adolescent Well-being (NSCAW), the first nationally representative study of child welfare in the United States. A subsample of 439 children who have experienced long-term foster care were included in this study. These data were used to estimate the impact of outpatient mental health services on the externalizing and internalizing behavior problems of children in long-term foster care. A propensity score matching model was employed to produce a robust estimate of the treatment effect. Results indicate that children who have experienced long-term foster care do not benefit from the receipt of outpatient mental health services. Study results are discussed in the context of earlier research on the quality of mental health services for children in foster care.

Cross-cultural adaptation of the Child Depression Inventory for use in Tanzania with children affected by HIV

Understanding the impact of the acquired immune deficiency syndrome (AIDS) epidemic is critical for developing appropriate interventions to create supportive environments for orphans and vulnerable children (OVC). Unfortunately, there are very few studies on the psychosocial wellbeing of children orphaned by AIDS in Africa, and even fewer in Tanzania. It has been difficult to make generalizations across studies and to identify and track children suffering from mental health difficulties, given the lack of culturally sensitive, standardized screening scales and diagnostic procedures. As a contribution to filling that gap, the current study demonstrates the applicability of an existing depression screening instrument (CDI) to evaluate both the needs of OVC as well as the effectiveness of interventions designed to support them.

Theory development for HIV behavioral health: empirical validation of behavior health models specific to HIV risk.

Abstract In the presence of numerous health behavior theories, it is difficult to determine which of the many theories is most precise in explaining health-related behavior. New models continue to be introduced to the field, despite already existing disparity, overlap, and lack of unification among health promotion theories. This paper will provide an overview of current arguments and frameworks for testing and developing a comprehensive set of health behavior theories. In addition, the authors make a unique contribution to the HIV health behavior theory literature by moving beyond current health behavior theory critiques to argue that one of the fields preexisting, but less popular theories, Social Action Theory (SAT), offers a pragmatic and broad framework to address many of the accuracy issues within HIV health behavior theory. The authors conclude this article by offering a comprehensive plan for validating model accuracy, variable influence, and behavioral applicability of SAT.

Adapting a Family-Based HIV Prevention Program for HIV-Infected Preadolescents and Their Families: Youth, Families and Health Care Providers Coming Together to Address Complex Needs

Summary This article describes a family-based HIV prevention and mental health promotion program specifically designed to meet the needs of perinatally-infected preadolescents and their families. This project represents one of the first attempts to involve perinatally HIV-infected youth in HIV prevention efforts while simultaneously addressing their mental health and health care needs. The program, entitled CHAMP+ (Collaborative HIV Prevention and Adolescent Mental Health Project-Plus), focuses on: (1) the impact of HIV on the family; (2) loss and stigma associated with HIV disease; (3) HIV knowledge and understanding of health and medication protocols; (4) family communication about puberty, sexuality and HIV; (5) social support and decision making related to disclosure; and (6) parental supervision and monitoring related to sexual possibility situations, sexual risk taking behavior and management of youth health and medication. Findings from a preliminary evaluation of CHAMP+ with six families are presented along with a discussion of challenges related to feasibility and implementation within a primary health care setting for perinatally infected youth.

Family-Based HIV Preventive Intervention : Child Level Results from the CHAMP Family Program

Summary Social indicators suggest that African American adolescents are in the highest risk categories of those contracting HIV/AIDS (CDC, 2001). The dramatic impact of HIV/AIDS on urban African American youth have influenced community leaders and policy makers to place high priority on programming that can prevent youths exposure to the virus (Pequegnat & Szapocznik, 2000). Program developers are encouraged to design programs that reflect the developmental ecology of urban youth (Tolan, Gorman-Smith, & Henry, 2003). This often translates into three concrete programmatic features: (1) Contextual relevance; (2) Developmental-groundedness; and (3) Systemic Delivery. Because families are considered to be urban youths best hope to grow up and survive multiple dangers in urban neighborhoods (Pequegnat& Szapocznik, 2000), centering prevention within families may ensure that youth receive ongoing support, education, and messages that can increase their capacity to negotiate peer situations involving sex. This paper will present preliminary data from an HIV/AIDS prevention program that is contextually relevant, developmentally grounded and systematically-delivered. The collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP) is aimed at decreasing HIV/AIDS risk exposure among a sample of African American youth living in a poverty-stricken, inner-city community in Chicago. This study describes results from this family-based HIV preventive intervention and involves 88 African American pre-adolescents and their primary caregivers. We present results for the intervention group at baseline and post intervention. We compare post test results to a community comparison group of youth. Suggestions for future research are provided.

Understanding the African American Research Experience (KAARE): Implications for HIV Prevention.

Summary Despite recognition that the African American population is underrepresented in studies of health and mental health treatment and prevention efforts, few investigations have systematically examined barriers to African American research participation. Without their participation, treatment and prevention strategies designed to curtail the spread of HIV in their communities will be bound to achieve less than optimal outcomes. Based on the assumption that successful recruitment of African Americans requires knowledge of (a) their beliefs about research, (b) their perceptions of the research process and researchers, (c) their motivations to participate, and (d) the historical and social factors that may be the source of at least some ambivalence, the current study undertook semi-structured interviews with 157 African American, low-income mothers residing in a large urban community where they and their children were at high risk for HIV. Given the sensitive nature of the research topic, members of the community were trained to conduct the interviews. Qualitative and quantitative analyses of the interview content suggest that despite having been consented, many participants (a) are not aware of their rights under informed consent and (b) lack knowledge of how the research will be used. Despite this and the subtle suspicion of White researchers held by some, many decide to participate for altruistic reasons. The implications for recruitment of participants in general and African Americans in particular into HIV prevention studies are discussed as are the implications for service providers directly or indirectly involved in the development and delivery of these interventions.

Environmental risk, social cognition, and drug use among young men who have sex with men: longitudinal effects of minority status on health processes and outcomes.

BACKGROUND Young men who have sex with men (YMSM) continue to be at elevated risk for substance use; however, models explaining this phenomenon have often focused on a limited array of explanatory constructs. This study examined the longitudinal relationship of contextual risk factors, social cognitive processes, mental health, and health protective behavior to identify key mechanisms of illicit drug use of YMSM as they aged through emerging adulthood. METHODS Our sample included an ethnically diverse cohort of 487 YMSM recruited through venue based probability sampling in Los Angeles. We used latent growth curve modeling to understand relationships between environmental risk factors, changing individual and social process variables, health protective behavior, psychological distress, and illicit drug use outcomes among YMSM. RESULTS Age, ethnicity, violence and discrimination, depression, and previous histories of illicit drug use were key elements of risk for future illicit drug use among YMSM. During this theoretically distinct time period, health as a value, self-efficacy, and social support are vital social cognitive processes for promoting self-change among YMSM, and YMSM have independent growth within each process. Health as a value, self-efficacy, and social support were dynamic social cognitive processes, which served as key mechanisms by which risk factors were converted into health promotion strategies or psychological distress, and ultimately illicit drug use. CONCLUSIONS The efficacy of prevention interventions aimed at reducing illicit drug use among YMSM can be enhanced by addressing social cognitive processes for this underserved portion of the male population.

Utilizing Social Action Theory as a framework to determine correlates of illicit drug use among young men who have sex with men.

Young men who have sex with men (YMSM) continue to be at elevated risk for substance use; however, models explaining this phenomenon have often focused on a limited array of explanatory constructs. This study utilizes Social Action Theory (SAT) as a framework to address gaps in research by documenting the social, behavioral, and demographic risk factors associated with illicit drug use among YMSM. Structural equation modeling was used to apply SAT to a cross-sectional sample of 526 men from the Healthy Young Men Study, a longitudinal study of substance use and sexual risk behavior among YMSM in Los Angeles. The final model possessed very good fit statistics (Comparative Fit Index (CFI) = 0.936, Tucker-Lewis Index (TLI) = 0.925, Root Mean Square Error of Approximation (RMSEA) = 0.040) indicating that SAT is appropriate for use with YMSM. Substance use interventions for YMSM could be enhanced by employing SAT as conceptualized in this study and using a multitargeted strategy for impacting illicit drug use.

Teaching evidence-based social work in foundation practice courses: learning from pedagogical choices of allied fields.

The field of social work is attuned to the need to incorporate evidence-based practice education into masters-level curriculum. One question remaining is how to integrate evidence-based practice in the foundation practice courses. Integration of evidence-based practice across the foundation-level curriculum coincides with the Council on Social Work Educations mandate that students engage in research-informed practice and practice-informed research. Through a discussion of definitions, criticisms, and pedagogy across the allied fields of medicine, nursing, and social work the authors address the current status of evidence-based practice curriculum in foundation-level education. The authors incorporate the lessons learned from allied fields and a Masters of Social Work students analyses of their experience of evidence-based practice learning to propose an adult-learner model to improve evidence-based practice pedagogy in Social Work.

Overview of Community Collaborative Partnerships and Empirical Findings: The Foundation for Youth HIV Prevention.

Summary This article presents a summary history and context of the CHAMP Family Program. Primarily, CHAMP was created and developed in response to rising levels of HIV and AIDS in inner-city communities of color. Concurrently, major changes in the field of psychology were underway during the late 1980s and early 1990s including new perceptions of the effect of culture and context on development; the birth of development psychopathology as a field; and increasing interest in-and recognition of-adolescent psychology. It is within the context of these transformations that this article places the design and implementation of CHAMP. The evolution of the CHAMP Family Program a relatively small, cyclical study in Chicago, to a major, multi-site project is discussed, with particular emphasis on the role of community collaboration in the transitions thatCHAMP has experienced thus far.