Victoria B. Mitrani

Structural Ecosystems Therapy for HIV-Seropositive African American Women: Effects on Psychological Distress, Family Hassles, and Family Support.

This study tests the efficacy of Structural Ecosystems Therapy (SET), a family-ecological intervention, in improving psychosocial functioning when compared with an attention-comparison person-centered condition and a community control condition. A sample of 209 HIV-seropositive, urban, low-income, African American women was randomized into 1 of the 3 conditions. Results of growth curve analyses over 5 time points revealed that SET was more efficacious than either of the control conditions in reducing psychological distress and family-related hassles. However, contrary to hypotheses, SET was not more efficacious in increasing family support. Latent growth mixture modeling analyses indicated that SET was most efficacious for women who, on average, were at or near the clinical threshold for psychological distress and for women with high levels of family hassles. Implications for further intervention development are discussed.

Brief structural/strategic family therapy with African and Hispanic high-risk youth

Brief Strategic/Structural Family Therapy was implemented as an indicated prevention intervention to reduce the likelihood that African American and Hispanic youth initiated drug use. The intervention was designed to impact two important risk factors for initiation, namely behavior problems and poor family functioning. One hundred twenty-two youth, 12–14 years of age and exhibiting behavior problems, were assigned within a basic one-group pretest/posttest/follow-up design. The first important finding was that the prevention intervention was effective in significantly modifying both high-risk factors, reducing behavior problems [F(2, 120) × 32.92; p < .000] and improving family functioning [F(1, 121) × 41.8; p < .000]. A second important finding was that both high-risk variables targeted were statistically significant predictors of initiation nine months later. A third important finding was that for a small subset of youth who entered the program already using, overall use was significantly decreased [t(22) × 2.11, p < .05].

Increasing Minority Research Participation Through Community Organization Outreach

Recruitment is one of the most significant challenges in conducting research with ethnic minority populations. Establishing relationships with organizations that serve ethnic minority communities can facilitate recruitment. To create a successful recruitment process, a strategic plan of action is necessary prior to implementing community outreach efforts. For this study population of women who were HIV+ and recovering from substance abuse disorder, the authors found that establishing trust with community organizations that serve these women allows for a productive referral relationship. Although the majority of women in this study are African American, the authors were particularly challenged in recruiting Hispanic women. This article presents a recruitment process model that has facilitated our recruitment efforts and has helped the authors to organize, document, and evaluate their community out-reach strategies. This model can be adopted and adapted by nurses and other health researchers to enhance engagement of minority populations.

HIV Risks, Substance Abuse, and Intimate Partner Violence Among Hispanic Women and Their Intimate Partners

Hispanic women in the United States are disproportionately affected by HIV infection. Substance abuse and intimate partner violence (IPV) are conditions that have been associated with risk for HIV in the general population. However, few studies have explored the intersection of these three conditions within one integrated framework. The purpose of this exploratory study was to describe the relationships between HIV risks, substance abuse, and IPV among Hispanic community‐dwelling women. A total of 82 structured interviews were conducted with Hispanic women between the ages of 18 and 60. Data regarding the participants and her partners histories of sexually transmitted infections, substance abuse, risky sexual behaviors, and IPV were collected. Relationships between the participants history of sexually transmitted infections, her partners substance abuse, risky sexual behaviors, and IPV were explored. Results from this study support the importance of targeting HIV, substance abuse, and IPV prevention among Hispanics within one integrated framework.

Intimate partner violence, depression, and resource availability among a community sample of hispanic women

This study investigated the relationships among resource availability, IPV, and depression among Hispanic community-dwelling women. The Vulnerable Populations Conceptual Framework (15) was used to conceptualize and test relationships among these variables. Cross-sectional questionnaires assessed resource availability (i.e., income, education, employment, insurance status, and self-esteem), depressive symptoms (CES-D), and intimate partner violence (IPV) by a current/recent partner. Linear and logistic regressions were conducted to explore relationship among variables. Although most of the relationships among resource availability, IPV, and depression supported the conceptual framework, the importance of incorporating additional cultural, relationship, and social factors are stressed.

Addressing immigration-related separations in Hispanic families with a behavior-problem adolescent.

This article presents specialized family therapy intervention strategies for Hispanic families with behavior-problem adolescents who have experienced an immigration-related separation. Such specialized interventions correspond to a philosophy of customized treatment delivery for Hispanic families. Interactional and cognitive/affective features are presented, and guidelines for building therapeutic alliances, identifying core family processes/themes, and transforming interactions are offered.

The Efficacy of Structural Ecosystems Therapy With Drug-Abusing/ Dependent African American and Hispanic American Adolescents

Many family therapies for adolescent drug use include ecological interventions. The purpose of this randomized clinical trial was to establish whether ecological interventions contribute to the impact of family therapy above and beyond the contributions of family process-only interventions. A family-based ecological approach, structural ecosystems therapy (SET), was compared with family process-only condition (FAM) and community services control (CS). One hundred ninety substance-abusing or dependent African American and Hispanic adolescents were randomized to SET, FAM, or CS. Follow-up assessments were conducted at 3, 6, 12, and 18 months postrandomization. SET was significantly more efficacious than FAM and CS in reducing adolescent drug use. However, these improvements were limited to Hispanic adolescents. The study demonstrates the importance of investigating changes in adolescent drug use as a result of treatment condition across more than 1 racial/ethnic group.

Adolescent and Parent Alliances With Therapists in Brief Strategic Family TherapyTM With Drug‐Using Hispanic Adolescents

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.

A Randomized Controlled Trial of Structural Ecosystems Therapy for HIV Medication Adherence and Substance Abuse Relapse Prevention

BACKGROUND Substance abuse in women with HIV/AIDS overshadows other priorities, including health care. Substance abuse may cause women to avoid health care systems and not adhere to their medication regimen. METHODS A randomized controlled trial tested the efficacy of Structural Ecosystems Therapy (SET) relative to a psychoeducational Health Group (HG) in 126 HIV+ women in recovery. SET, a 4-month intervention, focused on building family support for relapse prevention and HIV medication adherence. Over 12-month follow-up, women were assessed for drug use and medication adherence every 2 months; CD4 T-cell count and HIV viral load were assessed every 4 months. RESULTS Levels of drug use did not differ by condition. There was a significant difference in curvature of the rates of change in drug use with SET increasing and then decreasing and HG decreasing and then increasing. Women in SET were more likely to increase substance abuse services in response to relapse and separate from drug using household members than were women in HG. These two changes explained the decline in drug use observed within SET between 6 and 12 months. SET showed declines in medication adherence but increases in CD4 T-cell count relative to HG. The increase in CD4 T-cell count in SET was related to increasing proportions of women in SET taking antiretroviral medications. CONCLUSION The results of the trial were mixed. Women in SET did not show better drug use or medication adherence outcomes, but did show improvement in CD4 T-cell count and theoretical mechanisms of action on drug relapse.

The Efficacy of Structural Ecosystems Therapy for HIV Medication Adherence With African American Women

A systemic family therapy intervention, Structural Ecosystems Therapy (SET; Mitrani, Szapocznik, & Robinson-Batista, 2000; Szapocznik et al., 2004), has been shown to promote adaptation to living with HIV by reducing psychological distress and family hassles. This investigation examines the effect of SET on HIV medication adherence relative to a person-centered condition and a community control condition. Medication adherence was assessed on 156 trial participants. Results of a 2-part model showed that SET was significantly more likely to move women to high levels of adherence (defined as at least 95% adherence) than a person-centered therapy. Family hassles were also significantly reduced by SET, though the effect of SET on medication adherence did not appear related to this change in family hassles.