Below please find summaries of the following studies:
Funded by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (Grant # R01 DA016543), Victoria Mitrani, Principal Investigator
HIV/AIDS is an illness that not only affects the people who have HIV/AIDS, but also their families. Families also have an important impact on the health of persons with HIV/AIDS. This recently completed study investigated the effects of a family therapy intervention, Structural Ecosystems Therapy (SET; Mitrani, Robinson and Szapocznik, 2009), on the families of women with HIV and who were also in recent drug abuse recovery. This study was a companion to a randomized trial, the “SETA Study” that tested the efficacy of SET for reducing drug relapse and for improving medication adherence in HIV-seropositive women in drug recovery (NIDA Grant DA15004, Daniel Feaster, Principal Investigator). The SETA Study randomly assigned 126 women to receive either SET or an HIV educational support group. The interventions lasted four months and the women were assessed every two months for one year (Feaster et al., in press).
SET works to transform the family system to reinforce sobriety and increase adherence with HIV medical care in the woman with HIV/AIDS. Because SET targets changing the whole family as a means of helping the woman, we hypothesized that SET would effect the family as a whole (family functioning) and individual family members, and that these effects would account for the affects of SET on the woman.
The SETA-Fam study asked the women in the SETA Study to identify family members – defined as people who lived with her, her children, romantic partners, people helping her to raise her children, and other people who were important sources of support. SETA-Fam enrolled 224 family members who were identified by the women. The family members were interviewed every four months for one year to assess how they were doing as individuals with respect to psychological functioning, drug abuse, and behavior problems (in children); and to assess how the family was doing overall with respect to family functioning and how different subgroups of people in the family (e.g., woman and their children, women and their romantic partners) were getting along.
Data analysis is ongoing. So far, we have examined the impact of SET on the families of women who were raising children and found that SET helped to reduce behavior problems and internalizing problems (e.g., anxiety) in the children, and that the mothers also benefited by having reduced drug relapse and reduced psychological distress.
The following publications are from the SETA-Fam and SETA studies.
Feaster, D. J., Mitrani, V. B., Burns, M. J., McCabe, B. E., Brincks, A. M., Rodriguez, A. E., Asthana D., & Robbins, M. S. (in press). A randomized controlled trial of Structural Ecosystems Therapy for HIV medication adherence and substance abuse relapse prevention. Drug and Alcohol Dependence. PMID: 20538417.
Mitrani, V.B, Feaster, D.J., Weiss-Laxer, N.S & McCabe, B. E. (in press). Malaise, motivation and motherhood: Predictors of engagement in behavioral interventions from a randomized controlled trial for HIV+ women in drug abuse recovery. AIDS and Behavior.
Mitrani, V.B., Weiss-Laxer, N.S., Feaster, D.J. (2009). Factors related to loss of child custody in HIV+ women in drug abuse recovery. The American Journal of Drug and Alcohol Abuse. 35:320–324. NIMHS:170784.
Mitrani, V.B., Weiss-Laxer, N.S., Ow, C.E., Burns, M.J., Ross, S. & Feaster, D.J. (2009). Examining family networks of HIV+ women in drug recovery: Challenges and opportunities. Families, Systems, and Health. 27:3, 267–283. NIMHS: 171557.
Mitrani, V.B., Robinson, C., & Szapocznik, J. (2009). Structural Ecosystems Therapy (SET) for women with HIV/AIDS. In M. Stanton and J. Bray, Handbook of Family Psychology. Oxford, U.K.: Blackwell Publishing, 355-369.
Daniel Santisteban, Ph.D. : Principal Investigator
This study funded by the National Center for Minority Health and Health Disparities focuses on the development and testing of an innovative technology enhanced family-based behavioral treatment designed to change the high risk trajectory of African American and Hispanic adolescents.
Why is it needed?
There is research evidence that large numbers of African American and Hispanic adolescents exhibit the types of high risk behavior profiles and live in the types of high risk environments that can contribute to a course of deteriorating physical and mental health. Equally problematic is the fact that minority adolescents and families tend to underutilize prevention and treatment services and that those most in need are often precisely those that are least likely to utilize and benefit from interventions. From the point of view of service providers, most prevention and treatment interventions are office-based or home-based, require large amounts of staff time and resources, and are not easily accessible to high risk youth in the moments when they are truly needed (e.g., when decisions toward health or problem behaviors are made).
What is innovative?
There are two particularly innovative aspects to the intervention to be developed and tested. The first is the development of a system of health messages that is accessed through the web-enabled netbook given to the family to use from home. This net book becomes the vehicle that adolescents and parents will utilize to access the culturally informed and tailored interventions. The second is the culturally informed intervention itself which has developed state of the science content, within an adaptive/flexible framework – a treatment that has shown promising preliminary findings (Santisteban & Mena, 2009). Through this integrated system we hypothesize that families will receive more intervention, in a manner that is easier to learn from (e.g., viewing videos), with less need for visits to a clinic.
Stages of the Study:
Stage 1: Intervention and technology development includes:
Stage 2: A pilot test will be conducted with 5 African American and 5 Hispanic youth and families for the purpose of determining feasibility and acceptability and for refinements based on feedback from participants. Refinements can be made to the content of the interventions, the process of delivery, or to the logic of linking certain interventions to certain problems. Each family will be asked for feedback at multiple time-points during the pilot intervention.
Stage 3: Implementation of a randomized clinical trial in which 80 12-15 year old African American and Hispanic adolescents meeting criteria for being at high risk (e.g., showing depression, aggression, family conflict, school failure) and their families will be assessed at baseline and randomized to one of two conditions (Immediate Tele-CIFFTA or Delayed Tele-CIFFTA). Families will be assessed again 12 weeks later when the active treatment group is terminating treatment (T2) and 18 weeks post-baseline (T3). The Delayed Tele-CIFFTA cases will receive the intervention immediately following the 12 week assessment. At the end of the delayed treatment period, participants will be invited to participate in a focus group to share their treatment experience. Randomization will be stratified by race/ethnicity, gender, and number of comorbid psychiatric disorders.
Funding cycle:
This is a two year, one million dollar (total cost) study.
(Daniel Santisteban, Ph.D. : Principal Investigator)
This study funded by the National Institute on Drug Abuse is designed as a rigorous randomized clinical trial to test Culturally Informed & Flexible Family-Based Treatment for Adolescents (CIFFTA) a treatment developed as part of a Stage I treatment development effort and showing very promising preliminary findings.
Rationale
Drug use rates are highest among Hispanic middle school youth and to date no treatments have been “proven effective” with substance abusing Hispanic adolescents (Huey & Polo, 2008). Further treatment for Hispanic youth and families is complicated by the fact that these families often differ from mainstream drug users in culture-related values, beliefs and behaviors that can directly impact engagement, retention, and efficacy/effectiveness of drug treatment. Treatments do not typically address these type of unique stressors experienced my Hispanic families. Finally, Hispanic adolescents and families tend to underutilize prevention and treatment services and thus fail to benefit from current interventions.
Innovation
CIFFTA integrates innovative culturally-based, individually-based, and family-based components to:
Research Design
This is a randomized clinical trial in which 220 Hispanic adolescents (14-17 years of age) who meet DSM-IV criteria for Substance Abuse or Dependency will participate. Following screening, consent and assessment, the adolescents and their families will be randomly assigned to either the (1) Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) or to Traditional Family Therapy (TFT). The two conditions will be tested as a four month intervention with two sessions per week. Assessments will be conducted at baseline, termination (4 months), 6 month follow-up (10 months post baseline), and 12 month follow-up (16 months post baseline). Data from urine analyses, self-reports of therapeutic alliance and data on service utilization outside of the program, will also be collected throughout the entire course of therapy and service utilization will continue during periods between follow-up assessments. Longitudinal data analysis (growth curve modeling) will be used to test study hypotheses. Additional analyses will focus on mediating variables, cluster analysis of interesting family subtypes, and dose-response relationships.
Funding cycle:
This is a five year, three million dollar (total cost) study.
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