PERMANENCY PLANNING INTERVENTION FOR FAMILIES WITH AIDS

An estimated 125,000 children and adolescents will be orphaned as a result of AIDS by the year 2000. The social and economic circumstances of their lives place these children at high risk of psychiatric dysfunction yet their needs have gone largely unaddressed. This study is a randomized trial designed to evaluate the effects of a short-term preventive intervention, Project Care, on psychological functioning of healthy children who will survive the death of a mother from AIDS. The death of a parent in childhood increases psychological vulnerability, particularly in combination with additional risk factors. Project Care services children whose single mother with AIDS is receiving case management services from the Division of AIDS Services (DAS). Eligibility for DAS, a program of New York City's Human Resources Administration, includes Medicaid eligibility and advanced HIV disease. Project Care aims to reduce risk factors and increase protective factors to prevent psychological dysfunction after parental death through: (1) enhancing disclosure and communication between ill mother, designated guardian and the child; (2) enhancing stability and security of the child's future by developing an appropriate custody plan prior to parental death; (3) working with guardian and child after death to facilitate the transition to the new family; and (4) to enhance access to concrete resources and social support. Year 01 is a pilot year needed to finalize the standardized intervention, conduct a process evaluation, and pilot research tools and procedures. In Years 02-05 we will conduct a formal outcome evaluation using an experimental design with random assignment to two groups. 200 children will be entered into a research study, and 100 will be randomized to standard care and 100 to receive standard care plus Project Care. Assessments will be conducted four times: at baseline, 4 months later and 6 and 12 months after parental death. Project Care will be evaluated four ways, which are reflected in the specific aims. We will examine the extent to which Project Care successfully: (1) recruits and retains program subjects; (2) delivers the program as designed; (3) increases protective factors and prevents new risk factors; and (4) prevents psychological disturbance in the child. This study represents a collaboration among the Albert Einstein College of Medicine, the Medical and Health Research Association of New York City, Inc., the Family Center and the Orphan Project; the DAS provides services to a large majority of families with single mothers with AIDS who have children. In addition, Project Care has been developed over the last six months with funding with Ryan White Care Act Title l and the New York State AIDS Institute. The consortium of academic, nongovernmental and funding agencies that supports this project represents a unique combination of skills and resources.