2010 — 2012 |
Sharp, Carla |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Emotional-Behavior Disorders in South African Children Affected by Aids
DESCRIPTION (provided by applicant): The HIV/AIDS epidemic in sub-Saharan Africa has already orphaned a generation of children, and now seems set to orphan generations more (UNICEF, 2003). The devastating impact of this poses significant challenges for primary care services in addressing the mental health needs of orphans. Given the relative lack of skilled clinicians in low-resource countries like South Africa (Deslarlais et al., 1995), and a general lack of resources to address mental health needs in South African townships (Dlamini, 2004), there is an urgent need for the development of reliable and valid diagnostic tools for the early detection of psychiatric disorder as a first step towards successful intervention. In this proposal we seek (Specific aim 1a) to investigate the criterion validity of a brief and easy-to-administer population screen (SDQ;Goodman, 1997, 2001) in a sample of 750 7- 11 year old children (250 orphaned by AIDS, 250 orphaned by other means and 250 non-orphaned). The SDQ will be validated against clinician diagnosis and a diagnostic tool which our team has investigated for its cultural appropriateness in Sesotho families (the NIH-DISC-IV;Shaffer, Fisher, et al., 2000). We also seek (Specific aim 1b) to investigate the utility value of the SDQ in Sesotho schools to early detect children with EBD. We then seek to use the multi-method (questionnaire and interview-based) and multiple informant (caregiver-, teacher, and self-report) information collected in Specific aim 1a to test aspects of Cluver &Gardner's (2007) conceptual model of risk and protective factors by investigating the association between orphan type (paternal-, maternal-, double-, and non- orphan) and EBD (Specific aim 2a) and orphan status (orphan by AIDS, orphan by other means, non-orphan) and EBD (Specific aim 2b), taking into account factors that may mediate these relationships (poverty and caregiver substance use disorder). The unique partnerships and institutional resources established through our preliminary work, the mentorship of three senior NIH investigators combined with the interdisciplinary strengths of the assembled research team (developmental psychopathology, psychometrics, qualitative and quantitative research in the South African context, cross- cultural psychiatry and medical anthropology) and a demonstrated history of fruitful collaboration on related projects indicate a high likelihood of success for the current proposal. The proposed study is in line with the NIHM objective of developing assessment tools in mental health for children affected by HIV/AIDS especially in developing countries. Determining the validity of the SDQ and its usefulness in elementary schools as context for early intervention and prevention of EBD, in addition to understanding the role of poverty and caregiver SUD in the development of EBD in children affected and unaffected by AIDS will lay the foundation for school- based intervention work or offer much needed direction in targeting current interventions more effectively. PUBLIC HEALTH RELEVANCE: Significance and relevance of the proposed research for the program on Infants, Children, and Adolescents within the Center for Mental Health Research on AIDS (NIMH). Although the work proposed herein has indirect relevance for several research objectives of the aforementioned NIMH program, it has direct relevance for one of the key foci of research: "Develop assessment technologies as well as methodological and statistical tools for the evaluation of natural history and treatment related change in behavioral, cognitive, and social development of infants, children and adolescents infected with HIV or affected by HIV, particularly where applicable to resource poor environments". Addressing the problem of early detection of EBD should be of the highest priority as a first step in addressing the mental health and service needs of children in a developing country like South Africa. The validation of the SDQ and determining its usefulness in elementary schools as context for early intervention and prevention of EBD, in addition to understanding the role of poverty and caregiver SUD in the development of EBD in children affected and unaffected by AIDS, will offer much needed direction in targeting interventions more effectively. As such, this study if funded, may lay the foundation for the design of a follow-up study where a school-based assessment and intervention of EBD in children affected by HIV/AIDS may be conducted.
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2015 — 2017 |
Sharp, Carla |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Misc-Cbo: a Community-Based Intervention For Hiv Affected Children
? DESCRIPTION (provided by applicant): Currently, 12 million children in Sub-Saharan Africa and 1.9 million children in South Africa (SA) are orphaned by HIV/AIDS. Research addressing what can be done to support these children has been limited, clustered and of variable quality. Our prior work showed that an important support structure for care of HIV affected children (orphans) in SA is through Community Based Organizations (CBOs). Currently, no evidence-based CBO intervention exist. CBO careworkers report low efficacy in addressing the mental health and cognitive developmental needs of children. There is therefore a critical need to empower frontline CBO careworkers to be trained in addressing the mental health and cognitive developmental needs of orphans. The Mediational Intervention for Sensitizing Caregivers (MISC) used in our previous work with parents in Uganda holds promise. The objective in this application is to use a mixed methods approach (observations, focus groups, questionnaires) to test the acceptability and feasibility of adapting MISC to be used by CBO careworkers instead of parents (MISC-CBO), and to assess preliminary outcomes. Guided by the Mathews and Hudson's framework for evaluating caregiver-child training programs, our approach will consist of three phases: Adapt, Process evaluation, Outcome evaluation. In Phase 1 (Adapt, Year 1) we will conduct formative research (qualitative interviews and focus groups) with community stakeholders, a Community Advisory Board and children to ascertain feasibility and acceptability of MISC-CBO in the SA cultural context with 7-11 year old AIDS orphans. In Phase 2 (Implementation and process evaluation, Year 2) we will recruit 80 AIDS orphans through 4 CBOs (20 children and 4 careworkers from each CBO). Two CBOs will be allocated to MISC-CBO and 2 will be allocated to treatment as usual (TAU of comparable contact hours). One year of bi- weekly (every 2 weeks) intervention sessions will be conducted. Process evaluation will include individual interviews, observations, focus groups and questionnaire-based assessment of MISC-CBO feasibility, adherence and fidelity. In Phase 3 (Outcomes assessment, Years 2 & 3) the effects of MISC-CBO to promote mental health and cognitive development through the mechanism of improved quality of caregiving by CBO careworkers will be assessed through mental health and cognitive assessments at baseline (beginning of Year 2), 6, 12 and 18 months compared to TAU in the children and careworkers recruited in Phase 2. At the end of this formative RO1 that transforms a parent intervention into a CBO careworker intervention, we will have established the foundational assessments and intervention to apply for an RO1 to evaluate a randomized controlled trial designed to fully test the efficacy of MISC-CBO during the critical developmental window of at- risk HIV affected children aging into adolescence. This project will make possible the only culture-appropriate and sustainable evidence-based CBO intervention that can be readily and effectively implemented globally in low-resource settings with children generally at risk from disease, malnutrition and neglect.
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2017 — 2019 |
Neighbors, Clayton [⬀] Sharp, Carla Zvolensky, Michael J. (co-PI) [⬀] |
R34Activity Code Description: To provide support for the initial development of a clinical trial or research project, including the establishment of the research team; the development of tools for data management and oversight of the research; the development of a trial design or experimental research designs and other essential elements of the study or project, such as the protocol, recruitment strategies, procedure manuals and collection of feasibility data. |
Brief Personalized Feedback Intervention For Hazardous Drinking in An Hiv Clinic
? DESCRIPTION (provided by applicant): The objective of the proposed research is test the feasibility of a brief computer-based personalized feedback intervention to reduce heavy alcohol use among HIV+ individuals. Rates of hazardous alcohol use among HIV+ individuals are approximately two times that found in the general population. Hazardous alcohol use contributes to problems with HIV medication adherence, risky sexual behavior, and psychological problems, as well as physical complications (rapid disease progression, medication toxicities, organ failure, and poor viremic control), which may lead to increased risk of transmission and premature death. Yet, HIV+ hazardous alcohol users remain a hard-to-reach and underserved group. There is therefore a critical need to test alternative approaches to the implementation of effective interventions to reduce HIV disease transmission and progression in HIV+ hazardous alcohol users. One novel and promising intervention approach is the use of personalized feedback, which has consistently been found to be efficacious for reducing hazardous alcohol use across a number of populations. Personalized feedback highlights discrepancies between one's own drinking and typical drinking; reframes use in terms of personal, social, financial, health, and other consequences; and offers strategies for reducing use and alcohol-related negative consequences. The proposed research will develop and evaluate the feasibility, acceptability, and potential efficacy of a novel evidence- and computer-based Personalized Feedback Intervention (PFI) among HIV+ hazardous alcohol users in a high volume Houston HIV clinic. The research will include two primary aims. The first aim focuses on development and refinement of an intervention adapted from investigators' previous work to incorporate feedback for HIV+ individuals. Feasibility and acceptability will be established through iterative incorporation of focus group feedback regarding recruitment, assessment, and intervention procedures. The second aim will pilot the intervention to evaluate feasibility and potential efficacy. Outcomes include drinking change processes and behavior, alcohol-related risky sexual behavior, and HIV-related outcomes. The pilot will recruit 150 HIV+ hazardous alcohol users from clinic waiting areas. Participants will be randomly assigned to receive the PFI or to receive feedback unrelated to alcohol use. An underlying premise which will be evaluated through the aims is that the difficulty in reaching hazardous alcohol users who are HIV+ can be addressed with an approach that will not be burdensome to the individuals or to clinic staff. All assessments and procedures will take place in the clinic on tablets or laptop computers. Follow-up assessments will occur at 3 months post-baseline. This research builds on the collaborative work of an experienced team of investigators with complementary expertise supporting all aspects of the proposed research.
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2021 |
Sharp, Carla |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Misc-Ipv: a Community Based Intervention For Children Traumatized by Intimate Partner Violence
ABSTRACT One in four children (26%) in the U.S. are exposed to intimate partner violence (IPV), with higher rates among children of African American women. IPV exposure constitutes a traumatic stress environment with severe consequences for psychosocial outcomes in children. While maternal caregiving has been identified as a critical buffer against the effects of trauma on children, current IPV parenting interventions suffer from cultural insensitivity , and design and methodological limitations impeding scalability. Our scientific premise is that the adverse effects of IPV trauma on children can be interrupted through an intervention that enhances maternal caregiving capacity, and which is delivered by community-based paraprofessional caseworkers who are already delivering services to IPV-exposed African American women. The objective of this application is to adapt an established caregiver intervention program, Mediational Intervention for Sensitizing Caregivers (MISC), for the IPV and African American context (thereafter named MISC-IPV). MISC-IPV will be evaluated for acceptability, feasibility, and preliminary mechanisms and outcomes, guided by an evidence-based framework consisting of three aims (Adapt, Process Evaluation, Outcome/Mediator Evaluation). For Aim 1, (Adapt), we will adapt MISC through an iterative process involving qualitative interviews and focus groups with caseworkers and mothers in an IPV rehousing program until fit with context is achieved . Cultural adaptation and adaptation for the IPV context will be guided by a Community Advisory Board. For Aim 2 (Implementation and Process Evaluation), we will recruit N = 132 mothers/child pairs (children age 7 to 11) through the Harris County Domestic Violence Coordinating Council (HCDVCC) Collaborative of Houston, TX. Half will be randomly assigned to TAU+MISC-IPV vs. TAU. After initial training of caseworkers, one year of bi-weekly (every two weeks) intervention sessions of TAU+MISC-IPV vs. TAU will be delivered. Feasibility, adherence, and fidelity will be evaluated through percentage of sustained engagement, individual interviews, video-based observations, and questionnaire-based assessment. For Aim 3 (Outcomes and Mediators), we will evaluate the effects of TAU+MISC-IPV vs. TAU to interrupt the traumatizing effects of IPV exposure on children through assessing emotional, behavioral, and trauma symptoms at baseline, 6, 12, and 18 months in the children recruited in Aim 2. The mediational effects of enhanced caregiving capacity will be assessed through video observations and increase in knowledge. At the end of this formative study, we will have established the foundational assessments and intervention to apply for a multi-site RCT to fully test the efficacy, mediators, and moderators of MISC-IPV. This project will make possible a culturally sensitive, developmentally transportable, scalable, and sustainable evidence- and community-based intervention with proven in-vivo mechanisms of change that may serve as a model for future IPV programs also in different populations, that address the needs of IPV-exposed mothers and children simultaneously.
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