“It Takes a Village: Family-Based HIV Risk Reduction for Adolescents Exhibiting
Externalizing Behavior Difficulties.
Geetha Gopalan, LCSW, PhD
Specific Aims
Externalizing behavior difficulties are a constellation of disruptive, hyperactive, and/or
aggressive behaviors which include defiance towards others, rule-breaking, and delinquency (1).
Adolescents with these behavior difficulties tend to manifest increased impaired judgment,
reduced impulse control, poorer problem-solving abilities, and greater conflicted interpersonal
relationships than do their non-disordered peers (2). Although HIV seroprevalence among
adolescents with psychiatric disorders is unknown (2), research has linked these behavioral
difficulties to a broad array of HIV risk behaviors (3-9). Poor, inner-city, minority communities
face disproportionately high rates of adolescent externalizing behavior difficulties (10-12), and
male and female Black and Latino/a adolescents have high rates of HIV/STI infections (13-16),
particularly those who are disadvantaged (17) or residing in inner-city environments(18).
However, to our knowledge, there are no HIV risk prevention interventions focusing on innercity, Black and Latino/a adolescents exhibiting externalizing behavioral difficulties.
This two-year (24 month), two-phase study aims to reduce HIV risk behaviors among
these adolescents by utilizing a family-based approach, which has shown particular promise in
addressing HIV risk and externalizing behavior problems (19), especially interventions which
enhance parental monitoring, discipline, involvement, and parent-child communication (20-26) .
Thus, the proposed intervention incorporates HIV risk reduction and family process components,
sexual risk-reduction features and externalizing behavioral difficulty reduction strategies of three
successful, evidence-based, family-based interventions for minority youth.
Specifically, this 24-month project will be conducted two phases:
Phase I: (Months 1-9) A curriculum committee consisting of 6 inner-city, Black and Latino/a
youth exhibiting externalizing behavior difficulties (ages 14-17), 6 caregivers for them, and 2
school staff Central Park East High School will co-design the intervention consisting of a series
of 10-12 weekly meetings utilizing caregiver-only, youth-only, and multiple family (i.e., 6-10
families together) groups.
Phase II: (Months 10-24) A separate cohort of 10 inner-city, Black and Latino/a youth (ages 1417) with externalizing behavior difficulties and their caregivers will experience the intervention.
Intervention feasibility will be determined by attendance rates per session, written
feedback from participants regarding acceptability and recommendations for change, and written
feedback from facilitators regarding challenges, successes, and recommendations for change.
Pre- and post-intervention measures will assess youth sexual and drug risk behaviors; caregiver
and youth HIV knowledge; youth behavior difficulties; caregiver monitoring, discipline, and
involvement; and caregiver-adolescent communication. Both qualitative and quantitative data
will be used by the curriculum committee to revise the intervention prior to larger scale pilottesting.
Background and Significance
Inner-city Black and Latino/a adolescents exhibiting externalizing behavioral difficulties
represent a population with a high risk of contracting HIV. The current study focuses on innercity youth as they are four times as likely to exhibit externalizing behavior problem compared to
same age peers in the general population (10, 12). Adolescents with such elevated behavior
problems frequently exhibit impaired judgment, poorer impulse control and problem-solving
ability, and greater conflicted interpersonal relationships than do their non-disordered peers, all
of which further increase the risk of engaging in unsafe sexual and drug risk behavior (2, 8, 2729). Typical HIV risk behaviors among youth with externalizing behavior problems include
frequent sexual activity, early sexual debut, low rates of condom use, high numbers of sexual
partners, high rates of drug use, needle sharing, exchanging sex for drugs, as well as drug/alcohol
use before and during sex (2, 4-7, 9, 30, 31)
Black and Latino/a adolescent males and females overall manifest high-risk sexual
behavior (14) and experience high risks of contracting HIV (16). However, opportunities for
HIV exposure increase for sexually active youth residing in high seroprevalance, inner-city
communities that have poor access to preventive health care (13, 32, 33).
HIV-prevention programs for adolescents which rely on cognitive and behavioral
theoretical models (13, 34, 35) may not be effective for youth exhibiting externalizing behavioral
difficulties. Such typical programs emphasize provision of information, increasing motivation to
change behavior, and practicing behavioral skills (36). However, adolescents with psychiatric
difficulties typically manifest cognitive processing and emotional impairments (e.g., poor reality
testing, impaired judgment, affect dysregulation) which hinder effective HIV preventive
behavior (37). As a result, there is often a split between what teens know, think and feel, and
how they eventually behave. Consequently, acquiring behavioral skills alone will not affect how
information or motivation impact engaging in high-risk behavior among adolescents with high
mental health needs (37).
Instead, HIV risk-taking behavior may be more fully explained by social and personal
factors, such as peer influences, family relationships, and concerns about relationship intimacy
(38). For youth with externalizing behavioral difficulties, high levels of caregiver-youth conflict
in combination with negative peer influences can lead to early sexual debut (39). Unmet
relationship needs (i.e., love, affiliation, closeness) also increase the likelihood of HIV-risk
behaviors, as the desire to maintain relationships at all costs undermines adolescents’ abilities to
be assertive about sexually responsible behavior (40, 41).
Conversely, positive family functioning and stability help to reduce youth externalizing
behavioral difficulties, as well as adolescent sexual and drug risk-taking. Parenting skills (e.g.,
discipline, monitoring), more frequent and open parent-child communication, and increased
parental involvement correlate with youth’s positive psychological adjustment, delayed sexual
and drug related activity, and reduction in risky sexual behavior, delinquent behavior, substance
use, and susceptibility to peer pressure (42-50).
Consistent with Ecodevelopmental theory (51), family-based interventions can be
effective in addressing social and personal factors contributing to HIV risk among youth with
externalizing behavioral difficulties (19, 52, 53). Ecodevelopmental theory posits that the family
is the most fundamental influence on adolescent behavior (54). As a result, the family serves as
an ideal entry point to address adolescent externalizing and risk-taking behavior. To reduce
externalizing behavior difficulties, typical strategies focus on teaching parents to manage
children through consistent rules and monitoring, increased goal-setting and family
communication, and building on family strengths (55-60). HIV preventive interventions with
parent components focus on improving both quality and quantity of parent communication about
sexuality and sexual risk reduction, as well as increasing parental monitoring and supervision of
youth (61). As the interactional patterns among families whose adolescents have externalizing
behavioral difficulties are likely to be compromised, parents will require additional support to
improve their relationships with youth. Consequently, successful HIV prevention models for
youth with externalizing behavioral difficulties should teach parents how to talk to their teens
about sex rather than simply encouraging them to have these discussions (62).
The current project builds on the successes of these family-based models to address
concurrent adolescent HIV risk and externalizing behavioral difficulties among inner-city Black
and Latino/a youth. Specifically, the current study will integrate components of three evidenceinformed interventions which have proven successful in reducing HIV risk behavior and
externalizing behavioral difficulties among adolescents into “It Takes a Village”, a family-based
approach to reduce HIV risk behavior and externalizing behavioral difficulties. Described in
greater detail in the “Preliminary Studies” section of this application, these interventions are: 1)
the Collaborative HIV Prevention and Adolescent Mental Health (CHAMP) Family Program, an
NIMH-funded, evidence-based HIV prevention and mental health promotion program developed
for inner-city school-aged children (i.e., 4th and 5th grade children) and their families (20, 21, 24,
63-65); 2) the Be Proud! Be Responsible! curriculum (66, 67), a CDC-certified, “Program that
Works” developed specifically to reduce sexual risk behavior among inner-city, minority
adolescents; and 3) The Multiple Family Group (MFG) Service Delivery Model to Reduce
Childhood Disruptive Behavior Disorders (DBDs), an NIMH-funded family-based mental health
service delivery strategy aimed at reducing childhood externalizing behavioral difficulties (23,
25, 26, 68-70).
Preliminary Studies
Investigative Team
Dr. Geetha Gopalan, LCSW, Ph.D. (PI) is a post-doctoral fellow at the Mount Sinai
School of Medicine (MSSM). Dr. Gopalan has worked with Dr. McKay since 2005 at MSSM,
where she has been involved in multiple intervention projects pertaining to inner-city families
and youth. As a pre-doctoral intern from 2005-2008, she has facilitated and coordinated the
implementation of The MFG Service Delivery Model to Reduce Childhood DBDs (PI: Mary
McKay) study, which will be utilized in the current study. In 2005, Dr. Gopalan co-developed
an evidence-informed intervention for adolescents residing in group homes (“Developing mental
health services for youth in congregate care facilities,” PI: Susan Essock).
Additionally, since 2007, she has been involved in the development, implementation, and
evaluation of the Project STEP-UP (71) program at MSSM (PI: Mary McKay), a multicomponent, school-based, alternative mental health promotion program for high school
adolescents manifesting behavioral and educational difficulties. Dr. Gopalan has led a team of
clinicians and peer parent advocates to develop the family-based outreach component for Project
STEP-UP. Dr. Gopalan’s research has also focused on the needs of high risk adolescents, where
she has examined the differential risk factors of youth externalizing behavior in two inner-city,
urban communities (72), as well as the relationship between parenting quality among foster
caregivers and the mental health outcomes of adolescents in foster care (73).
Dr. Mary McKay, Ph.D., (Co-PI/Mentor) is a Professor of Psychiatry and Community
Medicine and the Director of the Division of Mental Health Services Research, Department of
Psychiatry, MSSM. Over the past decade she has directed a large program of federally funded
research focused on preventing adolescent sexual and drug risk behavior, identifying the mental
health and prevention needs of inner-city youth and their families, as well as developing,
delivering, and testing family and community-based interventions within inner-city communities
(20-23, 25, 68, 74-77). Dr. McKay has pioneered both service innovations and interventions that
enhance service use and outcomes for urban families of color. Dr. McKay is the Principal
Investigator of the CHAMP Family Program (20, 25), Multiple Family Group (MFG) service
delivery strategy to reduce DBDs (23, 25, 26, 68), and Project STEP-UP (71).
Institutional Resources
All personnel (research assistants, facilitators) for implementing the current study will be
paid through Dr. McKay’s existing research projects. Additionally, the current study will be
supported by Project STEP-UP staff members, who will provide assistance in recruitment and
implementation at Central Park East High school, where Project STEP-UP current operates.
Evidence-Informed Interventions Utilized in the Current Study. The following paragraphs
describe the approach of each contributing intervention and document achievement of outcomes.
CHAMP Family Program. CHAMP is an evidence-based HIV prevention and mental
health promotion program developed for inner-city school-age children (i.e., 4th and 5th grade
children) and their families, consisting of 12 weekly 90-minute meetings with 6-10 families.
Through multiple family group discussion and practice activities as well as separate parent- and
child-only groups, CHAMP focuses on bolstering key family (i.e., family communication, family
involvement, parental monitoring, parental discipline) and youth processes (i.e., social problemsolving, peer negotiation skills) in order to delay early sexual debut and avoid risky behavior (20,
25). Evidence indicates these goals have been achieved by the CHAMP Family Program (65).
Be Proud! Be Responsible! Since the CHAMP program focused on older school-age
children and early adolescents (ages 9-14) and did not specifically target youth exhibiting
externalizing behavior disorders, the current study aims to integrate content from additional HIV
prevention for older youth (ages 14-17) and mental health intervention models aimed at reducing
externalizing behavior difficulties. Consequently, this study will also integrate the sexual risk
reduction components of the Be Proud! Be Responsible! curriculum (66, 67). As a CDCcertified, “Program that Works” developed specifically to reduce sexual risk behavior among
inner-city, minority adolescents (grades 6 through 12, approximate age range = 12-19), Be
Proud! Be Responsible! consists of highly structured modules involving group discussion,
videos, games, brainstorming, experiential exercises, and skill-building activities. Since some
adolescents may have had no prior sexual experience, while others have already initiated sexual
activity (61, 78), the present study will integrate components of two variants of the Be Proud! Be
Responsible! Curriculum: abstinence based and sexual risk reduction based. The abstinencefocused variant targets increasing adolescents’ knowledge about HIV/STDs, strengthening
beliefs supporting abstinence, and enhancing self-efficacy and skills to resist pressure to have
sex. The safer sex variant emphasizes condom use to prevent pregnancy, STDs and HIV,
addresses potential fears that using condoms may reduce sexual pleasure, and increases skills and
self-efficacy regarding negotiation and use of condoms. Both variants have demonstrated
achievement of intervention aims (abstinence, protection, or delay of sexual onset) for Black and
Latino/a adolescents (66, 67, 79).
The MFG Service Delivery Model to Reduce Childhood Disruptive DBDs. Finally,
this study will incorporate components from The MFG Service Delivery Model to Reduce
Childhood DBDs in order to address externalizing behavior difficulties exhibited by adolescents
in the current study. MFGs are mental health services (1) involving 6-8 families; (2) with trained
clinicians, (3) where at least 2 generations of a family are present in each session, and (4) where
psychoeducation and practice activities foster both within-family and between-family learning
and interaction (80). Currently, the MFG service delivery strategy to reduce childhood DBD’s is
being tested in a large-scale NIMH-funded effectiveness study (PI: McKay). In its 3rd year of 5year funding, this model involves n=372 school-age, inner-city, minority children (7 to 11 years
of age) meeting diagnostic criteria for Oppositional Defiant Disorder (ODD) or Conduct
Disorder (CD) and their families (including adult caregivers and siblings between the ages of 6
to 18 years) in a 16-week series of group family meetings. As a melding of group therapy,
family support, systemic family therapy, and behavioral parent training, the MFG service
delivery model targets family factors (i.e., parental discipline and monitoring, behavioral limits,
parent-child bonding, family conflict, stress, family organization, communication and within
family support) which have been consistently implicated in the onset and maintenance of
childhood behavioral difficulties, and predict the development of ODD and CD (57, 81-92). In
addition, MFG content addresses specific family factors which hinder effective parenting,
contribute to child externalizing behavior problems, and influence early termination:
socioeconomic disadvantage, social isolation, high stress, and lack of social support (93-95).
Initial studies by McKay and colleagues demonstrate the effectiveness of MFGs within
child mental health clinics serving inner-city, low-income youth with disruptive behavior
difficulties with regards to increased engagement and decreased child disruptive behavior
symptoms relative to participants in control conditions (23, 25, 26, 68). Preliminary results from
the ongoing MFG effectiveness study suggest that MFGs are associated with positive child
mental health outcomes (reduced oppositional defiant behavior and inattention, increased social
skills) relative to treatment as usual (96).
Research Design and Methods
Phase I: Intervention Development
In Phase I (months 1-9), a collaborative planning group to develop the “It takes a village”
intervention will be convened (known as the curriculum committee), consisting of 6 male and
female adolescents (3 African American, 3 Latino, age 14-17), and their adult caregivers (n = 6).
If youth have more than one caregiver present, youth will nominate one caregiver to participate.
Youth and their caregivers will be recruited through self- and Project STEP-UP staff
nominations among former and current Project STEP-UP participants within Central Park East
High School. Caregivers can include biological mothers and fathers, foster caregivers, and/or
grandparents. Two staff members (a guidance counselor and a teacher) from the same school
will also be recruited into the planning committee. Based on the PI’s and Co-PI’s experience, it
is estimated that this recruitment process will take approximately 2 months.
Once convened, the “It takes a village” curriculum committee will be charged with
making decisions regarding the specific content and service delivery processes to be included in
the proposed intervention. The first planning meeting will involve a group discussion among
curriculum committee members regarding the predisposing, reinforcing, and enabling factors
associated with adolescent sexual risk-taking, spread of HIV and other STD’s, and adolescent
externalizing behavioral difficulties. This discussion group, adapted from the PRECEDEPROCEED model for community planning and health promotion (97), will maximize the
participation of key stakeholders in the planning process for developing the “It takes a village”
intervention. Curriculum committee participants will draw upon their personal experiences of
HIV/STD risk and youth externalizing behavioral difficulties in order to inform the development
of the “It takes a village” intervention.
Subsequently, the curriculum committee will develop the “It takes a village” intervention
utilizing existing components of the CHAMP Family Program (20, 24), Be Proud! Be
Responsible! (66, 67) and the MFG service delivery strategy to reduce DBDs (23, 25, 26, 68).
The curriculum committee will discuss the applicability of each topic to the “It takes a village”
model, adapt the existing curriculum content for adolescents, or devise innovative strategies to
address each topic. Twelve curriculum committee meetings are estimated in order to develop
10-12 “It takes a village” sessions. Two additional curriculum committee session will be
scheduled prior to and following implementation of the “It takes a village” intervention, in order
to allow for additional review and revisions. In total, it is estimated that the “It takes a village”
curriculum committee will meet over 15 sessions. It is anticipated that most curriculum
committee sessions will involve discussion with both caregivers and teens present. However, as
certain topics involve discussion of sensitive information (e.g., safer sex), the curriculum
committee will decide which topics require separate caregiver/teen sessions. Table 1 (see below)
presents a summary of curriculum committee meetings and suggested topics.
Table 1. Suggested Curriculum Content Topics
Session
Suggested content
1
Group discussion on predisposing, reinforcing, and enabling factors associated with
adolescent sexual risk-taking, HIV/STD’s, adolescent externalizing behavior difficulties
within existing communities
2-13
Curriculum Development
Sample topics:
Peer negotiation & refusal skills (from CHAMP; Be Proud! Be Responsible!)
Abstinence beliefs (from Be Proud! Be Responsible! Abstinence variant curriculum)
Safer sex (from Be Proud! Be Responsible! Sexual Risk reduction variant curriculum)
Promoting positive relationships (from CHAMP; MFG)
Parental Monitoring/supervision (from CHAMP; MFG)
Family Communication (from CHAMP; MFG)
Rules (from MFG)
Responsibilities (from MFG)
Coping with Stress (from MFG)
Use of support and other resources (from CHAMP; MFG)
14
Review of completed curriculum prior to implementation
15
Review of curriculum and feedback from participants and facilitators after implementation
Phase II: Feasibility testing
Sample. Beginning in month 10, an additional cohort of youth and caregiver participants
(who have had no prior involvement in Project STEP-UP) will be recruited for the “It takes a
village” intervention. A sample of 10 adolescents (14 to 17 year olds) and their caregivers will
be recruited from Central Park East High School, which is located within an inner-city
neighborhood with the following characteristics: a) high rates of health and mental health related
difficulties, including asthma, HIV infection, substance abuse, and depression (98); b) home to
primarily families of Latino and African descent (99); c) high rates of poverty (over 70% as of
school year 2008-2009; 99).
Inclusion criteria includes: a) 2 or more suspensions in the current school year; b)
nominated by the guidance staff as having behavioral difficulties over the last school year; c) be
English speaking; and d) have a caregiver with the capacity to sign legal consent for the child.
Exclusion criteria includes: a) a significant cognitive, mental health or health
impairment (either adolescent or caregiver) that interferes with understanding of program content
or with the participation of others in the program; and b) having a mental health issue that
requires immediate attention.
The project will be presented on multiple occasions to youth at school leadership teams,
parents’ associations, and at teacher’s meetings in order to inform about the “It takes a village”
intervention as well as garner support for recruitment. Subsequently, research staff will
collaborate with members of school guidance staff to identify students who meet the eligibility
criteria outlined above. Project STEP-UP staff will contact eligible students to gauge interest. If
students are interested, their caregivers will be contacted by letter and then telephoned to enroll
in the “It takes a village” feasibility study. If the caregiver is interested and the youth expresses
agreement, then a member of the research staff will schedule a time to conduct informed
consent/assent. If more than one caregiver is present in the home, all pertinent adults will be
invited to participate in the “It takes a village” feasibility study. Caregivers and teens will be
assured that their decisions about participation (yes or no) will not affect their relationship with
the school. Written consent from caregivers who are the legal guardians and assent from youth
will be obtained at an initial contact with research staff. To encourage truthful responding on all
assessments, confidentiality to all participants will be assured.
Study design. The “It takes a village” feasibility study will be conducted within Central
Park East High School after school or during evening hours. Child care, transportation expenses
(MetroCards), and dinner will be provided for participant families at each session. Weekly
sessions (approximately 12) will be led by one trained peer parent advocate and one social work
clinician (known as “facilitators”). Upon completion of each session, youth and caregivers will
participate in separate debriefing sessions with independent research assistants. Participants will
comment on what they liked or disliked about the session; what helped or hindered participation;
acceptability of the session curriculum, materials, delivery; and recommendations for
improvement. The facilitators will also provide written feedback on successes and challenges
regarding engagement and intervention implementation. Upon completion of the full
curriculum, written feedback from participants and facilitators will be reviewed with the original
curriculum committee in order to make any further changes to content, delivery, and/or
materials.
Intervention facilitator training. Two program facilitators and two research assistants
(who are already on staff with Dr. McKay’s current research and service delivery projects) will
be trained to implement and collect data for the “It takes a village” feasibility study. Every effort
will be made to utilize Black and Latino/a facilitators and research assistants. Facilitator training
will consist of up to 12 modules of each of the “It takes a village” components, as well as on
facilitating manualized interventions. Training will be completed in one day-long format, and
followed by one hour per week ongoing supervision with the Principal Investigator (Gopalan).
Supervision will be scheduled before or after program sessions to save staff time and provide
preparation or debriefing opportunities.
Measures
Demographics. Collected prior to the intervention (pre-test), caregivers and youth will
provide demographic information, including: youth gender, family composition/structure,
race/ethnicity, income, caregiver educational level and employment history, residential moves,
and changes in child’s educational placement. In addition, permission to record data from school
records summarizing suspensions, detentions, absences and grades will be obtained.
Attendance: Attendance for youth and caregivers will be recorded for each session. This
information will be collected through the intervention
Acceptability: Upon completion of the intervention (post-test), intervention acceptability
will be recorded based on written feedback youth, caregivers, and facilitators
The following measures will be collected at both pre-test and post-test assessment
periods. Preliminary data analyses will collect initial reliability estimates for the current study’s
population to ensure that such measures are appropriate for the target population of urban, innercity Black and Latino/a adolescents (ages 14-17). If at that time reliability estimates are low,
more appropriate measures will be located and utilized. Almost all measures (except youth
sexual behavior and sexual risk situations) include both caregiver and youth reports.
Youth Externalizing Behavior Difficulties. Child Behavior Checklist (CBCL) Caregiver
Report Externalizing Behavior Subscale (Ages 4-18) is composed of 33 items referring to
aggressive, destructive, and anti-social behavior. The CBCL is a practical alternative for
diagnosis of clinical need, with a sensitivity of 0.80 and specificity of 0.73 against the Parent
Version of the Diagnostic Interview for Children (100). Overall one-week test reliability for the
Externalizing Behavior Subscale is reported as .93(101). To asses adolescent reports of
externalizing behaviors, the Child Behavior Checklist Youth Self Report (YSR) Externalizing
Behavior Subscale (ages 11-17) will be utilized. Construction of externalizing standardized
symptom scales for the YSR is almost identical to the same scales for the CBCL. One-week testretest reliability is .81(102).
Youth Sexual Risk Situations. The Frequency of Situations of Sexual Possibility (SPS)
will be measured via a structured, gated, youth-report behavioral interview developed by Roberta
Paikoff (103, 104). Adolescents are asked a series of questions about their time in unsupervised
situations, mixed-sex, private situations of sexual possibility. Those who have spent time in such
situations are asked additional questions concerning participation, frequency, duration, parental
knowledge and risk behavior. Among African American adolescents (aged 11-14), Cronbach
alpha is .64 (105).
Youth Sexual Risk Behavior. This construct will be measured using items from the
Sexual Risk Behavior Assessment Schedule for Youths (SERBAS-Y) modified form (106, 107).
The SERBAS-Y is a semi-structured, youth-report interview measuring onset of sexual
intercourse, sexual activity in the past three months and lifetime and number of partners with
whom youth have had protected and unprotected sexual encounters. On a sample (n = 22) of
Black and Latino runaway adolescents (ages 11-17), test-retest reliability has been high, ranging
from .71 to 1.00 (108).
HIV Knowledge. A 54-item self-report survey will measure caregiver and youth
understanding and practical knowledge regarding (a) the natural history of HIV and its
relationship to AIDS; (b) major transmission routes, other blood/body fluid transmission, facts
and misconceptions about major transmission routes, facts and misconceptions about
household/casual transmission; (c) contagiousness of HIV and illnesses associated with HIV; (d)
sexual risk reduction strategies, needles/sharps risk reduction, universal precautions for all
blood-bourne illnesses; (e) effectiveness of various risk reduction strategies; (f) HIV exposure
prophylaxis; (g) meaning and interpretation of HIV diagnostic tests; (h) availability and
limitations of current treatments for HIV; and (i) social impact of HIV. Cronbach alpha is >.8
for caregivers, and >.9 for youth (109, 110).
Drug Risk Behavior. Youth Drug use will be assessed using Problem Oriented Screening
Instrument for Teenagers (POSIT) Substance abuse subscale, utilizing both youth and parent
reports. Cronbach alpha for the Substance Abuse scale is .94, test-retest reliability is above .72
(111).
Parental monitoring. Caregiver’s perception of parental monitoring and supervision
will be measured using a 17-item subscale from the interview adapted from the Pittsburgh Youth
Study (112) and the Chicago Youth Development Study (113). Items have been adapted from
the Family Environment Scale (Moos & Moos, 1986) and the Family Assessment Measure
(114). Inter-item reliabilities of the scales used in a sample of 500 urban parents of pre and
young adolescent males ranged from .68 to .81. Adolescent perception of parental monitoring
and supervision will be assessed using a 6-item parental monitoring scale which measures
adolescents’ perception that their parents’ track and supervise their activities (115). This scale
has been utilized in 3 cross-sectional community surveys in 1992, 1994, and 1996 with urban,
low-income African American children and adolescents aged 9-17 years old (115). Cronbach
alphas for this population ranged from .70 to .73.
Parental Involvement. A 16-item subscale of the Alabama Parenting Questionnaire
(APQ; 116) will measure both caregiver and youth reports of the quality of parental involvement.
Among low-income adolescents (ages 11-18) Cronbach alphas for caregiver- and youth-reported
subscales range from .82 to .87 (117, 118).
Parental Discipline. An 11-item subscale of the APQ (116) will measure both caregiver
and youth reports of the degree to which parents implement negative/ ineffectual discipline.
Among low-income adolescents (ages 11-18), Cronbach alphas for caregiver- and youth-reported
subscales range from .58 to .61 (117-119).
Family Communication. Two scales will be utilized to measure the quality of family
communication.
Krauss Interview. A structured interview procedure developed by Beatrice Krauss (120)
will be administered to both caregivers and adolescents about their conversations with each
other. Respondents respond to questions about the frequency of conversations within last month
between the caregiver and child on each of 14 topic areas (e.g., sports, friends, sex, drugs, and
HIV). Scores include frequency of conversations across topics and specific to HIV, drugs, and
sex.
Parent-Child Relationship Inventory (PCRI). A 9-item parent-child communication
subscale from the Parent Child Relationship Inventory (PCRI; 121) will measure caregiver
reports of the quality of communication. Internal consistency for the communication scale
ranges from .68 to .76 among both mothers and fathers of adolescents (122).
Data Analysis
Although the current study is limited by the small sample size of participants, this study
will be able to provide data for a subsequent pilot with a larger sample size, thus providing
greater statistical power. Descriptive statistics (means, proportions) will be conducted to
summarize demographic information. Attendance rates (% attendance at each session) will be
summed and averaged. Changes between pre- and post-tests scores will be analyzed for those
constructs measured at two time points, using paired t-tests for parametric data, and Wilcoxon
signed-rank tests for non-parametric data.
Dissemination Plan
Two articles will be written and published in peer-reviewed journals; one will describe
the “It Takes a Village” intervention, and the other will present study results. Findings also will
be presented at national mental health, social work, and HIV conferences based on the findings
from this feasibility study. Results from this study will be utilized to seek additional grant
funding for further refinement and testing. Finally, study findings will be shared with curriculum
committee members and intervention participants.
Timeline
Activity
PHASE I
Recruitment for curriculum committee,
Curriculum committee meetings
Curriculum committee meetings, complete
intervention curriculum and assessments
PHASE II
Recruitment for feasibility study
Implement intervention
Review feedback from feasibility study,
revise and refine intervention curriculum
Data analysis
Manuscript preparation dissemination
Mo 1-4
Mo 5-8
Mo 9-12
Mo 13-16
Mo 17-20
Mo 21-24
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