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Eighty-five HIV-positive mothers were tracked in a descriptive analysis of progress through a nonprofit organization's program of legal and mental health services designed to assist ill parents in making a permanency plan for their children after the parent's death. Data on service utilization was analyzed using a Hierarchical Classes (HICLAS) analysis, which uncovered an interpretable pattern of services that clearly distinguished basic (e.g., intake), legal, and clinical services. From the HICLAS output we created an index of progress: [no services] < [basic services only] < [basic + legal services] < [basic + legal + clinical] services. An index of mood was constructed from staff ratings of clients during home visits. Multiple regression analyses revealed that the number of different moods observed in a client was positively correlated with progress. Number of moods was also positively correlated with positive outcome, that is formulating a legal permanency plan and/or transferring care of the...

Factors associated with psychological distress were examined in 220 low-income, mostly minority mothers with late-stage HIV/AIDS. Mothers lived with at least one HIV-negative child of age 2-12 years and participated in a study of the effectiveness of a custody planning intervention provided by The Family Center. The mothers exhibited extraordinarily high levels of psychological disturbance on the Psychiatric Symptom Index (PSI). Multiple regression showed that higher PSI Total scores were significantly related to the mother's reports of having non-HIV-related medical conditions, spending time in bed in the past 2 weeks, having more activity restrictions, and having a lot of difficulty caring for her child due to ill health. Higher scores also were associated with lower education, experiencing more negative life events, and greater receipt and lower adequacy of social support. Thus, higher distress was associated with inability to perform usual activities and mobilization of support. However, other HIV-related health factors, traditional background characteristics, and psychosocial measures (e.g., HIV stigma, parenting stress, family environment) failed to indicate who was most vulnerable. Researchers need to identify the mechanisms of risk and develop appropriate mental health interventions.

This study examined the relationships between selected risk and resistance factors and maternal reports of child behavior problems on the Child Behavior Checklist (CBCL) in families affected by maternal HIV/AIDS. Data were obtained from 193 mothers with late-stage HIV/AIDS who were included in a sample consecutively recruited from the New York City Division of AIDS Services Income Support to participate in Project Care, a randomized trial of a permanency planning intervention. Each mother reported on one HIV negative index child 5–12 years of age. Child behavior problems were related significantly to the mother’s psychological distress and marginally to her having illness-related activity restrictions, but not to other measures of maternal physical health, stigma or disclosure of her HIV to the child. Two child dispositional factors, productivity and independence, and two family factors, adaptability and a good parent–child relationship, were related to better child functioning, but family cohesion was a risk factor for poorer adjustment in this sample. These are likely to be key target variables useful to policy makers in planning programs to assist these children in coping successfully with their mother’s illness.

SUMMARY The needs of well adolescents in families with AIDS have received little attention, despite the growing number of these youth nationwide. This report summarizes the experiences of 59 adolescents aged 10-19 years old and their parents with AIDS. Parents were faced with difficult decisions regarding custody planning and disclosure of serostatus to children: 39% chose not to disclose their illness to their children and 53% had no viable custody plan. Stigma associated with AIDS and social isolation of families intensified the stress families experienced in attempting to cope with these issues. Despite these challenges, families demonstrated tremendous resiliency and effective coping. These interviews demonstrate the importance of outlining methods for professionals to provide: (1) training to help parents decide if, how and when to disclose their serostatus; (2) assistance in planning for the future custody of children; and (3) in-home supportive counseling for families, and transitional case managem...

OBJECTIVE. The objective of this study was to use multiple measures and sources to assess mental health over time in uninfected 8- to 12-year-old children of HIV-positive mothers. METHODS. We recruited from the New York City Division of AIDS Services and Income Support a consecutive sample of 157 single mothers who were living with an HIV-negative child aged 8 to 12. Families were randomly assigned to receive a custody planning intervention, Project Care, or standard care. Data were collected at baseline and 4 subsequent times 6 months apart. Children completed the Children's Depression Inventory; 8- to 10-year-olds completed the Terry, and 11- to 12-year-olds completed the Youth Self-Report. Mothers completed the Child Behavior Checklist. Each measure has a validated cutoff score to signify clinically significant symptoms. RESULTS. All 5 data points were available on 129 (82%) children. During 2 years, every child had a score in the clinical range (12% once, 25% twice, 26% 3 times, 27% 4 times, and 9% all 5 times). Clinically significant symptoms were most likely at baseline when mothers were sickest. Few had clinically significant symptoms based on maternal report only (5%) or child report only (8%). Chronicity of clinically significant symptoms was not related to child age or gender, maternal health or depression, parent-child relationship, or being assigned to Project Care. Although two thirds of the children received mental health services during the study, CONCLUSIONS. Children who are affected by AIDS should be routinely screened for psychiatric problems by using multiple measures and sources to avoid underidentification and be carefully monitored long-term.