Intervention Summary

Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP) Family Program

The Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP) Family Program is a 12-week, family-focused, developmentally timed intervention for 4th- and 5th-grade students in urban, low-income communities. CHAMP is guided by a developmentally focused theoretical model informed by an amalgam of prior literature. Briefly, the model posits that at preadolescence, youth are exposed to "situations of sexual possibility" (i.e., unsupervised heterosocial interactions occurring in a private place) but are not yet sexually active, making this age a key intervention target to promote a delay in sexual onset.

The primary goal of CHAMP is to support family processes, specifically family communication, social support, and parental supervision and monitoring skills. The program also is designed to improve child assertiveness and social problem-solving skills. These goals are met through (1) discussion of sexual possibility situations; (2) intensive practice in family communication, making links between family processes and children's participation in sexual possibility situations (in particular, stressing family communication, rule setting, monitoring, support, and discussion of values); and (3) discussion of information relevant to puberty and HIV/AIDS to help prepare families for the coming changes of adolescence. Each program session includes both parent-child joint exercises and breakout sessions for parents and children separately.

The program is delivered through schools as well as by community groups. Local partnerships known as CHAMP Collaborative Boards are highly involved in the development, delivery, and evaluation of the program at each implementation site and include parents, school staff, community-based agency representatives, and university-based researchers. Facilitators receive training before and during implementation but are not required to have any prior specialized training or formal qualifications.

Descriptive Information

Areas of Interest	Mental health promotion
Outcomes	1: Family communication 2: Knowledge about HIV transmission 3: Perceived stigma of HIV/AIDS 4: Externalizing behavior
Outcome Categories	Drugs Family/relationships Mental health Social functioning
Ages	6-12 (Childhood)
Genders	Male Female
Races/Ethnicities	Black or African American Race/ethnicity unspecified Non-U.S. population
Settings	Home Other community settings
Geographic Locations	Urban
Implementation History	In the United States, the intervention has been provided to approximately 570 youth and their families in 5 communities in Chicago and New York City. The program also has been implemented in Argentina, South Africa, and Trinidad and Tobago. With the exception of the program in Argentina, all of the implementations have been evaluated empirically.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: No
Adaptations	The CHAMP model has been adapted for the needs of homeless families in HOPE (HIV Prevention Outreach for Parents and Early Adolescents), a family-based HIV and drug abuse prevention program for early adolescent youth and their adult caregivers living in homeless shelters in New York City. The multiple family group delivery strategy used in CHAMP also has been applied in the Multiple Family Group program, which provides mental health services to urban, low-income children of color.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Selective

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Outcomes

Outcome 1: Family communication
Description of Measures	In one study, two dimensions of family communication, comfort and frequency, were measured using items adapted from the Family Communication Scale. In a second study, comfort with communication about AIDS-related issues was measured with a series of questions adapted from the Youth AIDS Prevention Project and the Aban Aya Youth Project. Items address the degree to which youth/caregivers are comfortable with discussing HIV, AIDS, sexuality, and substance abuse. Items are scored on a 4-point scale (from "strongly disagree" to "strongly agree" or "very comfortable" to "uncomfortable").
Key Findings	In a study conducted in South Africa, youth and their adult caregivers were randomly assigned by school to the intervention group, which received CHAMP, or to the control group, which received standard school programming. From pre- to posttest, the change in caregivers' comfort with family communication and the frequency of communication was significantly greater among those receiving the intervention (p = .0021 and p = .0412, respectively). These differences were associated with small effect sizes (Cohen's d = 0.4 and 0.2, respectively), based on parameter estimates from mixed-effects regression models. In a single-group study conducted in the United States, caregivers participating in CHAMP showed a significant pre- to posttest improvement in their comfort with family communication (p < .01).
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental, Preexperimental
Quality of Research Rating	2.8 (0.0-4.0 scale)

Outcome 2: Knowledge about HIV transmission
Description of Measures	Knowledge about HIV transmission was measured with a series of questions adapted from the Youth AIDS Prevention Project and the Aban Aya Youth Project. Items address the degree to which respondents understand how HIV is caused and transmitted. Items are scored on a 3-point scale (as "true," "false," and "not sure").
Key Findings	In a study conducted in South Africa, youth and their adult caregivers were randomly assigned by school to the intervention group, which received CHAMP, or to the control group, which received standard school programming. From pre- to posttest, the change in caregivers' knowledge about HIV transmission was significantly greater among those in the intervention group (p = .0084). This difference was associated with a medium effect size (Cohen's d = 0.6), based on parameter estimates from mixed-effects regression models. In a single-group study conducted in the United States, youth and caregivers participating in CHAMP showed a significant pre- to posttest increase in their knowledge about HIV transmission (p < .01).
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental, Preexperimental
Quality of Research Rating	2.7 (0.0-4.0 scale)

Outcome 3: Perceived stigma of HIV/AIDS
Description of Measures	Perceived stigma of HIV/AIDS was measured with a series of questions adapted from the Youth AIDS Prevention Project and the Aban Aya Youth Project. Adult and child responses are coded differently, with low scores for adults and high scores for children indicating low levels of perceived stigma.
Key Findings	In a study conducted in South Africa, youth and their adult caregivers were randomly assigned by school to the intervention group, which received CHAMP, or to the control group, which received standard school programming. From pre- to posttest, the change in the perceived stigma of HIV was significantly greater among caregivers and youth in the intervention group (p = .0817 and p = .0045, respectively). These differences were associated with small and medium effect sizes (Cohen's d = 0.4 and 0.6, respectively), based on parameter estimates from mixed-effects regression models.
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.1 (0.0-4.0 scale)

Outcome 4: Externalizing behavior
Description of Measures	Externalizing behavior among youth participants was assessed using the Child Behavior Checklist (CBC-L/6-18), a widely used 112-item questionnaire in which eight measured characteristics are combined to produce two scales for internalizing and externalizing behavior. The checklist was administered to the parents/caregivers of youth participating in the program.
Key Findings	In a single-group study conducted in the United States, youth participating in CHAMPS showed a significant pre- to posttest improvement in externalizing behavior (p < .05).
Studies Measuring Outcome	Study 3
Study Designs	Preexperimental
Quality of Research Rating	2.8 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	6-12 (Childhood)	59.1% Female 40.9% Male	100% Non-U.S. population
Study 2	6-12 (Childhood)	60.2% Female 39.8% Male	99% Black or African American 1% Non-U.S. population
Study 3	6-12 (Childhood)	37.6% Female 24.8% Male	99% Black or African American 1% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Family communication	2.9	2.2	3.2	2.9	2.8	2.8	2.8
2: Knowledge about HIV transmission	2.4	2.2	3.2	2.9	2.9	2.8	2.7
3: Perceived stigma of HIV/AIDS	2.9	2.4	3.2	3.3	3.3	3.8	3.1
4: Externalizing behavior	3.8	3.3	2.9	2.0	2.3	2.4	2.8

Study Strengths

Reliability and validity were enhanced by the studies' use of portions of a measure that had prior study-based testing. The investigators made careful efforts to ensure intervention fidelity, both by putting mechanisms in place to train the implementers and by conducting regular follow-ups. Study population sizes were robust, and in two of three studies reviewed, attrition was very low. The most rigorous of the three studies used a quasi-experimental design, which helped to minimize the effects of potential confounding variables.

Study Weaknesses

Attrition in one of the three studies was quite high, approaching 50%. Although the steps taken to maximize intervention fidelity are described in some detail, evidence of the success of these steps is not provided. Two of the studies employed a preexperimental design that did not adequately control for potential confounding factors. Analytical procedures are not described in detail in all the studies reviewed, requiring some inferences to be made about the approach taken.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
2.0	2.0	3.3	2.4

Dissemination Strengths

The implementation manual offers handouts and general information on program engagement and family processes. A thorough training manual is provided and 2-day, on-site training is available. Outcome measurement tools are provided for both children and parents.

Dissemination Weaknesses

Information on organizational or facilitator requisites is not provided. The facilitator and training manuals were developed for a research project and rely heavily on direction provided by the research team. The manuals have not been revised to be used in routine community settings. The pre- and posttest instruments are lengthy, which may make them difficult to administer in real-world settings. Little guidance is provided about how to interpret the data collected from evaluation tools.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
CHAMP Facilitator Manual (includes session outlines, activity outlines, scripts, pre- and posttests, and other support materials)	Free	Yes
2-day, on-site training for supervisors and facilitators	$1,500 per day (cost includes travel expenses)	No
CHAMP Trainer Manual	Free	Yes
On-site or telephone consultation	$1,500 per day (cost includes travel expenses)	No

Additional Information

Consultation can be provided on site or over the phone. The cost can be prorated for consultations lasting less than 1 day.