HIV Prevention and Life Options for Youths
in Foster Care (Bridges to Life Options Program)

Principal Investigator:  Wendy Auslander, PhD
Funders:           National Institute of Child Health and Human Development (NICHHD)
                          Annie E. Casey Foundation (NICHD 5 R01 HD 35445)
Timeframe:       Funded 01/98 – 12/03
Affiliation:       Center for Social Development, Comorbidity and Addictions Center
                          Center for Mental Health Services Research.

Project Staff:    Curtis McMillen, Ph.D., Co PI
                          Michael Sherraden, Ph.D., Co PI
                          Arlene Stiffman, Ph.D., Investigator
                          Diane Elze, Ph.D., Investigator
                          Tonya Edmond, Ph.D., Investigator
Participating Organizations: Missouri Department of Social Services – St. Louis County Children's Division, St. Louis, MO, 63132
                           US Bank – Lindell Branch, St. Louis, MO, 63108.
Project Contact:  Wendy Auslander, PhD, (314) 935-6634
                              wendyaus@wustl.edu

Project Update as of 10/11/2007:
Stage:  Project completed.  Additional publications in progress.

Description: This study developed and evaluated an HIV-Prevention Plus educational planning program for abused and neglected youths in foster care.  The program was implemented through the Independent Living Program (ILP), a skills-building program that provides life skills to youths before they are discharged from state custody.  Previous research indicates that educational parameters such as relationships with teachers, skipping school, grades, and educational aspirations are predictive of HIV-risk knowledge, attitudes, behavioral intentions, and behaviors.  Although brief cognitive-behavioral interventions appear to be promising in the short-term, long-term follow-up indicates that outcomes achieved do not last in this high risk population.  An integral part of HIV-prevention with abused and neglected youth should involve providing youths with opportunities, skills, and hope for their future.  This was achieved by implementing a life skills program that integrates HIV-prevention with a life-options building intervention that emphasized educational aspirations and planning.
         An experimental design was utilized and 363 youths were randomly assigned to either the HIV-Prevention plus Life Options condition (Bridges to Life Options Program) or the usual care condition.  Both conditions were delivered over an 8-month intervention phase.  Evaluation of the program will be performed using data assessed during pre-, post-, and 9-month follow-up interview.  The primary outcome is HIV-risk behaviors.  Secondary outcomes include:  knowledge and attitudes about HIV-prevention, self-efficacy, intentions to engage in HIV-risk behaviors, future aspirations and beliefs about savings, and educational plans.  A major strength of this study is that the program was delivered through the ILP, a well-established state-administered program in the community.  ILP provided: (1) access to high-risk abused and neglected youths, (2) involvement of committed staff to deliver a program whose philosophy is consistent with that of the study, and (3) the potential to disseminate the curriculum developed for this study to ILP programs both statewide (in seven regions of Missouri’s Department of Social Services) and nationwide to all 50 states.

Key Findings:

• Youths in foster care who exhibit borderline and clinical levels of externalizing mental health problems engage in significantly more HIV risk behaviors and have greater intentions to engage in risky behaviors than those youth without these problems.
• Among youths involved in the child welfare system, more severe sexual abuse (i.e. unwanted intercourse) contributes to more frequent participation in HIV risk behaviors, even after accounting for their emotional and behavioral problems and experiences with other childhood trauma.
• A study of the educational experiences of our sample of youths in foster care documented an alarming number of school problems.  A majority had failed a class in the past year.  Most had been suspended from school at some point and many had physical fights with other students and verbal fights with teachers.  Disturbing in their own right, these problems also likely contribute to the low graduation rates found in other studies of youth involved in the foster care system.  Poor school achievement and behavior problems leading to suspensions and expulsions are typically robust predictors of later school dropout (e.g., Cairns, Cairns, & Neckerman, 1989).

Conference Presentations:

• Auslander, W., Elze, D., Edmond, T., Thompson, R., McMillen, C.  (2002, June.)  "Mental health problems and HIV risk among adolescents in foster care."  Brisbane, Australia:  Third International Conference on Child and Adolescent Mental Health.
• Auslander, W., McMillen, C., Stiffman, A., Williams, J.H., Elze, D.  (1999, January 30.)  “Methodological Strategies of Community-Based Intervention Research:  Successes and Pitfalls .”  Charleston, SC:  SSWR.
• Auslander, W., McMillen, C., Thompson, R., Elze, D., Sherraden, M.  (2001, July.)“Predictors of HIV Risk Among Adolescents in Foster Care:  Implications on Prevention Programs and Child Welfare Policy.”  Tampere, Finland:  International Conference on Social Work in Health and Mental Health.
• Auslander, W., McMillen, C., Thompson, R., Elze, D., White, T., Krebill, H. (2001, July 9.)   “Mental Health Problems and Sexual Abuse as Determinants of HIV Risk Behavior.”  Brighton, England:  AIDS Impact 2001 Conference.
• Elze, D. (2002, January.) “Severity of Sexual Abuse and HIV Risk Characteristics.”  San Diego, CA:  SSWR.
• McMillen, C., Auslander, W., Stiffman, A., Elze, D., Thompson, R., Krebill, H. (2000, July 12.)  “Prior Abuse as Critical Determinant of HIV Risk Behavior Among Adolescents in Foster Care.”  Durban, South Africa:  World AIDS Conference.
• McMillen, C.  (1999, August.) “HIV Sexual Risk Behaviors Among Youth in Foster Care:  Previous Abuse/Neglact, Unstable living situations, and/or school disruptions?”  CDC National HIV Prevention Conference.
• McMillen, C. (1999, June 23.)  “Bridges to Life Options:  Preliminary Description”.  Seattle, WA:  Casey Family Program Independent Living Forum, in conjunction with the Child Welfare League of America National Conference on Research in Child Welfare and Western Region Training Conference.
• Polgar, M. (2000, November 16.)   “Variations in Future Orientation Among Youth in Foster Care: Implications  for HIV Risk.”  Boston, MA:  APHA.
• Thompson, R., & Auslander, W. (2001, August 13.)  “Factors Related to Attendance in an HIV Prevention Program for Adolescents in Foster Care.”  Atlanta, GA:  National HIV Prevention Conference (CDC).
• Thompson, R., & Auslander, W. (2001.)  “Comorbid Mental health and Substance Use Problems Among Adolescents in Foster Care:  Relationship to HIV Risk.”  Society of Social Work Research.
• Thompson, R., & Auslander, W.  “The Bridges to Life Options Program for Adolescents in Foster Care:  Factors Related to Attendance.”Thompson, R., & Auslander, W.  (2001, April).  The Bridges to Life Options Program for adolescents in foster care: Factors related to attendance.  Paper presented at the Sixteenth Annual Symposium on the Empirical Foundations of Group Work, St. Louis, MO.
 

Forthcoming, In Press, or Published Papers:

• McMillen, C., Auslander, W., Elze, D., White, T., Thompson, R.  (2003.)  Educational experiences and aspirations of older youth in the foster care system. Child Welfare 72, 475-495.
• Edmond, T., Auslander, W., Elze, D., McMillen, J.C., & Thompson, R.(2002). Differences between sexually-abused and non-sexually abused adolescent girls in foster care. Child Abuse and Neglect.  
• Auslander, W., McMillen, JC., Elze, D., Thompson, R., Jonson-Reid, M., & Stiffman, A.  (2002).  Mental health problems and sexual abuse among youths in foster care:  Relationship to HIV risk behaviors and intentions.  AIDS and Behavior, 6, 351-359.
• Elze, D., Auslander, W., McMillen, C., Edmond, T., & Thompson, R. (2001). Untangling the impact of sexual abuse on HIV behaviors among youths in foster care.  AIDS Education and Prevention, 13, 377-389.
• Auslander, W., Slonim-Nevo, V., Elze, D., & Sherraden, M.  (1998.)  HIV prevention for youths in Independent Living Programs:  Expanding life options.  Child Welfare, 20, 208-221.