This study presents results of a subgroup analysis from a randomized trial to examine whether Structural Ecosystems Therapy (SET), a family intervention intended to improve medication adherence and reduce drug relapse of HIV-seropositive (HIV+) women recovering from drug abuse, provided benefits for families with children. Data from 42 children and 25 mothers were analyzed at baseline, and 4, 8, and 12 months post-baseline. Results of longitudinal Generalized Estimating Equations analyses suggested that SET was more efficacious than the Health Group (HG) control condition in decreasing children's internalizing and externalizing problems and reducing mothers' psychological distress and drug relapse. Children in SET reported improvements in positive parenting as compared to the children in HG, but there were no differences in mother-reported positive parenting, or parental involvement as reported by either the children or mothers. These findings suggest that family interventions such as SET may be beneficial for mothers and children. An adaptation of SET specifically for families with children could further enhance benefits and improve acceptability and cost-effectiveness. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript (CDC, 2009) estimates that 26% of all new HIV/AIDS diagnoses are among women. A sizable proportion of HIV seropositive (HIV+) women are mothers. The HIV Cost and Services Utilization Study surveyed a nationally representative sample of HIV+ adults receiving health care in 1996 and 1997. Of 840 women in the sample, 60% had minor children living with them (Schuster et al., 2000).Children of HIV+ mothers have been found to be at risk for internalizing and externalizing problems (e.g., Forehand et al., 2002;Tompkins & Wyatt, 2008), although some studies have not found significantly increased risk for children of HIV+ mothers when compared with demographically similar controls (e.g. Lester et al., 2010). Studies have also demonstrated that children of HIV+ mothers are detrimentally affected by maternal substance abuse (Lester et al., 2009; Rotheram-Borus & Stein, 1999). Children with duallydiagnosed parents appear to derive greater adverse effects from the parent's substance abuse than from HIV (Cowgill et al., 2007;Leonard, Gwadz, Cleland, Vekaria, & Ferns, 2008).Research has demonstrated the linkages between parenting processes and child outcomes in families affected by parental HIV and/or substance abuse. Studies with demographically comparable groups of children with HIV+ and HIV-mothers have found less close parentchild relationships (Forehand et al., 2002;Kotchick et al., 1997) and less monitoring (Forehand et al., 2002) in families with HIV+ mothers, which in turn were connected to less favorable child outcomes. Lester et al. (2010), however, while finding that family processes were associated with children's internalizing and externalizing problems, also found that children with HIV+ mothers reported more positive maternal bonds than children not in HIV-affect...
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