Family Spirit®

About This Program

Target Population: Any at-risk or young adult mother (under age 25 years) who is pregnant (ideally 28 weeks gestation or sooner) and/or has a child younger than 3 years old and lives in a Native American community; however, can be used with any pregnant woman and/or woman with a child younger than 3 years old, regardless of ethnicity/race

Program Overview

Family Spirit® is a culturally tailored home-visiting program designed to promote optimal health and well-being for parents and their children. Family Spirit combines the use of paraprofessionals from the community as home visitors and a culturally informed, strengths-based curriculum as a core strategy to support young families. Parents are given information and taught skills designed to promote healthy development and positive lifestyles for themselves and their children. Family Spirit consists of 63 lessons taught from pregnancy to age 3.

Family Spirit’s vision: To break intergenerational cycles of despair in historically disenfranchised communities by empowering a local workforce as change agents for promoting the best start for young families.

Family Spirit’s mission: Family Spirit envisions a future where every community, regardless of socioeconomic status, will have access to an evidence-based, culturally competent early childhood home-visiting model that employs local paraprofessionals to promote optimal health and well-being for parents and young children in their communities.

Program Goals

The goals of Family Spirit are:

Mothers:

  • Increase parenting knowledge and skills
  • Decrease psychosocial risks that could interfere with positive child-rearing (drug and alcohol use; depression; low education and employment; domestic violence problems)
  • Increase likelihood of taking child to recommended well-child visits and health care
  • Increase familiarity with and use of community services that address specific needs
  • Increase life skills and behavioral outcomes across the lifespan

Children:

  • Increase likelihood of optimal physical, cognitive, and social/emotional development from birth to 3 years
  • Increase early school success
  • Increase life skills and behavioral outcomes across the lifespan

Essential Components

The essential components of Family Spirit include:

  • Relationship with empathic culturally matched educator
    • Home visitors trained to create an environment that allows for a comfortable, confidential space to dialogue with families
    • Highly flexible and nonjudgmental home visitors who are accommodating of the participant’s needs
    • Continued development of the home visitor’s rapport and relationship with her clients supported through the Family Spirit training and observational quality assurance check-ups
  • Lessons following structured educational materials attuned to developmental time points of mother and child
    • Program materials developed to be highly structured teaching aids for home visitors right from the first visits
    • Structured materials designed to be used at developmentally appropriate time points
  • Duration of program enrollment (pregnancy through 36 months postpartum)
    • Specifically designed for the mothers to be in the program for at least 39 months (3 months before birth to child’s 3rd birthday)
    • Ideally mothers stay in Family Spirit program until completion
  • Content integrating parenting techniques and strategies designed to reduce maternal emotional and behavioral risks
    • Taught through a combination of:
      • Didactic lessons
      • Scenarios (brief stories) in which participants are guided to problem-solve a familiar issue
      • Activities
    • Delivered by trained home visitors familiar with the curriculum
    • Designed to teach mothers how to
      • Set a routine for the child and family and consistently monitor it
      • Read children’s cues and avoid coercive interactions (e.g., power struggles)
      • Promote nurturing parenting and avoid harsh/unresponsive/neglectful
    • Continually references these core parenting competencies in the curriculum to assist in learning them
    • Designed for mothers to:
      • Acquire and practice problem-solving, coping, and goal-setting skills
      • Receive support and education around self-care and developing positive peer relationships to reduce risks for substance use
      • Learn conflict resolution and communications skills to use with baby’s father and other caregivers to reduce risk of domestic violence.
  • Home visitors able to pinpoint areas of challenge or success and target home visits to their participant’s knowledge or skill gaps by assessing participant knowledge over time
  • Designed for children to achieve optimal social, emotional, and cognitive development through positive parent-child interactions
  • Curriculum that includes the following:
    • Implementation Guide –
      • Includes information about the Family Spirit program history and its impact on several maternal and child health outcomes
      • Includes a description of the “essentials” for successfully implementing the program
    • Family Spirit Lessons (6 modules)
      • Consists of six modules:
        • Prenatal Care - Information to help an expectant mother:
          • Prepare for the arrival of her baby
          • Know what to expect during pregnancy
          • How to take care of herself and her baby
        • Infant Care - Information to help a mother:
          • Adapt to her life with a new baby
          • Take care of herself
          • Learn basic infant care skills
          • Learn how to respond to her baby’s various wants/needs
        • Your Growing Child - Information to help a mother:
          • Track her child’s overall development from 7 months until the child’s 3rd birthday
          • Learn how to prepare her child for preschool through various activities and play
        • Toddler Care - Information to help a mother:
          • Build confidence in her parenting skills through daily routine and monitoring
          • Learn basic skills to help her child form healthy habits to last a lifetime
        • My Family and Me - Information to help a mother:
          • Develop life skills that will positively influence herself, her child, and her family and friends
        • Healthy Living - Information to help a mother:
          • Address and cope with difficult situations
          • Learn goal-setting to build self-esteem and be a good role model
          • Learn about substance abuse prevention, family planning, prevention of sexually transmitted infections (STIs), and where she can go to get help, if needed
      • 63 lessons in total, which can be taught between pregnancy and the child’s 3rd birthday (around 28 weeks gestation)
      • Designed to be taught one-on-one during home visits, but can also be used in clinic and group settings.
      • Can be administered sequentially or independently, depending on the program structure and participants’ needs
      • Includes a Health Educator Lesson Plan booklet with each module which provides home visitors with a comprehensive overview for conducting each lesson with the participants
    • Reference Manual
      • Provides the home visitor and participant with further and more in-depth information related to the lesson topics
      • Consists of 3 sections:
      • Reference Manual which includes relevant topics that are referred to in the lesson pages
      • Bibliography which includes additional resources, many of them web-based resources, which go into more detail about the lesson topics
      • Glossary of Terms which includes key terms and definitions discussed throughout the curriculum; each definition provides a reference back to the module and lesson pages where that topic is discussed
  • Participant Workbook
    • Provides the participant with handouts and worksheets to reinforce key teaching points
    • One sample Participant Workbook included in the curriculum package, and additional copies can be purchased
  • Evaluation Materials
    • Series of evaluation measures and screening tools developed specifically for the Family Spirit curriculum included on a USB drive within each curriculum box
    • Available for use as determined by program requirements but not required to implement the curriculum
  • Participant Certificates
    • 4 participant certificates to be awarded at various times throughout the program
    • PDF versions included on the USB drive within each curriculum box
    • “New baby” certificate given by the home visitor to every participant who gives birth during the Family Spirit Program
    • Breastfeeding certificate given to mothers who breastfeed their newborns for at least 2 weeks
    • Certificate of achievement given by the home visitor to recognize general participant achievements as she progresses through the Family Spirit Program
      • Home visitor can fill in the participant’s specific achievement, such as successfully receiving three months of Family Spirit lessons, on blank line
      • Several certificates of achievement can be awarded to the participant.
    • Certificate of completion given to each participant upon exit from the Family Spirit Program, regardless of how long she was enrolled in the program.

Program Delivery

Child/Adolescent Services

Family Spirit® directly provides services to children/adolescents and addresses the following:

  • Disruptive behaviors, medical/dental/social service needs

Parent/Caregiver Services

Family Spirit® directly provides services to parents/caregivers and addresses the following:

  • Maternal stress, coping, and problem-solving; maternal substance use; maternal depression; meeting children’s and family’s basic living needs (e.g., connecting with services to help with unstable housing, food/water insecurity, baby supplies); maternal goal setting for continuing education or seeking gainful employment; support in managing children’s behaviors
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Family Spirit recognizes that family is important, and many people help raise a child. While the focus is on the primary caregiver and index child, Family Spirit encourages involvement of other caregivers when appropriate. Parents are also referred to other health and social services available in the community needed by the whole family.

Recommended Intensity:

Total of 52 home visits which should be 45 minutes to 1.5 hours in length. Sessions 1–12 should be taught weekly through birth. Sessions 13–23 should be taught weekly through 3 months postpartum. Sessions 24–29 should be taught biweekly through 6 months postpartum. Sessions 30–45 should be taught monthly through 22 months post-partum. Lastly, sessions 46–52 should be taught bimonthly until the child’s 3rd birthday.

Recommended Duration:

39 months (third trimester until 36 months postpartum)

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Hospital
  • Community-based Agency / Organization / Provider
  • Other
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Family Spirit® includes a homework component:

Some Family Spirit curriculum lessons will have “homework” activities for parents to do either on their own or with children. Homework is not mandatory but is encouraged.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • A host organization to house the program and provide office space (e.g., local, state, tribal, and federal organizations)
  • Computer, printer, email, and internet connection
  • Staff cell phones
  • Office supplies
  • Recruitment/marketing materials
  • Incentives for participants
  • Props or supplies for lessons
  • 1 full-time supervisor per 6-10 full-time home visitors (1 full-time home visitor per 20-25 families served)
  • Program vehicle and/or travel reimbursement
  • Data collection and management system (Care4) access provided by Family Spirit
  • Licenses for certain evaluation tools
  • Community advisory board
  • Sustainable funding

Education and Training

Prerequisite/Minimum Provider Qualifications

Home visitors: High school degree or equivalent (i.e., GRE), plus two+ years of related work experience

Supervisors: College degree or equivalent work experience, plus experience in home visiting, case management, community networking, and staff supervision

Education and Training Resources

There is a manual that describes how to implement this program , and there is training available for this program.

Johns Hopkins Center for American Indian Health. (2019). Family Spirit curriculum. Author.

The Family Spirit curriculum includes:

  • Implementation Guide
  • 63 structured lessons divided into 6 modules
  • Lesson plans organized by module and lesson
  • Reference Manual for home visitors
  • Sample Participant Workbook that can be photocopied for the participating families
  • Evaluation materials
  • Participant certificates are also included on a USB drive in the curriculum box
Training Contact:
Training is obtained:

There is a mandatory in-person training (held either on-site at the affiliate’s location or at a Regional Training in a centrally located city) required before home visitors can be certified to administer Family Spirit. The training covers a wide range of topics including:

  • Introduction to the Family Spirit Program and Training: A session dedicated to teaching participants the history and background of the Family Spirit program, and existing research results.
  • Family Spirit Curriculum: This part of the training focuses on practicing the different methods of lesson delivery, adherence to the home visit structure, and a thorough understanding of Family Spirit core components.
  • Tools to Assist Home Visitors: Additional topics to promote skills specific to home visiting, including building rapport, boundary setting, maintaining balance, active listening, and reflective supervision.
  • Troubleshooting: A series of topics that address how to deal with challenges that might arise, including recruitment and retention strategies, confidentiality, addressing challenging situations, and sensitive topics such as abuse.
  • Program Evaluation and Fidelity: Training will be tailored to include each affiliate’s program goals and evaluation needs. During pretraining activities, supervisors will select which evaluation tools are necessary to achieve their fidelity and evaluation goals. A series of evaluation tools are available for each training site to select from and tailor to local program needs.
  • Each trainee will be rigorously evaluated on both comprehension of and ability to administer all of the Family Spirit lessons. Trainees must achieve a minimum score of 80% on the knowledge assessments for each of the 63 lessons. Before they can be certified, trainees must also earn a score of at least 3 out of 4 or higher on the quality assurance measure that assesses their capacity to administer the lesson. Further, trainees cannot miss more than 4 hours of the in-person training session. Upon successful completion of each of these requirements, trainees will be awarded a certificate to administer the Family Spirit program.
Number of days/hours:

The in-person training is 3-4 days long, depending on group size and program needs.

Supervisors also participate in the in-person training but also engage in additional training on topics such as:

  • Using the Quality Assurance Form to monitor and support home visitors
  • Community networking to integrate Family Spirit within community resources
  • Implementation management (e.g. policies and procedures tips, recruiting and supporting successful home visitors)
  • Supervisory skills and personnel management

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Family Spirit® as listed below:

All interested Family Spirit affiliates must fill out the Family Spirit Readiness Tool (https://www.jhsph.edu/research/affiliated-programs/family-spirit/training/readiness-tool/) prior to going through the contracting process. This form is helpful for potential affiliates and the Family Spirit leadership team to gauge readiness for model implementation and to address any gaps identified in advance of the training to ensure program success. The readiness tool asks questions related to the following topics:

  • Program information: These questions help the Family Spirit National Office get a better understanding of how the program will fit into an interested organization and how the program will be supported financially. These questions may also offer additional points for consideration as an organization prepares for implementation.
  • Program staffing: These questions relate to staffing for a potential Family Spirit program. A caseload of up to 20-25 families per full-time home visitor is recommended. This may fluctuate depending on the commuting distance to home visits. The recommended number of home visitors per supervisor is 6-10 home visitors.
  • Enrolling families: These questions help interested organizations begin thinking about recruiting families, starting implementation, and graduating participants. Making these decisions early on will help create program cohesion and, ultimately, increase participant retention in Family Spirit.
  • Program Evaluation: The Family Spirit National Office requests interested organizations to fill out an Evaluation Planning Tool to set them up for success around data collection and analysis.
  • Program fidelity: The Family Spirit National Office encourages all affiliates to think through their capacity and need for emphasis on fidelity to the model.
  • Program sustainability: The Family Spirit National Office encourages all affiliates to think about sustainability early on.

Formal Support for Implementation

There is formal support available for implementation of Family Spirit® as listed below:

The Family Spirit affiliation fee covers implementation support before and after the training and is ongoing as long as an affiliate pays the annual affiliation fee. This support includes ongoing technical support via phone and video conferences. For example, trainers meet with program managers and staff when the program launches to provide technical assistance on program implementation and sustainability, data collection, and analysis. Part of Family Spirit’s implementation support includes quarterly check-in calls, as well as monthly professional development webinars for supervisors. Quarterly topic-based and technical assistance webinars for home visitors, supervisors, and evaluators are also offered.

Technical assistance will vary by program location, needs, and available resources. There are formal pretraining and posttraining timelines and agendas, but the Family Spirit Leadership Team remains available for support in between these meetings. If technical assistance requests fall outside the scope of the contract, the Family Spirit Leadership Team works with the affiliate to put together a separate contract. In addition, affiliates can schedule an onsite visit as part of their annual affiliation fee in order to provide in-person technical assistance.

Fidelity Measures

There are fidelity measures for Family Spirit® as listed below:

Family Spirit utilizes a Quality Assurance Form on at least a quarterly basis. A trained supervisor or staff member administers the form in-person during a home visit. They assess the home visitor on specific tasks grouped according to three domains: 1) visit structure; 2) relationship with participant; and 3) adherence, competence, and flexibility. This measure is administered more often if there are concerns with a home visitor’s performance. All home-visiting staff members are trained on using this measure during the in-person Family Spirit training.

Home visits can also be audio-recorded if the visits cannot be observed. Recording all of them for a period of time and listening to 20% of randomly selected recordings for each home visitor can provide additional quality assurance feedback on home visits.

In addition to the Quality Assurance Form, all home visitors are required to complete curriculum knowledge assessments prior to the in-person training and pass with at least 80% on each of the 63 assessments. These knowledge assessments help ensure content mastery leading up to the in-person training session.

A copy of these measures can be obtained by emailing Allison Ingalls at aingalls@jhu.edu.

Implementation Guides or Manuals

There are implementation guides or manuals for Family Spirit® as listed below:

The purpose of the Family Spirit Implementation Guide is to act as a “how-to” for implementing Family Spirit. It includes information about the Family Spirit program history and its impact on several maternal and child health outcomes, as well as a description of the essentials for successfully implementing the program.

Implementation Cost

There are no studies of the costs of Family Spirit®.

Research on How to Implement the Program

Research has not been conducted on how to implement Family Spirit®.

Relevant Published, Peer-Reviewed Research

Barlow, A., Varipatis-Baker, E., Speakman, K., Friberg, I., Goklish, N., Cowboy, B., Fields, P., Hastings, R., Pan, W., Reid, R., Santosham, M., & Walkup, J. (2006). Home-visiting intervention to improve child care among American Indian adolescent mothers: A randomized trial. Archives of Pediatrics Adolescent Medicine, 160(11), 1101-1107. https:/doi.org/:10.1001/archpedi.160.11.1101

Type of Study: Randomized controlled trial
Number of Participants: 53

Population:

  • Age — 14-20 years (Mean=17.1 years)
  • Race/Ethnicity — 100% American Indians
  • Gender — 100% Female
  • Status — Participants were pregnant American Indian adolescents.

Location/Institution: 4 American Indian health service catchment areas on the Navajo and White Mountain Apache reservations in New Mexico and Arizona

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study aims to assess the impact the Family Spirit program to promote child care knowledge, skills, and involvement among pregnant American Indian adolescents. Participants were randomly assigned into the self-administered program with telephone support from a family consultant or a waitlist control condition. Measures utilized include the Parenting Knowledge Test, the Parent Involvement Measure. Measures also assessed involvement, family conflict, family cohesion, social support, self-esteem, depression, locus of control, and drug use. Results indicate mothers in the intervention, when compared with the control group, had significantly higher parent knowledge scores at 2 months and 6 months postpartum. Intervention group mothers scored significantly higher on maternal involvement scales at 2 months postpartum, and scores approached significance at 6 months postpartum. No between group differences were found for child care skills. Limitations small sample size, high attrition in the intervention group, reliance on self-reported measures, attrition, sample bias, and lack of follow-up.

Length of postintervention follow-up: None.

Walkup, J. T., Barlow, A., Mullany, B. C., Pan, W., Goklish, N., Hasting, R., Cowboy, B., Fields, P., Varipatis Baker, E., Speakman, K., Ginsburg, G., & Reid, R. (2009). Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers. Journal of the American Academy of Child & Adolescent Psychiatry, 48(6), 591–601. https://doi.org/10.1097/CHI.0b013e3181a0ab86

Type of Study: Randomized controlled trial
Number of Participants: 167

Population:

  • Age — 12-22 years
  • Race/Ethnicity — 100% American Indian
  • Gender — 100% Female
  • Status — Participants were pregnant American Indian adolescents.

Location/Institution: 4 American Indian health service catchment areas on the Navajo and White Mountain Apache reservations in New Mexico and Arizona

Summary: (To include comparison groups, outcomes, measures, notable limitations)
To evaluate the efficacy of the Family Spirit intervention among young, reservation-based American Indian (AI) mothers on parenting knowledge, involvement, and maternal and infant outcomes. Participants were randomly assigned to one of two paraprofessional-delivered, home-visiting interventions: the 25-visit Family Spirit intervention addressing prenatal and newborn care and maternal life skills (treatment) or a 23-visit breast-feeding/nutrition education intervention (active control). Measures utilized include the Parenting Knowledge Test, the Parent Involvement Measure, the Home Observation for Measurement of the Environment (HOME), the Infant Toddler Social Emotional Assessment (ITSEA), the Center for Epidemiological Studies Depression, and the Parenting Stress Index. Results indicate at 6 and 12 months postpartum, treatment mothers compared with control mothers had greater parenting knowledge gains. At 12 months postpartum, treatment mothers reported their infants to have significantly lower scores on the externalizing domain and less separation distress in the internalizing domain. No between-group differences were found for maternal involvement, home environment, or mothers’ stress, social support, depression, or substance use. Limitations include small sample size, high attrition in the intervention group, reliance on self-reported measures, attrition, sample bias, and lack of follow-up.

Length of postintervention follow-up: None.

Barlow, A., Mullany, B. C., Neault, N., Davis, Y., Billy, T., Hastings, R., Coho-Mescal, V., Lake, K., Powers, J., Clouse, E., Reid, R., & Walkup, J. T. (2010). Examining correlates of methamphetamine and other drug use in pregnant American Indian adolescents. American Indian and Alaska Native Mental Health Research, 17(1), 1–24. https://doi.org/10.5820/aian.1701.2010.1

Type of Study: One-group pretest-posttest
Number of Participants: 322

Population:

  • Age — 12-19 years (Mean =17.6 years)
  • Race/Ethnicity — 100% American Indian
  • Gender — 100% Female
  • Status — Participants were pregnant American Indian adolescents.

Location/Institution: White Mountain Apache and San Carlos Apache Reservations in eastern Arizona and the Tuba City and Fort Defiance communities on the Navajo Reservation in northern Arizona

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study explores correlates of meth use in a sample of pregnant American Indian (AI) teens enrolled in the Family Spirit intervention, with a focus on sociodemographic, familial, and cultural factors and use of other drugs. Measures utilized include the Voices of Indian Teens, the Problem Oriented Screening Instrument for Teenagers (POSIT) and sociodemographic information. Results indicate lifetime meth use in this sample of pregnant AI teens was up to 3 times higher than among previous national samples of AI/AN adolescents and approximately 5 times higher than U.S. all races adolescents. Past-month use of meth was double past-month use in comparable samples of U.S. all races youth. Reported meth use during pregnancy was approximately 5 times higher than recent national samples of pregnant women. Mean age at first meth use was considerably lower than among the general U.S. population. Generally consistent with gateway theory, exposure to meth in this sample occurred later than exposure to other legally available substances (alcohol and inhalants), marijuana, and crack/cocaine. However, in contrast with gateway theory findings in other U.S. adolescent populations, participants were more likely to initiate marijuana use prior to alcohol use and had equal exposure to alcohol and marijuana. Meth use was more highly correlated with marijuana use than with use of alcohol, cocaine, or any other drug. Limitations include lack of control group, small sample size, relatively small numbers of teens who used meth (n = 17) or any drugs (n = 81) during pregnancy limited our ability to draw definitive conclusions, generalizability of findings due to sampling bias, and lack of follow-up.

Length of postintervention follow-up: None.

Barlow, A., Mullany, B., Neault, N., Compton, S., Carter, A., Hastings, R., Billy, T., Coho-Mescal, V., Lorenzo, S., & Walkup, J. T. (2013). Effect of a paraprofessional home-visiting intervention on American Indian teen mothers’ and infants’ behavioral risks: A randomized controlled trial. The American Journal of Psychiatry, 170(1), 83–93. https://doi.org/10.1176/appi.ajp.2012.12010121

Type of Study: Randomized controlled trial
Number of Participants: 322

Population:

  • Age — 12-19 years (Mean =18.15 years)
  • Race/Ethnicity — 100% American Indian
  • Gender — 100% Female
  • Status — Participants were pregnant American Indian adolescents.

Location/Institution: White Mountain Apache and San Carlos Apache Reservations in eastern Arizona and the Tuba City and Fort Defiance communities on the Navajo Reservation in northern Arizona

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study sought to examine the effectiveness of Family Spirit intervention in improving American Indian teen mothers’ parenting outcomes and mothers’ and children’s emotional and behavioral functioning 12 months postpartum. Participants were randomly assigned in equal numbers to the Family Spirit intervention plus optimized standard care or to optimized standard care alone. Measures utilized include the Home Observation for Measurement of the Environment (HOME), the Parental Locus of Control Scale, the Center for Epidemiologic Studies Depression Scale, the Achenbach System of Empirically Based Assessment (ASEBA) and the Infant Toddler Social Emotional Assessment (ITSEA). Results indicate at 12 months postpartum, mothers in the intervention group had significantly greater parenting knowledge, parenting self-efficacy, and home safety attitudes and fewer externalizing behaviors, and their children had fewer externalizing problems. In a subsample of mothers with any lifetime substance use at baseline, children in the intervention group had fewer externalizing and dysregulation problems than those in the standard care group, and fewer scored in the clinically “at risk” range for externalizing and internalizing problems. No between-group differences were observed for outcomes measured by the Home Observation for Measurement of the Environment scale. Limitations include sample size, unclear generalizability from this study to the heterogeneous tribal population in the United States, reliance on self-reported measures, and lack of follow-up.

Length of postintervention follow-up: None.

Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., Lorenzo, S., Kee, C., Lake, K., Redmond, C., Carter, A., & Walkup, J. T. (2015). Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. American Journal of Psychiatry, 172(2), 154-162. https://doi.org/10.1176/appi.ajp.2014.14030332

Type of Study: Randomized controlled trial
Number of Participants: 322

Population:

  • Age — 12-19 years (Mean =18.15 years)
  • Race/Ethnicity — 100% American Indian
  • Gender — 100% Female
  • Status — Participants were pregnant American Indian adolescents.

Location/Institution: White Mountain Apache and San Carlos Apache Reservations in eastern Arizona and the Tuba City and Fort Defiance communities on the Navajo Reservation in northern Arizona.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This paper utilizes participants from Barlow et al. (2013). This paper reports 36-month outcomes of the Family Spirit home-visiting intervention program for American Indian teen mothers and children. Measures utilized include the Home Observation for Measurement of the Environment (HOME), the Parental Locus of Control Scale, the Center for Epidemiologic Studies Depression Scale, the Achenbach System of Empirically Based Assessment (ASEBA) and the Infant Toddler Social Emotional Assessment (ITSEA). Results indicate at baseline the mothers had high rates of substance use, depressive symptoms, dropping out of school, and residential instability. From pregnancy to 36 months postpartum, mothers in the intervention group had significantly greater parenting knowledge and parental locus of control, fewer depressive symptoms and externalizing problems, and lower past month use of marijuana and illegal drugs. Children in the intervention group had fewer externalizing, internalizing, and dysregulation problems. Limitations include sample size, unclear generalizability from this study to the heterogeneous tribal population in the United States, reliance on self-reported measures, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Barlow, A., McDaniel, J. A., Marfani, F., Lowe, A., Keplinger, C., Beltangady, M., & Goklish, N. (2018). Discovering frugal innovations through delivering early childhood home-visiting interventions in low-resource tribal communities. Infant Mental Health Journal. 39(3), 276–286. https://doi.org/10.1002/imhj.21711

Bullock, A. (2015). Getting to the roots: Early life intervention and adult health. American Journal of Psychiatry, 172(2), 108–110 https://doi.org/10.1176/appi.ajp.2014.14111394

Mullany, B., Barlow, A., Neault, N., Billy, T., Jones, T., Tortice, I., Lorenzo, S., Powers, J., Lake, K., Reid, R., & Walkup, J. (2012). The Family Spirit trial for American Indian teen mothers and their children: CBPR rationale, design, methods and baseline characteristics. Prevention Science, 3(5), 504–518. https://doi.org/10.1007/s11121-012-0277-2

Contact Information

Marissa Begay, BS
Title: Program Manager
Agency/Affiliation: Johns Hopkins Center for American Indian Health
Website: www.jhsph.edu/caih/familyspirit
Email:
Phone: (928) 674-7335

Date Research Evidence Last Reviewed by CEBC: January 2019

Date Program Content Last Reviewed by Program Staff: February 2020

Date Program Originally Loaded onto CEBC: February 2020