Evidence-based model
MIECHV eligible
Evidence-Based for Native Communities
Released in 1979 through 2025
Impact studies rated high or moderate quality
Skip to: Effectiveness Implementation
Family Spirit is designed for Native American pregnant women and provides services to families during pregnancy through the child’s third birthday. The model can also be used with non-Native families. Families served by this model learn how to support their children’s physical, cognitive, social-emotional, and language development and build self-help skills.
The culturally tailored curriculum includes six domains:
Family Spirit typically begins providing services to pregnant women and their families by the seventh month of pregnancy. Paraprofessional home visitors meet with families regularly, starting with weekly visits that become less frequent over time. Family Spirit recommends that home visitors be members of the communities they serve and be familiar with local or Native culture, traditions, and language(s).
Where to find out more
Johns Hopkins Center for Indigenous Health
415 N. Washington Street, 4th Floor, Baltimore, MD 21231
This model meets criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model.
This model meets criteria for an evidence-based home visiting model for Native communities.
For more information about manuscripts, search the research database.
For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.
Released in 1979 through 2025
Eligible for review
Impact studies rated high or moderate quality
To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.
Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.
No effect:
Findings are not statistically significant.
Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.
Ambiguous findings are excluded from this table. An ambiguous finding is a statistically significant impact on an outcome measure in a direction that is not clearly beneficial for or potentially harmful to children and/or parents.
| Outcomes | Manuscripts | Favorable Findings | No Effects Findings | Unfavorable Findings |
|---|---|---|---|---|
| Child Development and School Readiness | View 4 Manuscripts | 10 | 30 | 0 |
| Child Health | View 1 Manuscript | 1 | 4 | 0 |
| Family Economic Self-Sufficiency | Not measured | - | - | - |
| Linkages and Referrals | Not measured | - | - | - |
| Maternal Health | View 3 Manuscripts | 5 | 47 | 0 |
| Positive Parenting Practices | View 3 Manuscripts | 7 | 11 | 0 |
| Reductions In Child Maltreatment | Not measured | - | - | - |
| Reductions in Juvenile Delinquency, Family Violence, and Crime | Not measured | - | - | - |
Well-designed impact studies about this model were conducted in the following locations:
In this section:
Support Availability
Service Delivery
Model services, adaptions and enhancements, model intensity and length.
The Family Spirit model was developed in 1995 and has evolved over time. The model is based on the idea that parenting strongly affects child development. It also recognizes that parents’ own experiences, stressors, and living conditions affect how they parent and that parenting, in turn, influences children’s health and well-being. Family Spirit helps caregivers strengthen their parenting, coping, and problem-solving skills so they can manage personal and environmental challenges.
Family Spirit centers Native culture and weaves Native teachings throughout the curriculum. Home visitors are encouraged to bring local teachings and stories into their visits when they are relevant to the participating family. These cultural teachings may help support positive maternal and child health outcomes in Native American communities.
Family Spirit serves women and their families from pregnancy until the child turns three years old. The model developer strongly recommends enrolling mothers by the seventh month of their pregnancy. Family Spirit was designed for Native American families. The model can also be used with non-Native families if the implementing site determines the model is a good fit for their community.
The goals of the Family Spirit model are to:
Highlights
The Johns Hopkins Center for Indigenous Health (formerly the Center for American Indian Health)—in partnership with the Navajo, White Mountain Apache, and San Carlos Apache communities— designed, implemented, and evaluated Family Spirit. The Family Spirit National Office at the Center for Indigenous Health administers the model and provides implementation support. Local level agencies, called affiliates, provide personnel support for implementation.
The Family Spirit National Office provides technical assistance during required quarterly meetings and as needed.
Highlights
Paraprofessional home visitors meet with families in their homes or at a different location in the community based on family preference. Home visitors build trusting relationships and deliver 65 lessons across six topic areas:
Home visitors also refer families to community services to address their specific needs.
The curriculum package includes an implementation guide, lesson plans for home visitors, a reference manual on lesson topics, and a sample participant workbook with handouts and worksheets.
The Family Spirit National Office supports affiliates’ use of the model in settings outside of the home, such as clinic- or group-based administration; however, Family Spirit research trials have not evaluated clinic- or group-based administration. The office supports use of a hybrid model that allows virtual service delivery if that is feasible and most effective for the family.
Home visiting requirements
Family Spirit typically begins by about 7 months into a pregnancy. Visits are most frequent during pregnancy and early infancy and become less frequent as the child gets older, continuing until the child is three years old. The model developer recommends:
Visits typically last 45 to 90 minutes.
Service duration
Family Spirit includes 65 lessons across six areas. Home visitors deliver the lessons over 52 visits. The model developer recommends beginning services during pregnancy and continuing until the child’s third birthday.
Family Spirit allows affiliates to tailor the curriculum and model to meet local program and family needs. For example, affiliates can incorporate cultural elements to integrate local traditional knowledge and practices into the home visits. The Family Spirit National Office must approve tailored model curricula.
The Family Spirit National Office continually responds and adapts to emerging needs in Native communities by creating supplemental curricular materials. Additional curriculum modules addressing emerging needs and specific family circumstances include:
Other than Family Spirit Nurture, HomVEE has not reviewed research about these modules. For more information, please contact the model developer.
Family Spirit was developed for and with Native American communities and families. As of 2026, more than 180 Native communities across 29 states have received training to use Family Spirit.
Please contact the model developer to learn more about implementing this model with Native communities.
Highlights
Education and supervisory requirements:
Staff. Paraprofessionals from the community conduct home visits. A supervisor guides and monitors curriculum implementation. Nurses may also work with home visitors to conduct home visits and teach the lessons most relevant to their clinical expertise. The Family Spirit National Office noted that having an evaluator can be helpful given the model’s data collection requirements.
Education and experience. Family Spirit recommends that home visitors come from the participating community and be familiar with the local or Native culture, traditions, and language(s). Home visitors must have at least a high school education plus a minimum of two years of related work experience. The developers recommend that supervisors have a college degree or equivalent work experience along with experience in home visiting, case management, community networking, and staff supervision.
Supervision. Family Spirit requires supervision for home visitors. Please contact the model developer for additional information about the required types, mode, and frequency of supervision. Monthly supervisory and leadership training webinars are available.
Training and professional development
Pre-Service training. Family Spirit requires home visitors and supervisors at a new affiliate site to participate in pre-service training. This four-day training includes hands-on practice with the curriculum and strategies to implement the model. Home visitors must also complete pre-training and post-training periods to demonstrate mastery of the curriculum and model and become certified to deliver services. Family Spirit also offers training for new home visitors hired after the affiliate’s initial training.
In addition to the topics described, supervisors are also trained on the following:
Ongoing professional development. Family Spirit recommends but does not require ongoing professional development for home visitors and supervisors. The model encourages affiliates to provide ongoing training on maternal and child health issues, home visiting strategies, case management, and other topics that are relevant to the program and participating families. Family Spirit provides a list of suggested additional trainings on its online affiliate portal.
The Family Spirit National Office offers quarterly topic-based webinars for home visitors and supervisors from affiliate sites. Please contact the model developer for additional information about ongoing professional development requirements.
Family Spirit is implemented through local, state, tribal, and federal organizations. Some affiliates offer stand-alone Family Spirit programs, and others nest the model within their existing programs and services. There are no restrictions on the type of organization that can implement the model.
The model requires both programs and home visitors to meet ongoing fidelity guidelines. Please contact the model developer for additional information about these guidelines.
Highlights
HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model here may differ from how the model was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.