10
Manuscripts
Released in 1979 through 2021
4
Manuscripts
Impact studies rated high or moderate quality
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Family Spirit is designed for American Indian pregnant women and families with children younger than age 3. It can also be used with non-Native populations with high maternal and child behavioral health disparities. It aims to promote mothers’ parenting skills while assisting them in developing coping and problem-solving skills to overcome individual and environmental stressors. The curriculum, which incorporates traditional tribal teachings, consists of 63 lessons organized into six domains: (1) prenatal care, (2) infant care, (3) child development, (4) toddler care, (5) life skills, and (6) healthy living. Family Spirit recommends initiating the program with weekly visits by at least 28 weeks of gestation and tapering to bimonthly visits until the child’s third birthday. Paraprofessional home visitors conduct the visits, which typically last 45 to 90 minutes. Family Spirit recommends that home visitors be members of the participating community and have familiarity with the local or tribal 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 Indigenous peoples and 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.
10
Manuscripts
Released in 1979 through 2021
6
Manuscripts
Eligible for review
4
Manuscripts
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.
| Outcomes | Manuscripts | Favorable Findings | No Effects Findings | Unfavorable Findings |
|---|---|---|---|---|
| Child development and school readiness | View 4 Manuscripts | 10 | 30 | 0 |
| Child health | Not measured | - | - | - |
| 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 included participants with the following characteristics. The evidence for effectiveness for the model may include additional studies that did not report this participant information.
Race/Ethnicity
Maternal Education
Other Characteristics
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 conceptual framework is based on G.R. Patterson’s model, which suggests that parenting is the critical link between parents’ personal characteristics and environment, and children’s individual risks and outcomes. The Family Spirit intervention seeks to improve mothers’ parenting skills while helping them develop coping and problem-solving skills to overcome individual and environmental stressors.
The model also incorporates traditional tribal teachings throughout the curriculum. The model developers believe that cultural teachings are protective factors that can improve maternal and child health in Native American communities.
Family Spirit serves pregnant women and families with children from birth to age 36 months. The developer strongly recommends enrolling mothers while they are pregnant. Family Spirit was designed to be implemented with Native American families. However, it is now also used in non-Native populations with high maternal and child behavioral health disparities.
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 tribal 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. Locally, community agencies known as affiliates provide personnel support for implementing the model.
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. The home visitors try to establish a close rapport with families to enable delivery of the curriculum, which consists of 63 lessons within the following six domains: (1) prenatal care; (2) infant care; (3) child development; (4) toddler care; (5) life skills, such as planning, nutrition, physical exercise, budgeting, health, and communication; and (6) healthy living, including goal-setting, substance abuse prevention, family planning, and prevention of sexually transmitted infections. The home visitors also refer families to community resources to address specific needs.
The curriculum package includes an implementation guide, home visitor lesson plans, a reference manual on lesson topics, and a sample participant workbook with handouts and worksheets.
Family Spirit allows affiliates to make enhancements to the curriculum and model to meet program and family needs at the local level. For example, affiliates can incorporate cultural enhancements to integrate local traditional knowledge and practices into the home visits. The Family Spirit National Office supports affiliates’ use of the model in other settings, such as clinic- or group-based administration; however, Family Spirit research trials have not evaluated clinic- or group-based administration.
The Family Spirit National Office must approve adaptations to the model. There is no formal process for considering adaptations to the model. The National Office discusses potential adaptations and enhancements with affiliates as needed.
The Family Spirit National Office continually responds and adapts to emerging needs in tribal communities by creating supplemental curricular materials. For example, it created a lesson on COVID-19 during the pandemic. It has also developed or is developing new Family Spirit modules to address infant and family nutrition (Family Spirit Nurture); maternal mental health (Family Spirit Strengths); parents of children ages 3 through 5 (Family Spirit Thrive); and early childhood language development (+Language is Medicine).
Highlights
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 deemed most relevant to their clinical expertise. Family Spirit has no recommendations regarding necessary leadership positions but requires a supervisor for home visitors. The Family Spirit National Office noted that an evaluator can be useful given the model’s requirements for data collection.
Family Spirit recommends that home visitors come from the participating community and be familiar with the local or tribal culture, traditions, and languages. Home visitors must have at least a high school education plus at least two years of related work experience. The developers recommend that supervisors have a college degree or equivalent work experience, and experience in home visiting, case management, community networking, and staff 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 for supervisors.
Family Spirit requires home visitors and supervisors at a new affiliate to participate in a three- to four-day training that covers hands-on practice with the curriculum and strategies to implement the model. Home visitors must also complete a pre-training and post-training period to become certified to deliver services and to ensure mastery of the curriculum and model. Family Spirit offers a training for new home visitors hired after the affiliate’s original three- to four-day training.
In addition to the topics described, supervisors are also trained on the following:
Family Spirit encourages, but does not require, affiliates to conduct frequent ongoing training for staff and supervisors in 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 within the context of 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 requirements for the type of organization that can implement the model.
This model requires both programs and home visitors to meet a set of 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 as of the above date. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model(s) here may differ from how the model(s) 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.