Walkup, J. T., Barlow, A., Mullany, B. C., Pan, W., Goklish, N., Hasting, R., Cowboy, B., Fields, P., Baker, E. V., 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.
Model(s) Reviewed:
Family Spirit®
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| Moderate | Randomized controlled trial | High | Established on race/ethnicity, SES, and baseline measures of applicable outcomes | None | None | Not assessed in manuscripts reviewed before 2021 |
Notes:
Information about the SES and baseline measure equivalence of the analytic samples was obtained from the first author.
| Study participants | Reservation-based American Indian mothers ages 12 to 22 years with 28 weeks or earlier of gestation were eligible for participation if they did not also have extreme medical, psychiatric, or substance abuse problems. Randomized participants ranged in age from 14 to 22 years, with a median age of 18. All were American Indian, most were Navajo (65 percent) or White Mountain Apache (18 percent). At enrollment, 8 percent were married and 10 percent had one or more children. Among the sample remaining at the 12-month post-partum follow-up, fewer than half had at least a high school education (38 percent in the Family Spirit group and 40 percent in the control group) and the employment rate was low (10.8 percent in the Family Spirit group and 14.9 percent in the control group) |
|---|---|
| Setting | The program was implemented in four American Indian health service catchment areas on the Navajo and White Mountain Apache reservations in New Mexico and Arizona. |
| Intervention services | Mothers received approximately 25 one-hour visits in their homes or a confidential location of their choosing. During each session, home visitors used tabletop flip charts to deliver material that focused on developmentally timed prenatal and infant care parenting lessons, family planning, substance abuse prevention, problem solving, and coping skills. The model was designed to reflect local native practices and to respect cultural orientation and living situation of participants. When participants preferred, the services were delivered in their native language. |
| Comparison conditions | Control participants received a breastfeeding/nutrition education intervention over the course of 23 visits from paraprofessionals. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). • Maternal age (ages 18–22 years) • Maternal education (completed high school education) |
| Funding sources | Support for this research was provided by the Substance Abuse and Mental Health Services Administration, the Ford Foundation, the Annie E. Casey Foundation, and the C.S. Mott Foundation. |
| Author affiliation | Ms. Barlow is part of the team that developed this model. Dr. Walkup was affiliated with the Center for American Indian Health at the Johns Hopkins Bloomberg School of Public Health, where the team that developed this model is based. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
Study Registration:
Clinicaltrials.gov Identifier: NCT00356551
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | ITSEA Competence domain | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.94 | Adjusted mean = 0.95 | coeff = -0.01 | HomVEE calculated = -0.03 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Competence: Attention | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 1.11 | Adjusted mean = 1.07 | coeff = 0.05 | HomVEE calculated = 0.08 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Competence: Compliance | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.91 | Adjusted mean = 0.84 | coeff = 0.10 | HomVEE calculated = 0.18 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Competence: Empathy | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.66 | Adjusted mean = 0.59 | coeff = 0.09 | HomVEE calculated = 0.15 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Competence: Imitation/play | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 1.08 | Adjusted mean = 1.10 | coeff = -0.03 | HomVEE calculated = -0.05 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Competence: Mastery motivation | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 1.30 | Adjusted mean = 1.34 | coeff = -0.05 | HomVEE calculated = -0.08 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Competence: Prosocial peer relations | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.51 | Adjusted mean = 0.79 | coeff = -0.24 | HomVEE calculated = -0.68 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Dysregulation domain | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.43 | Adjusted mean = 0.49 | coeff = -0.05 | HomVEE calculated = -0.22 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Dysregulation: Eating | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.43 | Adjusted mean = 0.44 | coeff = -0.02 | HomVEE calculated = -0.04 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Dysregulation: Negative emotionality | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.47 | Adjusted mean = 0.48 | coeff = 0.02 | HomVEE calculated = -0.03 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Dysregulation: Sensory sensitivity | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.37 | Adjusted mean = 0.52 | coeff = -0.14 | HomVEE calculated = -0.41 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Dysregulation: Sleep | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.44 | Adjusted mean = 0.53 | coeff = -0.06 | HomVEE calculated = -0.25 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Externalizing domain | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.39 | Adjusted mean = 0.57 | coeff = -0.17 | HomVEE calculated = -0.63 | Statistically significant, p<.05 | Negative differences favor the program group
|
| Moderate | ITSEA Externalizing: Activity/impulsivity | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.69 | Adjusted mean = 0.98 | coeff = -0.27 | HomVEE calculated = -0.65 | Statistically significant, p<.05 | Negative differences favor the program group
|
| Moderate | ITSEA Externalizing: Aggression/defiance | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.27 | Adjusted mean = 0.35 | coeff = -0.06 | HomVEE calculated = -0.29 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Externalizing: Peer aggression | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.13 | Adjusted mean = 0.30 | coeff = -0.23 | HomVEE calculated = -0.68 | Statistically significant, p<.05 | Negative differences favor the program group
|
| Moderate | ITSEA Internalizing domain | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.48 | Adjusted mean = 0.55 | coeff = -0.06 | HomVEE calculated = -0.35 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Internalizing: Depression/withdraw | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.12 | Adjusted mean = 0.15 | coeff = 0.01 | HomVEE calculated = -0.13 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Internalizing: General anxiety | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.20 | Adjusted mean = 0.21 | coeff = 0.01 | HomVEE calculated = -0.04 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Internalizing: Inhibition to novelty | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.73 | Adjusted mean = 0.82 | coeff = -0.09 | HomVEE calculated = -0.24 | Not statistically significant, p = >=.10 |
|
| Moderate | ITSEA Internalizing: Separation distress | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months old | 65 children | Adjusted mean = 0.84 | Adjusted mean = 1.02 | coeff = -0.17 | HomVEE calculated = -0.52 | Statistically significant, p<.05 | Negative differences favor the program group
|
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Alcohol in last month - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean % = 19.00 | Adjusted mean % = 13.00 | OR = 1.54 | HomVEE calculated = 0.25 | Not statistically significant, p = >=.10 |
|
| Moderate | Alcohol in last month - 2 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 2 months postpartum | 125 mothers | Adjusted mean % = 11.00 | Adjusted mean % = 7.00 | OR = 1.52 | HomVEE calculated = 0.30 | Not statistically significant, p = >=.10 |
|
| Moderate | Alcohol in last month - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean % = 12.00 | Adjusted mean % = 6.00 | OR = 2.19 | HomVEE calculated = 0.39 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in depressive symptoms (CES-D) - 2 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 2 months postpartum | 125 mothers | Adjusted mean = -2.00 | Adjusted mean = -3.30 | coeff = 0.05 | HomVEE calculated = 0.12 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in depressive symptoms (CES-D) - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean = -4.00 | Adjusted mean = -4.00 | coeff = -0.58 | HomVEE calculated = 0.00 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in depressive symptoms (CES-D)- 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean = -3.10 | Adjusted mean = -2.00 | coeff = -1.69 | HomVEE calculated = -0.10 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in social support - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean = 0.50 | Adjusted mean = -2.20 | coeff = 1.98 | HomVEE calculated = 0.13 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in social support - 2 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 2 months postpartum | 125 mothers | Adjusted mean = -0.40 | Adjusted mean = -1.70 | coeff = -0.21 | HomVEE calculated = 0.07 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in social support - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean = -3.70 | Adjusted mean = -2.50 | coeff = -0.98 | HomVEE calculated = -0.06 | Not statistically significant, p = >=.10 |
|
| Moderate | Cigarette in last month - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean % = 19.00 | Adjusted mean % = 15.00 | OR = 1.27 | HomVEE calculated = 0.14 | Not statistically significant, p = >=.10 |
|
| Moderate | Cigarette in last month - 2 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 2 months postpartum | 125 mothers | Adjusted mean % = 13.00 | Adjusted mean % = 17.00 | OR = 0.74 | HomVEE calculated = -0.19 | Not statistically significant, p = >=.10 |
|
| Moderate | Cigarette in last month - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean % = 22.00 | Adjusted mean % = 13.00 | OR = 2.06 | HomVEE calculated = 0.35 | Not statistically significant, p = >=.10 |
|
| Moderate | Illegal substance in last month - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean % = 16.00 | Adjusted mean % = 9.00 | OR = 2.37 | HomVEE calculated = 0.41 | Not statistically significant, p = >=.10 |
|
| Moderate | Illegal substance in last month - 2 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 2 months postpartum | 125 mothers | Adjusted mean % = 13.00 | Adjusted mean % = 7.00 | OR = 2.02 | HomVEE calculated = 0.41 | Not statistically significant, p = >=.10 |
|
| Moderate | Illegal substance in last month - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean % = 7.00 | Adjusted mean % = 3.00 | OR = 2.57 | HomVEE calculated = 0.49 | Not statistically significant, p = >=.10 |
|
| Moderate | Parenting stress index - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean = 62.60 | Adjusted mean = 60.40 | coeff = 3.91 | HomVEE calculated = 0.14 | Not statistically significant, p = >=.10 |
|
| Moderate | Parenting stress index - 2 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 2 months postpartum | 125 mothers | Adjusted mean = 62.30 | Adjusted mean = 66.80 | coeff = -3.31 | HomVEE calculated = -0.26 | Not statistically significant, p = >=.10 |
|
| Moderate | Parenting stress index - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean = 63.30 | Adjusted mean = 64.10 | coeff = 1.01 | HomVEE calculated = -0.05 | Not statistically significant, p = >=.10 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Change in maternal involvement - 2 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 2 months postpartum | 125 mothers | Adjusted mean = 1.10 | Adjusted mean = 1.20 | coeff = -0.60 | HomVEE calculated = -0.04 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in maternal involvement - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean = 1.00 | Adjusted mean = 0.60 | coeff = 0.22 | HomVEE calculated = 0.15 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in maternal involvement - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean = 1.30 | Adjusted mean = 1.20 | coeff = -0.15 | HomVEE calculated = 0.03 | Not statistically significant, p = >=.10 |
|
| Moderate | Change in parenting knowledge - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean = 26.60 | Adjusted mean = 15.20 | coeff = 13.92 | HomVEE calculated = 0.86 | Statistically significant, p<.01 | |
| Moderate | Change in parenting knowledge - 2 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 2 months postpartum | 125 mothers | Adjusted mean = 3.20 | Adjusted mean = 2.60 | coeff = 3.10 | HomVEE calculated = 0.06 | Not statistically significant, p ≥ 0.05 | |
| Moderate | Change in parenting knowledge - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean = 23.80 | Adjusted mean = 12.80 | coeff = 13.46 | HomVEE calculated = 0.81 | Statistically significant, p<.01 | |
| Moderate | Home Observation for Measurement of the Environment - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 12 months postpartum | 82 mothers | Adjusted mean = 37.10 | Adjusted mean = 37.40 | coeff = -0.04 | HomVEE calculated = -0.04 | Not statistically significant, p = >=.10 |
|
| Moderate | Home Observation for Measurement of the Environment - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Mothers enrolled 2002-2004 | 6 months postpartum | 115 mothers | Adjusted mean = 32.50 | Adjusted mean = 33.40 | coeff = -1.27 | HomVEE calculated = -0.14 | Not statistically significant, p = >=.10 |