Manuscript Details

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): Family Spirit®
Study Registration: ClinicalTrials.gov
Moderate rating
Study reviewed under: Handbook of Procedures and Standards, Version 1
Study design characteristics contributing to rating
Design Attrition Baseline equivalence Confounding factors? Valid, reliable measures?
Randomized controlled trial High

Established on race/ethnicity, SES, and baseline measures of applicable outcomes

None

 Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1
Notes from the review of this manuscript

Information about the SES and baseline measure equivalence of the analytic samples was obtained from the first author.

Child Development and School Readiness
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
ITSEA Competence domain 12 months old Moderate
0.03 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Competence: Attention 12 months old Moderate
0.08 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Competence: Compliance 12 months old Moderate
0.18 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Competence: Empathy 12 months old Moderate
0.15 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Competence: Imitation/play 12 months old Moderate
0.05 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Competence: Mastery motivation 12 months old Moderate
0.08 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Competence: Prosocial peer relations 12 months old Moderate
0.68 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Dysregulation domain 12 months old Moderate
0.22 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Dysregulation: Eating 12 months old Moderate
0.04 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Dysregulation: Negative emotionality 12 months old Moderate
0.03 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Dysregulation: Sensory sensitivity 12 months old Moderate
0.41 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Dysregulation: Sleep 12 months old Moderate
0.25 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Externalizing domain 12 months old Moderate
0.63 Statistically significant, p 65 children Mothers enrolled 2002-2004
ITSEA Externalizing: Activity/impulsivity 12 months old Moderate
0.65 Statistically significant, p 65 children Mothers enrolled 2002-2004
ITSEA Externalizing: Aggression/defiance 12 months old Moderate
0.29 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Externalizing: Peer aggression 12 months old Moderate
0.68 Statistically significant, p 65 children Mothers enrolled 2002-2004
ITSEA Internalizing domain 12 months old Moderate
0.35 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Internalizing: Depression/withdraw 12 months old Moderate
0.13 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Internalizing: General anxiety 12 months old Moderate
0.04 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Internalizing: Inhibition to novelty 12 months old Moderate
0.24 Not statistically significant, p = >=.10 65 children Mothers enrolled 2002-2004
ITSEA Internalizing: Separation distress 12 months old Moderate
0.52 Statistically significant, p 65 children Mothers enrolled 2002-2004
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Maternal Health
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Alcohol in last month - 12 months 12 months postpartum Moderate
0.25 Not statistically significant, p = >=.10 82 mothers Mothers enrolled 2002-2004
Alcohol in last month - 2 months 2 months postpartum Moderate
0.30 Not statistically significant, p = >=.10 125 mothers Mothers enrolled 2002-2004
Alcohol in last month - 6 months 6 months postpartum Moderate
0.39 Not statistically significant, p = >=.10 115 mothers Mothers enrolled 2002-2004
Change in depressive symptoms (CES-D) - 2 months 2 months postpartum Moderate
0.12 Not statistically significant, p = >=.10 125 mothers Mothers enrolled 2002-2004
Change in depressive symptoms (CES-D) - 6 months 6 months postpartum Moderate
0.00 Not statistically significant, p = >=.10 115 mothers Mothers enrolled 2002-2004
Change in depressive symptoms (CES-D)- 12 months 12 months postpartum Moderate
0.10 Not statistically significant, p = >=.10 82 mothers Mothers enrolled 2002-2004
Change in social support - 12 months 12 months postpartum Moderate
0.13 Not statistically significant, p = >=.10 82 mothers Mothers enrolled 2002-2004
Change in social support - 2 months 2 months postpartum Moderate
0.07 Not statistically significant, p = >=.10 125 mothers Mothers enrolled 2002-2004
Change in social support - 6 months 6 months postpartum Moderate
0.06 Not statistically significant, p = >=.10 115 mothers Mothers enrolled 2002-2004
Cigarette in last month - 12 months 12 months postpartum Moderate
0.14 Not statistically significant, p = >=.10 82 mothers Mothers enrolled 2002-2004
Cigarette in last month - 2 months 2 months postpartum Moderate
0.19 Not statistically significant, p = >=.10 125 mothers Mothers enrolled 2002-2004
Cigarette in last month - 6 months 6 months postpartum Moderate
0.35 Not statistically significant, p = >=.10 115 mothers Mothers enrolled 2002-2004
Illegal substance in last month - 12 months 12 months postpartum Moderate
0.41 Not statistically significant, p = >=.10 82 mothers Mothers enrolled 2002-2004
Illegal substance in last month - 2 months 2 months postpartum Moderate
0.41 Not statistically significant, p = >=.10 125 mothers Mothers enrolled 2002-2004
Illegal substance in last month - 6 months 6 months postpartum Moderate
0.49 Not statistically significant, p = >=.10 115 mothers Mothers enrolled 2002-2004
Parenting stress index - 12 months 12 months postpartum Moderate
0.14 Not statistically significant, p = >=.10 82 mothers Mothers enrolled 2002-2004
Parenting stress index - 2 months 2 months postpartum Moderate
0.26 Not statistically significant, p = >=.10 125 mothers Mothers enrolled 2002-2004
Parenting stress index - 6 months 6 months postpartum Moderate
0.05 Not statistically significant, p = >=.10 115 mothers Mothers enrolled 2002-2004
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Positive Parenting Practices
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Change in maternal involvement - 2 months 2 months postpartum Moderate
0.04 Not statistically significant, p = >=.10 125 mothers Mothers enrolled 2002-2004
Change in maternal involvement - 12 months 12 months postpartum Moderate
0.15 Not statistically significant, p = >=.10 82 mothers Mothers enrolled 2002-2004
Change in maternal involvement - 6 months 6 months postpartum Moderate
0.03 Not statistically significant, p = >=.10 115 mothers Mothers enrolled 2002-2004
Change in parenting knowledge - 12 months 12 months postpartum Moderate
0.86 Statistically significant, p 82 mothers Mothers enrolled 2002-2004
Change in parenting knowledge - 2 months 2 months postpartum Moderate
0.06 Not statistically significant, p ≥ 0.05 125 mothers Mothers enrolled 2002-2004
Change in parenting knowledge - 6 months 6 months postpartum Moderate
0.81 Statistically significant, p 115 mothers Mothers enrolled 2002-2004
Home Observation for Measurement of the Environment - 12 months 12 months postpartum Moderate
0.04 Not statistically significant, p = >=.10 82 mothers Mothers enrolled 2002-2004
Home Observation for Measurement of the Environment - 6 months 6 months postpartum Moderate
0.14 Not statistically significant, p = >=.10 115 mothers Mothers enrolled 2002-2004
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

Note: Tables do not include findings that HomVEE rated low or indeterminate, or found to be ineligible for review.

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

American Indian or Alaska Native
100%

Maternal Education

Data not available

Other Characteristics

Indigenous population
100%

This study included participants from the following locations:

  • Arizona
  • New Mexico
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 condition
Family Spirit®

Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.

Comparison Conditions

Control participants received a breastfeeding/nutrition education intervention over the course of 23 visits from paraprofessionals.

Subgroups examined

• Maternal age (ages 18–22 years) • Maternal education (completed high school education)

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.

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.