Manuscript Details

Barlow, A., Mullany, B., Neault, N., Compton, S., Carter, A., Hastings, R., Billy, T., CohoMescal, V., Lorenzo, S., & Walkup, J. T. (Jan 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.

Additional Sources:

  • 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. Society of Prevention Research, 13, 504-518.

Model(s): Family Spirit®
Study Registration: ClinicalTrials.gov
High 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 Low

Established on race/ethnicity, SES, and baseline measures of the outcome.

None

 Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1
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 High
0.12 Not statistically significant, p ≥ 0.05 319 mothers Family Spirit RCT, 2006-2008 sample
ITSEA - Competence domain, % clinically at risk 12 months High
0.10 Not statistically significant, p ≥ 0.05 319 mothers Family Spirit RCT, 2006-2008 sample
ITSEA - Dysregulation domain 12 months High
0.15 Not statistically significant, p ≥ 0.05 319 mothers Family Spirit RCT, 2006-2008 sample
ITSEA - Dysregulation domain, % clinically at risk 12 months High
0.12 Not statistically significant, p ≥ 0.05 319 mothers Family Spirit RCT, 2006-2008 sample
ITSEA - Externalizing domain 12 months High
0.19 Statistically significant, p = 0.03 319 mothers Family Spirit RCT, 2006-2008 sample
ITSEA - Externalizing domain, % clinically at risk 12 months High
0.30 Not statistically significant, p ≥ 0.05 319 mothers Family Spirit RCT, 2006-2008 sample
ITSEA - Internalizing domain 12 months High
0.10 Not statistically significant, p ≥ 0.05 319 mothers Family Spirit RCT, 2006-2008 sample
ITSEA - Internalizing domain, % clinically at risk 12 months High
0.23 Not statistically significant, p ≥ 0.05 319 mothers Family Spirit RCT, 2006-2008 sample
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
ASEBA - Externalizing 6 months High
0.13 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
ASEBA - Externalizing 12 months High
0.20 Statistically significant, p = 0.04 322 mothers Family Spirit RCT, 2006-2008 sample
ASEBA - Internalizing 6 months High
0.12 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
ASEBA - Internalizing 12 months High
0.19 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
ASEBA - Total Problems 6 months High
0.13 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
ASEBA - Total Problems 12 months High
0.18 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
CES-D 2 months High
0.07 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
CES-D 6 months High
0.16 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
CES-D 12 months High
0.20 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
POSIT Mental Health 2 months High
0.13 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
POSIT Mental Health 6 months High
0.09 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
POSIT Mental Health 12 months High
0.04 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
POSIT Substance Abuse 2 months High
0.03 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
POSIT Substance Abuse 6 months High
0.08 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
POSIT Substance Abuse 12 months High
0.13 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Alcohol - past 30 days, use of 2 months High
0.00 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Alcohol - past 30 days, use of 6 months High
0.13 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Alcohol - past 30 days, use of 12 months High
0.14 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Any alcohol or illegal drug - past 30 days, use of 2 months High
0.11 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Any alcohol or illegal drug - past 30 days, use of 6 months High
0.09 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Any alcohol or illegal drug - past 30 days, use of 12 months High
0.11 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Any illegal drug - past 30 days, use of 2 months High
0.03 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Any illegal drug - past 30 days, use of 12 months High
0.02 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Marijuana - past 30 days, use of 2 months High
0.01 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Marijuana - past 30 days, use of 6 months High
0.30 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Marijuana - past 30 days, use of 12 months High
0.03 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
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
HOME inventory - 12 months 12 months High
0.08 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
HOME inventory - 6 months 6 months High
0.01 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
PLOC Parental self-efficacy - 12 months 12 months High
0.23 Statistically significant, p = 0.01 322 mothers Family Spirit RCT, 2006-2008 sample
PLOC Parental self-efficacy - 6 months 6 months High
0.13 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Home safety attitudes 12 months High
0.19 Statistically significant, p = 0.03 322 mothers Family Spirit RCT, 2006-2008 sample
Home safety practices 12 months High
0.16 Not statistically significant, p ≥ 0.05 322 mothers Family Spirit RCT, 2006-2008 sample
Parenting knowledge 12 months High
0.33 Statistically significant, p = 0.001 322 mothers Family Spirit RCT, 2006-2008 sample
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

Less than a high school diploma
73%
High school diploma or GED
27%

Other Characteristics

Indigenous population
100%

This study included participants from the following locations:

  • Arizona
Study Participants

American Indian adolescent females ages 12 to 19 years at conception and at 32 weeks or earlier gestation who resided in one of four participating communities were recruited. The study sample included 322 participants who were randomly assigned to either the Family Spirit group (159) or the control group (163). The average age of participants at baseline was 18.1 years. Sixty percent lived with their parents and slightly more than half lived in two or more homes within the past year. Seventy-seven percent of participants were pregnant with their first child. During pregnancy, 14 percent of participants drank alcohol, 19 percent smoked cigarettes, and 13 percent used marijuana.

Setting

The program was implemented in four tribal communities across three reservations in 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

Participants in the control group received transportation to and from prenatal and well-baby visits, information on child care and community resources, and referrals for services.

Subgroups examined

• Maternal substance use/disorder (yes)

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 National Institute on Drug Abuse.