American Indian or Alaska Native
100.00%
Source
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.
Model(s) Reviewed
Study Registration
Funding Sources
Support for this research was provided by the National Institute on Drug Abuse.
Study Design
| 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 |
Notes
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.
Home Visiting Services
Family Spirit is a home visiting program for young American Indian pregnant and parenting mothers staffed by American Indian paraprofessionals. The program’s goals are to increase mothers’ parenting knowledge and involvement, mothers’ psychosocial functioning, and children’s emotional and behavioral outcomes. The curriculum includes 43 lessons that cover parenting skills, infant development, and maternal psychosocial development. The frequency of the visits depends upon the stage of the program. One-hour home visits are provided weekly during pregnancy, biweekly visits for the first four months following the child’s birth, monthly from 4 to 14 months postpartum, and then bimonthly until the child’s third birthday. The study did not specify the dosage of services that program participants actually received.
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)
Findings that rate moderate or high in this manuscript
| Outcome measure | Timing of follow-up | Rating | Effect size | Stastical significance | Sample size | Sample description |
|---|---|---|---|---|---|---|
| Parenting knowledge | 12 months | High | 0.33 | Statistically significant, p = 0.001 |
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 |
| PLOC Parental self-efficacy - 12 months | 12 months | High | -0.23 | Statistically significant, p = 0.01 |
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 |
| HOME inventory - 12 months | 12 months | High | 0.08 | 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 |
| Outcome measure | Timing of follow-up | Rating | Effect size | Stastical significance | Sample size | Sample description |
|---|---|---|---|---|---|---|
| ITSEA - Externalizing domain | 12 months | High | -0.19 | Statistically significant, p = 0.03 |
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 - Dysregulation domain | 12 months | High | -0.15 | Not statistically significant, p ≥ 0.05 | 319 mothers | Family Spirit RCT, 2006-2008 sample |
| ITSEA - Competence domain | 12 months | High | 0.12 | Not statistically significant, p ≥ 0.05 | 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, % clinically at risk | 12 months | High | -0.23 | 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 - Competence domain, % clinically at risk | 12 months | High | 0.10 | Not statistically significant, p ≥ 0.05 | 319 mothers | Family Spirit RCT, 2006-2008 sample |
| Outcome measure | Timing of follow-up | Rating | Effect size | Stastical significance | Sample size | Sample description |
|---|---|---|---|---|---|---|
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- Arizona