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:
Family Spirit®
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.
| 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) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Established on race/ethnicity, SES, and baseline measures of the outcome. | None | None | Not assessed in manuscripts reviewed before 2021 |
| 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 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 |
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 substance use/disorder (yes) |
| Funding sources | Support for this research was provided by the National Institute on Drug Abuse. |
| 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: NCT00373750
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | ITSEA - Competence domain | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 319 mothers | Adjusted mean = 1.07 | Adjusted mean = 1.02 | Mean difference = 0.05 | Study reported = 0.12 | Not statistically significant, p ≥ 0.05 | |
| High | ITSEA - Competence domain, % clinically at risk | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 319 mothers | Adjusted % = 20.27 | Adjusted mean % = 17.66 | OR = 0.86 | HomVEE calculated = 0.10 | Not statistically significant, p ≥ 0.05 | |
| High | ITSEA - Dysregulation domain | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 319 mothers | Adjusted mean = 0.54 | Adjusted mean = 0.59 | Mean difference = -0.06 | Study reported = -0.15 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | ITSEA - Dysregulation domain, % clinically at risk | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 319 mothers | Adjusted % = 15.80 | Adjusted mean % = 18.67 | OR = 1.37 | HomVEE calculated = -0.12 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | ITSEA - Externalizing domain | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 319 mothers | Adjusted mean = 0.62 | Adjusted mean = 0.71 | Mean difference = -0.09 | Study reported = -0.19 | Statistically significant, p = 0.03 |
Negative value is favorable to the intervention.
|
| High | ITSEA - Externalizing domain, % clinically at risk | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 319 mothers | Adjusted % = 13.69 | Adjusted mean % = 20.62 | OR = 1.88 | HomVEE calculated = -0.30 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | ITSEA - Internalizing domain | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 319 mothers | Adjusted mean = 0.57 | Adjusted mean = 0.62 | Mean difference = -0.05 | Study reported = -0.10 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | ITSEA - Internalizing domain, % clinically at risk | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 319 mothers | Adjusted % = 20.27 | Adjusted mean % = 27.16 | OR = 1.61 | HomVEE calculated = -0.23 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | ASEBA - Externalizing | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted mean = 40.09 | Adjusted mean = 41.46 | Mean difference = -1.37 | Study reported = -0.13 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | ASEBA - Externalizing | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 38.20 | Adjusted mean = 40.70 | Mean difference = -2.50 | Study reported = -0.20 | Statistically significant, p = 0.04 |
Negative value is favorable to the intervention.
|
| High | ASEBA - Internalizing | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted mean = 43.80 | Adjusted mean = 45.12 | Mean difference = -1.32 | Study reported = -0.12 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | ASEBA - Internalizing | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 41.48 | Adjusted mean = 43.99 | Mean difference = -2.51 | Study reported = -0.19 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | ASEBA - Total Problems | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted mean = 40.27 | Adjusted mean = 41.65 | Mean difference = -1.38 | Study reported = -0.13 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | ASEBA - Total Problems | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 38.01 | Adjusted mean = 40.37 | Mean difference = -2.36 | Study reported = -0.18 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | CES-D | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 11.54 | Adjusted mean = 13.41 | Mean difference = -1.89 | Study reported = -0.20 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | CES-D | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 2 months | 322 mothers | Adjusted mean = 13.06 | Adjusted mean = 13.40 | Mean difference = -0.34 | Study reported = -0.07 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | CES-D | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted mean = 12.46 | Adjusted mean = 13.41 | Mean difference = -0.95 | Study reported = -0.16 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | POSIT Mental Health | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted mean = 3.05 | Adjusted mean = 3.30 | Mean difference = -0.25 | Study reported = -0.09 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | POSIT Mental Health | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 2.77 | Adjusted mean = 2.91 | Mean difference = -0.14 | Study reported = -0.04 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | POSIT Mental Health | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 2 months | 322 mothers | Adjusted mean = 3.23 | Adjusted mean = 3.56 | Mean difference = -0.33 | Study reported = -0.13 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | POSIT Substance Abuse | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 2 months | 322 mothers | Adjusted mean = 0.56 | Adjusted mean = 0.61 | Mean difference = -0.05 | Study reported = -0.03 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | POSIT Substance Abuse | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted mean = 0.39 | Adjusted mean = 0.55 | Mean difference = -0.16 | Study reported = -0.08 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | POSIT Substance Abuse | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 0.13 | Adjusted mean = 0.45 | Mean difference = -0.32 | Study reported = -0.13 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Alcohol - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 2 months | 322 mothers | Adjusted % = 17.92 | Adjusted mean % = 17.81 | OR = 0.80 | HomVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Alcohol - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted % = 16.88 | Adjusted mean % = 20.02 | OR = 0.71 | HomVEE calculated = -0.13 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Alcohol - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted % = 25.77 | Adjusted mean % = 21.55 | OR = 1.14 | HomVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Any alcohol or illegal drug - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted % = 38.93 | Adjusted mean % = 34.64 | OR = 1.07 | HomVEE calculated = 0.11 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Any alcohol or illegal drug - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 2 months | 322 mothers | Adjusted % = 32.91 | Adjusted mean % = 29.11 | OR = 1.04 | HomVEE calculated = 0.11 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Any alcohol or illegal drug - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted % = 27.74 | Adjusted mean % = 30.78 | OR = 0.76 | HomVEE calculated = -0.09 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Any illegal drug - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 2 months | 322 mothers | Adjusted % = 22.89 | Adjusted mean % = 21.92 | OR = 0.93 | HomVEE calculated = 0.03 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Any illegal drug - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted % = 21.34 | Adjusted mean % = 21.90 | OR = 0.83 | HomVEE calculated = -0.02 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Marijuana - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted % = 18.91 | Adjusted mean % = 19.65 | OR = 0.83 | HomVEE calculated = -0.03 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Marijuana - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 2 months | 322 mothers | Adjusted % = 20.63 | Adjusted mean % = 21.02 | OR = 0.87 | HomVEE calculated = -0.01 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Marijuana - past 30 days, use of | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted % = 12.39 | Adjusted mean % = 18.83 | OR = 0.57 | HomVEE calculated = -0.30 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | HOME inventory - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 25.92 | Adjusted mean = 25.41 | Mean difference = 0.51 | Study reported = 0.08 | Not statistically significant, p ≥ 0.05 | |
| High | HOME inventory - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted mean = 22.79 | Adjusted mean = 22.75 | Mean difference = 0.04 | Study reported = 0.01 | Not statistically significant, p ≥ 0.05 | |
| High | PLOC Parental self-efficacy - 12 months | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 23.21 | Adjusted mean = 24.71 | Mean difference = -1.51 | Study reported = -0.23 | Statistically significant, p = 0.01 |
Negative value is favorable to the intervention.
|
| High | PLOC Parental self-efficacy - 6 months | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 6 months | 322 mothers | Adjusted mean = 22.98 | Adjusted mean = 23.83 | Mean difference = -0.85 | Study reported = -0.13 | Not statistically significant, p ≥ 0.05 | Negative value is favorable to the intervention.
|
| High | Home safety attitudes | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 29.54 | Adjusted mean = 28.61 | Mean difference = 0.94 | Study reported = 0.19 | Statistically significant, p = 0.03 |
|
| High | Home safety practices | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 1.56 | Adjusted mean = 1.30 | Mean difference = 0.26 | Study reported = 0.16 | Not statistically significant, p ≥ 0.05 | |
| High | Parenting knowledge | FavorableUnfavorable or ambiguousNo Effect |
Family Spirit RCT, 2006-2008 sample | 12 months | 322 mothers | Adjusted mean = 15.43 | Adjusted mean = 14.08 | Mean difference = 1.35 | Study reported = 0.33 | Statistically significant, p = 0.001 |