American Indian or Alaska Native
100%
Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., ... Walkup, J. T. (2015). Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-Year outcomes from a randomized controlled trial. American Journal of Psychiatry, 172(2), 154-162.
Model(s): Family Spirit®
Study Registration: ClinicalTrials.gov
Study design characteristics contributing to rating
| Design | Attrition | Baseline equivalence | Confounding factors? | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low |
Established on race, SES, and outcome measures assessable at baseline |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
Notes from the review of this manuscript
Child outcomes (Infant-Toddler Social Emotional Assessment) rated moderate for this study, because of high attrition. Through communication with the first author, we established that the mothers of children in the child outcomes sample were equivalent at baseline on race/ethnicity and SES; the child outcomes themselves were not assessable at baseline because the sample enrolled prenatally.
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 (proportion clinically at risk (>10%)) | 2006-2008 sample, 3 years postpartum | Moderate | 0.03 | Not statistically significant, p = 0.78 | 288 children | Children with ITSEA data | |
| ITSEA Dysregulation domain (proportion clinically at risk (>10%)) | 2006-2008 sample, 3 years postpartum | Moderate | 0.23 | Not statistically significant, p = 0.08 | 288 children | Children with ITSEA data | |
| ITSEA Externalizing domain (proportion clinically at risk (>10%)) | 2006-2008 sample, 3 years postpartum | Moderate | 0.24 | Statistically significant, p = 0.03 | 288 children | Children with ITSEA data | |
| ITSEA Internalizing domain (proportion clinically at risk (>10%)) | 2006-2008 sample, 3 years postpartum | Moderate | 0.27 | Statistically significant, p = 0.04 | 288 children | Children with ITSEA data | |
| ITSEA mean, Competence domain (range 0-2) | 2006-2008 sample, 3 years postpartum | Moderate | 0.14 | Not statistically significant, p = 0.09 | 288 children | Children with ITSEA data | |
| ITSEA mean, Dysregulation domain (range 0-2) | 2006-2008 sample, 3 years postpartum | Moderate | 0.27 | Statistically significant, p < .001 | 288 children | Children with ITSEA data | |
| ITSEA mean, Externalizing domain (range 0-2) | 2006-2008 sample, 3 years postpartum | Moderate | 0.23 | Statistically significant, p < .01 | 288 children | Children with ITSEA data | |
| ITSEA mean, Internalizing domain (range 0-2) | 2006-2008 sample, 3 years postpartum | Moderate | 0.23 | Statistically significant, p < .01 | 288 children | Children with ITSEA data |
Maternal Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| ASEBA Externalizing (T-score) | 2006-2008 sample, 3 years postpartum | High | 0.14 | Statistically significant, p = 0.05 | 322 mothers | Full | |
| ASEBA Internalizing (T-score) | 2006-2008 sample, 3 years postpartum | High | 0.09 | Not statistically significant, p = 0.22 | 322 mothers | Full | |
| ASEBA Total Problems (T-score) | 2006-2008 sample, 3 years postpartum | High | 0.10 | Not statistically significant, p = 0.18 | 322 mothers | Full | |
| CES-D score (0-60) | 2006-2008 sample, 3 years postpartum | High | 0.16 | Statistically significant, p = 0.01 | 322 mothers | Full | |
| Alcohol use in past 30 days (proportion) | 2006-2008 sample, 3 years postpartum | High | 0.04 | Not statistically significant, p = 0.67 | 322 mothers | Full | |
| Any illegal drug use in past 30 days (proportion) | 2006-2008 sample, 3 years postpartum | High | 0.24 | Statistically significant, p = 0.01 | 322 mothers | Full | |
| Marijuana use in past 30 days (proportion) | 2006-2008 sample, 3 years postpartum | High | 0.26 | Statistically significant, p = 0.01 | 322 mothers | Full | |
| Parenting stress index (range 0-180) | 2006-2008 sample, 3 years postpartum | High | 0.18 | Not statistically significant, p = 0.10 | 322 mothers | Full |
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 (range 0-37) | 2006-2008 sample, 3 years postpartum | High | 0.02 | Not statistically significant, p = 0.77 | 322 mothers | Full | |
| Parenting knowledge (range 0-30) | 2006-2008 sample, 3 years postpartum | High | 0.42 | Statistically significant, p < .001 | 322 mothers | Full | |
| Parenting locus of control (range 27-135) | 2006-2008 sample, 3 years postpartum | High | 0.17 | Statistically significant, p = 0.02 | 322 mothers | Full |
This study included participants from the following locations:
- Arizona
Study Participants
Between 2006 and 2008, expectant women who were at less than or equal to 32 weeks gestation, aged 12-19 at conception, self-identified as American-Indian, and residing in one of the four participating reservation communities, were recruited into the study. Eligible participants were randomized by site, age, and history of previous live births. The sample sizes for the maternal parenting and health outcomes were as follows: analytic sample: 322 (159 T and 163 C)baseline sample: 322 (159 T and 163 C). Note: the study does not use a consistent analytic sample across different outcomes. The sample sizes shown here are relevant for maternal outcomes only. Sample sizes for child outcomes differ.
Setting
Four southwestern reservation communities
Intervention condition
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
Optimized Standard Care consisted of transportation to recommended prenatal and well-baby clinic visits, pamphlets about childcare and community resources, and referrals to local services.
Funding Sources
Supported by National Institute on Drug Abuse grant R01 DA-019042 (principal investigator, J. Walkup).