American Indian or Alaska Native
100%
Source
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) Reviewed
Study Registration
Funding Sources
Supported by National Institute on Drug Abuse grant R01 DA-019042 (principal investigator, J. Walkup).
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Established on race, SES, and outcome measures assessable at baseline | None |
Notes
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.
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
Home Visiting Services
The Family Spirit intervention consisted of 43 lessons delivered by Native American para-professionals from within participating communities. The lessons focused on parenting skills and maternal behavioral and psychosocial risks. The lessons were conducted in each participant's home and the visits lasted approximately one hour each. The visits occurred weekly through pregnancy, biweekly until 4 months postpartum, monthly between 4-12 months postpartum, and bimonthly between 12-36 months postpartum.
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.
Were any subgroups examined?
No
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
Home Visiting Services
The Family Spirit intervention consisted of 43 lessons delivered by Native American para-professionals from within participating communities. The lessons focused on parenting skills and maternal behavioral and psychosocial risks. The lessons were conducted in each participant's home and the visits lasted approximately one hour each. The visits occurred weekly through pregnancy, biweekly until 4 months postpartum, monthly between 4-12 months postpartum, and bimonthly between 12-36 months postpartum.
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.
Were any subgroups examined?
No
Findings that rate moderate or high in this manuscript
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| 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 | ||
| HOME inventory (range 0-37) | 2006-2008 sample, 3 years postpartum | High | 0.02 | Not statistically significant, p = 0.77 | 322 mothers | Full |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Parenting stress index (range 0-180) | 2006-2008 sample, 3 years postpartum | High | 0.18 | Not statistically significant, p = 0.10 | 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 | ||
| 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 | ||
| 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 | ||
| Marijuana use in past 30 days (proportion) | 2006-2008 sample, 3 years postpartum | High | 0.26 | Statistically significant, p = 0.01 | 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 |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| 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 | ||
| 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, 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 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 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 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 |
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