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Walkup, J. T., Barlow, A., Mullany, B. C., Pan, W., Goklish, N., Hasting, R., Cowboy, B., Fields, P., Baker, E. V., Speakman, K., Ginsburg, G., Reid, R. (2009). Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers. Journal of the American Academy of Child & Adolescent Psychiatry, 48(6), 591-601.

Model(s) Reviewed: Family Spirit®
Manuscript screening details
Screening decision Screening conclusion HomVEE procedures and standards version
Passes screens Eligible for review Version 1
Study design details
Rating Design Attrition Baseline equivalence Compromised randomization Confounding factors Valid, reliable measure(s)
Moderate Randomized controlled trial High Established on race/ethnicity, SES, and baseline measures of applicable outcomes None None Not assessed in manuscripts reviewed before 2021
Notes:

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Information about the SES and baseline measure equivalence of the analytic samples was obtained from the first author.

Study characteristics
Study participants Reservation-based American Indian mothers ages 12 to 22 years with 28 weeks or earlier of gestation were eligible for participation if they did not also have extreme medical, psychiatric, or substance abuse problems. Randomized participants ranged in age from 14 to 22 years, with a median age of 18. All were American Indian, most were Navajo (65 percent) or White Mountain Apache (18 percent). At enrollment, 8 percent were married and 10 percent had one or more children. Among the sample remaining at the 12-month post-partum follow-up, fewer than half had at least a high school education (38 percent in the Family Spirit group and 40 percent in the control group) and the employment rate was low (10.8 percent in the Family Spirit group and 14.9 percent in the control group)
Setting The program was implemented in four American Indian health service catchment areas on the Navajo and White Mountain Apache reservations in New Mexico and Arizona.
Intervention services Mothers received approximately 25 one-hour visits in their homes or a confidential location of their choosing. During each session, home visitors used tabletop flip charts to deliver material that focused on developmentally timed prenatal and infant care parenting lessons, family planning, substance abuse prevention, problem solving, and coping skills. The model was designed to reflect local native practices and to respect cultural orientation and living situation of participants. When participants preferred, the services were delivered in their native language.
Comparison conditions Control participants received a breastfeeding/nutrition education intervention over the course of 23 visits from paraprofessionals.
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 age (ages 18–22 years) • Maternal education (completed high school education)

Funding sources Support for this research was provided by the Substance Abuse and Mental Health Services Administration, the Ford Foundation, the Annie E. Casey Foundation, and the C.S. Mott Foundation.
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: NCT00356551

Findings that rate moderate or high

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate ITSEA Competence domain
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.94 Adjusted mean = 0.95 coeff = -0.01 HomVEE calculated = -0.03 Not statistically significant,
p = >=.10
Moderate ITSEA Competence: Attention
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 1.11 Adjusted mean = 1.07 coeff = 0.05 HomVEE calculated = 0.08 Not statistically significant,
p = >=.10
Moderate ITSEA Competence: Compliance
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.91 Adjusted mean = 0.84 coeff = 0.10 HomVEE calculated = 0.18 Not statistically significant,
p = >=.10
Moderate ITSEA Competence: Empathy
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.66 Adjusted mean = 0.59 coeff = 0.09 HomVEE calculated = 0.15 Not statistically significant,
p = >=.10
Moderate ITSEA Competence: Imitation/play
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 1.08 Adjusted mean = 1.10 coeff = -0.03 HomVEE calculated = -0.05 Not statistically significant,
p = >=.10
Moderate ITSEA Competence: Mastery motivation
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 1.30 Adjusted mean = 1.34 coeff = -0.05 HomVEE calculated = -0.08 Not statistically significant,
p = >=.10
Moderate ITSEA Competence: Prosocial peer relations
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.51 Adjusted mean = 0.79 coeff = -0.24 HomVEE calculated = -0.68 Not statistically significant,
p = >=.10
Moderate ITSEA Dysregulation domain
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.43 Adjusted mean = 0.49 coeff = -0.05 HomVEE calculated = -0.22 Not statistically significant,
p = >=.10
Moderate ITSEA Dysregulation: Eating
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.43 Adjusted mean = 0.44 coeff = -0.02 HomVEE calculated = -0.04 Not statistically significant,
p = >=.10
Moderate ITSEA Dysregulation: Negative emotionality
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.47 Adjusted mean = 0.48 coeff = 0.02 HomVEE calculated = -0.03 Not statistically significant,
p = >=.10
Moderate ITSEA Dysregulation: Sensory sensitivity
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.37 Adjusted mean = 0.52 coeff = -0.14 HomVEE calculated = -0.41 Not statistically significant,
p = >=.10
Moderate ITSEA Dysregulation: Sleep
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.44 Adjusted mean = 0.53 coeff = -0.06 HomVEE calculated = -0.25 Not statistically significant,
p = >=.10
Moderate ITSEA Externalizing domain
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.39 Adjusted mean = 0.57 coeff = -0.17 HomVEE calculated = -0.63 Statistically significant, p<.05

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Negative differences favor the program group

Moderate ITSEA Externalizing: Activity/impulsivity
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.69 Adjusted mean = 0.98 coeff = -0.27 HomVEE calculated = -0.65 Statistically significant, p<.05

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Negative differences favor the program group

Moderate ITSEA Externalizing: Aggression/defiance
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.27 Adjusted mean = 0.35 coeff = -0.06 HomVEE calculated = -0.29 Not statistically significant,
p = >=.10
Moderate ITSEA Externalizing: Peer aggression
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.13 Adjusted mean = 0.30 coeff = -0.23 HomVEE calculated = -0.68 Statistically significant, p<.05

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Negative differences favor the program group

Moderate ITSEA Internalizing domain
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.48 Adjusted mean = 0.55 coeff = -0.06 HomVEE calculated = -0.35 Not statistically significant,
p = >=.10
Moderate ITSEA Internalizing: Depression/withdraw
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.12 Adjusted mean = 0.15 coeff = 0.01 HomVEE calculated = -0.13 Not statistically significant,
p = >=.10
Moderate ITSEA Internalizing: General anxiety
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.20 Adjusted mean = 0.21 coeff = 0.01 HomVEE calculated = -0.04 Not statistically significant,
p = >=.10
Moderate ITSEA Internalizing: Inhibition to novelty
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.73 Adjusted mean = 0.82 coeff = -0.09 HomVEE calculated = -0.24 Not statistically significant,
p = >=.10
Moderate ITSEA Internalizing: Separation distress
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.84 Adjusted mean = 1.02 coeff = -0.17 HomVEE calculated = -0.52 Statistically significant, p<.05

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Negative differences favor the program group

Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Alcohol in last month - 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean % = 19.00 Adjusted mean % = 13.00 OR = 1.54 HomVEE calculated = 0.25 Not statistically significant,
p = >=.10
Moderate Alcohol in last month - 2 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean % = 11.00 Adjusted mean % = 7.00 OR = 1.52 HomVEE calculated = 0.30 Not statistically significant,
p = >=.10
Moderate Alcohol in last month - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean % = 12.00 Adjusted mean % = 6.00 OR = 2.19 HomVEE calculated = 0.39 Not statistically significant,
p = >=.10
Moderate Change in depressive symptoms (CES-D) - 2 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean = -2.00 Adjusted mean = -3.30 coeff = 0.05 HomVEE calculated = 0.12 Not statistically significant,
p = >=.10
Moderate Change in depressive symptoms (CES-D) - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = -4.00 Adjusted mean = -4.00 coeff = -0.58 HomVEE calculated = 0.00 Not statistically significant,
p = >=.10
Moderate Change in depressive symptoms (CES-D)- 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = -3.10 Adjusted mean = -2.00 coeff = -1.69 HomVEE calculated = -0.10 Not statistically significant,
p = >=.10
Moderate Change in social support - 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = 0.50 Adjusted mean = -2.20 coeff = 1.98 HomVEE calculated = 0.13 Not statistically significant,
p = >=.10
Moderate Change in social support - 2 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean = -0.40 Adjusted mean = -1.70 coeff = -0.21 HomVEE calculated = 0.07 Not statistically significant,
p = >=.10
Moderate Change in social support - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = -3.70 Adjusted mean = -2.50 coeff = -0.98 HomVEE calculated = -0.06 Not statistically significant,
p = >=.10
Moderate Cigarette in last month - 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean % = 19.00 Adjusted mean % = 15.00 OR = 1.27 HomVEE calculated = 0.14 Not statistically significant,
p = >=.10
Moderate Cigarette in last month - 2 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean % = 13.00 Adjusted mean % = 17.00 OR = 0.74 HomVEE calculated = -0.19 Not statistically significant,
p = >=.10
Moderate Cigarette in last month - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean % = 22.00 Adjusted mean % = 13.00 OR = 2.06 HomVEE calculated = 0.35 Not statistically significant,
p = >=.10
Moderate Illegal substance in last month - 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean % = 16.00 Adjusted mean % = 9.00 OR = 2.37 HomVEE calculated = 0.41 Not statistically significant,
p = >=.10
Moderate Illegal substance in last month - 2 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean % = 13.00 Adjusted mean % = 7.00 OR = 2.02 HomVEE calculated = 0.41 Not statistically significant,
p = >=.10
Moderate Illegal substance in last month - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean % = 7.00 Adjusted mean % = 3.00 OR = 2.57 HomVEE calculated = 0.49 Not statistically significant,
p = >=.10
Moderate Parenting stress index - 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = 62.60 Adjusted mean = 60.40 coeff = 3.91 HomVEE calculated = 0.14 Not statistically significant,
p = >=.10
Moderate Parenting stress index - 2 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean = 62.30 Adjusted mean = 66.80 coeff = -3.31 HomVEE calculated = -0.26 Not statistically significant,
p = >=.10
Moderate Parenting stress index - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = 63.30 Adjusted mean = 64.10 coeff = 1.01 HomVEE calculated = -0.05 Not statistically significant,
p = >=.10
Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Change in maternal involvement - 2 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean = 1.10 Adjusted mean = 1.20 coeff = -0.60 HomVEE calculated = -0.04 Not statistically significant,
p = >=.10
Moderate Change in maternal involvement - 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = 1.00 Adjusted mean = 0.60 coeff = 0.22 HomVEE calculated = 0.15 Not statistically significant,
p = >=.10
Moderate Change in maternal involvement - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = 1.30 Adjusted mean = 1.20 coeff = -0.15 HomVEE calculated = 0.03 Not statistically significant,
p = >=.10
Moderate Change in parenting knowledge - 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = 26.60 Adjusted mean = 15.20 coeff = 13.92 HomVEE calculated = 0.86 Statistically significant, p<.01
Moderate Change in parenting knowledge - 2 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean = 3.20 Adjusted mean = 2.60 coeff = 3.10 HomVEE calculated = 0.06 Not statistically significant, p ≥ 0.05
Moderate Change in parenting knowledge - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = 23.80 Adjusted mean = 12.80 coeff = 13.46 HomVEE calculated = 0.81 Statistically significant, p<.01
Moderate Home Observation for Measurement of the Environment - 12 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = 37.10 Adjusted mean = 37.40 coeff = -0.04 HomVEE calculated = -0.04 Not statistically significant,
p = >=.10
Moderate Home Observation for Measurement of the Environment - 6 months
FavorableUnfavorable or ambiguousNo Effect
Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = 32.50 Adjusted mean = 33.40 coeff = -1.27 HomVEE calculated = -0.14 Not statistically significant,
p = >=.10