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Family Spirit®

Meets DHHS criteria for an evidenced based model Meets DHHS criteria for an evidenced based model in tribal populations

Last Updated: May 2016

In Brief for Child Development and School Readiness Outcomes

Impact Studies Rated High


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.
Additional Source:

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.

Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
ITSEA - Competence domain No Effect Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted mean = 1.07 Adjusted mean = 1.02 MD = 0.05 Not statistically significant,
p > 0.05
Study reported = 0.12 Primary
ITSEA - Competence domain, % clinically at risk No Effect Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted % = 20.27 Adjusted % = 17.66 OR = 0.86 Not statistically significant,
p > 0.05
HomVEE = 0.10 Primary
ITSEA - Dysregulation domain No Effect Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted mean = 0.54 Adjusted mean = 0.59 MD = -0.061 Not statistically significant,
p > 0.05
Study reported = -0.15 Primary
ITSEA - Dysregulation domain, % clinically at risk No Effect Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted % = 15.80 Adjusted % = 18.67 OR = 1.371 Not statistically significant,
p > 0.05
HomVEE = -0.12 Primary
ITSEA - Externalizing domain Favorable Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted mean = 0.62 Adjusted mean = 0.71 MD = -0.091 Statistically significant,
p = 0.03
Study reported = -0.19 Primary
ITSEA - Externalizing domain, % clinically at risk No Effect Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted % = 13.69 Adjusted % = 20.62 OR = 1.881 Not statistically significant,
p > 0.05
HomVEE = -0.30 Primary
ITSEA - Internalizing domain No Effect Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted mean = 0.57 Adjusted mean = 0.62 MD = -0.051 Not statistically significant,
p > 0.05
Study reported = -0.1 Primary
ITSEA - Internalizing domain, % clinically at risk No Effect Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted % = 20.27 Adjusted % = 27.16 OR = 1.611 Not statistically significant,
p > 0.05
HomVEE = -0.23 Primary

1 Negative value is favorable to the intervention.

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
ITSEA - Competence domain Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.63-.81 Primary
ITSEA - Competence domain, % clinically at risk Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.63-.81 Primary
ITSEA - Dysregulation domain Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.63-.81 Primary
ITSEA - Dysregulation domain, % clinically at risk Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.63-.81 Primary
ITSEA - Externalizing domain Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.63-.81 Primary
ITSEA - Externalizing domain, % clinically at risk Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.63-.81 Primary
ITSEA - Internalizing domain Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.63-.81 Primary
ITSEA - Internalizing domain, % clinically at risk Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.63-.81 Primary
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Impact Studies Rated Moderate


Barlow, A., Mullany, B., Neault, N., Billy, T., Hastings, R., Lorenzo, S., ... Walkup, J. T. (2014). A randomized controlled trial of a paraprofessional-delivered, home-visiting intervention: Three-year outcomes for American Indian teen mothers and their children. Manuscript under review.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
CBCL mean, Externalizing domain (0-48) (T-score) No Effect Children with CBCL data 2006-2008 sample, 3 years postpartum 280 children Adjusted mean = 42.45 Adjusted mean = 42.59 MD = -0.141 Not statistically significant,
p = 0.89
Study reported = 0.01 Primary
CBCL mean, Internalizing domain (0-72) (T-score) No Effect Children with CBCL data 2006-2008 sample, 3 years postpartum 280 children Adjusted mean = 44.23 Adjusted mean = 44.91 MD = -0.681 Not statistically significant,
p = 0.57
Study reported = 0.06 Primary
CBCL mean, Total Problems (0-200) (T-score) No Effect Children with CBCL data 2006-2008 sample, 3 years postpartum 280 children Adjusted mean = 44.00 Adjusted mean = 44.79 MD = -0.791 Not statistically significant,
p = 0.52
Study reported = 0.07 Primary

1 Negative value is favorable to the intervention.

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
CBCL mean, Externalizing domain (0-48) (T-score) Child Behavior Check List is a 99-item normed parent report of child behavior Maternal report α = 0.91 for subscale Primary
CBCL mean, Internalizing domain (0-72) (T-score) Child Behavior Check List is a 99-item normed parent report of child behavior Maternal report α = 0.89 for subscale Primary
CBCL mean, Total Problems (0-200) (T-score) Child Behavior Check List is a 99-item normed parent report of child behavior Maternal report α = 0.94 for subscale Primary

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.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
ITSEA Competence domain (proportion clinically at risk (>10%)) No Effect Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Unadjusted mean = 0.24 Unadjusted mean = 0.23 MD = 0.01 Not statistically significant, p = 0.78 HomVEE = 0.03 Primary
ITSEA Dysregulation domain (proportion clinically at risk (>10%)) No Effect Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Unadjusted mean = 0.10 Unadjusted mean = 0.15 MD = -0.041 Not statistically significant, p = 0.08 HomVEE = -0.23 Primary
ITSEA Externalizing domain (proportion clinically at risk (>10%)) Favorable Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Unadjusted mean = 0.17 Unadjusted mean = 0.24 MD = -0.071 Statistically significant, p = 0.03 HomVEE = -0.24 Primary
ITSEA Internalizing domain (proportion clinically at risk (>10%)) Favorable Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Unadjusted mean = 0.10 Unadjusted mean = 0.15 MD = -0.051 Statistically significant, p = 0.04 HomVEE = -0.27 Primary
ITSEA mean, Competence domain (range 0-2) No Effect Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Adjusted mean = 1.28 Adjusted mean = 1.24 MD = 0.04 Not statistically significant, p = 0.09 Study reported = 0.14 Primary
ITSEA mean, Dysregulation domain (range 0-2) Favorable Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Adjusted mean = 0.48 Adjusted mean = 0.55 MD = -0.071 Statistically significant, p < .001 Study reported = 0.27 Primary
ITSEA mean, Externalizing domain (range 0-2) Favorable Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Adjusted mean = 0.64 Adjusted mean = 0.71 MD = -0.071 Statistically significant, p < .01 Study reported = 0.23 Primary
ITSEA mean, Internalizing domain (range 0-2) Favorable Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Adjusted mean = 0.54 Adjusted mean = 0.60 MD = -0.051 Statistically significant, p < .01 Study reported = 0.23 Primary

1 Negative value is favorable to the intervention.

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
ITSEA Competence domain (proportion clinically at risk (>10%)) Proportion clinically at risk on subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report a = 0.89 for subscale Primary
ITSEA Dysregulation domain (proportion clinically at risk (>10%)) Proportion clinically at risk on subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report a = 0.89 for subscale Primary
ITSEA Externalizing domain (proportion clinically at risk (>10%)) Proportion clinically at risk on subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report a = 0.84 for subscale Primary
ITSEA Internalizing domain (proportion clinically at risk (>10%)) Proportion clinically at risk on subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report a = 0.80 for subscale Primary
ITSEA mean, Competence domain (range 0-2) Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report a = 0.89 for subscale Primary
ITSEA mean, Dysregulation domain (range 0-2) Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report a = 0.89 for subscale Primary
ITSEA mean, Externalizing domain (range 0-2) Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report a = 0.84 for subscale Primary
ITSEA mean, Internalizing domain (range 0-2) Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report a = 0.80 for subscale Primary

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.
Show Study Effects Details
Outcome Effect Sample Timing of Follow-Up Sample Size Program Group Comparison Group Mean Difference or Odds Ratio
Statistical Significance
Effect Size
Outcome Type
ITSEA Competence domain No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.94 Adjusted mean = 0.95 Coeff. = -0.01 Not statistically significant,
p = >=.10
HomVEE = -0.03 Primary
ITSEA Competence: Attention No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 1.11 Adjusted mean = 1.07 Coeff. = 0.05 Not statistically significant,
p = >=.10
HomVEE = 0.08 Primary
ITSEA Competence: Compliance No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.91 Adjusted mean = 0.84 Coeff. = 0.10 Not statistically significant,
p = >=.10
HomVEE = 0.18 Primary
ITSEA Competence: Empathy No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.66 Adjusted mean = 0.59 Coeff. = 0.09 Not statistically significant,
p = >=.10
HomVEE = 0.15 Primary
ITSEA Competence: Imitation/play No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 1.08 Adjusted mean = 1.10 Coeff. = -0.03 Not statistically significant,
p = >=.10
HomVEE = -0.05 Primary
ITSEA Competence: Mastery motivation No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 1.30 Adjusted mean = 1.34 Coeff. = -0.05 Not statistically significant,
p = >=.10
HomVEE = -0.08 Primary
ITSEA Competence: Prosocial peer relations No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.51 Adjusted mean = 0.79 Coeff. = -0.24 Not statistically significant,
p = >=.10
HomVEE = -0.68 Primary
ITSEA Dysregulation domain No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.43 Adjusted mean = 0.49 Coeff. = -0.05 Not statistically significant,
p = >=.10
HomVEE = -0.22 Primary
ITSEA Dysregulation: Eating No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.43 Adjusted mean = 0.44 Coeff. = -0.02 Not statistically significant,
p = >=.10
HomVEE = -0.04 Primary
ITSEA Dysregulation: Negative emotionality No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.47 Adjusted mean = 0.48 Coeff. = 0.02 Not statistically significant,
p = >=.10
HomVEE = -0.03 Primary
ITSEA Dysregulation: Sensory sensitivity No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.37 Adjusted mean = 0.52 Coeff. = -0.14 Not statistically significant,
p = >=.10
HomVEE = -0.41 Primary
ITSEA Dysregulation: Sleep No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.44 Adjusted mean = 0.53 Coeff. = -0.06 Not statistically significant,
p = >=.10
HomVEE = -0.25 Primary
ITSEA Externalizing domain Favorable Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.39 Adjusted mean = 0.57 Coeff. = -0.171 Statistically significant, p<.05 HomVEE = -0.63 Primary
ITSEA Externalizing: Activity/impulsivity Favorable Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.69 Adjusted mean = 0.98 Coeff. = -0.271 Statistically significant, p<.05 HomVEE = -0.65 Primary
ITSEA Externalizing: Aggression/defiance No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.27 Adjusted mean = 0.35 Coeff. = -0.06 Not statistically significant,
p = >=.10
HomVEE = -0.29 Primary
ITSEA Externalizing: Peer aggression Favorable Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.13 Adjusted mean = 0.30 Coeff. = -0.231 Statistically significant, p<.05 HomVEE = -0.68 Primary
ITSEA Internalizing domain No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.48 Adjusted mean = 0.55 Coeff. = -0.06 Not statistically significant,
p = >=.10
HomVEE = -0.35 Primary
ITSEA Internalizing: Depression/withdraw No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.12 Adjusted mean = 0.15 Coeff. = 0.01 Not statistically significant,
p = >=.10
HomVEE = -0.13 Primary
ITSEA Internalizing: General anxiety No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.20 Adjusted mean = 0.21 Coeff. = 0.01 Not statistically significant,
p = >=.10
HomVEE = -0.04 Primary
ITSEA Internalizing: Inhibition to novelty No Effect Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.73 Adjusted mean = 0.82 Coeff. = -0.09 Not statistically significant,
p = >=.10
HomVEE = -0.24 Primary
ITSEA Internalizing: Separation distress Favorable Mothers enrolled 2002-2004 12 months old 65 children Adjusted mean = 0.84 Adjusted mean = 1.02 Coeff. = -0.171 Statistically significant, p<.05 HomVEE = -0.52 Primary

1 Negative differences favor the program group

Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
ITSEA Competence domain Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Competence: Attention Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Competence: Compliance Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Dysregulation domain Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Dysregulation: Eating Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Dysregulation: Negative emotionality Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Dysregulation: Sensory sensitivity Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Dysregulation: Sleep Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Externalizing domain Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Externalizing: Activity/impulsivity Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Externalizing: Aggression/defiance Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Externalizing: Peer aggression Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Internalizing domain Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Internalizing: Depression/withdraw Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Internalizing: General anxiety Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Internalizing: Inhibition to novelty Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
ITSEA Internalizing: Separation distress Subscale from 126 item normed assessment of child behaviors, the Infant Toddler Social Emotional Assessment Maternal report α range = 0.71-.83 Primary
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