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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 Maternal Health 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
Alcohol - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted % = 17.92 Adjusted % = 17.81 OR = 0.81 Not statistically significant,
p > 0.05
HomVEE = 0.00 Secondary
Alcohol - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted % = 16.88 Adjusted % = 20.02 OR = 0.711 Not statistically significant,
p > 0.05
HomVEE = -0.13 Secondary
Alcohol - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted % = 25.77 Adjusted % = 21.55 OR = 1.141 Not statistically significant,
p > 0.05
HomVEE = 0.14 Secondary
Any alcohol or illegal drug - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted % = 32.91 Adjusted % = 29.11 OR = 1.041 Not statistically significant,
p > 0.05
HomVEE = 0.11 Secondary
Any alcohol or illegal drug - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted % = 27.74 Adjusted % = 30.78 OR = 0.761 Not statistically significant,
p > 0.05
HomVEE = -0.09 Secondary
Any alcohol or illegal drug - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted % = 38.93 Adjusted % = 34.64 OR = 1.071 Not statistically significant,
p > 0.05
HomVEE = 0.11 Secondary
Any illegal drug - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted % = 22.89 Adjusted % = 21.92 OR = 0.931 Not statistically significant,
p > 0.05
HomVEE = 0.03 Secondary
Any illegal drug - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted % = 13.82 Adjusted % = 20.22 OR = 0.581 Not statistically significant,
p > 0.05
HomVEE = -0.28 Secondary
Any illegal drug - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted % = 21.34 Adjusted % = 21.90 OR = 0.831 Not statistically significant,
p > 0.05
HomVEE = -0.02 Secondary
ASEBA - Externalizing No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 40.09 Adjusted mean = 41.46 MD = -1.371 Not statistically significant,
p > 0.05
Study reported = -0.13 Primary
ASEBA - Externalizing Favorable Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 38.20 Adjusted mean = 40.70 MD = -2.501 Statistically significant,
p = 0.04
Study reported = -0.2 Primary
ASEBA - Internalizing No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 43.80 Adjusted mean = 45.12 MD = -1.321 Not statistically significant,
p > 0.05
Study reported = -0.12 Primary
ASEBA - Internalizing No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 41.48 Adjusted mean = 43.99 MD = -2.511 Not statistically significant,
p > 0.05
Study reported = -0.19 Primary
ASEBA - Total Problems No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 40.27 Adjusted mean = 41.65 MD = -1.381 Not statistically significant,
p > 0.05
Study reported = -0.13 Primary
ASEBA - Total Problems No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 38.01 Adjusted mean = 40.37 MD = -2.361 Not statistically significant,
p > 0.05
Study reported = -0.18 Primary
CES-D No Effect Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted mean = 13.06 Adjusted mean = 13.40 MD = -0.341 Not statistically significant,
p > 0.05
Study reported = -0.07 Secondary
CES-D No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 12.46 Adjusted mean = 13.41 MD = -0.951 Not statistically significant,
p > 0.05
Study reported = -0.16 Secondary
CES-D No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 11.54 Adjusted mean = 13.41 MD = -1.891 Not statistically significant,
p > 0.05
Study reported = -0.2 Secondary
Marijuana - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted % = 20.63 Adjusted % = 21.02 OR = 0.871 Not statistically significant,
p > 0.05
HomVEE = -0.01 Secondary
Marijuana - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted % = 12.39 Adjusted % = 18.83 OR = 0.571 Not statistically significant,
p > 0.05
HomVEE = -0.3 Secondary
Marijuana - past 30 days, use of No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted % = 18.91 Adjusted % = 19.65 OR = 0.831 Not statistically significant,
p > 0.05
HomVEE = -0.03 Secondary
POSIT Mental Health No Effect Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted mean = 3.23 Adjusted mean = 3.56 MD = -0.331 Not statistically significant,
p > 0.05
Study reported = -0.13 Primary
POSIT Mental Health No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 3.05 Adjusted mean = 3.30 MD = -0.251 Not statistically significant,
p > 0.05
Study reported = -0.09 Primary
POSIT Mental Health No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 2.77 Adjusted mean = 2.91 MD = -0.141 Not statistically significant,
p > 0.05
Study reported = -0.04 Primary
POSIT Substance Abuse No Effect Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted mean = 0.56 Adjusted mean = 0.61 MD = -0.051 Not statistically significant,
p > 0.05
Study reported = -0.03 Primary
POSIT Substance Abuse No Effect Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 0.39 Adjusted mean = 0.55 MD = -0.161 Not statistically significant,
p > 0.05
Study reported = -0.08 Primary
POSIT Substance Abuse No Effect Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 0.13 Adjusted mean = 0.45 MD = -0.321 Not statistically significant,
p > 0.05
Study reported = -0.13 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
Alcohol - past 30 days, use of Substance use, according to the Voices of Indian Teens survey Maternal self report Not applicable Secondary
Any alcohol or illegal drug - past 30 days, use of Substance use, according to the Voices of Indian Teens survey Maternal self report Not applicable Secondary
Any illegal drug - past 30 days, use of Substance use, according to the Voices of Indian Teens survey Maternal self report Not applicable Secondary
ASEBA - Externalizing Achenbach System of Empirically Based Assessment is a 112 item assessment of externalizing, internalizing, and total problems that produces results in relation to multicultural norms Maternal self-report α range = 0.69-0.79 across scales Primary
ASEBA - Internalizing Achenbach System of Empirically Based Assessment is a 112 item assessment of externalizing, internalizing, and total problems that produces results in relation to multicultural norms Maternal self-report α range = 0.69-0.79 across scales Primary
ASEBA - Total Problems Achenbach System of Empirically Based Assessment is a 112 item assessment of externalizing, internalizing, and total problems that produces results in relation to multicultural norms Maternal self-report α range = 0.69-0.79 across scales Primary
CES-D Center for Epidemiological Studies Depression is a 20-item assessment of depressive symptoms Maternal self-report α = 0.88 Secondary
Marijuana - past 30 days, use of Substance use, according to the Voices of Indian Teens survey Maternal self report Not applicable Secondary
POSIT Mental Health Problem Oriented Screening Instrument for Teens is a 139 item assessment containing 6 subscales, which include mental health and substance abuse. Maternal self-report α range = 0.60-0.83 across scales Secondary
POSIT Substance Abuse Problem Oriented Screening Instrument for Teens is a 139 item assessment containing 6 subscales, which include mental health and substance abuse. Maternal self-report α range = 0.60-0.83 across scales Secondary

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
Alcohol use in past 30 days (proportion) No Effect Full 2006-2008 sample, 3 years postpartum 322 mothers Unadjusted mean = 0.17 Unadjusted mean = 0.16 MD = 0.011 Not statistically significant, p = 0.67 HomVEE = 0.04 Secondary
Any illegal drug use in past 30 days (proportion) Favorable Full 2006-2008 sample, 3 years postpartum 322 mothers Unadjusted mean = 0.12 Unadjusted mean = 0.17 MD = -0.051 Statistically significant, p = 0.01 HomVEE = -0.24 Secondary
ASEBA Externalizing (T-score) Favorable Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 41.35 Adjusted mean = 42.58 MD = -1.232 Statistically significant, p = 0.05 Study reported = 0.14 Primary
ASEBA Internalizing (T-score) No Effect Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 42.89 Adjusted mean = 43.72 MD = -0.832 Not statistically significant, p = 0.22 Study reported = 0.09 Primary
ASEBA Total Problems (T-score) No Effect Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 40.51 Adjusted mean = 41.36 MD = -0.862 Not statistically significant, p = 0.18 Study reported = 0.10 Primary
CES-D score (0-60) Favorable Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 12.48 Adjusted mean = 13.65 MD = -1.172 Statistically significant, p = 0.01 Study reported = 0.16 Secondary
Marijuana use in past 30 days (proportion) Favorable Full 2006-2008 sample, 3 years postpartum 322 mothers Unadjusted mean = 0.11 Unadjusted mean = 0.16 MD = -0.051 Statistically significant, p = 0.01 HomVEE = -0.26 Secondary
Parenting stress index (range 0-180) No Effect Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 75.53 Adjusted mean = 79.10 MD = -3.572 Not statistically significant, p = 0.10 Study reported = 0.18 Primary

1 Lower values favor the intervention

2 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
Alcohol use in past 30 days (proportion) Proportion with use as measured by Voices for Indian Teens, a culturally specific assessment that measures quantity and frequency of substance use Maternal self-report a = 0.73 for overall scale Secondary
Any Illegal Drug use in past 30 days (proportion) Proportion with use as measured by Voices for Indian Teens, a culturally specific assessment that measures quantity and frequency of substance use Maternal self-report a = 0.73 for overall scale Secondary
ASEBA Externalizing (T-score) Achenbach System of Empirically Based Assessment is a 112 item assessment of externalizing, internalizing, and total problems that produces results in relation to multicultural norms Maternal self-report a = 0.90 for overall scale Primary
ASEBA Internalizing (T-score) Achenbach System of Empirically Based Assessment is a 112 item assessment of externalizing, internalizing, and total problems that produces results in relation to multicultural norms Maternal self-report a = 0.90 for overall scale Primary
ASEBA Total Problems (T-score) Achenbach System of Empirically Based Assessment is a 112 item assessment of externalizing, internalizing, and total problems that produces results in relation to multicultural norms Maternal self-report a = 0.90 for overall scale Primary
CES-D score (0-60) Center for Epidemiological Studies Depression is a 20-item assessment of depressive symptoms Maternal self-report a = 0.84 Secondary
Marijuana use in past 30 days (proportion) Proportion with use as measured by Voices for Indian Teens, a culturally specific assessment that measures quantity and frequency of substance use Maternal self-report a = 0.73 for overall scale Secondary
Parenting stress index (range 0-180) 36-item assessment of parenting-related stress, for which scoring norms are available by child age Maternal self-report a = 0.94 Primary
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Impact Studies Rated Moderate


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
Alcohol in last month - 12 months No Effect Mothers enrolled 2002-2004 12 months postpartum 82 mothers 19% (Adjusted) 13% (Adjusted) OR = 1.54 Not statistically significant,
p = >=.10
HomVEE = 0.25 Secondary
Alcohol in last month - 2 months No Effect Mothers enrolled 2002-2004 2 months postpartum 125 mothers 11% (Adjusted) 7% (Adjusted) OR = 1.52 Not statistically significant,
p = >=.10
HomVEE = 0.30 Secondary
Alcohol in last month - 6 months No Effect Mothers enrolled 2002-2004 6 months postpartum 115 mothers 12% (Adjusted) 6% (Adjusted) OR = 2.19 Not statistically significant,
p = >=.10
HomVEE = 0.39 Secondary
Change in depressive symptoms (CES-D) - 2 months No Effect Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean = -2.00 Adjusted mean = -3.30 Coeff. = 0.05 Not statistically significant,
p = >=.10
HomVEE = 0.12 Secondary
Change in depressive symptoms (CES-D) - 6 months No Effect Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = -4.00 Adjusted mean = -4.00 Coeff. = -0.58 Not statistically significant,
p = >=.10
HomVEE = 0.00 Secondary
Change in depressive symptoms (CES-D)- 12 months No Effect Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = -3.10 Adjusted mean = -2.00 Coeff. = -1.69 Not statistically significant,
p = >=.10
HomVEE = -0.10 Secondary
Change in social support - 12 months No Effect Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = 0.50 Adjusted mean = -2.20 Coeff. = 1.98 Not statistically significant,
p = >=.10
HomVEE = 0.13 Secondary
Change in social support - 2 months No Effect Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean = -0.40 Adjusted mean = -1.70 Coeff. = -0.21 Not statistically significant,
p = >=.10
HomVEE = 0.07 Secondary
Change in social support - 6 months No Effect Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = -3.70 Adjusted mean = -2.50 Coeff. = -0.98 Not statistically significant,
p = >=.10
HomVEE = -0.06 Secondary
Cigarette in last month - 12 months No Effect Mothers enrolled 2002-2004 12 months postpartum 82 mothers 19% (Adjusted) 15% (Adjusted) OR = 1.27 Not statistically significant,
p = >=.10
HomVEE = 0.14 Secondary
Cigarette in last month - 2 months No Effect Mothers enrolled 2002-2004 2 months postpartum 125 mothers 13% (Adjusted) 17% (Adjusted) OR = 0.74 Not statistically significant,
p = >=.10
HomVEE = -0.19 Secondary
Cigarette in last month - 6 months No Effect Mothers enrolled 2002-2004 6 months postpartum 115 mothers 22% (Adjusted) 13% (Adjusted) OR = 2.06 Not statistically significant,
p = >=.10
HomVEE = 0.35 Secondary
Illegal substance in last month - 12 months No Effect Mothers enrolled 2002-2004 12 months postpartum 82 mothers 16% (Adjusted) 9% (Adjusted) OR = 2.37 Not statistically significant,
p = >=.10
HomVEE = 0.41 Secondary
Illegal substance in last month - 2 months No Effect Mothers enrolled 2002-2004 2 months postpartum 125 mothers 13% (Adjusted) 7% (Adjusted) OR = 2.02 Not statistically significant,
p = >=.10
HomVEE = 0.41 Secondary
Illegal substance in last month - 6 months No Effect Mothers enrolled 2002-2004 6 months postpartum 115 mothers 7% (Adjusted) 3% (Adjusted) OR = 2.57 Not statistically significant,
p = >=.10
HomVEE = 0.49 Secondary
Parenting stress index - 12 months No Effect Mothers enrolled 2002-2004 12 months postpartum 82 mothers Adjusted mean = 62.60 Adjusted mean = 60.40 Coeff. = 3.91 Not statistically significant,
p = >=.10
HomVEE = 0.14 Primary
Parenting stress index - 2 months No Effect Mothers enrolled 2002-2004 2 months postpartum 125 mothers Adjusted mean = 62.30 Adjusted mean = 66.80 Coeff. = -3.31 Not statistically significant,
p = >=.10
HomVEE = -0.26 Primary
Parenting stress index - 6 months No Effect Mothers enrolled 2002-2004 6 months postpartum 115 mothers Adjusted mean = 63.30 Adjusted mean = 64.10 Coeff. = 1.01 Not statistically significant,
p = >=.10
HomVEE = -0.05 Primary
Show Study Outcome Measure Summary
Outcome Description of Measure Data Collection Method Properties of the Outcome Measure Outcome Type
Alcohol in last month - 12 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Alcohol in last month - 2 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Alcohol in last month - 6 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Change in depressive symptoms (CES-D) - 2 months Center for Epidemiological Studies Depression is a 20-item assessment of depressive symptoms scored on a 4-point scale Maternal self-report α = 0.88 Secondary
Change in depressive symptoms (CES-D) - 6 months Center for Epidemiological Studies Depression is a 20-item assessment of depressive symptoms scored on a 4-point scale Maternal self-report α = 0.88 Secondary
Change in depressive symptoms (CES-D)- 12 months Center for Epidemiological Studies Depression is a 20-item assessment of depressive symptoms scored on a 4-point scale Maternal self-report α = 0.88 Secondary
Change in social support - 12 months A 20-item assessment scored on a 5-point scale designed to measure participants’ perceived support form family, friends, and community Maternal self report α = 0.93 Secondary
Change in social support - 2 months A 20-item assessment scored on a 5-point scale designed to measure participants’ perceived support form family, friends, and community Maternal self report α = 0.93 Secondary
Change in social support - 6 months A 20-item assessment scored on a 5-point scale designed to measure participants’ perceived support form family, friends, and community Maternal self report α = 0.93 Secondary
Cigarette in last month - 12 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Cigarette in last month - 2 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Cigarette in last month - 6 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Illegal substance in last month - 12 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Illegal substance in last month - 2 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Illegal substance in last month - 6 months Self-report item developed by Substance Abuse and Mental Health Services Administration regarding participants’ substance use in the previous month Maternal self-report Not applicable Secondary
Parenting stress index - 12 months 30-item assessment of parenting-related stress, for which scoring norms are available by child age Maternal self-report α = 0.80 Secondary
Parenting stress index - 2 months 30-item assessment of parenting-related stress, for which scoring norms are available by child age Maternal self-report α = 0.80 Secondary
Parenting stress index - 6 months 30-item assessment of parenting-related stress, for which scoring norms are available by child age Maternal self-report α = 0.80 Secondary
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