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Implementing Family Spirit®

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

Program Model Overview

Last Updated

May 2016

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The information in this profile reflects feedback from this model’s developer as of the above date. The description of the implementation of the model here, including any adaptations, may differ from how it was implemented in the studies reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the DHHS criteria for evidence of effectiveness.

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Implementation Support

Family Spirit was designed, implemented, and evaluated by the Johns Hopkins University Center for American Indian Health in partnership with the Navajo, White Mountain Apache, and San Carlos Apache tribal communities. The Family Spirit national office at the Johns Hopkins University Center for American Indian Health administers the program and provides implementation support. Locally, community agencies known as affiliates provide personnel support for implementing the model.

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Theoretical Model

The Family Spirit conceptual framework is based on G. R. Patterson’s model that posits parenting as the critical link between parents’ personal characteristics and environmental context and children’s individual risks and outcomes. The Family Spirit intervention is designed to promote mothers’ parenting skills, while assisting them in developing coping and problem-solving skills to overcome individual and environmental stressors.

The model also incorporates traditional tribal teachings throughout the curriculum. The program developers believe that cultural teachings are protective factors that can improve maternal and child health in American Indian communities.

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Target Population

Family Spirit serves pregnant women and families with children younger than age 3. The developer strongly recommends enrolling mothers early in pregnancy. Family Spirit was designed to be implemented in Native American communities. However, it is now also being used with non-Native populations with high maternal and child behavioral health disparities.

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Targeted Outcomes

The program aims to (1) increase parenting knowledge and skills; (2) address maternal psychosocial risk factors that could interfere with positive child-rearing (such as drug and alcohol use, depression, low education, unemployment, and intimate partner violence); (3) promote optimal physical, cognitive, and social/emotional development for children ages birth to 3 years; (4) prepare children for early school success; (5) ensure children receive recommended well-child visits and health care; (6) link families to community services to address specific needs; and (7) promote parents’ and children’s life skills and behavioral outcomes across the lifespan.

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Program Model Components

Paraprofessional health educators visit families in their homes. They try to establish a close rapport with families to facilitate delivery of the curriculum, which consists of 63 lessons within the following six domains: prenatal care, infant care, child development, toddler care, life skills, and healthy living. The health educators also refer families to community resources to address specific needs.

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Program Model Intensity and Length

The model consists of 63 lessons divided into six domains. Lessons are intended to be taught sequentially over 52 home visits. Family Spirit recommends initiating the program by at least 28 weeks of gestation and continuing until the child’s third birthday. Home visits are more intensive in the prenatal and newborn stages, and diminish in frequency as children age. The program developers recommend weekly visits through the child’s first 3 months, biweekly from 4 to 6 months, monthly from 7 to 22 months, and bimonthly from 23 to 36 months of age. Visits typically last 45 to 90 minutes.

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Location

Family Spirit has been implemented in dozens of reservation-based and urban Native communities across 15 states. The Family Spirit national office is also working to implement Family Spirit with two non-Native urban communities with high maternal and child behavioral health disparities.

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Adaptations and Enhancements

Family Spirit allows affiliates to make enhancements to the curriculum and model to meet program and families’ needs at the local level. For example, affiliates can incorporate cultural enhancements and add group sessions on Family Spirit lessons such as basic infant and toddler care or life skills.

The Family Spirit national office at the Johns Hopkins University Center for American Indian Health must approve adaptations to the model.

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Notes

The information contained on this page was last updated in May 2016. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Family Spirit team at Johns Hopkins University Center for American Indian Health on March 23, 2016. HomVEE reserves the right to edit the profile for clarity and consistency.

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