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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

Materials and Forms to Support Implementation

Last Updated

May 2016


Operations Manuals

In addition to a manualized curriculum, Family Spirit operation materials include the following:

  • An implementation guide with a description of the core implementation components, Family Spirit history, and evaluation findings;
  • Health educator lesson plans; 
  • A reference manual to accompany the curriculum, containing in-depth information about the lesson topics, a bibliography of additional resources, and a glossary of key terms; 
  • A participant workbook for families, containing handouts and worksheets that reinforce key points; 
  • Evaluation materials, including evaluation measures and screening tools;  
  • Participant certificates, awarded for achievements throughout the program, such as a birth, completion of lessons, and program exit; and
  • Access to a password-protected online portal that contains program materials and provides opportunities to connect with other affiliates. 


Service Delivery Forms

Family Spirit requires affiliates to use the model’s session summary form, participant tracking log, quality assurance form, and the health educator independent knowledge curriculum assessments. Affiliates may use their own version of the session summary form and participant tracking log as long as the same fields are captured. The following additional forms are available for use during service delivery: home visitor weekly activities report, supervisor response to weekly activities report, satisfaction questionnaire, referral form, and exit form.


Assessment Tools

To screen mothers and children for special needs, Family Spirit recommends that affiliates use assessment tools that the Johns Hopkins University Center for American Indian Health has developed or identified for affiliate use.



The Family Spirit curriculum consists of 63 lessons organized into six modules: prenatal care; infant care; “Your Growing Child” (child development); toddler care; “My Family and Me” (planning, nutrition, exercise, budgeting, health, and communication); and “Healthy Living” (goal-setting, substance abuse, family planning, and sexually transmitted infections). The curriculum package includes an implementation guide, health educator lesson plans, a reference manual on lesson topics, and a sample participant workbook with handouts and worksheets.


Available Languages

Family Spirit materials are available in English. Health educators are encouraged to incorporate their Native language into lessons as appropriate.


Fidelity Measurement

At least quarterly, supervisors observe a visit conducted by each home visitor and complete a quality assurance form that assesses: (1) the structure of the visit, (2) the relationship between the home visitor and the participant, and (3) the home visitor’s flexibility and adherence to and competence with the curriculum. Supervisors have the opportunity to discuss how to correct fidelity problems with a Family Spirit affiliate liaison during quarterly meetings.

On a quarterly basis, the Johns Hopkins University Center for American Indian Health requires affiliates to report process data, including the session summary forms, participant tracking logs, quality assurance forms, and independent knowledge assessments. Family Spirit uses the data to monitor the number of families served across affiliate sites, monitor fidelity to the program content and structure, and provide ongoing technical assistance as needed. The Family Spirit national office offers consultation on assessing process and outcome data to promote continuous quality improvement and measure program impact. Affiliates must also report on their quality assurance process, the frequency of quality assurance checks, the number of completed quality assurance visits, and the results of their quality assurance activities.

To support adherence to the model, Family Spirit recommends affiliates use the following measures to assess fidelity to the core program components:

Core Component Instrument Frequency
Relationship Satisfaction questionnaire Every 6 months
Quality assurance form Quarterly (minimum)
Structured education/ supporting materials Session summary form Every visit
Quality assurance formQuarterly (minimum)
Content knowledgeComprehensive Knowledge Assessment – participantEvery 6 months
Independent Knowledge Assessment – health educatorBefore teaching lesson first time, every 12 months after (minimum)
Duration of program enrollmentSession summary formEvery visit
Participant tracking log Every visit
Evidence-based parenting techniquesSelf-Efficacy Scale of Parental Locus of Control ScaleEvery 6 months
Parenting Stress Index Every 6 months
Comprehensive Knowledge AssessmentEvery 6 months
Session summary formEvery visit
Participant tracking logEvery visit
Reduction of maternal psychosocial risksCenter for Epidemiological Studies-Depression Scale (CES-D)Every 2 months
Alcohol and drugs scales of the Voices of Indian Teens SurveyEvery 6 months
Targeted early childhood developmental outcomes Brief Infant Toddler Social Emotional Assessment (BITSEA) Every 6 months beginning at 12 months of age


Fidelity Standards

The Family Spirit model includes core components that are key to maintaining fidelity. These components address the following:

  • Relationship with the participant;
  • Structured education and support materials;
  • Content knowledge;
  • Duration of program enrollment;
  • Evidence-based parenting techniques to promote optimal child development;
  • Reduction of maternal psychosocial risks that could impede parenting efficacy or inhibit infant and toddler outcomes; and
  • Early childhood development outcomes.

Family Spirit advises that a minimum of half of the 63 possible lessons be delivered to program participants, beginning as early as possible in pregnancy and continuing sequentially until the child’s third birthday.



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.