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Study Detail

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.

Program(s) Reviewed: Family Spirit®

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignAttritionBaseline EquivalenceReassignmentConfounding Factors
ModerateRandomized Controlled TrialHighEstablished on race/ethnicity, SES, and baseline measures of applicable outcomesNoneNone
Notes:

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.
Home Visiting 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 Condition Control participants received a breastfeeding/nutrition education intervention over the course of 23 visits from paraprofessionals.
Staff Characteristics and Training Home visitors who delivered both Family Spirit and control conditions received more than 80 hours of training that focused on home visiting methods and curriculum content. They were required to demonstrate mastery of the content and fidelity to the study protocol. Supervision occurred through daily observation and weekly conference calls.
Funding Source 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 program 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 program model is based.

Study Registration

Clinicaltrials.gov Identifier: NCT00356551

Study registration was assessed by HomVEE beginning with the 2014 review.

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