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Study Detail

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.

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 and SES; outcomes not feasible to assess at baselineNoneNone

Here, we report only the Child Behavior Checklist outcomes not included in the published version of the study (Barlow et al., 2015).

Study Characteristics

Study Participants American Indian adolescent females ages 12 to 19 years at conception and at 32 weeks or earlier gestation who resided in one of four participating communities were recruited. The study sample included 322 participants who were randomly assigned to either the Family Spirit group (159) or the control group (163). The average age of participants at baseline was 18.1 years. Sixty percent lived with their parents and slightly more than half lived in two or more homes within the past year. Seventy-seven percent of participants were pregnant with their first child. During pregnancy, 14 percent of participants drank alcohol, 19 percent smoked cigarettes, and 13 percent used marijuana.
Setting The program was implemented in four tribal communities across three reservations in Arizona.
Home Visiting Services Family Spirit is a home visiting program for young American Indian pregnant and parenting mothers staffed by American Indian paraprofessionals. The program’s goals are to increase mothers’ parenting knowledge and involvement, mothers’ psychosocial functioning, and children’s emotional and behavioral outcomes. The curriculum includes 43 lessons that cover parenting skills, infant development, and maternal psychosocial development. The frequency of the visits depends upon the stage of the program. One-hour home visits are provided weekly during pregnancy, biweekly visits for the first four months following the child’s birth, monthly from 4 to 14 months postpartum, and then bimonthly until the child’s third birthday. The study did not specify the dosage of services that program participants actually received.
Comparison Condition Participants in the control group received transportation to and from prenatal and well-baby visits, information on child care and community resources, and referrals for services.
Staff Characteristics and Training Home visitors were trained for more than 80 hours on the evaluation protocol and delivering the intervention. After training, home visitors were required to demonstrate 85 percent mastery or better of the Family Spirit curriculum. Quarterly supervision visits and review of an audio recording of 20 percent of visits were administered to examine whether home visitors adhered to the intervention protocol
Funding Source Support for this research was provided by the National Institute on Drug Abuse.
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 Identifier: NCT00373750

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


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