Implementing Family Spirit® Meets HHS Criteria Meets HHS criteria for an evidenced based model in tribal populations

Implementation last updated: 2020

The information in this profile reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the research reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Similarly, models described here may not all have impact studies, and those with impact studies may vary in their effectiveness. Please see the Effectiveness button on the left for more information about research on the effectiveness of the models discussed here.

Materials and forms to support implementation

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;
  • Home visitor 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;
  • Certificates for participants, 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 model materials and provides opportunities to connect with other affiliates.
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Service delivery forms

Family Spirit requires affiliates to use the model’s session summary form, participant tracking log, quality assurance form, and the home visitor knowledge assessments. Affiliates may use their own version of the session summary form and participant tracking log as long as those versions capture the same fields. 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.

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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.

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The Family Spirit curriculum consists of 63 lessons organized into six domains: (1) prenatal care; (2) infant care; (3) child development; (4) toddler care; (5) life skills such as planning, nutrition, exercise, budgeting, health, and communication; and (6) healthy living, including goal-setting, substance abuse, family planning, and sexually transmitted infections. The curriculum package includes an implementation guide, home visitor lesson plans, a reference manual on lesson topics, and a sample participant workbook with handouts and worksheets.

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Available languages

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

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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 can 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 home visitor knowledge assessments. Family Spirit uses the data to monitor the number of families served across affiliates, monitor fidelity to the model’s 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.

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Fidelity standards

The Family Spirit model includes the following 11 core components that are key to maintaining fidelity.

  1. Target population: Family Spirit serves young mothers ages 14 through 24. Mothers enroll during the second trimester of pregnancy. Family Spirit recommends that affiliates use the maternal demographics form to monitor adherence to this component.  
  2. Relationship with participant: Home visitors create an environment that allows for a comfortable, confidential space to dialogue with families. Home visitors are highly flexible, nonjudgmental, and accommodating of participants’ needs. Supervisors use the quality assurance form to assess the participant–home visitor relationship at least quarterly. To maintain certification in Family Spirit, home visitors must score at least 3 of 4 points on the quality assurance form. Participants complete a satisfaction questionnaire every six months. No information is available on how this information is used.
  3. Curriculum knowledge, adherence, and flexibility: Home visitors are knowledgeable of and familiar and flexible with the curriculum content and ancillary materials. Home visitors use the curriculum as intended at developmentally appropriate times. Home visitors must score 80 percent or higher on the knowledge assessment for each lesson to be approved to teach that lesson. Supervisors must score 100 percent on the knowledge assessment for each lesson.
  4. Program duration: Affiliates serve mothers from 28 weeks of gestation until 3 years postpartum.
  5. Lesson frequency: Affiliates have the capacity to follow the sequential curriculum schedule of weekly visits from 28 weeks gestation to 3 months postpartum, biweekly visits from 3 to 6 months, monthly visits from 7 to 22 months, and bimonthly visits from 24 to 36 months postpartum. Families that receive at least 50 percent of the prescribed lessons by the end of 24 months postpartum maintain fidelity to the Family Spirit model.
  6. Staffing: Each affiliate has at least one home visitor working at least 0.5 full-time equivalent (FTE) on Family Spirit activities. Home visitors have at least a high school education and related work experience.
  7. Supervision: Each affiliate has at least one supervisor who provides direct program supervision for 6 to 10 home visitors. It is recommended that supervisors have a college degree, or equivalent work experience, and have experience in home-visiting, case management, community networking, and staff supervision.
  8. Training: All home visitors and supervisors attend pre-training meetings, pass knowledge assessments, and participate in the initial three- to four-day Family Spirit in-person training. The Family Spirit national office must certify home visitors and supervisors.
  9. Caseload: Family Spirit recommends a caseload of up to 20 to 25 families for each full-time home visitor (1.0 FTE), depending on stage of enrollment for each participant. Home visitors working 0.5 FTE can carry a caseload of 10 to 12 families.
  10. Community networking and resources: Each affiliate produces a community resource guide. Home visitors are familiar with resources available to families, including local service providers and participation requirements. Partnerships with these entities could be informal or formalized through a memorandum of understanding.
  11. Documentation and evaluation: Each affiliate determines its own process for documenting program processes and evaluating outcomes. At a minimum, affiliates must have processes in place to report on all of the fields in the Family Spirit quarterly affiliate report form. Family Spirit provides numerous evaluation tools and templates for affiliates to use.
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Implementation notes

The information contained on this page was last updated in April 2020. 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 the Johns Hopkins University Center for American Indian Health on February 14, 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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