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

Model implementation summary last updated: 2020

The information in this implementation report 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 manuscripts 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. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Model overview

Theoretical approach

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 seeks 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 model developers believe that cultural teachings are protective factors that can improve maternal and child health in American Indian communities.

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Implementation support

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

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Intended population

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

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Targeted outcomes

The model 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 and 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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Model services

Paraprofessional home visitors meet with families in their homes. The home visitors try to establish a close rapport with families to facilitate delivery of the curriculum, which consists of 63 lessons within the following six domains: (1) prenatal care, (2) infant care, (3) child development, (4) toddler care, (5) life skills, and (6) healthy living. The home visitors also refer families to community resources to address specific needs.

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Model intensity and length

The model consists of 63 lessons organized into six domains. Family Spirit intends that home visitors teach lessons 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 model 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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More than 130 tribal communities across 21 states have implemented Family Spirit. The Family Spirit national office has also trained affiliates in four 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. Family Spirit research trials have not evaluated clinic- or group-based administration.

The Family Spirit national office at the Johns Hopkins University Center for American Indian Health must approve adaptations to the model. No information is available on the process for considering adaptations to the model.

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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 in February 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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