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.

Prerequisites for implementation

Type of implementing program

Family Spirit is implemented within the context of local, state, tribal, and federal organizations. Some affiliates offer stand-alone Family Spirit programs, and others nest the model within existing programs and services that their organizations offer. There are no requirements for the type of organization that can implement the model.

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Staffing requirements

Paraprofessionals from the community conduct home visits. A supervisor guides and monitors implementation of the curriculum. Nurses may also work with home visitors to conduct home visits and teach the lessons deemed most relevant to their clinical expertise. Family Spirit has no recommendations regarding necessary leadership positions beyond requiring a supervisor for the home visitors. The Family Spirit national office noted that an evaluator can be useful given the model’s data collection requirements.

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Staff education and experience

Family Spirit recommends that home visitors come from the participating community and are familiar with the local or tribal culture, traditions, and language(s). Home visitors must have at least a high school education plus two or more years of related work experience. Specific Family Spirit training (described under Pre-Service Staff Training) is also required. The developers recommend that supervisors have a college degree or equivalent work experience, and have experience in home visiting, case management, community networking, and staff supervision.

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Supervision requirements

Family Spirit requires that home visitors receive supervision, but the model does not have requirements about the mode or frequency of supervision.

Family Spirit recommends weekly supervision of home visitors’ activities and challenges. The model provides three tools that agencies can use to facilitate supervision and monitor implementation quality:

  1. Home visitor weekly report: Home visitors submit this form to their supervisors describing the activities they completed that week, challenges encountered, and supplies needed. Affiliates that use the model’s data system for data collection and client monitoring (described under Data Systems/Technology Requirements) do not have to use the weekly report because the implementation support platform replaces the form.
  2. Supervisor response to home visitor weekly report: Supervisors complete this form to address any challenges or needs raised by the home visitors.
  3. Quality assurance form: Supervisors observe home visitors and rate the structure and quality of the visit according to a systematic rating scale.

Family Spirit recommends a maximum ratio of 6 to 10 home visitors per supervisor, depending on the design and scope of the program site.

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Staff ratio requirements

Family Spirit recommends a caseload of 20 to 25 families for each full-time home visitor, depending on the participants’ stages of enrollment and the commuting distance associated with home visits.

Family Spirit recommends that home visitors start with a caseload of three to five families and build a larger caseload over time.

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Data systems/technology requirements

Affiliates must report process data (described under Fidelity Measurement) quarterly to the Family Spirit national office via the model’s data system. The Family Spirit national office uses the Care4 system to track affiliate-level data, including pre-training activities and post-training quarterly reporting.

Affiliates may choose to also use Care4 as a data collection and management system to track clients’ outcomes over time, and/or as a system to guide program delivery.

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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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