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Barlow, A., Mullany, B., Neault, N., Compton, S., Carter, A., Hastings, R., Billy, T., CohoMescal, V., Lorenzo, S., & Walkup, J. T. (Jan 2013). Effect of a paraprofessional home-visiting intervention on American Indian teen mothers’ and infants’ behavioral risks: A randomized controlled trial. The American Journal of Psychiatry, 170(1), 83-93.

Model(s) Reviewed: Family Spirit®
Additional sources:

WWHV035854

Mullany, B., Barlow, A., Neault, N., Billy, T., Jones, T., Tortice, I., Lorenzo, S., Powers, J., Lake, K., Reid, R., & Walkup, J. (2012). The Family Spirit trial for American Indian teen mothers and their children: CBPR rationale, design, methods and baseline characteristics. Society of Prevention Research, 13, 504-518.
Manuscript screening details
Screening decision Screening conclusion HomVEE procedures and standards version
Passes screens Eligible for review Version 1
Study design details
Rating Design Attrition Baseline equivalence Compromised randomization Confounding factors Valid, reliable measure(s)
High Randomized controlled trial Low Established on race/ethnicity, SES, and baseline measures of the outcome. None None Not assessed in manuscripts reviewed before 2021
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.
Intervention 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 conditions 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.
Subgroups examined This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report).

• Maternal substance use/disorder (yes)

Funding sources 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 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 model is based.
Peer reviewed Peer reviewed status is not listed for manuscripts reviewed before 2021.
Study Registration:

Clinicaltrials.gov Identifier: NCT00373750

Findings that rate moderate or high

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High ITSEA - Competence domain
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted mean = 1.07 Adjusted mean = 1.02 Mean difference = 0.05 Study reported = 0.12 Not statistically significant, p ≥ 0.05
High ITSEA - Competence domain, % clinically at risk
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted % = 20.27 Adjusted mean % = 17.66 OR = 0.86 HomVEE calculated = 0.10 Not statistically significant, p ≥ 0.05
High ITSEA - Dysregulation domain
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted mean = 0.54 Adjusted mean = 0.59 Mean difference = -0.06 Study reported = -0.15 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High ITSEA - Dysregulation domain, % clinically at risk
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted % = 15.80 Adjusted mean % = 18.67 OR = 1.37 HomVEE calculated = -0.12 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High ITSEA - Externalizing domain
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted mean = 0.62 Adjusted mean = 0.71 Mean difference = -0.09 Study reported = -0.19 Statistically significant,
p = 0.03

footnote162

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Negative value is favorable to the intervention.

High ITSEA - Externalizing domain, % clinically at risk
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted % = 13.69 Adjusted mean % = 20.62 OR = 1.88 HomVEE calculated = -0.30 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High ITSEA - Internalizing domain
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted mean = 0.57 Adjusted mean = 0.62 Mean difference = -0.05 Study reported = -0.10 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High ITSEA - Internalizing domain, % clinically at risk
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 319 mothers Adjusted % = 20.27 Adjusted mean % = 27.16 OR = 1.61 HomVEE calculated = -0.23 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High ASEBA - Externalizing
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 38.20 Adjusted mean = 40.70 Mean difference = -2.50 Study reported = -0.20 Statistically significant,
p = 0.04

footnote162

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Negative value is favorable to the intervention.

High ASEBA - Externalizing
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 40.09 Adjusted mean = 41.46 Mean difference = -1.37 Study reported = -0.13 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High ASEBA - Internalizing
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 41.48 Adjusted mean = 43.99 Mean difference = -2.51 Study reported = -0.19 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High ASEBA - Internalizing
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 43.80 Adjusted mean = 45.12 Mean difference = -1.32 Study reported = -0.12 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High ASEBA - Total Problems
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 40.27 Adjusted mean = 41.65 Mean difference = -1.38 Study reported = -0.13 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High ASEBA - Total Problems
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 38.01 Adjusted mean = 40.37 Mean difference = -2.36 Study reported = -0.18 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High CES-D
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted mean = 13.06 Adjusted mean = 13.40 Mean difference = -0.34 Study reported = -0.07 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High CES-D
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 12.46 Adjusted mean = 13.41 Mean difference = -0.95 Study reported = -0.16 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High CES-D
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 11.54 Adjusted mean = 13.41 Mean difference = -1.89 Study reported = -0.20 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High POSIT Mental Health
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted mean = 3.23 Adjusted mean = 3.56 Mean difference = -0.33 Study reported = -0.13 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High POSIT Mental Health
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 3.05 Adjusted mean = 3.30 Mean difference = -0.25 Study reported = -0.09 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High POSIT Mental Health
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 2.77 Adjusted mean = 2.91 Mean difference = -0.14 Study reported = -0.04 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High POSIT Substance Abuse
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted mean = 0.56 Adjusted mean = 0.61 Mean difference = -0.05 Study reported = -0.03 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High POSIT Substance Abuse
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 0.39 Adjusted mean = 0.55 Mean difference = -0.16 Study reported = -0.08 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High POSIT Substance Abuse
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 0.13 Adjusted mean = 0.45 Mean difference = -0.32 Study reported = -0.13 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Alcohol - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted % = 17.92 Adjusted mean % = 17.81 OR = 0.80 HomVEE calculated = 0.00 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Alcohol - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted % = 16.88 Adjusted mean % = 20.02 OR = 0.71 HomVEE calculated = -0.13 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Alcohol - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted % = 25.77 Adjusted mean % = 21.55 OR = 1.14 HomVEE calculated = 0.14 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Any alcohol or illegal drug - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted % = 32.91 Adjusted mean % = 29.11 OR = 1.04 HomVEE calculated = 0.11 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Any alcohol or illegal drug - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted % = 27.74 Adjusted mean % = 30.78 OR = 0.76 HomVEE calculated = -0.09 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Any alcohol or illegal drug - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted % = 38.93 Adjusted mean % = 34.64 OR = 1.07 HomVEE calculated = 0.11 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Any illegal drug - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted % = 22.89 Adjusted mean % = 21.92 OR = 0.93 HomVEE calculated = 0.03 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Any illegal drug - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted % = 21.34 Adjusted mean % = 21.90 OR = 0.83 HomVEE calculated = -0.02 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Marijuana - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 2 months 322 mothers Adjusted % = 20.63 Adjusted mean % = 21.02 OR = 0.87 HomVEE calculated = -0.01 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Marijuana - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted % = 12.39 Adjusted mean % = 18.83 OR = 0.57 HomVEE calculated = -0.30 Not statistically significant, p ≥ 0.05

footnote162

Submitted by user on

Negative value is favorable to the intervention.

High Marijuana - past 30 days, use of
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted % = 18.91 Adjusted mean % = 19.65 OR = 0.83 HomVEE calculated = -0.03 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High HOME inventory - 12 months
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 25.92 Adjusted mean = 25.41 Mean difference = 0.51 Study reported = 0.08 Not statistically significant, p ≥ 0.05
High HOME inventory - 6 months
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 22.79 Adjusted mean = 22.75 Mean difference = 0.04 Study reported = 0.01 Not statistically significant, p ≥ 0.05
High PLOC Parental self-efficacy - 12 months
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 23.21 Adjusted mean = 24.71 Mean difference = -1.51 Study reported = -0.23 Statistically significant,
p = 0.01

footnote162

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Negative value is favorable to the intervention.

High PLOC Parental self-efficacy - 6 months
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 6 months 322 mothers Adjusted mean = 22.98 Adjusted mean = 23.83 Mean difference = -0.85 Study reported = -0.13 Not statistically significant, p ≥ 0.05

footnote162

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Negative value is favorable to the intervention.

High Home safety attitudes
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 29.54 Adjusted mean = 28.61 Mean difference = 0.94 Study reported = 0.19 Statistically significant,
p = 0.03
High Home safety practices
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 1.56 Adjusted mean = 1.30 Mean difference = 0.26 Study reported = 0.16 Not statistically significant, p ≥ 0.05
High Parenting knowledge
FavorableUnfavorable or ambiguousNo Effect
Family Spirit RCT, 2006-2008 sample 12 months 322 mothers Adjusted mean = 15.43 Adjusted mean = 14.08 Mean difference = 1.35 Study reported = 0.33 Statistically significant,
p = 0.001