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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.

Model(s) Reviewed: Family Spirit®
Manuscript Screening Details
Screening Decision Screening Conclusion
Passes screens Eligible for review
Study Design Details
Rating Design Attrition Baseline Equivalence Reassignment Confounding Factors
Moderate Randomized controlled trial High Established on race/ethnicity and SES; outcomes not feasible to assess at baseline None None
Notes:

footnote214

Submitted by user on Fri, 03/15/2019 - 14:29

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.
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.
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 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.
Study Registration:
Clinicaltrials.gov Identifier: NCT00373750

Findings Details

Outcome Domain: 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 Outcome Type Notes
Moderate CBCL mean, Externalizing domain (0-48) (T-score)
FavorableUnfavorable or ambiguousNo Effect
Children with CBCL data 2006-2008 sample, 3 years postpartum 280 children Adjusted mean = 42.45 Adjusted mean = 42.59 Mean difference = -0.14 Study reported = 0.01 Not statistically significant,
p = 0.89
Primary

footnote162

Submitted by user on Fri, 03/15/2019 - 14:29

Negative value is favorable to the intervention.

Moderate CBCL mean, Internalizing domain (0-72) (T-score)
FavorableUnfavorable or ambiguousNo Effect
Children with CBCL data 2006-2008 sample, 3 years postpartum 280 children Adjusted mean = 44.23 Adjusted mean = 44.91 Mean difference = -0.68 Study reported = 0.06 Not statistically significant,
p = 0.57
Primary

footnote162

Submitted by user on Fri, 03/15/2019 - 14:29

Negative value is favorable to the intervention.

Moderate CBCL mean, Total Problems (0-200) (T-score)
FavorableUnfavorable or ambiguousNo Effect
Children with CBCL data 2006-2008 sample, 3 years postpartum 280 children Adjusted mean = 44.00 Adjusted mean = 44.79 Mean difference = -0.79 Study reported = 0.07 Not statistically significant,
p = 0.52
Primary

footnote162

Submitted by user on Fri, 03/15/2019 - 14:29

Negative value is favorable to the intervention.

Outcome Measure Summary

Outcome Domain: Child Development and School Readiness
Rating Outcome Measure Description of Measure Data Collection Method Properties of Measure Outcome Type Link to delete Content
Moderate

CBCL mean, Externalizing domain (0-48) (T-score)

Child Behavior Check List is a 99-item normed parent report of child behavior Maternal report

α = 0.91 for subscale

Primary
Moderate

CBCL mean, Internalizing domain (0-72) (T-score)

Child Behavior Check List is a 99-item normed parent report of child behavior Maternal report

α = 0.89 for subscale

Primary
Moderate

CBCL mean, Total Problems (0-200) (T-score)

Child Behavior Check List is a 99-item normed parent report of child behavior Maternal report

α = 0.94 for subscale

Primary