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Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., ... Walkup, J. T. (2015). Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-Year outcomes from a randomized controlled trial. American Journal of Psychiatry, 172(2), 154-162.

Model(s) Reviewed: Family Spirit®
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, SES, and outcome measures assessable at baseline None None Not assessed in manuscripts reviewed before 2021
Notes:

footnote220

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Child outcomes (Infant-Toddler Social Emotional Assessment) rated moderate for this study, because of high attrition. Through communication with the first author, we established that the mothers of children in the child outcomes sample were equivalent at baseline on race/ethnicity and <abbr title="socioeconomic status">SES</abbr>; the child outcomes themselves were not assessable at baseline because the sample enrolled prenatally.

Study characteristics
Study participants Between 2006 and 2008, expectant women who were at less than or equal to 32 weeks gestation, aged 12-19 at conception, self-identified as American-Indian, and residing in one of the four participating reservation communities, were recruited into the study. Eligible participants were randomized by site, age, and history of previous live births. The sample sizes for the maternal parenting and health outcomes were as follows: analytic sample: 322 (159 T and 163 C)baseline sample: 322 (159 T and 163 C). Note: the study does not use a consistent analytic sample across different outcomes. The sample sizes shown here are relevant for maternal outcomes only. Sample sizes for child outcomes differ.
Setting Four southwestern reservation communities
Intervention services The Family Spirit intervention consisted of 43 lessons delivered by Native American para-professionals from within participating communities. The lessons focused on parenting skills and maternal behavioral and psychosocial risks. The lessons were conducted in each participant's home and the visits lasted approximately one hour each. The visits occurred weekly through pregnancy, biweekly until 4 months postpartum, monthly between 4-12 months postpartum, and bimonthly between 12-36 months postpartum.
Comparison conditions Optimized Standard Care consisted of transportation to recommended prenatal and well-baby clinic visits, pamphlets about childcare and community resources, and referrals to local 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).
Subgroups are not listed for manuscripts reviewed before 2021.
Funding sources Supported by National Institute on Drug Abuse grant R01 DA-019042 (principal investigator, J. Walkup).
Author affiliation The corresponding author is one of the program developers.
Peer reviewed Peer reviewed status is not listed for manuscripts reviewed before 2021.
Study Registration:
Clinicaltrials.gov Identifier: NCT00373750. Study registration was assessed by HomVEE beginning with the 2014 review.

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
Moderate ITSEA Competence domain (proportion clinically at risk (>10%))
FavorableUnfavorable or ambiguousNo Effect
Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Unadjusted mean = 0.24 Unadjusted mean = 0.23 Mean difference = 0.01 HomVEE calculated = 0.03 Not statistically significant, p = 0.78
Moderate ITSEA Dysregulation domain (proportion clinically at risk (>10%))
FavorableUnfavorable or ambiguousNo Effect
Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Unadjusted mean = 0.10 Unadjusted mean = 0.15 Mean difference = -0.04 HomVEE calculated = -0.23 Not statistically significant, p = 0.08

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Negative value is favorable to the intervention.

Moderate ITSEA Externalizing domain (proportion clinically at risk (>10%))
FavorableUnfavorable or ambiguousNo Effect
Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Unadjusted mean = 0.17 Unadjusted mean = 0.24 Mean difference = -0.07 HomVEE calculated = -0.24 Statistically significant, p = 0.03

footnote162

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Negative value is favorable to the intervention.

Moderate ITSEA Internalizing domain (proportion clinically at risk (>10%))
FavorableUnfavorable or ambiguousNo Effect
Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Unadjusted mean = 0.10 Unadjusted mean = 0.15 Mean difference = -0.05 HomVEE calculated = -0.27 Statistically significant, p = 0.04

footnote162

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Negative value is favorable to the intervention.

Moderate ITSEA mean, Competence domain (range 0-2)
FavorableUnfavorable or ambiguousNo Effect
Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Adjusted mean = 1.28 Adjusted mean = 1.24 Mean difference = 0.04 Study reported = 0.14 Not statistically significant, p = 0.09
Moderate ITSEA mean, Dysregulation domain (range 0-2)
FavorableUnfavorable or ambiguousNo Effect
Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Adjusted mean = 0.48 Adjusted mean = 0.55 Mean difference = -0.07 Study reported = 0.27 Statistically significant, p < .001

footnote162

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Negative value is favorable to the intervention.

Moderate ITSEA mean, Externalizing domain (range 0-2)
FavorableUnfavorable or ambiguousNo Effect
Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Adjusted mean = 0.64 Adjusted mean = 0.71 Mean difference = -0.07 Study reported = 0.23 Statistically significant, p < .01

footnote162

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Negative value is favorable to the intervention.

Moderate ITSEA mean, Internalizing domain (range 0-2)
FavorableUnfavorable or ambiguousNo Effect
Children with ITSEA data 2006-2008 sample, 3 years postpartum 288 children Adjusted mean = 0.54 Adjusted mean = 0.60 Mean difference = -0.05 Study reported = 0.23 Statistically significant, p < .01

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 (T-score)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 41.35 Adjusted mean = 42.58 Mean difference = -1.23 Study reported = 0.14 Statistically significant, p = 0.05

footnote162

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Negative value is favorable to the intervention.

High ASEBA Internalizing (T-score)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 42.89 Adjusted mean = 43.72 Mean difference = -0.83 Study reported = 0.09 Not statistically significant, p = 0.22

footnote162

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Negative value is favorable to the intervention.

High ASEBA Total Problems (T-score)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 40.51 Adjusted mean = 41.36 Mean difference = -0.86 Study reported = 0.10 Not statistically significant, p = 0.18

footnote162

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Negative value is favorable to the intervention.

High CES-D score (0-60)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 12.48 Adjusted mean = 13.65 Mean difference = -1.17 Study reported = 0.16 Statistically significant, p = 0.01

footnote162

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Negative value is favorable to the intervention.

High Alcohol use in past 30 days (proportion)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Unadjusted mean = 0.17 Unadjusted mean = 0.16 Mean difference = 0.01 HomVEE calculated = 0.04 Not statistically significant, p = 0.67

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Lower values favor the intervention

High Any illegal drug use in past 30 days (proportion)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Unadjusted mean = 0.12 Unadjusted mean = 0.17 Mean difference = -0.05 HomVEE calculated = -0.24 Statistically significant, p = 0.01

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Lower values favor the intervention

High Marijuana use in past 30 days (proportion)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Unadjusted mean = 0.11 Unadjusted mean = 0.16 Mean difference = -0.05 HomVEE calculated = -0.26 Statistically significant, p = 0.01

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Lower values favor the intervention

High Parenting stress index (range 0-180)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 75.53 Adjusted mean = 79.10 Mean difference = -3.57 Study reported = 0.18 Not statistically significant, p = 0.10

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 (range 0-37)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 31.73 Adjusted mean = 31.63 Mean difference = 0.10 Study reported = 0.02 Not statistically significant, p = 0.77
High Parenting knowledge (range 0-30)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 15.94 Adjusted mean = 14.66 Mean difference = 1.28 Study reported = 0.42 Statistically significant, p < .001
High Parenting locus of control (range 27-135)
FavorableUnfavorable or ambiguousNo Effect
Full 2006-2008 sample, 3 years postpartum 322 mothers Adjusted mean = 64.34 Adjusted mean = 66.03 Mean difference = -1.69 Study reported = 0.17 Statistically significant, p = 0.02

footnote162

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Negative value is favorable to the intervention.