Program

Dec 02, 2015

OVERVIEW

Family Spirit is a home visiting program focused on pregnancy and early childhood. It provides parenting training and substance abuse prevention activities, to improve American Indian teen mothers’ parenting outcomes, and mothers’ and children’s emotional and behavioral functioning.  An experimental evaluation found that the program had statistically significant positive impacts on mothers’ parenting knowledge, parenting self-efficacy, home safety attitudes, and externalizing behaviors, compared with mothers in the control group.  For children whose mothers had substance use problems at baseline, the study found statistically significant positive impacts on externalizing problems and emotion dysregulation, compared with those in the control group.

DESCRIPTION OF PROGRAM

Target population: American Indian teen mothers

Family Spirit is paraprofessional-delivered home visiting program focused on pregnancy and early childhood. The program is intended to improve American Indian teen mothers’ parenting outcomes, and mothers’ and children’s emotional and behavioral functioning, through parenting training and substance abuse prevention.  The conceptual model behind Family Spirit suggests that parenting is the critical link between parents’ personal characteristics and environmental context, and children’s emotional and behavioral outcomes from early childhood through adolescence.  The program targets specific negative parenting behaviors (e.g., poor monitoring, abuse or neglect, coercive interactions, and harsh, unresponsive, or rejecting parenting) associated with infant and toddler externalizing, internalizing, and emotion dysregulation problems.  Family Spirit also teaches mothers skills related to coping, problem solving, and conflict resolution.  The program consists of 43 highly structured lessons, delivered by American Indian paraprofessionals, that target three domains: parenting skills across early childhood, maternal drug abuse prevention, and maternal life skills and positive psychosocial development.  Home visitors deliver lessons one-on-one in participants’ homes, and each session is designed to last no more than one hour.  Home visits occur weekly through the end of pregnancy, biweekly until four months postpartum, monthly between four and 12 months postpartum, and bimonthly between 12 and 36 months postpartum.  Home visitors received at least 80 hours of training.

 EVALUATION OF PROGRAM

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

 

Evaluated Population: Study participants consisted of 322 American Indian teens.  To be eligible for the program, mothers had be pregnant, at less than 33 weeks’ gestation, between 12-19 years of age at conception, American Indian, and residing in one of the four participating reservations.  The communities are rural and isolated.  At baseline, participants were predominantly first-time mothers (76.7 percent); 96.6 percent were unmarried, the average age was 18.1 years, 18.0 percent were planned pregnancies, and 24 percent spoke only their American Indian language..

 Approach: The sample consisted of 322 pregnant American Indian teens from four southwestern tribal reservation communities.  The teens were randomly assigned to receive the program, along with standard care (n=159), or to be in the control group, receiving standard care only (n=163). Standard care included transportation to recommended prenatal and well-baby clinic visits, pamphlets on child care and community resources, and referrals to local services as needed.  Data collected included parenting outcomes (parenting knowledge and self-efficacy; maternal acceptance, involvement, and responsivity; and home safety strategies), and mothers’ psychosocial and behavioral status (internalizing problems, externalizing problems, and substance use). Data were collected through self-report questionnaires, in-person interviews, and observational assessment.  At 12 months postpartum, children’s psychosocial and behavioral functioning was assessed.  Independent evaluators, blind to participants’ treatment or control status, administered the primary parenting and child outcome assessments.  Data were collected at baseline, and at two, six, and 12 months postpartum, using self-reports, interviews, and observational measures.

Of the 322 participants, 16 percent did not complete the parenting assessments, and 21 percent did not complete the child assessment at 12 months postpartum.  There were no statistically significant differences between the study groups at baseline.

Results: The study found that, at 12 months postpartum, the program had statistically significant positive impacts on mothers’ parenting knowledge, parenting self-efficacy), home safety attitudes, and externalizing behaviors, compared with those in the control group.  For children of mothers with substance use at baseline, the study found statistically significant positive impacts on their externalizing problems and emotion dysregulation, compared with those in the control group.

SOURCES FOR MORE INFORMATION

 References

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

KEYWORDS:  Infants (0-12 mos.), Toddlers (12-36 mos.), Males and Females (Co-ed), American Indian/Alaska Native, Rural and/or Small Towns, Home-based, Home Visitation, Parent Training/Education, Substance Use, Child Maltreatment, Parent-Child Relationship

Program information last updated on 12/2/2015.

 

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