Skip Navigation

Family Spirit


elderly man

For, by, and with Native communities. This is the story of Family Spirit.


The Johns Hopkins Center for American Indian Health was established in 1991 with a focus on addressing infectious diseases. Community based staff recognized a need for an intervention in the tribe’s youngest and most vulnerable families. In 1995, the first curriculum lessons were developed for mothers to address maternal and child health topics.

In 1998, the fathers’ project began. It included curriculum with information on life skills like employment and budgeting. After the fathers’ project launched, there were mothers that expressed a desire to learn the same information the fathers were getting. So, the two projects “married” and became the Family Strengthening Project. The name was later changed to Family Spirit.

Program Effectiveness

1st randomized controlled trial (2001-2002): Family Strengthening included curriculum from prenatal to the child’s 6 month birthday. The first round of evaluation was completed with this curriculum.

2nd randomized controlled trial (2002-2005): The Family Strengthening curriculum expanded to cover prenatal through the child’s 12 month birthday and it became Family Spirit, named by one of our home visitors. The second round of evaluation was completed through 1 year.

3rd randomized controlled trial (2006-2011): In 2005, the curriculum expanded once again to include materials through the child’s 3rd birthday. A rigorous randomized controlled trial began on the 3-year curriculum.

Research findings from these 3 randomized controlled trials show positive outcomes for mothers and children that predict healthier futures. These findings are summarized and available in the Proven Results section of the website.

Sharing Family Spirit

Since 2011, Family Spirit uses evidence from it's evaluation. The Family Spirit Program has been implemented in dozens of communities in the US and continues to expand. 



Our conceptual model provides a written and visual description of Family Spirit’s theoretical background and how we achieve desired outcomes.

G.R. Patterson’s model

G.R. Patterson's Model


The Family Spirit conceptual framework is based on G.R. Patterson’s model that posits parenting as the critical link between parents’ personal characteristics and environmental context and children’s individual risks and ultimate outcomes.[i] Thus, the Family Spirit Program is designed to promote mothers’ effective parenting  while assisting mothers in developing coping and problem-solving skills to overcome individual and environmental stressors.

Key components of the intervention include one-on-one home-based parent training to help mothers: 1) provide consistent, responsive care and monitoring and avoid coercive parenting; 2) avoid drug use, which could interfere with effective parenting; and 3) attain coping and life skills to overcome personal and environmental stressors. In addition, interventionists are trained to establish a strong, consistent interpersonal bond to facilitate mothers’ progress toward goals.

Conceptual framework

Conceptual Framework


The Family Spirit Program is designed to impact short, intermediate and long-term maternal and child behavioral and emotional outcomes. It hypothesizes that effective, competent parenting and coping and problem-solving skills are the pathway for reducing long-term maternal and child emotional and behavior problems.

This model is supported by a large body of research demonstrating that ineffective parenting practices in early childhood lead to: 1) child behavior problems, academic under-achievement, and peer problems in middle childhood and 2) maladaptive peer group formation, conduct problems, and drug use in adolescence.[ii] [iii] [iv] Parenting knowledge and parental self-efficacy in the earliest phases of parenting are short-term outcomes that become mediators of intermediate and long-term maternal and child behavior outcomes. 

2020 Hearst Health Prize Finalist

Family Spirit was a finalist for the 2020 Hearst Health Prize! Watch the video below to learn more.


[i] Patterson GR, DeBaryshe BD, Ramsey E. A developmental perspective on antisocial behavior. American Psychologist. 1989; 44:329-335.

[ii] Vanderheyden A, Witt JC. Proven practices for reducing aggressive and noncompliant behaviors exhibited by young children at home and at school. J La State Med Soc. 2000; 152:485-496.

[iii] Pettit GS, Laird RD, Dodge KA, Bates JE, Criss MM. Antecedents and behavior-problem outcomes of parental monitoring and psychological control in early adolescence. Child Dev. 2001; 72:583-598.

[iv] Frick PJ, O'Brien BS, Wootton JM, McBurnett K. Psychopathy and conduct problems in children. J Abnorm Psychol. 1994; 103:700-707.