In partnership with the Navajo, White Mountain Apache, and San Carlos Tribes, the Johns Hopkins Center for American Indian Health has conducted three successive randomized controlled trials (RCTs) to assess the Family Spirit Program’s impact on parenting and maternal and child health and behavior outcomes. Each trial validated and extended prior findings.
The first RCT enrolled 53 expectant American Indian teen mothers and their offspring from pregnancy to 6 months postpartum. Mothers in the intervention group had significantly higher parent knowledge scores at 2 and 6 months postpartum as compared to their controls. They also scored significantly higher on maternal involvement scales at 2 months postpartum, and scores approached significance at 6 months postpartum.
The second RCT of the Family Spirit intervention enrolled 167 American Indian teen mothers and their offspring from early pregnancy to 12 months postpartum. At 6 and 12 months postpartum, intervention mothers compared with control mothers had greater parenting knowledge gains. At 12 months postpartum, intervention mothers reported that their children had significantly lower scores in the externalizing domain and less separation distress in the internalizing domain.
The third and most rigorous RCT enrolled 322 expectant American Indian teens from four southwestern tribal communities who were randomized (1:1) to the Family Spirit intervention plus Optimized Standard Care, or Optimized Standard Care alone, and evaluated at nine intervals through 3 years postpartum using self-reports, interviews and observational measures. Participants were young (mean=18.1 years), American Indian and <32 weeks gestation at the time of enrollment. Retention was >83% across the study period. From pregnancy to 36 months postpartum, intervention mothers had significantly greater parenting knowledge and parenting locus of control; fewer depressive symptoms and externalizing problems; lower past month marijuana and illegal drug use. Intervention children had fewer externalizing, internalizing, and dysregulation problems.
SUMMARY OF FAMILY SPIRIT IMPACT: PREGNANCY TO 3 YEARS POSTPARTUM
- Increased maternal knowledge   
- Increased parent self-efficacy 
- Reduced parent stress 
- Improved home safety attitudes
- Decreased maternal depression  
- Decreased substance use
- Fewer behavior problems in mothers 
- Fewer behavior problems in children to age 3 (externalizing, internalizing, and dysregulation)  
- Predicts lower risk of substance use and behavior health problems over life course
 Barlow A, Varipatis-Baker E, Speakman K, et al. Home-visiting intervention to improve child care among American Indian adolescent mothers: A randomized trial. Arch Pediatr Adolesc Med. 2006; 160(11):1101-1107.
 Walkup JT, Barlow A, Mullany BC, et al. Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers. J Am Acad Child Adolesc Psychiatry. 2009; 48(6):591-601.
 Barlow A, Mullany B, Neault N, et al. Effect of a Paraprofessional Home-Visiting Intervention on American Indian Teen Mothers’ and Infants’ Behavioral Risks: A Randomized Controlled Trial. American Journal of Psychiatry. 2013; 170:83–93.
 Barlow A, Mullany B, Neault N, et al. Paraprofessional Delivered, Home-Visiting Intervention for American Indian Teen Mothers and Children: Three-Year Outcomes from a Randomized Controlled Trial. American Journal of Psychiatry. 2015; 172(2):154-162.