Abstract
The purpose of this paper is to describe the rationale, design, methods and baseline results of the Family Spirit trial. The
goal of the trial is to evaluate the impact of the paraprofessional-delivered “Family Spirit” home-visiting intervention to
reduce health and behavioral risks for American Indian teen mothers and their children. A community based participatory research
(CBPR) process shaped the design of the current randomized controlled trial of the Family Spirit intervention. Between 2006
and 2008, 322 pregnant teens were randomized to receive the Family Spirit intervention plus Optimized Standard Care, or Optimized
Standard Care alone. The Family Spirit intervention is a 43-session home-visiting curriculum administered by American Indian
paraprofessionals to teen mothers from 28 weeks gestation until the baby’s third birthday. A mixed methods assessment administered
at nine intervals measures intervention impact on parental competence, mother’s and children’s social, emotional and behavioral
risks for drug use, and maladaptive functioning. Participants are young (mean age = 18.1 years), predominantly primiparous,
unmarried, and challenged by poverty, residential instability and low educational attainment. Lifetime and pregnancy drug
use were ~2–4 times higher and ~5–6 times higher, respectively, than US All Races. Baseline characteristics were evenly distributed
between groups, except for higher lifetime cigarette use and depressive symptoms among intervention mothers. If study aims
are achieved, the public health field will have new evidence supporting multi-generational prevention of behavioral health
disparities affecting young American Indian families and the utility of indigenous paraprofessional interventionists in under-resourced
communities.
goal of the trial is to evaluate the impact of the paraprofessional-delivered “Family Spirit” home-visiting intervention to
reduce health and behavioral risks for American Indian teen mothers and their children. A community based participatory research
(CBPR) process shaped the design of the current randomized controlled trial of the Family Spirit intervention. Between 2006
and 2008, 322 pregnant teens were randomized to receive the Family Spirit intervention plus Optimized Standard Care, or Optimized
Standard Care alone. The Family Spirit intervention is a 43-session home-visiting curriculum administered by American Indian
paraprofessionals to teen mothers from 28 weeks gestation until the baby’s third birthday. A mixed methods assessment administered
at nine intervals measures intervention impact on parental competence, mother’s and children’s social, emotional and behavioral
risks for drug use, and maladaptive functioning. Participants are young (mean age = 18.1 years), predominantly primiparous,
unmarried, and challenged by poverty, residential instability and low educational attainment. Lifetime and pregnancy drug
use were ~2–4 times higher and ~5–6 times higher, respectively, than US All Races. Baseline characteristics were evenly distributed
between groups, except for higher lifetime cigarette use and depressive symptoms among intervention mothers. If study aims
are achieved, the public health field will have new evidence supporting multi-generational prevention of behavioral health
disparities affecting young American Indian families and the utility of indigenous paraprofessional interventionists in under-resourced
communities.
- Content Type Journal Article
- Pages 1-15
- DOI 10.1007/s11121-012-0277-2
- Authors
- Britta Mullany, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Allison Barlow, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Nicole Neault, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Trudy Billy, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Tanya Jones, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Iralene Tortice, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Sherilynn Lorenzo, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Julia Powers, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Kristin Lake, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Raymond Reid, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- John Walkup, Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 621 North Washington Street, Baltimore, MD 21205, USA
- Journal Prevention Science
- Online ISSN 1573-6695
- Print ISSN 1389-4986