Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers
Open accessAbstract
Objective To evaluate the efficacy of a paraprofessional-delivered, home-visiting intervention among young, reservation-based American Indian (AI) mothers on parenting knowledge, involvement, and maternal and infant outcomes.Method From 2002 to 2004, expectant AI women aged 12 to 22 years (n = 167) were randomized (1:1) to one of two paraprofessional-delivered, home-visiting interventions: the 25-visit "Family Spirit" intervention addressing prenatal and newborn care and maternal life skills (treatment) or a 23-visit breast-feeding/nutrition education intervention (active control). The interventions began during pregnancy and continued to 6 months postpartum. Mothers and children were evaluated at baseline and 2, 6, and 12 months postpartum. Primary outcomes included changes in mothers' parenting knowledge and involvement. Secondary outcomes included infants' social and emotional behavior; the home environment; and mothers' stress, social support, depression, and substance use.Results Participants were mostly teenaged, first-time, unmarried mothers living in reservation communities. At 6 and 12 months postpartum, treatment mothers compared with control mothers had greater parenting knowledge gains, 13.5 (p < .0001) and 13.9 (p < .0001) points higher, respectively (100-point scale). At 12 months postpartum, treatment mothers reported their infants to have significantly lower scores on the externalizing domain (beta = -.17, p < .05) and less separation distress in the internalizing domain (beta = -.17, p < .05). No between-group differences were found for maternal involvement, home environment, or mothers' stress, social support, depression, or substance use.Conclusions This study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes. A longer, larger study is needed to replicate results and evaluate the durability of child behavior outcomes.
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Only 7 parenting interventions in this review (7%) engaged fathers to some degree.
“In spite of the observational evidence that fathers are critically important for ECD [56], only 7 parenting interventions in this review (7%) engaged fathers to some degree [34–40], and only 1 study measured paternal outcomes from fathers directly (who only comprised 5% of the respondents in this study) [39].”
From Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis (2021) · cites this paper as [34]
The Method (Study Design and Treatment and Control Conditions; page unavailable) identifies this as a parenting home-visiting intervention for young mothers. It does not say that fathers participated in the intervention. The paper also cannot establish the citing review’s count of seven interventions (7%). (LLM, conf=0.78)
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- Authors
- Walkup, J. T., Barlow, A., Mullany, B. C., Pan, W., Goklish, N., Hasting, R., Cowboy, B., Fields, P., Baker, E. V., Speakman, K., Ginsburg, G., & Reid, R.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Walkup, John T.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-06
- Volume
- 48
- Issue
- 6
- Pages
- 591-601
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6432645
- OpenAlex
- W1986989409
- Cited by
- 114
- References
- 41
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 9 · 2023: 3 · 2022: 8 · 2021: 7 · 2020: 9 · 2019: 6 · 2018: 4 · 2017: 7 · 2016: 7 · 2015: 4 · 2014: 5 · 2013: 5 · 2012: 11
- FWCI
- 10.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA019042)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K01HD055415)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Health › Indigenous Health, Education, and Rights
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- home visiting intervention, reservation communities, adolescent pregnancy, parenting knowledge, externalizing problems, separation distress, maternal depression, maternal substance use, social support
- MeSH terms
- Adolescent, Breast Feeding, Child, Community Health Nursing, Education, Emotions, Female, Follow-Up Studies, Humans, Indians, North American, Infant, Infant Care, Infant Nutrition Disorders, Infant, Newborn, Internal-External Control, Male, Mother-Child Relations, Pregnancy, Pregnancy in Adolescence, Prenatal Care, Social Behavior, Social Environment, Social Support, United States, Infant Behavior, Depression, Postpartum, Substance-Related Disorders, Cultural Competency, Young Adult
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