Paraprofessional-Delivered Home-Visiting Intervention for American Indian Teen Mothers and Children: 3-Year Outcomes From a Randomized Controlled Trial
Abstract
Objective The Affordable Care Act provides funding for home-visiting programs to reduce health care disparities, despite limited evidence that existing programs can overcome implementation and evaluation challenges with at-risk populations. The authors report 36-month outcomes of the paraprofessional-delivered Family Spirit home-visiting intervention for American Indian teen mothers and children. Method Expectant American Indian teens (N=322, mean age=18.1 years) from four southwestern reservation communities were randomly assigned to the Family Spirit intervention plus optimized standard care or optimized standard care alone. Maternal and child outcomes were evaluated at 28 and 36 weeks gestation and 2, 6, 12, 18, 24, 30, and 36 months postpartum. Results At baseline the mothers had high rates of substance use (>84%), depressive symptoms (>32%), dropping out of school (>57%), and residential instability (51%). Study retention was ≥83%. From pregnancy to 36 months postpartum, mothers in the intervention group had significantly greater parenting knowledge (effect size=0.42) and parental locus of control (effect size=0.17), fewer depressive symptoms (effect size=0.16) and externalizing problems (effect size=0.14), and lower past month use of marijuana (odds ratio=0.65) and illegal drugs (odds ratio=0.67). Children in the intervention group had fewer externalizing (effect size=0.23), internalizing (effect size=0.23), and dysregulation (effect size=0.27) problems. Conclusions The…
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There is literature to support the potential efficacy of home visiting programs for pregnant and parenting individuals misusing substances.
“There is also literature to support the potential efficacy of home visiting programs for pregnant and parenting individuals misusing substances (Barlow et al., 2015; Dauber et al., 2019)”
From Home‐based family recovery supports: Feasibility, acceptability, and adoption of training home visitors in “Mothering from the Inside Out” (2025) · cites this paper as Barlow et al., 2015
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References 40 · Cited by 138
- Authors
- Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., Lorenzo, S., Kee, C., Lake, K., Redmond, C., Carter, A., & Walkup, J. T.
- Affiliations
- Johns Hopkins University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2015-02-01
- Volume
- 172
- Issue
- 2
- Pages
- 154-162
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2142173614
- Cited by
- 138
- References
- 40
- Citations by year
- 2026: 16 · 2025: 10 · 2024: 8 · 2023: 12 · 2022: 10 · 2021: 18 · 2020: 13 · 2019: 13 · 2018: 12 · 2017: 9 · 2016: 9 · 2015: 8
- FWCI
- 8.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (R01DA019042)
- 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 › Adolescent Sexual and Reproductive Health
- Keywords
- home visiting intervention, family spirit, prenatal substance use, maternal depression, parenting knowledge, child externalizing problems, child internalizing problems, cannabis use, parental locus of control, health care disparities, reservation communities, vulnerable populations
- MeSH terms
- Adolescent, Child, Child Development, Child, Preschool, Depression, Education, Nonprofessional, Female, House Calls, Humans, Indians, North American, Infant, Male, Maternal Behavior, Mother-Child Relations, Pregnancy, Pregnancy in Adolescence, United States, Program Evaluation, Parenting, Substance-Related Disorders, Healthcare Disparities, Social Validity, Research
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