Family Spirit

Categories

Categories associated with best practice:

  • Health Equity
  • Individual
  • wtt_ico
  • Infancy (ages 0-2) icon
  • Teens (ages 13-18) icon
  • Young Adult (ages 19-24) icon
  • Culture
  • Education and literacy
  • English
  • Healthy child development
  • Home
  • Mental Health Icon 2
  • Personal health practices and coping skills

Determinants of Health: Language and culture, Personal health practices and coping skills, Education, literacy and life-long learning, Healthy child development

Overview

Family Spirit® is a culturally tailored home-visiting program developed by the Johns Hopkins Center for American Indian Health to promote optimal health and wellbeing of American Indian teenage mothers and their children. The program combines the use of paraprofessionals from the community as home visitors and a culturally focused, strengths-based curriculum as a core strategy to support young families. Parents gain knowledge and skills to promote healthy development and positive lifestyles for themselves and their children. The intervention is designed to increase parenting competence (e.g., parenting knowledge and self-efficacy), reduce maternal psychosocial and behavioral risks that could interfere with effective parenting (e.g., drug and alcohol use, depression, externalizing problems), and promote healthy infant and toddler emotional and social adjustment (i.e., internalizing and externalizing behaviors). It also aims to prepare toddlers for early school success, promote parents’ coping and life skills, and link families to appropriate community services.

The intervention consists of 63 structured lessons delivered one on one by Health Educators in participants’ homes, starting at about 28 weeks of gestation and continuing to 36 months postpartum. The lessons, designed to correspond to the changing developmental needs of the mother and child during this period, address topics such as prenatal care, infant care, child development, family planning, and healthy living. Each home visit lasts about an hour and includes a warm-up conversation, lesson content, question-and-answer period, and review of summary handouts. Health Educators, trained American Indian paraprofessionals, deliver the lessons using illustrated table-top flipcharts. The bond formed between the Health Educator and mother is intended to facilitate the mother’s progress toward goals.

The impacts of the Family Spirit® program have been evaluated in a longitudinal randomized controlled trial. Positive impacts were found on parenting knowledge, locus of control, depression symptoms, and externalizing behaviours. Positive impacts on children included decreased externalizing, internalizing and dysregulation behaviours.

Primary Source Document

B Mullany, A Barlow, N Neault, T Billy, T Jones et al. , The Family Spirit Trial for American Indian Teen Mothers and their Children: CBPR Rationale, Design, Methods and Baseline Characteristics. American Journal of Psychiatry. 2012: 13; 504-518

Contact information of developer(s) and/or implementer(s)

Allison Barlow, Ph.D., Principle Investigator and Family Spirit Program Director Email: abarlow@jhsph.edu

Intervention Focus

Intervention Goal / ObjectiveLevel(s) TargetedEquity Focus
Improved maternal social, emotional and behavioural outcomes (i.e. internalizing, externalizing and depression symptoms, drug use, safe sex practices, birth spacing, partner negotiation, educational/occupational goals).
  • Individual level
  • Interpersonal level
People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.
To improve parental competence outcomes (i.e., parenting knowledge, self-efficacy, home safety practices, acceptance, involvement, responsivity, monitoring and supervision, and parenting stress)
  • Individual level
  • Interpersonal level
People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.
To improve children’s social, emotional and behavioural outcomes (i.e., internalizing, externalizing and regulatory problems, injuries and ingestions, school achievement and drug use risks).
  • Individual level
  • Interpersonal level
People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.

Health Issue(s) that is/are addressed by the Intervention

Health Promotion

  • Mental Health
  • Other

Risk Reduction

  • Prevent/reduce illegal drug use/abuse
  • Prevent injury

Specific Activities of the Intervention

  • Information sessions offered about a risk factor or condition
  • Other

Priority/Target Population for Intervention Delivery

Life Stage

  • Prenatal
  • Infancy (birth to 2 years)
  • Youth (age 13-18 years)
  • Young adult (age 19-24 years)

Settings

Educational Settings

    • N/A

    Community Setting

    • Home
    • Other

    Outcomes

    Outcomes and Impact Chart
    Level of ImpactDescription of OutcomeEquity Focus
    Interpersonal LevelChildren in the intervention group had lower scores for externalizing problems (p =.005) and dysregulation (p<.001) from 12 to 36 months. Fewer children in the intervention group scored in the “of concern” range (#10th percentile) for externalizing problems (p=.03).Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
    Individual LevelMothers in the intervention group had lower use in the past month of marijuana (p=.007) and illicit drugs (p=.01)Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
    Individual LevelChildren in the intervention group had lower scores internalizing problems from 12 to 36 months (p=.004). Fewer children in the intervention group scored in the “of concern” range (#10th percentile) for internalizing problems (p=.04).Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
    Individual LevelThe mothers in the intervention group had significantly lower scores for depression (p.=.01)Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
    Individual LevelLe contenu de l’intervention à domicile était tiré de vastes consultations communautaires portant sur ce que les parents adolescents doivent apprendre. Les adaptations culturelles – y compris le style, les illustrations, la prestation et le contenu – ont été effectuées grâce à un processus de participation communautaire.Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.
    Individual LevelThe mothers in the intervention group had significantly more parental locus of control (p=.02).Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.

    Adaptability

    Implementation History

    • Multiple implementations - Similar settings/populations/providers - The intervention has been implemented more than twice in the same setting with the same population by similar providers, and is theoretically applicable to other settings and/or populations. This can include multiple implementations during the same time period. *Each implementation of the intervention must have been substantially the same and must have demonstrated positive results for the primary objectives of the intervention.

    Expertise Required for Implementation within the Context of the Intervention

    • Specialized skills training provided as part of the Intervention - The intervention does not require individuals or groups with highly specialized training, but requires that individuals or groups be trained as part of the implementation of the intervention.

    Are there supports available for implementation

    Yes.

    Family Spirit Connect is a series of services designed to make access to Family Spirit resources easy and efficient. Key features and benefits include: technical assistance from the Family Spirit Leadership Team for 3 years after completion of the Family Spirit Training; Quarterly Check-ins with an Affiliate Liaison who can assist with troubleshooting and answering questions during implementation of the Family Spirit Program; Family Spirit quarterly newsletter with updates about the program and other relevant news, publications, and information from the maternal and child health field; connection to other Family Spirit affiliates for knowledge sharing; and quarterly, topic-based webinars.

    Family Spirit training is held throughout the year on-site and quarterly at the central office in Albuquerque, New Mexico. Quarterly webinars are also offered to provide continuing education and skill building to enhance program delivery.

    Are there resources and/or products associated with the interventions

    Yes. The Family Spirit curriculum consists of 63 lessons to be taught between pregnancy and the child’s 3rd birthday. Each curriculum box includes an Implementation Guide, lesson modules, Health Educator Lesson Plans, a Reference Manual, and a sample Participant Workbook for the participating families. Evaluation materials and participant certificates are also included on a CD in the curriculum box.