Family Spirit


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


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.

Goals and Objectives:


Key Activities

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