Family Spirit®

In-home Parent Skill-Based Promising

Family Spirit® is a culturally-tailored home visiting program designed for young American Indian mothers (ages 14-24) who enroll during the second trimester of pregnancy. The goal of Family Spirit® is to address intergenerational behavioral health problems and promote positive behavioral and emotional outcomes among mothers and children. The program uses a culturally informed, strengths-based approach for helping mothers develop positive parenting practices, strengthen their coping skills, and learn how to avoid coercive parenting behaviors and substance abuse. Community health paraprofessional home visitors deliver program lessons to participating mothers through six modules: (1) Prenatal Care, (2) Infant Care, (3) Your Growing Child, (4) Toddler Care, (5) My Family and Me, and (6) Healthy Living. The program encourages other family members to participate in the lessons alongside mothers. Home visitors also provide case management and help families access services, as needed.


Family Spirit® is rated as a promising practice because at least one study achieved a rating of moderate or high on study design and execution and demonstrated a favorable effect on a target outcome.


Date Research Evidence Last Reviewed: May 2021


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, Home Visiting Evidence of Effectiveness, the program or service developer’s website, and the studies reviewed.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

Family Spirit® is designed to serve young American Indian mothers (ages 14-24) who enroll during the second trimester of pregnancy. Other family members can participate in the program lessons alongside mothers.

Dosage

Family Spirit® is designed to serve mothers for as long as possible, from 28 weeks gestation until 3 years postpartum. Home visitors teach 63 lessons during 52 home visits. Each visit is 45-90 minutes long. Visit frequency tapers over time. Specifically, mothers receive weekly visits from 28 weeks gestation to 3 months postpartum, biweekly visits between 3 months and 6 months postpartum, monthly visits between 7 months and 22 months postpartum, and bimonthly visits between 23 and 36 months postpartum.

Location/Delivery Setting
Recommended Locations/Delivery Settings

Family Spirit® is typically delivered in participants’ homes. Family Spirit® may also be delivered in other settings, such as community-based organizations, school and childcare locations, and hospitals.

Location/Delivery Settings Observed in the Research

  • Home

Education, Certifications and Training

Organizations delivering Family Spirit® must be certified and establish a formal contractual affiliation with the Family Spirit® program.

 

Certified affiliate organizations must employ supervisors to administer the program and support home visitors. Family Spirit® requires at least one supervisor for every 6-10 home visitors. Supervisors typically have a college degree or equivalent and relevant experience. Home visitors are typically community health paraprofessionals with a high school diploma or equivalent. Family Spirit® recommends that home visitors come from the communities they serve so they have knowledge of the local culture, practices, and language.

 

All home visitors and supervisors must attend pre-training meetings, pass Knowledge Assessments, and successfully complete the multi-day Family Spirit® core training with the Family Spirit® Leadership Team before using the curriculum.

Program or Service Documentation
Book/Manual/Available documentation used for review

The Family Spirit® Implementation Guide is implemented in conjunction with the Lesson Plans:

Family Spirit Program: Implementation guide. (2019). Johns Hopkins Center for American Indian Health.

Family Spirit Program: Lesson plans. (2019). Johns Hopkins Center for American Indian Health.

Available languages

Family Spirit® offers written materials in English. Home visitors are encouraged to converse with participants in their native languages during home visits.

Other supporting materials

Conceptual Model of Family Spirit®

Becoming A Family Spirit® Affiliate

Contact Information for Developers

Website: https://www.jhsph.edu/research/affiliated-programs/family-spirit/

Email: familyspirit@jhu.edu

Results of Search and Review Number of Studies Identified and Reviewed for Family Spirit®
Identified in Search 6
Eligible for Review 1
Rated High 1
Rated Moderate 0
Rated Low 0
Reviewed Only for Risk of Harm 0
Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings
Child well-being: Behavioral and emotional functioning 0.13
5
1 (4) 322 Favorable: 1
No Effect: 3
Unfavorable: 0
Adult well-being: Parent/caregiver mental or emotional health 0.11
4
1 (25) 322 Favorable: 4
No Effect: 21
Unfavorable: 0
Adult well-being: Parent/caregiver substance use 0.16
6
1 (10) 322 Favorable: 3
No Effect: 7
Unfavorable: 0
Adult well-being: Family functioning 0.03
1
1 (3) 322 Favorable: 0
No Effect: 3
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Months after treatment when outcome measured more info
Child well-being: Behavioral and emotional functioning 0.13
5
1 (4) 322 Favorable: 1
No Effect: 3
Unfavorable: 0
-
Barlow, 2013
Infant-Toddler Social and Emotional Assessment: Externalizing (Age 12 months) 0.19 *
7
- 322 - 0
Infant-Toddler Social and Emotional Assessment: Internalizing (Age 12 months) 0.10
3
- 322 - 0
Infant-Toddler Social and Emotional Assessment: Dysregulation (Age 12 months) 0.12
4
- 322 - 0
Infant-Toddler Social and Emotional Assessment: Competence (Age 12 months) 0.12
4
- 322 - 0
Adult well-being: Parent/caregiver mental or emotional health 0.11
4
1 (25) 322 Favorable: 4
No Effect: 21
Unfavorable: 0
-
Barlow, 2013
Center for Epidemiological Studies Depression Scale (Age 6 Months) 0.16
6
- 322 - 0
Center for Epidemiological Studies Depression Scale (Age 12 Months) 0.20
7
- 322 - 0
Achenbach System of Empirically Based Assessment: Externalizing (Maternal, Age 6 Months) 0.11
4
- 322 - 0
Achenbach System of Empirically Based Assessment: Externalizing (Maternal, Age 12 Months) 0.18 *
7
- 322 - 0
Achenbach System of Empirically Based Assessment: Internalizing (Maternal, Age 6 Months) 0.11
4
- 322 - 0
Achenbach System of Empirically Based Assessment: Internalizing (Maternal, Age 12 Months) 0.18
7
- 322 - 0
Achenbach System of Empirically Based Assessment: Total Problems (Maternal, Age 6 Months) 0.09
3
- 322 - 0
Achenbach System of Empirically Based Assessment: Total Problems (Maternal, Age 12 Months) 0.14
5
- 322 - 0
Problem Oriented Screening Instrument for Teenagers: Mental Health (Age 6 Months) -0.05
-1
- 322 - 0
Problem Oriented Screening Instrument for Teenagers: Mental Health (Age 12 Months) -0.10
-3
- 322 - 0
Barlow, 2015
Center for Epidemiological Studies Depression Scale (Age 18 Months) 0.33 *
12
- 272 - 0
Center for Epidemiological Studies Depression Scale (Age 24 Months) 0.26 *
10
- 261 - 0
Center for Epidemiological Studies Depression Scale (Age 36 Months) 0.25 *
9
- 268 - 0
Achenbach System of Empirically Based Assessment: Externalizing (Maternal, Age 18 Months) 0.06
2
- 264 - 0
Achenbach System of Empirically Based Assessment: Externalizing (Maternal, Age 24 Months) 0.10
3
- 220 - 0
Achenbach System of Empirically Based Assessment: Externalizing (Maternal, Age 30 Months) 0.16
6
- 261 - 0
Achenbach System of Empirically Based Assessment: Externalizing (Maternal, Age 36 Months) 0.17
6
- 256 - 0
Achenbach System of Empirically Based Assessment: Internalizing (Maternal, Age 18 Months) 0.01
0
- 264 - 0
Achenbach System of Empirically Based Assessment: Internalizing (Maternal, Age 24 Months) -0.07
-2
- 220 - 0
Achenbach System of Empirically Based Assessment: Internalizing (Maternal, Age 30 Months) 0.04
1
- 261 - 0
Achenbach System of Empirically Based Assessment: Internalizing (Maternal, Age 36 Months) 0.12
4
- 256 - 0
Achenbach System of Empirically Based Assessment: Total Problems (Maternal, Age 18 Months) 0.04
1
- 264 - 0
Achenbach System of Empirically Based Assessment: Total Problems (Maternal, Age 24 Months) -0.03
-1
- 220 - 0
Achenbach System of Empirically Based Assessment: Total Problems (Maternal, Age 30 Months) 0.08
3
- 261 - 0
Achenbach System of Empirically Based Assessment: Total Problems (Maternal, Age 36 Months) 0.13
5
- 256 - 0
Adult well-being: Parent/caregiver substance use 0.16
6
1 (10) 322 Favorable: 3
No Effect: 7
Unfavorable: 0
-
Barlow, 2013
Problem Oriented Screening Instrument for Teenagers: Substance Abuse (Age 6 Months) 0.09
3
- 322 - 0
Problem Oriented Screening Instrument for Teenagers: Substance Abuse (Age 12 Months) 0.14
5
- 322 - 0
Voices of Indian Teens: Any Alcohol Use in Past Month (Age 6 Months) 0.37 *
14
- 322 - 0
Voices of Indian Teens: Any Alcohol Use in Past Month (Age 12 Months) 0.08
3
- 322 - 0
Voices of Indian Teens: Any Marijuana Use in Past Month (Age 6 Months) 0.24 *
9
- 322 - 0
Voices of Indian Teens: Any Marijuana Use in Past Month (Age 12 Months) 0.01
0
- 322 - 0
Voices of Indian Teens: Any Illegal Drug Use in Past Month (Age 6 Months) 0.29 *
11
- 322 - 0
Voices of Indian Teens: Any Illegal Drug Use in Past Month (Age 12 Months) 0.08
3
- 322 - 0
Voices of Indian Teens: Any Alcohol or Illegal Drug Use in Past Month (Age 6 Months) 0.21
8
- 322 - 0
Voices of Indian Teens: Any Alcohol or Illegal Drug Use in Past Month (Age 12 Months) 0.09
3
- 322 - 0
Adult well-being: Family functioning 0.03
1
1 (3) 322 Favorable: 0
No Effect: 3
Unfavorable: 0
-
Barlow, 2013
Home Observation for Measurement of the Environment: Total Score (Age 6 months) 0.01
0
- 322 - 0
Home Observation for Measurement of the Environment: Total Score (Age 12 months) 0.08
3
- 322 - 0
Barlow, 2015
Home Observation for Measurement of the Environment: Total Score (Age 30 months) -0.01
0
- 225 - 0

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers.

Studies Rated High

Study 10928

Barlow, A., Mullany, B. C., Neault, N., Davis, Y., Billy, T., Hastings, R., Coho-Mescal, V., Lake, K., Powers, J., Clouse, E., Reid, R., & Walkup, J. T. (2010). Examining correlates of methamphetamine and other drug use in pregnant American Indian adolescents. American Indian and Alaska Native Mental Health Research, 17(1), 1-24. https://doi.org/10.5820/aian.1701.2010.1

Mullany, B., Barlow, A., Neault, N., Billy, T., Jones, T., Tortice, I., Lorenzo, S., Powers, J., Lake, K., Reid, R., & Walkup, J. (2012). The Family Spirit trial for American Indian teen mothers and their children: CBPR rationale, design, methods and baseline characteristics. Prevention Science, 13(5), 504-518. https://doi.org/10.1007/s11121-012-0277-2

Barlow, A., Mullany, B., Neault, N., Compton, S., Carter, A., Hastings, R., Billy, T., Coho-Mescal, V., Lorenzo, S., & Walkup, J. T. (2013). Effect of a paraprofessional home-visiting intervention on American Indian teen mothers' and infants' behavioral risks: A randomized controlled trial. The American Journal of Psychiatry, 170(1), 83-93. https://doi.org/10.1176/appi.ajp.2012.12010121

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. (2015). Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. The American Journal of Psychiatry, 172(2), 154-162. https://doi.org/10.1176/appi.ajp.2014.14030332

Haroz, E. E., Ingalls, A., Kee, C., Goklish, N., Neault, N., Begay, M., & Barlow, A. (2019). Informing precision home visiting: Identifying meaningful subgroups of families who benefit most from Family Spirit. Prevention Science: The Official Journal of the Society for Prevention Research, 20(8), 1244-1254. https://doi.org/10.1007/s11121-019-01039-9





Studies Not Eligible for Review

Study 10927

Barlow, A., Varipatis-Baker, E., Speakman, K., Ginsburg, G., Friberg, I., Goklish, N., Cowboy, B., Fields, P., Hastings, R., Pan, W., Reid, R., Santosham, M., & Walkup, J. (2006). Home-visiting intervention to improve child care among American Indian adolescent mothers: A randomized trial. Archives of Pediatrics & Adolescent Medicine, 160(11), 1101-1107. https://doi.org/10.1001/archpedi.160.11.1101

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10929

Karanja, N., Lutz, T., Ritenbaugh, C., Maupome, G., Jones, J., Becker, T., & Aickin, M. (2010). The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth: A feasibility and efficacy study. Journal of Community Health, 35(6), 667-675. https://doi.org/10.1007/s10900-010-9270-5

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10930

Mersky, J. P., & Janczewski, C. E. (2018). Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms. Maternal and Child Health Journal, 22(7), 1051-1058. https://doi.org/10.1007/s10995-018-2488-z

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10931

Novins, D. K., Ferron, C., Abramson, L., & Barlow, A. (2018). Addressing substance-use problems in tribal home visiting. Infant Mental Health Journal, 39(3), 287-294. https://doi.org/10.1002/imhj.21706

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10932

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. (2009). Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers. Journal of the American Academy of Child and Adolescent Psychiatry, 48(6), 591-601. https://doi.org/10.1097/CHI.0b013e3181a0ab86

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).