Family Spirit®
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 Last Reviewed (Handbook Version 1.0): 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, download the Handbook of Standards and Procedures, Version 1.0
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
For More Information
Website: https://www.jhsph.edu/research/affiliated-programs/family-spirit/
Email: familyspirit@jhu.edu
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| 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
 and Implied Percentile Effect
|
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
and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
Months after treatment when outcome measured
|
|---|---|---|---|---|---|
| Child well-being: Behavioral and emotional functioning |
0.13
5 |
1 (4) | 322 |
Favorable:
1 No Effect: 3 Unfavorable: 0 |
- |
| Study 10928 - Family Spirit + Optimized Standard Care vs. Optimized Standard Care (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 |
- |
| Study 10928 - Family Spirit + Optimized Standard Care vs. Optimized Standard Care (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 |
| Study 10928 - Family Spirit + Optimized Standard Care vs. Optimized Standard Care (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 |
- |
| Study 10928 - Family Spirit + Optimized Standard Care vs. Optimized Standard Care (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 |
- |
| Study 10928 - Family Spirit + Optimized Standard Care vs. Optimized Standard Care (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 |
| Study 10928 - Family Spirit + Optimized Standard Care vs. Optimized Standard Care (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, Version 1.0, Section 5.10.4 and may not align with effect sizes reported in individual publications. The Prevention Services Clearinghouse uses information reported in study documents and, when necessary, information provided by authors in response to author queries to assign study ratings and calculate effect sizes and statistical significance (see Section 7.3.2 in the Handbook of Standards and Procedures, Version 1.0). As a result, the effect sizes and statistical significance reported in the table may not align with the estimates as they are reported in study documents.
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.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 10928 - Family Spirit + Optimized Standard Care vs. Optimized Standard Care | ||||||
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Arizona, USA | 2006 | Average age: 18.1 years; Age range: 12-19 years; 42% age 12-17 years, 58% age 18+ years | 100% American Indian | -- |
100% American Indians from four tribal reservation communities; 100% Pregnant teens; 32% with depressive symptoms (CES-D >16); 23% were parents prior to birth of current pregnancy |
7% Currently employed |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated High
Study 10928Barlow, 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://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=cmedm&AN=23409290&site=ehost-live&scope=site&authtype=sso&custid=s1139472
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
This study was conducted in a usual care or practice setting (Handbook Version 1.0, Section 6.2.2)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 (Handbook Version 1.0, Section 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 (Handbook Version 1.0, Section 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 (Handbook Version 1.0, Section 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 (Handbook Version 1.0, Section 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 (Handbook Version 1.0, Section 4.1.6).