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Published Online: 1 January 2013

Effect of a Paraprofessional Home-Visiting Intervention on American Indian Teen Mothers’ and Infants’ Behavioral Risks: A Randomized Controlled Trial

Allison Barlow, M.A., M.P.H., Britta Mullany, Ph.D., M.H.S., Nicole Neault, M.P.H., Scott Compton, Ph.D., Alice Carter, Ph.D., Ranelda Hastings, B.S., Trudy Billy, B.S., Valerie Coho-Mescal, Sherilynn Lorenzo, and John T. Walkup, M.D.Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 170, Number 1
https://doi.org/10.1176/appi.ajp.2012.12010121
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Abstract

Objective

The authors sought to examine the effectiveness of Family Spirit, a paraprofessional-delivered, home-visiting pregnancy and early childhood intervention, in improving American Indian teen mothers’ parenting outcomes and mothers’ and children’s emotional and behavioral functioning 12 months postpartum.

Method

Pregnant American Indian teens (N=322) from four southwestern tribal reservation communities were randomly assigned in equal numbers to the Family Spirit intervention plus optimized standard care or to optimized standard care alone. Parent and child emotional and behavioral outcome data were collected at baseline and at 2, 6, and 12 months postpartum using self-reports, interviews, and observational measures.

Results

At 12 months postpartum, mothers in the intervention group had significantly greater parenting knowledge, parenting self-efficacy, and home safety attitudes and fewer externalizing behaviors, and their children had fewer externalizing problems. In a subsample of mothers with any lifetime substance use at baseline (N=285; 88.5%), children in the intervention group had fewer externalizing and dysregulation problems than those in the standard care group, and fewer scored in the clinically “at risk” range (≥10th percentile) for externalizing and internalizing problems. No between-group differences were observed for outcomes measured by the Home Observation for Measurement of the Environment scale.

Conclusions

Outcomes 12 months postpartum suggest that the Family Spirit intervention improves parenting and infant outcomes that predict lower lifetime behavioral and drug use risk for participating teen mothers and children.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 170 • Number 1 • January 2013
Pages: 83 - 93
PubMed: 23409290

History

Received: 24 January 2012
Revision received: 7 June 2012
Revision received: 24 July 2012
Accepted: 30 July 2012
Published online: 1 January 2013
Published in print: January 2013

Authors

Details

Allison Barlow, M.A., M.P.H.
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Britta Mullany, Ph.D., M.H.S.
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Nicole Neault, M.P.H.
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Scott Compton, Ph.D.
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Alice Carter, Ph.D.
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Ranelda Hastings, B.S.
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Trudy Billy, B.S.
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Valerie Coho-Mescal
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Sherilynn Lorenzo
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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John T. Walkup, M.D.
From the Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Baltimore; the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.; the Department of Psychology, University of Massachusetts, Boston; and the Department of Psychiatry, Weill Cornell Medical College, New York.
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Notes

Address correspondence to Ms. Barlow ([email protected]).

Funding Information

Dr. Compton has served as a consultant for Shire Pharmaceuticals, as a principal investigator on a study for Shire Pharmaceuticals, and as an associate editor for the Journal of Consulting and Clinical Psychology and the Journal of Child and Adolescent Psychopharmacology. Dr. Carter receives royalties for the Infant-Toddler Social and Emotional Assessment. Dr. Walkup has served as a consultant for Shire Pharmaceuticals and has received research support from, served on the advisory board of, and received travel support and honoraria from the Tourette Syndrome Association; he has received free medication and placebo for NIH-funded studies from Eli Lilly and from Pfizer; and he receives royalties from Guilford Press and Oxford University Press. The other authors report no financial relationships with commercial interests.
Supplementary Material
Supported by grant R01 DA019042 from the National Institute on Drug Abuse and the Office of Behavioral and Social Sciences Research (principal investigator, John T. Walkup).

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