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Prevention Science

, Volume 13, Issue 5, pp 504–518 | Cite as

The Family Spirit Trial for American Indian Teen Mothers and Their Children: CBPR Rationale, Design, Methods and Baseline Characteristics

  • Britta Mullany
  • Allison Barlow
  • Nicole Neault
  • Trudy Billy
  • Tanya Jones
  • Iralene Tortice
  • Sherilynn Lorenzo
  • Julia Powers
  • Kristin Lake
  • Raymond Reid
  • John Walkup
Article

Abstract

The purpose of this paper is to describe the rationale, design, methods and baseline results of the Family Spirit trial. The goal of the trial is to evaluate the impact of the paraprofessional-delivered “Family Spirit” home-visiting intervention to reduce health and behavioral risks for American Indian teen mothers and their children. A community based participatory research (CBPR) process shaped the design of the current randomized controlled trial of the Family Spirit intervention. Between 2006 and 2008, 322 pregnant teens were randomized to receive the Family Spirit intervention plus Optimized Standard Care, or Optimized Standard Care alone. The Family Spirit intervention is a 43-session home-visiting curriculum administered by American Indian paraprofessionals to teen mothers from 28 weeks gestation until the baby’s third birthday. A mixed methods assessment administered at nine intervals measures intervention impact on parental competence, mother’s and children’s social, emotional and behavioral risks for drug use, and maladaptive functioning. Participants are young (mean age = 18.1 years), predominantly primiparous, unmarried, and challenged by poverty, residential instability and low educational attainment. Lifetime and pregnancy drug use were ~2–4 times higher and ~5–6 times higher, respectively, than US All Races. Baseline characteristics were evenly distributed between groups, except for higher lifetime cigarette use and depressive symptoms among intervention mothers. If study aims are achieved, the public health field will have new evidence supporting multi-generational prevention of behavioral health disparities affecting young American Indian families and the utility of indigenous paraprofessional interventionists in under-resourced communities.

Keywords

American Indian Substance use Teen parenting Home-visiting Parenting interventions Randomized trial 

Notes

Acknowledgements

We respectfully acknowledge the mothers and children who participated in this study, and all study team members. We give thanks to tribal leaders and community stakeholders who generously contributed time and wisdom to shaping the research protocol. We are grateful to Indian Health Service for their long-standing collaboration in health promotion and for their review of the research. Financial support for this work was provided by National Institute on Drug Abuse (R01 DA019042). Disclaimer: The opinions expressed are those of the authors and do not necessarily reflect the views of the Indian Health Service.

References

  1. Abidin, R. R. (1995). Parenting Stress Index (3rd ed.). Odessa, FL: Psychological Assessment Resources, Inc.Google Scholar
  2. Achenbach, T. M. (2000). Achenbach system of empirically based assessments. Burlington: University of Vermont.Google Scholar
  3. Agency for Health Research and Quality. (2002). Community-based participatory research. Rockville, MD: Agency for Health Research and Quality.Google Scholar
  4. Aguilar, B., Sroufe, L. A., Egeland, B., & Carlson, E. (2000). Distinguishing the early-onset/persistent and adolescence-onset antisocial behavior types: From birth to 16 years. Development and Psychopathology, 12, 109–132.PubMedCrossRefGoogle Scholar
  5. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.CrossRefGoogle Scholar
  6. Barlow, A., & Walkup, J. T. (1998). Developing mental health services for native American children. Child and Adolescent Psychiatric Clinics of North America, 7, 555–577.PubMedGoogle Scholar
  7. Barlow, A., Varipatis-Baker, E., Speakman, K., Ginsburg, G., Friberg, I., Goklish, N., & Walkup, J. (2006). Home-visiting intervention to improve child care among American Indian adolescent mothers: A randomized trial. Archives of Pediatrics & Adolescent Medicine, 160, 1101–1107.CrossRefGoogle Scholar
  8. Bavolek, S.J., & Keene, R.G. (1999). Adult-adolescent parent inventory-2. Asheville, North Carolina: Family Development Resources, Inc.Google Scholar
  9. Beals, J., Novins, D. K., Whitesell, N. R., Spicer, P., Mitchell, C. M., & Manson, S. M. (2005). Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: Mental health disparities in a national context. The American Journal of Psychiatry, 162, 1723–1732.PubMedCrossRefGoogle Scholar
  10. Belsky, J., Bell, B., Bradley, R. H., Stallard, N., & Stewart-Brown, S. L. (2007). Socioeconomic risk, parenting during the preschool years and child health age 6 years. European Journal of Public Health, 17, 508–513.PubMedCrossRefGoogle Scholar
  11. Bricker, D., & Squires, J. (1999). Ages & stages questionnaires: A parent-completed, child-monitoring system, second edition. Asheville, North Carolina: Paul H. Brookes Publishing Co.Google Scholar
  12. Brook, J. S., Whiteman, M., Finch, S. J., & Cohen, P. (1996). Young adult drug use and delinquency: Childhood antecedents and adolescent mediators. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1584–1592.PubMedCrossRefGoogle Scholar
  13. Caldwell, B. M., & Bradley, R. H. (1979). HOME inventory administration manual. Little Rock: University of Arkansas for Medical Sciences and University of Arkansas at Little Rock.Google Scholar
  14. Campbell, S. B. (1995). Behavior problems in preschool children: A review of recent research. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 36, 113–149.PubMedCrossRefGoogle Scholar
  15. Campis, L. K., Lymann, R. D., & Prentice-Dunn, S. (1986). Parental locus of control scale: Development and validation. Journal of Clinical Child Psychology, 15, 260–267.CrossRefGoogle Scholar
  16. Carter, A. S., & Briggs-Gowan, M. J. (1999). Infant-toddler social and emotional assessment (ITSEA) manual. New Haven, CT: Yale University, Department of Psychology.Google Scholar
  17. Cufino Svitone, E., Garfield, R., Vasconcelos, M. I., & Araujo, C. V. (2000). Primary health care lessons from the northeast of Brazil: The agentes de saude program. Revista Panamericana de Salud Pública, 7, 293–302.PubMedCrossRefGoogle Scholar
  18. Daro, D. A., & Harding, K. A. (1999). Healthy Families America: Using research to enhance practice. The Future of Children, 9, 152–178.PubMedCrossRefGoogle Scholar
  19. Davis, S. M., & Reid, R. (1999). Practicing participatory research in American Indian communities. American Journal of Clinical Nutrition, 69, 755S–759S.PubMedGoogle Scholar
  20. Department of Health and Human Services (DHHS). (2008). Results from the 2007 National survey on drug use and health: National findings. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  21. Department of Health and Human Services (DHHS). (2009). Trends in Indian health, 2002–2003. Rockville: Public Health Service, Indian Health Service, US Government Printing Office.Google Scholar
  22. Eaton, D. K., Kann, L., Kinchen, S., Ross, J., Hawkins, J., Harris, W. A., & Wechsler, H. (2006). Youth risk behavior surveillance--United States, 2005. MMWR Surveillance Summaries, 55, 1–108.Google Scholar
  23. Emond, A., Pollock, J., Da, C. N., Maranhao, T., & Macedo, A. (2002). The effectiveness of community-based interventions to improve maternal and infant health in the northeast of Brazil. Revista Panamericana de Salud Pública, 12, 101–110.PubMedCrossRefGoogle Scholar
  24. Ertem, I. O., Forsyth, B. W., Avni-Singer, A. J., Damour, L. K., & Cicchetti, D. V. (1997). Development of a supplement to the HOME scale for children living in impoverished urban environments. Journal of Developmental and Behavioral Pediatrics: JDBP, 18, 322–328.PubMedCrossRefGoogle Scholar
  25. Franko, D. L., Striegel-Moore, R. H., Bean, J., Barton, B. A., Biro, F., Kraemer, H. C., & Daniels, S. R. (2005). Self-reported symptoms of depression in late adolescence to early adulthood: A comparison of African–American and Caucasian females. The Journal of Adolescent Health, 37, 526–529.PubMedCrossRefGoogle Scholar
  26. Frick, P. J., O’Brien, B. S., Wootton, J. M., & McBurnett, K. (1994). Psychopathy and conduct problems in children. Journal of Abnormal Psychology, 103, 700–707.PubMedCrossRefGoogle Scholar
  27. Gomby, D. S. (1999). Understanding evaluations of home visitation programs. The Future of Children, 9, 27–43.PubMedCrossRefGoogle Scholar
  28. Gomby, D. S., Culross, P. L., & Behrman, R. E. (1999). Home visiting: Recent program evaluation–analysis and recommendations. The Future of Children, 9, 4–26.PubMedCrossRefGoogle Scholar
  29. Grandbois, D. M., & Sanders, G. F. (2009). The resilience of native American elders. Issues in Mental Health Nursing, 30, 569–580.PubMedCrossRefGoogle Scholar
  30. Hoffman, S. (2006). By the numbers: The public costs of teen childbearing. Washington, DC: National Campaign to Prevent Teen Pregnancy.Google Scholar
  31. Huang, Z. J., Wong, F. Y., Ronzio, C. R., & Yu, S. M. (2007). Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers. Maternal and Child Health Journal, 11, 257–267.PubMedCrossRefGoogle Scholar
  32. Jack, S., DiCenso, A., & Lohfield, L. (2002). Opening doors: Factors influencing the establishment of a working relationship between paraprofessional home visitors and at-risk families. Canadian Journal of Nursing Research, 34, 59–69.PubMedGoogle Scholar
  33. Johnston, C., & Mash, E. J. (1989). A measure of parent satisfaction and efficacy. Journal Clinical Child Psychology, 18, 167–175.CrossRefGoogle Scholar
  34. Kegler, M. C., Stern, R., Whitecrow-Ollis, S., & Malcoe, L. H. (2003). Assessing lay health advisor activity in an intervention to prevent lead poisoning in native American children. Health Promotion Practice, 4, 189–196.PubMedCrossRefGoogle Scholar
  35. Knight, J. R., Goodman, E., Pulerwitz, T., & DuRant, R. H. (2001). Reliability of the problem oriented screening instrument for teenagers (POSIT) in adolescent medical practice. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 29, 125–130.CrossRefGoogle Scholar
  36. Lam, T. K., McPhee, S. J., Mock, J., Wong, C., Doan, H. T., Nguyen, T., & Luong, T. N. (2003). Encouraging Vietnamese–American women to obtain pap tests through lay health worker outreach and media education. Journal of General Internal Medicine, 18, 516–524.PubMedCrossRefGoogle Scholar
  37. Lindhout, I. E., Markus, M. T., Hoogendijk, T. H., & Boer, F. (2009). Temperament and parental child-rearing style: Unique contributions to clinical anxiety disorders in childhood. European Child & Adolescent Psychiatry, 18, 439–446.CrossRefGoogle Scholar
  38. Massachusetts Department of Health. (1986). Safe state, safe home. Boston: Massachusetts Department of Health.Google Scholar
  39. McGuigan, W. M., Katzev, A. R., & Pratt, C. C. (2003). Multi-level determinants of retention in a home-visiting child abuse prevention program. Child Abuse & Neglect, 27, 363–380.CrossRefGoogle Scholar
  40. Minkler, M., Blackwell, A. G., Thompson, M., & Tamir, H. (2003). Community-based participatory research: Implications for public health funding. American Journal of Public Health, 93, 1210–1213.PubMedCrossRefGoogle Scholar
  41. Montana Meth Project. (2008). Montana Meth: Use & Attitudes Survey 2008 - Statewide survey measuring attitudes & behaviors towards methamphetamine in Montana. New York: GfK Roper Public Affairs.Google Scholar
  42. Newman, B. M., Newman, P. R., Griffen, S., O’Connor, K., & Spas, J. (2007). The relationship of social support to depressive symptoms during the transition to high school. Adolescence, 42, 441–459.PubMedGoogle Scholar
  43. Novins, D. K., & Mitchell, C. M. (1998). Factors associated with marijuana use among American Indian adolescents. Addiction, 93, 1693–1702.PubMedCrossRefGoogle Scholar
  44. Olds, D. L. (2002). Prenatal and infancy home visiting by nurses: From randomized trials to community replication. Prevention Science, 3, 153–172.PubMedCrossRefGoogle Scholar
  45. Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., Jr., & Talmi, A. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110, 486–496.PubMedCrossRefGoogle Scholar
  46. Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., & Henderson, C. R., Jr. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114, 1560–1568.PubMedCrossRefGoogle Scholar
  47. Patterson, G. R., DeBaryshe, B. D., & Ramsey, E. (1989). A developmental perspective on antisocial behavior. American Psychologist, 44, 329–335.PubMedCrossRefGoogle Scholar
  48. Perper, K., Peterson, K., & Manlove, J. (2010). Diploma attainment among teen mothers. Washington, DC: Child Trends.Google Scholar
  49. Pettit, G. S., Laird, R. D., Dodge, K. A., Bates, J. E., & Criss, M. M. (2001). Antecedents and behavior-problem outcomes of parental monitoring and psychological control in early adolescence. Child Development, 72, 583–598.PubMedCrossRefGoogle Scholar
  50. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  51. Rahdert, E. (1991). Adolescent assessment/referral system manual, POSIT. Rockville, MD: US Department of Health and Human Services.Google Scholar
  52. Ramrakha, S., Bell, M. L., Paul, C., Dickson, N., Moffitt, T. E., & Caspi, A. (2007). Childhood behavior problems linked to sexual risk taking in young adulthood: A birth cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1272–1279.PubMedCrossRefGoogle Scholar
  53. Rushton, J. L., Forcier, M., & Schectman, R. M. (2002). Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 199–205.PubMedCrossRefGoogle Scholar
  54. Sartor, C. E., Lynskey, M. T., Heath, A. C., Jacob, T., & True, W. (2007). The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence. Addiction, 102, 216–225.PubMedCrossRefGoogle Scholar
  55. Shaw, D. S., Gilliom, M., Ingoldsby, E. M., & Nagin, D. S. (2003). Trajectories leading to school-age conduct problems. Developmental Psychology, 39, 189–200.PubMedCrossRefGoogle Scholar
  56. Shelov, S. P., Hannemann, R. E., Trubo, R., Agran, P. F., Altmann, T. R., & Baker, S. S. (2004). Caring for your baby and young child: Birth to age 5 (rev. ed.). New York: Bantam.Google Scholar
  57. Siebenbruner, J., Englund, M. M., Egeland, B., & Hudson, K. (2006). Developmental antecedents of late adolescence substance use patterns. Development and Psychopathology, 18, 551–571.PubMedCrossRefGoogle Scholar
  58. Simon, G. E., Goldberg, D. P., Von Korff, M., & Ustun, T. B. (2002). Understanding cross-national differences in depression prevalence. Psychological Medicine, 32, 585–594.PubMedCrossRefGoogle Scholar
  59. Singh, M. (1997). A harm reduction program for injecting drug users in Nepal. AIDS STD Health Promotion Exchange, 2, 3–6.Google Scholar
  60. StataCorp L.P. (2005). Stata statistical software. College Station, TX.Google Scholar
  61. Stier, D. M., Leventhal, J. M., Berg, A. T., Johnson, L., & Mezger, J. (1993). Are children born to young mothers at increased risk of maltreatment? Pediatrics, 91, 642–648.PubMedGoogle Scholar
  62. The National Campaign to Prevent Teen and Unplanned Pregnancy. (2008). American Indian/Alaska native youth and teen pregnancy prevention. Report No. 39. Washington D.C.Google Scholar
  63. Vanderheyden, A., & Witt, J. C. (2000). Proven practices for reducing aggressive and noncompliant behaviors exhibited by young children at home and at school. Journal of LA State Medical Society, 152, 485–496.Google Scholar
  64. Verhulst, F. C., Achenbach, T. M., van der Ende, J., Erol, N., Lambert, M. C., Leung, P. W., & Zubrick, S. R. (2003). Comparisons of problems reported by youths from seven countries. The American Journal of Psychiatry, 160, 1479–1485.PubMedCrossRefGoogle Scholar
  65. Walkup, J. T., Barlow, A., Mullany, B. C., Pan, W., Goklish, N., Hasting, R., & 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, 591–601.PubMedCrossRefGoogle Scholar
  66. Walt, G., Ross, D., Gilson, L., Owur-Omondi, L., & Knudsen, T. (1989). Community health workers in national programmes: The case of the family welfare educators in Botswana. Tropical Royal Society Tropical Medicine and Hygiene, 83, 49–55.CrossRefGoogle Scholar
  67. Waylen, A., Stallard, N., & Stewart-Brown, S. (2008). Parenting and health in mid-childhood: A longitudinal study. European Journal of Public Health, 18, 300–305.PubMedCrossRefGoogle Scholar
  68. Whitbeck, L. B., Yu, M., Johnson, K. D., Hoyt, D. R., & Walls, M. L. (2008). Diagnostic prevalence rates from early to mid-adolescence among indigenous adolescents: First results from a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 890–900.PubMedCrossRefGoogle Scholar
  69. Wong, M. M., Zucker, R. A., Puttler, L. I., & Fitzgerald, H. E. (1999). Heterogeneity of risk aggregation for alcohol problems between early and middle childhood: Nesting structure variations. Development and Psychopathology, 11, 727–744.PubMedCrossRefGoogle Scholar
  70. Zeitz, P. S., Harrison, L. H., Lopez, M., & Cornale, G. (1993). Community health worker competency in managing acute respiratory infections in childhood in Bolivia. Bulletin of the Pan American Health Organization, 27, 109–119.PubMedGoogle Scholar

Copyright information

© Society for Prevention Research 2012

Authors and Affiliations

  • Britta Mullany
    • 1
  • Allison Barlow
    • 1
  • Nicole Neault
    • 1
  • Trudy Billy
    • 1
  • Tanya Jones
    • 1
  • Iralene Tortice
    • 1
  • Sherilynn Lorenzo
    • 1
  • Julia Powers
    • 1
  • Kristin Lake
    • 1
  • Raymond Reid
    • 1
  • John Walkup
    • 1
  1. 1.Johns Hopkins Center for American Indian HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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