Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers.
OBJECTIVE
To evaluate the efficacy of a paraprofessional-delivered, home-visiting intervention among young, reservation-based American Indian (AI) mothers on parenting knowledge, involvement, and maternal and infant outcomes.


METHODS
From 2002 to 2004, expectant AI women aged 12 to 22 years (n = 167) were randomized (1:1) to one of two paraprofessional-delivered, home-visiting interventions: the 25-visit "Family Spirit" intervention addressing prenatal and newborn care and maternal life skills (treatment) or a 23-visit breast-feeding/nutrition education intervention (active control). The interventions began during pregnancy and continued to 6 months postpartum. Mothers and children were evaluated at baseline and 2, 6, and 12 months postpartum. Primary outcomes included changes in mothers' parenting knowledge and involvement. Secondary outcomes included infants' social and emotional behavior; the home environment; and mothers' stress, social support, depression, and substance use.


RESULTS
Participants were mostly teenaged, first-time, unmarried mothers living in reservation communities. At 6 and 12 months postpartum, treatment mothers compared with control mothers had greater parenting knowledge gains, 13.5 (p < .0001) and 13.9 (p < .0001) points higher, respectively (100-point scale). At 12 months postpartum, treatment mothers reported their infants to have significantly lower scores on the externalizing domain (beta = -.17, p < .05) and less separation distress in the internalizing domain (beta = -.17, p < .05). No between-group differences were found for maternal involvement, home environment, or mothers' stress, social support, depression, or substance use.


CONCLUSIONS
This study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes. A longer, larger study is needed to replicate results and evaluate the durability of child behavior outcomes.
Walkup
John T
JT
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health. Electronic address: jwalkup@jhmi.edu.
Barlow
Allison
A
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Mullany
Britta C
BC
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Pan
William
W
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Goklish
Novalene
N
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Hasting
Ranelda
R
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Cowboy
Brandii
B
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Fields
Pauline
P
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Baker
Elena Varipatis
EV
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Speakman
Kristen
K
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Ginsburg
Golda
G
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
Reid
Raymond
R
Drs. Walkup and Ginsburg are affiliated with Johns Hopkins University School of Medicine. The remaining authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and the Hopkins Center for American Indian Health.
D000293:Adolescent; D001942:Breast Feeding / Q000523:psychology; D002648:Child; D003152:Community Health Nursing; D054521:Cultural Competency; D019052:Depression, Postpartum / Q000517:prevention & control / Q000523:psychology; D004493:Education; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007198:Indians, North American / Q000193:education / Q000523:psychology*; D007223:Infant; D018730:Infant Behavior / Q000523:psychology; D007224:Infant Care / Q000523:psychology; D007228:Infant Nutrition Disorders / Q000517:prevention & control / Q000523:psychology; D007231:Infant, Newborn; D007389:Internal-External Control; D008297:Male; D009034:Mother-Child Relations; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology*; D011295:Prenatal Care; D012919:Social Behavior; D012931:Social Environment; D012944:Social Support; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000523:psychology; D014481:United States; D055815:Young Adult