title: Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial.
abstract: OBJECTIVE
  The Affordable Care Act provides funding for home-visiting programs to reduce health care disparities, despite limited evidence that existing programs can overcome implementation and evaluation challenges with at-risk populations. The authors report 36-month outcomes of the paraprofessional-delivered Family Spirit home-visiting intervention for American Indian teen mothers and children.
  
  
  METHODS
  Expectant American Indian teens (N=322, mean age=18.1 years) from four southwestern reservation communities were randomly assigned to the Family Spirit intervention plus optimized standard care or optimized standard care alone. Maternal and child outcomes were evaluated at 28 and 36 weeks gestation and 2, 6, 12, 18, 24, 30, and 36 months postpartum.
  
  
  RESULTS
  At baseline the mothers had high rates of substance use (>84%), depressive symptoms (>32%), dropping out of school (>57%), and residential instability (51%). Study retention was ≥83%. From pregnancy to 36 months postpartum, mothers in the intervention group had significantly greater parenting knowledge (effect size=0.42) and parental locus of control (effect size=0.17), fewer depressive symptoms (effect size=0.16) and externalizing problems (effect size=0.14), and lower past month use of marijuana (odds ratio=0.65) and illegal drugs (odds ratio=0.67). Children in the intervention group had fewer externalizing (effect size=0.23), internalizing (effect size=0.23), and dysregulation (effect size=0.27) problems.
  
  
  CONCLUSIONS
  The paraprofessional home-visiting intervention promoted effective parenting, reduced maternal risks, and improved child developmental outcomes in the U.S. population subgroup with the fewest resources and highest behavioral health disparities. The methods and results can inform federal efforts to disseminate and sustain evidence-based home-visiting interventions in at-risk populations.
authors.affiliation: From the Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; the Partnerships in Prevention Science Institute, Iowa State University, Ames; the Department of Psychology, University of Massachusetts, Boston; and the Weill Cornell Medical College, New York.
authors.forename: Allison
authors.initials: A
authors.lastname: Barlow
authors.forename: Britta
authors.initials: B
authors.lastname: Mullany
authors.forename: Nicole
authors.initials: N
authors.lastname: Neault
authors.forename: Novalene
authors.initials: N
authors.lastname: Goklish
authors.forename: Trudy
authors.initials: T
authors.lastname: Billy
authors.forename: Ranelda
authors.initials: R
authors.lastname: Hastings
authors.forename: Sherilynn
authors.initials: S
authors.lastname: Lorenzo
authors.forename: Crystal
authors.initials: C
authors.lastname: Kee
authors.forename: Kristin
authors.initials: K
authors.lastname: Lake
authors.forename: Cleve
authors.initials: C
authors.lastname: Redmond
authors.forename: Alice
authors.initials: A
authors.lastname: Carter
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control*; D004505:Education, Nonprofessional / Q000379:methods*; D005260:Female; D054625:Healthcare Disparities; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American / Q000523:psychology; D007223:Infant; D008297:Male; D008425:Maternal Behavior / Q000208:ethnology*; D009034:Mother-Child Relations / Q000208:ethnology; D016487:Parenting / Q000208:ethnology / Q000523:psychology; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000523:psychology; D015397:Program Evaluation; D063586:Social Validity, Research; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D014481:United States / Q000453:epidemiology