Paraprofessional-Delivered Home-Visiting Intervention for American Indian Teen Mothers and Children: 3-Year Outcomes From a Randomized Controlled Trial




Allison Barlow, Britta Mullany, Nicole Neault, Novalene Goklish, Trudy Billy, Ranelda Hastings, Sherrilynn Lorenzo, Crystal Kee, Kristin Lake, Cleve Redmond, Alice Carter, and John T. Walkup

Brief Type

Journal Publication


  • Family Spirit


Objective: The Affordable Care Act provides funding for home-visiting programs to reduce health care disparities, despite limited evidence that existing programs can over-come 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. Method: 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 sub-stance use (.84%), depressive symptoms (.32%), drop-ping 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. (author abstract)

Data Collection Methods

  • Standardized assessment tools
  • Surveys or questionnaires



For More Information

Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., ... & Carter, A. (2015). Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. American Journal of Psychiatry172(2), 154-162. doi: https://doi.org/10.1176/appi.ajp.2014.14030332
Author Contact Information:
Allison Barlow


  • Participant Characteristics
  • Participant, Family, and Program Outcomes