• Allison Barlow, Britta Mullany, Nicole Neault, Novalene Goklish, Trudy Billy, Ranelda Hastings, Sherilynn Lorenzo, Crystal Kee, Kristin Lake, Cleve Redmond, Alice Carter, and John T Walkup.
• 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.
• Am J Psychiatry. 2015 Feb 1;172(2):154-62.

ObjectiveThe 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.MethodExpectant 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.ResultsAt 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.ConclusionsThe 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.

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