• Allison Barlow, Elena Varipatis-Baker, Kristen Speakman, Golda Ginsburg, Ingrid Friberg, Novalene Goklish, Brandii Cowboy, Pauline Fields, Ranelda Hastings, William Pan, Raymond Reid, Mathuram Santosham, and John Walkup.
• Johns Hopkins Center for American Indian Health, 621 N. Washington Street, Baltimore, MD 21205, USA. abarlow@jhsph.edu
• Arch Pediat Adol Med. 2006 Nov 1;160(11):1101-7.

ObjectiveTo assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge, skills, and involvement among pregnant American Indian adolescents.DesignRandomized controlled trial comparing a family-strengthening intervention with a breastfeeding education program.SettingOne Apache and 3 Navajo communities.ParticipantsFifty-three pregnant American Indian adolescents were randomly assigned to intervention (n = 28) or control (n = 25) groups. Follow-up data were available for 19 intervention and 22 control participants. Intervention Paraprofessionals delivered 41 prenatal and infant care lessons in participants' homes from 28 weeks' gestation to 6 months post partum.Main Outcome MeasuresChild care knowledge, skills, and involvement.ResultsMothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months (adjusted mean difference [AMD], +14.9 [95% confidence interval (CI), +7.5 to +22.4]) and 6 months post partum (AMD, +15.3 [95% CI, +5.9 to +24.7]). Intervention group mothers scored significantly higher on maternal involvement scales at 2 months post partum (AMD, +1.5 [95% CI, -0.02 to +3.02]), and scores approached significance at 6 months post partum (AMD, +1.1 [95% CI, -0.06 to +2.2]). No between-group differences were found for child care skills.ConclusionsA paraprofessional-delivered, family-strengthening home-visiting program significantly increased mothers' child care knowledge and involvement. A longer and larger trial is needed to understand the intervention's potential to improve adolescent parenting and related child outcomes in American Indian communities.

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