Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial

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

Research output: Contribution to journalArticle

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. 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 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 ofmarijuana (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 evidencebased home-visiting interventions in at-risk populations.

Original languageEnglish (US)
Pages (from-to)154-162
Number of pages9
JournalAmerican Journal of Psychiatry
Volume172
Issue number2
DOIs
StatePublished - Feb 1 2015

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North American Indians
Randomized Controlled Trials
Mothers
Parenting
Postpartum Period
Odds Ratio
Healthcare Disparities
Patient Protection and Affordable Care Act
Depression
Pregnancy
Internal-External Control
Randomized Controlled Trial
Effect Size
American Indians
Health
Pharmaceutical Preparations
Population

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Arts and Humanities (miscellaneous)
  • Medicine(all)

Cite this

Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children : 3-year outcomes from a randomized controlled trial. / Barlow, Mary Allison; Mullany, Britta; Neault, Nicole Neault; Goklish, Novalene; Billy, Trudy; Hastings, Ranelda; Lorenzo, Sherilynn; Kee, Crystal; Lake, Kristin; Redmond, Cleve; Carter, Alice; Walkup, John T.

In: American Journal of Psychiatry, Vol. 172, No. 2, 01.02.2015, p. 154-162.

Research output: Contribution to journalArticle

Barlow, Mary Allison ; Mullany, Britta ; Neault, Nicole Neault ; Goklish, Novalene ; Billy, Trudy ; Hastings, Ranelda ; Lorenzo, Sherilynn ; Kee, Crystal ; Lake, Kristin ; Redmond, Cleve ; Carter, Alice ; Walkup, John T. / Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children : 3-year outcomes from a randomized controlled trial. In: American Journal of Psychiatry. 2015 ; Vol. 172, No. 2. pp. 154-162.
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AU - Billy, Trudy

AU - Hastings, Ranelda

AU - Lorenzo, Sherilynn

AU - Kee, Crystal

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