Randomized Controlled Trial of a Paraprofessional-Delivered In-Home Intervention for Young Reservation-Based American Indian Mothers - 07/08/11
, Allison Barlow, M.P.H., M.A., Britta C. Mullany, Ph.D., M.H.S., William Pan, Dr.Ph, M.S., M.P.H., Novalene Goklish, A.A., Ranelda Hasting, B.S., Brandii Cowboy, Pauline Fields, Elena Varipatis Baker, M.P.H., M.S.W., Kristen Speakman, M.P.H., M.A., Golda Ginsburg, Ph.D., Raymond Reid, M.D., M.P.H.Disclosure: Dr. Walkup has received research grant support from Eli Lilly, Pfizer, and Abbott. He has been a consultant to GlaxoSmithKline, Eli Lilly, and the Cliff’s Communities. He has received speaker’s honoraria from the Tourette Syndrome Association. The other authors report no conflicts of interest.
Abstract |
Objective |
To evaluate the efficacy of a paraprofessional-delivered, home-visiting intervention among young, reservation-based American Indian (AI) mothers on parenting knowledge, involvement, and maternal and infant outcomes.
Method |
From 2002 to 2004, expectant AI women aged 12 to 22 years (n = 167) were randomized (1:1) to one of two paraprofessional-delivered, home-visiting interventions: the 25-visit “Family Spirit” intervention addressing prenatal and newborn care and maternal life skills (treatment) or a 23-visit breast-feeding/nutrition education intervention (active control). The interventions began during pregnancy and continued to 6 months postpartum. Mothers and children were evaluated at baseline and 2, 6, and 12 months postpartum. Primary outcomes included changes in mothers’ parenting knowledge and involvement. Secondary outcomes included infants’ social and emotional behavior; the home environment; and mothers’ stress, social support, depression, and substance use.
Results |
Participants were mostly teenaged, first-time, unmarried mothers living in reservation communities. At 6 and 12 months postpartum, treatment mothers compared with control mothers had greater parenting knowledge gains, 13.5 (p < .0001) and 13.9 (p < .0001) points higher, respectively (100-point scale). At 12 months postpartum, treatment mothers reported their infants to have significantly lower scores on the externalizing domain (β = −.17, p < .05) and less separation distress in the internalizing domain (β = −.17, p < .05). No between-group differences were found for maternal involvement, home environment, or mothers’ stress, social support, depression, or substance use.
Conclusions |
This study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes. A longer, larger study is needed to replicate results and evaluate the durability of child behavior outcomes. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(6):591-601.
Le texte complet de cet article est disponible en PDF.Key Words : American Indian, home visiting, parenting, infant development
Plan
| This article was reviewed under and accepted by Ad Hoc Editor Bonnie T. Zima, M.D., M.P.H. Financial support for this work was provided by the Substance Abuse Mental Health Services Administration (SAMHSAI: Grant No. UD1SP08860, SAMHSA II: Grant No. UD1SP09588), and the Ford Foundation, the Annie E. Casey Foundation, and the C.S. Mott Foundation. The PI for this work, John Walkup, M.D., had full access to the study data and takes responsibility for the data integrity and accuracy of the analyses. Supplemental digital content for this article can be found online only. See text for specific links. The authors thank the Navajo and White Mountain Apache mothers, children, and families who participated in this study. The authors also thank the Navajo and White Mountain Apache leaders and community stakeholders who generously contributed time and wisdom to designing the Family Strengthening intervention and research protocol and reviewing the article. The authors also thank the Indian Health Service colleagues for their long-standing collaboration in health prevention research and service and for their review of the research and article. The opinions expressed are those of the authors and do not necessarily reflect the views of the Indian Health Service. This article is the subject of an editorial by Dr. Douglas K. Novins in this issue. Clinical trial registry information—Family Spirit Study URL: www.clinicaltrials.gov. Unique identifier: NCT00356551. |
Vol 48 - N° 6
P. 591-601 - juin 2009 Retour au numéro
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