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NIDA. (2015, March 19). Intervention Yields Sustained Health Benefits for American Indian Teen Mothers and Their Children. Retrieved from

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March 19, 2015
By Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer

Family Spirit, a program that teaches parenting skills to American Indian teen mothers, improved participants’ children’s emotional and behavioral development throughout their first 36 months of life, NIDA-supported researchers report. The new findings affirm and extend those of a previous evaluation that showed similar benefits up to the first year of life (see Intervention Strengthens American Indian Teen Mothers’ Parenting).

Developed in collaboration with American Indian communities in which it is implemented, Family Spirit aims to help young mothers raise healthy children in communities with high rates of single parenthood, unstable home environments, depression, substance use, and other challenges. In the recent study, participating women from four southwest reservation communities received teaching visits in their own homes from trained American Indian paraprofessionals, starting during pregnancy and continuing to 3 years postpartum. A comparison group of mothers did not receive Family Spirit, but did get upgraded pediatric care compared with the norm on their reservations.

Across seven postpartum assessments, Family Spirit mothers’ children scored consistently better on the Infant-Toddler Social Emotional Assessment (ITSEA) than did children of mothers in the comparison group. Lead researcher Dr. Allison Barlow from Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, in Baltimore, and colleagues, documented beneficial Family Spirit effects on three of the four domains that ITSEA evaluates: externalizing and internalizing behaviors, and self-regulation of affect and behavior.

See text description below Figure. The Family Spirit Intervention Reduced Children’s Clinical Risks for Future Problems Across seven assessments made over their first 3 years of life, children whose mothers received the Family Spirit intervention were less likely than those in a control group to be at clinical risk for externalizing (aggression, impulsivity) or internalizing (anxiety, depression) behaviors. A lower percentage of Family Spirit children scored in the clinical risk range for emotional dysregulation (difficulties sleeping or eating, or sensory hypersensitivity), but this difference was not statistically significant.

In addition, Family Spirit children were roughly one-third less likely than comparison children to have ITSEA scores in the range that indicates clinical risk for emotional or behavioral problems in childhood or adolescence (see Figure). Dr. Barlow explains, “Children whose ITSEA scores fall in the 10th percentile or lower, when compared with national samples, have an elevated likelihood of developing behavior problems, such as substance use, risky sex, and delinquent conduct, across the life course.” Between 9.9 percent and 17.8 percent of children in the Family Spirit group scored in this range, compared with between 14.6 percent and 23.8 percent in the control group.

Text Description of Graphic

The figure shows a bar graph indicating the proportion of children clinically at risk for emotional disorders. The vertical (y)-axis shows the percentage of children clinically at risk for these disorders, and the horizontal (x)-axis shows the types of emotional disorders, that is, externalizing, internalizing, and dysregulation behaviors. The green bars represent the percentage values for the children of teen mothers in the Family Spirit intervention group and the blue bars for the children of the control group of mothers receiving a standard-of-care intervention. As shown by the differences in bar heights between the two groups, the percentage of children at risk for each of the three emotional problems was lower in the intervention group than in the control group. As shown by horizontal lines and probability (p) values immediately above the pairs of bars for externalizing and internalizing disorders, the differences between the two groups in these two disorders were statistically significant, indicated by p values of equal or less than 0.05. The difference between the two groups in dysregulation disorders was not statistically significant.

As anticipated with the educational intervention, the Family Spirit mothers demonstrated more growth in parenting knowledge and confidence across the length of the study than did the mothers in the comparison group. Family Spirit mothers also scored significantly lower on assessments for depression and externalizing emotional problems, and were significantly less likely to use marijuana or illegal drugs across the intervention period.

In their 1-year assessment of Family Spirit, the investigators noted that many of the young women abstained from drug use while pregnant but resumed use in their first postpartum year. In response to this observation, Dr. Barlow says, “We added lessons focused on preventing drug use by the mothers, and we found lower marijuana and illicit drug use in the intervention group.” The additional measures had no impact on alcohol use. The researchers suggest that the likely reasons for this were that most of the mothers had reached the legal drinking age by 3 years postpartum and that alcohol use is more socially accepted.

The researchers conclude that culturally competent community members can be a valuable public health resource in communities with insufficient numbers of health care providers, such as the Indian reservations on which the Family Spirit mothers and their children lived. They suggest that Family Spirit may be a model for similar low-cost interventions to extend educational resources and health care to other communities.

This study was supported by NIH grant DA019042.


Barlow, A.; Mullany, B.; Neault, N. et al. Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. American Journal of Psychiatry 172(2):154-162, 2015. Abstract