Cradling Our Future Through Family Strengthening Study
Condition: Substance Abuse; Post-partum Depression; Depression
MeSH terms: Depression, Postpartum; Substance-Related Disorders; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether an in-home, paraprofessional-delivered
      family strengthening curriculum entitled Family Spirit is effective at increasing parental
      competence, improving maternal outcomes and improving childhood outcomes in a sample of
      at-risk teen mothers living in four Native American reservation communities. The
      effectiveness of the Family Spirit curriculum will be determined by comparing outcomes of
      mothers who receive the intervention plus assisted transportation to prenatal and well baby
      visits (called Optimal Standardized Care) to mothers who receive only Optimal Standardized
      Care. Outcomes will be assessed at multiple intervals over the course of a 39-month study
      period.
    

Detailed description: 
      American Indians (AIs) in reservation communities have the poorest health, education and
      socioeconomic status of any racial or ethnic group in the U.S., placing AI youth at increased
      risk for drug abuse (alcohol, marijuana, tobacco, etc.) and adverse health and behavior
      outcomes. This study focuses on one of the most vulnerable groups of reservation-based AIs-AI
      teen mothers and their children.

      Over the past two decades a number of research-based health promotion and drug abuse
      prevention programs for youth have been found to be effective. Of these, parenting
      interventions have been found to be more effective than other types of interventions. Home
      visiting programs for young, high-risk mothers have been designed to impact a wide range of
      outcomes--parenting, child and maternal health and behavior outcomes. More than 40 studies
      have been published since 1982 supporting the short and long-term efficacy of home visiting
      programs delivered during pregnancy and early childhood for low-income families. Positive
      outcomes have been demonstrated for improved parenting and the home environment; increased
      social support for mothers and children from extended family members and improved maternal
      health and behavior outcomes; increased birth spacing; improved children's health and
      behavior outcomes; prevention of child abuse and neglect; and reduced drug use.

      AI teen mothers and their offspring are arguably the most vulnerable and underserved
      population at risk for drug abuse and adverse health and behavior outcomes in the U.S. Given
      their high-risk status, pregnant AI teens are likely to benefit from a parenting-focused,
      home visiting intervention. Cultural support for developing individual strengths through a
      family-based model and the noted cultural relevance of employing AI paraprofessionals are
      expected to enhance participants' outcomes. As nearly half of AI women begin child-bearing in
      adolescence, improvement in outcomes of teen mothers and their offspring could substantially
      impact the public health and welfare of AI communities.

      Both nurses and paraprofessionals have been utilized in effective home visiting programs.
      However, the shortage of indigenous nurses in reservation communities renders an AI
      nurse-delivered, home visiting intervention unfeasible for the participating communities at
      this time. Further, young AI women's discomfort with health care delivered by non-Indians and
      the potential for cultural barriers with non-Indian home visitors provides an additional
      rationale for AI paraprofessionals as home visitors.

      Successful home visiting programs maintain a standard for frequency and dosage of visits,
      employ strategies for participant retention, provide intensive training, frequent direct
      supervision and intensive quality assurance measures. For this study, we will maintain the
      highest standards for dosage, retention strategies, home visitor training and supervision,
      and quality assurance. The core content of the curriculum is based on American Academy of
      Pediatrics' comprehensive guidelines for preparing mothers to care for infants and young
      children, with cultural adaptations derived through guidance from our Native Advisory Board
      and an iterative process of community input.
    

Intervention name(s): Family Spirit Intervention
Intervention type(s): Procedure
Intervention description(s): The Family Spirit Intervention was developed over a decade through community-based participatory research.The intervention content included 43 structured lessons and followed a culturally congruent format.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Native American health; Teen pregnancy; Family strengthening; Substance abuse prevention; Injury prevention