Family Spirit Home Visiting Program in American Indian Communities Reduces Drug Use in Pregnant Teens


In partnership with the Navajo, White Mountain Apache and San Carlos Tribes, the Johns Hopkins Center for American Indian Health has been conducting three successive randomized controlled trials to assess the Family Spirit intervention’s impact on parenting and maternal and child health and behavior outcomes.

Research findings from the third and largest trial were published last month and provide strong evidence for the effectiveness of home visiting programs on a range of outcomes.

In the most recent study, 322 pregnant teens were randomly assigned to receive optimized standard care — transportation to prenatal and well-baby clinic visits, pamphlets about childcare, and other resources and referrals to local services — or optimized standard care plus a program of 63 in-home education sessions, known as Family Spirit.

In the Family Spirit intervention, home visits occurred weekly through the last trimester of pregnancy, biweekly until four months after the baby’s birth, monthly from months four through 12, and then bimonthly until the child turned three. A key to the program’s success was utilizing local community health workers instead of more formally educated nurses.

Before beginning the study, the researchers noted that the teens had high rates of substance use in their lifetime (more than 84 percent). The researchers found that mothers in the Family Spirit group were less likely to use illegal drugs, be depressed, or experience behavior problems than those in the control group.

Read more about the study on the Johns Hopkins Bloomberg School of Public Health website.

Read the study abstract on PubMed or download the full study from The American Journal of Psychiatry.

For more on home visiting programs and FASD prevention, see earlier posts:


Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., Lorenzo, S., Kee, C., Lake, K., Redmond, C., Carter, A., Walkup, J.T. (2014). Paraprofessional-Delivered Home-Visiting Intervention for American Indian Teen Mothers and Children: 3-Year Outcomes From a Randomized Controlled Trial. The American Journal of Psychiatry. doi: 10.1176/appi.ajp.2014.14030332. [Epub ahead of print]

BC Healthy Connections Project

Five-year Randomized Control Trial of the Nurse-Family Partnership (NFP) Program set to begin in British Columbia


Nurse-Family Partnership  is a primary prevention program that was developed by Dr. David Olds in the United States with the goal of helping vulnerable young first-time mothers and their children.

The program involves public health nurses  visiting mothers in their homes, providing intensive supports starting in pregnancy and continuing until children reach their second birthday. Studies in the US have shown that NFP significantly reduces child maltreatment and child behaviour problems, while also improving children’s early learning and mother’s economic self-sufficiency. Economic studies have also shown that the program pays for itself over the long-term.

The government of  British Columbia is introducing the Nurse-Family Partnership program as part of its Healthy Families BC initiative. However, because the program has never been evaluated in the Canadian context, a five year randomized control trial will be an important first step. Compared with Canada, the United States has greater socioeconomic inequalities and fewer baseline health and social services. It’s possible that the program may not be more effective than existing services.

Using randomized-controlled trial methods, the program will be evaluated in comparison with existing perinatal services in BC regarding outcomes across three fundamental domains: 1) pregnancy and birth; 2) child health and development; and 3) maternal health and life course. Tobacco and alcohol use during pregnancy will be one of the key outcome measures. (Reductions in prenatal tobacco use have been reported in the US context but prenatal alcohol use is still an unknown.

Some of the project collaborators include: Simon Fraser University, McMaster University, BC Ministry of Health and BC Ministry of Children and Family Development. Learn more about the initiative here.

For more on home visiting programs, see earlier posts: