About
Family Spirit Program
The Family Spirit Program is an evidence-based and culturally tailored home visiting intervention delivered by community-based Health Educators as an Indigenous solution to supporting caregivers during pregnancy and early childhood. Caregivers gain knowledge and skills to achieve optimum development for their children across the domains of physical, cognitive, social-emotional, language learning, and self-help. The Family Spirit Core Curriculum consists of 63 lessons taught from pregnancy to age 3, with plans for an expanded curriculum through age 5. Additional curriculum modules address emerging needs and specific family circumstances. This in-home parent training and support program has been designed, implemented, and rigorously evaluated by the Johns Hopkins Center for Indigenous Health (CIH) in partnership with the Navajo, White Mountain Apache, and San Carlos Apache tribal communities since 1995. It is now replicated nationally, with training, technical assistance, and curriculum materials managed by Johns Hopkins CIH.
The Family Spirit program aims to:
Increase parenting knowledge and skills;
Address maternal psychosocial risks that could interfere with positive child-rearing
Promote optimal physical, cognitive, social/emotional development for children from 0 to 3
Prepare children for early school success;
Ensure children get recommended well-child visits and health care
Link families to community services to address specific needs
Promote parents’ and children’s life skills and behavioral outcomes across the lifespan
Proven Impact
Parenting
- Increased maternal knowledge
- Increased parent self-efficacy
- Reduced parent stress
- Improved home safety attitudes
Maternal Outcomes
- Decreased maternal depression
- Decreased substance use
- Fewer behavior problems in mothers
Child Outcomes
- Fewer behavior problems in children through age 3 (externalizing, internalizing, and dysregulation)
- Predicts lower risk of substance use and behavioral health problems over the life course
Family Spirit is also the first program to provide clear evidence of the effectiveness of paraprofessionals as home visitors to impact behavioral and mental health disparities. The use of Native paraprofessionals is essential in reservation communities where there is a shortage of nurses and cultural barriers to non-Native home visitors.
Family Spirit has met the highest standard of the Department of Health and Human Services’ (DHHS) HomVEE criteria for an “evidence-based early childhood home visiting service delivery model.” Family Spirit is listed on the National Registry of Evidence-based Programs and Practices (NREPP), a searchable online database of evidence-based mental health and substance abuse interventions. In 2013, Family Spirit received a perfect rating (4.0 out of 4.0) from NREPP for “Readiness for Dissemination.” Family Spirit is also listed in the California Evidence-Based Clearinghouse (CEBC) for Child Welfare.
Barlow A, Mullany B, Neault N, et al. Effect of a Paraprofessional Home-Visiting Intervention on American Indian Teen Mothers’ and Infants’ Behavioral Risks: A Randomized Controlled Trial. American Journal of Psychiatry. 2013; 170:83–93.
Barlow A, Mullany B, Neault N, et al. Examining correlates of methamphetamine and other drug use in pregnant American Indian adolescents. American Indian and Alaska Native Mental Health Research. The Journal of the National Center. 2010; 17(1):1-24.
Barlow A, Mullany B, Neault N, et al. Paraprofessional Delivered, Home-Visiting Intervention for American Indian Teen Mothers and Children: Three-Year Outcomes from a Randomized Controlled Trial. American Journal of Psychiatry. 2015; 172(2):154-162.
Barlow A, Varipatis-Baker E, Speakman K, et al. Home-visiting intervention to improve child care among American Indian adolescent mothers: A randomized trial. Arch Pediatr Adolesc Med. 2006; 160(11):1101-1107.
Barlow, A, McDaniel, JA, Marfani, F, et al. Discovering Frugal Innovations Through Delivering Early Childhood Home-Visiting Interventions in Low-Resource Tribal Communities. Infant Mental Health Journal. 2018; 00(0):1-9.
Bullock, A. Getting to the Roots: Early Life Intervention and Adult Health. American Journal of Psychiatry. 2015; 172(2):108-110.
Ingalls A, Barlow A, Kushman E, et al. (2021). Precision Family Spirit – A Pilot Randomized Implementation Trial of a Precision Home Visiting Approach with Native American families in Michigan: Trial Rationale and Study Protocol. Pilot and Feasibility Studies. 2021;7(8).
Ingalls A, Rosenstock S, Foy Cuddy, R, et al. Family Spirit Nurture (FSN) – a randomized controlled trial to prevent early childhood obesity in American Indian populations: trial rationale and study protocol. BMC Obesity. 2019;6:18.
Mullany B, Barlow A, Neault N, et al. The Family Spirit trial for American Indian teen mothers and their children: CBPR rationale, design, methods and baseline characteristics. Prev Sci. 2012; 13(5):504-518.
Novins, DK. Participatory Research Brings Knowledge and Hope to American Indian Communities. Journal of the American Academy of Child and Adolescent Psychiatry. 2009; 48(6):585-586.
Rosenstock S, Ingalls A, Cuddy R., et al. Effect of a Home Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children: A Randomized Controlled Trial. JAMA Pediatrics. 2021; 175(2): 133-142.
Walkup JT, Barlow A, Mullany BC, et al. Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers. J Am Acad Child Adolesc Psychiatry. 2009;48(6):591-601.
Leadership Team
Family Spirit leadership faculty and staff are based in several locations across the United States to bring a wide variety of knowledge and expertise to support our affiliates.
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Director of Maternal, Infant and Child Health, Elizabeth Kushman, MPH
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Director of Training and Implementation, Tara Stowbunenko, MPH, MSBH, CHES
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Director of Innovations and Special Projects, Cibonay Jimenez, MA
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Director of Curriculum and Content, Lisa Martin, MPH
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Lead Trainer, Brooke Perkins
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Program and Training Coordinator, Kristen Tallis, MPH
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Data and Evaluation Manager, Amanda Harris, MS
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Family Spirit Nurture Dissemination and Communications Manager, Sarah Vanegas, MS
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Director of Operations, Nicole Neault, MPH
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Contracts Coordinator, Johanna Blais, MA
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Image Manager and Curriculum Assistant, Sarah Stern
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Implementation Science Principal Investigator, Emily Haroz, PhD, MA
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Contracts Manager, Kristen Speakman, MA, MPH
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JHCAIH Director; Family Spirit Developer Allison Barlow, PhD, MA, MPH
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