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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


  • 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.

Director of Maternal, Infant and Child Health, Elizabeth Kushman, MPH

Director of Training and ImplementationTara Stowbunenko, MPH, MSBH, CHES

Director of Innovations and Special Projects, Cibonay Jimenez, MA

Director of Curriculum and Content, Lisa Martin, MPH

Lead TrainerBrooke Perkins

Program and Training CoordinatorKristen Tallis, MPH

Data and Evaluation Manager, Amanda Harris, MS

Family Spirit Nurture Dissemination and Communications Manager, Sarah Vanegas, MS

Director of OperationsNicole Neault, MPH

Contracts Coordinator, Johanna Blais, MA

Image Manager and Curriculum Assistant, Sarah Stern

Implementation Science Principal InvestigatorEmily Haroz, PhD, MA

Contracts Manager, Kristen Speakman, MA, MPH

JHCAIH Director; Family Spirit Developer Allison Barlow, PhD, MA, MPH

Family Spirit In The News

Essential Health Care Services Addressing Intimate Partner Violence (2024) National Academies of Sciences, Engineering, and Medicine

Michigan’s Indigenous children receive culturally sensitive nutrition education through new program.

Family Spirit Nurture Recognized by National Academies of Science, Engineering, and Medicine.  NASEM consensus study scoping review

Sesame Street’s Elmo spotted at baby celebration at Leech Lake. The Circle

Groups work to ditch the soda in tribal communities, where water scarcity feeds childhood obesity. NPR for Northern Colorado

Teaching Indigenous moms about nutrition has a lifelong impact on kids. Arizona Central

Indigenous early childhood program funding temporarily extended, but advocates say pressures remain. Yellowstone Public Radio

The LEGO Foundation Announces Recipients of 900 Million Danish Kroner (US$117 Million) Global Challenge. The LEGO Foundation Announces Recipients of 900 Million Danish Kroner (US$117 Million) Global Challenge – About Us –

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