Researchers at The Johns Hopkins Bloomberg School of Public Health said they also found that the intensive parenting and health education set the girls’ children on track to meet behavioral and emotional milestones they may have missed.
While the study was conducted in four American Indian communities in the Southwest, the researchers note that its success could be replicated in other low-income populations around the United States.
“For years in public health we have been working on immunizations and other medical interventions to set the course for the health of disadvantaged children, and we have turned the tide,” said the study’s lead author, Allison Barlow, M.P.H., Ph.D., associate director of the Center for American Indian Health at the Johns Hopkins Bloomberg School of Public Health.
“Now the burden is in multi-generational behavioral health problems, the substance abuse, depression, and domestic violence that are transferred from parents to children. This intervention can help us break that cycle of despair.”
American Indian adolescents have the highest rates of teen pregnancy, substance use, suicide, and dropping out of high school of any racial or ethnic group in the country, researchers noted.
For the 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, 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, the researchers explained.
The lessons covered everything from the benefits of breastfeeding and reading to your child to creating sleep and feeding schedules, as well as life skills such as budgeting, conflict resolution, and preventing substance use.
Before beginning the study, the researchers noted that the teens had high rates of substance use in their lifetime (more than 84 percent), depressive symptoms (more than 32 percent), high school dropout rates (more than 57 percent), and residential instability (51 percent moved more than twice in a year).
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. They also found that the children in the Family Spirit group were less likely to show early behaviors known to signal future conduct problems, anxiety, and depression.
The children were easier to soothe, had better sleeping and eating patterns, and were more likely to meet emotional and behavioral milestones than those in the control group.
“We found a consistent pattern of success across a number of different outcome measures,” said the study’s principal investigator, John Walkup, M.D., an adjunct professor at Johns Hopkins Bloomberg School of Public Health and a faculty member at the Center for American Indian Health.
“These early years are critical ones for children. We teach these mothers not only how to be competent parents, but how to cope with stressors and other risk factors that could impede positive parenting skills.”
A key to the program’s success is utilizing local community health workers instead of more formally educated nurses, added Barlow.
“We can grow the workforce in some of the poorest communities in the nation, where good jobs can be hard to come by,” she said.
“With focused training, people with little formal education but important life experiences and a passion to serve their communities can become change agents to overcome these very tough problems.”
The Affordable Care Act set aside $1.5 billion in funding for states to implement evidence-based home-visiting programs to support the health and development of at-risk children, with three percent earmarked for tribal communities.
Barlow notes that Family Spirit was recently approved by the U.S. Department of Health and Human Services as an evidence-based program, now eligible for the federal dollars.
The study, supported by a grant from the National Institutes of Health’s National Institute on Drug Abuse, was published in the American Journal of Psychiatry.