American Indian teenagers frequently face both impoverished homes and impoverished communities. As a group, they have the highest rates of illegal drug use, failure to finish high school, suicide and pregnancy of adolescents in any ethnic or racial group in the United States.
A recent study from the Johns Hopkins University Bloomberg School of Public Health explored whether intensive in-home health and parenting education could help pregnant American Indian teenagers to overcome some of these challenges and break the cycle of multi-generational substance, behavioral and mental health problems that affects many of these communities. The study was published in the October 10, 2014 issue of the American Journal of Psychiatry.
Subjects Randomly Selected for “Family Spirit” In-Home Visits
The researchers for this study selected 322 pregnant American Indian teenagers to receive either optimized standard care or optimized standard care with the addition of 63 home visits. 84 percent of the study participants had a history of substance use, 32 percent had a lifetime history of depression symptoms, 57 percent had not completed high school and 51 percent had experienced “residential instability,” meaning they had been forced to move more than two times in a 12 month period.
The optimized standard care provided the expectant mothers with transportation to prenatal and well-baby clinics, referrals and pamphlets with childcare information. The home visit program, known as Family Spirit, included weekly visits during the last trimester of pregnancy, bi-weekly visits until the infant was four months old and bimonthly visits until the child reached three years of age.
Health, Parenting and Life Skills Education Provided Through Home Visits
During the Family Spirit visits, the teenagers were educated about parenting skills such as breastfeeding and parenting techniques such as establishing reliable feeding and sleeping schedules. They also received education about pregnancy and maternal health, and even household management skills such as conflict resolution, budgeting and substance use prevention.
After three years of care and observation, both the mothers and the children in the Family Spirit group showed promising results. The mothers who received the in-home education were less likely to engage in illegal substance use, less likely to have symptoms of depression and less likely to display behavioral problems.
The children in the Family Spirit group were less likely to display early behaviors that have been identified as risk factors for later behavioral and emotional problems. They were easier to soothe than children in the optimized standard care group, had more regular sleeping patterns, had more regular appetites and met more of the emotional and behavioral milestones expected of their age group.
Questions Surround Cost of Intensive Parenting and Health Education
The positive results of intensive in-home education are not particularly surprising, but clear evidence of positive results is crucial given the significantly greater investment of both time and funds necessary for such a program. The Johns Hopkins study is a strong argument in favor of the significant and consistent results that can come from home-visit education programs.
This study also evaluated the success of using local community members as health educators rather than fully trained nurses. The results suggest that community members can be effective in such counseling and educating positions, reducing the cost of operating such programs while also providing much needed jobs to members of impoverished communities.
While this study focused on American Indian teenagers, the researchers believe that programs like Family Spirit could be equally effective in other low-income populations where there are high rates of incomplete schooling, substance abuse, behavior problems and depression, and where family and community dysfunction has become a cycle affecting generation after generation.