DiagnosticsHome-visit Interventions Result In Decreased Behavioral Problems In Infants Born To Young American Indian Mothers
American Indian teenagers become parents at twice the rate of other American teenagers. Many of these teens have greater environmental and behavioral challenges associated with living on reservations, including higher rates of poverty, increased rates of unemployment and school drop-out, higher rates of alcohol and drug abuse, impaired access to healthcare, as well as increased risk of domestic violence and suicide over the general population.
In a study to be published in the June 2009 issue of Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), Dr. John Walkup, of Johns Hopkins, and his colleagues followed 81 American Indian expectant females, age 12 to 22, who received educational support through a program called Family Spirit. The Family Spirit program provided paraprofessional-delivered, home visit interventions during pregnancy and for up to twelve months after delivery. The 25 home visit interventions were designed to address prenatal and newborn care, as well as maternal life skills. An additional 86 American Indian expectant females in the same age group serve as a control group and were given breastfeeding and nutritional education by paraprofessionals during 23 home visits. The researchers were interested in whether a home-based parent education program could promote effective parenting in the young American Indian population and mitigate environmental risks associated with living on a reservation.
Utilizing a seventy-six question survey, the researchers found that young expectant mothers receiving Family Spirit interventions improved in both their knowledge of parenting and of healthy home environments. Evaluations of children delivered to this group during the study period showed that infants demonstrated fewer behavioral difficulties at one year of age, including decreased peer aggression, hyperactivity, and separation anxiety.
Behavior problems seen in infancy are often associated with negative behaviors in later childhood and adolescence.
Walkup, associate professor and deputy director of the Division of Child and Adolescent Psychiatry at the Johns Hopkins Children"s Center, said: "The mental health needs of American Indian children and their families are substantial, yet our knowledge regarding effective preventive and clinical interventions is almost non-existent. We are encouraged that home visits to young, expectant, American Indian women by paraprofessionals resulted in demonstrated benefits in infant behavior. We look forward to conducting a larger study, with more participants over a longer time period, to fully evaluate whether improvements in infant behavior are sustained as the children get older."
Brandii Cowboy, co-author of the article, said: "I feel honored to work among my own people, helping the younger generation, knowing that my work made a difference. It"s a privilege to know that our work made an impact on these young mothers, also knowing that we made a difference in their children"s lives."
In an editorial about the article to be published in JAACAP, Dr. Doulas K. Novins, of the Centers for American Indian and Alaska Native Health and the University of Colorado stated, "The Family Spirit intervention thus represents a promising new preventive intervention for American Indian communities that was designed to meet their specific needs and draw on readily available human res - paraprofessionals. Indeed, for communities where nurses and other clinically-trained professionals may be largely unavailable for preventive work - including these and other American Indian reservation communities."
This study was carried out with support from the Substance Abuse Mental Health Services Administration, the Ford Foundation, the Annie E. Casey Foundation, and the C.S. Mott Foundation.
The study is published in the Journal of the American Academy of Child and Adolescent Psychiatry and online at the JAACAP"s Web site.
References
1. Walkup J, Barlow A, Mullany B, 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.
2. Barlow A, Walkup JT. The first Americans have much to teach us. J Am Acad Child Adolesc Psychiatry.
2008;47(8):843-844.
3. Novins DK. Participatory Research Brings Knowledge and Hope to American Indian Communities. J Am
Acad Child Adolesc Psychiatry. 2009;48(6):585-586.
The Journal of the American Academy of Child and Adolescent Psychiatry