Prevention Science

, Volume 20, Issue 8, pp 1244–1254 | Cite as

Informing Precision Home Visiting: Identifying Meaningful Subgroups of Families Who Benefit Most from Family Spirit

  • E. E. HarozEmail author
  • A. Ingalls
  • C. Kee
  • N. Goklish
  • N. Neault
  • M. Begay
  • A. Barlow


The Maternal, Infant, and Early Childhood Home Visiting Program was reauthorized February 8, 2018, and invests $2 billion over 5 years to improve mothers’ and children’s outcomes across the life course. Along with this investment, the home-visiting field is striving for implementation innovations to deliver the greatest impact to the most families at the most efficient cost through a focus on precision home visiting. Consistent with the precision home-visiting approach to identify meaningful subgroups to guide content tailoring, the purpose of this paper is to answer (1) how and to what degree an evidence-based home-visiting model benefits mothers and children with substance use or depression and (2) what baseline characteristics indicate who can benefit most. We completed a secondary data analysis of the most recently completed randomized controlled trial (RCT) of Family Spirit (N = 322), a federally endorsed home-visiting intervention designed for young Native American mothers and their children. We examined how baseline differences in mothers’ substance use, depression, and demographic characteristics (household mobility, education, parity, and premature birth) moderated mothers’ and children’s intervention-related outcomes. Children born to mothers with past substance use histories benefited more from the intervention than children born to abstinent mothers (p < 0.01). Unstable housing, parity, and low educational attainment emerged as moderators of intervention effectiveness. Results from this investigation will serve as a basis for designing and evaluating a precision approach to Family Spirit and may provide lessons for other models to explore tailoring variables for optimal impact and efficiency. Trial Registry: NCT00373750


Precision prevention science Home visiting Moderation analysis 



This study was funded by the Annie E. Casey Foundation GA-2017-X4166. Dr. Emily E. Haroz is funded through a career development grant from the National Institute of Mental Health (NIMH) K01MH116335.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11121_2019_1039_MOESM1_ESM.pdf (25 kb)
ESM 1 (PDF 24 kb)


  1. Abidin, R. (1995). Parenting stress index third edition: Professional manual. Lutz: Psychological Assessment Resources.Google Scholar
  2. Alati, R., Najman, J. M., Kinner, S. A., Mamun, A. A., Williams, G. M., O'Callaghan, M., & Bor, W. (2005a). Early predictors of adult drinking: A birth cohort study. American Journal of Epidemiology, 162, 1098–1107 %@ 1476–6256.CrossRefGoogle Scholar
  3. Alati, R., Najman, J. M., Kinner, S. A., Mamun, A. A., Williams, G. M., O'callaghan, M., & Bor, W. (2005b). Early predictors of adult drinking: A birth cohort study. American Journal of Epidemiology, 162, 1098–1107.CrossRefGoogle Scholar
  4. Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., … Redmond, C. (2015). Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. American Journal of Psychiatry, 172, 154–162.CrossRefGoogle Scholar
  5. Barlow, A., Mcdaniel, J. A., Marfani, F., Lowe, A., Keplinger, C., Beltangady, M., & Goklish, N. (2018). Discovering frugal innovations through delivering early childhood home-visiting interventions in low-resource tribal communities. Infant Mental Health Journal, 39, 276–286.Google Scholar
  6. Bolton, P., Lee, C., Haroz, E. E., Murray, L., Dorsey, S., Robinson, C., et al. (2014). A transdiagnostic community-based mental health treatment for comorbid disorders: Development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Medicine, 11, e1001757.CrossRefGoogle Scholar
  7. Briggs-Gowan, M. J., & Carter, A. S. (2008). Social-emotional screening status in early childhood predicts elementary school outcomes. Pediatrics, 121, 957–962.CrossRefGoogle Scholar
  8. Calhoun, S., Conner, E., Miller, M., & Messina, N. (2015). Improving the outcomes of children affected by parental substance abuse: A review of randomized controlled trials. Substance Abuse and Rehabilitation, 6, 15–24.PubMedPubMedCentralGoogle Scholar
  9. Campis, L. K., Lyman, R. D., & Prentice-Dunn, S. (1986). The parental locus of control scale: Development and validation. Journal of Clinical Child Psychology, 15, 260–267.CrossRefGoogle Scholar
  10. Carter, A. S., Briggs-Gowan, M. J., Jones, S. M., & Little, T. D. (2003). The infant–toddler social and emotional assessment (ITSEA): Factor structure, reliability, and validity. Journal of Abnormal Child Psychology, 31, 495–514.CrossRefGoogle Scholar
  11. Casillas, K. L., Fauchier, A., Derkash, B. T., & Garrido, E. F. (2016). Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse & Neglect, 53, 64–80.CrossRefGoogle Scholar
  12. Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7, 5–20.CrossRefGoogle Scholar
  13. Cook, D. I., Gebski, V. J., & Keech, A. C. (2004). Subgroup analysis in clinical trials. Medical Journal of Australia, 180, 289–292.CrossRefGoogle Scholar
  14. Dauber, S., John, T., Hogue, A., Nugent, J., & Hernandez, G. (2017a). Development and implementation of a screen-and-refer approach to addressing maternal depression, substance use, and intimate partner violence in home visiting clients. Children and youth services review, 81, 157–167.Google Scholar
  15. Dauber, S., Ferayorni, F., Henderson, C., Hogue, A., Nugent, J., & Alcantara, J. (2017b). Substance use and depression in home visiting clients: Home visitor perspectives on addressing clients’ needs. Journal of Community Psychology, 45, 396–412.Google Scholar
  16. Duggan, A., Minkovitz, C. S., Chaffin, M., Korfmacher, J., Brooks-Gunn, J., Crowne, S., … Harwood, R. (2013). Creating a national home visiting research network. Pediatrics, 132, S82-S89.CrossRefGoogle Scholar
  17. Duggan, A., Portilla, S. A., Filene, J., Shea Crowne, S., Hill, C. J., Lee, H., & Knox, V. (2018). Implementation of evidence-based early childhood home visiting: Results from the mother and infant home visiting program evaluation. Retrieved from Washington, DC: Accessed Sept 2018.
  18. Filene, J. H., Kaminski, J. W., Valle, L. A., & Cachat, P. (2013). Components associated with home visiting program outcomes: A meta-analysis. Pediatrics, 132, S100–S109.CrossRefGoogle Scholar
  19. Gomby, D. S., Culross, P. L., & Behrman, R. E. (1999). Home visiting: Recent program evaluations: Analysis and recommendations. The Future of Children, 4–26.Google Scholar
  20. Granic, I., & Patterson, G. R. (2006). Toward a comprehensive model of antisocial development: A dynamic systems approach. Psychological Review, 113, 1939–1471.CrossRefGoogle Scholar
  21. Hoffman, S. D. (2006). By the numbers. The public costs of teen childbearing, 600-16.Google Scholar
  22. Holland, M. L., Christensen, J. J., Shone, L. P., Kearney, M. H., & Kitzman, H. J. (2014). Women’s reasons for attrition from a nurse home visiting program. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 43, 61–70.CrossRefGoogle Scholar
  23. Home VIsiting Applied Research Network (HARC). (2017). Home visiting research agenda. Retrieved from Accessed Sept 2018.
  24. Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883.CrossRefGoogle Scholar
  25. Legha, R., Raleigh-Cohn, A., Fickenscher, A., & Novins, D. (2014). Challenges to providing quality substance abuse treatment services for American Indian and Alaska native communities: Perspectives of staff from 18 treatment centers. BMC Psychiatry, 14, 181–191.CrossRefGoogle Scholar
  26. McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65, 73–84.CrossRefGoogle Scholar
  27. Mullany, B., Barlow, A., Neault, N., Billy, T., Jones, T., Tortice, I., … Reid, R. (2012). The Family Spirit Trial for American Indian teen mothers and their children: CBPR rationale, design, methods and baseline characteristics. Prevention Science, 13, 504–518.CrossRefGoogle Scholar
  28. Murray, L. K., Dorsey, S., Haroz, E., Lee, C., Alsiary, M. M., Haydary, A., … Bolton, P. (2014). A common elements treatment approach for adult mental health problems in low-and middle-income countries. Cognitive and Behavioral Practice, 21, 111–123.CrossRefGoogle Scholar
  29. Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110.CrossRefGoogle Scholar
  30. Novins, D. K., & Mitchell, C. M. (1998). Factors associated with marijuana use among American Indian adolescents. Addiction, 93, 1693–1702.CrossRefGoogle Scholar
  31. O’Brien, R. A., Moritz, P., Luckey, D. W., McClatchey, M. W., Ingoldsby, E. M., & Olds, D. L. (2012). Mixed methods analysis of participant attrition in the nurse-family partnership. Prevention Science, 13, 219–228.CrossRefGoogle Scholar
  32. O'Connell, M. E., Boat, T., & Warner, K. E. (eds) (2009). National Research Council (US) and Institute of Medicine (US) committee on the prevention of mental disorders and substance abuse among children, youth, and young adults: Research advances and promising interventions. Washington (DC): National Academies Press (US).Google Scholar
  33. Patterson, G. R., DeBaryshe, B. D., & Ramsey, E. (1989). A developmental perspective on antisocial behavior (Vol. 44). US: American Psychological Association.Google Scholar
  34. Peacock, S., Konrad, S., Watson, E., Nickel, D., & Muhajarine, N. (2013). Effectiveness of home visiting programs on child outcomes: A systematic review. BMC Public Health, 13, 17–31.CrossRefGoogle Scholar
  35. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  36. Ramrakha, S., Bell, M. L., Paul, C., Dickson, N., Moffitt, T. E., & Caspi, A. (2007). Childhood behavior problems linked to sexual risk taking in young adulthood: A birth cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 1272–1279.CrossRefGoogle Scholar
  37. Sama-Miller, E., Akers, L., Mraz-Esposito, A., Zukiewicz, M., Avellar, S., Paulsell, D., & Grosso, P. D. (2016). Home visiting evidence of effectiveness review: Executive summary. Retrieved from: Accessed Sept 2018.
  38. Staerkel, F. J., & Spieker, S. (2006). Unstable housing—a significant challenge for home visiting programs: An early head start case example. Journal of Family Social Work, 10, 61–76.CrossRefGoogle Scholar
  39. Stanger, C., Dumenci, L., Kamon, J., & Burstein, M. (2004). Parenting and children’s externalizing problems in substance-abusing families. Journal of Clinical Child and Adolescent Psychology, 33, 590–600.CrossRefGoogle Scholar
  40. Supplee, L. H., Parekh, J., & Johnson, M. (2018). Principles of precision prevention science for improving recruitment and retention of participants. Prevention Science, 19, 689–694.CrossRefGoogle Scholar

Copyright information

© Society for Prevention Research 2019

Authors and Affiliations

  • E. E. Haroz
    • 1
    Email author
  • A. Ingalls
    • 1
  • C. Kee
    • 1
  • N. Goklish
    • 1
  • N. Neault
    • 1
  • M. Begay
    • 1
  • A. Barlow
    • 1
  1. 1.Center for American Indian Health, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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