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

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Abstract

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

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Data Availability

The datasets generated during and/or analyzed during this study are not publicly available as they are owned by the participating Native American communities. Requests to obtain the datasets must be made to the participating communities’ governing bodies.

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Funding

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.

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Authors and Affiliations

  1. Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    E. E. Haroz, A. Ingalls, C. Kee, N. Goklish, N. Neault, M. Begay & A. Barlow

Authors
  1. E. E. Haroz
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  2. A. Ingalls
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  3. C. Kee
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  4. N. Goklish
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  5. N. Neault
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  6. M. Begay
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  7. A. Barlow
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Corresponding author

Correspondence to E. E. Haroz.

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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.

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

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Haroz, E.E., Ingalls, A., Kee, C. et al. Informing Precision Home Visiting: Identifying Meaningful Subgroups of Families Who Benefit Most from Family Spirit. Prev Sci 20, 1244–1254 (2019). https://doi.org/10.1007/s11121-019-01039-9

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