Piloting a Prevision Approach to Home Visiting: Precision Family Spirit

Study Rationale
Early childhood home visiting plays a critical role in promoting maternal and child health. At scale, home visiting programs share challenges of participant recruitment and retention. Tailoring home visiting programs to each individual mother while maintaining fidelity to the original model may address these challenges, but more research is needed to understand if this approach is feasible and acceptable.

Pilot Study Overview & Aims
The Johns Hopkins for American Indian Health and the Inter-Tribal Council of Michigan conducted a pilot study to test a precision approach for the Family Spirit® early childhood home visiting program. Home visitors were given support to tailor the curriculum and meet the unique needs of each mother.

Aim 1: Explore the acceptability and feasibility of a precision approach to home visiting from the perspective of enrolled mothers
Aim 2: Examine the difference between Precision Family Spirit and Standard Family Spirit client-home visitor relationship, goal alliance
Aim 3: Gather information on family outcomes to inform study design and other features for a fully-powered study
Aim 4: Understand implementation facilitators and challenges from the perspective of home visitors
The full study protocol has been published and is available in Open Access here.

Study Participants

Sixty mothers from four home visiting sites in Michigan participated in the pilot study. Half the mothers received Standard Family Spirit and half received Precision Family Spirit.

  • The average age of the mothers in the program was 26.6 years old
  • About three-quarters (73%) of mothers reported household incomes below the federal poverty line
  • 20% of mothers were at moderate risk for substance abuse (alcohol or drugs)
  • 13% of mothers reported nutrition concerns when they started the study
  • Average of 6.26 visits completed between study enrollment and 6 months after birth
  • Top 3 most useful Family Spirit lessons: Breastfeeding, Parenting Techniques, and Child Development

“The most helpful part of the Family Spirit Program is being able to talk freely about my everyday life, not feeling judged, and receiving beneficial information and insights into my situation.”

– Precision Family Spirit Participant

Main Study Findings

  • Precision Family Spirit was found to be acceptable and feasible.
  • Standard Family Spirit had some lessons that were unnecessary for some families, indicating that tailoring of the curriculum is appropriate.
  • Home visitors and participants form strong alliances regardless of approach.
  • Participant outcomes across groups were what was expected.
  • The research team is in the process of disseminating study findings to the participants and communities, as well as preparing manuscripts for submission to academic journals.