Teenage pregnancies often increase both mother and child’s risk of suffering short- and long-term health complications. Unfortunately, these circumstances are exacerbated by the fact that over half of a pregnant teens admit to using drugs or alcohol the month before prenatal appointments. A recent study conducted at the Johns Hopkins Bloomberg School of Public Health suggests that in-home healthcare interventions could help to reduce drug use and depression in pregnant teens.

"For years in public health we have been working on immunizations and other medical interventions to set the course for the health of disadvantaged children, and we have turned the tide," Dr. Allison Barlow, associate director of the Center for American Indian Health at the Johns Hopkins Bloomberg School of Public Health, said in a statement. "Now the burden is in multi-generational behavioral health problems, the substance abuse, depression and domestic violence that are transferred from parents to children. This intervention can help us break that cycle of despair."

Barlow and her colleagues gathered data on 322 pregnant America Indian teens who either received standard care – transportation to prenatal clinics, childcare pamphlets, and referrals to local services – or optimized standard care which included 63 in-home education sessions, known as Family Spirit. American Indian teenagers have the highest rates of teen pregnancy, drug use, suicide, and dropping out of high school compared to any other racial or ethnic group. At the start of the study over 84 percent of teens included in the study reported drug use in their lifetime, over 32 percent reported depressive symptoms, over 57 percent dropped out of high school, and 51 percent reported residential instability.

Family Spirit intervention lessons covered the benefits of breastfeeding, reading to children to create sleep, feeding schedules, budgeting, conflict resolution, and drug use prevention. In-home visits occurred each week throughout the last trimester of pregnancy, twice a week in the four month’s leading up to the baby’s birth, monthly in the four to twelve months after the baby is born, and bimonthly after the child turns 3.

Teens who received Family Spirit interventions were less likely to use drugs, suffer from depressive symptoms, or experience behavioral problems compared to teens who received standard care. After following the infants until they turned 3, research found that those involved with Family Spirit were less likely to show signs of future conduct problems, anxiety, and depression. These children were also easier to soothe, slept better, ate healthier, and had a better chance of meeting emotional and behavioral milestones compared to children in the standard care group.

"We found a consistent pattern of success across a number of different outcome measures," said Dr. John Walkup, an adjunct professor at Johns Hopkins Bloomberg School of Public Health and a faculty member within the Center for American Indian Health. "These early years are critical ones for children. We teach these mothers not only how to be competent parents, but how to cope with stressors and other risk factors that could impede positive parenting skills."

Although this study was carried out using pregnant American Indian teens from the Southwest, researchers are confident their results can be replicated in other impoverished areas of the United States. A total of $1.5 billion in funding has been set aside by the Affordable Care Act for evidence-based home-visiting programs that benefit the health and development of at-risk children. The U.S. Department of Health and Human Services recently approved Family Spirit as an evidence-based program making it eligible for federal dollars.

"A key to the program's success is utilizing workers from the local community,” Barlow added. “We can grow the workforce in some of the poorest communities in the nation, where good jobs can be hard to come by. With focused training, people with little formal education but important life experiences and a passion to serve their communities can become change agents to overcome these very tough problems."

Source: Mullany B, Walkup J, Barlow A, et al. Paraprofessional-Delivered Home-Visiting Intervention from American Indian Teen Mothers and Children: 3-Year Outcomes From a Randomized Controlled Trial. American Journal of Psychiatry. 2014,