Evidence map›Paper›PMID 41749230›Full record

ArticleBMC public health2026

Testing the effectiveness of Family Spirit Strengths (FSS) - a culturally informed intervention designed to prevent mental health and substance misuse for indigenous families through home visiting.

Leonela Nelson, Laura Mata Lopez, Shannon Archuleta, Stephanie Skavenski Van Wyk, Elizabeth Kushman, Lisa Martin, Kristin Mitchell, Elizabeth Leffler, Timothy R Werwie, Christopher G Kemp and 2 more

Registry-linked trialAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05836090 (Family Spirit Strengths), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05836090 narecruitingnot on this map

Family Spirit Strengths

TypeinterventionalSponsorJohns Hopkins Bloomberg School of Public HealthRan2023 to 2028Enrolled188ConditionsDepressive Symptoms, Anxiety Disorders and Symptoms, Substance Use, Mental Health IssueArmsFamily Spirit Strengths (FSS), Family Spirit Nurture
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Leonela NelsonDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA.
Laura Mata LopezJohns Hopkins University School of Nursing, Baltimore, MD, USA.
Shannon ArchuletaDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA.
Stephanie Skavenski Van WykDepartment of Mental Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
Elizabeth KushmanDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA.
Lisa MartinDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA.
Kristin MitchellDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA.
Elizabeth LefflerPokagon Health Services, Pokagon Band of Potawatomi, Dowagiac, MI, USA.
Timothy R WerwieDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA.
Christopher G KempDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA.
Reese F CuddyDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA.
Emily E HarozDepartment of International Health, Johns Hopkins University Center for Indigenous Health, Bloomberg School of Public Health, Baltimore, MD, USA. eharoz1@jhu.edu.

Funding

Family Spirit Strengths: A home visiting strategy to support parents and caregivers with mental distress and substance misuseR01DA057913 · NIDA · JOHNS HOPKINS UNIVERSITY · PI Emily Haroz, Lisa Danielle Martin · 2023 to 2026
$2.4M
National Institute on Drug Abuse of the National Institutes of Health R01DA057913NIDA NIH HHS R01 DA057913
6 · The paper itself

Abstract

backgroundFamilies represent the foundation of health for many Indigenous communities. Yet, Indigenous women, particularly women of the age who are starting families, face profound challenges related to mental health and substance use. These challenges are rooted in historical trauma, ongoing discrimination, systemic racism, and chronic underfunding of mental health and substance use services, and result in significant gaps in access to care. Family-based home visiting has the potential to address multiple types of mental health and substance use concerns in a way that is more accessible and culturally acceptable. However, to date, there are no empirically supported family-based home visiting interventions designed to specifically to address these concerns in Indigenous communities. Family Spirit Strengths is a culturally tailored intervention developed to help fill this gap.

methodsThis study is a Hybrid Type I Effectiveness-Implementation randomized controlled trial with the primary goal is to test the effectiveness of Family Spirit Strengths (FSS) at reducing poor mental health days, symptoms of depression, anxiety, and substance use, among N = 188 primary caregivers across three diverse Tribal settings and contexts. Participants will be randomized 1:1 to receive FSS or a beneficial control, an evidence-based nutritional support program. FSS is a transdiagnostic secondary-prevention intervention that was adapted from the evidence-based Common Elements Treatment Approach. The FSS intervention consists of 4–16 lessons (average 6–8 lessons), tailored to participant needs, delivered weekly or bi-weekly by a trained home visitor. Primary outcomes will be measured 6–9 months post-enrollment. We will also seek to characterize heterogeneity and mechanisms of FSS effects by using mixed methods and exploring moderators and mediators of impact. We will also estimate FSS costs, cost-effectiveness, and budget impact. DISCUSSION: Serious mental health and substance use issues have long been challenges home visitors encounter with few tools to help, beyond screening and referral to clinical services, which are often hard to access if available at all. This has been particularly true when working with Indigenous families due to the profound mental health and substance use inequities they face. This trial will inform the evidence base for transdiagnostic interventions delivered through early childhood home visiting.

trial registrationNCT05836090; registered April 18, 2023.

Indexed as

House CallsIndians, North AmericanMental DisordersSubstance-Related DisordersCulturally Competent CareFamily SupportHumansRandomized Controlled Trials as TopicHome-visitingMaternal mental healthNative americanSubstance use prevention

Identifiers

PMID41749230
PMCPMC13041012

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.