TY - JOUR
T1 - DISCOVERING FRUGAL INNOVATIONS THROUGH DELIVERING EARLY CHILDHOOD HOME-VISITING INTERVENTIONS IN LOW-RESOURCE TRIBAL COMMUNITIES
AU - Barlow, Allison
AU - McDaniel, Judy A.
AU - Marfani, Farha
AU - Lowe, Anne
AU - Keplinger, Cassie
AU - Beltangady, Moushumi
AU - Goklish, Novalene
N1 - Funding Information:
Our work in the conceptualization, design, and drafting authors of this article was supported by Administration for Children and Families cooperative agreements to the University of Colorado-Denver (Grant 90PH0017), Choctaw Nation of Oklahoma (Grant 90TH0010-04), Native American Health Center, Inc. (Grant 90TH0015), and Kodiak Area Native Association (Grant 90TH0013). This article was approved by the relevant review boards of the Choctaw Nation of Oklahoma, the Native American Health Center, Inc., the Kodiak Area Native Association, and the White Mountain Apache Tribe. We declare no conflicts of interest. The views expressed in this publication do not necessarily reflect the views or policies of the Office of Planning, Research and Evaluation, the Administration for Children and Families, or the U.S. Department of Health & Human Services. We thank ourr fellow program team members, respective tribal leaders, and community stakeholders, and most important—the American Indian and Alaska Native parents, children, and community-based home visitors whose time, wisdom, and shared experiences informed the findings synthesized in this article.
Publisher Copyright:
© 2018 Michigan Association for Infant Mental Health
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Early childhood home-visiting has been shown to yield the greatest impact for the lowest income, highest disparity families. Yet, poor communities generally experience fractured systems of care, a paucity of providers, and limited resources to deliver intensive home-visiting models to families who stand to benefit most. This article explores lessons emerging from the recent Tribal Maternal and Infant Early Childhood Home Visiting (MIECHV) legislation supporting delivery of home-visiting interventions in low-income, hard-to-reach American Indian and Alaska Native communities. We draw experience from four diverse tribal communities that participated in the Tribal MIECHV Program and overcame socioeconomic, geographic, and structural challenges that called for both early childhood home-visiting services and increased the difficulty of delivery. Key innovations are described, including unique community engagement, recruitment and retention strategies, expanded case management roles of home visitors to overcome fragmented care systems, contextual demands for employing paraprofessional home visitors, and practical advances toward streamlined evaluation approaches. We draw on the concept of “frugal innovation” to explain how the experience of Tribal MIECHV participation has led to more efficient, effective, and culturally informed early childhood home-visiting service delivery, with lessons for future dissemination to underserved communities in the United States and abroad.
AB - Early childhood home-visiting has been shown to yield the greatest impact for the lowest income, highest disparity families. Yet, poor communities generally experience fractured systems of care, a paucity of providers, and limited resources to deliver intensive home-visiting models to families who stand to benefit most. This article explores lessons emerging from the recent Tribal Maternal and Infant Early Childhood Home Visiting (MIECHV) legislation supporting delivery of home-visiting interventions in low-income, hard-to-reach American Indian and Alaska Native communities. We draw experience from four diverse tribal communities that participated in the Tribal MIECHV Program and overcame socioeconomic, geographic, and structural challenges that called for both early childhood home-visiting services and increased the difficulty of delivery. Key innovations are described, including unique community engagement, recruitment and retention strategies, expanded case management roles of home visitors to overcome fragmented care systems, contextual demands for employing paraprofessional home visitors, and practical advances toward streamlined evaluation approaches. We draw on the concept of “frugal innovation” to explain how the experience of Tribal MIECHV participation has led to more efficient, effective, and culturally informed early childhood home-visiting service delivery, with lessons for future dissemination to underserved communities in the United States and abroad.
KW - Hausbesuchs-Implementation
KW - Mise en œuvre de visite à domicile
KW - Stammesinnovationen
KW - bajos recursos económicos
KW - disparidades de salud
KW - disparités en matière de santé
KW - early childhood
KW - frühe Kindheit
KW - gesundheitliche Disparitäten
KW - health disparities
KW - home-visiting implementation
KW - implementación de visitas a casa
KW - innovaciones tribales
KW - innovations tribales
KW - low income
KW - milieux défavorisés
KW - niedriges Einkommen
KW - petite enfance
KW - temprana niñez
KW - tribal innovations
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U2 - 10.1002/imhj.21711
DO - 10.1002/imhj.21711
M3 - Article
C2 - 29800487
AN - SCOPUS:85047624920
SN - 0163-9641
VL - 39
SP - 276
EP - 286
JO - Infant Mental Health Journal
JF - Infant Mental Health Journal
IS - 3
ER -