Adding a Precision Approach to Culturally Informed Home Visiting

With sup­port from the Annie E. Casey Foun­da­tion, the Johns Hop­kins Cen­ter for Amer­i­can Indi­an Health has devel­oped a web-based sup­port plat­form designed to help an evi­dence-based mater­nal home-vis­it­ing pro­gram more quick­ly and pre­cise­ly iden­ti­fy what young Native Amer­i­can moth­ers need.

Estab­lished at the Cen­ter for Amer­i­can Indi­an Health more than 20 years ago, Fam­i­ly Spir­it has been repli­cat­ed in more than 120 Native Amer­i­can com­mu­ni­ties across the Unit­ed States. The pro­gram has proven effec­tive in build­ing par­ent­ing skills, reduc­ing moth­ers’ sub­stance use and depres­sion and help­ing chil­dren reach devel­op­men­tal mile­stones. The ingre­di­ents for suc­cess: com­bin­ing para­pro­fes­sion­al home vis­i­tors from the com­mu­ni­ty with a cur­ricu­lum that focus­es on strengths and culture.

Casey’s goal in fund­ing the adap­ta­tion: Equip­ping home vis­i­tors to cus­tomize the pro­gram even more, and get the right ser­vices to fam­i­lies more quick­ly, while fol­low­ing the suc­cess­ful model.

“The ques­tion is: How can a cur­ricu­lum-based pro­gram, itself an inno­va­tion, be fur­ther inno­vat­ed to respond to moms’ emer­gent needs in real time?” says Cyn­thia Weaver, a senior asso­ciate with Casey’s Evi­dence-Based Prac­tice Group.

In the new ver­sion of the pro­gram, for exam­ple, a home vis­i­tor would be able to enter a mother’s con­cerns about her child’s nutri­tion into the sup­port plat­form, called Care4, and imme­di­ate­ly receive sug­ges­tions for lessons on nutri­tion that could be added to the mother’s care plan. The plat­form will also col­lect con­tin­u­ous infor­ma­tion on how indi­vid­ual clients are doing over the course of the pro­gram so that home vis­i­tors and their super­vi­sors can bet­ter address their needs.

The com­pre­hen­sive cur­ricu­lum cov­ers top­ics on infant and tod­dler care and devel­op­ment, as well as health and well-being for moth­ers and whole fam­i­lies. It incor­po­rates trib­al teach­ings and prac­tices, includ­ing infor­ma­tion about tra­di­tion­al cer­e­monies relat­ed to preg­nan­cy and chil­drea­r­ing and work­shops on tech­niques such as cradle­boards, an indige­nous baby-car­ry­ing method. Fam­i­ly Spirit’s strengths-based approach has allowed the mod­el to move eas­i­ly into non-Native com­mu­ni­ties that also rec­og­nize the impor­tance of revi­tal­iz­ing and pro­tect­ing cul­tur­al teach­ings and practices.

In 2019, the Cen­ter for Amer­i­can Indi­an Health will con­duct a pilot study to com­pare the adapt­ed approach for Fam­i­ly Spir­it to stan­dard Fam­i­ly Spir­it home vis­it­ing in mul­ti­ple trib­al sites in Michigan.

Learn more about Casey’s work adapt­ing evi­dence-based approaches