Evidence-Based Home Visiting Models Promote Early Brain Development in American Indian and Alaska Native Communities

July 26, 2018|11:35 a.m.| Community Health and Prevention Team

A child’s earliest experiences influence the brain’s developing architecture. Exposure to adversity during the early years can lead to long-term, negative outcomes later in life. Nurturing environments and strong caregiver-child relationships can buffer the consequences of poor early brain development stemming from adverse childhood experiences (ACEs) and toxic stress. Home visiting programs promote early childhood health and development by fostering these positive, interactive relationships which can go a long way toward both preventing child abuse and neglect and supporting early learning and school readiness. Although genetics and the environment are factors in determining a child’s health and developmental outcomes, strengthening the capacity of parents and caregivers to provide appropriate care and support is fundamental to helping children thrive and achieve lifelong health and wellness.

Poverty, crime, high school dropout rates, and substance use and addiction are among the challenges that characterize environments in which children may fail to thrive, due in part to exposure to ACEs. For example, children in American Indian and Alaska Native (AIAN) communities disproportionately experience ACEs and toxic stress compared to non-Hispanic, white children. More frequent ACEs in early childhood that go unmitigated by supportive relationships with caregivers are associated with more health problems later in life. In addition to the physical health implications, AIAN children who experience ACEs are more likely to be diagnosed with emotional and developmental conditions and may exhibit poor behavior and encounter problems at school, such as advancing to the next grade on time.

One way states and territories can address ACEs and toxic stress exposure among AIANs is by adopting evidence-based home visiting programs that reflect the specific cultural values of the communities they are serving to reach them most effectively. 

The Family Spirit model, for example, supports young AIAN parents and children from pregnancy to age three. The program is designed to address behavioral health disparities by targeting AIAN teen mothers. To improve early childhood emotional and behavioral outcomes, it focuses on child development, school readiness, and positive parenting practices. Evaluation data indicates the Family Spirit home visiting model has a positive effect on strengthening caregiver-child relationships and has been shown to improve measures related to maternal depression and substance abuse. Presently, 19 states are implementing the Family Spirit home visiting model, helping parents in AIAN communities gain the knowledge and skills to raise healthy children. 

State and territorial health departments can also consider adapting the program’s model to serve other communities. For example, New Mexico’s Tiwa Babies home visiting program provides services to the Taos Pueblo and Taos County communities and is based on the Family Spirit model. Tiwa Babies promotes healthy child development by incorporating tradition and culture into the home visiting program. Services include child development screening, cooking classes, parenting classes, as well as other resources and tools to promote healthy family and child development. Trained family health educators from the community provide home visits to families, including lessons based on the Family Spirit curriculum, and offer social and emotional support for parents and caregivers.

Another example of an evidence-based home visiting program that has been implemented in Tribal settings is Parents as Teachers. Parents as Teachers encourages the development of healthy AIAN populations by providing parenting education and building family support and protective factors. The program focuses on positive parent-child interaction, development-centered parentings, and overall family well-being. Outcomes of this program include positive development and school readiness, reductions in child maltreatment, and improvements in positive parenting practices. Tribal organizations can receive grants to implement Parents as Teachers from the Tribal Maternal, Infant, Early Childhood Home Visiting Program. Currently, Parents as Teachers provides services to Native communities throughout ten states with 20 different tribes in 70 tribal communities. A unique feature of Parents as Teachers is that American Indian organizations and Tribes can structure their programs to adapt to the needs of their communities. Parents as Teachers is another promising high-quality, culturally relevant home visiting strategy for AIAN communities. 

States, territories, and tribal entities can strengthen families and improve early child and brain development outcomes by creating home visiting programs tailored to each community’s unique needs. ASTHO’s primer explores how states are strengthening home visiting programs to improve maternal and child health and well-being. This upstream prevention strategy can limit exposure to risk factors while simultaneously promoting protective factors against ACEs and toxic stress. Home visiting programs present an opportunity to intervene early in the life course to promote healthy early child and brain development.


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