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Home visits help strengthen maternal, infant health in Native American communities

Posted: October 10, 2017

A baby's first laugh, in Navajo culture, is cause for formal celebration. Whoever provokes that milestone moment wins the privilege of hosting a "first laugh ceremony" to mark the infant's full arrival into the earthly world. "That laugh sounds to the world, 'This is me and this is who I am,'" says Crystal Kee, a Navajo health educator based in Chinle, Arizona. Though the tradition is unique to the Navajo, Kee finds it resonates across a variety of American Indian communities that take part in Family Spirit, a home-visiting program that supports maternal and infant health. "There is a thirst for some connection to the culture, and the ways our ancestors and people have always thought," says Kee, who works as a training and implementation manager for Family Spirit.

The program was designed both for and by Native tribal communities. It grew out of the Johns Hopkins Center for American Indian Health in the mid-1990s, when program leaders began working in partnership with the Navajo Nation and White Mountain Apache and San Carlos Apache tribes. Today Family Spirit is active in more than 100 tribal communities across 16 states, with the Hopkins center—part of the Bloomberg School of Public Health—disseminating the model to affiliate health centers and organizations.

The program trains people from the local community to deliver regular one-on-one home visits to mothers (and often fathers, too) from pregnancy through the first three years of the child's life. The general goal is to share best practices for parenting and early childhood health, covering topics like budgeting and breastfeeding. But because the program is so personalized, it often wades into deeper issues the families are facing, such as employment challenges or drug abuse. Kee notes that opioid and methamphetamine problems are on the rise for tribal communities, requiring "patience and care" from Family Spirit home visitors while they "remain neutral." And since many participants in Family Spirit are still in their teens and early 20s, the program often grapples with the risks and complexities of parenting at a young age.

With evidence showing successful outcomes—including decreases in depression and emotional problems for mothers, and reduced behavioral problems for their children—Family Spirit has expanded over the years beyond its initial rural settings in Arizona and New Mexico. It's now used in several urban communities with American Indian populations, including in Oakland, California, and Oklahoma City.

Beyond that, the program is showing promise even for non-tribal communities—an adapted model has served low-income, predominantly black or Latino populations at sites in St. Louis and Chicago, according to Kee. "We get a lot of requests for translating the curriculum into Spanish," she says.

In addition to reaching out to other populations, Nicole Neault, a field manager for Family Spirit, says future directions may include digitizing the curriculum and continuing to build an offshoot model, Family Spirit Nurture, that targets childhood obesity.

Learn more at HUB, Johns Hopkins University's news center.

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