DISCOVERING FRUGAL INNOVATIONS THROUGH DELIVERING EARLY CHILDHOOD HOME-VISITING INTERVENTIONS IN LOW-RESOURCE TRIBAL COMMUNITIES

Abstract

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.

Keywords: Hausbesuchs-Implementation; Mise en œuvre de visite à domicile; Stammesinnovationen; bajos recursos económicos; disparidades de salud; disparités en matière de santé; early childhood; frühe Kindheit; gesundheitliche Disparitäten; health disparities; home-visiting implementation; implementación de visitas a casa; innovaciones tribales; innovations tribales; low income; milieux défavorisés; niedriges Einkommen; petite enfance; temprana niñez; tribal innovations; تنفيذ الزيارات المنزلية ، الطفولة المبكرة ، الابتكارات القبلية ، انخفاض الدخل ، التفاوتات الصحية; 低所得; 低收入; 健康差距; 健康格差; 兒童早期; 家庭訪問の実施; 家訪實施; 早期児童期; 部族の革新; 部落創新.