The Maternal, Infant, and Early Childhood Home Visiting program, established by the Affordable Care Act of 2010, allows collaboration and partnership at the federal, state, tribal, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs. The Health Resources and Services Administration administers grants to states and six jurisdictions to develop statewide home visiting programs. ACF provides grants to Tribes, Tribal Organizations, and Urban Indian Organizations to develop home visiting programs in Native communities.
ACF, via the Office of the Deputy Assistant Secretary for Early Childhood Development and the Office of Child Care, awarded 25 grants through the Tribal Maternal, Infant, and Early Childhood Home Visiting program. The grants are five-year awards to develop, implement, and evaluate high-quality, culturally relevant, evidence-based home visiting programs for pregnant women, expectant fathers, and young children age birth to 5 and their families in American Indian and Alaska Native (AIAN) communities.
Through a grant received in FY 2010, the Lake County Tribal Health Consortium (LCTHC) in California conducted a comprehensive community needs and readiness assessment in the local AIAN community. Lake County has a population of 66,000, with about five percent of AIAN descent. Most of the AIAN population is represented by 111 tribes, with the majority from six Pomo tribes, including four reservations called “Rancherias.” LCTHC is a consortium of the six tribes and offers medical, dental, public health, and human services, funded by Indian Health Service (IHS), county, state, and other federal grants including tribal home visiting through ACF.
LCTHC’s assessment revealed a wide range of strengths and challenges. The greatest challenges included:
- Alcohol and substance use
- Maternal depression
- Substance-exposed pregnancies and births
- Family violence
- Lack of school success
Many of these challenges can be linked to historical and inter-generational trauma experienced by the Native population — most recently the termination and forced relocation of the Pomo tribes in the latter part of the 20th century. Community members view the tribal home visiting program as an opportunity for hope and healing.
As a result of the needs assessment, LCTHC is implementing the Parent-Child Assistance Program (PCAP), a case management-based home visiting model with a focus on preventing substance-exposed pregnancies and births as well as Fetal Alcohol Spectrum Disorder. PCAP is adaptable and flexible to community needs and based on the relationship between the family advocate (home visitor) and the client. LCTHC has supplemented the PCAP with the Nurturing Parenting curriculum and has also incorporated cultural activities and teachings into their tribal home visiting program.
Since beginning home visiting services in June 2012, LCTHC has implemented comprehensive services for Native families who are pregnant and/or have children to age 5. LCTHC has built capacity for effective program implementation, including a more structured and comprehensive approach to service delivery, broader use of assessment, better data collection and management, greater use of continuous quality improvement approaches, and improved collaboration with community partners. LCTHC has already seen that their program is improving outcomes for children and families, including:
- Increase in rates of health insurance
- Increased well child visits and immunizations
- More pre-natal visits
- Increased use of medical and dental services
- Increased use of family planning methods
- Greater rates of GED and adult education enrollment
- Improved safety planning by families