Early childhood home‐visiting has been shown to yield the greatest impact for lowest income, vulnerable families. Yet, poor communities, facing socioeconomic, geographic, and structural challenges, often struggle to deliver these programs to families who stand to benefit most. A new article published in Infant Mental Health uncovers 40 adaptive and low-cost, or frugal, innovations developed by home-vising programs supported by the Tribal Maternal and Infant Early Childhood Home Visiting (MIECHV) legislation, which was recently re-authorized for five years by the U.S. Congress in the Bipartisan Budget Act of 2018.
Authors identified solutions from home-visiting work in four diverse tribal settings reflecting the diversity of lands, languages, cultures, population densities, governance, and societal structures that distinguish the more than 560 North American tribal populations: a tribal jurisdictional area (Choctaw Nation of Oklahoma); a rural reservation‐based tribe (White Mountain Apache Tribe in Arizona); six remote Alaska Native villages (Kodiak Area Native Association; and an urban Indian center in Oakland, California.
Authors use the concept of frugal innovations to explain how Tribal MIECHV-funded programs have developed more efficient, effective, and culturally informed early childhood home‐visiting services. Innovations encompass unique community engagement, recruitment and retention strategies, expanded case management roles of home visitors to overcome disorganized health care systems, task-shifting to paraprofessionals, and practical ways to evaluate impact. Video-conferencing, meeting in vehicles, engaging grandparents, and developing comprehensive safety protocols are among the 40 solutions discussed, with many lessons for other underserved communities in the United States and abroad.
“Discovering frugal innovations through delivering early childhood home‐visiting interventions in low‐resource tribal communities” was written by Allison Barlow, Judy A. McDaniel, Farha Marfani, Anne Lowe, Cassie Keplinger, Moushumi Beltangady, and Novalene Goklish. The first and last authors are faculty members of the Johns Hopkins Bloomberg School of Public Health.