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DISCOVERING FRUGAL INNOVATIONS THROUGH DELIVERING EARLY CHILDHOOD HOME‐VISITING INTERVENTIONS IN LOW‐RESOURCE TRIBAL COMMUNITIES
Author(s) -
Barlow Allison,
McDaniel Judy A.,
Marfani Farha,
Lowe Anne,
Keplinger Cassie,
Beltangady Moushumi,
Goklish Novalene
Publication year - 2018
Publication title -
infant mental health journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.693
H-Index - 75
eISSN - 1097-0355
pISSN - 0163-9641
DOI - 10.1002/imhj.21711
Subject(s) - psychological intervention , early childhood , service delivery framework , socioeconomic status , public relations , community engagement , resource (disambiguation) , service provider , nursing , medicine , business , service (business) , economic growth , psychology , political science , marketing , environmental health , population , developmental psychology , computer network , computer science , economics
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.