Development of a culturally enhanced caregiver-facilitated language nutrition intervention "+Language is Medicine" to address developmental delay in Diné (Navajo) toddlers.

Introduction: Developmental Delay (DD) is highly common in American Indian and Alaska Native (AI/AN; Indigenous) toddlers and leads to high numbers of AI/AN children who eventually need special education services. AI/AN children are 2.89 times more likely to receive special education compared to other children in the U.S., yet developmental disorders are more frequently under diagnosed and untreated in AI/AN infants and toddlers. DD, which can be identified as early as toddlerhood, can lead to negative impacts on developmental trajectories, school readiness, and long-term health. Signs of DD can be identified early with proper developmental screening and remediated with high quality early intervention that includes effective parent training. There are many evidence-based language facilitation interventions often used in Early Intervention programs. However, in communities in rural parts of the Navajo Nation where there are limited services and resources, infants and toddlers with early signs of DD are often missed and do not get the culturally responsive support and evidence-based intervention they deserve. Methods: The community-based +Language is Medicine (+LiM) study team partnered with tribal home visitors, community members, and a Diné linguist/elder using a collaborative virtual workgroup approach in 2021 and 2022 to present the +LiM pilot study aims and to discuss strategies for enhancing a language intervention for toddlers experiencing DD in their tribal community. This paper will detail the stages of community engagement, intervention enhancement and preparation for field testing of the +LiM intervention to address elevated rates of DD in toddlers in the Northern Agency of the Navajo Nation. Results: Two major outcomes from this collaborative workgroup included: (1) a team-initiated redefining of language nutrition to align with Indigenous values that center cultural connectedness and native language use and (2) a five-lesson caregiver-facilitated curriculum titled +Language is Medicine which includes caregiver lessons on language nutrition, language facilitation, shared book reading, pretend play, and incorporation of native language into home routines. These two workgroup outcomes were leveraged to develop a pilot pre-/post-intervention study to test the effectiveness of the +LiM intervention with caregiver-toddler dyads living on the Navajo Nation. Discussion: Delivering tailored child interventions through tribal home visiting are cost-effective and innovative methods for reaching reservation-based families who benefit from culturally responsive parent coaching and instruction. The +LiM team has applied a precision tribal home visiting approach to enhance methods of early intervention for children with DD. Our enhancement process was grounded in Indigenous community-based participatory research that centered culture and language.

Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation During COVID-19.

BACKGROUND: Despite historical and contemporary trauma, American Indian and Alaska Native (AIAN; Indigenous) communities responded with resilience to the COVID-19 pandemic. However, AIANs experienced disproportionate rates of infection, hospitalization, death, and reduced life expectancy. School closures exacerbated disparities, leading to learning loss, economic instability, and mental health challenges among AIAN youth. METHODS: The Project SafeSchools cohort study employed a comprehensive longitudinal convergent mixed-methods approach, integrating community-based participatory research principles. The study enrolled Navajo Nation caregivers whose children were eligible to attend local reservation-based schools. We conducted an analysis of caregiver self-report baseline data collected between August 2021 and May 2022. RESULTS: A total of 242 caregivers completed at least part of the baseline assessment and were included in data analysis. Caregivers were primarily female (88.7%), non-Hispanic (97%), and Indigenous (97%). Most caregivers were in their late 30s (mean age 38), with varying educational backgrounds and employment statuses. Children were evenly split between males and females and distributed across different age groups. Most children attended school at baseline in various formats, including in-person, hybrid, and online-only settings. Caregivers reported a range of psychosocial and behavioral risks, including general mental distress, depressive symptoms, and anxiety for themselves and their children. Furthermore, caregivers and children exhibited various protective factors, such as strong cultural identity, resilience, and academic self-efficacy. CONCLUSIONS: This study highlights the higher rates of mental health distress among participating caregivers and children compared to national averages. Despite these challenges, cultural protective factors remained strong and should guide future crisis response efforts.

Social-Ecological Resilience of Indigenous Adolescents in the United States and Canada: A Situation-Specific Nursing Theory.

For the past decade, resilience research with American Indian/Alaska Native and First Nations/Métis/Inuit adolescents has improved our understanding of how adolescents overcome mental health challenges. A new situation-specific theory is presented to guide nurses in applying the evidence to their practice with Indigenous adolescents in the United States and Canada. The social-ecological resilience of indigenous adolescents (SERIA) theory was derived from integrating ( a ) existing social-ecological frameworks by Bronfenbrenner, Ungar, and Burnette and Figley, ( b ) findings from a systematic review of 78 studies about resilience factors for mental health of Indigenous adolescents, ( c ) clinical experience, and ( d ) Indigenous knowledge.

Summarizing Implementation Support for School-Based COVID-19 Testing Programs in Southwest American Indian Communities.

CONTEXT: American Indian communities have been disproportionately affected by the COVID-19 pandemic, with school closures exacerbating health and education disparities. PROGRAM: Project SafeSchools' COVID-19 school-based testing program utilized federal and state funding to provide weekly pooled testing with follow-up rapid antigen testing to students and staff from the White Mountain Apache Tribe and Navajo Nation. IMPLEMENTATION: The project provided partner schools with training and continual logistical and technical support to aid in school-based testing and adherence to state and local reporting requirements. EVALUATION: Using the EPIS (Exploration, Preparation, Implementation, and Sustainment) framework, we identified facilitators and barriers to successful program function. While community support and buy-in were essential for successfully implementing school-based testing in these communities, communication, school staff turnover, and funding are among the most significant challenges. DISCUSSION: Community partnerships in American Indian communities involving schools and local health authorities can successfully implement testing protocols by remaining flexible and working together to maintain strong lines of communication.

Common Data Element Collection in Underserved School Communities: Challenges and Recommendations.

OBJECTIVES: To provide recommendations for future common data element (CDE) development and collection that increases community partnership, harmonizes data interpretation, and continues to reduce barriers of mistrust between researchers and underserved communities. METHODS: We conducted a cross-sectional qualitative and quantitative evaluation of mandatory CDE collection among Rapid Acceleration of Diagnostics-Underserved Populations Return to School project teams with various priority populations and geographic locations in the United States to: (1) compare racial and ethnic representativeness of participants completing CDE questions relative to participants enrolled in project-level testing initiatives and (2) identify the amount of missing CDE data by CDE domain. Additionally, we conducted analyses stratified by aim-level variables characterizing CDE collection strategies. RESULTS: There were 15 study aims reported across the 13 participating Return to School projects, of which 7 (47%) were structured so that CDEs were fully uncoupled from the testing initiative, 4 (27%) were fully coupled, and 4 (27%) were partially coupled. In 9 (60%) study aims, participant incentives were provided in the form of monetary compensation. Most project teams modified CDE questions (8/13; 62%) to fit their population. Across all 13 projects, there was minimal variation in the racial and ethnic distribution of CDE survey participants from those who participated in testing; however, fully uncoupling CDE questions from testing increased the proportion of Black and Hispanic individuals participating in both initiatives. CONCLUSIONS: Collaboration with underrepresented populations from the early study design process may improve interest and participation in CDE collection efforts.

Interpreting Diné Epistemologies and Decolonization to Improve Language and Literacy Instruction for Diné Children.

PURPOSE: Culturally responsive teaching (CRT) is a recurring topic in preservice teacher and special education personnel training, especially as academic institutions work to implement anti-racist and anti-oppressive teaching pedagogies. These methods of instruction, specifically in the areas of language and literacy, can be implemented by programs that understand the needs of the Indigenous students that their trainees or students will eventually serve. Academic institutions must transform their teaching and mentoring approach to better prepare educators and clinicians who engage with Indigenous communities. METHOD: This tutorial includes a critical review and will focus on the Diné traditional perspectives of Sa'ah Naagháí Bik'eh Hózhóón (SNBH), as it applies to the educational experiences of Diné students. The principle, which represents the process of lifelong learning and reflection, will be used as a model for how Indigenous epistemologies can be used within a decolonized educational philosophy, Red Pedagogy, to improve language and literacy instruction for young Indigenous children. RESULTS: American Indian (AIs; Indigenous) students start school with unique heritages and diverse learning experiences that influence their learning styles. Often, the formal Western education experience beginning in early childhood and elementary program provides a cultural shock to young AI students, whose learning experiences are centered on oral storytelling, experiential and collective learning, and land-based experiences. As methods of CRT evolve and more AI professionals lead educational research, the Indigenization of teaching pedagogies is amplified. More importantly, the prioritization of Indigenous knowledge systems, including methods of teaching, is being centered as strategies toward decolonization of learning spaces. DISCUSSION: The SNBH principle, which represents the process of lifelong learning and reflection, is a model for how Indigenous epistemologies can be used within a decolonized educational philosophy, Red Pedagogy, to improve language and literacy instruction for young Indigenous children.

Prioritizing Connectedness and Equity in Speech-Language Services for American Indian and Alaska Native Children.

PURPOSE: American Indian and Alaska Native (AI/AN; Indigenous) students are at a high risk for language and learning disorders. This article aims to highlight how clinicians can use decolonization and Indigenization pedagogies when planning and delivering speech-language services to Indigenous students from the perspectives of Indigenous professionals. These efforts can help promote student resilience, well-being, and identity and are critical to addressing educational inequity and provide culturally responsive services to Indigenous children. Many AI/AN students receive IDEA Part B special education services including speech and language therapy. Many of these students are misidentified as needing special education due to unique learning and language environments (Soto-Boykin et al., 2021). These students bring a unique cultural heritage that is vital to their identity, well-being, health, and school success. Therefore, the goal should be to provide evidence-based services that are culturally tailored and meet the whole child. Using a precision public health approach to consider social determinants of health and historical trauma allows for leveraging of a multilayered, trauma-informed approach to addressing educational inequities. CONCLUSIONS: An Indigenous connectedness framework can be used to indicate how connectedness is essential to AI/AN child well-being. This framework can be interlaced with existing learning theories to shape instruction where indigenization is a cornerstone of learning. Further examined was the influence of historical trauma, racism, socioeconomic status, and culture loss on learning and language development in AI/AN children in the context of settler colonialism. Strategies on how to use Indigenous knowledge and evidence-based teaching practices were applied to therapeutic services offered by speech-language pathologists and educators.

An Updated Systematic Review of Risk and Protective Factors Related to the Resilience and Well-Being of Indigenous Youth in the United States and Canada.

Indigenous youth in North America experience mental health inequities compared to White peers, including a higher prevalence of depression, anxiety, suicide, and substance use. This systematic review of culturally specific risk and protective factors related to resilience and mental health in Indigenous youth aimed to synthesize the recent evidence and update a systematic review of evidence prior to 2013 (Burnette and Figley, 2016). Following PRISMA guidelines, seven academic databases were searched for peer-reviewed qualitative and quantitative resilience research with Indigenous youth (age 19 and under) in the United States and Canada published from 2014 to 2021. Seventy-eight studies met inclusion criteria and provided ample knowledge about risk and protective factors for the resilience of Indigenous youth across the Social Ecology of Resilience theory: individual (86%), family (53%), community (60%), cultural (50%), and societal (19%). A plethora of recent interventions serve as examples of context and culture-specific responses to the mental health needs of Indigenous youth. Further attention to younger children, urban populations, and Indigenous knowledge systems is needed. In particular, the influence of racism, settler colonialism, and cultural resurgence efforts on the well-being of Indigenous youth are areas for future research.

Measuring the effects of the COVID-19 pandemic on Diné and White Mountain Apache school personnel, families, and students: protocol for a prospective longitudinal cohort study.

BACKGROUND: This paper describes the protocol for a longitudinal cohort study, "Project SafeSchools" (PSS), which focuses on measuring the effects of COVID-19 and the return to in-person learning on Diné (Navajo) and White Mountain Apache (Apache) youth, parents, and educators. The early surges of the COVID-19 pandemic led to the closure of most reservation and border town schools serving Diné and Apache communities. This study aims to: (1) understand the barriers and facilitators to school re-opening and in-person school attendance from the perspective of multiple stakeholders in Diné and Apache communities; and (2) evaluate the educational, social, emotional, physical, and mental health impacts of returning to in-person learning for caregivers and youth ages 4-16 who reside or work on the Diné Nation and the White Mountain Apache Tribal lands. METHODS: We aim to recruit up to N = 200 primary caregivers of Diné and Apache youth ages 4-16 and up to N = 120 school personnel. In addition, up to n = 120 of these primary caregivers and their children, ages 11-16, will be selected to participate in qualitative interviews to learn more about the effects of the pandemic on their health and wellbeing. Data from caregiver and school personnel participants will be collected in three waves via self-report surveys that measure COVID-19 related behaviors and attitudes, mental health, educational attitudes, and cultural practices and beliefs for both themselves and their child (caregiver participants only). We hypothesize that an individual's engagement with a variety of cultural activities during school closures and as school re-opened will have a protective effect on adult and youth mental health as they return to in-person learning. DISCUSSION: The results of this study will inform the development or implementation of preventative interventions that may help Diné and Apache youth and their families recover from the negative impact of the COVID-19 pandemic, and positively impact their health and wellness.