Strengthening public health infrastructure to improve maternal and child health on the navajo nation

Improving maternal and child health outcomes is a global public health priority. A myriad of socio-economic factors on the Navajo Nation contribute to poor outcomes. Implementing a holistic, strengths-based approach is imperative to elevate the health of Navajo women, children, and families. At the IHS Four Corners Regional Health (FCRHC), which serves some of the most remote communities on the Navajo reservation, the Navajo Nation Community Health Representative (CHR) Outreach Program, in partnership with the FCRHC Community Health Department (Public Health Nurses and Health Promotion/Disease Prevention staff) and Johns Hopkins Center for American Indian Health, is implementing the Family Spirit Program, a rigorous and evidence-based maternal and child health home visiting program. The Family Spirit Program was designed specifically for and with Native American communities. The program uses a family strengthening approach and is culturally tailored to reflect traditional beliefs and practices. Health educators use a curriculum designed to be taught sequentially or independently, and conduct home visits any time between 28 weeks gestation until the child's third birthday. Anticipated health outcomes, based on previous Family Spirit research trials, include reduced maternal depression, increased maternal knowledge and engagement, increased parent self-efficacy, and fewer behavioral problems in infants. IHS Community Health staff and Navajo Nation CHRs will describe implementation and evaluation of the Family Spirit Program at the FCRHC and discuss how this unique IHS/CHR collaboration can serve as a model for promoting equity and strengthening public health infrastructure, capacity, and integration of community and clinic-based services.