Home Visiting in Tribal Communities: Using the OPRE Review

1. Home Visiting in Tribal Communities: Using the OPRE Review One Sky Center R. Dale Walker, MD Douglas A. Bigelow, PhD 19 February 2011

2. Outline • Frameworks for use in planning • Logic model details • Cultural appropriateness criteria • Intervention details • Creating, operating a planning coalition Using the OPRE Review

3. Developing a Community-Driven Best Practice Goal: An evidence-informed, community-driven program Coalition Criteria Logic Model • Community Assessment & Planning Process: • Cultural Validity • Evidence-informed program design Using the OPRE Review

4. Best Practice includes Culture Using the OPRE Review

5. Culture • Philosophies • Belief about causes of problems and solutions • Local innovation, trial and error • Medicinal use of wild plants and minerals • Healing procedures • Oral transmission of knowledge • Community evaluation and acceptance Practice (Service) Best Practice Science & Scholarship Using the OPRE Review

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12. Logic Model 8. Long term (Impact) 7. Medium term 6. Short term 5. Operations Manual 4. Theory of Change 3. Strategy Using the OPRE Review

13. 1. Causes Problem Causes Parenting role performance Family strength/dysfunction External factors • Injury • Lack of development • Not ready for school Using the OPRE Review

14. 1. Causes Goals Parent Child Cognitive & emotional development Health School readiness (ameliorated developmental delays, if any) • Delivery (birth) • Parenting knowledge • (of child development) • Parenting skills • Non-abuse • Non-neglect Using the OPRE Review

15. 2. Target Population • Kids are the TP • Abused kids • Neglected kids • Developmental deficiency (re school) • Physical • Cognitive • Emotional Using the OPRE Review

16. 3. Intervention Strategy • In home (“place-based”) • Trained Peer-parents • Professional staff • (RNs; MSWs) • Links to resources • Navigate and access • Parent needs • Counseling • Problem-solving • Access to resources • Income; education; employment; treatment • Context-specific needs • Culture • Family dynamics • Employment • Neighborhood Using the OPRE Review

17. 3. Strategy: Visits • Content (visit) • Frequency/intensity • One per week • Duration • 3 months to 2 years Using the OPRE Review

18. 4. Theory of Change • Place-based • Staff characteristics • Local context and culture Using the OPRE Review

19. Intervention: Criteria for Cultural Validity • Longevity • Teachings (based on) • Values (based on; incorporated) • Principles (based on; incorporated) • Elder’s approval • Community feedback/evaluation/acceptance • Contribution to advancement of the people Using the OPRE Review

20. Intervention: Activities • Experience, observation, listening, participating • Traditions, ceremonies, daily observances • Stories, songs, artwork • Oral, modeling, practice, animation • Language, worldview, teachings, experience Using the OPRE Review

21. Intervention: Materials • Settings • Dress; Regalia • Symbols; Graphics; Pictures • Sensory Substances • Food • Fun Using the OPRE Review

22. Intervention:Personnel • Enthusiasm • Confidence • Caring, compassion • Vision, knowledge • Charisma • Credibility • Community status • Peer group status Using the OPRE Review

23. 5. Program Manual • Intervention activities • Materials • Personnel characteristics • Training and supervision • Detailed procedures • Process milestones • Short-term outcomes • Long-term outcomes Using the OPRE Review

24. 6. Short-term Outcomes • Parents’ knowledge • Parents’ attitudes (incl. bonding) • Parents’ skills/performance • Child health Using the OPRE Review

25. 7. Medium-term Outcomes • Child development • Child school readiness • Child school performance • Child health and thriving • Family strength and function Using the OPRE Review

26. 8. Long-term Outcomes • Parental health and thriving • School enrollment, retention, achievement, and graduation rates • Non-delinquency • Child-as-adult Employment Using the OPRE Review

27. Create a Coalition • Agreed-upon goals • Vision & mission statements • Action plan • Structure for the coalition • Identify need for specialists • Resources (coalition ideas from the University of Kansas Community Tool Box http://ctb.ku.edu) Using the OPRE Review

28. Coalition Rules • Open communication • Inclusive & participatory • Constant networking • Achievable goals • Creative meetings • Keep promises • Acknowledge and use the diversity of the group Using the OPRE Review

29. Coalition • Train leaders in all sectors that have the vision, commitment, and respect necessary to lead a collaborative. • Identify a facilitator to bring the different groups together. • Find the information necessary to understand issues and possible solutions. • Promote community empowerment. • Identify the stakeholders. • Make a commitment to collaborate. • Establish procedural ground rules. • Teach potential participants process skills. • Build trust, learned process skills, and explored beliefs. • Identify problems. • Clarify a vision and develop a mission statement. • Keep the process open and get input from community members. • Create options for solving problems. • Formulate goals, objectives, and an action plan. • Implement the action plan. • Evaluate the results. • Celebrate every success, large and small Using the OPRE Review

30. Action Plan (Coalition) • Who, what, when action plan • Resource plan • Communication plan • (who should know what?) • Ensure follow through on plan • Keep track of progress • Keep everyone informed • Celebrate Using the OPRE Review

31. Contact us at Contact us at 503-494-3703 E-mail Dale Walker, MD onesky@ohsu.edu Or visit Contact us at 503-494-3703