Growing in Beauty Sees Program and Families Prosper Through Continuous Quality Improvement

Several factors contribute to the success of the Tribal Home Visiting program at the Navajo Nation. Home visiting is a delicate field that combines human connection, early childhood teaching, and data, among other human elements. Some visitors may prefer spending quality time with families enrolled in the program (versus reviewing data trends and reports), but program enhancement involves a balance of emotional and technical skills.

Growing in Beauty (GIB) Home Visiting Team Leader Adrienne Benally took the helm with a skill set and expertise to enhance the home visiting initiative. One of her talents, implementing and promoting continuous quality improvement (CQI), has contributed to a steady improvement of program outcomes. Within an intentionally built culture that embraces a balance of cultural and mainstream teachings and practices, home visiting staff and the families they serve have thrived.

From the beginning, the program and its leadership established a system that allows the team to pursue constant improvement. First, leadership connected with the Wellington Consulting Group to provide support and understanding of the data. The decision to partner with the Wellington Consulting Group was based on their experience in working with Indigenous communities and having positive engagement within those communities.

Wellington assisted in building a program data system, which the home visiting team manages and maintains. Because of this, the program retains its data sovereignty, allowing easy access and engagement with data analysis, insights, and reporting. The team actively participates in data exploration, giving the program comprehensive, clean datasets for reporting. 

The GIB Home Visiting Team implements the Parents as Teachers model and serves Navajo prenatal mothers and families with young children from birth to 5 years of age. The program supports enrolled families during visits by incorporating traditional, cultural, and language practices. GIB is implemented under a grant from the Administration for Children and Families (ACF) Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) program.

Although not all Tribal Home Visiting program leaders are comfortable in the data realm, GIB Program Director Adrienne Benally came into her position with over a decade of experience working in early childhood and special education. This, along with CQI training through the Arizona Department of Health Services and the Tribal MIECHV program, prepared her to build a team culture where CQI is integrated into day-to-day operations. Adrienne brings a balance of emotional and technical skills to her team. Thanks to her expertise and leadership, the GIB staff are comfortable with, and have become champions of, the CQI process and its impact on program improvement. Furthermore, the GIB staff know that they can trust Adrienne to lead and support them through both the challenging and positive times. 

GIB staff are another key to quality Tribal Home Visiting. As community members, staff can relate to families through Diné kinship practices, which allow home visiting staff to connect with clients over shared relations, family connections, and community history. Even the name of GIB's home visiting model aligns with Diné beliefs. As Adrienne Benally reflected, “We work to gear parents to understand they are their children’s first teachers. In our cultural awareness of being Diné, we know—teaching comes from the home.”

Building on this, GIB’s CQI work begins at families’ homes: Staff use insights from

 home visits and the community to explore trends in program data and

 opportunities for improvement This has allowed GIB to firmly connect their work with families to program data. For example, while engaging in the Tribal MIECHV program's CQI Collaboratives, the team used feedback from families

and staff to develop posters with cultural resources for families. These posters helped parents integrate Diné cultural practices with early language and literacy activities, including reading, singing, and storytelling. 

More recently, the team developed posters to help parents better understand child development. After brainstorming, researching, and compiling resources, GIB staff created several informational posters, including one on the importance of conducting child development screenings. CQI cycle testing has included gathering parent feedback about the effectiveness of the posters and then adjusting poster components, including new resource links, and altering the design. Testing started small, with home visitors introducing the posters to only a few families, who provided feedback on the relevance of information, ease of access, and appropriateness of resource references. After successful adjustments through the CQI process, the posters are now available program-wide, helping GIB staff demonstrate the importance of child development education in parenting.

Through building trust and rapport with each other and the families that GIB serves, Adrienne and the home visiting team have built a culture of support and empowerment for themselves and client families. The team uses data and community connections to improve their approach to supporting caregivers to step into their roles as their children's first teachers. With the team constantly striving for improvement and quality family outcomes, the GIB program and its CQI initiative have grown alongside the families served.

For more information about the GIP program, contact Adrienne Benally, GIB Program Director, at adriennebenally@nndode.org. 

ACF's Tribal MIECHV program awards grants to tribal entities to develop, implement, and evaluate home visiting programs in American Indian and Alaska Native (AIAN) communities. The grants help build and strengthen tribal capacity to support and promote the health and well-being of AIAN families, expand the evidence base around home visiting in tribal communities, and support and strengthen cooperation and linkages between programs that serve tribal children and their families. Find out more about the Tribal Home Visiting program and grantees.