Implementing Home Visiting in Native Communities: A Report from the Multi-site Implementation Evaluation of Home Visiting

The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides funding to Tribes and Tribal organizations to develop, implement, and evaluate evidence-based home visiting services that promote the health and well-being of American Indian and Alaska Native (AIAN) families, strengthen early childhood systems, and expand the evidence base for home visiting in AIAN communities. Although home visiting implementation has been the focus of prior studies, little is known about how evidence-based home visiting models are implemented in Native communities.

MUSE was designed to describe how Tribal MIECHV grant recipients implemented their programs across varied Native community contexts and to identify factors contributing to successful program implementation. MUSE is the first multi-site, multi-model study of home visiting in Native communities and used a mixed-methods, community-engaged approach. 

This report shares results and implications from the Multi-Site Implementation Evaluation of Tribal Home Visiting (MUSE), with a primary focus on how Tribal MIECHV grant recipients implemented their programs and, to a lesser extent, the supports and challenges related to implementation. The report describes implementation across 17 Tribal MIECHV programs and highlights practices and experiences that can inform communities developing, enhancing, or sustaining home visiting services.

• Tribal MIECHV programs successfully reached AIAN caregivers. During the MUSE data collection period from June 2019 to December 2021, half of caregivers were pregnant when they enrolled, and four-fifths had one or more children, with an average of 2.3 children under age 5. Most caregivers lived with a partner and/or other family members. Caregivers generally entered programs with high levels of social support and confidence in their parenting abilities.
• Caregivers reported positive experiences with Tribal MIECHV services. Caregivers were generally satisfied with how often visits occurred and how long they lasted. They particularly valued support related to parenting.
• Home visitors tailored services to families’ needs and circumstances. Home visitors spent the most time providing emotional support and delivering curriculum content. Child development, parent-child interaction, and caregiver stress and well-being were frequent topics during visits.
• Cultural and shared experiences supported relationships between home visitors and caregivers. Shared background and knowledge of cultural norms, language, and context benefited home visitor-caregiver relationships. Shared experiences as parents also fostered mutual respect.
• Home visitors felt confident and connected to the communities they served. Home visitors reported high levels of confidence in their ability to carry out a range of activities during visits and address diverse topics with families. They viewed their work within their communities as valuable and meaningful, and commitment to serving one’s community may help guard against burnout.

MUSE employed a mixed-methods approach, collecting survey, interview, and administrative data from caregivers and staff at 17 Tribal MIECHV programs. Data were collected over a 2.5-year period, from June 2019 through December 2021, including a 5-month pause starting in March 2020.

The study team partnered with the MUSE Technical Workgroup, participating programs, and other partners to design the study; develop, select, and modify data collection instruments; collect data; and develop the analysis plan. Multiple data sources provided information at different time points and through different modalities, allowing qualitative and quantitative findings to be integrated.

• Exploring opportunities to strategically engage additional household or family members in home visits could potentially extend and amplify the benefits of home visiting beyond the caregiver and child. 
• Ensuring adequate supports for home visitors to tailor the content of their home visits to fit the preferences and experiences of caregivers may be critical to satisfaction and retention.
• Staff recruitment strategies that emphasize serving one’s community may help attract and retain home visitors. 
• Workforce supports can be optimized by strategically leveraging the relative strengths of supervision, training, and peer support while also exploring ways to streamline training for data collection and enhance reflective supervision.
• Professional development opportunities and career pathways can strengthen the Tribal MIECHV workforce and may improve home visitor job satisfaction and retention.
• Investing in better pay, benefits, and other incentives can help retain experienced staff who are deeply committed to serving their communities.