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Parent-Child Assistance Program Comes to Lake County Tribal Health Consortium

Daphne Colacion, Tribal Home Visiting Program Coordinator, Lake County Tribal Health Consortium
Merrill Featherstone, Human Services Director, Lake County Tribal Health Consortium

Summary: Authors describe a tribal health organization’s process of bringing a Parent Child Assistance Program to their site.


Lake County Tribal Health Consortium (LCTHC) received the Tribal Maternal Infant Early Childhood Home Visiting (MIECHV) Cooperative Agreement in September 2010. We were one of the first in the nation to receive such a grant. MIECHV is funded for five years through the Affordable Care Act of 2010 (P.L. 111-148), Section 511 of Title V of Social Security Act (Maternal and Child Health Services) for States and Jurisdictions, with a three percent set-aside for grants to tribes, tribal and urban Indian organizations. Tribal MIECHV is managed by the Administration of Children and Families’ Childcare Division, in collaboration with the Health Resources Service Administration. Currently there are 25 tribal MIECHV programs around the nation.

Our board of directors and administration embraced the goal for the tribal MIECHV program, which is to provide high-quality, evidence-based home-visiting programs targeting pregnant women, expectant fathers, and parents and primary caregivers of children aged birth to kindergarten in at-risk communities. The primary benchmark areas of focus are improving maternal, prenatal, infant and child health and development; increasing school readiness; reducing incidence of child maltreatment; improving parenting and child development outcomes; improving family socio-economic status; reducing crime and domestic violence; and improving and increasing coordination of referrals to community resources. The MIECHV grant gave us an opportunity to bring much-needed programming into the community.

MIECHV requirements included that we conduct a comprehensive needs assessment, choosing and implementing an evidence-based home-visiting model to fit the community’s needs and conducting a rigorous evaluation to build the evidence base for home visiting programs in tribal communities. In year one, we completed a needs assessment that incorporated input from nearly 25% of the American Indian Alaskan Native community, which prioritized alcohol- and drug-free pregnancy (1), substance abuse treatment (2), relapse prevention (3) and cultural/community events (4) among their top ten concerns. The community also wanted to see a program for fathers and mothers. Other findings from the needs assessment included high rates of maternal depression for Lake County American Indian Alaskan Native women, with rates of depression at 40% versus 19% for all pregnant women statewide; a 30% rate of FASD per 1,000 births for AIAN women nationwide; and clinical evidence and observation from our human services department indicating approximately 70% of Alaskan Indian Native American children and youth being served by the department to be possibly affected by an FASD (currently there is no local FASD diagnostic clinic in Lake County for definitive diagnosis).

Concurrently with the needs assessment, a thorough review of evidence-based home visiting programs such as Parents as Teachers, Nurse-Family Partnership, Healthy Families America and Parent-Child Assistance Program (PCAP) was conducted by our project team. PCAP was brought to the program team for review by the clinical director of our Human Services Department, Merrill Featherstone. Featherstone had attended Indian Health Services FASD training in Washington State four years prior and had learned of PCAP. The program team was grateful for PCAP being introduced for review.

With the needs assessment results and the home-visiting program review complete, PCAP was the determined to be the best choice for the Alaskan Indian Native American population of Lake County. PCAP had the components necessary for success in our community: it was focused on FASD prevention and had the flexibility to meet the individual’s and community’s needs. The model is goal focused, relationship based and uses motivational interviewing to work with clients toward positive change and harm reduction to prevent FASD. Case managers have a three-year working relationship with their clients, during which they conduct visits with them a minimum of twice per month. Case managers work with clients to identify goals to bring about more stability in the client’s life, as well as educating and encouraging them in the use of effective family-planning methods. The intervention also includes a comprehensive assessment with the client shortly after intake that covers family history and behavioral health. To meet MIECHV requirements, we enhanced the PCAP model with Stephen Bavelok’s “Nurturing Parenting” model used widely by other agencies in our county for teaching parenting skills.

The PCAP model with the Nurturing Parenting enhancement has now been implemented by the Lake County Tribal Health Consortium for 18 months. We have served 45 clients and 75 children aged 0-5. Four family advocates, a data analyst, an evaluator and a program coordinator who are working under the direction of our clinical director implement the program under the name Gouk-Gumu Xolpelema Partnership with Parents All People Coming Together Tribal Home Visiting Program. Through this program we have been able to address many of the community’s top priorities, not only helping moms to have healthy, alcohol and drug-free pregnancies and healthy babies, but also working with moms and dads to practice nurturing parenting. The program has been much needed in the community and the community is grateful for it, as stated by one tribal home-visiting client: “Thank you for all the support you and your program and staff have given me. Your guys’ department (human services) is awesome, tribal health is awesome.”

Lake County Tribal Health Consortium, Inc., in Lakeport, CA, is a consortium of six federally recognized tribes. This Indian Health Services contracted clinic offers primary care to not only the Alaskan Indian Native American population, but to all residents of Lake County. Public Health Services and Human Services are primarily for Native American and Alaskan Native families residing in the county. The Lake County Tribal Health Community Needs Assessment 2011 can be found at their website.

This article was produced under grant #90TH0003 funded by the Affordable Care Act of 2010 awarded by the Administration for Children and Families and the US Department of Health and Human Services. The opinions, findings, conclusions, or recommendations expressed in this document are those of the contributor and do not necessarily represent the official position or policies of the HHS.

Author biography:

Merrill Featherstone, MS, MFT, is the human services director at Lake County Tribal Health and serves as Clinical Director of the Tribal Home Visiting Program. She has worked with Native American programs in California and Oregon for over 25 years. She is an experienced psychotherapist specializing in child, adolescent and adult counseling.

 

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