Johns Hopkins-run program 'Family Spirit,' active in more than 100 tribal communities in 16 states, relies on federal funding set to expire this month

Home visits help strengthen maternal, infant health in Native American communities

ORIGINAL ARTICLE BY Katie Pearce of John Hopkins University HERE

A baby’s first laugh, in Navajo culture, is cause for formal celebration. Whoever provokes that milestone moment wins the privilege of hosting a “first laugh ceremony” to mark the infant’s full arrival into the earthly world.

“That laugh sounds to the world, ‘This is me and this is who I am,'” says Crystal Kee, a Navajo health educator based in Chinle, Arizona.

Though the tradition is unique to the Navajo, Kee finds it resonates across a variety of American Indian communities that take part in Family Spirit, a home-visiting program that supports maternal and infant health.

Image caption: “There is a thirst for some connection to the culture, and the ways our ancestors and people have always thought,” says Crystal Kee.

“There is a thirst for some connection to the culture, and the ways our ancestors and people have always thought,” says Kee, who works as a training and implementation manager for Family Spirit.

The program was designed both for and by Native tribal communities. It grew out of the Johns Hopkins Center for American Indian Health in the mid-1990s, when program leaders began working in partnership with the Navajo Nation and White Mountain Apache and San Carlos Apache tribes.

Today Family Spirit is active in more than 100 tribal communities across 16 states, with the Hopkins center—part of the Bloomberg School of Public Health—disseminating the model to affiliate health centers and organizations.


The program trains people from the local community to deliver regular one-on-one home visits to mothers (and often fathers, too) from pregnancy through the first three years of the child’s life. The general goal is to share best practices for parenting and early childhood health, covering topics like budgeting and breastfeeding.

But because the program is so personalized, it often wades into deeper issues the families are facing, such as employment challenges or drug abuse. Kee notes that opioid and methamphetamine problems are on the rise for tribal communities, requiring “patience and care” from Family Spirit home visitors while they “remain neutral.”

And since many participants in Family Spirit are still in their teens and early 20s, the program often grapples with the risks and complexities of parenting at a young age.

With evidence showing successful outcomes—including decreases in depression and emotional problems for mothers, and reduced behavioral problems for their children—Family Spirit has expanded over the years beyond its initial rural settings in Arizona and New Mexico. It’s now used in several urban communities with American Indian populations, including in Oakland, California, and Oklahoma City.

Beyond that, the program is showing promise even for non-tribal communities—an adapted model has served low-income, predominantly black or Latino populations at sites in St. Louis and Chicago, according to Kee.

“We get a lot of requests for translating the curriculum into Spanish,” she says.

In addition to reaching out to other populations, Nicole Neault, a field manager for Family Spirit, says future directions may include digitizing the curriculum and continuing to build an offshoot model, Family Spirit Nurture, that targets childhood obesity.

Image caption: Family Spirit trains people from the local community to deliver regular home visits to new mothers (and fathers, too) from pregnancy through the first three years of the child’s life.

One critical factor for the future of this program, however, rests in a funding decision Congress must make over the next few days.

Family Spirit and other models like it have relied on funding support from the federal Maternal, Infant, and Early Childhood Home Visiting, or MIECHV, program, which was first authorized in the 1980s but is now set to expire by the end of September. As of last week, the debate in Congress was ongoing about the best ways to continue with MIECHV.

For Family Spirit, the end of MIECHV funding would be a huge loss for many of its community affiliates, according to Neault.

Kee, speaking on this issue with the Native America Calling radio program last week, touted the value of Family Spirit in reducing the health disparities for tribal communities throughout their lifetimes—thus reducing long-term costs for healthcare and social services.

In a conversation The Hub, Kee emphasized the make-or-break impact home visits can have for parents and their children.

“Sometimes you are the only person who is being the cheerleader, in a sense, for these families,” she says. “Sometimes you’re the only person who’s telling them they’re doing good.”


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FUNDING OPPORTUNITY - CDC's office for State, Tribal, Local, and Territorial Support (OSTLTS) is pleased to announce a new notice of funding opportunity, CDC-RFA OT18-1804:  Technical Assistance for Response to Public Health or Healthcare Crises.  Visit the STLT Gateway to learn more about the purposes of this funding opportunity and expected awardee strategies and activities.  This funding opportunity is a novel approach to emergency response that will allow CDC to expedite funding to qualified organizations to they can provide expert technical assistance and other support to entities engaged in a public health or healthcare crises.  Applications are due no later than 11:59 p.m. (ET) on March 16, 2018.  CDC will collect responsive proposals from eligible applicants and retain them as "approved but unfunded" until a crises occurs.  CDC will make funding available to relevant organizations once the agency determines the need for a public health emergency response.  If you have questions about this funding opportunity, contact the OSTLTS Partnership Support Unit at

LGBT HealthLink's 2018 E-Summit - Save the Date - Join us for Bacon, Eggs, and Data as the first course to our full workshop menu!  Time and topics to be announced next month!  REGISTER HERE

EVENT -Dialogue for Action® - April 11-13, 2018; Hilton McLean Tysons Corner; McLean, VirginiaDialogue for Action® is an annual national conference that brings a diversity of stakeholders together to discuss the best ways to reinforce cancer screening, prevention, and risk reduction initiatives in their communities.  The Wednesday through Friday schedule is packed with unique opportunities for participants to immerse themselves in engaging presentations facilitated conversations, relationship building, and more.  LEARN MORE

The NW NARCH program, in collaboration with the Northwest Portland Area Indian Health Board and the OHSU Prevention Research Center, are offering a new fellowship in cancer prevention and control research.  The training will be offered in conjunction with the last two weeks of the Summer Research Training Institute at the Indian Health Board in Portland, Oregon, June 17-29, 2018.  In addition, fellows will attend a one-week session in the fall of 2018 that is focused on additional topics in cancer prevention and control research among tribal people.  Fellows will work with peer and career mentors to develop and implement cancer control projects, and will be supported to attend professional meetings to present their research findings.  Please feel free to distribute your lists.  For more information, please see the NPAIHB website at or contact Ashley Thomas by email at or by phone at 503-494-2907.

Funding Opportunity - Robert Wood Johnson Foundation - Policies for Action:  Policy and Law Research to Build a Culture of Health - HERE