■发育延迟(DD)在美洲印第安人和阿拉斯加原住民(AI/AN;土著)幼儿中非常普遍,并导致大量AI/AN儿童最终需要特殊教育服务。与美国其他儿童相比,AI/AN儿童接受特殊教育的可能性是其他儿童的2.89倍。然而,在AI/AN婴儿和幼儿中,发育障碍更容易被诊断和治疗。DD,这可以在幼儿时期就被识别出来,会对发展轨迹产生负面影响,学校准备,和长期健康。通过适当的发育筛查,可以及早发现DD的迹象,并通过包括有效的父母培训在内的高质量早期干预措施进行补救。在早期干预计划中经常使用许多基于证据的语言促进干预措施。然而,在纳瓦霍族农村地区的社区,那里的服务和资源有限,有早期DD症状的婴幼儿经常被漏诊,得不到应有的文化反应性支持和循证干预.
■基于社区的+语言是医学(+LiM)研究小组与部落家庭游客合作,社区成员,以及在2021年和2022年使用协作虚拟工作组方法的Diné语言学家/长者提出了LiM试点研究的目标,并讨论了增强对在部落社区中经历DD的幼儿的语言干预的策略。本文将详细介绍社区参与的各个阶段,干预措施的增强和对LiM干预措施进行现场测试的准备,以解决纳瓦霍民族北部机构幼儿的DD发生率升高的问题。
■该合作工作组的两个主要成果包括:(1)团队发起的语言营养重新定义,以符合土著价值观,该价值观以文化连通性和母语使用为中心;(2)由照顾者促进的课程,名为“语言是医学”,其中包括有关语言营养的照顾者课程。语言促进,共享书籍阅读,假装玩耍,并将母语融入家庭例程中。利用这两个工作组的结果来开发一项干预前/干预后的试点研究,以测试生活在纳瓦霍民族的照顾者-幼儿二元组合的LiM干预措施的有效性。
■通过部落家庭访问提供量身定制的儿童干预措施是具有成本效益和创新的方法,可以帮助从文化响应的父母指导和指导中受益的基于预订的家庭。LiM团队采用了精确的部落家庭访问方法,以增强对DD儿童的早期干预方法。我们的增强过程以土著社区为基础的参与性研究为基础,该研究以文化和语言为中心。
UNASSIGNED: Developmental Delay (DD) is highly common in American Indian and Alaska Native (AI/AN; Indigenous)
toddlers and leads to high numbers of AI/AN children who eventually need special education services. AI/AN children are 2.89 times more likely to receive special education compared to other children in the U.S., yet developmental disorders are more frequently under diagnosed and untreated in AI/AN infants and
toddlers. DD, which can be identified as early as toddlerhood, can lead to negative impacts on developmental trajectories, school readiness, and long-term health. Signs of DD can be identified early with proper developmental screening and remediated with high quality early intervention that includes effective parent training. There are many evidence-based language facilitation interventions often used in Early Intervention programs. However, in communities in rural parts of the Navajo Nation where there are limited services and resources, infants and
toddlers with early signs of DD are often missed and do not get the culturally responsive support and evidence-based intervention they deserve.
UNASSIGNED: The community-based +Language is Medicine (+LiM) study team partnered with tribal home visitors, community members, and a Diné linguist/elder using a collaborative virtual workgroup approach in 2021 and 2022 to present the +LiM pilot study aims and to discuss strategies for enhancing a language intervention for
toddlers experiencing DD in their tribal community. This paper will detail the stages of community engagement, intervention enhancement and preparation for field testing of the +LiM intervention to address elevated rates of DD in
toddlers in the Northern Agency of the Navajo Nation.
UNASSIGNED: Two major outcomes from this collaborative workgroup included: (1) a team-initiated redefining of language nutrition to align with Indigenous values that center cultural connectedness and native language use and (2) a five-lesson caregiver-facilitated curriculum titled +Language is Medicine which includes caregiver lessons on language nutrition, language facilitation, shared book reading, pretend play, and incorporation of native language into home routines. These two workgroup outcomes were leveraged to develop a pilot pre-/post-intervention study to test the effectiveness of the +LiM intervention with caregiver-toddler dyads living on the Navajo Nation.
UNASSIGNED: Delivering tailored child interventions through tribal home visiting are cost-effective and innovative methods for reaching reservation-based families who benefit from culturally responsive parent coaching and instruction. The +LiM team has applied a precision tribal home visiting approach to enhance methods of early intervention for children with DD. Our enhancement process was grounded in Indigenous community-based participatory research that centered culture and language.