Developing cultural enhancements for a home visiting program based in an urban Indian community

Background: King County, WA is home to over 39,000 American Indian / Alaska Natives (AIAN). Urban Indian families prioritized the following issues in a community needs assessment: employment, anti-poverty efforts, and culturally-appropriate services. Countywide data supports these priorities: AIAN children under 5 live in poverty at a rate 3.5 times the rate for all races in King County and the AIAN unemployment rate is almost 2 times the rate of all races. Infant mortality and the teen birth rate are about 3 times higher among AIAN women than for all races. Qualitative focus group data demonstrated the need and importance of incorporating AIAN cultures into home visitation services for AIAN families. Families provided a variety of culturally appropriate services that could be included. Methods: Eighty community members participated in twelve Talking Circles (focus groups) and provided feedback on potential cultural enhancements: assessment tools, Elder participation, culturally-relevant materials and incentives, culturally meaningful activities, and historical trauma. Results: Identified specific, culturally acceptable methods of integrating key cultural constructs into program elements, including building relationships with elders and maintaining connections to cultural activities. Confirmed the interest and need to address historical trauma. Established regular and sustainable method of collecting community input on key cultural programmatic issues. Conclusions: Developed replicable framework for cultural enhancement development in an evidence-based social service program and established qualitative methodology to identify culturally-relevant commonalities among diverse Urban Indian populations. We anticipate improving program retention among a hard-to-reach population based on a culturally tailored program.