{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T19:34:42Z","timestamp":1792352082342,"version":"4.4.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T00:00:00Z","timestamp":1718755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The community-based +Language is Medicine (+LiM) study team partnered with tribal home visitors, community members, and a Din\u00e9 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2212\/post-intervention study to test the effectiveness of the +LiM intervention with caregiver-toddler dyads living on the Navajo Nation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1376742","type":"journal-article","created":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T04:41:06Z","timestamp":1718772066000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Development of a culturally enhanced caregiver-facilitated language nutrition intervention \u201c+Language is Medicine\u201d to address developmental delay in Din\u00e9 (Navajo) toddlers"],"prefix":"10.3389","volume":"12","author":[{"given":"Taylor","family":"Billey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Kushman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Meese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Jim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha A.","family":"Austin-Garrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshuaa D.","family":"Allison-Burbank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1007\/s10597-018-0331-z","article-title":"Adverse childhood experiences and their relation to parenting stress and parenting practices","volume":"55","author":"Lange","year":"2019","journal-title":"Community Ment Health J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1016\/j.pedhc.2017.01.007","article-title":"The power of language nutrition for Children\u2019s brain development, health, and future academic achievement","volume":"31","author":"Head Zauche","year":"2017","journal-title":"J Pediatr Health Care"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1212\/01.wnl.0000031431.81555.16","article-title":"Practice parameter: evaluation of the child with global developmental delay","volume":"60","author":"Shevell","year":"2003","journal-title":"Neurology"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"160","DOI":"10.4135\/9781452219424","volume-title":"Seven steps to separating difference from disability","author":"Collier","year":"2011"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1002\/imhj.21992","article-title":"Community perspectives on developmental screening of American Indian and Alaska native children","volume":"43","author":"Whitesell","year":"2022","journal-title":"Infant Ment Health J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1080\/13682820010019892","article-title":"Educational attainments of school leavers with a preschool history of speech-language impairments","volume":"36","author":"Snowling","year":"2001","journal-title":"Int J Lang Commun Disord"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/s0891-4222(97)00018-8","article-title":"Social-emotional behavior of preschool-age children with and without developmental delays","volume":"18","author":"Merrell","year":"1997","journal-title":"Res Dev Disabil"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"119","DOI":"10.11622\/smedj.2019025","article-title":"Developmental delay: identification and management at primary care level","volume":"60","author":"Choo","year":"2019","journal-title":"Singapore Med J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1001\/jamapediatrics.2019.1197","article-title":"Association of Parent Training with Child Language Development: a systematic review and Meta-analysis","volume":"173","author":"Roberts","year":"2019","journal-title":"JAMA Pediatr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1097\/CHI.0b013e3181a0ab86","article-title":"Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers","volume":"48","author":"Walkup","year":"2009","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1176\/appi.ajp.2012.12010121","article-title":"Effect of a paraprofessional home-visiting intervention on American Indian teen mothers\u2019 and infants\u2019 behavioral risks: a randomized controlled trial","volume":"170","author":"Barlow","year":"2013","journal-title":"Am J Psychiatry"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1016\/S0140-6736(11)60555-2","article-title":"Inequality in early childhood: risk and protective factors for early child development","volume":"378","author":"Walker","year":"2011","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1176\/appi.ajp.2014.14030332","article-title":"Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial","volume":"172","author":"Barlow","year":"2015","journal-title":"Am J Psychiatry"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1016\/j.jpeds.2005.01.049","article-title":"Prevalence of overweight in children with developmental disorders in the continuous national health and nutrition examination survey (NHANES) 1999-2002","volume":"146","author":"Bandini","year":"2005","journal-title":"J Pediatr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1111\/jar.12196","article-title":"Mortality in people with intellectual disabilities","volume":"28","author":"Heslop","year":"2015","journal-title":"J Appl Res Intellect Disabil"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1111\/jar.12191","article-title":"Mortality of people with intellectual and developmental disabilities from select US state disability service systems and medical claims data","volume":"28","author":"Lauer","year":"2015","journal-title":"J Appl Res Intellect Disabil"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1044\/2023_LSHSS-22-00147","article-title":"Interpreting Din\u00e9 epistemologies and decolonization to improve language and literacy instruction for Din\u00e9 children","volume":"54","author":"Allison-Burbank","year":"2023","journal-title":"Lang Speech Hear Serv Sch"},{"key":"ref18","volume-title":"Navajo Blessingway singer: The autobiography of frank Mitchell, 1881\u20131967","author":"Mitchell","year":"1978"},{"key":"ref19","volume-title":"Am\u00e1 Sani d\u00f3\u00f3 Achei Baahan\u00e9\/the office of Din\u00e9 culture, language, and community services","author":"Jackson","year":"2004"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1097\/ANS.0b013e3181dbc658","article-title":"Concept analysis of dine Hozho: a dine wellness philosophy","volume":"33","author":"Kahn-John","year":"2010","journal-title":"ANS Adv Nurs Sci"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"24","DOI":"10.7453\/gahmj.2015.044","article-title":"Living in health, harmony, and beauty: the Din\u00e9 (Navajo) H\u00f3zh\u00f3 wellness philosophy","volume":"4","author":"Kahn-John Din\u00e9","year":"2015","journal-title":"Glob Adv Health Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1044\/2022_LSHSS-22-00101","article-title":"Prioritizing connectedness and equity in speech-language Services for American Indian and Alaska Native Children","volume":"54","author":"Allison-Burbank","year":"2023","journal-title":"Lang Speech Hear Serv Sch"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1111\/j.1467-8624.2004.00750.x","article-title":"Is home visiting an effective strategy? A Meta-analytic review of home visiting programs for families with young children","volume":"75","author":"Sweet","year":"2004","journal-title":"Child Dev Perspect"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1001\/jamapediatrics.2020.3557","article-title":"Effect of a home-visiting intervention to reduce early childhood obesity among native American children: a randomized clinical trial","volume":"175","author":"Rosenstock","year":"2021","journal-title":"JAMA Pediatr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated consolidated framework for implementation research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implementation Sci"},{"key":"ref26","article-title":"What is decolonization, why is it important, and how can we practice it?","year":"2021"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/tbm\/ibx067","article-title":"A scoping study of frameworks for adapting public health evidence-based interventions","volume":"9","author":"Escoffery","year":"2018","journal-title":"Transl Behav Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1177\/0145721716658357","article-title":"The impact of a home-based diabetes prevention and management program on high-risk American Indian youth","volume":"42","author":"Kenney","year":"2016","journal-title":"Diabetes Educ"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1001\/archpedi.160.11.1101","article-title":"Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial","volume":"160","author":"Barlow","year":"2006","journal-title":"Arch Pediatr Adolesc Med"},{"key":"ref30","article-title":"It Takes Two to Talk \u2013 Hanen Program for Parents of Children with Language delays","year":"2016"},{"key":"ref31","first-page":"87","volume-title":"Treatment of language disorders in children","author":"McCauley","year":"2017"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1080\/10409280701838710","article-title":"Relations among the frequency of shared reading and 4-year-old children's vocabulary, morphological and syntax comprehension, and narrative skills","volume":"19","author":"S\u00e9n\u00e9chal","year":"2008","journal-title":"Early Educ Dev"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e383","DOI":"10.1111\/cdev.13225","article-title":"Shared picture book reading interventions for child language development: a systematic review and meta-analysis","volume":"91","author":"Dowdall","year":"2020","journal-title":"Child Dev"},{"key":"ref34","volume-title":"Learning language and loving it: A guide to promoting children\u2019s social, language, and literacy development in early childhood settings","author":"Weitzman","year":"2002"},{"key":"ref35","volume-title":"Pretend play","author":"Hammer","year":"2011"},{"key":"ref36","article-title":"Evidence-based definition of coaching practices","author":"Rush","year":"2005"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1353\/cpr.2020.0026","article-title":"Development of guidelines to improve the effectiveness of community advisory boards in Health Research","volume":"14","author":"Yuan","year":"2020","journal-title":"Prog Community Health Partnersh"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/env.2012.0017","article-title":"The three R's: How community based participatory research strengthens the rigor, relevance and reach of science","volume":"6","author":"Balazs","year":"2013","journal-title":"Environ Justice"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"22","DOI":"10.2105\/AJPH.2006.093641","article-title":"Indigenous ways of knowing: implications for participatory research and community","volume":"98","author":"Cochran","year":"2008","journal-title":"Am J Public Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1207\/s15430154jce2001s_11","article-title":"Recommendations for conducting successful research with native Americans","volume":"20","author":"Christopher","year":"2005","journal-title":"J Cancer Educ"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"58S","DOI":"10.1177\/0898264304268149","article-title":"Access, relevance, and control in the research process: lessons from Indian country","volume":"16","author":"Manson","year":"2004","journal-title":"JAH"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1097\/FCH.0b013e318219606f","article-title":"Applying indigenous community-based participatory research principles to partnership development in health disparities research","volume":"34","author":"Christopher","year":"2011","journal-title":"Fam Community Health"},{"key":"ref43","volume-title":"Ages & stages questionnaires, third edition (ASQ-3): A parent-completed child monitoring system","author":"Squires","year":"2009"},{"key":"ref44","volume-title":"Bayley-4: Scales of infant and toddler development","author":"Bayley","year":"2009"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1376742\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T04:41:17Z","timestamp":1718772077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1376742\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,19]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2024.1376742"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1376742","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,19]]},"article-number":"1376742"}}