P3.D069: Integrating Indigenous Ways of Knowing in Early Developmental Intervention: A strength-based, Interdisciplinary Approach in a Tribal Health System

Background: Children from historically underserved communities are disproportionately affected by diagnostic delays across systems of care. These diagnostic delays and health disparities substantially impact family stress and decrease access to early intervention services. While national efforts to address developmental delays in pediatrics are ongoing, voices from the indigenous community are lacking in the dialogue.

Methods: This presentation will highlight key strategies to enhance engagement and delivery of needed services to Indigenous families living in rural areas and present a model that could be replicated in similar communities. The Healthy Steps program provides universal screening, developmental support, and positive parenting guidance. Families and the treatment team work together to meet their goals through an interdisciplinary approach that supports cultural practices.
The addition of an Early Childhood Development (ECD) Therapist to the treatment team is a vital component of our strength-based approach. As an interdisciplinary team member in the pediatric clinic, the ECD therapist focuses on team-based visits for early intervention, to prevent behavioral needs and promote healthy parent-child relationships. They offer consistent family support, monitor developmental progress, and connect families to additional services based on family needs, ensuring that every child receives the best possible care and support

Results: 6,166 Survey of Well-being of Young Children (SWYC's) were collected between October 2022 and September 2023. The highest percentage of concerning screening results include social-emotional development (46%) and family needs (28%). Other results showed that parents often did not express concern regarding social-emotional development, developmental milestones, or autism despite not passing these areas of the SWYC. Family needs that have been identified on the SWYC include, 26% tobacco use, 10% food insecurity, 6% caregiver mood concerns, 2% substance abuse, and 2% interpersonal violence. Our integrated care model allowed for real-time intervention with an Early Childhood Developmental Therapist for those with identified developmental needs or medical family therapist for those with identified mental health concerns. For children and families ranked "Tier 3" due to their SWYC scoring, a pediatric psychologist also collaborated with the therapy team and the medical provider during the visit.

Conclusion: The Healthy Steps model is consistent with Indigenous ways of knowing and cultural values regarding the importance of holistic, collaborative approaches centered around the importance and well-being of children. Applying the Healthy Steps program to patient care within our tribal healthcare facility has provided early identification of developmental, behavioral, and social concerns and has allowed the team to build connections to improve the overall quality of life of our people.