Language is Medicine: A Caregiver-Implemented Language Intervention to Prevent Developmental Delay in Dine Toddlers

Johns Hopkins University, Baltimore MD

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Native American (NA) toddlers and preschoolers experience a high rate of preventable developmental delay (DD) which contributes to decreased kindergarten readiness and often results in the need for special education services. In addition, children with DD are at high risk for preventable health issues, such as obesity and behavior problems. Varying environmental factors, such as poverty, decreased opportunities for structured play, increased caregiver stress, and low print exposure can contribute to DD. One of the most effective ways to address this type of DD is through caregiver coaching intended to boost the frequency of quality, language- rich interactions between caregivers and their young children. Evidence shows DD, especially in the areas of language and social-emotional skills, can be both prevented and remediated through increased language nutrition (LN) exposure. LN is defined as early language exposure that is rich in quality and quantity and delivered through social interactions at home. LN is crucial for a young child's development and strongly associated with future literacy, academic achievement, and better health. An ideal opportunity to deliver LN programming to NA families today is through Tribal Home Visiting programs. The “+Language is Medicine (+LiM)” intervention that will be tested in this study combines cultural adaptations of two evidence-based language interventions: It Takes Two to Talk and Enhanced Milieu Teaching. The current +LiM training package equips tribal home visitors to model and coach primary caregivers through home-based education to use responsive and reciprocal early communication and language acquisition strategies--emphasizing traditional language learning, when possible—to support their children's development. This randomized controlled trial intends to test the effectiveness of the +LiM intervention with caregivers and children ages 9 to 24 months living on the Navajo Nation. We will evaluate +LiM versus a beneficial control condition (Family Spirit Nurture—which promotes optimal early childhood feeding) on preventing early childhood DD, using a Hybrid Type I Effectiveness-Implementation approach. We will track toddler's development before, during, and after the +LiM intervention is delivered. An additional aim is to co-design promising implementation strategies to support integration of +LiM at scale across the Navajo Nation and other communities. This aim will be accomplished through collaboration with +LiM participants and national stakeholders to understand barriers to and facilitators of +LiM implementation across the country. This study is responsive to Program Announcement PAR-20-238 and focuses on key areas of interest including the development, adaptation, and testing the effectiveness of health-promotion and disease-prevention interventions in NA populations. Our overall objective is to rigorously test the +LiM intervention designed to be embedded in tribal home visiting programs so that we can detect early signs of DD in NA toddlers and prevent these delays from progressing.