american indian and alaska native early childhood health: a systematic review nicolette teufel -...
TRANSCRIPT
![Page 1: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/1.jpg)
American Indian and Alaska Native Early Childhood Health: A Systematic Review
Nicolette Teufel - Shone, PhDCollege of Public Health, University of Arizona
2014 Native Research Network Conference, Phoenix, AZ
![Page 2: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/2.jpg)
Conceptual framework
Using the Life Course Approach, this review examines the social and political determinants that shape AIAN early childhood health
For all populations, childhood development and health has both lifelong and intergenerational effects (Shonkoff et al. 2012)
Identifying contextual factors that impact resilience and stress early in life is essential to guide public health action for a healthier population
![Page 3: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/3.jpg)
Objective of this reviewUnderstand the state of the science which
serves as the foundation for public health action to health equity
Identify how social determinants of health and the socio-ecological model are used in understanding and improving the health of young AIAN children
Understand context
![Page 4: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/4.jpg)
MethodsStandard procedures of the Cochrane Collaboration
(2008) for systematic review of primary research in health care and policy
Three databases searched: PubMed, Web of Science and EBSCO which includes PsycINFO and CINAHL
Search terms: American Indian (AI) Children, AI Early
Childhood; Native American Children; Native American Early Childhood; Alaska Native (AN) Children; AN Early Childhood; AI Children and Families, Native American Children and Families; and AN Children and Families
![Page 5: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/5.jpg)
Study Inclusion and Exclusion Criteria Available in English; peer-reviewed
Available electronically. published by April 1, 2014
Target population was predominantly AI and/or AN children, < 12 yrs
Described a nonclinical encounter that addressed the context of health outcomes and/or an intervention designed for AI/AN children
Applied socio-ecological or social determinants of health framework
Limited to AI/AN children of US tribes who entered into treaty agreements and endured a unique set of stressors linked to the residential, educational and governance requirements of the US government (Gone & Trimble, 2012)
Native Hawaiians not included, not covered by Indian Health Service, an agency having a distinct, homogenizing impact on the services provided to young AI/AN children
![Page 6: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/6.jpg)
Number of different articles identified in database search (n=287)
Titles and abstracts excluded, focus not early
childhood (n=195)
Articles reviewed by primary categories (n=77)
Excluded, socio-ecological framework
not applied ( n= 70)
Articles included (n=7), all address family dynamics and
influence
Over-nutrition in AIAN early
childhood (n=37)
Dental health in AIAN early
childhood (n=16)
Family dynamics and
influence (n=17)
Community dynamics and
influence (n=7)
Excluded as Other ( n= 10)
Nominal Categorical Analysis of Literature: American Indian and Alaska Native Early Childhood
![Page 7: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/7.jpg)
ResultsOf the initially identified 287 articles addressing AI/AN
early childhood health, only 7 met the criteria that included use of socio-ecological framework, addressing context
All 7 addressed family dynamics or family oriented services influence on childhood health
Four addressed socio-cultural resources and stressors in AI families that influence childhood physical, mental and emotional health
Three 3 addressed family behaviors grounded in AI/AN values, worldviews and experiences that shape early childhood physical, mental and emotional wellness
![Page 8: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/8.jpg)
Resources and stressors of AI families with young children
Cunningham-Sabo et al. (2008) Focus groups with 41 parents and staff of Navajo Head Start Program Identified need for: 1) community-level action to change
the food environment; 2) stronger parenting skills to control the food environment; and 3) culturally relevant strategies for caregivers
Bauer et al. (2012) Survey of 432 parents or caregivers of Lakota children Food insecurity associated with: 1) practice of feeding
children calorically dense foods linked to history of food scarcity and desire to have heavier children; and 2) pervasive feeling of inadequacies, stress and depression
![Page 9: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/9.jpg)
Resources and stressors of AI families with young children
Crofoot and Harris (2012) Review of historical practices that devastated AI families and policies of Indian Child Welfare Act Child welfare systems retain elements of systematic bias
from 200 years of US policy challenging AI families. Need systems based on AI strengths, e.g.,
interdependence of extended family, respect, and role of elders in leadership, discipline and spiritual guidance
Bussey and Lucero (2013) Case study of Denver Indian Family Resource Center (DIFRC) and AI families in the Denver area DIFRC implemented a Family Preservation Model that
addresses family stressors and mental health, cultural strengths (extended family/kinship) and referral to materials resources.
System change and improvement in staff training
![Page 10: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/10.jpg)
Family Behaviors that shape the early childhood experience Cheshire (2001) Interviews with 10 dyads, AI mothers + children
Cultural transmission - Children expected to be quiet, observe and learn
Listening is highly valued; asking questions is non-traditional transmission
Red Horse (1997) Literature review and counseling experience with AI families In traditional families, children raised in extended kin systems;
household residents are multi-generational , related by blood, marriage or adoption
Family members are always reminded of their place and responsibilities in the kinship system
Simmons et al. (2004) SAMSHA funded (Circle of Care) AIAN communities work to redefine serious emotionally disturbed (SED) children Definitions assert the role of the social and cultural environment in
shaping children’s physical, emotional, spiritual, and intellectual health SED Children with SED are from families who experienced trauma and
suffer from historical wounding. Shame and anger are acted out in addiction, suicide attempts, violent acts and other ant-social behaviors
![Page 11: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/11.jpg)
DiscussionSeven articles quite different, commonality is focus on
context
Literature on early AI childhood health has Focused on epidemiology of health conditions, predominantly
over-nutrition and dental health Have applied a framework that guides assessments and
interventions that emphasizes responsibility of parents
Reflections of the socio-political-historical context of family resources, stressors and behaviors influencing the physical, mental and emotional health of young AI children is not prevalent in the literature
![Page 12: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/12.jpg)
Conclusions Impact of social injustice on AIAN childhood health can not be
change in period of most external funding sources
Identification of short-term indicators of change in social determinants of health is needed and acceptable as feasible outcomes
Future public health efforts to understand and enhance AI childhood health should Examine contexts that yield healthy physical, mental and emotional
outcomes; identify factors linked to positive health outcomes
Identify, discontinue and change social-political and historical systems that reinforce family trauma by blaming families;
Need to focus on AI values that supporting raising healthy children in balance with their social and physical environment
![Page 13: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/13.jpg)
Questions?
![Page 14: American Indian and Alaska Native Early Childhood Health: A Systematic Review Nicolette Teufel - Shone, PhD College of Public Health, University of Arizona](https://reader033.vdocuments.site/reader033/viewer/2022051619/56649da75503460f94a941d1/html5/thumbnails/14.jpg)
Contact InformationNicolette I. Teufel-Shone, PhD
Work supported by: Center for American Indian Resilience ( CAIR) NIH – NIMHD P20 Exploratory Center of Excellence
(1P20MD006872) Awarded to Northern Arizona University Subcontracted to University of Arizona and Diné College