R01MD019448

LANGUAGE IS MEDICINE: A CAREGIVER-IMPLEMENTED LANGUAGE INTERVENTION TO PREVENT DEVELOPMENTAL DELAY IN DINE TODDLERS - 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.

The Johns Hopkins University

TO SUPPORT BASIC, CLINICAL, SOCIAL, AND BEHAVIORAL RESEARCH, PROMOTE RESEARCH INFRASTRUCTURE AND TRAINING, FOSTER EMERGING PROGRAMS, DISSEMINATE INFORMATION, AND REACH OUT TO MINORITY AND OTHER HEALTH DISPARITY COMMUNITIES. THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD) HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS: (1) THE CENTERS OF EXCELLENCE PROGRAM PROMOTES RESEARCH TO IMPROVE MINORITY HEALTH AND/OR REDUCE AND ELIMINATE HEALTH DISPARITIES, BUILDS RESEARCH CAPACITY FOR MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH IN ACADEMIC INSTITUTIONS, ENCOURAGES PARTICIPATION OF HEALTH DISPARITY GROUPS AND COMMUNITIES IN BIOMEDICAL AND BEHAVIORAL RESEARCH AND PREVENTION AND INTERVENTION ACTIVITIES, AND BRINGS TOGETHER INVESTIGATORS FROM RELEVANT DISCIPLINES IN A MANNER THAT WILL ENHANCE AND EXTEND THE EFFECTIVENESS OF THEIR RESEARCH, (2) NIMHD RESEARCH ENDOWMENT PROGRAM BUILDS RESEARCH CAPACITY AND INFRASTRUCTURE AT ELIGIBLE NIMHD CENTERS OF EXCELLENCE OR ELIGIBLE SECTION 736 HEALTH PROFESSIONS SCHOOLS (42 U.S.C. 293) TO FACILITATE MINORITY HEALTH AND OTHER HEALTH DISPARITIES RESEARCH TO CLOSE THE DISPARITY GAP IN THE BURDEN OF ILLNESS AND DEATH EXPERIENCED BY RACIAL AND ETHNIC MINORITY AMERICANS AND OTHER HEALTH DISPARITY POPULATIONS, PROMOTES A DIVERSE AND STRONG SCIENTIFIC, TECHNOLOGICAL AND ENGINEERING WORKFORCE, AND EMPHASIZES THE RECRUITMENT AND RETENTION OF UNDERREPRESENTED MINORITIES AND OTHER SOCIO-ECONOMICALLY DISADVANTAGED POPULATIONS IN THE FIELDS OF BIOMEDICAL AND BEHAVIORAL RESEARCH AND OTHER AREAS OF THE SCIENTIFIC WORKFORCE, (3) THE CENTERS OF EXCELLENCE ON ENVIRONMENTAL HEALTH DISPARITIES RESEARCH TO STIMULATE BASIC AND APPLIED RESEARCH ON ENVIRONMENTAL HEALTH DISPARITIES, (4) MINORITY HEALTH AND HEALTH DISPARITIES INTERNATIONAL RESEARCH TRAINING PROGRAM (MHIRT) AWARDS ENABLE U.S. INSTITUTIONS TO TAILOR SHORT-TERM BASIC SCIENCE, BIOMEDICAL AND BEHAVIORAL MENTORED STUDENT INTERNATIONAL RESEARCH TRAINING OPPORTUNITIES TO ADDRESS GLOBAL ISSUES RELATED TO UNDERSTANDING, REDUCING, AND ELIMINATING HEALTH DISPARITIES, (5) SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM INCREASES PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, ENCOURAGES SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND FOSTERS AND ENCOURAGES PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION, (6) SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM STIMULATES AND FOSTERS SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, FOSTERS TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, INCREASES PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND FOSTERS AND ENCOURAGES PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION, (7) HEALTH DISPARITIES RESEARCH PROJECT GRANTS (RPG) SUPPORT INNOVATIVE PROJECTS TO ENHANCE OUR UNDERSTANDING OF BIOLOGICAL MECHANISMS, SOCIAL, BEHAVIORAL, AND HEALTH SERVICES THAT CAN DIRECTLY AND DEMONSTRABLY CONTRIBUTE TO THE IMPROVEMENT IN MINORITY HEALTH AND THE ELIMINATION OF HEALTH DISPARITIES WHICH INCLUDES THE (8) RESEARCH CENTERS IN MINORITY INSTITUTIONS (RCMI) BUILD CAPACITY FOR BASIC BIOMEDICAL AND/OR BEHAVIORAL RESEARCH, CLINICAL AND TRANSLATIONAL RESEARCH (RCTR) AND A NETWORK (RCTN) BY FOCUSING ON INSTITUTIONAL RESOURCE DEVELOPMENT, SUCH AS SUPPORTING CORE RESEARCH FACILITIES AND STAFF, PURCHASING ADVANCED INSTRUMENTATION, AND LABORATORY RENOVATIONS/ALTERATIONS (9) CLINICAL RESEARCH EDUCATION AND CAREER DEVELOPMENT (CRECD) AWARDS PROVIDE DIDACTIC TRAINING AND MENTORED CLINICAL RESEARCH EXPERIENCES TO DEVELOP INDEPENDENT RESEARCHERS WHO CAN LEAD CLINICAL RESEARCH STUDIES, ESPECIALLY THOSE ADDRESSING HEALTH DISPARITIES, (10) PATHWAY TO INDEPENDENCE AWARDS (K99/R00) TO INCREASE AND MAINTAIN A STRONG COHORT OF NEW AND TALENTED, NIH-SUPPORTED, INDEPENDENT INVESTIGATORS. (11) NIH RESEARCH CONFERENCE GRANT AND NIH RESEARCH CONFERENCE COOPERATIVE AGREEMENT PROGRAMS SUPPORT HIGH-QUALITY CONFERENCES THAT ARE RELEVANT TO THE MINORITY HEALTH AND HEALTH DISPARITIES, (12) TRANSDISCIPLINARY COLLABORATIVE CENTERS FOR HEALTH DISPARITIES RESEARCH COMPRISE REGIONAL COALITIONS OF ACADEMIC INSTITUTIONS, COMMUNITY ORGANIZATIONS, SERVICE PROVIDERS AND SYSTEMS, GOVERNMENT AGENCIES AND OTHER STAKEHOLDERS CONDUCTING COORDINATED RESEARCH, IMPLEMENTATION AND DISSEMINATION ACTIVITIES THAT TRANSCEND CUSTOMARY APPROACHES AND SILO ORGANIZATIONAL STRUCTURES TO ADDRESS CRITICAL QUESTIONS AT MULTIPLE LEVELS IN INNOVATIVE WAYS FOCUSED ON PRIORITY RESEARCH AREAS IN MINORITY HEALTH AND HEALTH DISPARITIES, (13) RUTH L. KIRSCHSTEIN NRSA INDIVIDUAL PREDOCTORAL FELLOWSHIP

93.307 - Minority Health and Health Disparities Research

National Institute for Minority Health and Health Disparities (NIMHD) [HHS - NIH]

Maryland United States

State-Wide

Intervention Research to Improve Native American Health (R01 Clinical Trial Optional) (PAR-23-298)