It’s a sunny weekday morning in Lame Deer, and Family Spirit health educator Kaycee Martinez is helping a young couple apply for jobs. The family Martinez is counseling is housing insecure, so they meet in her office, their one-year-old daughter and six-year old son with them.
The Northern Cheyenne Boys and Girls Club in southeastern Montana is one of two groups in the state that use the Family Spirit model, which coaches Indigenous mothers in lower-income communities from pregnancy until their child turns 3.
Foundational to the program is tapping advocates from within the Indigenous communities they serve to provide a culturally-informed curriculum.
22-year-old Rose Russell has been going to Family Spirit in Lame Deer since she had the first of her four children. She says, at the time, her mother had just passed away, “so, I didn’t have a woman in my life to kind of guide me I guess, but they did help a lot.”
She says Martinez, who is also Northern Cheyenne, had been a young mother too.
"She understands what we’re going through and what it’s like being here,” Russell said. “It makes me feel better knowing that when I tell her something or ask her for something she understands that I really do need it and that it’s, you know, true.”
Family Spirit programs like this one in Lame Deer are largely funded through the federal Maternal, Infant, and Early Childhood Home Visiting program, or MIECHV. Congress renewed MIECHV five years ago and its funding had been set to expire at the end of September.
Hours before the deadline, the U.S. House on Friday passed a last-minute spending agreement to fund the government through mid-December.
Among other things, the bill temporarily extends funding for early childhood home visit programs like Family Spirit.
Despite the extension, advocates say nonprofits that oversee the program may have a year of funding left available at most. That can put added stress on organizations based in rural, lower-income communities like Lame Deer, where facilitators may struggle as much to find staff as they do other resources.
Elizabeth Kushman is a senior researcher with the Maryland-headquartered Johns Hopkins Center for Indigenous Health, which established Family Spirit in the mid-1990s in partnership with tribes.
“It takes months to hire people sometimes, and many organizations just won’t extend a job offer if they don’t have long-term funding in place," Kushman said. "A lot of people won’t accept a job knowing it’s conditional upon a grant."
On top of that, she says COVID-19 has exasperated staffing problems.
“There’s shortages of workers across the whole early childhood sector. So, this funding instability and this funding uncertainty just compounds the complexities of administering home visiting programs in our current environment," she said.
Johns Hopkins research shows that home-visiting programs can improve parenting skills, decrease the rate of depression among mothers and support children’s development in underserved indigenous communities, which are inordinately vulnerable to the health and economic effects of COVID-19.
The Northern Cheyenne government, which is based in Lame Deer, is still under COVID-19 restrictions, and health educator Kaycee Martinez says there are limited social services for the 2,000 people who live here.
“You have to learn to work around the resources you’re supposed to be able to utilize, because they’re just not there,” she said.
According to federal census data, about a quarter of families on the Northern Cheyenne Reservation are below the poverty line, double the national average.
Martinez says clients may not know how to find the help they need, so she often calls or shows up in person to advocate for them.
Martinez, who has a degree in psychiatric rehabilitation, says she works with 14 families — and more are on a waiting list. Even hiring a part-time staffer would help, she says.
“It’s so hard to find people to work in these types of positions. And here it’s even harder to find,” says Martinez. “Like, if I want to hire another family health educator, I might need to work for the next few months.”
The Johns Hopkins Center for Indigenous Health says MIECHV as drafted doubles the funding allocated to tribes and now allows for virtual visits. MIECHV must be reauthorized before it expires in order to continue funding the programs it supports.
Martinez says MIECHV makes up the bulk of Family Spirit’s funding in Lame Deer.
“To be able to have that program here to be able to connect all of our families with their culture, their way of life, their community resources, their outside resources, to be able to push them to obtain their goals, set goals, get their driver's license," she said, "all these things wouldn't be possible without the program, the person running it and the funding.
"And it is essential.”
