Preserving Elders' Wisdom to Support Home Visiting Families

Through the Eastern Band of Cherokee Indians (EBCI Nurse—Family Partnership1 (NFP) Elder Interview project, implemented under a grant from the Administration for Children and Families’ (ACF’s) Tribal Maternal, Infant, and Early Childhood Home Visiting program, Cherokee elders are sharing cultural stories and beliefs around pregnancy, childbirth, and breastfeeding. During interviews, elders answered questions about accepted treatments and taboos during pregnancy (“What was considered ’taboo’ for pregnancy, childbirth, or breastfeeding? What were considered remedies for pregnancy, childbirth, or breastfeeding?”). Responses to questions like this will be compiled in a booklet to preserve cultural teachings for families in the community. ) “

This concept has been around for years within the NFP Implementation Plan, to be able to learn from the elders and share it with the mothers,” Robin Bailey Callahan, program director of NFP and Cherokee Choices, explained. The team got a push to begin compiling wisdom from elders at the start of the COVID-19 pandemic; data on COVID-19 and its impact on vulnerable populations spurred urgency. “There was this fear of our elders passing because of COVID,” Robin noted. “That was sort of an ’a-ha!’ moment for me . . . we need to collect this information and share it so families can learn and connect with their roots and their culture for the health of them and their baby.”

And so, this journey to collect elder stories on pregnancy, childbirth, and childrearing— known as the Elder Interview project—began. Every step of the way, from planning to conducting interviews, the project team engaged in a thoughtfully iterative process that draws on community collaboration and respect.

The first step was to form a project team consisting of nurse home visitors, elders, and tribal program staff. Team members pilot-tested questions, provided feedback, and developed picture guides for interviews, with cultural items such as a birthing pipe, deer-tongue grass, and a mud turtle, among others. The team's system of pausing and reflecting has become a routine part of the ongoing process. Members regularly assess adherence to project protocols, ensuring that efforts yield the desired results. For example, the team developed an interview process that includes a cultural review committee reading interview notes. If the committee finds information in the interview to be sacred, that information is archived and preserved.

The iterative process of gathering and reviewing information has kept the Elder Interview project moving. The team has big goals; they completed 12 interviews, with a plan to complete 20 interviews annually going forward.

After finishing the interviews, the project team will review the booklet with Cherokee elders and NFP mothers for feedback. Once completed, the Elder Interview booklet will be shared with home visiting families to supplement the home visiting model’s lessons and activities and to provide a connection to culture, language revitalization efforts, and early language and literacy promotion. EBCI’s NFP team will also share the booklet with clients of the Women, Infants, and Children (WIC) program, families enrolled in other tribal programs, and others, including local health care workers. The team hopes that sharing the booklet with professionals will increase providers’ cultural sensitivity and competency.

By investing time in a well-thought-out process that incorporates feedback at all project levels, the EBCI NFP program is on track to develop a resource that will serve multiple purposes. From supporting families in connecting to their culture to improving the cultural competency of health care professionals, the EBCI's Elder Interview project is a strong example of how inclusion and collaboration can improve home visiting services for families. The project booklet—the culmination of years of partnership, meetings, and community engagement—will stand to preserve the Cherokee language, stories, and community traditions for home visiting families and the generations of EBCI relatives to come.

[1] Nurse-Family Partnership is an evidence-based home visiting model in which specially educated registered nurses visit first-time mothers-to-be. Home visits start during pregnancy and continue through the child’s second birthday. The EBCI’s home visiting program shares its name with the model it uses.

For more information about the Eastern Band of Cherokee Indians' Nurse-Family Partnership program and the Elder Interview Project, contact the EBCI NFP and Cherokee Choices Program Director, Robin Bailey Callahan, at robibail@ebci-nsn.gov.

ACF's Tribal Maternal, Infant, and Early Childhood Home Visiting program awards grants to tribal entities to develop, implement, and evaluate home visiting programs in American Indian and Alaska Native (AIAN) communities. The grants help build and strengthen tribal capacity to support and promote the health and well-being of AIAN families, expand the evidence base around home visiting in tribal communities, and support and strengthen cooperation and linkages between programs that serve tribal children and their families. Find out more about the Tribal Home Visiting program and grantees.