Identifying family-child activities among children with prenatal drug exposure in a Tribal Nation: Caregiver perspectives on barriers, facilitators and positive outcomes

Background Native American newborns experience high rates of prenatal drug exposure leading to devastating outcomes within Indigenous communities. Such children are at heightened risk of maladaptive outcomes if early intervention does not occur. A need exists to identify strategies that promote resilience. Objectives Identify barriers and facilitators that families experience in family-child engagement activities across the community, culture, outdoors, and home settings to inform a cultural-sensitive and community-relevant study aimed at quantifying positive family-child engagement activities as a resilience factor in this population. Methods Biological parents and caregivers to children, ages 0-3 years old with or without prenatal drug exposure (N = 15) were recruited from the Confederated Salish and Kootenai Tribes to participate in an in-person semi-structured interview. Data analysis consisted of research yarning and directed content analysis to collect unique stories and to identify common activities, barriers, supports and positive outcomes to families, respectively. Results Attending multiple powwows/celebrations, swimming, and reading were the most mentioned activities. Cost and transportation were common barriers. The most common support mechanism provided was having family or friends present to participate in activities. Cultural knowledge and bonding were common positive outcomes for a child engaging in activities. A collection of stories identified both familial barriers to traditional ways of knowing and participation in community, and community-implemented efforts to bridge that gap among families with a history of drug and alcohol use. Conclusions This study identifies potential resilience factors specific to families to children with prenatal drug exposure that reside in Indigenous communities.