Authors in this Special Issue of the Infant Mental Health Journal shared the work of the first three cohorts of Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grantees funded by the Administration for Children and Families. Since 2010, Tribal MIECHV grantees have served families and children prenatally to kindergarten entry in American Indian and Alaska Native (AI/AN) communities across the lower 48 United States and Alaska. Articles highlighted challenges and opportunities that arose as grantees adapted, enhanced, implemented, and evaluated their home-visiting models. This article summarizes nine lessons learned across the articles in this Special Issue. Lessons learned address the importance of strengths-based approaches, relationship-building, tribal community stakeholder involvement, capacity-building, alignment of resources and expectations, tribal values, adaptation to increase cultural and contextual attunement, indigenous ways of knowing, community voice, and sustainability. Next steps in Tribal MIECHV are discussed in light of these lessons learned.

Given the high rates for substance use among women and men of childbearing age, perinatal and early childhood home-visiting programs serving tribal communities must consider how they will address substance-use problems among the families they support. In this study, we explored the approaches to identifying and addressing family-based substance-use problems that were implemented by nine home-visiting programs serving American Indian/Alaska Native (AI/AN) communities that are funded through the federal Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV). These programs demonstrated a high awareness of substance-use problems and took concrete action to address them above and beyond that included in the home-visiting model they used. All nine programs reported that they provided substance-use preventive services and screened for substance-use problems. While all programs referred to substance-use treatment programs when needed, in six programs the home visitor provided substance-use services. Through Tribal MIECHV, the intense need for substance-use education, assessment, service delivery, and referral in many AI/AN communities is pushing the home-visiting field forward to address this increasingly critical issue for low-income families across the United States and the world.

Over the last several decades, performance measurement has become an increasingly prevalent requirement among human services agencies for demonstrating program progress and achieving outcomes. In the Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV), performance measurement was one of the central components of the Administration for Children and Families' cooperative agreements to tribes, urban Indian organizations, and tribal organizations. Since the inception of the Tribal MIECHV Program in 2010, the benchmark requirement was intended to be a mechanism to systematically monitor program progress and performance toward improving the quality of home-visiting programs that serve vulnerable American Indian or Alaska Native families. In this article, we examine performance measurement in the context of Tribal MIECHV, providing an overview of performance measurement, the Tribal MIECHV requirement, and how grantees experienced the requirement; we describe the existing literature on performance measurement challenges and benefits, and the specific challenges and advantages experienced by tribal grantees; and provide recommendations for performance measurement in tribal home-visiting contexts based on grantees' own experiences. This article contributes to the literature by examining performance measurement challenges and opportunities in the context of tribal communities, and provides recommendations that may inform future policy on performance measurement design and implementation in tribal communities.