+Language Is Medicine: A Precision Home Visiting Approach to Early Language Intervention for Diné (Navajo) Toddlers With DD

This pilot study examined the feasibility, acceptability, and preliminary effectiveness of the +Language is Medicine (+LiM) caregiver-implemented language intervention, a culturally grounded, caregiver-coaching early language intervention for Diné (Navajo) toddlers with developmental delay. The program integrates evidence-based language facilitation strategies, Enhanced Milieu Teaching and Hanen’s “It Takes Two to Talk,” within a precision home visiting framework. Twenty-seven caregiver–toddler (9-24 months) dyads ( n = 27) were enrolled from the Northern Agency of the Navajo Nation, with 15 dyads completing full baseline and post-intervention assessments. The intervention consisted of 5 weekly, home-based sessions delivered by trained Tribal Home Visitors (THVs) supervised by a speech-language pathologist. Treatment fidelity was monitored, with THVs achieving ≥90% adherence. Measures included the Early Communication Indicator, Bayley-4, and caregiver confidence surveys. Toddlers demonstrated significant gains in expressive language ( P = .017) from baseline to post-intervention, sustained at a 3-month follow-up assessment. Receptive language showed positive trends. Caregivers reported increased confidence and skill in supporting communication. Retention rate overall was 56%, with most attrition related to family relocation or scheduling conflicts. +LiM is a feasible, acceptable, and potentially effective approach to supporting early communication development in Navajo toddlers with early signs of DD. Its integration of precision tribal visiting principles and cultural adaptations offers a promising model for EI service delivery in rural reservation-based communities.