Critical and underrecognized home visitor competencies: Indigenous knowledge, culture, and self-determination in early childhood service delivery

Home visiting programs target maternal and infant mental health, family wellbeing, and child development. Culture is an essential ingredient in advancing these goals in Indigenous home visiting contexts. This study examines how Indigenous knowledge systems can inform home visitor professional competencies that nurture positive maternal and child mental health outcomes and community self-determination. We reviewed existing home visitor competency frameworks and Indigenous practice approaches and conducted a novel "grounded re-review" process with Indigenous home visitors that aimed to elevate Indigenous practice-based expertise. Through facilitated interviews and hands-on activities, Indigenous practitioners critically examined dominant frameworks and co-analyzed existing literature to identify areas of alignment, tension, and omission. Ten common home visitor competencies were identified, reflecting standardized approaches to promoting maternal and child wellbeing and mental health. These frameworks largely fail to account for Indigenous epistemologies and values. Indigenous literature and grounded re-review highlight misalignments for applying these competencies to Indigenous settings and embedding self-determined cultural best practices. These include the assumption of nuclear family structures, an emphasis on individual rather than collective wellbeing, and a failure to recognize the important role of cultural knowledge. In response, we propose an Indigenous Home Visitor Competencies Framework that positions Indigenous cultures and languages at the center of five other interconnected domains. This framework represents a fundamental shift from cultural adaptation to Indigenous sovereignty in early childhood practice. By centering Indigenous knowledge systems as complete epistemologies rather than add-on considerations, this supports both maternal and infant mental health and community self-determination. • Indigenous home visitors identified critical gaps in standardized professional competency frameworks • Novel "grounded re-review" methodology elevates Indigenous practice-based expertise • Framework centers Indigenous cultures rather than adaptation of Western models • Professional wellbeing reframed as systemic responsibility, not individual burden • Model supports Indigenous self-determination in maternal and infant mental health