BY DR. PAUL DWORKIN & KIMBERLY MARTINI-CARVELL

A 1997 pilot study in Hartford, CT showed promising results. Other states took notice, a National Center was born, and communities across the country began implementing the HMG Model. Twenty years later, a joint statement between the U.S. Department of Education and the U.S. Department of Health and Human Services pointed to HMG by name and stated unequivocally that, “all infants and toddlers and their families should have access to coordinated, comprehensive services that support overall health, development, and wellness”.

In 2021 the HMG National Affiliate Network grew by 7 systems and sixteen existing HMG systems advanced into full implementation, joining the 12 HMG systems that remained in full implementation from previous years. This is the most significant annual increase in the number of systems reaching full Model implementation in the history of our measurement. Today, the National Network spans across 29 states and the District of Columbia, operating 118 HMG systems nationwide. Our reach continues to grow and our full potential is unprecedented.

Just as our Network has evolved, so has Help Me Grow’s conception of family engagement.

A pediatric pioneer in doctor-patient communication, Dr. Barbara Korsch, first espoused the wisdom of addressing issues at the level of families’ cultural, cognitive, and psychological readiness during the middle of the last century. The critical importance of acknowledging and respecting the role of parents as the key drivers of their children’s optimal health, development, and well-being has influenced the design of the HMG Model since its inception 25 years ago. Furthermore, while this concept has remained a key principle of the Model, how it is operationalized has significantly evolved since HMG’s inception in 1997.

From the outset, the developers of HMG recognized the imperative of family engagement and the importance of sharing information with those who are the intended beneficiaries of the Model. This unidirectional and potentially patronizing approach, in which experts share their wisdom with families, was subsequently refined to acknowledge the importance of eliciting and attending to the voice of the family. While more respectful of the critical role of the family in developmental promotion, the concept remained somewhat paternalistic and failed to acknowledge the role of parents as partners in developmental promotion. More recently, HMG has focused on the importance of co-production, in which those with lived experience assume an equal role in the design of services and policy. The HMG Model is now refining the latter concept to that of prioritizing parent and family goals for their children’s well-being through the strength-based approach of goal concordant care. 

Goal concordant care is strength-based approach to eliciting parents’ goals for their child’s well-being that ensures parents’ goals drive the process of developmental promotion, early identification of concern and need, referral and linkage.

Recently, The JPB Foundation awarded the HMG National Center a two-year grant that will identify, test, and refine ways in which HMG can support the systematic partnering with parents to co-define and prioritize their goals for their child, family and community. As a key resource to this project, the HMG National Center has developed a framework that aims to support HMG affiliates in efforts to elicit parents’ goals for their child’s well-being and ensure those goals drive resource allocation, decisions, referrals and priorities for service delivery by all community-based providers working with a given family.

In spring 2022, the HMG National Center will release a request for participation to identify and resource a small number of affiliates to participate in a year-long learning community that will pilot test how HMG systems and their partners elicit and negotiate goals of care with families and document and monitor progress toward goal-attainment as part of HMG implementation. The ultimate goals of the learning community will be to study the potential impact of applying goal concordant care strategies on: (a) the protective factors of families with young children who receive HMG system services; and (b) parent and provider satisfaction within HMG.

The learning community will receive capacity-building support from national partner organizations that lead the field in promoting practices that are family-centered, strengths-based, multi-generational, and co-determined in alignment with families’ aspirations. Throughout January 2022, we have introduced the study’s capacity building partners and their tools through a series of webinars.

The Help Me Grow National Center believes that it is critical for early childhood systems to embed a formal process that allows parents to co-determine the goals of care and the services they receive to introduce direct accountability for family-centered priorities.

Efforts that engage families from the community as co-partners will improve early childhood system design and governance.

Goal concordant care offers the opportunity for HMG to advance a paradigm shift where all early childhood providers acknowledge parents and caregivers as partners in decision-making, and all resources provided must be in concordance with the goals, aspirations, and values of the family. The HMG National Center envisions early childhood systems that share power with the families they serve, and work to advance systems that are driven by co-developed goals.

Visit Advancing Goal Concordant Care through HMG Implementation for more. 

Paul H. Dworkin, MD is executive vice president for community child health at Connecticut Children’s, director of Connecticut Children’s Office for Community Child Health and founding director of the Help Me Grow National Center. Dr. Dworkin is also a professor of pediatrics at UConn School of Medicine.

Kimberly Martini-Carvell is the Executive Director of the Help Me Grow National Center and the Associate Director for Capacity Building, Organizational Learning, and Professional Advancement at the Connecticut Children’s Office for Community Child Health.