Help Me Grow National Blog

Partnering with Providers: HMG Butte’s Approach to Goal Concordant Care Through Child Health Care Provider Outreach

By Gabby Hamel

The Help Me Grow (HMG) National Center’s year-long Goal Concordant Care (GCC) Study explored the impact of aligning early childhood support systems with families’ unique goals for their children, moving beyond a traditional “needs-based” approach to prioritize understanding and empowering families in their children’s development.

The Study explored how to integrate goal concordant care within the four Core Components of the HMG Model:

  • Centralized Access Point: This branch implemented motivational interviewing techniques, guided by the University at Buffalo Motivational Interviewing Center, to effectively elicit and document parents’ goals at the Centralized Access Point.
  • Family & Community Outreach: This branch partnered with Be Strong Families to utilize their Parent Café model, empowering caregivers to identify and pursue their own goals for their children.
  • Child Health Care Provider Outreach: This branch collaborated with Healthy Outcomes from Positive Experiences, a program of Tufts Medical Center, to implement an asset-based care framework and ensure a seamless “loop closure” on referrals related to parent goals.
  • Data Collection & Analysis: This branch engaged the Center for the Study of Public Policy (CSSP) to provide initial training and technical assistance on the Protective Factors Framework, guiding data collection and analysis efforts.

View the Goal Concordant Care Study Findings Report.

Integrating Goal Concordant Care (GCC) into Provider Practices

A key focus of the Study was how to effectively integrate goal concordant care within Child Health Care Provider Outreach (CHCPO) strategies. With support from Healthy Outcomes from Positive Experiences (HOPE), a program of Tufts Medical Center, and their framework for asset-driven care, HMG system teams in the CHCPO branch of the Study engaged in training and technical assistance to implement GCC interventions directly within partner physician offices. This ensured that not only were HMG staff prepared to “close the loop” on referrals related to parent goals collected at the Centralized Access Point, but that the initial identification and support of those goals began within the context of the child’s health care provider’s office.

The HOPE Framework: Building Blocks for Goal-Concordant Care

The HOPE framework is rooted in the idea that strong relationships, supportive environments, engaging activities, and healthy emotional growth are the building blocks for a child’s success. These “positive childhood experiences” aren’t just nice to have – they actually lay the foundation for better learning, behavior, and overall health, both physically and mentally.

The HOPE framework groups positive childhood experiences into four building blocks:

  • Relationships
  • Environment
  • Engagement
  • Emotional growth

HOPE offers conversation-based tools to assess assets and opportunities around these building blocks.

Using the HOPE framework supports goal-driven care in health care in three ways:

  1. Establishes an emotional and informational foundation for collaborative goal-setting.
  2. Can be used to document family goals and communicate them efficiently within the team.
  3. Allows the creation of goal-directed quality improvement work.

HMG system teams in this branch were composed of:

  • The organization or individual leading HMG CHCPO efforts
  • The HMG Physician Champion
  • 2-5 child health care provider practices
  • The HMG system lead
  • Other key local partners as appropriate

The training and technical assistance provided by HOPE engaged Study participants in three different steps:

  • Introduction to HOPE: Covered the effects of adverse childhood experiences (ACEs) on health outcomes, the importance of positive childhood experiences and the research showing their mitigating effects on ACEs, the biological basis for these effects, the four building blocks of HOPE, and the HOPE framework.
  • Train the Facilitator Training: A highly interactive workshop for participants to hone their skills and materials to conduct HOPE-informed trainings in their own local community.
  • HOPE Champion Training: HOPE Champions typically two leads from each HMG system) were trained to serve as the on-the-ground HOPE expert leading implementation projects and ensuring the HOPE framework results in actionable change in an organization.

HMG Butte, a function of First 5 Butte, was one of three participating HMG systems in this branch. HMG National spoke with them to gain insights into how they implemented GCC within their network of providers, the challenges they encountered, and the impact this has had on their system’s approach to family-centered care.

National Center: What kinds of enhancements did you make to your HMG operations during the Learning Community and how did you support team members?

HMG Butte: HMG Butte uses a customizable data platform. Implementing GCC had a minimal impact on data collection and existing processes. We added a checkbox to identify the HMG case as an intervention case, included Healthy Outcomes from Positive Experiences (HOPE) building blocks, and created space to document the family’s self-identified goal. The HMG Program Manager made these changes after meeting with the HMG Care Coordinator to ensure the changes were intuitive and aligned with current data collection strategies.

We provided staff support through regular monthly grant management meetings to review data collection, strategy, and processes, making regular changes and modifications to fine-tune our procedures. Our HMG Program Manager also provided weekly reflective supervision to the HMG Care Coordinator, which allowed the Coordinator to reflect on the impact of GCC and their ability to provide HMG services.

National Center: What were the benefits of integrating these enhancements?

HMG Butte: The overarching benefit was an increase in the continuity of care for HMG families between HMG staff and the pediatric health care provider. HMG staff reported increased satisfaction in providing support using the HOPE framework and uplifting caregiver goals.

Caregivers reported overwhelming satisfaction in their HMG services when HOPE and GCC strategies were used.

The enhancement also improved our ability to report outcomes and trends of how GCC and HOPE affect the outcomes and satisfaction families experience.

National Center: What challenges did HMG Butte face integrating the enhancement into their HMG work?

HMG Butte: Our initial understanding of what constituted an appropriate “goal” for GCC within HMG services, and how to elicit that goal from a caregiver, was a challenge. This proved challenging for both our HMG Care Coordinator and health care provider partners. We recognized that caregiver goals documented by health care providers tended to reflect health-related issues, like immunization status. Several conversations were needed throughout the grant to fine-tune strategies for eliciting caregiver goals.

National Center: What approaches/strategies have been sustained to date?

HMG Butte: Utilizing the HOPE framework and eliciting caregiver goals continue to be core strategies for HMG Butte.

Conclusion

By focusing on caregiver goals and incorporating the HOPE framework, particularly within the context of physician offices, the HMG Butte team observed increased continuity of care and improved satisfaction among both staff and families. While initial challenges around defining and eliciting goals were addressed through ongoing communication and refinement, the team successfully sustained the key strategies of utilizing the HOPE framework and prioritizing caregiver goals within their CHCPO efforts.

Want to learn more about the ways HMG connects to the HOPE framework?
Check out HOPE – Healthy Outcomes from Positive Experiences and HMG National Center.

Read the Executive Summary
Read the Full Goal Concordant Care Final Report
(Available to HMG affiliates only – contact your state/system lead for login access)

Learn More about the Goal Concordant Care Learning Community

Want to learn more about the integration of GCC into the HMG Model?

Check out more from this series:

Gabby Hamel is the Communications & Network Relations Specialist for the Help Me Grow National Center at the Office for Community Child Health at CT Children’s Medical Center.