BY MORGAN REISS
The Help Me Grow (HMG) National Center is proud to announce the release of an executive summary describing the culmination of a multi-year Goal Concordant Care Study.
Beginning in 2022, the HMG National Center piloted a new framework to advance goal concordant care through implementation of the HMG Model. Under the pilot project, 12 HMG affiliates tested and refined ways that HMG staff could partner with parents to elicit and prioritize their goals for their child and family. The project also aimed to assess how HMG can serve to document and monitor progress toward achieving those goals.
What is goal concordant care?
Goal concordant care (GCC) is a term that originated in palliative care, defined as an alignment of care to patient preferences and values. It describes clinical care that supports a patient in reaching their self-identified goal(s), including respecting any treatment limitations the patient has placed on clinical care. While the notion of goal concordant care is not new, it has yet to be formalized and codified as a quality improvement and health equity strategy throughout local, state, and national early childhood ecosystems.
In the context of HMG, goal concordant care is a strengths-based approach to eliciting parents’ goals for their child’s well-being that elevates families’ goals as drivers in the process of developmental promotion, early identification of concern, referral, and linkage.
What is a goal?
While this could seem like a simple question, the HMG GCC Study found that the term “goal” can be interpreted in many ways, can change over time, can be large and broad or small and specific, and can be considered at the child, parent, or family-level.
Based on findings from the initial family partner focus group, the word “goal” was defined in this Study as, “a relatively consistent aspirational aim, result, or achievement toward which a parent’s efforts on behalf of their child(ren), their family, and their role as a parent or caregiver are directed”. In essence, a “goal” is meant to represent what families hope to achieve rather than what they want to resolve. This shift in perspective allows for more strength-based practice.
How was goal concordant care applied to Help Me Grow in the Study?
The Help Me Grow National Center envisions early childhood systems that share power with the families they serve, are driven by co-developed goals, and enhance conditions for promoting equity and inclusiveness.
The HMG Model’s Key Activities provide multiple opportunities to include methods that support parents/caregivers in identifying and expressing their goals, which then serve as the imperative for how HMG organizes its response and resource connections. We recognize that there is significant potential for GCC to be an important driver for early childhood system transformation through HMG Model implementation.
GCC enhancements to the HMG Model were explored through strategies related to family engagement, resource allocation, decision-making, referral processes, and priorities for service delivery within HMG systems, providers, and community partners working with a given family.
The Study was operationalized by a GCC Learning Community which was supported by four partner organizations that helped HMG systems test GCC enhancements correlating to each of the four Core Components of the HMG Model:
- Centralized Access Point (CAP) Branch: Used Motivational Interviewing in partnership with University at Buffalo Motivational Interviewing Center to test CAP enhancements.
- Family & Community Outreach (FCO) Branch: Implemented Parent Cafés in partnership with Be Strong Families to test FCO enhancements.
- Child Health Care Provider Outreach (CHCPO) Branch: Trained in Healthy Outcomes for Positive Experiences (HOPE) in partnership with the HOPE National Resource Center to test CHCPO enhancements.
- Data Collection & Analysis (DCA) Branch: Rooted in the Protective Factors Framework as advised by the Center for the Study of Social Policy to test DCA enhancements.
What did the Study find?
Despite challenges related to capacity, readiness, and buy-in around “goal concordance”, findings from the Study indicate there is substantial merit to expanding HMG’s role to consider parent goals in addition to the Model’s traditional focus on addressing family needs and concerns. Learning Community outcomes show that when HMG systems use strengths-based strategies to elicit, document, and provide referrals and resources in support of parent goals, potential benefits include:
- Expanded skill sets and more successful parent engagement for HMG system personnel;
- Improved relationships between HMG Centralized Access Point staff and families;
- Better alignment between parent goals and referrals/resources provided by HMG;
- Improved parent follow-through on referrals made by HMG;
- Enhanced utilization of early childhood and parenting programs that collaborate with HMG systems, their local partners, and child health care providers;
- Greater opportunities to promote specific family Protective Factors and greater alignment with the Strengthening Families Protective Factors Framework; and
- Opportunities for HMG systems to collect and share more comprehensive data that reference parents’ goals in addition to their needs and concerns.
The Study has many implications for the early childhood field, the HMG Model, and HMG affiliates. HMG may be best leveraged to help parents identify goals and support system partners in eliciting and sharing goals. Recommendations for next steps include further exploration of goal elicitation, tying the Protective Factors Framework to HMG implementation, codifying a strengths-based approach within the HMG Model, and sharing the best practices from the GCC Learning Community across the HMG National Affiliate Network and the early childhood field at large.
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
Morgan Reiss is the Policy & Communications Specialist for the Help Me Grow National Center at the Office for Community Child Health at CT Children’s Medical Center.