What does goal concordant care mean for early
childhood systems?

In order to provide the highest-quality care to young children and their families, all early childhood providers working on behalf of families must acknowledge parents and caregivers as partners in decision-making, and all services provided must be in concordance with the goals, needs, aspirations, and values of the family.

An early childhood system that shares power with the families it serves, and whose providers implement care plans that are co-developed with families, is operating with goal concordant care at the center.

Over the last twenty years of HMG implementation, there has been an evolution in the ways in which HMG communities have implemented outreach strategies to engage families, community-based partners, and child health care providers. Initial outreach and engagement efforts sought expertise from professionals who study communities and create policy recommendations. In response to feedback such as “nothing for us without us”, community engagement activities have increasingly solicited input directly from families and residents with lived experience.  Earlier on, HMG systems sought out the “voice of the family” using tools such as surveys and focus groups. Increasingly we have worked to identify and incorporate opportunities for families to be resourced and supported in order to co-produce and co-lead.

At the end of this two year project, the HMG National Center and Affiliate Network will be well-positioned to further expand the authentic engagement of families and caregivers by incorporating a collaborative approach with families determining the desirable outcomes for HMG’s efforts.

The HMG Model’s Key Activities provide multiple opportunities to integrate processes that can support parent/caregiver goal identification and elicitation, which then serve as the imperative for how HMG organizes its response and resources. We recognize that there is significant potential for GCC to be an important driver for early childhood system transformation through HMG Model implementation.

Most U.S. children who enter kindergarten are delayed in their health, social-emotional, and/or cognitive development. These gaps have been present for decades yet early childhood systems have failed to close them. To foster optimal short- and long-term outcomes for young children, it is necessary to systematically elicit parents’ and caregivers’ goals and priorities, and establish partnership with them in creating pathways toward achievement of health and developmental goals for their children.

Early childhood systems should 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.

We are studying the application of goal-setting and goal-monitoring through HMG and the infrastructure it establishes, and the impact that goal-setting and monitoring has on advancing parent-identified priorities for family well-being and child health and development.

The HMG National Center is committed to growing its national footprint, advancing affiliate performance, and evolving its approach to early childhood system design and operation.

This project 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.

Through a request for participants, the HMG National Center will select a small group of affiliates to participate in a year-long learning community consisting of leaders from affiliate backbone organizations, Core Component leads, and partnering pediatric primary care clinics.

1. Provide capacity building opportunities that support HMG systems across the country in their efforts to design, implement, assess, and improve early childhood systems in authentic partnership with families.

Project partners including UBMIC, Be Strong Families, Center for the Study of Social Policy (CSSP) and Healthy Outcomes from Positive Experiences (HOPE) will offer capacity building opportunities and useful resources to the National Affiliate Network in order to broadly support HMG systems in leveraging critical opportunities to elicit family priorities and enable parents to co-determine goals of care with their providers. See Project Partners below for more.

2. Benchmark optimal HMG Model practices that promote regard for parent-led concerns and coordinate services to meet family goals.

With CSSP, the HMG National Center will map existing performance measures to assess their functional equivalence with five protective factors: parental resilience, social connections, healthy parent-child dynamics, concrete supports as needed, and social and emotional growth (i.e., Protective Factors Framework).

3. Establish an advisory workgroup to develop and refine the tools, methods, and technical assistance to help HMG affiliates and their clinical partners elicit and negotiate goals of care, document and monitor their progress, and assess care outcomes and goal-attainment.

Project partners including UBMIC, Be Strong Families, and HOPE (see Project Partners below for more) will contribute expertise on:

A) Outreach and engagement through parent-led peer-to-peer support networks 
B) Motivational interviewing techniques and approaches to elicit family-centered priorities and aspirations
C) Family assessment techniques to emphasize positive childhood experiences in care planning
D) Evaluation and outcome frameworks that correlate HMG with impacting the protective factors

4. Implement, document, and disseminate the operation of new, promising workflows in participating affiliate systems.

The HMG National Center will assess the impact of these new competencies on the experience of care from the standpoint of parents and their providers, and on affiliate performance from the standpoint of goal-attainment, shared decision-making, mutual accountability, and targeted universalism   

Drawing on user-centered design and quality improvement methods, we will evaluate the impact of shared goal-setting and monitoring on HMG system implementation, as well as on provider and parent satisfaction. The study will illuminate parents’ perceived barriers and motivators for articulating and attaining goals; areas of alignment or tension between parent-stated priorities and institutional incentives and mandates. The study will also include performance improvement opportunities for the HMG National Affiliate Network as well as related insights for national early childhood stakeholders; behavioral and attitudinal shifts among community of practice affiliate participants and partners; and specific resource conditions (such as early childhood system infrastructure, state or local assets, and available technology) that foster the use of shared goal-setting and mutual accountability across stakeholders.

This project is powered by partnership.
The HMG National Center is joined by:

• Childhood Prosperity Lab

• Center for the Study of Social Policy (CSSP)

• Healthy Outcomes from Positive Experiences (HOPE)

• Be Strong Families

• The University at Buffalo Motivational Interviewing Center (UBMIC)

• CT Children’s Medical Center Practice Quality Improvement Program

• Small Community of Practice of HMG affiliates to be determined via RFP

Goal Concordant Care: Parent’s Goals as Drivers for Help Me Grow – Panel session from HMG Forum 2021