Using the HOPE framework to empower nurses and lift up families
HOPE, a strength-based framework centered on promoting positive childhood experiences (PCEs), helps empower nurses, even when the system they’re operating in feels broken, says HOPE Champion Julie Plagenhoef. Plagenhoef is a state nurse consultant for the Family and Child Health section of the Oregon Health Authority. She supports the implementation of two nurse home visiting programs, Babies First! and Nurse Family Partnership. In that work, she has watched nurses under the strain of helping families whose needs go beyond what nursing can provide: food security, access to transportation, and safe places for children to play.
“These can feel insurmountable,” said Plagenhoef, “and that it’s a system issue that is hard for an individual nurse or an individual family to fix.” But, the HOPE framework can help lift up the individual, no matter the external circumstances.
“[HOPE] puts everything that we do…into these four easy to say, easy to think about Building Blocks [key types of PCEs] that everybody can wrap their head around, including clients.” Plagenhoef gave an example involving the Building Block of environment.
“HOPE empowers the client to know that ‘even if I’m stuck in this apartment that I hate and wouldn’t want to raise my kids, I can think about what changes I can make, and it will make a difference for them.’”
“‘Even if I can’t move, I can do something to my surroundings, and it will make an impact. Or even if I’ve had substance use exposure or divorce in the family, or my partner’s incarcerated, or I’ve been incarcerated, I can do these other things that will build up my child and make them healthy.’”
The HOPE framework helps define what it means to be strengths-based
Plagenhoef has been in her current position for eight years, and said that “home visiting, at its core, has traditionally been trauma-informed [and] family-centered,” but that the HOPE framework makes it more digestible, accessible, and evidence-based.
“It is a really concise and accessible way for all kinds of people to think about, ‘What does it mean to be strength-based, and how do we do that?’”
Plagenhoef first learned about the HOPE framework through a colleague who loved the practice and thought it would work well with their programs. The colleague advocated for and had three staff get trained. Now, they are working on educating more staff both within and outside of their department.
“I did a presentation this morning for a group in one of our counties, and she just emailed me and said, ‘Hey, could you come back and do a whole day on this for our whole home visiting network?’” These trainings are not just for nurses, but other types of community health worker-oriented home visiting programs, including Department of Human Services programs.
Another strategy for disseminating the HOPE framework is through the Babies First! and CaCoon (Oregon Care COOrdinatioN Program) manual for nurses, which can be found on their website. There is a short section in the manual that introduces the practice of the HOPE framework. Additionally, peppered throughout the home visits section of the manual, are call-out boxes that offer suggestions for how nurses can incorporate the HOPE framework. One reads: “Name HOPEful moments you have seen, like bonding/enjoying baby, being responsive to crying child during the visit, and family making it to these appointments.” Another reminder says: “Every encounter is an opportunity to spotlight strengths within the family” and “Close with positive and HOPEful messaging.”
“It’s hard to see strengths sometimes. And so the question isn’t…‘Gosh, you really need to turn off that TV because you’re hurting….your kid. And instead it’s, you know, being in a relationship with your child,” said Plagenhoef. “You’re telling me a couple times a week you read a book to them. That is fantastic. Are you open to talk about how to do a little bit more of that relationship?”
Collecting data to show that the HOPE framework makes a difference
Plagenhoef is part of the 2025 HOPE Innovation Network cohort, a 6-month program in which participants identify, test, and disseminate practices that advance the use of the HOPE framework. She established the following goal as part of the program: By December 30, 2026, we will increase the number of programs using a HOPE-informed client survey feedback form from zero to 2, with an overall client response rate of 30%.
She said that the survey workgroup has finished developing a draft client feedback survey which will go to their Babies First and CaCoon Advisory group for approval on December 15. Then they will reach out to volunteer pilot sites to administer the survey to clients.
Plagenhoef said that one reason the HOPE framework is a good fit is that “nurses and public health people…like data.”
“We do like to be able to say, ‘Hey, look at all this information that tells us that the work we’re doing is impactful and does make a difference.’” And the partners that they train can show it to their neighbors or their politicians and say, “‘This actually makes a difference.’”
Plagenhoef and her colleagues have a goal of incorporating the HOPE framework more fully into the clinical guidelines they use as nurses.
“We have 19 different clinical guidelines on all different kinds of topics. And I think there’s an opportunity to embed the framework in that more specifically.”
