Becoming HOPE-informed from assessment to implementation
Over the last year, Tufts Medicine Pediatric Primary Care – Boston has worked with the HOPE team to become the first HOPE-informed pediatrics clinic. Through the HOPE-informed Organizational Certification program, organizations can create changes in their policies and practices that align with the HOPE framework to promote positive childhood experiences (PCEs). By doing so, service delivery organizations and care providers can more consistently identify, honor, and promote child and family strengths. Through the interview below, Charles Hannum, MD, and Shirley Huang, MD share their experience creating changes to the clinic.
How did your organization first hear about the HOPE framework and the Four Building Blocks of HOPE?
Dr. Shirley Huang: I have held an interest in building family resiliency, especially in our work with children with medical complexity. In discussions about this with Dr. Robert Sege and in learning about his work with HOPE, I began to see how we could incorporate this more broadly into our entire Division to align the HOPE framework with our core values.
Dr. Charles Hannum: I know Dr. Robert Sege through working with him in the clinic when he was a pinch-hitting clinic preceptor with our resident continuity clinic. I helped with content validity and feedback related to the beta version of the HOPE online training, and so I learned about HOPE many years ago!
Why is promoting positive childhood experiences to your patients important as a pediatric practice?
Dr. Hannum: Promoting PCEs is important given the robust evidence we have about how adverse childhood experiences (ACEs) are unhealthy, and that PCEs can help combat the negative health outcomes associated with them. Additionally, I am in the medical education sphere in my clinical work, and this concept is important when I am teaching students, and helps shift the frame of clinical care into a less negative one.
Dr. Huang: We are skilled as providers in identifying and addressing problems, but it is equally as important to identify, purposefully call out, and strengthen positive experiences for patients and families. Whereas we may not be able to “fix” all ACEs, we can mitigate the impact by promoting PCEs to build upon those relationships, environments, community engagements, and emotional growth that serve as the Four Building Blocks of HOPE.
As part of the HOPE-Informed Organizational Certification process, your organization completed a self-assessment. Did anything surprise you during the assessment? What challenges did you discover that called for improvement?
Dr. Huang: We had many informal processes that we assumed we were doing across all team members, but realized that we needed to be more deliberate to ensure that there was a common understanding of how we choose to practice. For example, in looking at our space (environment), we realized that there were several areas where we were not as HOPE-inspired as we should be in the wording of our policies, posting of signs, and welcoming of families and celebrating their diversity.
Dr. Hannum: The self-assessment was quite long… which I think helped expand where HOPE could live within our clinic and helped us recognize where we were already doing a good job with being HOPE-informed. The assessment prioritized work to get us on our journey to being HOPE-informed. It let us focus on things we could have an easier time to change/adapt and kept our implementation timeline on track.
Using the self-assessment, you and the HOPE National Resource Center team created and worked through an action plan to implement the HOPE framework at Tufts Pediatrics. What changes did your organization make to become HOPE-Informed?
Dr. Hannum: The action plan focused on our clinic environment, updating policies with improved patient-centered language, and allowed us to create a more meaningful implementation by creating a Quality Improvement (QI) project focused on engaging staff in this process. We found the implementation to be challenging for some staff (both clinical and non-clinical) to conceptualize, so we broke down the building blocks into behaviors we could do and could measure to help bring a positive lens to the clinic. We use an adapted building block worksheet to ask specific questions to our school-aged patients. Our other changes, which we hope to be long-lasting, have been related to asking parents what name they prefer to be called, and discussing the importance of school as a safe and supportive environment, and how participating in activities outside of the home and school can help strengthen community engagement. It is often we talk about these things in routine well care, but with a HOPE-informed lens, it became clear we needed to talk about why these opportunities are important.
Dr. Huang: We changed our physical space to be more welcoming to the diverse patient population, created a community resource corner to support families, reworded our clinic policies with the HOPE framework in mind, created a building blocks worksheet for school aged and adolescent patients to complete as conversation starters to engage more discussion around the HOPE Building Blocks, and developed quality improvement projects across all team members to promote active engagement with patients/families to strengthen relationships.
Congratulations on being the first HOPE-Informed organization in the United States! What advice would you give to organizations interested in the certification?
Dr. Huang: This has been a wonderful journey to shift how we practice to promote positive childhood experiences with the patients and families who are part of our practice. This journey also allowed us to promote resiliency and teamwork amongst our entire team of providers and staff. We were fortunate to have champions within the practice and a medical student to continuously move us forward in the journey. We may have become HOPE-informed, but this is just the beginning as we continue to build upon the foundation for how we have chosen to practice.
Dr. Hannum: My advice would be to take things slow, focus on the most meaningful aspects of change, and to have frequent group and 1:1 conversation with all people in the practice, so that everyone can feel they are learning and participating in becoming HOPE-informed. I highly recommend a QI project to help guide your clinic!
