The HOPE framework focuses on key PCEs. This paper describes the development of that framework and how it has adapted to respond to needs presented by the COVID-19 pandemic. The framework complements other research-based approaches, including the centers for disease control and prevention’s (CDC’s) Essentials for Childhood initiative, which focuses on policy and cultural norms (Centers for Disease Control & Prevention, 2019), and the Strengthening Families Approach (Center for the Study of Social Policy, 2020),™ which focuses on families.
Development of the HOPE Framework
Translational research seeks to transform research findings into practices to improve individual and public health. HOPE was developed as a confluence of systematic research and stakeholder input (Sege et al., 2017a). Research results have been previously reported (Bethell et al., 2019; Sege, 2017b). Development of the HOPE framework just prior to the pandemic relied on three steps: (1) distilling research results into messages and infographics to seed stakeholder conversations, (2) systematically engaging key stakeholders in strategic planning, and (3) deploying a dissemination strategy for multiple audiences.
Distilling Research Results to Seed Stakeholder Conversations
We studied PCEs using a 7-item scale developed and implemented with the Wisconsin Behavioral Risk Factor Surveillance Survey. The scale was adapted from the previously validated child and youth resilience measure (CYRM-28) (Ungar, 2011). (See Table 1). As reported in our 2019 article in JAMA pediatrics, these items had the psychometric properties allowing us to develop a PCE score. More generally, similar results have been obtained with adolescents (counter-ACEs) and with a clinical scale for use in early childhood (benevolent childhood experiences). Analysis of these survey results demonstrated a dose-response association between the number of PCEs reported and the extent to which these protective factors reduced the likelihood of adult depression or poor mental health.
Concepts central to HOPE were developed via a 2017 literature review, which examined multiple evidence-based interventions and found common elements in their core concepts. The infographic shown as Fig. 1 illustrates the four evidence-based themes, which are the building blocks—or key PCEs and their sources—central to the HOPE framework: (1) relationships with adults and other children, (2) safe, stable, and equitable environments to live, learn and play, (3) social/civic engagement, and (4) social/emotional growth (Sege, 2017b).
Engaging Key Stakeholders
Stakeholder input was garnered through (1) workshops at locations throughout the United States, and (2) the HOPE national advisory board (NAB), formed to help develop the HOPE strategic plan for implementation and dissemination.
In order to root the HOPE framework in actual organizational and professional needs, we conducted workshops and presentations with practitioners, organizational leaders, and government officials throughout the country. We held in-depth workshops with three groups of key stakeholders: (1) three sessions hosted by the California ACEs Connection, (2) an all-day meeting at the National Center for Injury Prevention and Control at the CDC in Atlanta, and (3) meetings with leadership from Prevent Child Abuse America and Healthy Families America. Our goal was to solicit feedback on how workshop participants perceived the value of HOPE as a shift in paradigm, how HOPE might fit into their work, and what specific tools and approaches they would need to adopt the HOPE framework. We queried participants with direct questions and collected their input systematically. A major purpose of our presentations and workshops was to garner input on how to move the HOPE program forward from theory into practice, and specifically, how attendees might incorporate the framework of HOPE into their work.
To invite guidance from leaders in the fields of clinical medicine, child abuse prevention, public health, and health equity, HOPE personnel convened a NAB. The board met three times during the first half of 2020, to advise and guide the HOPE project team on strategic planning, dissemination, and development activities. This group also facilitated connections between the HOPE team and additional relevant organizations and stakeholders, accelerating initial dissemination of the HOPE framework.
Deploying a Dissemination Strategy
HOPE relies on three major dissemination avenues: (1) in person or virtual trainings and workshops, (2) digital engagement, and (3) earned media. HOPE launched a website, https://positiveexperience.org, in February 2020, an ACEs connection community page in March 2020, and a newsletter in June 2020 (which one can subscribe to on the HOPE website). Finally, HOPE has developed an earned media presence through national outlets, including PBS NewsHour, CNN.com, and the Wall Street Journal. The website has received over 25,000 visitors from across the country and serves as a hub for HOPE materials, updates, and resources. As of April 2021, 1072 individuals are subscribed to the newsletter, and the ACEs Connection community contains 118 members. A complete list of HOPE dissemination strategies and reach are listed in Table 2.
Refining the HOPE Framework and Adaptation for COVID-19
Engagement with key stakeholders led to substantial refinement of the HOPE model and strategic plan. The following principles arose from stakeholder engagement:
The HOPE framework and language can serve as a bridge between health, family support, and social services sectors.
HOPE can be embedded into existing community outreach and community action efforts, including those focused on ACEs and trauma-informed care.
Providers want community and individual skill-building tools to assist them with incorporating HOPE into their work.
Frontline providers, including pediatricians, home visitors, and substance use prevention counselors, needed to pivot from in person or in school direct interactions to virtual sessions with clients. Providers themselves also experienced disruptions in their childcare and expressed increased concerns about their older relatives. Many became quite concerned about their clients. This created a need and desire for assistance in successfully making this pivot to virtual platforms. The HOPE team responded to numerous requests for training and technical assistance and has conducted a total of 21 COVID-19 focused webinars and virtual workshops, reaching a total of approximately 2,500 individuals. These highly interactive events gave participants the opportunity to share how they are already using HOPE in their work, as well as barriers and facilitators to implementing HOPE.
In order to focus attention on the effectiveness of PCEs in supporting child development during the pandemic, we published 23 COVID-19 related blog posts to the HOPE website, ACEs Connection main page, and the balancing ACEs with HOPE community on ACEs connection. Some of these blog posts were also cross-posted to the websites of the Center for the Study of Social Policy and the Early Childhood Connector, hosted by Start Early.
Using the HOPE approach, the initial focus of these blog posts was to provide tips for how to manage in these difficult times, emphasizing opportunities for positive experiences presented by the COVID-19 crisis, specifically those related to families, children, and adolescents. Some blog posts were written as advice directly to families, and others were written for providers who serve families. Our most read post to date is “Love in the time of Coronavirus: a HOPE-informed guide for parents”. This post has been viewed more than 2,400 times. Dr. David Willis (pediatrician and Senior Fellow at the Center for the Study of Social Policy) wrote a blog post about how foundational relationships early in life provide support for lifelong health and development, with emphasis on how to encourage strong foundational relationships, even in a period of physical distancing and social isolation. Pediatricians Dr. Heather Forkey and Dr. Moira Szilagyi, president-elect of the American Academy of Pediatrics, were interviewed about the importance of understanding and promoting resilience and positive experiences during the pandemic. Policy leaders Dr. Charles Bruner and Kay Johnson provided insights regarding how public programs such as Medicaid and the Title V Maternal and Child Health Services Block Grant can support action to advance the HOPE approach. Nine additional blogs specifically addressing COVID-19 issues have attracted nearly 3,000 views collectively. All blog posts are available on the HOPE website (Yang, 2021).
As the movement for racial justice grew, we added content related to specific challenges and inequities exacerbated by COVID-19, often written from interviews with experts who provided key insights. The following examples give a sense of the tone and focus of these blog pieces: Corey Best (a member of the HOPE NAB and leader of the Birth Parent National Network, Children’s Trust Fund Alliance) spoke on fatherhood, as well as the disparities and racism illuminated by the pandemic. Dr. Danielle Laraque-Arena (a member of the HOPE NAB, a senior scholar-in-residence at the New York Academy of Medicine, professor and president emerita at SUNY Upstate Medical University, pediatrician, and adjunct professor of epidemiology at Columbia University) spoke about inequities that have been exacerbated by COVID-19, including access to health care, poverty, and mental health needs. The Reverend Darrell Armstrong (pastor of the Shiloh Baptist Church of Trenton, NJ) shared his views as a national leader on implementing the Strengthening Families approach, as well as communities’ lack of access to food, technology, and mental health services during the COVID-19 crisis.
Additionally, amidst growing national concerns about family life during the pandemic, HOPE garnered a great deal of earned media attention related to COVID-19. Earned media, in the context of this article, refers to public media coverage of an issue, program, or campaign that is of public interest and is broadcast by different media outlets. This is in contrast to paid media or conventional advertising (Kornfield et al., 2015). For HOPE, earned media included features in the Wall Street Journal, CNN.com, and PBS NewsHour. These opportunities helped spread the general message of family and community support for child development, resulting in increased awareness of the HOPE strengths-based approach.