What is it that allows some children to flourish despite everything stacked against them? It’s a question that has long puzzled researchers, and one that helped define the work of Brookline pediatrician Dr. Robert Sege.
As a pediatric resident in the 1990s, Sege worked one evening a week in the adolescent clinic at Boston Children’s Hospital during the height of the youth violence epidemic. There, he noticed a recurring concern in conversations with the young men he treated, whose lives had been shaped by trauma.
“Many of my patients didn’t expect to live much beyond 20,” Sege said. “They really talked about the huge impact that violence was having on their future orientation and their plans.”
Trauma-informed care gained traction only a few years later, reshaping how clinicians understood the lasting effects of adverse childhood experiences. But Sege, along with several colleagues and others involved in reducing youth violence, came to believe the field was missing something essential.
“What we found is it’s only half of the picture,” he said. “Children’s brains respond to all of their experiences.”
That realization led Sege to develop HOPE, Healthy Outcomes from Positive Experiences, a framework that shifts the focus from adversity to the role of positive relationships and environments in shaping long-term health. The approach is now taking hold nationwide and in Sege’s own backyard in Brookline.
More than 100,000 health and social service providers across the country have been trained in the HOPE framework, according to a recent New York Times article that featured Sege’s work.
Based at Tufts Medical Center, Sege leads the HOPE National Resource Center, where his team identifies changes that could be made both within communities and on a systemic level to ensure children have the positive experiences they need to succeed. From improving public spaces to providing resources to foster healthy relationships at home, HOPE partners with schools, health care providers, community organizations and local governments.
There is an onslaught of evidence of the long-term repercussions of childhood trauma, including health issues and an increased crime rate. These statistics can be discouraging rather than productive, Sege said, leaving those who have experienced childhood trauma with a sense of impending doom.
“We’re making a mistake if we only look at the problems,” Sege said. “We’re not looking at people’s capacities and the strengths they’re already exhibiting.”
Sege often points to Olympic gymnast Simone Biles as an example. Despite a childhood marked by abuse and early separation from her biological parents, Biles went on to become not only one of the most decorated gymnasts in history but a strong public personality and advocate for mental health.
Working with the Centers for Disease Control and Prevention, Sege and his colleagues examined how positive and adverse experiences interact. Their findings suggest that positive childhood experiences can buffer the lifelong health effects of trauma.
In the case of Biles, Sege said the positive relationships with those who saw her strengths, such as her grandmother, brother and teammates, helped her manage and overcome the negative ones.
This idea, however, was not popular at first.
“Metaphorically, people would kind of pat me on the head and say, ‘That’s very nice, Bob,’” he said.
He kept a photo of Paula Duncan, a pioneering pediatrician who advocated for strength-based care, on his laptop and would look at it when receiving skepticism in early meetings.
“When people were talking, I didn’t feel so alone,” he said.
But the quality of the framework his colleagues initially criticised as “vague” is just what Nancy Slamet, director of the Eastie Coalition, said makes it accessible.
Eastie Coalition takes on “HOPE”
Today East Boston is one of many Boston neighborhoods that are putting the framework into practice. Working with a largely Hispanic and Latino population, Slamet said she needed the framework to be all encompassing to fit the community’s unique needs.
The coalition first came together to address the opioid crisis, and continues work to prevent substance misuse in the community. While rates of substance misuse among the white population, historically the highest users, are decreasing, usage among Hispanic and Latino populations have risen in recent years.
“It’s a health disparity,” Slamet said.
In East Boston, where high schools serve an estimated 85 percent Hispanic and Latino student population, the coalition has focused heavily on youth, aiming to reduce that disparity in the next generation. Slamet said she had been searching for an approach that moved beyond troubling statistics and instead built on community strengths.
“We don’t want to blame people for using substances,” she said. “We know that there are many pressures in their lives that are acting upon them that don’t have to do with their personal choice.”
That search led her to Sege, whom she invited to hold a training session at the coalition.
The coalition was quick to adopt the HOPE framework, which it translated into Spanish, and implemented into bilingual programming.
Efforts to increase positive experiences and spaces, in place of a punitive approach, are apparent throughout the neighborhood. Liberty Plaza Park , once known as a hub for substance use, now hosts movie nights, live music and open mic events. A carnival held in February centered on food, music and dance, drawing on cultural traditions of the residents’ backgrounds.
“This group in some way saved me,” said Abbe Pena Lopez, 16, a youth leader at the Eastie Coalition. The youth leadership program offered an alternative way to deal with stress outside school, where vaping and other substance use is often normalized, she said.
Slamet said the work must extend beyond young people to their families. In many households, parents work multiple jobs, limiting time for connection and support at home, which Sege pins as a crucial component to a healthy upbringing.
“The better the parents are doing, the better their children will do,” Slamet said.
That has meant developing parent-focused programs and an intergeneration program with the “abuelas,” or grandmothers recognizing the role of family in shaping a child’s environment.
“We may not have the perfect program with the perfect logic model,” Slamet said. “But if anything we do generates a positive experience, then we’re doing the work.”
Bringing HOPE to Brookline
Sege is now working to bring that same approach to Brookline.
This past year, he has met with leaders from the Brookline Housing Authority and the Brookline Center for Community Mental Health to explore how HOPE can be integrated locally. The conversations come as providers report rising rates of anxiety and other mental health challenges among children.
Danielle Mendola, the housing authority program director who met with Sege, said she was interested in finding ways to implement the framework as well.
Sege said the team behind HOPE has turned into both an advocacy group on both a local and national scale. Currently up to bat are efforts to increase paid family and medical leave, and reducing after school programming fees for kids.
“Protecting kids from risk is important, but it’s not enough,” he said. “We also have to give kids the opportunity to have the kinds of experiences that promote lifelong health and well-being.”
This story is part of a partnership between Brookline.News and the Boston University Department of Journalism.
Editor’s note: Robert Sege is the brother of Irene Sege, a Brookline.News board member. She played no role in the conception, reporting or editing of this story. Read our full ethics policy here.