Advances in Early Relational Health Research |
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Recent scientific advancements have led to an understanding of the importance of Early Relational Health (ERH) in the first years of a child’s life. The AAP policy statement, "Preventing Toxic Stress: Partnering with Families and Communities to Promote Relational Health," calls for pediatric primary care to focus on the safe, stable, and nurturing relationships that buffer adversity and build resilience. The statement proposes that pediatric care is on the cusp of a paradigm shift to reprioritize clinical activities, rewrite research agendas and realign child health collective advocacy. It introduces a public health approach in which universal promotion of ERH through pediatric primary care is reinforced by vertical integration across the entire health system and horizontal integration that occurs within communities beyond the health care sector.
This statement is the inspiration for the Early Relational Health Research Collaborative Network which is being designed through a core partnership between Reach Out and Read (ROR), CSSP and the Pediatrics Department at Columbia University, and aims to bring together a wide network of parents, pediatricians, researchers, implementation scientists, and experts in ERH. ROR is an evidence-based program incorporated into pediatric primary care that promotes ERH through guidance to parents about the importance of positive parent-child interactions and reading aloud. Columbia University conducts research on the importance of emotional connection and its underlying neurophysiological foundations as captured in the Welch Emotional Connection Screen (WECS), a tool co-developed by Drs. Martha Welch and Amie Hane to measure ERH through a dyadic lens.
The ROR network includes over 6,100 pediatric sites and reaches more than 4.2 million children annually, making it a key strategy to advance ERH to families. Dani Dumitriu, MD, PhD, pediatrician, neuroscientist, and Director of the Nurture Science Program at Columbia University, shared that by working with the ROR Network, “We are hoping this iterative, collaborative process will usher in a new era that supports the very fabric of emotional connections. We will not be teaching parents how to do it. We will support them through the process of discovering and building emotional connection. It’s not a thing you learn. It’s a thing you do.”
Nikki Shearman, PhD, Chief of Strategic Initiatives at ROR, stressed the importance of this being a truly collaborative project, “We want to co-develop our learnings in concert with pediatric care providers and families, so that it strengthens trusted clinician-family relationships and offers a new experience that is desired and meaningful for families.” The planning group is incorporating both clinician and parent partnership as core components in the co-development process. Cristina Rivera Carpenter, Parent Partner, added, “This relational approach to research is empowering for both researchers and parent partners and brings a rigor not achieved through traditional research methodology. Centering parent perspective and honoring lived experience ensures a different kind of validity and reliability for long-term success and sustainability.”
Initial publications outline the success of promotion of ERH in clinical situations, but there are many questions still to be answered. Most current efforts to strengthen parent-child relationships are based on attachment theory or parenting education. “With the emotional connection construct, we’re really not talking about what the baby does and what the parent does. It’s about the magic that happens between them – focusing on a truly dyadic approach,” said Dr. Dumitriu. The Network will focus on using implementation science methodologies and bringing science into practice as they develop both research questions and clinical applications.
The goal is for this emerging framework to be scaled to effectively and equitably promote ERH for all families and their young children through pediatric care, the broader healthcare system and community engagement. The group envisions pediatric practice moving into a more proactive and preventative approach to build resilience for the next generation through nurturing the parent-child emotional connection and advancing ERH.
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Updates from the Early Relational Hub at CSSP |
California Governor Newsom’s vision in early childhood has included comprehensive child development programs for education, health and family strengthening and groundbreaking boosts to the state’s early learning efforts and the foundation of clinical health supports for young child and families. And CA’s first appointed Surgeon General, Dr. Nadine Burke Harris, brought unprecedented leadership and vision to elevate the needs of children who experience toxic stress and its disproportionate impact on children of color. She championed a statewide initiative to screen for Adverse Childhood Experiences (ACEs) and to advance transformative efforts in child health care and communities to mitigate those impacts by intentional supports, especially those of safe, stable, and nurturing relationships. As a result, state innovative and visionary leaders leaned in to advance child health system transformation, new training and guidance for practitioners and upstream focus on preventing and mitigating adversity and advancing early relational health.
Watch the recording of the dialogue with two influential early childhood leaders from California to discuss their state’s progress from ACEs to Resilience and many of the innovative activities and policies that have emerged: Alicia Lieberman, PhD and Dayna Long, MD.
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The Early Relational Health Community Mapping Tool allows community leaders to (1) reflect on the ways in which their community currently supports and promotes the development of ERH, and (2) identify action steps to improve and expand upon those efforts.
The tool consists of two distinct parts, each designed to inform the development of an action plan. Part 1 guides participants to map current ERH-promoting activities across various domains of the early childhood system as well as cross-sector, system-level efforts promoting ERH in the community. Part 2 refers to what CSSP calls a Family-Centered Community Health System (FCCHS) and guides participants to assess their community’s performance within the six elements of an FCCHS.
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We've added Discussion Guides to each of our four Perspectives on ERH videos! Read our blog to learn more about the videos and how to use the discussion guides to prompt conversation with a group of colleagues, partners, or community members about one or more of these videos.
We are curious to hear about how you use the videos and discussion guides, and what conversations and activities take place as a result. Please send an email to ERH@cssp.org to tell us all about it!
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What is Early
Relational Health?
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Early Relational Health is the state of emotional well-being that grows from the positive emotional connection between babies and toddlers and their parents when they experience safe, stable, and nurturing relationships with each other. ERH is foundational to children’s healthy growth and development and parents’ sense of competence, connection, and overall well-being. These resilient and enduring relationships also help to protect the family from the harmful effects of stress. |
Perspectives on ERH Video Series
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Toward a More Equitable Tomorrow: A Landscape Analysis of Early Childhood Leadership, Ascend at the Aspen Institute. May 2022. Read Here.
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Shonkoff, J, et al., Translating the Biology of Adversity and Resilience into New Measures for Pediatric Practice. Pediatrics. June 2022 Read Here.
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Seven ERH Papers featured in Infant Mental Health Journal. Vol 43, Issue 3. May 2022. Read Here.
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Early Relational Health Initiative Vision:
Harness the power of early relationships
for the flourishing of all.
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The mission of the National Early Relational Health Initiative 3.0 is to ensure that all infants, young children, and their families benefit from supports and social connections that advance early relational health and its contribution to lifelong well-being and thriving.
Structural racism, poverty, and other societal barriers can impede the formation of strong early relationships when they result in family stress, community disinvestment, and limited opportunity. When we focus on this foundation and support these relationships, children and their caregivers thrive—now and into the future.
The ERH Initiative is one piece of the many activities at CSSP related to young children and their families, from DULCE, to Strengthening Families, to the Early Learning Nation work, to the EC-LINC work, to the development and promotions of anti-racist, family-driven, and effective early childhood policies, programs, and systems.
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