For decades, field leaders and funders have focused on developmental screening and kindergarten readiness as markers of child and family well-being. While those efforts have advanced a policy and community emphasis on Head Start, Universal Pre-K, and other efforts in early education, public officials have placed much less emphasis on the critical importance of foundational relationships between children and caregivers in the first weeks, months, and early years of life, until recently.
Just this month, the American Academy of Pediatrics released its new policy statement that advances a new focus on relationships in child health care:
“By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy.”
This shift in approach represents an enormous change from a pediatric culture that traditionally concentrates on the individual physical and developmental well-being of infants and children. That emphasis is consistent with our culture's values – we’ve advanced a myth of centering and prioritizing individual competence rather than a focus on relationships that help support that competence in development. The attention on individual development obscures the relational network that individuals develop and may thrive within.
By learning to care for the nurturing relationship between children and their caregivers rather than simply monitoring the health of the child, pediatricians may dramatically expand the positive impact of care. Of course, the context of stress and supports for these relationships and the attendant social determinants of health remain important to good quality pediatric care.
Given this timely opportunity, Einhorn Collaborative is deepening its partnership with the Early Relational Health (ERH) Coordinating Center at the Center for the Study of Social Policy (CSSP) to build a new collaboration that brings ERH training to family-facing professionals. This training will be built upon the science that has emerged from the Nurture Science Program at Columbia University around autonomic emotional connection, a newly identified construct that describes a mutually positive nurturing relationship between parent and child that is crucial to modulating and regulating emotions, learning, and behavior. CSSP will leverage the reach and expertise of national organizations, like Reach Out and Read, in order to refine, prototype, and spread this training to communities across the country.
Ira Hillman, the Strategy Lead for Bonding at Einhorn Collaborative, joined David Willis, MD, the leader of the ERH Coordinating Center at CSSP, in conversation about the emerging movement of early relational health and autonomic emotional connection.
David Willis (DW): Despite significant gains in our scientific knowledge of early human development over the past few decades, we have struggled to improve social-emotional development and kindergarten readiness. We’ve spent trillions of dollars on early learning, yet I believe that our interventions have not started early enough, nor have they focused on two critical drivers of future well-being: our foundational relationships, and the contexts and social drivers of health that surround young families – poverty, racism, stress, isolation, and demoralization. As a pediatric resident, I witnessed firsthand how vital these family relationships and contexts are for the future development and well-being for all children. I became passionate about supporting the earliest relationships of young children and their families and to work on strengthening their communities by working on early childhood systems change.
Ira Hillman (IH): Being an adoptive parent of two children, my husband and I focused a lot on the importance of building intentional emotional connection with our children to overcome not having the benefit of the pre-existing connection a child has with their birth mother. It has been exciting to learn and witness how fostering emotional connection isn’t only good for my children, but also good for my own health. Co-regulation works both ways and has the power to offer benefits to anyone who engages in it.
DW: That gets right at the importance of relationships to our individual and collective well-being. We’re facing a major public health crisis in human development with a growing number of children experiencing mental, behavioral, and social difficulties with the absence of a sufficient mental health system of care to address their needs, let alone a major public health prevention agenda. When children are struggling behaviorally and emotionally as a result of stress surrounding them without the safe, stable, and nurturing protective relationships, they’re already off-the mark developmentally, and need immediate attention, including strong relational and emotional supports for healing and recovery.
IH: When I hear you say emotional support, I am reminded again of the scientific discoveries that are coming out of the Nurture Science Program (NSP) at Columbia University.
DW: NSP’s research is essential to our ability to measure and intentionally foster emotional connection between parent-child dyads. The four elements of autonomic emotional connection – attraction, vocal communication, facial communication, and sensitivity/reciprocity – are mutual behaviors based in physiology that can be viewed as vital signs of early relational health.
IH: Now, we just need to help and encourage parent-facing professionals like pediatricians and teachers to understand these vital signs, be able to observe them, and to act on the information they get from them. There are simple ways to facilitate parent-child connection in the course of a clinical encounter through emotional expression, face-to-face interactions, and other quick and easy supports.
DW: This is one way in which this early relational health knowledge combines with universal promotion, prevention, and early intervention messaging to support the future well-being for all of our children. It is these strong early relationships that buffer adversity and promote future well-being. The opportunity is in front of us; we just need to build the movement to seize it.
IH: Well, over the last several years, a growing number of leaders in the field have begun to explore ways to work together to advance an alternative approach to child development that puts relationships at the center. For the past decade and a half, Einhorn Collaborative has invested in understanding the importance of emotional connection in relationships. Now, we’re seeking to use that science to amplify it into the field, and the broader world. But creating a field that shares the passion for the work has been challenging. It’s been invigorating and encouraging to see CSSP emerging as a backbone to convene and encourage this broader work and the creation of a field of practice.
DW: Likewise, it’s very exciting to see funders accelerate scientific knowledge in community-based activities, especially training physicians and family-facing supports in how to strengthen relationships with families from the start. We are grateful to Einhorn Collaborative for supporting the collaboration to develop, test, refine, and spread emotional connection training for parent-facing professionals, starting with pediatricians in Reach Out and Read.
IH: We saw a triple opportunity: the hard science from Nurture Science Program, the convening and amplification capacity of CSSP's ERH coordinating center, and a core partner, Reach Out and Read, who can successfully reach 20 percent of families through their affiliates and networks.
DW: The recent AAP policy statement calls for a paradigm shift in pediatric care to focus on partnering with families and communities to advance relational health. Equipped with the latest scientific understandings of the importance of foundational relationships, physicians can partner with families to create greater trust, stronger relationships, and improved impact on well-being.
IH: Those partnerships between physicians and families, as well as with program-delivery organizations like Reach Out and Read, are critical to the translations and implementation of the science so that we can see the results at scale. CSSP will coordinate on-going learning and evaluation among different organizations operating in this space to ensure the diverse group of actors advancing this work will all benefit from what we learn.
DW: This isn’t a small project. It’s a movement requiring major systems change, including authentic partnership with families, that addresses racial and economic inequities. The Einhorn Collaborative investment to make this work visible, to support on-going learning, and to amplify those learnings will be transformational. The lived experience of families becomes the driver of our learning. Every family wants to experience deep emotional connection with their children, and we must make certain our family-facing systems work in service to that.