Early Relational Health: What the Pandemic Has Revealed

Science tells us that relationships are foundational to the health and well-being of young children—in fact to children and youth of all ages—and their caregivers. Why, then, shouldn’t they be central to how we think about early childhood health and systems? This is the question that our early relational health (ERH) initiative seeks to answer.   

In recent years, research has advanced our understanding of how engaged, responsive, and emotionally attuned early relationships shape brain architecture and social-emotional development in the first three years of a baby’s life. ERH describes the “positive, stimulating, and nurturing early relationships that ensure the emotional security and connections that advance physical health and development, social well-being, and resilience.”[1] The two-way nature of early relationships affects two-generational parent-child health and well-being, both in the moment and long term. Moreover, these relationships are not limited to parents and caregivers, but include everyone who makes up each child’s interpersonal and social network of support.

To be clear, ERH is not a new program or concept. It is not trauma- or deficit-focused, and it is definitely not new news. Instead, it aims to elevate what we know about the centrality of these foundational relationships in early childhood; to partner with families, family leaders, and providers to ensure that services and supports are more family-focused, culturally responsive, strengths-based, and evidence based; and to engage policymakers in addressing the systemic barriers that stand in the way for all families to meet the needs of their children. The focus on all families is especially urgent now as we seek to redress inequities in access to resources and opportunities that have been created by racism, low-income bias, and ableism.

On April 30th, I led a panel on ERH with four cross-sector early childhood experts for an interactive conversation hosted by Early Childhood (EC) Connector: Effie Alofoje-Carr, a senior parent leader from Michigan Statewide Parent Leaders; Dominique Charlot-Swilley, HealthySteps advisor; Janice Gruendel, senior consultant to Bridgeport Prospers; and Kay Johnson, Maternal and Child Health  policy leader. The EC Connector, housed through Start Early, is a resource for the networking and exchange of information about early childhood systems. In this conversation, two themes emerged:

  • The lessons we’ve learned as a result of the COVID-19 pandemic must inform our ERH thinking; and
  • Our thinking and actions to promote ERH must be grounded in an explicitly anti-racist, parent-led frame.

So, why now? What is special about this moment as we focus on “Building Back Better?” My colleagues shared many important perspectives, which I want to highlight here.

As we are hopefully emerging from the worst of the pandemic, we are confronting both vulnerabilities and opportunities. The mental health and well-being of many at all ages has suffered; at the same time, we have seen inspiring individual and collective examples of community building, helping others, and supporting connection and resilience. And we have seen

seen not only the damaging disparate health, social-emotional, and economic impacts of COVID-19 on Black, Native, and Latinx communities and families living in poverty, but also the coming together of people and communities to raise their voices and to support one another with hope and attention to recovery and healing. With the Biden/Harris Administration, we are seeing unprecedented investments for combating structural racism  and for the uplifting and strengthening of families and communities, grounded in a commitment to equity for all and the science of human development and recovery.

Above all, we must all heal from the pandemic. As Effie Alofoje-Carr, a Senior Parent Leader from Michigan, said, “Mental health is suffering right now. There are people [including children and parents] who are not doing so well right now, and they need that extra support.” This healing and extra support will spring from our relationships. “Children and families are connecting and getting reacquainted as never before,” noted Dominique Charlot-Swilley, the Director of the Wellbeing Practice and expert advisor at HealthySteps Technical Assistance. The long days and the economic and health crises were stressful, she acknowledged, but deep learning and connection between child and caregiver also occurred. “As families re-enter pediatric primary care, now is the time to really support and engage in discovery with our families about what is working, what is not, and how to build that relationship to [support that kind] of knowing.”

ERH holds that it is not only a close family, but the full web of relationships, that support healthy growth and development for young children. And with the continued evidence of community connections and social networks as important protective factors, advancing ERH must include the elevation of neighborhood, community, and system building, as well.

“From COVID to racial justice to economic crisis, this is the moment,” Janice Gruendel, a senior consultant with Bridgeport Prospers, says. “Suddenly we have a resilience, positivity-based administration….the road has been set differently.” Kay Johnson, President of Johnson Group Consulting, concurs, saying, “The Biden/Harris Administration finally is moving towards a family policy that looks like the rest of the world. But,” she warns, “implementation will be key.”

How we implement policy change to capitalize on the commitment of the new administration to support parents and families and how we bring ERH to the systems level will make all the difference. As a nation, we are newly reminded of how much work parents do, how key neighborhood and community relationships are, and how much those foundational relationships matter for our current and future well-being. We need to take advantage of the opportunities available right now to advance this work with families, in communities and at the systems level.

The key element, as all panelists agreed, is to co-design and co-lead with parents. As Alofoje-Carr so eloquently put it, “Parents are professionals in their own right, experts in their own lives. [And] when you bring them to the table, that’s the beginning.” She cautioned that salaried “experts” may not be aware of barriers that parents face, and she stressed that financial compensation for parental contributions is key for equity.

Charlot-Swilley echoed this theme; in her work, she strives to “put culture and equity at the center of things,” focusing on parental strengths. For example, at the pediatric clinic where Charlot-Swilley works as a child psychologist, she asks families about the “precious moments” and instances of real triumph that they see. From there, she can both learn “the vision that families have for their families,” as well as begin to address any vulnerabilities.

In Bridgeport CT, Gruendel says they use early relational health as an underlying concept when devising core strategies, using it not as a new program (which it’s not), but as a frame for existing strategies. She noted, “Having the language to talk about it [ERH] really helps.”

It is critical to build an explicitly anti-racist frame into the work to ensure ERH continues at the level of policy as well. For example, Johnson notes that home visiting—a common program that incorporates an ERH frame—is not always based on contemporary evidence or is culturally responsive to today’s society. We need ever better models and approaches, she says: “How do we make [these programs] responsive to diverse family needs while honoring their strengths and searching for more meaningful impacts for families?” The home visiting field has begun to reflect on its own history, to engage families as partners at local home visiting leadership tables and to build equity and anti-racist training and reflection into their clinical practices.

As we all work to “Build Back Better,” we must also “do the work in regard to equity,” as Alofoje-Carr said. Policy grounded in equity and anti-racism begins (but cannot end) with important mind shifts and self-reflection. The other three experts on the panel echoed this theme, agreeing that any call to action begins with forming real partnerships with families and communities, holding providers and agencies accountable for engaging families, and making sure that anti-racist and family-friendly policies are in place to ensure that families can thrive.

The pandemic has taught us much: about economic disparities and racial justice, about community resilience and the power, promise, and limitations of large-scale government interventions.

Above all, the pandemic has showed us the power of relationships. Young children need healthy, loving relationships for their future well-being; parents need time to nurture relationships with their children to fulfill their desires and aspirations; and everyone needs strong relationships and social connections to heal and flourish. Bringing an ERH framework into early childhood systems practice and policy—with a strong emphasis on anti-racism, co-created and designed with parents—will help us lift up what we’ve begun to learn these past 14 months and cement the role of relationships in our understanding of socio-emotional and mental health in a child’s first one thousand days.


[1] Willis, D., Chavez, S., Lee, J., Hampton, P., and Fine, P (2020). “Early Relational Health National Survey: What We’re Learning from the Field.” Washington, DC: Center for the Study of Social Policy