Mother and son playing with wooden toys.

Advancing Early Relational Health

Transforming child health care and early childhood system building

What We Work For

In partnership with many stakeholders and leaders in child health, public health, and communities we are working to further galvanize interest in an early relational health frame, believing that there is an urgent need and an immediate opportunity. 

Early relational health (ERH) is an emergent term that has galvanized the interest of many leaders in the child and public health sectors and simply means that healthy and positive child development emerges best in the context of nurturing, warm, and responsive early parent/caregiver child relationships, when children are surrounded by safe communities with strong trust and social connectedness.

How We Do It

By engaging with child health systems, thought partners, early childhood system builders, policy and network leaders, parent voices, and practitioners in co-creating, innovating, testing, and disseminating strategic activities, we are advancing an early relational health frame.

In addition:

  1. We maintain the National Coordinating Hub on Early Relational Health that builds key trainings, materials, and resources to improve practices and systems.
  2. We staff the National Early Relational Health Advisory Panel that advises the Coordinating Hub and helps advance a national consensus on foundational relationships
  3. We partner with strategic networks to test, disseminate, and measure the impact of ERH resources to advance foundational relations. Such networks include Reach Out and Read and EC-LINC.
  4. We work to expand next-generation leadership that will advance early relational health at CSSP and beyond.

Erhealth Stacked Color RgbIn partnership with many stakeholders and leaders in child health, public health, and communities we are working to further galvanize interest in an early relational health frame, believing that there is an urgent need and an immediate opportunity. 

Early relational health (ERH) is an emergent term that has galvanized the interest of many leaders in the child and public health sectors and simply means that healthy and positive child development emerges best in the context of nurturing, warm, and responsive early parent/caregiver child relationships, when children are surrounded by safe communities with strong trust and social connectedness.

What is early relational health (ERH)?
Early Relational Health (ERH) refers to the foundational relationships between a young child and their caregivers that advances physical health and development, social well-being, and resilience. 

Why is ERH important? Why should we care about ERH?
Decades of research have shown that safe, stable, and nurturing relationships between adults and children increase positive outcomes for children including health, early learning, and future well-being. ERH balances the stressful experiences that caregivers and their children may experience, and contributes to prevention, healing and resiliency building.

Is ERH a new concept?
ERH is not a new concept, but a new term that builds upon decades of research in child development, early childhood mental health, and neurodevelopment.

Why do we need a new term, if ERH is not a new concept?
There has not been enough attention paid to the foundational dyadic experiences (those between a caregiver and a child) that set the stage for future health and social emotional well-being. Focused efforts to promote positive health and development outcomes for an individual child are important, but the relational context that influences those outcomes is often forgotten. Therefore, there is a need for a new term and resulting practices that highlight the efforts needed to elevate the child/caregiver relationship as central to child development.

How does ERH seek to address structural and institutional racism? How does it incorporate an anti-racist frame?
Advancing ERH requires an anti-racist foundation. We cannot promote ERH without also doing the work of examining and then dismantling historical and present day institutional and structural racism that disrupts opportunities for many families and communities, especially Black, Latinx, and Indigenous families. All families have the capacity for strength and resilience, particularly within the cultural context of relationships, but racism continues to be in our structural groundwater as a disruptive and unjust counter force.

What do these early relationships in families look like?
When witnessing the natural and growth-promoting early interactions of infants, young children, and their parents, we see the smiles, eye contact, mutual responses, turn-taking, pauses, playfulness, spontaneity, cooperation, and delight for all parties in these shared moments of love. Even those moments of sadness, fear, or frustration can be indicative of shared tender and sensitive relationships. These characteristics are the observable signs of ERH.

How does ERH consider cultural differences?
Cultural variations in parenting practices and caregiving are well known. However, there is a growing body of evidence to suggest that the earliest relational patterns are actually more universal—the first patterns of interactions between mothers and babies have both reflexive and predictable interactions that help establish the beginnings of the social brain and stress responsive system. As human development proceeds over time, culture begins to enrich and shape parenting practices that come from cultural and historical traditions. Cultural variations of communication styles, verbal and interactive play patterns, and, ultimately, storytelling and cultural teaching bring richness and variety to our early childhood communities.

What kind of approaches can pediatricians, community health workers, and mental health workers use to strengthen the foundational relationships of ERH?
The most important step towards ensuring that practitioners are integrating ERH into their practice begins with practitioners themselves reflecting on how they perceive the strengths and capacities of all families and their perspectives about partnering with families. Then comes the work of creating space for trusted, open, and welcomed conversations with families about the value of family relationships for the well-being of all. For example, asking new parents about their family histories and their thoughts and experiences with their new baby, including insecurities, worries, concerns, and doubts. Building an authentic and trusted relationship with families starts with listening. Then, practitioners must understand that all families need a network of trusted support. Ensuring those connections and encouraging their value also creates a social context that promotes ERH.   

What can early childhood system builders and policy leaders do to advance early relational health?
Many families face the burdens and stresses from poverty, racism, housing, food insecurity, unsafe neighborhoods and climate change. Early childhood system builders and policy leaders must focus to eliminate these burdens to allow families to focus more energy and time on establishing positive and hopeful relationships with their babies. Early childhood system builders and federal, state and local leaders must seek to develop and promote policies and strategies to reduce the burdens and stresses on caregivers that stem from racism, economic insecurity and barriers families face in securing safe and stable housing. Policies that support families are essential for caregivers to have the time and space to focus on establishing and nurturing healthy positive relationships with their babies.

What can parents and caregivers do to strengthen early relational health?
The well-being of parents and caregivers is an essential element in the development of early relational health, as well described within the protective factors—parent resilience, social connections, and concrete support in times of need. Research also shows that early relational health experiences are beneficial for both the baby and their parents and caregiver. Caregivers can build early relational health in many ways—through eye contact, touch, and intimate emotional communication. Talking to your baby—even if they can’t fully understand you—helps to develop that close emotional connection and bond. Sharing personally meaningful stories with your baby, like the story of their birth, how you chose their name, or what is going on around them at the moment seems to awaken deep and important autonomic emotional connections. Those brief, daily moments of connection are priceless—the simplest moments (talking and singing as you change a diaper, breastfeeding, playful interactions, or reading together) all combine to enhance close relationships.

CSSP has an initiative to promote early relational health. What are some of its current activities?
CSSP has five areas of ERH work: (1) training the next generation of physicians that are part of the Reach Out and Read network in the importance of and vital signs of ERH; (2) building promotion and measurement strategies that support strong foundational relationships for child health practice transformation; (3) developing relational health training for the relational health work-force of doulas, community health workers, mental health workers, clinicians, and early childhood leaders; (4) promoting policies that enable greater focus and support of early relational health best practices; and (5) testing the best practices and innovations in ready communities.

How is ERH embedded in CSSP’s child health practice transformation work?
ERH is a part of the framing within many activities that CSSP undertakes with regard 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 early childhood policies.

Small Cover Erh Messaging Guide November 2022Download the Messaging Guide

Early Relational Health is the state of emotional well-being that grows from the positive emotional connection between babies and toddlers and their parents/caregivers when they experience strong, positive, and nurturing relationships with each other. 

Early Relational Health is becoming more widely and urgently recognized as central to building the health, educational capacities, and social well-being of the next generation.

Our success in building a movement to advance Early Relational Health rests on the strength of our partnerships and effective communications to tell a consistent story and to amplify key messages. 

This guide is a tool to help the many voices supporting and working alongside young children and families speak the same language to spread awareness, spark interest, advocate holistically, and accelerate change. 

In this guide users will find:

  • A definition of Early Relational Health
  • A core story about why attention to Early Relational Health matters and how we can effect change
  • Key messages for specific stakeholders
  • Framing strategies and language that users can leverage to support their communications needs taken from Building Relationships: Framing Early Relational Health, a FrameWorks Institute strategic brief.

Download the Messaging Guide

  • Sherri L. Alderman, MD MPH, IMHM-E®, FAAP, board certified Developmental Behavioral Pediatrician
  • Tyson Barker, Research Associate, the Center for Translational Neuroscience; Director of the Early Childhood Precision, Innovation, and Shared Measurement (EC PRISM), the University of Oregon
  • Brenda Blasingame, Program Manager, the Pritzker Children’s Initiative
  • Rahil D. Briggs, PsyD, National Director, HealthySteps
  • Lindsey Burghardt, MD, MPH, FAAP, Fellow at Center on the Developing Child at Harvard University
  • Amy Fine, MPH Early Childhood Systems Consultant
  • Phil Fisher, PhD., the Philip H. Knight Chair, Professor of Psychology, University of Oregon; Director of the University of Oregon Center for Translational Neuroscience
  • Bryn Fortune, Family and Parent Leadership Director
  • Andrew Garner, MD, PhD, FAAP, Clinical Professor of Pediatrics, Case Western Reserve University and Private Practice of Pediatrics, Partners in Pediatrics
  • Janice Gruendel, PhD, research professor at the University of North Carolina—Charlotte in the Academy for Research in Community Health, Engagement, and Services (ARCHES)
  • Kay Johnson, President of Johnson Group Consulting, Inc.
  • Alicia Lieberman, PhD, the Irving B. Harris Endowed Chair in Infant Mental Health and Vice Chair for Academic Affairs at the UCSF Department of Psychiatry, and Director of the Child Trauma Research Program
  • Dina Lieser, MD, Senior Adviser at HRSA’s Maternal and Child Health Bureau’s Division of Home Visiting and Early Childhood Systems
  • Junlei Li, PhD, the Saul Zaentz Senior Lecturer in Early Childhood Education at the Harvard Graduate School of Education
  • Joan Lombardi, Ph.D., directs Early Opportunities LLC
  • Dayna Long, MD, primary care pediatrician at UCSF Benioff Children’s Hospital Oakland
  • Tish MacInnis, Alabama Strengthening Families Coordinator, Alabama Partnership for Children (APC)
  • Kimberly Martini-Cavell, MA, Executive Director, Help Me Grow National Center
  • Mary Mackrain, M.Ed, IMH-E® (IV), Managing Director, EDC
  • Alan Mendelsohn, MD, is a developmental-behavioral pediatrician, Associate Professor of Pediatrics and Population Health at New York University School of Medicine and Bellevue Hospital Center
  • Cynthia Minkovitz, MD, the William H. Gates, Sr. Professor and Chair in the Department of Population, Family, and Reproductive Health; Professor of Pediatrics at Johns Hopkins University
  • Kaitlin Mulcahy, Associate Director, Center for Autism and Early Childhood Mental Health at Montclair State University
  • Colleen Murphy, Vice President of the Early Childhood Knowledge Navigator, Ounce of Prevention
  • Cynthia Osborne, PhD, Executive Director, Prenatal-to-3 Policy Impact Center; Professor of Early Childhood Education and Policy at Vanderbilt University’s Peabody College of Education and Human Development
  • Anthony Queen, Parent Liaison, Great Start Collaborative in Kent County, MI
  • Kate Rosenblum, PhD, IMH-E., clinical and developmental psychologist; Professor of Psychiatry, Obstetrics & Gynecology, University of Michigan
  • Robert Sege, MD, PhD, Executive Director, the Charles H. Hood Foundation
  • Daniel Shaw, PhD, Distinguished Professor of Psychology at the University of Pittsburgh and Director of the Center for Parents and Children and the Pitt Parents and Children Laboratory
  • Nikki Shearman, PhD, Chief of Strategic Initiatives, Reach Out and Read
  • Lynlee Tanner Stapleton, Ph.D., Public Health Analyst, HRSA’s Maternal and Child Health Bureau in the Division of Home Visiting and Early Childhood Systems
  • Dana M. Winters, PhD, Director of Simple Interactions and Academic Programs at the Fred Rogers Center for Early Learning and Children’s Med at Saint Vincent College

The Center for the Study of Social Policy (CSSP) and Reach Out and Read National (ROR) have partnered to advance Early Relational Health, the belief that—when children are surrounded by safe communities with strong trust and social connectedness along with nurturing, warm, and responsive early parent/caregiver-child relationships—healthier and more positive child development emerges.

This livestream series, hosted by David Willis, MD, FAAP, a Senior Fellow at CSSP, will explore innovative and thought provoking efforts to advance Early Relational Health in child health transformation and communities and why it is important for those across the early childhood field to embrace this transformational model and mindset for improving child and family well-being.

In our first conversation, panelists will discuss the development of an initial set of training modules and materials for ROR pediatricians about observing autonomic emotional connection as learned from the key elements within the Welch Emotional Connection Scale (WECS). These observations have opened groundbreaking discussions about how ROR pediatricians can partner with families to support their foundational relationships as pediatric care moves toward advancing “relationships as a vital sign.”

The Perspectives on Early Relational Health Series brings together a diverse group of parents, pediatricians, researchers, and providers to share their perspectives on why Early Relational Health matters, and what they are doing to support and promote foundational early relationships.

Click here to visit the Perspectives on Early Relational Health Series page.

Our Experts

Pasty Hampton portrait.

Patsy Hampton

Senior Associate and Director, EC-LINC
She, Her, Hers
David Willis portrait.

David Willis, MD

Senior Fellow
He, Him, His