“Our report talks about reciprocity, which means that for Early Relational Health to grow, we must understand not only the benefit of these relationships to children but also to caregivers and to the community. These benefits are equally important and they’re tied to each other. You can’t isolate the children from the family, and you can’t isolate the family from all the supports and resources in the community.” – Dr. Junlei Li
Interview with LaVonia Abavana and Dr. Junlei Li
We were fortunate to speak recently with early childhood education expert Dr. Junlei Li and Camden, NJ parent advocate LaVonia Abavana about Early Relational Health, the subject of a new Burke Foundation report co-authored by Dr. Li, in which Ms. Abavana is featured. Readers of Starting Early, might recall our interview with Dr. Li in June 2021, in which he spoke about his Simple Interactions approach to fostering positive child development. In our latest conversation, Dr. Li and Ms. Abavana widened the lens on our understanding of Early Relational Health, exploring how the health of children is tied to the health of parents and caregivers, and the health of the ecosystem that surrounds them. Read on for insights into how advocates, practitioners, and really anyone intersecting with parents and children can offer support and compassion so children, families, and communities can thrive.
Dr. Li, explain what Early Relational Health means and why it’s important?
Junlei: Its importance lies in the words themselves. When we say “early” we’re talking about very young children. “Relational” means it’s about the relationships young children have with the people around them. And “health,” in this case, means the wellbeing of the whole person.
It’s not just your physical health. It’s your mental health, it’s the health of your learning. Early Relational Health puts all these things together: the development of very young children, the protective relational buffer they have around them, and their overall health.
This is so important for me because, more than 20 years ago, I was working in orphanages, and there was a phenomenon regarding orphans being cared for in orphanages, which medical doctors called “failure to thrive.” Failure to thrive was the medical way of saying, “we have no idea why this child is not healthy. There was no obvious illness, no obvious immune dysfunction, there is good nutrition and diet, but the child essentially withers away. It was a mystery and the closest we came to understanding was that, in the orphanage environment, despite a child having food, shelter, and clothing, they didn’t have the relationships a child needs and naturally comes to expect. If you take away those relationships, it doesn’t matter if you have everything else — children fail to thrive and some ultimately die. That’s the most tragic example of the opposite of Early Relational Health. In contrast, Early Relational Health provides for the thriving of children, their caregivers, and the community. That is what makes it so important — as an inclusive concept and vision.
Can you share some key findings from your report?
Junlei: Historically, when we think about young children’s relationships with family, other caregivers, early childhood providers, we consider the impact on those children. Sometimes we even think about parents as a kind of means to an end, as in “let’s support parents so young children can develop well.” Our report talks about reciprocity, which means that for Early Relational Health to grow, we must understand not only the benefit of these relationships to children but also to caregivers and to the community. These benefits are equally important and they’re tied to each other. You can’t isolate the children from the family, and you can’t isolate the family from all the supports and resources in the community. But, for years, the way we talked about early relationships put a kind of deficit view on families and on community: If early relational health isn’t going well, people blame parents, and if parents are struggling, people blame community, implying that there’s something wrong with the neighborhood.
But what we find in the larger research is that parents — whether birth parents, foster parents, or adoptive parents — have this incredible capacity to want to build a relationship with their child, and their brains actually start to change while they engage in caregiving. These changes make them better caregivers, more attuned to the signals from their child, leading them to have more empathy as to what their child is going through.
So how do we support adults who struggle with caregiving? Instead of the old thinking — if the adults are not building a relationship, it must be the adult’s fault — if you understand that adults have this capacity to build relationships with their children, then you can ask nonjudgmentally what is holding them back from that capacity. That allows you to look at supports and resources available for the family, and for the community to better support families. It changes not just how we understand science and practice, but the way we talk with families and communities.
LaVonia, you were interviewed for this report in your role as a community and parent advocate. How did you get involved in supporting families and children?
LaVonia: My son was bullied in school because of his Tourette Syndrome. When he was having physical and vocal tics, teachers thought he was being disrespectful. Kids would call him names and threaten him. My son was traumatized. They dismissed me when I advocated for him. Neither his voice nor mine was being heard.
I reached out to NJ Children’s System of Care – (PerformCare) a government agency that took our issues seriously and gave us a tool to get the 504 Plan, which ensures that students with disabilities have equity in schools or any environment that is federally funded. We took that information to his doctors at Cooper Pediatric Care. Our experience with them – from his primary care doctor through his neurologist – was amazing. They took the time to listen to my son, to ask how he was doing and to find what was going on in school. They used this information to develop the accommodations for his 504 Plan. Because they made the effort to hear his voice, he started to feel empowered. While things did not work out at that school, and I moved my son to an awesome nurturing school, Uncommon Schools Camden Prep, we continued to have incredible help and support from our primary care doctor.
Not only was she gentle and kind to my son, but she helped me too because I was going through a traumatizing situation. Focused only on making sure my son was okay, I had forgotten about myself. His primary care doctor also helped me. It was a two-generational effort on her part.
It really was the theory that “it takes a village” that got me started. I don’t want any parent to feel they’re alone in dealing with these types of situations. That’s why I advocate for all these systems and teach parents how to advocate for themselves.
What issues do you see parents facing today and what resources are important for families that support early relational health?
LaVonia: Some of the tools I use to support families include helping them understand their child’s developmental milestones, suggesting they track them, and if they have any concerns about developmental delays bringing them to their doctors. I provide them with contact numbers for interventions and services, I bring childcare options to them, help them with directories, and share programs I have access to through the CDC’s “Learn the Signs. Act Early” program, the Department of Children and Families Services, and early childhood systems. And I follow up with them. The goal is to give them a full range of options but, most important, to let them know their voice is being heard and to work with them at their comfort level.
Junlei: To echo LaVonia, whatever the services are, what makes the difference between the service just being there and one that families will use stems from this idea of meeting families where they are. Sometimes it means geographically, like having services in places where families can access them or being integrated in the places that families already go, like school libraries or community centers. Efforts that we’ve seen across the country include mobile pediatric vans that go to neighborhoods at predictable times every week, instead of expecting families to take their young children’s strollers on a bus for an hour to get to a pediatric office.
A physician I know who is focused on domestic violence and works with families found that at her clinic, people were making appointments but then not showing up. Once they realized it was a transportation issue, they arranged with the city to provide families free Uber rides to come to the clinic and then hardly any families missed their appointments.
There’s one level that’s even deeper than geography or access, which is to meet families where they are developmentally and in terms of their circumstances. So many families talk about not wanting to go back to see doctors because on the first visit they felt they were being judged by the assumptions made about them.
LaVonia said “the number one barrier and difficulty for parents to work with professionals, beyond logistics and scheduling, is trust.” That trust comes from meeting families where they are, not only geographically and logistically, but also when you’re face to face. You need to be there for the family and understand where the family is, and not start with whatever stereotypes, biases, and assumptions that you might have with you.
In your report, you focus on positive childhood experiences. For those of us that are more familiar with the literature and practice around Adverse Childhood Experiences, talk about the role positive childhood experiences play in kids’ lives.
Junlei: Of all the research I’ve come across in the last 10 years, the literature focused on positive childhood experiences is my favorite to talk about. The initiative behind positive childhood experiences quite literally has the acronym HOPE, for Healthy Outcomes from Positive Experiences.
And it really is some of the most hopeful research I’ve come across. To explain, we need to backtrack a little bit. Let’s think about the story that we tell about Adverse Childhood Experiences. Clearly, it’s been important to raise awareness over the past two decades about these adverse childhood experiences. But let’s take a step and think about how unbalanced that story is. What the ACEs work essentially says is if you grow up exposed to all these adverse experiences, it will have a long-term harmful impact on your health, your behavior, and on your life. And what follows from that is the identification of the communities where children are experiencing lots of ACEs. But then the story just stops there. We’re essentially saying, “Well, if you are stuck in these communities with these kinds of ACEs, you’re all going to have negative long-term consequences.” But anyone who grows up in these communities knows that, despite all the challenges, people do thrive, and many do rise above. So the question is how and why?
Looking at positive childhood experiences helps to answer that question. The way we’ve begun to think about positive childhood experiences is: When considering how you grew up, can you say yes to one of seven questions about positive childhood experiences? These are questions along the lines of: When you were going through a tough time, did you feel like your family stood by you? Or did you feel like you were supported by your friends? Did you feel like you were part of your community? Did you participate in the rituals and activities of your community, the kind of things that make you feel like you belong and that give you a sense of pride? My favorite question from the list is: Did you have two non-parental adults who took a genuine interest in you as you were growing up?
Of course, championing positive childhood experiences is not to excuse the fact that children and families are surrounded by adverse childhood experiences. Instead, it’s to provide hope that if we invest in the people and places in these communities, whether it’s individuals, or churches, or coaches, or teachers who organize children in sports or arts or other activities, we can help create these positive childhood experiences while reducing the adverse childhood experiences.
LaVonia, you mentioned that a goal for you as a parent advocate is for parents not to feel they’re alone in managing their challenges. How can advocates help parents and caregivers feel less isolated?
LaVonia: When I’m actively outreaching in the community and I’m faced with a parent who feels isolated, there is a lot of power in actively listening with empathy and compassion and with my full attention. It’s critical to validate their concerns and understand where they’re at emotionally, financially, and otherwise. I want to make sure I use eye contact and respectfully respond with nonverbal cues; I want to be relatable to them, so they open up to me and let me know what’s going on so that I can best support them. If they feel comfortable communicating with me, that helps them feel less isolated and alone. And to underscore what we mentioned before, being non-judgmental is really important. If those elements of communication were put into place in other environments and situations where parents and caregivers find themselves, it would be easier to build trust. Parents and caregivers could develop beautiful relationships with providers and doctors, schools, community partners, and social service agencies.
Dr Li, what policy solutions would help support Early Relational Health?
Junlei: The science and the practice of Early Relational Health isn’t new, yet it is exciting to use it as an inclusive vision across diverse communities of families and professionals. Parents, practitioners, and policymakers know the importance of early development and of relationships and we know how they connect to health. We focus on the concept of an Early Relational Health ecosystem in our report because an ecosystem thrives when everyone in it is healthy. In the past, we talked about policies primarily in terms of wanting children to be well. And if children were not well, we blamed adults — teachers, parents, the community. Our report suggests a more inclusive goal: Healthy child development depends on supporting everyone who cares for the child. We want everyone to be healthy within this Early Relational Health ecosystem.
That means we need to do what we can to bring equitable access to supports and resources to everyone in the community. That includes the caregivers and the children, and it also includes the many professionals and sometimes informal supports in the community. So that’s one important idea, thinking of the health of the ecosystem rather than thinking about service delivery to the individual child.
I think of an image that helps further this point. If you can picture when the rain starts to fall on a pond, you start to see ripples. Each raindrop is just one drop but when the raindrop hits the water, it creates ripples that radiate outward. Then other raindrops hit and create their own ripples and after a while the whole surface of the pond is covered with ripples.
When you think about the work of someone like LaVonia, the way she impacts systems, the way she finds and talks to families, everywhere she goes, she leaves behind ripples. Even in the story of one single interaction, you can see how these ripples go farther and farther out and strengthen and improve the health and wellbeing of an entire community.
These ripples of impact can go out from every part of the ecosystem, whether it’s a pediatrician’s office or the street corner where two families meet, whether it’s at a school board meeting, each of us can become the center of ripples and soon you can’t go anywhere without being touched by the ripples. And that, to me, is the ultimate picture of the health of the community.