“The physical, behavioral, and mental health of children and adults are built on this foundation of relational health. Relational health serves as the foundation of the well-being of a person, a family, or an entire community.”
– Dr. Junlei Li
Interview with Dr. Junlei Li and Thelma Ramirez
In Early Relational Health: A Review of Research Principles and Perspectives, lead authors Dr. Junlei Li and Thelma Ramirez from the Harvard University Graduate School of Education explore the science and practical applications of Early Relational Health, presenting a valuable resource for practitioners working to advance the health and well-being of children and families.
In a recent interview, they discussed their findings and recommendations for advancing Early Relational Health at an individual, family, and community level.
What was the most interesting neuroscience-related research you came across when producing your report?
Junlei Li:
A lot of neuroscience is associated with early childhood, but the way we’ve talked about it has always missed half the story. Early childhood is about young children being in relationships with parents, family, and other caregivers. But the way we typically talk about Early Relational Health only relates to a child’s brain development; we don’t address brain development of the caregiver.
A cluster of research, primarily within the past decade, beautifully illustrates the effects on brain development of caregivers, including birth moms, fathers, and adoptive parents who have no biological connection to the children.
Neuroscientific research indicates there is a “caregiving network” — not a region, but a whole network — spread throughout the brain from the emotional to the attentional to other connected systems. This network starts to turn on in parents’ and caregivers’ brains even prior to childbirth. The same research shows that, even for adoptive parents, the sheer act of intimate caregiving — holding the child, just being engaged in everyday caregiving moments — turns on and strengthens the caregiving network in their brains as well.
Thelma Ramirez:
Research around interventions that are focused on building the relationship between caregivers and young children shows amazing benefits that come from their interactions. I want to mention those that relate, in particular, to a parent’s mental health and to potentially reducing depression or helping with anxiety. This is especially the case with moms at risk for depression or anxiety, who may be living in situations where they are far from their own families and don’t have a large support network or have a mental health history in their own family. This is why, with new moms, it’s important to talk about the benefits of connecting with their child, even when they may not feel like doing it all the time.
The benefits go beyond the family setting. When we think about schools, research shows that positive early relationships between teachers and young students are associated with more joy and a sense of purpose for teachers and reduced stress. Most of the time, people only think about the impact on the family, but we can really include many other players when we think about relationships with children.
Beyond the brain story, what other significant aspects of Early Relational Health should inform how we think about it?
Junlei Li:
Just as we’ve neglected half the brain story by focusing only on the child, we’ve neglected the impact and benefit for adults by focusing primarily on the developmental impact on the child. By recognizing that Early Relational Health fundamentally affects children and their caregivers, we’re looking at a much bigger picture: The physical, behavioral, and mental health of children and adults are built on this foundation of relational health. Relational health serves as the foundation of the well-being of a person, a family, or an entire community.
When we invest and work on policies and support systems that help strengthen relational health, starting from the early years for the family, we’re actually strengthening the relational health of the entire community and therefore the well-being of the entire community.
What are some big barriers to building Early Relational Health and how can we address them?
Junlei Li:
Some barriers relate to the way we think and talk about young children and families. If all we focus on is the child’s development and the child’s needs and we develop programs and policies based on that, then these programs and policies will — at best — be half effective. And if we think of providing parents with individual services, as opposed to weaving together for them a coherent system of formal and informal support that includes early learning, early intervention, prenatal and post-natal care, along with playgrounds, and safe spaces for families to be, won’t be able to create a well community in which families and children can develop and thrive. One of the values of talking about Early Relational Health is to outline a vision that allows us to think differently and design policies, programs, and services in a more connected way.
Thelma Ramirez:
I’m reminded of conversations we had with parents about barriers they experience. One mother made that very point about only having her child’s needs recognized. She spoke about how she was able to qualify for healthcare while she was pregnant but, once the baby was born, it felt like she became invisible. She no longer had any kind of coverage and this was at the very moment when she needed the most support. She was experiencing depression and felt she couldn’t be a good mom to her baby. She was still able to bring her baby to well visits but couldn’t get any help for herself. Other parents revealed that they felt unseen in conversations with doctors, who were solely focused on their children, when those parents could have used support and connection as well.
Many parents have multiple responsibilities to manage, whether it’s their work, caring for relatives, or other obligations. Is a lack of time also a barrier in building Early Relational Health?
Junlei Li:
What we’ve found and are still wrestling through is that there are two simultaneously important ways to talk about time. For policymakers, for those who can reshape systems for employers, implementing the kind of policies that create time or protect time for families to build their Early Relational Health — such as paid family leave — is incredibly important.
– Dr. Junlei Li
At the same time, you don’t want to imply to families that the only way they can be good enough parents to their child is if they have infinite amounts of time. It’s very important for families and caregivers to understand that just the simple, ordinary caregiving interactions and playful interactions you have with a child, even if it’s just for a few minutes, make a huge difference. Families can focus on the impact of the simplest or smallest interactions and not feel overwhelmed or stressed thinking, “I’m working a second or third job and I don’t have enough time to be with my child.”
Your report focuses on key principles that explain why and how Early Relational Health-focused programs work. One of these principles is about trusting parents. How can professionals better incorporate that in the work that they do to support families?
Thelma Ramirez:
– Thelma Ramirez
In interviews we did for this report, when we spoke with people who do home visiting, or with the directors of programs, or with policymakers, we repeatedly heard this concept around trusting the parents. And they all described it in a similar way: It’s about understanding that parents want to do what’s best for their children, that they have the capacity to parent, and that we as professionals are there as a partner to parents, in a supportive role.
When I was a home visitor, we’d go into a home and tell the parents, “You’re the number one expert when it comes to your child.” And parents do hear this, but how does a home visitor actually put this into practice and show them that you trust them? For my program, it meant we planned the visits together with parents, creating together what the activity would be at the next visit. We’d discuss what goals we wanted to achieve for their child. The key was listening to and hearing the parents.
We heard from experts at all levels about the importance of having faith that parents know what they’re doing, that they’re resilient, and that they were parenting before any professionals came into the picture. Most important, we have to listen to parents regarding their needs and then act on helping them meet those needs.
Junlei Li:
We felt it’s important to talk about underlying principles that make Early Relational Health-focused programs successful versus just the programs themselves because within this ecosystem there are many big and small actions that people can take to help support Early Relational Health. And these actions occur both in and outside of programs. For example, a pediatrician may have been part of the Reach Out and Read Program, but this doesn’t mean that only when the pediatrician is doing Reach Out and Read activities do they support Early Relational Health.
There are countless small interactions that pediatricians and other healthcare providers can have with a family to support Early Relational Health. One thing may be how pediatricians talk with not just moms, but fathers as well, when they’re at a visit together. Even just the pediatrician’s subtle gestures, and whether they turn to the father when asking a question, play a part in supporting Early Relational Health within that family and conveying this trust of both parents.
How can we better embed issues of equity in our approach to Early Relational Health?
Thelma Ramirez:
When I think about embedding equity in Early Relational Health, I go back to those conversations we had with parents at all income levels, with different kinds of educational backgrounds and circumstances. Parents spoke about the importance of having their basic needs covered to be in a place where they could actually engage in responsive caregiving interactions.
One parent said, “You can tell me I’m a good parent, but how can I actually feel that about myself when I’m not able to make rent this month or when I can’t gather enough money for diapers? That’s not being a good parent.” Whatever services programs offer, it’s important to look at the whole picture. So if, for example, you offer home visits around child development, you need to also understand what resources can help this parent get their basic needs met in order for her to be open to doing the home visit.
Junlei Li:
Equity manifests itself in many ways. There are activists, including parent leaders and grassroots providers, who’ve been doing work closely aligned to Early Relational Health principles for a very long time. They don’t have formalized evidence-based programs, so they often can’t attract the kind of recognition and financial support they need. So, even related to funding, thinking equitably means moving beyond the way we used to think, which is that we only fund programs that are so-called “evidence-based.”
An Early Relational Health lens helps us see that when the larger ecosystem breaks down within the family or within a neighborhood, it’s inevitably the result of inequitable structures. If you actually trust the parent, then, when you see they’re struggling, the questions that come afterwards are, “What part of this system is inequitable? What is broken in terms of access to services, in terms of the availability of support?” So Early Relational Health also serves as one lens to push forward and have much more complex conversations and critical examinations of equity.
About the Authors
Dr. Junlei Li is Saul Zaentz Senior Lecturer in Early Childhood Education and Faculty Co-Chair, Human Development and Education Program at the Harvard Graduate School of Education. He previously served as Co-Director and Rita M. McGinley Professor for Early Learning and Children’s Media at the Fred Rogers Center at Saint Vincent College.
Research Associate Thelma Ramirez is a research project manager at the Harvard Graduate School of Education. She previously supervised home-based parenting education for families of children prenatal to 5 years of age.