We knew we had a problem on our hands. A group of us — parents, pediatricians, nonprofit leaders, and donors — had come together to discuss the role of strong and nurturing relationships between parents and babies in healthy childhood development. But it quickly became clear that some of the language medical professionals use to describe what’s known as “early relational health” did not resonate with, and in some cases even alienated, the people and communities the group hoped to support.
The gathering was part of a project launched early last year — the Early Relational Health Coordinating Hub at the Center for the Study of Social Policy — to ensure pediatricians and other medical professionals who work with parents understand and support healthy parent-baby relationships. The participants, including parents who were leaders in their communities, were tasked with developing training tools and resources on how to notice and encourage these positive emotional connections.
But soon after the process began, the parents at the table, including Mia Halthon, co-author of this op-ed, spoke up to share feedback from families in their community networks. Many, they said, objected to the standard clinical use of the words “safe” and “stable” to describe the strength of the connection needed between babies and their parents to develop emotional well-being. Those words, they felt, implied external observation and judgment. They suggested replacing them with “positive” and “strong” to underline the power within each family to nurture parent-child connections regardless of outside support.
After much discussion, a decision was made to replace the old language with the terminology preferred by the parents — a small but critical change in how the issue is communicated and one that would not have happened without the active participation of those most affected by this work.
This seemingly minor adjustment reverberated throughout the coalition. Parent leaders and families in their networks became more invested in shaping the emerging field of early relational health because they knew their lived experiences and expertise were valued and respected. The group’s work was more accessible and had a wider reach because we took time to incorporate diverse viewpoints that span ideological, racial, socioeconomic, and geographical differences.
While there is much talk within philanthropy about bringing people with diverse experiences to the table, it’s clear more still needs to be done to ensure that community members are given opportunities for participation and decision making equal to the so-called traditional experts.
The Early Relational Health Coordinating Hub — supported in part by Einhorn Collaborative, where Ira Hillman, the co-author of this op-ed, leads the work — offers an effective approach that could be replicated widely. From the start, the project has embraced a unique structure in which parent leaders are part of the governing body, sharing power with other steering-committee members. Six parent leaders also oversee a network of 10 other parents in each of their communities who weigh in on program strategy and design, effectively bringing the perspectives of 66 diverse voices into the room.
Combined, the parent leaders and their networks represent communities across the country that are central to our collaborative effort — Black, brown, and Indigenous parents; parents whose children have special health care needs or disabilities; Spanish-speaking immigrant parents; parents with a Southern cultural background; and fathers in single- or two-parent households.
In our experience, this structure differs dramatically from the standard approach to parent involvement used in other collaborative projects. Researchers, for example, typically bring in a few parent voices to include in their study or conduct a focus group or survey to get a parent perspective. We are sharing what has helped our group of donors, grantees, and parent leaders create effective partnerships in the hope that these suggestions can guide others involved in similar efforts.
Build connection and trust. At the start of the partnership, instead of diving straight into the work, we spent the first few sessions establishing a sense of shared purpose and connection among the diverse group of committee members. During the second meeting, shortly after the horrific elementary-school shooting in Uvalde, Tex., we took turns discussing what it felt like to be a parent today in a country grappling with so many challenges. This allowed all of us to be more vulnerable with one another and develop the trust needed to raise diverging viewpoints and be open to new ideas. Since then, we have regularly carved out time during meetings to learn about the values and motivations that brought people to this work.
Value people’s time and reduce barriers to participation. Steering-committee members who are not donors are compensated for participation. Parents receive monthly stipends to support their work for the group, including but not limited to attending and preparing for meetings, traveling, and participating in speaking engagements, and paying for child care.
A parent coordinator works closely with the parent leaders to ensure that all materials and meetings are fully accessible. For example, meetings are scheduled at times convenient for parents, and materials are created in plain English and languages spoken by the parents. The coordinator also has frequent conversations with parent leaders to ensure that they have multiple opportunities outside of the steering-committee meetings to voice their perspectives and ideas.
Actively encourage diverse views and disagreements. The steering-committee members and parent networks were selected specifically because they have different backgrounds and perspectives. The committee and each of the parent-leader networks created its own community agreement to guide communication and interaction within the coalition. These written principles create a structure that allows participants to speak honestly and openly even when it means contradicting others. The agreements range from simple logistics like using the “raise hand” function during Zoom meetings to working norms, such as giving all members the right of refusal, meaning we discuss disagreements as a group and respect a person’s decision to maintain their position on an issue.
This equal partnership among parent leaders, health care providers, researchers, policy makers, and donors allows us to engage deeply with families from diverse backgrounds and experiences, identify and prevent potential pitfalls before they happen, and expand the impact of early relational health across the country. The initial result of this work will be the launch this month in three states of an early relational health pilot training curriculum for clinicians in collaboration with Columbia University’s Department of Pediatrics and Reach Out and Read. During the next five years, we will continue to incorporate parent partnership as a central component in the design and implementation of the program.
It takes time to build trusting partnerships with parents and others whose expertise derives to an important degree from their own life experiences. For grant makers, these relationships are fundamental to achieving lasting results in the communities they support and should be a central focus of any effective investment strategy.
