To Start Children on the Right Path, Funders Seek to Strengthen Their Earliest Relationships

In 2017, the Einhorn Collaborative and a core group of other funders came together to investigate where they could best support parents so that their children would reach the necessary milestones to be ready for kindergarten.

The anchoring point, they decided, was the pediatric well-child visit — a routine checkup that allows a doctor to ensure development is on track and spot any potential problems. There was substantial evidence that during these regular visits in a child’s early years, parents tend to trust their baby’s doctors and don’t feel judged by them, according to Einhorn Collaborative’s Bonding Strategy Lead Ira Hillman.

“There was this real opportunity to say, how can we better leverage that moment to support parents and promote social and emotional development?” he says.

The name the group gave its initiative says it all: Pediatrics Supporting Parents (PSP). It’s grown into an extensive effort to elevate the routine doctor visit into an opportunity to support parents in any number of ways, thereby strengthening the critical bond between parent and child that has such a profound impact on early development. PSP is one of a growing number of funding efforts that Einhorn and others are making to support “early relational health,” the forming of strong connections in the first years of life.

The original group of partners included the W.K. Kellogg Foundation, the Overdeck Family Foundation and the David and Lucile Packard Foundation. Today, that list has expanded to eight collaborative funders, including the Conrad N. Hilton Foundation, the Perigee Fund, the J.B. and M.K. Pritzker Family Foundation, the Roots & Wings Foundation and the Stupski Foundation.

The partnership is currently seeking to engage national, local and regional funders to support investments at either the community or national level.

A research-based approach

Early on, to tease out what would best nurture the parent-child relationship and support children’s social and emotional development, the funders commissioned a study by the Center for the Study of Social Policy (CSSP), which, in 2019, laid out 14 common practices culled from site visits to numerous programs. Drawing on input from parents at every step of the way, the research identified actions that are foundational to promoting strong emotional connections between parents and their babies.

These practices, which providers could share during their well-child visits, include helping people gain confidence in their parenting skills while explaining child development milestones. The study also highlighted the need for providers to identify and refer parents to resources to address barriers that interfere with parent-child bonds, such as maternal depression, or the profound stress caused by the lack of basic necessities, such as access to food or housing. The study also recognized that any further demands on pediatric practices required building in time for training and support for healthcare staff to prevent on-the-job burnout.

Einhorn and the other core funders selected five pediatric sites in partnership with community-based organizations in North Carolina, New York, Washington State and two in California. These will join a learning community with parental involvement to figure out how best to implement those 14 practices. As the funding collaborative making the initiative possible, Pediatrics Supporting Parents will continue up until 2026. So far, it has raised $14 million of a projected $23 million budget, according to Hillman.

The PSP’s focus dovetails with an American Academy of Pediatrics’ call to action for pediatricians to work with families and communities to prevent toxic stress, a term referring to unpredictable, constant stress from adverse childhood experiences, discrimination and other factors that trigger a threat response in the body. To counter and prevent toxic stress, the AAP advised building strong, safe and nurturing relationships between parents and their children through early relational health.

The emphasis on easing stresses and shocks in a child’s first years has shown up in any number of education funding programs lately, with foundations recognizing an opportunity to head off barriers to learning and development.

In the same vein, Einhorn has long supported research by Columbia University’s Nurture Science Program, which has been investigating how to assess and fortify emotional connection between mothers and newborns, work that complements Einhorn’s mission to find an antidote to the “crisis of connection” that it believes is endemic in the country. It’s a focus that extends beyond childhood development, as Einhorn has backed efforts to bridge America’s divides and issued a call to “cultivate a culture of connection.”

How strong emotional connections between mothers and their babies affect both of their nervous systems has been documented in a growing body of research, including that of the Nurture Science Program, which gauged the effect over time of mothers touching, holding and soothing their premature babies shortly after birth in a neonatal intensive care unit compared to a group that did not. In a follow-up when the infants had reached ages four to five, researchers measuring heart rates and doing other stress tests found the moms and children who had soothed each other were significantly more able to self-regulate.

“In other words, when a mom and baby are cuddling, talking and cooing warmly with each other, making eye contact, listening and responding to each other, they are influencing the very physiological functions that underlie their health,” noted a summary of the research on the Nurture Science Program’s website.

To encourage other types of parent-child bonding, Einhorn is also funding a collaboration between the Nurture Science program and Reach Out And Read (ROR), a national program that trains pediatric healthcare staff in encouraging parents to read with their children and provides age-appropriate books to parents. In 2021, the program adapted its training to include tenets of early relational health, which has been taken by nearly 10,000 pediatric clinic staff.

“Clinicians learn how to have conversations with families on how these early positive relationships lay the foundation for social, emotional and cognitive development, support life-long physical and mental health, and can also support the wellbeing of caregivers and families,” says Dr. Usha Ramachandran, Reach Out and Read’s medical director for New Jersey.

Centering families

A common thread in this field, as seen in the Pediatrics Supporting Parents initiative, is making sure that parents help create these programs and that the programs are tailored to their needs.

“If we are to transform pediatric care, which is the goal of this project, we cannot do it without centering families in the work and facilitating the racial healing journey of clinical systems to better support families experiencing the worst health outcomes,” said Monica Beltran, a program officer for the W.K Kellogg Foundation, one of the core funders of the initiative. The foundation has committed over $4 million toward PSP since 2017.

Besides its support of Pediatrics Supporting Parents and the five sites, the Kellogg Foundation, along with the Burke Foundation and the Pritzker Children’s Initiative has been tackling early relational health by supporting a collaboration between the Center for the Study of Social Policy and Health Connect One, a national network that trains community health workers in Black, brown and Indigenous communities who work as doulas and lactation specialists and provide home visiting services to parents. The collaboration is currently developing early relational training to be piloted in several areas.

The collaboration seeks to promote “strengthening familial bonds through peer-to-peer support that centers on communities most impacted by years of historical disinvestment and structural inequities,” according to a recent CSSP newsletter.

For Carly Roberts, the associate program director of Out of School Learning at the Overdeck Family Foundation, participating in the PSP initiative was right on par with the foundation’s focus on early childhood.

“Our priority outcomes, which we try to focus all of our [early childhood] grantmaking around, are healthy births, so really, avoiding preterm and low birth weight and getting a solid start in life from day one,” she said. The foundation has committed $250,000 annually to the PSP initiative.

Overdeck has also funded direct service programs such as the Reach Out and Read program, the Nurse Family Partnership, a national program that improves birth outcomes by pairing expectant parents with nurses, and Centering Health Care, a program whose focus is about “disrupting the structures and systems that drive poor health to co-create communities where everyone has an equitable opportunity to thrive,” according to its website.

A growth area for philanthropy

Early relational health appears to be gaining traction among funders focused on early childhood. The Einhorn Collaborative and more than 120 other supporters of early childhood are part of a relatively new philanthropic group to promote early relational health, the ERH Funders Community. Some of the foundations in this community are supporters of Nurture Connection, another early relational health collaborative, that has thus far raised $6 million of a $30 million, five-year budget that extends through 2027.

With the lack of paid parental leave, economic pressures, difficulty accessing care for children’s mental health, and 1 in 6 mothers facing maternal depression and anxiety, parents face numerous barriers to emotional connection with their children.

“It doesn’t need to be this way. Change is possible,” Hillman wrote recently. Working with parents in a collaborative, respectful and nonjudgmental way, he says, offers new hope. “Emotional connection is a state we move in and out of with each other, not a trait a person either has or lacks.”

That is why involving philanthropy is so essential, Hillman says. “It has been heartening to see funders increasingly coming together to invest in early relational health," said Hillman. "If we want to buffer the serious health effects of adversity and stress in the lives of children and families, we must foster strong and nurturing parent-child relationships at the earliest stages. Understanding the building blocks of these social connections is crucial to developing and maintaining relationships throughout life — with people who are like us, and across lines of difference.”

Clarification: This article has been updated to clarify the distinction between two early relational health collaboratives, ERH Funders Community and Nurture Connection.

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