By Nurture Connection
Early Relational Health (ERH) research and practice illuminate how positive, strong, and nurturing relationships in the early years of life are foundational to flourishing and provide a protective buffer to the effects of life’s many stresses.
But what role does intercultural wisdom play in ERH? And how can Indigenous knowledge and cultural pathways transform and expand our collective understanding of ERH practices?
Dominique Charlot-Swilley, David Willis, and Marie-Celeste Condon explore these questions in their paper, “A Holistic Approach to Early Relational Health: Cultivating Culture, Diversity, and Equity,” which they coauthored with Kandace Thomas and Christina Mondi. The paper appeared in the April 2024 issue of the International Journal of Environmental Research and Public Health.
Bringing the lived experiences of families and cultural and community wisdom into the field of ERH can be critical for practice transformation. The purpose of the paper, write the authors, “is to offer a synthesis of current knowledge about ERH in the United States; begin to integrate Indigenous and non-Indigenous research and knowledge about ERH in the hope that readers will embrace Etuaptmumk; and contribute to international dialogue about holistic infant-family ERH care.” Etuaptmumk is one of four Mi’kmaw guiding principles. It is a mutually respectful, relational way of being with one another, and integrating different ways of seeing, understanding, and responding to situations and experiences for the benefit of all.
To discover the relevance of Etuaptmumk to ERH practice, policy, and research, the authors encourage non-Indigenous people to be fully present, listening to stories and experiences that shaped Indigenous ways of being in good relationship with one another. In that spirit, during a recent conversation, Nurture Connection Founder and Director David Willis, MD, asked his coauthors Dominique Charlot-Swilley, PhD, an assistant professor in the department of pediatrics at the Georgetown University School of Medicine, and Marie-Celeste Condon, PhD, an independent consultant and former researcher at the University of Washington, to please share their origin stories about their work in ERH.
Telling the Story of “We”
For Charlot-Swilley, who grew up in Haiti, ERH was rooted in her experience of village and community. “For me, this came to be as a young child being raised in a system of communal family support we call Lakou. Although not raised in the traditional Lakou system, I experienced the deep sense of community and intergenerational connection that is at the heart of the Lakou traditions. There is the sense of the Ubuntu philosophy, ‘I am because we are; because we are, I am,’” says Charlot-Swilley.
Significantly, when her family moved to the United States, her parents were aware that as a child she would be absorbing English and the nuances of living in a new country. They nonetheless were very grounded in “maintaining within the home our language, cultural traditions, the sense of community, of a family support network, the sense of Lakou,” she said.
Condon, a descendent of First Nation Mi’kmaq L’nu, Québécois, and Irish immigrants, had a very different experience. Members of her mother’s family survived generations of British and French colonization, wars that pitted First Nations people against one another, broken treaties, the loss of traditional territories and fishing rights, and the erosion of language and cultural traditions that occurred when First Nations children across Canada were forcibly separated from their families and communities and sent to boarding schools for “reeducation.” Condon’s mother’s family immigrated to Massachusetts, where her mother was born. The family became part of a Québécois-speaking community. They went to work in mills and shipyards with hopes of making a better life for their children. Gradually, within three generations, they lost touch with L’nu relatives, their language, and tribal affiliation.
“Ironically, my mother and her siblings ended up being sent to a boarding school in Massachusetts that was run by the same order that operated a notorious boarding school in Canada,” says Condon. She survived but was haunted by the abuse for the rest of her life. Reeducation; systemic racism against dark-skinned, Québécois-speaking “Indian” immigrants in the United States; and the impacts of WWI, the Depression, and WWII on the family — it was a lot to endure. “If it weren’t for a wise and kind great-great-grandfather and a great-great-grandmother, a healer who knew how to make medicine using Gaspésie flora and fauna . . . if it weren’t for them taking my mother into their care when she was released from the boarding school, passing stories through her to me, the knowledge would have been totally lost,” Condon says. “My mother is a remarkable person in terms of what she survived, her determination to excel in school, and her audacity in marrying my father, an orphaned Texan who became a Coast Guard officer.
“Raising seven children was difficult, but my parents persevered. So, I come to this work having delighted in the births and babyhoods of my younger siblings and curious about ways of being with one another.”
Connecting Through Curiosity
That curiosity fed into Condon’s dissertation research, which involved witnessing the relationship stories that babies, their parents, and other loved ones told during back-and-forth interactions, wondering about the babies’ perspectives, what they had to say. The stories and reflections of parents, babies, and other members of their communities informed the approach that Condon, Charlot-Swilley, and their fellow authors highlight in their recent paper on ERH.
That is: the necessity of changing how providers approach ERH in practice and research. In the paper, notes Willis, they discuss how the clinician’s role in ERH has been rooted in a white European perspective of clinicians as observers using screening tools to measure families’ strengths and weaknesses, a role that implicitly “has the risk of being judgmental,” says Willis.
Charlot-Swilley and Condon worked with African American families and HealthySteps Specialists of Color to develop a culture- and family-centric model known as Early Relational Health-Conversations (ERH-C) to pivot from putting clinicians in the role of sole arbiter/observer of well-being or vulnerability in infant-family relationships. Collective well-being and interdependence underlie the ERH-C model.
In building their approach, explains Condon, there was a constant awareness “that Westernized thinking has clouded the ways in which we see infants.”
As an antidote to that, says Charlot-Swilley, “we come into that space with families not as the expert but as the learner, the student. That, in turn, builds trust. As we move forward and families ask a question around something they feel vulnerable about, then we put on our expert’s hat.”
Charlot-Swilley credits her own origin story with laying the foundation for her work on ERH-C and her approach to centering families. “The sense of maintaining culture rather than assimilating was essential because it deepened my ties to a sense of identity, to a sense of belonging, and to a sense of well-being,” says Charlot-Swilley. Her origins in a village of a caring community also run through her mind each time she welcomes a family in for a visit to explore ERH. For example, when she’s about to enter a room with a family, she explains, “as I put my hand on the doorknob, I think to myself, I am because we are. We are because I am.”
Condon travels a different path. She continues to search for her ancestors’ names and ways to connect with L’nu culture and traditions. She recalls how surprised and delighted she was to find her Mi’kmaw roots in Gaspésie and to discover the Institute for Integrative Science and Health, in neighboring Cape Breton. The institute was founded by Mi’kmaq Elders Albert Marshall and Murdena Marshall, who taught and modeled the institute’s guiding principles, and their colleague Dr. Cheryl Bartlett. “I was amazed to learn that the Elders who came together to lift up the institute were Mi’kmaq in the same region where my mother’s great-great-grandparents lived . . . that Mi’kmawi’simk sounds much like the language my mother’s father interspersed with Québécois during conversations with me at the end of his life. I had no idea how much the institute’s teachings would resonate with me.”
Core Concepts to Consider
The authors offer these concepts for researchers and practitioners to consider in their efforts to build a more holistic approach to ERH:
- The importance of intercultural learning
- Witness and listen — the transformational experience of witnessing* the shared experiences of families
- Parallel process — ways in which dynamics in one relationship influence dynamics in another relationship; we aim to be with providers in ways we hope they will be with families
- Community-centered — Ubuntu and Lakou both emphasize collective wellbeing, interdependence, and communal responsibility (“I am because we are. We are because I am”); interconnectedness, community, and village are central to Early Relational Health
- The principle of Etuaptmumk — a way of being with members of other cultures and integrating Indigenous and Western knowledge for the benefit of all
- The principle of “Holding Hands” — knowledge is conditioned by mutual respect
- Relationships are co-created through the exchange of stories
- Storytelling is healing
*Witnessing carries a deeper relational dimension — of presence, engagement, and sometimes even responsibility. It implies seeing with understanding, validation, and attunement rather than passive observation, and reflects the emotional and relational depth of truly seeing a caregiver-child interaction. It acknowledges not just what is happening but also the meaning behind it, validating both the caregiver’s and child’s experiences. Observing is more detached, often implying a clinical, objective, or research-based perspective — watching interactions without necessarily engaging emotionally.
In the Mi’kmaw language, there’s a verb tense that we don’t have in English, Spanish, French, or other European languages. It’s called the healing tense. . .
When the healing tense is used, one is speaking honestly about one’s deeds. No part is unwelcomed by the listeners, who serve as witnesses. One is seen in the fullness of oneself. One hears in the witnesses’ use of the healing tense that one belongs, is respected, forgiven, and beloved before and after sharing the fullness of the story.
It’s a bit like the Japanese practice of kintsugi, where something broken is mended with gold. You can see the imperfections. But it’s even more beautiful after the repair, right?
There’s this idea of “we are all related.” Healing for one is part of healing for all. It is so embedded in the ecosystem, how authentic, humble, and respectful Mi’kmaq are with one another, that is actually part of the way the language is constructed.
—Marie-Celeste Condon
Final Reflections
“I’m thinking about how afraid many people are in the United States right now,” says Condon. “How much there’s a danger of fragmentation, of people not feeling that they can speak, be seen and heard.” She’s also concerned about how patients’ struggles can affect providers in pediatrics and other fields. “It would be helpful to make a regular part of providers’ work be sharing stories, thoughts, feelings, and reflections alongside peers in small, trustworthy groups. Reflective consultation helps participants find ways to mitigate secondary trauma, compassion fatigue, and burnout.” Ultimately, she adds, “we have to know how to stay in relationship with one another and cultivate a shared sense of belonging.
“Culture wasn’t much passed down in my family, but heroism was.” she continues. “Stories of perseverance and heroism were passed from one generation to the next. I think that type of encouragement — that in American Sign Language is this word [she signs the concept], meaning ‘heartening the hearts of other people’ and ‘heartening relationships’ — is so much needed. We’ve been here before, and we know how to do this.”
In the current climate, says Charlot-Swilley, “we do not want children and families to lose hope; we want them to flourish and thrive, and believe that they can — a belief that is anchored in relationships and community.
“It is important now more than ever that children and families are linked to the community. That there’s a sense that this is my village, these are my people, this is my group,” she says. “This is where I could go to restore and rebuild, put on my armor, so that when I open the door, I am grounded.” Charlot-Swilley sees that armor formed through relationships, music, language, and dance: “There has to be a way that we find healing in all of these things, so that we are infused with internal joy while we face the external world.”
ERH, when practiced with a holistic lens that centers cultural wisdom, is one more crucial link in that armor. Along with regular access to reflective, heartening, mutually supportive spaces that providers and families need, ERH ensures that every community is made stronger through positive and enduring emotional connection.
At its heart, Nurture Connection is an engaged, insightful community of parents, caregivers, researchers, medical professionals, philanthropists, early childhood systems leaders, and policymakers dedicated to ensuring every child has strong, nurturing relationships during their earliest, formative years.
Our “Reflecting Forward” series features guest articles and reflections by dedicated members of our national network, from across the country — who are advancing the Early Relational Health field through practice, research, and parent leadership. These reflections pave paths forward for transforming early childhood systems and imagining new possibilities for children, families, and communities.