NASEM Early Relational Health Report Webinar: Insights for Change

The National Academies of Sciences, Engineering, and Medicine’s (NASEM) recent consensus study report, Early Relational Health: Building Foundations for Child, Family, and Community Well-Being, describes the biological and developmental foundations of Early Relational Health (ERH) and its benefits across the lifespan. It also provides actionable guidance for advancing ERH through practice, policy, and research. The report leads the ERH conversation in new directions and makes it relevant for audiences beyond pediatrics and healthcare. In addition, it provides tools to help professionals across sectors identify opportunities for change. 

In a webinar on October 22, 2025, the report’s authors shared key insights and addressed participants’ questions. This blog highlights some main takeaways from the webinar. For a deeper dive, watch the full webinar recording.

Answering Key Questions About ERH

The NASEM report was commissioned to seek answers to specific questions about ERH and sponsored by the Centers for Disease Control and Prevention (CDC) and Trust for Learning/New Venture Fund. Its authors — who brought expertise from multiple disciplines — were tasked with synthesizing the most advanced thinking on questions including:

• What is the link between ERH and lifelong health and well-being? 
• What is the impact of ERH on addressing health and societal challenges? 
• What factors create ERH? 
• What are best practices to advance ERH? 
• How can we support ERH through state and federal policies?

Shifting the Current Mindset

The NASEM report seeks to deepen understanding about what ERH is, and how it is created and nurtured. The authors emphasize that relationships are biologically necessary for health. They also underscore that ERH is determined by many factors, from families to community resources to macro-level forces that shape daily life. In order to advance ERH, the authors encourage shifting toward a mindset that embraces multiple ERH constructs and moves beyond dyadic thinking in order to center positive buffering factors and relational abundance.

Embracing a multitude of constructs: The report includes the first published recognition that ERH is comprised of a multitude of constructs, such as safe attachments, emotional availability, and biobehavioral synchrony. This recognition is a direct appeal for more cross-sector collaboration and research to understand how these constructs individually and synergistically map onto life-course outcomes.

Thinking beyond the dyad: Relational health is commonly thought of as a connection between two people. However, it is much broader and impacted by the dynamics of families, communities, built environment, and systems-level policies. “ERH is not just the dyad but the relationships and influences around the dyad. It’s important to view them all together,” said report author Andrea Gonzalez, PhD, an associate professor in the department of psychiatry and behavioral neurosciences at McMaster University in Ontario.

The authors note that the dyadic concept is a Western construct; other cultures simultaneously engage multiple children and generations. This view has influenced research — most focuses on families and often on the mother-child relationship — and doesn’t explore the contributions of the broader community, early education settings, and governmental and nongovernmental supports. 

Preventing adversity isn’t enough: There are two ways that ERH impacts health. When children have safe and secure relationships, they have better psychological, social, and physical health outcomes. Also, ERH has a buffering effect on the impact of childhood adversity. Research shows that children in families with high adversity but also high family resilience (such as strong social supports) can thrive — even more so than children with low adversity and low family resilience. 

“Even if we could wave a magic wand and eliminate all adversity, it wouldn’t be enough to have kids develop the way we want them to,” said report author Andrew Garner, MD, PhD, a clinical professor in the department of pediatrics at Case Western Reserve University and University Hospitals of Cleveland. “That’s why we need to support families: so they can create positive childhood experiences that not only buffer adversity but build the skills they need to pass on the resiliency to the next generation.” 

Centering relational abundance: A relational abundance mindset is a way of seeing and engaging with the world. Instead of focusing on scarcity (what families or communities lack), it highlights the assets, wisdom, culture, and capacities that people bring to one another through connection. As Dr. Garner explained, relational abundance is a transformational concept that anyone can apply. “There’s no limit on being good to one another,” he said. “Instead of asking, ‘What’s wrong with this family?’ it’s asking, ‘What strengths does this family have that we can build on?’”

From Service Providers to Relationship Builders

Embedding ERH into systems, programs, support models, and workforce supervision structures shifts healthcare and childcare from being transactional to being relational — enabling families and communities to flourish and thrive.

Relationships are also built through codesign and collaboration across sectors and with community members. In the webinar, the authors commented that “moments of connection are universal but not uniform,” meaning that relational health doesn’t look the same for everyone. To connect with different people requires diverse relational approaches grounded in family, community, and cultural perspectives. 

“Ensuring families and communities are partners in shaping ERH approaches starts from the beginning — where they are not just advisory but leading the way,” said Shayla Collins, a report committee member and continuing education specialist at the Center for Child & Family Well-Being at the University of Washington in Seattle. “Families and communities know what they need and should be seen as equals in this journey of developing the policies and systems that we’re working toward.”

Tools for Action

The authors emphasize that advancing ERH is achievable — even small changes can have big impact. Change is already happening, including the AAP’s call to action to support safe, stable, nurturing relationships (SSNRs) and the work so many are leading in early childhood ecosystems across communities, including members of the Nurture Connection’s National ERH Network. As highlighted in the webinar, the report provides tools to help accelerate this work, including:

• Public health framework for ERH: A tiered, multifaceted, and cohesive approach to prevention and intervention, as well as examples of types of programs at each level
• Principles for embedding ERH in systems: Guides a fundamental shift in how we design and implement early childhood systems, including with family/community codesign and reflective supervision  
• Principles to guide policymaking for ERH: Provides a “lens” to evaluate existing policies and consider if new policies will promote ERH
• Financing opportunities through Medicaid: Identifies ways to promote ERH for nearly half of all U.S. children and 75 percent of low-income children under 6 years
• Future directions for research: Identifies five research priority areas for future research, interdisciplinary approaches, participatory research with families and communities, and population-based measurement and infrastructures

Collective Commitment to Promoting ERH

The authors concluded that collaborating on the report produced a shared set of insights, including the importance of a collective commitment. “We believe that advancing ERH is a national imperative because it builds resilience, social cohesion, and economic stability,” explained report author David W. Willis, MD, FAAP, Nurture Connection’s founder and director, and chair of the NASEM Committee on the Early Relational Health Determinants of Future Health and Well-Being.

“Only our imagination gets in the way of what we can do,” said report author Elisabeth Burak, a senior fellow at the Georgetown University McCourt School of Public Policy’s Center for Children and Families. “If we think differently in small and big ways, from local communities to policy, there are opportunities in every state, especially when it comes to Medicaid and making those benefits work for families.”