Community Resilience is Foundational for Early Relational Health

By Wendy Ellis, DrPH, MPH, David W. Willis, MD, and Kay Johnson

Our growing understanding of the factors that ensure the heathy development of young children within strong families focuses both on the foundational relationships of Early Relational Health (ERH) and on the contexts and resources of families within the communities as articulated within the Community Resilience Public Health Model 3.0. These synergistic frameworks come together with their combined strength and create multiple opportunities to create alignment.

The Center for Community Resilience (CCR) at George Washington University and its national networks of CCR are leading the way in the Community Resilience movement with the Community Resilience: A Dynamic Model for Public Health 3.0. framework. The purpose of the model is to inspire, support, and sustain a network of communities that are committed to addressing the root causes of childhood trauma, fostering equity, and building community resilience. Informed by research, the BCR Network sites and Resilience Catalysts in local public health departments are working to eliminate adversity and foster equity through upstream systems change. (1) The CCR articulation of the Pair of ACEs Tree depicts the interconnectedness of adverse community environments — the soil in which some children’s lives are rooted — and the adverse childhood experiences — the branches that may grow for children and families from such roots. (2) The interface between adverse community and childhood experiences as depicted by the Tree can help community partners and local health departments consider not only individual experiences, but also the context (community environments) in which many personal and family traumas are experienced. Further, the Pair of ACE’s Tree reminds partners of the importance of creating multi-tiered and concrete solutions in communities for families that promote healthier outcomes. In short, the Tree model encourages community partners to think beyond only addressing individual challenges, but toward enriching community context and addressing equity- the nutrients in the soil.

Early relational health, too, requires good, rich soil to support and foster the growth of positive relational experiences. The development of foundational relationships requires such safe, stable, and nurturing environments that comprise elements of the social and community context. These elements are aligned with the Community Resilience model which also centers the importance of the neighborhoods and communities where children and families live. We know that under-resourced communities are a result of years of intentionally racist and discriminatory policies and practices that continue to generate persistent maternal and child health disparities. The growing recognition and measurement of opportunity gaps is valuable but insufficient without intentional and anti-racist actions designed to stimulate community resilience. (3)

The 2021 AAP Policy Statement, Preventing Childhood Toxic Stress: Partnering with Families and Communities to Promote Relational Health, calls for an immediate and urgent shift from current practices to a focus on safe, stable, and nurturing relationships that buffer adversity and build resilience. (4) However, instituting this relational health framework in a meaningful way will require the entire pediatric community to adopt an aligned public health agenda that advances new ways of partnering with families and communities. Child health care has much to learn from the Pair of ACE’s Tree and the Community Resilience framework that operationalizes the Public Health 3.0 Model. In addition, adopting these types of core strategies along with the AAP recommendations for change requires that child health providers understand the impact of racism both on families and on their communities, and commit to promoting equity, community and family engagement, policy solutions for advancing equity, resilience, and early relational health.

What would it look like if the pediatric community aligned behind an early relational health framework and — in so doing — successfully used the Community Resilience model? Imagine the reality of eliminating racial disparities and witnessing the flourishing of children, families, and communities! The work must start with broad, community conversations as captured in CCR’s recent documentary film, “Truth and Equity”, which illustrates the story of Cincinnati’s efforts to address the long-standing effects of structural racism. And given that more than 90 percent of families in need of perinatal and child health care touch the health system, the opportunity for families and communities to build effective collaborations with health systems for the alignment of needed critical services is enormous. Developing the connections between families, communities, and health systems and empowering each sector to tackle the root causes of adversity are an essential first step. Building on the concept of Resilience Catalysts in public health can foster community-wide, cross systems action to address adversity and structural racism. CSSP’s Family Centered Community Health System model also articulates further activities to align family engagement, equity, a focus on foundational relationships and the health system to improve outcomes for all families.(5) New high performing medical homes with expanded team-based care models that incorporate doula’s, community health workers, community navigators, home visitors and peer-to-peer counselors drawn from the community will help forge more trusted and equitable relationships among health providers, families, and communities. This relational health workforce will be the frontline in support of the developing foundational relationships, promoting equity for families within health systems, and a key part of transforming pediatric health care. (6,7)

· Economic security: including paid family leave, jobs with living wages, and income supports such as tax credits or cash assistance

· Safe home and community environments: including adequate housing and food, safe communities, and recreation areas

· Health care: including a high performing medical home as part of a family-centered community health system

· Social and relational supports: including formal and informal social networks, parenting education and supports, and home visiting

· Early care and education: including affordable high quality child care and universal pre-Kindergarten

There is no greater time to bring together the two powerful movements of the Community Resilience and the Early Relational Health to enrich the soil and ensure that every family can thrive.

Wendy Ellis, DrPH, MPH is Director of the Center for Community Resilience at the Milken Institute School of Public Health at George Washington University. David W. Willis, MD, FAAP is a Senior Fellow at the Center for the Study of Social Policy. Kay Johnson is President of Johnson Group Consulting, Inc.

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1. Ellis WR, MPH; Dietz, William H. MD, PhD; Chen, Kuan-Lung Daniel DrPH, MPH. Community Resilience: A Dynamic Model for Public Health 3.0. Journal of Public Health Management and Practice. 2022;28.

2. Ellis WR, Dietz WH. A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience Model. Academic Pediatrics. 2017;17(7, Supplement):S86-S93.

3. Acevedo-Garcia DN, C., and McArdle, N. The Geography of Child Opportunity: Why Neighborhoods Matter for Equity: First findings from the Child Opportunity Index 2.0. Brandeis: diversitydatakids.org;2020.

4. Garner A, Yogman M. Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. Pediatrics. 2021;148(2):e2021052582.

5. Willis D. Advancing a Family-Centered Community Health System: A Community Agenda focused on Child Health Care, Early Relationships, and Equity”. In. Washington, DC: Center for the Study of Social Policy; 2020.

6. Johnson K, & Bruner, C. A Sourcebook on Medicaid’s Role in Early Childhood: Advancing High Performing Medical Homes and Improving Lifelong Health. Child and Policy Family Policy;2018.

7. Bruner C. Building A Relational Health Workforce for Young Children: A Framework for Improving Child Well-Being. Des Moines, IA: InCK Marks Initiative;2021.

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Center for Community Resilience

A Milken Institute School of Public Health collaborative seeking to address the root causes of childhood & community adversity.