What is relational health, and why is it so important?

Rebecca Baum, chief, section of Development, Behavior, and Learning at the University of North Carolina, Hillsborough, North Carolina; and Katherine Wu, MD, FAAP, Pediatric Health Care Associates in Cambridge, Massachusetts began their presentation, “Promoting relational health during health supervision visits” with an anecdote of a mother sitting in a pediatrician’s office with 2 of her children, one rather unruly. “If you don’t stop misbehaving, I’m going to get the doctor to give you a shot,” the very stressed mother warned her child.

Comical or concerning? Using the Bright Futures Guidelines, 4th edition, a book that offers principles, strategies, and tools to improve the health and well-being of children through culturally appropriate interventions, the 2 practitioners went on to explain relational health, how the pediatric HCP can promote relational health during office visits, and offered both strategies and resources for attendees.

Baum and Wu explored 4 concepts during their session: adverse childhood experiences (ACEs); toxic stress; relational health; and strength-based approach. ACEs were categorized into 3 different types; neglect, abuse and household challenges, such as substance misuse, divorce, etc) along with other adversity (bullying, community violence, etc). “ACEs can increase the risk for disease, early death, and poor social outcomes,” Baum stated.

Toxic stress was explained as biological processes that occur after the extreme or prolonged activation of the body’s stress response in the absence of safe, stable, and nurturing relationships (SSNRs), the crux of this conversation. With SSNRs, children, even in the face of ACEs, can still grow up to be mentally and emotionally stable adults.
Relational health, in essence is what creates these SSNRs, and the focus is on finding patient, family, and community capacities that can promote these SSNRs. How to create, though? As the presenters explained, the strength-based approach shifts the focus from a deficient model (emphasizing problems and disease detection) to health promotion and disease prevention, acknowledging the patient and family’s particular skills that can promote family (and particularly patient) overall well-being.

Baum and Wu then shared examples through videos of doctors and parents discussing challenges in the family that could be impacting the patient. The key takeaways here:
--the clinician should echo the mother’s concerns (“I am sorry to hear that you are going through the challenge of a divorce right now”)
-- then through positive reinforcement, help the parent to strategize additional solutions to the problem (“It is great that you can work with your ex-husband in that way; would it be OK if I help you explore some additional options to come up with a solution to your child’s misbehaving?”).

If a family is successfully executing SSNRs, it will reap positive benefits; the child will demonstrate interest and curiosity to learn new things; complete tasks; and (one of the most important), stay calm and in control when faced with a new challenge (ie, moving to a new school).

Additionally, Baum and WU shared both screening tools and resources, and offered these final suggestions:
--Assess a child’s level of relational health as part of pediatric health supervision visits
--Support families by utilizing the common factors approach (using hope, empathy, lay language, support; ask the family for permission to delve further with questions; and partner with family for solutions)
--Provide prevention and treatment counseling and guidance to children and adolescents and their parents/families
--Refer to local parent/child services when relationships are strained
--Advocate for effective opportunities for focusing on relational health in schools, communities, and hospitals
--Incorporate relational health in medical school curricula

Reference
Baum R, Wu K. Promoting relational health during health supervision visits. 2022 AAP National Conference & Exhibition. October 9, 2022. Anaheim, California.