In‐the‐moment ratings on the Early Relational Health Screen: A pilot study of application in home visiting and primary care

Abstract

Early infant-parent interaction sets a critical foundation for young children's well-being, and evidence regarding the protective role of secure early relationships has led to increased interest in effective screening and promotion of early relational health in pediatric primary care and home visiting settings. We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS), implemented in two different contexts: an innovative model of relational health promotion in pediatric primary care (Study 1) and an Infant Mental Health Home Visiting (IMH-HV) model (Study 2). Across both studies, a trained clinician rated the ERHS following real-time observation of interaction (i.e., "in-the-moment" ratings). Reliability was assessed by comparing "in-the-moment" ERHS ratings to subsequent coding of the same interaction from video by an independent evaluator. In addition, Study 2 data permitted evaluation of the validity of "in-the-moment" ERHS ratings. Results from both studies indicated reliability of "in-the-moment" ERHS ratings. In addition, Study 2 clinician "in-the-moment" ratings were associated with maternal depression and ratings of child-parent interaction derived from a separate observational task coded by independent evaluators using a different well-validated research-based measure. Discussion highlights the potential of the ERHS as a screening, promotion, and prevention tool that may be feasibly administered by providers across pediatric primary care and home visiting settings.

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

“…'Early relational health', refers to 'the capacity to develop and sustain safe, stable and nurturing relationships ( [21], p.3). It is advocated as an important way to improve early childhood development and mitigate the effect of early life adversity [16,20,21,[23][24][25][26][27]. Although no one would deny its importance, the question is how to reach children living in the most vulnerable contexts, at what point in time to address their social and biological embedded regulation problems, how to timeously address (self-)regulation and other problems before they become persistent [18,35,47] From a neurodivergent perspective many challenges faced by neurodivergent individuals are seen as stemming from a lack of fit between their characteristics and expectations and biases in the proximal (home) and more distal (e.g., school, societal) context [45 There has been a wealth of studies on how a supportive parent-child relationship may promote child (self-)regulation [35].…”

“…‘Early relational health’, refers to ‘the capacity to develop and sustain safe, stable and nurturing relationships ([21], p.3). It is advocated as an important way to improve early childhood development and mitigate the effect of early life adversity [16,20,21,23–27]. Although no one would deny its importance, the question is how to reach children living in the most vulnerable contexts, at what point in time to address their social and biological embedded regulation problems, how to timeously address (self-)regulation and other problems before they become persistent [18,35,47] and how to set realistic expectations in infant with special needs [15 ▪ ,210].…”

“…Several professional organizations and task forces, e.g. the American Academy of Pediatrics [20,21] and the Canadian Paediatric Society (Early Years Task Force) [22] advocate that supporting 'early relation health' may mitigate -or even prevent -the effect of adversity on early childhood neurodevelopment [20, [23][24][25][26][27]28 && ]. They envision a multidisciplinary and system level approach to address the complexity of perinatal mental health problems and to promote neurobehavioral development.…”

A Holistic Approach to Early Relational Health: Cultivating Culture, Diversity, and Equity

“…The BHS evolved to become the Early Relational Health Screen (ERHS) [41]. The ERHS was validated during a population-level Norwegian study [40] and two US studies in primary care and home visiting settings [42]. The BHS and ERHS were developed and validated by White Euro-American researchers with relatively homogeneous samples.…”

The context and development of the early relational health screen

“…The subsequent interview can take 2 to 6 minutes depending on the length TA B L E 3 ERHS 4.0 mutual capacities 6 months 12 months 18 months 24 months Mutual capacities of parent responses and the extent to which the screener probes for more information. The ERHS videotape review and ratings of affect and capacities require no more than 5 to 8 minutes, although, with experience, an observer can learn to score in real time (Rosenblum et al, 2008). The ERHS observer can also select a short segment to watch with families for reflective video review.…”