What is relationship health and why is it so important?

Rebecca Baum, chief, section of development, behavior and learning at the University of North Carolina, Hillsborough, NC; and Katherine Wu, MD, FAAP, Pediatric Health Care Associates in Cambridge, Massachusetts began their presentation, “Promoting Relationship Health During Health Supervisory Visits” with an anecdote of a mother sitting in a pediatrician’s office with 2 of his children, a rather unruly one. “If you don’t stop behaving badly, I’m going to ask the doctor to give you an injection,” the very stressed mother warned her child.

Funny or disturbing? 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 then explained the health relational health, how the pediatric health professional can promote relational health during office visits and offered strategies and resources to participants.

Baum and Wu explored 4 concepts during their session: negative childhood experiences (ACE); toxic stress; relational health; and strengths-based approach. ACEs have been classified into 3 different types; neglect, abuse, and domestic issues, such as drug addiction, divorce, etc.) as well as other adversities (bullying, community violence, etc.). “ACEs can increase the risk of disease, early death, and poor social outcomes,” Baum said.

Toxic stress has been explained as biological processes that occur after extreme or prolonged activation of the body’s stress response in the absence of secure, stable, and nurturing (SSNR) relationships, central to this conversation. With SSNRs, children, even in the face of ACEs, can still grow into mentally and emotionally stable adults.
Relationship health is essentially what creates these SSNRs, and the focus is on finding patient, family, and community capacities that can promote these SSNRs. But how to create? As the presenters explained, the strengths-based approach shifts the focus from a deficient model (emphasizing problems and disease detection) to health promotion and disease prevention, recognizing the special skills of the patient and family that can promote the general well-being of the family (and in particular the patient). being.

Baum and Wu then shared examples through videos of doctors and parents discussing challenges in the family that might impact the patient. The main takeaways here:
–the clinician should echo the mother’s concerns (“I am sorry to hear that you are currently going through the challenge of a divorce”)
— then, through positive reinforcement, help the parent find additional solutions to the problem (“It’s great that you can work with your ex-husband in this way; would it be okay for me to help you explore options to come up with a solution to your child’s misbehavior?”).

If a family successfully performs SSNRs, they will reap positive benefits; the child will show interest and curiosity in learning new things; complete tasks; and (one of the most important), staying calm and in control when faced with a new challenge (eg, 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
–Supporting families using the common factors approach (using hope, empathy, lay language, support; asking family for permission to pursue issues; and partnering with family to find solutions)
–Provide advice and guidance on prevention and treatment to children and adolescents and their parents/families
–Refer to local parent/child services when relationships are strained
–Advocate for effective opportunities to focus on relational health in schools, communities and hospitals
–Integrate relational health into medical school curricula

Baum R, Wu K. Promoting relational health during health supervision visits. 2022 AAP National Conference and Expo. October 9, 2022. Anaheim, CA.

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