Early Literacy Research Library (ELRL) - Article

The Context and Development of the Early Relational Health Screen

Willis, D.W., Condon, M., Moe, V., Munson, L., Smith, L., Eddy, J.M. (2022) The Context and Development of the Early Relational Health Screen. Infant Mental Health Journal, 43(3), 493-506.,

Access: Institutional Access

Publication year


study description


core topic(s)

Early Relational Health

Population Characteristics


Exposures, Outcomes, Other

Anticipatory Guidance , Child Development (general) , Parent-Child Relationships/Interactions , Positive Parenting , Screening and Tools , Technology and Digital/Screen-Based Media , Validity, Reliability, Feasibility, and Acceptability


Despite a variety of validated parent-infant observational assessment tools, few are practical within busy practice settings, acceptable with all racial and ethnic groups and ready for universal adoption. In response to this need, a team of clinicians, early childhood educators, researchers and infant mental health specialists collaborated to develop and test a novel video-based, dyadic relational screening and monitoring tool, the Early Relational Health Screen (ERHS).


Early Relational Health Screen (ERHS).

outcomes evaluated

ERHS feasibility, reliability, and validity.


Topics Discussed: Introduction; Early Relational Health (ERH) as an Emergent and Expanding Concept; ERH Screening: Why Another Screening and Monitoring Initiative?; The Development of the Early Relational Health Screen (ERHS) [The Origins of the ERHS: 2002-2011; The ERHS Proof of Concept Study: 2011-2017; The Little in Norway (LiN) Study: 2011-2020; The ERHS 4.0: 2017 to Present; Discussion [Limitations]; Conclusions.




This tool uniquely focuses on the early parent-child relationship (6-24 months), within the construct of early relational health (ERH). Initial testing demonstrated that the ERHS is a valid, reliable, feasible, and useful screening and monitoring tool for clinical applications. The ERHS was further developed within a population-based, prospective research study and adapted with brief video feedback for parents in the home visiting and child health sectors.


The ERHS and its adaptations appear to advance ERH and equity within the transforming child health and public health care systems of today.


The most obvious limitation of this work relates to limited cultural and equity perspectives and co-development. The ERHS was developed 2 decades ago by white dominant culture clinicians and researchers and the initial validation efforts were limited to the Nordic populations. As such, the use of the current ERHS in clinical practice in the U.S. comes with true risks of racial bias, white dominant perspectives, and inappropriate judgments of parents and parenting practices...Additional concerns have been raised about the validity and reliability of the ERHS and its interpretation after such brief relational observations within the medical home. The ERHS is solely a brief observation that occurs in-the moment and is intended as a screening and monitoring tool to celebrate observed strengths, ensure a positive, nurturing parent-child relationship, and to identify families where greater support or intervention might be needed. Screening results at a single point in time are surely not sufficient to establish a diagnosis and may have limited utility in predicting future outcomes. The ERHS is meant simply to be one observational tool that can be used to assist in the monitoring of ERH during the first 1000 days of life and was not designed to be a thorough assessment or evaluation on its own. Further, it is not intended to be a tool for forensic use.