Center for Early Relational Health

COMBO National

COMBO National is the first nationwide study focusing specifically on Early Relational Health (ERH), to uncover how each component of relational health maps onto social functioning throughout a child’s development. 

The center is committed to building the scientific evidence base for ERH and making evidence-based universal primary prevention possible in pediatrics. 

To build that evidence base, we must first identify where the evidence is lacking and focus on filling those gaps. For the field of ERH, that means: 

  1. Causative science on the mechanisms of parent/caregiver-child ERH 
  2. Long-term benefits to child health & development 
  3. Population-level applicability of universal interventions 

To get a comprehensive picture of the current landscape of dyadic ERH interventions, we conducted an enormous fieldwide meta-analysis. The data were shocking: 

  1. While some interventions did show improvements in the quality of parent/caregiver-child ERH, they were small and waned after 1-2 years 
  2. There were no improvements in child outcomes outside of ERH, such as health or development 
  3. Most current interventions are for families already at high risk for impaired ERH, meaning that these strategies may not apply to early relationships, broadly 

Despite the existence of many interventions aimed at ERH, the field does not currently have sufficient evidence to universally recommend any dyadic ERH interventions for improving child health or development, to meet the American Academy of Pediatrics’ call for relational solutions. 

Our sweeping systematic review helped crucially narrow the spotlight for the field of ERH: To develop relational interventions, we need relational evidence. Only then can we build, evaluate, and implement universal tools that any parent/caregiver and child could benefit from, setting every family up for future positive outcomes. 

That’s what COMBO National is doing, together with families and pediatric clinicians across the United States. 

A nationwide study of the full space of early childhood relationships 

Having developed some of the most sophisticated remote protocols for qualitative and quantitative evaluation of ERH, COMBO paved the way for the center to grow its unprecedented cohort into a study of the wide spectrum of early childhood relationships across the United States. 

COMBO National is an exclusive partnership between the Center for Early Relational Health and Reach Out and Read, a network of pediatric care providers serving nearly 5 million American families across every state. This partnership brings COMBO’s rigorous longitudinal study of parent/caregiver-child health into a nationwide clinical network, building the most comprehensive understanding of the full space of early relationships. 

The center leads the clinical research component of COMBO National (including its large-scale data analysis), while Reach Out and Read leads the implementation research (designed in partnership with COMBO and the ERH Learning Community at Nurture Connection) to translate the center’s clinical findings into universal pediatric practice. 

While the original COMBO cohort focuses on maternal-infant/maternal-child health, COMBO National’s pilot is enrolling as many parents and caregivers as possible to generate a truly comprehensive data set on the meaningful relationships in a child's life. 

A field-leading approach to studying & supporting early relational health 

Crucially, via Nurture Connection’s ERH Learning Community, COMBO and Reach Out and Read co-designed this phase of the study with the families and pediatricians themselves, listening to the lived experiences of those who will be most impacted by the research and by any interventions that come out of it. 

This collaborative approach to pediatric research is an essential step in producing real-world data that is both actionable and scalable. With this foundational data, COMBO National seeks to begin to answer the AAP’s call, toward building a world where pediatricians have access to truly evidence-based dyadic interventions — developed for and with the families they serve — for those critical early years. 

In a field that so profoundly affects lifelong outcomes, designing, conducting, and spreading this work in a relational way holds enormous potential to promote the well-being of the American family and invest in our future generations.