Project Summary

This project seeks to:

Develop multi-component intervention to address toxic stress.
Evaluate efficacy of intervention to mitigate toxic stress.

Background

Children with Adverse Childhood Experiences (ACEs) may benefit from interventions to mitigate the negative health effects of prior trauma. The challenge for many communities, especially those that are underserved, is that health and education systems are fragmented and often fail to accommodate families’ level of need.

Community Health Workers (CHWs) are members of the community that provide health care services and support to members of their communities and can also serve as a bridge to community members across systems. CHWs can serve critical roles in child health by linking families with community resources and assisting them in navigating the health care system. CHWs usually share ethnicity, language, socioeconomic status, and life experiences with the community members they serve. They are known by many titles: community health advisors, lay health advocates, promotoras or promotores, outreach educators, community health representatives, peer health promoters, and peer health educators. They are an important link between a community and the health care system, and they perform a wide range of activities including peer education and counseling, referral assistance, and direct clinical care such as blood pressure screening. The Loma Linda University team brings together pediatricians, community health workers, and parenting educators to improve the delivery of information and resources to a diverse population of families throughout the Inland Empire.

Project Goals

Improve the child outcomes in children with ACE's using the HEAL FIRST intervention.
This graphic describes the project goals. The goals of this project are to test the association between children’s ACEs scores and their toxic stress, test if the HEAL FIRST intervention in health and education reduces toxic stress, and evaluate the impact of mediating variables on the efficacy of the intervention.
An image of three AIM goals. AIM 1: Test association between child-ACE sores and toxic stress. AIM 2: Test if HEAL FIRST reduces toxic stress in children with ACEs. AIM 3: Evaluate impact of mediating variables on intervention efficacy.

The Loma Linda University (LLU) team brings together pediatricians, community health workers, and parenting educators to foster Health, Education, And Learning (HEAL) partnerships and improve the delivery of information and resources to a diverse population of families throughout the Inland Empire. Service providers will be trained with an established technique known as Families Implementing Resilience Together (FIRST), which focuses on strengthening families and building youth resilience. The FIRST curriculum focuses on (1) understanding trauma and promoting resilience, (2) supporting stress management and executive function through mindfulness, emotional self-regulation, and healthy lifestyle, and (3) creating safe, stable, nurturing relationships to encourage social-emotional development.

During several follow-ups over twelve months, researchers stay in touch with children and families to determine if the HEAL FIRST intervention is effective at decreasing toxic stress associated with ACEs, improving health outcomes, and reducing health disparities. Research visits will include the measurement of biomarkers of toxic stress and other psychosocial indicators which, in combination with ACE scores, will be used to better understand the biopsychosocial changes that lead to poor health.

  1. Is there a baseline association between Child-ACE scores and toxic stress in children from 3-11 years old?
  2. Does the HEAL First intervention reduce toxic stress and child health & psychosocial problems at follow-up for children ages 3-11 with ACEs?
  3. What other variables play a role in the effectiveness of the HEAL FIRST intervention?

Many factors govern whether or not a child will be resilient to ACEs, including genetic and environmental factors. Importantly, the effects of ACEs can be mitigated, and the LLU team aims to foster the development of stress management skills and safe, stable, nurturing relationships to encourage social-emotional development.

Team Leaders

Ariane Marie-Mitchell, MD, PhD, MPH

Loma Linda University

Ariane Marie-Mitchell, MD, PhD, MPH is a clinician, researcher, and educator. She practices primary preventive care through the Preventive Medicine and Pediatrics Departments at Loma Linda University. Her research interests focus on understanding: 1) mechanisms underlying the links between psychosocial risk factors, biological markers, and health outcomes; 2) the development of primary care interventions to assess risk and improve outcomes; and 3) the translation and dissemination of research on clinical preventive services.

Dr. Marie-Mitchell obtained a BA at Stanford University, a PhD and MD at the University of Southern California, and a Master of Public Health and residency in preventive medicine at the University of Rochester.

Marti Baum, MD

SAC Health System

Marti Baum, MD, is Medical Director for Community Engagement at SACHS (Social Action Community Health System) and Medical Director for Help Me Grow Inland Empire. She has longstanding relationships and connections with numerous organizations in the community, including the San Bernardino City Unified School District and the San Bernardino County Medical Society. Dr. Baum obtained a BS from Southern Missionary College (now Southern Adventist University), her MD at Loma Linda University School of Medicine, and her residency in pediatrics at Loma Linda University Health.

Elizabeth Park, MA, PsyD

SAC Health System

Elizabeth Park, MA, PsyD, is a clinical psychologist providing behavioral health services at SAC Health System (SACHS). She is also a supervisor for psychology trainees at the SACHS Family Medicine Integrated Care program. Her past practicum, internship, postdoctoral training, and experiences have been primarily with underserved, economically disadvantaged, and culturally diverse populations that have been impacted by ACEs. She has been trained in a variety of evidence-based practices, including Parent Child Interaction Therapy, Trauma Focused Cognitive Behavior Therapy, Incredible Years, and Cognitive Processing Therapy. She has also trained and supervised clinicians from different disciplines (including psychiatry residents, psychology interns, and occupational therapists) in parenting interventions.

Dr. Park received her doctoral degree in clinical psychology with an emphasis in Family Psychology from Azusa Pacific University. She completed her pre-doctoral internship at UC Davis Medical Center and postdoctoral fellowship in trauma psychology at Children’s Hospital Los Angeles.

Partners, Collaborators, and Supporters

  • First 5 San Bernardino
    • Karen Scott
  • Children’s Network
    • Hillary Steenson-Ray
  • El Sol Neighborhood Educational Center Children’s Network
    • Alex Fajardo
  • Help Me Grow Inland Empire
    • Marti Baum, MD
  • Inland Empire Health Plan
    • Jarrod McNaughton
    • Daniela Ramirez
    • Carmen Vega
  • Loma Linda University
    • Maud Joachim-Celestin, DrPH
    • Cameron Neece, PhD, MA
    • Nico Rizzo, PhD
    • Catherine Tan, MD
    • John Testerman, MD, PhD
  • San Bernardino City Unified School District and Preschool Services
    • James Johnson
    • Arlene Molina
    • Harold J. Volkommer
  • Social Action Community (SAC) Health System
    • Marti Baum, MD
    • Elizabeth Park, PsyD
  • University of California Los Angeles
    • Steve Cole
    • Judith Carrol
    • Teresa Seeman
  • Walden Family Services
    • Kim Kimpel

For More Information

David Reiner, PhD
David Reiner is a Science Officer within the California Initiative to Advance Precision Medicine.