California Initiative to Advance Precision Medicine ACEs Request for Proposals – Awardees

Summary

The very best outcomes will be achieved by identifying infants at greatest risk for ACEs and toxic stress and intervening to reduce the chronic stress response. This project will improve early screening by combining a questionnaire with innovative laboratory tests that detect disruptions in metabolic health, a key indicator of toxic stress. The collaboration between experts in precision medicine, laboratory test development, child development, stress-related health risks, and health equity improvement will bring a greater understanding of infant-caregiver well-being, and—through screening—close the equity gap in access to quality behavioral health programs.

Team

Lead Principal Investigator: Pat Levitt, PhD, Chief Scientific Officer, Vice President, and Director, The Saban Research Institute; Simms/Mann Chair in Developmental Neurogenetics, Children's Hospital Los Angeles; WM Keck Provost Professor in Neurogenetics, Department of Pediatrics, Keck School of Medicine, University of Southern California

Principal Investigator: Rajan Sonik, PhD, JD, MPH, Institute for Health Equity, AltaMed Health Services

Summary

This project will mobilize pediatricians, community health workers, and parenting educators to improve the delivery of information and resources to a diverse population of families with ACEs across the Inland Empire region. Service providers will be trained using an evidence-informed curriculum intended to strengthen families and build youth resilience. Biomarkers of toxic stress will be collected alongside ACE scores. At different timepoints, follow-up evaluations with children and families will indicate which intervention is most effective in decreasing toxic stress associated with ACEs, improving health outcomes, and reducing health disparities.

Team

Lead Principal Investigator: Ariane Marie-Mitchell, MD, PhD, MPH, Associate Professor of Preventive Medicine & Pediatrics, Loma Linda University

Principal Investigators: Marti Baum, MD, Medical Director-Community Engagement, Social Action Community (SAC) Health System; Physician Champion, Help Me Grow Inland Empire; Elizabeth Park, PsyD, Clinical Psychologist, SAC Health System

Summary

Currently, the impacts of Adverse Childhood Experiences and toxic stress are detected by symptoms like depression or anxiety rather than the underlying root changes to a person's neurologic, endocrine, metabolic, and immune system functions. The SYSTEMAATIC Project will use machine learning and artificial intelligence to create a clinical diagnostic tool for toxic stress by integrating multiple disciplines and taking a systems-based approach, rather than just symptoms-based. The results will be earlier detection and more targeted clinical recommendations to address the root causes of toxic stress.

Team

Lead Principal Investigator: Sayantani Sindher, MD, Clinical Assistant Professor of Medicine, Stanford University

Principal Investigators: Rachel Gilgoff, MD, Chief Medical Officer, Stronger Brains Inc.; Lisa Chamberlain, MD, MPH, Professor of Pediatrics, Stanford University; Ryan Padrez, MD, Assistant Clinical Professor, Stanford University; Hadi Hosseini, PhD, Assistant Professor of Psychiatry and Behavioral Sciences, Stanford University; Ann Ming Yeh, MD, DABMA, Clinical Associate Professor of Pediatric Gastroenterology, Stanford University; Lydia Vincent-White, Community Programs Manager, Center for Youth Wellness; Kari Nadeau, MD, PhD, Endowed Professor, Director of the Sean N. Parker Center for Allergy and Asthma Research, Director of the Center of Excellence, Food Allergy Research and Education, Stanford University; Michael Snyder, MD, Stanford W. Ascherman Professor, Chair of Department of Genetics, Director of Center for Genomics and Personalized Medicine, Stanford University; Safwan Jaradeh, MD, Professor of Neurology and Neurological Sciences, Stanford University

Summary

The burden of ACEs is not equally distributed, with greater risk of exposure among low socioeconomic and racial/ethnic minority communities. This project seeks to answer two unmet needs: 1. identify the degree that ACEs influence children’s neurodevelopment and 2. discover for each child a marker that can predict their level of resilience, so that targeted interventions can be delivered to children who need them most. The team aims to screen 100,000 children across Orange County and apply interdisciplinary expertise in brain development, emotional health, health disparities, community engagement, epigenetics, big data, and data-base design and sharing.

Team

Lead Principal Investigator: Tallie Z. Baram, MD, PhD, Bren Distinguished Professor, Director of the Conte Center, University of California, Irvine (UCI)

Principal Investigators: Michael Weiss, DO, FAAP, Vice President of Population Health, Children’s Hospital Orange County (CHOC); Dan Cooper, MD, Associate Vice Chancellor for Clinical and Translational Science, Professor of Pediatrics and Biomedical Engineering, Director of the Institute for Clinical and Translational Research, UCI; Laura Glynn, PhD, Professor of Psychology, Associate Dean for Research, Chapman University; Candice Taylor Lucas, MD, Associate Professor, Co-Director of LEAD-ABC, UCI/CHOC

Summary

Stress is among the leading causes of disability and death in California, especially if experienced early on in life. However, stress levels are rarely assessed by doctors, and exactly how stress impacts individuals' health remains a mystery. This project combines the best of stress science and precision medicine to address the health impacts of Adverse Childhood Experiences. The community-driven team will develop a statewide stress surveillance system and a statewide network of scientists and clinicians who focus on stress to uncover how stress impacts the body and what we can do to increase resiliency.

Team

Lead Principal Investigator: George Slavich, PhD, Founding Director of the Laboratory for Stress Assessment & Research, UCLA

Principal Investigators: Michael Snyder, PhD, Chair of Genetics, Director of Center of Genomics and Personalized Medicine, Stanford University; Atul Butte, MD, PhD, Priscilla Chan and Mark Zuckerberg Distinguished Professor of Pediatrics, Bioengineering and Therapeutic Sciences, and Epidemiology and Biostatistics, Director of the Bakar Computational Health Sciences Institute, UCSF, Chief Data Scientist of UC Health; Alicia Lieberman, PhD, Irving B. Harris Endowed Chair in Infant Mental Health, Vice Chair for Academic Affairs in the Department of Psychiatry and Behavioral Sciences, Director of the Child Trauma Research Program, Director of the Early Trauma Treatment Network; Shannon Thyne, MD, Director of Pediatrics and ACEs Assessment Leader, Los Angeles County Department of Health Services; Patricia Lester, MD, Jane and Marc Nathanson Professor, Vice Chair for Community Engagement, Director of Division of Population Behavioral Health in the Department of Psychiatry and Biobehavioral Sciences, Director of the Nathanson Family Resilience Center, Medical Director of the Stress, Trauma & Resilience Clinic, UCLA

Summary

In collaboration with Latino communities, promotores community health workers, and community clinics, UC San Diego researchers will create a family-based approach to improve individual and community-wide resiliency to health impacts of stress and obesity. A community-designed intervention will be implemented that will be tailored to different families, according to their unique needs. The network and system of learning and improvement will strengthen communications, needs assessment, and researcher-community relationships to better design and deliver the right preventive and treatment services at the right time.

Team

Lead Principal Investigator: Gary S. Firestein, MD, Senior Associate Vice Chancellor of Health Sciences and Distinguished Professor of Medicine, UCSD

Principal Investigators: Gregory Aarons, PhD, Professor of Psychiatry, UCSD; Eric Hekler, PhD, Professor, Herbert Wertheim School of Public Health & Human Longevity Science, UCSD; Margarita Holguin, MPA, Director of Partnership Initiatives for We Support U, Founding Chair of San Diego County Promotores Coalition; Blanca Meléndrez, MA, Executive Director at the UCSD Center for Equity and Community Health, Altman Clinical and Translational Research Institute and the San Diego County Childhood Obesity Initiative; Deysi Merino, Poder Popular Representative and Community Health Specialist, Vista Community Clinic

Summary

The cross-disciplinary team will study how to enhance resilience in children and families who have experienced adversity. Though it is well understood that ACEs can impact life-long health, more knowledge is required, from both scientists and communities, to personalize and implement interventions to fit individual physiology and environmental circumstances. This project draws upon clinical intervention, stress-biology science, and community partnership to help us understand which children are most vulnerable to the effects of ACEs, what family and community-level factors provide the most buffering protection, and which interventions most improve child and family outcomes—and for whom.

Team

Lead Principal Investigator: Neeta Thakur, MD, MPH, Assistant Professor of Medicine, University of California, San Francisco (UCSF)

Principal Investigators: Lisa James, MA, Director of Health, Futures Without Violence; Dayna Long, MD, Co-Director, Center for Child and Community Health, UCSF Benioff Children's Hospital Oakland; Nicole R. Bush, PhD, Associate Professor of Psychiatry & Pediatrics, UCSF; Danielle Hessler, PhD, Associate Professor and Vice Chair of Research, Department of Family and Community Medicine, UCSF; Maryam Kia Keating, PhD, Professor and Licensed Clinical Psychologist, University of California, Santa Barbara