Precision medicine holds promise to more fully apply data to improve health and advance equity. Over $20 million dollars of state funds have been awarded to support proof-of-principle demonstration projects for families and communities with Adverse Childhood Experiences (ACEs) with an aim to improve access, care, and outcomes through collaboration between academic, community, nonprofit, and industry partners. All projects were selected through a competitive RFP, and the 2021–22 State Budget provided an additional $12.4 million, to fully support a total of seven research teams. Each project will receive $2.5-3 million over three years, beginning summer 2021.

The seven teams are:

  • Children's Hospital Los Angeles: Scalable Measurement and Clinical Deployment of Mitochondrial Biomarkers of Toxic Stress
  • Loma Linda University: A Multi-Component Intervention to Strengthen Families and Build Youth Resilience
  • Stanford University: Systems-based, Multidisciplinary Assessment of Adversity and Toxic Stress for Individualized Care (The SYSTEMAATIC Project)
  • University of California, Irvine: Using Precision Medicine to Tackle Impacts of Adverse and Unpredictable Experiences on Children's Neurodevelopment
  • University of California, Los Angeles: Identifying Social, Molecular, & Immunological Processes for Mitigating Toxic Stress & Enhancing Personalized Resilience
  • University of California, San Diego: San Diego County, UC San Diego, & Community Partners Better Address ACEs with Precision Medicine & Organizational Change
  • University of California, San Francisco: The Collaborative approach to examining Adversity and building Resilience (CARE) Program

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


Key Partners, Collaborators, and Supporters

  • Children's Hospital Los Angeles: Xiaowu Gai, PhD, Faculty Co-Investigator; Alma Gharib, PhD, Research Scientist; Hannah Perez, PsyD, Clinical Psychologist; Aime Ozuna, MPH, Research Coordinator
  • University of Southern California/Children's Hospital Los Angeles: Alexander Judkins, MD, Faculty Co-Investigator; Jenny Kingsley, MD, MA, Faculty Co-Investigator; Marian Williams, PhD, Faculty Co-Investigator; Suzanne Roberts, MD, Joint appointment to AltaMed Health Services Pediatric Care Center, Faculty Co-Investigator
  • AltaMed Health Services: Gabriela Tovar, JD, Institute for Health Equity
  • University of Southern California: Lauren Klein, Viterbi School of Engineering
  • Fiesta Educativa, Inc.: Irene Martinez, MSW, Executive Director
  • Para Los Niños: Natalia Garcia, Director of Community Resilience
  • St Anne's: Lorna Little, MSW, Chief Executive Officer
  • Karsh Family Social Service Center: Frances Nova, MSW, Director of Programs and Operations

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


Key Partners, Collaborators, and Supporters

  • Loma Linda University: Nicholas J. Rockwood, PhD, Assistant Professor of Interdisciplinary Studies, School of Behavioral Health; Cameron L. Neece, PhD, Associate Professor, Dept. of Psychology; Maud Joachim-Célestin, MD, DrPH, MPH, Assistant Professor, School of Behavioral Health
  • University of California, Los Angeles: Steve W. Cole, PhD, Professor of Psychiatry & Biobehavioral Sciences and Medicine, Cousins Center for Psychoneuroimmunology, Semel Institute for Neurosciences & Human Behavior; Judith Carroll, PhD, Associate Professor of Psychiatry & Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neurosciences & Human Behavior; Teresa Seeman, PhD, Professor of Medicine & Epidemiology, David Geffen School of Medicine
  • Social Action Community Health System: Jason Lohr, MD, FAAFP, FACHE, Chief Executive Officer
  • Help Me Grow - Inland Empire: Ronald Stewart, PhD, Manager
  • El Sol Neighborhood Educational Center: Alex Fajardo, MCP, CFC, Executive Director, Co-Investigator
  • Walden Family Services: Sue Evans, Chief Operating Officer, Co-Investigator
  • First 5 San Bernardino: Karen E. Scott, Executive Director
  • Inland Empire Health Plan: Jarrod McNaughton, MBA, FACHE, Chief Executive Officer
  • San Bernardino County Children's Network: Janki Patel, MPH, Children's Network Officer
  • San Bernardino County Preschool Services: Phalos Haire, Director
  • San Bernardino County Unified School District: Harold J. Vollkommer, EdD, Interim Superintendent
  • Inland Empire Community Collaborative: Susan Gomez, MA, CRC, Chief Executive Officer

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


Key Partners, Collaborators, and Supporters

  • Stanford University: R. Sharon Chinthrajah, MD, Clinical Associate Professor; Brenda Golianu, MD, Professor of Anesthesiology, Perioperative and Pain Medicine; Lisa Goldman-Rosas, PhD, MPH, Assistant Professor of Medicine, Epidemiology and Population Health; Wei-ting Chen, PhD, Associate Director of Community Partnerships in the Office of Community Engagement; Megan Mahoney, MD, Clinical Professor in the Division of Primary Care and Population Health, Chief of Staff of Stanford Health Care
  • Child Trauma Academy: Bruce D. Perry, MD, Founder, Senior Fellow
  • University of California, San Francisco: Michael Merzenich, PhD, Professor Emeritus
  • University at Buffalo: Beatrice Wood, PhD, Professor of Psychiatry and Pediatrics
  • Sebern Fisher, MA, LMH, BCN, Psychotherapist, neurofeedback clinician (private practice)
  • San Mateo County Health: Beth Grady, MD, Pediatrician
  • Central Valley Community Foundation: Artie Padilla, Senior Program Officer
  • Johns Hopkins University: Christina Bethell, PhD, MBA, MPH, Professor, Director of Child and Adolescent Health Measurement Initiative

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


Key Partners, Collaborators, and Supporters

  • University of California, Irvine: David Keator, PhD, Research Professor, Database Structure Expert and Computational Scientist; Ali Mortazavi, PhD, Professor, ENCODE Human Genome Project Leader; Hal Stern, PhD, Professor of Statistics, Information and Computer Sciences, Interim Provost; Leslie Thompson, PhD, Co-Director of Precision Health Through Artificial Intelligence; Pramod Khargonekar, Vice Chancellor for Research
  • Children's Hospital Orange County: Louis Ehwerhemuepha, PhD, Senior Data Scientist; Mary L. Zupanc, MD, Co-Medical Director, Neuroscience Institute
  • Children's Hospital Orange County Primary Care Network: Charles Golden, DO, FAAP, Executive Medical Director, Chapman University; Thomas Piechota, PhD, PE, Vice President for Research; Sabrina Liu, PhD, Postdoctoral Researcher
  • Syntropy Technologies, LLC: James Kugler, Director
  • Illumina, Inc.: Mark Van Oene, Sr. Vice President and Chief Commercial Officer
  • The Simms/Mann Family Foundation: Victoria Mann Simms, PhD, President

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


Key Partners, Collaborators, and Supporters

  • University of California, Berkeley: Stephen P. Hinshaw, PhD, Professor of Psychology
  • Burnham Benefits: Michael Michalski, Regional President and Partner
  • Yale University: Randi Hutter Epstein, MD, MPH, Writer in Residence, Lecturer
  • University of Palo Alto: Joyce P. Chu, PhD, Professor
  • Donna Jackson Nakazawa, Journalist

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


Key Partners, Collaborators, and Supporters

  • University of California, San Diego: David Boyle, Professor of Medicine; Michael Hogarth, MD, Professor of Medicine; Kyung Rhee, MD, Professor of Pediatrics; Xin Tu, PhD, Professor, Herbert Wertheim School of Public Health and Human Longevity Science
  • San Diego State University: Noe Crespo, PhD, MPH, MS, Associate Professor, Division Head of Health Promotion and Behavioral Science
  • Olivewood Gardens and Learning Center, Kitchenistas: Patty Corona, Cooking for Salud Coordinator
  • American Academy of Pediatrics, CA Chapter 3: Pradeep Gidwani, MD, MPH, Director of Projects
  • Family Health Centers of San Diego: Job Godino, PhD, Scientific Director of the Laura Rodriguez Research Institute
  • San Diego County Childhood Obesity Initiative: Shaila Serpas, MD, COI Executive Tri-Chair; Wilma Wooten, MD, COI Co-Executive Tri-Chair; Debbie Macdonald, COI Executive Tri-Chair
  • San Diego Promotores Coalition
  • Streetwyze: Antwi Akom, PhD, CEO & Co-Founder, Professor (UCSF/SFSU)
  • San Diego County Health & Human Services, Behavioral Health Services: Danyte Mockus-Valenzuela, PhD, Prevention and Community Engagement Manager
  • University of San Diego: Jo Ellen Patterson, PhD, Professor in the Marital and Family Therapy Program
  • YMCA Childcare Resource Service: Kim McDougal, Executive Director

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


Key Partners, Collaborators, and Supporters

  • University of California, San Francisco: Danielle Sy Roubinov, PhD, Assistant Professor and Licensed Clinical Psychologist, Department of Psychiatry and Behavioral Sciences; Rosemarie de la Rosa, PhD, UC President's Postdoctoral Scholar; Mohsen Malekinejad, MD, MPH, DrPH, Assistant Professor, Department of Epidemiology and Biostatistics Institute for Global Health Sciences; Raphael Hirsch, MD, Department of Pediatrics; Neil R. Powe, MD, MPH, MBA, Vice-Chair of Medicine, UCSF, Chief of Medicine, Zuckerberg San Francisco General Hospital Constance B. Wofsy Distinguished Professor; W. Thomas Boyce, MD, Distinguished Professor of Pediatrics and Psychiatry, Emeritus; Alicia F. Lieberman, PhD, Irving Harris Endowed Chair in Infant Mental Health, Professor and Vice Chair for Faculty Development (joint affiliation with Zuckerberg San Francisco General Hospital as Director of the Child Trauma Research Program)
  • LifeLong Medical William Jenkins Health Center: Omoniyi Omotoso, MD MPH, FAAP, Associate Medical Director of Pediatrics; Michael Stacey, MD, MPH, Chief Medical Officer
  • Benioff Children's Hospital Oakland: Joan Jeung, MD, MPH, MS, Pediatrician (Joint affiliation with UCSF); Mindy Benson PNP, FQHC Manager of Program and Projects
  • University of California, Santa Barbara: Miya Barnett, PhD, Assistant Professor, Licensed Clinical Psychologist, Department of Counseling, Clinical, & School Psychology
  • Santa Barbara Neighborhood Clinics: Andria Ruth, MD, Pediatrician
  • Harvard University: Jack P. Shonkoff, MD, Director, Center on the Developing Child, Professor of Pediatrics, Harvard Medical School and Boston Children's Hospital, and Research Staff, Massachusetts General Hospital
  • University of Delaware: Mary Dozier, PhD, Francis Alison Professor; Amy E. du Pont Chair of Child Development; and Professor, Psychological and Brain Sciences

Selection Process

Demonstration Projects were selected through a three-step competitive peer-review process by an independent, out-of-state Expert Selection Committee. Following the submission of Letters of Intent, expert reviewers employed a process for selection of Concept Proposals and Full Proposals (Finalist Stage) based on National Institutes of Health standards. Proposals were reviewed across several factors embedded in CIAPM's enabling statute, including the 1. potential for tangible benefit to patients within five years; 2. expertise of the team; 3. clinical and commercial potential; 4. potential to reduce health disparities; and 5. potential to scale and leverage multiple electronic health records systems, among other criteria listed in the RFP. Each proposal was also assigned an overall impact score. As per statutory requirements and the Request for Proposals, at least one project must be located in both northern and southern regions of California. Additionally, lead institutions may only receive one award.

Applicants

  • A Tale of Two Treatments: Approaches to Preventing Long-Term Negative Health Sequelae Among Low-Income Latinx Youth with ACEs, UC Irvine
  • ACEs Mechanisms in Disease–The Role of DNA Methylation, UCLA
  • Getting to Healthy Outcomes of Pregnancy for Everyone: Addressing Risk for and Resiliency Against Adverse Pregnancy Outcomes in Women with Multiple Adverse Childhood Experiences and Their Infants (The HOPE-ACEs Study), UCSF
  • Integration of Biomarkers to Inform Tailored Disease Management and Behavioral Interventions for Homeless Youth Experiencing Toxic Stress, UCLA
  • Shared DataEcosytem: A New Paradigm to Build Community Resilience and Inform Resource Allocation, Stanford University
  • Effectiveness, Kaiser Permanente Southern California
  • A Precision Population Health Approach to Measuring and Reducing Exposure to ACEs in Inland Southern California, UC Riverside
  • ACEs and Specific Learning Disabilities: Patterns of Neurocognitive, Social, and Educational Features, UCSF
  • ACEs in Youth with Serious Mental Illness: The Need for Precision Medicine, UC Davis
  • And Still I RISE: Resilience In Students Experiencing ACEs, UC Davis
  • Biopsychosocial Predictors of Resilience and Treatment Effects in Youth Exposed to Adverse Childhood Experiences, UC Irvine
  • Collaborative Community ACES Intervention to Reduce Health Disparities and Close the Academic Acheivement Gap, Touro University California
  • Developing Biomarker-Informed Primary Care Screening Tools for Mental and Physical Health Risk in Adversity-Exposed youth, UCLA
  • Engineering an Integrated Systems Approach to Reduce ACEs and Promote Resilience in a Diverse Child, Adolescent, and Early Adult Population, Claremont Graduate University
  • Examining the Influence of Adverse Childhood Experiences and Childhood Stress on Brain Health Biomarkers in a Diverse Cohort of Older Adults Living in San Francisco, UCSF
  • Implementation and Evaluation of an ACE Screening and Treatment System, UC Merced
  • Interrupting Intergenerational Trauma: Trauma-Informed Approach to Public Health Nursing, UCSF
  • Mitigating Toxic Stress by Building Resilience in California's Latino Immigrant Communities: A Community-Engaged, Precision Medicine Approach, UC Davis
  • Nutritional Supplementation as a Means to Reduce Early Life Adversity In the Context of Substance Use in Pregnancy, UCSF
  • Precision Mental Health for Youth with Adverse Childhood Experiences From Low-Socioeconomic Status Families, UCSF
  • Ravenswood Wellness Partnership: Increasing Capacity and Access to Culturally Relevant and Responsive Mental Health and Wellness Services for Youth in East Palo Alto and Belle Haven, Stanford University
  • The Santa Barbara ACEs Project for Inclusion, Education and Diversity, Santa Barbara Cottage Hospital

For more information about this content, please contact:

Julianne McCall, PhD
Julianne McCall is Co-Director of the California Initiative to Advance Precision Medicine at OPR. She oversees the ACEs projects.