Project Summary

This project seeks to:

Estimate cumulative impact of childhood adversity on biologic and behavioral health.
Improve and develop toolkit to address toxic stress.

Background

The evidence connecting Adverse Childhood Experiences (ACEs) to lifelong negative health impacts is clear. Dr. Thakur and members of the UCSF team have previously found, for example, that children with a high number of ACEs had metabolic dysregulation, a common sign of stress. In the Pediatric ACEs and Resiliency Study (PEARLS), children with a high number of ACEs whose caregivers report low levels of stress, do not show metabolic dysregulation. These findings suggest that caregivers experiencing low levels of stress may provide a potentially protective effect on the health of children who have a high number of ACEs. However, we need more research to better understand why some children’s health are more affected by ACEs than others. The CARE team will assess biomarkers to look for early biological signs of toxic stress physiology, test three pilot interventions, and work directly with communities impacted by ACEs to overcome barriers to treatment.

Biomarkers (short for biological markers) are indicators that can be measured and used to determine information about the state of a living thing, including one’s blood pressure, antibodies, genes, or bones via x-ray images.

Predictive biomarkers can be used to identify people who may be more susceptible to a certain health outcome before it happens, or who might respond the best to a particular course of treatment. A well-known predictive biomarker is the BRCA1/BRCA2 gene mutation, which increases risk of developing breast and ovarian cancer.

Exposure to ACEs can change a child’s biomarkers, especially those related to immune and metabolic systems. These disrupted biomarkers might be the earliest signs that a child is at risk of developing toxic stress physiology and conditions like asthma and diabetes later in life.

Project Goals

Steps from top to bottom: ACEs over the life course, biology environment interactions, physiological adaptation and/or disruption, disease susceptibility. Final step: Disease and disease progression.
AIM Goals: 1: Analyze bio markers and stress-related markers at baseline, 1 year, and 3 years. 2: Examine the behavioral, psychological, and biologic impact of resilience-promoting interventions that focus on reducing caregiver stress. 3: Identify barriers and enablers to resilience-promoting interventions across the care-continuum.

The first aim of the CARE study allows for the CARE team to build in the previous PEARLS Study. They will look at the longitudinal effects of a child’s ACEs score, by following up 5 years after the first PEARLS Study concluded. 350 children will be followed over a three year period to examine biomarkers compared to each child’s ACEs score an overall health. This approach will allow the CARE team to ask the following questions:

  • How does exposure to ACEs change biomarkers over time?
  • Are there biological changes associated with improved health in children enrolled in one of the study’s pilot interventions?
  • Can they identify predictive biomarkers associated with children more vulnerable to ACEs?

Pilot Interventions

The CARE team is testing the effectiveness of three resilience-promoting pilot interventions, which focus on reducing caregiver stress and improving the child-caregiver relationship. In earlier work, members of the team discovered that when caregivers report less stress, their children maintain healthy biomarkers even if they are exposed to ACEs.

Breaking Down Barriers for Care

Even the most effective interventions will not work if patients are not willing or able to access them. The research team holds interviews and focus groups with frontline clinic staff and caregivers to learn about their experiences with previous screenings or interventions and identifies barriers to seeking or receiving care. The CARE team then collaborates with a Family Board to explore the strongest themes from these sessions and develop a toolkit offering community-informed strategies and practical tools for health care providers.

Team Leaders

Neeta Thakur, MD, MPH

UC San Francisco

Neeta Thakur, MD, MPH, is a pulmonary and critical care physician at UCSF who examines the role of social and environmental stressors on asthma and chronic obstructive pulmonary disease (COPD) in vulnerable populations. Dr. Thakur completed her residency in Internal Medicine and a Pulmonary and Critical Care Medicine fellowship at UCSF. She has expertise in clinical research methods, social epidemiology, and implementation sciences. Dr. Thakur's experience as a clinician and Medical Director of the Zuckerberg San Francisco General Hospital Chest Clinic gives her first-hand insight on how social and environmental stress negatively affect asthma and COPD outcomes. She has also gained practical knowledge of what barriers exist in adopting evidence-based interventions into practice.

Dr. Thakur’s NIH supported research focuses on defining obstructive lung disease phenotypes in racially and ethnically diverse communities; identifying individuals at high risk for poor outcomes using a risk profile of genetic, biomarker, clinical, and socio-environmental data; and developing targeted interventions aimed at social and environmental factors to improve asthma and COPD.

Dr. Thakur earned an MD and MPH at the University of Arizona in a dual-degree program focused on community health, and program development and evaluation.

Nicole R. Bush, PhD

Associate Professor
Departments of Psychiatry and Behavioral Sciences and Pediatrics

UCSF

Dr. Nicole Bush is an Associate Professor in the Departments of Psychiatry and Behavioral Sciences and of Pediatrics at UCSF. She is the Director of the Division of Developmental Medicine and the Lisa and John Pritzker Distinguished Professor of Developmental and Behavioral Health.

Dr. Bush has published more than 100 empirical papers on research focused on how early life psychosocial environments, beginning in utero, affect developmental trajectories of health and disease for life. She investigates the ways in which experiences of adversity—from socioeconomic status to interpersonal violence—become biologically embedded by changing children’s developing physiologic systems and organs. Her work focuses on identifying points for prevention of disease as well as protective factors and interventions that promote resilience, with special attention to vulnerable populations and the unique interplay between maternal-child health across generations.

Dr. Bush received her PhD in Child Clinical Psychology from the University of Washington and completed her child clinical training internship at the Institute for Juvenile Research at the University of Illinois, Chicago.

Danielle Hessler Jones, PhD

Co-Director
Social Interventions Research and Evaluation Network (SIREN)
Professor and Vice Chair for Research
Department of Family and Community Medicine
UCSF

Dr. Danielle Hessler Jones is co-Director of the Social Interventions Research and Evaluation Network (SIREN) and a Professor and Vice Chair for Research in the Department of Family and Community Medicine at UCSF. Her research focuses on social care delivery in the health care sector, including understanding the impact and implementation of programs aimed at screening and addressing social risks alongside programs that seek to adjust care to fit an individual’s social context. As a health psychologist Dr. Hessler Jones also brings experience in health behaviors and engagement and intersections with mental health.

Dr. Hessler Jones earned an MS and PhD in Psychology at the University of Washington.

Lisa James, MA

Director of Health
Futures Without Violence

Lisa James is Director of Health at Futures Without Violence. As part of a National Health Initiative on Domestic Violence, James has collaborated with health care providers, domestic violence experts, and health policymakers in over 25 states across the US to develop statewide health care responses to domestic violence through training, health policy reform, and public education. She collaborates with national medical and nursing associations to enact effective health policy and programmatic health care responses to abuse, and was the recipient of the American Medical Associations’ Citation for Distinguished Service for her efforts to train health care providers on domestic violence. James coordinates the biennial National Conference on Health Care and Domestic Violence. During her 20 years at Futures without Violence, James has also worked with the international program, collaborating with leaders from non-governmental and health care organizations in Russia, Mexico, India, and China to build the capacity of health systems, providers, and community members to identify and help victims in reproductive health settings.

James earned a BA from San Francisco State University and an MA in Social Policy and Women's Studies from the University College Dublin.

Danya Long, MD

Professor & Interim Associate Dean
Hebert Wertheim School of Public Health and Human Longevity Science

UC San Diego

Dr. Dayna Long is a pediatrician with special interests in community health and engagement, and in promoting equity in health care. Her goal is to enable all children to be as healthy as possible by eliminating the inequities that lead to poor health outcomes for many families and young children.

She is the founder and director of the Family Information and Navigation Desk (FIND), along with the FIND connect platform, an innovative cloud-based solution to address the social and environmental factors affecting children’s health outcomes through culturally responsive navigators and a robust technology platform that connects families with community resources to fulfill unmet basic needs. She was named the Faculty Chair for the National Institute for Children’s Health Quality Pediatrics Supporting Parenting Initiative, focused on improving pediatric primary care to foster social and emotional development with the same focus that is placed on physical health and cognitive development. She was also part of the California AB340 work group to implement state policy incentives for providers to screen for ACEs and trauma. At UCSF Benioff Children's Hospital Oakland, she completed a residency in pediatrics and a fellowship in infectious diseases, and has additional training in incorporating cultural humility into patient care.

Dr. Long earned an MD from the George Washington University School of Medicine and Health Sciences.

Maryam Kia Keating, PhD

Jane and Marc Nathanson Family Professor of Psychiatry
David Geffen School of Medicine

UCLA

Dr. Maryam Kia-Keating is a Professor at the University of California, Santa Barbara, Gevirtz Graduate School of Education, Department of Counseling, Clinical, and School Psychology. She is a Licensed Clinical Psychologist.

As a postdoctoral scholar at UC San Diego and an adjunct faculty member at the University of San Diego, she was the clinical director of a school-based prevention program for adolescents. Her fellowships with the National Institute on Mental Health and the National Institute on Child Health and Human Development focused on youth programs. She developed an expertise in childhood traumatic stress through her work at National Child Traumatic Stress Network sites Yale Childhood Violent Trauma Center, and the Center for Refugee Trauma at Children’s Hospital/Harvard Medical Center.

Dr. Kia-Keating has worked with displaced populations from around the globe and served on the American Psychological Association Task Force on the Psychosocial Effects of War on Children and Families who are Refugees from Armed Conflict Residing in the United States. She utilizes participatory and human-centered design approaches to empower communities and form multisector collaborations to find innovative solutions to public health challenges and to reduce disparities.

She earned an EdM from Harvard University and a PhD at Boston University.

Partners, Collaborators, and Supporters

  • Futures Without Violence
    • Lisa James, MA
  • LifeLong Medical William Jenkins Health Center
    • Omoniyi Omotoso, MD MPH
  • Santa Barbara Neighborhood Clinics
    • Andria Ruth, MD
  • UC Berkeley
    • Rosemarie de la Rosa, PhD
  • UC San Francisco
    • Joan Jeung, MD, MPH, MS
  • UCSF Benioff Children’s Hospital Oakland
    • Lourdes Juarez, NP
  • UC Santa Barbara
    • Maryam Kia Keating, PhD
    • Miya Barnett, PhD
  • University of Delaware
    • Mary Dozier, PhD
  • University of North Carolina
    • Danielle Roubinov, PhD

For More Information

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