Our Research Goals

CARE will build upon our child ACEs longitudinal research studies and align efforts across Northern and Central California. With our collaborative’s diverse expertise, expansive network, infrastructure, and capabilities, we are poised to address critical gaps in ACEs science and propose to achieve the following aims:  

Discovery research (aim 1) 

Advance evidence base for the CA ACEs assessment tool (PEARLS), toxic stress biomarkers, and the prediction of longitudinal child health outcomes. 

Applying a Precision Medicine approach, we will expand upon the existing Pediatric ACEs and Resiliency Study (PEARLS) cohort by adding a 3-year follow up biomarker testing and analysis point. This will allow us to identify early effects of adversity and pinpoint heterogeneity, including identifying factors that are protective or stress-buffering, which may allude to intervention.   

  • Examine longitudinal associations between cumulative childhood adversity and biologic (metabolic and inflammation) and health (psychosocial, behavioral, physical [asthma, obesity]) outcomes in early childhood.  
  • Identify contextual protective factors (social supports, parent-child relationship, exposure to pilot intervention) that may buffer against risk from adversity on outcomes in early childhood.  
  • Determine if candidate stress-sensitive biomarkers (IGF-BP1, leptin, HA1C, hs-CRP, immune cytokines, telomere) predicts longitudinal health outcomes among at-risk children [i.e. high ACEs]. 

Learn more about Aim 1 - Discovery 

Intervention research (aim 2)  

Examine the behavioral, psychosocial, and biologic impact of resilience-promoting interventions associated with primary care. Our team has piloted three resilience-promoting, caregiver-child interventions:  

  • Resilience Clinic (primary care-based, group-delivered) 
  • Attachment and Biobehavioral Catch-up (home-based, dyadic) 
  • Resiliency Family Program (primary care-based, dyadic) 

Using a randomized wait-list controlled trial design, families will be assigned to intervention or enhanced primary care. Pre- and post-intervention health (behavioral, caregiver stress) and biology will be compared between intervention and controls, as well as modifying factors such as setting and delivery method.  

    Learn more about Aim 2 - Intervention 

    Implementation research (aim 3)  

    Identify barriers and enablers to resilience-promoting interventions across the care continuum and pilot a Resilience Toolkit in low-resource, primary care settings across California.  

    Supported by our partnership with Futures Without Violence and with local communities and informed by Aims 1 and 2, we will:  

    • Identify family preferences, system-level entry points, and barriers for receiving/delivering resilience-promoting messaging and interventions, and  
    • Pilot community-informed messaging and strategies to develop a scalable resilience-promoting Toolkit for use in low-resource, primary care settings. 

    The proposed activities under CARE will accelerate our understanding of how to best identify those at greatest risk, enhance protective factors, and intervene to bolster resilience across the care continuum. 

    Learn more about Aim 3 - implementation