PROVIDENCE –If there were a Facebook or an Instagram app for journalists to revisit stories from their past and to reconnect to see what has changed, this act of storytelling might prove to be an opportunity worthy to develop a new startup on social media, focused on revisiting cold cases of investigative journalists.

Can you imagine the potential of such explorations as a dramatic miniseries on Netflix? As an opening sequence, imagine: a graying, grizzled reporter watches a video published by The Washington Post, focused on how research into early life stress has been linked to the continuing decline of life expectancy in the U.S., linking the latest neuroscience research and the increasing social disparities in America to “toxic stress.”

In 2015, ConvergenceRI became intrigued with innovative neuroscience research developments that identified the potential for bioluminescent optogenetics, pioneered by Christopher Moore at Brown University [Moore is now the Associate Director of the Carney Institute for Brain Science.]

The new technology examined how cells could produce their own light, and then respond to that light, as a way to control their own activity as well as the activities of neighboring cells. [See link to ConvergenceRI story, “Programming brain cells to turn their own light on off, like a firefly.”]

At the same time, ConvergenceRI became aware of ongoing efforts in Rhode Island to look into the behavior health outcomes related to toxic stress – and the efforts by the Rhode Island chapter of the American Association of Pediatricians to develop a screening tool to identify toxic stress in children.

The two stories led to the creation of a one-day gathering at Rhode Island College, co-sponsored by Kalina Brabeck, Ph.D., held in the October of 2015.

As ConvergenceRI reported in the Oct. 23, 2023, story, “It’s all about the data, the data, the data…” Eight years ago, ConvergenceRI had been ahead of the curve – and sought to bring together a collaborative group of neuroscientists, behavioral health practitioners, and community advocacy groups to talk about developing a Rhode Island-centric strategy to combat toxic stress:

•           Last week, The Washington Post did an in-depth report, “Stress is weathering our bodies from the inside out,” looking at how “striving to get ahead in an unequal society contributes to people in the United States aging quicker, becoming sicker and dying younger.”

The story continued: Eight years ago, on Oct. 28, 2015, ConvergenceRI sponsored an event, “Building a Collaborative Strategy To Reduce Toxic Stress in Rhode Island: A Conversation/Convergence,” with the goal of catalyzing the development of an innovative, collaborative strategy on toxic stress, bringing together experts from numerous disciplines – neuroscience research, early childhood pediatrics, counseling, family visiting, nursing, social work, and healthy housing – to find common ground on how to move forward.

The event, organized in partnership with RIC’s Kalina Brabeck, Ph.D., drew more than 120 participants. The co-sponsors included the R.I. Department of Health, Care New England, Green & Healthy Homes Initiative, South County Health System, Rhode Island KIDS COUNT, The Providence Plan, the R.I. Public Health Institute, and R.I. BHDDH. 

What did – and did not – happen next?
The question is: What had happened following the conference, which generated a great deal of positive feedback from the participants? There were a series of follow-up stories in ConvergenceRI, but the excitement around the potential of a collaborative strategy to address toxic stress in Rhode Island dissipated. [See links below to ConvergenceRI stories.]

After reading the Washington Post story, ConvergenceRI reached out to Dr. Audrey Tyrka, whose pioneering research into what caused the shortening of telomeres in DNA had been linked to early childhood adversity.

Tyrka, in turn, had suggested that ConvergenceRI talk with Dr. Teresa Daniels, a psychiatrist and an assistant professor at Brown, who had worked as a post-doc in Tyrka’s lab.

Dr. Daniels wrote to ConvergenceRI, in advance of the interview: “As a brief introduction, I am an assistant professor and a child and adolescent psychiatrist at EP Bradley Hospital and Hasbro Children's Hospital. I was fortunate to do research as a resident, fellow, and post-doctoral fellow in Audrey's lab. My research interest is in the biological and behavioral effects of early life stress, with the goal of identifying biobehavioral targets for future prevention and intervention.”

In response, ConvergenceRI shared potential questions in advance of the interview with Dr. Daniels:

4. How is the current thinking in neuroscience research organized in regard to addressing the origins and potential treatments for toxic stress? Most of my stories were eight years ago.
5. Dr. Jill Maron, a pediatrician at Women & Infants, has been conducting clinical research studies using saliva swabs of newborns as a diagnostic tool. Are you familiar with her work? What kinds of research collaborations might be possible looking at toxic stress in neurodevelopment?
6. Is there any continuing group of neuroscience researchers in Rhode Island discussing toxic stress and strategies to diagnose and prevent it?
7. What is your current work involved with? [I probably should have started with this question…]
8. What did you think of The Washington Post story?

The changing landscape
Eight years later, after the initial conference, the science has progressed, ConvergeneRI discovered. There is a new research center, STAR COBRE, operating in Rhode Island, which is involved in an ongoing collaboration with community groups.

Here is the ConverenceRI interview with Dr. Teresa Daniels, MD, talking about the new research approaches being developed around toxic stress, exploring the potential relationships between mitochondrial changes in DNA and toxic stress in infants.

ConvergenceRI: Dr. Tyrka certainly chose the right person to talk with. I had an opportunity to look at the work that you have been doing, and it seems remarkably on target to talk about toxic stress.
DANIELS: Yes. I came to Rhode Island as a resident in psychiatry. And, I saw so many patients that had profound psychiatric challenges and also health problems. Many of them were experiencing effects related to early stress.

I felt compelled to continue that work, to build on the understanding of why do we see so much of that in our clinical work with adults.

I ended up [focusing] on child adolescent psychiatry, working with children and families. I really want to continue to understand this [relationship] better, from a clinical and a scientific lens.

ConvergenceRI: Congratulations.
DANIELS: Thanks. It has been a really exciting period, continuing to work on existing projects and also building some studies for my own trajectory.

ConvergenceRI: What did you think of the Washington Post story?
DANIELS: That article is touching on a theme that is increasingly understood to be critical to the health and well-being throughout the life course.

I think, over the years since you had last published on this, that topic has become more and more present in the minds not just of research scientists who are interested in early life stress, but with clinicians from across the health spectrum – not just psychiatrists but internal medicine doctors and pediatricians – because the effects are substantial.

Interventions need to be coming from a broad spectrum of health care providers.

ConvergenceRI: When I began reporting on this research, this work, it was serendipitous. Every person I talked to led to a new avenue of research. It was my hope to be able to serve as a catalyst, to try to bring all these people together in a room and get them to talk with each other to address the potential interventions around toxic stress in Rhode Island.

 I believed that Rhode Island might become a leader in this work. I brought all these people together, and we had a great session, and there is actually a videotape of it somewhere. But then, everybody went back into their own silos. Which was predictable, because there was no glue to hold them together, to continue to talk, to continue to collaborate.

 Is there any sort of interaction that takes place to develop a cross-disciplinary strategy to address toxic stress and how to prevent it in Rhode Island

DANIELS: Actually, I think that question is very well timed. Because yes, there is a center for stress, trauma and resilience [STAR], that was founded through a grant that Audrey and Laura Stroud received from NIGMS [National Institute of General Medical Sciences] to establish a center for biomedical research into stress, trauma and resilience.

That has been underway for the past few years. They have a broad set of goals that are aimed at bringing together diverse scientific perspectives, community and health-related perspectives on stress. And, that work is also funding future development for stress and trauma researchers.

 [The goal is] to grow different areas of research, community partnerships, and futur interventions.

ConvergenceRI: What is the best strategy to move forward, to be able to take the research that has been going on and to translate that into effective strategies to improve health outcomes?
DANIELS: I think that is a really key question: where is stress science currently in terms of developing intervention?

In some ways, there’s been a lot of progress in terms of how the science has improved; we understand more about the developmental impact.

It was really interesting that you mentioned the work by Dr. Jill Maron at Women & Infants and her using salivary markers of diagnostic tools. We are also working with salivary biomarkers in infants and children, so our science around some of those methods has improved quite a bit, and we are able to target, more closely, genetic pathways.

So, your question: “What is the target or what is the intervention?” is something that a lot of researchers are reaching toward.

ConvergenceRI: Are there questions I should be asking, that I haven’t asked, that you would suggest that I follow up on, that you would like to talk about?  
DANIELS: Not specifically. You suggest a goal of having a research consortium. What would such a consortium look like, and what are barriers to developing types of collaborations that you are interested in?

ConvergenceRI: I don’t have the answer to your question. I only have suggestions about who might be involved. There is a research scientist at Brown who has developed an app around pain, called SOMA, and her belief that pain is a learned mechanism in the brain.

There is also a lot of money that came into the state, thanks to the legal work by the Attorney General’s office, suing all the bad actors within the opioid epidemic. There is a committee that dispenses the money for programs that are geared toward intervention. But I think that there is a lack of clarity about what people mean by intervention.

 Investing in research that seeks to identify biological changes related to toxic stress in the brains of infants may prove to be an important kind of intervention, but I do not believe that it is on the table for discussion, in part because there is a tendency of governmental bureaucracies to fall back into usual patterns of behavior – and investments, whether or not the programs have proven effective in the past.

 There are also the community advocacy groups – such as Rhode Island KIDS COUNT – and the Care Transformation Collaborative, which helps to direct pediatric practices involved in patient-centered medical homes.
DANIELS: That’s really interesting. I wonder if there is some way to have that kind of conversation occurring on a regular basis – how it may actually grow into more collaborations, to help push the field forward in some ways.

Following the interview, Dr. Tyrka wrote to ConvergenceRI, providing clarification around the ongoing collaborative research work underway.

TYRKA: Dr. Daniels tells me that she had a good conversation with you. She mentioned that you were asking about bringing together a group of people to collaborate on stress research, and I wanted to let you know that we are already doing this with the STAR COBRE and T32.

We have multidisciplinary faculty and collaborators, and a Community Collaborative Core that engages with community partners – governmental, non-profit, and members of the public – to partner around research and solutions.  Please let me know if you need more info on this. Thanks, and I look forward to seeing your piece!