Daphna Yasova Barbeau, MD

Today in the studio, I'm so fortunate to have on Dr. Shirley Russ. Dr. Russ was a clinical professor of pediatrics at Cedar Sinai Medical Center in Los Angeles, but now holds the esteemed title as the Senior Project Scientist for the Life Course Translational Research Network. Dr. Russ, thank you for being here.

Shirley Russ

Thank you, Daphna, for having me on.

Daphna Yasova Barbeau, MD

Well, we're learning a lot about life course theory. And so tell us a little bit about the Life Course Translational Research Network. What's the mission? What are some of the tasks that you guys are tackling today?

Shirley Russ

Well, what we're really trying to do is to take what are the potential benefits of a life course approach and translate it into practice in a very wide way, thinking about how do we take this knowledge that we now have about how health develops across the life course, and how do we make sure that we are influencing research, policy, and practice with all that we know? And how can we translate what we know into practice at speed and at scale? So it's all about really how do we make sure that the research that we're doing is actually benefiting the people that we're doing the research to try to help. And that's really the mission of the Life Course Translational Research Network.

Daphna Yasova Barbeau, MD

I imagine this is no small task because I mean, part of the concept of the life course is it's across a lifespan. So you must have lots of stakeholders to be working with.

Shirley Russ

Yes, we definitely do. So I'll probably tell you a little bit about the history of the translational network. And it is a very broad remit, as you say. So back in 2010, the Maternal and Child Health Bureau recognized the potential of a life course approach to really, in a sense, revolutionize our approach to child health and thinking of child health as the foundation for health across the life course, and they put out an RFP to form a Life Course Research Network, which we applied for and were successful in getting. But we started off at that point with just five researchers at UCLA with a huge interest in life course. And Neil and Myles Hoxstein had done this foundational work in Life Course Health Development, which we thought was tremendously important and had great potential. Over the next eight years, we continually had to recompete and were refunded. We grew the network from just five people to a thousand people across the U.S. who were all very interested and passionate about life course. We found that people had a desire to apply these principles to their own subspecialty area, to their own area of practice. And so we were able to do things like have a series of 50 webinars where people would apply the principles of life course to the work they were doing. We put out a couple of research agendas, and we were able to do some additional work incorporating new evidence from epigenetics, genetics, what we now understand about early developmental processes, responses to stress, and so on, and we integrated that into an updated version of the Life Course Health Development approach. Most importantly, it allowed Neil and Chris Forrest and others to develop the Handbook of Life Course Health Development. In that handbook, experts from different specialties contributed chapters, really summarizing their thoughts about how we could apply these life course principles to their topic area. One of the chapters was around prematurity, which at the time was led by Michael Msall. Then in 2018, the Bureau decided that we wanted to move from thinking about research to thinking about intervention research. How do we take what we've learned, what we know, to actually fashion interventions that can be used across the population? From 2018 to 2023, we had funding from the Maternal and Child Health Bureau to develop interventions. By this point, the network had grown to around 2000 across the U.S. We also had a core group of about 125 researchers spread over 20 different institutions. We had a number of different nodes. One of the nodes we had was the prematurity node because we knew from the beginning that prematurity is relatively common in the U.S. (over 10% of births), and if we could improve outcomes after prematurity, it would make quite an impact on population health. In 2023, after competing again for funding, we became the Life Course Translational Research Network with the broader remit of translating life course into practice across research, policy, and practice at a larger scale.

Daphna Yasova Barbeau, MD

Well, certainly we are going to be talking about the prematurity node. That's, for our listeners, a topic of definitive interest. But I want to make sure we get the full scope. So tell us what some of the other nodes look like and the goals for those arms of the program.

Shirley Russ

So the other nodes that we have at the moment are ADHD, adversity. Adversity covers a wide span of adversity, including ACEs. We're also working in the juvenile justice space, looking at transition-age youth who are emerging from incarceration—how do we best support them? One of the interesting things about that project, led by Liz Barnett at UCLA and Laura Abrams, is that we've realized that a lot of those people coming out of incarceration are themselves parents. So it's become more of an intergenerational project. Then we have a node looking at early childhood mental health. You'll notice ADHD, early childhood mental health— there’s lots of crossovers with the prematurity space. We have a family node, and we've become very interested in the idea of family health and family health development - recognizing that the health of one family member impacts the health of other family members. It's not a linear process; it's more of a recursive process, with recurring loops of family health. Then we have a school node, looking at schools as platforms for life course interventions. Children spend a lot of time at school, and we think there’s potential for interventions that can improve people’s life course and life course health. We also have some cross-cutting cores looking at things like measurement and engagement of family, youth, and communities. One of the things that our Translational Network feels is pivotal to all of our work is the strong engagement of family, youth, and communities. The interventions we're working on developing are co-developed with the people they are meant to help - whether that's families, youth, or others. This co-development is essential for creating interventions likely to work.

Daphna Yasova Barbeau, MD

I love that. So let's focus on the prematurity node and what are the interventions that you are tackling.

Shirley Russ

So in the network at the moment, one of the focuses, which we are coming up to next year, is that we roll out different pilot projects in different years. And part of the way that this node has been structured from the beginning, Neil is the PI and he felt very strongly that we wanted to have multiple nodes so people could try things that are a bit different, a bit innovative. We could have kept the funding in-house or divided it among one or two groups, but we really wanted to have a broader remit. The funding we're supplying is seed funding to generate innovation, and then we can apply for more substantive funding. In the prematurity node right now, Susan Hintz and Jonathan Litt at Stanford, who of course you know and co-led this children's special issue, are going to be looking at an intervention around PTSD in the NICU. We know that for families, the experience of the NICU can be a traumatic event. And when we think about the health development of the baby, it’s so closely connected to the health and wellbeing of the parents, which in turn affects the parents’ ability to provide the nurturing care that is such an important buffer to many challenges these infants face. As part of this more holistic approach to care, we're very focused on making sure the family's health, the parents' health, is in the best possible state. Recognizing that trauma and PTSD are part of this, Susan and Jonathan are working with colleagues at Stanford on further developing and implementing a PTSD prevention intervention.