“The institute has done exactly what we intended for it to do — to seamlessly coordinate our collective system-wide efforts to address these urgent children’s health challenges,” said Phyllis A. Dennery, chair of pediatrics at the medical school, pediatrician-in-chief at Hasbro and a member of the institute's executive committee. 

Patrick M. Vivier, a public health and medicine professor at Brown who specializes in pediatrics and directs the Hassenfeld Institute, says the innovative ways the institute has tackled its goals over its first half-decade have made an immediate impact for kids in Rhode Island.

“While it’s exciting to be doing cutting-edge research that will eventually have large-scale applications, it’s also very gratifying to get out in the community and see how our programs are helping families right now,” Vivier said.

Bench-to-bedside autism initiative

One of the Hassenfeld Institute’s signature projects is its Autism Initiative, which draws on the expertise of scholars from across Brown with the aims of identifying risk factors for autism spectrum disorder (ASD) during the earliest days of life, predicting outcomes and guiding individualized treatment strategies.

The co-leads of the initiative bring complementary skills and interests: Stephen Sheinkopf, an associate professor of psychiatry and human behavior and of pediatrics, has studied the social communication abilities in young children with autism. Eric Morrow is a physician-scientist with a primary appointment in molecular biology, cell biology and biochemistry whose research focus is on normal mechanisms that regulate brain development and on genetic and cellular mechanisms that lead to severe forms of autism. Supported by talented research teams, they’re studying autism from intersecting angles.

Sheinkopf and Morrow, for example, are co-authors of a study published in 2020 that found that girls with autism tend to be diagnosed later than boys, and that people with autism frequently exhibit co-occurring psychiatric and medical conditions. And among other projects, a new $4.1-million federal grant is allowing Sheinkopf to assess gaps in autism detection by analyzing infant cries and neonatal measures of neurobehavior.

“The method we use to measure and quantify infant acoustics was developed through a unique collaboration with the Warren Alpert Medical School, the School of Engineering and our psychiatry department,” Sheinkopf said. “We now have a tool that informs our work as well as that of other researchers.” 

Recognizing the influence of genetics on the development of autism, Morrow’s team is doing deeper research in the lab into the genetic subtypes of autism and also implementing genetic testing in clinical settings.

Based on the efforts of a fellow Autism Initiative member Daniel Moreno De Luca, a Brown assistant professor of psychiatry and human behavior, a new clinic at nearby Bradley Hospital not only offers genetic testing to all families with a new diagnosis of autism, but also provides expert consultation on how to use genetics results to tailor clinical management, a prime example of precision medicine. 

After a recent study done in partnership with the Rhode Island Consortium for Autism Research and Treatment showed that only a low percentage of people diagnosed with autism report receiving recommended genetic tests, Moreno De Luca established the Genomic Psychiatry Consultation Service, which provides clinical recommendations based on genetic testing results, and the Genetic Counseling Service, which performs genetic testing for people with ASD and neurodevelopmental disorders. Chanika Phornphutkul, a Brown associate professor of pediatrics who is chief of human genetics at Rhode Island Hospital and Hasbro Children's Hospital, has been a key collaborator in this clinical initiative. A physician can now send a patient to Bradley Hospital for these services in English, Spanish, French or Italian, where they will receive tailored, precision medicine recommendations for ASD.

The autism genetics clinic is one of just a few such centers in the country, according to Morrow.

“You’ll hear the term ‘bench-to-bedside’ to describe what we’re doing,” Morrow said. “For example, we’re using genetics to enhance the biomedical science and the translational science, the treatment development. At the same time, we are studying the most effective ways to implement genetic testing in the clinic and bringing that to the community as well.” 

Local impact with national significance

With asthma reported in 9.8% of children in Rhode Island compared with a national average of 8.5%, Hassenfeld leaders identified upon the institute’s launch that asthma was a challenge on which they could make a significant difference in a short amount of time. To do that, they’ve created strategic partnerships among existing groups, sparked new projects and harnessed the expertise of Brown faculty and students.

One participant group within the larger Hassenfeld Study was created specifically to focus on this respiratory illness, enrolling pregnant women with asthma and following up with them before and after delivery to examine factors that may predict the development of asthma in children. A smaller project, Children with Asthma in their Real Environments, observes kids to see how the severity of their asthma is affected by different factors.

Rebecca Noga, who earned a master’s degree in behavioral and social health sciences from Brown in 2019, worked with the Asthma Initiative in 2018 as part of the Hassenfeld Summer Scholars program, a competitive internship that provides intensive, hands-on research experience in child health. Noga’s experience sparked an interest in helping children with asthma that led to her work today. She used data from her graduate-level participation in the Childhood Asthma Research Program (CARP) to write her thesis about the impact of gender differences in family asthma management and sleep health in kids, and a study related to this research is slated for publication in the Journal of Child Healthcare. After graduating from Brown, she was hired to join CARP as a clinical research program coordinator at Rhode Island Hospital.

“It’s been so amazing to get out in the community and see the impact of public health research,” said Noga, who says she’s been gratified to help families learn to manage their child’s asthma more effectively so that kids can participate in experiences — like camps — they might normally think were out of their reach.

In one of its most far-reaching asthma projects, the Hassenfeld Institute and the leaders of the Asthma Initiative, professors Elizabeth McQuaid and Daphne Koinis Mitchell, partnered with state health care leaders to develop the Rhode Island Asthma Integrated Response Program, which identifies children with asthma living in high-risk areas and refers them to science-backed treatment programs at home and school. The ultimate goals are to see if children with asthma fare better as a result of participating, gather information from community experts and adjust the interventions to implement them on a larger scale. In 2017, the institute received an $8 million grant from the National Heart, Lung and Blood Institute to evaluate the effectiveness of the program in 16 communities over six years.

“Through this generous grant,” Vivier said, “the institute is providing critical services to hundreds of Rhode Island children with asthma right now, and in the process, the asthma team is undertaking research that can inform communities nationally how to improve the lives of families dealing with this condition.”

Communities coming together to help kids

Another critical Hassenfeld focus has been addressing obesity, one of the most serious chronic health issues faced by kids in America today. Scholars from the institute’s Healthy Weight, Nutrition and Fitness Initiative, which is led by professors Elissa Jelalian, Erika Werner and Rena Wing, have worked with communities in economically disadvantaged cities as well as with the nonprofit Providence Community Health Centers to deliver programs to children at risk of being overweight or obese.

Since 2016, researchers have teamed up with the Providence Healthy Communities Office’s Eat, Play, Learn program to provide kids access to healthy food, outdoor play, enrichment programs and jobs during the summer. Last year, the Hassenfeld Institute awarded the program a $10,000 grant to expand via in-person and online programming.

Kaitlyn Rabb, who earned a bachelor’s degree from Brown in 2020 and recently completed her master of public health, was part of the Healthy Weight, Nutrition and Fitness team. Last year as a Hassenfeld Summer Scholar, Rabb investigated obesity interventions in low-income communities. This year, she helped the Providence Healthy Communities Office strengthen their health promotion programs.

“The organization offers summer meal kits to the kids who would usually get free or reduced lunch at school,” Rabb said. “The twist is that we’re handing out the kits at parks. Research has found that having activities to engage students increases their participation in these sites. So we’re creating enrichment activities to get them interested — and, as a bonus, get them moving.”

Using GIS and mapping software, which she learned how to use in a course Vivier teaches on engaged scholarship in maternal and child health, Rabb worked on a team that created a scavenger hunt that takes place in Providence parks. She also helped create an online park locator for kids and families to plan visits to play spaces around the city.

Rabb, who studied disparities in health care outcomes and quality, said she greatly valued collaborating with faculty and researchers as part of a Hassenfeld project team, and also seeing the application of software tools strengthen and refine community programs.

“I’m connecting research to engagement and using it to implement changes in the community,” she said.

Vivier said that students are part of the lifeblood of the institute. “We’ve been integrating learners into every aspect of every Hassenfeld project,” he said. 

While most students involved to date are studying public health or medicine, Vivier said the institute is working to involve a broader array of students — artists who are interested in creating films, education students who want to be involved in school programs, scholars who enjoy tracing the history of public health interventions, or biologists who can research the effects on children of exposure to toxins.

He said that the while the autism, asthma and healthy weight, nutrition and fitness programs offered the institute early opportunities to make big differences in the lives of children, they are a starting point.

“In five years, we’ve been able to establish and take advantage of the breadth of the Hassenfeld study and our core data set while also digging deep into those three critical issues,” Vivier said. “We’ve been able to focus our impact. In the future, we’re looking forward to expanding beyond these areas. This is just the beginning.”