Center for the Study of Childhood Adversity and Resilience


The Center for the Study of Childhood Adversity and Resilience will be the focal point for community-level research on the many vexing adversities that children and their families face. Among these challenges are poverty, violence, inequality, homelessness, mental health, education, and nutrition. Interest has been sparked nationally and in the greater Houston complex to raise awareness of the impact that early childhood has on the life trajectory.

In the 1990s, the Adverse Childhood Experiences (ACE) study demonstrated clearly the impact of childhood adversity to increased morbidity and early mortality in adults. The CDC adopted the ACE framework as a paradigm for health promotion for the entire lifespan (“Safe and Stable Nurturing Relationships”). The AAP has endorsed the Eco-Bio-Developmental framework for childhood toxic stress and has developed the national Center for Healthy and Resilient Children. The CARE is exceptionally positioned to work within the Houston community, as well as across the state and nationally, to embrace and enhance these efforts. There is great interest within the academic and non-profit sectors of Houston in having a center specializing in the study of childhood wellbeing and adversity.

Many public health efforts are hindered by scopes that are too narrow and time horizons that are too short. The CARE will have as one of its objectives to promote the need for strategies that are broad in scope, meaningful in dose, and sustained for longer periods of time. A cornerstone will be comprehensive outcomes and economic evaluations to ensure efficient use of resources from a societal perspective.

To address the absence of any center or organization within Houston that has the explicit mission to focus on childhood well-being from a comprehensive, public health perspective, the CARE will provide research, scholarship, and policy collaboration to help influence how children and families are valued in the Houston complex. This focus will complement the clinical services being offered within SPHP and the full Texas Children’s Hospital services. The CARE will also collaborate with and support organizations in Houston that are providing direct services that impact families and children.

Adverse Childhood Experiences Workgroups

Currently, the CARE is facilitating four workgroups focus on specific adversities, including: postpartum depression, intimate partner violence, child abuse prevention, and food insecurity. Each workgroup includes representation from academia/healthcare, county/city offices, and local non-profit, and is constructing meaningful next-steps in moving collective effort forward.


upWORDS was launched in the summer of 2016 at Texas Children's Hospital - West.  It is a program for families that features the use of the LENA Foundation’s "talk pedometer" technology to measure how often parents talk to their infants and the extent to which the infants respond. The six-month upWORDS program helps parents improve the quantity and quality of language spoken to their child and educates them on the long-term impact of language on the child’s future, as well as on how to use simple techniques to increase interactive speech with their child. The LENA system uses a small recorder, which fits inside a vest worn by the child, to measure the number of words the family members speak to that child and the child’s responses. The recording is translated into data to help the parents gauge the level of spoken interaction. Parents also have the opportunity to discuss the data from the recordings and to gain insights into how to work through other obstacles that might hinder the child’s development. The program also provides books for the parents to read to their children

Researchers have found that 80 percent of a child’s brain development is complete by three years of age, rendering those first few years of the child’s life critical to their later opportunities for success. Studies indicate that academic achievement gaps exist for children who experience fewer words and conversations than do their peers during these important early years. In some cases, the “talk gap” involves millions fewer words and conversations. Research measures include increases in parental bonding, parenting efficacy and language development.

upWORDS Goals

  • To provide children from low-resourced communities with the best opportunity to success by educating families on the importance of talking, reading.
  • To improve bonding between parents and their children.
  • To identify children who are in need of medical services (therapy, mental health) sooner and provide parents with education on services and resources available.

Safe Babies

Safe Babies is a collaborative research project with The University of Texas Tyler Health Science Center funded by the Texas State Department of Family and Protective Services. Research has shown that infants in the first sixteen weeks of life have an increased risk of abuse head trauma triggered by bouts of extended crying. The Safe Babies project is designed to address: parental response to inconsolable crying, social and economic stressors, and parental competencies focused on caring for self and for the baby. The three prevention strategies that make up the current project span the spectrum from being evidence-based to evidence-informed programs. Because of the relative experimental nature of two of the prevention strategies, the evaluation was designed so that the relative contribution of each strategy to outcomes could be assessed.

The table below outlines the four arms of the project. Each arm will be administered in a single clinic. The clinics were not randomly assigned to the arms, rather they were picked based on the type of clinic staff that were present in the clinic. The clinics administering the +Stress and the +Action Plan arms both have full-time social workers on staff that can provide the community referrals. All clinics currently screen for postnatal depression at infant well-checks as a standard of care. Further, all clinics use the same referral algorithm and refer mothers to the same clinic for further postnatal depression screening and treatment.  Research measures include: parenting attributions, parenting self-efficacy, infant characteristics, and maternal experiences.

Outline of the prevention strategies being provided in each arm of the program

Arm of Program

Depression screen +
Referral for treatment

Period of PURPLE Crying

Social and economic stressors + Referrals

Parenting Action Plan










+Action Plan





Based on the current volume of infants in each clinic, we will aim to recruit 150 mothers for each arm of the study, with 600 mothers being recruited for the study overall. We expect 20 percent of mothers to be lost to follow-up or to not complete all data collection points for the six months each will be followed.