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As a clinician and researcher, , has long dedicated himself to understanding the impact of traumatic events on children and adolescents. He pioneered Trauma Systems Therapy, a unique community-based model of caring and healing for children and families. He also helped develop the , which partners academic research centers with community practices.

In September 2023, Dr. Saxe, a professor of child and adolescent psychiatry, received an from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to support the launch of the Center on Causal Data Science for Child and Adolescent Maltreatment Prevention (The CHAMP Center). Based in the , and in partnership with the , the Family Health Centers at ��ɫtv Langone Health, and the University of Minnesota, the center will use data science to uncover the complex causes of maltreatment of children and develop effective interventions. Below, Dr. Saxe explains how the center will address one of our society’s most heartbreaking crises.

The CHAMP Center focuses on the maltreatment of children. Could you define “maltreatment” and explain the magnitude of this problem?

Child maltreatment is defined as harm that is done to a child at the hands of their caregivers, usually their legal guardians. This may involve acts of abuse, such as physical or sexual abuse, but it may also involve caregivers neglecting a child’s physical needs. These categories of maltreatment are investigated by child welfare systems to protect children. However, those investigated are probably the tip of the iceberg. In 2019, over 650,000 cases of maltreatment were substantiated in the United States, but many cases go unreported.

What are the adverse effects of maltreatment?

Exposures, especially early in life, can affect how kids think of themselves, others, the world, and their future. They set expectations about relationships with others and how people will treat them. If a child grows up expecting that people will not take care of their basic needs, they feel as if they can’t depend on anyone. Maltreatment can lead to drug abuse, serious mental disorders, suicidal behavior, aggression, and poor physical health. So it’s extremely important to develop a system for preventing maltreatment, and if a child is already maltreated, preventing or treating its harmful consequences.

How will this center improve prevention and treatment strategies?

We have two goals: to advance scientific knowledge that enables professionals to reduce a child’s risk, and to implement personalized interventions guided by decision-support tools, with that aim. Decades of research allow us to predict the kinds of bad outcomes that may result from maltreatment, but a risk factor is not necessarily a causal factor. There are many factors—genetic, biological, social, developmental—but it’s important to identify a smaller, more specific set of factors that could be intervened on to change the outcome. By discovering the causal factors that contribute to a bad outcome, we can help clinicians know which interventions to use. For example, if we determine that the three most important factors for a maltreated teen’s risk for suicidal behavior are the mother’s depression, the death of someone close in the last year, and the teen’s level of substance abuse, then a clinician can help the mother and child get treatment for those issues.

How will you build the decision-support tools?

For more than a decade, I’ve been working with colleagues at the Institute for Health Informatics at the University of Minnesota to adapt their causal data science methods and algorithms for mental health and child maltreatment. Using data on tens of thousands of children at risk, we apply those algorithms to build models that can determine causal factors for bad outcomes. Our colleagues at the ��ɫtv Silver School of Social Work will help us select models that can translate into care, then we’ll create assessment tools for children and families. Software will apply the information gathered to identify a child’s level of risk and the interventions needed to reduce that risk. The aim is to tell the clinician which causes are relevant to a child’s maltreatment, and which interventions they should provide or recommend. Because the tool can be broadly scaled, pediatricians will be able to use it to help many kids at risk.

How will you test and deploy these new tools?

By 2025, we’ll test them with primary care pediatricians at the Family Health Centers at ��ɫtv Langone in Sunset Park, Brooklyn, a community that faces a lot of distress. Our decision-support tools will help them process the child’s clinical information and risk, and provide them with personalized recommendations for interventions needed to reduce that risk. We’ll support the child and family throughout these interventions, and follow them over time to see if their risk was reduced, compared to other groups whose care was not guided by such decision support.

What compelled you to embark on such an ambitious project?

When NICHD released the call for proposals for national centers of excellence in child maltreatment research in early 2022, I became incredibly excited, because it seemed like a perfect fit for my team’s work. Then reality intruded.

A few months earlier, in May of 2021, I had sustained a very serious stroke that left half my body completely paralyzed. I spent a week in ��ɫtv Langone’s neurointensive care unit, which saved my life, and a month at Rusk Rehabilitation, which got my body moving. I’ve since recovered far more than anyone expected. But could I pull off writing a big, complex grant proposal? Then, a moment of clarity set in that perhaps only a near-death experience can reveal. This call for proposals was written for me. I was uniquely qualified to respond. I called my team. We got to work. The CHAMP Center is now here at ��ɫtv Langone. Sometimes, when you are called, you have no choice but to answer.