Clinical Collaboration: Thompson Center Researchers Partner with MU Health Care Clinics

The summer before David Beversdorf began his fellowship, he attended a workshop where one message rang clear: research should be driven by a question, not a technique. Having a clinic at his fingertips as a researcher at the Thompson Center for Autism and Neurodevelopment is a helpful recruitment asset in many contexts, but was not the right technique for the job when he wanted to study the effects of stress during pregnancy on microRNA biomarkers that could be used as an indicator of autism. “We already know that there is some association between prenatal stress and autism,” said Beversdorf, “but we hope to better understand the link so we can hone in on the risk factor.”

The methodology for this study involves administering surveys about stress to pregnant women and collecting saliva samples from which concentrations of microRNA can be measured. The key to accomplishing this is recruiting pregnant women, a demographic that the Thompson Center clinic does not provide services for.

“So, this research question led us to collaborate with Dr. Goodman’s clinic,” said Beversdorf, “they have the population we don’t have that’s needed to explore this question.” Dr. Jean Goodman is the Griffin Endowed Chair and Professor in the University of Missouri’s Department of Obstetrics, Gynecology, and Women’s Health as well as the director of MU Health Care’s Maternal Fetal Medicine clinic, which sees roughly 1,500 patients annually. This study aims to collect survey data and saliva samples from 150 participants at their second trimester ultrasound appointment during its one-year pilot phase funded by BioNexus, a private academic research partnership in Kansas City.

“We here at the University of Missouri – Columbia are working to improve pregnancy outcomes for our mothers and their babies,” said Dr. Goodman. “Doing so in a multidisciplinary, collaborative way – like this study – allows expertise from varied specialties to come together in a unified way with the common goal of improving maternal-child health.”

The BioNexus study is not the first time Thompson Center researchers have sought partnerships with other clinics for recruitment. The Thompson Center has been testing REACH, a mobile-based screening tool for early identification of autism, since November 2021 and will be concluding trials in October 2022. The goal is to develop a tool that families can use for at-home screening; however, in its current form, the screening tool must be administered by professionals.

This study requires a sample of children from the general population to determine the effectiveness of the app. “If kids are coming to the Thompson Center, someone is already concerned, and they’re more likely to screen positive,” said Dr. Kerri Nowell, the principal investigator on REACH at the Thompson Center. To this end, the team of researchers partnered with MU South Providence Pediatrics, which sees approximately 2,000 children ages 0-3 for well child visits annually.

Research Specialist Julie Muckerman said this partnership created a new question: “What does it look like to do a research visit at a pediatric appointment?” The answer involved collaborating with every pediatrician and resident at the clinic in order to reach the most families with information about the study. Outreach through practitioners will continue to be a key tool as REACH evolves from its current testing phase to a ready-to-use screening tool. “We want to identify high-risk kids without requiring them to come to a specialty clinic,” said Muckerman, “and one of the best ways to reach them is through their pediatrician.”

The Thompson Center will soon be bringing another study into its collaboration with the Maternal Fetal Medicine clinic. The Early Years Study will be looking at characteristics of infant cry as early indicators of autism and other developmental disabilities. This study funded by the National Institute of Mental Health was brought to the Thompson Center by Dr. Stephen Sheinkopf when he became the Executive Director in September 2021.

“If we want to know about development in early infancy, we need to make contact with families early on,” Dr. Sheinkopf said, explaining the need for clinical partnership. “We don’t serve infants at the Thompson Center, yet.”

The Early Years Study is the Missouri site of this NIMH-funded study. The initial location, called the Rhode Island Neurobehavior Observation Study (RhINOS), involves a partnership between Women and Infants Hospital of Rhode Island, Brown University, and the University of Rhode Island. The methodology for RhINOS is based around reaching out to parents and offering the opportunity to enroll while mothers are still in the mother-baby unit after delivery. When adapting the study for recruitment in Missouri, Maternal Fetal Medicine stood out as a centralized location for many expecting parents, so the project adapted so that the Early Years team could approach mothers during their prenatal visits.

“There is a natural synergy between Early Years and Dr. Beversdorf’s work on the BioNexus project,” Dr. Sheinkopf added in his reasoning for working with Maternal Fetal Medicine. Both studies are contingent on recruitment at the earliest stages of development and have a common goal of ultimately gaining insight into early identification of autism and other neurodevelopmental disorders.

Despite their shared recruitment source, the eligibility standards vary between the two studies. Early Years has its sights set on the general population. “We’re looking to recruit a broad group of parents to participate,” said Dr. Sheinkopf. “Most newborns will be eligible for this study.”

The BioNexus study will be recruiting from a narrower subset of patients at Maternal Fetal Medicine: Black and African American women. As a historically marginalized group, these women of color are underrepresented in research. They are also at a higher risk of experiencing stress factors during pregnancy. Dr. Goodman echoed the need for this nuance in research. “The association between mental well-being and pregnancy-related outcomes is particularly evident in our most vulnerable populations, those patients of color.”

“Clinical partnerships go beyond the research relationship,” Dr. Nowell said of the experience she had working with South Providence Pediatrics. Working closely with providers and staff at other practices creates opportunities to discuss when a child should be referred for an autism evaluation and a deeper understanding of the Thompson Center’s processes and services. “We now have advocates there.”

Muckerman explained that recruitment for REACH has already made an impact on the clinic at the Thompson Center. “Many of the participants that screened positive have joined our waitlist,” she said. “They are starting on a path to receive services.”