Title:Building the conditions to thrive

When Mallika Pajjuri cold-messaged Georgetown professor Matthew Biel, director of the Thrive Center for Children, Families, and Communities, on LinkedIn in late 2024, she had no idea the exchange would end up being so consequential for her new company.

Pajjuri’s startup, Psyche Care—which she began developing as an undergraduate at MIT—sought to address what she and her co-founder see as a critical yet overlooked aspect of children’s mental health: the parent or caregiver. One parent she interviewed in her research shared that if her child had a diagnosis such as cancer, casseroles would appear on her doorstep. For mental illness, she felt she was scrambling for support.

“Parents and caregivers of kids in crisis are largely left on their own, without guidance, support or resources to manage the situation,” says Pajjuri.

The timing was fortunate. The Thrive Center was looking for candidates for a new initiative called the Innovation Hub, a Silicon Valley-style accelerator pairing startups and nonprofit organizations with Georgetown researchers. Biel thought Psyche Care would be a perfect fit.

The Innovation Hub turned out to be exactly what Psyche Care needed to take its business model to the next level. The three-month experience offered not only community and mentorship, but also a framework for translating research into real-world settings.

Through the fellowship, Psyche Care launched a quality improvement study with MedStar Montgomery Medical Center in Olney, Maryland. Working with more than 20 families drawn from the hospital’s emergency department and inpatient unit, Psyche Care tested its caregiver coaching model in real time, connecting parents with peer support and personalized crisis management tools. The initiative achieved a 92 percent reduction in emergency department use among participants and a 100 percent post-enrollment completion rate. Psyche Care has also secured $500,000 in investor funding as a result of the fellowship, building on $100,000 in prior grant funding.

“This kind of support can be game-changing for a company. We were clear on our mission and had big ideas of what could potentially work, but didn’t know how to frame the argument and the evidence for it,” says Pajjuri. “We left the fellowship with this new knowledge and new connections. It’s had a snowball effect.”

Since its launch in early 2025, the Innovation Hub has supported 19 organizations across three cohorts, collectively reaching more than 2 million kids and families in over 20 states and four continents. The program has facilitated hundreds of connections to state and systems leaders, and has fostered partnerships between fellows and major institutions.

Fifty years in the making

While the Innovation Hub focuses on startups, the Thrive Center itself builds on decades of existing research and relationships. Founded in 2024, it grew out of two institutions with deep roots at Georgetown: the Center for Child and Human Development—which Phyllis Magrab led for more than 50 years—and the research and community engagement components of MedStar Health’s Division of Child and Adolescent Psychiatry. That division was founded and is led by Biel, a professor of psychiatry and pediatrics at Georgetown, where he holds the Marriott Endowed Chair of Child, Adolescent, and Family Mental Health.

The merger linked Magrab’s expertise in early childhood systems, disabilities, and community-based work with Biel’s clinical and research depth in child, adolescent, and family mental health.

Choosing the name Thrive was intentional. Rather than centering the work on illness and its treatment, the name signals the need to build the holistic conditions for children, families, and communities to flourish. As Biel says, the risk of not doing so is clear.

“Too often, young children and their families have experiences of adversity that have long-lasting consequences for their health and well-being. We can do better to nurture and protect our young people.”

Over the past two decades, research on early development has made an overwhelming case for investing in children at the very beginning of life, and the return on that investment is well documented. Positive early experiences are strongly linked to lifetime gains in learning, health, and economic productivity, while early adversity, such as poverty, trauma, and parental mental illness, carries financial and societal costs.

Thrive’s approach is grounded in a concept called early relational health, or the state of emotional well-being that comes from positive connections between a child and parents, caregivers, teachers, doctors, and others in their orbit. It reflects the core belief that you cannot effectively serve a child without understanding the family, community, and systems in which the child grows up.

The gap between this understanding and how society actually invests in children is vast. Biel points to the lack of paid parental leave in the U.S. as one example. Research shows that paid leave in the first year of life significantly increases the likelihood that children will form healthy attachments and be protected from early trauma and stress.

More broadly, the systems designed to serve children and families, such as health care, education, and social services, are too often siloed and difficult to navigate. Mental health care continues to be reimbursed differently than other medical care, creating persistent gaps in access. And too often, a child’s trajectory is helped or hindered by the zip code where they were born.

“There are tremendous barriers to putting in motion the policies and decisions we need to make as a society to show we value young children,” says Biel.

To address these challenges, Thrive connects a multidisciplinary array of researchers, clinicians, policy experts, and public health scholars in ways that few centers can. Structured around four pillars—early childhood, disabilities, child and family mental health, and digital health—Thrive also convenes experts from across the university, including the School of Medicine, School of Health, Berkley School of Nursing, McCourt School of Public Policy, College of Arts and Sciences, and Georgetown’s clinical partner, MedStar Health.

Faculty maintain deep community relationships across the Washington area, long-standing partnerships in early childhood, mental health, and disability research nationally, and a growing portfolio of international collaborations.

“The well-recognized and sustained crisis in youth mental health in this country requires a deep understanding of the factors at play,” says Biel. “We bring broad expertise and community connections to identify where we see the best opportunities for intervention.”

The first thousand days

David Willis, professor of pediatrics and psychiatry at Georgetown and founder of Nurture Connection, a prevention and community systems-change initiative now headquartered at the Thrive Center, has spent his career making the case for why those early relationships are foundational.

“Every year, skills beget skills beget skills—it’s like building the foundation of a house,” he says. “If the foundation is not strong, the house doesn’t weather storms well. And the foundation of human flourishing is laid in the first thousand days.”

Though the science is clear, the country has largely failed to act on that understanding, Willis says. Over the past 25 years, billions of dollars have flowed into early learning programs without delivering the outcomes the science would predict, because those programs have too often neglected the relational connections that make learning, social development, and emotional regulation possible.

“Early childhood systems and supports in the first thousand days have always and truly faced a scarcity mindset, with programs chronically competing for scarce dollars,” Willis says. “Investing early in the foundations of flourishing in this nation is essential. And we’re not talking about huge dollars. We’re talking about intentional dollars.”

The investment gap is compounded by the fact that the informal family and community networks that once supported young children have broken down, Willis says. For example, roughly 40 percent of newborns come home to single parents who are largely on their own. This shift has eroded what Willis calls the “generational social protective environments” that families once relied on.

The effects of all this on children and young people are profound. Half of all mental illnesses emerge by age 14; three quarters before age 24.

Chronic conditions like depression, post-traumatic stress disorder, and substance use disorders are among the conditions that have the most devastating impact on individuals, families, and communities. The situation is compounded by access to care, which remains deeply unequal, and shaped by race, income, insurance status, and geography.

Yet Willis sees reasons for cautious optimism. Communities and states are beginning to shift from a scarcity mindset toward what he calls an abundance mindset, working together towards common goals with “the recognition that human flourishing is built through collective action.”

Where families already are

Thrive’s approach to these challenges takes shape across several initiatives, all of which entail deep community-based work.

Neal Horen, one of the country’s foremost experts in early childhood mental health systems, leads Georgetown’s Center of Excellence for Infant and Early Childhood Mental Health Consultation. He holds the Phyllis R. Magrab Endowed Chair and serves as associate professor of pediatrics and director of infant, early childhood, and relational health at Thrive.

The center’s premise is that adults who work with very young children in early care settings regularly encounter behavior that signals distress, but they often lack the mental health expertise to respond.

Over more than two decades of work in infant and early childhood mental health consultation, Georgetown has trained and supported consultants to bridge the gap, serving programs across states, territories, and tribal communities, from which the center has also drawn deep knowledge about community-centered approaches to children’s well-being. The federally funded Center of Excellence has formalized and expanded that reach and has become the national clearing-house for best practices in the field.

Horen says this work demonstrates Georgetown’s commitment to translating research into practical and tangible outcomes.

“The academics and research are really important pieces, but this is a place where we take all that into the community and we base our efforts on what the actual needs are that we are seeing,” he says.

Another Thrive initiative, the Early Childhood Innovation Network (ECIN), is a 10-year partnership with Children’s National Hospital focused on DC’s youngest children.

Co-directed by J. Corey Williams, associate professor of psychiatry at Georgetown whose career has centered on community-based approaches to mental health, ECIN works in Washington’s most underserved neighborhoods to build the conditions for children and families to be healthier from the start.

Through partnerships with Children’s National Hospital and community leaders, ECIN builds child mental health programs that embed support where families already are, such as in pediatric checkups, classrooms, and neighborhood gathering spaces.

The community-based approach emphasizes prevention by reaching children and families early, preemptively reducing the demand for emergency intervention rather than simply responding to it.

“We need to double down on preventative investments and catch emergent problems before they spiral into crisis—and that support should be community-based, living in people’s neighborhoods and schools and Head Start centers. And it has to be focused on whole-family care,” says Williams.

Central to that model is having people with lived experience navigating the mental health system provide screening, group interventions, counseling, and home visits. In collaboration with the Thrive Center, ECIN helps administer a training program for peer support specialists and community health workers to build exactly that kind of local capacity and ensure that family is at the center of care.

The ECIN model has attracted long-term philanthropic investment—including from the A. James & Alice B. Clark Foundation, the J. Willard and Alice S. Marriott Foundation, the Bainum Family Foundation, and the Howard and Geraldine Polinger Family Foundation, among others.

The “whole-family” approach runs through Thrive’s work in developmental disabilities as well.

For families raising children with disabilities, the timeline stretches far beyond early childhood, according to Pamala Trivedi, an associate professor of pediatrics who directs Georgetown University Leadership Education in Neurodevelopmental Disabilities (GULEND) training program and serves as associate director of the Georgetown University Center for Excellence in Developmental Disabilities. Both federally funded programs, headquartered at the Thrive Center, are part of extensive national networks supporting disability training, research, and community partnership.

“Families raising young people with high support needs aren’t navigating a single crisis or transition. They’re navigating over decades,” says Trivedi. And they’re doing it through school, health care, and social service systems that have been “designed to see only part of them at a time.”

GULEND is among the more unusual training models in the country. Rather than training clinicians, family caregivers, and people with disabilities in separate tracks, it brings them together to avoid fragmentation. Classes are taught by disabled people, family caregivers, and community members, alongside credentialed professionals, and trainees complete practicum placements in community settings where people with disabilities and their families are served.

A new Thrive initiative called Centering Voices builds on this same commitment to inclusion, by focusing on the role of school-based staff who provide assistance to students with disabilities in DC public and charter schools. These staff members, known as direct and dedicated aides, are often the primary anchor for a student with neurodevelopmental disabilities, yet they receive limited training, inconsistent supervision, and little acknowledgment.

“What we have heard from the aides was consistent: the work is deeply relational, they’re doing it largely alone, and what they need isn’t abstract developmental theory—it’s real practice, real words, real support,” says Trivedi.

Funded by the Graham Foundation, the Centering Voices pilot is a collaboration between the MedStar Georgetown Center for Well-being in School Environments and the Thrive Center.

Trivedi and colleagues have been running listening sessions and pilot trainings with dedicated aides in DC public and charter schools, co-designed with a practicing aide, school-based behavioral health clinicians, and family members of students with disabilities served in local, public schools to build more sustainable pathways for inclusion.

Trivedi also works with another overlooked constituency: fathers and what she calls “fathering caregivers” (the latter a term she prefers for its breadth, encompassing grandfathers, stepfathers, and others who don’t fit the conventional model).

Fathering caregivers have been historically underrepresented in research, clinical practice, and program design, Trivedi says.

“What our research has shown is how expansive fathering actually is, fathers centering social-emotional health, disrupting intergenerational cycles, being role models against violence, shattering stereotypes about gender and disability, and creating seats at the table in systems that weren’t designed with them in mind,” she says.

Thrive’s disabilities work will soon receive a new boost. In January 2027, Georgetown will launch a joint Executive Master’s in Global Leadership in Disability and Systems Transformation, developed with the University of Thessaly in Greece and housed in Georgetown’s School of Medicine Biomedical Graduate Education program.

The course of study, aimed at mid-career leaders across health, policy, law, and technology, is built on the premise that the knowledge most essential to systems change lives with the people closest to those systems.

“Disability doesn’t look the same everywhere. Family systems don’t work the same everywhere,” Trivedi says. “Our job is to train leaders who know how to listen to families, to people with disabilities, and to people with mental health support needs, and who have the skills to build something better.”

‘We live that at Georgetown’

For a center like Thrive, which is fueled by multidisciplinary and cross-institutional collaboration in DC and beyond, Georgetown is a natural home.

Further, Georgetown’s Jesuit tradition of cura personalis—care for the whole person—runs through Thrive’s approach.

“The mindset of the institution, its Jesuit background, its social justice commitment, its historical view about the dignity of every person—those core values are relational values,” says Willis. “Humans flourish through their physical health, their psychological sense of connectedness with others, and their spiritual lives. We live that at Georgetown.”

It is precisely that orientation toward the whole person, the whole family, and the whole system that attracted Pajjuri to the Innovation Hub fellowship program.

She had grown up watching friends cycle through diagnoses, inpatient programs, and mental health crises, and what she kept coming back to was the lack of attention to the people surrounding the child—care of the whole family and community. The Thrive Center’s Innovation Hub gave her company the tools to do something about it.

“Being able to be in the driver’s seat of building Psyche Care, while having these advisors as champions, was an experience I’ve never had in any other program,” says Pajjuri.