PROJECT SUMMARY / ABSTRACT. Neonatal opioid withdrawal syndrome (NOWS) is a major public health problem. While existing findings suggest an increased biological risk of neurodevelopmental impairment, the direct developmental effects are nearly impossible to disentangle fromsocioeconomic, environmental, and family factors. Children with NOWS are often exposed to multiple adverse childhood experiences (ACEs) with known detrimental effects on long-term health, however, positive childhood experiences (PCEs) can buffer the effects of ACEs, promoting positive adaptation. In this proposal our objective is to identify PCEs associated with optimal developmental outcomes as meaningful and feasible future intervention targets. To achieve this goal, we propose incorporating lived experience through an active partnership with a local community advisory board and an innovative, strengths-based focus on positive experiences. We will capitalize on our established, prospective longitudinal cohort of children with a history of NOWS, adding a school-age assessment to establish a more complete developmental trajectory with a comprehensive evaluation of socioeconomic, parental, and environmental variables. We will accomplish this study through the following specific aims: (1) Engage key community members as active partners in the research process to participate in identification of key patient- centered outcomes and explore acceptability, appropriateness, and feasibility of potential interventions, (2) Assess the independent and moderating effects of total PCEs/ACEs and longitudinal measures of parenting on school-age neurodevelopmental outcomes in a prospective cohort of infants with NOWS, (3) Examine the association between the individual PCEs and components with neurodevelopmental outcomes in children with a history of NOWS. We use several novel concepts that differentiate this proposal and line of research from others including an analysis plan directed by positive psychology principles and incorporation of key community members in all phases of the project to improve study processes, reduce barriers, and facilitate meaningful results. I will work with a team of experienced mentors (Drs. Freisthler, Taylor, Sege, Breitenstein & Rausch) to increase my competency in three critical areas: (1) community-engaged research, (2) design and analysis of longitudinal studies, (3) methods for assessment of and intervention to promote PCEs and prevent ACEs. These three training objectives will be accomplished through formal coursework, interactive workshops, presentations and conference attendance, completion of my research aims, and hands-on mentorship activities with my diverse, multi-disciplinary group of mentors and collaborators. This early career development award will provide the necessary candidate training and foundation for an R01 testing the efficacy of an intervention to increase relevant PCEs identified during the K23, propelling an independent, federally funded ...