Trauma has a undeniable impact on our patients' health and illness, but it is not often addressed in the clinical setting, even though many trauma survivors think their healthcare team should know about their trauma history. Join us in learning from Dr. Moira Szilagyi (President of the American Academy of Pediatrics) and Dr. Edward Machtinger (Internal Medicine physician and director of UC San Francisco's Center to Advance Trauma-Informed Healthcare) about the key features and signs of trauma, fundamental principles of trauma-informed care, and the impact of trauma and adverse childhood experiences (ACE) on our patients' health.

Click here to claim CME credit for listening to the episode!

Show Notes
​

Learning Objectives:
  1. Define the terms trauma, trauma-informed care, and adverse childhood experiences.
  2. Gain familiarity with SAMHSA’s 3 E’s of trauma and 4 R’s of trauma-informed care.
  3. List 2 ACE (adverse childhood experiences), and describe how ACE screening/intervention fit within the larger framework of trauma-informed care.
​​
Co-hosts’ Notice: Physician and provider are terms used interchangeably by many in the medical community. The DEI Shift podcast team endorses and supports the use of physician in place of provider where applicable as outlined in ACP policy.

[0:00] Intro
  • Introduction of our co-hosts, the episode topic, and the guests, Dr. Moira Szilagyi and Dr. Edward Machtinger

[3:40] “Step in Your Shoes” Segment
  • Dr. Machtinger explains that his love for animals and nature guided his decision to enter the medical field. 
  • Dr. Szilagyi discusses how growing up in an immigrant family has influences her work in childhood trauma. 

[7:50] Defining Trauma and Trauma-Informed Care
  • Dr. Szilagyi shares SAMHSA’s definition of individual trauma, which results from "an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being."
  • Dr. Kozman reviews SAMHSA’s the 3 E’s of trauma, which are Event(s), Experience, and Effects.
  • Dr. Szilagyi details the National Child Traumatic Stress Network’s definition of trauma-informed care, which is when “all parties involved recognize and respond to the impact of traumatic stress on those who have contact with an organization, including children, caregivers, and service providers”.
 
[14:45] SAMHSA’s 4 R’s of Trauma-Informed Care
  • Dr. Machtinger describes SAMHSA's 4 R’s of trauma-informed care, which includes Realization, Recognition, Response, and Resist re-traumatization. 
  • CDC-Kaiser Permanente released a paper detailing the percentage of each disease that is attributed to trauma.   
  • Healthcare providers can take this understanding of trauma and its impacts to integrate a more compassionate and patient approach.

[22:00] Signs and Symptoms of Trauma in Children 
  • Dr. Szilagyi explains how trauma might present differently in children
  • Clinicians can utilize a different trauma-informed approach towards recognizing and treating trauma in adolescents.

[23:15] Dr. Szilagyi’s Addition to SAMHSA’s 4 R’s
  • Dr. Szilagyi share two R’s she integrates into trauma-informed care: Relationship-based care and that builds Resilience.  

[25:15] The ACE Study and ACEs 
  • The lasting impacts of Adverse Childhood Experiences (ACEs) were explored in the ACEs Study. 
  • Socioeconomic status, upbringing, familial relationships can all be ACEs that affect adolescents’ long-term development and mental health. 
    
[30:25] Closing Remarks 
  • Dr. Gaines and Dr. Kozman summarize the topics and acronyms discussed, and how this will be the foundation for the following episode.

 Resources
  • Forkey HC, Griffin JL, Szilagyi M. Childhood trauma and resilience: a practical guide. American Academy of Pediatrics; 2021.  
  • Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. Free download at https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884
  • National Child Traumatic Stress Network. https://www.nctsn.org/ 
  • Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58. PMID: 9635069. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext 
  • Masten AS, Barnes AJ. Resilience in children: developmental perspective. Children (Basel). 2018;5(7):98 PMID:30018217
  • Masten AS. Ordinary magic: resilience processes in development. Am Psychol. 2001;56(3):227-238 PMID: 11315249
  • Machtinger EL, Davis KB, Kimberg LS, Khanna N, Cuca YP, Dawson-Rose C, Shumway M, Campbell J, Lewis-O’Connor A, Blake M, Blanch A, McCaw B. From treatment to healing: Inquiry and response to recent and past trauma in adult health care. Women’s Health Issues. 2019 March;29(2):97-102. Published online Dec 2018. https://doi.org/10.1016/j.whi.2018.11.003 







Credits:
Guests: Dr. Moira Szilagyi, Dr. Edward Machtinger
Co-hosts/Producers: Dr. Maggie Kozman, Dr. DJ Gaines
Executive Producer: Dr. Tammy Lin 
Co-Executive Producers: Dr. Pooja Jaeel, Dr. Tiffany Leung
Senior Producers: Dr. Maggie Kozman, Dr. DJ Gaines
Editor/Assistant Producer: Joanna Jain
Production Assistants: Nilgoun Farhadi, Sanika Walimbe
Website/Art Design: Ann Truong
Music: Chris Dingman
 
Disclaimer: The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with. 
 
Season 4 of The DEI Shift podcast is proudly sponsored by the American College of Physicians Southern California Region III Chapter.  
 
The DEI Shift theme music is brought to you by Chris Dingman. Learn more at www.chrisdingman.com. 
 
Contact us: thedeishift@gmail.com, @thedeishift, thedeishift.com 






Disclaimer

.The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with.