Trauma-Informed Care Part 1

The DEI Shift

Trauma has an undeniable impact on our patients' health and illness, and resilience is vital to their ability to buffer that trauma. The DEI Shift welcomes 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, as they discuss the key elements of resilience, symptoms that develop when resilience factors are challenged, reframing trauma-informed care as resilience-informed care, secondary traumatic stress, and the fundamental role of trauma in creating/exacerbating health disparities.  Join us for Trauma-Informed Care part 1.

First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.


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Podcasts and Audio Content


The DEI Shift

The DEI Shift's mission is to create a podcast series on diversity, equity, and inclusion (D.E.I.) in medicine that sparks discussion and provides practice-changing data and stories for a physician, student, allied health professional, and health care leader audience. Listeners will be able to gain useful information to improve their practices and environments, to gain empathy, cultural competency, and humility, and to learn more about emerging D.E.I. concepts. The DEI Shift will discuss issues related to gender, race, sexuality, religion, ability, socioeconomics, and so much more.

Co-Hosts: Dr. Maggie Kozman, Dr. DJ Gaines
Guests: Dr. Moira Szilagyi, Dr. Edward Machtinger
Editor/Assistant Producer: Joanna Jain
Production Assistants: Sanike Walimbe, Nilgoun Farhadi

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.

Cohosts’ 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 influenced her work in childhood trauma.

[7:50] Defining Trauma and Trauma-Informed Care

  • Dr. Szilagyi shares SAHMSA’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 SAHMA’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 SAHMSA’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.


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

Contact us:, @thedeishift,


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

National Child Traumatic Stress Network.

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.

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.


Maggie Kozman, MD, ACP Member – Co-host, Sr. Producer

DJ Gaines, MD, ACP Member – Co-host, Sr. Producer

Moira Szilagyi, MD – Guest

Edward Machtinger, MD – Guest

Tammy Lin, MD, MPH, FACP – Executive Producer

Pooja Jaeel, MD – Co-Executive Producer

Tiffany I. Leung, MD, MPH, FACP, FAMIA, FEFIM – Co-Executive Producer

Joanna Jain – Editor/ Assistant Producer

Sanike Walimbe – Production Assistant

Nilgoun Farhadi – Production Assistant


Branden Barger, MAS

Tiffany I. Leung, MD, MPH, FACP, FAMIA, FEFIM

None of the contributors or reviewers for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Release Date: May 13, 2022

Expiration Date: May 13, 2025

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the DEI Shift.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to .5 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz.  To claim CME credit and MOC points you must achieve a minimum passing score of 66%.  You may take the quiz multiple times to achieve a passing score.