Trauma-Informed Care Part 2

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 term resilience in the context of trauma-informed care.
2. List 3 key individual resilience factors, and identify the symptoms of trauma that may result from impairment in those resilience factors.
3. Define secondary traumatic stress, and distinguish it from burnout.
4. Consider how health disparities are caused and exacerbated by trauma, and therefore necessitate a trauma-informed approach to address disparities.

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] Introduction

• Introduction to co-hosts, guests, and Part 2

[01:17] ACE Screening and TRIADS Framework in Adults and Families

• Dr. Machtinger discusses the impact of ACE screening and how it provides patients with an ability to reflect on their trauma and inform the physician as well.
• Dr. Machtinger describes the TRIADS screening framework developed by child psychologist Alicia Lieberman.
• Dr. Machtinger discusses how his patients (many black and brown women with HIV and substance use disorder) and healthcare professionals in their clinic both have high ACE scores.
• He is working on a “Whole Family Wellness” study that will be used to do extensive qualitative interviews with patients, families, staff, and community organizations, to understand their needs.
• Dr. Szilagyi discusses a study wherein they found the importance of debriefing patients on their trauma, making real connections with them, and listening to their own reflections on how trauma has impacted them and what they wanted from their children’s pediatricians.

[10:27] Resilience and Individual Resilience Factors

• Dr. Kozman mentions Dr. Szilagyi’s book: Childhood Trauma and Resilience: A Practical Guide and asks her to define “resilience”.
• Dr. Szilagyi talks about how resilience is a process that develops over time and is an interaction between genes, environment, and the care one receives.
• Dr. Szilagyi discusses research on resilience and how it is found the resilience can be biologically embedded.

[15:00] THREADS of Resilience, which can become FRAYED

• Dr. Szilagyi discusses co-author Dr. Heather Forkey’s THREADS acronym for individual resilience factors and details each component.
• She then discusses Dr. Forkey’s FRAYED acronym for symptoms that occur when one’s threads of resilience factors become frayed.

[22:00] Secondary Traumatic Stress/Compassion Fatigue

• Dr. Kozman defines Secondary Traumatic Stress (also called compassion fatigue) which refers to symptoms resulting from indirect exposure to traumatic experiences of others and leads to symptoms that mimic PTSD symptoms in the people who are taking care of trauma survivors.
• Secondary traumatic stress/compassion fatigue are different from burnout, but some of the same things can mitigate both phenomena.

[23:20] Trauma’s Fundamental Role in Health Disparities, and Need for Reform

• Dr. Machtinger describes how the differential distributions of trauma and protective factors are fundamental in the development of health disparities, and strongly believes that we cannot meaningfully address disparities until we first dramatically reform primary care and implement a trauma-informed approach.

[29:00] Take Home Points

• Dr. Machtinger and Dr. Szilagyi both discuss their final take home points. They stress that trauma-informed care allows us to build better understanding and connections with patients and leads to better health outcomes for them, as well as more joy and thriving for us in our professional lives and work.

[31:00] Closing Remarks

• Contact The DEI Shift if you would like to share about trauma-informed care projects you are implementing in your own health system!

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 

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

Contributors

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

Reviewers

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 12, 2022

Termination Date: May 12, 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.