Award-winning educator, pediatrician fights to upgrade standards of care for vulnerable children

‘Children are our future and if we don’t invest in them, we don’t have a shot,’ says UCLA Health’s Dr. Moira Szilagyi.

For Moira Szilagyi, MD, PhD, FAAP, life has been a series of serendipitous moments.

Case in point: During her residency at the University of Rochester, she happened to wander into a small foster care clinic to fill in two hours a week for a doctor on maternity leave. It was the type of clinic where kids were given basic, Army-issue physicals to make sure they had no acute issues, she says.

That first day, Dr. Szilagyi saw a teenage boy who had been in foster care since he was 6 months old. After spending about 40 minutes with the boy, she asked if there was anything else she could do for him.

“It was like the air had been sucked out of the room,” she says. “I stood there and he said to me, ‘You can tell me what I did when I was 6 months old to get put in foster care.’”

The child had grown up in the same wonderful foster home for 16 years, Dr. Szilagyi recounts. “He was going to the best high school in town, playing sports and planning to go to college. This is the best of foster care experiences and he has this huge hole in his life because of this.”

Dr. Szilagyi, now a professor of Pediatrics, interim division chief of General Pediatrics and chief of Developmental Behavioral Pediatrics at UCLA Health, calls it an eye-opening moment — one that launched her on a lifelong journey to try to improve the foster care and adoption system for families.

Leader in her field

Dr. Moira Szilagyi was awarded the 2021 Thomas F. Tonniges, MD, FAAP Lifetime Achievement Award for Advocacy on behalf of Vulnerable Children.

Over the next three decades in Rochester, N.Y., Dr. Szilagyi developed a community-based, integrated-care medical home for children in foster care, worked in a suburban private practice, created and led a regional child abuse program, conducted research highlighting vulnerable children, and mentored trainees in Continuity Clinic., which offers medical residents the opportunity to provide primary care for its patient panel.

Dr. Szilagyi led the development of the first health care standards for children in foster care in New York State and she continues to lead the development of health care standards for children and teens with the American Academy of Pediatrics (AAP). She is currently president-elect of the AAP and works closely with the AAP’s Washington, D.C., office on legislation related to equity, diversity and the care of vulnerable children.

For her significant contributions in her field, Dr. Szilagyi was awarded the 2021 Thomas F. Tonniges, MD, FAAP Lifetime Achievement Award for Advocacy on behalf of Vulnerable Children.

“Tom was both a mentor and a friend to me, just a wonderful man and a great physician,” Dr. Szilagyi says about the award’s namesake and first recipient. “There’s probably no greater honor for me to receive than this particular award.”

Medicine not her first plan

Dr. Szilagyi was raised in a working-class family in upstate New York. Her parents grew up in Ireland and each migrated, as teenagers, to Great Britain to find work. Her father was a bricklayer; her mother a nanny. They married days before her father was drafted into the Irish Battalion of the British Army in World War II.

After the war, they moved to Australia, where they had a son and a daughter. A final relocation brought the family to New York, looking for a better life.

“They were wonderful people, and they set an amazing example of always taking care of others,” Dr. Szilagyi says about her parents. “This was a time when women weren’t encouraged to have a career outside of nursing or being a secretary. But my parents were always pro-education. They told me, ‘You can do anything you want.’”

Dr. Szilagyi became the first person in her family to graduate from high school. She planned to go into teaching after college, but toward the end of her undergraduate studies at a small Catholic college, she began to consider graduate school. She enrolled in the University of Rochester to pursue a graduate degree in biochemistry.

“It was there that I discovered medicine,” she says. “It had never crossed my mind. (But) I realized all my friends were medical students, I was going to the library to read the New England Journal of Medicine and I was learning about what being a physician entailed.”

Being a physician was a way to serve people, she says. “I think that came from my parents and my faith at the time.”

Found her home

She applied to and got into medical school in Rochester (conveniently, her future husband, Peter, was in medical school there). She had her first child during medical school and was able to do a shared residency with another medical student with an infant — an instance of being in the right place at the right time, she says.

“We literally cruised into the chair’s office and announced, ‘We’ve got a deal for you,’” she recalls with a chuckle. The shared residency provided both women the flexibility to have more children (Dr. Szilagyi has a daughter and a son) at a time when residency training was 100-plus hours a week.

Dr. Szilagyi landed on pediatrics by happenstance, too. Not convinced she wanted to work with sick children, she saved pediatrics for her last clinical rotation in her third year.

“My first rotation was in the special care nursery,” she recounts. “I walked in and within the first hour, I knew I had found my home in medicine.”

Writing policy

Dr. Szilagyi knew she wanted to practice what she calls high-risk medicine — informed, she says, by the place she grew up. “By the time I left my neighborhood to go to college, 10 kids I grew up with had died from accidents, suicide and one was murdered. Some of these deaths were highly preventable.”

It was that self-knowledge coupled with a desire to help vulnerable children that landed her in that small foster care clinic in Rochester. Appalled by what she saw as a failure within the foster care system, she walked into the office of the deputy director of social services to address the health concerns she was seeing in the clinic and the need for better care.

The next thing she knew, she found herself as a second-year resident “sitting on a task force with all sorts of luminaries in the town in which I lived and trying to figure out how to solve these problems.”

Dr. Szilagyi spent the next two decades working to improve services in the clinics, improve communication with social services and the courts, educate and support foster and kinship parents and obtain appropriate mental health services for children and families. Seeing the lack of guidelines in health care for this population, she complained to another pediatrician and was invited to lead an 18-member task force to hammer out standards of care statewide.

Under the mentorship of the late Louis Cooper, professor emeritus of pediatrics at the College of Physicians and Surgeons of Columbia University and past-president (2001-2002) of the AAP, the team developed a set of guidelines for the American Academy of Pediatrics in New York State, which were later adopted by AAP as national standards.

Soon, she found herself on a committee at the national level, writing policy about foster care for the AAP.

For the next 27 years, Dr. Szilagyi moved from one project to the next, all related to foster care work, she says.

“It enabled me to work with the AAP and others across the country advocating for policy changes in foster care and kinship care, and advocate for all the children involved with child welfare including those aging out of care, returning home and adopted out of care,” she says. “It really has been an area in which my passion matched the work I was doing.”

Change of focus

A move west to Los Angeles to be nearer to family landed Dr. Szilagyi at UCLA Health in 2014. Here, her focus shifted from foster care to trauma-informed care: teaching pediatricians, educators and child care workers how to prevent traumatic experiences and how to help children and families recover from them.

Her life has come full circle, she says, noting her training in biopsychosocial medicine at Rochester prepared her to work in this field. She’s grateful to continue working clinically with children in foster and kinship care and their families at Olive View UCLA Medical Center while growing UCLA Health’s Developmental Behavioral Pediatrics program, a subspecialty of pediatrics that cares for children with developmental issues such as autism.

“Children are our future and if we don’t invest in them, we don’t have a shot,” she says. “Who they become determines not only their direction in life, which is crucially important, but it determines the direction of everything else. … I feel this overriding sense of responsibility toward doing my bit toward that.”

Learn more about services provided through the Developmental Behavioral Pediatrics program at UCLA Health.

Jennifer Karmarkar is the author of this article.