CTRI Study guide || with Complete Solutions.
What is the most significant public health problem in the US according to the CDC? correct
answers Childhood Trauma
How many people affected by Childhood Trauma? correct answers 1 million children suffer
physical and sexual abuse each year
1 in 10 children exposed to intrafamilial violence
Adverse Childhood Experiences correct answers ACEs
Mechanisms by Which ACES influence health and wellbeing (pyramid) correct answers -
disrupted neurodevelopment
-social, emotional, cognitive impairment
-adaption of health-risk behaviors
-disease disability and social problems
-early death
Impact of Trauma on Emotional/Behavioral Stress correct answers -History of trauma increases
likelihood of substance abuse; mental illness - and vice versa
-Substance abuse and MI decrease a person's ability to mitigate the effects of trauma and prevent
future trauma
-interpersonal trauma increases likelihood of future trauma
Characteristics of ACEs correct answers -come in groups
-produce behaviors that if sustained, created illness and disease = as a coping strategy (smoking)
-Cumulative ACEs increase clinical complexity of individual case (# of lifetime mental health
diagnoses increases)
Clinical Complexity correct answers ACEs --> complex, multiple problems
-treatment of presenting problems may not be the best path to significant change
-multiple disciplinary approaches may be most effective
Factors that increase difficulty of trauma recovery correct answers -repeated or prolonged trauma
-closer the perp is to the victim emotionally (capacity of victim to trust in the future)
-intentional action vs. accidents
Why does childhood experience matter so much? correct answers -child cannot escape the
problem (especially under 5 y/o)
-don't have good affect-regulation skills yet
-no control over when and how often
-abused children extremely in tune to minute changes in a persons emotional state
Betrayal Trauma correct answers when the abuser is a primary attachment figure
,-particularly difficult for later intimate relationships ---entangles emotional closeness and care
with fear, shame and rage [sexually abusive, nice dad and very physically abusive mom]
-very basic sense of self as bad, disgusting and worthless
Hyperarousal vs. Hypoarousal correct answers Very aware of surroundings (PTSD -like)
vs.
Feeling numb
It is common to flip flop
-often attempt to shut off negative feelings, which would require shutting off positive ones too
(feeling numb)
Regulation of Emotions correct answers Frequent episodes of intense dysregulation in childhood
lead to harsh difficulties regulating emotions later.
-If a child is scared and a parent screams at the child - escalates these feelings. Child learns that
when you get emotional - things get worse.
-Example: VERY angry about being "disrespected" for being 15 minutes late to an appointment
Triggering correct answers -Memory and emotion are both associative.
-Disrespect - reminds us of previous times when we were disrespected
-Emotions associated with previous incidents may greatly magnified the current incident
90/10 Reaction correct answers Emotions associated with previous incidents may greatly
magnified the current incident
Child Abuse & Emotion correct answers Parents unable to regulate their own emotions
Triggering in medical settings correct answers various things can reenact abuse
-lack of predictability, feeling disrespected, etc
Change of Attitude in Trauma Informed Care correct answers From What's wrong with you?
to
What's happened to you?
Three R's of Trauma Informed Care correct answers -REALIZES the widespread impact of
trauma and understands potential paths for healing
-RECOGNIZES the signs/symptoms of trauma
-RESPONDS by fully integrating knowledge about trauma into polices, procedures
Three Pillars of Trauma Informed Care correct answers -SAFETY: What happened to you?
CONNECTION: forming healing relationships
-MANAGEMENT OF EMOTIONS-affect regulation and coping skills
Key Elements of Trauma Care correct answers -Encourages autonomy, agency and self-efficacy
-Emphasize that trauma responses are a NORMAL response to an ABNORMAL situation
-once you understand a person's history, their behavior may make sense.
, Children & Youth Involved in "Trauma informed Care" programs demonstrate correct answers
Reduced: behavior/emotional problems, trauma symptoms and substance abuse problems
improved: behavioral/emotional skills, functioning in school & community, ability to build
relationships
What is clinically important? correct answers The response, not the event.
Physician Behaviors in Trauma Practice correct answers -Let patient be in charge
-slow down
-say what you are going to do beforehand - be predictable
-respect autonomy
Patient Care Tips correct answers -coping strategies
-encourage self-acceptance
-daily routines are helpful
-teach sleep hygiene
-normalize their emotional or physical symptoms
Degree of Specifics varies with type of trauma correct answers Personal (general) <-->
impersonal (specific)
What Is Trauma Informed Care? correct answers "Trauma-informed" services are not
specifically designed to treat symptoms or syndromes related to sexual or physical abuse or other
trauma
They are informed about, and sensitive to, trauma-related issues present in survivors
Types of Trauma That Often Result in Mental Health & Substance Use Problems correct answers
Interpersonal in nature: intentional, prolonged, repeated, severe
Sexual & physical abuse, severe neglect, emotional abuse
Witnessing violence, repeated abandonment, sudden and traumatic loss
Often occurs in childhood and adolescence and may extend over an individual's life span
ACE Study
(Adverse Childhood Experiences) from Conception --> Death correct answers Adverse
Childhood Experiences --> Social, Emotional, & Cognitive Impairments--> Adoption of Health-
risk behaviors --> Disease, disability, and social problems --> Early death
STATS: Persons in Adult Substance Use Disorder Treatment Settings correct answers Up to
two-thirds of men and women in substance use disorder treatment report childhood history of
abuse & neglect
Study of male veterans in an inpatient unit
77% exposed to severe childhood trauma
58% history of lifetime PTSD
What is the most significant public health problem in the US according to the CDC? correct
answers Childhood Trauma
How many people affected by Childhood Trauma? correct answers 1 million children suffer
physical and sexual abuse each year
1 in 10 children exposed to intrafamilial violence
Adverse Childhood Experiences correct answers ACEs
Mechanisms by Which ACES influence health and wellbeing (pyramid) correct answers -
disrupted neurodevelopment
-social, emotional, cognitive impairment
-adaption of health-risk behaviors
-disease disability and social problems
-early death
Impact of Trauma on Emotional/Behavioral Stress correct answers -History of trauma increases
likelihood of substance abuse; mental illness - and vice versa
-Substance abuse and MI decrease a person's ability to mitigate the effects of trauma and prevent
future trauma
-interpersonal trauma increases likelihood of future trauma
Characteristics of ACEs correct answers -come in groups
-produce behaviors that if sustained, created illness and disease = as a coping strategy (smoking)
-Cumulative ACEs increase clinical complexity of individual case (# of lifetime mental health
diagnoses increases)
Clinical Complexity correct answers ACEs --> complex, multiple problems
-treatment of presenting problems may not be the best path to significant change
-multiple disciplinary approaches may be most effective
Factors that increase difficulty of trauma recovery correct answers -repeated or prolonged trauma
-closer the perp is to the victim emotionally (capacity of victim to trust in the future)
-intentional action vs. accidents
Why does childhood experience matter so much? correct answers -child cannot escape the
problem (especially under 5 y/o)
-don't have good affect-regulation skills yet
-no control over when and how often
-abused children extremely in tune to minute changes in a persons emotional state
Betrayal Trauma correct answers when the abuser is a primary attachment figure
,-particularly difficult for later intimate relationships ---entangles emotional closeness and care
with fear, shame and rage [sexually abusive, nice dad and very physically abusive mom]
-very basic sense of self as bad, disgusting and worthless
Hyperarousal vs. Hypoarousal correct answers Very aware of surroundings (PTSD -like)
vs.
Feeling numb
It is common to flip flop
-often attempt to shut off negative feelings, which would require shutting off positive ones too
(feeling numb)
Regulation of Emotions correct answers Frequent episodes of intense dysregulation in childhood
lead to harsh difficulties regulating emotions later.
-If a child is scared and a parent screams at the child - escalates these feelings. Child learns that
when you get emotional - things get worse.
-Example: VERY angry about being "disrespected" for being 15 minutes late to an appointment
Triggering correct answers -Memory and emotion are both associative.
-Disrespect - reminds us of previous times when we were disrespected
-Emotions associated with previous incidents may greatly magnified the current incident
90/10 Reaction correct answers Emotions associated with previous incidents may greatly
magnified the current incident
Child Abuse & Emotion correct answers Parents unable to regulate their own emotions
Triggering in medical settings correct answers various things can reenact abuse
-lack of predictability, feeling disrespected, etc
Change of Attitude in Trauma Informed Care correct answers From What's wrong with you?
to
What's happened to you?
Three R's of Trauma Informed Care correct answers -REALIZES the widespread impact of
trauma and understands potential paths for healing
-RECOGNIZES the signs/symptoms of trauma
-RESPONDS by fully integrating knowledge about trauma into polices, procedures
Three Pillars of Trauma Informed Care correct answers -SAFETY: What happened to you?
CONNECTION: forming healing relationships
-MANAGEMENT OF EMOTIONS-affect regulation and coping skills
Key Elements of Trauma Care correct answers -Encourages autonomy, agency and self-efficacy
-Emphasize that trauma responses are a NORMAL response to an ABNORMAL situation
-once you understand a person's history, their behavior may make sense.
, Children & Youth Involved in "Trauma informed Care" programs demonstrate correct answers
Reduced: behavior/emotional problems, trauma symptoms and substance abuse problems
improved: behavioral/emotional skills, functioning in school & community, ability to build
relationships
What is clinically important? correct answers The response, not the event.
Physician Behaviors in Trauma Practice correct answers -Let patient be in charge
-slow down
-say what you are going to do beforehand - be predictable
-respect autonomy
Patient Care Tips correct answers -coping strategies
-encourage self-acceptance
-daily routines are helpful
-teach sleep hygiene
-normalize their emotional or physical symptoms
Degree of Specifics varies with type of trauma correct answers Personal (general) <-->
impersonal (specific)
What Is Trauma Informed Care? correct answers "Trauma-informed" services are not
specifically designed to treat symptoms or syndromes related to sexual or physical abuse or other
trauma
They are informed about, and sensitive to, trauma-related issues present in survivors
Types of Trauma That Often Result in Mental Health & Substance Use Problems correct answers
Interpersonal in nature: intentional, prolonged, repeated, severe
Sexual & physical abuse, severe neglect, emotional abuse
Witnessing violence, repeated abandonment, sudden and traumatic loss
Often occurs in childhood and adolescence and may extend over an individual's life span
ACE Study
(Adverse Childhood Experiences) from Conception --> Death correct answers Adverse
Childhood Experiences --> Social, Emotional, & Cognitive Impairments--> Adoption of Health-
risk behaviors --> Disease, disability, and social problems --> Early death
STATS: Persons in Adult Substance Use Disorder Treatment Settings correct answers Up to
two-thirds of men and women in substance use disorder treatment report childhood history of
abuse & neglect
Study of male veterans in an inpatient unit
77% exposed to severe childhood trauma
58% history of lifetime PTSD
