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Adverse childhood experiences and implementing trauma-informed primary care

doi: 10.1097/01.NPR.0000550095.67418.73
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INSTRUCTIONS Adverse childhood experiences and implementing trauma-informed primary care


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Adverse childhood experiences and implementing trauma-informed primary care

Purpose Statement: To provide information about ACEs, their long-term consequences, and trauma-informed care to reduce the impact of ACEs in adulthood. Learning Objectives/Outcomes: After completing this continuing-education activity, you should be able to: 1. Recall the prevalence of ACEs and their associated behaviors and health consequences. 2. Identify implications of ACEs and understand trauma-informed care strategies that healthcare providers can use to help patients recover from childhood trauma.

  1. The CDC's ACE studies revealed that
    1. 36.1% of participants experienced two ACEs.
    2. 42% of participants experienced four or more ACEs.
    3. more than 60% of participants experienced at least one ACE.
  2. The most common ACE reported in the studies was
    1. emotional abuse.
    2. physical abuse.
    3. neglect.
  3. How many women reported a history of sexual abuse during childhood in the ACE studies?
    1. 1 in 4 women.
    2. 1 in 24 women.
    3. 55% of women.
  4. Compared with individuals with no childhood trauma, study participants with four or more ACEs were
    1. 3 times more likely to have attempted suicide.
    2. 7 times more likely to have an alcohol use disorder.
    3. 20 times more likely to have ever injected I.V. drugs.
  5. Participants reporting six or more ACEs compared with no ACEs
    1. died 20 years earlier on average.
    2. had 12 times higher risk for schizophrenia.
    3. reported substance abuse 20 years earlier.
  6. Prolonged activation of the stress response system that occurs in the absence of a supportive caregiver is considered
    1. transient stress.
    2. toxic stress.
    3. developmental stress.
  7. Changes in the amygdala from exposure to toxic stress can result in
    1. abnormal fear responses.
    2. reduced ability to regulate mood.
    3. impaired problem solving.
  8. Nelson and coauthors revealed a strong relationship between ACEs and severe, treatment-refractory
    1. panic disorder.
    2. bipolar disorder.
    3. depression.
  9. Carr and coauthors disclosed a link between physical neglect and
    1. personality disorders and schizophrenia.
    2. anxiety disorders and dementia.
    3. posttraumatic sleep disorders and brain tumor.
  10. Behaviors such as overeating, smoking, and illegal drug use are sometimes viewed by patients following an ACE as
    1. normal.
    2. solutions.
    3. not harmful.
  11. Barr reported that chronic elevated cortisol and inflammatory proteins can cause young adults to have changes in the
    1. digestive system.
    2. prefrontal cortex.
    3. cardiovascular system.
  12. Levenson and colleagues' study of sex offenders showed that sexual abuse as children was experienced by
    1. 31% of females.
    2. 50% of females.
    3. 65.7% of males.
  13. The estimated annual economic burden of childhood abuse and neglect in the US is
    1. $124 million.
    2. $24 billion.
    3. $124 billion.
  14. Kerker and colleagues reported that what percent of nearly 600 pediatricians surveyed routinely asked about all relevant ACEs?
    1. 4%
    2. 24%
    3. 40%
  15. The top barrier among family medicine residents to screening patients after disclosure of ACEs reported in a study was
    1. belief that it was not their responsibility.
    2. lack of time to counsel patients.
    3. lack of training in behavior modification.
  16. The four E's model of trauma-informed care includes
    1. educate, employ, enhance, and empower.
    2. educate, enable, endorse, and enrich.
    3. educate, empathize, explain, and empower.
  17. Palfrey and colleagues reported that after a 1-day workshop on trauma-informed care, staff and mental health providers had
    1. increased empathy toward the victims and their families.
    2. decreased their use of triggers in communication with patients with ACEs.
    3. increased awareness, confidence, and more positive attitudes.
  18. When working with patients who have disclosed abuse, healthcare providers should exhibit
    1. positivity and gentle, comforting touch.
    2. empathy and refrain from using physical touch to comfort patients.
    3. a position of power to be an advocate and direct health choices.


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