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Clinical Pearls Video Series: Trauma-Informed Care

Video Chapters

Click on the three lines in the upper left corner to see chapter information or reference the chapter table of contents below to navigate to specific chapters.

  • Assessment
    • How do I ask about adverse childhood experiences (ACEs) without being intrusive? (0:31–2:28)
    • What screening tools and language can I use to understand the potential exposure risk while creating a safe environment to talk about trauma? (2:31–4:01)
    • What do I do if I suspect the caregiver is the perpetrator of abuse or neglect? (4:02–4:43)
    • What are other signs or red flags that may suggest abuse or neglect is occurring to a child? How does this present across different age groups? (4:44–5:52)
    • How can I make a busy practice more friendly to patients and families who may have experienced trauma or generational trauma? (5:52–8:19)
  • Management
    • What therapies and medications can help the emotions, behaviors, and interpersonal conflict seen in youth with trauma or PTSD? (8:20–11:08)
    • Where can I find resources for patients, families, my staff, and myself related to the manifestations and impact of trauma on youth and families? (11:09–12:14)
  • Key Takeaways (12:17–13:00)
Alyse Folino Ley, D.O., Child & Adolescent Psychiatrist, Michigan State University

Traumatic events in childhood negatively impact mental and physical health across the lifespan. These adverse childhood experiences, or ACEs, are common but also preventable.

  • In the late 1990s, the Center for Disease Control and Kaiser Permanente surveyed 17,000 adults regarding ACEs. The ten ACEs initially researched included child abuse (physical, sexual, or emotional); household stressors/traumas (family violence, substance use, mental illness, divorce and/or incarceration of a family member); and neglect (emotional and/ or physical).
  • Researchers discovered over 64% of adults reported experiencing at least one of the negative events/trauma as children or adolescents and over 17% of individuals reported enduring four or more ACES prior to age 18.
  • The researchers also discovered that the more adverse experiences a person endured, the more likely they were to have poor physical and mental health outcomes as an adult, including cancer, cardiovascular disease, substance use disorders, depression, and early death.

Individuals who face or witness a life-threatening or traumatic event, serious injury, sexual violence, or learn of a family member who experienced such an event, are at risk of developing Post Traumatic Stress Disorder (PTSD).

  • Yearly, PTSD affects 3.5% of adults and 5% of youth in the U.S..
  • Approximately one in 11 individuals are diagnosed with PTSD during their life. The development of PTSD is dependent upon many factors, including, severity of the event, the nature of the event, the age of the child, a history of other psychiatric disorders, the ability to obtain help and support, and adults’ reactions.

ACEs are linked to an increased risk of chronic health conditions, mental health conditions, and substance use disorders, and decreased educational and vocational achievement.

  • PTSD can vary in severity from mild functional impairment to severe and can even become debilitating.
  • The neurochemical changes that take place during a traumatic event can hijack brain functioning, leaving an individual trapped in the fight or flight response.
  • Youth with PTSD have symptoms related to intrusive memories (nightmares, flashbacks), hyperarousal, avoidance, as well as mood and cognitive alterations.
  • Children and adolescents manifest their symptoms in different ways at different ages. Young children are more likely to reenact their trauma through play whereas older children and adolescents may present with suicidal ideation, somatic complaints, social withdrawal, detachment, disorganized, oppositional /defiant behavior, difficulties with concentration, aggression, anger outbursts, anhedonia, irritability, worries about safety, and fear of death. 

Although traumatic events and adverse experiences increase an individual’s mental and physical comorbidities, individuals who have been traumatized often avoid seeking care. Avoidance behaviors and the stigma associated with pursuing psychiatric care often prevent individuals from obtaining the care they need. 

Resources Mentioned in the Video

 

Screening Tools

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Other Resources

Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946114/ 

Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. MMWR Morb Mortal Wkly Rep 2023;72:707–715. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a2

Test your knowledge with an optional 5-question quiz below. (Note: If you wish to receive a certificate of completion for this MC3 Clinical Pearl, you must receive a passing score of 80%.)

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Trauma-Informed Care Quiz

1. Which of the following statements is true regarding screening for ACEs?

2. Which of the following is contraindicated in the treatment of PTSD?

3. Which of the following is considered first-line in the treatment of comorbid psychiatric and behavioral symptoms of PTSD?

4. Which of the following medications may be helpful in the treatment of hyperarousal symptoms in PTSD?

5. Which of the following statements is true regarding the medication management of PTSD in children and adolescents?

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