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Trauma and Urban Poverty

Executive Summary: Understanding the Impact of Trauma and Urban Poverty on Family

1. Families living in urban poverty often encounter multiple traumas over many years, and they are less likely than families living in more affluent communities to have access to the resources that may help them cope with traumatic experiences.

A. True

B. False


2. Research on intergenerational trauma and urban poverty has demonstrated that adults with histories of childhood abuse and exposure to family violence have problems with emotional regulation, aggression, and:

A. Ability to adapt and coping skills

B. Social competence and interpersonal relationships

C. Self-regulation and trust

D. None of the above


Chapter 1: Introduction to Understanding the Impact of Trauma and Urban Poverty on Family Systems-Scope of Need

3. Which of the following is a correct statement about the multifaceted risks associated with living in urban poverty?

A. 38% of American children in urban areas (9.7 million) live in low-income families

B. 73% of inner city youth report experiencing one or more traumatic events

C. 59% - 91% of children and youth in the community mental health system report trauma exposure

D. 50% - 80% of youth in juvenile justice have experienced traumas


Theories and Proposed Model

4. The interconnectedness of family members and family subsystems to better understand how their shared history, familial bonds, and collaborative coping strategies support the family’s functioning occurs in which type of theories?

A. Family systems and family resiliency theories

B. Ecodevelopmental and attachment theories

C. Social learning and family stress theories

D. Family trauma and behavioral treatment models


Proposed Model: The Family-Informed Trauma Treatment Model

5. The family-informed trauma treatment (FITT) model integrates aspects of nine different theories and provides an ecological, family systems approach to reduce symptoms of trauma-related distress and to promote safety and recovery for all family members.

A. True

B. False


6. Favorable outcomes for families affected by trauma and urban poverty are highly dependent upon access to assessment and treatment practices that target all levels of the system impacted by trauma and are:

A. Focused on regulating emotions and behavior

B. Problem-solving and communication oriented

C. Interconnected and systematic

D. Trauma-specific and family centered


Chapter 2: Impact of Trauma and Urban Poverty on Children and Adolescents

7. Although exposure to and effects of chronic trauma in children from low-income, urban environments have been labeled a public health concern, there is still limited treatment effectiveness or practice research available to guide the delivery of services to this population.  

A. True

B. False


Key Research Findings

8. Studies indicate that posttraumatic stress symptoms (PTSS) progress to PTSD in what percentage of children exposed to urban community violence?

A. 14-24 percent

B. 24-34 percent

C. 34-44 percent

D. 44-54 percent


Risk and Protective Factors

9. Each of the following is an example of a protective factor that increases the chances for positive adaptation for children and adolescents living in urban poverty EXCEPT:

A. Socioeconomic advantage

B. Easygoing temperament

C. Caring and support

D. Female gender


Interventions

10. Structured Psychotherapy/Intervention for Trauma in Schools (SPITS) is a group intervention designed to increase needed services to treat chronically traumatized children/adolescents in elementary school settings.

A. True

B. False


11. Essential elements for Trauma Focused Cognitive Behavioral Therapy (TF-CBT) include:

A. Real life exposure to trauma and social problem-solving

B. Relationship building and communication skills

C. Affective expression and regulation

D. Psycho-education on stress and tolerance


Conclusion and Comment

12. Research with children and adolescents living in urban poverty has shown that youth are resilient, and with help, can learn to survive and emerge stronger from even the most challenging environments.

A. True

B. False


Chapter 3: Impact of Trauma and Urban Poverty on Adult Family Members-Key Research Findings

13. National epidemiological studies of PTSD have determined that approximately _________ of adults in the United States have experienced one or more traumatic events; and up to _____ will develop some symptoms of PTSD.

A. 40 to 80%; 57%

B. 45 to 85%; 62%

C. 50 to 90%; 68%

D. 55 to 95%; 73%


14. Some research suggests that successful negotiation of a traumatic event can lead to positive outcomes such as improved relationships with others, openness to new possibilities, greater appreciation of life, enhanced personal strength, and spiritual development, which is known as post traumatic _________.

A. Survival

B. Stability

C. Resiliency

D. Growth


Risk and Protective Factors for Adult Family Members

15. Lack of self-concept and poor self-esteem are considered risk factors for adult family members who have experienced trauma.

A. True

B. False


Interventions

16. Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), stress management, Cognitive Behavioral Therapy (CBT), and supportive therapy have all been proven to be effective to treat PTSD, with CBT being the most effective.

A. True

B. False


17. Which of the following accurately describes Stress Inoculation Training (SIT)?

A. Studies have demonstrated effectiveness in using SIT to treat PTSD in female sexual assault survivors

B. It consists of eight phases of treatment combining aspects of exposure therapy, cognitive therapy, and psychodynamic therapy

C. It is designed for women experiencing mental health and substance use disorders who have a history of physical and/or sexual abuse

D. Research has shown positive results in treating PTSD in a variety of populations including Vietnam Veterans and mixed trauma survivors


Conclusion and Comment

18. Up to 50% of individuals who finish treatment continue to experience symptoms that qualify them for an ongoing diagnosis of PTSD, so it is critical to continue research in this area and look for ways to achieve the goal of improving long term outcomes.

A. True

B. False


Chapter 4: Impact of Trauma and Urban Poverty on the Family as a Whole-Theory

19. Intrafamilial trauma occurs when:

A. All members of the family are exposed to the same event

B. When one family member is the perpetrator of the trauma

C. When traumatic distress symptoms disrupt family functioning

D. When trauma spreads from the exposed family member to others in the family


Coping

20. Each of the following are accurate characteristics of resilient families who are faced with difficult environments and multiple stressors EXCEPT:

A. They structure their routines to accomplish daily tasks safely

B. They pull together, support each other, and believe that they can overcome their difficulties

C. They often rely on a collective value and belief system that helps them in understanding what is important to the family

D. They work together to focus on the positive events in their lives while refusing to justify any negativity


Risk and Protective Factors

21. Studies of families impacted by trauma related to urban poverty have determined that the strongest risk and protective factors tend to be:

A. Parental characteristics

B. A positive or negative support network

C. Level of stress and ability to manage that stress

D. Communication and interaction patterns


Assessment Instruments

22. The Family Assessment Device (FAD) is an assessment tool that has been used in in multiple studies to assess family interaction, adjustment, adaptability, and cohesion across a variety of traumatic circumstances.

A. True

B. False


Interventions: Family

23. Essential elements of Intensive Family Preservation Services (IFPS) include:

A. A focus on creating or rebuilding safe family structures that can continue to function following professional involvement

B. A provision of multiple treatment interventions that target key factors within the family’s social system that create dissidence and problems

C. Family-focused and community-based crisis intervention services that strive to maintain family unity and prevent the removal of children from the home

D. The development of new understandings about the value of violence-free interactions


24. Contextual Family Therapy is based on the psychodynamic model, and it accentuates the need for trust, loyalty, and mutual support to hold families together.

A. True

B. False


25. Strengthening Family Coping Resources (SFCR) uses ___________________  to increase the family’s sense of safety, stability, and ability to cope with crises.

A. Coaching and communication

B. Family ritual and routine

C. Trust, loyalty, and fairness

D. Personal growth and collaboration


Chapter 5: Impact of Trauma and Urban Poverty on Intergenerational Relationships

26. A parent's "traumatized worldview" can be learned through the parent-child relationship and transmitted by:

A. Silence

B. Overdisclosure

C. Identification

D. All of the above


Key Research Findings

27. The results of nine relevant studies have found that approximately ____ of maritally violent men report family-of-origin violence compared to approximately ____ of non-maritally violent men.

A. 80; 40

B. 70; 30

C. 60; 20

D. 50; 10


Risk and Protective Factors for Intergenerational Transmission of Trauma Effects

28. Risk factors for men with violent families of origin include personal psychopathology and psychological distress, antisocial personality traits, hostility, patriarchal attitudes, and substance abuse.

A. True

B. False


Assessment Instruments

29. When measuring trauma within the family of origin, the use of qualitative open-ended questions is suggested, such as, "When you think back to your childhood, what sorts of traumatic events did your parent(s), grandparent(s), or primary caregiver(s) experience?"

A. True

B. False


Interventions: Intergenerational Trauma Effects

30. The 12 week family-based intervention for urban youth which includes psychoeducation, safety planning, risk identification, and harm reduction is known as:

A. The Multigenerational Trauma Initiative (MTI)

B. Supporting Urban Residents to be Violence-Free in a Violent Environment (SURVIVE)

C. The Transgenerational Trauma and Resilency Model (TTRM)

D. Preventing Intergenerational Trauma and Violence (PITAV)


Chapter 6: Impact of Trauma and Urban Poverty on Parent-Child Relationships-Theory

31. Two well-known theories that provide a framework for examining impact of trauma on the parent-child relationship are family stress theory and emotional responsiveness theory.

A. True

B. False


Risk and Protective Factors for Parent-Child Relationships

32. Protective factors for parent-child relationships included secure attachment, emotionally responsive parenting attitudes, and:

A. Healthy problem-solving skills

B. Strong social bonds

C. Maintenance of routines and rituals

D. Positive mental health


Interventions

33. Parent-Child Interaction Therapy (PCIT) was specifically designed to treat children under the age of 6 years with domestic violence exposures, and includes a focus on family systems, and behavior modifications.

A. True

B. False


Chapter 7: Impact of Trauma and Urban Poverty on Parenting Practices

34. Research has firmly demonstrated both that parenting practices have a direct effect on children’s behaviors and outcomes, and that trauma and the stress of urban poverty may impact an individual’s ability to be a parent.

A. True

B. False


Key Research Findings

35. The impact of childhood sexual abuse (CSA) is one of the most widely researched forms of trauma in terms of the trauma’s impact on parenting practices, and each of the following has been reported EXCEPT:

A. A connection between maternal CSA and difficulty establishing appropriate hierarchical boundaries with children

B. A connection between a history of CSA and lax discipline practices

C. Increased stress about one's performance as a parent

D. A tendency for mothers with a history of CSA to become more permissive parents


Assessment Instruments

36. The  Parent Sense of Competence Scale (PSOC) is a self-report assessment tool that with 32 items that measure caregiver stress and inappropriate parenting.

A. True

B. False


Interventions: Parenting Practices

37. Family Connections is a community-based intervention that focuses on:

A. Assisting children living in inner-city and other poor communities

B. Teaching parents to take on the therapeutic role

C. Training for parents on appropriate use of consequences

D. Service coordination with referrals targeted toward risk and protective factors


38. According to research outcomes, Multisystemic Therapy (MST) has demonstrated an increase in supportiveness and decrease in conflict-hostility in families.

A. True

B. False


39. The STAR Parenting Program uses cognitive behavioral and anger management techniques to help parents develop a more "thoughtful" parenting style, and encourages them to stop, think, ask, and:

A. Respond

B. React

C. Recognize

D. Report


Chapter 8: Impact of Trauma and Urban Poverty on Intimate Partner Relationships

40. In intimate adult partner relationships, each partner must manage their personal responses to traumatic stress individually, and within their relationship must negotiate levels of closeness, communication, and collaboration.

A. True

B. False


Key Research Findings

41. Although supportive adult intimate relationships can be a source of strength in recovering from traumatic experiences, couples dealing with trauma are five to eight times more likely to separate or divorce than couples without a history of trauma.

A. True

B. False


Risk and Protective Factors for Intimate Partner Relationships

42. Low relationship quality, a history of mental illness, and ____________________ are all risk factors for how intimate partners cope with traumatic experiences.

A. Low levels of self-efficacy

B. Poor coping responses

C. Lack of family support

D. Poor socioeconomic status


43. Which of the following is NOT one of the three phases of treatment for Cognitive Behavioral Couples Therapy (CBCT)?

A. Treatment orientation and psychoeducation about PTSD and its related intimate relationship problems

B. Behavioral communication

C. Conflict disengagement education

D. Cognitive interventions


Conclusion and Comment

44. Protective factors such as positive coping strategies and social support may help strengthen resilience and build cohesive partner relationships for couples who have experienced poverty and trauma exposure.

A. True

B. False


Chapter 9: Impact of Trauma and Urban Poverty on Sibling Relationships

45. Siblings represent an important and long-term relationship for children and they may provide a protective function when parenting is compromised or when a child suffers a significant adverse life event.

A. True

B. False


Risk and Protective Factors

46. Sibling relationship quality has been linked to younger siblings' adjustment, and positive sibling relationships linked to better individual adjustment, while negative sibling relationships were linked to problem behaviors.

A. True

B. False


Assessment Instruments

47. The Sibling Relationship Questionnaire (SRQ) is an assessment instrument that consists of 15 subscales that are used to measure four factors including warmth/closeness, relative status/power, conflict, and:

A. Loyalty

B. Rivalry

C. Cohesion

D. None of the above


Interventions

48. Sibling play therapy tends to be the most effective strategy for reducing behavioral problems and increasing self-concept among child witnesses of domestic violence.

A. True

B. False


Chapter 10: Conclusion

49. Within the parent-child relationship, compromised attachment and mistrust may stem from re-enactment of abandonment/betrayal themes and:

A. Difficulty expressing emotion/affection

B. Conflicted relationships/roles

C. Generational abuse/neglect

D. Parental withdrawal/worry


50. Family treatments that are sensitive to the traumatic context of urban poverty should include engagement strategies that: 

A. Incorporate alliances with primary and extended family systems

B. Build family coping skills

C. Acknowledge cultural variations in family roles and functions

D. All of the above


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