A Bottom-Up Treatment for Children and Adolescents with Complex Trauma Post-Test | September 9, 2022 – October 21, 2022

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Which of the following include the threads of the SMART Spiral?*
- Somatic Regulation, Trauma Processing, and Attachment Building
- Trauma Processing, Cognitive Reframing, and Attachment Repair
- Stabilization, Coherent Trauma Narrative, and Emotion Regulation
- Body Awareness, Relational Safety, and Traumatic Expression
Somatic Regulation involves*
- Addressing physiological arousal through exploration of sensory inputs
- Teaching body based coping skills such as yoga and breathing skills
- A sequence of body exercise to regulate arousal
- Child based mindfulness activities
Trauma processing in SMART tends to the relational and behavioral forms of traumatic expression in session through supporting_____.*
- the child to share a verbal narrative of their trauma experience with safe adults.
- symbolic expression of painful content that is too difficult to verbalize.
- somatic regulation and embodied play to foster integration of traumatic experiences.
- the child to confront the person who perpetrated the abuse to promote mastery
In SMART Attachment Building primarily*
- Facilitates embodied exploration of connection and rhythms with others
- Focuses primarily on the caregiver child interactions
- Provides coaching and prompts to build caregiver skills
- Facilitates dialogue and problem solving between caregivers and child
The Hierarchy of Development is best defined as*
- A framework that reflects the importance of attending to sensory processing, rhythms, and motor coordination before addressing emotions
- A clinical protocol that guides steps towards somatic regulation
- A tool for assessing the child’s developmental milestones during intake for SMART
- A theory for understanding how attachment patterns are developed 1,2
SMART was designed to be effective without depending on language processing. Which reason does NOT apply?*
- Developmental Trauma negatively impacts executive functioning
- Experiences of chronic adversity disrupt explicit memory formation
- Adverse childhood experiences impact brain structures associated with language formation.
- Complex trauma negatively impacts the child’s development of a sense of self.
The three sensory systems that comprise the “movement senses” from the SMART perspective are:*
- Visual, Vestibular, and Tactile
- Auditory, Vestibular, and Visual
- Vestibular, Tactile, and Proprioceptive
- Proprioceptive, Visual, and Tactile
Which sensory system contributes to a sense of body schema which helps us to know where our body parts are in relation to each other*
- The Proprioceptive System
- The Vestibular System
- Proprioceptive Sense
- Hearing Sense
Infants are dependent on __________to regulate their bodies, emotions and later to make meaning about themselves and relationships*
- Auto Regulation
- Co-regulation
- Self-Regulation
- Internal Regulation
This form of unconscious regulation is present from the time we are born, and can be a precursor to dissociation for children impacted by trauma.*
- Auto Regulation
- Co-regulation
- Self-Regulation
- Internal Regulation
A child is using _________when they can consciously use a preferred Regulation Tool to change states.*
- Auto Regulation
- Co-regulation
- Self-Regulation
- Internal Regulation
In what manner is the SMART Regulation Map NOT utilized?*
- To determine if Tending to Safety is needed
- To assess the state of the child’s arousal
- To make a shift to Somatic Regulation
- To determine if the child earned their reward for completing chores.
In which category of the SMART Regulation Map are client’s most likely widening their Window of Tolerance?*
- Fluid Zones because they are experiencing arousal but still are socially engaged and can accept support
- Integrated State because they are the most regulated and able to reflect
- Dissociative State because one can access other parts of self
- To determine if the child earned their reward for completing chores.
When a child is in a Traumatic State of Hyperarousal and the therapist asks the client to take off their shoes before entering, what response would you NOT expect?*
- Increased agitation
- Arguing back
- Clarifying question
- Throwing the shoes
When a child is in a Traumatic State of Hypoarousal on the cushion and the therapist asks the child to begin cleaning up, what response might you MOST expect?*
- Increased eye contact
- Question about where things go
- No response from the child
- The child to transition to an Integrated State
What does it mean to Tend to Safety in the SMART model*
- To help the child develop an internalized sense of felt safety within self and in relationship.
- To establish the child in a safe environment prior to initiating treatment
- To provide psychoeducation about the neuroception of safety, danger, and life threat.
- To educate caregivers on childproofing their home.
Your client is in a Hyperaroused State and using a trampoline to jump with intensity into a crash mat located close to the corner of a wall. To employ the Therapist Skill Tending to Physical Safety you would:*
- Tell the child they have to stop using the trampoline because they are being unsafe.
- Ask the child if they can think of a way to set up the room so they can be safer
- Place a mat against the corner of the wall and stating you want them to be safe.
- Suggest that the child sit down on the cushion so that they can calm down.
This client continues to engage in jumping from the trampoline into the crash mat and seems curious to explore a variety of sensations including; crashing, rolling and tumbling upon landing. What Regulation Tool does it seem most likely that they are exploring?*
- Safe Space
- Rhymicity
- Combining Inputs
- Light Touch Pressure
If a child repeatedly hides under a chair in your waiting room, you might begin to wonder if they are seeking the following tool to regulate.*
- Vestibular Input
- Proprioceptive Input
- Safe Space
- Tactile Input
What is an example of Verbal Scaffolding?*
- Name Interpreting the child’s emotions
- Teaching the child a list of breathing techniques
- Asking the child why they are did what they did
- Reflecting back to the child what the therapist observes
When using this skill, the therapist listens, observes and senses the child’s non-verbal communication, actions, and body language*
- Embodied Attuning
- Verbal Scaffolding
- Tracking Out
- Tracking In
A SMART therapist uses their whole self to facilitate an experience of connection or to get in sync with the child*
- Tracking Out
- Embodied Attuning
- Leading
- Verbal Scaffolding
This essential SMART therapist skill focuses on the therapist trusting the inner wisdom of the child’s body to, with support, find what it needs to help.*
- Tending to Safety
- Tracking In
- Following
- Leading
In what way is Video Reflection NOT used in SMART.*
- Allows therapist to notice patterns in the child, the therapist, the interaction and the therapeutic process
- Provides documentation to be used for legal proceedings
- Supports the therapist to make hypothesis about what is unfolding in the session
- Provides the therapist an opportunity to integrate various layers of information and refining interventions.
Video Reflection with colleagues provides*
- a unique opportunity to learn from each other that supports creativity and development of skills.
- a forum for supervisors to evaluate the performance of their staff.
- an opportunity to offer critique to another therapist regarding their use of Therapist Skills.
- a collaborative space to determine if clients are making progress on treatment goals
A 16 year old client enters the room and begins intensely jumping on a trampoline while sharing about his bad day at school. Where do you assess this child to be, using the SMART Regulation Map?*
- Hyper-aroused - Traumatic State
- Fluid Zone
- Dissociated State
- Hypo-aroused-Traumatic State
Based on the above assessment, what external Therapist Skill would you most likely employ at this moment?*
- Tracking Out
- Following
- Leading
- Tending to Physical Safety
Based on the equipment the child selected, what is the most dominant Regulation Tool assess the child seeking at this time?*
- Proprioceptive
- Tactile
- Safe Space
- Sensory Satiation
Later in the session, as the child recalls the gym teacher’s loud voice and the teacher being mad, they stop jumping and collapse into the soft cushion, their body becomes floppy and their speech gets slow and garbled. Tracking Out, assess this child’s functioning using the SMART Regulation Map.*
- Hyper-aroused Traumatic State
- Fluid State
- Integrated State
- Hypo-aroused-Traumatic State
As you observe the child lying on the cushions, what does the child seem to be seeking as their primary Regulation Tool?*
- Vestibular Input
- Tactile Input
- Sensory Satiation
- Rhythmicity
Based on the above assessments, which external Therapist Skill would you most likely employ at this moment?*
- Tracking In
- Choice Point
- Following
- Leading
Based on all the information you have about this child, what would be the best next Choice as the child lies in the cushion and appears shut down and disconnected?*
- Invite the child to notice the texture of the cushion again his hand to engage Regulation Tool Tactile Input to explore slowly shifting out of the Hypoaroused State.
- Ask the child to resume jumping on the trampoline to engage the Regulation Tool Proprioception with the goal of upregulating from the Hypoaroused State
- Verbally engage the child and let him know that he might feel better if he talks more about his anger toward his gym teacher.
- Wonder with the child if the teachers angry tone reminded them of his former foster father who would yell when intoxicated.
Your 7 year old client enters into the SMART room in a Hyperaroused State and begins to throw her body into cushions repeatedly. You decide to support this child to continue to jump into the cushions as much and as long as her body wants, while tending to physical safety. After about 15 minutes the child lies back in the cushions and lets out a long sigh. What Regulation Tool was the client seeking?*
- Sensory Satiation
- Rhymicity
- Safe Space
- Vestibular
This child asks if she can show her caregiver this new game. When in the room, the caregiver recalls how the child used to jump into couch cushions as a toddler when she had high energy. The child asks if she can do this again at home when her body starts to feel wild in the middle of homework time. You, the child and caregiver make a plan as to what this would look like at home. This is an example of:*
- Embodied attunement between child and parent
- Generalizing Somatic Regulation Tools to Home
- Tending to Safety in the home setting
- Using Rhythms to support routines
Based on your observation of this caregiver’s response to the child, how do you assess the quality of the caregiver attachment?*
- This caregiver presents as rigid in their approach and overwhelmed by the child’s needs
- This caregiver is able to organize around the child’s needs in a flexible and predictable manner
- This caregiver is able to attend to the child’s needs but struggles with providing adequate structure
- This caregiver is overwhelmed by the child’s needs and appears dissociative
While engaging in a ball toss game with your client, you Track In they repeatedly throw the ball with more intensity and speed than feels comfortable to your body. You respond to them by saying - “Wow you are strong, Let's see if we can find a way to keep this game going so it feels safe for you and for me”. The client starts to bounce the ball off the wall asking you to catch the rebound. What Therapist Skill is prioritized in this example?*
- Leading
- Following
- Tending To Relational Safety
- Full Participation
You and your client continue to play this catch the rebound game back and forth, laughing and enjoying the connection. Which of the tools below is most evident in this game?*
- Sensory Satiation
- Rhymicity
- Vestibular
- Tactile
At the end of the session, the client invites their caregiver to come in and play the game with them. You observe a playfulness and warmth in their interaction that you haven’t seen before. This is an example*
- Building Rhythms of Engagement
- Embodied Dramatic Play
- Symbolic Play
- Safe Space
In a follow-up caregiver consultation meeting, the caregiver asks you to explain how a game of catch could be therapeutic for their child who has experienced a great deal of trauma. You are able to provide psychoeducation that explains*
- our goal of helping their child get all of their energy out in session so that their behaviors can improve at home.
- the role that movement and rhythms have in strengthening attachment and improving co and self regulatory capacities, that are impacted by trauma.
- Your plan to use play as a distraction to help their child to get to the real goal of talking about their traumatic experiences.
- your hypothesis that the child is using play to avoid processing their trauma and that it might be time to think about a new approach.
SMART therapists learn to Track Out for indicators of non-verbal or embodied forms of traumatic expression during session. Which of the following is NOT an example of embodied trauma expression.*
- Action - when a client wants a ball thrown at him to explore protecting his body
- Body memory - remembering an experience of sexual abuse while lying on crash mat
- Relational enactment - seeking support from a caregiver and then pushing them away
- Displaced symbolic play - using dolls to reenact witnessing a homicide in one’s community
A 4-year- old client with a history significant for placement in five foster care settings within the last three years is referred for SMART Therapy. This child spends time in session building multiple “homes” out of mats and wants his clinician to take on the role of a scary monster that tries to steal him from the different homes. The following is an example of:*
- Somatic Regulation
- Building Rhythms of Engagement
- Embodied Dramatic Play
- Tending to Safety
In the above example, which of the therapist skills is the clinician utilizing most?*
- Verbal Scaffolding
- Full Participation
- Leading
- Embodied Attunement
The clinician assesses that this child is functioning within their Fluid Zone and chooses to Follow the child’s lead, rather than Leading by offering a regulation tool. This choice is more likely to result in:*
- Resistance or power struggles
- Compliance with an adult agenda
- A natural unfolding of experience that occurs at the child’s pace
- Inhibiting the child’s ability to express their own experience
As the therapist Follows the child, the play begins to evolve and the child begins to find creative ways to trap or banish the monster in session. Based on all of the information above you would assess:*
- The child is moving from the Fluid Zone toward a Hyperaroused state and is re-experiencing the trauma experience
- The child is moving from the Fluid Zone toward a Hypoaroused state and is re-experiencing the traumatic experience
- The child is moving from the Fluid Zone toward an integrated state and re-working the traumatic experience
- The child’s play is stuck and looping and the therapist should make the choice to Lead
Which of the following is NOT a goal of the Integrative Process of weaving Somatic Regulation, Trauma Processing and Attachment-Building in SMART.*
- To gain a flexible window of tolerance that is adaptive to the situation in the present moment.
- To support the child to eventually be able to process their trauma by writing or verbally sharing their story.
- To enhance the child’s capacity for relationship building including tolerating rupture and repair.
- To develop a strong sense of self, agency and vitality in the present moment.

A Bottom-Up Treatment for Children and Adolescents with Complex Trauma Post-Test | September 9, 2022 – October 21, 2022

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