Which of the following is an example of an adverse childhood experience (ACE)?

A. An adult client is confined with physical restraints after throwing chairs at other clients and staff. Physical restraints are highly restrictive and should be used as a last resort when safety is at risk.

B. An adolescent is taken to a secure, quiet room after threatening and lashing out at other clients and staff. Seclusion is restrictive but less so than physical restraints; however, other interventions should be attempted first.

C. An 8-year-old child is asked to return to their room after yelling at other children during a group therapy session. This is the least restrictive intervention, as it involves verbal redirection rather than confinement or medication.

D. An adult client is given clozapine, an antipsychotic medication, after punching a wall with their fist and telling everyone that they intend to hurt them. Medication can be restrictive when used for behavior control rather than for medical necessity.

A. "The gathering spaces should have the chairs positioned around the perimeter of the day room." Seating arrangements should encourage interaction and engagement, not isolation. A circular arrangement fosters group discussion and socialization.

B. "The milieu consists of the physical and psychosocial environmental factors." Therapeutic milieu refers to the structured environment of a mental health unit, which includes both physical (safety, layout) and psychosocial (staff interactions, routines) components that support healing.

C. "The clients can keep any personal items they would like in their rooms." While personal items can be comforting, safety concerns may limit what clients can keep. Sharp objects, lighters, or items that could be used for self-harm are typically restricted.

D. "A therapeutic milieu requires unstructured programming, allowing clients to focus on their interests." A structured routine is essential in a therapeutic milieu to promote stability, predictability, and therapeutic engagement. Unstructured environments may increase anxiety or behavioral issues.