Suburban Healthcare Initiative (DBA, Suburbancares) has provided several training sessions and workshops in child trauma and child behavioral health awareness in several States in south-west Nigeria since 2009. The awareness campaign was started in response to the invitation by Mrs. Folasade Adefisayo who was Principal of the Corona Secondary School, Agbara at the time. Dr. Bukola Ogunkua, CEO Suburbancares and a child trauma expert with the American Academy of Experts in Traumatic Stress organized the workshops to address her concerns about the bizarre behaviors observed among students who seemed to have family problems or were separated from family members when they returned from abroad to continue schooling in Nigeria.
The session involved speaking with the teachers and some of the students in order to have a better understanding of their stories utilizing motivational interviewing techniques and interpersonal skills such as attending, active listening, reflecting of conversation content and emotion to convey empathy for the students and their teachers. This initial visit helped to lay the foundation for future engagement and to build a working relationship with all pertinent stakeholders.
The week-long observation and information gathered from the students and teachers indicated that the behaviors exhibited by the students were due to stress. The teachers did not have any understanding of Adverse Childhood Experiences (ACES) or child trauma and its attending behavioral consequences, even though they were well meaning and concerned about the decline in the children’s’ academic performance and classroom behaviors.
The path to project Trauma Informed Education (TIE) began seven years ago when the evaluation report from participants in the one-day ACES trainings in multiple states revealed a gap in the understanding of ACES by the educators. Many participants commented that they were overwhelmed and were struggling with students’ behaviors in the classroom. In addition, a preliminary ACES survey (the original ten ACEs cited in the landmark 1998 study) of the participants showed that 77% of attendees had at least one ACE score and 22% had a high ACE score (4 or more ACEs) and were probably child trauma survivors themselves. The Teachers and Counselors also felt that the school-based career counselors were ill-equipped to address the problems occurring in the classrooms such as poor attention span, acting-out behaviors, students being withdrawn and sometimes showing a nonchalant attitude towards failing grades.
A second ACE survey of 536 students conducted in 2018 which showed high ACES scores enabled a recognition and better understanding of the root causes of the problems identified by the teachers. Consequently, discussions were commenced with school counselors and introductory ACES training was conducted for school counselors and administrators. This group requested a follow- up with parents and guardians in order to determine what was happening within their families and in their larger communities. It was evident from this interaction that the educators were eager to learn.
After meeting with a group of private school owners at the National Association of Independent Schools (NAIS) conference in Boston, Massachusetts in 2015, I was invited by the Association of Private Educators in Nigeria (APEN) to speak on child trauma at their 6th Annual Conference later that year. There was a lot of curiosity about the knowledge of how child trauma affects children’s’ learning and how children are dealing with them with risky behaviors can be helped. Many school owners showed an interest in applying the information provided and how their teachers could access the training. “That was the beginning of our Trauma-informed Education (TIE) journey.”
Our mission was simple, to create awareness of ACES/child trauma and reduce the incidence of mental illness in children and youths. Suburbancares had no external funding and therefore depended on the fees charged for training to begin sharing the knowledge of ACES, toxic stress, attachment, neuroscience of child trauma and resilience science in education. The TIE initiative is now being offered to all public elementary and secondary school teachers in Lagos, Nigeria. It was designed to raise awareness and develop capacity among teachers and counselors who have daily contact with the children with the possibility of extending this program nationally and across Africa. This preventive and cost-effective trauma education and child sexual abuse awareness will help to address concerns about filling gaps in the mental health care of children and young adults especially in light of the increase in behavioral health challenges, post-COVID-19 pandemic.
At its inception, Suburbancares partnered with three private schools (Vale College, Ibadan, Green Springs School, Anthony-Village Lagos, and Christ the Redeemers College, Shagamu, Ogun State) to host the Child Trauma Awareness Campaigns. The Christ Redeemers School System (CCRS) under the leadership of Pastor Antoinette Omo-Osagie, was embracing of TIE. The CRSS invited educators within their system across Nigeria to the Redeemers Camp on several occasions for Teachers and Administrators to be trained in child trauma and youth mental health. CRSS committed to retraining and refresher classes for their Teachers and Support Staff at their school in Shagamu, with training open to all schools in the Remo area.
Along with TIE training for School Teachers and Counsellors, Suburbancares started an annual Child Trauma Conference on October 18, 2018 and maintained the quarterly TIE training in April, July and October. Participants at these training programs have been mainly private school teachers. In October 2019, Suburbancares sponsored 100 educators from Lagos State Districts 3 and 4. The interest of the participants has led to a Private Public Partnership (PPP) agreement between the Lagos State Ministry of Education and Suburbancares to train all teachers in all the School Districts in Child Trauma, Child Sexual Abuse prevention and youth mental health education.
The introductory ACES/Resilience science series for the teachers will begin on November 5, 2020 as a rolling cycle. This TIE Project aims to extend its reach beyond the State Schools to include not-for-profit agencies, private providers of education as well as parents and guardians. There will be collaboration with community counselors, community and hospital-based psychiatrists and relevant stakeholders. This will serve to facilitate consolidation of efforts through community support as well as wide and deep awareness about child trauma training. It is understood that collaboration between schools with limited resources and healthcare providers will be needed to optimize community support in building healthy students and families. Considering the impact of COVID-19 requirements of physical distancing and stay-at-home orders for the elderly, many teachers are describing major changes in children’s’ moods and behaviors.
The long-term goal with the TIE and Child Sexual Abuse Campaign is to create a change in the mindset of teachers, administrators, counselors, and all adults who interact with children in school and daycare settings. We want these care-givers to embrace the principles of Trauma-informed Care: respect for privacy, ensuring physical and emotional safety; protection of children’s rights and responsibilities with individual choice and control of their own learning; giving students opportunities to participate in decisions that affect them; building trustworthy professional relationships with clear rules, boundaries and agreed-upon consequences; providing empowering school experiences where every student feels acknowledged, valued and affirmed by every adult they come in contact with.
Suburbancares also aims to raise awareness about staff wellness. The analysis of the ACES data collected from the participants of the TIE will be shared with the Honorable Commissioner of Education, Lagos State for policy development considerations and resource provision for staff wellness. This is imperative at a time when some teachers are engaged both ‘in-person’ and ‘online’ classes every day and are becoming more aware of the traumatic stress in the students.
Through TIE, teachers will begin to see students’ behavior as means of communicating their distress. It is hopes that this training in child trauma and resilience will result in a shift in approach by the educators to first self-regulate and thereafter develop a state of mind that will begin to explore the reasons for the adverse behaviors instead of punishment that re-traumatizes the students.
The trauma-informed model not only understands the reasons for the students behaviors, but also teaches educators to incorporate this understanding into education plans for the student, providing accommodation when needed, offering simple coping skills and removing the distress where possible. The teachers are taught to acknowledge the distress and work with the student to try to dig beneath the behavior to find the cause and provide support to relieve the distress. This changes the teacher’s mindset from ‘punishment’ to ‘care’.
The COVID-19 pandemic provided Suburbancares a new opportunity to reach more teachers at no cost to the educators through online training on Microsoft Teams for large-groups, weekly chats on Facebook, Zoom meetings for coaching teachers and to discuss Case Scenarios involving real life examples that help to put the theories into practice. With improved funding, it is hoped that these trainings will be extended to families to help them parent children with high ACE scores.
Trauma-Informed Education effectiveness is monitored using data collected from educators - the number of teachers trained; number of teachers reporting the usefulness of training in their practice; student attendance’ students’ academic performance; students’ behaviors and changes in numbers of students needing discipline and/or expulsion from school.
It is hoped that this PPP initiative in Lagos State will become a model that can be replicated in other States in Nigeria.
Dr. Bukola Ogunkua, MBBS, MPH, MHS, CPRP, LPC, FAAETS