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West Africa ACEs CONNECTION: Chasing solutions for own ACE Score

 

Dr B

Even though I have excelled in practically all endeavors that I set out to do and have succeeded in new learning, I continued to have flash backs of certain events from my past and residual anger on certain things.

I was first introduced to Trauma theory when I was working in an Outpatient clinic for Men in 2001. The Trauma Recovery Empowerment Model TREM was the philosophy practiced in conjunction with Boston model of psychiatric rehabilitation at the clinic. The concept of recovery made sense to me and the aspect of helping men develop vocabulary for the emotional and relational issues they had stemming from the abuse and neglect with continued distress they suffered was familiar to me. In a weird way, I felt I could relate to the men’s issues too. Some of the adversities they reluctantly described was familiar.

I wondered a lot about what these men discussed and focused on the things that occurred to them when they were children and teens. I was curious to ask them more but instinctively; I knew it was too painful to probe them. After all I was yet to talk about my own experiences 40 years later at the time. So, I waited for them to talk when they felt like talking. Usually the men talked when others in the group shared their experiences in group sessions or while they were smoking together outside. It was a safe space and they were not feeling alone in their struggle anymore even if it was for a moment.

I wondered if I could find TREM for children too, because the child in me was still in pain, but there was none at the time. I looked for and read the book, New Directions for Mental Health Services, Using trauma theory to design services and systems by Harris, M and Fallot, R.D,. (2001).

I threw myself into learning all I could on trauma theory and that was when I stumbled across the ACEs study. Taking the ACEs Score was initially confusing for me because the questions were not quite applicable to me, I thought. The knowledge of ACEs and Childhood trauma was a new language and the questions did not quite fit into my West African cultural paradigm. As a Public Health Physician, the ACE study and its findings later became clear and made an easy read with clear logical sequence of behavioral progression.

I followed up with more readings of the works by authors like Bruce Perry, Jack Shonkhoff, and Bessel van der kolk etc. I spent hours listening to lectures by these authors and reading more on trauma from others in the field of traumatic stress.

I wanted to better understand how I was able to thrive with an ACE score of 8. In fact, I often say I have an ACE score of 8 and a 1/2 because question #6 of the ACE score was not applicable to me because my parents were bound by tradition to stay together, but the home atmosphere negatively impacted me.

I continued to seek information and practice the interventions shared by many of these great trauma experts. I realized through my readings that my past programmed me to be who I am today. I can now see the protective factors that steered me towards excellence even with my high ACEs. I better understand why I have flashbacks when I am under stress.

My ACE score became my diagnosis.

My curiosity for solutions to my newfound “diagnosis” led me to a master’s project thesis for the Master of Human Services Counseling degree in 2007. My only goal was to seek a solution to ACEs in children. My previous degree in Public Health drove me to seeking prevalence and prevention. My topic “A Trauma Informed Case Management Project to Address Recidivism in Children Receiving Case Management Services for Emotional and Behavioral Needs."

I thought I could hide behind these youths to uncover solutions to my own unending chains of flash backs. I wanted to know the scope, causes, contributory factors and solutions to why the children and youths we served in the tri-county region of Cumberland, Gloucester, and Salem Counties, New Jersey, kept returning to old behaviors after treatment.

What I uncovered as major factor in 2009, was the lack of knowledge and awareness of ACES by the people who were serving the children and the inadvertent re-traumatization of the youths by the same people hired to help them.

I knew I needed to keep reading and keep tweaking the solutions I come across to meet the cultural needs of not just the children in New Jersey but also to take the awareness campaign back to my home of origin, Nigeria.

Dr Ogunkua

I have developed curricula for care/case managers, teachers, counselors and parents to help with the knowledge, skills and attitudes that are trauma informed for all adults who come in contact with children. I continue to learn and internalize the solutions others have tried.

May I add that in this quest for knowledge I have become a better me.

I have moved from an authoritarian parent to an authoritative parent of adult children, with a second chance of helping to shape the development of my grandchildren and all children I meet.

All the above is what led to asking for this platform and I hope you will join me in sharing your experiences and practices with the people of West Africa.

Dr. B 
(also known as Dr. Bukola Ogunkua MD, MPH, MHS, LPC, CCTP, CPRP, FAAETS)

Photos from Presentation at the National Council of Women's Society in Nigeria speaking with parents and educators.

ogunkua

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  • ogunkua: Speaking to rhe National Council of Women's Society Nigeria

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Comments (6)

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I have learnt a lot from you Dr. B and now I am more empathetic with people who are going through trauma, have a few ACEs scores and having PTSD. I realised that almost everyone has had one of these experiences or another.  Careful listening and observations will help in identifying children that might need help early enough. 

Working with you has changed the way I think and has improved my empathy towards teens and youths. Also it has taught me why people sometimes behave the way they do ,and the appropriate response to those going through challenges to be a support, than to be judgemental. Thanks very much

Hello Sonia,

I do recognize the same challenges with the wordings of the ACES questionnaire and how its cultural applications may not be a good fit for people in Nigeria at this time.

I am working on the wordings of the questions to be colloquially understood and culturally appropriate while seeing that the intent of authors to  measure the experiences of the child/youth in the domains of abuse, neglect, mother battering, house hold substance use, household dysfunction, mental illness and household member in jail or prison before age 18 is correctly captured. You are welcomed to join in the development of the adapted questionnaire. Thank you

Thank you Dr B. for all you are doing in the area of educating educators in Nigeria to be better informed on how to provide assistance and support to children who have experienced some form of trauma.

One key area that struck me while reading the article is that no matter how old we become as adults, we will still have flashbacks if we have unresolved Adverse childhood experiences. 

I however have some challenges with interpreting the ACEs because some of the description do not seem to fit our cultural setting in terms of our experiences. Are there plans to adapt the ACEs to our local content? I will be glad to provide some support in modifying the scorecard aspects to suit our Nigerian context.

This I believe is very important especially if you consider that fact that we tend to live in denial here because of our religious affiliations. I strongly believe that an contextualized ACEs scorecard might go a long way in opening the door to providing tailored solutions to ACEs challenges facing the average Nigerian child and by extension, the average African child.

 

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