Maybe a physician hosts an annual conference bringing trauma-informed approaches to medical practice. Perhaps a woman shares ACEs 101 information with students or families or goes more in-depth about ACEs science with community members and leaders. Perhaps a survivor of trauma joins or starts an initiative while keeping a career and family together. Perhaps someone shows up, time and time again, meeting after meeting, and is the only person of color in the room. That person may also be the only one to speak about poverty and equity as essential aspects of addressing ACEs.
I've wondered how it feels to either turn people away from training that cost half a year's salary or to pay out of her own pocket repeatedly, as she has done. This work and all it requires is challenging, complex, and important. And those with the most to offer, who can teach us the most, are often the most tired, weary, and stretched. Like many, Dr. Ogunkua is short on time juggling too many to-do lists. However, she recently agreed to answer a few questions over email and I'm grateful. I hope you enjoy getting to know her and learning from her as much as I have.
First, please tell me a little about you and your work? What do you do and where and why?
I am a public health physician and pediatric medical psychologist who is currently the chief clinical officer for a care management organization in the Children's System of Care in NJ. I am also the CEO of Suburbancares (a child behavioral health non-profit organization). Also, I have two masters degrees in public health (Drexel University) and human services counseling (Lincoln University).
How long have you been doing this work as a pediatrician and as a community leader?
I started work in public health (Maternal and Child Health) in 1983 in a health center in Nigeria. I became a community leader very early in my career as a physician in Lagos, to champion the care of people in rural areas that would otherwise have no doctors to care for women and children. I immigrated to the US in 1993 to work in Montgomery County local government and state healthcare systems in PA, DE, and NJ.
When did you become aware of the original CDC-Kaiser Permanente Adverse Childhood Experiences Study?
I became aware of the ACE Study in 2007 while conducting a small study to understand recidivism in children receiving behavioral health serves for moderate to severe challenging behaviors in the tri-county area of Cumberland, Gloucester and Salem, NJ.
The literature search led me to further study this topic and I wrote a thesis for the master's degree in human services counseling in 2009 on trauma-informed practices. The title of the thesis is "A Trauma Informed Case Management Project to Address Recidivism in Children Receiving Case Management Services for Emotional and Behavioral Needs". (Thesis isn't currently available online, but please contact @Dr. Bukola Ogunkua directly for a copy if you're interested).
How does what you've learned about ACEs science impact the work you do and/or the way you work?
ACEs science has impacted my medical and clinical work tremendously by shedding light on not only what happened to the children and the consequent challenging behaviors they exhibit, but more importantly, it has given me a better understanding of why and how to integrate the traumatic history of these children/youth into the treatment plan and offer more support and services to help manage the arousal and dysregulation that occurs in survivors of childhood adversities and/or trauma.
Racism is now included on many updated and expanded ACE screening tools. What are your views on this?
I support the inclusion of racism in an ACEs screening tool. Distinguishing a group of people as inferior just by virtue of their color or perceived characteristic traits and subjugating the group to less preferred roles in itself is psychologically distressful and therefore falls into the category of permanent adversity to the group, especially starting in childhood. Racism for the group that is labeled, is, therefore, a stressor that has physical health, emotional and behavioral consequences long-term that needs to be factored into treatment planning.
Do you use any of the expanded surveys? Why/Why not?
I do use the expanded survey to inform me on the total health picture of the youth served and to educate the treating team on provision of services and type of provider or provider knowledge/attitude needed in treating the children/youths. I used the original ACE survey to poll 2000+ educators in Nigeria and about 500 care and caseworkers trained in South Jersey. I have started using the Philadelphia Urban ACE survey for Chester and Philadelphia school districts (ee below).
When you do training, do you talk about:
- health equity?
- generational trauma?
- historical trauma?
- systems-caused trauma?
Yes, I do touch on all the above including the potential re-traumatization resulting from lack of knowledge and skills around ACEs by adults who care for children.
What's it like to be a black female pediatrician in the United States and in Nigeria?
It seems I have to constantly prove myself and explain my credentials, experience, and skills at each stop. There is an inherent bias that is obvious. It's unfortunate that I am often the only black person in many meetings to discuss ACEs to managers of programs and the juvenile justice system when the population is about 20% black and the children in the system needing services are about 40% black.
How do you think about equity and inclusion in how you do your work, in working with others, as a public health physician, pediatric psychologist, health manager, person with ACEs, and community leader?
I think about equity in the context of social justice. I believe that every child/youth should have a fair chance to reach their full potential by removing assumed bias and racial stereotypes.
I attempt to meet each individual's needs at the level they are at the moment in time. Not using a uniform approach, but rather being individually specific about care and services provided. Ensuring that barriers to progress and care are removed through active listening to the family's stories of their journey and observing their needs from the perspective of finding them hope even in situations that seem dire.
Inclusion for me is the actual respect for the voice and choice of the children and families and the integration of their wishes in the care they receive. I consciously look for the strength, efforts, and abilities of each person that I review and try to appreciate the value they bring to their own health decisions.
Do you include the perspectives of survivors, parents, and community members as part of your initiatives? If yes, how so. If not, why not?
Yes, it is important for me to include the perspective of the children and their families to all care-planning steps and processes since the plan is about them and their vision of a better tomorrow that is hopeful.
I need their buy-in to make these hopes and aspirations come alive and be successful. It is their plan for success, after all, so I find it imperative to have their input and active involvement, otherwise, the plan will fail before the ink on the paper dries out.
How is the work you are doing in NJ, PA, and West Africa different or similar?
PA and NJ are different in their approach to care. PA is disorganized in approach to caring for children and families even though they have good intentions. NJ is more organized and goal-oriented.
ACEs and trauma work are new to West Africa and the people are engaged and willing to learn. We just don't have the resources to get the word out fast enough.
Any interesting trends and/or differences among the ACE surveys you've gathered to date in Nigeria and the United States?
The result of the 10-question ACEs survey gathered in Nigeria is different from the ACE Study. At a glance of the raw data,it almost looked like a reverse cone to the one of Drs. Anda and Fellitti. I am having a statistician take a look at the data and should have a report in a month.
My immediate reaction is the influence of the cultural norm and childhood messages in both continents. Also, the data collected in Nigeria was from attendees of trauma-informed education training over four years, from 2014-2018.
Do you talk about how race and systems-caused traumas impact individuals and communities when doing ACEs awareness training?
What tools or guiding principles inform you and your work most?
My personal philosophy is: "I am yet to meet a bad child, but I have met far too many children in bad situations doing bad things."
If you had a magic wand, what changes would you like to see in sectors, systems, as well as how initiatives work?
I would like to have more resources into the public health education of the educators and all adults that come in contact with children in the course of their work on child and adolescent mental health globally.
Our children spend most of their wakeful hours in school in the care of mostly caring adults who are generally ignorant of the ACEs the students have and therefore are unable to recognize their distress or understand the bizarre behaviors the traumatized students display. This has adversely contributed to the inadvertent but real "preschool to prison pipeline", especially in poor and minority neighborhoods of the US. In Nigeria, this has led to total community breakdown.
My greatest fear is the increased incidence of mental illness in children and youths, often mislabeled as truancy and antisocial behaviors. This misrepresentation has left children punished and untreated with a growing population of injured and angry youths.
It sounds like you are a one-woman show. Can you tell me more about how you are working with others?
I started out in 1994 in the US as a 'one-woman show' as a consultant educating the Montgomery County Office of Mental Health (MH)/ Mental Retardation (MR)/ Drug & Alcohol (now called the Montgomery County Office of Mental Health (MH) / Developmental Disabilities & Early Intervention) about primary prevention of mental illness and substance use in adolescents and young adults. While there, I helped develop the first morbidity and mortality review of this group living with developmental disabilities. I instituted the medical coordinator position for each program funded for this sub-population which has now evolved into what we now refer to as health or nurse navigators across the county.
I have since worked on task forces and steering committees in groups like the American Psychiatric Rehabilitation Association to help develop psychiatric rehabilitation for children as a subject matter expert.
I currently have formed multiple task forces to address retraumatization in schools by developing trauma-informed education programs in a South Jersey school district, Chester and Philadelphia school districts, and in Nigerian schools. I focus on developing trainer of trainers in this task force so I can be freed up and the trainers continue the work.
I want to believe leading and/or being a part of community initiatives is my major work now. My non-profit Suburbancares focuses on child behavioral health workforce development in West Africa. I have been able to set up a small but mighty network of workers and volunteers to implement and maintain projects like trauma-informed care management, Enough Abuse Campaign, nurtured heart approach, trauma-informed care management in Lagos, Nigeria, two states and West Africa with one vision in mind: to reduce the incidence of mental illness in children.
When/where is your next training/conference in Nigeria?
Cissy's Note: I've wondered how Dr. Ogunkua, and other ACEs champions, balance self-care and preservation with community-care and preservation. I've wondered how people find the time to go outside of comfort zones and familiar territory to work across sectors, in multiple communities in the United States as well as around the world. Dr. Ogunkua works in NJ, PA, and Nigeria.