A project supported by Theirworld, that uses art therapy and other skills to aid affected students, has helped over 3,500 children and trained nearly 800 teachers.
Omar was angry and frustrated. He disrupted his school class and didn't seem bothered when his actions were challenged.
Luckily, his teacher knew what was behind the 10-year-old's behaviour. He was traumatised. Affected deeply - like so many other Syrian refugee children - by the horrific conflict, fleeing from home with his family and how he felt about his new life in a different country.
Thanks to the teacher, Omar was placed in a programme that identifies troubled refugee children in Turkish schools and provides them with crucial psychosocial support.
The Trauma-Informed Schools project, run by the Istanbul-based organisation Maya Vakfi (Maya Foundation) and supported by Theirworld, initially with funding provided by the Conrad N. Hilton Foundation, has helped more than 3,500 children and trained nearly 800 teachers to spot the signs of trauma and learn how to help those affected.
Maya Vakfi contributes to the mental, physical and academic development of children and adolescents aged from five to 18.
When Omar joined the programme's sessions at his school in Istanbul, he was nervous, argued with other children and even attacked them.
But his behaviour gradually changed - thanks to art therapy, which includes asking children to draw something and then talk about their feelings.
"There was a significant change in Omar," said Betül Akdeniz, a clinical psychologist with the Trauma-Informed Schools programme in the Fatih district of Istanbul.
"In a session on anger management, he said he could not control himself. When he came to the next session, he was more confident and controlled himself in the discussions.
"Omar thanked us for encouraging him to open his own feelings. In later sessions, he seemed happier and his communication with his friends became more moderate.
"He did not have a verbal discussion and physical fight. He stopped cursing completely."
Omar's successful transformation is being repeated throughout the programme, which is run in co-operation with Turkey's Education Ministry. By supporting the teachers through skills building training, the effectiveness of their overall teaching will increase - which has a direct impact on children’s ability to learn.
Fiona Duggan, Head of Projects at Theirworld, said: “This school training programme plays a vital part in equipping teachers with the skills they need to help Syrian children manage the trauma they have experienced.
“So that they can fully embrace all that school has to offer, that includes learning, making friends and realising their full potential. That is why Theirworld is very proud to have supported this initiative.”
See some of the children's amazing artworks
A full and detailed evaluation of the Trauma-Informed Schools programme has been carried out. Theirworld aims to produce a report based on the teacher training findings so that other organisations or governments can scale up help for traumatised children.
Maya Vakfi’s programme gives the identified children eight weeks of sessions - including art therapy - which encourage positive skills, creating thinking and a feeling of hope.
Groups are tailored to treat the specific symptoms being shown. But there is also a one-day general session for all children in each school.
There are more than 3.5 million registered Syrian refugees in the country - 44% of them under the age of 17. When the Syrian conflict saw millions cross the border into Turkey, children were educated at first in informal centres.
But now the Turkish government is moving all Syrian refugee children into the school system. In Istanbul, all Syrian children learn in public schools alongside Turkish children.
So teachers - but also school staff, counsellors and parents - need to understand how to spot children who are struggling and know how to help them.
The Trauma-Informed Schools programme, which began in 2016, grew out of Maya Vakfi's work on child development.
An example of art therapy is an activity called "Build your own super hero". Children talk about their emotions and are told they have a super hero inside them. They are asked to paint or decorate that super hero and say what powers or features they have.
"We had started to create a programme that was directly targeting children and their parents by giving them psychosocial support," explained Çağrı Hürmüzlü, Program and Grants Director at Maya Vakfi.
"That meant doing group sessions and individual therapy sessions for children who needed closer attention - but also positive parenting training sessions.
"We realised the Syrian children were going to school but the Turkish education system didn’t have the capacity to identify kids who had been through traumatic experiences.
"Even if they did identify them, they didn’t know any positive classroom techniques - they didn’t know how to refer them or interact with them."
Out of that realisation came the Trauma-Informed Schools programme. It was designed to train teachers how to identify children in the classroom who had suffered traumatic experiences and were showing anger, not doing their studies well or not participating like the other students.
"Once you do identify them, teachers can interact with these children in the classroom setting or one-on-one," said Hürmüzlü.
"The training programme goes through the basics of what trauma is, how to do trauma rehabilitation, positive classroom techniques - the whole works."
For most Turkish teachers, this was new territory. In a report being produced by Maya Vakfi for Theirworld, one teacher said about troubled Syrian children: “When I first started I was thinking that they had problems with intelligence.
"After the training, I realised that all of these children were traumatised.”
When you think about trauma, people usually think about the war and the migration. But once they are in Turkey, they can witness trauma at school and at home.
Another teacher who has been through the programme admitted: "We're trying to be more careful. When we encounter trauma, we wonder if we understand better. We are trying to build better empathy. We began to care more.”
The trauma experienced by refugee children can result in such symptoms as bedwetting, not being able to sleep or having nightmares. They can also experience low self-esteem, difficulties in attention and learning, along with negative beliefs about themselves and their future.
Maya Vakfi's trauma team said boys tend to show more aggressive or risk-taking behaviours, while girls can become more socially withdrawn.
It's not all down to the effects of conflict or being forced to move to another country.
"You have some cases where children are going through domestic violence at home and the breakdown of the family," said Hürmüzlü.
"The Syrian refugees who have moved to Istanbul are usually in the more impoverished parts of the city.
"When you think about trauma, people usually think about the war and the migration. But once they are in Turkey, they can witness trauma at school and at home.
"A lot of the kids also have problems in integrating into general society and the Turkish school system. So the kids will report bullying at school. The language barrier is also a big issue."
Traumatic experiences can seriously affect children's ability to learn and remember information.
Maya Vakfi's trauma team said: "Trauma derives from some changes in the brain. Because of high levels of cortisol hormone secretion after trauma, the hippocampus is damaged. That is the area that is responsible for learning information and memory.
"Based on our observations, when children have learning problems in the classroom, it was noticed that their self-confidence also decreases. As a result, they are absent and more importantly they might drop out from school.
"We saw such examples at schools where we work and we intervened by providing psychosocial support to those cases. By our intervention, these children returned to the school."
Omar is a great example of the success of the programme. During the group sessions, his behaviour improved drastically, said psychologist Betül Akdeniz.
"When he wanted to say something, he raised his finger and he apologised at the moments when he spoke without waiting for his turn," she said.
"He learned to regulate his feelings."
The core modules
Trauma-Informed Schools is based on the Skills for Psychological Recovery (SPR) programme used in many post-disaster situations in the United States and globally. SPR modules focus on reducing negative effects of traumatic experiences and helping children to break vicious cycle of trauma.
The five core modules are:
- Promoting positive skills. Creating a safe environment for children, supporting them to gain familiarity with expressive art methods and supporting them to learn to use art for communication and self-expression.
- Identifying emotions and managing reactions. Bringing children the skills to recognise and manage their emotions and coping with their difficult emotions.
- Building problem-solving skills. Encouraging creative thinking, improving problem-solving skills and using different perspectives for problem solving.
- Promoting helpful thinking: Instilling hope in children, increasing their creativity through dreams and making them think creatively.
- Building healthy social connections: Supporting group solidarity, integration and positive relations.