Identification of mental health needs

of children in child care institutions

NIPCCD, 19 June, 2018

Dr Rakesh Kumar Tripathi

Associate Professor & Clinical Psycholoist
Department of Geriatric Mental Health
King George’s Medical University, Lucknow , India
 Learning objectives
• What is mental health?
• Component of mental health
• Understanding child development (normal &
abnormal)
• Psychosocial theories of development
• Mental Health needs of children
• Identification of mental health needs in child
care institutions
 What is Health ?
The positive dimension of mental health is
stressed in WHO's definition of health as
contained in its constitution:
"Health is a state of complete physical,
mental, social and spiritual well-being and
not merely the absence of disease or
infirmity."
 What is mental health ?
Mental health is “a state of well-
being in which the individual realizes
his / her own abilities, can cope
with the normal stresses of life, can
work productively and fruitfully, and
is able to make a contribution to
his/her community.”
 Component of mental health
1. State of well being (कुशऱता)
2. Realizes abilities (योग्यता )
3. Cope with the normal stresses of life (तनाव
से सामना)
4. Work productively & fruitfully (उत्पादक और
पररणामपरक कायय)
5. Able to make contribution to community
(समुदाय/समाज में योगदान करने योग्य)
 Normal

(Special words or expression difficult to understand)

Jargon clip
 UNICEF, 2011
Affect (Emotion) Behavior Cognition
New experience Learning by doing Shapes, colours, people,
& Fearful and playing, helping animals, sounds, places
Dependency to Motor skills- Language development,
separation & crawling-walking- Differentiate- gender,
autonomy running, accident disability, formation of
prone social attitude
Awareness of Fine motor skill in Difficulty in distinguishing
emotions (own & fingers- cutting fantasy from reality, codes
others), express & coloring, playing & conversation
control emotion with others

Communication Needs: Loved and Safe, Range of Emotions

are Normal, Positivity
 UNICEF, 2011
Affect (Emotion) Behavior Cognition
Same sex Friends Learning by doing Better distinguishing
in more central and playing between fantasy & reality
role
Learning about More independent Language development,
right & wrong in taking care of ADL Understanding causality

Awareness of Learning to follow Developing problem

emotions (own & rules and interaction solving & critical thinking,
others) use of gadgets

Communication Needs: explore skills & talents, use their potential

in positive way, Understand Feelings & worries & respect
 UNICEF,2011
Affect (Emotion) Behavior Cognition
Influence by peer, Independence & Adult like abstract and
breaking away from logical thought
adult authority
Romantic & sexual Experimenting with Emerging concern for
relationship new behaviors, risky, Exploring future plans
(depending on related to gender,
culture) religion , class
Awareness of Exhibiting rebellious Inconsistency with
emotions (own & behaviour against chronological age
others) authorities (education)
Communication need: Guidance & awareness about adult life, strong
positive role models with high moral standards, learn from mistake,
recognition & respect
Erikson’s Stages of Psychosocial
development
 Childhood & Adolescent Psychiatric
Disorders/Problems
• Mental Retardation • Separation Anxiety
• Learning disorders Disorder
• Motor Skill disorders • Selective mutism
• Communication disorders • Reactive attachment
(>46%) disorder
• Pervasive developmental • Substance use
disorders • Schiz. and other
• ADHD (30.1%) psychotic disorders in
• Disruptive Behaviour Adolescent
disorders • Anxiety & Depression
• Tic Disorders (>40%)
• Elimination Disorders • Eating disorders
• PTSD (20-23%)
Young et al. 2017, BJPsych Bulletin (for prevalence only)
 Mental Retardation
• Significantly sub average general intellectual
functioning resulting in or associated with
concurrent impairment in adaptive behaviour
and manifested during the developmental
period, before the age of 18. (IQ below 70)
• Mild 50-69 9 to under 12 yrs
• Moderate 35-49 6 to under 9
• Severe 20-34 3 to under 6
• Profound below 20 less than 3
Mental Health Problems in Children
Warning Signs of School Violence

Synopsis of Psychiatry, 2015

Warning Signs of School Violence (contd.)

Synopsis of Psychiatry, 2015

For Autism
One in 8 adolescents
at risk of mental
health prolems

Teenage screening
Sandhya Nair et al. 2017
questionnaire-
Trivendrum

Strengths and
difficulties
questionnaire
Child mental health centers in India
• NIMHANS, Bangalore
• PGIMER, Chandigarh
• AIIMS, New Delhi, Mumbai, Chennai
• CIP, Ranchi
• RINPAS, Ranchi
• IHBAS, New Delhi
• Dept of Psychiatry, KGMU, Lucknow
• NGO’s & Pvt Universities
• http://www.niepid.nic.in/index.php National Institute
for the Empowerment of Persons with Intellectual
Disabilities (formerly NIMH), Secunderabad
• NIPCCDs
 Child mental health in India

Promotion
using life skills • Children
for
psychosocial • Adolescence
School competence

Mental
Health
Program orientation
• Child mental
& health specialists
counseling • Mental health
skills
problems
 Publication list from NIEPID
• Directory of Institutions for Persons with Mental Retardation in India (2002)
• A Manual for Village Rehabilitation Workers (1988)
• A Manual for Guidance Counsellors (1988)
• A Manual for Psychologists (1989)
• Vocational Training and Employment of Persons with Mental Retardation
(1990)
• Handbook for the Trainers of the Mentally Retarded Persons - Pre-primary
level (1989)
• Organization of Special School for Mentally Retarded Children (1989)
• Organization of Special Class in A Regular School (1989)
• Towards Independence Series 1-9 (1990)
• Manual for Towards Independence Series (1990)
• Skill Training in the Mentally Retarded Persons 1-9 (1990)
• Play Activities for Young Children with Special Needs (1991)
• Manufacture of Wire-cut Bricks and Tiles (1992)
• Preparation of Ploy bag, Nursery, Vegetable garden and Seed Packets (1992)
 Publication list from NIEPID (contd.)
• Behavioural Approach in Teaching Mentally Retarded Children - A Manual for
Teachers (1992)
• Behavioural Assessment Scales for Indian Children with Mental Retardation
(Basic-MR) (1992)
• Behavioural Assessment scales for Indian Children with Mental Retardation -
Record Booklet (1992)
• Manual on developing communication skills in Mentally Retarded Persons (1992)
• Manufacture of Cardboard Files (1993)
• Functional Assessment Checklists for Programming (NIMH-FACP) (1994)
• Directory of parent associations working for the welfare of the MR persons in
India (1994)
• Moving Forward - An information gide for parents of children with mental
retardation (1994)
• Understanding Indian Families having persons with mental retardation (1995)
• NIMH Family Needs Schedule (NIMH-FAMNS) ('95)
• NSSO Report on delayed mental development among Indian children (1996)
• Grade level Assessment Device for Children with Learning Problem in Schools
(GLAD) (1997)
 Publication list from NIEPID (contd.)
• Functional Literacy Series (1997)
• Functional Academics for Students with Mental Retardation - A Guide for
Teachers (1998)
• NIMH Vocational Assessment and Programming System for Persons with MR
(NIMH-VAPS)(1998)
• School Readiness for Children with Special Needs (1999)
• Flip Books - Literacy Series (1999)
• Flip Books - Numeracy Series (1999)
• NIMH Disability Impact Scale (NIMH-DIS), (2000)
• Family Efficacy Scale (NIMH-FES), (2000)
• NIMH Gem Questionnaire, (2000)
• Transition of persons with mental retardation from school to work - A guide
(2001)
• Play Fun "n" Learn, (2001)
• Curriculum for Vocational Education of persons with mental retardation,
(2001) SERIES -1
 Publication list from NIEPID (contd.)
• Cirriculum for Vocational Education of persons with mental retardation, (2003)
SERIES -2
• Early Intervention, A Service Model – 2003
• Manual on Preparation of Stimulation Materials for Rural Infants and Toddlers –
2003
• Hope Beyond Hope, Some Success Stories
• Functional Numeracy Series (1997)
• MENTARD, An awareness bulletin (bi-monthly)
• KARAVALAMBAN News Letter (Quarterly)
• Training in Communication Skills for Persons with Mental Retardation, Utility
Guide for parents (2003)
• Ten Different Posters on prevention and management of Mental Retardation
• Early Intervention Series – Brouchures
• Flip Chart on Early childhood disabilities
• Six Different Posters on Employment Awareness of persons with mental
retardation
Mental Health Need of Children
• Health need
• Communication need
• Need to understand
• Need to listen
• Love need
• Safety need
• Need of independence
• Achievement need
Identification
Tool of MH in
CCI
 Tools
• NIMH interview schedule for children version
iv (DSM 4&5 based more than 30 diagnoses):
– Parent form (6-17 years)
– Children form (9-17 years)

• Children’s interview for psychiatric syndromes:

– 6-18 years of age by trained interviewer
– 40 minutes to administer
– Depression, mania, ADHD, OCD, conduct disorder,
substance use disorder, separation disorder,
anorexia and bulimia
Tools

Ref. Synopsis of Psychiatry, 2015

 UNICEF, 2011

What?

uncomfortable Share
information

mode of
communication
 Building effective communication (contd.)
UNICEF, 2011

Others
perspective
Acknowledge &
Accept the
Different
difference
values or
opinion Respect

Ask ?

Hesitant nonverbal consider &

communication correct them
 Building effective communication (contd.) UNICEF, 2011

Think

Can’t find right Ask & discuss with

others
words to express

Seek help

Feedback
 What is Communication?

 Communication is the process of

imparting one’s thoughts and feelings by
speech, symbols or signs. In this
process individual also becomes aware
of other’s thinking and feelings.
 How we Communicate
Verbal Communication Non- Verbal Communication

Speaking
Writing
Listening Non-verbal
language
 Process of Communication

says what. . . to whom. . .

Who. . .
in what way. . .
Message Receiver

. . . with what effect

Characteristics of Good Communicator
 Introduces him/herself and explains actions
 Listening and understanding
 Clarity in communication
 Validate understanding with person/patient
 Encourage questioning, answer appropriately
 Explain clearly
 To explore the person’s feelings, perceptions,
personal, social and family life
 To attend verbal and non verbal cues
 Be Confident
 Communicating with Child Listening

• Encourage your children to speak and express

their opinions. Let them know the importance of
listening to others first before talking to them.
• Teach them how active and meaningful
communication occurs between two people.
• Teach them basics of communicating with other
people, especially adults.
• Train them how to be polite, while talking to
others.
 Communication with Encouraging words
• Good, Very good,
• Fantastic, Excellent,
• Amazing,
• Fine, Great,
• Right, Correct,
• Wonderful,
• I am so proud of you,
• I like the manner in which you
are doing your homework,
• That was really good
• Nice, Very Nice,
• You are doing well,
• That is good,
•That is a great idea,
• What a great idea,
• Great job,
• Good job,
• Keep it up,
• You are improving,
• You were so patient,
• You did great,
• You are a genius,
• I appreciate that you did your
homework by yourself,
• I like your initiative,
• I simply love you and
• Many other words that you find
are good for your children.
 Communicating with child….
With activities

• Board games
• Puppet show
• Shop or a theatre
• Classroom imitation
• Impromptu (Unplanned/Surprise) speech
 Communicating with child….
By Imitation
• Initiate a debating competition in your home
for the benefit of children
• Start the debate and dialogue
• Ask your children to start talking on any topic
of their choice
• Help them to start the conversation and keep
it going
• Correct them, if they commit any mistakes or
errors
 Principle of communication with
children
• Age appropriate & child friendly
• Address the child holistically
• Positive & strength based
• Address the needs for all, including those who
are most disadvnataged

UNICEF
 Concluding Remarks
 To be Healthy
Listen and understand
Clarification
Open minded
Use verbal and nonverbal clues
Respect
Be knowledgeable
Accept
Early Identification of the problem
Referral
 King George’s Medical University Lucknow
INDIA
Contact: Dr R K Tripathi
rastripathi@gmail.com
91+9454202905