Proposal for Development of Community Child and Adolescent

Proposal for Development of Community Child and Adolescent Mental Health Service Model DWCD, Karnataka Dr. Shekhar Seshadri Dept. of Child & Adolescent Psychiatry NIMHANS, Bangalore 4 th July 2014

Objectives • Establishment of community-based child and adolescent services. • Training and capacity building of childcare workers and staff from various governmental and non-governmental agencies, including schools. • Develop a comprehensive community child and adolescent mental health service model that may be replicated elsewhere in the country.

Geographic Location and Area • Bangalore South Zone: – A minimum of 10 slums (total population=5, 335) + larger community – 12 PHCs (10 MOs, 12 Health Assistants, 48 Link Workers) – 20 government schools (& 10 private schools) – 30 Anganwadis – 90 child care institutions (Registered under DWCD & J. J. Act) • 2 remote/rural districts (Remote Communication)

Principles & Technical Approach • Universal access to child (mental) healthcare • Equitable coverage (with focus on vulnerable children and adolescents) • Community involvement and participation to ensure sustainability • Adoption of multi-sectional approach through involvement of various sectors such as health, education, women and child welfare.

Mental Health Intervention Spectrum for Mental Disorders

Proposal Implementation: Phase (1) Activity 1: Mapping of Existing Community Services • What? – identify types of services provided by the agency/services – understand child mental health issues in the community. – assess the capacity needs and gaps of the service providers. – assess scope for government schemes (RBSK/RKSK implementation? ) • How? – key informant interviews and focus group discussions • With Whom? – – – Child Care Institutions (government & non-government agencies) public health professionals (MO, health assistants, link workers) Anganwadi workers schools/teachers Government departments (Women & Child Development, BBMP, Education, Health, NRHM, JJ Act functionaries)

Proposal Implementation: Phase 2 Activity 1: Service Delivery Intervention Type of Service Provided Preventive Developmental &Promotive play program Life Skills Services program in schools. Life Skills program in NGO and other community spaces. Targeted Children/Adolescents Pre-school children Service Providers School children (ages Teachers Aanganwadi workers Children in institutions; Government staff (such special populations and as child protection staff); vulnerable children and NGO workers adolescents served by NGOs. (Example street children; substance abuse issues; HIV+ children etc)

Service Delivery Intervention Type of Service Provided Targeted Children/Adolescents Case identification All children availing of Basic/ first level preventive/ promotive psychosocial support and services and other care individual children who may have psychiatric problems or developmental disabilities, thereby requiring specialized services and care. Standard treatment for known (psychiatric) disorders Service Providers Treatment/ Curative Services Teachers, health workers, private & public health practitioners (paediatricians/ general physicians), government and NGO staff in consultation with NIMHANS team NIMHANS Child & Adolescent Psychiatry Dept. and/or other Mental Health Centers (Referral)

Conditions Covered by Curative Services Behaviour/Emotional Sub-Threshold Disturbances Disorders Oppositional Defiant Disorders Conduct Disorders Anxiety disorders Depressive disorders Elimination disorders Somatoform disorders Other uncommon disorders – Obsessive Compulsive Disorders, tics, psychoses, bipolar disorders Neurodevelopmental Disorders Scholastic backwardness Learning difficulties School refusal Temper tantrums Difficult temperament Aggressive tendency Suicidality Running away from home Bullying Pica Early unspecified developmental delays Truancy School drop-outs Conduct symptoms Oppositional Defiant Disorder Excessive shyness Examination anxiety Stress-related problems Inter-personal problems in adolescence Intellectual Disability Autism Speech delays / disorders Non-Specific Global Delays in young children) Attention Deficit Hyperactive Disorder Specific Learning Disabilities Cerebral Palsy

Reaching out to Remote Rural Districts • Staff of government services from 2 remote/rural areas identified by DWCD will be provided with technical support remotely. • Advice on preventive and curative services, provided through telephone and internet communication on a periodic basis (weekly). • Staff to be included in training and capacity building activities conducted in Bangalore

Proposal Implementation: Phase 2 Activity 2: Training & Capacity Building Training for Whom? • Gate-Keepers: o o Health workers (public health practitioners, Link workers) Anganwadi workers Teachers Child care institutions’ staff • ICPS Staff: o o Program officers Counsellors Social workers House Parents

Training Content? o o o o Psychological health promotion Parent education leaflets Behavior therapy training packages Consultation liaison clinics Screening for early diagnosis Disability related interventions Small modules for grass root workers Universal preventive interventions (violence prevention, problem solving, suicide prevention, bully victim problems) Programmes for externalizing behaviours (anger control) Programmes for internalizing behaviours (stress and coping) School programmes (teacher training, life skill education) Referral protocols Working with children in difficult circumstances (street children, high risk behaviors)

• Training Material? o o Information, Education and Communication Materials Videos Manuals for various trainer groups Creative materials for use with children/adolescents

Outcomes • Increased access to and availability of preventive, promotive and curative child and adolescent mental health services in the community. • Increased access to and availability of mental health services to vulnerable children (disabled and other special groups). • Development of training materials and manuals. • Development of capacities in community childcare workers. • A tested out model for widespread implementation for promotive, preventive and curative interventions in child and adolescent mental health in the community.

Timelines Year 1 Staff Recruitment and Orientation Mapping: Identification and Assessment of Community Needs & Resources Development of Training Materials Finalization of Service Model Staff Training of Community Childcare Workers Preventive/ Promotive programs Curative Services Year 2 Training of Community Childcare Workers Preventive/ Promotive programs Curative Services Monitoring of Services Year 3 Refresher Staff Training Refresher/ Follow-up Community Childcare Workers Training Revision of Training Material Development of Training Packages Preventive/ Promotive programs Curative Services Monitoring & Evaluation of Services Documentation and Finalization of Model Dissemination of Model

Budget Item Staff Senior Scientific Officer- 1 (Project Coordinator) Year 1 Year 2 Year 3 6, 74, 388 7, 41, 826 8, 16, 008 8, 02, 536 8, 82, 789 9, 71, 067 Clinical Psychologist- 1 Psychiatric Social Worker- 1 Staff Sub-Total 14, 76, 924 16, 24, 615 17, 87, 075 48, 88, 614 Vehicle +Field travel 50, 000 1, 50, 000 (@ approx. 250 project visits per year) Travel Sub-Total Travel 50, 000 1, 50, 000 3, 50, 000 Training material, manuals, posters, videos, printing costs 75, 000 Training Workshops for Service Providers 2, 00, 000 2, 000 Consumables Sub-Total Grand Total 2, 75, 000 8, 25, 000 60, 63, 614 2, 75, 000

Progress: June 1 st to July 4 th 2014 • Expansion of geographic area of project (from only BTM Layout to Bangalore South Zone) • Introduction/ orientation meeting about proposal + permission seeking from Dept. of Health (chief health officer/ Health Officer, South Zone), Dept. of Women & Child Welfare (Director of Women & Child Welfare) , Dept. of Education (Block Education Officer/DDI) • Mapping of/ basic information collected from 12 PHCs in Bangalore South Zone (through field visits) • Key Informant Interviews with 4 Medical Officers • Community walks in slum areas initiated • Preliminary categorization of 90 child care institutions registered under DWCD and J. J. Act based on typology of children served and /or common service needs/ capacities

Progress cont… • 14 assessment and sensitization workshops scheduled for July-September for PHC staff, government schools/teachers, anganwadi workers, child care institution staff (to establish in-depth understanding of needs of target population + staff capacity building needs) • Recording of data/ preliminary analysis initiated

Support Requested… • Permissions to conduct assessment and training with your department staff. • Cooperation on space within the community (to enable us to conduct children’s activites…eg: in anganwadis, schools etc) • Expediting paperwork and processes for permissions for initiation of project (funds) and activities therein.