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Synopsis For Registration of Subject For Dissertation: Submitted To
Synopsis For Registration of Subject For Dissertation: Submitted To
SUBMITTED TO:
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
IN PARTIAL FULFILLMENT
OF
M.Sc (N) IN PSYCHIATRIC NURSING
SUBMITTED BY:
MS.DHANYA MARIA SEBASTIAN
I YEAR M.Sc (N)
DATE OF ADMISSION TO
4 O8-06-2009
COURSE
WORKERS.
.
3
INTRODUCTION
Erickson, during the first 3 years, children’s physical development allows them to
increase their autonomy and establish greater contact with the surroundings. If the child
fails to master the skills, self doubt and hostile rejection of all controls, both internal and
external may develop. Children become increasingly active between 3 to 6 years, they
undertake new projects and conquer new challenges. If they encounter severe criticism
Egger and Angold (2006) suggested that to understand early onset of psychiatric
events that occurred early in life. Some problem may resolve with neurological
disorders and reducing the risk of development of psychological disorders at a later stage
is recognized as a major public health goal. The rates of childhood mental problems
continue to increase and interventions carried out later on in childhood appear limited in
In India there is a lack of mental health services, more so for this age group. 1 There is
also a lack of qualified personnel to cater to these needs. Under these circumstances, the
role of the anganwadi worker in early detection and prevention of mental problem is
essential. The anganwadi workers spend most of their time with children under 5 years of
age group. Therefore they are the ideal personnel who will be in the position to identify
the childhood mental disabilities early and reduce the risk for psychiatric disorders
reaching into their adult life. There is very limited knowledge in the area of effectiveness
of training the anganwadi workers in identifying those children at risk and promoting
teaching programme for anganwadi workers regarding mental health promotion and early
Professor Oberklaid says” mental health problem can emerge at any time, from
The global burden of diseases study indicates that by the year 2020,
become one of the five most common causes of morbidity, mortality and disability
among children in the world. Mental illnesses that develop before the age 6 can interfere
with critical aspects of the child’s emotional, cognitive and physical development. So too,
5
prior anxiety, behavior and mood disorders all increase likelihood of child having
disability. According to U.S surgeon general previous research suggested that depression
affects about 2% of U.S preschoolers .Luy’s research team followed more than 200
based sample from Bangalore. Prevalence of mental retardation is estimated 2.0% with a
range from 1.0 to 2.5%.A recent epidemiology study reported prevalence of 2/1000 of
25% of 5 year old children present with language and speech disorders. 3The above
mentioned statistics points towards the need for mental health promotion of toddlers and
preschoolers.
NIMH estimates that “only 50% of children are diagnosed before kindergarten” they also
state that 44% of primary care providers report caring for at least 10 children with
There are 100 child guidance clinics across nation. The largest service for
children is provided at NIMHANS, Bangalore. This center caters to nearly 1000 mentally
6
retarded and 800 child psychiatric cases a year. It has 4 psychiatrists, 3 clinical
child mental health at post graduate level, there is little commitment a serious of concern
about the child mental health. There is no available survey of the facilities offered in the
so called 100 or so child mental health services across the country, but anecdotal
information is that the services are poorly manned and more often than not headed by
people who have little training in child psychiatry. This reveals the lack of health care
anganwadi workers who are already taking care of the toddlers and preschoolers become
the available alternative. Therefore she should be adequately trained in early detection of
psychiatric disorders and promotion of mental health among this age group.4
In India mental health of the children under 1 to 5 years is not given much
consideration. This may be due to lack of mental health promotion services, this
predisposes the children to mental health problems which may in turn lead to psychiatric
disorders in later adulthood. Evidences have shown that interventions for preventing
chronic behavior problems are effective if applied early in life. 1 A chance of success in
promoting mental health is more if it is carried out through the ICDS system. There fore
there is a need for training for anganwadi workers regarding mental health promotion
preschoolers
The 2009 World Mental Health Day global awareness campaign which was
celebrated on the 10th of October 2009 focused on the theme “Mental Health in primary
care enhancing treatment & promoting mental health” this has led to the focus on the
often neglected fact that mental health is an integral element of individual’s overall health
& well being. The importance of psychological well being in children for their healthy
.So steps to promote mental health should be identified and importance needs to be
given the often neglected age group, namely the preschoolers & toddlers 5
the community, this again reinforces the fact that these children belonging to this age
group belong to the neglected group. However, studies conducted in mental health care
centers provide some literature. In 2001 a data was released by Indian council of Medical
Research (ICMR), this study conducted in Bangalore and Lucknow in 1997 shows the
The depth for literature regarding this aspect has let to the consideration of the
following study. A multicentre study of the pattern of child psychiatric disorders among
children attending the psychiatric OPD was conducted in 1997. The study reveals that
among the age group of 0 to 5 years 33 % had been diagnosed to have hyperkinetic
syndrome, mild MR was present in 22 % children .It was also found that abnormal
psychosocial factors were associated with conduct disorders and emotional disorders. 7
psychopathology among children of 1-18 years of age group was carried out over 20
countries in1998 revealed that most of the countries including the United States & United
Kingdom, the prevalence estimate ranged from1% to nearly 51 %. Mean rates were 8 %
for preschoolers. 8
of autism in Japan in 1984. The survey revealed a prevalence of 0.13 %, which is 3 times
school children (4-6 yrs) in Stafford U.K in2005 concludes the prevalence rate was 58.7
per 10,000 populations of which 29.8%had MR. The study concluded that the rate of
Among 796, four year old children taken for the study to examine the
identified were attention deficit, hyperactivity disorder, and oppositional defiant disorder.
Very little literature is available regarding this aspect. However a study was
and prevention of disability in children below 6 years of age. It was found that trained
AWW identified mental disability. The mental disability rate was found to be 2654 per
100,000. This study supports the researcher’s assumption that anganwadi workers can
disabilities.13
WHO report examined the extent of the gap between a prevalence and
treatment of psychiatric disorders globally. They found that one in every five children has
a mental health issue. If we invest in identifying the problems early and intervene at the
right time, it will be more cost effective, as we will be preventing further breakdown and
10
avoid an adult treatment and rehabilitation program which is much more expensive. As it
education component of ICDS on mental and cognitive development of rural and urban
Punjabi urban children. Fifteen anganwadi workers were randomly selected both from
urban and rural areas. Comparisons were made with non ICDS attenders. It was observed
that mental health knowledge of attenders was significantly better than non attenders in
Bangalore were taken up the project which covers a total 4000 population. The
behavior and emotional problems and disabilities in children below 5 years. They are able
Bangalore program. Six batches of students were trained. The results showed that
management with drugs and counseling.35 anganwadi workers took part in training
programmed .It was found that workers were able to detect and manage the cases in
rural mental health center managed by NIMHANS, Bangalore. The Center is trying to
design and develop a training module to give skills to anganwadi workers to identify
,manage and prevent mental retardation and behavioral problem in children .AWW are
being observed to be doing a good job in managing 2 to 3 MR children, they are able to
give time to both the child and parents and train them. A total of 225 AWW were trained
19
.
preschoolers.
12
6.4:OPERATIONAL DEFINITIONS
standardized questionnaire.
Physical needs
Social needs
Emotional needs
Mental needs
Common mental health problems of this age group & its signs and
symptoms.
13
Anganwadi workers –It refers to workers with an education of 10th standard and
anganwadi.
6.5 :ASSUMPTION
6.6 : HYPOTHESIS
14
regarding mental health & early identification of mental illness in toddlers and
significance
regarding mental health & early identification of mental illness in toddlers and
6.7 :DELIMITATION
7.2.2 Research Design : Pre test- Post test design with control group
&control –45)
Inclusion criteria
Exclusion criteria
1. Anganwadi workers who are not available at the time of data collection.
7.2.6 Setting
Description of tool
prepared. The Questionnaire will be given to experts in the field for assessing the face
validity and test retest method will be used to assess the reliability
programme
Descriptive statistics;
Inferential statistics;
Yes, the study requires structured teaching programme among anganwadi worker in the
Anekkal taluk. in the form of one day workshop on mental health promotion and early
BIBLIOGRAPHY
publication;7th edition.2005.
http://www.usatoday.com/news/health/2009-08-03-depression-kids_N.htm
4. Kapoormalavika.An integrated
approachtochildmentalhealthservices.JIACAM.vol1(1):2
priority.oct2009.www.wfmh.org.pdf
http://medind.nic.in/iby/t05/i7/ibyt05i7p67.pdf
7. http://cogprints.org
http://ajp.psychiatryonline.org/cgi/content/full/155/6/715
11. www.ncbi.nlm.nih/pubmed/16175102
http://www.britannica.com/bps/additionalcontent/18/39567356/
19
http://www.britannica.com/bps/additionalcontent/18/39567356/
http://www.ncbi.nlm.nih.gov/pubmed/8617553
approachtochildmentalhealthservices.JIACAM.vol1(1):4
http://openmed.nic.in/172/01/jiacam05_1_4.pdf
9 Signature of Candidate
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11.2 Signature :
11.4 Signature :
11.6 Signature :
12.2 Signature