Proposal for

Development of Community
Child and Adolescent Mental
Health Service Model
DWCD, Karnataka
Dr. Shekhar Seshadri
Dept. of Child & Adolescent Psychiatry
NIMHANS, Bangalore
4th 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 Targeted Service Providers
Provided Children/Adolescents
Preventive Developmental Pre-school children Aanganwadi workers
&Promotive play program
Services Life Skills School children (ages Teachers
program in
schools.
Life Skills Children in institutions; Government staff (such
program in special populations and as child protection staff);
NGO and other vulnerable children and NGO workers
community adolescents served by
spaces. NGOs. (Example street
children; substance abuse
issues; HIV+ children etc)
Service Delivery
Intervention Type of Service Provided Targeted Service Providers
Children/Adolescents
Treatment/ Case identification All children availing of Teachers, health
Curative Basic/ first level preventive/ promotive workers, private &
Services psychosocial support and services and other public health
care individual children who practitioners
may have psychiatric (paediatricians/
problems or general physicians),
developmental government and NGO
disabilities, thereby staff in consultation
requiring specialized with NIMHANS team
services and care.

Standard treatment for

known (psychiatric) NIMHANS Child &
disorders Adolescent Psychiatry
Dept. and/or other
Mental Health Centers
(Referral)
Conditions Covered by Curative Services
Behaviour/Emotional
Disorders
 Oppositional Defiant
Disorders
 Conduct Disorders
 Anxiety disorders
 Depressive disorders
 Elimination disorders
 Somatoform disorders
 Other uncommon
disorders – Obsessive
Compulsive Disorders,
tics, psychoses, bipolar
disorders
 
Sub-Threshold Disturbances Neurodevelopmental
Disorders
 Scholastic backwardness  Intellectual Disability
 Learning difficulties  Autism
 School refusal  Speech delays / disorders
 Temper tantrums  Non-Specific Global Delays
 Difficult temperament in young children)
 Aggressive tendency  Attention Deficit Hyperactive
 Suicidality Disorder
 Running away from home  Specific Learning Disabilities
 Bullying  Cerebral Palsy
 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
 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 Health workers (public health practitioners, Link workers)
o Anganwadi workers
o Teachers
o Child care institutions’ staff

• ICPS Staff:
o Program officers
o Counsellors
o Social workers
o House Parents
Training Content?

o Psychological health promotion

o Parent education leaflets
o Behavior therapy training packages
o Consultation liaison clinics
o Screening for early diagnosis
o Disability related interventions
o Small modules for grass root workers
o Universal preventive interventions (violence prevention, problem
solving, suicide prevention, bully victim problems)
o Programmes for externalizing behaviours (anger control)
o Programmes for internalizing behaviours (stress and coping)
o School programmes (teacher training, life skill education)
o Referral protocols
o Working with children in difficult circumstances (street children, high risk
behaviors)
• Training Material?
o Information, Education and Communication Materials
o Videos
o Manuals for various trainer groups
o 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 Monitoring of Services
Staff Training
Training of Community
Childcare Workers
Preventive/ Promotive
programs
Curative Services
Year 2 Year 3
Training of Community Refresher Staff Training
Childcare Workers
Preventive/ Promotive Refresher/ Follow-up
programs Community Childcare
Workers Training
Curative Services 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 Year 1 Year 2 Year 3
6,74,388 7,41,826 8,16,008
Staff Senior Scientific Officer- 1 (Project Coordinator)
Clinical Psychologist- 1
 
8,02,536 8,82,789 9,71,067
  Psychiatric Social Worker- 1

    14,76,924 16,24,615 17,87,075

  Staff Sub-Total 48,88,614

Vehicle +Field travel 50,000 1,50,000 1,50,000
Travel

  (@ approx. 250 project visits per year)      

    50,000 1,50,000 1,50,000

  Travel Sub-Total 3,50,000

Training material, manuals, posters, videos, printing costs 75,000 75,000 75,000
Consumables
Training Workshops for Service Providers 2,00,000 2,00,000 2,00,000
 

    2,75,000 2,75,000 2,75,000

  Consumables Sub-Total 8,25,000

Grand Total     60,63,614  

Progress: June 1st to July 4th 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.