Introduction and Background
Salaam Baalak Trust (SBT) has been working to protect the rights of children living in difficult circumstances for more than three decades. Placing the child’s interest first, SBT strives to provide a package of all-inclusive and quality services to children rescued from streets. These services comprise health, education, nutrition and vocational training. Given the hostile circumstances in which these children live, they often experience psychological trauma and violence which leaves them emotionally frail. Thus, mental health programme forms the pivot of SBT’s care and protection services. Running successfully for more than 18 years, SBT’s mental health programme is solely driven to help rescued children overcome their traumatic past and enable them live freely and happily in their present.
To set children on a path of holistic development, it is extremely critical to help them constructively get over the abuse, exploitation and trauma they face on streets and difficult circumstances. This transformation requires patience, perseverance, sensitivity and specialised skills to engage with children and help them express their suppressed pain and negative emotions and experience. To deliver these specialised services, SBT’s qualified and highly skilled mental health team works passionately and dedicatedly. The team under the leadership of Dr. Amit Sen (one of the leading psychiatrists in India) comprises a mental health coordinator and a team of trained counsellors. A counselor is posted at every centre of SBT to provide mental health services to children viz., counseling and individual and group therapies. SBT’s mental health programme is recognised as one of its kind given its child-centric nature and focus on professional and trained care.
The programme is continuously evolving to meet the ever changing needs of children in general and those rescued from difficult circumstances in particular. Laying thrust on equality, the mental health programme began providing services for inclusion of children with disabilities who are rescued from difficult circumstances. These children are extremely marginalised and highly vulnerable to abuse and exploitation. Thus, they face the double brunt of living in perilous situations and inability to raise their voice against violence and abuse being meted out to them. To this end, in the year 2015 the mental health programme expanded its scope by initiating Child Development Unit (CDU) to cater to the needs of children with neuro-developmental difficulties.The CDU is based at Aasra Children’s Home located in Najafgarh, Delhi. It adopts an integrative approach whereby the children (boys) with neurodevelopmental difficulties and in need of additional support are provided shelter along with care and protection services.
Key Objectives of CDU
CDU’s vision is to provide children with neuro-developmental difficulties a safe, nurturing environment. It also aims to protect these children from abuse and ensure early screening of their difficulties and provide timely intervention. CDU further attempts to provide 24x7 special care and emotional support to these children. The Unit operates on the ‘principle of equality and inclusion’ wherein children with mental disabilities live with typically developing children (those meeting age-appropriate development milestones) to foster peer interaction and learning. The key objectives of CDU are as follows.
1. To mainstream children with neuro-developmental difficulties and disorders by provision of inclusive services in Aasra Children’s Home.
2. To enable these children, learn basic activities of daily living (ADL) and communication skills to express and deal with their individual needs.
As indicated earlier, CDU caters to children with mild intellectual difficulties and other neuro-developmental difficulties. Due to limited resources, the CDU houses maximum of 10 boys below 13 years at any given point of time.
Key Activities and Processes
CDU Team: CDU team includes skilled developmental therapist, supervisor and three caretakers. The supervisor oversees the administrative work, while the therapist conducts a wide range of therapeutic sessions with the children and the care takers provide food and nutrition, health and other services to children. The CDU team specifically caretakers are trained at regular intervals to improve their work performance and efficiency.
Screening and Early Diagnosis: All children coming to Aasra Children’s Home are screened using a baseline assessment interview at the first point of contact and if mental health concerns are observed then a more comprehensive assessment is conducted. This assessment is carefully done by the counselor. This assessment is critical for early diagnosis and screening of children with neuro-developmental difficulties. Following this, a focused discussion is conducted with the psychiatrist to confirm the diagnosis and ascertain if the child matches the CDU admission criteria. Upon meeting the criteria, the child is admitted to the CDU.
Provision of Holistic Services: The key services provided to children enrolled in at the CDU for their holistic development are as follows.
Therapies: Most of the children at CDU need various therapies such as sensory integration, occupational therapy and speech therapy. These therapies are provided to the children through a well-known psychiatric organisation called Children First. SBT is making efforts to provide this service in-house by constituting an inter-disciplinary team. Steps are being taken to build the team’s capacities to deliver various kinds of therapies. Apart from the specialised therapies, regular therapeutic sessions are also conducted by the therapist.
Education: Pliable educational services are provided to children keeping in mind their existing knowledge, skills and intellectual capacities. Individual education plan is prepared for each child and adhered to. Play-way and joyful methods of teaching and learning are used. Each child is given individual attention to engage them in a meaningful learning process. The CDU childrenalso being provided special education.
Special care and emotional support: A number of services are provided to children by care takers and therapist on a continued basis. Caution is taken to meet children’s emotional needs adequately so that they adjust well in the Children’s Home. These children are under constant care and supervision.
Pharmacology: Many children who need medicines are provided the same as prescribed by the psychiatrist. Medicines along with therapies show tangible improvements in children within a short span of time.
ADL (Activity of daily Living) skills training: This is an important area of intervention with children. The therapist and care takers help children learn ADL skills to make the more self-reliant. While training when children pick up ADL skills, they feel a sense of confidence and independence and show improvement in many aspects of their life.
Occupational therapy: Children are provided occupational therapy at both Children First and Aasra. The therapy helps them actively participate in activities at children’s home and other social situations. It also instills a sense of independence among children and prepares them for learning other skills.
Speech therapy: To support children with speech impairment, speech therapy is also provided. This improves children’s communication skills. Various techniques are used to enhance their communication in a conventional way. Through speech therapy children learn to express themselves well.Key Challenges
Uncertainties and restrictions due to COVID-19: The global outbreak of COVID-19 has resulted in many restrictions and unprecedented changes on the lives of people. In these uncertain times, people across the world are grappling with mental health concerns. One of the worst affected groups include children and youth. The same is true for children with disabilities. They are experiencing the negative effects of lockdown as schools and therapy centres are closed. The children are confined to the CDU which has a huge impact on the education and learning needs of children with disabilities. While social distancing has been widely promoted as a key strategy to avoid transmission, but the same is not possible to strictly adhere for care takers for children with special needs who often require assistance for their daily tasks. In addition, while children may not be at a high risk of contracting COVID-19 those with disability may fall into the category of “high risk“ due to their pre-existing health conditions. During this pandemic, the centre psychologist (CDU Therapist) is also not able to visit centre to avoid transmission regularly. However, to stay connected and the centre psychologist is in regular touch with care giver and children.
Other challenges: Apart from above, the other challenges beingfaced by CDU include,
• Rehabilitation of CDU children is a big challenge as some of them are going to turn 16 soon.
• Lack of multidisciplinary team to meet the special needs of the children in context to different areas of development
• High attrition rate of CDU therapist
Stories of Change
D*15 years old came to the CDU two years ago from some other children’s home. The child was diagnosed with learning and intellectual disability. At that time the child was less active and was lacking social skills. While D was capable of self-care but was unable to express himself or needs. He had limited desire to engage socially or participate in social interaction and remain aloof. His speech abilities were present but he had limited vocabulary. The CDU team helped D to acclimatize to the environment of Aasra Home. D was then enrolled in Holy Heart Special School for his academic and intellectual development. He was simultaneously provided regular therapy sessions, special care and emotional support by the caretakers. These multifaceted efforts resulted in visible improvements in D. For instance D has now, started to speak with verbal prompts and his vocabulary has expanded. He also takes part in all activities of the Home with interest and enjoys all the group activities. It has been observed that with support of care taker now D also helps CDU team in daily activities of the Home. His cognitive functioning has also improved. The team now plans to continue these activities so that they can become more self-reliant and confident.