ORGANIZED BY Institute of Mental Health & Neuro Sciences, Kashmir - PowerPoint Presentation

1. ORGANIZED BYInstitute of Mental Health & Neuro Sciences, Kashmir Government Medical College, Srinagar Under the MHPSS Program of UNICEFProviding Mental Health Psycho Social Support to Children during Covid – 19 1CHILD GUIDANCE & WELL-BEING CENTER

2. The mental, emotional, social, and spiritual dimensions of healthIntroductionWhat is Psycho social wellbeing?

3. In children and adolescents, it is especially about the capacity to: 1. learn 2. enjoy friendships 3. meet challenges 4. and develop talents and capacities.3Psycho Social Wellbeing of Chilren and Adolescents

4. Stress is a NORMAL reaction to ABNORMAL situation. It is inner reaction to a particular event. It is the body’s way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina and alertness.Stress

5. In case of emergencies like Covid-19 pandemics various physical, Cognitive, emotional and behavioural symptoms that may lead to the emergence of various mental illnesses in child and adolescent population. Some of the major risk factors include:5When Psychosocial Health Deteriorates?Physical SymptomsCognitive SymptomsEmotional symptomsBehavioural symptomsRestlessnessNegative ThoughtsCrying/ClingingAggressionsFatigabilityTendency to be highly self criticalPoor self expressionIrritabilityBody AchesFeeling helpless when dealing with negative eventsDistressSocial withdrawalNauseaPoor decision makingFear/ WorryDrug AbuseChest DiscomfortPoor ConcentrationNervousnessSelf Harm

6. VentilationEmpathyActive Listening Enhancing Social SupportExternalization of InterestRelaxation/RecreationReferral to specialized careHow we can Help?6

7. 7Mental Health and Psycho social well-being of childrenduring COVID-19 pandemicUnderstanding emotional needs of children1. Children may express psychological distress (anxiety, sadness) by acting out in a different way - each child behaves differently. Some may become silent while other may feel and express anger and hyperactivity. Caregivers need to be patient with children and understand their emotions.2. All emotions are valid emotions, and as caregivers we need to understand them with empathy.

8. 83. Sometimes engaging in a creative interactive activity, such as playing and drawing can facilitate this process. Help children find positive ways to express disturbing feelings such as anger, fear and sadness.4. Keep regular routines and schedules as much as possible. 5. If children are witnessing violence at home, or if they are the target of the violence, it causes traumaand distress and may lead to disruptive behaviour.

9. 96. Explain to them that nobody should be stigmatized or signaled for having the disease.7. Avoid watching, reading, listening or discussing too much news about the COVID-19 and persuade children to divert their attention to other topics as well. 8. If someone is sick in the family/ child care institution and have been taken to hospital, or if there has been a death, children may experience added anxiety and may need specialized help.

10. 10Understanding emotional needs of most vulnerable children Vulnerable Children includeChildren in child care institution (CCIs) or without parental care• Street connected children• Children of migrant workers put into isolation facilities• Children in other NGO shelters etc.Children who are most vulnerable face more challenges and maytherefore need more care and attention. Some of these children do nothave strong support systems and emotional references. The fear andstress caused by COVID-19 may increase their sense of insecurity andcause even more serious mental health issues if not addressed in atimely manner.•

11. 11Helping Children deal with stressful eventsListen: Give children opportunities totalk about what they are feeling.Encourage them to share concernsand ask questionsComfort: Use simple tools tocomfort and calm children, for e.g.telling stories, singing with them andplaying games. Praise themfrequently for their strengths, such asshowing courage, compassion andhelpfulness• Reassure children that you areprepared to keep them safe. Providethem with correct in

12. 12Recognizing signs of psychological distress needingspecialized helpSome children may also face serious mental health issues due to ongoing pandemic. They may exhibit the following signs:• Difficulties in sleeping and eating• Nightmares• Being withdrawn or aggressive• Complain of pain in stomach or headache without physical reason• Having fears, being afraid to be left alone• Clinging, depending behaviours• New fears manifest (for instance fear of the dark)• Decreased interest in playing and engaging in playful activities• Being sad, crying more than usual or for no apparent reason

13. 13Tips for parents and caregivers to take care of both physical and emotional needs of children and how to talk to them about COVID 19Children need adults to help them understand what is going on.➢ Talk to children about what is happening in a way that they can understand.➢ Keep it simple and appropriate for each child’s age.Quality and positive parentingStructure their day (balance between studies and play)

14. Make sure you look after your own safety and wellbeing.Look for some support for yourself so you are better able to understand and help your child or adolescent.Remove the child and yourself as much as possible from the exposure of COVID 19 infectious places. Look for a quiet and settled place with other people around. Tell your child that they are safe (when this is the case), that you are with them and that you will look after them .14COVID-19Ways Parents And Care Givers Can Help

15. Try to avoid exposure to distressed people, other people’s conversations about their experience and media reporting of Covid-19 pandemics.Accept the child’s responses, reactions and feelings. Don’t tell them to ‘be good’ to ‘stop being silly’, or to ‘be brave’.Allow the child or adolescent to talk and say what needs to be said. Let them cry, but do not force them to talk. Calming and quiet conversation will help a child to settle and feel safe. Answer any questions factually, clearly and concisely without unnecessary detail. Reassure the child or adolescent that their reactions are normal and will pass in time .As soon as possible connect with something familiar - a person, a place, an object. Familiarity and routine help to establish and maintain recovery. 15Ways Parents And Care Givers Can Help

16. Emotional DisordersAnxiety DisordersDepressionBehavioural DisordersBed WettingCommon Psychological Issues Among Children16

17. Consistent or chronic inappropriate type of feelings under normal circumstances for a long period of time and to a marked degree that adversely affects the child.17Emotional Disorders

18. Fear, excessive worry, anger, irritability, difficulty concentrating, headacheLack of talk, no concentration18Anxiety Disorder

19. Irritability or anger difficulty concentrating Vocal outbursts or crying ,increased sensitivity to rejection Social withdrawal, changes in sleep & appetite 19Depression

20. Intermittent urinary incontinence during sleep.20Bed Wetting

21. When children cannot adjust to a complex environment change (COVID-19) around them, they may be unable to behave in the socially acceptable way resulting in exhibition of peculiar behaviours and those behaviours may be called as behavioural problems.Only when these behaviours are very severe and influence children's ability to perform daily activities (e.g. learning, playing) they may be defined as “behavioural issues”. During current situation if the parents who had difficulty in controlling impulses and emotionally rejecting parenting and even children are forced to stay home for longer periods due to current Pandemic can aggravate the behaviour issues in children. 21Behavioural Issues

22. Temper tantrumsAttention Deficits and Hyperactivity Defiant behaviourAggressive behaviour22Common Behavioural Problems

23. 23Management of Behavioural Problems in view of COVID-19Structuring the daily routinePhysical activitiesPositive reinforcementEncouragement Manage Stressors

24. Self-harm also known as Self injury, is defined as intentional, direct injuring of body tissue, done without the intent to commit suicide.Self-injury: Behaviours; it includes Carving, Scratching, Branding, Marking, Burning, Cutting, Biting, etc.Warning signs are; Unexplained, frequent injuries including cuts and bruises, Wearing of long pants/sleeves in warm weather, Low self-esteem, Overwhelmed by feelings, Inability to function at home, school or at work, Inability to maintain stable relationships.Self Harm24

25. Emotional reliefPhysical pain distracts from emotional painTo dissociate intolerable feelingsTo transfer emotional pain into physical painMeans of communicating distressMake internal wounds external (visible)Replicates earlier abuseCoping strategyWhy Self Harm?25

26. Seek professional help (addressing family/milieu risk factors) and for other psychotherapeutic interventionsSoothing/Stress-reliefDistraction techniquesReleasing emotionsRelaxation techniquesCoping Startegies for Self Harm26

27. Lockdown means sharing homes with abusers.Possibility of increase in the cases of INCEST during lockdown.Cases of CSA in institutions rise during these times.27Child Sexual Abuse and Covid-19

28. Understanding and Responding to CSAAsk only one question at a time.Wait for the child’s response.Resolution of confusionValidation of Fear & TraumaPersonal Safety EducationGuidance and Decision Making28Psychosocial Interventions

29. 29SIX T’s There are six T’s to providing support to those experiencing an emotional reaction to any crisis situation: Tears, Touch, Talk, Trust, Toil, and Time. • Tears – Let the client know that it is normal, helpful and OK to cry. • Touch – A gentle touch on the shoulder, hand, or a hug can be very supportive. It is generally a good idea to ask permission before touching. • Talk – Encourage the individual to talk about the experience, not only with you, but with family and friends, or support groups. Talking helps one put the incident in perspective so they can put it behind them. • Trust – You must build up a sense of trust between you and the individual. They need to know that what they share with you will be held confidential, and that you will be non-judgmental. • Toil – Be willing to work with the client. Don’t rush them. Give them the opportunity to work through their emotions and problems. • Time – It takes time to sit with a client. Let them talk, and let them know that the recovery process does take time

30. 30Acknowledge and normalize their feelings:Allow children to discuss their feelings and concerns Listen and empathize Let them know that their reactions are normal and expected.

31. 31Emphasize children’s resiliency:Focus on their competencies Help children identify what they have done in the past that helped them cope when they were frightened or upset

32. 32Strengthen children’s friendship and peer support: Children’s relationships with peers can provide suggestions for how to cope and can help decrease isolation Activities such as asking children to work cooperatively in small groups can help children strengthen supportive relationships with their peers.

33. 33Encourage children to talk about disaster/stress-related events:Children need an opportunity to discuss their experiences in a safe, accepting environment Activities that enable children to discuss their experiences may include a range of methods drawingstories

34. 34What is PSYCHO-EDUCATION?Psycho education is a behavioural therapeutic concept which consists of ;Briefing and educating the patients or caretakers about their illnessProblem solving trainingCommunication trainingSelf-assertiveness training,

35. 35Psycho-Education can be targeted atIndividualFamily GroupCommunity level

36. 36Importance of Psycho educationDevelopment of good therapeutic relationship De-stigmatization of mental health conditions Ensuring patients and their relatives’ attainment of basic competence.Facilitating an informed and self-responsible handling of the illnessDeepening the patients' role as an “expert”“Co-therapists”—strengthening the role of relatives and caretakers.Improving insight into illness and improvement of compliancePromoting relapse preventionEngaging in crisis management and suicide preventionSupporting healthy componentsStimulation of hope and reassurance

37. What to Do When Children continue to be Severely Distressed: Referral to Specialized ServicesWhat Can I Do When Children Continue to be Severely Distressed?The level and causes of distress in some children are such that they won't go away no matter how much psychosocial support and what responses schools and teachers can give.If children continue to show a high level of distress after you have tried all of the things suggested here, discuss the situation with the child’s family. Ask for their permission to refer the child to services that specialize in helping children in distress.37 Referral

38. 38Confirm the status of established referral pathways for patients (children) with mental health conditions and that all responding to the outbreak are aware of and use such system(s) if/when needed.Reach to helpline number for referral of children and also in case of a worker who needs help.IMHANS HELPLINE NO: 9419083109

39. 39Self and Team CareDuring a crisis such as the COVID-19 pandemic, it is common for everyone to experience increased levels of distress and anxiety, particularly as a result of social isolation.Feel free to feel your feelings*Intentionally employ coping strategies**Take breaks from the news and social media***Maintain a routine of physical exercises at home****

40. 40It is best for helpers to be connected with an agency or group to ensure safety and good coordination.Check in with fellow helpers to see how they are doing, and have them check in with you.When your helping role in the crisis is over, be sure to take time for rest and reflection.  Talk about your experience with a supervisor, colleague or someone else you trust. Eat Healthy Food.

41. .41Be in Contact with Us @cnc_imhanskashmirChild Nodal Center-IMHANS @CNC_IMHANScnc.imhans@gmail.com