The Department provides all modern forms of psychiatric treatment including medication, electroconvulsive therapy, and a broad range of psychosocial interventions for individual patients and group. The department has three adult psychiatry units and a unit for child and adolescent psychiatry which also takes care of children with neurodevelopmental disorders.
Services of the Child and Adolescent Psychiatry Unit
1. EMOTIONAL AND BEHAVIORAL DISORDER SERVICES
2. NEURODEVELOPMENTAL DISORDER SERVICES
3. OTHER SERVICES
We offer different intensive evaluation and treatment programs at our Center. Our services use a family-centered model to develop a plan of care that is unique to the individual needs of our patients. Other pediatric subspecialists within Christian Medical College and Hospital are available, and liaison done as needed.
Services in Child and Adolescent Psychiatry Unit, MHC, Bagayam
EMOTIONAL AND BEHAVIORAL DISORDER SERVICES
Services are available for patients both on Inpatient and Out Patient basis. Acute care or emergency services are also available.
Out Patient Services:
New Case/ Initial Assessment OPD: New case are seen on 3 days of the week (Monday, Wednesday and Saturday) between 8.00 am and 11.00 am, for initial psychiatric evaluation and management accordingly.
Review OPD: Old cases are reviewed on Monday and Wednesday afternoons. In Review OPD, patients are reviewed by a Psychiatrist/ Psychologist and / or Occupational therapist as per patient’s requirements. Parents are allowed to discuss their difficulties and supported.
Psychological and Psychiatric Assessments: Various standard assessments are available and are done as per the requirements of patient as indicated in initial psychiatric evaluation or review OPD.
Psychotherapy: Psychotherapy sessions which include cognitive behavioral therapy, behavioral therapy, family therapy, and other standard therapies are available, and are provided as per the requirement for the patient.
Inpatient Services:
The unit has 12 inpatient beds for children and adolescents with emotional and behavior disorders. It is an open ward where patient is advised to stay with family members during the period of stay. The average length of stay is between three to eight weeks depending upon the diagnosis. This service is suggested for patients who need more intensive treatment. It provides a caring, safe and supportive environment for both the patient and the family. It focuses on rapid assessment and stabilization of patients in crisis. Each treatment plan is tailored to individual requirements. Management includes pharmacological intervention, psychotherapy sessions, occupational therapy services and nursing services.
Grand rounds are taken twice a week on Tuesdays and Thursdays, and there is a clinical case conference on Fridays when all the cases are presented and discussed in detail in the presence of the multidisciplinary team members taking care of the child.
Emergency Services (Acute Care Services):
This service is available 24 hours throughout the year. It is available for patient who need acute or crisis situation for both new and old patients. It includes initial evaluation and management. The management can be done as an outpatient or by admitting in Acute Care Room. Once the crisis situation is managed, further management can be done as for regular patient, who may be either managed as an outpatient or admitted in inpatient ward. All management options available are discussed with parents/ guardians.
Psychological Services:
Children and Adolescents presenting with various childhood psychiatric disorders are evaluated extensively through clinical interviews and assessments. Both outpatient and inpatient care are available.
Specific services provided:
Psychological assessments for diagnostic and therapeutic purposes/Structured interviews and rating scales for specific clinical disorders.
Intellectual and Developmental assessments /Behavioral assessments /Academic assessments Neuropsychological assessments and Personality assessments.
Specific assessments batteries for Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder & Specific Learning Disorder
Psychotherapy –Behavior therapy, Cognitive therapies, family intervention & family therapy, Parent counseling, Intervention for SLD, Stress management, Management of Suicidal behaviors
School liaison- The team liaise with school when required for the benefit of the child or adolescent.
Occupational Therapy Services:
Occupational therapy occurs within the context of the multidisciplinary team in Child & Adolescent psychiatry unit. Occupational therapy services are offered to clients based on individualized need. Occupational therapy uses an activity- based approach to highlight areas of strength & engage the client in functional and age appropriate tasks that increase independence in social skills, self-care, leisure activities, coping skills, cognitive skills, academic performance skills & group skills.
The objectives include:
Augmentation of therapeutic efforts by providing opportunities for the expression or sublimation of emotional needs and drive.
Provision of opportunities for assisting in diagnosis.
Concerned with enabling function, wellbeing and basic fulfillment of their roles.
Addressing challenges or difficulties that threaten or impair patient’s ability to perform activities.
Occupational therapy functions regular from Monday to Saturday between 8:00am – 5:00pm both for inpatients and outpatients. Weekly goals are set in the multidisciplinary team and gains reviewed. Occupational therapist also works with the primary caregivers and if necessary other family members to develop strategies in managing their child’s difficult behavior and empowers them to express self appropriately.
NEURODEVELOPMENTAL DISORDER SERVICES:
The Neurodevelopmental Disorder unit (also known as Nambikkai Nilayam), is a facility for children with intellectual disability which was started in 1978 and has been the part of the Child and Adolescent Psychiatry unit since 1998, serving children with neurodevelopmental disorders. The emphasis of treatment is on caring for children with intellectual disability and other neurodevelopmental disorders, with multiple medical and psychiatric co-morbidities, with the emphasis on involving the parents and family members through education and therapeutic involvement. Based on their cognitive, communicative and adaptive functions, outpatient follow up and/or a 12- week parent training intervention as day care or inpatient is provided in either of the following programs:
The services are provided with input from the members of a multidisciplinary team of experienced Psychiatrists, Clinical Psychologists, Rehabilitation Psychologists, Occupational therapists, Speech therapists, Special Educators and nurses. Services are available for both inpatients and outpatients
The therapy suites for the 12- week intervention, have groups of a limited number of patients per session. Individualized assessments and goals are given for each child, along with sessions of group activities and parent education. The interventions work on the principle of involving the primary care giver as the co-therapist in the care of their special child.
Out Patient Services:
These services are provided on OPD basis. It includes:New Case/ Initial Assessment OPD: New case are seen on 3 days of the week (Monday, Wednesday and Saturday), in the mornings, for comprehensive initial psychiatric and psychological evaluation. After initial evaluation by a Psychiatrist and a Psychologist, an individualized plan is made for the child. Further management may include:
Pharmacological intervention: Depending upon the indication, or comorbid psychiatric illness.
Psychological assessments: Developmental / Intellectual and adaptive functioning assessments are carried out. Other specific assessments based on comorbid conditions like ADHD, Autism, behavioral problems and other psychiatric conditions may also be done.
Speech assessment: Can be done if required.
Referral: Referral to other pediatric subspecialties like Pediatric Neurology, Child Health, ENT, Ophthalmology, Medical genetics, and PMR is given if indicated.
Investigations: Required blood investigation, EEG and imaging like MRI and CT may be done.
Psycho-education: Parents are psychoeducated and there queries are answered, along with management plan and options discussion in context to the diagnosis of the child.
Home Program: Individualized home program is given to every child based on the initial assessment.
Review OPD: Old cases are reviewed on Monday and Wednesday afternoon. In Review OPD, patient is reviewed by a Psychiatrist followed by review in the respective therapy classes. Patient is reviewed for progress made and further home program goals are given. Parents are allowed to discuss their difficulties and supported.
Speech Therapy: Include initial assessments are done for patients when needed and accordingly home programs are given. Patients are reviewed regularly, their progress is assessed and further goals are given.
3 month day-care program: A 12 week day care program is available for local patients who reside within a 50 km radius of the hospital and is provided on a wait list basis.
Inpatient Services:
The inpatient services include 24 rooms in an open ward where the child stays with family and attends the intervention program. The child is allocated to one of the four intervention programs depending upon the needs and adaptive age. The intervention is a 12 week parent mediated therapeutic training program. Each program has a therapy team which includes Psychiatrist, Psychologist, Special educator, Occupational therapist, and Speech therapist. Other pediatric subspecialists within Christian Medical College and Hospital are available as needed and coordinated.
After initial assessment of child, if eligible for intervention the child will be waitlisted for our Inpatient program
In general, each program has the following steps:
Initial Assessments: The required assessments will be completed within 15 to 20 days from the date of admission. The nature of the assessment and the scoring is explained to the parent.
Therapy: After initial assessment the child undergoes an extensive therapy along with training to parents/guardians.
Discharge: Just before the discharge a reassessment of child is done along with parents and a home program is given.
Post Discharge: Child is advised follow up and reviewed in the Review OPD and Therapy room.
As part of the 12 weeks program, sessions for parents on various topics related to understanding the various disability conditions, special education and behavior modification strategies are conducted twice a week. This training is presented by expert trainers including psychiatrist, psychologist, special educator, speech and occupational therapist. It’s a great platform for parents to have an insight on the holistic approach to their child with special need.
By the end of 12 weeks parents gain confidence and are empowered to train their children.
Specific psychological services provided:
Autism Suite intervention (ASI):
This particular program caters to children with Autism (with or without co-morbidity of intellectual disability). Developmental and behavioural approaches are primarily used for intervention
Initial Assessments include various standard tests available for:
Diagnostic confirmation.
Rating the severity of symptoms of autism in the child.
Planning an individualized educational program for children with Autism.
Listing out and rating the problem behaviors in the children
Profiling of sensory processing
After initial assessment child undergoes an extensive therapy along with training to parents/guardians. Before the discharge a reassessment of child is done by therapists along with parents to see the improvements made and also to plan a home program. Post discharge, the child is reviewed in the Review OPD and Therapy room.
Infant Stimulation Programme (ISP):
This particular programme caters to children with Developmental Delay with a mental age less than 2 years (with or without co-morbidity of physical disability). Developmental and behavioural approaches are primarily used for intervention.
Apart from the treating therapy team, consultation by Paediatric Neurology and Physical Medicine Rehabilitation will be done for children with neurological and physical disabilities.
Initial Assessments include various standard tests available for:
Diagnostic confirmation.
Rating the severity of symptoms of autism in the child.
Planning an individualized educational program for children with Autism.
Listing out and rating the problem behaviors in the children
Profiling of sensory processing.
After initial assessment the child undergoes an extensive therapy along with training to parents/guardians. Before the discharge a reassessment of child is done by therapists along with parents to see the improvements made and also to plan a home program. Post- discharge, the child is reviewed in the Review OPD and Therapy room.
Early Intervention Programme
Early Intervention Program provides services to children with intellectual disabilities and associated other neurodevelopmental disorders like Autism and Attention Deficit Hyperactivity Disorder, functioning between 2 to 5 years of adaptive age.
The primary therapist will assess the child’s current level in the presence of the parents and an individualized intervention program is made based on the need and level of the child. The parents will be educated on the strategies to improve the skill behaviours and decreasing the problem behaviours. Weekly evaluation of the progress will be reviewed with parents. Apart from this, group sessions for the parents will be conducted to help them understand their child and to implement the behavioral and teaching strategies. Experience in working as a team creates an opportunity for the parents to join hands and work with our experts for the welfare of the child with special needs and their family.
At the time of discharge, educational options for children at school age level are provided. Facilitation for availing government benefits and educational guidance are also done. Subsequent follow up is done in the review OPD and therapy room.
Advanced Intervention Programme
Advanced Intervention Program provides special services to children with special needs who are functioning 5 years and above of adaptive age.
Emphasizing that “parents are the first and best teachers for children with special need”, we impart a holistic approach to strengthening families.
Therapists with expertise in rehabilitation and special education impart 12 weeks training to the parents. The 12 week training includes diagnostic and special education assessments, equipping parents on the special education and behavior management strategies to improve adaptive behaviors and to decrease maladaptive behaviors.
The intervention program is individualized based on the need and level of the child. Weekly evaluation is done to review the progress of the child.
Apart from the individualized program, group sessions are conducted to improve the social, communication and occupational skills.
Parents are educated on the welfare schemes available for persons with disabilities and referrals are made to avail government benefits.
At the time of discharge the facilitation for educational options for children at school age level and vocational guidance at pre-vocational level will be given, with further outpatient follow up.
Speech Therapy services:
Services rendered by the speech therapist are:
Detailed speech and language assessment for children with the diagnosis of Autism, Intellectual Disability, Stuttering, Articulatory Disorders, Cerebral Palsy, Attention Deficit Hyperactivity Disorder, Multiple Disabilities and other neurodevelopmental disorders.
Speech therapy sessions for inpatients and outpatients either in individual sessions or in a group.
Parental sessions to empower them with speech- related goal setting: group and individual
OPD reviews on every Mondays and Wednesdays between 2 to 5 pm
Regular follow up
Nursing Services:
The Nursing team of the Child and Adolescent Psychiatry unit works in collaboration with the other members of unit in meeting the needs of the children and families admitted within the unit. Currently the nursing team consists of a Nurse Manager, Ward-incharge, Nurse Coordinator and 9 Staff Nurses, each with specific roles and responsibilities. The nursing team is available 24hrs to ensure holistic and quality care to the children with Psychiatric and Neurodevelopmental disorders as well as to cater to their families.
OTHER SERVICES
Consultation-liaison OPD:
A child and adolescent consultation-liaison service is also provided in the CMC main hospital campus, Vellore town on Tuesday and Friday afternoons. The team also sees inpatient psychiatry consults requested by other pediatric specialties on a regular basis.
Infant Mother Nurture Clinic
Infant Mental Health represents the social and emotional wellbeing of infants, toddlers and their families, or those who share responsibility for their care and nurturing. Comprehensive, integrated perinatal and infant mental health services requirement comes from extensive finding in research. This is an interdisciplinary field and embraces the importance of promoting positive development within a relational context and understanding how to best support it across service systems and disciplines.
The Infant Mental Health Clinic is conducted every week Tuesday afternoon, 2- 4pm in Child and Adolescent Psychiatry liaison OPD, CMC main Hospital Campus, Vellore town.
Parents can bring infants and toddlers upto 5 years of age with emotional, behavioral, relationship, attachment and regulatory difficulties. They can also consult our specialists when they are facing emotional difficulties and having parenting challenges related to the child.
At this point parents are provided with psycho-education regarding normal infant and toddler behaviors. If there are problems identified then the infant mother dyad is referred to Child and Adolescent Psychiatry department, Mental Health Centre, Bagayam for further management. Here structured assessments are done for the same, and the parents are encouraged to attend structured sessions over 8 weeks, highlighting on child and parental needs.
Electro Convulsive Therapy:
Our center strictly follows the provisions laid down in the Mental Healthcare Act, 2017 regarding ECT for Children and Adolescents
Lab facilities:
Sample collection lab is available from in Room 118 from 8:00 am to 11:00 am on all on all days except Sunday. Blood is collected for routine blood investigations and drug serum levels on the request of the treating team. The investigations are processed at our standard labs at CMCH, Vellore.
Workshops and Conferences:
Our team participates and also conducts various workshops in our center, communities and schools. They are focused on school mental health, teacher education programs, and parent’s awareness programs. Team members also have active participation in national and international conferences.
Government related Services:
Our team is involved in consultation work with Juvenile Justice Board, Vellore District. The team is a part of an integrated work group for child sexual abuse for the POCSO implementation. The unit also participates in various awareness programs promoted by Government agencies for the welfare of children and adolescents. Part of our work also involves educating parents about various Government schemes and benefits available.
