Mainstreaming

HOLISTIC PSYCHO-EDUCATIONAL INTERVENTION FOR CHILDREN IN MAINSTREAM SCHOOLS

Dr. Praful Barvalia –Hon. Director & Founder Trustee M.B Barvalia Foundation’s Spandan Holistic Institute-Mumbai

 (M.B.Barvalia foundation’s Spandan Holistic Child Care Centre  Mumbai was inaugurated in 1998 to promote a healthy childhood for all the children irrelevant to their race, caste and religion. It was founded by Dr. Praful Barvalia, a consultant homeopath. Since its inception, Spandan has done quality work in the area of Mental health & developmental disability especially Autism, Learning Disability and various neuro-developmental problems. It operates through a sound conceptual framework: spandan’s symphony- The holistic psycho-educational approach. (Link:www.spandan.co)

1. INTRODUCTION:

Every child has divine potential. Many times various factors work as obstacles and do not allow the child to achieve his potential. Obstacles could be due to emotional difficulties, serious behavioural dysfunctions or problems of perceptions.

21st Century has witnessed tremendous turmoil among children & teenagers leading to violence at one extreme to suicidal impulse at other. Roots of the behaviour lie in the elements of psychopathology in the early formative age. At times they exist with learning disorders in school children or independent of it, Incidences are more widespread in urban settings. WHO has indicated that by 2020 childhood  Neuropsychiatric disorders will raise proportionately by 50% to become one of the five most common cause of morbidity, mortality and disability among children. Abhishek Tyagi’s murder at Gurgaon and Gaurang Dalvi’s suicide in Mumbai are great examples of what is happening to Indian Teenagers.

Our schools have paid little attention to these emerging trends. Our state has hardly conducted any significant survey to undertake an epidemiological study to identify systematically incidence of mental health dysfunctions and learning disorders among mainstream school children

Current settings of the mainstream schools do not allow caretakers to handle these issues and child suffers. Eventually, it is THE SOCIETY, which suffers.

Ever since the inception of our foundation, we have carried out a series of camps in the community as well as in schools, which has proved beyond doubt that almost 9-10% children belong to this category. In many instances, they are never identified or discovered quite late & when found there are no remedial measures. Foundation’s holistic child care centre took up this challenge and decided to embark a project of holistic intervention in the mainstream school.

In the last 10 years, we have covered many schools run by trusts, BMC schools and schools in slum areas of Ghatkopar, Chembur, Shivaji Nagar, Govandi and Deonar.

Some of the prominent schools intervened were Rashtriya shala, Gurukul, Kumud Vidya Mandir, Al Mehndi Urdu High school, BMC School No.3 in Pant Nagar, BMC School in Ramabai Nagar located in ‘N’ ward of Mumbai Municipal Corporation.

The Ahmedabad chapter of Spandan,  keeping in tune with the Mumbai Vision also launched its first project at a mass level in the city of Ahmedabad in  Ahmedabad Municipal’s Naranpura School No.4.

Early identification and intervention have been one of the most crucial aspects of Spandan Holistic Child Care Centre. With this objective, our dynamic multidisciplinary team has taken up camps in mainstream schools on a regular basis. In each of these schools, a multidisciplinary team of Homoeopathic doctor,  psychologist, occupational therapist, counsellor and social worker examined children. The objective was to trace problems of learning disability, behaviour problems, emotional disturbances, neurological and other developmental disorders etc; basically an entire spectrum of neurological and developmental disabilities and mental health disorders.

OUR TEAM

Project was conceived and implemented by Dr. Praful Barvalia M.D (Hom)

Chief Coordinator: Dr. Piyush Oza (Homoeopath)

Following Homoeopathic Physicians participated:

Dr. Amit Daftary M.D

Dr. Poornima Patil B.H.M.S

Dr. Vijaya Patil M.D

Dr. Vaishali Joshi  

Dr. Chhaya Laddha

Dr. Seema Rangparia

Dr. Munjal Thacker

Dr. Hardik Khammar.

Psychologist: Miss Vinita Agarwal

Mrs. Tina Timbadia

Mrs. Purnima

Occupational Therapist: Mr. Dilip Kurani

  Ms. Gauri Sali

Special Educator: Mrs. Ajanta Iyer, Kirti Shah, Anjali 

Social Worker : Mr. Thomas Varghese

Following other specialists were consulted in specific cases of organic/complex dimension.

Neurosurgeon

Orthopaedic Surgeon

Psychiatrist

1. OUR OBJECTIVES:
2. Early identification of mainstream school children with a developmental disability and mental health dysfunction.
3. Carrying out the evaluation of these children and working out modalities for their counselling and educational inputs.
4. To access the pattern of manifestation of mental health dysfunction particularly related to stress and behaviour in mainstream school children
5. To carry out Homoeopathic intervention in above-mentioned disorders of school children.

AIMS AND OBJECTIVES FOR THE INTERVENTION

I  FOR CHILDREN

1. To enhance self-confidence and self-esteem
2. To identify evidence of behaviour disorders like ADHD, conduct disorders;       Learning disability, dyslexia, dysgraphia, dyscalculia, slow learners and handle them through Homoeopathic treatment.
3. To understand the difficulties faced by young teenagers with respect to interpersonal relationships and sexuality.

II  FOR TEACHERS AND CARETAKERS

1. To understand teacher’s perception of difficulties of children with mental health dysfunction and learning problem.
2. Orient teachers about special needs of these children and making them aware of the resource required to meet these demands.
3. Making teachers aware of the role of Homoeopathic Therapeutics, Yoga in the management of these children.

III FOR PARENTS

1. Orient parents about the special needs of the children with the above mentioned difficulties
2. Provide them counselling 
3. Give awareness about Homoeopathic science and its role in dealing with these issues.

III. STRATEGIES ADOPTED WERE AS FOLLOWS.

Project was conducted in different phases

PHASE -1 ORIENTATION

• The primary section was the target group for 5 schools. While in 2 other schools we had worked with secondary sections too.
• Initially, a workshop was taken up for the teachers to create awareness about disability, mental health and Homoeopathic science.
• Meeting with parents group organized with the help of  PTA(Parents Teachers Association)

PHASE-II SCREENING

• Teachers were given a simple questionnaire to create the first filter.
• This was jointly filled up by the class teacher and individual parent.
• Homoeopathic doctors carried out the screening of the children as per screening sheets
• Affected children’s list was evolved.

PHASE -III PSYCHOMETRY

• Each child was evaluated by the clinical psychologist by various psychological tests like N.V.T.I/SFB and D.T.L.D. Their IQ and SQ were evaluated, as well as the educational assessment carried out.
• Students were classified as under

1. LEARNING DISORDERS

(i) Learning Disability: Single or Compound.

     Further classification with subtypes Dyslexia, Dysgraphia and Dyscalculia.

     Also examined from the standpoint of DSM IV.

LEARNING DISORDERS(46)

Reading Disorder(48)

Mathematics Disorder(50)

Disorder of Written Expression(51)

Learning Disorder N.O.S(53)

(ii) Slow learners

(iii) Visuo motor difficulties

(iv) Mild Mental Retardation

1. COMORBIDITY/ MENTAL HEALTH DYSFUNCTIONS.

     Associated with L.D or independent

1. Behavioural disorders: ADHD, ADD, Conduct disorders etc.
2. Autism Spectrum Disorders/Autistic traits
3. Mood disorders/ Emotional disorders like- Anxiety neurosis, Phobia, O.C.D etc

 

PHASE-IV HOMOEOPATHIC OPERATION

• Homoeopathy is a healing science, which believes in individual as a whole and not as a part.
• Subsequently, the camp was organized by the entire team to examine the problem in detail.
• A detailed history was taken up on special case record and children were motivated to take Homoeopathic medications.
• After a detailed assessment, parents of children who were found to fall under the problem areas were motivated to continue the treatment programme designed by the team. This was done with the help of the class teacher and principal of the school. Parents were given relevant educational materials.

PHASE-V PARENTS & TEACHERS SEMINAR

• Parents were given orientation about the mental health problems, Homoeopathic science and its role in child care. Conducted workshop for teachers about learning disability and behavior problems of the children from the standard point of management.
• Homoeopathic doctors, as well as educators and therapist, conducted seminars/workshop for teachers about ongoing holistic management of special children in mainstream schools.

PHASE-VI PSYCHO-EDUCATIONAL INPUTS

• Our team oriented and guided parents and school management/teachers about carrying out a detailed assessment of children and requirement of relevant therapies like psychological/occupational and remedial education.
• Some children were motivated to visit our centre for S.I therapy.
• It would have been better to create an O.T centre in mainstream schools.

PHASE-VII HOLISTIC HEALING THROUGH HOMOEOPATHY

Cases which continued for more than 6 months were studied to find out changes at the following level.

1. PERCEPTION: As evident through improvement in reading, writing and calculations
2. BEHAVIOUR: Changes in attention span, frequency of tantrums, aggression and easy distractibility.
3. Sensitivity and reactions to sensory inputs.
4. Motor Pattern.

OVERALL CHANGES IN SCHOLASTIC PERFORMANCE, BEHAVIOUR AND CHARACTER WERE STUDIED UTILIZING

1. 1. Remedy Response Comprehension Form
   2. Psychometric tools-Relevant  SCALES
   3. Feedbacks through parents and teachers
   4. Results/mark sheets

In Two BMC schools, we collaborated with MUSKAAN; TISS (Tata Institute of Social Sciences) in coordination with the multidisciplinary team of Spandan, social workers from TISS conducted individual and group session with the students. These sessions were focused on value education and personality development, building up self esteem etc. This session were thoroughly planned after a detailed need assessment based on inputs from teachers, parents and observing the children.

FINDINGS

It was of great significance to  find at least 1 out of 10 children studying in mainstream school had some kind of neurological, developmental and/ or mental health disabilities.

Many children with the following conditions were diagnosed during the camp.

Educational: Learning disability, slow learners.

Genetic: Down syndrome

Mental Health:- Nocturnal enuresis, to more serious problems like mood disorders, conduct disorders such as stealing, running away from home etc.

Neurological: – Epilepsy; cerebral palsy

Sr. No	Name of the school	Address	Std.	Total no. of children screened	No of children with disability & mental health issues
1	S.VD.D English Medium School	Hingwala Lane Ghatkopar(E) Mumbai-77	V,VII (div.A&B)	496	22
2	Gurukul School	Tilak Rd,  Ghatkopar(E) Mumbai-77	I to IV (div, A&B)	1236	132
3	BMC school no.3	Pant Nagar Ghatkopar(E) Mumbai-75	II-V (div.A&B)	500	104
4	Kumud Vidya Mandir	Govandi(E) Mumbai	III &IV (div.A&B)	350	47
5	Al Mehdi Urdu High School	Shivagi Nagar Mumbai-	IV & V (div.A&B)	100	20
6	Ramabai Nagar BMC School 1&2	Ramabai Ambedkar Nagar Ghatkopar(E) Mumbai-75	IV & V	200	40
7	Municipal School No.4	Naranpura  Ahmedabad	III & IV	173	33

 

Six schools were from Maharashtra State and one school was from Gujarat State

Follow up analysis of school no 3, 4,5 & 6 was carried out. Out of 1150 students screened, total 211 students were found affected. They followed up for more than 9 months in the years 2004-20005-20006

Sr. No	CLINICAL CONDITION	NO. OF STUDENTS
I
1	L.D/ Slow Learners	146
2	Mild  mental retardation	16
3	Visuo motor difficulties	06
	Total	168
II
1	Behavioural Disorders ADHD/ Conduct disorders	156
2	Mood disorder	42
3	Autism spectrum disorder	13
	Total	211

A 14 year male was not performing in school and our team evaluated him, we diagnosed him to be suffering from depression. He also had suicidal thoughts. Parents were called and regular counseling sessions were taken for the child and the family. Teachers and principal were explained about the child’s condition & were oriented about ways to handle him. He improved with Homoeopathy & counselling.

 

Another 9 year old student from one of the reputed schools was just refusing to attend school. On detailed inquiry, our team found out that he was very disturbed after a teacher told him that he “looked like a monkey “ and the whole class ridiculed him. Since that day he refused to attend School.

 

One more child was ridiculed by a teacher for having migraine, He was told that he would be hence called “Migraine boy” & that his entire family needed to visit a psychiatrists. He simply refused to attend school, because socially withdrawn and become extremely violent at home. When he was brought to us during the camp, mother told that she was unable to manage him at home.

 

Many such children were in extremely disturbed states and needed urgent help. Left alone, he would have soon perished and the damage would have been irreparable.

 

Teachers and school authority were taken into confidence .Workshops and group sessions were conducted to understand teacher’s issues and were dealt with by improving them with knowledge and skill required to handle such children.

Teachers were assured that our team would be at their back & call whenever they needed help. A positive response boosted their enthusiasm as they felt more in control of the situation. 

Parents and teachers were oriented about the system of Homoeopathy through our meetings, audio visual presentations, charts, exhibitions etc.

 

Restoring the lost smile and the full bloom required a sensitive and healing touch. It indeed brought them back to life and we could restore many into the mainstream with a healthier sensitivity, positive attitude and a receptive environment.

 

1. OUTCOME

 

Sr.No	Disabiliity	Total Students	Improvement as demonstrated by DTLD/ Psychologist evaluation
1	Learning Disability/Slow Learner	146	105
2	Visuo-motor difficulties	06	04
3	Behavioural Disorders(ADHD /CONDUCT DISORDER)	156	125
4	Mood Disorders	42	30

Out of 16 children with mild mental retardation 10 children improved with respect behavioural problems, attention span, self confidence and self esteem. But their cognitive levels did not show any significant change in the period of study. They were suggested to attend special school after discussion with parents and school authorities.

 

Children with Autism were treated with Homoeopathy and they were motivated to visit our centre for sensory integration therapy and special education back up.

Shown significant improvement at the level of behaviour Autistic features and speech.

 

All students, parents, teachers and school authorities were oriented about the role of the Homoeopathy in general conditions, paediatric clinical conditions as well as in the area of disability and mental health. 

 

Through workshops for teachers and parents, exhibitions and charts, role of Homoeopathy could be highlighted. Target population got greater awareness about system of Homoeopathy and how it works in coordination with other system.

There was greater sensitization in the teachers towards the affected students. Teachers could realize that through this positive attitude and by showing sensitivity, the children would definitely improve.

The fact that they received support from our team gave them a lot confidence. Many teachers started personally bringing the children whom they found had psycho-educational difficulties and took personal interest in their follow up. They started coordinating well with our managing team.

 

Children requiring opinion from experts were taken up in our multidisciplinary PANEL meetings where they were examined by our Neurologist, Pediatric Orthopaedic surgeon, Paediatrician etc. Through their expert opinion and coordination, we were able to effectively manage various complicated conditions like epilepsy, cerebral palsy etc. we could also diagnose certain rare conditions like Morquio’s disease, Nesideoblastosis etc. 

 

 Number of children was helped with scientific early diagnosis and holistic intervention.

Greater awareness in parents and teachers about disability as well as greater sensitivity towards problem child.

Children from slums were provided with medicine and relevant therapies in the Mobile Van itself.

This resulted in greater alertness on the part of school authorities to pick up problems right at the time of admission and readmission at the beginning of the academic year. Children who did not do well in exams were also referred to Spandan.

 

Spandan Holistic Child Care became a guiding force and referral centre for disability, thus helping number of children with disability.

 

Over last 10 years, number of children from 1st to 6th std. was evaluated by multidisciplinary team of Foundation free of charge and holistic intervention was carried out.

What does Homoeopathic science offer in the management of LD?

 

Swapnil 11 years old child was referred to us by Remedial Teacher, since he was not doing well, in spite of all the best efforts by Occupational therapist, remedial teacher as well as school teacher. Chief complaint was very poor scholastic performance in spite of 110 IQ. He was extremely poor in English and had difficulties in reading as well as writing. He will read words ‘GOD’ instead of ‘DOG’.

 

He was extremely clumpy and awkward. He will drop things from hand, cannot hold them properly. While running at times, he will bang his head with the hands. He gives very poor peace of writing. Words are jumbled up together and innumerable mistakes in writing

 

• Text is in past tense, reads in present tense.
• Mispronounces the words 
• Makes on stories from illustration rather read.

• Reverses letter ‘b’ for ‘d’ inverts letter ‘n’ for ‘u’.
• Spells words as the sound ‘bizzy’ for ‘busy’

 

All these were indications of learning disability. 

 

His personality also indicated various peculiarities. He is extremely irritable and will become at times quite violent. Once he showed impulsive act under the spell of rage and contradiction. He became so impulsive and chopped off his own eyebrows with a knife. He was extremely emotional and he had profound grief after grandfather’s death with whom he was quite attached. He came down with depressed mood for a long period of time. 

 

Based on this understanding, Swapnil was prescribed Natrum Mur, which brought about a significant relief in following points:

1. His attention span, concentration improved in six months time. 
2. His irritability and impulsivity substantially reduced and now he is calm and can cope up with stress as well as a contradiction with patience.
3. After six months, he could see a distinct change in writing skills and reading skills. 
4. Remedial teachers and therapist acknowledged distinct positive role, which Homoeopathy has played in improving this child, is scholastic performance. 

Homoeopathic science lays a lot of emphasis on ‘individualistic patterns’ and not merely the diagnosis. 

Homoeopathic literature provides rich material describing graphically various characteristic features, which we relate to a learning disorder. e.g. 

• Omits final letter when writing (Lac. Can – Herring page 515) 
• Uses wrong syllables, mixes up letters and syllables or omits parts of words (Herring page 91)
• While writing transposing letters: China, Lyco, (Kent Rep. Page 67)
• Mistakes reading (Kent Rep. Page 66)
• Mistakes writing (Kent Rep. Page 67) 

 

A systematic study of such characteristic individualistic patterns of LD allows us to select an appropriate homoeopathic remedy. Problems of LD cannot be cured, but rational homoeopathic therapeutics can definitely bring about amelioration in perceptual errors, behavioral problems and emotional disturbances. 

What improvement can I expect in my child with homoeopathic treatment?

• Homoeopathic medicines help in correcting the faulty motor patterns and help in improving the coordination thus reducing difficulties of perception. 
• This helps in reduction of difficulty in reading & writing.
• Correction in the altered state of sensitivity. Children appear calmer. It helps in reducing emotional disturbances. 
• Improvement in behavioral problems like hyperactivity, fidgetiness, impulsiveness etc.
• Attention span improves. A child who was earlier very inattentive starts to focus on the task given. 

Is Homoeopathy compatible with other therapies?  

Homoeopathic medicines are no substitute for all other essential therapies or teaching techniques like Remedial education, occupational therapy, counseling, speech therapy etc. Homoeopathy works in perfect synergy with above techniques and therefore we promote holistic integrated care. 

In fact, the positive influence of correct homoeopathic remedy makes the child more receptive to other therapeutic inputs like remediation, occupational therapy etc. 

This entire process speeds up the process of management. 

Homoeopathy in emotional problems.

Homoeopathy works effectively to reduce intense emotional disturbances like fears, sadness, depressed state of mind etc.

We do come across a number of children showing mood disorder, depression. Children can present with lot of tantrums, irritability and withdrawal symptoms indicating marked aversion to pleasurable activities. Once a young child was brought to us with a complaint of severe irritability and refusal to go to school since 4 months. Child did not get along with parents too. Total lack of concentration with poor attention span. They consulted number of experts who labeled the child suffering from behavioral disorder like hyper activity, ADHD etc.

Careful enquiry revealed that child had become absolutely averse to these most favorite activities that is watching carton network. This aroused clinical suspicion of depressed mood.

There was wrong diagnosis of behavioral disorder like hyper activity, ADHD. Depression was masked by tantrums. 

The Case was thoroughly investigated. The background revealed big tragedy child had experienced and its aftermath. 

When the boy was in 2nd Std, he lost his father. Father was 32 years old who had gone to Surat for some business. He came back home late evening, took dinner with family and went to sleep. He never woke up. He suffered from Cardiac arrest. Mother discovered this at 5.30 A.M. She cried bitterly. It was a joint family. When boy woke up, he saw lot of people and soon discovered that Father was no more. He was stunned, paralyzed for a moment, but he decided to go to School since there was an examination. He went to School , his Uncle dropped him at 7.30 A.M.. When the examination was over, he started crying. The teacher came to the boy and asked him what happened my child, why are you crying? He slowly told the teacher that I lost my father. The teacher was shocked and asked him, then why did you come? He said I don’t want a red mark in the book and my mother does not like it nor my class teacher likes it. 

The family took a lot of care. After six months, the boy and mother had also gone out for trips for a little relaxation of mind. The family insisted for remarriage of boy’s mother since she was quite young. Mother was reluctant. In-Laws as well as parents pressurized. Mother spoke to the boy about this. He met stepfather and finally told his mother to go ahead with the marriage. 

Remarriage took place 8 months back. The boy could never adjust with stepfather and stepsister. He never called him father. Wherever he went he used his old Surname. For the last 4 months, the situation worsened, and a lot of tantrums with a strong refusal to go to School. 

This is the case of mood disorder – childhood depression; which came up because of repressed grief. 

When tears don’t find vent through eyes they take devious form. 

His attitude towards exam in the second standard shows great peculiarity. Such conscientious attitude evolves because of rigid parental expectations. We need to read in between the lines. 

Homoeopathic medicines are selected on the basis of understanding of personality. Conscientious attitude and Repressed Grief permitted me to prescribe CARCINOSIN. Few doses in 200 potencies brought about great relief and restored his desire for carton network and other enjoyments. 

Homoeopathic medicines like AETHUSA CYNAPIUM, GELSEMISM are well known to reduce the anxiety state and prepares well the child for the exam. 

CONCLUSION

The emotional, intellectual social and physical growth of the child is dependent on various factors. The PSYCHOSOCIAL inputs, which the child receives in the early formative years, are crucial amongst them. Any childhood disorder, whether intellectual, emotional or behavioural, would demand a holistic approach dealing also with the parents and the school. This, in turn, will demand a multidisciplinary approach. 

Homeopathy’s humane approach essentially focuses on positive health.

What is most important is the concept of CARE & CURE which this science propounds and teaches its practitioner to be FRIEND, PHILOSOPHER & GUIDE.