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Psycho-Social Support – A must for Children at Institutional Care

The year is 2015, child care institutions (CCIs) are viewed as the best place for a child if their family cannot support them. These children come to the CCI with few personal belongings, but a lot of emotional baggage. They are scared, thrown into an unknown environment with complete strangers. They have left everything familiar behind. Some of the children have escaped days and nights filled with hunger, abusive relationships, dangerous neighborhoods, yet they long for the only life they know. They are burdened with immense fear, grief, sadness, and they live in survival mode emotionally, coping by either shutting down or acting out.

Miracle Foundation India witnessed this heartbreaking scenario first-hand in the CCIs that it supported. The empathetic staff of the CCIs poured their hearts into helping the children feel safe and welcome, but many of the children did not have the capacity to open themselves to such a personal relationship for fear that it, too, would result in loss.

Over time, we taught house parents the importance of building attachment with these children in distress, and coached children through the development of essential life skills such as expressing emotions and communication skills. We worked to build the capacity (and confidence) of CCI’s social workers to provide the first level of counseling to traumatized children.  We partnered with psychologists who visited the CCIs to provide guidance to children with complex issues.

However, it was not a smooth journey filled with success and triumph. Myths and misunderstandings surrounded the reasons for the children’s behavioral outbursts. Many children were viewed as “bad” kids because they engaged in disrespectful conduct with the staff and bullying episodes with their peers. Others were viewed as “problem children” when they isolated themselves from their peers, or had nightly bedwetting episodes. There was a lack of awareness that the withdrawal or eruptions were truly expressions of emotions that the children did not know how to release in a healthy manner. Counseling with the social worker was used in a punitive way much like being sent to the principal if the student misbehaved. In some extreme cases, the child was taken to the psychiatrist to gain control of their attitudes and actions, and they ended up on potent psychotropic medications with serious side effects.  While the CCI Staff sincerely cared, they were at a loss as to how to deal with the intensity of what these children experienced.

Awareness building on effective strategies to help children achieve mental well-being was at the center of Miracle Foundation India’s mission. Everyone in the CCI, from the Chief Functionaries to the Caregivers, was taught the impact of the trauma that their children had faced, and how it affected their health, cognitive skills, sensory sensitivity, motivation, ability to form relationships of all kinds, and more. They were educated on the purpose, types, and benefits of psycho-social support (PSS), and though there was skepticism at first, we could see their minds opening to new possibilities.  As they witnessed the positive results of their guidance and encouragement alongside the PSS interventions, their attitudes transformed, and they began to not just accept, but welcome the support. Children were growing in ways they never expected as they learned to work through their wounds of the past and master new ways of releasing their emotions.

Fast forward to 2019, when the eyes of the world are opening to the concept that the best place for a child is indeed with their family, and the focus globally turns to strengthening the family for a safe and permanent return of their child.

Miracle Foundation’s emphasis on helping children feel comfortable, safe, and loved in the CCI shifted to preparing children for a return to their families and communities. We recognized that the transition, while joyous, would require adjustments as the children settled back into their family routines and expectations, often quite different from their life in the CCI. The psycho-social skills they learned in the CCI would take them far in their new environment, but it was never assumed that the path would be without challenge. For the family members, too, though they welcomed the return of their children with open arms, emotions and adjustments were sure to be a part of the picture.

Taking a proactive stance, Miracle Foundation implemented a series of psycho-social awareness building, skill building, and supportive strategies to be put into action while planning for the child’s move.  All children continue to receive life skills education with an emphasis on the skills needed most in the outside world. Social workers and psychologists meet with children, individually and in groups, to provide the opportunity for children to openly discuss their hopes and dreams related to family reintegration, realistic expectations of family life, and any concerns they may have regarding the return to their communities.  Children with serious issues such as clinical depression, anxiety, bipolar disorder continue to receive guidance at first from a psychologist provided by Miracle Foundation, but transition to a psychologist in their community upon their reintegration.

Family members, too, face a multitude of emotions regarding their child’s return and are often apprehensive about adding another mouth to feed, potential conflicts within the family, and dealing with their own set of stressors. That is why Miracle Foundation provides just as much support and preparation to the family as we do to the child.

The support is broad in its reach because difficulties in daily life have an immediate impact on the child and family’s mental well-being. For example, if the child struggles in school, it will affect their self-confidence and self-esteem, if the family is financially unstable, the tension will weigh on all family members, if chronic or serious health concerns are in the picture, the impact will reach far beyond the ill member. It is critical to address issues that on the surface appear to be something other than mental health related, but in truth have a significant influence on the family’s well-being.

Psycho-social needs are wide-ranging, and in turn support needs to be holistic and comprehensive. With this in mind, Miracle Foundation developed the Home Thrive ScaleTM, a planning tool designed to identify gaps in the domains of Family and Social Relationships, Household Economy, Living Conditions, Education, and Health/Mental Health. This tool is a guide for social workers to determine where support is needed for the family, and plan specific interventions. Progress is tracked over time to ensure that the family is growing and thriving.

We’ve come a long way in the area of caring for children living apart from their families, and Miracle Foundation is proud to be at the forefront of recognizing the challenges and paving the way to provide the psycho-social support required to result in a family environment in which all members can thrive – together at last.

As India resurfaces from the impact of the COVID virus, and neighborhoods are able to gather together once again, Miracle Foundation’s PSS Program will spread out into communities, not only to continue to follow up with the recently reintegrated families, but also to support families at risk of separation. Collaborating with NGOs, community volunteers, VCPCs, ASHA workers and more, we will take PSS services directly to the families who need them most in the form of education on how to achieve positive mental well-being, the development of coping skills, positive parenting techniques, and so forth. And we will grow our efforts to build the capacity of the social service workforce engaged with these families to ensure productive interventions, wrapped with warmth and compassion.

Though the journey to recognizing the importance of psycho-social support began years ago, it really has only just begun. The future holds nothing but promise.

“Your present circumstances don’t determine where you can go, they merely determine where you start.” ~Nido Qubein

Nancy Behnke,
MSW, PSS Consultant,
Miracle Foundation

 

October 27, 2021 CATEGORY: CCI

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