1. Child Mental Health in the Eastern Himalayas Designing a System of Care Michael Matergia MD September 13, 2014

2. 22 Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. Michael Matergia has indicated they have no relevant financial relationships to disclose.

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7. 7 A Delivery System for School Health 7

8. 8 Comprehensive Health and Hygiene Improvement Program (CHHIP) 8 Health Education Primary Health Services Healthy School Environment

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11. 11 Health Services Package Deworming Growth Monitoring Epilepsy Screening Skin & Dental Exam Iron Supplementation Well Child Exam Vision Screening ORT & Zinc 11

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13. 13 Data-Driven Impact 140 referrals to specialist care 97% successfully completed 13

14. 14 A Delivery System for Mental Health 14

15. 15 Denver, Colorado 15

16. 16 Darjeeling Hills 1 Psychiatrist 4 Pediatricians 0 Youth Social Workers 0 School Psychologists 0 Speech & Occupational Therapist 16

17. 17 Task Shifting 17 Rational redistribution of tasks among health workforce teams

18. 18 Goal To develop, implement, and demonstrate an approach to child mental health that is integrated into a scalable approach to school health for rural primary schools throughout the Eastern Himalayas 18

19. 19 Objectives Mental Health Prevention and Promotion - To reduce risks faced by students in the school environment, ensure a healthy school environment and promote the development of resilience and protective factors in school-aged children. To avoid later adult mental health disorders including depression, alcoholism, and suicide. Case-finding - To increase the identification of children struggling with mental health challenges, disorders, and disabilities. Access - To increase access to and utilization of mental health services by school-aged children in rural communities of the Darjeeling Hills Community-Based Care - To provide community-based mental health services to identified children and strengthen current family and educational resources that support these children Human Resource Development - To train, support, and supervise a cadre of lay field workers to provide community-based mental health services to identified children.

20. 20 Defining the Role of the SHA 20

21. 21 Case Identification A Two - Step Process Key Informants to Identify At-Risk Children Validated Screening Tool to Trigger Entry into Health System 21

22. 22 Strengths & Difficulties Questionnaire 22

23. 23 Strengths and Difficulties Questionnaire short, easy to administer (~5 mins) validated in many LMIC settings including rural Bangledesh and Pakistan adequate sensitivity and specificity allows for identification of positive & negative traits 23

24. 24 Carepathway

25. 25 Decision Support Tools 25

26. 26 Decision Support Tools 26

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