“Los Momentos Magicos”: A poster at WAIMH

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This is one of the two posters I presented at WAIMH (World Association of Infant Mental Health) this past week in Edinburgh.

“Los Momentos Magicos”: A Practical Model for Child Mental Health Professionals to Volunteer by Supporting Caregivers in Institutions in Developing Countries.

“Los momentos magicos” refers to small interactions between caregiver and child that when repeated multiple times can have a lasting positive effect. This hopeful perspective is important for caregivers of children in institutions in developing countries, many of whom carry the scars of early neglect and abuse. Through her experiences in visits to orphanages in Central America and India, Dr. Harrison has developed a model for mental health professionals in developed countries to volunteer their consultation services to caregivers (CG) of children in care in developing countries in the context of a long term relationship with episodic visits and regular skype and video contact.

Weekly Skypes:

Example of Notes from Skype Sessions with Director of Caregivers (DCG) – In a meeting with the teachers, DCG felt frustrated when the teachers implied that the children were neglected. The teacher said the children do well in school but do not bring in their homework. The teacher was concerned that they were hanging out with kids at school who were a negative influence. DCG has told them that they can be friends with these kids, but when they see them involved in problem behavior they should walk away. I suggest – because this has been successful in the past – the possibility of a community meeting in which the other children at the home are invited to brainstorm how to stay out of trouble and how to deal with other kids who are getting into trouble at school. DCG says that is a good idea. She will try it and let me know how it went. We talk about how much responsibility to expect from a 10-yo with his homework. A CG is leaving, and we talk about how to prepare the children for this loss – which children will be most affected, how they might express their distress, how to say good bye.

El Salvador Workshops:

Workshops take place in the orphanage during a weekday, when the children are in school. They begin with coffee and pastry, and there is a break for lunch, sponsored by the workshop leaders. The format is a power point presentation with accompanying video. Following a consultation model, the workshops focus on the caregivers’ chief concerns, underscored by the consistent message of the importance of the relationship. Videotapes of caregivers engaging in interaction with children are used to illustrate successful caregiving techniques, while also demonstrating how the caregiver’s ability to imagine the mind of the child is crucial. Discussion is encouraged throughout the presentation. After the first workshop, examples of the caregivers’ evaluations included, “It is good what you said, but now you should tell the children to do what we tell them to do.” Examples of evaluations after subsequent workshops included, “ I learned that it’s important to get down to a child’s level and listen to him, before I set a limit.” And “How to have a better relationship with a child and how to understand his situation.”

North India Workshop

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Workshop to 80 nursing students at mission hospital in No India. Subject: Supporting the First Relationship.

Using Nugent’s book, Your Baby is Speaking to You ( 2011), Harrison and Gregory emphasized three points: (1) Babies are speaking to their mothers; (2) Mothers can listen to their babies; and (3) Nurses can help mothers listen to their babies in a way that can influence the future health and well being of the children. We stressed the importance of making the mother feel competent to understand the communications of her own baby. To illustrate these points, Ginger played the role of the mother, and I played the role of the nurse. As usual, eliciting the help of the translator added another dimension of cultural richness and respect to the consultation process.

South India Consultation to Teachers at School

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Again followed consultative model focusing on teachers’ questions about students. Using data from teacher and child interview to answer the questions. For example, (1) Why does he not attend school regularly? (2) How can we make school more interesting to him and motivate his learning?

Child was observed in the classroom and child and teacher were interviewed. Data from observation and interviews were used to answer the questions:

(1) There is the feeling in the family that he will be the brother who stays home and keeps the farm. He is also afraid of family discord and wants to protect family from fighting. He does not see the practical reason for studying. He also has some learning problems – working memory, auditory processing, executive functioning. (Include explanations of executive functioning, working memory, auditory processing).

(2) Story problems about farming (math) – buying selling, ratios of the fields, making calculations on the spot to determine prices and make sure venders are not cheating.

Auditory processing support – when possible, give him important factual information parsed in chunks separated by few seconds pause, with repetition of information afterwards.

Building working memory – tasks that require remembering longer and longer bits of information over time (addresses, phone numbers, “telephone games” of hearing information from one person who repeats it to the next person, etc., drills, repetition, and rote memorization for basic facts, making up his own acronyms for information that is hard to retain.

Strengthening executive functioning –practicing organization of homework, building predictable routines, checking homework lists to make sure everything is done and in its place, going over tests and assignments afterwards to identify errors and to understand how to avoid those errors in the future.

 

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