1 Introduction 

The National Mental Health Survey of India (NMHS), conducted in 2015–16 estimated the prevalence of mental disorders in the age group of 13–17 years to be 7.3%. Less than 1% of children and adolescents receive treatment for their mental health in India [1]. As reported by Sourander A et al. there are only 0.02 child psychiatrists per 100,000 children less than 14 years of age, in the country [2]. When it comes to children with neurodiversity or disabilities, the statistics are far more alarming. As per the Global Burden of Disease survey, in India, developmental disabilities are projected to affect more than 11 million children in the age group of less than 5 years [3]. The highest percentage of persons with disability is in the age group of 10–19 years, amounting to 17% of the disabled population and around 1.2% are disabled in the age group of 0–6 years [4]. Research based evidence has reported that intervention provided at the early stages of development has been proven to be highly effective in addressing developmental challenges of children with special needs and improving their quality of life.

2 Conception of the Early Intervention and Rehabilitation Centre for Children (EIRCC), Mumbai

There are very few national institutes in the country aided by the government, where holistic, integrated, multidisciplinary care is provided in the sphere of rehabilitation. These are limited in number and spread across the length and breadth of the country, and hence not sufficient to cater to the needs of the population [5, 6]. Around 6% of children are born with birth defects and 10% of children are affected with development delays. If timely intervention is not provided, these delays may lead to permanent disabilities [5]. alth Screening and Early Intervention Services’ Programme was initiated under National Rural Health Mission, by theTo provide early and timely intervention, ‘Child He Ministry of Health and Family Welfare, government of India [5]. Under this programme various District Early Intervention Centres (DEIC) were set up for children of 0–6 years of age [6,7,8,9,10,11]. The children are referred from Aanganwadis (Integrated child care centres), play schools, community workers, primary and community health centres, and hospitals. The centres then screen and asses developmental delays, deficiencies, defects and diseases. They provide minimal treatment, rehabilitation and psychosocial interventions in a holistic manner. The services include- medical/ paediatric services, occupational therapy, physiotherapy, audiology, speech therapy, dental services, vision services, cognitive and psychosocial services. They follow a progressive step care model by stepping up services in the form of referrals to tertiary hospitals, District Disability Rehabilitation Centres, and vocational training centres for further management [6].

Various studies conducted on the functioning of these DEIC centres reported lack of infrastructure, equipment, adequate space and non-availability of staff. It was also noted that there was vacancy in many posts, as most of them lacked training for the 0–6 years age group [6,7,8,9,10]. The state of Maharashtra has very few DEICs allotted to it, which cater to children in the age group of 0–6 years. The district of Mumbai has a huge population and does not have a DEIC to cater to children with special needs. This has led to seeking help from private sectors and alternate methods of treatment [7,8,9,10,11]. The Municipal Corporation of the city of Mumbai hence decided to start the Early Intervention and Rehabilitation Centre for Children (EIRCC). This is attached to a tertiary municipal hospital and a medical college, hence would have research and training facilities, as well as supervision, in addition to rehabilitation, thereby serving as an epitome for other DEIC centres to follow.

The EIRCC is a comprehensive facility that offers a wide range of evidence-based therapies, interventions and support services to children with various developmental needs, delays, defects, deficiencies, disorders and disabilities.

The five floored centre was proposed in 2018 and the first phase was completed and opened for the public on the 12th of July, 2023. The centre currently has 3 Paediatricians, 3 Psychiatrists, 2 Ophthalmologists, 2 ENT specialists, 4 Speech Therapists, 7 Occupational Therapists, 7 Physiotherapists, 1 Special Educator, 5 Psychologists (Registered under the Rehabilitation Council of India- RCI), 4 Dentists, 1 Orthopaedician, 2 community developmental officers, who all have proficiency to work with children and adolescents with special needs. This integrated and multidisciplinary approach ensures that children receive well-coordinated, comprehensive, and customized intervention, addressing their unique needs in a holistic manner. The centre provides free of cost rehabilitative services to children with special needs from birth to 18 years of age, (compared to other DEICs which cater to the 0–6 years age group) post diagnosis of disabilities, from various hospitals and health centres. The entire centre has been designed in a child friendly manner to make children at ease while undertaking various therapies. The centre follows a stratified step care model as depicted in the Fig. 1. Multidisciplinary case discussions are held monthly, to discuss challenging cases to ensure common goals are addressed and progress is made towards the child’s needs. Unlike public hospitals which cater to quantity, the centre caters to quality service by providing a time of 45–60 min for each child or young person visiting the centre. As the therapies are placed under one roof, it’s a one stop centre for families seeking therapy, reducing their travel time. So far (February 2024), the centre has catered to 1500 children with special needs.

Fig. 1
figure 1

Flow chart describing the flow of the children and young persons into the centre

Full size image

In the second phase there will be addition of services such as aqua-therapy, gait lab, animal assisted therapy, Brain Evoked Response Audiometry(BERA) testing, telemedicine for guidance of remote centres, remedial education for children with learning disability and an auditorium for therapy related programmes for children and training of specialists. Implementation of these facilities has been approved by the Municipal Corporation, the necessary budget been allocated and the work will be completed in the next 1 year.

3 Importance of mental health services in an early intervention centre

Children with neurodevelopmental disorders have a higher risk of developing emotional, behavioural and cognitive problems [12]. Children and adolescents with disability experience poorer mental heath when compared to children without disability [13,14,15,16]. The caregivers of children with special needs often perceive psychological distress which is usually neglected [12, 16]. A early intervention centre needs to screen for emotional and behavioural issues of the child with disability and provide appropriate management when required.

The department of Psychiatry at EIRCC, Mumbai, India was set up with the goal of assessing and providing adequate management to the children with special needs in a holistic manner. The approach is of right care at the first time, applying a stratified stepped care model rather than the progressive stepped care model. The child or an adolescent visiting the department is screened by the psychiatrist for emotional, cognitive, behavioural and psychological issues. Reassessment of neurodevelopmental disorders is done to avoid misdiagnosis due to underlying behavioural or psychiatric issues. The child is then referred to the clinical psychologist for psychological assessments, assessing the caregiver burden of the parents and the child parent relationship. Once detailed assessments are completed, the child and parents are taken up by the same psychiatrist or the counselling psychologist for management through medication and therapy. The child is also referred to the special educator for assessment, planning an individual education plan and aiding in the education of the child with special needs.

Weekly team meetings are held to discuss the progress of treatment, any obstacles faced, need for further referrals, weaning and discontinuation of treatment. Liaison is also done with the child’s school, local therapist/clinician (if any) to ensure everyone is abreast with the management plan. Parent management therapy sessions in the form of groups have been started for parents of children with Attention Deficit Hyperactivity Disorder (ADHD), Autism and Intellectual Disability. Group therapy sessions have been started for children with ADHD and Autism, to impart social skills and for their emotional well-being. Caregiver burden is assessed and therapy is provided to the parents. Parent child interaction is assessed and promoted for better attachment through parent child interaction therapy. Stepping up to the tertiary parent hospital is done for children and adolescents who require acute care or admission, for disability certification and when they become 18 years old.

We have below described the management of 2 children who were referred to the centre, highlighting the role of mental health professionals.

3.1 Case 1

Master AD, a 9 year-old boy was brought to the centre by his grandmother. Evaluation by the child psychiatrist led to the diagnosis of ADHD. He was started on stimulants and referred to the counselling psychologist for behavior therapy and parent management training. The child’s father had recently passed away in an accident and his mother had abandoned him at birth. The grandmother suffered from caregiver burden and often used authoritarian and punitive measures to discipline the child. This was also addressed in therapy. On examination, the child was found to have strabismus and was referred to the ophthalmologist for management. Corrective surgery was planned after which exercises were recommended. The child was also referred to the occupational therapist for enhancing his attention, sitting tolerance and fine motor skills. Subsequently, physiotherapy sessions were planned to address his upper limb hypotonia. The child has been visiting the centre since the past 3 months and his behavioural issues have shown improvement.

3.2 Case 2

Master AS, an 8 year-old boy with autism and ADHD was referred to our centre for speech and occupational therapy. He was on Tablet Atomoxetine 25 mg and Tablet Risperidone 1 mg for his ADHD. It was difficult for the speech therapist to engage him in sessions due to his hyperactivity and poor social skills. His medication was revised to T. Aripiprazole 1 mg and increased to 2 mg and he was weaned off atomoxetine. The psychiatrist and behaviour therapist attended a few speech therapy sessions with him. Initially he was just made familiar with the room and sent back. The next session was planned for 10 min and subsequently the time was increased by 5 min in each session. So far, he is able to engage in a session of 30 min. The mother had major depressive disorder and was referred to adult psychiatry services for further management. The child is doing better now in terms of hyperactivity, sitting tolerance and engagement in speech and occupational therapies. This highlights the importance of a liaison approach and comprehensive management for better patient outcomes.

4 Conclusion

Developmental delays and neurodevelopmental disorders require an integrated and multi-disciplinary approach. Following a progressive stepped cared model at the EIRCC centre may not be feasible as it is not personalised, doesn’t involve family at the first step, time consuming and can lead to discontinuation of treatment. Hence the EIRCC adopts an integrated, multidisciplinary, personalised, early, preventive and stratified stepped care approach. This centre is one of the few in the public sector in the entire country (India), developed to guide other such centres and train specialists. Two more similar centres are being developed for the city of Mumbai. However, considering the population burden of the country, it is imperative to set up more such centres with trained specialists in order to cater to maximum children with special needs and enhance their quality of life. This may be achieved if more tertiary care centres take up the initiative to set up such centres under their guidance and administrative support. The supervision of tertiary care centres will also help further research in this field.