Health Promotion Using Life Skills

Approach for Adolescents in Schools

NIMHANS Model
Dr. Srikala Bharath
Professor of Psychiatry
NIMHANS, Bangalore
Dr. K.V. Kishore Kumar
Senior Psychiatrist
Department of Psychiatry
NIMHANS, Bangalore Health Promotion using LS

YOUTH in INDIA
40% of the 100 Crores of India are
below the age of young adults.
20 Crores are adolescents and young
adults (below 24 years)
Different from the developed countries
Seen as a `resource by experts population, economical, technological
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The Indian Scene - Issues

Rapid industrialization, globalization
Target for International Market HR, Drugs,
Consumables
Huge Population Economy not keeping pace
Poor Infrastructure welfare, law & order, housing
Transition in Families - Joint to Nuclear
Academic and Career Stress
Parents no Longer the Role Model
8/10 Youths are not employed in an organized sector
Risk is enormous
Suppression & Exploitation of Adolescent Girl Gender
Issues
High street population/Child Labor
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Changes in Outlook

Premium to Money - Corruption

Premium to Power - Politics, Religion
Premium to Education-Academics Stressful
Pleasure - Seeking is seen very importance
Quick-Results
Individual is more important than the
Collective
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There is a CHANGE In the

VALUE-SYSTEM

 Culture, Religion, Family are no longer

Controls; but Rather Buffers

When External Controls no longer are

effective Internal Controls have to be
strengthened.

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Problems Among the Youth

VIOLENCE (incl self)
domestic, labor, sexual, communal,
SUICIDE, religious, political, accidents,
riots,
ABUSE - DRUGS, PHYSICAL
domestic, labor, tobacco, alcohol, HIV
AIDS, sex determination, female foeticide
EARLY SEXUAL EXPERIMENTATION
teenage marriage, high risk behavior, drug
use, domestic violence
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Scenario in the West

Specific Programs for Children & Youth

at Risk
Project 8% - California
Head-Start Program for younger
children - USA
Project HOPE - Children of Depressed
Mothers - U.K.
Specific Prog. For Substance Abuse,
Teenage Pregnancy, Bullying etc. Planned
Parenthood/Buddy Program/Mentor
Program
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 IN INDIA
Rather Neglected till recently

Promotive Programs
are
mainly School Based
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In the field of education we have achieved

Increase in literacy rates from 18.33 per cent in
1951, to 52.21 per cent in 1991, 64.84 % in 2003
Decrease in dropout rates from 62.7 per cent in
1977-78, to 39.37 per cent in 1995-96
Increase in enrolment at primary school from 19.2
million in 1950-51, to 109.8 million in 1995-96
Increase in primary schools from 209,671 in 195051, to 590,421 in 1995-96
Increase in Secondary Schools 7416 in 1951 to
1,16,820 in 2000
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51% participationHealth
by Private
Sector.

SCHOOL MENTAL HEALTH

PROGRAM
In
INDIA

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SCHOOL MENTAL HEALTH

Increasing Awareness of Psychological
Problems in Students
Recognition of ADHD, Retardation, LD
Counseling Skills/Referral
Support by trained paraprofessionals
THE ABOVE ARE RELATIVELY CLEAR
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ISSUES AMONG YOUTH

in
SCHOOLS

Motivation to study on a regular basis

Communication with teachers and parents
Coping with stress exams/failures, SUICIDE
Self - esteem not related to performance,
appearance, possessions
Bullying
Cigarette Smoking/Substance Use
Girl - Boy relations
Making Choices
education.
career,
marriage
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SURVEY of ADOLESCENTS
Boys
Anger - 65%
Study - 55-85%
Indecisive - 58%
Less time w/ parents
- 53%
wanting to discuss
problems - 53%

Girls
Anger - 60%
Study -38-80%
Indecisive - 83%
Less time w/ parents
- 43%
wanting to discuss
problems - 53%

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REFLECTIONS
INTERVENTIONS
RELATIVELY
CLEAR
PREVENTION & PROMOTIVE
WORK with TEACHERS AND
PARENTS - FUZZY for MHP
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School Mental Health Program

Philosophy
Going beyond the Medical Model and using the
Developmental and Educational Model
A Universal Promotive Program Stress on well
being/ self esteem
A Selective Preventive Program focus is on
Illness/disorder

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Framework in Health Promotion

Primary Prevention
Preventive Before the onset of
disorder/behavior
Universal Preventive Promotive for the
General Public
Selective Preventive Higher than average
risk
Indicated Preventive High Risk Individuals
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School Mental Health Program

Goals:
Program and Actions that empower participants (here
students) to
1. Prevent predictable and interrelated problems
2. Protect existing states of health/healthy
functioning
3. Promote psychosocial wellness
(Bloom & Gullotta 2003)

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The Need
Most current co curricular activities in schools
focus on specific areas of Reproductive Health,
Sexuality or Drug Abuse.
Suicide, Violence are neglected
A more Holistic Program is needed to be used in
all contexts by the Adolescents.
PIL 2007/ Parliament ratification
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The Challenge
Empowerment of the Adolescent is the
Need of the Day
Life Skills Promotion is the relevant
strategy for this Empowerment
Educational System and Secondary Schools
are the important spaces to initiate this
process of Empowerment
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Life Skills Education

LIFE SKILLS EDUCATION
A promotional activity by WHO since
1994 after taking cognizance of the
UNHOLY TRIAD - violence, drug abuse
and sex
Part of the Youth Declaration, Bangkok,
1998 ( Clause 5; part of curriculum)
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Life Skills
Life Skills are abilities for adaptive
behavior, that enable individuals to
deal effectively with the demands
and challenges of everyday life .
Psychosocial Competence.
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Life Skills - What are they?

Critical Thinking & Creative Thinking
Decision-Making & Problem-Solving
Interpersonal Skills & Effective
Communication
Self-Awareness & Empathy
Coping with Emotions & Stress
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Critical Thinking -It is the ability to analyze

information and experiences in an objective manner.
Creative Thinking - It is an ability that helps us look
beyond our direct experience and address issues
Decision Making -The process of assessing an issue
by considering all possible/available options and
the effects those different decisions might have on
them.
Problem Solving - Having made decisions about each
of the options, choosing the one, which suits best,
following it through even in the face of impediments
and going through the process again till a positive
outcome of the problem is achieved.
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IPR- It is a skill that helps us to understand our relations with relevant

others and relate in a positive/reciprocal manner with them.
Communication Sk- It is an ability to express ourselves both verbally
and non-verbally in an appropriate manner
Coping with Stress & Emotions- It is an ability, which involves
recognizing emotions in others and ourselves, being aware of how
emotions influence behavior and being able to respond to emotions
appropriately.
It an ability to recognize the source of stress in our lives, its effect on
us and acting in ways that help to control our levels of stress.
Self Awareness - Our recognition of ourselves, our character,
strengths and weakness, desires and dislikes

Empathy - Is an ability to imagine what life is like for another person

even in a situation that we may not be familiar with. It helps us to
understand and accept others and their behavior that may be very
different from ourselves.

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Life Skills - Components

Bargaining
Negotiation
Taking Turns
Being Sympathetic
Appraisal Downwards
Dealing with Jealousy
Dealing with Anger
Social contacts

Listening
Paying attention to
intuition
Frustration Tolerance
Delaying Gratification
Working in a Team
Leading the way
Prioritizing

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Value - Education
Changes with time,
culture, settings.
Result is important
Expected Outcome
Prescriptive

Life -Skills Education

Suits to any time,
culture
Culture sensitive
Buildings blocks
Skills than outcome
Process is important
Participative
Results in Values

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Health Promotion using LSENIMHANS Model

For Adolescents in Schools
Developed by Department of Psychiatry NIMHANS,
Bangalore - Background 2 suicides, program in 4
schools, needs being different in crisis and regular times
Authors and Coordinators
Dr. Srikala Bharath
Dr. K.V. Kishore Kumar

Model Program developed with support from SEARO,

WHO India in 2002 followed
Collaborative Venture NIMHANS DSERT, Karnataka
2002
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Model Development
Need Assessment with Adolescents
Focus Groups mtg. w/ parents, teachers, experts,
policy makers
Review of similar program and resource materials
Clarity on the methodology, strategy, areas of focus
Development of resource materials culturally relevant
Tested with 59 school teachers in 2 workshops
Reviewed by experts , finalized, published
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Resource Materials
Resource Materials for the Life Skills Teachers
developed in 2002.
Resource Materials tested by Government Teachers
and Experts and finalized in 2002. Reprinted in 2005.
Resource Materials available in Kannada
(vernacular) since 2003.
Consists of 3 modules for 8th, 9th and 10th std
teachers.
Simple with independent activities for teachers to
promote Life Skills Learning using a specific theme.
Each activity has a clear structure to be followed by

the teacher.

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This Program contd..

Funding DSERT, Karnataka
Technical Ownership NIMHANS
III Phases

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Location
Select 21 Taluks from 4 Districts
Bangalore Rural, Bangalore South
(Urban) Haveri and Udipi
265 Schools
Only fully government run secondary
schools
One LS teacher for each class
For 55, 000 Adolescents covered
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Methodology of the Program

Program focuses on Life Skills as building blocks towards
Coping, Empowerment and Value Development in
adolescents (8th,9th 10th).
Program focuses on all themes/areas of Adolescent
Development. Not only on ARSH
Utilization of the established Educational System and
Infrastructure towards this
Cascade Model of Training and Capacity Building is used.
Training of the Master Trainers at District Level ( DIET)
Teachers at district level are trained as Life Skills
Facilitators for Promotion of the Program.
Sensitization of the BEOs and HMs on LSE and
implementation
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HEALTH PROMOTION USING LIFE SKILLS APPROACH FOR

ADOLESCENTS IN SCHOOLS A DISTRICT MODEL

Tr.g of

Master Trainers

Tr.g of Teachers

Implementation of the of the

Program in Schools Weekly
By Teachers

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Themes
Motivation
Continuing School
Improving Concentration & Memory
Study Habits
Preparing for exams/answering exam paper
Career Choice
Discipline
TV/Movie viewing/media pressure
- Time Management
Nutrition
Health & Hygiene
Relationships
- with parents/friends/opp.sex
Self Awareness
- dealing with anger
Sexuality & Reproduction
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Processes

Generic Skills are focussed

All Adolescent Developmental Themes included
Increasing Complexity
One hour a week in the Value Education Class
Teacher is the Facilitator
Group work, Games, Theater, Story, Discussion, Role
Play- are the techniques
Discussion, Summarization - Mirror it Back
Awareness of the ISSUE /STRATEGY/ABILITIES in
youth
Peer Learning is ensured
Used by Youth when needed in real life Participative and
Experiential
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Facilitator - Requisites

Facilitator Pivot of the Program Teacher/Parent

Encourage Active participation
Provide Equal chance to all children
Being open and non-judgmental
Not to provide solutions to situations at the outset
Focus on the Steps than the Goal
Facilitator encourages students to share strategies
ABILITIES
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Uniqueness contd
Support
Supervision of the Training by Key Resource
Persons
Refresher Courses for the Master Trainers
Networking of the Teachers in a District
Methodology, Implementation and Evaluation
clearly built into the program.

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Implementation
Implementation of the Program initiated in
some of the schools in 2004.
Implementation in all the 265 schools with
a GO from June 2005.
55, 000 students covered.

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Evaluation
Training of DIET Lecturers as Master Trainers was
feasible. There was a significant transfer of Knowledge,
Skills and Positive Attitudinal Change in the Master
Trainers after 5 days of training in Life Skills Education.
Training of Secondary School Teachers as Life Skills
Educators by the Master Trainers over 3 days was
feasible. There was a significant transfer of Knowledge,
Skills and Positive Attitudinal Change in the teachers after
training in Life Skills Education.
Resource Materials (3 Modules) were used both in the
Master Trainers and Teachers Training. They were
evaluated and found
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Evaluation contd
Majority of the teachers were able to run the
Life Skills Program in their respective
schools about 10 sessions on an average
in an academic year.
Schools were supportive of the program.
Most Life Skills Teachers were confident of
their facilitatory abilities.

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Evaluation contd

Teachers perceived a positive change in the

class room behavior of the students in the
Life Skills Program better Interaction,
Study Habits and Participation.

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Changes expressed by the Teachers:

I do not have any difficulty in understanding the activities, since

the manual is very simple, and instructions are clear and easy to
understand.
Lady Teacher
Udupi South Distrit

I was very anxious while doing activity related to sexually

transmitted diseases, students were also very shy; the participation
among the children was very less. I could not able to facilitate well
and control my anxiety and discussion among the students also
less.
Lady Teacher
Udupi South District

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continued)

There is no stress on students in Life Skills Education Class. So students

shows more interest and participate voluntarily and
expresses their ideas and views freely without any hesitation
Male Teacher , GHS, Shetty Bettu (T), Udupi North District

In life skills class there is no barrier between teacher and students. In

regular teaching class students participation and interaction is limited
and students see the teaching in examination point of view
Male Teacher, Bangalore South

Few students came and shared their personal family problems with me
after the life skills class.
Lady Teacher, Bangalore South District

I observed that self-confidence of the some students has improved after a

few Life Skills Classes. They ask questions and clarify their doubts in the
regular teaching class.
Female Teacher, Kokarne, Udupi District

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Outcome
Cross sectional assessment of the Impact done
at the end of one year
Coping Styles and Prosocial Behaviour of the
Adolescents in Program Better
School and Teacher Adjustment better
Family Adjustment and Psychopathology no
difference
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Other Groups Trained

Navodaya Vidyalaya 115 MTs

Tribal School BR Hills
Teachers of Private Schools -100
Many many Sensitization Program
Counselors for Children of Fathers with Alcoholism -TTK
Street Children BOSCO
Working Children Maya Trac
Bhutan Scouts
Cambodia Child & Adolescent Mental Health Centre
Volunteers as Life Skills Educators
Modification for Specific Groups
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Lesson Learnt ..
Trained master trainers can effectively impart
knowledge and skills for teachers
Teachers were satisfied with training skills of the
MTs
Administrative support is very crucial for regular
LSE classes in the school GO
Training teachers to impart life skills education in
schools is feasible
Budgetary support for duplication of activity
material and review meetings is very vital
Improvement in student teacher relationship, self
confidence, academic skills,
improvement in
classroom behavior, class room participation,
leadership skills, coping reported
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Blocks
Lack of clear mandate on Life Skills Education in
DPI
There is no institutionalization of the program by
DPI.
Multiplicity of similar projects (ARSH, Population
control etc.)
Lack of continued Financial Support for the
program is not available.
Attrition in the Master Trainers and Life Skills
Teachers due to transfer.
Lack of collaboration between the Departments of
Education and Health
Academics still given significantly more relevance
than development and coping.
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Attitudinal Issues
PIL,
Teachers
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Future
Government needs to take cognizance of the Significant Positive
Outcome of the Holistic Program of NIMHANS Health Promotion
using Life Skills Program for Adolescent in Secondary Schools as
means to improve Coping, Adjustment and Self Esteem
Institutionalization of the Program in all Secondary Schools of the
country (already with CBSE board).
Provide Advocacy to the country for School Mental Health Program
as a part of National Mental Health Program ((included in the 11th NMHP
budget) .

Clear Mandate on the type of co curricular program to be followed in

schools for psychosocial development.
Initiation of Life Skills Education Program in Middle and Primary
Schools also.
Support to Life Skills Education Program by Pre and In Service
Training of Teachers Training.
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Comprehensive SMHP
Recognition of the SMH Program to be an integral
part of NMHP.
Collaborative Liaison between Departments of Health
and Education
Allocation of Funding over 5 years
A two pronged Model of (High Schools)
Promotion LS approach for High
Schools
Identification, Referral and Treatment.
Capacity Building Resource Materials
Development, Training of Teachers in a Cascade
Manner (TOT).
Implementation, Monitoring and Evaluation
Active NGOs & INGOs dialogue and participation
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It is a Road Less Traveled ..

Peter Scott

THANK YOU
Dr. Srikala Bharath
Professor of Psychiatry
NIMHANS, Bangalore
Dr. K.V. Kishore Kumar
Senior Psychiatrist
Department of Psychiatry
NIMHANS, Bangalore
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