Early Intervention and Rehabilitation Centre for Children in Mumbai, India: A Journey from Diagnosis to Rehabilitation

Introduction 

In India around 11 million children in the age group of less than five years are affected by developmental disorders as per the Global Burden of Disease survey.¹ The age group of 10-19 years contributes to the highest percentage of disability which is 17%, and 1.2% belong to the age group of 0-6 years.² Unfortunately, fewer than 1% of children and adolescents are able to get treatment for their mental health in India.³ Sourander A et al. (2018) reported that India had just 0.02 child and adolescent psychiatrists for every 100,000 children aged 14 years or younger.⁴ The numbers drop down further for children with  neurodiversity or disabilities. Research has time and again reiterated that interventions provided at the early stages of development have proven to be extremely effective in catering to developmental challenges of children with special needs, thereby enhancing their quality of life.  

The centre, housed in five-storeyed building spanning 35,000 square feet, was proposed in 2018, with the first phase completed in 2023. Catering to children from 0 to 18 years of age, EIRCC provides its services entirely free of cost, ensuring accessibility to early intervention and rehabilitation support. Each floor of the building is designed with a unique child-friendly theme, creating a soothing and engaging environment to make the experience comfortable and less intimidating for children. Currently, the team includes a Pediatric Neurologist, Neurodevelopmental Pediatrician, three Child Psychiatrists, two Pediatric Ophthalmologists, two ENT specialists, five speech therapists, seven occupational therapists, seven physiotherapists, three special educators, five psychologists, three dentists, two Orthopedicians, and two community developmental officers, all having additional training in working with children and adolescents with special needs.

By employing an integrated, interdisciplinary, and multidisciplinary approach, the center ensures that each child receives well-coordinated, comprehensive, and personalized care that addresses their unique needs holistically. Unlike other DEICs that typically serve children aged 0–6, this facility offers free rehabilitative services to children with special needs from birth to 18 years, following referrals from various hospitals, health centres and private clinicians. 

The entire center is designed in order to be child and disability friendly. It operates on a stratified step-care model and stands apart from public hospitals by focusing on quality over quantity, allocating between 45 minutes to one hour per session. With all therapies provided under one roof, it serves as a one-stop destination for families seeking comprehensive care. 

As of February 2025, the center has provided support to approximately 2,500 children with special needs, delivering around 45,000 specialized therapy sessions tailored to their requirements. In its second phase, plans include introducing additional services such as aqua-therapy, gait analysis lab, animal-assisted therapy, BERA testing, telemedicine support for remote centers, remedial education for children with learning disabilities, and an auditorium for therapy programs and specialist training. These enhancements have been approved by the Municipal Corporation of the city, with the necessary budget allocated, and are expected to be completed within the next year. 

Function of various departments at EIRCC (Table 1) 

1. Paediatric Department: Screening, assessment, diagnosing and treatment of developmental delays, seizures, neurological, neuromuscular, and genetic disorders. 
2. Audiology and Speech Therapy Department: Assessment and management of speech, language, communication, fluency and articulation difficulties, Oro-sensory and Oro-motor deficits, feeding and swallowing difficulties and screening of hearing and audiological testing. 
3. Occupational therapy Department: Assessment and management of neurodevelopmental and sensory integrative dysfunction. Assessment for orthotic, splintage and adaptive devices and training in activities of daily living.  Focuses on improving fine and gross motor skills, sensory processing, co-ordination and attention span. 
4. Physiotherapy: Assessment & management of posture, balance, co-ordination, range of motion, muscle tone and muscle strength. Training for gait, motor skills and pain relief. 
5. ENT Department: Screening of hearing loss and management of various ENT disorders such as chronic/ recurrent ear infections, hearing loss, speech delays, nasal congestion, tongue tie, tonsil pathologies and respiratory issues, which are common in children with special needs. 
6. Ophthalmology Department: The department conducts visual screening, assessments and manages refractive errors, glaucoma, and cataracts. It provides therapy for binocular vision issues, amblyopia, and strabismus. Evaluation for orthoptics and offers low vision aids to enhance visual function for children with special needs. 
7. Dental Department: Addresses issues related to teeth, gums and oral hygiene offering complete orofacial prevention, restorative and surgical treatment such as dental filling, root canals, crowns, replacement of teeth. 
8. Orthopaedics Department: Specialized assessment and management of bone defects, fractures, and disorders in children with special needs. Correctional surgeries for bone and spinal deformities, treatment of clubfoot, bone injuries, joint infections, neuromuscular disorders, and limb malformations. Tailored care to address the unique orthopaedic needs of children with disabilities, ensuring better mobility and quality of life 
9. Community Development Officers: They play a key role in facilitating social interventions, enrolling special needs children in government schemes, providing guidance on financial support for their families, and fostering integration of special needs children in the community. 

Functioning of the Department of Psychiatry at EIRCC 

The Psychiatry Department at EIRCC, Mumbai, India, provides comprehensive assessment and management for children with special needs in a holistic manner, using a stratified stepped care model emphasizing right care from the first time.  Upon visiting, a Psychiatrist screens for emotional, cognitive, behavioral, and psychological issues, with reassessment of neurodevelopmental disorders to prevent misdiagnosis due to underlying behavioural or psychiatric issues. The child is then referred to a clinical psychologist for psychological evaluations, including assessment of caregiver burden and the parent-child relationship. After completing the assessments, the child and parents receive care from either the same psychiatrist or a counseling psychologist for management through medications and therapy. Additionally, the child is referred to a special educator for assessment, development of an individualized education plan, and to support the child's educational progress. 

Weekly meetings are held to review treatment progress, address any challenges, discuss further referrals, and plan for the weaning or discontinuation of treatment. Collaboration occurs with the child's school and local therapists or clinicians (if applicable) to ensure everyone is aligned with the management plan. Parents of children with ADHD, autism, and intellectual disabilities are offered parent management therapy sessions to assist them in managing their children more effectively, while also assessing and addressing caregiver burden. Parent-child interactions are evaluated and parents encouraged to enhance attachment through parent-child interaction therapy. Additionally, group therapies have been started for children with ASD and ADHD to enhance their social, emotional and play skills. For children and adolescents requiring acute care, admission, disability certification, or care after turning 18, referral to a tertiary parent hospital is arranged. 

Figure 4-6: Department of Psychiatry @ EIRCC

Conclusion  

India, previously focused on acute management, is now gradually moving towards early intervention and prevention, along with rehabilitation, in Psychiatry and other medical fields. As one of the few public-sector centres in India, EIRCC serves as a model for training specialists and guiding similar centres. Two more centres are being developed in Mumbai, but given the country’s population burden, expanding such facilities with trained specialists is crucial. Tertiary care centres can play a key role by establishing and supervising these centres, ensuring administrative support, and advancing research in the field. 

References 

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This article represents the view of its author(s) and does not necessarily represent the view of the IACAPAP's bureau or executive committee.

IACAPAP Bulletin, Issue 77