Supporting institutional caregivers in a children's home in rural south India.

Orphans and other institutionalized children frequently have histories of maltreatment prior to entering institutional care. Better understanding the impact of these maltreatment experiences is essential to meeting the needs of these children. Institutional caregivers are challenged to address the unique and complex needs of these children. A team of child psychiatrists and mental health specialists visited a children's home in south India to provide consultation to the caregivers. The cases of two adolescent girls illustrate two distinct presentations following histories of significant maltreatment and early loss. One of the girls was significantly dysregulated. The other was struggling academically after leaving the home but was better able to regulate her affective states. The team recommended supporting the children's existing defensive structures and allowing them to speak about any past traumas on their own terms without being pushed to do so. The team also considered the self-regulating function of the cultural practices in which the children engaged and encouraged them to continue these activities.