ICMR
arrow  Indicators of Mental Health Books 

APPENDIX VII

Intervention Record Form

Sl. No. of the visit Date of visit Risk Factors intervened with Any other new risk factors identified Changes in the risk factors from the previous visit Major changes in Family
(see Appendix)
Intervention Done
(see Appendix VII)
Family Reactions Anganwadi Worker's reactions
          1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8  
                                                          Overall change
(every 3 months)
  1. No. change

  2. Minimal change

  3. Adequate change

If no change, possible reasons:
Family   Counsellor Factors     Factors


 

 


<< Back
 | Index | Next >>