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APPENDIX-I

Interview Schedule for Identifying Children
at risk of Poor Psychosocial Development
(HOME RISK CARD)

  Job No. Cols. 1-3 ..................
    Cord No. 4 ..................
Centre : 5 ..................
Type of area : 6 ..................
Address :   ..................
Family serial no. : 7-9 ..................
Name of the mother :   ..................
SI. No. of mother : 10-11 ..................
Age : 12-13 ..................
Education : 14 ..................
Occupation : 15-16 ..................
Number of children : 17 ..................
Number of children between 3 and 6 years : 18 ..................
  1. Adverse Neighbourhood Environment
    (not at all conducive for child's proper growth and development)
: 19 ..................
  1. Abject poverty
    (the family has difficulty even for food/clothes, or cannot afford any play material for child)
: 20 ..................
  1. Poor house keeping
    (Unclean house, poor house routine, unclean children)
: 21 ..................
  1. Characteristics of mother
    (She remains sad or depressed for long periods without reason or often gets upset easily)
: 22 ..................
  1. Severe marital discord
    (There is often serious problem with husband, conflict over money matters, drinking habits or she does not feel happy with married life in general)
: 23 ..................
  1. Neurotic traits
    (in any child in house in age group 3-6 years) (bed wetting or stammering)
: 24 ..................
  1. Child neglect (for any child in age group 3-6 years)
    (lack of interest/affection and lack of routine for child or child gets frequent beating or is blamed, child lacks playmates)
    1. Yes         2. No        3. Not certain
: 25 ..................

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