- Email: [email protected]
Child psychiatry in Ivory Coast, from yesterday to today
S292
IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S254–S309
although even in the absence of such medical specialty in Spain. After more than 15 years of existence of such a network, this awareness has been reflected even in the development of two mental health plans specific to this population. However, are these sensitivity and specificity reflected in diary health care in Andalusia? To answer this question in our area, we studied the number of referrals under 18 years during a year in our unit of Mental Health, which should initially receive all cases to decide after its derivation (or not) to Child and Adolescent Mental Health. We will show the very low number of patients referred as well as their distribution according gender and age, and the criteria used to send them. We will also discuss the implications of these ratios in Mental Health policies and Continuing Medical Education. http://dx.doi.org/10.1016/j.neurenf.2012.04.824 We-P-3179
Correlates of dropout from a Nigerian child and adolescent mental health service
I.I. Adeosun , O.A. Otesile ∗ , O. Ogun , T. Ijarogbe , A. Bello , O. Akinjola , O. Jeje Clinical Services, Federal Neuropsychiatric Hospital, Lagos, Nigeria ∗ Corresponding author.
Background.– Despite the availability of effective treatment for childhood psychiatric disorders, the successful treatment of children and adolescents (C&A) who access mental health services is undermined by high rates of dropout from these services. Aim.– To determine the correlates of dropout from the C&A clinic of the Federal Neuro-Psychiatric Hospital, Yaba, Nigeria. Method.– A retrospective study of all patients (n = 450) registered at the clinic within a period of one year. Results.– Patients who missed their first appointment were more likely to dropout from treatment (P < 0.001). Children with seizure disorder (P = 0.001), stable mental state (P = 0.00) and those accompanied by both parents to the clinic at their index visit (P = 0.02) were less likely to dropout. Conclusion.– Efforts to improve retention of C&A in psychiatric treatment may need to target certain categories of children, including those who miss their first appointment and those unaccompanied by both parents at index visit. http://dx.doi.org/10.1016/j.neurenf.2012.04.825 We-P-3180
N.V. Semenova Department of Science-medical Information, V.M.-Bekhterev Psychoneurological Research Institute, Saint Petersburg, Russia Leningradskaya Oblast’ is a region of Russia with the population of 1.6 million people including 200 thousand children under the age of 14 years old (12.5% of the population) and 50 thousand adolescents aged between 15 to 17 years old (3%). The prevalence of mental disorders in children decreased over the period of 2000–2009 from 3741.9 to 2618.3 per 100 thousand of child population (by 30%) and in adolescents it increased from 2631.5 per 100 thousand of adolescent population in the year 2000 up to 4319.3 in 2009 (by 64.1%). The mental retardation (F70-F79) is responsible for 44%, non-psychotic childhood and adolescence disorders (F50-F59, F80-F83, F84.5, F90-F98) for 28%, organic non-psychotic disorders (F06.3-F06.9; F07) for 11%, organic psychoses and (or) dementia (F00-F05, F06.0-F06.2, F09) for 8%, neurotic, stress-related, and somatoform disorders (F40-F48) for 7%, schizophrenia (F20) for 0.4%. http://dx.doi.org/10.1016/j.neurenf.2012.04.827 We-P-3182
Developing a structured approach to individual care and treatment planning F.T. Ademola a,∗ , D. Sheerin b Child and Adolescent Mental Health Service, Linn Dara, Dublin, Ireland b Louth Child and Adolescent Psychiatry Service, Drogheda, Ireland ∗ Corresponding author.
a
Individual Care and Treatment Planning is a regulatory and quality requirement by the Irish Mental Health Commission. Following an in-service audit, a pilot project to develop a structured approach to planning and documenting care plans for service-users was implemented, in a community Child and Adolescent Mental Health Service in Ireland. A template was designed for documentation of care plans, completed by the keyworker following clinical assessment. Focus group evaluation of 12 of 15 staff (80%) revealed benefits including clarity of treatment plans, ease of prioritization of goals and involvement of clients in the management plan. Challenges include time constraints, interference with therapeutic engagement, and aligning differing goals between the client and their parent. Based on findings, the initial template was re-designed and adopted. The process is now included in the service policy. Recommendations for the future include service-user survey and audit of the template for rate of completion and content.
Translational research controversies: A model integrating research and clinical practice
http://dx.doi.org/10.1016/j.neurenf.2012.04.828
G. Milavic Camhs Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
We-P-3183
Basic science, genetics and neuroscience are growing at an exponential rate. What will be applicable to clinical practice? The importance of translation of scientific findings into therapeutic interventions is well recognized but the use of clinical observations and findings to inform research is undervalued. New experimental models are essential to increasing our understanding of disease mechanisms and securing clear health benefits for patients and the population at large. This presentation will set out some of the controversies related to translational research. A model integrating clinical work and research, as developed in the Child and Adolescent Mental Health Services at the Maudsley Hospital, is described. Practice data will illustrate how the use of electronic medical records and search tools underpin the pathways between research and clinical practice. Further reading Rutter M, Plomin R. Pathways from science findings to health benefits, Psychol Med 2009;39:529–542. http://dx.doi.org/10.1016/j.neurenf.2012.04.826 We-P-3181
The prevalence of mental disorders in children and adolescents in Leningradskaya Oblast’ Russian Federation, 2000–2009
Child psychiatry in Ivory Coast, from yesterday to today A.E.L. Bissouma a,∗ , M.A.P.N. Anoumatacky b , L.B. Moke a , M. Te Bonle a , M. Fourment c , D. Kone b , R.C.J. Delafosse d a Institut national de santé publique, centre de guidance infantile, Abidjan, Ivory Coast b Bingerville, hôpital psychiatrique, Abidjan 20, Ivory Coast c EA 4403, ED Erasme, UP13, Labo UTRPP, Seine Saint-Denis, Villetaneuse, France d Programme national de santé mentale, Abidjan, Ivory Coast ∗ Corresponding author. Born in its modern sense in the twentieth century, the Ivorian psychiatry and its corollary child psychiatry are still searching for their identity. Ivorian child psychiatry suffers from an unfavorable situation structurally in terms of personal (1 psychiatrist for 1,446,204 children), of means and infrastructure, both public and private. There is only one state structure of child psychiatric care, the Child Guidance Center, established in 1974, and all the trades necessary to the practice are not represented. On average 477 new children are received each year. Think child psychiatry so that it fits the current challenges marked by the postconflict requires the historicization of this discipline as the foundation of a new era.
IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S254–S309 To do so, this means that some are involved in the role of “griot” guarantor of the tradition, but also transmitting agent of the present writer and tomorrow . . .that’s what the authors are trying to do here. http://dx.doi.org/10.1016/j.neurenf.2012.04.829 We-P-3184
Deaf services for children and young people: A national approach V. Fernandez Deaf Children, Young People And Family Service, South West London and St George’s Mental Health Trust, London, UK The literature shows how deaf children are at higher risk of mental health problems. Studies also indicate major difficulties for them accessing mental health services and inequality of access depending on geography. In 2004, a pilot of an outpatient service based on 3 different locations across the UK (Dudley, London and York) began. Funding was subsequently extended for 2 more years and in 2009 the service was granted with permanent funding for a full national service. Teams include: Social Workers, BSL interpreters, Clinical Psychologists, Primary Mental Health Workers, Occupational Therapists, CAMHS nurses, Deaf CAMHS Support Workers, Speech and Language Therapists and C&A Psychiatrists. The service works with young people up to the age of 18 with a moderate to profound hearing loss and hearing children of deaf parents. They have to present with a CGAS below 50, profound hearing loss or BSL as preferred language. http://dx.doi.org/10.1016/j.neurenf.2012.04.830 We-P-3185
A study of pediatric consultation liaison psychiatry (PCLP) clinicians’ activities
P.I. Ibeziako ∗ , K. Gallagher , G. Kuss , R. Kitts , G. Garcia , M. Oliva , S. Bujoreanu Psychiatry, Harvard Medical School, Children’s Hospital Boston, Boston, USA ∗ Corresponding author.
Objectives.– To describe the types and amounts of activities in daily PCLP; to assess outcomes of PCLP service. Methods.– Over a 4-week period, PCLP clinicians recorded data on activities spent for every patient encounter. Results.– We note that 544 forms were completed on 90 consults (47 females, 43 males) performed by 15 clinicians. There were more encounters for treatment (72.2%) than for diagnostic evaluations (10.2%); 67.6% of time was spent on non-direct service and 32.4% on direct patient care. Time spent per patient was inversely proportional to the training/expertise level of the clinician. Most frequent consultation outcomes included: – providing psycho-education and behavioral management recommendations; – preventing deterioration in patient’s functioning; – referral for additional mental health services. Conclusion.– This study will be helpful to plan PCLP staffing and costs as well as improve efficiency and outcomes of PCLP services.
S293
lescents in school system. It provides emotional and psychological screening, assessment, and intervention of common child psychiatric conditions, and associated learning disabilities related to school learning environment and outcome. The simplicity of service design and funding model, helped navigate through the complex inter-government and private agencies collaborations, straddling across healthcare, education and community service professionals. It also provided opportunities and challenges to the successful implementation of the national REACH program serving the western zone of close to hundred schools. The multi-discipline program design included direct services offered to school educators, students and their parents, minimizing the stigmatization, improved the service utilization and outcome. Niche services contextualized to the common parenting training needs, ADHD learning support, music intervention therapy and cyber-addiction intervention program were value add programs piloted to optimize service utilization and sustained the services. This work will present the service evaluation outcome of the REACH (West) program and critical success factors. http://dx.doi.org/10.1016/j.neurenf.2012.04.832 We-P-3187
Health professionals perceived need for child and adolescent mental health (CAMH) training in Lagos, Nigeria Y.O. Oshodi a,∗ , O.M. Simoyan b , A.F.E. Lesi c , P.I. Ibeziako d Department of Psychiatry, College of Medicine University Lagos. Lagos, LAGOS, Nigeria b Family Medicine, The Commonwealth Medical College, Scantron, PA, USA c Pediatrics, College of Medicine University of Lagos. Lagos, Nigeria, Lagos, Nigeria d Psychiatry, Children’s Hospital Boston, Harvard Medical School, Boston, USA ∗ Corresponding author.
a
Background.– Skilled health personnel are essential for providing basic mental health care to children and adolescents and providing appropriate referrals to mental health experts, especially in low income countries. Method.– Health professionals involved in caring for children in Lagos state, Nigeria, were surveyed. Results.– Respondents included Pediatricians, Primary Care Practitioners, Pediatric Surgeons, Psychiatrists and Nurses. 98.4% treat children and adolescents. 58.9% admitted to feeling incompetent in CAMH issues. 46.6% had no knowledge of CAMH services in their locality: 90% felt they would benefit from CAMH training. Highest identified areas for training included ADHD (88.1%), Autism (88%), Depression (87.3%), CAMH Screening (87.5%) and Assessment (86.4%), Substance use (86.2%), Child Abuse (84.4%), End of Life Care (83.1%) and Family Therapy (82.4%). Conclusion.– There is a need for increased CAMH training and awareness in low income countries. The information obtained from this needs assessment will be used in planning future educational interventions. http://dx.doi.org/10.1016/j.neurenf.2012.04.833
http://dx.doi.org/10.1016/j.neurenf.2012.04.831 We-P-3188 We-P-3186
Optimizing and sustaining a school based child and adolescent mental health service – Perspectives and lessons learned from a Singapore team P.Y. Lee a , J.C.M. Wong a,∗ , H. Noor a , D.S.S. Fung b Psychological Medicine, National University Health System, Singapore, Singapore b Department of Child and Adolescent Psychiatry, Institute of Mental Health Singapore, Singapore, Singapore ∗ Corresponding author.
a
Under the Singapore National Mental Health Blueprint [2007–2012], school based community mental health program has evolved into an important element of mental public health outreach, bringing direct care to at-risk children and ado-
The process of recovery from mental suffering
T. Adachi ∗ , S. Kono Psychology and Human Developmental Sciences, Nagoya University, Nagoya, Japan ∗ Corresponding author. People face various difficulties throughout life. However, stressful experiences do not always have negative effects. In this study we investigated the resilience process, that is, how people come back from depression caused by such stressful experiences. Semi-structured interviews were conducted on six university students (age average = 18–20). The results of qualitative analysis indicated that individual differences were seen in dealing with the negative feelings caused by experiences of conflict or setback. Furthermore, there were forward movement from the thought stages to the self-contemplation and behavioral stages. The flow is an important step to the recognition to oneself, the others and situations.
IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S254–S309
although even in the absence of such medical specialty in Spain. After more than 15 years of existence of such a network, this awareness has been reflected even in the development of two mental health plans specific to this population. However, are these sensitivity and specificity reflected in diary health care in Andalusia? To answer this question in our area, we studied the number of referrals under 18 years during a year in our unit of Mental Health, which should initially receive all cases to decide after its derivation (or not) to Child and Adolescent Mental Health. We will show the very low number of patients referred as well as their distribution according gender and age, and the criteria used to send them. We will also discuss the implications of these ratios in Mental Health policies and Continuing Medical Education. http://dx.doi.org/10.1016/j.neurenf.2012.04.824 We-P-3179
Correlates of dropout from a Nigerian child and adolescent mental health service
I.I. Adeosun , O.A. Otesile ∗ , O. Ogun , T. Ijarogbe , A. Bello , O. Akinjola , O. Jeje Clinical Services, Federal Neuropsychiatric Hospital, Lagos, Nigeria ∗ Corresponding author.
Background.– Despite the availability of effective treatment for childhood psychiatric disorders, the successful treatment of children and adolescents (C&A) who access mental health services is undermined by high rates of dropout from these services. Aim.– To determine the correlates of dropout from the C&A clinic of the Federal Neuro-Psychiatric Hospital, Yaba, Nigeria. Method.– A retrospective study of all patients (n = 450) registered at the clinic within a period of one year. Results.– Patients who missed their first appointment were more likely to dropout from treatment (P < 0.001). Children with seizure disorder (P = 0.001), stable mental state (P = 0.00) and those accompanied by both parents to the clinic at their index visit (P = 0.02) were less likely to dropout. Conclusion.– Efforts to improve retention of C&A in psychiatric treatment may need to target certain categories of children, including those who miss their first appointment and those unaccompanied by both parents at index visit. http://dx.doi.org/10.1016/j.neurenf.2012.04.825 We-P-3180
N.V. Semenova Department of Science-medical Information, V.M.-Bekhterev Psychoneurological Research Institute, Saint Petersburg, Russia Leningradskaya Oblast’ is a region of Russia with the population of 1.6 million people including 200 thousand children under the age of 14 years old (12.5% of the population) and 50 thousand adolescents aged between 15 to 17 years old (3%). The prevalence of mental disorders in children decreased over the period of 2000–2009 from 3741.9 to 2618.3 per 100 thousand of child population (by 30%) and in adolescents it increased from 2631.5 per 100 thousand of adolescent population in the year 2000 up to 4319.3 in 2009 (by 64.1%). The mental retardation (F70-F79) is responsible for 44%, non-psychotic childhood and adolescence disorders (F50-F59, F80-F83, F84.5, F90-F98) for 28%, organic non-psychotic disorders (F06.3-F06.9; F07) for 11%, organic psychoses and (or) dementia (F00-F05, F06.0-F06.2, F09) for 8%, neurotic, stress-related, and somatoform disorders (F40-F48) for 7%, schizophrenia (F20) for 0.4%. http://dx.doi.org/10.1016/j.neurenf.2012.04.827 We-P-3182
Developing a structured approach to individual care and treatment planning F.T. Ademola a,∗ , D. Sheerin b Child and Adolescent Mental Health Service, Linn Dara, Dublin, Ireland b Louth Child and Adolescent Psychiatry Service, Drogheda, Ireland ∗ Corresponding author.
a
Individual Care and Treatment Planning is a regulatory and quality requirement by the Irish Mental Health Commission. Following an in-service audit, a pilot project to develop a structured approach to planning and documenting care plans for service-users was implemented, in a community Child and Adolescent Mental Health Service in Ireland. A template was designed for documentation of care plans, completed by the keyworker following clinical assessment. Focus group evaluation of 12 of 15 staff (80%) revealed benefits including clarity of treatment plans, ease of prioritization of goals and involvement of clients in the management plan. Challenges include time constraints, interference with therapeutic engagement, and aligning differing goals between the client and their parent. Based on findings, the initial template was re-designed and adopted. The process is now included in the service policy. Recommendations for the future include service-user survey and audit of the template for rate of completion and content.
Translational research controversies: A model integrating research and clinical practice
http://dx.doi.org/10.1016/j.neurenf.2012.04.828
G. Milavic Camhs Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
We-P-3183
Basic science, genetics and neuroscience are growing at an exponential rate. What will be applicable to clinical practice? The importance of translation of scientific findings into therapeutic interventions is well recognized but the use of clinical observations and findings to inform research is undervalued. New experimental models are essential to increasing our understanding of disease mechanisms and securing clear health benefits for patients and the population at large. This presentation will set out some of the controversies related to translational research. A model integrating clinical work and research, as developed in the Child and Adolescent Mental Health Services at the Maudsley Hospital, is described. Practice data will illustrate how the use of electronic medical records and search tools underpin the pathways between research and clinical practice. Further reading Rutter M, Plomin R. Pathways from science findings to health benefits, Psychol Med 2009;39:529–542. http://dx.doi.org/10.1016/j.neurenf.2012.04.826 We-P-3181
The prevalence of mental disorders in children and adolescents in Leningradskaya Oblast’ Russian Federation, 2000–2009
Child psychiatry in Ivory Coast, from yesterday to today A.E.L. Bissouma a,∗ , M.A.P.N. Anoumatacky b , L.B. Moke a , M. Te Bonle a , M. Fourment c , D. Kone b , R.C.J. Delafosse d a Institut national de santé publique, centre de guidance infantile, Abidjan, Ivory Coast b Bingerville, hôpital psychiatrique, Abidjan 20, Ivory Coast c EA 4403, ED Erasme, UP13, Labo UTRPP, Seine Saint-Denis, Villetaneuse, France d Programme national de santé mentale, Abidjan, Ivory Coast ∗ Corresponding author. Born in its modern sense in the twentieth century, the Ivorian psychiatry and its corollary child psychiatry are still searching for their identity. Ivorian child psychiatry suffers from an unfavorable situation structurally in terms of personal (1 psychiatrist for 1,446,204 children), of means and infrastructure, both public and private. There is only one state structure of child psychiatric care, the Child Guidance Center, established in 1974, and all the trades necessary to the practice are not represented. On average 477 new children are received each year. Think child psychiatry so that it fits the current challenges marked by the postconflict requires the historicization of this discipline as the foundation of a new era.
IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S254–S309 To do so, this means that some are involved in the role of “griot” guarantor of the tradition, but also transmitting agent of the present writer and tomorrow . . .that’s what the authors are trying to do here. http://dx.doi.org/10.1016/j.neurenf.2012.04.829 We-P-3184
Deaf services for children and young people: A national approach V. Fernandez Deaf Children, Young People And Family Service, South West London and St George’s Mental Health Trust, London, UK The literature shows how deaf children are at higher risk of mental health problems. Studies also indicate major difficulties for them accessing mental health services and inequality of access depending on geography. In 2004, a pilot of an outpatient service based on 3 different locations across the UK (Dudley, London and York) began. Funding was subsequently extended for 2 more years and in 2009 the service was granted with permanent funding for a full national service. Teams include: Social Workers, BSL interpreters, Clinical Psychologists, Primary Mental Health Workers, Occupational Therapists, CAMHS nurses, Deaf CAMHS Support Workers, Speech and Language Therapists and C&A Psychiatrists. The service works with young people up to the age of 18 with a moderate to profound hearing loss and hearing children of deaf parents. They have to present with a CGAS below 50, profound hearing loss or BSL as preferred language. http://dx.doi.org/10.1016/j.neurenf.2012.04.830 We-P-3185
A study of pediatric consultation liaison psychiatry (PCLP) clinicians’ activities
P.I. Ibeziako ∗ , K. Gallagher , G. Kuss , R. Kitts , G. Garcia , M. Oliva , S. Bujoreanu Psychiatry, Harvard Medical School, Children’s Hospital Boston, Boston, USA ∗ Corresponding author.
Objectives.– To describe the types and amounts of activities in daily PCLP; to assess outcomes of PCLP service. Methods.– Over a 4-week period, PCLP clinicians recorded data on activities spent for every patient encounter. Results.– We note that 544 forms were completed on 90 consults (47 females, 43 males) performed by 15 clinicians. There were more encounters for treatment (72.2%) than for diagnostic evaluations (10.2%); 67.6% of time was spent on non-direct service and 32.4% on direct patient care. Time spent per patient was inversely proportional to the training/expertise level of the clinician. Most frequent consultation outcomes included: – providing psycho-education and behavioral management recommendations; – preventing deterioration in patient’s functioning; – referral for additional mental health services. Conclusion.– This study will be helpful to plan PCLP staffing and costs as well as improve efficiency and outcomes of PCLP services.
S293
lescents in school system. It provides emotional and psychological screening, assessment, and intervention of common child psychiatric conditions, and associated learning disabilities related to school learning environment and outcome. The simplicity of service design and funding model, helped navigate through the complex inter-government and private agencies collaborations, straddling across healthcare, education and community service professionals. It also provided opportunities and challenges to the successful implementation of the national REACH program serving the western zone of close to hundred schools. The multi-discipline program design included direct services offered to school educators, students and their parents, minimizing the stigmatization, improved the service utilization and outcome. Niche services contextualized to the common parenting training needs, ADHD learning support, music intervention therapy and cyber-addiction intervention program were value add programs piloted to optimize service utilization and sustained the services. This work will present the service evaluation outcome of the REACH (West) program and critical success factors. http://dx.doi.org/10.1016/j.neurenf.2012.04.832 We-P-3187
Health professionals perceived need for child and adolescent mental health (CAMH) training in Lagos, Nigeria Y.O. Oshodi a,∗ , O.M. Simoyan b , A.F.E. Lesi c , P.I. Ibeziako d Department of Psychiatry, College of Medicine University Lagos. Lagos, LAGOS, Nigeria b Family Medicine, The Commonwealth Medical College, Scantron, PA, USA c Pediatrics, College of Medicine University of Lagos. Lagos, Nigeria, Lagos, Nigeria d Psychiatry, Children’s Hospital Boston, Harvard Medical School, Boston, USA ∗ Corresponding author.
a
Background.– Skilled health personnel are essential for providing basic mental health care to children and adolescents and providing appropriate referrals to mental health experts, especially in low income countries. Method.– Health professionals involved in caring for children in Lagos state, Nigeria, were surveyed. Results.– Respondents included Pediatricians, Primary Care Practitioners, Pediatric Surgeons, Psychiatrists and Nurses. 98.4% treat children and adolescents. 58.9% admitted to feeling incompetent in CAMH issues. 46.6% had no knowledge of CAMH services in their locality: 90% felt they would benefit from CAMH training. Highest identified areas for training included ADHD (88.1%), Autism (88%), Depression (87.3%), CAMH Screening (87.5%) and Assessment (86.4%), Substance use (86.2%), Child Abuse (84.4%), End of Life Care (83.1%) and Family Therapy (82.4%). Conclusion.– There is a need for increased CAMH training and awareness in low income countries. The information obtained from this needs assessment will be used in planning future educational interventions. http://dx.doi.org/10.1016/j.neurenf.2012.04.833
http://dx.doi.org/10.1016/j.neurenf.2012.04.831 We-P-3188 We-P-3186
Optimizing and sustaining a school based child and adolescent mental health service – Perspectives and lessons learned from a Singapore team P.Y. Lee a , J.C.M. Wong a,∗ , H. Noor a , D.S.S. Fung b Psychological Medicine, National University Health System, Singapore, Singapore b Department of Child and Adolescent Psychiatry, Institute of Mental Health Singapore, Singapore, Singapore ∗ Corresponding author.
a
Under the Singapore National Mental Health Blueprint [2007–2012], school based community mental health program has evolved into an important element of mental public health outreach, bringing direct care to at-risk children and ado-
The process of recovery from mental suffering
T. Adachi ∗ , S. Kono Psychology and Human Developmental Sciences, Nagoya University, Nagoya, Japan ∗ Corresponding author. People face various difficulties throughout life. However, stressful experiences do not always have negative effects. In this study we investigated the resilience process, that is, how people come back from depression caused by such stressful experiences. Semi-structured interviews were conducted on six university students (age average = 18–20). The results of qualitative analysis indicated that individual differences were seen in dealing with the negative feelings caused by experiences of conflict or setback. Furthermore, there were forward movement from the thought stages to the self-contemplation and behavioral stages. The flow is an important step to the recognition to oneself, the others and situations.