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Given By
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VOLUME 17
Vol. ^'l_
AUGUST-SEPTEMBER 1952
to JUNE-JULY 1953
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U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Social Security Administration Children's Bureau
PO BL IC
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Superintendent of Documents
FEB 9-1954
INDEX THE CHILD
-Xu\7^^
Volume 17, August-September 1952 to June-July 1953
erson, Odin W.:
Infant Mortality and Patterns of Liv- ing, 122 Apr. ;, Bertram M.:
Focus on Delinquency, 59 Dec. sing, Leo B. :
Eyewitnesses to the Toll of Delin- quency— Juvenile Court, 51 Dec. bria, Sophie T. : Bool: review by, 166 June-July, ney, Paul R.: Point IV and the Children of the
Punjab, 81 Jan. 1 Health Day, 1953 (proclamation), 138 May. lolm, Brock:
Prescription for Peace, 140 May. \, Kenneth B. :
Race Prejudice and Children, 113 Mar. aenen, Richard: Training Schools and the Future,
3 Aug.-Sept. e, Marian M.: ^ote by, 166 June-July, iggio, Gellestrina, and Marguerite B. linas : Parents Learn About Their Premature
Baby, 106 Mar. , Martha M.: Furthering Individual Well-Being
Through Social Welfare, 19 Oct. iVe Can Do Something About Juvenile
Delinquency, 2, Aug.-Sept. What Do We Want for Our Delinquent
Children? 50 Dec. 3n, Lucile: Conference Works Toward Better
Citizenship, 41 Nov. ish, O. Spurgeon: Book i-eview by, 118 Mar. hs, Elisabeth Shirley: For Child Welfare in Venezuela, 42
Nov. re, Marion L.: Book reviews by, 87 Jan., 119 Mar.
Clue to Child Health, 140 May. - _ e, Robert M., and Sylvia Stecher:
Toward Better Speech and Hearing. 154 June-July. Gardner, George E.:
Children in the Contemporary Scene, 141 May.
Gelinas, Marguerite B., and Gellestrina Di- Maggio:
Parents Learn About Their Premature Baby, 106 Mar. Gula. Martin:
Toward Better and Safer Camping, 7 Aug.-Sept. Harper, Nancy:
Instead of "Blood-and-Thunder" Radio, 37 Nov. Hobby, Oveta Gulp:
To Understand Children Better, 139 May. Huse, Betty:
Book review by, 31 Oct. Illing, Hans A.:
Book reviews by, 31 Oct., 118 Mar. Inslev, Virginia:
Sick Children Benefit From a Citys Home-Care Program, 78 Jan. Kanner, Leo:
Mental Health in Child Rearing, 116 Mar. Kline, Draza B.:
Should Children Be Separated From Their Parents? 74 Jan. Kneisel, Stephan H.:
Eyewitnesses to the Toll of Delin- quency— Detention, 52 Dec. Leamy, Catherine M. :
Book reviews by, 47 Nov., 166 June- July. McGrath, Earl J.:
School Is More Than Three R's, 140 May. MacNeil, Douglas H.:
Communities Act Against Delinquency, 66 Dec. Margolin, Lillian:
For More Rewarding Summer Recrea- tion, 162 June-July. Meltzer, Esther S., and Miriam Wanne:
Foster Parents Speak Up, 158 June- July. Morrison, L. D.:
Eyewitnesses to the Toll of Delin- quency— Police, 55 Dec. Olson, Ruth'C:
Book review by, 119 Mar. Palumbo, Adelaide Z.:
Social Casework and the Child Camper, 144 May.
Phillipson, Elma:
Follow-up of 1950 White Hou.e Con- ference Enters a New Stage, 1 iO P ,. . Prevey, Esther E.:
Films on Family Life Stir Di.- 148 May. Price, Bronson:
Book review by, 118 Mar. Pruski, Beatrice:
When a Couple Plans to Adopt 127 Apr. Rubin, H. Ted and Bunny:
A Visitor's View of Child Wf Vienna, 10 Aug.-Sept., 27 Oct. Smith, I Evelyn:
Book review by, 46 Nov. Stecher, Sylvia, and Robert M. Fo Toward Better Speech and Hea June-July. Taylor, Alice L.:
Social Agencies Can Imp tot Training, 109 Mar. United Nations Day, 1952 (procla
16 Oct. Unsigned:
Children and the School-Lun
gram, 40 Nov. Delinquency Project Moves A -
Nov. A Few Facts About Juvenil ' i"
quency, 63 Dec. For Better Child Health; Pedi; Exchange Views on Ways Children's Health Problems, Sept. Recommended for Every Co; (services for delinquent child Dec. Veney, Lawson J. :
Eyewitnesses to the Toll o
quency — Training School, 57
Wanne, Miriam, and Esther S. Me
Foster Parents Speak Up, 11
July.
Winkley, Ruth:
When a Child Must Go to the , 34 Nov. Witmer, Helen Leland:
How Can We Evaluate Socia 24 Oct. Yarrow, Leon J.:
When a Child Is Deprived of M 84 Jan.
AUGUST-SEPTEMBER 1952
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WE CAN DO SOMETHING ABOUT
JUVENILE DELINQUENCY
JUVENILE DELINQUENCY is again on the increase. In the last 3 years the number of delinquency cases handled by juvenile courts in this country has risen almost 20 percent, according to estimates based on data now in the Children's Bureau.
By 1960, even if the delinquency rate does not increase, law-enforce- ment agencies will be dealing with 50 percent more children 10 to 17 years old (the age group in which most juvenile-delinquency cases fall) than in 1950. This is because the number of youngsters of these ages will in- crease that much, as a result of high birth rates during and after World War II.
A million or so boys and girls are picked up by the police each year. And every time a child doesn't get the kind of help he needs at such a time, society is the loser.
Far too many of our adult jails and prisons are filled with men and women who have juvenile-delinquency records.
No one can calculate exactly the cost of maintaining all our adult criminals, but we know that it runs into millions upon millions of dollars a year.
Nor can one estimate, in any mathematical terms, the great loss to the Nation in the creative, produc- tive, and cooperative power that these people might have contributed under other circumstances to our well-being, but we know the loss is great.
The problem of juvenile delin- quency has been with us before, and many times. During World War II delinquency rose to a new peak. As a people, we have made some gains against it. But only here and there.
We have courses of training for police officers who have to deal with youthful delinquents. But only a
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handful of officers have a chance to benefit from such courses.
We have to some extent stopped putting youngsters awaiting court action into jails housing adult crimi- nals. But 50,000 to 100,000 juvenile delinquents will be held in jails this year because there is no better place to put them.
Again and again we have seen the help that well-selected, well-trained probation officers can give to juve- nile-court judges. Yet more than half our counties today have no probation services to help judges weigh the problems behind a child's delinquency.
We have some training schools for juvenile delinquents which no longer put them in uniforms, crop their hair all alike, and march them this way and that. Some of our training schools have excellent diagnostic and treatment services, excellent school- ing, health, recreation, and religious programs, all designed to help boys and girls in trouble to find their way out of trouble and into a responsible and satisfying role in life. But this kind of training school exists only here and there.
The time has come to pull together what we know about juvenile delin- quents and their needs — what we know has worked well in helping them — and to build programs of ac- tion that will serve, not just a few, but all the youngsters who come up against the law.
This is a job that can best be done by citizens in their own communities and States. Many highly skilled and trained workers in the delinquency field are available to help.
Because citizens have a right to ex- pect help from their Federal Gov- ernment too, the Children's Bureau is stepping up its services. We have established a Juvenile Delinquency Branch in our Division of Social Ser- vices. Working closely with this new
Branch is the staff of a special Juve- nile Delinquency Project, created through the generosity of private contributors.
Together, our new Branch and Project will help to bring out into the open what is known about the causes and treatment of juvenile delin- quency in this country today. They will help National, State, and local citizen groups to develop programs that we hope will help delinquent boys and girls turn to activities that will increase their self-respect. With- in the next several months, we will have new pamphlets and other mate- rials that should be useful tools for such groups in organizing their own efforts in this direction.
Clearly, no such program can ac- complish its end unless it is con- cerned with averting delinquency as well as treating it. Our special j Branch and Project, therefore, will be concerned with measures to strengthen community services that make delinquency unattractive and unnecessary to youngsters.
Readers of The Child, associated as most of you are with services for children, can contribute greatly to this Nation-wide effort. I appeal to you to lend it your support, through the work of your present organiza- tion and through additional efforts. Your State or local committee or council for children and youth will be glad to put you in touch with other groups working against delinquency. If we can be of help to you, we invite your correspondence. We hope you will share with us an account of your activities.
lii^MjDcrl^ . ?^oU- 1
Martha M. Eliot, M.D. Chief, Children's Bureau
THECHILD VOL. 17N0. 1
TRAINING SCHOOLS AND THE > FUTURE
RICHARD CLENDENEN
NINETEEN - FIFTY - TWO marks, as never before to my knowledge, a period of trial, change, and • flux in training-school programs. Developments in training schools do not come about through happenstance. They grow out of problem solving. And the develop- ments begin to add up only as they are related to the problems to be solved and the knowledge and skills available for their solution. It is im- possible for me to make a compre- hensive analysis of this process in a relatively brief paper. However, it seems logical to begin by listing some of the problems that seem somewhat new or pressing at this particular time.
The number of boys and girls com- ing to the attention of law-enforce- ment agencies is increasing sharply in this country. National data indi- cate a rise of between 6 and 8 per- cent in 1951 over 1950. Individual communities were harder hit, some showing a 36 percent jump in the volume of juvenile delinquency court cases. Thus far in 1952 all signs point to a still further increase.
During World War II we experi- enced a similar rise in the volume of juvenile delinquency. We were not surprised at this. The unsettling conditions of war have always re- sulted in increased delinquency, and we were able to regard the rise as a
A training-school staff member talks over a boy's misconduct with him. When siuh every- day problems are handled with insight, the child is helped to reshape his entire behavior.
temporary phenomenon. And at the war's end the size of the problem de- creased.
But in 1949 the trend again re- versed, and since that time the vol- ume of delinquency has steadily mounted, each successive year. Obvi- ously, many of the forces that oper- ate during periods of tension and con- flict are again at work, and we can- not assume that the situation will change soon. For unlike the 1941-45 era, the present troubled state of world affairs does not enable us to
RICHARD CLENDENEN is Chief of the newly established Juvenile Delinquency Branch of the Division of Social Services, Children's Bureau. For several years he has been that Division's Consultant on Training Schools.
Mr. Clendenen gave this paper at a meet- ing of the National Association of Training Schools, held in connection with the seventy- ninth annual meeting of the National Con- ference of Social Work, held at Chicago.
look forward to so definite a termina- tion of the pressures which are un- settling our national life.
In the Nation as a whole, training- school populations are mounting, too. Many schools are already caring for numbers beyond normal capacity. And this is not all. We know that in the immediate future even more chil- dren will need care. In the early forties birth rates increased sharply and have remained at relatively high levels since that time. Very soon, then, training schools that accept children as young as 10 years of age will feel the effects of that increase. By 1960 in this country we shall have 50 percent more boys and girls age 10 to 17 than we had in 1950.
How are the training schools to care for more boys and girls? There are only two possible ways for them to do this. Either existing training
AUGUST - SEPTEMBER 1952
3
schools must be enlarged or new facilities must be established. The sound answer in the majority of States, I believe, will not be found in providing additional housing in exist- ing plants. This may be feasible in very small institutions, but, more often than not, training schools are already required to care for too di- versified groups of children, and many schools are already too large.
Additional facilities established
There is evidence of a trend in the direction of establishing new facili- ties to permit better grouping of children according to their needs. California has taken the lead in this. During the last 10 years four for- estry camps and three additional training schools have been estab- lished there, making a total of 10 facilities as contrasted with 3 exist- ing a decade ago. It is only fair to point out, of course, that the popula- tion of California has increased more than 50 percent during the same pe- riod. A number of other States have established additional facilities, too. All told, between 15 and 20 new State training schools have been estab- lished in the past 10 years; some of these are giving care to Negroes, a group for which previously no such care had been provided in some com- munities.
Many training schools are feeling the eifects of receiving a larger per- centage of children with serious be- havior problems. Exact data on the nature and extent of this change in training-school populations are lack- ing. We do not have adequate analy- ses of the composition of present and past populations for detailed com- parisons, but many experienced ad- ministrators agree that such a shift has taken place. It is also logical to assume that a smaller proportion of children with less serious behavior problems are sent to training schools, as the social-insurance programs and the social services of schools, courts, and social agencies are expanded, thereby enabling these children, as well as children who are more de- pendent than delinquent, to remain in their own homes and be cared for in their own communities.
4
Training - school administrators have long recognized that some of the boys and girls committed to their care are too aggressive — too lacking in self-control — to handle themselves in the general program, a program geared to the needs of the more typi- cal delinquent boy or girl. Improved community screening before commit- ment has left the training school with a higher concentration of the very aggressive boys and girls who need more intensive treatment in a setting providing more physical security than training schools usually are able to offer. A number of developments de- signed to meet this problem are under way.
Several States are planning to fol- low the lead of New York and estab- lish one or more separate facilities for the care and treatment of these so-called "unadjustable individuals." In Texas funds have already been appropriated for this purpose. A somewhat different approach to the problem is planned in California, where two combination receiving and
treatment units are to be established. Boys and girls retained in or referred to these units for treatment will be handled apart from those in reception status. Still another type of facility has been established in New Jersey, where a single study and treatment center serves both juveniles and adults, referred from a variety of sources.
Another movement aimed at the same problem, but not necessarily a substitute for this type of facility, may be seen in the establishment of security units within training schools. This is not a new idea in this field, but several additional units have been constructed within the past 2 or 3 years. These range in type from a single detention room to a ward similar to those used for housing dis- turbed patients in a mental hospital. This is a development that needs ex- tremely careful and thoughtful scrutiny.
There is no ready answer to "what to do with, how to handle" the very aggressive boy or girl — and a secur-
When staff members in a training school can help a child to feel liked and wanted and impor- tant, they are likely to succeed in changing that child's attitudes toward society and self.
ity unit is not an answer in itself. I do not question that some boys and girls require temporary care in physically secure quarters. Indeed, both the aims of treatment and the protection of other people often re- quire it. But boys or girls who are so lacking in self-control that they are temporarily unmanageable in the general training-school program are not helped to develop such control by the simple process of restricting their physical freedom to vent aggression on others and on others' rights and property. If such care is to be moi*e than cold-storage isolation, the pro- gram within such units must be geared to meeting the needs of seri- ously maladjusted personalities. Ade- quate social, psychological, and psy- chiatric services are a "must." And it may be difficult to provide these ser- vices in sufficient quantities on an institution-by-institution basis. In many States it would seem more feasible to develop such a program on a State-wide basis with a single facility serving two or more training schools.
States plan to pool resources
Adjacent small States might com- bine resources in order to establish and maintain such a facility. Again we have evidence of some planning in this direction. In 1951 a bill was introduced in Congress to enable the States of Maine, New Hampshire, and Vermont to enter into a compact relating to the joint construction of buildings necessary to satisfy human needs in the fields of education, hos- pitalization, welfare, and correction. The possibility of combining re- sources for the establishment of cer- tain institutional facilities also has been a topic at several interstate con- ferences.
Some States meet the problem of handling the very aggressive boy or girl through administrative transfer to institutions established for the care of persons convicted of crime. Yet we know that finding a young person delinquent is not the same as convicting him of a crime. Not only is such transfer of doubtful constitu- tionality, but it violates the spirit of
the cause for which we have long labored — namely, the development of specialized provisions and procedures for children before the law.
It is abundantly clear that the more inadequate the general training- school program is, the larger the number of children who cannot ad- just within it. The ability of a boy or girl to use and benefit from the regular training-school program can- not be truly evaluated unless and un- til that program is reasonably ade- quate to do the job for which it was designed. I have visited training schools in which large security units had been constructed during periods of very inadequate program develop- ment, units little used after those pro- grams were enriched and extended.
The need for a security unit looms largest during periods of stress and tension. And unfortunately it is at these very times that program ac- tivities become most threatened. In the face of mounting problems of con- trol, the temptation to restrict activi- ties is strong. Of course, some cur- tailment may be indicated if it seems impossible to supervise certain ac- tivities properly. But during times of tension in an institution, the need for outlets for energy and feeling is greater, not less. A material cut-back in activities will generate even more tension, which in turn will increase problems of control.
The basic job then is not new, but old ; a job that training schools share with all other agencies serving chil- dren and youth. It is : How can we improve and extend present services? Obviously, as the training schools are called upon to care for more boys and girls presenting serious behavior problems, the task of providing pro- grams adequate to meet their indi- vidual and group needs is vastly complicated. To achieve and maintain such programs requires better train- ing for personnel than we have usually been able to provide. It re- quires more professional services — psychological, psychiatric, and social — than we have usually been able to command. It requires more effective, better - planned community - relations programs than we have generally
had. Above all, it requires an abund- ance of courage to hold the line for a treatment program in the face of in- creased aggressiveness in the boys and girls we serve. Happily, we are able to report progress on some of these fronts too.
Staff training is receiving wider and more intensive attention. Various new programs for on-the-job training of personnel have been established within the past 2 years. I can men- tion only a few here.
The National Training School for Boys, in Washington, D. C, recently appointed a full-time staff-training officer, thereby becoming the first training school, to my knowledge, to employ a person to give full time to the orientation of new personnel and the on-the-job training of all staff. With this service, the National Train- ing School for Boys is experimenting with training methods. Recently, a cross-section of staff, about 12 in number, were released from all other duties to devote a full week to inten- sive group discussions of program. Interest and enthusiasm were high among participants, although it is still too early to evaluate how this experience has influenced the per- formance of these staff members.
In New York State the Bureau of Child Welfare of the State Depart- ment of Social Welfare has until re- cently assigned a staff-training spe- cialist to work half time at the New York Training School for Boys. This specialist devoted major attention to working with the individuals re- sponsible for the direction and super- vision of houseparents and other cot- tage personnel.
Although still in the planning stage, the New York Training School for Boys contemplates a training and research project geared primarily to on-the-job staff training. Through the services of specialists in the fields of group work, group therapy, psychi- atric casework, and clinical psychol- ogy, explorations will be made to de- termine what these professions have to offer in both methods and knowl- edge, which can be used in staff training and by staff in their respec- tive jobs. The project team will also
AUGUST - SEPTEMBER 1952
5
include a person skilled in research who will be responsible for establish- ing the controls and methods neces- sary for evaluating results.
Somewhat more than a year ago, the California Youth Authority em- barked on a carefully planned on-the- job training program, participated in by the six training schools and the four forestry camps administered by that agency.
With the help of a committee, a syllabus consisting of 12 study units was developed. Each unit represented a study outline for some aspect of the training-school job. One staff member in each facility was then selected to serve as its training officer or in- structor. Prior to launching the training sessions, these persons were brought together for a week of dis- cussion, instruction, and indoctrina- tion.
This was followed by a 3-day meet- ing for going over the syllabus, identifying and defining the func- tions of training officers and their relationship to staff and administra- tion, and determining the objectives of the training program. A specific amount of time was provided in each facility's budget for this on-the-job training.
Major emphasis was given to the orientation and training of new staff, but time was allotted for the training of all personnel. Group sessions util- izing a variety of methods, such as discussions led by staff members or outside persons, lectures by selected speakers, and presentation of films followed by discussions, were then arranged for regularly by the train- ing officer in each facility.
None of the programs outlined above, nor any others with which I am acquainted, would be described by the originators as ideal or as fully meeting on-the-job staff training needs. But the fact that these, among other programs, have been started, that time and money for such staff training have been budgeted, repre- sents a tremendous step forward. And I am convinced that we are not going to make material progress in developing staff-training programs
until we make specific provision for this function in the planning of each year's budget and work program.
One person responsible for program
still another general observation can be made about the staff-training programs described here. In each training school, specific and continu- ing responsibility for carrying on the program was delegated to a selected member of the staff. Ideally, of course, this person should be espe- cially qualified for this function. In practice, it is gratifying to observe how much can be achieved through the leadership of a person lacking such ideal qualifications, if assistance and guidance can be provided. Ex- perience, which at this point is mea- ger, would indicate that a training school employing a staff of substan- tial size could well use the services of a full-time person in the develop- ment and provision of a staff -training program. A beginning might be made in some States by employing such a person and dividing his time between two or more training schools.
I have said that the larger numbers of serious behavior problems that the training schools are being called upon to meet intensifies the need for staff training, professional services, and sound community relationships. Space will not permit me to discuss the shortage of professional person- nel, nor to mention some of the inter- esting variations in the ways profes- sional services are being geared into training-school programs. Neither do I have space to discuss community relations, a subject that is compli- cated by the uncertain, vacillating, and often punitive attitudes of the public toward the delinquent. I have also said that the job requires an abundance of courage to hold the line for a treatment program in the face of increased aggressiveness in the boys and girls we serve — aggressive- ness that inevitably breaks forth at times in a manner that results in public demands to "get tough." And that kind of courageous leadership is emerging more and more.
The spread of knowledge and un- derstanding in the training-school
field is impressive. We have long had considerable knowledge about human behavior, and progressive training schools have drawn upon this body of knowledge in program development. But we have also had large deserts into which the understanding that flows out of that knowledge has not penetrated. Gradually these deserts are diminishing.
I am referring, for example, to a fuller and more widely accepted ap- preciation of the importance of hu- man relationships in the job we are trying to do. There is growing recog- nition that the end result of every training-school experience is deter- mined by the network of relationships existing among those sharing it. Whereas many training schools once concentrated almost exclusively upon outward behavior, and unfortunately some still do, there is greater recogni- tion of the importance of feelings, re- actions, relationships, whatever the outward behavior.
How can we change a child's attitudes?
A better understanding of the dis- tinction between the control of be- havior and its permanent modifica- tion is developing. I do not mean to imply that the control and modifi- cation of behavior are unrelated. Rather they are most intimately re- lated. The ways in which be- havior is controlled from day to day has a strong influence upon the shaping of future conduct. And rec- ognition that behavior grows out of the individual's attitude toward so- ciety and self has led to a wider eval- uation of methods utilized in main- taining controls. Penalties that hu- miliate the individual, diminish his self-respect, shake his self-confidence, or confirm his feeling that the world is a harsh, unfriendly place are giv- ing way to methods that though some- times less effective in altering im- mediate behavior will over the long haul build self-respect, as well as confidence in others.
Recognition that a person's atti- tudes cannot be changed unless he feels liked and wanted and important has led to wider efforts to make boys
(Continued on page 14)
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THE CHILD VOL. 17 NO. 1 ..
TOWARD BETTER AND SAFER CAMPING
A State Welfare Department Surveys Children's Camps
MARTIN GULA
THIS SUMMER more than three million boys and girls have been away from home for weeks, or even months, camping in the woods, at a lakeside, or in some other natural setting. Some parents have paid sev- eral hundred dollars in fees for pri- vate camps ; others have sent their children to less expensive camps, op- erated by nonprofit organizations. All the parents expect the camp to safeguard their children's life and health. All hope that their children will have an enjoyable time that is also a wholesome, constructive ex- perience.
Many camps fulfill these parents' expectations. A camp that is ad- mitted to membership in the Ameri- can Camping Association, for ex- ample, is recognized as a camp that lives up to the high standards set by the Association. In the same way, the Boy Scouts and the Girl Scouts, the YMCA and the YWCA, the Boys' Clubs of America, and some other national groups hold their member camps to high standards.
Large numbers of camps, however, are not accredited by any organiza- tion. When a mother and father send Joe or Susie to a camp that they have heard about through an adver- tisement, or from a neighbor, what assurance have they that the camp will be suitable for the child? Will the workers in charge be mature, re- sponsible persons, who understand children and like them, who know
MARTIN GULA is Consultant on Group Care in tlie Division of Social Services, Chil- dren's Bureau. He holds master's degrees in social work and in education. During the past 15 years his work with children has included a variety of positions in the field of social group work, including 8 years of directing summer camps in New York State. Just before joining the Children's Bureau staff Mr. Gula was director of a study and treatment residence for emotion- ally disturbed boys and girls.
AUGUST - SEPTEMBER 1952
how much activity boys and girls of different ages can undertake, and who will not subject a child to tiring competition? Will safety provisions be adequate? Will a doctor be avail- able if the child falls ill? How about emergency hospitalization?
Many parents, and some social agencies too, assume that camps are supervised by State authorities, as many schools are, and as children's institutions are. It is true that most States, through their public- health laws and regulations, set mini- mum sanitary requirements, such as those concerning sewer facilities, garbage disposal, and water supply. But few State laws or regulations pay attention to the qualifications of the director and his staff — the per- sons responsible for safeguarding the children's lives, their health, and their well-being, while they are away from home.
Not many States, for example, re- quire that a registered nurse be on the staff, to watch for signs of illness in the children and to judge when a
doctor is needed. Few require camps to make sure that a doctor can be reached in an emergency. And al- though swimming and boating are a prominent feature of the activities in most camps, only a handful of States include a requirement that some one employed by the camp be able to ad- minister artificial respiration.
Yet even if all the States had laws or regulations requiring camps to meet high standards, enforcing these requirements would take more staff than many State governments have been able to provide. Up to now, few States have been able even to assess the extent of camping within their borders, much less to provide enough staff to supervise the camps ade- quately.
But in spite of the difficulties, some States are trying to fulfill their re- sponsibility for guarding the welfare of the youngsters that every summer throng to camp. Among these States is California.
The California State Department of Social Welfare is responsible by
"Having wonderful time." Their parents hope that it will also be a safe and healthful time.
law for protecting children under 16 years of age in "the absence of their parents," and its Division of Child Welfare fulfills this responsibility through inspecting and licensing a variety of facilities for child care.
The Department has for many years recognized its responsibility for inspecting and licensing summer camps for children under 16, but it has never had enough staff for this purpose. However, it has been able to take action on any serious com- plaint about a camp. And it has in- spected and licensed a small number of camps that requested this service. Also it has worked with the help of the American Camping Association toward developing tentative stand- ards for protecting the health and safety of child campers in the State.
A long step forward was taken to- ward fulfilling the Department's re- sponsibility for protecting children in camps through licensing, when the State legislature provided, in the De- partment's budget for 1951-52, the equivalent of two full-time positions, specifically for work with camps. With this provision the Department planned the following activities :
"1. A survey of camps — locating and identifying camps to determine the number and type of camps and the number of children served and to collect information on camping practices.
"2. Inspection and licensing of as many camps as possible on a cross- section sampling basis as to types and location.
"3. Identification of any problem areas, and evaluation of the practical problems of licensing.
"4. Continuation of the process of development of standards to protect the basic health and safety of camp- ers and to promote good camping practice."
In its work toward these goals the Department enlisted the help of a committee representing the organiza- tions in the State with major leader- ship in the field of children's camp- ing. These included the five Cali- fornia sections of the American Camping Association ; the Pacific Camping Federation; the Northern
8
and Southern California Private Camp Directors' Associations; the national youth-serving organizations — Boy Scouts, Girl Scouts, Camp Fire Girls, YMCA, YWCA, Boys' Clubs of America, and Salvation Army; gov- ernmental agencies, such as the State Fire Marshal, the State Department of Public Health, the State Recrea- tion Commission, the State Depart- ment of Education, the State Divi- sion of Beaches and Parks; and the United States Forest Service.
Committee's work appreciated
This committee gave valuable ser- vice in locating and identifying camps, in interpreting the Depart- ment's program to individual camps, and in guiding the Department in methods of approaching the problem as a whole.
The first step in the survey was to collect the names and addresses of as many camps as possible, even though it was clear that a large num- ber of these would have to be re- moved from the list, for some would be duplicates, some would no longer be in operation, and many would prove either to be not "established camps," by administrative definition, or to be outside the jurisdiction of the Department of Social Welfare. (Camps maintained by public schools or other public agencies, camps for the handicapped, week-end or day camps, family camps, and camps for boys and girls over 16 are not the responsibility of the Department of Social Welfare.)
The members of the survey com- mittee provided the names of a large number of camps aflfiliated with their organizations. Other sources of in- formation were county health and welfare departments and churches and church organizations. Then there were local camp organizations, cham- bers of commerce, directories pub- lished by clothing and camp-supply stores, welfare councils, local park and recreation commissions, automo- bile club lists, and so forth.
About 900 names of camps were obtained, and a questionnaire, accom- panied by an explanatory letter and a copy of the tentative camp stand-
ards, was sent to each. The letter told the camp that the State Depart- ment of Social Welfare planned to inspect and license a cross-section of camps, and that for this reason the questionnaire had been designed to serve also as an application for license. The camps were assured that all information would be confidential and that no data on individual camps would be published.
The letter went on to say:
"In filing the completed question- naire, you will have fulfilled your ob- ligation under the law to apply for a license, even though the Department is unable to complete a licensing study of your camp this summer. In this year's work with camps the De- partment will select a sample of all types of camps in the major camping areas of the State.
"If your camp is selected for li- censing (no fee involved), an ap- pointment for a visit, at your con- venience, will be arranged. If you would like to be included in the sam- ple, please let us know.
"In licensing camps the Depart- ment will make every effort to indi- vidualize camps. There will be no attempt to fit camps to a single pre- conceived idea of a "good camp." The items on the questionnaire are not specifically related to licensing; "no" answers will not necessarily mean that a license could not be issued. You will note that the standards for li- censing, which are enclosed, are ten- tative for this year at least, and that suggestions for changes will be wel- comed."
Among the items on the question- naire were :
What is the minimum age for counselors?
Has the camp been inspected by fire-safety officials? By health offi- cials?
Is a qualified water-safety instruc- tor on the staff?
Is a physician on the staff, or on call and accessible?
Is a registered nurse on the staff?
Is a precamp medical examination required for campers? For staflf?
Is the camp accessible by a good road ?
THECHILD VOL. UNO. 1-
I
Have arrangements been made for emergency hospitalization?
Of the camps that were sent copies of the questionnaire, 368, in 43 of the State's 58 counties, returned com- pleted questionnaires in time for tabulating. These camps had a sea- sonal capacity of nearly 166,000 campers (capacity at one time multi- plied by number of sessions). Non- profit groups operated more than three-fourths of the camps ; 80 camps were privately operated. Most of the camps served children in the 8-16 group; 22 accepted children of pre- school age and 92 served 6- and 7- year-olds. The large majority of the campers were between 8 and 12 years old.
Quality of personnel stressed
No attempt was made to evaluate individual camp programs on the basis of the questionnaires. However, the Department, in its report, classi- fies the camps according to their ma- jor program emphasis. Some camps went in for outdoor primitive camp- ing; others had a major interest in athletics, team sports, and games ; others were set up for the purpose of religious education ; still others were planned to serve underprivileged chil- dren (a few of these camps were in- terested in treating children with be- havior disturbances). The Depart- ment does not intend to suggest that any one of these types of camp pro- grams is more desirable than another, but rather to point to the necessity for wider knowledge, understanding, and experience in persons who evalu- ate such programs.
The most important factor in camping, as in any other child-wel- fare program, says the report, is the quality of the personnel. There is general recognition that camp coun- selors with responsibility for super- vision of living-groups should be ma- ture, responsible persons, at least 19 years of age. It was, therefore, a matter for serious concern that more than half the camps had counselors under the age of 19.
The Department selected a cross- section of the camps to be visited by its staff. With the funds allotted for
AUGUST ■ SEPTEMBER 1952
the 1951 work with camps a camp consultant was employed for 6 months and six social-welfare agents for 3 months each. In the course of the summer the six agents visited 123 camps of various types. These were in 32 counties, representing all the major camping areas of the State.
Of the 123 camps visited, the De- partment issued licenses to 66 (53 percent) . In practically all of the 66, it was necessary for the camp to make changes before it could be li- censed.
Another 26 camps would probably have been licensed were it not for de- lay in receiving their fire-safety or sanitary clearances. The Department workers visited some of the camps late in the season, and frequently a camp would be closed before local fire or health officials could inspect it. A serious factor in lack of inspection was that some counties did not have complete fire- and health-inspection services.
The remaining 28 camps could not be licensed, either because these camps did not provide basic mini- mum protection of the children or because it was not possible in a brief visit to obtain sufficient information as to whether minimum standards were met.
Major problems preventing camps from being licensed were in the fol- lowing categories:
1. Fire safety. Major changes or improvements were needed to bring the camp to minimum standards of fire safety.
2. Sanitation. Correction of haz- ardous conditions needed before sani- tary conditions would be satisfactory — sewage disposal, water supply, and so forth.
3. Personnel. Counselor staff in- adequate in number or questionable as to age, training, or experience.
4. Medical-care program. Pre- camp examinations not required for campers, or for staff, or for both ; in- adequate provision for health super- vision or emergency medical care, or both.
5. General administrative organi- zation. Responsibility for care and supervision of campers not clearly placed ; general organization and ad- ministrative lines unclear.
In general the response to the li- censing program was good. Most camps willingly made changes or planned to make them in the follow- ing season in order to provide basic minimum safety.
The Department's experience in visiting camps showed that a worker could be expected to visit two camps a week. Half a day in each camp is needed in order to gather sufficient information to evaluate operation (Continued on page 14)
Under guidance of mature, understanding staff, children can gain rich experience in camp.
A VISITOR'S VIEW OF CHILD WELFARE IN VIENNA
H. TED and BUNNY RUBIN
.USTRIA HAS ALWAYS looked to Vienna as the stimulus to its progress in social welfare, and much of the western world in the past has done the same. For in Vienna dynamic psychology had its genesis, and the soil out of which it grew was the same as that out of which arose Vienna's advanced so- cial-welfare structure.
But World War II left Vienna with many bombed homes, schools, and welfare institutions; many health problems ; physically handicapped citizens ; parentless children ; and the uncountable damage resulting from widespread injurious experiences. And only now is Vienna beginning to shake off the deadening effects of the Hitler Anschluss and the devastation of war.
Austria's social-welfare program, like that of most European nations, is largely a public one. In the im- mediate postwar period, a consider- able part of Vienna's social-welfare budget had to be allocated for recon- struction and rehabilitation, and could not be used for new develop- ments needed in this field. The gen- eral poverty of the country has seri- ously restricted the carrying through of plans for improvements.
It has also severely limited family incomes. And this in turn has re- sulted in a high proportion of work- ing mothers ; in consequence, the city has to provide day care for a large number of children.
Provision for care for preschool children includes day nurseries for children from 6 weeks of age to the second birthday; also day-care cen- ters for children 3 to 4 years of age and for 5- and 6-year-olds. For school- age children the city provides centers for after-school study and recreation. Vienna's schools, which are open 6 days each week, close very early in
the afternoon, and this necessitates many such centers.
The American type of kindergar- ten, with its primary emphasis on education rather than on social wel- fare, is nonexistent in Vienna. En- rollment in day-care centers and kin- dergartens is restricted to children whose mothers work. Although many more are eligible, at present about one Viennese child out of seven par- ticipates in a preschool group experi- ence.
Newer ideas slow of acceptance
Another major factor that has shaped Vienna's present social-wel- fare program, to a degree difficult for the outsider to realize, has been the devotion to past tradition of many officials and of a tremendous part of the people as a whole. Per- haps it is understandable in the cur- rent period of impoverishment that the Viennese people look back to their once golden age of leadership. Still, the more progressive social-welfare leaders feel hindered by this glorifi- cation of the past and the accompany- ing resistance to adapting to changed conditions.
Examples of this are the slow and difficult struggles in the municipal Jugendamt, or children's office, to shift the emphasis from the chiefly physical factors in the child's devel- opment to the social and psychologi-
H. TED RUBIN received his master's degree from the School of Applied Social Sciences, Western Reserve University, and he is now a caseworker with the Illinois Children's Home and Aid Society, Chicago. BUNNY R. RUBIN received her master's degree from Western Reserve University in Speech and Hearing Therapy. She is an instructor at the Speech and Hearing Rehabilitation Clinic, University of Illinois Medical School, Chicago.
In addition to studying child welfare in Vienna, Mr. and Mrs. Rubin have surveyed child-w^rlfare facilities in several other Eu- ropean countries and have taught at a training center for institutional personnel in Geneva.
cal ones, and to alter accordingly the requirements for district directors. The newer movement is aiming to require directors to have been trained in working with the whole child and individualizing him, instead of, as at present, requiring them either to have a legal background or to have had training that stresses the child's physical development.
In each of the various districts a Jugendamt forms the core of Vien- na's child-welfare program, and serves children until the end of their eighteenth year. It is often located in the same building as the district tuberculosis office, the health office, the well-baby clinic, the marriage bureau, the vital-statistics bureau, and the office of guardians for chil- dren born out of wedlock.
Through the Jugendamt the city furnishes every baby with a complete layette. Behind this program is an effort to control congenital syphilis, since each expectant mother must undergo a Wassermann test before the fourth month of pregnancy in order to obtain the layette. The Jugendamt social worker arranges for this test and also visits the home after the baby is born.
In Austria the State assumes the guardianship of every child born out of wedlock, and a so-called statutory guardian in the Jugendamt handles questions such as establishment of paternity and arrangement for the financial allotment required of the father. The social aspects of illegiti- mate birth are dealt with by the reg- ular Jugendamt social worker.
In addition, this social worker reg- ularly serves as doctor's assistant in one or more well-baby clinics and arranges for summer holiday camps for school-age children. She also car- ries 170 or more cases, including fam- ily problems that involve children, behavior problems of children, and referrals to various child-care facili-
10
THE CHILD VOL. 17 NO. 1 '
ties. She makes pre-licensing studies of foster homes and supervises chil- dren in these homes. She also makes weekly visits to two or three schools or day-care centers, where she ad- vises teachers and works directly with some children. Besides all this, ishe writes her own short case records 'without secretarial assistance.
How much help can a social worker give individual children when she has such wide responsibilities? Without the benefit of the type of supervision that stimulates continuous profes- sional growth, without much knowl- edge of how to apply psychological principles to social work, and without jmuch time because of her many du- ties, her work must be largely limited to efforts to improve the children's environment.
"Viennese people consider social service a public duty provided as a matter of right to all; they feel no diminished status in seeking such help, and use facilities more easily than do most people in the United States," explains Dr. Anton Tesarek, city director of child welfare. "Vien- na has a highly specialized child- welfare organization without highly trained social workers. United States caseworkers have done wonderfully in a comparatively few cases," Dr. Tesarek continues. "In Vienna spe- cialization has been neglected to han- dle many thousands of cases."
A Jugendamt social worker, in her work with problems concerning chil- dren, may seek guidance from her senior social worker, and in cases of parental neglect the juvenile court
Children of Vienna's working mothers attend day-care centers operated by the municipality.
A step forward, however, has been ;aken by the city-operated school of social work, the most advanced of Austrian social-work schools, which las initiated a long-range program ;o develop the teaching and practice )f casework and to encourage the ntroduction of trained supervision, -like many other European schools )f social work, the Vienna school re- luires no previous university educa- ion for admission.
iUGUST - SEPTEMBER 1952
may actually award partial or total custody of the child to this senior worker. The latter then guides the regular worker in planning for and in supervising the child.
For help with her most difficult cases, the social worker consults with the office's Erziehungsberater, who may herself advise the child and the family, or may recommend outside psychological treatment, or may sug- gest placing the child away from his
home. Erziehungsberater may best be translated as "counselor on chil- dren's total development." Aichhorn introduced these counselors into the Jugendamter and trained the first of them in the 1920's.
After the staff decision to place a child away from his home, the social worker takes him to Vienna's central 212-bed KinderiibernahmsteUe, liter- ally the "children's-taking-over-cen- ter." Here the child receives physical and psychological examinations; and some social history is obtained. After a stay of several weeks or months, he is placed in a foster home or an insti- tution.
Parents unable to pay for foster care
Approximately 1,400 children are in foster homes supervised by the city of Vienna. Since by law the Jugendamt is responsible for super- vising foster homes, no private Viennese social agency can place chil- dren in such homes. Low incomes prevent parents from contributing a meaningful percentage toward reim- bursing the city for foster care of their children.
Physical destruction resulting from the war has strongly contributed to the foster-home shortage. Twenty- one percent of all Viennese dwelling units were damaged, and only a hand- ful of new housing has been com- pleted since this took place.
The money allotment for foster- home care has increased more than 100 percent since the end of the war, and this has helped to increase the number of homes. Viennese foster mothers now receive the equivalent of $7.50 to $8 per month per child; this is in hne with the average father's monthly income of $28 to $30. The cost of living is far lower than in the United States, but in ad- dition to food expenditures, the fos- ter-home allotment must cover recre- ation, allowance, dry cleaning, and shoe repairs. Foster homes in areas beyond the city limits receive the equivalent of $4.50 to $6 per month per child. Nearly half the boarded- out children live in foster homes in the provinces outside Vienna. (To be continued in October issue)
II
FOR BETTER CHILD HEALTH
Pediatricians Exchange Views on Ways to Solve Children's Health Problems!
OW SUCCESSFULLY an ado- lescent solves his life problems depends partly on how well he solved the same types of problems when he encountered them in earlier childhood, said Dr. Reginald S. Lourie at the Eastern Area meeting of the American Academy of Pedi- atrics, held in Washington, May 22- 23, 1952.
Dr. Lourie, who is Director of the Department of Psychiatry, Chil- dren's Hospital, Washington, D. C, cited examples of the types of difR- culties that a child meets again and again in his life. Some of these. Dr. Lourie said, grow out of the young- ster's close relationships with other people ; some are related to the need for his obeying rules ; others are con- cerned with his learning orderliness and cleanliness. Then there are prob- lems concerning his concepts of his own body and of sex.
When the adolescent gets another chance at solving such problems, went on Dr. Lourie, he may be able to correct distortions in his ideas that faulty training or environmental sit- uations had previously created. And in adolescence the child deals with the old problems in new ways — with different perspectives and more energy — ways that can make him and the people around him uncomfortable. Dr. Leona Baumgartner, New York City's Assistant Commissioner of Health, and formerly Associate Chief of the Children's Bureau, stressed the need for integrated and concentrated research on the under- lying causes of mortality and mor- bidity among infants in the danger- ous period before birth and just afterward. Dr. Baumgartner advo- cated development of one or more institutes where continuing studies of such mortality and morbidity can be made through research by workers in many fields — by the embryologist.
the chemist, the physiologist, the pediatrician, the obstetrician, the physicist, the sociologist, the statis- tician— in fact, by every kind of re- search worker who has something to contribute toward solving this prob- lem.
What one medical ward is doing
Can we decrease the emotional im- pact of hospitalization on a child and his parents? Discussing this question. Dr. Dane G. Prugh of the Children's Medical Center, Boston, described an experiment in one medical ward. In this experiment professional workers in a number of fields are joining to lessen children's disturbing reactions to illness and hospitalization.
One step in this direction is to re- duce the amount of separation be- tween child and parents. Dr. Prugh reminded his audience. And so the ward's welcome to the parents begins when the child is first brought to the hospital. At this time the mother and father may accompany the child to the ward, where they meet and talk with the staff members. Again, they are encouraged to visit their child every day. If they cannot come at the regular visiting hours, arrangements are made for them to come at times more convenient for them. They may also help to care for their youngster. They may feed him, or read him to sleep, or, if they wish, just sit by his bed and hold his hand.
Many people concerned with hos- pital management have long thought that children cry more if their par- ents visit them frequently than if the visits are far apart, said Dr. Prugh. But when the parents come every day, he said, the children soon real- ize that the separation will be short. And they cry less frantically and less frequently than do children who are visited only once a week.
In the experimental group, special attention is paid to the individual needs of every child. Dr. Prugh said. For example, a play supervisor offers various kinds of activities to meet the emotional needs of different children. Although more than one nurse may give care to a child from time to time, an effort is made to assign one nurse to be in particular charge of him. Dr. Prugh made it clear that this is done especially for a young child or one' having difficulty in adjusting. {
The adjustment of different chil-; dren is discussed at a weekly staff conference. At this conference, which, is directed by a pediatrician with psychiatric training, various profes-! sional workers contribute ideas from their own points of view. Such a con- ference may include the ward physi-| cian, the head nurse, the play super-] visor, the occupational therapist, thej medical social worker, the dietitian,j the psychologist, and frequently aj public-health nurse. :
Efforts are made to keep from scheduling injections or other un- pleasant medical procedures near the: child's time for play, or a meal, or a nap. '
Flexible methods v. conventional ones
Dr. Prugh told of a research studj that was made to compare the adjust-^ ment of the children treated by these fiexible methods with that of the sam( number of children cared for by tral ditional methods. Children in the lat, ter group saw their parents only onc<i a week, for an hour, and in otheij ways the conditions were similar t(! those in most hospitals. i
Dr. Prugh said that the childrei were studied both while they wen still in the hospital and after the; were taken home, and their reaction; to their hospital stay were noted.
All the children, he said, showe( some adverse reactions. In botl
12
THE CHILD VOL. 17 NO.
i^roups, the most severe reactions A^ere in the children 3 years of age and younger. In children 4 to 6 years aid severe reactions were less com- mon, and in children over 6 they were few.
After returning home most of the children behaved much as they did before going to the hospital. A num- ber, however, in both groups showed significant behavior disturbances soon after being discharged that they had not shown before they were hos- pitalized. More of those in the con- ventionally treated group showed this temporary maladjustment than of those more flexibly treated.
Dr. Prugh said that in every age group the children who had received the specially planned individual treat- ment, including daily visits from their parents, showed fewer and less se- vere reactions than did those treated by conventional methods.
INarcotics users need msdical aid
Dr. Harold Jacobziner, Director of New York City's Bureau of Child Health, urged special institutions for teen-age narcotics users. He based his recommendation on studies of more than 150 high-school students who, when given medical examina- tions during the 1950-51 school year, were discovered to be users of nar- cotics.
Most of these boys and girls were not true addicts. Dr. Jacobziner re- ported. They could be weaned away
from use of narcotics, he said, by a 4- to 5-month course in a special institution.
Dr. Jacobziner also urged that teen- age narcotics users not be treated as off'enders against the laws, but as diseased persons who need medical aid. Treatment, he continued, should include not only withdrawal of the drug but mental, emotional, and so- cial rehabilitation.
Twenty-five scientific exhibits had been set up in connection with the meeting. Among these were exhibits on Dental services (Children's Hos- pital, Washington, D. C.) ; Evalua- tion and handling of the infant and preschool child with impaired hear- ing (Harriet Lane Home, Johns Hopkins University Hospital, Balti- more) ; Psychological evaluation of physically handicapped children (Bu- reau of Maternal and Child Welfare, Health Department of the District of Columbia) ; Unsolved problems in fetal and infant mortality (Children's Bureau, Federal Security Agency.)
The Children's Bureau exhibit highlighted the hazards to babies during the last few weeks of gesta- tion and the first few weeks of life. It listed these facts on deaths of un- born and of newborn babies :
In the United States in 1949—
1. Unborn babies who died just before birth reached a total of 48,000. Not all of these were full term, but ail were at least "7-month babies."
2. Over 37,000 babies died before they were a day old. These deaths represent a third of all deaths during the first year.
3. Deaths in the first week of life amounted to over 65,000 — 58 percent of all the deaths of babies less than a year old. (This figure includes, of course, the 37,000 who died before they were a day old.) Of the 65,000 babies that died during their first week nearly 40,000 were prematurely born.
Deaths in the first weel( still high
The exhibit compared infant deaths hi 1948 with those in 1915, when im- proved birth registration first per- mitted study of trends in infant mor- tality. During those 34 years the death rate for babies in their first year of life was reduced by more than two-thirds, but for those in their first week the decrease was only one- third.
Dr. Alice D. Chenoweth, pediatric consultant on the staff of the Chil- dren's Bureau, discussed the implica- tions of the exhibit with some of the pediatricians attending the meeting. Now that maternal mortality has been so greatly reduced, she said, and also the deaths of infants from the second month of life to the end of the first year, both pediatricians and obstetricians are focusing their at- tention on the babies that die before birth or soon afterward.
UNSOLVED PROBLEMS
IN FETAL AMD INFANT MORTALITY
little gain has been made in reducing mortslily in the first week of life
over 60^0 of the deaths in the first vteek are in prematures
TRAINING SCHOOLS
(Continued from page 6)
and girls in training schools feel the respect and dignity fundamental to the mental health of each of us. Care- fully planned reception and orienta- tion procedures, student participation in program planning— these are not frills but important ingredients in treatment. Decent clothing, palatable and attractive food, pleasant sur- roundings, courteous handling— these are not privileges but the rights of every American child, and these, too, are essentials in a treatment pro- gram.
In my work with the Children's Bureau I visit training schools in every part of the country. And in the course of these visits I am impressed again and again by the fact that the training-school administrator occu- pies a trying and lonely position. He must reconcile the demands of treat- ment with the need to protect chil- dren, program, and public. Failure to provide adequate protection will quickly result in public criticism. At the same time, colleagues in closely related professions are frequently in- tolerant of any restrictions placed upon the children under care. While subjected to these conflicting de- mands, the administrator must de- velop a treatment program, which means achieving and maintaining a progressive but realistic focus for himself and staff.
Yet in a broader sense, his is not a solitary endeavor. Others are en- gaged in this same hard task. For the program he seeks to develop is directed toward resolving human con- flict, improving human relationships —and this is the concern of all of us. The wellsprings of juvenile delin- quency—neglect, poverty, fear, hate, cultural conflicts, ignorance — these are also the wellsprings of all human conflict. And whether we work to improve training-school programs or the United Nations, we are applying ourselves to the task of helping peo- ple to find a constructive and satisfy- ing way of life in a society of free men.
Reprints in about 6 weeks
CAMPING
{Continued from page 9)
properly. Travel to camps requires a great deal of time because many of them are located many miles from the nearest major highway.
The Department's report of the survey points to the serious need of adequate State staffing if protection of children in camp is to be achieved. The report says:
"While the 1951 licensing experi- ence cannot be considered conclusive as to the number of camps one field worker can license, it did provide the following general conclusions, on which future plans for licensing would need to be based :
"Staff must be available on a year- round basis and not during the sum- mer months only. The most construc- tive work in bringing about improve- ments in camps can be done only dur- ing the noncamping season. Changes in staflF, buildings, sanitary facilities, and so forth cannot be made while children are at camp.
"Most camps begin to plan for the summer during January and Febru- ary. Counselor recruitment is begun in February and staffs are usually complete by April or May. Camp re- pairs and improvement are made in the spring and sometimes during the winter, if weather permits.
"It is essential to have staff in the summer to visit and evaluate camps ; in the fall to follow-up with camps on the results of the summer visiting ; in the winter and spring to discuss preliminary planning for next sea- ion's operations.
"Fire and sanitary inspections should be requested by the first of April at the latest, to allow time for any needed changes. Ideally, camps should be licensed before the season starts and visits during the season made as a follow-up on discussed plans and as the basis for next sea- son's license.
"As more experience is gained and more camps licensed, it can be ex- pected that renewals of licenses will require less time, but it can be ex- pected that there will be considerable
"Sufficient staff must be available! to act promptly on serious complaint| situations, without neglecting the to- tal caseload of camps.
The foregoing information on Cali- fornia is given in a report of the 1951 survey, published in February 1952 by the State Department of Social Welfare, entitled "Camps for Chil- dren in California."
During the present year, the De- partment has continued to work with its camp advisory committee, which has been expanded to include repre- sentatives of additional groups.
A subcommittee, appointed to con- sider sound, practical requirements covering all aspects of fire safety in [•amps, has developed a booklet, "Guides to Fire Safety in Camps for Children in California," and copies have been sent to all camps. Another j subcommittee is considering sanita- tion and the whole area of health pro- tection. Plans have been worked out with the State Department of Public Health and the Conference of Local ; Health Ofl^cers, under which sanita- tion inspection services will be avail- able to every camp.
Licensing activity, still on a limited scale, is continuing, with major em- phasis on private camps. Cooperative eff'orts toward stimulating the camps to meet minimum standards are con- tinuing with such groups as the American Camping Association and the national youth-serving agencies.
California's State Department of Social Welfare is hopeful that its ef- forts will bring about a sound practi- cal program in the State, leading to adequate protection of children in camps.
A number of other progressive States also are working to improve camping programs for their children. These efforts are becoming more and more significant in view of the rising number of children in the United States, for by the end of the present decade probably as many as 4,000,000 youngsters will be going to camp each summer.
THE CHILD VOL 17 NO. 1.
THE NEWS
Education for social work. After several years devoted to a study of methods of improving social-work education, the National Council on Social Work Education, reconstituted as the Council on Social Work Edu- cation, began operation July 1 with a new constitution and by-laws.
The Council is now governed by a delegate body of 78 members. Thirty of these are representatives of educa- tional institutions — graduate schools of social work (20) and undergradu- ate departments (10) offering pro- grams with social-work content in- troductory to professional social work. Eighteen represent national professional social-work organiza- tions. Another 18 represent national agencies employing social workers (9 public agencies and 9 private). The other 12 delegates are member s-at- large, representing higher education — especially departments of the so- cial sciences — disciplines related to social work, and the general public.
The work is carried on by four commissions : A commission on ac- creditation ; a commission on pro- gram, planning and services, and publications ; a commission on re- search ; and a commission on schools and departments of social work.
The Council will assume the func- tions that have been carried on by the American Association of Schools of Social Work and the National Asso- ciation of Schools of Social Work.
OR YOUR BOOKSHELF
A HEALTHY PERSONALITY FOR YOUR CHILD. Federal Security Agency, Social Security Adminis- tration, Children's Bureau. CB Pub. No. 337. Washington. 1952. 23 pp. For sale at 15 cents by the Superintendent of Documents, Government Printing Office, Wash- ington 25, D. C. Single copies avail- able from the Children's Bureau without charge.
Nobody is completely certain about the way personality gains health and strength. But many people — psy- chologists and psychiatrists, anthro- pologists and sociologists, physiolo- gists and geneticists — have been studying children for many years.
They have some practical ideas about what brings good results in building healthy personalities. Some of the conclusions they have arrived at are given in this pamphlet, which was written by James L. Hymes, Jr., Ed.D., Professor of Education, George Peabody College for Teach- ers, Nashville, Tenn.
Dr. Hymes based his manuscript largely on material submitted to the Fact Finding Committee of the Mid- century White House Conference by Dr. Erik H. Erikson and incorpo- rated in the report of this committee, entitled "For Every Child a Healthy Personality," which is usually re- ferred to as the "Fact-Finding Di- gest."
For the use of parents' groups in- terested in exploring problems of emotional growth in children, a dis- cussion aid based on this pamphlet has also been published. See the notice below.
DISCUSSION AID FOR "A HEALTHY PERSONALITY FOR YOUR CHILD." Federal Security Agency, Social Security Adminis- tration, Children's Bureau. CB Pub. No. 338. Washington. 1952. IG pp. For sale at 10 cents by the Superintendent of Documents, Government Printing Office, Wash- ington 25, D. C. Single copies available from the Children's Bu- reau without charge.
Mrs. Marion L. Faegre, Consultant in Parent Education, Children's Bu- reau, and Dr. Hymes, the author of "A Healthy Personality for Your Child," collaborated in preparing this discussion aid for use by parents' groups.
The bulletin includes suggestions on subjects for discussion and on methods of conducting group meet- ings. It lists some useful material — pamphlets, books, and films.
LENDAR
Aug. 2.5-28. American Legion. Thirty- fourth annual national convention. New York, N. Y.
Aug. 26-28. American Political Science Association. Forty-eighth annual meeting. Buffalo, N. Y.
Aug. 27-29. Southwest Regional Con- ference on Migrant Labor. (Needs of children and youth.) University of New Mexico. Albuquerque, N. Mex.
Aug. 31-Sept. 2. National Council on Family Relations. New Brunswick, N. J. '
Sept. 1-5. National Urban League. Annual conference. Cleveland, Ohio.
Sept. 1-6. American Psychological Association. Sixtieth annual meet- ing. Washington, D. C.
Sept. 1-30. Sight Saving Month. In- formation from National Society for the Prevention of Blindness, 1790 Broadway, New York 19, N. Y.
Sept. 3-5. American Sociological So- ciety. Forty-seventh annual meet- ing. Atlantic City, N. J.
Sept. 6-7. American Society of Den- tistry for Children. Silver anni- versary meeting. St. Louis, Mo.
Sept. 8-11. American Dental Associ- ation. Ninety-third annual meet- ing. St. Louis, Mo.
Sept. 11-13. National Legal Aid Con- ference. Thirtieth annual confer- ence. San Francisco, Calif.
Sept. 11-16. National Conference of Catholic Charities. Thirty-eighth annual meeting. Cleveland, Ohio.
Sept. 1.5-18. American Hospital Asso- ciation. Fifty-fourth annual con- vention. Philadelphia, Pa.
Sept. 17. Citizenship Day.
Sept. 17-19. National Conference on Citizenship. Seventh annual meet- ing. Washington, D. C.
Sept. 28-Oct. 4. Christian Education Week. Twenty-second annual ob- servance. Sponsored by the Na- tional Council of the Churches of Christ, Division of Christian Edu- cation, 79 East Adams Street, Chi- cago 3, 111.
Sept. 29-Oct. 3. National Recreation Association. Thirty-fourth Na- tional Recreation Congress. Se- attle, Wash.
Regional conferences, American Public Welfare Association: Sept. 2-4. West Coast region. Vic- toria, B.C., Canada. Oct. 9-11. Northeast region. Phila- delphia, Pa. Oct. 23-25. Southeast region. Charles- ton, W. Va.
Regional conference. Child Wel- fare League of America: Sept. 2.5-27. Midwest region. Des
Moines, Iowa.
Illustrations:
Pages 3 and 4, Philip Bonn for the Chil- dren's Bureau. Page 11, courtesy of the authors.
AUGUST - SEPTEMBER 1952
15
VOL. 17 NO. 1
AUGUST-SEPTEMBER
1952
In This Issue
Page
We Can Do Something Abont Juvenile Delinquency Martha M. Eliot, M.D.
Training Schools and the Future 3
Richard Clendenen
Toward Better and Safer Camping 7
Martin Gula
A Visitor's View of Child Welfare in Vienna 10
H. Ted and Bunny Rubin
For Better Child Health 12
Published 10 times a year by the Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
FEDERAL SECURITY AGENCY Oscar R. Ewing, Administrator
SOCIAL SECURITY ADMINISTRATION Arthur J. Altmeyer, Commissioner
CHILDREN'S BUREAU Martha M. Eliot, M.D., Chief
Publication of THE CHILD, monthly bulletin, has been authorized by the Bureau of the Budget, September 19, 1950, to meet the needs of agencies working with or for children. The Children's Bureau does not necessarily assume responsibility for state- ments or opinions of contributors not connected with the Bureau.
THE CHILD is sent free, on request, to libraries and to public employees in fields concerning children; address requests to the Children's Bureau, Federal Security Agency, Washington 25, D. C. For others the subscription price is $1.25 a year. On all orders of 100 or more sent to one address there is a discount of 25 percent. Send your remittance to the Superintendent of Documents, Government Printing Office, Washington 25, D. C. Single copies 15 cents each.
Foreign postage — 25 cents additional — must be paid on all subscriptions to coun- tries in the Eastern Hemisphere and those sent to Argentina and Brazil. Domestic postage applies to all other subscriptions.
U S. GOVERNMENT PRJNTING OFFICE: 1951—912
HE
CHILD
.-X-^v^ —
OCTOBER 1952
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UNITED NATIONS DAY, 1952
BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
U. 8. SUPERINTENDENT OFITOCUMEff^
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Whereas the founding of the United Nations has given the people of the world an organization through which nations may resolve their differences without resort to war and has made possible greater international cooperation in the economic, political, and cultural fields ; and
Whereas the United Nations continues to be the only existing international organ which offers mankind a hope for ultimate world peace ; and
Whereas the realization by citizens of other nations that the overwhelming majority of Americans support the United Nations and its great purposes would help to speed the day when there will in fact be peace on earth, good will toward men ; and
Whereas the General Assembly of the United Nations has declared that October 24, the anniversary of the entry into force of the United Nations Charter, shall be dedicated each year to the dissemination of information concerning the aims and accomplishments of the United Nations:
Now, Therefore, I, Harry S. Truman, President of the United States of America, do hereby urge the citizens of this Nation to observe Friday, October 24, 1952, as United Nations Day by sending greetings to friends, relatives, and associates in other countries which are members of the United Nations, and by expressing their confidence in the United Nations, their friendship for other peoples, and their faith in the ulti- mate demonstration throughout the world of the brotherhood of man.
I also call upon the officials of the Federal, State, and local Governments, the National Citizens' Committee for United Nations Day, representatives of civic, educa- tional, and religious organizations, agencies of the press, radio, television, motion pictures, and other communications media, and all citizens to cooperate in appropriate observance of this day throughout our country.
In Witness Whereof, I have hereunto set my hand and caused the Seal of the United States of America to be affixed.
Done at the City of Washington this seventeenth day of July in the year of our
Lord nineteen hundred and fifty-two, and of the Independence of the United States of America the one hundred and seventy-seventh.
By the President :
Secretary of State
FURTHERING INDIVIDUAL WELL-BEING THROUGH SOCIAL WELFARE
MARTHA M. ELIOT, M.D.
Chief, Children's Bureau
TO THOSE of US who spend our days and years in the broad field of social welfare, it seems un- necessary to labor the point that the welfare of our society as a whole and individual well-being are indivisible, that our culture has been built around the individual and his rights, his de- sires, his present and future hopes. But when we see how, in crisis situa- tions such as the one we are in now, our programs for social advance are questioned as expendable, as luxuries, we must admit that we have failed to make our own trust and confidence in these programs clear to others. It behooves us to restate this confidence. And to restate it so convincingly that even the most ingrown individualist can not only tolerate it but accept it as his own.
It may be unnecessary to say it, but I want to make it clear that I am using the term welfare in the broad- est sense, to include, as does the World Health Organization's defini- tion of health, the total well-being of people in our society. Many profes- sions contribute to it ; it includes the family, the community, the Nation ; it means health, education, employ- ment, and economic security, as well as provision of social services ; it means full opportunity for the de- velopment of a healthy personality for each new member of our society as he or she comes into being.
Concern for the well-being of indi- viduals is the essence then of our concept of social welfare. One of the wisest acts of our forefathers was to imbed in our Constitution — as an
Dr. Eliot gave this paper at the California State Conference of Social Work, held at Long Beach, Calif.
eternal reminder to us — this concept that individual well-being is some- thing that we must unite to achieve. It is not something that each of us plucks for himself. "To promote the general welfare," as our Constitution says, was one of the primary pur- poses for which we created this Na- tion. And the purpose of uniting to promote the general welfare was to achieve the greatest possible degree of security, happiness, freedom, and well-being for each individual.
I have the privilege of serving as Chief of a Bureau of the Federal Government which was created to give meaning to this phrase in the Constitution. The act creating the Children's Bureau is significant be- cause it is a recognition that the struggle for the well-being of your child cannot be won unless it is won for all children.
In a living democracy there can be no separation between individual and social well-being.
Now individual well-being calls for many things . . . things of the body
and, what is much more important, things of the mind and the feelings. As I see it, each of us is best able to function when we see ourselves and our environment in perspective; when we can share our purposes with others and trust each other and our- selves ; when we are not afraid to question, or to use our imaginations ; when we accept limits ; and when we have courage and strength to fight when fighting is called for.
These are things of the mind and the feelings. And they are the stuff of life for most of us. Some of us do a fair job of achieving these qualities. But none of us achieves them entirely "on our own." All of us must have help, from our families, our schools, our communities and their institutions, our Nation . . . yes, and from the world. Some of us have need of special help in acquiring that quality of strength that makes it possible for us to function with- out doubts about ourselves, with trust and generosity toward others.
Social welfare has many goals, but
When day-care services are planned for children of working mothers, skills from many fields need to be drawn upon, such as health, social work, and nursery-school education.
OCTOBER 1952
one of its major goals, I am con- vinced, is to find the way to give that extra ounce of support to those indi- viduals who need help in finding their strengths so that they can build on them.
Critics say that programs designed to underpin the economic and social well-being of people make people soft, indulge them in alleged laziness, shiftlessness, or vanity. They say the money we dole out buys sister a fur coat. Or when it doesn't do that, it encourages her to have babies out of wedlock. These things we resent.
But I must say, in fairness, that the problem is largely one of under- standing on both sides. The purpose of social-welfare programs has not been sufl^ciently well interpreted to the general public, and social-welfare workers still need to understand more fully the forces, the traditions, the cultural patterns that underlie the criticisms.
Democracy and the individual
The purpose of social-welfare effort is simple and clear. It can also be persuasive. It starts from the premise that each individual has a uniqueness of power, and that each individual develops best and accomplishes most — for himself and for society — when he has a chance to develop along the line of his own strength, however feeble or strong it may be.
This is, and this must be, the basic premise of a democratic society in all its activities.
Once the idea becomes clear that the purpose of the social-welfare pro- gram is to help individuals discover what they are best at doing so that they can do their best, most of the cynical and hostile criticism of these programs will evaporate.
I will go even a step farther and say this : Once the idea becomes cen- tral in our culture that, as Harry Overstreet says, "a man is at his best when he is doi7ig his best at what he can do best," then the need for at least some kinds of social-welfare programs will disappear.
At no time in its history has our Nation been in greater need than
20
right now for competent, well-inte- grated, productive citizens. Instead of decreasing programs that make for social well-being and better hu- man relations, we should be strength- ening them. Instead of cutting their budgets, we should be zealously pro- tecting their priority to funds, in the interest both of national and indi- vidual well-being. The problems that
services, medical and hospital care when sick, vocational counseling, and above all warm and congenial family life. But, as you and I well know, the picture is not as rosy as this for hun- dreds of thousands of our children.
Today there are II/2 million depen- dent children in families receiving Aid to Dependent Children under the Social Security Act. We are proud
Today l'/2 million children are enabled to remain at home through the Aid to Dependent Children program. But in some of the States the living afforded these families is meager.
many individuals encounter in func- tioning as competent, well-integrated, productive citizens in peacetime are compounded when the threat of war hangs heavy over us.
But it is not only external threats that make the support of our social- welfare programs essential. We have the obligations that a democracy has toward its citizens who need help.
My first concern, naturally, is with the well-being of children. After see- ing the wretchedness that surrounds the lives of so many millions of chil- dren in other countries, I am well aware of the advantages that the great majority of our children enjoy — life in a free community, educa- tion, good housing, recreation facili- ties, play space, health and welfare
that we have such a program that assures home life for these children. But we cannot take pride in the meager living that ADC affords many of them in some States, nor in the punitive attitude some people take to- ward mothers who need this help to hold their families together.
Juvenile delinquency is on the up- grade again, if we can take as an index the number of youngsters who become known to the police or are brought before our courts for delin- quent acts. More than 350,000 de- linquent children, now appearing in juvenile courts in a year, are a stark reminder of the many deprivations, neglects, and inequities which chil- dren suffer, and of the lack of warm parent-child relations in many fami-
THE CHILD VOL. 17 NO. 2
lies. Between 50 and 100 thousand young delinquents are detained in city and county jails, places where no child should ever be housed. The 30,000 boys and girls in training or correctional schools for delinquent children are still another prod to our consciences.
In an ever-increasing number of homes today, the mother as well as the father has a job and is away from home for long hours. Suitable day- care services for children of working mothers — and there are well over 6 million such children today — are all but nonexistent in many communities.
Our State crippled children's agen- cies have on their waiting lists many thousands of children whose only hope for medical or surgical care rests in agencies that do not have adequate funds to provide such care.
Health and welfare agencies are doing good jobs for children in many communities. But hundreds of thou- sands of children live in areas that such services rarely if ever reach.
Of all our children, some of the most disadvantaged are those in families of migrant workers, those who grow up in isolated communities such as mining and mountain towns, and children who are members of minority groups clustered in urban and rural slums. The conditions under which many of these children live are a blight on our national life.
Democracy has much unfinished work to do for such groups as these.
How can the promotion of indi- vidual well-being best be accom- plished? Belief that social good is achieved through concern for the wel- fare of individuals leads away from generalities to some practical mea- sures.
In the ifield of social service, I sometimes wonder whether too great a concentration of effort has been placed upon measures that will rem- edy or mitigate difficulties that have already happened. The preventive approach that now dominates public health has not yet been developed as effectively in the social-welfare field as it should and will be. Planning for social services too often has had to be restricted to children and adults in
special need. This does not reflect on the planners as much as it reflects the limited understanding the public has of the positive role that social welfare can play. Even in public health, where preventive programs have long been accepted, it is only comparatively recently that workers have made organized efforts to pro- mote sound mental health and di- rected their efforts against the social conditions that undermine it.
Health and welfare interrelated
This growing recognition of the importance of emotional factors in individual well-being is changing the concept of needed measures in both health and welfare fields, and draw- ing these two fields closer together.
As public-health workers come to see that few individuals can be truly healthy when they live in an atmos- phere of suspicion and doubt, or when their opportunity to live de- cently is continually threatened by advancing living costs, they find that they must reconsider what preventive health work calls for.
So, too, social-welfare workers find that they cannot be content with mea- sures aimed at aiding only those who have fallen by the wayside. They, too, must do preventive work and reach children and families before damage is done. This means pro- grams for children in their own homes, in schools, in playgrounds. It means working ever more closely with health workers, who have ready access to the homes of nearly all families.
Important as preventive measures are — measures that seek to assure that physical, social, and emotional growth shall proceed satisfactorily — we cannot, however, concentrate on them to the exclusion of measures for aiding people who are in difficulty. Let me touch on some of the areas of work to which I believe we should give attention right now.
First on my list of problems of the welfare of individual children I have placed juvenile delinquency.
Preventing delinquency is to all in- tents and purposes the equivalent of promoting individual well-being. Its ramifications are so varied, its area
of operations is so broad, that it is indeed difficult to formulate the all- embracing program that might guar- antee success. The prevention of de- linquency and the study of its causes must, however, stand as our over-all purpose in any comprehensive pro- gram in this field. It involves all the best of the total welfare program. Those responsible for preventive wel- fare and health services should bear more constantly in mind that one of their goals — and a large and impor- tant one — is the contribution they can make to reducing juvenile de- linquency. This is too often over- looked, usually because the connec- tion has not been clear.
There are, however, certain specific things we must do for children who are already delinquent. It is from the ranks of these children that many adult ci-iminals come. For national as well as individual welfare, we must do all we can to restore to full social and emotional well-being the children who engage in delinquent acts.
Recently, the press of the Nation has been greatly agitated about one manifestation of delinquent behavior, the use of narcotics by juveniles. Al- though this problem seems to be acute among certain groups of chil- dren, reports indicate that it exists mostly in large cities, and it may not have the proportions that popular re- ports have given it. Nevertheless, there is still a major job to do in con- trolling sources of supply and in as- suring that the laws regarding the sale of narcotics are strictly enforced. Much more attention must also be given to discovering the causes of drug addiction on the part of young people and to rehabilitating those who have acquired this fearful habit.
To work effectively with juvenile delinquents calls for many skills that, as a Nation, we have still to make generally available. It requires that a better job be done in equipping for this work police and probation workers, judges, and institutional staffs ; it means special training for child-welfare workers, teachers, and doctors, who see many of these chil- dren before they become known to police or courts. We must concern ourselves more with problems of the
OCTOBER 1952
21
delinquent's family and with the so- cial conditions under which they live. We need skilled workers, whom we do not now have in sufficient num- bers, to carry on effective programs of treatment and rehabilitation. This includes psychiatrists and other workers in child-guidance clinics. We need special study homes or other provision for diagnostic and treat- ment facilities. We need to know much more about how delinquents are handled in detention homes and insti- tutions, what are the best methods of treatment, and what are the subse- quent careers of those who spend time in jail or correctional institutions.
If all of us in the social-welfare, education, and health fields were to put our minds to it we could evolve a long-range program that would not only improve this situation but con- tribute greatly to the well-being of many thousands of children and adults.
Second on my special list of areas of work for children is the care of children who must live away from home all or part of the time, either in foster-family homes or in institu- tions.
Dr. John Bowlby, a distinguished child psychiatrist of the Tavistock Clinic in London, in a recent mono- graph published by the World Health Organization, reviews scientific evi- dence from many countries regarding the effect on children of separation from their mothers. He comes to the conclusion that this is a very hazard- ous undertaking. In the light of Dr. Bowlby's observations, it certainly behooves us to study various aspects of this problem and to examine very carefully our criteria and our prac- tices in placing childi'en away from their own homes.
It is also important to determine how day-care services can best be given, what the most helpful joint contributions of teachers, doctors, nurses, and social workers can be, what we can learn from the experi- ence of nursery-school educators.
Day care for children is a problem that is likely to remain with us in- definitely. We in the Children's Bu- reau are inclined to agree with Dr.
22
Bowlby that it is best that mothers of young children stay at home with their children whenever the strain of doing so does not outweigh the ad- vantages. Nevertheless, it is only realistic to recognize current develop- ments and to insist that, if mothers are to be employed, services for the day care of their children be pro- vided, and that these services be con- ducted in a way that conserves and advances the children's well-being and makes for their future mental health.
Federal funds can, under the "De- fense Housing and Community Fa- cilities and Services Act of 1951," be made available for day care in critical defense housing areas. But whether they will be appropriated, and how soon, I do not know. Of course you know that grants to States for child- welfare services under the Social Se- curity Act can be used in promoting day-care services. The grants are not yet adequate to provide much in the line of direct services, but they can be effectively used for consultation to communities and for planning.
The third area of work that I want to emphasize is research and evalua- tion of operational programs. This applies to the child-health as well as the child-welfare fields. It involves a great variety of study methods and without question must be multidisci- plinary in its approach.
The maternal and child-welfare programs under the Social Security Act are now 17 years old. Some of the State and local child-health and child-welfare programs are much, much older than that. It is high time that we in the States and communi- ties and in the Federal agencies de- veloped better yardsticks for measur- ing how well we are doing our jobs. Progress should be made in this direc- tion, not only because funds must be well spent, but, even more, because the objectives of our programs have great meaning for the national wel- fare when they are well conceived and the ways of achieving them effec- tively designed and carried out.
Along with evaluative studies should go research of an operational nature that will produce facts on
which decisions about new programs, policies, and working methods can be based. For example, we need to know more about the kinds and costs of health service and medical care received by children in rural as well as in urban areas ; and by children in special groups, such as those in mi- gi'ant families, ADC families, and children in institutions. We need to study methods of improving the qual- ity of care for such children. We need to know what becomes of chil- dren who for one reason or another are refused care or public assistance. We need to know more about the end results of adoption practices in terms of the mental health of adopted chil- dren. The same is true for children in institutions. Answers to questions like these would give us much to go on in our everyday work. They might also prove an effective means of show- ing the public why health and wel- fare programs are so much needed.
Basic research needed
Evaluation and fact-finding of these types, however, are not enough. More basic research in the social and biological sciences should be going on. Our work is seriously handi- capped by lack of adequate under- standing, for example, of the values and customs of the various subcul- tures in American society and how they relate to the origins of delin- quent behavior. We recognize pre- mature birth as problem number one in reducing infant mortality, but we know too little about the psychologi- cal and physical conditions producing it. The choice of operational or basic research to be fostered could well be guided by questions arising in every- day program activities.
Thei'e isn't a business of any size in the country that is operating suc- cessfully and keeping up with its market that does not earmark funds for research. Despite the fact that legislatures and social-welfare boards are composed largely of persons who are already persuaded of the value of market and product research, it is usually hard to get appropriations for research in the social-welfare field. I wonder whether much of our problem is not our own lack of con-
THE CHILD VOL 17 NO 2
viction that research in the social sciences must be a part of all welfare programs if progress in practice is to be continuous. Or is it that meth- ods of investigation in the social- welfare field need to be set up? Or, again, is it that we are satisfied for the time being with present practices, while we wait for the gaps to be nar- rowed between our present knowl- edge and the extent to which that knowledge is put to work? Do we sometimes hesitate to seek new facts for fear they will add more work to an already overburdened staif? Let me suggest that well-directed re- search, especially that of an opera- tional or methodological nature, may well simplify rather than complicate existing programs. Whatever the rea- son for the inadequacy of research, it seems to me to be imperative that new impetus be given to research that will provide the facts upon which programs in social welfare will be based. In such a program the central idea should be the search for ways of furthering individual well-being in our modern complex society.
I can only touch on two more aspects of the social-welfare program — more and better training of more workers, and increased citizen par- ticipation in our programs — but the
space I can give to these is no mea- sure of their importance.
Again and again, experience has shown that effective service to people calls for skilled, trained workers. We could do a far better job of strength- ening individuals and of helping fam- ilies if more of our workers were given help in getting the professional skills they need. Too few boys and girls are preparing to enter the so- cial-welfare professions. Vigorous campaigns for recruitment of new workers must go along with expan- sion of training opportunities for the workers we now have.
None can stand alone
At the beginning of this paper I said that none of us can achieve a genuine feeling of well-being "on our own," or in isolation from the rest of the world. Gradually, through such participation, especially in local groups, there will spread a more thorough understanding and appreci- ation of the purposes and underlying principles of the total welfare pro- gram.
In working with the World Health Organization, it was brought home to me again and again that typhus and typhoid fever, dysentery, and malaria have no nationalism. Mavbe
Some of the most disadvantaged of our children are those in families of migrant workers.
we in the health field have a special obligation to remind others also of the simple fact that the well-being of people everywhere is interrelated.
I cannot urge on you too strongly support of the programs of the United Nations and of the specialized organizations affiliated with it, which are attempting to improve the opportunities for better living for the children of the world. Our own tech- nical-assistance program has great potentialities, too, for making the world a safer, more decent place for children. I share with Mr. Justice William Douglas the hope that wher- ever our Point IV program goes, with its technical and economic help to other peoples, it goes accompanied by a "Point V," the spirit and con- victions of 1776, out of which our ancestors framed a government dedi- cated to promotion of the general wel- fare, and, I might add, to the rights of peoples to self-determination and self-government.
When we give assistance to so- called underdeveloped areas for agri- cultural and industrial development, we should give support at the same time to programs in the spheres of health and welfare which go hand in hand with economic development. Let us not be guilty of encouraging others to make the mistake we made in our own country for so long in concen- trating on expanding our economic resources and neglecting the well- being of the human beings for whom those resources are intended. The time to plan programs of social ad- vance is not after great wealth has been built up, but at the start of programs for economic development.
In these critical times we must be more alert than ever to express our conviction that social-welfare pro- grams do contribute positively and effectively to furthering individual well-being and the general welfare. We do not have to persuade ourselves of this fact. But we do have to spread confidence that it is so, and to make very clear to the public our convic- tion that the long-time emergency we are in requires the utmost in preserv- ing and enhancing every human re- source we have.
23
HELEN LELAND WITMER
TiHIS PAPER might well have a subtitle: An interpretation of social research to the social- work public and a plea for help. Year after year, for about 30 years, speak- ers before this Conference have urged that social workers give serious at- tention to the business of evaluating their work. Dr. Richard Cabot, in a presidential address in the early 1930's, startled the Conference by insisting that social work should fol- low medicine's example and deter- mine the effectiveness of its services. Others had said much the same thing years before, and annually we listen to the same plea. Persons outside the profession are perhaps even more in- sistent that social workers should determine how much they accom- IDlish.
In view of all this, why have we as a profession generally and we social-research people in particular been so slow in getting ahead with this task? There are various answers to that question: Lack of money, of time, of professional skill ; unwilling- ness to face possibly unpleasant facts ; and so on. All these are easily under- standable. But there is one answer to which insufficient attention has been paid : The inherent difficulties in evaluating so tenuous a thing as so- cial work. These difficulties are well known to research workers. I think, however, that we in research have hugged them to our bosom too fondly; they are so precious, so eso- teric, so useful in protecting our sense of self-esteem. It might be bet- ter if we showed them to the rest of you — even at the risk of having them disappear.
The first problem we face in at- tempting to devise a scheme for judg- ing the effectiveness of social work is that of goals or objectives. In medi- cine— our favorite analogy — effec- tiveness is judged by lives saved, by the crippling effects of diseases and disorders being eliminated or re-
24
duced, by the progress of the disease be'ng halted, and so on. What are the comparable aims of social work? What do we expect the accomplish- ments of social work, successfully carried on, to be?
Goais ssem cisar
Offhand, it would seem as though that question could be easily an- swered. We expect social work to re- duce the number of delinquents, to result in fewer parents neglecting their children. If the claims of the drives for funds are to be believed — the man-on-the-street says — social work should mean fewer broken homes, fewer children separated from their parents, fewer old people living in extreme poverty. And so on.
The trouble with this kind of test, however, lies in that word "fewer." Fewer than v/hat? Obviously we mean "fewer than there would have been if there had been no social-work services." But this is not the same as saying "fewer now than there were in the past." Conditions may have changed in such a way as to make for an increase in separations and di- vorces, a decrease in jobs for old peo- ple, a greater likelihood of delin- quency— and for these changes social work is neither to be credited nor blamed. This being so, no easy test of social work's effectiveness is to be found in comparing the present with the past or in noting the incidence of maladjustment generally.
The criterion "fewer" may, how- ever, be taken to refer to change in particular cases. The X family ex- hibited such-and-such behavior be- fore a social worker entered the pic-
HELEN LELAND WITMER is Director of the Children's Bureau Division of Research.
Before joining the Bureau, Dr. Witmer was Director of Fact Finding for the Mid- century White House Conference for Chil- dren and Youth. Previously she was Direc- tor of Research at Smith College School for Social Work, and she was editor of Smith College Studies in Social Work.
Dr. Witmer gave this paper at the seventy-ninth annual meeting of the Na- tional Conference of Social Work, held at Chicago.
t'.u e ; Eubsequently their behavior changed for the better in certain specified respects. The imiprovement is ci edited to social work, and we say that the number of maladjusted fami- lies is fewer by this one case. But can we be more sure of cause-and- eiTect relationships in individual cases than in communities generally? It is again a matter of past and present, and the possibility of numer- ous ether factors having influenced the situation so that the part that i:^oc al work played is far from clear. But to come back to social work's objectives. It is probably too easy an answer to say, for example, that we expect social work to reduce the inci- dence of delinquency or marital dis- ; cord or even to make the repetition of such social disorders less likely in individual cases. Do we aim to achieve these outcomes regardless of psychological cost to the individual concerned? Would it be adequate to achieve reduction in delinquency by extremely punitive methods? Is mari- tal discord to be lessened through the wife — or husband — becoming utterly subservient and submissive? These may seem foolish examples but they highlight the fact that social work aims not at suppression of symptoms but at some other kind of change, the nature of which is difficult to state in general terms.
The question of social-work objec- tives in particular programs or with particular types of individuals would be easier to answer if we could agree what social work in general is, what it is for. A conception of the basic function or functions of social work would provide a touchstone from which the analysis of the aims of particular programs could take its start. Lacking such an agreed-upon conception, we are forced to deter- mine for each particular program its raison d'etre, without reference to general principles.
The lack of a unifying conception of social work's function also means that we have no way of assessing a
THE CHILD VOL. 17 NO 2
community's over-all need for social services or of determining the extent to which this need is being- met. I do not mean to imply that this need for service could be easily determined if the general purposes of social work were established. I only mean that lacking clarity on social work's func- tion, we cannot even consider the measurement of need. And, vice versa, it is not possible to use as a measure of social work's effectiveness the extent to which the need for social services, generally speaking, is met.
When we turn to particular pro- grams and try to line up what their objectives are, we have to deal with the possibility that the sponsoring group, the professional staff, and the clients may have different ideas on this subject. It seems to be an ac- cepted principle of casework that if professional worker and client can- not get together on this matter of aims little can be accomplished. There are those who maintain that in the long run the same principle holds for professional staff, and boards, and contributing public also. At any one time, however, a difference of opinion on this matter may exist, and it then becomes a nice question whether the accomplishments of a social agency's program are to be judged on the basis of the kinds of changes the staff aims to produce, the kinds the con- tributing public wants to see brought about, or whether it is to the clients that we should look for finding out what they think of the agency's ser- vices.
Involved in these distinctions is also the fact that the sponsors of a program are likely to have absolute standards and the social workers and clients relative ones. The sponsors are inclined to want to know, for ex- ample, how many children are no longer delinquent, how many families are no longer in need of aid of one kind or another. Caseworkers and clients are probably chiefly concerned with "movement" — with whether things got better rather than whether some ideal goal was reached. Closely related to this, too, is the casework- er's idea that social service is a help in time of trouble but no guarantee that trouble will not recur.
OCTOBER 1952
With objectives of a social-work program frequently so difficult to de- termine or at least to agree upon, it is easy to see why evaluative re- search does not flourish lustily. But even if goals can be set, the difficul- ties of evaluative research do not cease. The next step that must be taken is to decide upon criteria by which success, however defined, is to be judged. Whether this is difficult or not will depend in part upon the nature of the program's objectives.
What constitutes success?
If the aim of a program, for exam- ple, is a marked decrease in number of delinquents brought to court or in the individual child's delinquent acts, this step will be relatively easy. Even here, however, there will be differ- ences of opinion. Such a question as how large the decline must be to be counted as a success will have to be considered, as well as the knottier questions of whether all offenses are to be regarded as of equal impor- tance, whether first offenses count the same as repetitions, and so on.
The term "success" is more appli- cable when results are to be judged in terms of degree or kind of im- provement in individual cases. Here criteria are often hard to define in ways that will be widely agreed upon and that will be similarly applied by various raters. And even if this is done, all is not clear.
For instance, after a great deal of careful work McVicker Hunt was able to draw up criteria by which it
could be reliably determined how much "movement" had occurred dur- ing the course of casework treatment of certain clients of the Community Service Society of New York. It was found, however, that these criteria were not applicable in a large pro- portion of the cases of the agency as a whole, either because the clients did not have enough interviews to yield information or because their difficul- ties were not of the sort to which the criteria applied.
Others who have tried to devise schemes for judging success, espe- cially in that particularly difficult area, family casework, have found the going no easier. Whether we de- cide to judge results by whether the clients felt that they were helped, by what kind of solution of their prob- lems they arrived at, by how well- adjusted they became or how long the improvement lasted, the problem of criteria and their reliability and validity is difficult to solve. This is not to say that the problem is insolu- ble ; it is only to say that it will take hard thinking and painstaking work on the part of the profession gen- erally— not only the research work- ers— before we shall be in a position to state definitely : "This is what a given social-work program or service is trying to accomplish, and these are the signs by which you can tell that the goal has or has not been achieved in pai'ticular cases or generally."
But even if we arrive at that happy stage, our troubles are not over. How are we going to demonstrate that
We IVel that the social worker's efforts will brin<j good results, but how can we be sure?
social-work efforts produced or con- tributed to the so-called results? This is perhaps the toughest part of the research problem. We can firmly say that such-and-such are to be con- sidered the objectives for the purpose of this study, that these are the goals with which this particular investiga- tion deals. And after careful consid- eration we can draw up a list of signs or describe typical cases or even con- struct tests that will serve as guides for judging the extent of change that occurred during or after social treat- ment. But how are we to demon- strate that it was social work that did the trick?
The usual social-science answer to that difficulty is the control group. By this device the treatment in question is given to one series of individuals and withheld from another. This sec- ond series is chosen in such a way as to be as much like the first as pos- sible, insofar as traits or circum- stances likely to influence the kind of change under consideration are con- cerned. In comparable biological studies, the animals used in the con- trol group come from the same pure strain as those in the study group. In biological and psychological studies of human beings, identical twins are often regarded as the best subjects.
So much is intangible
In social work — according to pres- ent theory at least — the traits of the client usually regarded as most influ- ential in determining success or fail- ure in treatment are such intangibles as personality make-up, the dynamics of the problem under treatment, the nature of the significant environmen- tal circumstances (what is significant varying with the problem under con- sideration), and so on. This is not to say that such more or less easily de- terminable traits as sex, age, intelli- gence, nationality, and the like are of no importance. It is obvious, how- ever, that individuals can be alike in these latter respects and still be very different so far as their need for the services of a social worker or their likelihood of dealing with their prob- lems without such help are concerned. This we can probably agree on. The
26
tough problem, however, is how we are to secure for the control group a series of individuals whose personal- ity make-up and characteristic ways of responding to diflficulties is known but who have not received and are not to receive treatment?
It would take more space than we have here to discuss this problem at all adequately. It should be noted, however, that a few attempts at solv- ing it have been made. In a study at the Jewish Board of Guardians, for example, children who had been ex- amined and found to be within the agency's function and yet not treated were used as a control group. In the Cambridge-Somerville Youth Study groups of children were equated for various traits on the basis of indi- vidual examinations and home studies and then arbitrarily selected for treatment or control purposes. Other investigators have used pro- jective tests or other such devices for quickly securing information about personality and psychological func- tioning. None of these methods has wholly solved the problem of getting comparable cases for control pur- poses, however, chiefly because some of the significant facts often cannot be learned until treatment is well under way.
Recognizing the difl^culty of secur- ing proper controls, social-work in- vestigators usually pin their hope on intragroup comparisons. They reason that if the cases that turn out well can be shown to be different in sig- nificant ways from those that turned out poorly, a connection between out- come and the work of the agency is likely. For instance, if it is found that the cases labeled "success" were much more likely than the failures to have taken an active part in treat- ment, to have wanted treatment and found it useful, if many more of them than of the failures had traits that theoretically would make them better treatment "risks," then social- work investigators are inclined to say that the changes that took place in these cases were probably largely at- tributable to the treatment measures.
This, however, is not wholly satis- factory reasoning. It may be that in-
stead of indicating that social work can be helpful to certain clients in certain situations, these investiga- tions have only identified the people who will solve their problems satis- factorily with or without the help of a social worker.
There is, nevertheless, an exten- sion of this reasoning in regard to determining causal relations that holds promise. Briefiy it is this. Granted that in any particular pro- gram the apparent success achieved may be explainable as above, what is to be said if similar studies are made in different kinds of programs aimed at, say, delinquency prevention, and it is found that one program appears to work with one kind of case and another program with another? Would this not greatly increase the weight of the argument that outcome and treatment are related? Vice versa, if in program after program the same sorts of boys turned up as the ones apparently aided, would this not suggest either that any kind of method works with these boys or even that such boys would probably get along all right without treatment?
Studies of this sort, if they did in- dicate causal relations, would have the additional merit of providing in- formation on other important points. For instance, to keep to the delin- quency example, they would provide much-needed basic diagnostic cate- gories for distinguishing delinquents on the basis of treatment needs. They would also make possible the efficient use of treatment resources, for by the careful matching of delinquent and treatment measure the chance of good results would be greatly increased.
We need to find answers
It is said to be a good idea to end papers on a hopeful note. If so, this is probably the best point for ending what may have sounded like a dis- couraging account. I hope that, in this description of the diificulties that beset research when the effectiveness of social work is to be studied, I have not discouraged you but rather have aroused your interest in helping us research workers find the answers. Reprints in about 6 weeks
THE CHILD VOL. 17 NO 2
PART 2
A VISITOR'S VIEW OF CHILD WELFARE IN VIENNA
EDITOR'S NOTE: This is the second part of an article that began in our August-September issue. (We shall be glad to send a copy of that issue to any reader who missed part 1.)
H. TED and BUNNY RUBIN
In Vienna children with problems are usually sent to institutions rather than to foster homes. The basis for this decision is not a careful diagnosis and evaluation as to what setting would be best for the child. The de- termining factor for institutional placement, we should like to suggest, is that the usual Viennese family finds it very difficult to tolerate prob- lems of behavior and personality. Typically, the mother is strong, domi- neering, and overprotective, and the father is either a feared figure who commmands respect, or a genial, gemiitlich person who plays a role not always easy to define.
Although the Viennese family is generally characterized as an affec- tionate one, this affection may often be used as a controlling device. Con- forming behavior is rewarded with much affection, but affection is with- held when a child is resistive.
This can be a punishing environ- ment for an aggressive foster child, and the restrictive atmosphere dis- courages the more inhibited child from any expression of his feelings.
Under these conditions, the num- ber of effective foster homes is natu- rally limited, and it w^ould also seem that fewer families would request that children be placed in their homes. In addition, the average Viennese social worker has little time for working toward helping foster parents to be more effective. It is generally felt that lay acceptance and application of established principles of child psychology is more advanced in the United States than in Austria.
There is another long road ahead in improving methods for studying and certifying foster homes. At pres-
OCTOBER 1952
ent the city grants a certificate after approving a report submitted by a Jugendamt social worker who has visited the home only once and has reported mainly the physical setting and surface attitudes.
The majority of Vienna's institu- tions for children are operated by the city. In 1950 the city's budget for its 20 such institutions, approximately $1,000,000, covered total personnel, food, clothing, new furniture, and maintenance expenses. About one- eighth of the institutional budget over the past 6 years has been al- lotted to the reconstruction of dam- aged buildings, and completing this work will take another 5 years. Al- most 3.000 children are in these insti- tutions, and besides, many children are placed at public expense in pri- vate institutions. The cost to the city for this latter expenditure is charged to a budget different from the insti- tutional one.
No existing institution is built on the cottage plan, and no new chil- dren's institution has been completed since World War I. The first cottage- type institution is now under con- struction. Family-group atmosphere, especially important to children who remain in an institution a long time, has been especially difficult because the large buildings are not divided into small enough units. Administra- tion and program of the institutions have not kept up with modern meth- ods ; and the personnel, in most of them, lack knowledge of psychologi- cal factors in human behavior. Few institutions have a social worker, and still fewer have a part-time psycholo- gist. It is difficult to imagine this as the city of Adler, Aichhorn, Freud, and Rank.
An outstanding exception is a pri-
vate institution for girls 14 to 21 years, maintained by the Interna- tional Quakers. This home, with sev- eral associates of Aichhorn as con- sultants, successfully creates a free atmosphere, with each girl's individ- uality recognized and confidence placed in her as a person. Another Quaker institution, in which the city places some children, has been reor- ganized as a treatment center for dis- turbed children; it employs couples as houseparents in its approach to the children's problems. Only one other institution, a public one, does this. The rest have, for each group of children, a housemother and an Erzieher (counselor), or an Erzieher alone. The latter may live in the institution or may come daily to di- rect such group activities as arts and crafts, household chores, and study periods.
The city operates several institu- tions for the care of dependent and neglected children up to the age of 3 years. One is a large, central, hos- pital-like institution, which has 560 beds for dependent and sick children under 3. The emphasis in its pro- gram of care is overwhelmingly medi- cal, and there is almost none of the warm, human contact needed espe- cially by a small child. Toddlers are only slowly removed to foster homes, and babies under 1 year are rarely placed in such homes. A new mother in need may remain in the institution with her baby for a nursing period of 3 months, and if she finds it neces- sary to leave the baby in the institu- tion longer she may visit him for regular feeding periods.
In the same building is a milk bank that buys excess milk from nursing mothers for distribution to mothers unable to breast-feed their babies. (With relatively few exceptions Vien- nese babies are breast-fed.) The milk bank also dehydrates milk for ship- ment in powder form to smaller Aus- trian communities.
One public institution specializes in the care of children from 3 to 6 years of age, and another oflfers short-term placement for children of various ages.
The city has converted an old
27
Hapsburg castle into a diagnostic center for school-age children. Chil- dren with more difficult behavior problems are sent here from the cen- tral reception center. After a 2- to 3- month observation and testing pe- riod, recommendations concerning treatment are made. This represents a beginning effort to use more care- ful methods in studying large num- bers of Viennese children who have problems.
Vienna's vast anti-tuberculosis program, which has received inter- national attention, sprang from the "black menace" epidemics that scourged the city after World War I. Each district has a TB center, which investigates home surroundings and which tests and X-rays children and adults. Extensive preventive and con- trol measures also include careful study of school children's diet and health, as well as extensive use of health camps in the nearby mountain areas. Tubercular children are treated in three well-equipped insti- tutions.
To help the handicapped
War injuries have, of course, in- creased the number of handicapped children. Efforts to meet their needs are made through a combination of special schools and institutions. For the physically handicapped, including the cerebral-palsied and the epileptic, some physical therapy as well as pre- liminary vocational training are given both in the schools and the institutions. Although Vienna has long provided facilities for its handi- capped, its teaching techniques have not always kept up with modern methods. Lack of sufficient special equipment can, however, be under- stood in the light of present-day eco- nomic conditions in Austria.
For deaf children a federally oper- ated institution provides both resi- dential care for children from bor- dering provinces and day-schooling for those nearer by. Like the chil- dren in most other. Viennese institu- tions, these children live in large units. The absence of any electrical hearing aids often thwarts the excel- lent efforts toward teaching these
Vienna's child-welfare program is only now beginning to recover from the ravages of war.
children oral language. Hearing aids, along with a much improved differ- ential diagnosis concerning the de- gree of the child's hearing loss and his potentialities for learning to talk would enable some of these children to adjust to the city's day school for the hard of hearing. At this latter school also, lack of such aids similarly robs some children of a future in the more normal environment of the reg- ular school.
Children with speech handicaps have long received therapy within the normal school setting. Retraining is done mostly through drill mate- rials, with little emphasis on contrib- uting emotional factors. Children with more involved language prob- lems— organic or functional — may attend special clinics at the Univer- sity of Vienna Hospital for individual or group therapy.
The rehabilitative work for blind children is done through an institu- tion and at the school for the par- tially-sighted.
Various organizations are begin- ning to study how handicapped chil- dren can be better integrated with normal children.
Austria, including Vienna, is now developing an important program for all categories of handicapped per- sons, including children, under the auspices of the newly founded Aus- trian Society for the Rehabilitation of the Physically and Sensorially Handicapped. It is probable that sig- nificant developments can be expected in this field in the next several years.
Two institutions and many Hilf- schule, or special schools, are devoted
to the education of mentally deficient children. The Viennese school system, \ with its high academic demands and i lack of pupil individualization, pre- ; sents great problems for the slower-] learning child who is, however, not' feeble-minded. Inaccurate diagnosis! incorrectly assigns to these facilities' certain children whose educational; problems are not due to feeble- j mindedness.
Many school-age children with emotional problems are removed from their homes to institutions. Even when such removal seems to be the proper course, lack of profes-j sional staff in these institutions often! nullifies the purpose of the place- ment.
A pavilion of the Steinhof mental hospital houses 60 children — psy- chotic, grossly feeble-minded, epilep- tic, encephalitic, hydrocephalic, and undiagnosed — all without special grouping. Children here receive little or no individual psychotherapy, and even the physical care is primitive. There is one social worker for 2,000 cases in the entire hospital. With a prewar population of 4,000 patients, Steinhof had been one of the largest mental hospitals in Europe, but Nazi officials rewrote this figure by leading 3,000 patients into gas chambers.
A remarkable new experimental treatment center for epileptic chil- dren is now being set up, which offers great promise for the future.
The Federal Government operates Steinhof, as well as training schools for children adjudged delinquent anc juvenile courts. Other personnel, whc may be teachers or social workers
28
THE CHILD VOL. 17 NO.
assist a judge in hearing each juve- nile case. Through such a structure, the court seeks to associate itself more with educative and rehabilita- tive aims, rather than with punish- ment. Although some vocational training is given delinquents, the psychological and social-work ser- vices are quite inadequate.
However, a newly opened home, organized by the police to house cer- tain neglected and vagrant children temporarily, is one of the most ad- vanced of Viennese institutions. When a child leaves this institution, he or she signs the guest book, the same guest book that government offi- cials and foreign visitors sign after inspecting the home. Here older chil- dren are addressed with the formal German "Sie," indicating respect for them as people.
From school to work
The age of 14 may be called the apprentice age, for at this time a majority of boys and girls leave school to begin training for their chosen trades. (Compulsory school attendance in Vienna covers an 8- year period between the sixth and the fourteenth birthdays.)
The city, recognizing the separate needs of youths who have left school, has created a number of special in.sti- tutions for them. Young people from 14 to 18 years of age eat and sleep in these homes, studying and work- ing at their trades during the day- time. In addition, several of these homes serve as temporary reception centers until the youngsters are able I to obtain other living accommoda- t tions. Group activities are planned
for the evenings. As their stay length- ens the young people pay an increas- ingly larger share of the cost, since their small salaries increase as train- ing continues.
At present a need is felt for a home for 18- to 21-year-olds. Such an insti- tution could offer a healthy group- living experience for these economi- cally self-sufficient young adults.
It should be noted that a movement has been launched to raise the com- pulsory school-attendance age to 16.
In addition to the services given by the counselor on the staff of the Jngendamter, psychological services for children are offered by several facilities. Two of these are in their early developmental stages. On the whole, such services are grossly in- sufficient.
The best-established facility for psychological services is the Chil- dren's Clinic of the University of Vienna Hospital. The director of both the psychiatric out-patient de- partment and the residential diag- nostic center for 60 childi'en is medi- cally oriented, with a firm belief in the physical basis of deviant be- havior. His therapeutic approach is directed toward integration of the various centers of the brain through pedagogic methods. Comparatively little attention is given to the role played by the emotions or by environ- mental influences. No deep therapy- is performed in the out-patient de- partment. However, plans are being discussed for a children's treatment center nearby, and the first small de- velopment is under way in the uni- versity's psychiatric hospital, where
About one Viennese child out of every seven participates in a preschool group experience.
the approach will be from the stand- point of dynamic psychiatry.
Another diagnostic center has been developed within the past 2 years by the city's school system to provide testing services for school-age chil- dren. The standards of this center are high, and its director has ex- tended the Biihler Preschool Develop- mental Test to school-age children and has adapted other tests that are currently used in German-speaking countries. In the near future this center will be enlarged, and its ex- tended services will include special classes, with concurrent treatment, for neurotic children.
What is technically Austria's first child-guidance center was inaugu- rated in 1949 as a demonstration clinic. Simultaneous help to Viennese parents and children is offered through the team approach — by psy- chiatrist, psychologist, and social worker. The director, a psychiatrist, has an eclectic orientation, borrow- ing from both dynamic psychology and the prevalent Viennese physical approach. Like the psychiatrist, the psychologist uses play therapy, and in addition does testing and group tutoring. This clinic is one of the two Viennese training centers for social-work students who plan to be- come psychiatric social workers. Less than 2 years ago, the students in the first course ever offered in Austria in psychiatric social work completed their studies, which included some months' field placement in England.
Although not a psychological ser- vice, the new special experimental kindergarten, the famous Sonder- kindergarten, should be described. The park-located, pavilion-type build- ing was especially designed for six groups of children under comparative ■^tudy. These include a control group of normal 3- to 6-year-olds, as well as a group of feeble-minded children, a group of children with speech and hearing handicaps, a group of the physically handicapped, a group of emotionally disturbed children who have a history of mental illness in their families, and a similar group of children who do not have such a history. (Originally a group of blind
29
children was to be a part of the ex- periment, but there were not enough such children of kindergarten age to bring in for this purpose.) In addi- tion to the latest equipment and well- trained kindergarten teachers, the staff includes a social worker, a psy- chologist, a speech-and-hearing ther- apist, and a physical therapist.
Social group work is as yet com- paratively unknown in practice in Vienna. A course in group work, taught by a psychologist, has been initiated by the city's school of social work. Aside from the after-school centers for school-age children, there are few recreational centers for chil- dren other than those provided by political parties.
The future trend of Viennese child- welfare work will probably be chan- neled along the two courses of (1) bi'oad social planning and (2) further advances in social casework and in family services.
Housing and day-care centers are the first need. At the end of 1950 there remained 100,000 people with- out homes. But extensive housing projects, which had their first great growth from 1924 to 1934, are finally under construction again. From 1946 to 1951 the city allocated its total housing budget for reconstruction of damaged dwellings. Vienna considers housing its focal problem. City wel- fare authorities, basing their belief on similar experience after World War I, state that the number of chil- dren under their care will lessen con- siderably when more housing units are available.
Coordinated city planning will again include many day-care centers in the large housing projects, but the huge program will nevertheless fall considerably short of its goal of making places available in such cen- ters for one-third of all Viennese children.
The second area, the further de- velopment of casework and of family services, depends almost completely upon the progress of the Vienna School of Social Work in conjunction with the Jugendamt and the Fiir- sorgeamt or Public Assistance Bu- reau. For its present students the
30
school is rapidly revising and ex- panding its program. The school has influenced community agencies to recognize the need for better-trained workers ; the agencies have responded by providing more effective field- work placements. Actual practice of casework by students is beginning to replace the traditional observation or apprentice experiences. Men stu- dents, first admitted to the social- work school in 1948, now number about 15 percent of each class.
Casework courses throughout each of the four semesters have come to replace the former emphasis on pure theory. In the next few years the school plans to lengthen its curricu- lum from 2 to 3 years.
The development among social agencies of the practice of keeping case records and the exchange of ideas and teaching materials among the various schools of social work in Europe will help to advance the de- velopment of the Vienna school, which in turn will be able to contrib- ute much to other schools. The school offers weekly classes on an extension basis for practicing social workers, conducts a special program to train supervisors, and plans to meet re- quests for similar courses for coun- selors and for psychiatric social workers.
Creative leadership in all aspects of social work training in Vienna comes largely from the Dean of the Vienna School of Social Work, Dr. Nuna L. Sailer, and her far-seeing courage and soundly progressive ideas. She is considered one of the most capable leaders in European social work.
In summary, Vienna's city govern- ment has a rich tradition of broad planning and legislation to serve the basic needs of its total population. It believes that the degree of its advance in social welfare is, like its music, a mark of its culture. Although dy- namic psychology had its birth in Vienna, only now is it being incor- porated in broad social-work prac- tice. The end result of this trend will be a heightened cultural and so- cial achievement for this city and in turn for Austria.
ITHE NEWS
Nursing groups. After a decade of progressive planning, a two-organi- zation plan for national nursing asso- ciations was adopted at the Seven- teenth Biennial Nursing Convention, held at Atlantic City, N. J., June 16- 20, 1952.
One of these two organizations is the previously existing American Nurses' Association, which continues under revised bylaws ; the other is the new National League for Nurs- ing. I
The new League was established by i amendment to the existing charter of 1 the National League of Nursing ; Education ; and two other organiza- i tions — the National Organization for I Public Health Nursing and the As- i sociation of Collegiate Schools of | Nursing — voted to dissolve and be- ] come part of the League.
According to Pearl Mclver, R.N., chairman of the Joint Coordinating Committee on Structure, which rec- ommended the reorganization, the aim of the new League is the best utilization, distribution, and financial support of nursing services and nurs- ing-education facilities. All nurses, from every occupational field, will have the opportunity (and the respon- sibility) to plan jointly with allied professional workers and with the public in efforts to reach this goal.
The American Nurses' Association, which is an organization made up of professional registered nurses, will have full responsibility for all func- tions which should be carried out by the members of a profession. These functions include establishing stand- ards for nursing practice, recom- mending desirable qualifications for nurses in the various nursing special- ties, and promoting the general wel- fai'e of nurses.
The first national nursing organi- zation formed in the United States came into being in 1894. This was the National League of Nursing Edu- cation, the group that amended its charter in 1952 as a step toward forming the new National League for Nursing. In 1896 the American Nurses' Association was formed, with the help of the NLNE. In the more than half a century that has elapsed since then, various national nursing groups have been formed ; at one time there were as many as six.
The two-organization plan now in force, with its clear differentiation between the functions of the groups,
THE CHILD VOL 17 NO.
should enable Federal agencies whose programs are concerned with nursing to work even more effectively with these organizations than in the past.
Marriage and divorce. The marriage rate for 1951 (10.4 per thousand population) was 37 percent below the all-time high, which was reached in 1946 (16.5 per thousand), according to the Bureau of the Census, Depart- ment of Commerce. Divorces also fell off. In 1951 there were 2.4 divorces per thousand population (44 percent below the 1946 peak of 5.5 per thou- sand) .
Guidance services for youth were re- ported by only one-sixth of the public schools in 1948. Even those schools reporting such services averaged only one counselor to every 398 students, and were principally in cities.
Deadline: October 15
Each year, according to law, the Federal Security Agency sends each person on the official mailing list for The Child a pos- tal card asking whether he wishes to continue to receive it.
You will soon receive such a card. Be sure to return it by October 15 if you want your name to be kept on the list.
FOR YOUR BOOKSHELF
MY SON'S STORY. By John P. Frank. Alfred A. Knopf, New York. 1952. 209 pp. $3.
A father tells the story of his men- tally retarded child, Petey. It is a moving story, written with emotion but without sentimentality. From the normal and happy welcoming of the new baby into the family it pro- gresses to the first frightening ill- ness, the diagnosis of untreatable brain damage, the struggle of the parents between belief and despair on the one hand and disbelief and phantom hope on the other. Then follows for the parents a period of trying to find a way to meet this problem in the way that will be best for the much-loved child and for themselves and their other child.
They decide to institutionalize Petey, but they have a most difficult time trying to find an institution that
OCTOBER 1952
will care for such a child. Eventually they find an excellent place, and the remainder of the book is concerned with the pain of separation and how the parents managed to put their lives together again into some sort of normal and satisfying pattern. Neither the anguish nor the courage of these parents is minimized.
Mr. Frank has not written this story for relief of his own personal grief, although it may have helped him. Nor has he written it to help other parents with mentally retarded children, although it could not fail to help them. His main purpose, it seems, is to make people understand what he means when he says : "No one knows exactly how many retarded children there are, but something over 10,000 of Petey's general class are born every year. I wish that families less well situated than ours could come out as well. We and our fellow Americans as a people don't do nearly enough to provide for these sick children."
Betty Huse, M.D.
CHILD PSYCHIATRIC TECH- NIQUES ; diagnostic and therapeu- tic approach to normal and ab- normal development through pat- terned, expressive, and group be- havior. By Lauretta Bender, M.D. Charles C. Thomas, Springfield, 111. 1952. 335 pp. $8.50.
As Dr. Bender explains in her fore- word, this book consists of a collec- tion of papers written by Paul Schil- der (her late husband), herself, and a number of their associates at Belle- vue Hospital, New York City, during the past 15 years. She credits Dr. Schilder with the authorship of 4 of the 19 chapters; she also credits him with being the "originator of most of the concepts, attitudes, and result- ing philosophies expressed in all these papers." But the book essen- tially is still hers. The idea of an endeavor as vast as this is hers ; so are the concepts, with and without variations from Freudian concepts ; and so is the admirable execution of diagnostic and therapeutic techniques demonstrating the entity of the child as a personality.
Most readers familiar with child welfare and child psychiatry will find little that is startlmgly new. Each of the various tests and psychothera- pies, individual and group, has been elaborated on in the past. It seems that Dr. Bender does not wish to present conclusions other than those based on the experience shown in her abundant case material.
What is new is the integration of
all techniques, regardless of origin, theory, or type, in one volume, to serve the reader as reference and as stimulus for further thought.
Hans A. Uling
Oct. 1-31. Red Feather Month. In- formation from the United Com- munitv Chests of America, 155 East " Fortv-f ourth Street, New York 18, N. Y.
Oct. 2-4. American Academy for Cer- ebral Palsy. Sixth annual meeting. Durham, N. C.
Oct. 2-.5. Rural Youth of the U. S. A. Conference. Annual meeting. Jack- son's Mill, Weston, W. Va.
Oct. 19-23. American School Health Association. Twenty-sixth annual meeting and twenty-fifth anniver- sary of the founding of the Associ- ation. Cleveland, Ohio.
Oct. 20. Association of Maternal and Child Health and Crippled Chil- dren's Directors. Annual meeting. Cleveland, Ohio.
Oct. 20-23. American Academy of Pediatrics. Twenty-first annual meeting. Chicago, 111.
Oct. 20-23. National Conference of Juvenile Agencies. Forty-ninth an- nual meeting. Columbus, Ohio.
Oct. 20-24. National Safety Council. Fortieth National Safety Congress and Exposition. Chicago, 111.
Oct. 20-24. American Public Health Association. Eightieth annual meeting. Cleveland, Ohio.
Oct. 21-24. American Dietetic Associ- ation. Thirty-fifth annual meeting. Minneapolis, Minn.
Oct. 23-24. National Midcentury Com- mittee for Children and Youth. New York, N. Y.
Oct. 24. United Nations Day.
Oct. 26-30. National Society for Crip- pled Children and Adults. Twenty- ninth annual convention. San Francisco, Calif.
Oct. 27-30. National League to Pro- mote School Attendance. Thirty- eighth annual convention. Boston. Mass.
Illustrations:
Cover, Esther Bubley for Standard Oil Co. P. 19, Esther Bubley for Children's Bureau. P. 2.3, Farm Security Administration. P. 25, Library of Congress photograph. Pp. 28 and 29, courtesy of the authors.
31
VOL. 17 NO. 2 OCTOBER 1952
In This Issue
United Nations Dav, 1952
Page . 18
Furthering Individual Well-Being Through Social Welfare 19 Martha M. Eliot, M.D.
How Can We Evaluate Social Work? Helen Leland W itmer
24
A Visitor's View of Child Welfare in Vienna (Concluded) 27 H. Ted and Bunny Rubin
Published 10 times a year by the Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
FEDERAL SECURITY AGENCY Oscar R. Ewing, Administrator
SOCIAL SECURITY ADMINISTRATION Arthur J. Altmeyer, Commissioner
CHILDREN'S BUREAU Martha M. Eliot, M.D., Chief
Publication of THE CHILD, monthly bulletin, has been authorized by the Bureau of the Budget, September 19, 1950, to meet the needs of agencies working with or for children. The Children's Bureau does not necessarily assume responsibility for state- ments or opinions of contributors not connected with the Bureau.
THE CHILD is sent free, on request, to libraries and to public employees in fields concerning children; address requests to the Children's Bureau, Federal Security Agency, Washington 25, D. C. For others the subscription price is $1.25 a year. On all orders of 100 or more sent to one address there is a discount of 25 percent. Send your remittance to the Superintendent of Documents, Government Printing Office, Washington 25, D. C. Single copies 15 cents each.
Foreign postage — 25 cents additional — must be paid on all subscriptions to coun- tries in the Eastern Hemisphere and those sent to Argentina and Brazil. Domestic postage applies to all other subscriptions.
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CHILD
NOVEMBER 1952
I.
SUPEBIWrCHC
NOV 25 1952
WHEN A CHILD MUST GO TO THE HOSPITAL
Much can be done to prevent emotional disturbances
RUTH WINKLEY
WE KNOW that children differ in the ways they meet difficult situations, and that a child who is well-adjusted, whose family life is a life of love, trust, and secur- ity, is the one who is most likely to go through his tonsil operation with- out much emotional disturbance.
But however well-adjusted a child may be, his first hospitalization may be full of disagreeable surprises. And some of the hospital procedures, es- pecially if he misinterprets them, may frighten him or otherwise dis- turb him.
To find out which procedures were bothering the child most, a team of five professional workers — four phy- sicians and a psychiatric social worker — have made a 3-year study of children undergoing tonsillectomy at Albany Hospital, Albany, N. Y. More than 100 children 3 to 8 years of age were studied — before they went to the hospital, while they were there, and afterward.
Children's resentment heeded
The study showed that what the children resented most was a jab with a hypodermic needle. And as a result this hospital has reduced the use of needles, and by the end of the study the only jab these children had to take while conscious was the finger prick for a hemoglobin reading.
Some other procedures were modi- fied or eliminated, though many, of course, could not be.
But as a step toward making the whole hospital experience less dis- turbing to the child, the social worker — myself — visited the child's home a week or two before the operation, got acquainted with him and his parents, and talked over the various things
that would happen in the hospital. I especially explained the procedures that had been found most disturbing.
As for reassurance, I found that the mother needed this more than did the child. What the child needed was information. And that is what I gave, along with reasons for some proce- dures that we had learned were mis- interpreted by some children in ways that had unhappy results.
I also studied each child, evaluating his emotional characteristics and his relations with his parents.
In order to bring to light the things that were disturbing the chil- dren, members of the study team con- sidered the situation of each child from the time he entered the lobby of the hospital until he went home the next day. And they noticed a source of disturbance for a few children at the very beginning of their hospitali- zation— in fact, in the elevator. For a few children are afraid of shut-in places. And when such a child steps into the hospital elevator he is likely to become panicky. After we learned about this, I included elevators in the discussion with the child at home.
But even if the child knows about elevators, the hospital elevator may
RUTH WINKLEY is Associate in Pedi- atrics at Albany Medical College, Albany, N. Y. She is a graduate of the University of Michigan and of the New York School of Social Work.
The members of the team that worked on the study Miss Winkley describes here are all on the staff of Albany Medical College. The director of the project was Otto A. Faust, M.D., Professor of Pediatrics. The other members, besides Miss Winkley, were Katherine Jackson, M.D., Anesthesiologist; Ethel G. Cermak, M.D.. Associate Professor of Pediatrics; and Marjorie Murray Burtt, M.D., formerly Associate Professor of Pedi- atrics.
The study was made with the cooperation and support of the New York State Depart- ment of Health.
be crowded, with many grown-ups towering above him and obstructing his view, and he may become frightened. If he has learned to count, it helps if he is told beforehand that he and his mother are to get off, say, at the sixth floor. Watching the floors go by and confirming the truth of this may sufficiently engage his attention to keep him from being afraid.
Then there are the "men in white." Many children have never seen doc- tors dressed in white, even on tele- vision. For an occasional child, see- ing men in white clothes may be a scary encounter unless someone has told him about this ahead of time.
Another thing that may bring con- sternation is undressing and going to bed in the daytime. It may make a child feel that he is being punished, especially if that is the way he is punished at home. In this hospital a child does not need to go to bed when he arrives. The hospital has a large playroom, and there Johnny will find himself with other children, and this may take his attention away from his own troubles, at least to some extent.
When the real bedtime comes, how- ever, Johnny may be distressed to find that his hospital bed has sides, like a baby's crib. If he is proud of his youth-bed status, the resemblance to a crib may bring with it a tinge of humiliation. But if he has been told at home about the kind of hos- pital bed he will sleep in, and if the reason for the crib-like sides is ex- plained to him, he is likely to take the whole thing in stride. Therefore, when I visited a child in his home, I told him why his hospital bed would have sides — it is because the beds are so high and so narrow that even a
34
THE CHILD VOL. 17 NO. 3 '
A child whose family life is a life of love, trust, and security is the one who is likely to go through a hospital experience, such as a tonsil operation, without much trouble.
grown-up might roll over in his sleep and fall out.
Again, if Johnny wants to be Hopalong Cassidy both day and night, and is used to wearing cowboy pa- jamas (and something similar may apply to little Mary too), the hospital gown will seem a rather dull affair. There is something about being Hopa- long Cassidy, even in the hospital, and about wearing one's own night clothes, that keeps many a little fel- low from feeling he has lost his identity in this very strange place.
Mother's presence usually helps
In Albany Hospital, a mother is en- couraged to stay with her child the 2 nights he is there and is permitted to sleep in the same room with him. This, too, is a boost to most children's spirits. During these 2 important days in his life Johnny has the as- surance of his mother's constant pres- ence in case he needs her. If Johnny and his mother are truly close, this is a good arrangement; but it can be disturbing if his mother is more up- set than he is, as such feelings com-
municate themselves to children with- out words. Fortunately some mothers know this themselves deep down in- side ; and sometimes one of these will say that Johnny will be better off without her, and another lets herself believe that she is more needed at home.
Taking a blood sample is a routine requirement in the hospital, and, of course, Johnny will have to undergo this, often to his mother's distress. For most adults have disagreeable as- sociations with blood; and it is hard for a mother not to transmit to her child her horror, or her association of blood with pain. Yet children, unless they have picked up this idea from adults, need not have any such feel- ings. If Johnny knows ahead of time that his finger will receive a slight prick, such as he gets dozens of times crawling around in briars at play, fol- lowed by the appearance of a round bead of his own beautiful red blood, he will probably watch the whole per- formance with fascination. Mother may be standing by, trying to keep from shuddering or cringing, but
Johnny watches without anxiety the bead of blood rise in the little glass tube, just as he was told it would.
Another routine procedure is to take a sample of urine. Johnny may feel a little strange about using a urinal. But if he has been told about it beforehand and nobody hurries him, he may be less disturbed. And after he is a little more used to his surroundings, he is likely to produce the sample readily.
For Mary this process may be a bit more embarrassing. Mary is proud of the fact that she is trained and never gets her bed wet. The bedpan with its strange feeling may make her think she has spilled in her bed, which she would never wish to do, es- pecially in a strange place. A little description ahead of time of the bed- pan and of how it feels, and assurance that it will not spill over, can make this procedure easier for her.
Anesthetist briefs Johnny
In the late afternoon a woman doc- tor, who is to administer the anes- thetic the next morning, comes to see Johnny to get acquainted with him. She is wearing her operating-room costume, and she tells him that when he goes to the operating room tomor- row all the other people in the room will be wearing clothes like hers.
She says to him that he probably will not be sleepy when it is time for the operation because it will be day- time, but that she has medicine that will help him go to sleep so he will not feel anji;hing when his throat is being fixed. She lets him smell this medi- cine, and shows him the anesthesia mask. He turns it over and tries it on his nose so that he knows just what it will be like the next morning. She tells him she will put the medicine onto the mask a little at a time, that he will bcome very sleepy, maybe dizzy-sleepy. Then, she says, he will go fast asleep and will feel no pain during the operation.
The anesthetist goes on to tell Johnny that when he awakens he will be back in his bed and that his mother will be there (if this is the case). She mentions to him that his throat will
NOVEMBER 1952
35
be very sore, but that he will be able to take little sips of ice water when he feels thirsty. Each day after that his throat will be less sore, and she tells him that soon it will be all well.
Johnny learns also that on the morning of the operation he will have no breakfast, as that might make his tummy feel sick.
Tonight he will have his supper on a trav; he hkes this.
room, there is the anesthetist he met the afternoon before. She hands him the mask, asking if he remembers what he does with it. He replies tliat of course he does, putting it on his nose and holding it himself. No one else touches it except the anesthetist, who tells him she is going to hold it steady for him.
Then the anesthetist says quietly that now she is beginning to put on
When Mary woke after her operation, there was her mother, as well as a friendly nurse. Pleasant awakening helps to minimize emotional disturbance caused by hospitalization.
When it is time for him to go to sleep he has a snug, comfortable feel- ing, for there in the bed across the room from him is his mother. He also has his favorite teddy bear, which always sleeps with him. No- body in the hospital thinks that this is silly, but that it is a good idea to have whatever is familiar and com- forting.
In the morning Johnny looks for the cart that he has been told will come rolling along to ride him to the operating room. And this time he rides right into the elevator on his cart. But this is not a surprise. He has been told about this too.
When he arrives at the operating
36
the medicine he smelled the night be- fore. Johnny recognizes the smell and after a few moments may say, "I feel a little sleepy," or his hands, holding the mask, may slip down to his sides as he gets drowsier and drowsier. That's all there is to it! No battle, no holding down, and no feeling of a surprise attack.
We found that among the most an- noying procedures for a child are taking his temperature by rectum and giving him an enema. And why not? Nowhere in history has anyone exclaimed with joy over an attack from the rear, so why should Johnny ? In tins hospital he will not be given an enema. His temperature is taken
by mouth, and if he is sleeping it can be taken under his arm perfectly well without wakening him.
Some doctors give penicillin to help fight any low-grade infection the operation might stir up. Such an in- jection would be painful, but there's nothing to it if Johnny gets it right after the operation while he is still under the anesthetic.
Sometimes after the operation the child is nauseated and sometimes not. At any rate he is glad to have the ice collar on his sore throat and to sip cool drinks.
Home visit repeated
Duving our study I visited each child at home a week or so after the operation and again after 2 months. The child was free to say just what he thought of the whole thing. Instead of major complaints, which used to be the rule, these children had rather trivial gripes, uncon- nected with terror and fear. It might ba that being given vanilla ice cream instead of strawberry was the worst happening they could think of, or that the television screen in the hospital was not as large as theirs at home; some of them couldn't think of a single gripe about the hospital. Of course, we know that many children do not talk about feelings that are deep-seated. And it is true that at the time of this visit many of the children were still showing some ad- verse results of their experience, such as restlessness in their sleep. But by the time 2 months had passed, only 17 of the 105 studied seemed to be still affected.
Apparently these children went through the tonsillectomy with much less emotional damage than might have been expected. Much of this success was due to the understanding j of the hospital staff and to their en- thusiastic response to the changes in practice. But the changes have been made primarily through the efforts of the chief pediatrician (the direc- tor of the study), who has given | leadership for many years in develop- \ ing hospital practices in the interest ' of the children's emotional well-being. !
Reprints in about 6 weeks j
THE CHILD VOL. 17 NO. 3'
INSTEAD OF "BLOOD-AND-THUNDER" RADIO
A noncommercial program encourages little children to learn through dramatic play
NANCY HARPER
SO FAR as children are con- cerned, everything on radio and television is educational. Every program that reaches them, regard- less of the quality, teaches them some- thing, and it seems high time for par- ents, and others interested in chil- dren, to pay more attention to what and how the children are learning from their new teachers. Of coui'se a child is the same person whether he is in school, or at home in front of a radio or a television set. Whatever he learns from radio and television, it should reenforce, not destroy, what parents and teachers are trying to build.
As an experiment in radio program- ing, designed to give, over the air, some of the same kind of learning and fun and confidence that children would get in a kindergarten or nurs- ery school, "The Children's Circle" goes on the air in Boston every day at 5:30 p.m. over a noncommercial radio station. In preparing the pro- gram, we draw on the resources and personnel of Boston's Museum of Fine Arts, Museum of Science, Chil- dren's Museum, and other organiza- tions in the Boston area that are in- terested in children.
NANCY HARPER is a faculty member of the Nursery Training School of Boston. She is co-producer of '"The Children's Circle," a daily radio program for children 2 to 6 years of age. which she describes here. She is the mother of two children. 7 and .5 years of age.
Mrs. Harper's radio program was begun in October lO.')!. It is broadcast on Boston's 1-year-old noncommercial, educational, FM station, WGBH. This station is operated with the advice and cooperation of the Lowell Institute Cooperative Broadcasting Council, who e members are the Lowell In- stitute, Boston College, the Boston Sym- phony Orchestra, Boston University, Massa- chusetts Institute of Technology, the Mu- seum of Fine Arts, the New England Con- servatory of Music. Northeastern Univer- sity, and Tufts College.
NOVEMBER 1952
Patterned on everyday children's everyday interests, each program is written in a series of brief episodes, generously interlarded with music and conversational periods, to avoid overstretching a child's attention span.
Each program lasts half an hour. It is given slowly; dramatic play is suggested; and time is allowed for the children to carry out the sugges- tions on the spot.
On Columbus Day, for example, historical material is woven in. Upon the program's suggestion, the chil- dren may act out how the boy Colum- bus was told that the world was flat and how he figured out that it must be round. They may climb up into their armchair "sailing ships" and start on the great adventure across the Atlantic Ocean, which, in their case, of course, is the living-room rug.
Again, a program in connection with science material about animal habits may start such a game as bears preparing for winter — storing up food and preparing their homes. And an hour or so later the children will still be "bears," eating their sup-
pers peacefully or going to bed under sheets that have become, by chil- dren's own magic, special caves for baby bears!
We keep up with the seasons
The program moves with the child's life — from fall experiences to winter ones, and so on.
Even before the days and nights begin to grow cold, coal or oil trucks arrive at people's houses; and chil- dren, for the first time, or with in- creased appreciation, learn where coal and oil come from, how they are car- ried to our homes, and what these fuels will do.
Cooler weather brings on a ques- tion : "Why must I wear a jacket just because it's fall?" And the program combines science material and stories and music to answer just such ques- tions. At jacket-wearing time a child may find it hard to learn to zip a zip- per and remember to button a button. A game and a story and radio-sug- gested practice on these exasperating problems give such necessary things importance and fun.
As fall days grow shorter, an elec-
This time the radio story is about flowers, and a picture book helps this child to enjoy it.
trie-light bulb becomes more impor- tant than it was in summer; and it needs explanation, along with the reason why a finger mustn't be poked into the light socket. A game about sunlight and shadows makes use of a light bulb, too, with the bulb play- ing the part of the sun, and the child's hand serving as a cloud, to cast shadows where it will.
As winter approaches and sunny bedtimes change to dark ones, fears and bedtime problems may crop up. But they can lose their sting when a dramatic game accompanies an eve- ning program, like the one about the baby bears.
Another bear story involves a "treasure hunt," in which a present for the child's mother is supposed to be hidden somewhere in the room. This leads to a search — under every chair, behind every cushion, even un- der the rug. Then, somewhat as in Marjorie Flack's story, "Ask Mr. Bear," the child meets a bear and asks for help. Whereupon the bear in this radio story whispers to the child and tells him where the present is. It is in the child's arms — a great big bear hug — and he promptly gives it to his mother.
Violent play not always fun
It is true that the rocket ships and gun-toting cowboys on many radio programs demand and get children's rapt attention, sometimes resulting in violent and aggressive imitative play. But the amount of noise a child makes does not necessarily indicate enjoyment. On the other hand, a child may not make much noise play- ing at being a trafhc policeman as part of a radio game, but he may en- joy it, and he may find it a step to- ward learning that his community really cares about him.
And excitement is not a satisfac- tory substitute for the confidence that a child acquires when he begins to experiment on his own — to find out through play what makes a shadow over the sun, why a cork floats and stones don't, why a kite flies, and what makes thunder.
The program comes into the home,
See: We found the star in the apple, just the way The Children's Circle lady said we would!
with the stories told as a mother or father would tell them, or a friend, or a teacher, to a child alone or with other children. No studio audience takes part, for this would probably only distract the home listeners. The program narrator permits sufficient time for the children to respond with words and action. Only simple activi- ties are suggested; the children de- velop these themselves, without a standard that might be too hard to live up to — or too easy.
And their relaxed behavior during such a program is very different from the tense, edge-of-the-chair attention they give to high-powered blood-and- thunder programs.
The programs are recorded, and some of the recordings have been played for children in the Boston Floating Hospital; some of these children are in bed, while others are up and around. Among sick children the program appeals to a surprisingly wide age range — under 2 up to 15 in some cases. The little children are in- clined to listen passively ; the older ones with amusement and response. Because the program deals with the
everyday, comfortable things, it seems to offer more peace and quiet and comfort, not only to a child dis- turbed by illness, but to any young child who is tired at the end of a day.
Programs can help parents
It is not easy to help a child feel at home in a world that is often too com- plicated even for adults. In this ef- fort parents need any help they can find, and increasingly they are learn- ing that help can come from radio and television. And radio, of course, reaches many thousands of children to whom television is not yet avail- able (and who do not have nursery schools or kindergartens to go to).
Both radio and television are be- coming part of the basic home edu- cation of children, preceding and sometimes overshadowing school les- sons. The programs can make a child's world more puzzling and frightening than it already is — even more full of noise and violence. Or they can increase his enjoyment and understanding and self-confidence, and this is the aim of the program called "The Children's Circle."
38
THECHILD VOL UNO. 3'
DELINQUENCY PROJECT MOVES AHEAD
GROUPS and individuals all over the Nation are giving their full support to the recently an- nounced Special Juvenile Delinquency Project sponsored by the Children's Bureau. This Project, on behalf of the Bureau, aims to focus national attention on the problem of delin- quency and to stimulate community action toward improvement of serv- ices for delinquent children.
The Project, financed by private contributions to the Child Welfare League of America, has received many definite offers of assistance and cooperation in this campaign.
On July 14 and 15 representatives of 14 national agencies whose every- day concern is the prevention and treatment of delinquent behavior met in Washington to advise the Bureau on specific needs for helping delin- quent children. The group empha- sized the need for more facts about delinquency, for better training of the personnel who work with these children, and for a code of desirable practices to govern the services of- fered. The agencies represented at the meeting have offered to aid in fact finding and in furnishing con- sultation to communities undertaking improvements in their services.
Through the cooperation of the International Association of Chiefs of Police, one of the groups represented, a questionnaire has already been sent out to approximately 2,800 pohce de- partments in all parts of the country, asking whether or not they have of- ficers who are trained for work with children; how many children are picked up by the police each year — and for what reason ; and what pro- cedure is followed for handling these various children.
The entire group of agencies will continue to act as an ad hoc tech- nical committee.
The agencies represented at this meeting were: Administrative Office of the United States Courts; Ameri- can Public Welfare Association ; Bur- eau of Prisons, Department of Jus-
NOVEMBER 1952
tice; Bureau of Public Assistance, Federal Security Agency ; Child Wel- fare League of America ; Field Foun- dation ; International Association of Chiefs of Police; National Associa- tion of Training Schools; National Conference of Juvenile Agencies ; Na- tional Council of Juvenile Court Judges; National Institute of Mental Health, Federal Security Agency ; Na- tional Midcentury Committee for Children and Youth ; National Proba- tion and Parole Association ; Office of Education, Federal Security Agency; and Osborne Association.
To promote local aciion
One week later, on July 21, in New York, the National Social Welfare Assembly called a meeting of its member organizations to consider ways in which they could cooperate with the Children's Bureau in this Nation-wide campaign. The 33 groups represented at the meeting have a membership which reaches into every community in the United States. The national organizations promised their full assistance in car- rying information to their local chap- ters and in stimulating and support- ing local projects connected with bet- ter services for delinquent children.
In addition, a number of the organ- izations reported that they would un- dertake work directly related to serv- ices for'delinquents. The Girl Scouts, for example, are organizing troops in training schools. The National Coun- cil of the Protestant Episcopal Church will train chaplains specifi- cally for work in training schools. Other groups indicated that they would explore this field of direct services. All the organizations rep- resented at the meeting promised to reexamine their current programs, to see how effective they are in pre- venting delinquency and whether they can be adapted to better advan- tage in this campaign.
A summary of proceedings of an earlier meeting, the Conference on
Control of Juvenile Delinquency, has also stimulated widespread interest. This conference, held in Washington April 17-19 under the sponsorship of the Children's Bureau, was attended mainly by experts in the field of de- linquency. The conference made recommendations affecting the opera- tion of services for delinquents, the training of personnel, and the need for research in the field of delin- quency. The summary of proceed- ings has been distributed recently to some 3,000 persons who work with delinquent children.
In his foreword to the summary, John H. Winters, Executive Director of the Texas State Department of Public Welfare and Chairman of the Conference, said: "The meeting in Washington was, in my opinion, the first step in a necessary pi'ocess aimed at alerting leaders to the grow- ing problems of juvenile delinquency. You, the reader, are called upon to use the structure we have created in order to continue building. Specifi- cally, you are asked to consider the contents of this report and let us know what you think about it. We should be pleased to have the report used as a basis for meetings of per- sons concerned with the control of delinquency and to receive the min- utes of such meetings."
Workers in a number of States have already reported plans for hold- ing meetings such as Mr. Winters calls for. Among these States are Connecticut, New York, Delaware, and the District of Columbia. Num- erous requests for additional copies of the summary continue to be received. A copy will be sent to any reader of The Child who requests it.
Pamphlets related to the work of the project will shortly be available. A special bulletin will be issued peri- odically to keep all persons interested informed about the latest develop- ments. A copy of this bulletin also will be sent to any reader of The Child who would like to receive it.
39
CHILDREN AND THE SCHOOL-LUNCH PROGRAM
THE NOON LUNCHES that a child eats in the course of a school year have an appreciable influence on his health, his education, and his general welfare. The agencies represented on the Interagency Com- mittee on Nutrition Education and School Lunch are concerned with one or more aspects of school-lunch pro- grams. To assist all member agencies in carrying out such responsibilities as they may have, the Interagency Committee has prepared a statement of the values inherent in school-lunch programs. The paragraphs that fol- low develop the main theme of the statement of goals, which is that school-lunch programs should be cen- tered on the child — his nutrition, his physical, mental, and emotional de- velopment, and his education.
1. The school lunch should foster good food habits and safeguard the health of school children
The noon meal served at school will fulfill its nutritional purpose only if it supplies at least one-third of the day's requirements for calories, pro- teins, vitamins, and minerals. Its contribution of nutrients should be such that, in combination with the breakfast and the evening meal typi- cal of those served in homes of the community, the total daily needs of the children will be met. Food needs of children differ with their size, ac- tivity, and physical condition.
The school meal will serve as a safeguard of nutrition and health
The agencies represented on the Inter- agency Committee on Nutrition Education and School Lunch are: In the Department of Agriculture, the Bureau of Human Nu- trition and Home Economics, the Coopera- tive Extension Service, the Farmers Home Administration, the Food Distribution Branch of the Production and Marketing Administration, the Office of Experiment Stations, and the Rural Electrification Ad- ministration; in the Federal Security Agency, the Children's Bureau, the Office of Education, and the Public Health Serv- ice; and the American National Red Cross.
only if it is so acceptable that it is eaten by the children in the quantities provided for them. Therefore, the quality of the food and its accept- ability should receive due attention. School lunches provide a means for gaining acceptance of foods of high nutritive value, the increased con- sumption of which is in the interest of nutritional betterment. The school that serves only appetizing, moder- ately priced food under pleasant sur- roundings has taken an important step toward protecting children from unsuitable foods and beverages.
Sanitary safeguards are essential for all food handling, especially group feeding. The public health agency often has legal responsibility for the sanitary conditions and practices in school lunchrooms. Even if legal au- thority is lacking, this agency can provide valuable advice and assist-
When a school serves only appetizing, moderat has taken an important step toward protecting
ance to school administrators in en- suring that school lunchrooms meet accepted sanitary standards both as to facilities and operations.
The conditions under which the lunch is served affect the mental and emotional health of children. To this end effort should be directed toward provision of attractive surroundings, an unluirried quiet atmosphere, smoothly functioning service, servers who understand the children and their food needs, unobtrusive guid- ance when necessary in the choice of foods, and absence of any discrim- mination.
2. The school lunch should contribute to the education of the child and his family
The school lunch can provide a practical form of education in nutri- tion, sanitation, and social behavior for all children. It may also give practice to some pupils in planning menus ; in buying, preparing, and serving foods on either a home or a commercial scale ; and even in pro- ducing and processing foods. {Continued on page 45)
ely priced food under pleasant surroundings, it children from unsuitable foods and beverages.
40
CONFERENCE WORKS TOWARD BETTER CITIZENSHIP
I LUCILE ELLISON
THE SPIRIT of young America, vigorous and unafraid, was evi- dent throughout the 1952 Na- tional Conference on Citizenship, held in Washington September 17-19. Seventh in a series, the conference was jointly sponsored by the National Education Association and the United States Department of Justice. In it were assembled 1.000 representatives of over 600 organizations and agencies, all deeply concerned with the rights and responsibilities con- nected with citizenship. They came from every State in the Union and from numerous foreign countries.
In each of the 18 groups, a cross- section of America came together. In the words of the summarizer: ''You are, after all, America in miniature. There are some 1,000 of you, repre- senting millions of doctors, lawyers, merchant-chiefs — to say nothing of the butchers, bakers, and candlestick makers. You are not all of one mind and I would be less than candid if I were to report that you were." Each conference group included a number of young people of high-school and college age and they were accepted as equals with the adults.
Some don't appreciate citizenship
Some pointed questions were asked in the various groups :
"How are our rights and privileges identified and acquired?"
"What rights and privileges seem most fundamental at this midcen- tury?"
"What are the most persistently troublesome problems arising from
LUCILE ELLISON is a staff member of the National Education Association. .As- sistant Secretary of the NEA's National Commission for the Defense of Democracy through Education, Mrs. Ellison is assigned as staff liaison to the NEA's Citizenship Committee. In this capacity, she is a member of the Executive Committee for the National Conference on Citizenship.
NOVEMBER 1952
the exercise of our rights and the en- joyment of our privileges'?"
"What principles can we formulate, and what means can we employ, to improve the relationship of the indi- vidual citizen to his rights and privi- leges, as well as his duties and re- sponsibilities, under the Constitu- tion?"
First of the "troublesome" prob- lems to be identified was the apathy of many citizens toward their consti- tutional rights and obhgations as citi- zens. Such apathy, one delegate said, is in fact "subversive iKactivity" be- cause it plays into the hands of those seeking to destroy our democratic system.
Another problem, delegates sug- gested, is that young adults, for many different reasons, either do not or cannot exercise their rights. For ex- ample, because the voting age is fixed at 21, many younger people lose interest in and concern with their re- sponsibilities as citizens.
The conference gave much atten- tion to the practice of good citizen- ship. As one group reported: "It is not a matter of kuowing right but of doing right." Said the summarizer: "There was one point on which you seemed all to be in complete agree-
ment. You couched it in different phrases, but the thought was this: Good citizenship demands action and participation. It is an active, not a passive thing."
The youth-adult panel on the open- ing evening of the conference pre- sented the active role of schools in making better citizens. Dr. William S. Vincent, director of the Citizenship Education Project at Columbia Uni- versity and moderator of the panel, said: "Since their beginning in America, schools have devoted a large part of their program of courses and activities to citizenship education. But the job is not an easy one and it is not a cheap one. More recently we have come to realize that you can't make good citizens solely by reading and talking about good citizenship. Good citizenship is a way of behav- ing. It is a matter of action, and if we know one thing about how people learn it is this: Active things you learn through action. Imagine trying to teach a girl to sew without a needle and thread. Active things require some sort of laboratory approach, and citizenship is no exception."
This panel also illustrated, as was true of the discussion groups, the in- tegration of young people and grown- ups in the conference. In it, six high- school students, a judge of a juvenile court, and a newspaper correspondent took part. The students represented public, private, and parochial schools. From dozens of illustrations, it be- {Continucd on page 44)
What principles can we formulate, and what m ship of the citizen to his rights and privilege
ean.s can we employ, to improve the relation- s. as well as his duties and responsibilities?
FOR CHILD WELFARE IN VENEZUELA
ELISABETH SHIRLEY ENOCHS
FEW countries of the Western Hemisphere have made more i-apid progress in the field of child welfare than Venezuela. In 1936, when a new Government was set up after the death of General Juan Vicente Gomez, who had ruled the country for more than a quarter of a century, one of the first oificial acts was issuance of a decree estab- lishing a child-welfare agency. Plans were immediately laid for the country's First National Child Wel- fare Conference, held in 1938, to which the Venezuelan Government invited the Chief of the United States Children's Bureau as an honored guest. Shortly thereafter, in line with recommendations made at this meeting, Venezuela's Federal Con- gress enacted a Children's Code, which became the organic act of the present Venezuelan Children's Coun- cil (Consejo Venezolano del Nino). Ten years later, in 1948, Caracas, the beautiful capital city of Vene- zuela, was host to representatives of all the American nations at the Ninth Pan American Child Congress. The delegation from the United States, of which Katharine F. Lenroot, then Chief of the Children's Bureau, was chairman, noted the great strides al- ready made in work for children in Venezuela and the eagerness with which all branches of government — Federal, State, and local — were plan- ning future progress. A draft of a new Children's Code had been devel- oped under the leadership of a dis- tinguished Venezuelan jurist who to- day is Minister of Justice, and that Pan American gathering reviewed the draft. Several of the United States delegates were members of the working group that reviewed the proposed code. A year later the Fed- eral Congress of Venezuela approved that draft, with appropriate amend- ments, and the Code provides the le- gal authority under which the Ven-
zuelan Children's Council now oper- ates.
How the Council functions
In its structure the Council differs from many similarly named agencies in the other American Republics. In accordance with its basic statute it functions through an Assembly (Asamblea) ; a Board of Directors (Junta Directiva) ; a General Secre- tariat (Secretaria General) ; and 13 Regional or State Councils (Consejos Seccionales).
The Assembly is composed of rep- resentatives of the Federal Executive
ELISABETH SHIRLEY ENOCHS is Chief of International Technical Missions (Point IV) in the office of the Commissioner for Social Security, Federal Security Agency. For a number of years she was on the staff of the Children's Bureau, during the last 10 years as Director of the Bureau's Division of International Cooperation.
Mrs. Enochs has been a delegate to vari- ous Pan American Child Congresses, in- cluding the Ninth Child Congress, which was held in Caracas, Venezuela. She has also represented the United States at several of the meetings of the Directing Council of the American International Institute for the Protection of Childhood.
In Venezuela, as in our own country, children are the nation's most important resource.
branch of the Government and of the Ministries of Interior, Defense, Pub- lic Works, Education, Health and So- cial Welfare, Labor, Justice, and the Government of the Federal District. In addition to issuing regulations and reports, as prescribed by the Chil- dren's Code, it serves as a consulta- tive body to the Council's Board of Directors.
The five-member Board carries the full executive and administrative re- sponsibility of the Council; the Board's resolutions and orders are carried out through the General Sec- retariat.
Designed to serve the "whole child," the Council is largely the achievement of a far-seeing group of experts in the fields of pediatrics, public health, education, law, and so- cial service. Its basic philosophy has been summed up by the President of the Board in the following terms: "... the goal of all programs of child care and welfare is to conserve the child in his own home, to strengthen family ties, to serve the whole child
42
THE CHILD VOL 17 NO. 3
there, in his natiu-al setting. The wel- fare of a people can be achieved only through the family . . . The home is the first line of defense against mis- fortune, against crime, against im- morality and social crises . . ."
Direct service to mothers and chil-" dren is offered through eight tech- nical divisions.
The Division of Prenatal and Ma- ternal Care sets standards and gives subsidies to maternity homes and postnatal centers founded by volun- tary women's organizations. It has also established a nutrition center for pi'egnant and nursing women and has under study a national plan for fam- ily allowances. The Council works in close cooperation with the Ministry of Health and Social Assistance, which operates maternal and child- health centers.
The Division of Infancy and Pre- school Children cares for children from birth to 7 years of age through day-care centers and kindergartens. The Council's 41 day-care centers now care for 1,555 children, while its 25 kindergartens, in the capital and the several States, have a capacity of 1,609. Subsidies are also given to a number of private agencies providing similar facihties.
Dependent and delinquent children, as well as those with mental or physi- cal handicaps, are cared for through a division called the Division of Mi- nors in Irregular Situations. This part of the Council's program is largely the work of a psychiatrist, who was formerly Minister of Edu- cation and was the first Secretary General of the Council, Dr. Rafael Vegas. The program is generally re- ferred to as the "Vegas Plan." A whole article might well be written about this Division; its boarding homes ; its observation and treatment homes ; its educational, scholarship, and apprenticeship programs — as well as about the plans for develop- ing an eflfective system of financial aid to families to prevent many of the problems dealt with by these in- stitutions. Through a technical ad- visory committee many types of pro- fessional skill are mobilized by the
NOVEMBER 1952
Council to sei*ve the needs of its wards, and special staff-development programs are being planned to im- prove the quality of care the children now receive.
The Social Service Division, with a staff of 58, has 27 offices through- out the country, including a few of- fices in States where as yet there is no regional or branch Council. The activities of the social workers are largely decentralized. In Caracas the social workers are assigned to work in the 14 maternal and child-health centers of the Ministry of Health and Social Assistance. The Division plans to extend this arrangement to other localities since it provides a basis for close and useful collaboration be- tween social workers and public- health nurses. The social workers do casework and groupwork, child plac- ing, and family counseling. They settle questions of parental authority and guardianship and refer certain problems to the Juridical Division.
As its name implies, the Juridical Division handles the Council's legis- lative matters. In addition to main- taining a legislative reference center it provides legal-consultation service, and through a staff of so-called "chil- dren's attorneys" it appears in court cases where the rights of minors are involved. In furtherance of its vari- ous programs this Division is now planning a series of "juridical semi- nars" for juvenile-court judges, chil- dren's attorneys, and Division staff.
The Division of Reports and Pub- lications and the Division of Statis-
tics have contributed greatly to mak- ing known throughout the country the problems of child welfare and the services of the Council. The Admin- istrative Division handles all details of purchasing, transportation, per- sonnel, budget, and fiscal work for a program which last year totaled more than $12,000,000. It is esti- mated that the Council's services reach four-fifths of the approxi- mately 2 million children under 18 years of age in Venezuela.
A Cuban social worker has recently published in the Revista de Servicio Social of Havana the following ac- count of her work in Venezuela :
"As a social worker J was part of a hard-working army on the staff of the Children's Council, carrying to the most remote and hidden hamlets of Venezeula the message of social justice and the material and spiritual benefits of the Council's work for children.
Social workers in short supply
"The social worker is an important member of the Council's staff, for it is she who studies at first hand each case referred to it and who deals di- rectly with the child and his family or, through her reports, advises di- rectors of agencies, doctors, attor- neys, and judges of juvenile courts. Although a large number of the so- cial workers graduated each year from the two schools of social work are employed by the Council, there are not enough to meet the needs. The Regional or State Councils send
Homes of families in Venezuela are often located in tiny hamlets hidden away in the moun- tains; and health and social workers are likely to find much difficulty in reaching the people.
girls on fellowships to Caracas for training in order to build up their own trained staffs in the hope of avoiding constant changes.
"From the beginning of my assign- ment, while I was in the capital, in the headquarters office, I was able to know and evaluate the great humane and social task of the agency. Cara- cas enjoys greater resources because of the collaboration given by the Min- istry of Health and Social Assistance through its maternal and child-health centers and through the pediatric dis- pensaries of the Municipal Govern- ment. There are more agencies in the capital, better facilities for fos- ter-home placements and for adop- tions. There are likewise greater eco- nomic resources.
"The second phase of my assign- ment was in the State of Bolivar. This State includes, in addition to the State capital, Ciudad Bolivar, on the banks of the Orinoco River, the whole of Venezuelan Guayana with its enormous reserves of iron, gold, and diamonds. Yet despite its min- eral wealth Bolivar is not one of Vene- zuela's richest States. It is inhabited by Indian tribes reached only by mis- sionaries and explorers. During our stay we found, among the hundreds of cases passing through our office, which we handled or visited pei-- sonally, a number related directly or indirectly to the Indians of those dis- tant jungles whom we could not visit but to whom the Council's work was not unknown. I remember the case of an old Indian woman who came in from her distant tribe with a blind son to ask the 'Tribunal of Children' to find another son, 15 years old, who had run away from the tribe. The blind son was interpreter for the old lady, who spoke only an Indian dia- lect. Having registered her request she went away satisfied that the 'Tri- bunal of Children' would find her boy. And a few days later, as a result of talegrams, press notices, and radio broadcasts, the young Indian lad was on a plans headed for Santa Elena de Uairen, the last outpost reached by the airlines in Indian territory.
"Our last assignment was Merida,
the university town in the West on a plateau in the Venezuelan Andes, where I established a Regional Coun- cil. The preliminary studies took me to every part of the State — to towns, villages, and tiny hamlets hidden in the mountains. I interviewed author- ities and neighbors, studying re- sources and needs. The opportunity thus offered me gave me a better un- derstanding of the scope of this work that the Venezuelan Children's Coun- cil is doing for its future citizens."
For advanced study
During each stage of its develop- ment the Children's Council has sought the cooperation of experts from the other American Republics.
The President of the Venezuelan Children's Council, Dr. E. Santos Mendoza, has been most active in promoting international exchange of knowledge and experience with simi- lar agencies in other countries. A few years ago, at Dr. Mendoza's request, Katharine F. Lenroot, then Chief of the Children's- Bureau, made an agreement with him, according to which the Children's Bureau would undertake to supervise trainees — pe- diatricians, nurses, social workers, nutritionists, and so forth — who were sent to the United States by the Venezuelan Council for advanced work. Some assistance already has been given to three such trainees.
Last year Dr. Mendoza asked the Bureau to recommend a specialist in social groupwork to be employed di- rectly by the Council to develop an in-service training program. The worker recommended by the Bureau accepted the position. And she has just returned from an 8-month as- signment in Venezuela during which she taught groupwork to the Coun- cil's social workers as part of its pro- gram of staff development.
The cooperation initiated with the visit of the Chief of the Children's Bureau to Venezuela's First National Child Welfare Conference in 1938 has ripened through the years and shows once more that interest in the welfare of childi'en is a strong element in pro- moting international friendship.
CITIZENSHIP
(Continued from page 41)
came evident that the school itself can be a civic laboratory that, with the help of community leaders, can broaden into the community, into the State, into the Nation, and into the world.
But, whether for youth or adult citizens, "On every liberty there is a price tag of responsibility," delegates agreed. Some of the responsibilities of the adult citizen, they pointed out, were :
To vote — regularly and intelli- gently, and in the primary as well as the general election.
To follow-up on voting by holding the elected officials responsible for their actions and conduct. At the same time, it is urgent that citizens aid actively in the development of a feeling of trust and confidence in the vast majority of loyal, honest, and ca- pable public servants.
To obey the duly enacted laws of the land even though some individual pieces of legislation may not coincide with our convictions.
To pay taxes with as good a grace as possible and to seek information about the disposition of tax money in order to hold elected officials respon- sible for the wise use of it.
To support our country in armed conflict.
To oppose the activities of subver- sive persons and organizations, with- out, however, subverting the liberties that are guaranteed us by the Con- stitution.
To put public interest ahead of private advancement.
To speak out, even at considerable cost to the individual, in support of the rights of others.
To define rights and responsibilities in terms meaningful to the individual and to develop a program of action for meeting the problems involved.
To join with others in "making the Constitution live" by insisting upon a constructive approach which em- phasizes the contributions that all in- dividuals and groups are capable of making toward better citizenship.
44
THE CHILD VOL. 17 NO. 3 \
SCHOOL LUNCH
' (Continued from page 40)
The good school kinch, adequately pubhcized to parents by both children and school officials, can be a potent iforce in improving home food prac- tices and in increasing nutrition knowledge among other members of the family.
Since the school lunch affords both health and education benefits, it is im- portant that it be available to all chil- dren attending school who wish to partake of it. If charges are made for the school lunch, a plan should be worked out so that no child is ex- cluded or is the object of discrimina- tion because of inability to pay the full price of the lunch. All receipts from school-lunch operations ought to be used to provide the best pos- sible lunches at the lowest possible price. In order that school lunches may be of maximum benefit to school children, community resources may need to be supplemented by outside financial aid for facilities, equipment, and upkeep, as well as for current operations.
In order to make the school lunch a school-wide educational project, it has to be administered by school officials and operated with the assistance of qualified workers, whether paid or volunteer. All individuals involved in a school-lunch program need to be adequately prepared for the respon- sibilities they carry. This statement applies with equal force to adminis- trators, supervisors, managers, workers, and teachers. School-lunch workers should be selected because of their aptitudes, should be given ade- quate training for the job, and should work under competent supervision.
3. The school lunch should be a com- munity-wide enterprise
Much of the success of a school- lunch program rests with the local community. It is the concern of par- ents and teachers, of the agencies re- sponsible for or interested in com- munity health and welfare in general, and of those with specific responsi-
NOVEMBER 1952
bility for the health and education of the child of school age.
Community planning involving par- ents and citizens' groups, as well as civic and school officials, is essential for full realization of the potenti- alities of school-lunch programs. These planners should direct their at- tention to such essentials for success- ful school lunches as: Adequate fin- ancing, facilities, and equipment; sound administration; competent di- rection by individuals aware of the food needs of children, as well as skilled in management and super- vision; and educational programs in both the school and the community.
Copies of this statement are avail- able from the Nutrition Programs Service, Bureau of Human Nutrition and Home Economics, U. S. Depart- ment of Agriculture, Washington 25, D. C.
IN THE NEWS
Elizabeth Healy Ross, psychiatric so- cial worker, took office October 1, 1952, in the newly created position of Deputy Chief of the Children's Bu- reau. As Deputy Chief, Mrs. Ross is working directly with Dr. Martha M. Eliot, Chief of the Children's Bureau, in directing the Bureau's programs of research in child life and adminis- tration of grants to the States for extending and improving maternal and child-health, crippled children's, and child-welfare services.
Before coming to the Children's Bureau, Mrs. Ross was for 6 years consultant to various Federal and District of Columbia agencies on de- velopment of psychiatric social ser- vices for children, for military per- sonnel, and for veterans.
Born in Fort Dodge, Iowa, Mrs. Ross was graduated from the Univer- sitv of Minnesota and from the Smith College School for Social Work.
For several years she worked in child-guidance clinics. Then, during the 30's, she was a member of the staff of the Bank Street College of Education, New York City, where she helped develop a program of educa- tion for nursery-school and elemen- tary-school teachers. This involved courses in child development and guidance. Following her work with the Bank Street College, Mrs. Ross
became admissions secretary and faculty member of the Pennsylvania School of Social Work, Philadelphia, Pa where she taught, among other things, "Approaches to Work with Children."
While in Philadelphia, the major focus of Mrs. Ross' work was in the field of emotional growth of children. She gave courses to nursery-school teachers and to vocational-education teachers. She also served the Charles- town Play House, Phoenixville, Pa., and the Philadelphia Home for In- fants.
During World War II, Mrs. Ross was Secretary of the War Service Office of the American Association ot Psvchiatric Social Workers, created with funds from the Rockefeller Foundation for the purpose of msur- ino- maximum use of psychiatric so- cial work personnel during the war period. She served as consultant in psychiatric social work to Dr. Wil- liam C. Menninger, Chief of Psychia- trv in the office of the Surgeon Gen- eral, Department of the Army, and has continued to advise on the mili- tary social-work program since the war.
Since 1946 Mrs. Ross has also served as consultant in the develop- ment of program, policies, and stand- ards of psvchiatric social work to several agencies— the Veterans Ad- ministration; the National Institute of Mental Health, of the Public Health Service; Walter Reed Army Hospital ; and the Child Welfare Divi- sion, Board of Public Welfare, Dis- trict of Columbia. She assisted m the preparation of the Fact Finding Re- port of the Midcentury White House Conference on Children and Youth. Elected a member of the executive committee of the National Confer- ence of Social Work in 1951, Mrs. Ross is a member also of the Ameri- can Association of Social Workers and of the American Association of Psychiatric Social Workers. She was formerly on the advisory board on health services to the Chairman of the American Red Cross. Mrs. Ross' writings have appeared in various professional magazines.
Dr Eliot and Mrs. Ross are as- sisted by Dr. Katherine Bain, the Bureau's principal consultant on health program, who continues to ad- vise particularly on matters of pro- gram development for the Bureau as a whole, and Neota Larson, whose special area of work is administrative policy and legislation.
Melvin Glasser has been appointed Special Assistant for State and Na- tional Organization Relations on the
45
Special Juvenile Delinquency Project sponsored by the Children's Bureau. He will bring to this Project the full benefit of his experience as Executive Director of the Midcentury White House Conference.
Community and child. How com- munities can improve life for children was one of the principal subjects dis- cussed by delegates from 30 nations at a 3-week seminar on Mental Health and Infant Development, which was held July 19 to August 10, 1952, at Bishop Otter College, Chichester, England.
The seminar was based on clinical studies of child development, made in France, the United Kingdom, and the United States of America.
The teaching faculty consisted of about 15 specialists from these three countries, and the delegates included doctors, psychologists, pediatricians, and social workers.
The seminar was sponsored by the World Federation for Mental Health, with the cooperation of UNESCO, the World Health Organization, the International Children's Centre in Paris, the United States National Ad- visory Mental Health Council, and the Grant Foundation of New York.
Young workers. According to Census estimates, in 1951 more than twice as many boys and girls under 18 were employed as were employed in 1940 Two-thirds of the 2V-> million em- ployed in 1951 were also attending school.
School enrollm. it. Data released July 21, 1952, by the Bureau of the Census show that, in October 1951, 99 percent of the children 7 to 13 years old in the United States were enrolled in school. (The age group 7-13 is included under compulsory- attendance laws in practically every State.) Of boys and girls 14 and 15 years of age, 94.8 percent were in school, but only 74.9 percent of those 16 and 17 years.
The high enrollment among chil- dren 7 to 13 years old— 18,000,000— is due primarily to the presence in the elementary grades of a large number of children born shortly be- fore World War II and during the war years, the report says. The num- ber of children in this age group en- rolled in October 1951 is 3,200,000 greater than the comparable number for October 1945.
Live births in the United States in 1951 soared above 3,800,000 for the second time in our history, and topped the 1950 birth total by more
than 200,000, according to prelimi- nary figures from the National Office of Vital Statistics, Public Health Ser- vice, Federal Security Agency.
Moreover, the 1951 total may be an all-time high for the United States.
The number of children born in 1951 was estimated at 3,833,000 as compared with the 3,818,000 born in 1947, the previous record year. Be- cause of the small difference between the two figures, it is necessary to wait for final data for 1951 before deter- mining whether 1951 is definitely the all-time high.
The annual birth rate for 1951, based on registered births alone, rose to 24.5 per thousand population, an increase of 4.3 percent over 1950.
A fall in the infant mortality rate, which dropped for the fifteenth straight year, also helped to swell the 1951 addition to the infant popula- tion. Infant deaths last year oc- curred at the rate of 28.8 per thou- sand live births, contrasted with a rate of 47.4 in 1940 and 64.8 in 1930.
MCH services (preliminary figures).
Under Federal-State maternal and child-health programs carried on un- der the Social Security Act, almost 395,000 babies under 1 year of age and 565,000 other children of pre- school age attended health clinics in the calendar year 1951. This repre- sents increases of 30 pei-cent and 35 percent respectively over the num- bers attending in 1950.
Physicians examined about 2,394,- 000 school children in 1951 under this program, an increase of nearly 8 per- cent over the 1950 figure.
About 189,000 women attended prenatal clinics in 1951, which was an increase of 8 percent over 1950 (175,000). There was only a slight increase in the number of expectant mothers who received public-health- nursing service (268,000 in 1951 and 258,000 in 1950) . There was a 13 per- cent increase in the number of women who received postpartum nursing service— nearly 279,000 in 1951. The number given a postpartum medical examination — nearly 53,000 — was nearly 12 percent below the number for the previous year.
DEADLINE EXTENDED TO OCTOBER 31
Owing to an unavoidable delay in sending out circularization cards to the official mailing list for The Child, the closing date for the return of the cards has been extended to Octo- ber 31.
FOffliirBOOKSHELF
SCHOOLS FOR THE VERY YOUNG.
By Heinrich H. Waechter and
Elizabeth Waechter. F. W. Dodge
Corporation, 119 West Fortieth
Street, New York 18, N. Y.
1951. 197 pp. $6.50.
This is the first book I have seen in which an architect and an educator join to give a comprehensive view of the physical and social needs of the preschool child in relation to physical equipment planned to meet these needs when he is in a nursery school.
The authors review the history of preschool education and give a picture of life in the nursery school of today. They believe that if an architect is to plan and design schools for young children, he should visit schools "to observe and experience for himself the great difference between the building as an inorganic structure of more or less formal beauty and the building which has come to life by its use."
Recognizing that no standardized methods of construction have been developed for these schools, the au- thors consider this fortunate, for the whole conception of preschool educa- tion is still in a developmental stage. As for their idea of how to construct a building for preschool education, they say that it is logical to draw on experience with construction of the two types of buildings most nearly related to it, namely, the home and the school.
The book covers such subjects as problems of layout and design ; the relation of the nursery school to its neighborhood and community; out- door equipment and playground sur- face ; and the technological problems of lighting and ventilation, color, me- chanical equipment, and furnishings. There are many photographs and floor plans, as well as a bibliography.
This book is "must" reading for all who are concerned with planning new buildings (or remodeling old ones) to give group care to young children.
I. Evelyn Smith
PRACTICES IN HOMEMAKER SERVICE; as reported by agen- cies providing the service on June 30, 1949. Federal Security A- gency, Social Security Adminis- tration, Children's Bureau, Wash- ington, 1951. Processed. 19 pp. Single copies free. This study, made by the National
Committee on Homemaker Service,
46
THE CHILD VOL. 17 NO. 3
supplies social agencies with a set 3f facts on actual practices in home- naker service. It is a "working re- port," without comment or conclu- sions.
The report tells how 63 social igencies were administering their honiemaker services in mid-1949. Fifty-six of the agencies were pri- v'ately supported, 6 were publicly supported, and 1 was operated un- der combined private and public auspices. Thirty-two of those pri- i'ately supported were family serv- ice societies, 19 were family and children's services combined into Dne agency, and 12 were children's agencies.
The agencies reported on five points: (1) On how the families 3ame to them for service and how the original arrangement was made ; (2) on their homemaker staff (num- ber, work week, wages, training, 3tc.) ; and (3) on the professional staff (time the supervisor gives to the service, her education and ex- perience, her duties, the line of au- ;hority, and the range of salaries) ; (4) on homemaker-service commit- ;ees; and (5) on keeping the boards -){ directors informed about the serv- ce and letting the public know what such a service can do for families.
PRACTICAL GUIDE FOR FOOD SERVICE IN NURSERY SCHOOLS AND OTHER GROUP CARE CENTERS. By Edna Mohr. Elizabeth McCormick Memorial Fund, 848 North Dearborn Street, Chicago 10, 111. 1951. 34 pp. 50 cents.
What types of foods should all voung children have every day? How many meals should be served n order to meet the child's daily
food needs? What variation should there be in the amount and type of food served at different times dur- ing the day? How can an effec- tive working relationship be main- tained between the home and school in order to be certain that the child's food needs are met? How can the efforts of the home and school be unified in helping the child learn to like the foods he needs?
This guide offers concise, practi- cal answers to these questions, based on the author's breadth of experi- ence as a nutritionist and nursery- school consultant on the staff of the Elizabeth McCormick Memorial Fund.
The appendix contains a limited number of favoi-ite recipes and is followed bv a brief and pertinent bibliosrraphy.
Although this material is designed narticularlv to help untrained and inexperienced staff, it should prove a helpful handbook for all con- renipd with plannins- snd servine food in group-care centers.
Catherine M. Leamy
YOUR NEIGHBOR'S HEALTH IS YOUR BUSINESS. By Albert Q. Maisel. Public Affairs Pamphlet No. 180. Public Affairs Committee, Inc.. 22 East Thirtv-eighth Street. New York 16, N. Y. 1952. 31 pp. 25 cents.
Graphic examples are given in this pamphlet of some of the things a health department does.
The booklet makes specific sugges- tions on how a citizen can find out how adequate the public health serv- ices are in his own community and how to work for improvements that mav be needed.
w
;A L E N D A R
Superintendent of Documents Government Printing Office Washington 25, D. C.
Please send me THE CHILD for 1 year. I am enclosing $1.25 (check or money order) .
Name ..„ Address-
On every order of 100 copies or more, sent to one address, there is a discount of 25 percent.
Nov. 6. Play Schools Association. Annual meeting. New York, N. Y.
Nov. 7-11. National Conference of Christians and Jews. Annual meet- ing. Washington, D. C.
Nov. 9-15. American Education Week. Thirty-second annual ob- servance. Information from Na- tional Education Association, 1201 Sixteenth Street, N. W., Washing- ton 6, D. C.
Nov. 12-14. National Association of Intergroup Relations 0 ffi c i a 1 s. Sixth annual meeting. Washing- ton. D. C.
Nov. 12-14. American School Food Service Association. Annual meet- ing. Los Angeles, Calif.
Nov. 12-15. National Association for Nursery Education. National con- ference. Minneapolis, Minn.
Nov. 12-Dec. 10. Unite d Nations Educational, Scientific, and Cul- tural Organization (UNESCO) . Seventh session of the General Con- ference. Paris, France.
Nov. 13-14. National Social Welfare Assembly. Seventh annual meet- ing. New York, N. Y.
Nov. 13-15. Family Service Associa- % tion of America. Biennial meeting. Buffalo, N. Y.
Nov. 16-22. Book Week. Thirty- fourth annual celebration. Infor- mation from Children's Book Coun- cil, 50 West Fifty-third Street, New York 19, N. Y.
Nov. 17-19. National Association for Mental Health. Annual meeting. New York, N. Y.
Nov. 20-22. American Speech and Hearing Association. Twenty- eighth annual meeting. Detroit, Mich.
Illustrations:
Cover and page 35, Philip Bonn for Chil- dren's Bureau.
Page 36, Archie Hardy for Children's Bureau.
Page 37. National Film Board, Canada.
Page 38, R. A. Hayes for Nursery Training School of Boston.
Page 40, Mathews for Production and Mar- keting Administration, U. S. Department of Agriculture.
lOVEMBER 1952
47
V***"^***'**'^ *;*» ,^J ^■' V
VOL. 17 NO. 3 NOVEMBER 1952
In This Issue
Page
When a Child Must Go to the Hospital 34
Ruth Winkley
Instead of "Blood-and-Thvmder" Radio 37
Naiicy Harper
Delinquency Project Moves Ahead 39
Children and the School-lunch Program 40
Conference Works Toward Better Citizenship 11
Liicile Ellison
For Child Welfare in Venezuela 42
Elisabeth Shirley Enochs
Published 10 times a year by the Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
FEDERAL SECURITY AGENCY Oscar R. Ewing, Administrator
SOCIAL SECURITY ADMINISTRATION Arthur J. Altmeyer, Commissioner
CHILDREN'S BUREAU Martha M. Eliot, M.D., Chief
Publication of THE CHILD, monthly bulletin, has been authorized by the Bureau of the Budget, September 19, 1950, to meet the needs of agencies working with or for children. The Children's Bureau does not necessarily assume responsibility for statements or opinions of contributors not connected with the Bureau.
The subscription price of THE CHILD is S1.25 a year. On all orders of 100 or more sent to one address there is a discount of 25 percent. Single copies 15 cents each. Send your remittance to the Superintendent of Documents, Government Printing Office, Washington 25, D. C.
Foreign postage — 25 cents additional — must be paid on all subscriptions to countries in the Eastern Hemisphere and those, sent to Argentina and Brazil. Domestic postage applies to all other subscriptions.
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U. S. GOVERNMENT PRINTING OFFICE: I9S1--9I2044
H
CHILD
DECEMBER 1952
WHAT DO WE WANT FOR OUR DELINQUENT CHILDREN?
WHEN A CHILD gets in trouble with the law, unless there are services available in the com- munity to help that child find his way back to normal and healthy develop- ment, he is apt to take just the op- posite road and end up in a career of crime. More than half of our adult criminals were juvenile delinquents.
Then, you may ask, why don't we have the community services to pre- vent the development of these be- havior problems and to keep delin- quent children from going from bad to worse?
One of the principal reasons why we don't have adequate services for the care and treatment of delinquent children is that there has not been a sufficient understanding on the part of the public of why they are neces- sary, what kind of services they should be, and what it means to a child to be treated as if he were a criminal.
Becaus. -k of public under-
standing, as been lack of pub-
lic suppoi " e quality and quan-
tity of sei lese children need.
A good as been written in
the efforl 1 the public about
these ser lut sometimes this
material 1 i complex and diffi-
cult to vi£ Many of us have to
see thinp-a wp can hp.lipvp. them
or ;
C sis agr
spect to the total problem of how ju- venile delinquents are made will not be overcome by talk of prevention. Sometimes the end result of a disease or social ill must be studied and the costs to society dramatized before firm steps to prevention can be taken with public support. Then, too, chil- dren who are sick cannot be left to suffer.
If we were to raise the quality of practices in our handling of juvenile delinquents up to the level of the best jobs being done here and there over the country, I am convinced we would give many delinquent boys and girls a much greater chance than they now have to find a satisfying and useful role in society.
There is a practical program of action we can take to improve our treatment of juvenile delinquents. It calls, first, for over-all planning by States and communities to explore conditions, develop a blueprint of ob- jectives, and work particularly on:
1. Aiding the police in developing special services for children ;
2. Getting juveniles out of jail and providing proper detention facilities ;
3. Providing the courts with ade- qi led probation officers ;
g training schools to get qi sonnel and additional fa-
need.
\\ ahead in these directions
~ single public- agency in
ry 9^1^' with clear responsibility
for insuring teamwork amongst the various services for delinquent chil- dren and sound relationships between these services and child-welfare serv- ices for all children. Each State will want to work out its own kind of State-wide organization. Training of personnel, too, must be stepped up, and there must be more adequate fin- ancing of public services for delin- quent children.
Through its newly organized Juve- nile Delinquency Branch and the Spe- cial Juvenile Delinquency Project which is working closely with the Bureau, citizens and agencies will get increased help so they can move ahead on programs of improvement.
Every reader of this issue of The Child can help greatly in this effort, even if it is no more than by spread- ing "the news." Will you, as a first step, get this issue to the attention of 10 people in your community? Per- haps you can make this issue the focus of discussion at a coming meet- ing of one of the organizations in which you are active.
The Children's Bureau wants to keep in touch with every group thai joins in this campaign. So when youi organization gets going, won't yoi drop us a Hne?
Martha M. Eliot, M.D., Chief, Children's Bureau^
(JAN 6 - 1863
THE CHILD VOL. 17 NO. 4
EYEWITNESSES TO THE TOLL OF DELINQUENCY
A juvenile-court judge, the director of a detention home, a police chief, the superintendent of a training school — four men whose everyday concern is the prevention or treatment of juvenile delinquency — tell about their exper- iences in this v/ork and of the problems they face
JUVENILE COURT
LEO B. BLESSING
Judge of the Juvenile Court, Parish of Orleans, I\ew Orleans, La.
IF ENOUGH SPACE were avail- able, I could list many problems and many unmet needs of our ju- venile court in New Orleans, and they would undoubtedly be those of every juvenile court in the Nation. I know of none completely satisfied with its situation.
J Some of our needs are so pressing, the function of the court as an agency for good in the community is vitally affected.
For example, at the present time we are unable to plan intelligently for the detention of children who are awaiting the court's decision as to what should be done with them. This period of detention can be a new and shaking experience for a child. We should try to profit from every mo- ment of it in our treatment program.
But our present detention-care ar- rangement is makeshift and unsatis- factoiy. We are using quarters in other institutions, to the detriment of the care of their regular inmates, and sometimes we are forced to detain obstreperous juveniles in the parish jail.
The absence of a treatment center for disturbed juveniles is sorely and frequently felt. Yet there is not even a faint stirring of recognition of this need by the community.
Our case loads have grown con- siderably in recent times. This is
DECEMBER 1952
more the result of increased service potential than of increased delin- quency. We are being called on more than ever before by other social agencies to help solve their problems, and parents are now voluntarily com- ing to us with their children who chronically misbehave. We welcome this confidence, but it often taxes our court facilities beyond their capacity. Another problem is the legal segre- gation of races in our State. This
makes it necessary for us to supply separate accommodations and facili- ties for Negro and white delinquents. There is at present only one State institution for white boys and girls, only one State institution for Negro boys, and no public institution of any kind for the care of delinquent Negro girls.
Community understanding most important
However, the greatest problem fac- ing the New Orleans Juvenile Court and, for that matter, every juvenile court, I believe, is failure to receive complete and wholehearted accept- ance by the community it is intended to serve. It may seem strange and perhaps even absurd that a com- munity should have to be urged to ac- cept one of its own creatures — a crea-
The informal procedure used in this juvenile court helps to make the young delinquent feel relaxed and makes it easier for the judge to work effectively with him. The judge relies heavily on the skilled services of the trained probation officer who is attached to his court.
ture submissive to its will and com- pletely at its mercy. But too often juvenile courts are simply poor little Cinderellas without the protection of a fairy godmother.
As it exists in the laws of most States, the juvenile court is a social agency within the framework of the law. It is the hybrid result of tem- pering the law's sternness with mercy and understanding.
In the chain of events that makes up the life of a dehnquent child, be- ing brought before the juvenile court is but a single link. However, it is an important link.
I know parents who search about for the best possible schools and teachers for their children. They buy the best clothes and most wholesome food obtainable. When sickness oc- curs, they insist on only the best pediatrician to attend their children. But they pay little attention to their juvenile court. At every available op- portunity I ask these parents : "Why do you not insist on the maintenance of a good juvenile court for children for whom you want the best of every other kind of care? Why, indeed, this neglect of the juvenile court?"
A great deterrent to community understanding and acceptance of the juvenile court is the fact that the more active and prosperous elements in the population have little contact with the court. The majority of our children come from a level of society that has no voice and no weight in community affairs. Many of their families are so entirely engaged in eking out an existence that they can- not take time to champion the cause of community agencies even when such agencies affect the futures of their own children.
The vocal group in community af- fairs usually take little interest in the court because they do not expect to use its facilities.
Fortunately, not all children come to the juvenile court, but any child within the juvenile-court age limit might get into trouble with the law so long as he is forced to live in the artificial, accelerated economic en- vironment of our typical urban com-
munities. And every child remains a potential victim of delinquency so long as our social services are inade- quate to check the delinquency that exists in a community.
Perhaps the best way to create a sense of community responsibility for these services is to help the citizens of our communities understand the importance of juvenile delinquency: how it springs from basic unhealthy conditions in the life of a community, and how, unless checked, it can spread.
Not many people would be willing to gamble their whole life earnings on the flip of a card, but many com- munities are taking just as great a chance when they permit the whole future lives of many of their children to be decided by a poorly trained, in- adequately staffed, and weakly led juvenile court.
If we can arouse the individual members of a community to an un- derstanding of their responsibilities for the proper development of their juvenile court, we shall then be guar- anteed an adequate court and all the necessary outside facilities for carry- ing out a successful treatment plan.
Expanded New Orleans needs expanded services
In New Orleans, where the popula- tion had been more or less static at the half-million mark for many years (due in part to expansion-limiting water boundaries and in part to a lack of aggressive planning), the ju- venile court was for a long time shamefully neglected by the com-
munity and was let stagnate in hope- lessness and frustration. But the fight we have made for our court dur- ing the past 4 years has brought us recognition and is beginning to re- turn dividends.
We have won an increased appro- priation, a trained probation staff (though it is still too small), and con- struction of physical quarters that have added much to effective work and judicial dignity and have been helpful in gaining additional com- ! munity recognition and support.
But the fight is not finished. It is never-ending, for a good juvenile court must be progressive, flexible in program, and far-seeing. Already we are planning for our future needs — a program that will "sell" the com- ' munity on the value of the juvenile court and the need to protect our chil- dren. With reclaimed swamplands now available for industrial develop- ment and because of the courageous leadership of our mayor. New Orleans has expanded considerably within a few years' time, but our court has failed to expand in keeping with this increase in population, interest, and problems. We are already alarmingly , understaffed. The court's services are being taxed beyond their capacity, and we should be expanding and plan- ning for additional community serv- ice. This is our most immediate prob- lem, and we shall continue with cour- age and persistence to seek complete community acceptance as a major step toward its solution.
DETENTION
STEPHAN H. KNEISEL
Executive Director of the Essex County Parental School, I\ewark, N. J.
THE COMMENT I've been hear- ing for 25 years, that "Every- body talks about juvenile delin- quency, but nobody does anything about it," does have some truth in it. I believe the truth of the statement arises largely from the fact that this social ill has not been given the same
amount of attention and focus that has been given such hazards to chil- dren as infantile paralysis, tubercu- losis, and various physical handicaps. It is therefore encouraging to have a special juvenile-delinquency project of Nation-wide scope.
I work in a home that provides tem-
52
THE CHILD VOL. 17 NO. 4
VPSI>HDRtHHI<N flbni
■iUrL'4i4S.'
In some pending kind of
communities delinquents who require temporary detention, court hearing, are held in jail — often with criminals. This detention care offers nothing in the way of rehabilitation.
Detention can be a constructive experience. In this home young de- linquents follow a varied program. They are offered individual coun- seling, and their educational and recreational needs are taken care of.
porary detention for delinquent cliil- dren. This is a highly specialized .child-care service, little known and less understood by the community, and only recently emerging from a jail philosophy to that of social treat- ment of the emotionally ill offender. My primary concern in this article will be to comment on the problems of temporary detention, but I should like to point out that these observations will take into account other prob- lems in this field that I have met with during 25 years' experience working with children in trouble. [Mr. Kneisel has been a school teacher, a parole of- ficer, a social worker in a court psy- chiatric clinic, an administrator of day-care and nursery-school pro- grams, the director of a council of so- cial agencies, and during the past 8 years the administrator of juvenile- detention facilities in three areas of two States. — ED.]
Consistent with the recent reports on national statistics, the rate of com- mitments to our little detention fa- cihty in 1951 showed a 20-percent in- crease. If our experience for the first 6 months of this year continues, 1952 will show a substantial increase in de-
DECEMBER 1952
linquency over the previous year. In fact, during the month of May we were at an all-time high in the rate of daily admissions, exceeded only by the first day of June, when 18 chil- dren were admitted in one day. The impact of an additional 18 children in a home that is meant to accommodate 50 can well be imagined, particularly when the rate of intake for the previ- ous week had been almost as high. We were sending our overflow to the adult house of detention. We simply did not have the bed space.
Architect's plans for a more ade- quate juvenile-detention facility — to accommodate 80 children — are pres- ently before county officials. We hope for final approval before long. But if the rate of intake continues to in- crease, we may find that at peak peri- ods we'll have to continue to use the adult facilities.
We get children who shculd not be heie
We in children's work have long- been aware of the trauma involved in separating a child from his home for foster-home placement. Much time is therefore devoted to preparing the child for the separation and place-
ment. And we recognize and accept that, despite our best efforts, there will still be deep disturbance. Yet, to my knowledge, throughout the years there has been little awareness of our concern for the deep trauma that results from forced separation and placement in a detention facility, an experience that sometimes drives children to emotional outbursts bord- ering on the psychotic, or even to at- tempts at suicide. The community and its agencies have not yet begun to understand fully the injustices ignorantly committed against chil- dren in this way.
For this reason I urge that deten- tion be used only when it has been determined by competent authority that no other resource exists in the community to provide temporary care for the child and that it is in the best interest of the child and of the com- munity for him to be detained. The role of the detention facility should be limited to the detention and care of children who are too unstable and ill emotionally to be permitted to remain at large in the community. It should be the first step in an expeditious and integrated treatment process.
53
children in trouble with the law — where they come from and where they go
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The detention facility should cease to be a juvenile jail. Too often it functions as the "back room" of the police station ; or as the temporary "dumping ground" for agencies too understaffed to follow through in planning for the return of a child to his own home or to a foster home; or as the agent to serve the personal vin- dictiveness and animosity of a par- ticular official toward a particular child.
Detention care should be temporary
Despite our best efforts some chil- dren are held in detention far too long. I make this observation without prejudice to my present facility, for it pertains as well to institutions I pre- viously served, and, in fact, it consti- tutes one of the gravest concerns of most administrators of temporary de- tention facilities. Along with the re- cent inci'eased rate of placement in my present facility, the number of days of care would have increased correspondingly but for the consist- ent effort on the part of the juvenile court and other local agencies to sup- port the intent of temporary deten-
tion by keeping the length of stay at a minimum. Consequently, although intake went up, the average length of stay dropped from 11 days to 10.
It is understood that the court should know something about a child before making a final disposition. The information required may vary from a social study to the result of psy- chiatric observation and diagnosis. However, although we have come to accept the need for knowing some- thing of the child, we have not yet begun to meet the need to do it ex- peditiously, if the child in detention is to be constructively served.
Fevv communities are equipped to undertake such studies expeditiously, and weeks can run into months be- fore studies are completed and a court disposition is made. Meanwhile the child in detention lives in a purga- tory of anxiety, despite the best ef- forts of skilled workers and the best of physical facilities.
As with my first institution, my present institution is in a community whose child-serving resources are probably at least equal to those of most communities, yet both com-
munities lack a psychiatric hospital to which emotionally disturbed chil- dren may be referred on an immedi- ate and emergency basis for study and observation. One institution with which I once worked had the advan- tage of the services of a children's pa- vilion in a psychiatric hospital. I had forgotten how desperately such a re- source is needed until I came to my present institution and found that no such service existed.
Treatment resources vitally important
Once a diagnosis has been made and a treatment plan determined, the child should be moved to the treat- ment facility promptly. There can be no justification for continuing a child in temporary detention for weeks and months once a plan has been made.
The result of study may indicate that the kind of service needed by a child is that provided by a foster home. In court the child may be told that he will be placed in such a home, rather than being sent to an institu- tion. The immediate reaction of the child is apt to be joy and new trust in the sincerity of the adult world.
54
THE CHILD VOL. 17 NO. 4'
But as week follows dreary week and no foster home is forthcoming, the child's mood turns to bitterness and defiance. If a foster home is finally located, is it any wonder that the child no longer responds? Often the home is not found and, after weeks of waiting, the child is simply sent to the State school.
If a foster home is not to be used, the study may indicate that intensive psychiatric treatment is needed — either in an institution or in the com- munity. Again the question is: Where can such service be found? Treatment institutions for older chil- dren are so rare that even where they exist they constitute demonstration projects rather than community re- sources.
The present dearth of treatment facilities in all communities too often results in ultimate commitment to that catch-all, the State school, which most often is not staffed to give psy- chiatric treatment. If State schools are to continue to be the major re- source for the long-term detention of children with serious character and behavior disorders, steps must be taken to make it possible for these in- stitutions to offer the treatment and care necessary for the children com- mitted to their care.
I know of no community — city.
county. State — that is providing the varied and integrated services neces- sary for the differential treatment of the various types of behavior we lump under the head of "juvenile delin- quency." This is a blanket term with- out much meaning: — much like the word "sickness." We have come to understand that though infantile pa- ralysis is a sickness, it is different from tuberculosis both in symptoms and in treatment. And we accept the fact that although infantile paralysis, tuberculosis, and other diseases are all "sicknesses," each has to be
treated differently, and that treat- ment is difficult and expensive. But we seem not to have accepted the same inevitable conclusion for juve- nile delinquency.
The primary answer to the problem of the prevention and proper treat- ment of delinquent behavior is, I feel, the gaining of an enlightened and en- thusiastic public understanding and support of the kinds of programs and services that are so vitally needed by those children who, because of their behavior, are termed juvenile delin- quents.
POLICE
L. D. MORRISON
Chief of Police, Houston, Tex.
THE RESPONSIBILITY of the Police Department to help pre- vent juvenile dehnquency and crime flows naturally from its funda- mental obligation to protect the peo- ple and property of the entire com- munity.
Police administrators have recog- nized their grave responsibility, and, as a result, many of them have estab- lished a special unit or division with-
in their departments to meet the needs of those children in the com- munity who come to their attention because of misbehavior.
Here in Houston we estabhshed such a division many years ago. It is called the Crime Prevention Division. Through this division we attempt to carry out our responsibility for delin- quency control in a growing metropo- lis.
I In your community, when a child is picked up by a policeman for The juvenile-aid policeman who is taking this delinquent boy to a de- I misbehavior, is he "handled just as though he were an adult criminal? tent ion home has been trained to work constructively with children.
A prison-like atmosphere in an institution maizes it hard for the staff to win the boys' cooperation. They are apt to feel like criminals.
A pleasant and homelike air about a training school helps the boys to feel that they are there to be rehabilitated rather than punished.
It is hardly necessary to say how valuable such a division is. Children are the community's most precious asset, and it is worth our every effort to help prevent future criminal ca- reers.
Police officers must always be aware of the fact that a young per- son's entire future may depend upon his first contact with law-enforcing officers. If a child is treated firmly, but with kindness and understanding, much can be accomplished toward making a good future citizen out of a potential threat to society.
Advances made with difficulty
We are vitally conscious of our fail- ings and of our difficulties. Dealing with children has made us feel a spe- cial need for perfectionism, and we make an all-out endeavor in our work with them.
We make every effort, therefore, to select carefully the personnel who staff our Crime Prevention Division. In the not-too-dim past, assignment to the juvenile division was literally banishment to isolation. The most inept officers were to be found in most police juvenile agencies, work- ing half-heartedly and without en- thusiasm.
Today, because of the influx of young, well-trained, and energetic of- ficers into the police field, the picture is more encouraging. No longer is as- signment to the Crime Prevention Di- vision considered a casting away of the officers, but is a choice and favor- able experience.
We have been most fortunate in having what we consider the most modern police administration build- ing in the South. A generous citi- zenry has spared no expense in build- ing and equipping a modern workshop for police activities. Consequently we have been able to provide more than adequate facilities to house a growing Crime Prevention Division. Occupying a complete wing, the Di- vision is able to carry out its function in almost total separation from the adult divisions. This healthful atmos- phere affords us a greater oppor- tunity to remove the damaging stig- ma of police procedure from the child's experience in the police build- ing.
It is imperative that we work in close harmony with the many public and private agencies that are con- cerned with the welfare of children. We want community agencies to feel
free to use juvenile-police services. The juvenile-aid officer must, to dis- charge his duties properly, refer many children to these agencies. Un- less they understand our function as a discovery and referral agency, and unless we know about their facilities, the efforts of both would be for nought. For that reason, we are in- vited to participate in the round-table planning of the Council of Social Agencies and of the Community Council.
Some children, of course, cannot be referred by police officers to com- munity agencies, but must be taken to the juvenile court. Naturally the Crime Prevention Division officers give wholehearted support to efforts to improve the official public services for adjudged delinquents.
In reviewing our Texas procedure we learned that about one-half of our boys and girls who are adjudged de- linquent are, in later life, committed to adult prisons. This indictment of our procedure led to the creation of the Texas Youth Development Coun- cil, a new and revolutionary scheme, which promises to be one of the Na-i tion's most workable plans for reha- bilitating delinquent children.
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THE CHILD VOL. 17 NO. 4
Narcotics and wild drivers
Much concern has been exhibited in our community in recent times over the use of narcotics by our teen- agers. Certainly a southern city such as ours — a focal point for narcotic traffic northward — might be a most fertile ground for inducing youth to become addicted. But our experience indicates that the extent of this prob- lem has been greatly exaggerated. Records reveal that few of our chil- dren of school age have been dealt with for contact with narcotics. In the few cases in which this has hap- pened, the boy or girl was one who had been involved in many other de- linquent acts, and contact with nar- cotics was only one facet in the de- linquency pattern. We have found no cases where a child who was not al- ready delinquent has been introduced to the use of narcotics.
Larger cities in Texas have found juvenile traffic violation to be some- thing of a problem. The machine age presents juvenile law-enforcement , agencies with one type of offense for
which a satisfactory disposition re- mains to be found.
At present, a statute is available — • though its worth is questioned by many — for Texas officers seeking an- swers to the juvenile traffic problem. This statute provides that juvenile traffic offenders found guilty of driv- ing intoxicated, recklessly, or above the maximum speed limit are subject to penalties similar to those that may be imposed on adults for the same of- fenses. The suspended sentence un- der this statute, used most widely in rural counties, has been found effect- ive.
We still have a long way to go. But our experience so far has convinced us that the police must function as a working cog in the community ef- fort to control delinquency. Care must be exercised to select proper personnel, and great attention must be given to community conditions that might lead to delinquency.
With a young police department, such as ours, much can be accom- plished toward effective crime pre- vention.
TRAINING SCHOOL
LAWSON J. VENEY
Superintendent of Boys' Village of Maryland, Cheltenham, Md.
BOYS' VILLAGE of Maryland, an 80-year-old institution, is in many respects a typical training school. We have had our due proportion of failure and success. Some of the youths who were once here have since become involved in additional delin- quencies— and have made headlines. But it is difficult to fold stories about our successes. Although many juve- nile courts and other agencies fur- nishing aftercare service for us do re- port that we have been successful in our planning for disturbed children, this information does not make "good copy" and receives little of the atten- tion given our failures.
The Village was not founded yes- terday; it has to live with its past. Local newspaper morgues are full of stories about its past brutality to- ward children. The fact that bru- tality was practiced cannot be denied. Many training schools have dungeon relics. Our old records show that, as punishment for running away or fighting, young boys were confined in these dungeons for as long as 30 days, with a restricted diet and after being lashed. But these methods of control have not been used at Boys' Village for many years.
Our progress on other fronts has been somewhat slower. Not too long
ago we had as few as 30 employees to control 300 or more boys. As re- cently as the early 1940's college graduates on the staff were earning as little as $50 a month, with other personnel many times receiving less, for long hours of work. Today we can talk of "treatment" and "train- ing," but we must remember that our advances have been made by a slow and tortuous process. It has been through the errors and sacrifices of our forerunners that we have reached our present "state of grace."
In some respects the reputation handed down to us from the past con- tinues to hinder our work today. Each month we receive children whose older brothers, cousins, or fathers even were once institutionalized here. The stories that they have heard from these relatives have definitely made these children afraid of the in- stitution. Sometimes it takes months for us to succeed in overcoming their fears. Meanwhile, they have related the Village's past history to others.
Background of deprivation
A great deal of water has passed over the dam of our boys' lives before they come to us. Chances are they either were born out of wedlock or cannot remember a real father re- siding in their homes. Their mothers frequently were at the doll-playing age when they became pregnant. At present we have one 14-j'ear-old youth whose mother is but 25 years old. Another of our youths is the re- sult of a young girl's being raped at the age of 14. At 15 she died from tuberculosis, and this boy was hos- pitalized 5 years for the same disease before he came to us as physically cured.
Our "average youth" is about 15 years old, with a mother in her early 30's. The child was reared usually by a grandmother or by some other elderly relative who neither under- stood nor wanted him. Often he has lived in a series of foster homes, placed there because of family neg- lect. In a majority of instances his family has lived in a well-known slum area, in a marginal dwelling, and has received public relief grants.
DECEMBER 1952
57
Record after record shows that his schoohng did not start until after his seventh year. Even then he was out of school as often as he attended, at first because of lack of shoes, or too great distance from home, or some such reason ; later because remaining away from class became the easiest way to meet his failure to achieve.
The pattern after that is often the same. Roaming the streets is no fun without money to spend, and begging for pennies not too successful after a child passes the "Uttle" stage. As one boy told me: "As long as I was small and cute, people gave me money. After that stopped I began shoplift- ing."
Delinquents jre early truants
On a recent visit to the Village by a group of public-school administrators from a city that sends us 65 percent of our students, these school officials expressed their amazement at the number of boys they could call by name. They told stories of how ag- gressive some of these children were toward their teachers — even to the extent of fighting them. Many boys were pointed out as gang leaders, who forced smaller and weaker children to give them money. Others were said to have maliciously destroyed school property.
These public-school administrators all agreed on one point in particular, namely, that the children here whom they knew had all been persistent truants from school. During the past few years, as I have talked with in- stitutional officials in the United States and from foreign countries, this basic fact has been repeated many times: The children sent to training schools have been well- known truants who disliked and re- fused to attend school classes. One principal said: "Those of your chil- dren known to me were spotted years ago by teachers who could easily have predicted their commitment here."
The typical Boys' Village youth has an I. Q. in the 80's. After a series of school failures, usually because of poor attendance, he may have reached the sixth grade at the time of his
commitment. The results of the edu- cational and psychological tests given by the Village personnel show that he is 4 to 5 years behind in his school work. Very frequently he is a non- reader and is unable to do classroom work in a level higher than the fourth grade.
After they are released, 50 percent of our youths 16 years or older never return to school. Why should they? As they ask, "Who wants to sit in classes with junior high kids and not understand what they are doing?" If they were placed at the level where they should be, they would be "twice as large" as the other children in the class.
Some people call these children "misfits." Actually, they are children for whom society has failed to plan adequately. Thrust out into a com- petitive society that expects a dollar's work for a dollar's pay, they again find it difficult to achieve their bal- ance. Even when there are jobs avail- able for teen-agers, the competition from children who are products of in- tact homes is too great.
Recently I interviewed one of our boys, a 16-year-old who had run through four jobs in 6 months' time. His story was typical of many I have heard :
"There is no one home to get me up .... My mother never gives me any breakfast .... I didn't have lunch money for 8 days. When I walked home there was nothing to eat, and the boss fired me for taking too much time off for lunch."
This youngster had tried to walk to and from home for lunch — a total distance of 6 miles — in one hour's time!
One 16-year-old boy who was with us for 3 years returned to visit us last week in a stolen car. We learned that he could not find a job and his mother was tired of feeding him. She had told him to move in around the corner with a 17-year-old girl friend who worked.
Another recently released 16-year- old who had made a very successful adjustment here, begged the courts to let him return. In making room
for him at home, his mother had forced her boy friend to move out. However, she only accepted the boy as a "duty," and constantly irritated him by relating how much money her friend had given her. It is little wonder that the boy became involved in further trouble within 3 months of his release from training school.
Careful planning needed
Training-school employees have a tremendous responsibility. They re- ceive for treatment children who are usually unwanted and often unloved. Within a short span of time — the average length of stay at Boys' Vil- lage is 11 months — and assuming that there has been proper diagnosis and a good treatment plan, the training- school personnel must gain accept- ance of children who have learned to distrust adults.
Institutions can be havens of ref- uge for those children who need planned group-living experience. The smaller and less complicated the school, the easier it is for every em- ' ployee to know the total child. And the better the State classification pro- cedure, the less often will feeble- minded children be found housed with aggressive delinquents, and sex de- viants with healthy youngsters who are just beginning to ask questions about life.
There are answers to the many j problems involved in planning for in- stitutionalized children, though they may not be easy to find. Citizens must be alerted and officials and legis- lators intelligently "sold" on the need for services. One man or woman in each State can do this. But he will need the humility and tenacity of pur- pose of a Ghandi, the firmness of St. Peter, the wisdom of Solomon. In a sense, citizens who seek to give chil- dren the chance for a fuller and hap- pier life must be dedicated in their mission. They must believe in the democratic way of life. And they must recognize our children as America's richest heritage.
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THE CHILD VOL. 17 NO. 4
FOCUS ON DELINQUENCY
BERTRA3I M. BECK
JUST A FEW months ago repre- sentatives of about two dozen major national voluntary or- ganizations concerned with the wel- fare of children sat down to discuss the recent rise in delinquency. The group was struck by the fact that although practically all of them saw their acti\'ity as at least in part con- tributing to the prevention of delin- quency, only a few had any specific program for delinquent children. This was perhaps no more than to be expected.
In the past we have quite properly held the view that prevention of de- hnquency, rather than treatment, is our major goal. We have been re- luctant to talk of a program that of- fers treatment to the juvenile delin- quent, holding that such a concept has little meaning and that what we do in the interest of children should be accomplished for all children, not for just one category.
The recent steady rise in delin- quency, however, gives cause for a careful examination of some of our ideas about delinquency. We have come to the point where we must face certain questions squarely: Do de- linquent children have characteris- tics that are different from those of other children served by our public and private child-welfare program? If so, what are they? And if there are such differences, what implica- tions do they have for our programs in the prevention and treatment of juvenile delinquency?
In answer to these questions, there is reason to believe that finally, though perhaps reluctantly, we are commencing to accept the fact that dehnquent children can be distin- guished from other children and that their distinguishing characteristics have definite implications for treat- ment.
Two ways in which these children are distinguished will be discussed
here. In one case the characteristic arises purely from their situation. The simple fact that a child comes before the court as a delinquent and is involved in a legal process sets him off from other children. The authori- tive setting cannot fail to have con- siderable significance in the way in which delinquent children respond to treatment. This fact has long been understood, but we have failed to ac- cord it sufficient recognition, par- ticularly in the training of person- nel.
The second distinguishing charac- teristic is more limited but is of no less importance. It is the tempera- ment of a certain kind of delinquent child within the larger group of de- linquents, both adjudicated and non- adjudicated. This child is one of the "chronic delinquents," who make up the "hard core" of the delinquency problem. New research has shed a brighter light on this group of chil- dren.
Let us look at the more general characteristic first.
I
Authority pervades the life of the delinquent child so long as he remains witliin the pale of legal supervision. And although the juvenile court acts in the interest of all children who come before it, there is a marked dif- ference between the reason why a de- linquent child is brought to court and the reason why a neglected or depend- ent child appears before the court.
The neglected or dependent child is brought before the court because of events outside his control, the delin- quent child because of his own delin- quent act or acts. The delinquent
BERTRAM M. BECK is Director of the Special Juvenile Delinquency Project spon- sored by the Children's Bureau. Formerly associated with the Community Service So- ciety of New- York, he has made several studies in the field of delinquency. Mr. Beck has taught at the College of the City of New York and at the Smith College School for Social Work.
child may, and often does, view his court experience as punishment for misbehavior. The public more or less sees the delinquent child as a threat to public safety, and as an offender rather than as a child offended against.
In other words, once a child be- comes the official concern of the ju- venile court because of an act of de- linquency, his court experience has an effect both on him and on the pub- lic's attitude toward him.
Here, then, is one considerable difference between children coming to the attention of the court because of delinquency and children of com- parable age who are the concern of the court or of public and private child-welfare services for other rea- sons. This difference must be taken into account in the treatment pro- gram for all delinquents who come before the juvenile court.
"Treatment" may seem like punishment
Whatever the juvenile court does to alter the course of life of a delin- quent child is likely to be seen by that child as punishment for his mis- conduct. This fancied or real punish- ment may aggravate the hostility of a child and perhaps induce other re- bellious acts. Thus, the treatment may aggravate the disease.
The delinquent's distrust and re- bellion against authority commence at an early age. The case records of delinquent children tell us that the large majority were truants from school.
It is interesting in this regard to look at an account of the appearance of two ex-delinquents before a meet- ing of the National Conference of Juvenile Agencies.
In response to the question from the floor, "What was the first institu- tion that you ever went to?" one of the boys named the public school he had attended !
These two boys found absolutely nothing good to say of the various
DECEMBER 1952
59
institutions they had been in. So far as they were concerned, they were made to do things and when they failed to do them, they were punish- ed. They said they could understand being "knocked off" for doing some- thing wrong but it seemed to them that they were always being "knock- ed off" — and without any apparent reason. In other words, to those two boys, treatment was punishment.
In summing up their opinion about institutions, the boys had this to say : "There ain't no such thing as a good joint — and there never will be. A good joint is no joint."
Implications for treatment
The statements of these two boys highlight the very difficult problems of those workers who are engaged in programs for the "officially" de- linquent child.
The police officer who apprehends such children, the juvenile-court judge, the probation officer, the staff of the detention home, and the staff of the training school — all need spe- cial skill and knowledge to deal with these children. All must have an acute awareness of the need to pro- tect public safety and the civil rights of parents and children. All must ex- ercise authority vested in them by law. All must function in such a way, however, that the child is not em- bittered and the delinquency is not aggravated.
The police have a major role in de- linquency control. They bring a ma-
jority of delinquents to the court. At least one million children come to their attention each year because of some alleged act of delinquency. Many of these children are not taken to court. The police officer must decide in each instance what action he will take.
Recent years have witnessed a rapid expansion of special branches of police forces for work with juve- niles. Many police forces have de- veloped services for children that seem more appropriately the job of the social agency. According to police authorities, however, such services have been developed simply because of the reluctance of existing social agencies to adapt their programs to meet the need of the delinquent child.
Those social agencies that work with delinquent children must de- velop sympathetic and cooperative relations with the police. They must learn to appreciate the difficult role of the police, who have the dual task of protecting public safety and, at the same time, serving the broader interests of the child and the com- munity. They must aid the police by accepting such responsibility for the treatment of delinquency as is rightfully that of the social agency, and by supporting necessary mea- sures to promote special training for juvenile police officers.
The part that the juvenile court plays in a program for helping de- linquent children is crucial. The juvenile-court judge must have legal
Friendly, skilled counsel gains trust and often brings a desire to be better. Improved train- ing for personnel who work with children is probably the delinquency field's greatest need.
skill and also the ability to use the knowledge both of the social workers who serve him as probation officers and of other such specialists.
In some instances the judge's opinion as to what might be best for the delinquent child has to be tem- pered by other considerations. For example, a boy who sets fires may have to be committed to an institu-- tion even though he might better be given psychological treatment while remaining in his own home. In other words, when a delinquent constitutes a real and immediate danger to other persons, the necessity to protect pub- lic safety will undoubtedly influence treatment plans for this child.
As another example, community sentiment in regard to certain sex of- fenses may necessitate removal of a child from the community in contra- diction to his best interest. The juve- nile-court judge must know how to strike a balance between the inter- est of the delinquent child and the protection of the public safety. Such considerations usually do not enter into his work with dependent and neglected children.
Another primary consideration that must invariably determine the opinion of the judge is respect for the civil rights of children and their parents. These rights must be pro- tected. The fact that a child has com- mitted certain acts must be well established before a court can take action in the interest of the child. No attempt should be made to "stretch the law" so that a child who cannot properly be considered delin- quent under the laws of a State is adjudicated delinquent merely to make it possible for him to receive services. The maintenance of the proper legal process in protection of the rights of man takes precedence over procuring services for an indi- vidual child.
The role of the probation officer is particularly difficult. Not only must he be guided by the same con- sideration that affects the court but also he must undertake treatment that will best help the child. The child on probation may, if he fails to make adjustment, be returned to
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THE CHILD VOL. 17 NO. 4
that court and possibly sent to an in- stitution— a possibility that repre- sents the extreme in punishment to most delinquent children. The proba- tion worker becomes for the child the symbol of the authority against which he rebels.
The probation worker must there- fore attempt to convert what appears to be a handicap into an asset. He must not surrender his authority, but he must exercise it on behalf of the child and the general public. With skillful handling by the proba- tion officer, it is hoped that the child comes finally to accept his guidance and counsel. And as the child learns to accept reasonable authority, he learns also to accept the authority exercised in the outside adult world.
Although probation services are offered by the child-welfare worker in many jurisdictions, the authority role remains the same. The worker needs special skill and knowledge over and above what is required for serving children in nonauthoritative settings.
Discussion of the role played by the staff of the training school might best perhaps be included in our dis- cussion of the second major distin- guishing characteristic of delinquent children. For usually it becomes the responsibility of the training school to treat the "hard core" group of de- linquents, about whom we are now going to talk.
n
Within the group of adjudicated delinquents dealt with in the juvenile court, there is a smaller group of chronic delinquents. These children are different from other groups of delinquents, and treatment must be planned for them in the light of their special characteristics.
Their differences have recently been brought out more clearly as the result of a study by Sheldon and Eleanor Glueck. In this study 500 delinquents in a training school were compared with 500 nondelinquents of similar background and characteris- tics. All the children were boys, and all lived in underprivileged neighbor- hoods. In each pair, the delinquent and the nondelinquent were of simi-
Will these children become delinquent? Well-planned community services can prevent this.
lar age, intelligence, and national origin.
The most important distinguishing characteristic between the groups of children was that the delinquent chil- dren did not have the ability to con- trol their rebellious, aggressive, hos- tile feelings, and gave vent to such feelings in antisocial acts.
The nondelinquent children, on the other hand, either had some kind of safety valve, so that they could deal with their hostile impulses without conflict with the law, or they held their hostility inside them, where it contributed to a feeling of discom- fort but was not of immediate con- cern to those around them. Anyone who has restrained an impulse to "tell somebody off" and then has de- veloped a "nervous headache" or up- set stomach can understand the plight of such nondelinquent chil- dren.
The nondelinquents, to a far greater extent than the institutional- ized delinquents, had internalized emotional disturbances. The delin- quents were free-wheelers — adven- turesome, restless, impulsive, and de- structive, but relatively free from worries and anxieties until the com- munity interfered with their be- havior pattern. The nondelinquent group contained by far the larger proportion of the "worried" children.
What makes them delinquent?
All the children the Gluecks studied were children of the slums. Sociologists, led by Clifford Shaw, have pointed out how most adjudged delinquents come from the disadvan- taged areas of a city. Allison Davis, a prominent educator, has deepened our understanding of why so many delinquents come from slums. He showed us how difficult it is for all the people in a community to have a single idea of right and wrong when people of one race or people from one economic level are segregated in a particular section of a city. The youngster brought up on the "wrong side of the tracks," where the fight for survival is bitter, may in turn enter into battle with society in gen- eral. The child on the "right side of the tracks" usually adopts the con- ventional or conforming behavior of his elders.
All the children studied by the Gluecks were early in danger of be- coming delinquent because of condi- tions in the neighborhood in which they lived. The delinquents, however, had an additional handicap not suf- fered by the nondelinquent. To a far greater extent than the nondelin- quents, the chronic delinquents were reared in homes offering little affec- tion, guidance, stability, or protec- tion. Their parents, weighed down by
DECEMBER 1952
61
personal misery and poverty, were not able to offer that extra some- thing that can keep a child even in , the worst of slums from becoming delinquent.
Although most of the delinquent children studied did not come into court until early adolescence, about one-third were noticeably delinquent as early as 8 years of age.
Implications for prevention
Knowledge about this hard-core group of delinquent children now makes it possible for a community to attack the delinquency problem in a precise fashion — both from the pre- ventive and treatment aspects.
Preventive activities can and should be part of a broad program designed to prevent all kinds of so- cial maladjustment. Certain activi- ties, however, can be aimed at a spe- cific objective, namely, those chil- dren who are prone to delinquency but are not officially delinquent. This group includes the youngster who is just beginning to develop a pattern of delinquent behavior. Also includ- ed are the chronic delinquents who have been known to law-enforcement agencies in the past, and those chronic delinquents who through wit or luck have escaped official notice.
Our knowledge of the characteris- tics of the chronic delinquent, for example, demonstrates that even at an early age he probably cannot be reached by the conventional super- vised recreation program. He is more often a child of the street. He re- sents the authority represented by supervision and he craves excitement and adventure. To reach these chil- dren, therefore, a recreation pro- gram must reach out to the delin- quent child and his gang, and must operate in the child's own territory — the street. Such programs have been launched in several cities.
Furthermore, we know that if we wish to curtail the development of a delinquent pattern in a child opposed to school, we must utilize the best in modern educational techniques to hold the attention of that child.
The fact that the children in our training schools usually have an al-
legiance to gang activity makes it important that a preventive program in the community offer services to the gang as a unit.
In other words, if a community wants to reach the truly delinquent child, its program must reflect the definite knowledge that we have of the characteristics of this kind of child and not merely provide activity good for children in general.
In addition to programs aimed at children already involved in delin- quency patterns, preventive programs must also be aimed at strength- ening family living, so that problem behavior will not develop among the very young children. New light on the subject of delinquency makes it clear that if such broad programs of prevention are to be successful in curtailing delinquency, they must be aimed at the preschool child. Citi- zens, regardless of their walk in life, must band together to eliminate the areas that are the primary breeding places of delinquency. Basic social and economic measures are usually necessary. Parent education and guidance and counseling for children and parents should be provided in the community to aid parents in the rearing of healthy children. All that we now know about the prevention of behavior disorders underlines the need to aid parents with problems of child rearing during the earliest years of the child's life.
Implications] for treatment
Knowledge of the special charac- teristics of the child whose delin- quency pattern is well developed pro- vides clues for the successful treat- ment of such children.
Social and psychological under- standing is needed in order to com- prehend the relationship of family and community in promoting delin- quency. The treatment offered the chronic delinquent, however, prob- ably must be something different from that oflfered the emotionally disturbed child.
Because of rejection by adults and substitution of the gang for the family, it may be that the chronic de- linquent could be treated, at least in-
itially, in groups. Singly or in groups, the establishment of the re- lationship between the person doing the treating and the child being treated is of primary importance.
The major problem would seem to be that of helping the child de- velop necessary inner controls of be- havior, rather than aiding him in the resolution of internal conflicts.
Herein lies the task of the staflf of the training school in most instances.
Delinquent children have special needs
In summary we can therefore say that the delinquent child has, on the one hand, the same needs as all chil- dren and, on the other, special needs.
Just like other children who re- quire attention from public or priv- ate social agencies, the delinquent child may need casework treatment, psychiatric treatment, or foster care — singly or in combination. Since such services are offered for all chil- dren who need them, they may be and often should be under the ad- ministrative auspices of a single agency. Services for certain groups of children, however, must be geared to the particular needs of those groups.
Infatuation with the concept that children are children, and that the word "delinquent" is a label without any particular significance, has im- peded the development of necessary services for delinquent children. A great deal of attention has been given to activities for prevention. Such activities often march under the popular banner of delinquency pre- vention, but are, in reality, activities designed to make possible a healthy development of all children. It is very likely that these activities do prevent delinquency, as well as a host of other social disorders. Such pre- vention programs, however, will not cope with the chronic delinquent in the community, who needs preven- tive services specially adapted to his particular characteristics.
At the present time, services for
delinquent children who come to the
attention of our law-enforcement |
agencies are seriously limited.
(Continued on page 71)
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THE CHILD VOL. 17 NO. 4
A FEW FACTS ABOUT JUVENILE DELINQUENCY
OUR FACTS on juvenile delin- quency are taken mainly from two sources: police fingerprint records, sent in to the FBI, and juve- nile-court delinquency cases, reported to the Children's Bureau.
All these reports are sent in on a voluntary basis, and they give only uneven coverage. As a result, the data may not be representative of the national picture.
Limited as they are, however, these facts, combined with data from other sources, furnish the best available means for estimate.
It will be one of the aims of the Special Juvenile Delinquency Project to help secure more reliable data on juvenile delinquents, and thereby im- prove our methods of helping them.
HOW MANY DELINQUENTS?
In 1951, (in estimaled 350,000 chil- dren were brought to the attention of the juvenile courts in this country for delinquent behavior. The boys outnumbered the girls 4 to 1.
A much greater number, perhaps a million or so, came in contact with the police on account of misbehavior. This group included many who were referred to the court.
Many delinquent children escape the attention of the lair. We do not
know definitely the number of these "concealed" delinquents, but studies indicate that it may be considerable. A survey made in a large Eastern city of the case records of childi'en coming to social-work agencies for help and guidance revealed that of the large number of children who spoke openly of the serious acts of de- linquency they had committed, almost one-third of the children tvere itn-
knoun to the police. It is impossible to estimate how many delinquent children escaped the attention of all agencies in the community.
IS THEIR NUMBER INCREASING?
The answer is ijcs if preliminary data for 19.51 from juvenile courts reporting to the Children's Bureau is a reliable indication of what is hap- pening. For these courts the number of child delinquents increased 19 per- cent between 1948 and 1951. Figures on police fingerprint records show a similar trend. The number of chil- dren in the country in the principal age group affected (10-17) increased only 5 percent during that year.
Unless we do something now to prevent it, there may be further in- creases in the number of delinquent children. The total number of chil- dren in the age group 10-17 is ex- pected to increase 45 percent between 1950 and 1960.
The babies born during and after World War II are growing up. Will the number of delinquent children also increase 45 percent? Will it in- crease at an even greater rate, as it is now doing? Or will we succeed in preventing an increase?
WHAT HAVE THEY DONE?
Juvenile-court reports show that the majority of the boys are brought in for stealing or committing malici- ous mischief.
Most of the girl delinquents are brought in for being ungovernable, for running auay, or for having com- mitted a sexual offense.
Police fingerprint records reveal that in 1951 childi'en under 18 com-
mitted 24 percent of the Nation's auto thefts.
They also commit crimes of vio- lence : 3 percent of homicide cases and 7 percent of rape in 1951.
More serious crimes were com- mitted by boys and girls 18 years old during the first 6 months of 1952 than by persons of any other age group.
HOW OLD ARE THEY?
The majority of delinquent children who come before juvenile courts are betiieen 15 and 17 years of age.
Approximately 35 percent of the delinquent children who come before the courts have been there on one or more previous occasions.
The age at which the largest num- ber of delinquents are first appre- hended by the police or referred to the court seems to be betueen 13 and 15, or approximately at puberty. This was shown by a study of a thousand delinquent children.
Nine-tenths of these same children were having considerable difficulty adjusting to normal life before they ivere 11 years old. More than a third of this total group of one thousand childi'en were showing noticeable signs of becoming delinquent at the age of S or younger.
WHAT HAPPENS TO THEM?
Of the one million children who came to the attention of the police for misbehavior last year, about 750,000 were dealt tiith directly by the police, who let them go with a warning or perhaps referred them to a social agency for guidance and help.
DECEMBER 1952
63
The remaining 250,000 committed acts of delinquency so serious that the police referred them to the juvenile court.
An additional 100,000 were brought to juvenile courts by parents, teach- ers, social agencies, and the like.
At least 115,000 of the 350,000 children who were brought to the juvenile court were held overnight or longer in a detention facility, police station house or jail.
It has been estimated that from 50,000 to 100,000 children are con- fined in jails each year by the author- ity of the courts or other law-enforce- ment agencies.
Of the 350,000 delinquent children who came before the juvenile courts in 1951, the cases of about half were dismissed, adjusted, or held open
without further action.
Of the remaining children, ap- proximately 95,000 M'cre placed on probation and the rest were either referred to other agencies, committed to institutions, or handled in other ways.
About 35,000 children a year are committed by juvenile coui'ts to train- ing institutions designed primarily for delinquents.
WHAT SERVICES ARE AVAILABLE?
At the present time we have no ad- equate information as to the number of police officers with special training for work with juveniles. (This in- formation is currently being collected by the Children's Bureau and the In- ternational Association of Chiefs of Police.) The number needed has been estimated at 10,000, or at least 5 per- cent of our total number of police officers. A city with a population of 20,000 should have at leas* one police- man trained for work with delin- quents.
A recent study of 177 cities, each with a population of more than 20,000, revealed that more than one- third of them have not yet made
JUVENILE DELINQUENCY IS RISING SHARPLY
Child population of U. S. (10-17 yrs. of a^e) World War n
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Korean conflic
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special provision in their police de- partments for work with children.
The Delinquency Control Institute of the University of Southern Cali- fornia, which offers the only univer- sity-operated training program for juvenile officers in the country, has graduated 173 persons since it was founded in 1946. A few other schools — the Police Training Institute of the University of Louisville, the FBI Academy, and local academies and police schools — do give some atten- tion to police work with juveniles, but, so far as we know, this instruc- tion represents only a small portion of the total curriculum.
There are more than 2,500 juvenile
courts distributed over the Nation. If the children brought before them are to receive even minimum help, a court needs sufficient probation serv- ice for study of each child's back- ground and for guiding those chil- dren that the court places on pro- bation.
The court should also have avail- able to it a detention facility suitable for keeping children in secure cus- tody. One detention facility may oc- casionallv serve more than one court.
The number of such detention homes in the United States is only 174.
At least one-half the counties in the
United States are ivithout probation
services for juvenile delinquents.
There are at present 3,716 local probation officers for juveniles. Many of these officers serve both children and adults.
In 1951 these officers had the major responsibility of serving not only 350,000 delinquent children, but also 150,000 dependent, neglected, and other children who are the concern of juvenile courts. In other words, there is 1 probation officer for every 135 children coming to the court. Of course, this is only an average. Some courts have highly developed probation ser\aces, but many have none whatever.
About 30,000 delinquent children are in the more than 250 training institutions designed primarily for such children.
The average length of stay of a delinquent child in a training insti- tution is somewhat less than one year.
;.B4
THE CHILD VOL. 17 NO. 4
RECOMMENDED FOR EVERY COMMUNITY
ON THIS PAGE are set forth certain desirable practices, or standards of practice, that have been recom- mended to communities seeking to improve their services for delinquent children.
The services considered here are those of- fered by the police, the juvenile court, the detention facility, and the training school — four agencies entrusted with a legal and so- cial responsibility for helping our delin- quent children become better-adjusted in- dividuals and better citizens. In addition, standards for the organization and admin- istration of these services are included.
The statements given here, which are part of a more complete list now being compiled by the Children's Bureau, were drawn from the publications and proceed- ings of a large numb^r of national groups and organizations that are interested in preventing juvenile delinquency and in giving proper treatment to those children who have become delinquent.
These organizations, and others like them, are continuing to add to those standards and to bring them up to date. During the coming year, the Children's Bureau will lend encouragement to these efforts, and hopes eventually to have standards formu- lated for every aspect of our community's services for delinquents.
In the meantime, the list of existing standards should be useful not only in guiding the development of services in the areas covered but also to mark the areas not covered.
The selection of standards on this page covers just a few aspects of each service. The goals set forth are not new. They are familiar to many people. But there is not a town in the Nation that would not bene- fit its children immeasurably by making these simple statements come true.
State organization and administration
In every State government a single department should have authority and responsibility for coordinating services for delinquent children, de- veloping standards for such services, establishing new services, relating these services to those of other agen- cies in the State, using the services of other agencies in the State, and stim- ulating leadership in local communi- ties.
This State agency should have re- sponsibility for aiding political sub- divisions of the State in providing probation service and detention care.
This State agency should make consultation service available to the various agencies providing care and treatment to delinquent children, and should have responsibility for pro- moting the development and use of social services in juvenile-court cases.
This State agency should have a
clear responsibility for giving leader- ship and assistance in developing in- service training programs in all State and local agencies that operate programs for delinquent children.
Programs of service to children, including delinquent children, should be coordinated at the State and local levels by some form of planning and coordinating body.
Police
Instruction and training in the handling of juveniles should be a part of the basic training of every police officer.
Police officers with a major respon- sibility for work with children should have special training that will en- able them to make constructive use of the broad discretion they have in handling each instance of juvenile delinquency that comes to their at- tention.
Law-enforcement agencies should participate along with other com- munity agencies as full partners in the process of coordinating and plan- ning services for children.
Police departments in urban cen- ters should have a special unit de- voted to protective and preventive work with juveniles.
Officers assigned specific responsi- bihty with respect to juveniles should be assigned on a basis of personal fit- ness and capacity to work with chil- dren and youth.
Juvenile court
The juvenile-court judge should have legal training and should be a member of the bar. He should have sufficient knowledge of the sciences of human behavior to be able to use and to be willing to use expert advice on the problems of human relations.
Provision must be made for social study of the child prior to final court action and for the services of trained and skilled counselors to aid children placed on probation.
A probation officer should have, as a minimum requirement for appoint-
ment to his position, a bachelor's de- gree from a college or university of recognized standing, with specializa- tion in the social sciences.
Probation officers should be ap- pointed only on merit, without regard to political affiliation.
Child-guidance clinics, mental- health clinics, and psychological, pe- diatric, and other needed services for children should be made available to the juvenile court.
Detention
A delinquent child who must be kept in secure custody should be held in a detention facility designed and conducted for such children, and not in a jail or police lockup.
It should be possible to admit a child to detention at any hour of the day or night. All detention should be authorized by the court.
Detention must in every case be as brief as possible.
Every detention facility should have a plant, program, and staff that will enable it to make detention the first step in a constructive treatment process.
Training school
The training school should be sent only those children who are in need of and who can profit by its services.
In the training-school treatment process, an attempt should be made soon after a child's arrival to gauge his emotional and social maladjust- ments and their underlying reasons. A program of individual and group therapy should then be prescribed to correct them.
The director and staff should be selected on the basis of merit alone.
Psychiatric and psychological serv- ices should be available.
Children in training schools should have educational opportunities that are at least equivalent to those offer- ed in the community.
An aftercare program should be maintained for the guidance of chil- dren released from the school.
DECEMBER 1952
65
COMMUNITIES ACT AGAINST DELINQUENCY
DOUGLAS H. MACNEIL
COMMUNITIES find out about their delinquency problem in a number of ways, and they go about taking action toward solv- ing the problem in just as many dif- ferent fashions.
Hundreds of cities and counties al- ready- have much information avail- able about their delinquency problem. In these communities, local commit- tees on children and youth collected facts for use in the 1950 Midcentury White House Conference. A number of these committees are continuing their efforts to bring these recom- mendations to fruition. In some cities, an oiUcial body — the welfare council for instance — may keep close tab on the situation and alert the community to any pressing need.
Elsewhere, the discovery that there is a delinquency problem may come as a surprise, and generally that sur- prise is apt to be unpleasant. I know of a number of cases like this and will mention a few of them here.
On Hallowe'en of 1950 such ex- treme acts of vandalism took place in Oneida County, Wis., that the need to do something about juvenile delin- quency was plain. The local chapter of the Veterans of Foreign Wars soon went to work and helped organ- ize a citizens' committee to find out why so many young people were get- ting into trouble. The State of Wis- consin helped Oneida County make a survey to see what was needed, and the community has gone far toward filling those needs.
DOUGLAS H. MACNEIL is the Director of the Division of Community Services of the New Jersey State Department of In- stitutions and Agencies. This Division is concerned with helping communities im- prove and coordinate services for children and youth. Through the courtesy of the State of New Jersey, Mr. MacNeil is tem- porarily serving as a special consultant with the Juvenile Delinquency Project sponsored by the Children's Bureau.
In Austin, Tex., a grand jury called the attention of the people to the problem of delinquency in that com- munity. During February 1948, in the course of investigating the ad- ministration of justice in the county, the grand jury handed down a strict indictment of the way delinquent children were being dealt with. The jury proposed far-reaching reforms. The community council was asked to take on the job of getting interested individuals and groups organized in an effort to bring these reforms into being. Today the city of Austin, and Travis County, together have a new detention home, and the proba- tion services of the juvenile court have been strengthened by the addi- tion of new probation officers to work with delinquent children.
In Seattle, Wash., the brutal mur- der of a 16-year-old boy by other
juvenile inmates in the county jail finally made the citizens of that com- munity aware of how greatly they had failed in their responsibility. For 5 years the juvenile-court judge and other ofiicials had been warning the public about the terrible conditions under which juvenile delinquents were being held. But no group had responded to the judge's pleas, and he could not remedy the situation alone. It took a cruel and inhuman murder to awaken the public to the urgency of the need for better juve- nile-court facilities. Today Seattle has a magnificent new Youth Service Center dedicated to the task of re- habilitating its delinquent youth.
Another case that comes to mind has to do with the establishment of the Child Guidance Clinic of the Oranges and Maplewood in New Jer- sey. For several years, the Mental Hygiene Committee of the Social Planning Council had urged the crea- tion of such a clinic but without much response from the public. Then three boys from families with standing in the community stole weapons from a
These children in a crowded neighborhood find workers trying to prevent delinquency need to J
their recreation in the street. Recreation eek out children wherever they congregate.
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THE CHILD VOL 17 NO.
collection of guns owned by the ! father of one and shot a passer-by in the course of what amounted to an act of armed robbery.
A newspaper editorial asked how such an episode could have been anti- i cipated. The Council pointed out that, ' properly used, the proposed clinic might have helped. Thereupon the newspaper announced a substantial gift from its own corporate funds and then spearheaded an intensive drive for the clinic. This assured its estab- lishment. Now several years old, the clinic is one of the basic community services for atypical children.
One man can do a great deal
In each of these communities, the need to do something about the delin- quency problem had to be forced upon the attention of the public. And once the need was discovered, a group of people stimulated the community to action. But sometimes one key per- son, if he is determined enough, can open the eyes of a community to bad conditions affecting children. This person may be someone officially con- cerned— a juvenile-court judge, for example, or the chief of police. Or he may be just an ordinary citizen.
A newspaperman started the ball rolling in Monroe, Mich., back in the thirties. He first began to think about juvenile delinquency when he noticed how many of the news stories that crossed his desk involved chil- I dren and young people. Soon he be- gan to wonder what it was in the community life that was causing these kids to become delinquent, and what the officials in the town were doing to help these children and to prevent further delinquency. So, in his own words: "I wrote to half a dozen people in town I knew would be concerned, enclosed the clippings, and suggested we meet Monday."
Thus commenced a campaign that was to lead eventually to many im- provements in Monroe's services for children, delinquent and nondelin- quent. The juvenile court has been bettered ; two policewomen have been hired to work with juveniles ; recrea- tional facilities have been expanded and improved. But these gains were
not easily won. They took 10 years of hard and sometimes frustrating work.
In Middletown, N. Y., a boxing pro- moter, disturbed by the social atti- tudes of some of the boys who came to watch his fighters train, set in mo- tion a community program to meet the recreational needs of children who do not fit into conventional group-work or recreation programs. After much determined eft'ort, he succeeded in obtaining .support for his idea from virtually all civic and youth-service organizations in his community.
Fixing community responsibility
Of the many suggestions that could be drawn from these case histories of community action, I believe we should emphasize two in particular:
First, no matter who starts the campaign, a large and representative group of citizens must be brought in to participate. It isn't a job for one man to carry through alone. One man can do much to stimulate interest and to prod those who lag. But if a campaign is to be successful, it must have the backing of a lot of people. Which brings us to the second idea: People must be informed about every aspect of the campaign — why it is necessary, tchat it hopes to reach, and hoir the goals can be accomplished. The public is not apt to get very ex- cited about raising salaries for pro- bation officers, or sending a local policeman away for training to fit him for work with juveniles, or build- ing a detention home, unless it knows why these things are necessary and what good they are expected to ac- complish.
Individuals and groups undertak- ing such campaigns have found how essential it is to keep these two ideas in mind. In some cases they've learn- ed by bitter experience how unpre- dictable the public can be — and also public officials.
Take the case of Leliigh County and its detention home, for example. Lehigh County is in Pennsylvania. Some professional people who work with delinquent children there under- took to bring to the community's at-
tention the need for a detention home. The story of the struggle that ensued before the home was finally secured is told in the September 1951 issue of the Quarterly of the Penn- sylvania Association on Probation and Parole.
The campaign started back in 1932. School authorities conducted a sur- vey of detention and made a report. No other groups were called in, how- ever— and nothing happened. In 1937, in 1939, and again in 1943 the prob- lem of detention came up — but noth- ing was done.
Finally, in 1946, the council of social agencies was asked by the pro- bation office and the Family Service Agency to undertake a study of the problem. Professional workers for children were already convinced that a detention home was needed. But this time the public was going to find out that a detention home was need- ed. Citizen participation was sought.
A subcommittee heavily weighted with interested citizens was formed to study facilities for the care of delin- quent children. The first thing they discovered was that Lehigh County was keephig juvenile delinquents in jail. This was against the State law. The law clearly and specifically stated that no city or county could detain adolescents in any jail where adults were confined. Clearly the law was being violated. No one seemed very concerned.
But the subcommittee was dis- turbed. It went to work figuring out plans for a detention facility. And fortunately at this point it called in the chief probation officer of the local juvenile court to give guidance and advice. Later on, the National Pro- bation and Parole Association was asked to advise on specific details of the construction of the home. Tech- nical advice of this sort is nearly al- ways necessary.
After about a year's work, the sub- committee came out with an excellent report on the need for detention fa- cilities, and the executive committee of the council approved it overwhelm- ingly.
A lot of publicity was given the re- port, but a way iiad still to be found
DECEMBER 1952
67
to keep the issue alive and to press for action. A citizens' committee was formed. Composed of some 20 in- dividuals representing industry, la- bor, clubs, professions, and other in- terests in the community, the com- mittee was led by a man described as having the tenacity of a bulldog. He opened the meeting with words to this effect : "If any one of you thinks I am going to be chairman of a com- mittee that is going to do nothing, and forget this report, each and every one of you has another guess com- ing."
The citizens' committee went about its task in the most direct way pos- sible : political action. By now, it was election time — September 1948. All the candidates for county office promised to take up the matter of the detention home the moment they got into office. This was very satisfying. But, once in office, the elected commissioners allowed the budget to get through without men- tion of a detention home.
This was a blow, but the committee took it standing. They had been strengthened in their determination by a little demonstration staged by the chief probation officer that, al- though not generally to be recom- mended, left a lasting impression. Three or four youngsters under 13 who had been picked up and placed
in the county jail for some delinquent act were brought to a meeting of the committee. No one knew their names cr what they had done. The commit- tse saw simply a small group of or- dinary youngsters. These children were not criminals, to be kept in a jail.
The campaign for a detention home went on. A mass meeting was held. The grand jury recommended that the home should be built. And finally a lawyer on the committee "... be- gan to talk of the possibility of man- damus proceedings against the county commissioners ... to compel these public officia's to do their duty."
With that the battle was won. The county commissioners shortly there- after voted funds and authorized the drawing up of plans for a detention home. Today Lehigh County has a detention home that it feels is "sec- ond to none in the Commonwealth."
Steps in a ccmmunity action program
Perhaps these case histories have served to point to the steps a com- munity may have to take in an action program. Of course the situation will vary considerably from community to community, but in general there are several definite stages in any cam- paign.
1. Someone has to start the cam- paign— either an individual or a group.
2. Other interested individiuds and groups must immediately he iiv- vited to participate. Many com- munities have a Community Chest or Council that can sei've to coordinate the efforts of individuals and groups. In some others the committees organ- ized on behalf of the 1950 White House Conference may serve as the coordinating body. Still another uni- fying agent may be a coordinating council or youth-guidance council or- ganized for the specific purpose of im- proving preventive and treatment services relating to delinquency.
Often it will be found that the problem about which a group is con- cerned is one that has also worried other groups in the community. If these groups join forces, the proba- bilities of a successful solution are enhanced. Or it may be found that someone else has thought of a dif- ferent solution from the one a par- ticular group has in mind. My advice in this case is, explore all the alterna- tives and try to reach an agreement as to what should be attempted. Nothing is more fatal to community progress than conflict over which solution or which organization should take precedence.
3. The need must be ivell defined. Sometimes the need is self-evident. If a juvenile court has no probation
Does your community give every child a fair chance starting out in life? Children in slum neighborhoods face some obvious handicaps.
These children live in a reconstructed neighborhood. Healthful sur- roundings encourage self-respect and respect for one's community.
service, it is obvious that such a serv- ice should be provided.
In other cases, however, the situa- tion may be more complex. For ex- ample, an interested group may be- lieve that the community needs a de- tention home. Study reveals, how- ever, that most of the children who come to the juvenile court would be better served in their own homes or in foster homes, with improved proba- tion service. A detention home in this community would therefore be a needless expense.
In those cases where the need is not clear and precise, a survey is generally to be recommended. Exist- ing services should be measured. Every effort should be made to find out what the need is and how it can best be filled.
In case a full-scale survey is called for, to determine what the com- munity is doing — or 7iot doing — for all children, special consideration can be given the problem of delinquent children.
4. To get accurate data on its needs, a community or neighborhood quite often requires the assistance of consultants.
In Cleveland, Ohio, a citizens' group in a high-delinquency area used a ■ survey made by skilled workers from the Welfare Federation of that city. The Federation also assisted in a fol- low-up campaign in the neighborhood, a campaign that led, over a 10-year period, to a 70-percent reduction in delinquency in the area.
In the case of Oneida County, Wis., mentioned previously, the citi- zens' committee was helped by the Division for Children and Youth of the State Department of Public Wel- fare. A State worker went to the community and, with the help of local citizens, conducted a thorough survey of the services and resources avail- able to young people.
In addition to Wisconsin, a num- ber of other States offer consultation service, related to juvenile delin- quency, to local communities. Cali- fornia, Minnesota, Rhode Island, Illi- nois, New York, Kansas, Texas, and Mississippi all offer assistance through the Department of Welfare
or a Youth Commission, or other pub- lic body.
In my own State of New Jersey, this service is given by the Depart- ment of Institutions and Agencies through its Division of Community Services, of which I am the Director.
Sometimes it is wise to consult the State agency in this field even though you may see no immediate need for help. In a number of in- stances, our Division has been able to bring two groups in the same com- munity together, both of which per- ceived a need, but both unaware of the potential ally next door. A parallel service has been to bring groups from adjoining communities together so as to develop joint pro- grams which neither community could operate successfully alone.
In New York State, in addition to the advisory service it offers, the Youth Commission has funds that can be granted for community youth service projects under certain con- ditions. No other State has a similar grant-in-aid program. But it has sometimes been possible for us in New Jersey to help local projects qualify for help through existing State or Federal grant-in-aid pro- grams. A community group should not build hopes on such support, however.
In addition to these State agencies that offer consultation service, a number of voluntary organizations will go into a community, when in- vited, and help local citizens survey their needs and resources. In the de- linquency field the National Probation and Parole Association is an out- standing organization of this type.
Perhaps it would be helpful for me to try to be a little more specific about the ways in which a group of citizens can obtain counsel and other assistance for their program of bet- tering the community's service for delinquent children.
I suggest that the committee mem- bers first explore the resources right there in agencies, if there is one. This group usually bears the name wel- fare council, welfare federation, com- munity council, community chest, or the like. Its purpose in most cases
is to act as a pool for all available so- cial knowledge and resources in the community.
Failing a local resource, the group of citizens can go for assistance to • the State planning body for children and youth — the group that co- operated with the Midcentury White House Conference. Nearly every State has such an organization, usually appointed by the Governor. The Governor's office can give an in- terested group the address of this or- ganization. Generally, these planning bodies will be able to put a com- munity group in direct contact with the State agency or voluntary organi- zation that can best serve them.
Any local group or individual that cannot get help or doesn't know where to apply for help in their own State can get that information from the Children's Bureau of the Federal Se- curity Agency in Washington, D. C.
5. Publicity is the next step in the campaign. Once the community's need has been well defined — either by general agreement or by survey — the report should be made known to every citizen in the community. Newspapers, mass meetings, radio interviews — these are all accessible to any group.
6. The final stage in the campaign is to press for action — wherever and however necessary.
In some instances, a single official may be persuaded to bring about a much needed improvement. A police chief, for example, may agree to as- sign one or two of his men to work with juveniles, and to inspect public places that may be tending to contri- bute to delinquency.
Or a group in the community can assume new responsibilities. A pri- vate social agency, for example, may accept for treatment cases referred by the juvenile court.
But, quite often, the force of the entire community may be necessary to achieve what seems to be a very simple objective. For example, it took Lehigh County almost twenty years — and talk of mandamus pro- ceedings— to secure a detention home. This was no quick and easy solution.
Indeed, there is seldom any quick
DECEMBER 1952
69
and easy solution or any permanent one. A youth-service facility can de- teriorate— quickly or slowly. To as- sure long and fruitful life, continuing ' citizen interest is essential.
Perhaps the group that initiated or sponsored the project can transmit its responsibility to some successor organization. But, in the long run, the responsibility for seeing that community services sustain a high level of quahty is hkely to rest upon the same organizations, the same civic groups, the same individuals that fought for their establishment in the first instance.
In other words, we must be real- istic about our community action pro- grams in the field of delinquency. De- linquency springs from social con- ditions that are deeply imbedded in community life. They cannot be eradicated overnight. But, with con- stant and patient effort, the public and its officials can be given a better understanding of the dangers of de- linquency-— and be persuaded to take measures to help children avoid seri- ous maladjustment in their personal and social life.
The newspaperman who started the community effort in Monroe, Mich., has summed up his group's ef- forts in this clear and forthright way:
"Kids still run wild at times . . . Cops still lecture miscreants and let them go. The new, alert judge still has no place to send kids not quite bad enough for reform school but too tough for foster homes.
"On the other hand, in large part, both the community and officialdom now admit that delinquency does ex- ist, and both are doing something, if not all they could, about it. And, gradually, trained personnel is being employed by the agencies dealing with children and youth. Because the community is awake, it is easier now to get official action, whether for a new detention home or increased funds for foster-home care. But the battle must go on ... . Eternal vigil- ance is the price of civic virtue."
Are not these words both honest and hopeful?
REPRINTS ON JUVENILE DELINQUENCY
A number of recent articles on ju- venile delinquency, repi'inted from The Child and other publications, are available for distribution. Smgle copies may be had without charge un- til the supply is exhausted.
Boys and Books Get Together. By Leita P. Craig. Reprint from The Child.
Citizens Help a Juvenile Court. By Charles H. Boswell. Reprint from The Child.
The Institution as Therapist. Bv George E. Gardner, Ph.D., M.D. Re- print from The Child.
Learning Casework in a Juvenile Probation Setting. By ElHot Studt. Reprinted by permission from Social Caseivork.
A Look at Our Training Schools. By Richard Clendenen. Reprint from The Child.
New Horizons for Youth. By Ber- tram M. Beck. Reprinted by permis- sion from Ohio Probation.
Probation Work Requires Special Training. By Clarence M. Leeds. Re- printed by permission from Federal Prohation.
To Synchronize the Training-school Program With Life in the Com- munity. By Richard Clendenen. Re- print from The Child.
Training Schools and the Future. By Richard Clendenen. Reprint from The Child.
We Can Do Something About Ju- venile Delinquency. By Martha M. Eliot, M.D. Reprint from The Child.
Why Does a Young Delinquent Re- sist Treatment? Bv Harris B. Peck, M.D. Reprint from The Child.
Dec. 1-2. National Midcentury Com- mittee for Children and Youth. 2- year anniversary conference. With the Advisory Council on State and Local Action ; the Advisory Coun- cil on Participation of National Or- ganizations and the Federal Inter- departmental Committee on Chil- dren and Youth. New York, N. Y.
Dec. 2-4. National Conference on Labor Legislation. 19th annual meeting. Washington, D. C.
Dec. 5-12. International Study Con- ference, held by the International Union for Child Welfare. Bombay, India. Information from the Inter- national Conference of Social Work, 22 West Gay Street, Columbus 15, Ohio.
Dec. 7-8. The Associated Women of the American Farm Bureau Fed- eration. 18th annual convention. Seattle, Wash.
Dec. 8-11. Association of State and Territorial Health Officers. 51st an- nual meeting. The Association will meet with the Surgeon General of the Public Health Service and the Chief of the Children's Bureau as well as the State Mental Health Au- thorities and the State Hospital Survey and Construction Authori- ties. Washington, D. C.
Dec. 9-11. American Farm Bureau Federation. 34th annual meeting. Seattle, Wash.
Dec. 10. Human Rights Day. 4th anniversary of the Universal Dec- laration of Human Rights.
Dec. 14-19. International Confer- ence of Social Work. 6th world- wide meeting. Madras, India.
Dec. 27-29. American Economic As- sociation. 65th annual meeting.. Chicago, 111.
Dec. 27-30. American Statistical As- sociation. 112th annual meeting. Chicago, 111.
Dec. 28-30. American Anthropolo- gical Association. Annual meet- ing. Philadelphia, Pa.
Dec. 29-31. American Association for the Advancement of Science. 119th annual meeting. St. Louis, Mo.
Area conference. National Child Welfare Division. American Legion:
Dec. 4-6. Area E — Alaska, Ari- zona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mex- ico, Oregon, Utah, Washington, Wy- oming.
To Our Readers —
AA'e welcome comments and siie:o;cstions about The Child.
70
THE CHILD VOL. 17 NO. 4
FOCUS
(Co)iti)iiied from page 62)
We need more personnel, and better-trained personnel. This need continues from year to year, despite the fact that if we could somehow offer full and effective services to delinquent children and their famil- ies, we could probably prevent de- velopment of a major portion of adult criminality.
Aiding one delinquent child to be- come a good citizen may prevent the spread of delinquency among many other children. Behavior of adoles- cents is greatly influenced by that of their friends and companions. Im- proved court services available to de- linquent children could reach into the most distressed families in our communities. Study upon study has demonstrated that delinquency most often occurs in a family subject to a variety of social ills. These are fami- lies, that though few in number, use up the lion's share of the social serv- ices established in any particular community. These are also the fami- lies most often shunted from agency
to agency because the depth and severity of their distress makes it difficult for them to be assisted.
It is because of the great gains that may be made by improving services to delinquent children that the Children's Bureau has establish- ed its Juvenile Delinquency Branch, which is assi-sted by a Special Juve- nile Delinquency Project, sponsored by the Children's Bureau and financ- ed by private contributions made to the Child Welfare League of America.
The Branch and Project together are trying to stimulate State and local action to improve public serv- ices for delinquent children. Im- provement of such services is not sought as a substitute for more in- clusive measures to prevent malad- justment or to serve children who are not in conflict with the law but who need help.
The antidelinquency program is a small segment of the Children's Bureau's total effort to aid parents in rearing children and to aid chil- dren from families that have been unable to give them sufficient care.
Services to delinquent children must be seen as a part in the over-all pic- ture of child-welfare services, but in seeing the whole, we cannot neglect the special needs of groups of chil- dren within that whole.
Illustrations:
Cover. Esther Bubley for the Children's Bureau.
Page .51. Courtesy of the Times Picayune Publishing Co., New Orleans, La.
Page .'jS. Left, posed photograph, cour- tesy of the Community Service Society of New York. Right, courtesy of the Essex County (N. J.) Parental School.
Page 54. Drawn by Philip Bonn.
Page 55. Left, Palma for Black Star. Right, Philip Bonn for the Children's Bureau.
Page 56. Both by Philip Bonn for the Children's Bureau.
Page 60. Philip Bonn for the Children's Bureau.
Page 6L Arch Hardy for the Federal Se- curity Agency.
Page 66. Courtesy of the Community Service Society of New York.
Page 68. Left, posed photograph, cour- tesy of the Community Service Society of New York. Right, courtesy of the New York City Housing Authority.
Ij/u'utjjta.)
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DECEMBER 1952
VOL. 17 NO. 4 DECEMBER 1952
In This Issue
What Do We Want for Our Delinquent Children? Martha M. Eliot, M.D.
Page . 50
Eyewitnesses to the Toll of Delinquency
Juvenile Court Leo B. Blessing 51
Detention Stephan H. Kneisel ,52
Police L. D. Morrison 55
Training School Laivson J. J'eney 57
Focus on Delinquency 59
Bertram M. Beck
A Few Facts About Juvenile Delinquency 63
Recommended for Every Community 65
Communities Act Against Delinquency 66
Douglas H. MacNeil
This issue of THE CHILD was planned by the Special Juvenile Delinquency Project and edited by Stanley J. Edwards of the Project. Reprints of each article will be available in about
6 weeks.
Published 10 times a year by the Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
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CHILDREN'S BUREAU Martha M. Eliot, M.D., Chief
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JANUARY 1953
r
SHOULD CHILDREN BE SEPARATED FROM THEIR PARENTS?
DRAZA B. KLINE
CHILDREN who are sent to an agency for placement are al- ways in some degree emotion- ally damaged. The unfortunate fam- ily experiences that lead to separat- ing a child from his parents and the injurious effect of that separation interfere with a child's normal per- sonality development and cause vari- ous psychic disabilities. Therefore every placement should be planned as treatment to improve the child's emo- tional health.
The responsibility of the social agency, the child-guidance clinic, the psychiatrist, the psychologist, and others using placement to improve a child's emotional health is greater than is generally recognized. Part of this responsibility is to know, as in medical practice, the exact nature of the treatment and the secondary damage it may cause, so that it can be weighed against less radical mea- sures. This means that any worker who refers a child for foster-family care needs to be acquainted not only with the potential values of place- ment but also with its potential haz- ards— the shock to the child when separated from his parents, the harm- ful effect on the parents, the pain of foster-child status, and the dangers in changing homes.
Placement means different things to different children, but for many a child we find that being separated from his parents means that he was either so bad or so unlovable that his parents had to give him up, or even wanted to. The stigma of being a foster child, different from other children because of his parents' fail- ure, is clear to himself and to some members of the community, who may bring this to his attention in many hurtful ways. The longing to be re- united with his own family, to be accepted by his parents, and to live.
74
like other children, in his own home, persists in some degree throughout his separation.
To his parents, the separation also has its evils. A parent who is unable to care for his own child is, in his own eyes, a failure. When he cannot meet this most basic requirement of our culture, the damage to his ego is inestimable. For some this can later be overcome ; for others it leads to further damage and decreased capac- ity for interest in and responsibility for the child, despite the best efforts of the caseworker.
Child may lose home afier home
Perhaps most serious of all is the fact that child-welfare agencies can- not offer a child long-time foster care with assurance that he will not be taken out of that home and placed in another, thus suffering again from separation and loss. Foster parents, like other people, meet disrupting changes in their lives. They move to other parts of the country, they have serious illnesses, deaths, financial crises, emotional crises. A child is born to them, or a relative who needs their care moves in. Any such change may make it necessary for the family to give up the child. These factors, however, account for only a minor number of changes for individual children ; a greater number occur be- cause the child is so severely dis- turbed that there seems no way to treat him. The child is removed from home after home because the trouble
DRAZA B. KLINE has been Director of the Foster Care Division of the Illinois Chil- dren's Home and Aid Society for the past 6 years. Before that she was for several years on the staff of the Bobs Roberts Child Guidance Clinic at the University of Chi- cago Medical School, and she supervised a student-training unit for the School of So- cial Service Administration. Miss Kline's training was at the University of Minnesota and the University of Chicago.
This paper is condensed from one given by Miss Kline at the seventy-ninth annual meet^ ing of the National Conference of Social Work, held at Chicago.
.at of Documents
\i\M O — ICCTQ
for which he needed treatment at first makes his care intolerable to foster parents, or because his own parents are unable to cooperate with the foster parents.
The potential dangers of place- ment must be weighed against the injurious influence of the child's own home. Before we decide that a child should be placed in a foster home it should be clearly established that the family situation is predomi- nantly injurious to the child. For if this situation can be improved suffi- ciently it is better to keep the family together.
Sometimes there is no alternative to placement, but frequently the deci- sion must be based on factors that are not clear cut. In these cases a wise decision must be based on a com- prehensive diagnostic study. Such a study should include an accurate as- sessment of the character and per- sonality development of the child and his parents, of the family interrela- tionships, of the causes of the fam- ily's current failure. We need to evaluate the interaction of the psy- chological, social, and economic fac- tors in the family situation. From such a study we may determine with reasonable assurance how bad the situation is and what can be done.
When it is decided that the family situation is predominantly injurious to the child and that the child cannot be treated in his own home, two addi- tional questions must be considered: (1) Is there a family available that can care for the child in such a way as to im.prove his situation? (2) Can the child and his parents be helped by placing him? If the answer is No to either question, the agency's ef- forts to give service are wasted. For example, a seriously disturbed child too often is obliged to enter on an endless succession of moves from one home to another.
THE CHILD VOL 17 No. 5 '
Likewise, when a parent is incapa- ble of having a satisfactory parental relationship with the child and yet cannot permit him to have it with substitute parents, we are likely to provide a psychologically untenable situation. The parent's behavior makes it impossible for the child to feel that he belongs with either set af parents and makes him hostile to- ward both. Thus with neither love nor consistency, the minimum condi- tions necessary to healthy personality development are absent, and the child is increasingly disturbed.
ro treat the "untreatabie"
For us to busy ourselves with such unproductive and costly services vio- lates our responsibility to the child and to the community and damages resources that could be used advan- tageously for other children. Our re- sponsibility to the so-called "untreat- abie" child is to develop, in some way, an effective method for treating him.
In cases in which the factors are not clear cut, joint examination by the referring agency and the place- ment agency would help both of them to understand the case and hence to select the appropriate service.
Just as the decision whether a child should be placed in a foster home is based on a comprehensive analysis of the child and his family, so is the selection of the new home. The more fully we know the characteristics of the available foster homes or institu- tions, the better we are able to select the one that will most nearly meet
the child's needs. In the following case story about the J family, I will describe some of the methods of plan- ning for placement which the staff of the Illinois Children's Home and Aid Society, under the psychiatric direc- tion of Dr. Margaret Gerard, have found useful.
The case illustrates: (1) a basi- cally injurious and unmodifiable fam- ily situation; (2) diagnosis and eval- uation of the three children begin- ning at the point of intake and con- tinuing throughout the service; and (3) differential placement planning, based on their individual personality development, the characters of the parents, the family interrelation- ships, and the characteristics of the available resources for treatment.
Mrs. J was referred by a child- guidance clinic for placement of Bill, her 5-year-old son. (Later, two older sisters, Ann, age 7, and Norma, age 9, were also placed in foster care.) The first study revealed that the par- ents, then in their late twenties, had been in severe conflict throughout the 10 years of their marriage. They had been known to various community agencies from which the mother sought help each time the marriage reached a crisis.
The trouble had begun shortly after the^'^birth of the first child, with the crises building up from the mother's nagging and the father's periods of alcoholism and brutal attacks on the mother. These episodes were followed by separations and reconciliations. The mother sought help from agen-
Each child in a family has his own individuality — his own personality and his special needs.
cies only in financial desperation or in an attempt to punish her husband, but she did not wish to give up the marriage. She wished only to give up the children.
The increasing tension between the wife and husband, which resulted in placement of the children in a foster home, seemed to arise in part from the mother's increasing fear of preg- nancy and the inability of both par- ents to tolerate the responsibility of caring for three children who were becoming more and more difficult to handle.
This application for foster care for Bill came at a time when the par- ents were separated and the mother could no longer endure caring for Bill. She said she "yelled at him and beat him," and wanted to "put him out of the way," but she could not comply with the father's wish to give him up for adoption because she felt she had to be able to see him to be sure that he was well taken care of. She attributed this to her own experi- ence of living in an institution for 5 years in her childhood and knowing how it felt to be neglected. (Later, however, she told of being removed from the institution at the age of 10 to live with her father and new step- mother and wanting to return be- cause she had liked the routine, the recreation, and the other children.)
When the mother was pregnant with Bill, the father had urged her to abort, which she refused to do. After Bill's birth, the father ignored him except when drunk ; then he was abusive to him. At home Bill was fretful and demanding, except that sometimes, when alone with the mother, he sat quietly and asked her to read to him. When the father was at home Bill frantically urged the mother not to go into the bedroom with father but to stay with him. He was often heard to say, "Why doesn't Daddy die?"
This history shows all the condi- tions that point to a need for foster- home care. The conflict between the parents had been violent and per- sistent over a period of many years. Both parents openly rejected the child. Both parents repeatedly re- fused help in solving their marital
JANUARY 1953
75
problems, which were destroying the family.
First try unsuccessful
Foster care for Bill was considered in relation to his age, his symptoms, and his relationships with his par- ents. His warm reaction to the case- worker indicated that his severe symptoms might have been the result of the beatings and the rejection he was suffering at home, rather than arising entirely from internal con- flict. If so, he could improve in a good foster home. Bill needed foster par- ents that not only offered stable fam- ily life and gave him consistent affec- tion and care, but also had the ability to treat his impulsiveness firmly. He needed a foster father who could per- mit Bill to test him in his role as father and thus to change his concept of a father as a cruel person.
After first making an unsuccessful selection of foster parents we realized that for Bill foster parents would also have to have an unusual degree of personal security because he drew close to the foster father and ex- cluded the foster mother. He needed more than "good parenting"; he needed treatment within the frame- work of consistent parental affection and care.
We accordingly placed Bill in an- other foster home, where he has re- mained for the past 4 years. Bill's progress in this home has been steady but slow. The intensity of his symp- toms gradually decreased, but the core of his neurosis has not yielded even to excellent environmental treat- ment. His need for direct psycho- therapy is recognized by the foster family and the agency, and plans are pending to make this available to him.
Two months after Bill's placement, the parents were ready to request foster-family care for Norma and Ann. The mother had wanted this earlier, but the father, because of his attachment to Norma, was opposed to it. However, after an episode in which he attempted to choke the mother, he recognized that the chil- dren were terrified by the constant fighting, and he, too, requested the agency to place the girls.
The placement of the two girls will illustrate the way in which the plan for foster care is related to the par- ent-child relationship, the sibling re- lationship, and the child's personal needs.
We learned from the parents that Norma, the oldest child, was the favo- rite of both. The mother was depend- ent on her, confided in her, and had relied on her to mother the two younger children, because Norma could be more firm with them than she. The father looked to her for companionship, taught her music, and treated her, in general, as an adult.
Norma, in turn, was attached to both parents and resisted placement. She had enjoyed the position of fav- ored child, but this was a precarious position since both parents were too immature to have a consistent rela- tionship even with the favorite, and she was often in the role of trying to protect one parent from the rage of the other or competing with one for the attention of the other. In addi- tion, her responsibility to the other children at too early an age made her hostile to them and to her parents. She was bossy, defiant, selfish, and aggressive. She had recently begun to steal, taking rather large sums of money from adults and toys from other children.
The younger sister, Ann, was con- sistently rejected by both parents, but the mother was not unkind to her. The father had never liked her and he would slap her or send her to bed upon the slightest provocation. She was conforming, timid, and extremely fearful of men. She did well in school, but she was nervous and had vomit- ing spells with no apparent physical basis. Her relationships with other children were satisfactory. She and Norma were described as inseparable companions.
It is clear that in psychological development, needs, and relationships to each other and to the parents the two girls were strikingly different. All these factors had to be considered in planning for foster care. Because of Norma's complex attachment to both parents, her resistance to place- ment, and the parents' attachment to her, it could be foreseen that she
would be unable to accept a relation- ship with substitute parents and that her parents would be unable to free her to do so. Also it was apparent that she needed intensive casework help to resolve her conflict about the separation, correct her distorted con- cept of her triangular role in the rela- tionship between the parents, and realistically evaluate her relationship to each of them and their meaning i to her. :
For Ann, from the standpoint of I her age and the lack of complicated ! involvement with the parents, one j would first consider foster-home care, I but two factors suggested a different I plan. First, her fear of men needed ; to be observed in a setting where its intensity could be evaluated, without subjecting her to too great anxiety from close proximity to a foster father. And secondly, the meaning of the relationship between her and Norma was not sufficiently clear to show whether the development of both girls would be facilitated by separating them or by placing them together.
Sisters placed in group home
Ordinarily, we would wish to place these children together. But with emotionally sick families, where the children have had to share the meager love of immature parents, the ordinary relationship between brothers and sisters usually is sup- planted by rivalry and hostility. Fail- ure to recognize this before placing children of the same family together often leads to the necessity to sepa- rate them later and place one of them with another foster family. When this occurs the child who remains in the home may feel responsible for his real or imagined part in pushing out the child that he hated; the one who leaves may feel that he is so "bad" that not only his own parents can't love him, but neither can the substi- tute parents, who can love his brother or sister. Such conflict can be modi- fied through skillful casework help, but it is safer to avoid those damag-i ing complications whenever possible, even if this means a temporary period in an institution. For these reasons it was decided to place both girls in
76
THE CHILD VOL. 17 No. 5'
the agency's group home.
In the early months it was noticed that during the parents' weekly visits they centered their attention on Norma and were indifferent to Ann. This confirmed the depth and extent of the neurotic involvement in the relationships between Norma and the parents, and it could be foreseen that this would not be quickly dissolved, if ever.
In the group home Norma was ex- tremely jealous of Ann in her rela- tionships with other children and with houseparents. She felt displaced by Ann when she could not establish herself as the favorite. She tended to domineer and boss Ann in all ac- tivities. Ann gradually withdrew from Norma's domination and re- sponded warmly to kind, protective care. We soon realized that the two girls needed to be separated. Norma's relationship with the parents had to be continued on a regular basis and under adequate supervision, since neither she nor the parents would be able to tolerate separation. Ann, on the other hand, showed no need for the parents when substitute relation- ships were offered her.
After a year in the institution, Ann's fear of men seemed to have dis- appeared, as a result of her experi- ence with kind and consistent male staff members and the help the case- worker gave her in expressing her fears and clarifying the difference between men.
As she drew away from Norma, she developed her own friends and interests, and became an attractive, vivacious, lovable youngster. We real- ized that she needed to be cherished by sensitive foster parents to give her the long-time, sustained protection from hurt that would decrease her vulnerability to rejection. She was placed with foster parents who had some wish to adopt her. They were outgoing, friendly, gentle, and sensi- tive. The foster mother delighted in caring for her — sewing and selecting clothes for her and providing health- ful group activities. Ann enjoyed the experience of seeing herself as a loved and worthwhile person in the eyes of both foster mother and father. Like Bill, she has now been in her present
home for more than 4 years.
Norma, because of the problems already described, remained for 3 years in the agency's institution, where it was possible to provide reg- ular casework treatment. When she showed more capacity to deal realisti- cally with herself and her parents and greater personal security in her performance in school and in music, she was moved to a girls' school. This school was selected because the pro- gram offered minimum demand for personal relationships; a full pro- gram of activities; opportunities for recognition for performance in the various areas of her talents, such as music and art ; and routines and rules that would help develop the conform- ing side of her nature. In such an environment, this child could develop skills without being thrown into further conflict by interference with her ties to her parents or by demand for closer relationships with other adults.
She has made as much progress as possible for a child so damaged by neurotic parental attachments. She has begun to take pride in her per- formance as such, as contrasted to earlier intense and anguished rivalry with other children.
The agency's work with the par- ents, throughout the 5 years these children have been under care, has been based on the initial evaluation of their characters and the meaning of the relationships between them and the children. The father eventu- ally withdrew from all contacts with the agency and the children. Our ef- forts to help the mother, geared to- ward enabling the children to main- tain and use their placements con- structively, have included keeping her closely informed about the chil- dren, thus easing her feeling of guilt and her sense of worthlessness as a parent, helping her verbalize rather than act in regard to the children, and freeing her from financial re- sponsibility for their care at points where she was unable to pay. We have used this method to help this basically dependent, distrusting mother to trust the agency with the care of her children, since it was only through experiencing such care her-
self that she could permit the children to experience it. Through this kind of relationship she has been able, for the most part, to respond to the guid- ance of the caseworker and act on the agency's advice for the best interests of the children. The present immedi- ate casework goal is to help her re- linquish Ann and Bill for adoption and to maintain Norma's placement until she has completed high school.
We see here how the study and treatment center served several im- portant purposes. The girls' relation- ships to their parents and each other became clear. The desirable degree of separation from each other and from the parents could be evaluated and the degree of individual person- ality damage determined. The plan- ning of institutional care for Norma and foster-home care in a potential adoptive home for Ann was based on evaluation of this combination of fac- tors. In addition, the casework treat- ment, in this neutral but protective setting, prepared them for the types of care in which they could develop.
The use of a diagnostic and treat- ment center is not typical of the cases studied in a placement agency, but the areas of observation, diagnosis, and evaluation delineated here are applicable to all cases. Less complex cases can be studied while the child is in his own home.
Many factors to be weighed
A child separated from his family is a complicated human being, and the therapeutic resource consists of one or more human beings, less com- plicated but nevertheless subject to the usual human responses. The ob- jective of the principles and methods discussed is to bring these two to- gether, not in predefined, categorical combinations, but rather with refer- ence to the infinite variations in each personality, to meet the distinctly dif- ferent needs of each case. To do this, we must weigh all the known factors and arrive at a conclusion that satis- fies the demands of our current knowledge of personality develop- ment and individual dynamics, of the meaning of family relations, and of the unique characteristics of place- ment.
Reprints in about 6 weeks
JANUARY 1953
77
SICK CHILDREN BENEFIT FROM A CITY'S HOME-CARE PROGRAM
VIRGINIA INSLEY
IN RICHMOND, VA., the city health department's program for home medical care does more than just send a city doctor into the homes of people who are too sick to go to a clinic and who cannot af- ford to pay a private doctor. The pro- gram gives complete care to these patients, integrating its home medi- cal service with the services of clinics, hospitals, and other agencies in the fields of health and welfare. The home-care program provides the ser- vices not only of physicians, but of medical social workers and public- health nurses.
The home-care program also works to improve medical education by in- troducing future practitioners to family social and economic problems that affect their patients — something their hospital training as a rule does not do. The opportunities given these young men and women to discuss with physicians, public-health nurses, and medical social workers the situ- ations that they observe in patients' homes undoubtedly will make them better doctors.
More than half the patients who receive home care are under 20 years of age; large numbers are under 4. And besides the children actually treated, many more benefit through the home-care services provided to their families.
Until the present home-care service, began to function, in 1949, the health department was giving a limited kind of home medical care to patients who could not get any other.
For many years, in each of five dis- tricts of Richmond, a part-time doc- tor, employed by the year, was as- signed by the department to visit patients in their homes, with an addi- tional doctor to provide for a rotating assignment to answer night calls. One of these physicians would visit a patient, often after some delay, but
unless he was specifically called again he did not return.
If the patient was taken to a hos- pital, the physician who had called at his home did not see him in the ward, nor later in the out-patient de- partment. Nor was any record given to the physician of ward or out- patient treatment. After a patient had been discharged from the hos- pital the city doctor did not keep in touch with him. Often the patient did not follow the hospital recommen- dations, with the result that he had to be returned to the hospital for further care.
Social workers and public-health nurses found it impossible to get the kind of medical support they needed in caring for a patient at home.
The cost of the program was high and the medical results were poor.
The Director of the Health Depart- ment realized that the system was un- satisfactory both from the humani- tarian and the economic standpoint. He felt that if sick people were diag- nosed sooner, if they were cared for with some continuity, and if the so- cial and emotional factors in their ill- nesses were considered by the doctor who visited them, the program could be worthwhile. Fewer of the patients would become severely ill, and more would be restored to a productive place in the community. Also, fewer people would need hospital care, and the cost to the city of caring for the sick would be reduced.
VIRGINIA INSLEY received her master's degree from the Graduate School of Social Work, University of Washington, where she completed the medical social work sequence. She has also studied in the Boston Psycho- analytic Institute.
Miss Insley has worked in the Washington State Health Department and in the Social Service Department of Beth Israel Hospital, Boston.
For 2'/2 years Miss Insley was on the staff of the Department of Public Health, Rich- mond, Va., where she initiated social services in the health department and carried special responsibility in connection with the home- care program that she describes here. She has recently joined the staff of the Chil- dren's Bureau.
In 1947, the Director of the Health Department asked the Richmond Area Community Council to appoint a committee to study the whole prob- lem and recommend a better plan.
The committee worked for a year on the problem, consulting many per- sons concerned with health and wel- fare, such as practicing physicians, nurses, and social workers, and mem- bers of the faculty of the Medical College of Virginia.
In conference with the committee, members of the Medical College fac- ulty discussed the fact that medical students, internes, and resident phy- sicians in the two hospitals affiliated with the College had no opportunities to observe, and try to solve, patients' personal and family problems, the kind that doctors have to face in prac- tice. The patients seen by these young men and women usually were brought to them because of some ad- vanced, unusual, or obscure condi- tion, and no patients were seen under the circumstances of usual medical practice, that is, at home.
Joint plan adopted
It seemed clear that the College would gain an important teaching advantage if it accepted responsibil- ity for cooperating with the Health Department in providing well-super- vised medical care to patients in the city's low-income group, and that the patients would benefit tremendously from this care. And apparently the cost to the city would not be higher than it had been, and might be lower. Therefore both the Health Depart- ment and the College favored a plan for joining forces in providing home care to the sick.
After careful consideration all around, and with the approval of the Richmond Academy of Medicine, the committee recommended that the city adopt the cooperative plan that is now in operation. A grant from the Commonwealth Fund made it possible
78
THECHILD VOL. UNO. 5'
to start the program as a demonstra- tion; it was continued until the Health Department and the Medical College were able to take over full re- sponsibility, in 1952.
Under the plan, which is part of the over-all program of Richmond's City Department of Public Health, Medical College faculty members on the staff of the Health Department are responsible for supervising the medical care given by the department in the homes and for coordinating this care with any hospital care in a ward or the out-patient department. The medical staff of the program con- sists of three physicians who are faculty members, one of whom is clinical director of the program. These three physicians supervise the work of seven senior students, as well as of three resident physicians as- signed to the two hospitals affiliated with the college. Each student serves on the home-care staff for 3 weeks ; each resident for 10 weeks.
When a call comes in from a sick person's family, or from any individ- ual or agency interested in the case, two senior medical students are sent to visit the patient. (The students are not accompanied by a physician on their first trip to a patient's home, as the program believes that this de- tracts from the students' interest and feeling of responsibility.)
After examining the patient, gain- ing an impression of his personality, and studying his household, the stu- dents make a tentative diagnosis. They then go back to the clinic that is their office and write a brief re- port, which contains the salient facts about the patient's medical and social problems. The report should include notes on any physical conditions in the home that might affect the pa- tient's health. A resident physician reviews the case with the students, and then all three go to the patient's home. After this visit they discuss the case with one of the three super- vising physicians, who may also visit the patient's home if he considers this necessary. A pediatrician paid by the Health Department is available for consultation.
If the supervising physician de- cides that the patient needs to be
Home medical care can make a valuable contribution to a total health and welfare program.
treated in the hospital or in a special clinic, this is done, and the case is followed throughout the treatment and afterward. Home visits are con- tinued, if necessary. If laboratory work is needed, or X-rays, these are provided ; likewise facilities for physical medicine. Social service and nursing care are available, and some- times homemaker service, all paid for by the Department of Health.
For patients who continue to be treated at home, such sickroom equip- ment as hospital beds and wheelchairs can be rented at the expense of the Health Department. Drugs and dress- ings are provided by the department, with some help from the Cancer So- ciety.
Medical students and residents are expected to obtain the facts of the family's social situation as well as the medical problems ; they are helped to understand the social factors by members of the social-work staff, who participate in daily discussions among students, residents, medical preceptors, and the clinical chief. Members of the medical staff and the social-work staff, medical students, social-work students, supervisors
from public-health-nursing agencies and the director or assistant director of the Health Department attend two clinical conferences each week, in which home-care cases are presented by medical students and discussed by the entire group. Social workers from the Welfare Department are in- vited when cases known to them are discussed.
Integration of services necessary
Since the idea of the present home- care program was first conceived, the Health Department recognized that the program could succeed in ful- filling the community's needs only in- sofar as it could be integrated into the structure of health and welfare services. Integration of medical ser- vices to patients seen at some points by home-care physicians and at other times, often within a few days or hours, by physicians in hospitals or clinics, is of course essential to qual- ity, continuity, and economy of medi- cal care.
Abbie Watson, Director of Rich- mond Instructive Visiting Nurse As- sociation, discusses the cooperation of nursing agencies in an article entitled
JANUARY 1953
79
"The Public Health Nurse in the Richmond Home Care Program" {Public Health Nursing, May 1952).
Social agencies in Richmond refer sick children to the home-care pro- gram for medical visits; they also give social services when these are requested, and they exchange medical and social data with the social-work staff of the program. The agency most concerned is the city's Welfare Department, which, through Aid to Dependent Children, contributes to the support of a large number of the children who receive medical care at the city's expense. This department i!i also responsible for the care of a number of children in foster homes who receive home medical visits. These children often have medical and social problems that require close cooperation between the home-care program and the Welfare Depart- ment.
Valuable service to children has been given by the Welfare Depart- ment's protective services in dealing with social conditions discovered through home-care visits. And the doctors on the staff of the home-care program have been helpful in evalu- ating the physical care given children by parents accused of neglecting them.
Program follows through
An example of the way the pro- gram works to give complete care to a sick child, from the onset of an acute illness through convalescence, is the case of 13-year-old Edna:
When Edna fell ill, with a very sore throat, her aunt, with whom she lived, telephoned to the city Health Department for a doctor. Two senior medical students went to the three- room apartment where Edna and her aunt lived. The apartment had run- ning water, but it had only an outside toilet.
The students learned that since the death of the aunt's husband, she and Edna had been supported by pay- ments from his insurance, but that these had come to an end, and that she had applied for public assistance.
After examining the child, the stu- dents returned to the Medical College and reported to the resident physi- cian on duty that in their opinion she
80
had acute tonsilitis and that they suspected that she had a kidney dis- ease also. The resident then went with them to the child's home, con- firmed the diagnosis of acute tonsil- itis, and treated her.
The next step was to take Edna to the out-patient department of the hospital for further studies. A diag- nosis of kidney disease was estab- lished, and the child was admitted directly to the hospital. After 9 days of treatment, she was returned home for an indefinite period of bed rest under medical supervision.
In the home-care conference that followed Edna's discharge from the hospital it was decided that a public- health nurse and a medical social worker should evaluate the adequacy of her home as a place for carrying out medical recommendations, also that the services of a home teacher should be requested so that Edna would not fall behind her class.
The public-health nurse, after visiting the home, repoi'ted that Edna's aunt seemed capable of learn- ing how to care for the child during her illness, and that she was likely to do a good job, with supervisory visits from the nurse. In order to make Edna more comfortable, the nurse obtained a hospital bed, an over-bed table, and a bed pan from the Sick Room Loan Chest, a private agency with which the Health De- partment contracts for renting equip- ment.
The home-care medical social worker learned that Edna had been living with her aunt for 2 years — ever since her mother had died. Their relation- ship was good, and both wanted to continue living together if some plan could be worked out for support. (The aunt's general public-assistance grant would not take care of them both.) Aid to Dependent Children was considered, but the Welfare De- partment found that they were not eligible for this, as the aunt, who had been reared by Edna's grandparents, was not really a blood relative. A plan under which the Welfare Depart- ment would make payments to the aunt as a foster mother was then car- ried out. Under this plan the home- care program was responsible for interpreting to the Welfare Depart- ment Edna's special needs and mak- ing sure of the aunt's ability to care for her.
Three months after the aunt first called on the home-care program for help, the program discharged Edna and placed her under the supervision of the hospital's out-patient depart- ment, recommending that she in- crease her activities gradually and that she continue studying with the home teacher. The hospital's social- service department was asked to take the responsibility for interpreting to the Welfare Department medical rec- ommendations concerning the child.
The way in which an integrated medical-care program can work to
(Continued on joage 85)
Hospital care may be partly wasted unless there is a plan for continued care at home.
Jte, /
POINT IV AND THE CHILDREN OF THE PUNJAB
U. S. Government helps a Pakistan Province reestablish some social services for children
PAUL R. CHERNEY
IN THE PUNJAB, which used to be part of British India, but now — since 1947 — is a province of the new Mushm nation of Pakistan, live many thousands of orphans — their parents killed during the bloody ex- change of populations that took place at the time Pakistan separated from the rest of India. With millions of Muslims crowding into the Punjab and other parts of Pakistan, and mil- lions of Hindus and Sikhs struggling to get away from Pakistan into the Hindu provinces, trainloads of men, women, and children were mutilated or slaughtered.
More than half the Muslims that fled into Pakistan settled in the Pun- jab, after remaining for various pe- riods in its capital city, Lahore.
The resulting increase of popula- tion taxed the city's resources, as most of the incoming refugees were poor, and ill-equipped to earn an ade- quate income. And since the depart- ing Hindus included many of the teachers, social workers, and those supporting children's services, these services were seriously curtailed or in many instances eliminated entirely. With thousands of children left home- less, and practically nothing done for them, it is not strange that 3,000 beg- gar children were roaming the streets of Lahore in 1951 — three times as many as in 1938.
PAUL R. CHERNEY is Executive Secretary of the Family and Child Welfare Section, United Community Services of Washington, D. C.
He was formerly with the Children's Bu- reau; while on the staff of the Bureau he directed a demonstration community-organ- ization project in Newport News, Va., and later served as Regional Child Welfare Rep- resentative for Kentucky, Michigan, and Ohio.
Mr. Cherney's previous experience in the Far East included a childhood spent in China and work in education and welfare as a military government officer in Japan.
Half a dozen years before Pakistan became a Muslim nation, the Punjab Children's Aid Society was founded by Mrs. Rameshwari Nehru, a cousin of India's present Prime Minister, to work for the protection and well- being of children in the Province, especially those who had no one else to look out for them.
The Society was established as a private organization, but was mainly supported by the Punjab Provincial Government. Its executive and most of the members of its central commit- tee were Hindus.
The Society helped to raise stand- ards of care in orphanages and made efforts to improve the treatment of juvenile delinquents. It provided some direct services, maintaining a temporary shelter for children, oper- ating seven play centers, and arrang- ing periodic outings for children in congested neighborhoods. These di- rect services were carried on in the city of Lahore and did not reach the rural sections of the Punjab, though the Society's constitution provides for work outside the city as well as within it. The Society also did con-
siderable groundwork for enactment of basic legislation for the care and protection of children. (This bill, called the Children's Bill, is before the Punjab Legislature as we go to press, and is expected to pass.)
When the Hindus fled from Pakis- tan in 1947 the Society was left with- out an executive and practically with- out a central committee. Also, the building that housed its headquarters and the children's shelter was taken over by the Provincial Government as evacuated property and was used for housing refugees.
First steps taken
For 2 years efforts to provide any services for children were at a stand- still. Then the few remaining mem- bers of the Society's central commit- tee— Muslims and Christians — set to work to rebuild the committee, and gradually it was built up to 12 active members, with Muslims in the major- ity. The committee members, how- ever, were new in this type of work and knew little of what is necessary in a child-welfare program. How- ever, the committee succeeded in en-
Syed Hasan, Chief Welfare Officer of the Punjab Children's Aid Society, examines a display of handwork at one of the play centers operated by the Society in the city of Lahore.
JANUARY 1953
81
gaging- an executive, a Muslim refu- gee who had some social-work train- ing and some experience in work with children. I say "succeeded in engag- ing" because this man was, and is, so far as I know, the only person with social-work training in the Pun- jab. The municipal government of Lahore and the Punjab Department of Public Instruction gave the Society some money to operate a program, but little was done at that time.
Enter Point IV
Late in 1951 the Pakistan Govern- ment requested the United States Government to send a social worker to advise the Society on the reorgani- zation of its services, under the gen- eral agreement for technical coopera- tion between the two countries. I was assigned to do this work, and I ar- rived in Pakistan in April 1952, to remain there till early in August.
The question then was how best to help the Children's Aid Society to serve the children of the Punjab. I was sure of one thing — that the social-work methods and techniques of one country cannot and should not be imposed on another; that social services in any place need to grow out of the concern that the people in that place feel for one another.
But I recognized also a common denominator between my own coun- try and the one I was sent to help; it is a similarity in religious thinking
that motivates the more fortunate to help the less fortunate.
Besides, I realized that in both countries social consciousness is growing, and that this has found ex- pression in the spontaneous efforts of private individuals and groups and in Government action to promote mea- sures for the well-being of the people.
But like anyone else from the West who goes into a country in the Far East, I soon noticed an approach to- ward social problems that is different from ours.
In the Far East life is cheap; the individual is less important than in our Western culture. The social prob- lems are so great and so over- whelming that the tendency is either to shrug one's shoulders and say that nothing can be done, or else to em- Iiark upon a mass program. Our idea of starting in a small way, of dealing with individuals, is foreign to their thinking.
Closely related to people's lack of interest in the individual is the idea that development of measures for welfare must be postponed, or de- emphasized, in favor of efforts for economic development.
Again, I found little tradition for voluntary effort. A few voluntary programs have developed, but these are exceptions. I found little spon- taneous community action to meet a community problem. The tendency at
At a games festival, the winner of a contest is congratulated by the author of this article.
the moment seemed to be to look to the Government for everything.
I realized that efforts to improve the care of children are handicapped by the low status of women. This status is changing, but in the cities the vast majority of women are still kept in seclusion (purdah) and do not appear in public except with their faces covered with a hurqa. Their activities are severely restricted, and their participation in community af- fairs is very much circumscribed. They have not been considered worth educating, and even now, with the present emphasis on extending educa- tion, only 15 percent of the girls of primary-school age (6-11) in the Punjab are in school, as compared with 55 percent of the boys.
Subcommittee studies ths program
As the first step toward the reor- ganization of the Society's services, the central committee designated a subcommittee, at my request, to (1) examine all aspects of the present program, (2) study the unmet child- care needs of the community, (3) de- termine what services might best be provided by the Society, and (4) formulate plans for a new program to be presented to the Society's cen- tral committee.
We noted that the Society was oper- ating the seven play centers, as it had before 1947. Only one of them had a paid supervisor. The others depended on volunteers, with unsuccessful re- sults.
The Society had picked up again on the work with orphanages, and in the previous year the executive had visited nine of them. These were operated under Muslim auspices and appealed for voluntary support on the basis of Zakat, a fundamental tenet of Islam that wealth over and beyond the needs of modest living is to be used in giving assistance to persons who have been unable to obtain their share according to their needs — espe- cially widows and orphans. The ex- ecutive found that only four of the orphanages were adequately operated with regard to feeding, medical ser- vices and sanitation, recreation, and school facilities. Several of the insti- tutions had very poor conditions, and
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THE CHILD VOL. 17 No. 5 |
one, referred to as a "beggars' school," was closed by the Governor of the Punjab after the Society had brought its conditions to public at- tention.
The Society was looking forward to passage by the Punjab Legislature of the previously mentioned Chil- dren's Bill, which includes provisions for the protection of dependent and neglected children, and the Youthful Offenders Bill, which relates to de- linquent children. The proposed leg- islation provides that the Govern- ment shall designate "a society" to carry out its provisions. If the pat- tern that has been established in other major cities of the Indian subconti- nent is followed in the Punjab, the Children's Aid Society will be called upon by the Government to carry out the pi'ovisions of this act. In April 1952, however, the Society was not prepared to assist in setting up a program under the new legislation. (For one thing, its executive was its only staff member, other than a mes- senger.)
The chairman of the subcommittee, the widow of a former Deputy Gov- ernor of the Punjab, had recently been elected a member of Lahore's city council and was influential in the Muslim community. The other mem- bers of the subcommittee were two Muslims and two Christians. It was an interested and hard-working group, with almost perfect attend- ance at every one of the weekly meet- ings, which took place in May and June. This was notable in view of the temperatures of 110^ to 116° which prevail in the Punjab at that time of year.
How the program stands today
The subcommittee on reorganiza- tion made a number of recommenda- tions to the Society's central commit- tee, and all but one were accepted. The Society began at once to put the recommendations into effect, and the present status of the program may be described as follows :
Recreation centers. Paid super- visors have been appointed in each of the seven recreation centers, part time. The pay is sufficient to interest I college students. As it is impossible
to find people with training or experi- ence in this kind of work, selections were made according to an estimate of each applicant's potentialities based on his personality, school rec- ord, and employment history. The paid supervisors help to sustain the interest of the volunteers.
Individual services to families and children. As a start in giving indi- vidualized social services, the Society has added to its staff two welfare officers, full time, to give "direct and individualized assistance to children and families who can be expected to respond constructively to such help, including financial assistance, family counseling, child guidance, and direct care of homeless children."
Shelter facilities. Children who are left without father or mother often need temporary care, and help in being placed in the home of rela- tives, or in an orphanage, or else- where. At present unattached chil- dren are exploited by bogus orphan- ages and by beggars and criminals, or they work as underpaid servants in private homes. There has been no facility for temporary care of chil- dren since the Society's building was taken over as a refugee center.
Therefore the Society plans to re- establish a small shelter for tempo- rary care of homeless children. But first it is trying to work out a pro- gram for such children in cooperation with one of the existing children's
institutions with good standards. This would be done on a contract basis, and it would be considerably less expensive than setting up a sepa- rate facility. Besides, a cooperative relationship of this kind would bene- fit both agencies.
Recreation in children's institu- tions. Two relatively good institu- tions requested the aid of the Society in developing recreational programs. One is caring for more than 300 refugee children, the residual of some 3,500 who have been cared for and resettled by this home. The other — for the deaf and dumb — is new. The two occupy different parts of what was once a Hindu college.
The Society now employs a recrea- tion worker who divides his time be- tween the two institutions. Here is an opportunity for the Society to de- velop close relations with two impor- tant children's services. Both have resources that the Society will even- tually need to call on if it is to evolve a well-rounded program.
Reorganization of the central com- mittee. I proposed that the terms of office of the Society's officers and the members of the central committee be rotated. This would provide oppor- tunity to different people to lead the work, and it is well known that when a person once assumes such responsi- bility he usually can be counted on to become a lifelong friend and sup-
{Continui'd on page 86)
A game of "Kab-bad-di" is enjoyed by both players and spectators at the Water Works Play Center. The water works for which the center is named can be seen in the background.
JANUARY 1953
83
WHEN A CHILD IS DEPRIVED OF MOTHERING
A Comment on Bowlby's "Maternal Care and Mental Health"
LEON J. YARROW
MENTAL-HEALTH workers agree that lack of a warm, continuous relationship with his mother or a mother substitute during a child's early years may lead to later personality disturbances.
A number of studies of the effects of depriving children of such mater- nal care have been reported by Dr. John Bowlby, Director of the Child Guidance Department of the Tavi- stock Clinic, in London, at the re- quest of the World Health Organiza- tion. In a monograph, "Maternal Care and Mental Health," Dr. Bowlby analyzes research findings about chil- dren so deprived, and discusses the implications of the findings for so- cial-welfare programs. First he pre- sents evidence from research and con- siders its contributions to psycho- dynamic theories of personality de- velopment. Secondly he analyzes the social conditions that lead to depriva- tion of maternal care, and he makes suggestions for preventing such de- privation and alleviating its effects.
The findings are based on three types of studies: The first type in- cludes studies of the mental health and development of children in insti- tutions, hospitals, and foster homes, made by direct observation of these children. The second group of studies is made up of investigations of the early histories of adolescents and adults who have developed psycho- logical illnesses. And the third class comprises follow-up studies of the mental health of children who have been deprived of their mothers in their early years.
The direct studies show clearly that children deprived of their mothers,
LEON J. YARROW is Assistant Chief of the Child Development Research Branch in the Research Division of the Children's Bureau. He was formerly Research Psychologist on the staff of the Child Research Council, University of Colorado School of Medicine, where he took part in a longitudinal study of the growth of normal children.
with no warm and loving substitute, are retarded in their language devel- opment and in their social and adap- tive behavior. Dr. Rene Spitz's studies of infants in emotionally sterile institutions demonstrate dra- matically the psychological — as well as the physical — impact of extreme deprivation of this kind. Other studies found the same patterns of intellec- tual retardation and emotional blunt- ing in older children who had lived in institutions over a period of years.
Life histories studied
The retrospective studies review a great deal of evidence based on the histories of adolescents and adults who were treated in psychiatric clinics or brought before juvenile courts. A common background factor in one group of persons, who were called by Bowlby "affectionless char- acters," is a history of being placed in an institution very early in life, or otherwise being separated from their mothers or mother-substitutes. The outstanding characteristic of these persons is an inability to establish genuine, warm human relationships.
The follow-up studies tend to sup- port the general findings of the direct and the retrospective investigations.
W. Goldfarb, who has contributed
the major share of the studies, sum- marizes concisely the chief effects of deprivation in early life on the per- sonality. The children brought up in institutions, he finds, "present a his- tory of aggressive, distractible, un- controlled behavior. Normal patterns of anxiety and self-inhibition are not developed. Human identifications are limited, and relationships are weak and easily broken. . . . Finally, the fact that personality distortions caused by early deprivation are not overcome by later community and family experience must be stressed. There is a continuity of essential traits as late as adolescence. If any- thing, there is growing inaccessibility to change."
From a research point of view, it would have been desirable to analyze critically the methodological limita- tions of these studies. Such an analy- sis would point up the need for better designed and more carefully con- trolled studies to clarify or elaborate on the significant nuances of these early relationships that lead to emo- tional or personality disturbances.
The sheer mass of evidence in sup- port of the basic thesis that extreme emotional deprivation in infancy re- sults in personality disturbances is overwhelming. It should be empha-
What is believed to be essential for mental health, says Dr. John Bowlby, is that the in- fant and young child should experience a warm, intimate, and continuous relationship with the mother (or permanent mother-substitute), in which both find satisfaction and enjoyment.
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THE CHILD VOL. 17 No. 5
:*
sized that the majority of the studies are based on circumstances of ex- treme deprivation resulting from prolonged stay in an institution. For practice as well as for basic theory, we need research on the effects of less extreme deprivation, as well as critical studies of the extent to which subsequent favorable experiences can overcome or mitigate the effects of very early traumatic experiences.
Bowlby does not distinguish sharply between the effects of separa- tion, of deprivation, and of institu- tionalization. The experience of sepa- ration— a break in the continuity of the mother-child relationship — can be differentiated from that of depriva- tion. Deprivation essentially involves a lack of warm mothering either by the mother herself or by a substitute. Institutionalization may involve both separation and deprivation, but may be different from either in that there is prolonged absence of a consistent mother-figure.
None of the studies gives any clear evidence on the highly significant question for adoption practices — that of the age at which separation from the mother is most damaging. Most of the studies suggest that the second half of the first year is the critical period; some indicate that separa- tion during the first 6 months is equally traumatic. The basic hy- pothesis that needs further testing is whether the crucial age is that at which the child has begun to identify himself with a mother-figure. We need to consider also how individual differences among infants may in- fluence the degree or nature of per- sonality damage.
Another significant question is: What is the effect on the child of the kind of mothering he has had before being separated from his mother or mother-substitute? If a child receives "warm mothering" before the sepa- ration, this, of course, may increase the severity of his immediate reac- tions. Still, one might hypothesize that the loving relations that existed between mother and child in his early life might provide the child with a foundation for forming new close relationships, and thus lessen the probability of later damage being
done to the child's personality.
Bowlby, of course, recognizes the need for further research, and is cur- rently engaged in such research. In the November 1951 issue of the Courrier of the International Chil- dren's Center (Paris), Rosenbluth, Bowlby, and Roudinesco offer sug- gestions on some of the factors to be considered in further studies on separation. ("Separation from the Mother as a Traumatic Experience for the Child: Some Notes on Ob- taining a Relevant History.") Some of these factors are the age of the child at separation, the length of the separation, the quality of the mother- child relationship before separation, and the quality of the substitute mothering. In evaluating the effects on the child of the separation experi- ence they suggest as significant ob- servations : The child's initial re- sponses to separation (screaming, regressing, fretting, withdrawal, de- pression), his later adjustment as the separation is prolonged (quality and degree of discrimination of new re- lationship in environment), and his reactions when reunited with his mother.
In the light of the evidence, Bowlby develops in some detail recommenda- tions for foster care, adoption prac- tices, and hospital care of children. He advocates that sick children, whenever possible, should be cared for at home. If a child is hospitalized, he recommends that the mother be allowed to remain with him in the hospital. If a child is to be adopted, Bowlby recommends the adoption as soon after birth as possible. While maintaining firmly that the "right place for a child is in his own home," Bowlby recognizes that in certain situations care outside of the home is necessary. He feels this should be undertaken only as a last resort, when it is impossible to make the home fit for the child.
This work will certainly have an impact on social-work practice. Be- yond its application to the immediate problems with which it is concerned, it represents a significant contribu- tion by demonstrating the close inter- dependence of psychological theory and social-work practice.
HOME-CARE PROGRAM
{Continued from page 80)
guard the physical health of a child whose mother is sick, and to protect both from too much emotional shock caused by separation is shown in the story of Bobby S, 9 years old.
Bobby's mother had felt increas- ingly ill ever since her husband was admitted to a mental hospital, 6 weeks before. At last she telephoned the home-care ofliice. The medical stu- dents who visited her diagnosed pneumonia, and reported this diag- nosis to a resident physician, who went to the home and confirmed the diagnosis ; he also raised the question that Mrs. S. might have tuberculosis, and recommended X-ray studies.
Next, arrangements were made for Mrs. S to talk with a medical social worker about making plans for Bobby in case the X-ray studies established the fact that she had tuberculosis and needed hospitalization.
Mrs. S was taken to the hospital in an ambulance for the X-rays. But before being admitted to the hospital for treatment, she was taken home in an ambulance so that she could ex- plain to Bobby what was happening, and could tell him that she would have to stay away from him for some time, and why. This kept him from being frightened by her absence.
The medical social worker ar- ranged with a children's agency to find a foster home where Bobby could stay until his mother could return.
Mrs. S was treated in the hospital for pneumonia and later was trans- ferred to a tuberculosis sanitarium.
Since Bobby had been exposed to the danger of catching tuberculosis from his mother, the doctor arranged with a public-health nurse to see that he received adequate and continuous health supervision, including regular check-ups at the hospital chest clinic.
Thus, through the home-care pro- gram, not only were the mother's medical needs fulfilled, but her mind was set at rest by the knowledge that her boy was well cared for. Bobby was benefited through the thoughtful and sensitive action of the doctor who saw to it that the mother had the opportunity to prepare the little boy for the necessary separation.
JANUARY 1953
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It is not remarkable that a pro- gram set up to give good home medi- cal care, with consideration of social factors, can evaluate the total needs of chronically ill patients treated over long periods of time. It is more difficult, and probably more impor- tant from a preventive standpoint, to find and deal with the problems of patients and their families seen only once or twice for minor illnesses.
The majority of children seen by home-care physicians have diseases such as measles and upper-respii'a- tory infections. Despite the fact that these diseases usually require only two or three medical visits, it is fre- quently possible for students and residents to learn to recognize symp- toms of serious medical and social pathology in these visits. The home- care program is often the means of introducing patients and their fami- lies to other community services which may be helpful in the future. A child whose heart murmur was dis- covered by a medical student, a fam- ily whose landlord refused to repair the plumbing, and a mother who ob- viously preferred one child to another were all referred to appropriate agen- cies in the course of visits requested for treatment of measles.
Although the agencies that helped to solve these problems were avail- able in the community where the problems were found, it is unlikely that these families would have known of these agencies or would have seen the need for their services without the help of the home-care program. It is certain that many medical and social problems are thus discovered and dealt with before they reach serious proportions.
In conclusion it may be said that many medical and social problems of children in economically underprivi- leged families can be found and treated in a program operated by a health department and a medical school. Many other children may benefit, as the future patients of medical students and resident phy- sicians trained in the program. And all the children in the city should benefit from growing up in a healthier community.
Reprints in about 6 weeks
PUNJAB
(Continued from page 83)
porter. This, however, was a new idea to the committee, and it was not possible for all of them to accept it, and so action on the proposal was postponed.
Finances. For several years the Society had been spending less than the amounts granted it by the Pro- vincial Government, and a surplus had accumulated — enough to finance the new program for almost a year. Soon, however, more money will be needed. And I recommended that it would be better if the Society sought funds not only from the Government but also from voluntary contributors. This would bring more people into direct contact with the work of the Society — a result that might benefit the program even more than the ac- tual funds contributed. At present, though some persons are contributing to help care for orphans and for other worthwhile causes, many give only to beggars.
I suggested that a committee of in- fluential men and women be organ- ized to make an annual appeal to the community on the basis of Zakat and charity to support the part of the So- ciety's program that helps widows and homeless children.
What of the program's future? It seems to me that this depends largely on what can be done to obtain profes- sional training for social-work per- sonnel. Some steps have been taken toward making such training avail- able. In the fall of 1951 the trustees of Punjab University authorized es- tablishment of a committee to con- sider ways and means of establishing a diploma course in social work. Co- operative relationships have been es- tablished between the United Nations technical-assistance program and the Pakistan Government to assist Pun- jab University and Pakistan in estab- lishing facilities for this course.
If the Society can carry out its pro- gram successfully, this will be a most important step toward integrating children's services. The recreation centers are strategically placed to reach the locations where child-care needs are greatest. They should in-
fluence the adults of the neighbor- hood to take more responsibility for improving neighborhood conditions that affect the well-being of the chil- dren and also to bring to the atten- tion of organized services the prob- lems that cannot be met by the people unaided.
The individual counseling service just getting under way will focus on the child as an individual and will concentrate on strengthening his family. This approach will empha- size that almost every threat to the well-being of child and family is many-sided and that help should be drawn from several different facili- ties— from health service, from school program, from economic and employment aid, and so forth. It is the responsibility of the welfare offi- cer to seek out and use these different resources in dealing with problems of families and children.
Whether the program can be car- ried out will depend on the skill and understanding of the personnel. Or- dinarily professional training is re- quired to develop the skills essential for such work. Up to now such train- ing has not been available in Pakis- tan but, as I have indicated, is now being started under the sponsorship of the central Government. The mem- bers of the new staff have been care- fully selected and show great prom- ise, and we expect that they will soon obtain the professional training that they need.
The significance of the Punjab Children's Aid Society reaches far beyond the size, scope, and variety of services that it will be able to undertake in the immediate future. If its new program is successful the Society's efforts will mean much more for child welfare than they do now. But we shall note the significance of its work in the extent to which it can demonstrate the effectiveness of the scientific approach in alleviating so- cial problems, in arousing community interest, and in obtaining widespread participation in and support of social work for children. Its success will depend on how much it contributes to the development of a coordinated community program of services for the care of children.
86
THE CHILD VOL. 17 No. 5
FOR YOUR BOOKSHELF
YOUR CHILD CAN HE HAPPY IN BED ; over 100 ways in which chil- dren can entertain themselves. By Cornelia Stratton Parker. Thomas Y. Crowell Co., New York. 1952. 275 pp. $2.95.
Not only parents, but professional workers caring for sick or convales- cent children, will bless Mrs. Parker for the practical suggestions given in this book.
"What can be done to bring happi- ness to a small patient feeling none too physically fit, and time lying so heavy on his hands?" The author an- swers this question with hundreds of tested ideas. She gives detailed — and lively — instructions for such things as modeling, papier-mache work, doll-making, and weaving. She out- lines amusements according to age periods, beginning with "around 1 year"; going on to "by 15 months"; then "by 18 months" ; and so on, up to "9 and 10." She itemizes toys ac- cording to the child's age, with ap- proximate prices ; story books, again by age periods ; book catalogs ; infor- mation on children's magazines; and recipes, such as for modeling mate- rials and for finger-paint.
But this is much more than another "what-to-do" book. It is a guide, based on knowing how children de- velop and on using this knowledge for keeping a sick child happy.
Marion L. Faegre
IN THE NEWS
Juvenile delinquency. Many addi- tional national organizations with widespread membership have ex- pressed to the Children's Bureau and the Special Juvenile Delinquency Project their interest in the campaign against juvenile delinquency. "Three recent meetings brought large groups together in New York and Washing- ington to discuss the problem of de- linquency and to work out ways in which they might cooperate in the current campaign to improve com- munity services that treat children for delinquent behavior. The meet- ings were of health agencies, educa- tional organizations, and civic groups. The first of these meetings was held on October 15 in New York under the sponsorship of the National Health Council. The member agen- cies of this Council met to study some of the specific implications of chil- dren's delinquent behavior so far as
JANUARY 1953
the health services are concerned. Dr. Martha M. Eliot, Chief of the Chil- dren's Bureau, and Bertram M. Beck, Director of the Special Juvenile De- linquency Project, explored the prob- lem with the organizations repre- sented and asked them to seek out ways in which, through their existing programs, the health agencies could contribute to the over-all objective of improving services for delinquent children.
In Washington, on November 12, a meeting jointly sponsored by the Office of Education and the Children's Bureau brought together a number of prominent individuals, educators, and representatives of about 15 national educational organizations that are concerned about the problem of juve- nile delinquency. The American Red Cross and the National Institute of Mental Health also sent delegates to this meeting. In their discussion of the problem of juvenile delinquency as it affects schools, the representa- tives pointed out a number of specific needs :
(1) School programs should be evaluated to see if each child is get- ting the sort of teaching from which he can profit. (2) Teachers require better training to be able to recognize signs of approaching delinquency — it was believed in-service training might be stressed. (3) Many commu- nities lack the social and clinical ser- vices to which schools might profit- ably refer children having difficulty in personal adjustment. (4) Good consultative services within the school or the community could aid schools in helping children and might also be used for teacher training.
The group felt that all State mem- bers of the national organizations, including the various member groups of the National Education Associa- tion, should receive full information about the delinquency problem, and that meetings should be held to dis- cuss the campaign against increasing delinquency. It was recommended that the NEA issue a special pam- phlet explaining the problem and suggesting what could be done about it.
The third and largest of these three meetings was that of representatives of about 30 major civic organizations — fraternal, religious, veteran, educa- tional, and professional. They met in Washington on November 17-18. The group heard the delinquency sit- uation described — as it is today and as it may be tomorrow — by people who work in the field: A police- woman, Captain Mary Ganey of Washington, D. C. ; a detention-home director. Dr. Preston Sharp of Phila- delphia; a juvenile-court judge, the
Hon. Alfred D. Noyes of Montgomery County, Md. ; a training-school super- intendent, Charles W. Leonard of Illinois; and the director of a State community-service program, Douglas H. MacNeil of New Jersey.
Representatives at the meeting stressed the necessity for developing public understanding of the problem, of juvenile delinquency, and of creat- ing public awareness that something can be done to help delinquent chil- dren become well-adjusted and law- abiding citizens. A number of people at the meeting thought that their na- tional organizations would undertake to inform all their local groups about the size and importance of the prob- lem, ask them to look into their local situation, and then encourage them to take appropriate action, along with other interested groups, toward im- proving their local situation. The groups will also work at the State level in cooperation with the various State planning bodies for children and youth. Some of the national organi- zations, it was reported, have already worked out plans for working toward the Delinquency Project goals during the coming year.
CALENDAR
Jan. 9-10. American Group Psycho- therapy Association. 10th annual conference. New York, N. Y.
Jan. 17-18. United Service for New Americans. Annual meeting. New York, N. Y.
Jan. 19-30. Population Commission, United Nations Economic and So- cial Council. 7th session. New York, N. Y.
Jan. 21-24. Council on Social Work Education. 1st annual program meeting. St. Louis, Mo.
Jan. 24-29. American Academy of Orthopaedic Surgeons. 20th annual meeting. Chicago, 111.
Area conferences. National Child Welfare Division, American Legion:
Jan. 9-10. Area D — Illinois, Indi- ana, Iowa, Kansas, Michigan, Minne- sota, Missouri, Nebraska, North Da- kota, Ohio, South Dakota, Wisconsin.
Feb. 6-7. Area B — Delaware, Dis- trict of Columbia, Maryland, New Jersey, New York, Pennsylvania, Puerto Rico, Virginia, West Virginia.
Illustrations: Cover, Philip Bonn.
I'. 7.'.. Larry Elliott.
Pp. 79, 80, Virginia State Department of
Health. Pp. 81, 82, 83, courtesy of the author.
87
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VOL. 17 NO. 5 JANUARY 1953
in This Issue
Should Children Be Separated from Their Parents? Draza B. Kline
Page
. 74
Sick Children Benefit from^a City's Home-Care Program . 78 Virginia Insley
Point IV and the Children of the Punjab Paul R. Cherney
When a Child Is Deprived of Mothering Leon J. Yarrow
81
84
Published 10 times a year by the Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
FEDERAL SECURITY AGENCY Oscar R. Evving, Administrator
SOCIAL SECURITY ADMINISTRATION Arthur J. Altmeyer, Commissioner
CHILDREN'S BUREAU Martha M. Eliot, M.D., Chief
Publication of THE CHILD, monthly bulletin, has been authorized by the Bureau of the Budget, September 19, 1950, to meet the needs of agencies working with or for children. The Children's Bureau does not necessarily assume responsibility for statements or opinions of contributors not connected with the Bureau.
THE CHILD is sent free, on request, to libraries and to public employees in fields concerning children; address requests to the Children's Bureau, Federal Security Agency, Washington 25, D. C. For others the subscription price is $1.25 a year. On all orders of 100 or more sent to one address there is a discount of 25 percent. Single copies 15 cents each. Send your remittance to the Superintendent of Documents, Government Printing OfiSce, Washington 25, D. C.
Foreign postage — 25 cents additional — must be paid on all subscriptions to countries in the Eastern Hemisphere and those sent to Argentina and Brazil. Domestic postage applies to all other subscriptions.
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FEBRUARY 1953
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nearly 4 MILLION
NEW CHANCES
to fashion a Nation of healthy, wholesome, and wise citizens
VITAL statisticians have not yet been able to count every last one, but they think the number of babies born in 1952 topped all previous records. Nearly 4 million were born.
With each new year, the chances
grow better that babies will survive the threat of illness and death from diseases. They grow better, too, for older children. But they are still far from even for all children.
Just keeping alive of course is not good enough. Our goal for every child is buoyant good health and the chance
for him to grow equally well in social and emotional health. Here, too, the chances are unequal.
These pages picture a few of the yardsticks we have with which to measure differences in opportunity for children, and to point up our un- finished business for them.
BIGGEST FAMILIES HAVE LOWEST INCOMES
The Nation's children are concen- trated in a small proportion of its families. Over half its 47 million under 18 belong to 16 percent of its families. These are the families with three or more children. Families with one or two children under 18 make up 40 percent of the total. The rest are families with no children under 18. Families with the most children usually have the lowest incomes. The median income for all families in 1950 was $3,319.
One out of every 10 families is headed by a woman. In 1950, families headed by a woman had an average income of $1,922.
©
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or more
Median family Incomes, 1950
THE CHILD VOL. 17 NO. 6
A ROUND-UP OF FACTS
ABOUT CHILDREN
AND CHILDREN'S SERVICES
as seen by the Children's Bureau
Number of children under 18 for every 100 adults of working age,
REGIONS RICHEST IN CHILDREN HAVE LOWER INCOMES
Regions rich in children have pro- portionately fewer adults to support both children and the schools, the health, Avelfare, and other community activities that serve children. These regions have lower per capita in- comes, too. In the South, for instance, South Carolina, with 74 children under 18 years for every 100 adults of working age (18 to 64 years), had a per capita income of $838 in 1950. At the other extreme, in the North- east, New York, with 40 children per 100 adults of working age, had a per capita income of $1,875.
MANY CHILDREN LIVE IN BROKEN HOMES
Nine out of every 100 children under 18 years of age live with one parent only; 6 live with neither par- ent. Among the more than 4 million children with one parent, some 1,700,000 have a widowed parent; 900,000 have a divorced parent; 1,500,000 have a parent living away.
Divorces, down from their peak figure of 610,000 in 1946, are esti- mated at 371,000 for 1951. Family breakups put great strains on chil- dren, as well as parents, that some- times can be reduced when skilled workers are at hand to help.
The home of I out of 7 children lacked one or both parents in 1950
FEBRUARY 1953
MANY INFANTS ARE BORN OUTSIDE [CARRIAGE
Children born to unmarried mothers are in special need of help. First, the mothers should have as- sistance before, during, and after childbirth. In 1940, 89,500 babies were born out of wedlock. By 1949 the number had swelled to 133,200. In 1940, the rate of illegitimate births was 7.1 for every 1,000 unmarried women 15 to 44 years of age. By 1949, the rate was 13.4. In that year 30,000 of these unmarried mothers were 17 years of age or younger.
1940
1949
n
13.4
numb&r per 1,000 unmarried women 15-44 years of age
Number of illegitimate births
INFANT MORTALITY IS TOO HIGH IN MANY PLACES
A larger proportion of babies now reach their first birthday than ever before. In 1950, the U. S. infant mor- tality rate was 29 for every 1,000 live births. Ten years earlier the figure was 47. Still, many babies die who need not die. If the record of infant lifesaving in the years 1946- 49 had been as good in the shaded counties, mostly rural areas, as it was in metropolitan counties (where the death rate was 29.7), 50,000 babies would have been saved. Over 180,000 babies born in 1949 had no medical attendance at birth.
Greatest gains can be made In these counties
MORE HEALTH CARE OF CHILDREN IS NEEDED
Only the very old are sick more often than children. While deaths from many serious communicable diseases are all but wiped out, these diseases still occur often among chil- dren. Other types of sickness also occur often. However, doctors, nurses, hospitals, and clinics tend to center in cities and towns; specialists, in big cities. Children in isolated counties, in low-income families, and those with dark skins stand the poorest chances for health care in this coun- try. In the whole country, there are 232 children under 18 years for each physician.
Number of children under 18 for each physician
THE CHILD VOL. 17 NO.
Out of any 10,000 under 18 years, these numbers of cliildren attend psyctiiatric clinics
MENTAL-HEALTH SERVICES ARE HARD TO FIND
Emotional difficulties are now high up on the list of health problems of childhood. As a Nation we are beginning to develop mental-health services through community clinics, and some children's specialists are giving increased attention to emo- tional problems. Little psychiatric treatment is given to children through private practitioners. Many well-child clinics make no provision for psychiatric advice. Many juvenile courts and institutions for delinquent children are unable to provide ade- quate psychiatric diagnosis and treat- ment. Psychiatric clinics, usually with long waiting lists, are able to provide for only 33 out of every 10,- 000 children.
1,695 counties liave no full-time public child-welfare workers
FULL-Tlli/IE PUBLIC CHILD-WELFARE WORKERS ARE TOO FEW
In June 1951, in this country, 4,465 full-time public child-welfare work- ers were employed through local, State, or Federal funds. The great majority of these were caseworkers working directly on the problems of children. These caseworkers were available to children in less than half our 3,187 counties. Some counties without full-time public child-welfare workers used the services of general public-welfare workers (mostly pub- lic-assistance workers) who gave part time to children. Most caseworkers in voluntary agencies are in urban areas ; few in rural areas. Rural areas, if served at all, are usually served by public child-welfare workers.
PARENTS have primary respon- sibility for providing the daily care and opportunity for growth that every child should have.
To plan wisely, they must know what children require for physical, emotional, and social health. They need facts from skilled and objective investigators and reporters, and guid- ance from persons especially trained in child development, education, health, and welfare.
Parents must have at hand, ready to use when needed, a broad range of facilities and services that no family, rich or poor, can of itself sup- ply. Good schools, libraries, and churches; good playgrounds and rec- reation facilities; good hospitals, clinics, and health services ; these are only a few of the community aids to a healthy, happy childhood.
Children who have lost their par- ents, or whose parents are unable to
fulfill their responsibilities, have al- ways had a special claim for help.
Children in the United States are, in many ways, much more fortunate than the children of many lands. Our ideal, however, of a secure, whole- some, and invigorating personal, family, and community life for every child, from birth throughout his growing years, is still far from achievement.
FEBRUARY 1953
93
TO BETTER CHILDREN'S CHANCES
the Children's Bureau works with public and private agencies, professional workers, civic groups, and parents
THE Children's Bureau, as au- thorized by the Congress and the Federal Security Adminis- trator, operates under two directives. The first, to investigate and report "upon all matters pertaining to the welfare of children and child life among all classes of our people," comes from the 1912 act creating the Bureau. Under this act the Bureau studies many types of conditions af- fecting the lives of children ; provides data and makes recommendations to improve practice in child-health and child-welfare service programs under the Social Security Act; helps to es- tablish standards for the care of children.
The second of its directives charges it with the responsibility of making grants to States to "extend and im- prove" services for promoting the health and welfare of children, espe- cially in rural areas and in areas of special need. This is contained in the Social Security Act, first passed in 1935, and amended in 1939, 1946, and 1950.
1. Helping parents and citi- zens generally with facts about children's needs which the Chil- dren's Bureau gathers from its investigations.
2. advising with workers and agencies serving children on methods and standards of care,
3. administering- grants to States to strengthen State and local child-health and child- welfare services —
these are the three broad fronts on which the Bureau serves the children of the Nation.
The progress it can make, year after year, must be measured against its resources of persons and money. In 1952 the Children's Bureau had a staff of 244 workers and an operating budget of $1,585,000.
For children's health and welfare
Title V of the Social Security Act established the principle that all the people of the United States, through their Federal Government, share with State governments responsibility for helping to provide community health and welfare services that children need.
When this act was passed, the first full year's authorized grants totaled $8,150,000. Under the 1950 amend- ments, the total that may be appro- priated in any one year is fixed at $41,500,000. Actual appropriations
for the fiscal year were $31,500,000. Of this total, $12,524,100 was for ma- ternal and child-health services ; $11,385,500 for services for crippled children; and $7,590,400 for child- welfare services. The great bulk of it pays salaries of doctors, nurses, medical social workers, nutritionists, dentists, physical therapists, child- welfare workers, and other profes- sional workers for children. Some is used to help increase the number of trained workers by granting stipends to promising candidates for training in various professional fields. Most of the money for crippled children pays for medical, hospital, clinic, and convalescent care. Some of the child- welfare money helps to pay the cost of foster care for children who can- not be cared for at home.
All States, with one exception, and the District of Columbia, Alaska, Hawaii, Puerto Rico, and the Virgin Islands receive grants-in-aid for all three of these programs. (The one exception is Arizona, which, at pres- ent, does not receive Federal grants for crippled children's services.)
Each State receives a flat amount, specified in the Social Security Act, for each of the three programs. The balance of the Federal funds is
Helping young couples learn more about their expected baby is part of the maternity care given by public-health nurses in many States.
Members of the staffs of State and local health departmenti helping large numbers of mothers to keep their well babies
apportioned to the States on the basis of various factors that reflect the size of the child population and the State's resources for meeting the needs of its children.
To receive funds, State agencies present plans for spending Federal grants that meet the requirements of the Social Security Act and that as- sure good quality of services. These plans are approved by the Children's Bureau.
To take full advantage of the grants for maternal and child-health services and for crippled children's services, each State must match part of its Federal grant.
To take advantage of the child- welfare funds, each State must as- sume some of the cost of services in rural areas, although no fixed amount of Federal funds must be matched.
Of course, no State is limited in the amount of its own money that it spends for children's services. In- deed, many States spend a great deal more of their money than the amount needed to match Federal funds.
So long as States meet the require- ments of the Social Security Act, they are free to use Federal funds in the way they think best. As a result, no two State plans are alike. This is one of the great strengths of these grant- in-aid programs. They respect and preserve State and local initiative.
In planning their programs, State agencies consult with voluntary agencies and groups on what services are needed, so as to avoid duplication and to encourage good teamwork be- tween public and voluntary agencies.
States themselves decide which chil- dren may get the benefits of Federally supported services, under certain gen- eral policies laid down by the Federal Government. The staff of the Chil- dren's Bureau is available to State agencies to help them in planning and strengthening their services.
Types of services
Most of the services provided by State and local health departments for mothers and children are health- promotion services; that is, they are designed to help well mothers and children keep well. Typical health- promotion services are : prenatal clinics ; child-health conferences ; im- munization services ; health services for children of school age. Some States also provide medical care for pregnant women and for premature infants, but this is done in a limited way for relatively few. All States use some of their funds for the train- ing of professional personnel needed to provide these services.
In their programs for crippled chil- dren, all States provide diagnostic services. Within the limits of their funds, all States pay for skilled treat- ment for some children. This may include medical care, hospitalization, and convalescent care. Children most generally helped are those needing orthopedic or plastic treatment. But most States do something also for children with other handicapping conditions, such as rheumatic fever, cerebral palsy, epilepsy, and hearing defects.
Child-welfare services are social
services for children. They are usu- ally provided by social workers who have some special training or experi- ence in child welfare. These workers help parents with social and emo- tional problems that affect the well- being of their children. The first effort of a child-welfare worker is to keep the family together. But if the problems are such that its chil- dren are neglected, or emotionally dis- turbed, or show other adverse effects, it may be necessary, for the protec- tion of the children, to remove them from their homes. When this hap- pens, child-welfare workers help to make other plans for the care of such children, either in foster-family homes or in institutions. They place children for adoption when it has been determined that a child must be permanently removed from his own home. They find family homes or day nurseries for children whose mothers work outside the home. They help children who get into trouble with the law, and work with agencies deal- ing with such children. They help unmarried mothers, and babies born out of wedlock. They work with citi- zens and agencies in improving State laws on adoption, guardianship, and support, and in building better com- munity conditions for children. In a limited way, they give help to mothers receiving assistance for dependent children under the Public Assistance program.
Pages that follow report on recent developments in children's services aided by Federal funds.
; crippled children's agencies hospitalize 4,3,000 children a year. To find welcoming families like this for children without homes is ;hey provide care at clinics for more than four times as many. one of the many big jobs that State child-welfare workers are doing.
• i III I
• I lilll I?
H .11, i
School health
Speech therapy
Homemaker services
SOME CHILDREN ARE WINNERS
IN THE past decade and a half, during which the Social Security Act has been in effect, many hun- dreds of thousands of children have benefited through the provisions for maternal and child health, for crip- pled children, and for child welfare.
The numbers served under these State-Federal programs in 1951, as made available through reports from the States, are shown in the table on the next page.
In that year, the number of expec- tant mothers attending prenatal clinics approached 200,000. Almost 400,000 babies were brought to well- baby clinics. Well over half a million children of preschool age attended well-child conferences.
In the same year about 230,000 children received care under the crippled children's program.
Under the child-welfare program in 1951 more than a quarter of a million children received child-wel- fare casework service, the largest proportion of them in foster homes.
Every State, of course, has its own individual approach to problems con- cerning children's well-being, accord- ing to its resources and the condi- tions in the State. Here are a very few examples of the work done in the various States for maternal and child health, crippled children, and child welfare :
MATERNAL AND CHILD HEALTH
More and more State health de- partments are joining with hospitals and medical schools in developing
community services for the care of premature babies. And they are un- derstanding better what a financial burden premature birth places on a family.
In order to reduce complications of pregnancy, which cause many pre- mature births, several States that have been active in caring for pre- mature babies are giving greater emphasis to prenatal care, and to planning for medical and hospital care for women with complications of pregnancy.
Sixteen State health departments are helping families to pay the costs of medical and hospital care for a limited number of such infants.
In several States — California, for example, the health department joins with a medical school's department of pediatrics to bring a well-trained pediatrician into rural areas regu- larly, so that he can provide consul- tation services to the doctors in these areas. More arrangements like this would greatly improve the care of children.
A number of State health depart- ments, especially in the Southwest, have been joining with their State departments of education to develop better health services for children of school age. Arkansas, for instance, has a "pilot-school health program." This means that several schools, in different parts of the State, have been developing a complete health- education program in their own
localities. These serve as examples to the other schools in the State, sug- gesting what can be accomplished when all a community's services for children are focused on the schools in the interest of the children's health. Each summer key personnel from the pilot schools meet to review the programs.
CRIPPLED CHILDREN
State crippled children's agencies are continuing to broaden their pro- grams to include more kinds of handi- capping conditions, and are experi- menting with new types of services.
Perhaps the most notable example of these is the rapid development of clinic and hospital care for children with congenital heart disease. Many States that have the specialists needed to care for children with con- genital heart disease are including such children under the regular crip- pled children's program.
In order to diagnose and treat chil- dren who live in States that do not have this type of medical and surgical experts, regional centers have been established in three States — Con- necticut, to serve some of the New England States; Illinois, to serve 12 States in the Midwest; and Cali- fornia, to serve Far Western States, as well as Alaska and Hawaii. Two more centers — in Marjiand and Texas — are beginning work.
The importance of a child's hear- ing and speech, in school and in later life, is recognized by many States,
96
THE CHILD VOL. 17 NO. 6
and their concern has been gaining momentum.
Tennessee's State Health Depart- ment has joined with the Tennessee Speech and Hearing Foundation and Vanderbilt University to develop in Nashville a speech and hearing facil- ity for diagnosis and treatment. Ten- nessee's legislature has appropriated $120,000 for each of 2 years— fiscal years 1951-52 and 1952-53 — in order to develop a State-wide speech and hearing program that includes hear- ing tests and speech evaluation throughout the schools. When further diagnosis and treatment are needed the children are referred to the speech-and-hearing center.
A center for the hard-of-hearing has been established in Houston, Tex. The District of Columbia now offers crippled children's services to chil- dren who are hard of hearing. Cali- fornia has virtually completed plans for a speech-and-hearing center in Los Angeles, to which children may be sent by the MCH and CC programs for complete study and treatment. In Arizona a hearing program is being developed in cooperation with the schools and other agencies, aimed at early discovery of children with hear- ing impairments and provision of medical treatment and corrective therapy, as well as adjustment of their educational programs.
Although programs for children with epilepsy have not developed widely as yet, the States have shown increasing interest in them. Utah, Maryland, Iowa, and Illinois have set up special programs for such chil- dren ; and a number of other States are working out plans for epilepsy programs.
CHILD WELFARE
Reaching children before their troubles become so serious that they must be removed from their homes is a major objective of the child- welfare programs. Both public and voluntary agencies are trying to do this through providing social services to children in their own homes.
Some States (notably Alabama, California, Florida, and New York) are studying the relation between the
child-welfare program and the Public Assistance program for Aid to De- pendent Children, and methods of providing social services to children in families receiving Aid to Depen- dent Children.
Interest in homemaker services as part of a program for the social, emo- tional, and physical well-being of children is growing. Under this plan, a social agency selects women chosen for their skills in homemaking and their ability to work with children and to adjust to various situations, and places them in homes where chil- dren lack their mother's care because of her death or illness. Councils of social agencies are trying to extend or develop this type of service in Worcester, Mass. ; Dallas, Tex. ; San Francisco and Los Angeles, Calif. ; Toledo and Dayton, Ohio; South Bend and Richmond, Ind. ; and others. Several States have initiated home- maker service as part of their public child-welfare programs.
Development of protective services for children who are neglected or abused by their parents continues, especially in Denver, St. Paul, St. Louis, and Chicago.
A number of States have strength- ened standards for licensing foster- family homes, child-placing agencies, and children's institutions. Public and voluntary agencies are helping foster parents, and cottage parents and other staff members in children's institutions, to provide better care for children. The number of children in foster-family care has increased in many communities, but the need for additional foster-family homes is still urgent.
Widespread public interest in adop- tion continues. The Arizona Bar As- sociation is sponsoring legislation for improving the adoption law; a civic group in Portland, Oreg., has studied the State adoption law and has rec- ommended further legislation to im- prove it; California has developed State and local citizens' groups to study and foster improved adoption programs.
Many agencies are giving more at- tention to the need of older children for adoption as well as to placement of infants at an earlier age.
CHILDREN AND MOTHERS SERVED
BY STATE AGENCIES
UNDER TITLE V, SOCIAL SECURITY ACT
Maternal and Child-Health Services in 1951
Medical services
Mothers admitted to antepartum
medical service 189,000
Mothers given postpartum medical
examination 53,000
Infants admitted to medical ser- vice 395,000
Preschool children admitted to
medical service 565,000
Examinations by physicians of
school-age children 2,394,000
Public-health nursing services
Mothers admitted to antepartum
nursing service 268,000
Mothers given nursing service at
delivery 4,000
Mothers admitted to postpartum
nursing service 279,000
Infants admitted to nursing ser- vice 677,000
Preschool children admitted to
nursing service 697,000
Field and office nursing visits for
school-age children 2,160,000
Immunizations
Smallpox 1,821,000
Diphtheria 1,831,000
Dental inspections
Preschool children 80,000
School children 2,466,000
Crippled Children's Services in 1951
Total, children receiving physi- cians' services from State crip- pled children's agencies (un- duplicated count) 229,000
Physicians' services
Clinic service 186,000
Hospital in-patient care 43,000
Convalescent-home care 6,000
Physicians' services other than clinic services, hospital in- patient care, or convalescent- home care 24,000
Child-Welfare Services, December 31, 1951
Total, children receiving child- welfare casework service from
State public welfare agencies . . 258,000
In homes of parents or relatives 102,000
In foster-family homes 112,000
In institutions or elsewhere 44,000
FEBRUARY 1953
97
CHILDREN IN SPECIAL JEOPARDY
CHILDREN in this country are on the whole making gains, but some groups seem to have two strikes against them.
Among these are:
1. Babies prematurely born, and babies born in places where health and medical services are poor or lack- ing.
2. Children of migratory agricul- tural laborei's.
3. Boys and girls who are delin- quent or in danger of becoming de- linquent.
There are others, but special attention was given in 1951-52 to studying the situation affecting these groups.
INFANT MORTALITY
Special medical and nursing ser- vices are already saving many pre- mature babies' lives ; even very small babies have been saved. Even so, large numbers die. More than one- third of all the babies who die in the first year of life and 60 percent of those who die in the first month are prematures.
With some 200,000 babies a year born prematurely — at least 6 percent of all the babies born alive in this country — the main problem is not only to save these babies after they are born, but also to prolong preg- nancy to normal duration.
It is now well established that women who have poor prenatal care, or none, are more likely to have a premature baby than are those who have good prenatal care.
Good prenatal care, with special care for women with complications of pregnancy, offers the greatest possi- bility of reducing the incidence of prematurity and thereby of lowering infant mortality.
In saving babies' lives, a question that is equal in importance to that
of prematurity is the problem of the baby — premature or full term — who is born in one of the many localities — mainly rural — where progress in pro- viding medical services for mothers and babies lags far behind that of the Nation as a whole.
Problems connected with saving premature and other babies' lives in such localities are more than medical ones. They involve low incomes, poor sanitation, and habits of people. Needlessly high are the infant death rates among Negroes, among the Spanish-speaking, among Indians, and among migratory agricultural laborers.
These people need comprehensive help with their problems by volun- tary agencies and local. State, and Federal Governments.
Such concerted action should bring to these people more doctors, nurses, nutritionists, and medical social workers who know the special prob- lems of the group they are dealing with and can work with them effec- tively.
Community programs focused on saving the lives of babies in such places must, of course, be a part of the State and community health programs. They must be kept closely related to the skills of the public- health officer, the public-health nurse, and the sanitary engineer, and to treatment in doctors' offices, clinics, and hospitals. Social services may often be needed to help individual families with economic or social prob- lems that in themselves affect the health care that can be given. Where this type of help is needed a medical- social worker or a child-welfare worker in the community may be called for.
If a local health unit is already established, maternal and child-health services should be operated in and from that unit. In areas with few or
no health facilities, additional local health centers designed to make a frontal attack on infant mortality may need to be organized.
CHILDREN IN MIGRANT FAMILIES
Children of migratory agricultural laborers are, economically and so- cially, the most depressed group of
Modern ways of caring for prematures save many lives; but the main problem is to re- duce the incidence of prematurity through adequate care of mothers during pregnancy.
children in the United States. There are between 250,000 and 1,500,000 of these children. Too many of them are growing up without having enough of anything: enough food, adequate shelter and clothing, ade- quate medical care, and basic educa- tion. Sickness and mortality rates are high among them. As they follow the crops, many of these families move from one set of makeshift quar- ters to another, badly overcrowded, dirty, unsanitary, dilapidated.
Their problem is fundamentally an
THECHILD VOL. 17N0. 6"
economic one, and its solution lies in long-range social and industrial mea- sures. But in the meantime much could be done for them.
Though in some localities these families are receiving particular at- tention, in others their needs are ignored. If efforts to improve their situation are to be effective, not only- must the several agencies involved within a State work together, but States must work together coopera- tively. Among the measures these families need are : Adequate housing ; environmental sanitation ; health and medical care for infants and expec- tant mothers ; health education that
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A boy in trouble with the law wonders what will happen to him. If his community has good treatment services, he will be helped to find his way to normal social adjustment.
will reach the different cultural groups.
One of the basic handicaps in pro- viding help for migrants is the lack of coverage by local health units. Strengthening local health units should have a high priority among public-health advances. When these exist, especially in rural areas, the mechanism will be available for solv- ing other urgent health needs.
Mobile health units may also be a -useful device for putting health care within reach of these families. Prob-
ably additional staff — physicians, nurses, medical social workers, nutri- tionists, health educators — will be needed to provide individual care and to make arrangements with social agencies for welfare services. In view of the poor resources these families have, provision must be made for medical and hospital care. Exchange of information between States on a planned basis would help to maintain the services.
Another constructive measure for health as well as welfare would be provision of day-care centers. Since in these families both the parents and the older children usually work.
Many children of migrant agricultural labor- ers grow up without enough of anything — enough food, adequate shelter and clothing, adequate medical care, and basic education.
young children are often left pretty, much on their own. In a few States, day care is provided, but this type of care is sparse indeed.
State and local health and welfare departments, which have the basic organization to do the job, should take responsibility for administering health and welfare services to meet the needs of migrants. Migrants should not be set off from the rest of the population, brt should be en- abled to participate in all community services as much as possible.
JUVENILE DELINQUENCY
One of the most serious by-prod- ucts of the general insecurity brought about by periods of international un- rest— a period such as we are now again experiencing — is the marked increase in juvenile delinquency.
Adolescence is a period when youth is naturally in revolt against the adult world. In seeking their own place in the world and establishing their identity, adolescents tend to band together. They may easily fall into antisocial patterns of behavior, with which we are familiar in this country. They may also be exploited, as in totalitarian countries. Adults dare not shirk their responsibility to understand the behavior of ado- lescents and to help direct it into con- structive channels.
Because this problem is becoming increasingly serious, the Children's Bureau during the past year gave a major part of its attention to it. It established in the Division of Social Services a newly organized Juvenile Delinquency Branch. Working closely with this Branch is a Special Juve- nile Delinquency Project, financed through private contributions to the Child Welfare League of America. In cooperation with the Special Project the Children's Bureau has sponsored a series of conferences with many leaders in this field and with public and private agencies.
The Project and the Bureau have been developing material that will be of immediate practical value. Many States and communities are not clear about what kind of services they should have. The Project and the Bureau have therefore undertaken to develop standards, or statements of desirable practices, governing juve- nile-police services, the juvenile court, and the training school. Spe- cialists from over the country are, or will soon be, working on these stand- ards. When completed, they should be useful guides in bettering services.
The Children's Bureau is also pre- paring material for the use of State agencies when working with their State legislatures in the organization and administration of services for children, including delinquents.
FEBRUARY 1953
99
WORKERS BEHIND THE CHILDREN
IF PROGRAMS to aid children are to be of value, they have to be manned by competent people. Even though colleges, universities, and professional schools are trying to increase the number and the skills of people competent to vs^ork with children, the demand for these work- ers far exceeds the supply.
For this reason one of the major uses to which State agencies put their Federal grants for maternal and child-health, crippled children's, and child-welfare services is in special training of workers. One way they do this is to help finance the cost of courses, institutes, or work groups, where doctors, nurses, social workers, and others can go for specialized training in the care of children. An- other way is to use some of their Federal-State funds for stipends and tuition for people to take advanced training in some specialized area of child care.
Recently, training opportunities in such specialized areas as audiology (the science of hearing) , rheumatic fever, epilepsy, and care of prema- ture infants have been utilized more fully by the States. Persons complet- ing the special training project in audiology at the State University of Iowa have taken positions in widely scattered States.
The epilepsy training program in Massachusetts trained six physicians and five electroencephalographic tech- nicians in its first 6 months.
The 1952 rheumatic-fever work group in Connecticut was attended by medical, nursing, medical social, and administrative personnel from rheumatic-fever programs in Cali- fornia, Kentucky, Nebraska, New Hampshire, Oklahoma, and Washing- ton.
The institutes sponsored by the New York Hospital Premature Train- ing Project have been attended by teams of physicians and nurses from New York City, New York State, Connecticut, Florida, Maine, New Hampshire, New Jersey, North Caro- lina, Massachusetts, and Pennsyl- vania.
Additional training facilities in public-health nutrition have been set up by two schools of public health (at the University of Minnesota and the University of Pittsburgh) . A number of other educational institu- tions are attempting to bridge the gap between the demand and the sup- ply of nutritionists by offering for the first time a major in public-health nutrition.
A few States are providing work- ers with stipends for the second year of medical social work training or for an interneship program in medical social work in a hospital. Special training projects in medical social work have been established by three States (Illinois, Louisiana, and Mas- sachusetts), with schools of social work cooperating in preparing medi- cal social workers more adequately for the maternal and child-health and crippled children's programs.
The shortage of maternity and pediatric nurses is particularly seri-
ous. Advanced programs of study in maternity and pediatric nursing have been developed in six university cen- ters. Scholarship funds are not yet suflScient to meet the requests of many young nurses who wish to spe- cialize in maternal and child care.
Health personnel working with mothers and children need under- standing about the emotional grov^rth and development of children. Many State agencies have been active in this field, holding work groups in child development for physicians, nurses, and other personnel, and help- ing medical schools provide training in maternal and child-health work. An institute for medical social work- ers, on growth and development of children, organized by the Harvard School of Public Health was enthusi- astically received.
State public-welfare agencies are making steady progress in training and staff-development programs for child-welfare staff. This is reflected in increases in the positions estab- lished for special consultants on staff development; in the number of field- work training units developed in co- operation with schools of social work ; in the amounts set aside for profes- sional education; and in the number of States providing Federal funds for salaries of new workers during orien- tation before they enroll in a school of social work. Work groups and institutes, including representatives from other public agencies serving children and from voluntary agen- cies, are being used to a greater ex- tent as a medium for staff develop- ment.
100
THE CHILD VOL. 17 NO. 8
QUEST FOR KNOWLEDGE
FORTY-THREE years ago, the President of the United States, in urging the creation of a Chil- dren's Bureau, said this in a Message to Congress :
"It is not only discreditable to us as a people that there is now no rec- ognized and authoritative source of information upon these subjects re- lating to child life, but in the absence of such information as should be supplied by the Federal Government many abuses have gone unchecked ; for public sentiment, with its great corrective power, can only be aroused by full knowledge of the facts."
Two years later a Children's Bu- reau came into existence by Act of Congress. The act creating it charged it to investigate and report on child life.
For close to 41 years this Bureau has been gathering facts about chil- dren and ways of caring for them. Because it has always been a small bureau and the child population has, happily, been large, it has had to be selective about the aspects of child life which it studied.
Main target of its investigations through the years has been the plight of disadvantaged children: babies who die in infancy ; children who are beyond the reach of good health ser- vices; infants born to unmarried mothers ; children who have lost their parents or whose parents are unable to carry their responsibilities for their children; juvenile delinquents; children who go to work at too early an age and in hazardous occupations ; crippled and handicapped children.
"Public sentiment, with its great corrective power," informed by these studies, has corrected many of the "abuses" that were common four decades ago. Many State laws today deal more wisely with the child who is in trouble with the law; the child who is to be adopted; the child who I has been neglected or abused ; the child for whom a legal guardian must
be approved by the court; the child who is crippled.
Federal laws, too, have reflected the findings of these studies. Out of the Bureau's investigations, at least in part, flowed the Sheppard-Towner Maternity and Infancy Act of the 20's — the first Federal law to put Federal funds in the hands of State departments of health for extending and improving their maternal and child-health services. In the 30's came the Social Security Act, again to strengthen State and local maternal
HOW . . . WHEN . . . FROM WHERE WILL ANSWERS COME TO SUCH QUES- TIONS AS THESE . . .
How many feeble-minded children are there who should be cared for at home rather than in institu- tions?
Is the health of school children improving through existing school health services?
W'hy are some physically handi- capped children able to function well socially when others, with the same handicap, cannot?
Could well-child clinics do a more effective job of preventing illness?
Which adoptions turn out well?
What becomes of children of un- married mothers who are refused Aid to Dependent Children?
and child-health services, and to do the same for the social services chil- dren need. Behind the program of Aid to Dependent Children, provided for in the same act, were many studies made by the Bureau into the problems of mothers who had to carry entire responsibility for their children. The child-labor provisions of the Fair Labor Standards Act of the late 30's had as a forerunner years of Bureau
investigation into conditions of child employment.
At the turn of the midcentury, a year ago, the Bureau took a long look at its record of investigations. It had earlier called in experts from a wide variety of research fields to advise the Bureau on future plans. With them, the Bureau pondered at length its responsibility as the Federal Gov- ernment's chief investigator of "all matters pertaining to the welfare of children and child life among all classes of our people."
Clearly the job of fact finding had not come to an end. Indeed, the pres- sure on the Bureau for more and more facts had grown with the years. With the establishment of the ma- ternal- and child-welfare programs under the Social Security Act, a mul- titude of questions and problems arising out of the service programs had turned up for study and answer. The questions, too, had become more difficult to answer as the people con- cerned about the well-being of chil- dren had grown more sensitive to the emotional needs of growing human beings.
For four years the Bureau has maintained a Clearinghouse of infor- mation on research on child life con- ducted in universities and other cen- ters around the country. From this, it has gathered a general view of where the answers to questions about children might be forthcoming from others.
Out of this review, the Bureau has now drawn its plan of investigations for the immediate years ahead. For the present, at least, the Bureau pro- poses to hold rather closely to the line suggested by its past studies, focus- ing its investigations on children whose health or welfare is in jeop- ardy. Studies of such children can add greatly to knowledge of child life in general, for they will raise and deal with questions of fundamental importance for the health and wel- fare of all childi'en.
(Continued on page 103)
FEBRUARY 1953
101
TEAMWORK HELPS
Cooperation with otiier countries
Although this Nation has large concerns in improving the chances of its own children, it realizes more and more that their well-being is affected by the well-being of children in other countries. The Children's Bureau has for years exchanged experience and ideas with children's agencies in other countries. In recent years the scope of its international program has broadened.
Under Point IV, for example, the Bureau is responsible for sending specialists to assist in establishing or improving programs of social ser- vices for children and of maternal and child health, when countries re- quest our Government for such help. At the present time the Bureau has 12 such specialists working abroad.
■ Many specialists in maternal and child health and child welfare come to the United States, under various auspices or independently, to study and observe activities of public and private social or health agencies. The Children's Bureau is responsible for planning programs of study and ob- servation for these specialists.
Many of these visitors are spon- sored by the United Nations Secre- tariat, some by the World Health Or- ganization, others by the Mutual Se- curity Agency. The Department of State sponsors certain leaders from many countries, including former enemy nations, as well as visitors under the sponsorship of their own governments.
During the fiscal year 1952 pro- grams of observation and study were planned and arranged for 66 visitors from 29 countries (in this country for periods varying from a month to 2 years) ; and interviews, group dis- cussions, and brief observation for 257 visitors from 48 countries (for periods varying from a day to sev- eral weeks) .
Cooperation witli otiier Federal agencies
By May 1953 the Interdepartmen- tal Committee on Children and Youth
102
will have completed 5 years of shar- ing information about their programs affecting the well-being of children and youth. Through this exchange, cooperative effort between the mem- ber agencies has been greatly strengthened.
The committee, which includes 35 representatives of Federal agencies and their subdivisions, has met monthly since May 1948, when it was created at the request of the Presi- dent of the United States.
Much of the committee's work goes forward through subcommittees. One subcommittee, on "Research in the Federal Government on Problems of Child Life," is chaired by a repre- sentative of the National Institute of Health. Another is working on "Care of American and American-Related Children Outside the United States," under the chairmanship of a member of the Defense Department. A third, whose chairman is on the staff of the Department of Labor, is studying "Children in Families of Migratory Agricultural Workers."
Several of the committee's impor- tant problems have been discussed at seminars, at which consultants from different parts of the country con- tribute experience and ideas.
The first of these, held with the help of the Josiah Macy, Jr., Founda- tion, was developed to help the com-
mittee consider how the philosophy and findings of the Midcentury White House Conference on Children and Youth could be woven into Federal programs affecting children and young people.
Understanding and Working To- gether on Juvenile Delinquency was the subject of the second seminar.
The committee's most recent semi- nar aimed to arrive at a plan whereby all interested Federal agencies can work together in behalf of children of agricultural migratory laborers.
The commmittee has issued three reports : "The Needs of Children of Puerto Rico" (1950), "Programs of the Federal Government Affecting Children and Youth" (1951), and "Youth — the Nation's Richest Re- source" (1953).
Among the agencies represented are: De- partment of Agriculture (Extension Ser- vice; Production and Marketing Adminis- tration). Department of Defense (Depart- ments of the Army, Navy, and Air Force). Department of the Interior (Bureau of Indian Affairs; Office of Territories). De- partment of Justice (Bureau of Prisons). Department of Labor (Bureau of Labor Standards ; Bureau of Employment Secur- ity; Wage and Hour and Public Contracts Divisions). Department of State (five sub- divisions). Administrative Office of the U. S. Courts (Division of Probation). Fed- eral Security Agency (Children's Bureau; Bureau of Public Assistance; Office of Edu- cation; Public Health Service; Bureau of Old Age and Survivors Insurance; Office of Vocational Rehabilitation). Housing and Home Finance Agency (Public Housing Administration). Selective Service System. The committee also includes a consultant from the Bureau of the Budget.
Children benefit through cooperation between nations. This mother is learning how to care for her baby through a program carried on by Pakistan's Government with the help of the United Nations International Children's Emergency Fund and the World Health Organization.
QUEST FOR KNOWLEDGE
{Co>ttinued from page 101)
Many thousands of children, for one reason or another — such as their own illness, or the death of or neglect by their parents, or their own illegiti- mate birth — are separated from their parents. Sometimes this separation is short; sometimes it is for life. Health and social workers are often involved in such separations and so must know how to deal with them wisely.
Because such situations may cause deep-seated difficulties for many chil- dren and because they have been studied so little, the Bureau is making them the focus of its investigations in the immediate future. At first a small study to test out research method will be made. Depending on its outcome, a broader piece of re- search will be undertaken in this field later.
Such questions as these will be ex- plored : How harmful is the separa- tion of a child from his parents? At what ages, under what circumstances, in what ways, and to what extent is it damaging? By what means can the detrimental effects of separation from parents be overcome?
To learn|about delinquency
Another line of inquiry which the Bureau will pursue in the near future concerns juvenile delinquency. Out of this study the Bureau hopes to find answers to such questions as these: What different methods have been at- tempted to reduce the incidence of juvenile delinquency? How successful did they prove to be? Do some meth- ods prove to be more effective with some boys and girls? Does experience point to new and better ways of treating these youngsters?
Again, this would be a pilot investi- gation, a gathering together of cur- rent knowledge, intended to pave the way to more comprehensive research later. This might be undertaken by some other research organization, by itself or in cooperation with the Bureau.
The whole area of parental atti- tudes toward child rearing presents many difficult questions crying for answers. To what extent are parents
unduly worried about how to bring up their children? Are over-worried parents found in all economic and cultural groups? How can such undue anxiety be alleviated? How success- ful have the various means of educat- ing parents been in reducing over- concern in parents? Exploration of such questions is something which the Bureau cannot undertake in the near future, but it is on the Bureau's long-time calendar.
How effective is the worit for cliildren?
Like all sound business enterprises, many health and welfare agencies serving children, eager to make their time, their skills, and their dollars produce the greatest possible good for their clients, are asking for help in appraising the effectiveness of their operations. Because of their close working relations with the Chil- dren's Bureau under the grant-in-aid child health or welfare programs, some of them turn to this Bureau for advice on how such studies can be made. A part of the time of the Bu- reau's research staff is, therefore, earmarked for this kind of assistance. The staff is still small, however, so the amount of consultation that can be given is limited. To spread its knowledge more widely, the staff is preparing a report on methodology of this kind of research which will be shared with all interested child- health and welfare agencies.
As the Children's Bureau moves into its fifth decade of investigating and reporting, it rededicates itself to finding new or better guides to help parents and workers give all children the fair chance they should have for a useful and satisfying life.
CALENDAR
Feb. 2. Natioiiul Children's Dental Health Day. 5th annual observ- ance. Information from Bureau of Public Information, American Den- tal Association, 222 East Superior Street, Chicago 11. 111.
Feb. 7-13. Boy Scout Week. 43rd an- niversary. Information from Boy Scouts of America, 2 Park Avenue, New York 16, N. Y.
Feb. S-15. Negro History Week. 28th
annual observance. Information from the Association for the Study of Negro Life and History, 1538 Ninth Street, N.W., Washington 1, D. C. Feb. 15-22. Brotherhood Week. 19th annual observance. Sponsored by the National Conference of Chris- tians and Jews. Information from the National Conference of Chris- tians and Jews, 381 Fourth Ave- nue, New York 16, N. Y. Feb. 18-20. National Conference of Superintendents of Training Schools and Reformatories. 30th annual meeting. New York, N. Y. Feb. 23-25. American Orthopsychia- tric Association. 30th annual meet- ing. Cleveland, Ohio. Feb. 27-28. Eighth National Confer- ence on Rural Health. Council on Rural Health, American Medical Association. Roanoke, Va. Regional conferences. Child Wel- fare League of America:
Feb. 4-6. Eastern Region. Asbury Park, N. J.
Mar. 16-18. Central Region. Co- lumbus, Ohio.
Apr. 16-18. Southern Region. Nash- ville, Tenn.
Apr. 26-28. South Pacific Region. Berkeley, Calif.
Apr. 30-May 2. North Pacific Re- gion. Seattle, Wash.
Area conferences. National Child Welfare Division, American Legion: Feb. 6-7. Area B — Delaware, Dis- trict of Columbia, Maryland, New Jersey, New York, Pennsylvania, Puerto Rico, Virginia, West Virginia. Feb. 12-14. Area C— Alabama, Ar- kansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Caro- lina, Oklahoma, Panama Canal Zone, South Carolina, Tennessee, Texas.
Mar. 13-14 (tentative). Area A — Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Ver- mont.
•
The National Midcentury Committee on Children and Youth has closed its office in New York. Inquiries may be addressed to the chairman. Leonard W. Mavo, Room 700, 580 Fifth Avenue, New York 36. N. Y.
Illustrations:
Cover and page 9.5, left. Esther Bublev.
Page 90, Philip Bonn.
Page 91, left and right, Rie Gaddis Photog- raphy, Chicago.
Page 95, right. New York State College of Home Economics at Cornell Universitv.
Page B(i, left. Public Health Service," Fed- eral Security Agency.
Page 96, center, Kentucky Society for Crippled Children.
Page 96. right, Lilo Kaskell, New York.
Page 98, Virginia State Department of Health.
Page 99, left. Look Magazine photograph.
Page 99, right. Library of Congress photo- graph.
Page 102, Unations.
FEBRUARY 1953
103
VOL. 17 NO. 6 FEBRUARY 1953
In This Issue
Page
Nearly 4 Million New Chances 90
To Better Children's Chances 94
Some Children Are Winners 96
Children in Special Jeopardy 98
Workers Behind the Children 100
Quest for Knowledge 101
Teamwork Helps, 102
Published 10 times a year by the Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
FEDERAL SECURITY AGENCY Oveta Culp Hobby, Administrator
SOCIAL SECURITY ADMINISTRATION CHILDREN'S BUREAU
Arthur J. Altmeyer, Commissioner Martha M. Eliot, M.D., Chief
Publication of THE CHILD, monthly bulletin, has been authorized by the Bureau of the Budget, September 19, 1950, to meet the needs of agencies working with or for children. The Children's Bureau does not necessarily assume responsibility for statements or opinions of contributors not connected with the Bureau.
THE CHILD is sent free, on request, to libraries and to public employees in fields concerning children; address requests to the Children's Bureau, Federal Security Agency, Washington 25, D. C. For others the subscription price is $1.25 a year. On all orders of 100 or more sent to one address there is a discount of 25 percent. Single copies 15 cents each. Send your remittance to the Superintendent of Documents, Government Printing Office, Washington 25, D. C.
Foreign postage — 25 cents additional — must be paid on all subscriptions to countries in the Eastern Hemisphere and those sent to Argentina and Brazil. Domestic postage applies to all other subscriptions.
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U. S. GOVERNMENT PRINTING OFFICE: 1951—912044 '
HE
CHILD
A^
MARCH 1953
PARENTS LEARN ABOUT THEIR
PREMATURE BABY
Boston Public i^. ,-^^, Superintendent of Documents
MAYl 1953
Hospital holds discussion groups to help fathers and mothers whose baby is born ahead of time
GELLESTRINA DIMAGGIO, R.N.
and
MARGUERITE B. GELINAS
HEN A BABY is born pre- maturely in our hospital, we of the staff try to reassure the parents and help them to solve their problems concerning the baby. Some parents are afraid that they are responsible for the baby's prema- turity, and sometimes one parent thinks the other is at fault. Most do not understand why a prem.ature baby needs such special care. A large number fear that the baby will be mentally retarded, or in some way marked. Many other doubts and fears plague the parents of a premature baby.
Meeting supplements hospita! teacfiing
In the comparatvely short time the mother remains in the hospital it is impossible for the staff to give the parents all the information and reas- surance they need, even though the doctor, the nurses, and the medical social worker do what they can in the time available.
Since we staff members cannot help the parents as much as we should like to during the mother's hospitali- zation, we take a step toward help- ing them later. For this purpose we invite the parents of each premature baby to meet with some of us, along with a group of other such parents soon after the mother is discharged, while the baby is still in the hospital.
Before the mother goes home the
medical social worker tells her and the father about the meeting. She says that it will be held some evening within a month, at the hospital, and that three hospital staff members that the parents already know will be there to answer questions. These staff members are: a doctor (who is an assistant resident assigned to the pediatric ward) ; a nurse; and the medical social worker. The medical social worker points out to the father and mother that other parents may have problems like theirs, and that the various couples will have a chance to exchange ideas. She encourages them to go to the meeting and to ex- press their views, and she helps them to formulate some of the questions they have in the back of their minds so that they can be more ready to ask them at the meeting. Lastly she tells them that they will soon receive a postal card telling them when the meeting will be held.
We find that if the postal card is followed by a personal invitation from the nurse, the doctor, or the
GELLESTRINA DIMAGGIO, R.N.. is Admin- istrative Supervisor on the Children's Ser- vice at the Grace-New Haven Community Hospital, New Haven, Conn. She received her degree as master of nursing from Yale University School of Nursing.
MARGUERITE GELINAS is the in-patient Pediatric Social Worker at the Grace-New Haven Community Hospital. She received her master's degree in social work from Simmons College and has worked at the Gushing Veterans Administration Hospital in Framington, Mass.
This article is an outgrowth of material prepared for the eightieth National Confer- ence of the American Public Health Asso- ciation.
medical social worker, the couples in- vited are more likely to come. We welcome also grandmothers, aunts, and others who will be helping to care for the baby.
On the evening of the meeting the parents gather in a conference room adjoining the children's ward in the hospital, and they sit in easy chairs, in an informal circle. The doctor in- troduces the couples to one another and says a few words about the pur- pose of the meeting. He then goes on to tell the parents some of the facts about prematurity. Now and then during the doctor's talk the nurse and the medical social worker (the pres- ent writers) raise questions that we know some of the parents wish to have answered.
Prematurity explained
The doctor explains what happens when a baby is born prematurely and tells what is known about the causes of premature birth. Then he makes clear why the baby must be kept un- der special care in the hospital until he has developed sufficiently to be taken home like other babies, and he points out the great importance of gain in the premature baby's weight, which shows that he is becoming more mature — more like a full-term baby.
Explaining the purpose of incuba- tors, he tells about the special pre- cautions that must be taken when a baby is in an incubator.
The special hospital care, the doc- tor goes on, brings the baby through
106
THE CHILD VOL. 17 NO. 7
A nurse shows how she holds a premature baby in her arms while giving him feedings.
the ci'ucial period after premature birth by providing, so far as possible, the protection he would have had if he had remained in his mother's body for the full term. The doctor helps the parents to see that when they take their baby home they can treat him just like a full-term newborn baby.
The doctor explains why the baby needs to be followed up by an oph- thalmologist. The explanation is pre- sented to the parents as a precaution- ary measure even though only a very small percentage of babies develop retrolentral fibroplasia, an eye condi- tion associated with prematurity.
When the doctor is through speak- ing, he asks the nurse to tell a little about the care that the nurses give to a premature baby and to offer the parenls some suggestions on caring for the baby after he is taken home.
The nurse tells the parents that a premature baby needs much more at- tention when he is little than does a full-term newborn baby, and that the smaller the baby the more nursing care he needs. She says that the very small baby, who needs incubator care, remains in the incubator as long as his body temperature is unstable and as long as he needs to be given
oxygen ; later he will be placed in a little crib. When he is very small, she goes on, he is too weak to suck, and is fed through a tube or with a medicine dropper while he lies in the incubator. Later, when he is strong enough to suck, a nurse holds him in her arms and gives him his feedings from a nursing bottle.
Shs encourages the parents to come in during the baby's last few weeks in the hospital to visit, hold, feed, bathe, and get acquainted with him, explaining that when the baby is ready to be discharged, he has been receiving for a week or two the reg- ular baby care that the mother her- self will give.
The nurse tells the gi'oup that a day's supply of formula will be given the family on discharge. A discus- sion usually follows as to the type of formula that will be needed and how to prepare it at home.
Many questions asked
Questions that parents frequently ask the nurse are : When can we take the baby outdoors? What should be the temperature of the baby's room? Can we open the window? May the baby have sun baths? Do we have
to give any particular care to the baby's clothes? Can we use commer- cial diaper service? What kind of skin care should the baby have? Is a flexible schedule suitable for prema- ture babies?
She explains also that some one on the hospital staff will ask the visit- ing nurse to look in on the mother and baby in the home a few times to be sure that everything is going well. This is not because we expect any difficulties, but because we feel it gives a sense of security to the mother and helps bridge the gap from hos- pital to home for the baby. The par- ents are glad to have this help; as a rule they have already been visited by the nurse before they attend this meeting. They know who she is, remember what she has discussed with them, and realize that she will help them to prepare the home for the coming of the baby and that she will visit the baby after he is discharged from the hospital.
During the nurse's talk the medical social worker and the doctor ask questions as a step toward amplify- ing some of the points she brings up.
After the nurse finishes, the medi- cal social worker talks with the group of parents about various ques- tions, most of which the parents have already mentioned to her. Most of these questions revolve around six topics :
1. Why was this child premature? One young mother attributed the
premature birth to the fact that she washed a floor once during preg- nancy. After the baby was born her anxious husband told her that he would be boss during the next pre- natal period.
2. What can be expected of the growth and development of a pre- mature baby?
One father was sure that the child would be an idiot. He could see the child was v\'ell formed, but he felt that some major mark of prematurity must remain.
3. Is there danger of overprotect- ing the baby because he is prema- ture?
The word "premature" is discussed, and emphasis given to what may hap-
MARCH 1S53
107
pen if the parents continue to think of the child as being premature after he has reached the stage where his development is going along at a nor- mal pace.
4. How should the other children at home be prepared for the home- coming of the premature baby?
What the parents have already told the other children is discussed, as well as what the other youngsters expect this baby to look like when he is brought home, since he may be smaller than they expect.
5. What are the feelings of the parents themselves about not having had the baby at home with them dur- ing his long hospital stay, and how
Some parents feel that this baby may be more fragile than their other children were or that they may ex- pect too much of him during his per- iod of growth.
In the discussion, individual mem- bers support and stimulate one an- other. Sometimes a shy mother will speak up when the parent next to her asks a question bordering on one she herself has in mind.
We have learned the value of recog- nizing the parent who might be a good discussion leader. If this par- ent's interest is stimulated he or she may be able to initiate discussion around particular points.
Often intelligent, articulate par-
This premature baby is just as well-developed as a full-term newborn baby, after comple- tion of his special hospital care. His parents were not worried, for hospital staff members had helped them realize that the baby would soon catch up with normal development.
might their feelings affect their care of the baby during the post-hospitali- zation period?
This question is closely related to the feelings of guilt that some par- ents have when they imagine that they have done something during the mother's pregnancy that might have brought on the premature birth — or that they have neglected to take some necessary precautions.
6. Might the parents feel insecure in caring for such a small baby?
ents who have had a previous pre- mature baby are present. Such par- ents can speak from experience and can supply concrete examples of some of the problems involved in the care of these babies. They can also de- scribe their methods of solving those problems.
The staff assisting with the meet- ings has learned a great deal. We have seen that a simple explanation to the parents about prematurity does not necessarily tell them all they
want to know. They must be given an opportunity to express their doubts and fears. The discussions at the meetings show us where each couple needs help most.
Most of the parents come to only one meeting, though a few come to the next one if their child is in the hospital for more than a month. Par- ents seem to get enough help from one group session to enable them to work more effectively with the medi- cal social worker, the doctor, and the nurse on the ward if the premature baby is still in the hospital, or with the visiting nurse if he is already at home.
Attendance at the meetings varies greatly. Usually only three or four sets of parents attend. The number seems to vary according to how many premature babies are in the hospital and the time of the babies' stay there. We feel that the attendance is also related to the spacing of the meet- ings. In the future we hope to reach more parents by having the meetings every 3 weeks instead of once a month.
It may also be true that the parents of a premature baby who is already at home may not feel they need to attend the meeting if things are go- ing well with them and with the baby.
Most of the parents feel that these meetings are helpful to them; they feel that we are interested in them as well as in the baby; and in talk- ing with other parents face to face they realize that they are not the only ones who have questions about their baby.
The help given at the meeting, ac- cording to many parents, makes their adjustment to their baby easier.
We have found the program ex- tremely valuable in helping parents give better care to their premature babies. We are examining the pro- cedure and seeking methods of im- provement. This has been an inter- esting experience for all of us and one that we hope has contributed to the care of premature babies in general.
Reprints in about 6 weeks
THE CHILD VOL 17 NO. 7
I
SOCIAL AGENCIES CAN IMPROVE STAFF TRAINING
ALICE L. TAYLOR
FOR HALF A CENTURY, par- ticularly in the last 15 years, the social-work profession has been talking about the preparation of social workers and who should be re- sponsible for it. We are still saying many of the things that we have said in the past, but two important steps have been taken toward clarifying the problem and solving it.
One of these is the completion of the Bureau of Labor Statistics sur- vey, "Social Workers in 1950" (pub- lished by the American Association of Social Workers, 1952). This re- port gives, among other facts, the number of workers in various posi- tions in social-work agencies and their education and experience. The facts are sobering, because they point out serious lacks in the educational status of the profession.
The other step was taken when a new national body, the Council on Social Work Education, was formed in 1952. The Council represents not only graduate schools of social work and agencies employing social work- ers, but also undergraduate colleges, professional social-work organiza- tions, and the general public. Under the Council's constitution, the agen- cies assume a share of the responsi- bility for developing policies, prin- ciples, and programs for education in social work. The other groups repre-
Expcriencf. based on professional education, in helping people. These skills can be de
sented on the Council also share in
this responsibility.
As a result of these two important happenings we now have not only some facts on which planning for social-work education can be based, but also a broadly representative body to lead and coordinate this planning.
As a base from which to plan, both for preparing new social workers and for giving additional training to those
ALICE L. TAYLOR, Special Lecturer, How- ard LTniversity School of Social Work, is a graduate of the George Warren Brown School of Social Work, W'ashington L'niver- sity, St. Louis, Mo. She was a specialist on training and education in the Division of Technical Training in the Federal Security Agency's Bureau of Public Assistance, 1945- 1952.
Miss Taylor has been associated with the St. Louis Provident Association, the Missouri Social Security Commission, and the Nebras- ka Division of Child Welfare and Public Assistance. She has been on the faculties of the schools of social work of the Univer-
sity of Nebraska, the University of British Columbia, and McGill LTniversity, and has supervised field-work students from the L'ni- versity of Chicago, the LTniversity of Mis- souri, St. Louis University, and Washington L'niversity.
With Dr. Ernest V. Hollis, Miss Taylor is co-author of "Social Work Education in the L^nited States" (Columbia University Press,
1951).
This article is condensed from a paper .Miss Taylor gave at the seventy-ninth annual meeting of the National Conference of Social Work, held at Chicago.
enables a social worker to develop her skills veloped further through in-service training.
already employed, let us look at the total number of positions in social- work agencies in the United States. In June 1950 this number was 75,000, the Bureau of Labor Statistics study shows; and only one-sixth of the people in these positions had had the two years of graduate study in social work that is now generally accepted as professional preparation for a social worker.
These figures give us a rough idea of what social workers lack in the way of professional education. But we cannot be sure that the figure 75,000 represents the upper limit of the num- ber of social-work positions for which educational planning needs to be con- sidered.
Why is it not necessarily the upper limit?
1. Because no comprehensive study has been made to determine what each
MARCH 1953
109
of these 75,000 positions requires with regard to knowledge and skill.
2. Because we do not know how many additional social workers will be employed in established social-wel- fare programs, or in new social serv- ices, or in the social-work programs of organizations that are not primar- ily social agencies. Additional social workers may be employed by the public-health services and by large private medical-care programs. They may take positions with labor unions and industry; they may join the staffs of public schools ; and they may enter the international field of social work.
3. Because more than 40 percent of these 75,000 positions are in public- assistance work, the need for which should decrease as more people are covered by social insurance and as in- surance payments to individuals be- come more adequate. Thus, we do not know how many staff members will be necessary in order to serve the people still needing public assistance. Again, we do not know what qualifi- cations will be required of these work- ers nor of those carrying social-work functions in insurance programs.
Since we cannot know how various factors will affect the number of social workers needed, we must, for the time being, consider 75,000 social- work positions as a basis for planning improvements in professional prep- aration.
At the same time we recognize that the distribution of workers among programs and the qualifications re- quired in the various positions may shift with continued movement of workers, with more knowledge about the specifics of practice, and with re- finement of our professional knowl- edge and skills through research.
The Bureau of Labor Statistics fig- ures, of course, can give us little on quality of service and individual com- petence. Social work differs from pro- fessions like law and medicine, whose practitioners are licensed as compe- tent to practice. To identify a social woi'ker who is professionally quali- fied, a social agency depends upon the amount and kind of education he has and on his membership in profes- sional organizations, based on educa-
110
tional requirements. In a public agency the merit system may deline- ate further qualifications required of the social worker.
The social worker practices, not on his own, but within the structure of agency administration, policy, philos- ophy, and supervision, all of which are subject to review by the commu- nity; for example, by a board or a council of social agencies, or through legislative study, or through a licens- ing procedure, as in a child-welfare agency. Although social workers hold themselves individually respon- sible as professional people, they should recognize the importance to the public interest of the supervisory structure within which they operate.
The community depends for protec- tion upon the agency's upholding the quality of its service through selec- tion of qualified staff, through ad- ministrative standards, and through supervision and continuing develop- ment of staff on the job.
In view of the lack of full profes- sional preparation of five-sixths of the workers already employed by social agencies, as shown by the Bu- reau of Labor Statistics report, and the many changes occurring in the field, it is clear that some practical steps need to be taken by the agencies toward improving the training of their workers.
We are generally agreed that agen- cies have two goals in staff develop- ment : The first is to get the agency's
A child welfare worker helps a child and his foster parents better when her natural ability and her training are backed up by good agency supervision and continued in-service training.
work done effectively. The second is to help each employee, trained or un- trained, to keep abreast of the field and to develop as he carries out his part of the work. These two purposes are not to be looked at as primary and secondary purposes, but rather as as- sociated goals.
Survey figures point to need
There is no doubt that all agencies, particularly the public social services, have urgent responsibilities for staff training. The needs of the public services are especially clear from fig- ures in the survey showing that gov- ernmental workers at the State and local level have had the least educa- tion and experience.
Also, the fact must be faced square- ly that for years to come the agencies will have to operate with a number of untrained workers. This points to the need for a study of agency prac- tice to determine which jobs require professional training as a "must."
An agency in the long view should aim at engaging persons with a col- lege degree as a minimum educational requirement. This is important, par- ticularly as the degree is one require- ment for admission to a school of social work, and the worker may later be given educational leave to enter such a school.
For older, untrained workers who have demonstrated ability and ca- pacity for growth, on-the-job training will continue to be the chief measure
by which their competence can be improved. Refresher opportunities should be provided by the agency to keep workers up to date. With social workers at an average age of around 40 years, we would indeed be a dis- couraged profession if we believed that only young persons can continue to learn.
Since good supervision is the key- stone of an agency's constant efforts to improve the work of its staff, let us look at the qualifications of the more than 6,000 supervisors of casework- ers and group workers reported in the Bureau of Labor Statistics study.
In State and local tax-supported agencies as a whole — including public welfare agencies, courts, hospitals, and others — just over half the super- visors had had some graduate social- work study; another fourth reported some other type of graduate study, or a bachelor's degree but no graduate study. Only about one-sixth had had two years or more of graduate social- work study.
In the private agencies almost four- fifths of the supervisors reported some graduate social-work study, and 54 per cent had had two years or more of graduate social-work study.
We see that the supervisors in the private agencies had more profes- sional education than those in the public agencies. But even in the pri- vate agencies only a little more than half the supervisors had had the two or more years of graduate social-work study now accepted as the profes- sional education needed by a social worker. Yet the supervisors are re- sponsible for teaching other workers on the job through the supervisory process.
The supervisors were an experi- enced group. About three-fifths of them reported 10 or more years of social-work experience of various types; only 10 percent had had less than five years. Experience is exceed- ingly important in developing compe- tence and expertness, but experience needs to be based on professional education.
Whatever the content of the job, if persons in supervisory positions are to teach staff and otherwise give
leadership in social work, they should be well equipped with social-work knowledge and skills. I shall refer to this later in discussing the steps that agencies should take in staff develop- ment. If individuals and communities are to receive the social services they need, social agencies need to pay spe- cial attention to the number and qualifications of supervisors, their salaries, and the distribution of quali- fied supervisors among the various services.
Share responsibility for training
Let us turn for a moment from the number and qualifications of social workers to the significance of agency membership in the Council on Social Work Education.
The Council recognizes that —
1. Social-work education is the re- sponsibility of the whole profession — educators, practitioners, membership organizations, social agencies, and regulatory bodies.
2. The public has a stake in the kind of social-work education that is pro- vided, as this determines largely the nature and caliber of services in the community.
How do these principles affect agencies that employ social workers?
Over the years, selected social agencies have been contributing to social-work education by providing field work for students from schools of social work. Most agencies have followed some plan for training their own staffs.
But do agencies realize what it will mean to share fully, through the Council, the responsibility for social- work education? It will mean that if the agencies are dissatisfied with the products of social-work education, they can no longer complain without doing something about it. The agen- cies must share fully in a long-range plan to improve the preparation of social workers.
Since under the principles agreed upon, the agencies have a voice in formulating educational policy and plans, they will be expected also to contribute to carrjing out these poli- cies and plans. How can the agencies best do this during the next few
years? I present several suggestions, which concern study of agency prac- tices, financial support, exchange of personnel between schools and agen- cies, and staff development within the agency, particularly the training of supervisors.
Social agencies should find ways to take part in establishing and carrying out a profession-wide study of agency practice, to include analysis both of social-work concepts and of social- work jobs. Such a study would help point out more clearly the role of social work in the community and the nature of the qualifications required in each of the 75,000 social-work positions.
This tremendous undertaking is essential if we are to be clearer about what should be taught in agencies and in schools. The agencies should carry a full share of responsibility in this kind of project as the next important study among the many areas of social- work research that await doing.
To contribute to such a project, agencies will need to give their staffs time to work, in groups or individu- ally, toward clarifying concepts and methods and to designate or prepare materials identifying these. This kind of activity will contribute directly to improving curriculum content.
The need for a study of practice is already under consideration by na- tional organizations closely related to practice, such as the American Public Welfare Association, the American Association of Social Workers, and the National Social Welfare As- sembly.
Agencies can contribute to the study of practice in many ways.
An agency might study, for ex- ample, the relation between the social workers' job and jobs of other pro- fessional persons, a relation about which there is still a good deal of confusion. This relation has been highlighted in the international field through increasing emphasis on team- work between social workers and, for instance, public-health nurses, and on the domestic scene, between social workers and clinical psychologists.
Efforts need to be made, also, to answer questions that have arisen as to the social-work content in public-
MARCH 1953
111
assistance work and the specific knowledge and skills needed by ad- ministrators and consultants in large public welfare and health programs.
Delineation of social-work function may come more easily if tackled first in the better-defined and long-estab- lished fields such as child welfare or medical social work.
In placing a child, for example, the responsibilities of the social worker, the judge, the doctor, and the psy- chologist are fairly specific.
Medical social work, which has clarified its functions in relation to doctors, nurses, dietitians, and other hospital personnel, could well carry this on by further delineation of the broader medical social work functions in large public welfare and health programs. In fact, the Federal Secur- ity Agency's Children's Bureau has begun preliminary exploration of this subject with medical social consult- ants from State maternal and child health and crippled children's pro- grams. The Bureau of Public Assist- ance is also engaged in this type of study, focusing it on the social-service components of Aid to Dependent Chil- dren.
Again, agency studies to clarify concepts, principles, and processes of administration in the public social services would help in curriculum re- vision to strengthen courses in ad- ministration and public welfare. Curriculum study by the American Association of Schools of Social Work has indicated need for such improve- ment. Local, State, and Federal agen- cies, which have developed and im- proved administrative practice in the last 15 years, have much to offer curriculum.
Discussion of agency responsibility for the study of content of social- work practice leads to a second area in which agencies should contribute to staff development directly and in- directly.
Faculties of schools of social work, as well as agency personnel, need re- fresher opportunities. Faculty mem- bers need more time for research and greater opportunity to keep in direct touch with agency programs in order to distill from practice the principles of professional education. This will
112
keep social-work education abreast of the needs of the field and thus will contribute to the competence of agency staffs.
Agencies should consider ways to provide opportunities for faculties to participate more directly and continu- ously in practice. This could be done by inviting faculty members to attend conferences on policy formulation, to join in special agency training ses- sions, to help develop — or to carry on — research projects, and to partici- pate as temporary employees in the day-to-day work of the agency during the nonteaching semester or while on sabbatical leave. Participation in these activities would contribute both to agencies' administration and to faculty development and would help to clarify the areas of content that should become a part of the cur- riculum.
Another example of a desirable two-way flow between the agency and the school is the opportunity for qualified agency staff to teach, on request, in schools of social work.
To plan in-service training
This kind of exchange between the agency and the school, and on-the-job training of staff as outlined below, will require that agencies designate a portion of the budget for educa- tional purposes. Agencies should con- sider, also, ways to stabilize this part of the budget, so that educational planning can be done on a long-range basis, say 5 to 10 years.
Extended use of such educational funds to strengthen the qualifications of staff on the job should be consid- ered. This may well be done :
1. By establishing a well-balanced staff-development plan and a clearly written policy to carry it out, includ- ing orientation, adequate supervision, educational leave, and use of supple- mentary resources.
2. By assigning the staff -training function in large agencies to a special position, and in small agencies speci- fying clearly its place among related functions.
3. By making staff training an in- tegral part of the program.
This requires conviction about staff
4. By considering plans for educa- tional leave. If the agency pays salaries, tuition, and travel costs to permit staff to obtain basic or special- ized training, or refresher courses, depending upon the agency's needs, this will make formal professional education possible for workers.
To improve its supervisory group, for example, agencies should develop objective criteria for potential super- visors, spot such people within the agency, and give them opportunity to learn to supervise. This will involve practice in supervising others while receiving supervision. Developing skill on the job on a planned basis is essential. Such a program may well require special educational-leave planning for this group. This kind of staff training cannot and need not wait on analysis of practice.
Schools also should consider their part in supplementing agency re- sources for development of super- visors. Supervisors need to be well equipped as professional persons, re- gardless of the breadth or intensive nature of services or program content supervised.
I have not attempted to provide the answers to even one of the many com- plex problems in development of staff. My suggestions will be validated or discarded and the answers found only as the four groups represented in the Council for Social Work Education — the agencies, the schools, professional organizations, and the general public — work together nationally and in local and State communities. Develop- ment of staff is not the responsibility of agencies or schools alone. It must be a shared responsibility.
Reprints in about 6 weeks
THE CHILD VOL. 17 NO. 7
RACE PREJUDICEIAND CHILDREN
KENNETH B. CLARK
RACE PREJUDICE damages the children of the dominant group as well as children of the minor- ity group against which the prejudice is directed. As minority-group chil- dren learn about the inferior status to which they are assigned — as they observe the fact that they are almost always kept apart from the dominant group, who are treated with more re- spect by society as a whole — these children may react with deep feelings of inferiority and a sense of humilia- tion. They lose some of their self- esteem; they become doubtful about their personal worth. Like all other human beings, they need a sense of personal dignity ; but almost nowhere do they find their dignity as human beings respected.
Under these conditions it is inevit- able that the minority-group child is thrown into a conflict that affects not only his attitudes toward himself but also his attitudes toward his group. "Am I and my group worthy of no more respect that we get?" he asks. And thus the seeds of self -hatred and of rejection of his own group are sown.
These children need to find some way in which to deal with their con- fusion. The way in which a given child resolves this basic conflict de- pends upon many interrelated factors. Among these are : the cultural and historical background of his particu- lar minority group; the social and economic class of his family ; the sta- bility and quality of his family re- lations; the cultural and educational background of his parents ; his own personal characteristics, intelligence, special talents, and personality pat- tern.
Not all minority-group children re- act to racial rejection with the same patterns of behavior. Some children,
^•H^
Not all children are learning to build up prejudice against persons of minority groups.
usually of the lower socio-economic classes, may react by overt aggression and hostility, directed toward their own group or toward members of the dominant group. Then the larger society may not only punish the chil- dren concerned, but may interpret their aggressive behavior as justifica- tion for prejudice and segregation. Thus the cycle is perpetuated.
Middle- and upper-class minority-
KENNETH B. CLARK is Associate Profes- sor of Psychology, College of the City of New York, and Associate Director of the Northside Center for Child Development, New York City. He is Social Science Con- sultant to the Legal Division of the National Association for the Advancement of Colored People.
During the preparatory period for the Mid- century White House Conference on Chil- dren and Youth, Dr. Clark was on the staff of the Fact Finding Committee.
This article is excerpted from a paper pre- sented by Dr. Clark at a meeting of the National Urban League, in connection with the seventy-ninth meeting of the National Conference of Social Work, held in Chicago.
group children are more likely to re- act to their racial frustrations and conflicts by withdrawn and submis- sive behavior. On the other hand, they may compensate by rigidly conform- ing to the prevailing middle-class values and aggressively determining to succeed in meeting these values in spite of the handicap of their minor- ity status.
Many children, however, of various social and economic classes, react with a generally defeatist attitude and a lowering of personal ambitions. These children tend to be hypersensi- tive and to be anxious about their relations with the larger society. They see hostility and rejection even where they do not exist.
Undoubtedly a pattern of person- ality difficulties results when any human beings are placed in an unjust and unreasonable social situation. Al- though the specific aspects of this
MARCH 1953
113
pattern do not hold for every child in a rejected minority group, and although the range of individual dif- ferences among members of such a group is as wide as among other peo- ples, the evidence suggests that all these children are in some vi^ays un- necessarily harmed by discrimination against them.
The effect of race prejudice on the personalities of children of the domi- nant group is more subtle and some- vi^hat more obscure. These children are supposed to benefit from the system of differentiated status. It is their position that allegedly is being safeguarded against the encroach- ments of the "inferior" peoples. They stand to gain in economic and social status. How then can we say that such a child's personality is damaged by the very system that seeks to offer him such advantages ? How is it that the advantages gained through race prejudice interfere with the develop- ment of healthy personality in the children of the dominant group?
The children of the dominant group who are required to adopt the preju- dices of their society are taught to gain status at the expense of the status of others. They are not ex- pected, when comparing themselves with members of a minority group, to evaluate themselves in terms of the basic standards of personal ability and achievement.
Our culture permits them, and at times encourages them, to direct their feelings of hostility against whole groups of people. These children learn to fear and hate the rejected minority peoples. They develop mechanisms to use in an attempt to protect them- selves from recognizing the injustice of their behavior toward the minority group.
Teaching may be contradictory
Children who are being taught race prejudice at the same time and by the same persons and institutions that teach them the moral, religious, and democratic principles of the brother- hood of man and the importance of justice and fair play are likely to become confused. It is clear to chil- dren of average intelligence and higher that there is a contradiction
To be effective in an interracial agency a worker must understand basic human values.
between adults' race prejudice and their moral teachings. When this con- tradiction is imposed upon children, it may become a personal problem that demands personal attempts at solution. Some may try to solve the problem by intensifying their hostil- ity toward the minority group. Others may react with feelings of guilt, which are not necessarily reflected in more humane attitudes toward the minority group.
A serious reaction to this moral and ethical conflict brought about by race prejudice in an ostensibly democratic society is the development of a pat- tern of moral cynicism, through which some of the children of the dominant group attempt to relieve themselves of disturbing moral pres- sures. Such children react by repudi- ating the right of their parents and other authority figures to offer any moral guidance. They excuse their own egocentric behavior by develop- ing a pseudo-sophisticated philosophy of life, expressed as "The strong should dominate the weak" — "Every man for himself" — "Get what you can while you can."
Other children may attempt to re- solve this conflict by assuming a rigid and uncritical acceptance of the right- ness of their parents and other au- thority figures. These children tend to idealize all authority figures, such as their parents and strong political and economic leaders. They despise the weak, while they obsequiously and unquestionably conform to the de- mands of the strong.
Understanding of the effect of race prejudice on the lives of children of different groups has encouraged the idea of combating such prejudice through the medium of the interracial social agency.
More and more social agencies are being recognized as an effective force in bringing about social change. But it would be too much to expect that all the workers in this or any other field have escaped the many personal and social manifestations of race prejudice. The corroding effect of such prejudice is seen in the fact that many social agencies exclude from their benefits the members of minor-
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THE CHILD VOL. 17 NO. 7
ity groups who are most in need of help. Others accept a token number of such people in order to appease their feeling of guilt and to satisfy the vestige of their social conscience. Some have strict quotas as to the number of minority-group persons they will help.
Should develop out of needs
This fosters development of agen- cies dealing exclusively with a partic- ular minority group. Many agencies dealing exclusively with Negroes reflect the community pattern of segregation ; and, what is even more serious, they tend to perpetuate it.
An agency that seeks to help the members of a minority group to break down the barriers of segregation needs to develop a pattern of con- structive interracial activity and per- sonnel. A truly interracial agency that works effectively in reducing the economic and psychological racial pressures upon the Negro is difficult to find.
An interracial agency cannot be imposed upon the Negro community by detached, impersonal whites, no
matter how good their intellectual motives, and be effective. To be effec- tive the agency must develop out of the real needs of the people whom it intends to serve. It must be a result of the cooperative efforts of truly ma- ture people who recognize these needs and are able to work together as human beings in an attempt to meet them realistically.
A genuinely successful interracial agency will not indulge in the trans- parent maneuver of having a token number of individuals of one or the other group in a professional capac- ity, or a token number of clients of either group.
One should not fall into the trap of thinking that a strong and effective interracial agency can be built by choosing personnel of different races primarily in terms of race and with little regard for the qualifications of the individual and the degree to which these are appropriate to the job that he will be required to do. A strong agency must have qualified people. To have an unqualified Negro in a position in order to demonstrate that an agency is "democratic" does
Race prejudice injures not only the children of rejected minority groups, but all children.
MARCH 1953
not help society, the agency, or the Negro. There are an increasing num- ber of Negroes who are qualified and who can be evaluated by the standards used to evaluate whites. Either posi- tive or negative use of a double standard of judgment represents race prejudice.
The personality demands upon the individuals who attempt to work to- gether in an interracial agency are great. These demands cannot be mini- mized for either the whites or the Negroes. The work will require the highest level of maturity of personal- ity that is attainable in our culture today. Only truly developed human beings can work with individuals of a different race with mutual respect.
Mature personalities needed
It is to be expected that some whites, who eventually might be quite effective in a joint social-action pro- gram, will at first bring to their attempts to work with Negroes the residue of past stereotyped ideas, con- descending and patronizing attitudes, and at times naive and oversentimen- tal ideas. On the other hand, many Negroes show their discomfort in an interracial situation by self-righteous posings, by aggressiveness, and by hostile hypersensitivity concerning the intentions of whites. If an inter- racial agency is to make an effective contribution to our society, the indi- viduals of both groups must rise from these infantile levels of reaction to a more mature one.
An individual, white or Negro, who seeks to function successfully in an interracial agency cannot be status- conscious, since such agencies gener- ally do not have high status. If an individual can find personal security only in rigid conformity to conven- tional, middle-class values, he is not likely to be an asset to such an agency.
Furthermore, a white worker who is still struggling with the elementary problem of unresolved racial guilt feelings, and who expresses this struggle by "loving" all Negroes or constantly proclaiming his freedom from prejudice, is likely to arouse the suspicion and resentment of Negroes and thereby reduce his effectiveness. (Continued on page 117)
115
MENTAL HEALTH IN CHILD REARING
LEO KANNER, M.D.
IN THE past few decades consider- able stirring has taken place among psychologists, educators, and psychiatrists concerning the fac- tors responsible for adequate person- ality development in children.
We have seen a stage in which rigid rules and regulations were handed to parents in order to assure what seemed to be optimal nutrition and "habit conditioning" for the child. This pediatric perfectionism and behaviorist mechanization of child rearing tended, perhaps un- intentionally, to lay down the law and to treat such auxiliaries as the clock and the scales as major factors in bringing up children.
Parents sometimes confused
Now that we recognize the signifi- cance of parent-child relationships in the child's development, we no longer set up commandments requiring cer- tain procedures in child-rearing, but rather emphasize the effects of par- ental attitudes. However, I believe that the literature — both professional and popular — has put too much stress on injurious parental attitudes and not enough on affection, acceptance, and approval.
As a result, many parents have been made uneasily self-conscious about their influence on their chil- dren. The whole modern development has somewhat too abruptly taken away from parents the age-old sanc- tions that they had received from centuries of "Mother knows best," "Children should be seen and not heard," "Spare the rod and spoil the child." Those were the days when discipline was interpreted as "break- ing a child's will." There was no room for doubt. It was clearly parents' obligation to teach children to submit unquestioningly. For the children's future safety, any tendency toward nonconformance had to be nipped in the bud. Surrender by the
child was "good" behavior, and any- thing less than surrender was "bad" behavior.
Now, however, instead of feeling under obligation to fit their children into a prescribed mold, parents have grown to feel — with considerable jus- tification— that these are secondary in importance to something that we call, more or less vaguely, the child's happiness, security, or emotional comfort. A generation or two of par- ents has had to relearn, to shift from coerciveness to guidance.
Hence we have a mixture, puzzling to parents, of age-old tradition and relatively new ideas — a mixture that impinges differently on different par- ental personalities. The mature, se- cure, genuinely accepting parent has little difficulty in adjusting to the newer ideas because they blend easily with his or her own needs.
The newer ideas lift from the parents the pressures which earlier.
against their nature, had pushed them toward a repressive kind of child rearing.
Rejecting, perfectionist parents can find great comfort in pooh-pooh- ing the "newfangled" ideas and can find sanctuary in the pronouncements of pediatricians and psychologists who still believe the old ways of child- rearing are best. Overprotective par- ents can seek solace for their agita- tions in the scary type of pseudo-pre- ventive ideas which are poured upon them, lava-like, from frightening books — now fortunately decreasing — from advertisements, from the lips of neighbors, and even from some medi- cal peddlers of gloom.
We are now in the middle of the twentieth century, which Ellen Key, the Swedish sociologist, called "the century of the child." In the first half of these hundred years, with the help of various branches of science, we have come to an understanding of the needs of children, both physical and emotional. There is still much to be learned, but a certain number of basic principles have emerged, which, even after the disappearance of ephemeral fashions, should stand the test of time.
We have learned the simple truth that any child has a good chance for satisfactory mental health, regardless of physical condition and I.Q. and other circumstances, if he can from
LEO KANNER, M.D., has been director of the Children's Psychiatric Service of the Johns Hopkins Hospital since 1930. He is Associate Professor of Psychiatry and Asso- ciate Professor of Pediatrics at the Johns Hopkins University School of Medicine. He is the author of a number of books, includ- ing "Child Psychiatry" and "In Defense of Mothers."
This article is based by Dr. Kanner on a paper that he prepared for the Midcentury White House Conference on Children and Youth. The paper is one of a number that served as resource material for the Fact Finding Report of the Midcentury White House Conference on Children and Youth. The procedures of the conference did not provide for official approval of these papers. Address inquiries to the chairman, Leonard W. Mavo, Room 700, 580 Fifth Avenue, New York 36, N. Y.
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the beginning of life feel that those closest to him like him, want him, and accept him as he is. We have also learned that it is not only severe cere- bral and endocrinologic disorders that can work havoc with the mental health and adjustment of human beings ; personality and behavior dis- orders can also result from the atti- tudes of parents who are max'kedly rejecting, disapproving, exploiting, perfectionistic, overprotective, or overpossessive.
We have not quite learned how to translate this knowledge into terms that would lead it to become as thor- oughly accepted by parents as is, for instance, the knowledge that children should be vaccinated against small- pox or that cleanliness will prevent many forms of physical illness. Such acceptance is difficult because many individuals are too emotionally in- volved in the older ideas of child rear- ing to accept the newer ones.
To restore parents' self-confidence
There will always be parents who will need individual guidance, and this, we hope, will be offered them through an expanding number of child - guidance and mental - health units all over the country. Neverthe- less much will be gained if we can present to the public simply stated truths, which can eventually become an integral part of our culture and that of future generations.
Because of progress in the sciences dealing with human beings, we have taken away from parents the cer- tainty, the complacency, the assumed omniscience, the power that was theirs in generations past. We have thus made parents self-conscious in their role as parents, have made them grop- ing and jittery. We have produced a generation of parents who wail : "It is all our fault, but what can we do?" It is therefore our solemn obligation, which we shall not and dare not evade, to restore to parents a com- fortable modicum of self-reliance, poise, and composure and to provide a basis for self-confidence that is dif- ferent from the authoritarian rigidity that underlay it in the not too distant past.
Reprints in about 6 weeks
RACE PREJUDICE
{Continued from page 115) Equally ineffective is the Negro who is constantly demanding of whites absolute freedom from all forms of prejudice or the one who seeks to curry favor with whites by obsequi- ous and fawning behavior.
The individuals of each group must be people of integrity. They must have an understanding of basic hu- man values. And they must be clear about their common human and social goals. In short, they must be so clear about the relation between their joint struggle for racial justice and the larger goals of strengthening the foundations of American democracy for all people, that they are not likely to become ensnared in racialism even as they are allegedly fighting for racial justice. It should be clear that they are in a joint fight for human equality, decency, and justice. This, I believe should be the basic philosophy of the staff, the board of directors, and the contributors to an effective interracial social agency.
Fortunately, the days of the Lady Bountiful approach to social services have gone. The modern world de- mands that the field of social work become a dynamic instrument in the process of social action. Intelligent planning of the curriculum in schools of social work will have to take into account the fundamental social changes that are taking place in our society. These schools must play a positive role in preparing their stu- dents to take an active part in social action beyond the more restricted community programs.
Social workers must be prepared to help individuals live more effectively in a changed world — a more demo- cratic world. Social workers must be prepared to help people mobilize their strength to help in the attainment of a more democratic world by demo- cratic means.
In order to do this a social worker must be clear in his own values. He must understand the need of all human beings for that dignity and integrity which is the essence of humanity.
Reprints in about 6 weeks
IN THE NEWS
A child adopted in a foreign country by American citizens can now be nat- uralized on the petition of his adoptive parents without being readopted in this country. This is provided by an act of Congress that became effective December 24, 1952 (Public Law 414) .
Previously such a child could not be naturalized before he became 18 years of age unless a decree of adop- tion had been issued for him in this country.
Under the present law, before a child adopted in a foreign country can be naturalized he must have been admitted to the United States for permanent residence ; must have been adopted before he reached the age of 16; and must have resided continu- ously in the United States in legal custody of the adoptive parent or parents for 2 years before the peti- tion for naturalization is filed, though only 1 year of the child's physical presence is required.
The present law applies not only to children adopted after the law became effective but to children adopted previously.
Under the former law children of some racial origins were not eligible for citizenship, but under the present law any child is eligible who is admit- ted to this country for permanent residence. Thus a Japanese or a Ko- rean child adopted abroad by Ameri- can citizens can now be naturalized. Population. The number of children in the United States under 18 years old increased more than twice as fast as the total population between April 1, 1950, the date of the last census, and July 1, 1951, according to esti- mates released February 11, 1953, by the Bureau of the Census, Depart- ment of Commerce. On July 1, 1951, there were 48,585,000 children under 18, compared with 46,724,000 on April 1, 1950 — an increase of about 4.0 percent. During that 15-month period, the total population in the United States increased from 150,- 697,361 to 153,383,000 — an increase of only about 1.8 percent. The figures for both dates relate to the civilian population and exclude persons serv- ing in the armed forces.
The relatively large increase in the population under 18 years old reflects the high birth rates of the 1950's. Moreover, the children born in the early 1930's, when birth rates were low, are attaining age 18 and leaving
MARCH 1953
117
this group. The number of persons under 18 is expected to increase at a rapid rate for several years as per- sons born during the 1950's replace those born during the depression years.
Adoptions have increased sharply in the last few years. In 1951 the num- ber of adoption petitions filed in the United States probably reached 80,000 — 60 percent more than in 1944.
These estimates are based on re- ports from State public welfare agen- cies that transmitted adoption data to the Children's Bureau. In 1951, 33 States reported; and their reports provide the base for the estimate for that year.
There seems to be an increase both in the number of children adopted by stepparents or other relatives and the number adopted by nonrelated per- sons. In the small and perhaps un- representative group of 11 States for which such data are available a 65 percent increase took place between 1944 and 1951 in adoptions by rela- tives, and an 85 percent increase in adoptions by persons not related to the child.
Among the factors accounting for the increase in adoptions is the large number of homes broken during and following World War II by death, divorce, or desertion. In many cases the mothers remarried and the chil- dren were subsequently adopted by their stepfathers.
Columbia University Press publishes "Maternal Care and Mental Health," by John Bowlby, M.D. This informa- tion was accidentally omitted from the discussion of this subject that was published in the January issue of The Child.
UNDERSTANDING HEEEDITY; an introduction to genetics. By Richard B. Goldschmidt. John Wiley & Sons, New York. 1952. 228 pp. $3.75.
For those who have no knowledge of genetics to begin with, this book is probably not as good an introduc- tion to the subject as several of the books that the author recommends to his readers. Nevertheless, those seeking highly authoritative infor- mation will find it in this book. For Goldschmidt is among those few great experimental researchers who, after generations before them had failed, have at last wrested from na-
ture the secrets of how heredity works.
The author is famous for his con- tributions to the genetics of sex, physiological genetics, and chromo- some theory. Yet the reader who did not know that fact in advance would hardly guess it from this book, which covers all the main principles of gen- etical science in a balanced fashion. Goldschmidt assures the reader that those main principles will not be changed by further developments in genetical theory. This assurance is noteworthy because it is given by a geneticist who has upset his col- leagues' thinking as often — and as constructively — as anyone in the field.
Difficult terms are well defined as they come up in the text, and a con- venient glossary is included. What the book lacks (from the layman's view- point) in the style of writing is largely compensated for by the lib- eral use of diagrams. Most of them are unusually well done, and they would be worth studying even if the reader did not attempt to assimilate all of the accompanying discussion.
The author uses few examples from human genetics, yet he stresses throughout the book that the princi- ples derived from work with other animals apply equally to humans. Goldschmidt maintains that man can- not claim "any special position" or exemption so far as the laws of heredity are concerned. He points out that genetic differences are modi- fied by environmental factors, but he does not say that behavior traits are more susceptible to environmental conditions than are physical traits. Indeed, he repeatedly mentions hu- man psychological traits as being in- fluenced by genetic factors in essen- tially the same ways as are other kinds of traits. Moreover, though man is unique in being able to hand down an immense treasure of knowl- edge, "no one receives any of it via hereditary transmission in the bio- logical sense." The Soviet Politburo's denial of that fact is, he declares, a "pai'tiy ridiculous, partly mystical as- semblage of nonsensical claims."
Bronson Price
CHILD PSYCHOTHERAPY. By S. R. Slavson. Columbia Univer- sity Press, New York. 1952. 332 pp. $4.50.
Although the author implicitly ad- mits that he has already presented many of the ideas ofi'ered in this book, he nevertheless hopes that "new vigor and meaning is given them by a fresh restatement in a different context, in new relations, and in the integrative
approach to the biopsychosocial en- tity that is MAN."
The book indeed restates with "new vigor and meaning" the Freud- ian psychology, both orthodox and modified, for social workers and other nonmedical therapists. It has the "in- tegrative approach" that, in a book by Slavson, makes the third and larg- est portion a novelty. Here the entire basis of psychotherapy is examined — its various aims, settings, and dy- namics; the relationships between the child patient and his parents and between each of these persons and the therapist. Only one-fourth of the entire discussion is devoted to group psychotherapy as one of the many techniciues within the broad scope of psychotherapy.
In the last chapter, a case history entitled, "Treatment of a Neurotic Nine-Year-Old Boy with Organic De- ficiency," not only illustrates the ap- plication of the various techniques at the right time and place, but also demonstrates the operation of real team action among five workers — two psychiatric caseworkers, a group psy- chotherapist, a psychologist, and a psychiatrist.
Few social workers can afford to ignore this "restatement" of Slav- son's, if they are concerned with the child and the "orderly and sound de- velopment of his dynamic drives for action, achievement, and reality con- trol."
Hans A. Illing
GUIDANCE IN A RURAL COM- MUNITY; Green Sea — a South Carolina school district plans with and for boys and girls. By Amber Arthun Warburton. Alliance for Guidance of Rural Youth and the Department of Rural Education, of the National Education Associa- i tion, 1201 Sixteenth Street, N.W. Washington 6, D. C. 1952. 156 pp. $2.
More than 3 years ago the Green Sea High School District in Horry County, S. C, launched a guidance program, with the aid of the South Carolina State Department of Edu- cation and of the Alliance for Guid- ance of Rural Youth, to stimulate concerted community action to bene- fit rural children ancl young people.
Community problems concerning children, such as irregular school at- tendance and premature school leav- ing, were studied. These conditions, . it was found, resulted from many • causes, such as sickness, dissatisfac- tion with school, and use of child labor by parents at peak farming seasons.
In turn, recognition of each of these causes uncovered other condi-
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THE CHILD VOL. 17 NO. 7
tions needing correction. For in- stance, sickness was traced to unsani- tary conditions at school and at home, inadequate food, and uncorrected physical defects. Removing these causes involved a broad community- betterment program. The program involved skillful counseling, improved methods of instruction, curriculum changes, and adjustment in school programs. Besides, guidance and counseling programs for parents were instituted to help them recog- nize conditions hindering the chil- dren and to develop and utilize re- sources available for helping the children mature.
The author conveys very well the wide scope of activities involved as well as the method of developing en- thusiasm and carrying an excellent program forward in a strictly agri- cultural community. This book should serve as a guide for many rural areas that are in need of instituting a similar program. Such guidance ac- tivity, carried out on a large scale, would improve immeasurably the health, both physical and mental, of the people in our country.
O. Spurgeon English, M.D.
PARENT GROUPS AND SOCIAL AGENCIES; the activities of health and welfare agencies with groups of parents of handicapped children in Chicago. By Joseph H. Levy. University of Chicago Press, Chicago. 1951. 103 pp. $2.
Two different types of groups are discussed in this report. These are: (1) associations of parents of handicapped children, which are composed entirely or predominantly of such parents — associations that are either affiliated with or opera,t- ing independently of health or wel- fare agencies, and (2) projects sponsored by the agencies, in which groups of parents are brought to- gether for education or counseling.
The author describes the compo- sition and organization of various such groups in Chicago, their activi- ties, and the relationships between the groups and the agencies. A chapter is devoted to the values and limitations of parents' groups. An- other one raises some questions con- cerning the formation of such groups and the role of the social- work profession in relation to them ; this chapter points out clearly the need for further study of these questions.
Ruth C. Okon
UNDERSTANDING YOUR CHILD. Bv James L. Hymes, Jr. Prentice- Hall, New York. 1952. 188 pp. $2.95.
James L. Hymes' name has come to be a synonym for guides for par- ents— pointed but reassuring, light- hearted but solidly meaningful. He knows child development, but what's more, he knows children. He knows how to communicate ideas, too.
Take for example his suggestions on bothersome behavior that arises out of the stage of growth a child is in:
"Ygu tolerate it. You practice the fine art of looking the other way, of not hearing every word that is spoken, of letting a lot that goes on just slide off your back.
"You cJkddh'I it, when you have taken as much as you comfortably can. 'You can't do this in here, but you can out there. . . . You can't do it now, but you can later. . . .'
"YoK stop it, when you have racked
your brain and no bright ideas come ; when despite all your thinking, you cannot stand it any more. You stop it firmly if you must, but you stop it gently, without anger and without upset. You stop it definitely if you must, but with no illusions that it is stopped forever."
Even when "you cannot stand it any more," and thoughtlessly use the last-resort method without meaning to, he says, there's always a chance to start over, always a chance to get a better grasp of reasons back of the behavior. Effective discipline, whether of the 2- or the 10-year-old, is "What frees. What opens up. What makes possible."
The helpful, deeply understanding advice offered in this .small book will be sought over and over again. The amusing illustrations do a lot to point up the author's sensible and sensitive analysis of how parents — and teach- ers, too — can help to bring out in children the best that is in them.
Marion L. Faegre
Mar. 1-7. S.i\-.' "ri>r.r A'ision Week. Twenty-seventh annual observance. Information from American Opto- metric Association, Jenkins Build- ing, Pittsburgh 22, Pa.
Mar. 2. Child Study Association of America. Annual conference. New York, N. Y.
Mar. 15-20. National Council of Jew- ish Women. Twentieth triennial convention. Cleveland, Ohio.
Mar. 1.5-21. Camp Fire Girls Birthday Week. Forty-third anniversary. In- formation from Camp Fire Girls, Inc.. 16 East Fortv-eighth Street, New York 17, N. Y.
Mar. 18-20. National Society for the Prevention of Blindness. Forty- fifth annual conference. New York, N. Y.
Mar. 18-20. National Health Council. Thirty-third annual meeting. New- York, N. Y.
Mar. 20-27. Jewish Youth Week. Fifth annual observance. Information from National Jewish Youth Con- ference, 145 East Thirty-second Street, New York 16, N. Y.
Mar. 29-Apr. 2. American Personnel and Guidance Association (former- ly the Council of Guidance and Personnel Associations). (Four organizations — the American Col- lege Personnel Association, the National Association of Guidance
Supervisors and Counselor Train- ers, the National Vocational Guid- ance Association, and the Student Personnel Association for Teacher Education — have become Divisions of the new American Personnel and Guidance Association.) Annual convention. Chicago, 111. Regional conferences, Child Wel- fare League of America : Mar. 16-18. Central Region. Colum- bus, Ohio.
Apr. 16-18. Southern Region. Nash- ville, Tenn.
Apr. 26-28. South Pacific Region. Berkeley, Calif.
Apr. .30-Mav 2. North Pacific Region. Seattle, Wash.
May 18-19. New England Region. Swampscott. Mass.
June 10-12. Southwest Region. Den- ver, Colo. Regional conferences, American
Public Welfare Asseciation:
Mar. 23-24. Southwest Region. Little Rock, Ark.
Apr. 26-28. Central Region. St. Paul, Minn.
Mav 6-8. Mountain Region. Bismarck, N. Dak.
Illuslrations:
Cover and pages 113, 114, 115, Esther Bubley.
Page 107, George Washington University.
Page 108, Philip Bonn.
Page 109, American National Red Cross.
Page 110, Boston University School of So- cial Work.
Page 116, Richard Perlman.
MARCH 1953
119
VOL. 17 NO. 7 MARCH 1953
n
This Is
sue
Page
Parents Learn About Their Premature Baby 106
Gellestrina DiMaggio, R. N., and Marguerite B. Gelinas
Social Agencies Can Improve Staff" Training 109
Alice L. Taylor
Race Prejudice and Children 113
Kenneth B. Clark
Mental Health in Child Rearing 116
Leo Kanner, M.D.
Published 10 times a year by the Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
FEDERAL SECURITY AGENCY Oveta Culp Hobby, Administrator
SOCIAL SECURITY ADMINISTRATION CHILDREN'S BUREAU
Arthur J. Altmeyer, Commissioner Martha M. El^ii, M.D., Chief
Publication of THE CHILD, monthly bulletin, has been authorized by the Bureau of the Budget, September 19, 1950, to meet the needs of agencies working with or for children. The Children's Bureau does not necessarily assume responsibility for statements or opinions of contributors not connected with the Bureau.
THE CHILD is sent free, on request, to libraries and to public employees in fields concerning children; address requests to the Children's Bureau, Federal Security Agency, Washington 25, D. C. For others the subscription price is $1.25 a year. On all orders of 100 or more sent to one address there is a discount of 25 percent. Single copies 15 cents each. Send your remittance to the Superintendent of Documents, Government Printing OflSce, Washington 25, D. C.
Foreign postage — 25 cents additional — must be paid on all subscriptions to countries in the Eastern Hemisphere and those sent to Argentina and BraziL Domestic postage applies to all other subscriptions.
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APRIL 1953
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MAYl 195;)
INFANT MORTALITY AND PAHERNS OF LIVING
What directions should new research take?
ODIN^W. ANDERSON
MORE AND MORE BABIES' lives have been saved in Western countries since the turn of the century. Before that 100 to 150 deaths under 1 year per thous- and live births were common in coun- tries like Sweden, England and Wales, Germany, and New Zealand; now an infant mortality rate over 50 is uncommon in such countries.
It is well known that infant mor- tality rates vary widely between coun- tries, between areas within countries, and even between residential areas within cities. In 1949 Chile's rate was 169; Sweden's only 23. In 1947 Scotland reported an infant mortality rate of 27 in its most favored social class, but 89 in its most disadvan- taged one. The difference suggests strongly the effect of environment on infant mortality. Again and again, in the extensive literature on infant mortality that has appeared in the last 50 years, we find that infant mor- tality differs in various groups of people, according to income, occupa- tion, socio-economic group, country, color, and so on.
We know that a high infant mor- tality rate is associated with poverty ; we know that the rate began to drop perceptibly in many countries at a certain stage of their technological development; we know that in the United States infant mortality before the turn of the century was higher in cities than in rural areas and that this continued until 1920 or so, after which the rates in cities were lower.
Infant mortality is often referred to as a sensitive index of health level. For example, Berlin in 1943 had an infant mortality rate of 66; 2 years
later, as a result of extreme disrup- tion caused by bombing, the rate shot up to 359. A year later, in 1946, the rate dropped to 123, and in 1949 it was 75. Similarly, but to a lesser degree, France's rate increased — from 73 in 1941 to 109 in 1945. Addi- tional evidence of the effects of war on infant mortality rates has been presented graphically by Collins. [1] Of course, high infant mortality rates in wartime are not caused only by bombing or other violence; many in- fant deaths are undobutedly due to health hazards caused by wartime disruption of living patterns. Where the health level is low, whether in wartime or peacetime, the infant mortality is high accordingly.
Obviously, it is difficult if not im- possible to isolate the specific factors influencing an infant mortality rate. A reasonable plan, however, is to look at fairly general factors and show how they are likely to operate at any given time and place.
Some biological factors, such as age and sex, are stable and are inde-
ODIN W. ANDERSON received his B.A. and M.A. from the University of Wisconsin and his Ph.D. from the University of Michigan — all in sociology.
Under a fellowship granted by the World Health Organization, Dr. Anderson studied and observed in the field of preventive medi- cine in Great Britain, Norway, Denmark, and Sweden, in 19.51. He is a member of the American Sociological Society and of the Society for Applied Anthropology, and a fel- low of the American Public Health Associa- tion.
This article is condensed from a paper that Dr. Anderson gave before the Maternal and Child Health Section of the American Public Health Association at its eightieth annual meeting, held at Cleveland.
When Dr. Anderson gave the paper he was Associate Professor in Charge of the Social Aspects of Medicine, Faculty of Medicine, University of Western Ontario, London, On- tario, Canada. He is now Research Director of the Health Information Foundation, New York City.
pendent of period and place; and an- other stable factor may be a con- stitutional predisposition to certain diseases. Individuals who may be predisposed to certain diseases be- cause of constitutional factors can usually be found in a representative sample of the population. Such con- ditions can be regarded as biological facts that cannot be changed in the short run.
Other factors, basically biological, respond somewhat to environment; that is, their effects vary from time to time and from place to place. Death itself is a biological fact, but in some contemporary populations most deaths occur after age 65 ; in others most occur under 50. Similar differences are found even within the first year of life.
Another biological factor respon- sive to environment is birth, since the number of births in a population and the size of families vary consid- erably with circumstances. These in turn have real though undetermined influences on infant mortality. For example, a high birth rate is associ- ated with a high infant mortality rate. A low birth rate could conceiv- ably be associated with a high rate of deaths during the first month of life, because a low birth rate suggests a high proportion of first births, which in turn is associated with a relatively high mortality rate during the first month of life.
Among the socio-economic factors that influence the magnitude and dis- tribution of biological factors are: Occupation ; income ; level of educa- tion ; marital status ; and place of residence, such as rural, urban, slum, high-income. These factors, which overlap considerably, indicate roughly socio-economic differences
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THE CHILD VOL. 17 NO. 8
New research may succeed in showing how mothering affects babies' health and survival.
among groups of people. They tell us little, however, of the quality of the human beings themselves unless we assume that the higher the socio- economic group the more biologically able to survive are the people. Ex- cept for so-called "problem families" and apparent social misfits, this as- sumption is scientifically untenable, because so many factors other than "ability," however defined, are re- sponsible for the socio-economic niche a person or a family may occupy.
Socio-economic factors, of course, reflect patterns of living in the gen- eral population and in subgroups such as ethnic and occupational groups. Patterns of living, as we know, vary with religious beliefs and practices, attitudes toward human life, concepts of standards of living, hygienic habits — in short, what social anthropologists call culture.
Long-term trends show gains
Until the latter part of the nine- teenth century, infant mortality rates in England and Wales, Scotland, and Iceland underwent great annual oscil- lations. At the beginning of the twentieth century, when the periodic epidemics of childhood communicable diseases were becoming less common and less virulent, these oscillations diminished. Many other factors have
APRIL 1953
operated indirectly to reduce infant mortality, but they are extremely difficult to isolate.
Sweden's records of infant mor- tality rates go back further than those of any other country. In the decade 1751-1800 the rates for differ- ent years ranged from 164 to 286 deaths in the first year of life per thousand live births. In the decade after that the range was from 141 to 2.32. Since 1812 the infant mor- tality rate has never exceeded 200, and in each of the following decades it has decreased consistently. In 1941-49 the rates ranged from 23 to 37.
In Scotland, for which we have reports as far back as 1855, the rates during the period 1855-1900 ranged from 108 to 138. In the decade 1901-20 the range was 92 to 129, and the rates decreased in each of the next two decades. For the period 1941-47 the range was 54-83.
Making allowance for the small population of Iceland (only 140,000 even today), we note that that coun- try experienced extremely violent os- cillations in infant mortality during the nineteenth century, but that dur- ing the twentieth century it has com- pared very favorably with any other area in the world.
The rates in other countries, such as Denmark and Norway, have had a similar pattern.
A similar change in trends of in- fant mortality rates has taken place in areas like India, Cyprus, Jamaica, and Spain; this suggests that the annual oscillations are narrowing and that the rates are becoming more stable, although declining.
At periods during which the in- fant mortality rates fell perceptibly in various countries the trends sug- gest that similar forces influencing the decline of infant mortality were operating simultaneously over wide areas. In the decade 1890-99 the rate fell noticeably in Denmark, England and Wales, Iceland, Scotland, New Zealand, Sweden, Switzerland, Nor- way, and France. In 1900-09, a simi- lar fall took place in Luxemburg; in 1910-19, in Quebec and in India; in 1920-29, in Jamaica and in Spain; and in 1930-39, in Cyprus.
The decade 1890-1900 is an ex- tremely important one in the history of infant mortality in Europe because so many countries experienced an im- provement in such mortality. A similar improvement occurred in cer- tain large cities in the United States, as reported by Winslow and Holland. [2] In other areas infant mortality rates improved distinctly in later dec- ades, and it should be easy to demon- strate that the periods during which the rates began to decline are asso- ciated with sanitary and hygienic developments. This was true, for example, in Quebec, India, Spain, and Cyprus.
Some causes of death are being controlled
In saving the lives of babies less than a year old, the greatest gain has taken place during the period after the first month of life. Improve- ments in mortality during the first month of life have also been made, but hardly to the same degree as dur- ing the ensuing 11-month period. The reason for this lies in how well cer- tain causes of death are being con- trolled. Prematurity and congenital malformations account for the largest proportion of deaths during the first
123
year of life, and usually the majority of these deaths occur before the end of the first month. The greatest pro- portion of deaths from respiratory and gastro-intestinal conditions usu- ally occurs after the first month. These causes are responsive to en- vironmental sanitation. Respiratory and gastro-intestinal causes have de- clined markedly in importance, and prematurity to a lesser degree; con- genital malformations have not de- clined.
In a study of infant mortality in Cleveland, Green showed that from 1919 to 1937 the mortality among vv^hite infants 1 to 12 months of age improved 73 percent while mortality in the first month improved only 24 percent. [3]
Continuing studies of infant mor- tality in the United States made by the Children's Bureau reveal a simi- lar pattern. From 1915 to 1949 the mortality among infants in the age group from 1 to 12 months improved 82 percent ; and among those 1 month of age and under, it improved 52 per- cent. [4]
In Ontario, Canada, the rate of deaths during the first year of life improved 55 percent between the pe- riod 1921-25 and the period 1941-45, while the rate for the first month improved only 39 percent.
Association of low mortality rate in the first year of life with high per- centage of deaths in the first month can be seen clearly when we compare deaths in some countries that have very high infant mortality rates with deaths in other countries that have very low rates. I have selected New Zealand, Sweden, and the United States as low-rate countries, and Guatemala, Mexico, and Egypt as high-rate ones. The period is 1945-47.
In New Zealand the death rate for the first year of life was only 26, and the percentage of babies that died during the first month was high — 73. In Guatemala, whose rate for the first year was as high as 153, only 14 percent of the babies died in their first month. For all six countries a similar relation appears between the figures for the ages concerned, as will be seen in the following list:
Percentage of
Deaths under infants under 1
1 year, per 1,000 year that died
live births, in first month.
Country 191,0-1,7 19l,5-l,7
New Zealand 26 73
Sweden 30
United States 34
Guatemala 110
Mexico 111
Egypt 153
64 71 36 33 14
Studies of the causes of infant mor- tality by age over a long period of time are few, but an excellent and authoritative one has recently been made by W. P. D. Logan, using data from England and Wales for the past 100 years.
The greatest relative improvements occurred in mortality from diseases that are more likely to occur after the first month of life — • communicable diseases, and diarrhea and enteritis, rather than in mortality from pre- maturity, congenital conditions, and other prenatal and natal causes. Also, prenatal and natal causes accounted for about a third of the deaths in 1901-1910, and for nearly half in 1947. [5]
Obviously, socio-economic group, occupation, and income are closely re- lated to one another, and in turn are associated with infant mortality rates. The higher the socio-economic group and income, the lower is the infant mortality rate for the group, although there are exceptions, which will be discussed later.
A study of infant mortality among the families of the rulers of European countries since the year 1500 by Fel- ler reveals a noteworthy long-term trend among a wealthy segment of the population. [6] Over 8,460 chil- dren in these families were born to parents who married between 1500 and 1930. This relatively small num- ber, statistically speaking, is subject to some error, but there is no doubt of the trend, as shown in the follow- ing list.
|
Time of parents' marriage 1500-99 |
DeatJis under 1 year, per 1,000 live births 193 |
Deaths under 1 month, per 1,000 live births 98 |
|
1600-99 |
246 |
96 |
|
1700-99 |
153 |
60 |
|
1800-49 |
96 |
50 |
|
1850-99 |
41 |
17 |
|
1900-30 |
8 |
5 |
The improvements in mortality rates among ruling families — both for the first year of life and the first month — preceded the improvements among the general populations of the countries ruled by these families by 50 years or more. Infant mortality rates as low as 96 and 41 did not begin to appear in statistics for these coun- tries until the end of the nineteenth century. An infant mortality rate of 8 has never been recorded for a gen- eral population, nor a neonatal mor- tality rate of 5. With present medi- cal knowledge these low rates seem almost impossible to attain in a gen- eral population. But as reported for the ruling families they may be so low merely because they were calculated on such a small number of infants. The lowest recorded neonatal rate to- day for any country is Norway's 18 ; yet a rate of 17 was recorded for the ruling families as far back as 1850-99.
About a quarter of a century ago a crude but significant study of infant mortality in 1865 by age and eco- nomic group was made by Chapin. He separated the population of Provi- dence, R. I., into persons who paid certain taxes and those who did not. He found that the infant mortality rate in the nontaxpaying group was twice that in the other group — 190 and 93 respectively. [7]
In York, England, at the turn of the century, Rowntree made his famous study of poverty, a study that was repeated nearly four decades later. In this study the population was divided into four classes. One included only people who kept serv- ants. The other three were groups of working people, and the groups were described, according to economic status, as "highest," "middle," and "poorest." As would be expected, he found the best infant mortality rate among the group that could afford to keep servants — 94. In the three groups of working people the rates were : 247 for the "poorest," 184 for the middle group, and 173 for the highest-income group of workers. In 1936 the corresponding rates for the three groups were 78, 75, and 41. (The rate for the servant-keeping group in 1939 was not given.) [8]
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THE CHILD VOL. 17 NO. 8
At irregular intervals for the past 40 years the Registrar-General's Of- fice for England and Wales has pub- lished infant mortality rates for each of five socio-economic groups. In 1939 the infant mortality rate for the low- est group was better than the 1911 rate for the highest. During the period from 1911 to 1930-32 the higher the group the greater was the relative improvement, but from 1930- 32 to 1939 the four lower groups ex- perienced gains greater than that of the highest, and their own improve- ments were almost equal. This may indicate that the upper group is reaching a "diminishing return," as its 1939 rate was relatively low — 27. In both 1911 and 1939 the difi'erences between the highest and the lowest groups in infant mortality rates are far greater than their differences in neonatal mortality rates, indicating that the neonatal mortality rates are relatively less variable among differ- ent groups and at different periods. Among- all groups the infant mortal- ity rate declined much more than did the neonatal rate.
As is to be expected, mortality rates by income alone follow the same pat- tern as do rates by socio-economic group.
What a pioneer study sJiowed
In an early study of infant and neo- natal mortality, made by Woodbury for the Children's Bureau from 1911 to 1916, in eight cities in the United States, the earnings of the father were studied in relation to infant mortality in seven of the eight cities. In the highest-income group the mor- tality rate was 59.1 ; in the lowest the rate was 166.9. The neonatal mortal- ity rate for the highest-income group was 38.2; for the lowest it was 55.8. As did other studies of income groups, this one showed much less variation in the mortality rates for the first month than for the first year. [9]
Green's aforementioned study of economic status and infant mortal- ity in Cleveland, made in the peri- ods 1919-23 and 1934-37, repeats the findings even when the differ- ences between the income groups are slight. [10]
INFANT MORTALITY, 1915-49
(U.S. BIRTH REGISTRATION AREA)
1900
1910
1930
1940
1950
UNDER I YEAR
100
50
10
Deaths between the ages of 1 month and 1 year have dropped rapidlv, for these deaths are chiefly due to causes that can be controlled through improved community health con- ditions and better baby care. Deaths under 1 month of age, however, have decreased slow- ly; these babies die mainly from prenatal and natal causes, about which we know too little.
Our discussion of the relationships between income and infant mortality may well be closed by reference to a recently published study of 973 cities in the United States, 1939-1940, by Altenderfer and Crowther. In this study, again, the group of cities with the highest per capita income had the lowe-st infant mortality rate (28) ; the group with the lowest per capita income, the highest rate (73). [11]
Studies show us that infant mortal- ity rates vary widely by residential areas within cities [12] ; rural rates are higher than urban rates [13] ; rates for nonwhites are higher than for whites [13] ; certain ethnic groups have higher rates than others [14] ; rates for foreign-born families are higher than those for native-born [14] and so on.
In summary, when we examine the gross relationships between infant
mortality and various socio-economic factors, we see that a low infant mor- tality rate goes with high income, with high socio-economic status, with well-paying occupations, and with other favorable socio-economic fac- tors. An apparently obvious inference from this fact is that if all families could enjoy the general standard of living as to food, clothing, shelter, medical care, and public-health serv- ices that is attained by the level of society experiencing the lowest infant mortality rate, all families would then approximate this rate. In short, there is assumed to be a direct and un- diminished correlation between a high standard of living and low in- fant mortality.
It might reasonably be suggested that where infant mortality rates go higher than about 30, an improve- ment in the standard of living will
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125
have a long-run effect, as it has had since 1890 in various countries. It seems, however, that, for a given population, once the rate drops to about 30, the broad economic and social factors operate with lessening effect. Then an increasing influence on the rate begins to be exercised by personal factors in the care of the baby. Among these factors are (1) adequacy of mothering and (2) readiness — and ability — to use proved methods of infant care.
Perhaps the dividing line of 30 is too high or too low, but I submit that a theoretical line exists at one point or another. Perhaps that point is where the socio-economic level for the population as a whole is favorable, and family differences in this respect are small.
Tradition may be a factor
I suggest, then, that some fairly specific practices in infant care are relatively independent of economics, once basic essentials of living are accessible. (Given the essentials of living, use of a bottle sterilizer, for example, can have a greater effect in some families on saving babies' lives than an increase in income of $500 a year.)
Attainment of an infant mortality rate of 15 to 20 would require excel- lent care of each baby. If this were given, a low rate could be achieved by families in Canada and the United States earning considerably less than families whose incomes are in the upper range of the income scale.
Among the 45 or more studies on infant mortality and social and cul- tural factors are two studies that suggest the plausible idea that, once the basic minimum standard of liv- ing has been attained in a given popu- lation, there is a point of diminishing return in the effect on infant mortal- ity, of income, occupation, and socio- economic group.
When the Children's Bureau made its studies of infant mortality in eight cities, which I referred to pre- viously, the infant mortality rate for the eight cities studied was 111, indi- cating a tremendous area of potential
126
improvement by means of broadside attacks on poverty, bad housing, and ignorance, with demonstrable effects in a short time.
One of the analyses was by color and nationality of mother, as follows : Colored ; native-born white ; foreign- born white (Italian, Jewish, French- Canadian, German, Polish, Portu- guese). [15]
Even though the Jewish mothers were foreign-born, lived under as crowded conditions as the other foreign-born, had families as large as any other groups, and had an income that was much lower than that of the native-born white mothers, the Jew- ish group experienced the lowest infant mortality rate of all groups — 54 — and the lowest neonatal mortal- ity rate — 28. (The native-born white group had much poorer rates — an infant mortality rate of 94 and a neo- natal rate of 42.)
Obviously factors other than gen- eral economic ones account for the low infant mortality rates among the foreign-born Jewish group. Closer examination would probably reveal a pattern of infant care of a high order embedded in the Jewish culture, since even bottle-fed Jewish infants experi- enced a lower mortality rate than infants of native-born whites. This is implicit in a Canadian study atso. [16]
A second study that points to the influence of a factor in infant mor- tality other than economic ones was made in British Columbia, 1945-46. This gives infant mortality rates by occupation of father. The total infant mortality rate for the population studied was 31. The best rate among the occupation groups, 16, was at- tained, not by the professional and owner-manager groups, which had rates of 27 and 28, respectively, but by the clerical group, which hardly had a high income. To me this sug- gests especially good care of the babies in the families in the clerical group. [17]
I suggest that any further research to establish general relationships be- tween infant mortality and such factors as income level and occupa- tion is probably needless, because the
gross relationships have been estab- lished conclusively enough.
Toward the future
What research, then, other than purely medical, is needed concerning factors in infant survival?
One such field in which few studies have been made recently is illness of babies in relation to socio-economic factors. A study of this relation, made since World War II in a town in England, found the usual class difference in infant mortality, but suggested, at least tentatively, that no such difference was evident in infant sickness. [18] Evidence from a later study, based on a larger number of babies, who were dravm from all parts of Great Britain, disagrees with this. [19] This, of course, suggests need for further research.
Another subject, relatively un- touched, concerns the effect of ad- verse socio-economic conditions on the unborn baby and on the ability of the mother to bear a full-term, healthy child. Such study is especially needed to help us understand the causes of deaths of infants just before birth, during birth, and in their first days of life. As a step toward pre- venting the numerous deaths — many associated with prematurity — during this critical period, we need a fuller understanding of the relation be- tween these deaths and the adequacy of the care the mother receives dur- ing pregnancy. Such care, undoubt- edly, depends to some extent on the socio-economic status of the family and the community.
Many other questions are still un- answered concerning socio-economic and ethnic factors in relation to ba- bies' deaths: What are the environ- mental conditions in localities where infant mortality is still extra high by m.odern standards? How do tradi- tional ways of caring for infants in various ethnic groups affect the sur- vival of infants in these groups? These are only a few of the many questions that research workers might attack as steps toward mak- ing available to doctors and other health workers facts that will help them to save babies' lives.
(References are on page 134)
THE CHILD VOL. 17 NO. 8
L^ - 'IB^I^^iMiipl^
WHEN A COUPLE PLANS TO ADOPT A BABY
Group technique helps to clarify agency procedures
BEATRICE PRUSKI
COUPLES that apply to an adop- tion agency for a child often have very little idea of how the agency goes about getting children for adoption or of how it decides which applicants are to receive chil- dren. They are likely to feel that the process is mysterious and that the agency makes its decisions arbitrar- ily. When a couple does not receive a child for adoption they often resent this and feel that the agency must consider them in some way inferior.
Agencies use different methods of meeting this problem. One agency that uses a group technique in work- ing with the applicants is the Los Angeles Adoption Institute, a non- profit, fee-supported agency. This agency serves not only couples who apply for a child, but the child's natural parents. And its first interest is the welfare of the child himself.
In the interest of the child, the
agency wishes to make clear to all applicants just what its purposes are, how it proceeds, and what it requires of couples wishing to adopt a child. It has found that an effective way to do this is by means of a group meet- ing, not as a substitute for separate, individual interviews, but as a prep- aration for them.
Couples face same problems
The group meeting gives the couples their first opportunity to talk with professional staff members of the agency. Before that, they have had only a brief conversation with a receptionist, who has checked their eligibility with regard to age, resi- dence, citizenship, and length of mar- riage. The receptionist has noted also some additional information on race, religion, and number of children, has assured them of the agency's desire to be of service, and has explained that all general que-stions would be discussed at a meeting to be attended
by a number of other couples who also were applying for a child.
The meeting is held in the evening ; usually about 10 couples attend. Join- ing with other applicants brings home to each couple that they are not alone with their problem. Also, group dis- cussion can modify the extremely per- sonal point of view of an individual family's situation. Each couple is part of a group in which all have faced the question of sterility and are now tak- ing the same chances of disappoint- ment in trying to adopt a child. They feel that all will be treated alike.
The group meeting helps to set the tone for all later individual relations with the agency workers. At the time of this first contact there are 20 clients to 1 professional worker. The
BEATRICE PRUSKI has the degree of master of arts in psychology from the Uni- versity of Chicago. For about 20 years she has worked in various phases of vocational and clinical psychology.
At the time Mrs. Pruski wrote this article she was Director of the Los Angeles Adop- tion Institute.
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127
couples have the support of a group of other couples who hope to become adoptive parents. Their problems are immediately identified to some extent with the problems of the agency, and they are asked to join in trying to solve them. Through questions that other couples ask, which might not have occurred to them, they see the whole situation in broader terms. Also, people who do not easily formu- late in words the things that concern them, or who are shy about asking, benefit through the verbal facility of others. The dominance of the pro- fessional worker is reduced to a mini- mum ; and a more mature, a more co- operative, and a more nearly equal relationship is established at the out- set.
When the meeting begins
The method of handling the meet- ing varies somewhat with the worker who acts as leader. Since people begin arriving at least 20 minutes early, this time needs to be used in some way other than having them sit around self-consciously. At first, couples were asked to write down their ideas about their adoption plans, but later a more flexible plan was followed. The leader gives out paper and suggests that the people jot down questions they wish to ask, but she also carries on conversation with those who prefer to talk. The discus- sion starts not later than 10 minutes after the designated time.
Discussion may start directly with the questions uppermost in the minds of the couples, and gradually may be shaped into a general outline; or the leader may follow an outline, allow- ing time for discussion of each point. Whichever method is followed, a number of fundamental questions al- ways emerge, although the content differs somewhat at different meet- ings.
All groups ask about the origin of the agency, who is behind it, and how it is financed. Since the Institute is fee-supported, the leader explains this type of financing, as well as the method of paying the fees. This leads up to the agency's procedure for ap- plicants ; this is discussed and then a
When a couple receives a baby from an authorized adoption agency, they can be sure that the child's interests have been given first importance in all the planning by the agency.
written statement of it is distributed for the group members to take home. Under this procedure, which aims to solve the problem of long lists of applicants and an indefinite waiting period, each couple's application moves according to definite time in- tervals, and the applicants always know where they stand.
Each group is asked whether they can think of a better plan. Although it is a long time since anyone has made a new suggestion, the discussion helps the applicants to realize that the agency is doing everything in its power to show them consideration.
Agency's procedure explained
Every group is interested in where we get our children, what we know about the child himself at the time of placement, and what we know about his background. The leader explains that the agency tells the adoptive parents all it knows about the child's background and makes clear that it would never place a child with a fam- ily that would be uneasy about any specific fact in his history. The role of heredity is discussed from the point of view of helping the appli- cants to clarify their own beliefs be- fore the individual interview that
each couple will have with a staff member. Only two definite points are made : { 1 ) That we have no conclusive evidence on what is hereditary; (2) that many characteristics run in families, but that this does not neces- sarily mean that any particular char- acteristic, other than physical ones, is transmitted by heredity rather than by environment.
The applicants always ask, and are frankly told, what the agency is look- ing for in homes for the children. It is most gratifying to see how simply and spontaneously this discussion focuses on the needs of the child, rather than on the needs of the appli- cants.
The leader begins with the ques- tion, "Suppose that you had to sur- render a child of your own to be reared by sti'angers, what things would you want to be sure were pres- ent in that home and what things would you want to be sure were not there?"
All groups spontaneously place personality and emotional traits first. Experience has shown that it is best to keep this discussion in general terms. Too much detail in this field, particularly if illustrated by ex- amples, tends to make some people
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THE CHILD VOL. 17 NO. 8
uneasy and self-conscious in the in- dividual interviews that are to come. Properly handled, however, this dis- cussion makes for greater ease and frankness later. The mere fact that the applicants gain some idea of what the agency is looking for, in- stead of depending on rumor about agency standards, gives them much more assurance.
The agency is able to make the point that it does not bar people be- cause of any specific experience of their own, such as a broken home in their childhood, or a divorce. It is interested only in what these experi- ences have done to them ; and the final result may be favorable, since people who have met and solved problems are stronger than those who have not.
The group knows the agency does not consider itself infallible in evalu- ating their situation and that it needs their help. The worker explains fully the agency's attitudes on finances, living space, health, and life expec- tancy, and it has never met with any- thing but complete approval of these. Each couple sees, as a result of dis- cussion, that the agency's standards are not artificial values of its own.
Every adoption involves rislts
It is well known that personal anxiety is often relieved through group discussion. People are able to ask questions that might be difficult for them in an individual interview.
For example, "If the child develops a handicap, will the agency take him back before the final adoption?" Couples usually ask this because they fear they might lose a child after they have become attached to him, but sometimes the question is whether they can return a child who is un- satisfactory to them, and what will be done about the fee in that case. They want to know what risks they take in regard to the child himself. The agency does not minimize these risks, especially since it believes in placing babies early in life.
Every group contains some people who are concerned about these risks, and some who dismiss the whole ques- tion on the ground that you take even greater risks with a child of your
own. In the discussion, the group per- forms its own therapy for extreme attitudes of either type. Many couples have told the worker later that they felt she was overstressing these risks, and so the agency now tells the groups how very few real problems it has encountered regard- ing the children placed.
Major anxieties seem to concern the question of the applicants' own qualifications and the reputed strict- ness and artificiality of agency prac- tices in general. Here too the group sets its own standards and performs its own therapy. Sometimes, although rarely, this discussion arouses such anxiety that a couple decides not to proceed with the application. Most people, however, feel enough security in their marriage, and at this point have enough faith in the agency's fairness, to go ahead in a much more relaxed frame of mind after the group discussion.
Interesting emotional reactions are often noticed during the meeting. Couples often move physically closer together and frequently hold each other's hands. Naturally they feel an implied challenge in the discussion of qualifications; and in the face of it, surrounded by other people experi- encing the same challenge, a couple will become more conscious of their unity and of how much they mean to each other. One can sense their de- cision to stand by each other. The ex- pression of their faith in each other seems to help them go through the rest of the procedure with greater frankness and courage.
Couples have frequently told the workers, and also have mentioned to outsiders, how much more informa- tion they have given than they had originally intended to give. When they are asked why, they usually answer, "Because we felt from the beginning that you cared what hap- pened to us and would do the best you could for us." The agency feels that the close emotional unity of the group meeting has a great deal to do with setting this tone.
One of the chief ways in which the group meeting saves time later is that it stimulates the applicants to visual-
ize themselves as possible parents be- fore the individual interviews. Con- scious effort is made to have them do this to prepare themselves to co- operate later in their interviews.
The agency is now trying to formu- late the best content for group meet- ings in relation to the interviews. At the time of the individual interviews applicants are asked for comments on the group meeting. On specific points the comments are often constructively critical, and on the subject in general they are usually enthusiastic. People often tell the agency they have thought considerably about certain points afterward or have discussed them with friends.
Group meeting has several values
One value of the group meeting is the contribution it makes to the agency's own thinking and to clarifi- cation of policy. On a question that hinges on how people in general feel, an agency will gain more by bringing it up in a group meeting than by hav- ing the staff debate it among them- selves. One such question is that of placement of a child with handi- capped parents — whether or not such a child would be injured by com- munity attitudes. This is a sensitive area today and one which no one can dismiss lightly in view of the number of men who returned handicapped from the war.
By the time the Institute set its pol- icy on this, it had behind it the think- ing and feeling of a number of the applicants, who certainly represent a broader sample of the community than does any agency staff. The couples talked very frankly on this point, with some differences of opin- ion but much fundamental agreement. It was evident that most of them felt that to preclude placement of a child in a home there must be some reason beyond the physical fact of a parent's handicap itself. They gave example after example of people they knew who were in this situation and of the neighborhood attitude and appar- ent effect on the children.
In group meetings, discussions of problems are kept general, but many (Continued on page 134)
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FOLLOW-UP OF 1950 WHITE HOUSE CONFERENCE ENTERS A NEW STAGE
National Committee hands torch to other groups
ELMA PHILLIPSON
AFTER 2 years of leading the work of advancing the findings of the 1950 White House Con- ference, the National Midcentury Committee for Children and Youth has placed the Conference follow-up in the hands of permanent groups and has voted to dissolve in the near future.
The Committee's two Advisory Councils, however, will continue to lead their constituent agencies in their follow-up work. (The Advisory Council on State and Local Action represents 51 State and Territorial committees and more than 1,100 local units. The Advisory Council on Par- ticipation of National Organizations represents 452 national organizations, whose membership extends into all the States and Territories.)
These decisions were announced at a Two- Year Anniversary Conference, held by the Committee and the two Councils, November 30 and December 1-2, 1952, at New York.
The meeting was held to inven- tory progress made throughout the country in translating into action the findings of the Midcentury Confer- ence and to note what still must be done to reach the goal of the Confer- ence— the goal of assuring for every
child a fair chance for healthy person- ality development.
Although five White House Confer- ences on children were held during the first half of this century, the 1950 Conference was the first to hold a follow-up meeting such as this one.
The Committee's chairman, Leonard W. Mayo, said frankly that the Mid- century Committee would have wel- comed another year's active work — if money had been available. But, he said, the Committee was never in- tended to function more than 2 or 3 years.
"Two years of intensive follow-up under the National Midcentury Com- mittee have already been provided," he said. "There are a good number of highly competent and experienced national organizations in the country that are not only capable of but inter- ested in advancing the findings of the
ELMA PHILLIPSON, whose A.M. degree is from the University of Chicago's School of Social Service Administration, has been Ex- ecutive Secretary of the National Midcentury Committee for Children and Youth ever since it was created, December 19.50. For more than a year before that she had been on the staff of the White House Conference, working with the 464 national voluntary or- ganizations that took part in preparing for the Conference. Previously she had had wide experience with such organizations.
Miss Phillipson is now planning and di- recting a recruitment project for the Ameri- can Association of Medical Social Workers — a G-month project made possible by means of a grant from the National Foundation for Infantile Paralysis.
White House Conference through their programs. This is an appropri- ate time to bring to a successful con- clusion the work of the National Mid- century Committee."
What are the next steps?
Among the reasons why the com- mittee should plan an early exit, Mr. Mayo said, are the solid job being done by most of the State and local committees and the necessity for leav- ing a clear field for the planners of the 1960 White House Conference.
Taking up the big question in the mind of every delegate, Mr. Mayo asked, "Where do we go from here?" As for future action, he asked the Conference to consider three ques- tions :
1. How can we accelerate inte- gration of the formal follow-up program of the White House Conference with the main stream of regular agency and commun- ity programs and services? Al- ready, he said, the "main stream" has been modified in many parts of the country by the infiltration of the follow-up pro- gram and by many other con- structive influences.
2. How can the impetus that has been given to the work of State and ' local committees be con-
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tinued and stren^hened? And in this strengthening how can encouragement be given to the process by which committees or- ganized for White House Con- ference follow-up are moving into broader community plan- ning for children and youth? 3. What provisions should be made with respect to the main phases of the follow-up program? Foremost among the achievements of the 1950 Conference and its follow- up program are the impetus given to local, State and Territorial commit- tees and the impetus generated by them, Mr. Mayo continued. These committees, he said, should strength- en and expand their activities. "Some committees have been broad planning bodies throughout their existence," he pointed out. "Others have already moved from programs devoted solely to preparation for and follow-up of the White House Conference to even broader planning and action func- tions, in cooperation with existing organizations."
Harking back to the National Mid- century Committee's original aims, Mr. Mayo specifically recommended:
1. Continued interpretation and pub-
licizing of White House Confer- ence findings by local and State committees. National organiza- tions, and Government agencies.
2. Continued life for the Advisory Council on State and Local Ac- tion and the Advisory Council on Participation of National Or- ganizations.
3. More emphasis on youth partici- pation, which should become "a main interest of all youth-serv- ing agencies."
4. Drafting of a research program in personality development and the broad field of child care, on the basis of the Fact-Finding Report of the White House Con- ference, by a qualified profes- sional group.
Two additional questions, some- what broader in scope, Mr. Mayo said, need to be asked because they bear such a close relation to the other problems.
The first question arises in view of
the fact that there is no general agreement on what constitutes a sound and comprehensive program for children and youth in a commu- nity. Shouldn't there be a definition, he asked, to serve as a goal for pro- fessional and lay workers in com- munities that are doing less than they might? It is likely that an answer will be found through a study being made jointly by the Children's Bureau and the Child Welfare League of America, he said.
Secondly, Mr. Mayo asked, should provision be made for the organiza- tion of a national group of outstand- ing citizens whose sole function would be to represent, and to act as a spear- head for, the broad interests of the children and youth of the Nation? This, he said, would be a group of distinguished citizens who would be responsible to the Nation and not primarily or exclusively to any or- ganization.
Gains made in many States over the past 2 years in putting into prac- tice the findings and recommenda- tions of the Midcentury Conference were reviewed by Lyman Bryson, professor of education. Teachers College, Columbia University. Mr. Bryson drew his facts from the Com- mittee's "Report on Children and Youth, 1950-52."
Mr. Bryson discussed some gains that the Committee had reported in different States. Among the gains: State aid was voted for more educa- tion for mentally retarded, hospital- ized, and home-bound children; com- munity health councils were organ- ized ; small towns were included in public recreation programs. And some disappointments were reported too, such as rejection by some adults of youth participation; no public- health nurse in many counties; juve- nile offenders jailed with adults; de- feat of legislation for a children's psychiatric-treatment center.
Speaking of the defeat concerning psychiatric treatment, Mr. Bryson said, "You can get help for a child whose difficulty is obvious and visible, but it is hard to persuade people to pay attention to children's emotional and psychological problems.
"It's extraordinarily difficult to equip, and to get the proper personnel for, good juvenile courts and for psy- chiatric treatment for juvenile of- fenders," he pointed out. "The public won't quite get over the combination of sentimentality and brutality which means that if a child is obviously handicapped something can be done about it, but if the handicap is secret, elusive, and difficult to get at, nothing can be done about it."
Going back to the bright side, Mr. Bryson pointed to the importance of small gains. "Don't think that because the great program is not immediately accepted, the little victory doesn't count," he said. "The little victories give the campaigners something to talk about; they encourage the staff and the committee members, and they give the local citizens something to be proud of."
Young people's opinions valued
A great need today, Mr. Bryson said, is to get people to look at hurt souls. "But it's going to be hard to minister to the souls of the young un- less we know what youth is thinking and doing.
"We had young people in the meet- ings at Washington in 1950. They were disruptive, they were sometimes extravagant, they were often wise; they were always interesting; and they were eminently worth while.
"I've tried a number of quite ex- tensive experiments, trying to get at the contributions which young people make to public opinion. I've found that they nearly always have good opinions. Just on a straight Yes or No vote I would be as willing to put any nontechnical public question to the vote of the young people — say between 16 and 20 — as to any other group in the United States.
"The reason why they don't con- tribute much to the deliberations and operation of public agencies is that they very often don't know why they have those good opinions.
"There are two fallacies in this field. One is the fallacy of young people who think that intelligence is a substitute for experience. The other is that of older people who think that
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experience is a substitute for intelli- gence.
"The real reason why we want youth in our deliberations is not for their contribution, but for what it does for them. Young people are living now. Citizenship is not only something you learn for the future, but it's something you practice for what it does to you while you're practicing it. Young people have a right to that, for its own sake and for now."
Concluding, Mr. Bryson cautioned against resting on the progress made so far. "Each of us," he said, "must help constantly to make a different social atmosphere in America, help constantly to make more people sensi- tive to the things that are wrong, to straighten out conditions which are evil and damaging."
Melvin A. Glasser, who was execu- tive director of the Midcentury White House Conference, pointed out that young people have been getting more plentiful than ever. There were 35,000,000 children under the age of 18 when President Theodore Roose- velt called the first White House Con- ference in 1909. In the next 40 years that figure was increased by only 12,000,000, but in the current decade alone an increase of 10,000,000 is expected.
Midcentury marks improvements
Significant gains cited by Mr. Glasser were : New emphasis on chil- dren's emotional needs, increased activity of citizens, greater attention to the teen-age group, more coopera- tion among the professions, and heightened interest in fact finding and research. He cautioned against being content with the status quo and urged the delegates to keep pushing forward.
Martha M. Eliot, M.D., Chief of the Children's Bureau, spoke as vice chairman of the Federal Interdepart- mental Committee on Children and Youth.
"The meetings of this anniversary conference," she said, "have made me realize more keenly than ever before the effective leadership which the National Midcentury Committee has
given to the White House Conference follow-up program."
Dr. Eliot explained the work of the Federal Interdepartmental Commit- tee on Children and Youth, which represents 35 Government agencies, and showed how both public and pri- vate agencies gain from a friendly interrelationship.
"Each older generation piously hopes that its successors will be able to avoid the mistakes of its forerun- ners and triumph over the legacy of difficulty bequeathed to it," said Dr. Buell Gallagher, President of the College of the City of New York. "Yet each oncoming generation is forced to
PUBLICATIONS of the Mid- century White House Conference, including the "Report on Children and Youth, 1950-1952" (46 pp. $1) and the "Directory of State and Ter- ritorial Committees Cooperating with the National Midcentury Com- mittee for Children and Youth" (60 pp. 75 cents), should be ordered from Health Publications Institute, 216 North Dawson Street, Raleigh, N. C. Ask for quantity and packet rates.
Health Publications Institute, a nonprofit organization, has on sale all the Midcentury Conference pub- lications except "Personality in the Making," which is published by Har- per & Bros. (454 pp.).
grow up in a world where adults set the patterns of control and determine the possibilities for growth. Each generation's teeth are set on edge by the sour grapes eaten by its fathers.
"No matter how much progress can be shown over the last half -century, we know that the next half-century still poses for the present generation of adults the same old problem — how to release the leadership of today's children in constructive directions without corrupting it with the preju- dices, foibles, and chicanery of to- day's adults."
Dr. Gallagher pointed out that it won't be easy to give children a better chance. Citizens can be rallied to battle against "entrenched evil when it is clearly unmasked," but they are slow to meet the need for patient, plodding work on constructive pro- jects. Too many are willing to stop at the talking, or listening, stage.
And even when they move ahead, much of their energy is wasted in the cumbersome process of building the kind of machinery that will ulti- mately get results.
"Since today's children will be to- morrow's leaders, the only way to make sure they will lead well is to give them good leadership today," Dr. Gallagher said.
"We must work very hard on to- day's adults," he continued. "There is no other way to make sure that those who today lead tomorrow's leaders will not corrupt and ruin the bright hope on which mankind must rely."
As a goal in reforming the current crop of adults. Dr. Gallagher sug- gested that adulthood should "seek earnestly to recapture the virtues (without the vices) of youth, to be- come childlike without being childish."
Margaret Price, chairman of the Advisory Council on State and Local Action, said : "In some cases I believe the citizens are ahead of us in their desire for action." She cautioned the State committees to make sure in future planning "that this citizen interest shall neither die nor be siphoned off into unproductive chan- nels." Mrs. Price announced that the Advisory Council on State and Local Action is planning to expand its ac- tivities, and that another meeting of the Council is to be held toward the end of 1953.
George Corwin, vice chairman of the Advisory Council on Participation of National Organizations, said that the 92 national organizations repre- sented at the meeting had agreed to urge all national groups to step up their efforts to eliminate prejudice and discrimination; to strengthen local welfare councils, to develop more lay leadership, to work for vital legis- lation, and to encourage youth par- ticipation.
A strong plea for more attention to young people who will not go to college or may not even finish high school was made by Charlotte Peter- son of Detroit, a Wayne University student who is vice chairman of the Michigan Youth Advisory Council.
"The schools' educational and coun- seling programs are not as effective
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THE CHILD VOL 17 NO. 8
as they could be," she said. "Too often they pay attention to the top group who will go to college, or to the troublemakers at the bottom."
Better vocational-counseling serv- ice, coupled with full recognition of the dignity of all forms of labor, are two main goals of the Michigan Youth Advisory Council, Miss Peterson re- ported. Another aim is to give boys and girls "the opportunity to acquire an actual, constructive work experi- ence on a job they are best qualified to perform." Employers and labor unions should help work out a feasible apprenticeship program, she said.
Strengthening of State and Terri- torial youth committees to make them better watchdogs was recommended by the Advisory Council on State and Local Action.
The delegates urged that every State committee have a formally de- fined purpose and a clearly outlined structure.
Committee members, rather than the executive secretary, should be primarily responsible for raising money, the group agreed. Because the planning functions of the com- mittees involve both public and pri- vate services, it was recommended that funds be sought from public and/or private sources.
The importance of regularly sched- uled conferences and regularly pub- lished newsletters was emphasized. It was suggested that State and Terri- torial committees give special atten- tion to one or more projects with youth participation and to enactment of needed legislation.
How to eliminate prejudice and discrimination that still persist in the programs and staff and membership policies of many national organiza- tions was discussed by the Advisory Council on Participation of National Organizations at a work session.
Many national organizations, the delegates reported, have changed their bylaws or adopted policies to prevent discrimination in their own ranks, and to avoid holding con- ventions in cities that practice seg- regation.
"We recommend," the discussion group announced, "that national or-
ganizations gather the facts about the makeup of their personnel and their constituency and their existing prac- tices and then face the implications of these findings in terms of policy changes.
"We recommend that national or- ganizations help set a pattern by operating with completely integrated national clerical and professional .staffs."
Fairness called for
The delegates pointed out that dis- crimination is not limited to racial and religious groups but extends also to physically handicapped persons and low-income families. Action to stop discrimination in these areas is also needed, it was agreed.
The Committee's new pamphlet, "Report on Children and Youth, 1950- 1952," was distributed at the Two- Year Anniversary Conference.
Based on material supplied by State and Territorial youth commit- tees, by national organizations, and by Federal agencies, the report is packed with examples of voluntary and offi- cial action in carrying out the find- ings of the White House Conference.
The Committee has issued another new publication, the "Directory of State and Territorial Committees Co- operating with the National Mid- century Committee for Children and
Youth." This is far more than just a directory. It includes highlights of the present activities of many of the State and Territorial Committees' programs, as well as some of their plans for the future. As the Mid- century Committee chairman says in the foreword, "It reveals amazing and admirable ingenuity, skill, and leader- ship on the part of State and Terri- torial Committees in providing in- creasingly better opportunities for the healthy personality development of all our children and youth."
As was reported in the February issue of The Child, the National Mid- century Committee has closed its office in New York. The Committee will not disband, however, until July or possibly later in 1953. General correspondence should be addressed henceforth to the chairman, Leonard W. Mayo, director of the Association for the Aid of Crippled Children, 580 Fifth Avenue, New York 36.
The Advisory Council on State and Local Action should be addressed in care of the secretary, Douglas H. MacNeil, 222 West State Street, Trenton 8, N. J.
The Advisory Council on Participa- tion of National Organizations should be addressed in care of the chairman, Robert E. Bondy, National Social Welfare Assembly, 1790 Broadway, New York 19.
At the Midcenturj ( imrcrfnce, in 1950, at which \()iiP!; doloyates t(»()k part in discussions, adults found that the younj; people had good opinions, though they didn't always know why.
APRIL 1953
133
INFANT MORTALITY
(Continned fro»i page 126)
REFERENCES
1. Selwyn D. Collins: Trends in Illness and Mor- tality. Public Health Reports, May 1952, 67, pp. 502-503.
2. C.-E. A. Winslow and Dorothy F. Holland: The Influence of Certain Public Health Procedures upon Infant Mortality. Hinrian Biology, May 1937, 9, pp. 133-174.
3. Howard W. Green : Infant Mortality and Eco- nomic Status. Cleveland Five-City Area, Cleveland, Cleveland Health Council, 1939, p. 10.
4. U. S. Children's Bureau: Statistical Series No. 9. Charts on Infant, Childhood, and Maternal Mor- tality, 1949. Washington.
5. W. P. D. Logan : Mortality in England and Wales from 1848 to 1947 ; a Survey of the Changing Causes of Death During the Past Hundred Years. Population Studies, September 1950, 4, pp. 132-178.
6. Sigismund Feller: Studies on Mortality since the Renaissance. Bulletin of the History of Medicine, 1943, 13, pp. 427-461.
7. Charles V. Chapin : Deaths among Taxpayers and Nontaxpayers Income Tax, Providence, 1865. American Journal of Public Health, August 1924, 14, p. 648.
8. B. Seebohm Rowntree : Poverty and Progress : a Second Social Survey of York. London, Longmans, Green, 1941, p. 297, 298.
9. Robert M. Woodbury: Causal Factors in Infant Mortality ; a Statistical Study Based on Investiga- tions in Eight Cities. 1925. 246 pp. (U. S. Children's Bureau Publication No. 142), p. 148.
10. Howard W. Green, op. cit., p. 33.
11. Marion E Altenderfer and Beatrice Crowther: Relationship between Infant Mortality and Socio- Economic Factors in Urban Areas. Public Health Reports, March 18, 1949, 64, p. 333.
12. A. D. H. Kaplan : Significance of Infant Mor- tality Data in Appraisal of an Urban Community. American Journal of Public Health, October 1932, 22, pp. 1037-49. C. A. McMahan : The People of Atlanta ; a Demographic Study of Georgia's Capital City. Athens, Ga., University of Georgia Press, 1950, pp. 172-173.
13. Mary Cover: Negro Mortality. II. The Birth Rate and Infant and Maternal Mortality. Public Health Reports, October 25, 1946, 61, pp. 1529-1538. Amanda L. Stoughton : A Study of Negro Infant Mortality. Public Health Reports. November 8, 1929, 44, pp. 2705-2731.
Howard W. Green : Op. cit.
Alfred Yankauer: The Relationship of Fetal and In- fant Mortality to Residential Segregation ; an Inquiry into Social Epidemiology. American Sociological Re- view, October 1950, 15, pp. 664-648. Harry Bakwin : The Negro Infant. Human Biology, February, 1932, 4, pp. 1-33.
Herbert J. Sommers : Infant Mortality in Rural and Urban Areas. Public Health Reports, October 2, 1942, 57, pp. 1494-1501.
14. Robert W. Woodbury: Op. cit.
15. Ibid., pp. 104-106.
16. Louis Rosenberg : Canada's Jews : A Social and Economic Study of the Jews in Canada. Montreal, Canadian Jewish Congress, 1939. 418 pp.
17. J. Doughty: Some Observations from a Prelim- inary Study of Infant Mortality in British Columbia, Based on Birth-Death Linkage. Canadian Journal of Public Health, July 1949, 40, p. 303.
18. E. M. Dykes: Illness in Infancy; a Compara- tive Study of Infant Sickness and Infant Mortality in Luton. Luton, England, Leagrave Press, 1950. 46 pp.
19. J. W. B. Douglas: Social Class Differences in Health and Survival during the First Two Years of Life; the Results of a National Survey. Population Studies, July 1951, 5, p. 37.
References to official vital-statistics reports, here, are in complete paper.
litted
Copies of the complete paper now available from the Children's Bureau.
ADOPTION
{Continued from page 129)
couples remain to ask questions later about their personal situation. This also saves much time for everyone concerned, since special problems can be clarified before the couple makes another special trip for an intervie-w. Through the discussion they become aware of problems that might other- wise not emerge until later in a per- sonal interview.
As already noted, preparation for rejection of applications is achieved in the group meeting as it never could be through any number of individual interviews. The applicants know that only a few of the couples who are sitting there with them can possibly be given a child, because there are not enough children to go around. They know that all these people are sensi- tive about sterility, and that this con- dition is one of the main reasons why they are at the meeting.
The agency explains that the appli- cants will be notified of rejection simply by a form letter and tells why no reasons will be given at the time. The couples know that they will be told during the interview about tangi- ble reasons such as finances or health or about anything they could change without getting involved in problems of psychotherapy.
When the couples are first asked if they would like to have reasons given, the answer is almost universally yes. However, the leader points out what it might do to a marriage if the rea- sons for rejection were focused solely on one person and not the other. Again, she shows that attempting such explanations would add to the size of the fee. She makes clear that if the explanations were given briefly and not followed up by help in solving the problems, the result would be at least nonconstructive and might be injurious. When the applicants stop to think of all these factors most of them come to agree with the agency practice. People with any degree of imagination or insight realize that in applying for a child they are not ask- ing for discussion of deep emotional problems to which they may have al-
ready worked out some sort of adjust- ment, or which may not even exist.
The agency stresses that when it has nothing constructive to offer it has no desire to convince the couples that its decision is right, and there is always the possibility that its workers are mistaken. Although the agency must abide by its own best judgment in doing its job, no one is infallible in evaluating emotional traits and esti- mating their effect upon a child who is not yet there. It would be unfortu- nate if anxieties were aroused that might not even be based upon reality and that the agency is not prepared to work out with the applicants.
Not enough babies for all
There is no doubt that not giving reasons for a rejection can arouse great anxiety. However, it is made clear that because of the surplus of applicants, standards for acceptance are high, and therefore reasons for rejection are not necessarily serious.
It is true that, in spite of this prep- aration, some applicants do request reasons at the time of rejection, but the number is very small and the request is usually prefixed by the statement, "We know that this is con- trary to your policy, but we hoped in this case . . ." Usually a restate- ment of the agency's position is suffi- cient to close the matter without great resentment, although the agency sees its share of people whose only desire is to strike out irrationally at some- thing. However, for most reasonably well-adjusted people, and these make up the vast majority of couples who apply for babies to adopt, a good preparation for the rejection is found in the group meeting.
The group technique has proved so successful that the agency's director is now considering extending it in two other possible ways. One would be to have small groups of accepted appli- cants come together prior to receiving their child for a discussion of child care. The other would be for small groups of couples ready for final adoption to discuss the court pro- cedure and questions of later child development.
Reprints in about 6 weeks
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THE CHILD VOL 17 NO. 8
IN THE NEWS
Jobs in social work. A public em- ployment service office, manned by employment specialists and serving as a Nation-wide clearinghouse for jobs in the social-work field, will be a feature of the 1953 National Con- ference of Social Work in Cleveland. The job clearinghouse will be in- stalled on an experimental basis by the United States Employment Serv- ice in cooperation with aifiliated State Employment Services. The specific purpose of the plan is to provide ar- rangements for bringing job orders and job applicants in the social-work field together. A centrally placed booth, staffed by experienced employ- ment service interviewers, will be available to bring together interested applicants and agency representatives who have listed vacancies.
Advanced training courses for child- care specialists of many countries will be conducted in 1953 by the Interna- tional Children's Center in Paris, an institution aided by the United Na- tions International Children's Emer- gency Fund.
The four courses offered deal with : (1) The prevention of tuberculosis in children, including methods of BCG vaccination; (2) the rehabilitation of motor-handicapped children; (3) so- cial pediatrics ; and (4) problems en- countered in prenatal care and at the time of childbirth.
Fellowships for doctors, health offi- cers, and social workers are offered to help personnel in some 50 countries and territories to participate in the training, which will include field trips to a number of French institutions.
In addition to offering the training courses, the Center will continue a number of research projects on child- development problems, will serve as a documentation center in the field, will issue publications on child-care questions, and will organize a popular educational exhibition.
Young people of working age.
Because fewer babies were born dur- ing the depression of the 1930's, the number of boys and girls now reach- ing working age — 15 years — is com- paratively small. There was a drop of 13 percent in the 15- to 19-year age group in 1950 as compared with 1940 (from 12,333,523 to some 10,- 732,000), according to decennial- census figures. This is the age group now leaving school and college and starting work. Military demands on the boys and early marriage and
childbearing among the girls further reduce the number of new workers. By 1960, however, because of the large number of births during and since World War II, the Bureau of the Census estimates that the number of young people in the 15- to 19-year age group will be 30 percent greater than it was in 1950.
Millions of mothers employed. Just over 514. million women workers were mothers of children under 18 in April 1951, according to the Bureau of the Census ; about 2 million had children under 6.
Absence of the husband tends to force mothers into seeking employ- ment. Of all mothers with children under 18, one-fifth of those with the husband present and one-half of all other women that were ever married were employed.
Even among mothers whose chil- dren were all under 6, the proportion of working mothers was considerable — 14 percent for those with husband present, and 37 percent for all others ever married.
To Our Readers —
We welcome comments and suggestions about The Child.
CAL
Apr. 6-10. AssuciHtion for Childhood Education International. Annual study conference. Denver, Colo.
Apr. 7. World Health Day.
Apr. 8-10. United States-Mexico Bor- der Public Health Association. Eleventh annual meeting. El Paso, Tex., and Ciudad Juarez, Chihua- hua, Mexico.
Apr. 8-11. International Council for Exceptional Children. Thirty-first annual convention. Boston, Mass.
Apr. 8-12. American Heart Associa- tion. Twenty-ninth annual meeting and twentv-sixth scientific sessions. Atlantic City, N. J.
Apr. 10-11. American Academy of Political and Social Science. Fifty- seventh annual meeting. Philadel- phia, Pa.
Apr. 13-15. Girls Clubs of America. Eighth annual conference. New York, N. Y.
Apr. 13-19. National Boys' Club Week. Information from Boys' Clubs of America, 381 Fourth Avenue, New York 16, N. Y.
Apr. 18-19. American Psychosomatic Society. Tenth annual meeting. At- lantic City, N. J.
Apr. 19-25. National YWCA Week. Sixth annual observance. Informa- tion from National Board, Young Women's Christian Association, 600 Lexington Avenue, New York 22, N. Y.
Apr. 20-22. Sixteenth Annual Groves Conference on Marriage and the Family. Sponsored by the Univer- sity of North Carolina. Held at Ohio State University, Columbus.
Apr. 20-23. National Council of Juve- nile Court Judges. Sixteenth an- nual conference. The National Juvenile Court Foundation will meet concurrently with the Na- tional Council. New Orleans, La.
Apr. 21 - 26. International Union Against the Venereal Diseases. Nineteenth general assembly. Rot- terdam, Netherlands.
Apr. 22. National Social Hygiene Day. Information from the Ameri- can Social Hygiene Association, 1790 Broadway, New York 19, N. Y.
Apr. 25-May 2. Boys and Girls Week. Thirty-third annual observance. In- formation may be obtained from the nearest Rotary Club.
Apr. 27-28. American Association for Cleft Palate Rehabilitation. Eleventh annual convention. At- lanta, Ga.
Apr. 30-May 3. American Psycho- analytic Association. Annual meet- ing. Los Angeles, Calif.
Regional conferences, American Public Health Association:
Apr. 23-25. Southern Branch. At- lanta, Ga.
June 10-13. Western Branch. Los Angeles, Calif.
Regional conferences. Child Wel- fare League of America:
Apr. 16-18. Southern Region. Nash- ville, Tenn.
Apr. 26-28. South Pacific Region. Berkeley, Calif.
Apr. 30-May 2. North Pacific Re- gion. Seattle, Wash.
May 18-19. New England Region. Swampscott, Mass.
June 10-12. Southwest Region. Den- ver, Colo.
Illustrations:
Cover. Esther Bubley.
P. 127, Jane Schroeter.
P. 128, courtesy of Parade and the Spence- Chapin Adoption Service.
P. 130: Left, seal of the Midcentury Con- ference, drawn by William N. Thompson; right, Esther Bubley for UAW-CIO.
P. 133, Singer for Children's Bureau.
APRIL 1953
135
VOL. 17 NO. 8 APRIL 1953
In This Issue
Infant Mortality and Patterns of Living Odin W. Anderson
When a Couple Plans to Adopt a Baby Beatrice Pruski
Follow-up of 1950 White House Conference Enters
a New Stage
Elma Phillipson
Page
122
127 130
Published 10 times a year by tiie Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
FEDERAL SECURITY AGENCY Oveta Culp Hobby, Administrator
CHILDREN'S BUREAU Martha M. Eliot, M.D., Chief
SOCIAL SECURITY ADMINISTRATION Arthur J. Altmeyer, Commissioner
Publication of THE CHILD, monthly bulletin, has been authorized by the Bureau of the Budget, September 19, 1950, to meet the needs of agencies working with or for children. The Children's Bureau does not necessarily assume responsibility for statements or opinions of contributors not connected with the Bureau.
THE CHILD is sent free, on request, to libraries and to public employees in fields concerning children; address requests to the Children's Bureau, Federal Security Agency, Washington 25, D. C. For others the subscription price is $1.25 a year. On all orders of 100 or more sent to one address there is a discount of 25 percent. Single copies 15 cents each. Send your remittance to the Superintendent of Documents, Government Printing Office, Washington 25, D. C.
Foreign postage — 25 cents additional — must be paid on all subscriptions to countries in the Eastern Hemisphere and those sent to Argentina and Brazil. Domestic postage applies to all other subscriptions.
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U. S. GOVERNMENT PRfNTING OFFICE; I95I--912044
MAY 1953
CHILD HEALTH DAY, 1953
by the President of the United States of America
Boston Public Library Superintendent of Documents
JUN16 1953 a Proclamation
Whereas the Congress, by a joint resolution of May 18, 1928 (45 Stat. 617), authorized and requested the President of the United States to issue annually a proc- lamation setting apart May 1 as Child Health Day; and
Whereas the health and wholesome development of our children are matters of the deepest concern to all Americans ; and
Whereas the stresses and strains of our times create many problems bearing on the spiritual and emotional health of our children and are reflected notably in juvenile delinquency; and
Whereas we have made tremendous advances in overcoming the most severe physi- cal hazards of childhood, and are now striving to make equally significant progress in- understanding the nature of emotional health, in order that our children may grow into mature, responsible citizens of a democracy :
Now, Therefore, I, Dwight D. Eisenhower, President of the United States of America, do hereby designate the first day of May, 1953, as Child Health Day; and I urge all parents and young people, and all other individuals, as well as agencies and organizations interested in the well-being of children, to increase their understanding of the emotional, social, and spiritual growth of children, so as to apply this understanding in their day-to-day relations with the rising generation.
In Witness Whereof, I have hereunto set my hand and caused the Seal of the United States of America to be affixed.
Done at the City of Washington this twentieth day of February in the year of our
Lord nineteen hundred and fifty-three, and of the Independence of the United States of America the one hundred and seventy- seventh.
By the President :
/
Ljis-^ C-i^^ Ca-iCc^ X^i-o.^
Secretary of State
138
THE CHILD VOL. 17 NO. 9
TO UNDERSTAND CHILDREN BETTER
OVETA GULP HOBBY
A MERICANS could do a tremen- r^ dous job of preventing crime, unhappiness, and mental ill- ness if they would carry out the ob- jective of Child Health Day for 1953.
Child Health Day, proclaimed by President Eisenhower for May 1, 1953, is the day on which all Ameri- cans are urged "to increase their understanding of the emotional, so- cial, and spiritual gro^^'th of children, so as to apply this understanding in their day-to-day relations with the rising generation."
We know that children who do not get the chance to develop their fullest capacities in each stage of their growth run larger risks of growing into maladjusted, unhappy, and not fully productive adults.
All along the way we see evidence that the knowledge we have about child growth is not being fully ap- plied. We see it in rising juvenile- delinquency rates, in a fantastically large national crime bill, in mounting numbers of emotionally disturbed, mentally ill people.
There is nothing that leads us to believe that people are born delin- quents or criminals. It is in their childhood that tendencies in these di- rections first appear.
If, as parents, we can understand more about the growth processes of childhood, we increase the chances that our children can develop the emotional and mental strength re- quired to live happy, useful, and sat- isfying lives.
Those who are interested in learn- ing more about the stages of growth might start with "A Healthy Person- ality for Your Child," a booklet pub- lished by the Children's Bureau. It sums up in popular form what we know today of how children grow emotionally and has a companion "Discussion Aid" for groups that want to talk over the problems they encounter in rearing and working with children.
The Children's Bureau is proud to join with the State and local health departments, traditional sponsors of Child Health Day activities, in their observance of May Day.
The 1953 observance marks the twenty-fifth year that Child Health Day has been observed by Presiden- tial proclamation. It was authorized
by a joint congressional resolution, passed in 1928, which called atten- tion to "the fundamental necessity of a year-round program for the protec- tion and development of the Nation's children."
In the quarter century since Presi- dent Coolidge issued the first Child Health Day Proclamation, through new medical and scientific discoveries and extensive public-health work, our country has made tremendous ad- vances in overcoming many of the great physical hazards that used to threaten children.
In the words of President Eisen- hower, "We are now striving to make equally significant progress in under- standing the nature of emotional health in order that our children may grow into mature, responsible citi- zens of a democracy."
OVETA GULP HOBBY became the first Secretary of Health, Education, and Welfare April 11." 195.3.
On that day, the President's Reorganiza- tion Plan Xo. 1. 1!).53, went into effect, chang- ing the former Federal Security Agency, of which Mrs. Hobby was Administrator, into the U. S. Department of Health, Educa- tion, and Welfare.
Mrs. Hobby was born in Killeen, Tex. She received her education in the public schools of Killeen, under private tutors, and at Mary Hardin-Baylor College.
In 1942 when the Women's Army Auxili- ary Corps was created Mrs. Hobby was ap- pointed as Director. In 1943 the Corps be- came the Women's Army Corps, and Mrs. Hobbv served as its Director, with the rank of Colonel, till 194.5. She was awarded the Distinguished Service Medal by the United States Government and the Jlilitary Merit .Medal by the Philippine Government.
At the time of her appointment as Federal Security Administrator, Mrs. Hobby was edi- tor and publisher of the Houston Post and
executive director of Station KPRC-AM- FM-TV.
Mrs. Hobby served as consultant on the Bipartisan Commission on Organization of the Executive Branch of the Government, and later on the Board of Directors of the Citizens Committee for the Hoover Report. She was on the National Advisory Council of the American Cancer Society.
She is a former member of the Board of Governors of the American National Red Cross and has been a member of the De- fense Advisory Committee on Women in the Services. For several years she served on the Board of Directors of the National Con- ference of Christians and Jews.
Mrs. Hobby holds honorary degrees from Baylor University, Mary Hardin-Baylor Col- lege, the University of Chattanooga, Sam Houston State Teachers College, Colorado Woman's College, and Bard College. In 1950 she was awarded honor medals for distin- guished service to journalism by the Uni- versity of Missouri and by the Texas Press Association. In 1951 her name was added to the roster of the South's Hall of Fame for the Living.
MAY 1953
139
FOR BETTER AND HAPPIER CHILDREN
School Is More Than Three R's
EARL J. McGRATH
Commissioner of Education. Department of Health, Edncation, and Welfare
Most children like to go to school. They like to go for a variety of rea- sons. Usually, when boys and girls are enthusiastic about school it is because they feel the teacher likes and understands them. In return, they like her.
All over the country, there are classrooms that reflect good pupil re- lationships. In such classrooms, every child comes to know that :
— he has friends in the class, his being "there" makes a difference, and he is missed when he is away.
— the teacher and principal believe in him. He and his schoolmates have a part in planning what goes on in school. Their ideas count.
— his work is important to the group. Once he accepts responsibility for something which he is able to do and which is needed by the group, he must carry through; he approaches his responsibility with confidence that he can carry it. He knows that he does not have to work exactly as others do; instead, he can work at a pace and in a way that is comfortable for him. He learns, however, that he must often work hard to do the work he really wants to do.
— he can get help in carrying out his responsibilities from his teacher and classmates, from books and other source materials as he works alone, in a group, or as a committee mem- ber.
— he is becoming more skillful day by day as he learns to read, write, figure, listen, and talk ; to make deci- sions on the basis of what he reads, hears, sees, and discusses ; to express himself creatively through difi'erent mediums; and to work with mate- rials and tools. He knows that as he becomes more skillful both he and the group profit.
— other children respect his rights
and belongings and he is learning to respect their rights and belongings.
— he can trust the teacher and his classmates and they can have faith in him.
— the teacher is a friend who will listen to him when he is troubled and will hold in confidence the things he tells her in confidence.
— he and his teacher and his par- ents are all friends, working together to help him "grow up" and since he is doing his best they, as well as he, are satisfied with his progress. Con- sequently, he is free from anxiety, tension, and fear.
Prescription
for Peace
BROCK CHISHOLM
Director General, World Health Organization
The observance of Child Health Day in the United States is a remind- er to all of us of the very intimate relationship which exists between the health of the child — when defined as total health — and the solution of the great crisis which confronts human- ity today.
If in our ignorance, our short- sightedness, our lack of courage and vision, we continue to deny our chil- dren the blessings of physical well- being; if, moreover, we continue to inculcate in them prejudices, uncriti- cal and emotional beliefs in unreason- able things, excessive fears of others and, as a result, aggressive desire for power and domination, then we can be sure that the world of tomorrow will be a world of fear, of chaos, of cruelty — and of death.
If, on the other hand, we succeed not only in making our children physically healthy, but also in freeing them of our taboos, our anxieties, our destructive impulses; if we teach them to feel, and to act in accord with, a sense of responsibility for the welfare of their fellow human beings — not just locally, not just nationally, but for the whole human race, then we need not worry about our future
and theirs; it cannot but be secure, peaceful, and truly rich in the values that make life worthwhile.
To resolve on May 1 to dedicate our energies to the healthy emotional development of our children will be to provide ourselves and them with one of the strongest possible guar- antees that man's age-old dream of a better and happier world shall after all become a living reality.
Clue to Child Health
R. H. FELIX, M.D.
Director, National Institnte of Mental Health,
Fnl'lic Health Service,
Department of Health, Education, and Welfare
On Child Health Day in 1953, we can see the gradual evolution during the past few years of a new concept in child health.
We recognize that the child with persistent behavior problems is neither happy nor healthy, and that a crippled personality may be just as serious a handicap as a crippled body. We also recognize that it is impossible to deal with the child alone, and that we must also deal with the adults upon whom he is de- pendent.
It is gratifying that communities are making efforts to help both chil- dren and parents by establishing more child-guidance clinics. All child- guidance workers recognize how im- portant it is for parents to see that a child feels wanted and loved through- out childhood.
Parents should help the child de- velop his own personality, and not try to make him a carbon copy of someone else. He should not be over- protected or overindulged, but should rather be able to feel that he can rely on his parents for consistent atti- tudes, sympathetic understanding, and a gradual "loosening of the apron strings."
Child Health Day should remind us all of our obligation to help every child grow up to be a well-adjusted individual, able to face his duties with resourcefulness and to choose his opportunities with wisdom.
140
THE CHILD VOL. 17 NO. 9
CHILDREN IN THE CONTEMPORARY SCENE
GEORGE E. GARDNER, Ph.D., M.D.
ONE of the hardest things in the world for man to evaluate is his present world — his con- temporary scene — whether he views it solely in relation to his own posi- tion, enmeshed in his own series of relationships, or whether he tries to estimate the worth of his entire soci- ety in respect to some particular so- cial issue or social program. It is much easier for him to appraise a his- torical segment of the past or to spec- ulate upon the f ruitf ulness of a future plan than to state categorically and emphatically just where he now stands. His own involvement or in- vestment in his numberless roles in the present precludes accuracy and minimizes objectivity.
But he is forever trying such mea- surements, and I too shall try as a physician and psychiatrist to outline for you what the American child and parent face as they seek what seems to me to be that ultimate goal for both — namely, a comprehensive child- care program in a democratic society. I have no doubts whatsoever as to the correctness of the goal, and I would be particularly emphatic in my inclusion of the word "comprehen- sive" and the word "democratic." For you will note as I proceed that any shortcomings that we have in the care of children in our country today can be ascribed either to a lack of "comprehensiveness" or to a lack of "democraticity" or to both.
This then is the larger measure- ment that I would apply — or better, it is the microscopic low-power view that one can take of our present scene. But the high-power view, and the most revealing measure applica- ble, is that which involves not the whole field, but the selection merely of the individual child within an area — any specifically designated child in any area of our field. Only
The child-guidance clinic, with its emphasis on psychiatric care, is less than 50 years old.
through such samplings can one get an estimate of how far we have actu- ally approached our goal of demo- cratic comprehensive child care, and only in such samplings do we dis- cover the moderate — or the painful — lacks that must be eradicated. My basic thesis, therefore, is that our present scene — or any society — can be judged in respect to the adequacy of its child care only by estimating what programs have been devised in that society to care for the individual needs of the individual child, and to what extent this program of indi- viduation has become universally applied. The battles that have been waged and won to secure the more
GEORGE E. GARDNER is Director of the Judge Baker Guidance Center, at Boston. He is also Editor of the American Journal of Orthopsychiatry.
Dr. Gardner gave this paper at the Play Schools Association Conference, New York City, January 24, 1953.
adequate care of children, whether in the area of sheer protection of life, the prevention of disease, universal education (or specialized education within this framework) , the treat- ment of the delinquent child or the emotionally disturbed child — all these battles have been waged for the ex- pansion of the concept of individual treatment in accordance with indi- vidual needs.
Advantages not universal
Then how does our contemporary scene measure up? I am intrinsically an optimist. In other writings I have declared my position as an optimist as regards both Ameri- can children and American parents, and I am happy to do so again and with it add my optimism regarding the present-day scene in general. I do this in the hope that it may have a tempering effect on whatever pessi-
MAY 1953
141
mism I have toward the present scene, which we are now considering. I am an optimist, but not a satisfied one — and least of all a blind one.
However, I am thoroughly con- vinced that nowhere in the world at any time in history has the level of child care been as high as it is in America today. Widespread pro- grams of disease prevention — super- vision of milk and food supplies, rules and regulations in regard to sanita- tion, well-timed immunization pro- cedures, and recreational programs — are all designed to meet the basic physical needs of children.
I know, of course, that these do not reach every individual child, and hence fall short of our goal of uni- versality, but withal these disease- prevention programs of ours are the marvel of the world when viewed from the distance of numberless countries that one might mention.
To move to the area of cii.re of disease in childhood, I might men- tion that just a short 16 years ago when I was a house pupil and resi- dent in pediatrics, before the dis- covery of the modern antibiotics, we were (at least by present-day stand- ards) practically powerless in the face of certain infectious agents. (I should say in passing that the major
Programs for prevention of disease in children are at a high level in this country today.
emphasis in pediatric practice will probably change under the impact of these curative measures.) Finally, merely to emphasize the uniqueness and comprehensiveness of the child- care scene, I will recall to your mind that the child-guidance clinic, with its emphasis on the psychiatric care of children, is a contribution to the total program that is less than 50 years old.
Parents are conscientious
And now to reemphasize my opti- mism, I should state also that in spite of the fact that I am a child psychia- trist who sees at times the most flagrant evidences of the physical, emotional, social, and moral neglect of children by their parents, I am convinced that no society of parents, taken by and large, have ever been so desirous as are parents in present- day America of extending to their children — and so eager to prepare themselves to extend to their chil- dren— over-all thoughtful and scien- tific care.
As one views the sincere efforts of the great majority of American par- ents to familiarize themselves with all the tenets of good child care in- volved in the medical and psychiatric programs that I have outlined above,
and when one notes the eagerness and conscientiousness displayed in insuring that their children receive the benefits to be derived from such programs, one very soon gives up the easy and seemingly popular role of "parent-baiter." (Possibly I shall be read out of the American Academy of Child Psychiatry for such heresy, but if so, I shall feel that I have been demoted for leading a much-needed crusade!)
In the light of all this, why should I not be completely contented with the contemporary scene? For I am really not content. I am not content for two reasons : First, because — as I stated above — these programs are not yet universally applied and within the reach of all parents and children ; and secondly, because we in America are continually forced to use up a lot of • our energy in fighting rear-guard actions against those who would either (a) modify our present programs of individuation of treat- ment of children; (b) prevent an ex- pansion of them; or (c) worst of all, eliminate them entirely on the grounds that society as a whole is not responsible for carrying them out.
Before specifying the area of my discontent, I would like to bring to your attention what seems to me to be a growing tendency of the moment in regard to the general philosophy of child care. This tendency is a temporary (I hope it is temporary) swing away from programs entailing inherent democracy and individua- tion in child care toward those in- herently totalitarian and disciplinary in nature. There is a growing dis- trust of that which might be termed progressive and individuated in na- ture.
As indicators of this undesirable reaction I would cite for you three items printed recently in one of our large metropolitan dailies: 1 The first was a reported inter- ^* view with a judge of one of our leading juvenile courts, outlining the causes of the recent increase in juve- nile delinquency throughout the coun- try. The report said that the judge "attributed this intolerable situation to four factors : (1) misinformed but well-intentioned social workers; (2)
142
THE CHILD VOL. 17 NO. 9
police laxity on full enforcement of the law; (3) courts handicapped by pressure of modern thinking; and (4) parents." The judge also "said the situation has been developing for the past 20 years, 'or since about the time of the introduction of the phi- losophy that there is magic in the medical approach to cure young de- linquents. This is known as the pro- gressive attitude.' " As the treat-
It is obvious to us that these pro- nouncements indicate a growing dis- trust of our programs of individu- ated child care; and though a single statement does not reflect the feeling of all the representatives of any one of these three fields, there may well be a generalization of such feelings at the present time ; and the struggle for ideas and ideals essentially demo- cratic in nature against the yearning
We now know much more than we used to about how to cure the diseases of childhood.
ments of choice the judge urged that "we mu^ get as tough as they are and put them where they won't be menaces to the public," and added, "We have to return to the system of reward and punishment." iy A second item, from the field of ^* the clergy, suggested that the maladjustments and misbehavior of children were the result solely of god- lessness and urged the induction of rigid moral codes as the one best pre- ventative or treatment.
3 The third voice was raised by a • group of nationally prominent educators, who were firm in their be- lief that the present-day emphasis on social studies was ineffectual and a waste of time, and urged that a re- turn to an efficient grounding in "the three R's" and academically oriented history be instituted in our schools.
for the more disciplinary totalitarian notions of child rearing is always with us.
Problems worth solving
I submit that one essential differ- ence between totalitarian programs and democratic programs in this area is that the totalitarian programs are easier to carry out. There would be fewer problems in such a system, and problems as they arose would be han- dled in a swift, summary, and re- pressive manner. On the other hand, the very essence of our democratic, progressive program of child care is that it places a higher value upon sensible and constructive freedom of expression by the child than it does upon coercion and restraint. And to maintain this value, we must content ourselves with being faced forever
with more problems to be solved, and we must be ready with en- lightened methods to solve them. It will be well worth the price.
The repeated emergence of this opposing philosophy of child care is the source of my general discontent with the contemporary scene. I will list some specific areas of child life that need our attention if all children are to be accorded the comprehensive and individuated care that is my chosen measure of minimal excel- lence :
"I In the field of physical health -*- • more and more research and treatment programs are needed rela- tive to (a) prenatal care of mothers; (b) care of premature infants; (c) early and adequate treatment of con- genital defects; and (d) care of chil- dren who are physically handicapped as a result of infections, such as polio, that attack the central nervous system, or of handicaps resulting from the accidents sustained by chil- dren in this exceedingly dangerous (to children) world of ours. In re- spect to all our services, I would espe- cially emphasize the woeful lacks in application in our rural areas. Chil- dren and mothers in these areas are definitely in the position of second- class citizens when their opportuni- ties to secure medical care to insure life and health are compared with those within easy reach of people in urban places.
iy I would cite secondly the mini- ^* mal or nonexistent facilities for mental-health care (and particularly preventive care) of children in all areas of the country. This applies to both the mentally handicapped child and the emotionally upset or malad- justed child.
O In the field of education we are *-*• not yet even approaching the needed emphasis on the individual educational needs of our children. I do not refer here only to the lack of physical facilities or the lack of teachers. These shortcomings are known to you. But of equal concern is the lack of individual care of large numbers of normal children with generalized or specialized learning blocks or disabilities. Not to apply
(Continued on page 149)
MAY 1953
143
SOCIAL CASEWORK AND THE CHILD CAMPER
ADELAIDE Z. PALUMBO
CAMP has been reputed to do a child so much "good" that ideas about it have outranked those about spinach as a "must" for sturdy growth. The concentrated period of group living outdoors has been believed to supply any quantity or quality of nutrients for a child's body, mind, and soul. With the best of intentions, we caseworkers have fed camp to a child without first assess- ing his need to have it or his capacity to take it.
A camp vacation, of course, can be a truly enriching summer interlude in a child's life. In camping 24 hours a day he meets all kinds of spontane- ous and planned opportunities for so- cial relationships not only with other children but with adults, and for creative and educational experiences.
One major factor to remember, however, is that a child's primary group experience comes from his family, and we must not, therefore, lose sight of the fact that the child's camp stay is a temporary group placement. If we caseworkers have a part in planning a camp placement, we should accept our responsibility for knowing enough about the pro- spective camper, his family, and their interrelationships so that we are clear that a camp vacation is what the child needs and wants. Also we should have enough knowledge about the camp. There are camps and camps, and the fact that a camp is approved does not mean that it is
ADELAIDE Z. PALUMBO has her master's degree from the School of Applied Social Sciences of Western Reserve University, from which school she also received a Com- monwealth Fund Fellowship in Advanced Psychiatric Social Work. She has had a wide experience in family, children's, group, and health agencies.
Mrs. Palumbo's article is drawn from personal experiences in agencies in the Mid- west and the East. Since 1947 she has been with the Community Service Society of New York both as a caseworker and as group therapist in its Division of Family Services and for the past 2 years in its Department of Public Interest, where she is also a con- tributing editor to the Community Service Society Weekly Bulletin.
necessarily a good camp for a par- ticular child.
Because family agencies, children's agencies, and health agencies have been sending children to camp for years, it is rare to find a caseworker who has not had some direct or in- direct experience in placing children in camp.
In order to improve their practice in camp placements, some agencies have a caseworker as "camp chair- man," who handles all arrangements and relations with camps, consults with their staffs, and, through visits and reports, evaluates the camps the agency will use. Others set up tem- porary staff committees to study the casework practice of the agency in relation to camping.
One such committee concluded that "camp placement is a casework ser- vice, which requires as good diagnos- tic thinking and casework planning as any service which the agency has to offer." This is a sound first princi- ple in camp placement.
Camp life is an environmental treatment experience that we offer children with various individual or family difficulties. How can we make the most of this temporary placement for the best interests of the parents and of their children?
There is a growing trend toward working out ways and means of answering this question. Casework- ers and groupworkers who have worked in camps, and the camping organizations that have employed them, are becoming convinced that closer cooperation between camping organizations and social-work agen- cies is a sound and effective way to team up toward their common goal of helping children.
Social workers are now taking varied roles as camp counselor, as supervisor of counselors, and as camp-intake and follow-up worker. Insofar as we in social work take a more active part in camping pro- grams, our understanding of chil- dren's behavior will be enriched by
In 24-hour-a-day camping a child gains spontaneous and planned opportunities for social rela- tionships with other children and with adults, and for creative and educational experiences.
144
THE CHILD VOL. 17 NO. 9
more first-hand experience with both normal and maladjusted children, and we shall learn more ways by which we can improve and quicken our help to them.
The day may come when it will be more common for workers in health, education, social work, and camping to team up in camp. Some privately owned and operated camps, as well as organizational ones, have done this by engaging groupworkers and caseworkers, psychiatrists, psycholo- gists, and education and recreation specialists. These workers' experi- ence indicates that camping is as yet an untapped natural resource for dealing with the whole child. Some camps are authorized to offer ac- credited field experience to social- work students. Social workers who are planning to work with families and children in casework, group- work, or psychiatric agencies would do well to investigate such opportuni- ties.
The caseworker acts as consultant on camping
The caseworker from an outside agency who is to serve as consultant to the camp of a groupwork agency should first become well acquainted with the function of the latter. This is especially important if he has never had any groupwork experi- ence. His role may be defined by assignment: for example, he may help in the training of camp person- nel, or he may be available for con- sultation on individual situations.
If the caseworker is on the staff of the groupwork agency he should know when to suggest closer case- work and groupwork cooperation in the over-all program. In the YWCA, for example, a caseworker, known as the "personal counselor," is available for help to any individual who comes to the "Y," or to any of the depart- ments of the Association. She thus functions in connection with the vari- ous agency services as well as in her own line of giving individual help. This has particular value in relation to camping.
For instance, it was a chance inter- view between such a worker and a little girl that brought about an im-
portant improvement in the camp- application policy of a YWCA.
In the camp director's absence, I was asked to interview a 12-year-old youngster, Kathe, who came to our office during her vacation from an out-of-town boarding school. Kathe feared her camp application might be rejected, as a balance was due on her last year's bill.
She matter-of-f actly explained that her aunt, who had sent her to camp, was not her legal guardian, although she was the only relative on whom she could depend. Her parents, sepa- rated by mutual consent, had never got along well enough to make a home for her.
Her father, out of town on a war job, was accustomed to sending her tuition fees directly to her school be- cause her mother was not responsible in handling money. Unfortunately, instead of paying the camp fees in the same way, he had given the camp pajTnent to her mother, and the camp bill was not paid.
Kathe could not bear to think she might not go to camp. She "lived" for it all year. When I said that she was with a lot of girls during the year and suggested that she might want a vacation from dormitory life, Kathe took me to task and said there was "no comparison." She described her life in a large sectarian boarding school, where she got along fairly well. Though the dormitories were large, she felt it was the best solu- tion for her in view of her broken home.
At camp, however, there were only six beds in a cabin and she and her bunkmates had a counselor "all to themselves." The girl found living in a small group under able, relaxed leadership a happy experience to which she wanted to return. It was evident that to Kathe her bunk unit was a substitute family group.
When I asked Kathe to tell me about how she happened to go to camp in the first place, she sighed and said it was "quite a story." At the end of her school year she had returned to her aunt's home to begin her sum- mer vacation. But her aunt told her that the hours of her war job were changeable from time to time, and
therefore she could not have Kathe with her. The next morning Kathe found her clothes packed for a "sur- prise" trip. She was apprehensive, yet she realized that her aunt could not possibly care for her. Although she knew her aunt would not send her "just any place," Kathe was "plenty scared," even after she had arrived at camp.
When I said it was too bad she had not known about camp and that it was a lucky break that she liked it, Kathe agreed. She "loved" camp and if she could go again she would ex- plain about the bill to her father. I told her that the bill would need to be paid first but that I would talk to her aunt. Everjlhing was settled later, and Kathe went to camp.
This girl's application, like most applications at that time, had been handled by mail. Not until she was interviewed in person was her prob- lem brought to the fore. When the interviews with Kathe and with her aunt were described to an advisory committee composed of lay and pro- fessional people, they unanimously recommended that in future all camp applicants and parents have a per- sonal interview, and they offered the services of the "personal counselor" to the camping department.
When the agency executive, the camp director, and the counselor met together to set down criteria for camp intake, they drew up two out- line forms for interviews with each camper and her parent. Caseworkers on committees and groupworkers on the staff voluntered to help in the interviews, which were to be sched- uled for both day and evening ap- pointments.
Records of sample interviews held by the counselor and the camp direc- tor were examined so that they could use practical experience with the out- lines in orienting interviewers. In this way the interviewers became somewhat acquainted with all phases of camp life, such as regulations, policy in handling bedwetting, food fads, and illness, and so on, so as to be prepared for parents' and camp- ers' questions. The arrangement of the waiting room, with camp pic- tures, set the feeling tone of the camp project.
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Through the intake interview it was possible to make early decisions on camp applications; this, in turn, helped the camp director, who had learned a good deal about the camp- ers before they arrived. The case- workers and groupworkers who co- operated in the project made the satisfying discovery that their pur- poses and goals for children were parallel and that they had more ground in common than they had been aware of before this joint ex- perience.
In his diagnostic thinking the case- worker not only should focus one eye on the camper as an individual and the other on the group with which he is going to live, but should then accommodate both eyes to the total situation. If unconsciously the case- worker allows himself to become overidentified with the needs of the individual child he will lose sight of that child as a member of a group.
Factors like time, sex and age of campers, program, budget, and per- sonnel may at some time enter into
Camping can be an enriching interlude, especially for a well-adjusted child. Other children can often be helped by a caseworker so that they too can get the most out of camp life.
An awareness of group dynamics and some groupwork experience are desirable for a caseworker who han- dles intake for a camp. With this preparation he will have keener per- ception, for example, of the degree and kind of aggressive or withdrawn behavior that can be handled help- fully through a group experience. In a casework relationship the child and the caseworker are the only two indi- viduals involved in the treatment in- terviews; but in group relationships the child, the other children, and the group leader are involved and the interaction may be more than the child or the group can accept.
an individual camp decision, but the basic consideration is the child.
Should it be in the best interests of the child and the parent for him not to go to camp, the caseworker should be responsible for following through on any necessary referral to another agency or a private resource. The camp application in itself is a helping process, and a placement that does not materialize may open the way for needed help to a child and his family from other sources.
Role of the caseworker in camp
The boys' camp operated by the Community Service Society of New
York is for children of families under care of its caseworkers and its public- health nurses. Some of the young- sters who go to camp have already been receiving individual casework help.
During the camp season to which this article refers, the camp director and the caseworker were the only social workers on the camp staff and both had had groupwork and case- work experience. The director, a trained and experienced group- worker, had done student casework in the Society; and the caseworker had had training and experience in 'jroupwork and activity group ther- apy. The counselors were college undergraduates or graduates, except one who was a high-school student. All were on the staff for the season only.
In general, the responsibilities as- signed to the caseworker in the camp were such that they could have been carried out by either a man or a woman. The caseworker was to be the liaison between the camper and the Society's caseworkers and nurses. The fact that the caseworker in a camp for boys was a woman, of course, affected her role.
As caseworker she dealt with chil- dren who had difficulties in adjusting to group life and who were referred to her by counselors for special at- tention. Campers came to her on their own initiative and also referred their friends. In addition she supervised the counselors regarding children and their needs. She was responsible for the use of the "camp summaries" and shared pertinent material from them with the counselors. (Camp summaries are reports sent by the agency to the camp to provide infor- mation about the individual chil- dren.)
She was available for consultation with counselors through regular con- ference and as needed. Through her supervision they were helped to understand to some extent the inter- relationships among the children in their groups and their own emotional involvement in the experience. Al- , though she did not attempt to go into this deeply, she was able to touch on it sufficiently to provide consider-
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able support for counselors who had the maturity to become more aware of their involvement.
The composition of the groups that the caseworker had set up was worked out in line with the needs of the individual campers and the kind of supervision that was planned for them. The criteria for grouping helped some counselors to see the in- dividual child as a part of the group and to see the group as a whole. For example, when the caseworker helped counselors to set up the bunk sleeping arrangements, they could foresee that a belligerent, provocative boy placed next to a passive, submissive one would set the stage for a bully and a victim, or that an all-around boy able to defend himself could be placed to better advantage to the group if he were between a shy, with- drawn boy and a fairly aggressive one.
S. R. Slavson, under whose super- vision the writer carried on group therapy, suggests that camp groups be made up on the basis of "interests and quality of personalities." "Com- mon interests," he says, "are a bridge between people * * *. They prevent isolation of individuals and fragmen- tation of the group."
Unfortunately, the camp summary often is not clear about a camper's interests and activities. The summary may say that the child likes music, but may not tell whether he likes to sing, or dance, or whether he can play an instrument. It may mention that he likes "sports and games" without specifying what kind, and without saying whether the child wants to be a spectator or a partici- pant.
It is possible, however, to learn enough from the child himself and from his parent or teacher about his preferences and his responsiveness to creative ideas so that his natural interests and talents can be a means for satisfaction and achievement.
The caseworker in camp needs to be flexible and to be able to adjust his supervision of counselors to their experience and emotional equipment.
Some counselors need direct sug- gestions on handling individual chil- dren. Help ranges all the way from
giving very simple suggestions, such as casually taking an elusive and restless child by the hand when going to dinner, to more involved interpre- tation of the cause and effect of be- havior. For example, the caseworker might need to interpret to a coun- selor how he might be trapped by a child with a neurotic need to provoke him. She could then point out to him the step-by-step process of be- coming aware of this kind of be- havior pattern so that he might, in the future, be better able to handle himself, the child, and his group. The caseworker has to gage the all-around needs of the counselor in relation to his individual campers.
In the camp mentioned here, the agency caseworker was the liaison person in relationships outside the camp. She kept in close touch with the agency's caseworkers and nurses during the camp session by means of memos and telephone calls to them personally or through the agency's camp consultant.
These communications from the camp were about adjustment difficul- ties that might necessitate a visit from the child's caseworker or nurse, or about a pending decision to send the child home, or achievements of youngsters that merited recognition, or about any of the myriad problems of camp life, such as those concern- ing mail, clothing, spending money, homesickness, and anxieties about the family.
When counselors wrote their camp reports the caseworker on the camp staff added comments in regard to the child, the group, or the counselor. In situations in which she had had interviews with the child, or where the camp data were of diagnostic value, she recommended further so- cial, medical, psychologic, or psychi- atric study, or consultation with the health or casework services of the agency.
One such situation concerned a plump boy of 11, who became the butt of other campers because of his high-pitched voice and effeminate mannerisms. Desperately unhappy, he came to the caseworker to retrieve mail from the outgoing mailbox. He had written home that "this place is
awful," but he said now that he didn't mean it.
The caseworker suggested that some things about camp might be dis- tressing to him, and he poured out his unhappiness and said the trouble was "there are too many boys."
This boy's body build was such as to raise the question of glandular im- balance. Closely coordinated work be- tween the camp caseworker, who talked with the boy, and the family caseworker, who talked with the family, resulted in the boy's return home at the end of his first week, and he was helped to bear up under his experience. The family caseworker used the camp observations in consul- tation with the psychiatrist. The boy's difficulty at camp quickened the parents' concern about him, and they agreed to the recommendations for psychiatric treatment.
As would be expected, younger boys and "mother-dependent" camp- ers frequently came to the case- worker with problems and often re- created the pattern of their mother- son relationship. One aggressive boy, who had been overprotected by his mother, would always come to the caseworker for implied "permission," whenever he was trying a new ex- perience that he feared and wanted, such as his first overnight hike. He would usually start, "What do you say, should I go?"
When the caseworker happened to be on the swimming dock, youngsters vied with each other to show her what they could do. Adolescent boys who were sophisticated in their rec- reational tastes felt safe in voicing any criticism of program to her as a neutral person rather than the pro- gram director.
The caseworker in a camp lives, works, and plays with his colleagues and with the campers who are his temporary clients. He should be an outgoing person with a genuine warmth for children and an ability to share close living with others.
Professionally he should have some group-work philosophy and experi- ence that is a part of him. An in- tellectual awareness of the group process is not enough. He is not a
(Continued on page 150)
MAY 1953
147
FILMS ON FAMILY LIFE STIR DISCUSSION
Group leaders use ed as a techn
ESTHER E. PREVEY, Ph.D.
\HAT'S EXACTLY what my oldest girl said when I told her to stay home. Remember, John?"
"Well, the father in the movie didn't act the way my husband does when our daughter answers back."
Talk like this is likely to start when fathers and mothers in a par- ent-teacher group have just seen an educational motion picture that brings up problems of family life. And if the group has a leader who does her part skillfully, both before and after the picture is shown, the group members' immediate comments usually develop into a rewarding dis- cussion.
That is what we have found in the parent-education program of the Kansas City, Mo., public schools, in which about 100 groups of parents meet regularly with leaders who work under supervision of the schools' Di- rector of Family Life Education.
The groups are organized by par- ent-teacher associations in different parts of the city, and they meet in their neighborhood schools.
Techniques vary
Parent - education leaders are women well qualified by education and by experience in working with groups of adults. A continuous in- service training program allows for consideration of subject matter and techniques of presentation.
ESTHER ELIZABETH PREVEY, Director of Family Life Education, Kansas City Pub- lic Schools, received her doctorate from the Institute of Child Welfare of the University of Minnesota. Previously she was on the staff of the Merrill-Palmer School of Home- making, Detroit, Mich., as parent-education specialist.
Dr. Prevey is at present serving as chair- man of the Committee on Home and Family Life for the National Congress of Parents and Teachers.
ucational motion pictures ique in parent education
The subjects, of course, cover wide fields, for when we talk about family life we may touch on such matters as baby-sitting ; parent disagreements about bringing up children ; boy-girl friendships ; school homework ; grandparents in the household — the myriad things that enter into family life.
As for techniques, the present ar- ticle takes up only motion pictures, but the leaders use other media also to help them stimulate discussion: Books and pamphlets, tape record- ings, radio, and other devices, each of which deserves a separate article. Films, however, seem especially popular.
With scores of films available, we have to select those most likely to bring about fruitful discussion. Among those we show are "Answer- ing the Child's Why," "Children's Emotions," "Fears of Children,"
"Meeting Emotional Needs in Child- hood," "Palmour Street," "Preface to a Life," "Social Development," "Why Won't Tommy Eat?" and "Your Chil- dren's Sleep." Two film lists are on sale by the Superintendent of Docu- ments, Government Printing Office, Washington 25, D. C. One is "Motion Pictures on Child Life" (Children's Bureau. 61pp. 40 cents). The other is "Mental Health Motion Pictures" (National Institute of Mental Health. 124 pp. 30 cents). The latter in- cludes suggestions on using films for group discussion.
Leader encourages discussion
But deciding on films is only one step toward our goal. We have found that if the parents are to get the greatest possible help from a selected movie, skillful leadership is needed, to channel the group discussion and keep it from wandering.
At the parents' meeting a leader prepares the way for the discussion by talking informally with the group before showing the picture. Since she is thoroughly familiar with the se-
This scene comes from "Preface to a Life," a film used by Kansas City's parent -education program. It was produced by the National Institute of Mental Health, Public Health Service.
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quences, and has discussed them with other leaders and with the Director, she is able to help the parents look critically at the film so that they will be more ready to express their ideas later, whether they agree or disagree with its implications.
After the film is shown, the leader exerts her skill in carrying the dis- cussion forward and bringing it to a conclusion that is satisfying to the group members because they feel that they really have gained some help that they needed.
As a step toward improving their techniques of leading discussion con- cerning films, leaders can refer to a memorandum prepared by the Di- rector, which reads as follows :
THE USE OF FILMS
Educational films on child life are used as a device or technique for stimulating the discussion of family relationships, principles of mental health, and child de- velopment. They are not used for entertain- ment.
Preparation
The group needs adequate preparation before seeing the film, but a detailed ac- count of what goes on in it should be avoided.
Suggestions for preparation:
1. When selecting a film, be sure to choose one in which the ages of the persons shown are related to the interests of the specific group.
2. Mention can be made of what is to be seen, as: "You will see instances of disci- pline" or "You will see parents' disagree- ment."
3. Emphasize that what the film will show will be only one segment of child develop- ment, or family relationships, and does not represent a complete lifetime, with all its ups and downs. Also stress that not all that is shown will apply or happen to every family or every child.
4. Bring to the gi'oup's attention that the film is not trying to show the only or the ideal way to handle certain situations, and that the group does not need to agree with the people in the film. (In fact, dis- agreement will make for more lively discus- sion.)
5. Relate the film to a specific topic or idea, such as emotional growth, parents' goals, importance of the child's early years.
6. Clear up points that might be mis- interpreted.
Discussion
Good questions are needed to stimulate discussion after the showing of a film.
1. Avoid questions that can be answered by "yes" or "no," such as "Did you like it?"
2. Avoid opinion questions, such as "Don't you think that is a good film?" or "Didn't the mother handle that well?"
In questions concerning family relation- ships and personalities, avoid "It is" or "It was," and use "It could be" or "It might be."
Examples of preferred form:
"What could have made So-and-so behave as he did?"
"What might be some possible causes for behavior such as So-and-so's?"
4. Use questions that will lead the group to think:
Examples :
"What would you have done if you were So-and-so?"
"How would you have handled [Name specific situation] ?"
"What could have made So-and-so as he was?" (Unhappy, angry, resentful, well adjusted, and so forth.)
Summary
1. Summarize briefly the general prin- ciples brought out in the discussion.
2. Ask the group members whether they have any other observations or criticisms.
On a "Film Evaluation Sheet" the leader records a number of items con- cerning each showing. This record is helpful in planning for future meetings. The sheet asks, for ex- ample, whether the group had enough time for adequate discussion of the film. It asks whether the discussion was spontaneous and spirited, or whether the leader had difficulty in keeping it going. Another point to be noted concerns devices for the pur- pose of starting discussion : Whether the leader asked questions — and if so what questions she asked — whether she set up buzz sessions, and so forth.
In our family-life program we find that films are a particularly valu- able discussion aid. When group members analyze the problems of parents and children in a fictional family as shown on the screen, they can talk freely without revealing that some of the problems might be similar to their own. Thus they are able to discuss intimate concerns without embarrassment to anyone.
By means of our weekly leaders' meetings and such devices as our evaluation sheet we are hoping to improve our techniques for stimulat- ing parents toward gro\\i;h in relat- ing to one another and to their chil- dren.
CONTEMPORARY SCENE
(Continued from page 143)
diagnostic and treatment measures in the cases of such children is not only educational waste; it is educa- tional malpractice.
4 The lack of proper care and • treatment of the juvenile delin- quent also contributes to my discon- tent. Individuation of the child is probably needed more in this area than in any other. And I will state that the problem of juvenile delin- quency, or rather the problems in- herent in the development and ex- pansion of suitable programs to care for these children, will never be solved on a local level, but will be solved only when the Federal Gov- ernment assumes the responsibility of assisting the local areas.
I say this because every conference that has ever been held to set up pro- grams in this area has ended on the note of emphasis that we just do not have the trained personnel to do the job required and the unhappy sequitur that moneys at the local level cannot be used to train personnel.
It follows in turn that lack of highly trained personnel in the field — and no way to train them — makes for a low prestige-value attached to persons engaged in work with juvenile delinquents. There is but one way to break this vicious cycle and provide adequate care for the de- linquent child, and that is through establishment and expansion with Federal funds of training centers for the medical, psychological, so- cial service, educational, and recrea- tional experts that are so sorely needed. Such training programs have been sponsored in the field of mental health in the past 5 years and have recruited and trained hundreds of men and women for this important field. It could and should be done for the care of delinquent boys and girls.
5 1 regret too the preposterous • frontierlike attitude that per- sists regarding the emergence of spe- cial creative abilities in children. Such children are not specifically se- lected by us and their potentialities
MAY 1953
149
encouraged and nurtured. On the contrary, they may very often be condemned.
It seems to me that just as our society zealously nurtures the de- velopment of future scientific person- nel, we in a democratic society have every obligation to seek with equal assiduousness possible creators in the arts — and we need the educational machinery to discover such potential contributors to our culture to foster their growth.
I am totally unimpressed by the argument that such children will bat- tle against adversity (or indeed will need to battle) to the point of effec- tive creativity. And I should add too that I am chagrined that colleagues in my own field of child psychiatry are prone to view all deviance in child expression as a personality-destroy- ing mechanism, with little or no con- sideration of the possibility that such atypicality may indicate — or may be- come— a creative deviance.
I will cease the elaborations of whatever pessimistic views I have of our contemporary scene with the added indictment that application of what we do know about child care — and can do about it — has not been ex- tended to large areas and to large segments of our population in America. This I deplore — and I de- plore even more the policy of extend- ing such application through a proc- ess of expedient gradualism that seems to satisfy the thinking and feeling of many in our country. This thoroughly undemocratic process is the despair of us all and calls for a complete eradication of it through all the destructive means that we can apply.
In conclusion, then, these are my estimates of some of the aspects of the American scene as they relate to child care — good or bad, adequate or inadequate. I now reemphasize my original feelings, which are essen- tially optimistic. I am optimistic be- cause in spite of temporary reactions that may ensue, our ideal of a uni- versal comprehensive child-care pro- gram is as sound and as practical as the democratic system with which it is entwined.
CAMPING
{Continued from page 147)
unit head, nor an administrator; but he is closely involved in all parts of the camp program, including its health and administration phases. It is important that he maintain his personal and professional relation- ships in balance and that he keep these clear and distinct as the need and occasion demand. He can be a friendly person who is easy to live with and still be a respected profes- sional person who is comfortable to work with.
Possibilities for caseworkers in camp
There well may be a role for case- workers in many private and organi- zational camps, and in those oper- ated for the special needs of physi- cally or emotionally handicapped children. For the average comfort- ably adjusted boy or girl, too, case- workers have an important role to play, for we know by experience that a little help, when needed, goes a long way with these children.
If schools of social work and camp- ing organizations eventually develop more camp placements to offer for accredited field experience to stu- dents in casework and groupwork, both will gain. As either student workers or regular staff members these young men and women would share first-hand camp experience with their colleagues. In actual prac- tice, a caseworker plans camp for only a few of the children under her care.
With camps as training centers for social workers, camping would de- velop its potential as a source of help for children, which it has yet to ex- plore to the full.
Although social workers place chil- dren in camps for group experiences and although some social agencies operate camps, social work as a pro- fession is not yet involved enough in camping. Not yet do camp staffs, as a rule, include social workers, either groupworkers or caseworkers. Yet a camp provides a service for children as much as does a child- guidance clinic, a casework agency, or a neighborhood center, and as such
it lies within the area of competence of social workers.
Significant trends are beginning to be apparent, however: A recognized school of social work has offered its first course in camping, and a vaca- tion association has created the first fellowship for advanced study in social-agency camping.
Until social work as a profession takes more responsibility for camp- ing, the practitioners must pave the way and demonstrate the need.
I hope the day is already here when more social workers are join- ing camp staffs in various positions from counselors on up to administra- tors. The more this is done, the sooner all of us will use camp experi- ence as another means of learning about individual and group behavior of children of various ages. In a children's camp one lives with both the inner and outer world of child- hood. What a natural opportunity for us, as social workers, to live and learn !
YOUTH, THE NATION'S RICH- EST RESOURCE; their educa- tion and employment needs. A report prepared by the Interde- partmental Committee on Children and Youth, of the Federal Govern- ment. 1953. 54 pp. For sale by Superintendent of Documents, Government Printing Office, Wash- ington 25, D. C, at 20 cents.
Today — not next year or next decade — is the time when we must use and cultivate all of- our resources, human and material, if we are to sur- vive as a democratic society, says this report, which, as its title suggests, looks on the young people of the Na- tion as our richest resource.
It is the responsibility of the com- munity, primarily, to see that its young people are prepared to take their part in the world, the report maintains. To help communities ful- fill this responsibility, the report pre- sents facts on teen-agers in school and at work and on youth guidance, counseling, and placement services, and sets forth guides for communi- ties to use in improving their services in these fields.
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The guides for improving- school programs suggest, among other things, that school be related to everyday living, that the needs of in- dividual students be emphasized, and that school-administration policies be planned to serve all children; and they offer suggestions on steps that communities can take toward attain- ing these ends.
Similar guides to improvement are given with regard to youth-employ- ment conditions, and youth guidance, counseling, and placement services.
Communities are urged to use the guides to learn what gaps exist in their local programs and then to sur- vey their resources to meet the needs. After the most urgent needs have been decided on, the next step is to explore the available financial aid from State and Federal resources for fulfilling these needs.
The report suggests various chan- nels for information and consultation concerning improvement of commu- nity programs for youth. Some of those listed are : State and local com- mittees planning for children and youth ; public and private agency officials; State youth councils; State agencies, including education depart- ments, departments of labor, health and welfare, employment service, apprenticeship councils, and agricul- tural extension service; and Federal agencies with programs that concern children and youth.
Some of the services available from Federal agencies are listed, along with some helpful publications.
The report was developed during 1950 and 1951 by a Subcommittee on Youth Employment and Education, of the Interdepartmental Committee on Children and Youth.
REPRINTS AVAILABLE
A limited number of copies of the following reprints from The Child are available. Single copies may be had without charge until the supply is exhausted.
Aid to Dependent Children Keeps Homes Together. By Jane M. Hoey.
America Welcomes Displaced Or- phan Children. By I. Evelyn Smith.
Attitudes Toward Minority Groups. By Annie Lee Davis.
Boys and Books Get Together. By Leita P. Craig.
Chicago's Public Housing Program Helps to Save Babies' Lives. By J. S. Fuerst and Rosalyn Kaplan.
Children Can Be Helped to Face Surgery. By Ruth M. Pillsbury, M.D.
Citizens Help a Juvenile Court. By Charles H. Boswell.
''fi<iiiSf^r'jsi,Avf>'!y .
CALENDAR
May 1. Child Health Day.
May 1-7. National Correct Posture Week. Sponsored by the National Chiropractic Association.
May 3-9. National Hearing Week. Twenty-fifth annual observance. Information from the American Hearing Society, 817 Fourteenth Street, N.W., Washington 5, D. C.
May 3-9. National Mental Health Week. Fifth annual observance. Information from the National As- sociation for Mental Health, 1790 Broadway, New York 19, N. Y.
May 3-10. National Family Week. Eleventh annual observance, by Protestant, Catholic, and Jewish groups. Information from the Na- tional Council of the Churches of Christ, 79 East Adams Street. Chi- cago 3, 111.
May 4-6. Society for Pediatric Re- search. Twenty-third annual meet- ing. Atlantic City, N. J.
May 4-8. American Psychiatric As- sociation. One hundred and ninth annual meeting. Los Angeles, Calif.
May 5. Sixth World Health Assem- bly. World Health Organization. Geneva, Switzerland.
May 6. Young Women's Christian Association. Forty-sixth annual meeting of the National Board. New York, N. Y.
May 6-8. American Pediatric Society. Sixty-third annual meeting. At- lantic City, N. J.
May 10-14. Boys' Club of America. Forty-seventh national convention. Buffalo, N. Y.
May 12-16. American Association on Mental Deficiency. Seventy-seventh annual meeting. Los Angeles, Calif.
May 15-17. National Council of the Young Men's Christian Associa- tions. Twenty-seventh annual meeting. Cincinnati, Ohio.
May 17-22. Tenth North American Assembly on YMCA Work With Youth. East Lansing, Mich.
May 18-20. National Congress of Parents and Teachers. Fifty- seventh annual convention. Okla- homa City, Okla.
May 18-22. National Tuberculosis As- sociation. Forty-ninth annual meeting. Los Angeles, Calif.
May 24-27. National Conference of Jewish Communal Service. Fifty- fourth annual meeting. Atlantic City, N. J.
May 25-27. International Association of Governmental Labor Officials.
Thirty-sixth annual convention. Providence, R. I. May 25-29. General Federation of Women's Clubs. Sixty-second an- nual convention. Washington, D. C. May 27-29. Canadian Welfare Coun- cil. Thirty-third annual meeting. Ottawa. May 30-31. American Diabetes Asso- ciation. Thirteenth annual meet- ing. New York, N. Y. May 31-June 5. National Conference of Social Work. Eightieth annual meeting. Cleveland, Ohio. Some other organizations meeting in association with the National Con- ference of Social Work:
American Association of Group Workers.
American Association of Medical Social Workers.
American Association of Psychi- atric Social Woi'kers.
American Association of Social Workers.
Association for the Study of Com- munity Organization.
Child Welfare League of America. Florence Crittenton Homes Asso- ciation.
Medical Social Consultants in State and Local MCH and CC Programs (May 30).
National Association of School So- cial Workers.
National Association of Training Schools.
National Child Labor Committee. National Committee on Services to Unmarried Parents.
National Federation of Settlements and Neighborhood Centers.
National Probation and Parole As- sociation.
Regional conference, American Public Welfare Association:
May 6-8. Mountain Region. Bis- marck, N. Dak.
Regional conferences, Child Wel- fare League of America:
May 18-19. New England Region. Swampscott, Mass.
June 10-12. Southwest Region. Den- ver, Colo.
Regional conference, American Public Health Association:
June 10-13. Western Branch. Los Angeles, Calif.
Illustrations :
Cover, Esther Bubley. Courtesy of Wes- leyan University Press.
Page 139, courtesy of the Houston Post.
Page 141, George Jones.
Page 142, Esther Bubley.
Page 143, Library of Congress photograph.
Pages 144 and 146, courtesy of Community Service Society, New York City.
Page 148, National Institute of Mental Health, Public Health Service, U. S. Depart- ment of Health, Education, and Welfare.
MAY 1953
151
VOL. 17 NO. 9 MAY 1953
In This Issue
Child Health Day, 1953, by the President of the United States of America
To Understand Children Better Oveta Culp Hobby
For Better and Happier Children . .
Children in the Contemporary Scene George E. Gardner, Ph.D.. M.D.
Social Casework and the Child Camper Adelaide Z. Pahimbo
Films on Family Life Stir Discussion . Esther E. Preiey, Ph.D.
Page
. 138 . 139
. 140 . 141
144 148
Published 10 times a year by the Division of Reports, Children's Bureau Editor, Sarah L. Doran Art Editor, Philip Bonn
U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Oveta Culp Hobby, Secretary
Social Security Administration William L. Mitchell, Acting Commissioner
Children's Bureau Martha M. Eliot, M.D., Chief
Publication of THE CHILD, monthly bulletin, has been authorized by the Bureau of the Budget, September 19, 1950, to meet the needs of agencies working with or for children. The Children's Bureau does not necessarily assume responsibility for statements or opinions of contributors not connected with the Bureau. THE CHILD is sent free, on request, to libraries and to public employees in fields concerning children; address requests to the Children's Bureau, U. S. Depart- ment of Health, Education, and Welfare, Washington 25, D. C. For others the sub- scription price is $1.25 a vear. On all orders of 100 or more sent to one address there is a discount of 25 percent. Single copies 15 cents each. Send your remittance to the Superintendent of Documents, Government Printing Office, Washington 2.i, D. C. Foreign postage-25 cents additional-must be paid on all subscriptions to countries in the Eastern Hemisphere and those sent to Argentina and Brazil. Domestic postage applies to all other subscriptions.
THE CHILD is indexed in the Education Index, the Quarterly Cumulative Index Medicus, and Psychological Abstracts.
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JUNE-JULY 1953
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TOWARD BETTER SPEECH AND HEARING
Tennessee children are tested by State Crippled Children's Service
Superintendent of Documents
ROBERT M. FOOTE, M. D.
and SYLVIA STECHER
TESTING the children of Ten- nessee to discover hearing and speech defects is part of an over-all State-wide program to find, treat, and rehabilitate children and adults handicapped by defects of speech and hearing.
The program was started through a movement sparked by the medical profession. This movement, in 1949, led to organization of the Tennessee Hearing and Speech Foundation, a cooperative nonprofit enterprise sponsored first by the Tennessee State Medical Association and now supported by more than 40 public and private agencies and organizations. A major function of the Foundation is to establish speech and hearing clinical centers, to which we shall refer later.
The over-all program consists of three phases: The first phase, which is the subject of this article, consists of finding the children with speech or hearing defects. The second phase consists of providing medical services in some circumstances, and also specialized clinical services, such as making detailed audiometric studies, fitting hearing aids, providing speech therapy, and so forth. These special- ized services are given through hear- ing and speech centers provided by the Foundation. These two phases' are under the direction of the Crippled Children's Service of the State De- partment of Public Health. The third phase, the education of children with hearing or speech defects, is the responsibility of the State Depart- ment of Education.
The part played by the Crippled Children's Service in this over-all program is the result of action by the State Legislature in 1951, redefining the term "crippled child," to include
.JUL 15 1S53
nth speech or hear
children with'speecli "or hearing han- dicaps as eligible to receive service under the State program for crippled children. The Legislature at the same time appropriated funds to finance a speech and hearing program for children.
In order to carry out its new duties, the Crippled Children's Service estab- lished a Speech and Hearing Section, with an Assistant Service Director at
21 years of age, are tested through clinics established at local health departments.
Our Speech and Hearing Section includes four senior speech and hear- ing consultants who hold a master's degree, and four junior speech and hearing consultants with a B.S. or an A.B. degree. The consultants travel and work in teams of two, a senior and a junior consultant.
After complete medical, audiological, and social diagnosis, a hearing aid is sometimes rec- ommended for a child. This little boy seems to be enjoying his experience with the aid.
its head. This Section sends into each part of the State a diagnostic and screening team, consisting of two workers. The team is equipped to carry out mass or individual audio- metric testing, speech recording, and other procedures to determine whether a child is handicapped by any speech or hearing defect. School children are usually tested in their own schools. Preschool children, and boys and girls out of school but under
During our first year of operation the teams traveled over the Statt with Nashville as their base. This year, however, we have three regional offices : one in Johnson City, one in Jackson, and one in Nashville. Two consultants are stationed in Johnson City and cover the northeastern sec- tion of the State ; two in Jackson, to cover 17 western counties; and four in Nashville, to serve the counties in middle Tennessee.
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THE CHILD VOL. 17 No. 10
We plan eventually to divide the territory up still further and to have regional offices in three more cities, Memphis, Chattanooga, and Knox- ville. By next year the staff of con- sultants will have to be increased, since it is impossible for the present staff to cover every county in the State every year.
This year we are testing children in the counties that we did not reach last year. We also are going back to the counties that we visited last year to retest children who were found to have defects.
Finding the ciiildren
Our first year of operation was an experimental one. Three different methods of case finding were tried, to determine which was the most effective. These methods were: (1) Complete survey, as described below. (2) Referrals, by the teacher, of children who seemed to her to have speech or hearing defects. Under this plan the teachers sent to the county health department, through the edu- cation department, a list of the chil- dren who seemed to have either speech or hearing problems. In most cases the children referred were brought by teachers or parents to the local health department and we tested them there. (3) Similar referrals, by the teacher, with the aid of "symptom sheets," which list things that might indicate a speech or hearing problem. The children so referred were tested just as were those under "(2)."
Statistics were compiled concern- ing all three methods, and, needless to say, the complete survey by trained consultants ferreted out more prob- lems than did either of the other methods. The classroom teacher does not have much trouble recognizing the major problems, but it is very difficult for her to detect borderline ones, and it is these children espe- cially that we want to reach, since our program is mainly one of con- servation.
Under the complete-survey pro- cedure, which we tried in six coun- ties and which involved testing ap- proximately 15,000 children, we went into every school in the county and screened every child in the first eight
grades for both speech and hearing. We used a pure-tone portable screen- ing audiometer.
Testing was done under a variety of circumstances:
In one-room schools we usually tested in the classroom, with all the children in the room at one time. This eliminated individual explanations to each child. The testing procedure was explained once, and then each child was screened in turn. In the larger schools we used the quietest room we could get: clinic, library, gymnasium, auditorium — stage and dressing rooms — lunchroom, or any other quiet location.
When a school had no electricity, which is needed for operating our equipment, we tested in a nearby church, and now and then even in a farmhouse.
In all our testing we found only one school in which we could not manage somehow to give an audiometric test. That was a one-room mountain school at the end of a precariously steep ascent. There was no electricity any- where on the ridge, and taking the children down from the mountain was not feasible. But all in all very few of our rural schools do not have electricity, and we managed to get the children in these schools tested some- how.
An example of such a situation comes to mind, which shows how eager the teachers are to have the children tested. We were working in Fayette County in southwest Tennes- see— a county with a predominantly Negro population. One school had no electricity, and so the teacher was told to take her children to another. When we arrived there we were told that the teacher had sent word that she could not get transportation for her children, but that they would walk 214 miles to a church where
ROBERT M. FOOTE, M.D., is Medical Director of Crippled Children's Service, Tennessee Department of Public Health. Na.shville.
SYLVIA STECHER is Assistant Service Director of the Speech and Hearing Section of the same Crippled Children's Service.
This paper was presented to the Section on Testing Programs in Speech and Hear- ing at last year's meeting of the Speech Association of America, Cincinnati, Ohio.
JUNE-JULY 1953
there was electricity. We drove on to the church only to find that it was occupied — a revival was in progress — but again we had a message from the teacher. She would 'take her children to a farmhouse a mile down the road. We finally found her and 24 children, and we tested them in the bedroom of a tenant farmer's home. So you see there is always a way.
On the basis of our first year's find- ings we set up what will be our regular yearly procedure from now on. In every county we test the hear- ing of every child in the second, fourth, and sixth grades. In this way every child will be tested every other year. In the second grade the children are also checked for speech. We test children in any of the other grades, including high-school grades, when the teacher refers them to us.
The second, fourth, and sixth grades were selected because accord- ing to our findings more significant hearing problems occur in children in these age groups than in others.
Most children outgrow baby tall(
For speech testing, the second grade was selected rather than the first, because, although many young- sters still use baby talk when they enter the first grade, they are likely to overcome this through being in school, learning to read, talking with other children, and just growing up. If they have not overcome it by the time they reach the second grade, they probably need some special training.
The children who fail to pass the initial screening test for hearing are recalled and given a more thorough test ; and, if necessary, an audiogram is made and the child is referred to a doctor. For children with speech defects the procedure is similar.
At first we used to screen all the schools and then go back to retest. But we found that this took up too much time, and so we now retest while we still are at the school.
In each county we work through the local public-health department and department of education. Several weeks before work is begun a plan- ning meeting is held. At the meeting the medical director of the county
155
health department, the public-health nurse, the school superintendent, and teaching supervisors are present. In addition anyone else who is to work on the program or who is interested in it may come — the attendance teacher, school principals, the welfare worker, and at some meetings even the county judge.
At this planning meeting the senior speech and hearing consultant ex- plains fully the workings of the pro- gram and the services available for the children. According to the num- ber of children to be tested, dates are set up. The public-health nurse and the teaching supervisor are usually the ones who work out the schedule for testing, and in most cases, it is tlie teaching supervisor who goes M'ith us to the schools.
When we go into a county to test under this plan we prefer not to go to a school where there are fewer than 20 children to test ; it takes too much time to set up our apparatus and to go from one school to another. Therefore we like to have these children brought in to one of the larger schools nearby. All the coun- ties in which we have worked so far this year have been most cooperative about this. As many as 50 children have been brought to a central loca- tion from one school. This makes it possible for us to test more children in a day. We have found that a good daily average for two consultants, counting screening and retesting, is about 200 children.
Next year, when we hope to have more consultants, we will also retest in every school all the children for whom we made medical or clinical referrals this year. That will become our established procedure — screening for hearing all childi'en in the second, fourth, and sixth grades, testing the speech of all second-graders, recheck- ing children placed under observa- tion, checking teacher referrals from other grades, and retesting the chil- dren referred to doctors or clinics in the previous year to see whether or not their condition has improved.
When we leave a county, we give the department of education and the public-health department a complete list of the children that we have found
to have speech or hearing problems. This list includes not only children with serious difficulties, whom we have referred to a doctor or to a center, but also children with less severe problems for whom we feel that such a referral is not called for at the time, but whom we place under observation. For example, we usually put a first-grader with a speech problem under observation unless his speech is completely unintelligible. Other children are placed under ob- servation if they have one or two slight deviations. A second-grader with a slight speech problem is checked again when he reaches the fourth grade and notation is made as to whether he has improved or not. We consider a speech problem serious enough for referral to a speech and hearing center only when it inter- feres with adequate communication and is causing maladjustment in the child.
Public-health nurse plays a key role
The referrals are left with the county public-health department, and it is the duty of the public-health nurse to follow these up and see that the children receive the recommended examination and treatment. Refer- rals are marked with a first, second, or third priority, depending upon the severity of the problem. No. 1 indi- cates that the child should have im- mediate attention ; No. 2, that he needs attention, but that the need is not pressing ; No. 3, that he does not need attention now but may need it in the future.
If a child has a hearing loss the nurse visits his parents, and discusses the case with them. She suggests that the child be seen by the family doctor, who may recommend a specialist if he thinks it necessary. If the family cannot afford to pay for medical serv- ice the public-health nurse completes an application for such service, which is sent to the regional office of Crip- pled Children's Service through which she works.
In the regional office an authoriza- tion is issued and the child is seen by one of the ear specialists who are working with us on this program. If he recommends a series of medical
treatments, Crippled Children's Serv- ice pays for these; also for surgical or radiological treatments if the spe- cialist recommends these. (We do not provide for surgery unless the ear specialist feels that the child's hearing will be improved by it.) If the child needs a hearing aid and his family cannot afford to buy one, Crippled Children's Service will buy it for him, and if necessary, service it. If the child's hearing is impaired so much that speech training is advisable, this is made available through the facili- ties of the nearest hearing and speech center.
Children with organic speech prob- lems are, of course, referred to the proper specialists. Repair of cleft palate, a condition that causes much speech difficulty, has long been a function of Crippled Children's Serv- ice. Children with cleft palate are | seen by the plastic surgeon, the ortho- ! dontist, the prosthedontist, and the pediatrician, as well as the speech correctionist. Speech correction goes hand in hand with repair of the child's cleft palate.
Purely functional speech problems are referred to an ear, nose, and throat specialist before the child is admitted to the center for treatment.
We have referred several times to speech and hearing centers, and we'd like to tell a little about them.
The first one of these centers estab- lished in the State is the one at Nash- ville. It is housed in the Tennessee Hearing and Speech Foundation building, provided by the Vanderbilt University School of Medicine. It is located directly across the street from Vanderbilt Hospital, and it is equip- j ped with every modern device neces- I sary for the efficient functioning of a speech and hearing center. Last year this was the only such center we had, and service was available mainly to children within a convenient radius of Nashville.
This year another such center is in operation, in Johnson City, under the sponsorship of East Tennessee State College, and children in eastern and northeastern Tennessee are served through it.
Another center is being established
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THE CHILD VOL. 17 No. 10
in Jackson, in Madison County, west Tennessee. This center has a wide and varied sponsorship. The building has been provided by the county — a building which, incidentally, has 18- inch concrete walls, ceilings, and floors, these are a great aid to sound- proofing. One of the leading ear specialists in Jackson is president of the Jackson Hearing and Speech Center. The city of Jackson and Madison County contributed $2,000 apiece toward the cost of the center. Each of the 16 other west Tennessee counties whose children will receive service at this center contributed $500, and this $500 was raised in various and sundry ways — by PTA's and by civic clubs, and through pri- vate donations, county funds, and so forth. A group of ladies comprising the Jackson Service League under- took to get the building ready for use. They were very successful in obtain- ing donations of both material and labor. This center is truly a regional project.
Centers open to all
Crippled Children's Service does not operate any of these centers. Our role is merely one of stimulating in- terest, assisting in planning, recom- mending standards, and aiding in getting centers opened.
The State health department has helped by purchasing a considerable amount of equipment for each center, and for a limited time will pay the salary of one therapist. The equip- ment is on loan as long as the center is in operation. After a center is established we purchase service from it for children whose parents are unable to pay.
These centers offer complete speech and hearing diagnostic service, a full program of speech therapy, hearing evaluation, auditory training, speech reading (formerly called lip i-eading), and psychological testing. They are open to all, regardless of race, creed, color, or age. They accept children referred by private doctors, as well as those referred by Crippled Chil- dren's Service. State services for crippled children are extended only to persons under 21 years of age. However, the State Vocational Re-
habilitation Service is available to persons 21 or over.
Memphis already has its own speech and hearing center, organized about 5 years ago, and we hope eventually to have speech and hearing centers in Chattanooga and Knox- ville. Then every child in the State will be within easy reach of speech and hearing service. Of all the handi- capped children, those with speech handicaps can be most readily helped if help is made available.
During our first year of testing, it was frustrating at times to find so many severe speech problems and to know that nothing much could be done for the children since they were too far from the center at Nashville, and very few counties had speech correc- tionists. Now, however, the State Department of Education has a scholarship plan, whereby a teacher who is interested in the field of speech correction may go to summer school for four summers; thus she can qualify as a speech correctionist and get a master's degree at the same time. Each year when she returns to her county she takes on a little more responsibility. After the fii'st summer
she works only on simple problems of articulation. The following year she takes on more serious cases, and so on. Through this system we hope to have speech correctionists in many more counties in Tennessee.
Another of our functions is parti- cipation in monthly cleft-palate clinics, which are held in Memphis, Nashville, and Knoxville. We test the child's speech and hearing at the clinic. This we usually do in the morning, and in the afternoon the child is brought before a group of specialists for complete study.
In Jackson we take part in a cerebral-palsy clinic, which is held once every 3 months.
We feel that finding children with hearing or speech defects is the foundation of Tennessee's speech and hearing program. The program aims to reach, before long, every child in the State who has a defect either in his speech or his hearing, so that no Tennessee child will be hampered by this type of defect in obtaining an education leading to eventual self- support and responsible citizenship.
This is part of the equipment used at hearing and speech centers in diagnosing. The photo- graph was taken at the Speech and Hearing Center, Johns Hopkins University and Hospital.
JUNE-JULY 1953
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FOSTER PARENTS SPEAK UP
Children's agency welcomes their participation in planning
ESTHER S. MELTZER
and
MIRIAM WANNE
LIKE most foster-home agencies, the Jewish Children's Bureau of Cleveland for years tradi- tionally gave an annual tea or dinner for foster parents (usually the former, out of consideration for the agency's budget) .
The purpose of the annual social event was twofold : ( 1 ) To give foster parents an opportunity for identifica- tion as a group and as a part of a larger whole, and (2) to give the agency staff and board an opportu- nity to give recognition to them for the important role they play in the agency's service to children.
But this once-a-year social gather- ing, we began to realize, was doing nothing to help the foster parents deal with their difficulties and uncer- tainties regarding their relationship to the agency, which they knew only through their contacts with various caseworkers.
Before it was time to plan the 1948 annual get-together, we of the agency realized that just another social meet- ing would not suffice. We felt that foster parents ought to be given a chance to know more about the whys of the work in which they and we were mutually engaged. They needed to know more about such things as why some parents cannot provide homes for their children, so that the children need foster care; why the agency functions as it does ; why chil- dren behave as they do; why foster children at times are very much like one's own children and why at other times they are incomprehensible strangers.
We decided to offer a brief study course made up of lectures on child
development and child behavior, and we took our plans to our case con- sultant, who had done considerable work in group education. After a vigorous discussion, we recognized that we had again fallen into the standard attitude of workers toward foster parents, that is, thrusting the foster parents into the role of pas- sive onlookers. Such a program would not encourage striving for answers to questions.
Our next plan was a variation of our original proposal. This time we decided to hold a series of monthly meetings at which there would be no outside speakers. The foster parents themselves would determine the range and depth of the discussion. A planning committee composed of two staff members and seven or eight foster parents would meet before each general meeting to draw up the agenda. The case consultant would lead the group discussion, and after each meeting a staff committee would analyze the progress we had made. What we would deliberately seek would be an exchange of knowledge and experience that should lead us all to a better understanding of why foster-home placement is needed for some children and how foster parents
ESTHER S. MELTZER is now with the Spence-Chapin Adoption Service, New York City. Before that she was a district super- visor with the Jewish Family and Children's Bureau of Boston. At the time the program described here was started. Miss Meltzer was a caseworker with the Jewish Chil- dren's Bureau of Cleveland. This article is based primarily on a paper that Miss Melt- zer Rave at the Ohio State Welfare Con- ference when the program of foster-parent meetings had been going on about a year and a half. The article is planned to show the dynamics of the program's start. MIRIAM WANNE, who is a caseworker with the Jewish Children's Bureau of Cleve- land, has contributed additional material to show some of the later developments in the foster-parent meetings.
Concerning the more recent stages of the program much still remains to be told.
and caseworkers can best work to- gether for the greatest benefit of these children.
The meetings were to be held at night so that foster fathers, too, could come.
This plan was put into effect in April 1948. The response of the foster parents was electrifying. All of us — foster parents and staff — were fired with enthusiasm to wrest from each meeting the maximum in learn- ing from one another and in finding out how to translate our knowledge into more fruitful cooperative work.
For members of the planning com- mittee we chose some foster parents who had had long service with the agency and whose foster children were representative, in age and type, of the children generally served by the agency. About half these couples had European children in their homes. We sought people who would be able to speak up in the group with- out hesitation or embarrassment, since the committee members would act as co-leaders in each discussion and at times would have to take a defi- nite assignment to prepare to focus discussion on a certain point. We asked the staff to recommend foster parents who in their opinion meas- ured up to these requirements. We included foster fathers as well as foster mothers.
The Sterns were our first and unan- imous choice, a couple in their early forties, with two children of their own, a boy of 13 and a girl of 4. They were then entering their third year as foster parents and had in their home four foster children. They were people of moderate means, with only a sketchy formal education, and they had an earthy, natural dignity.
Mrs. Stern was a truly maternal person, who liked children. She saw in foster parenthood the opportunity to provide companionship for her own youngsters, as well as to add to the family income. During her con- tact with the agency she had demon- strated capacity to serve youngsters of varying capacities and behavior patterns. She was completely identi- fied with the agency and eager to participate in planning. In spite of
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THE CHILD VOL. 17 No. 10
the assurance she had of the agency's confidence in her, she found it diffi- cult to express negative feeHngs about the children or to take excep- tion to the agency's planning for them.
Mr. and Mrs. Hart were also among our oldest foster parents in length of service. They too were in their early forties, and they had one adolescent daughter. They had been outstandingly successful with their one foster child over a period of sev- eral years. Mrs. Hart, characteris- tically, was the dominant member of the family. She was a person who ex- pressed herself easily. There was a forthrightness about her comments that was provocative and challeng- ing. Midway in our program the Harts dropped out, partly because their foster daughter became finan- cially independent. Another factor in the Harts' withdrawal, we believe, was the fact that Mrs. Hart's out- spokenness in the meetings created negative reactions in the group to- ward Mrs. Hart, which she could not tolerate.
The Harts were replaced by the Pearls, a younger couple with two small girls of their own and one foster child, an adolescent girl.
Mrs. Pearl, like Mrs. Hart, was the dominant person in the family group, but Mr. Pearl was more articulate than Mr. Hart and expressed himself more freely in the group. Mrs. Pearl, a practical, thoughtful, even-tem- pered person, contributed a matter- of-fact objective mood to committee meetings.
European child welcomed
Mr. and Mrs. Robins were of the newer foster-parent group, the post- war applicants. They were in their middle thirties, with three children of their own. Their foster child was a displaced European girl. Mr. Robins' experience with the Army of Occu- pation in Germany, when he came in contact with the "lost" children in the concentration camps, stimulated his interest in providing a home for a youngster from Europe. He was a quiet young man, apparently secure in his familial and marital relation-
A good foster mother gives the child the same personal care she would give her own child
ships. Mrs. Robins shared her hus- band's interest in serving, but she was a less relaxed person and one more concerned with matching reality to the ideal. Their earnestness bore fruit in the success they had with the displaced youngster they took into their home.
The Millers could be described as the most challengingly outspoken of our foster parents. They had an intense interest in the agency's pro- gram, and Mrs. Miller, active in Jew- ish community life, had a keen under- standing of the professional point of view and consciously tries to make use of it in her work as a foster parent. They had begun to provide an infant home for us about 10 years before this program began, and, after a lapse of more than 5 years, applied again, this time for adoles- cent foster children. We now use their home as a small group home for children of all ages.
Mrs. Tager was a woman in her late 50's, bright but unschooled, with real liking for children and sensi- tivity to their needs, but little interest in or concern about the agency's con- cepts. She "indulged" the workers just as she did a foster child. She at the same time demonstrated tremend- ous tolerance and warmth for a youngster with serious behavior difficulties.
This then was really the beginning of our program — a program that falls into three distinct periods. The first,
May to July 1948, was a period of groping and free discussion ; the second, October 1948 to July 1949, was the period when the areas of interest and concern were more clearly identified and formulated ; and the third, October 1949 to the present, when foster parents have partici- pated actively in the selection of the subjects to be considered and in long- range planning of discussions. The foster-parent meetings today are much more the group's own program than was possible at the outset, be- cause today we have in the group a large enough nucleus of foster par- ents who have been active in the program and through it have gained experience in self-scrutiny and self- expression, so that continuity and direction can stem from the group.
When we suggested the plan of monthly foster-parent meetings to the group of four couples, Mrs. Stern, always eager to express approval of the agency, thought it would be a wonderful idea. Mrs. Robins wanted to know the precise arrangements, and her husband said it was a good plan if we could really work it up.
Then Mrs. Hart spoke her mind, prefacing her remarks with her usual "You won't like what Pm going to say." She wanted to know how we could expect foster parents to be completely honest, to tell what prob- lems they really have, and to confront the caseworkers and the agency openly with criticism of their
JUNE-JULY 1953
159
methods. It might be a good idea, she said, like many of the agency's other ideas, but she for one doubted that it would work. Then, as an afterthought she quietly remarked that it wouldn't hurt to try.
A general, free-for-all discussion followed, with the foster parents com- miserating with one another on their "problems" and occasionally remem- bering to reassure the two staff mem- bers who were present with: "We think the agency does a wonderful thing, the way you give the children everything."
First general meeting planned
After some time, the chairman re- marked that what we hoped to do in a more organized fashion in the larger meeting had been done here in some slight degree — we had found some mutual problems and questions and had engaged in a lively discussion of them. The value such meetings might have for all of us was pointed out. The kind of frankness Mrs. Hart had displayed was good, and we hoped that eventually all our foster parents would feel equally free to share their reactions and feelings about the work we were doing together. Gradually, as each member expressed himself, enthusiasm seemed to develop within the group about the program we had suggested, and the committee began to plan thoughtfully for the first gen- eral meeting.
Our first meetings were held in the homes of staff members. A generally social air predominated and a note of informality developed around re- freshments served at the end of each meeting.
About 30 foster parents came to the first meeting. We were struck by their reaction to one another. Be- cause of the close ties in Cleveland's Jewish community, few of the group were really strangers to one another. Visible on many of their faces was the question that one or two blurted out. "Are you a foster parent, too?" We saw some instances of bridling embarrassment, but after the first brief period of constraint and tension the group relaxed.
The group was formally greeted by our director, who stressed the im-
160
portance of the work in which we were mutually engaged and expressed the hope that our meetings together would prove helpful in improving the quality of our service to children. The case consultant then took over the meeting. He outlined the purpose of the meeting as seen by our staff and the group of foster parents who had met with the staff in an advisory capacity; and then he encouraged discussion and questions on the pro- posed program and on our work in general.
What questions did they have about the agency, about the children, about their work as foster parents? The first uneasy response was volunteered by one of the committee members, and the way was opened. How can you satisfy an adolescent girl about the amount of clothing she asks for? Why do the children seem to resent the agency at times? Why is it you can say anything you want to your own children, but can't to a foster child? Why are there certain rules about parents visiting? And wouldn't it be better if some parents didn't visit at all? Just what do the social workers do with the children in their offices?
There were comments, tentative at first, then more and more bold. Some foster parents seemed fearful of im- plying any criticism of the agency and were lyrical in their declaration that all is right with the foster child's world so long as he is in the foster home; others, of a more aggressive bent, sounded a critical note. The greater number, however, were silent in the meeting, but later, over the coffee cups, expressed interest in further meetings.
Planning committee meets again
At the second meeting of the plan- ning committee, only cautious ap- proval of the first general meeting was expressed. Each committee member launched into a discussion of his own experiences with his specific foster child and caseworker, as though testing the tolerance of the group for real questioning and nega- tive feelings. It was only after free expression had been given to this that the group was able to settle down to considering a topic for the next gen-
eral meeting. The subject which seemed of most urgent interest to the group was "the caseworker": What is the role of the caseworker? What happens in the individual conferences between the caseworker and the child? Why does the child so often come away from his contacts with the caseworker so upset? And on and on.
Thus "the caseworker" became the subject of the second general meet- ing. For the group to understand the role of the caseworker it was felt that it would be important and helpful for them to study, not only the case- worker, but themselves, in relation to the total agency structure and net- work of services. The director there- fore was asked to explain the agency organization to the group. He ex- plained the foster-home-care depart- ment of the agency and its relation- ship to the agency's institution and its day nursery. He explained then, in considerable detail, the specific role and training of the caseworker, her responsibility in approving and su- pervising foster homes, and the im- portance of her work with children who are in placement, and with their parents. He mentioned, too, the State licensing procedures.
The foster parents then were encouraged to give their impres- sion of the role and function of the caseworker. One foster parent described the caseworker as a "referee" between the foster parent and the child; another spoke of the caseworker as the person to whom the child can go "to get things off his chest"; still another saw the caseworker as the person whom the child "plays against" the foster parents. It was apparent that the foster parents had much ques- tion about the need for and the use- fulness of the caseworker. There was some suggestion, even, that the case- worker was a source of confusion and disturbance to all concerned, particu- larly in such matters as allowances, jobs, and dating.
The discussion branched into a consideration of why and how chil- dren come to the attention of the agency and how parents and chil-
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dren are helped to use its services. There was discussion, too, of the part the caseworker plays in the selection of foster homes. And out of this evolved the question: "Why do people become foster parents?" a basic question which made up one of the many recurrent themes of the meetings that followed, but one which at this point had in it a bombshell quality.
A foster mother who had one of our babies in her home replied, "We want to help children." Mrs. Tager said, "We want to do a good deed, like the Bible says." But our forth- rij:ht Mrs. Hart stated bluntly, "We do it for selfish reasons. We can't love the children because we don't know them before they come to us. I had only one child and I wanted a companion for her, but we also do it for the money; let's not forget that!"
There was an audible silence, a momentary gasping for breath as though reacting to shock, and then an outburst of protestation. One foster mother went so far as to assert vehemently that the agency should not accept foster parents who said they were interested in the money. Others weren't sure. One ventured that if a foster mother was honest enough to indicate that she was inter- ested in the money, when that was the situation, she would also be honest with the child. She thought that if the family met the agency's other qualifications, their interest in fi- nances should not disqualify them.
It was at this point that the dis- cussion leader raised the question about whether it was so wrong to be interested in earning extra money. The rest of us, referring to case- workers and other members of the staff, get paid for what we do — why should there be any question about money as a motive for foster parent- hood? Being paid does not take away from the special nature of the job; nor does it matter that while we may be earning extra money we may at the same time be meeting o'.her needs, such as the need for compan- ionship.
After this outburst and sorting out of feelings, it seemed that the dis-
Many factors, of course, enter into a couple's reasons for taking a foster child into their hdme. Often the most important factor is enjoyment of the child's companionship.
cussion of what goes into the agency's selection of foster parents, which fol- lowed, took on new meaning. The group was obviously impressed and intrigued with the fact that the staff saw foster parenthood as a form of employment and felt that work should be paid for. They became curious about how the agency decided which couples to accept and which to reject. This gave the staff an oppor- tunity to discuss our intake proced- ures, our study of the foster homes, and our use of references.
Over the coffee cups after this meeting there was more than in- formality and cordiality. There was an air of elation as foster parents talked with other foster parents and with agency staff. As one foster mother put it : "I never knew so much time and thought went into the work we are doing together." Staff mem- bers, in their home calls after the meeting, were unanimous in their feeling that "something had hap- pened" to level away the barrier that had always seemed to exist between foster parents and staff. There was a quality of togetherness that had never been so apparent before. There was a clearer understanding on the part of foster parents of their place in the total agency organization, a new feeling of status, and of appre- ciation of the real importance of the job they were doing.
Our third meeting continued what
might be called our stream-of-con- sciousness discussion. It was held at the beginning of the summer-vacation period. The staff committee planned it as a party. The one bit of serious business would be in the form of a parlor game. We presented to the group six situations : Three in which a foster child needed placement, and three in which foster parents were awaiting placement of the kind of child they had requested. We asked our foster parents to match children to homes. From the discussion evolved such questions as :
Could you love a foster child as much as you love your own? Perhaps not, but you could try not to show favoritism in front of the children.
A foster child ought to be placed in a home where he would not have to compete with an "own" child near his age.
Maybe the agency does have a hard time if we foster parents limit them too exactly in the kind of foster children we ask for.
In the kind of things they expect and demand from adults, in the way they talk to adults, foster children aren't much dif- ferent from our own children.
An adolescent girl may be better off with a young foster mother, who can remember her adolescence and act as an older sister, rather than with a motherly older woman.
Perhaps there is not much difference between the .American child and the dis- placed European child.
The meeting ended with eagerly expressed anticipation of the begin- ning of the .series in the fall.
(To be concluded in the next issue)
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FOR MORE REWARDING SUMMER RECREATION
A city health department provides consultation services to day camps
LILLIAN MARGOLIN
IN A CROWDED CITY, children need opportunities for the kinds of summer recreation that are safer, more healthful, and more con- structive than haphazard play on the street. During the school-vacation months, many groups and some indi- viduals in New York City attempt to supply such opportunities by offering children a wide variety of organized recreational programs, known in gen- eral as day camps. It is estimated that nearly 600 such camps are open in the city for about 8 weeks each summer. (These do not include year- round day-care centers, nor mass recreation programs such as the va- cation playgrounds provided by the Board of Education and by the De- partment of Parks — programs in which the children may not be regu- larly enrolled.)
Sponsorship varies
Such organizations as settlement houses, Boy Scouts and Girl Scouts, religious groups, and various social , agencies sponsor some of the day camps. The municipal government is responsible for some, through its Board of Education, its Housing Authority, and its Youth Board. Others are operated by private indi- viduals, and by cooperative groups of parents. Some landlords have estab- lished day camps for the children of their tenants. The large majority of the camps are run by nonprofit groups; less than a quarter of them are commercial.
LILLIAN MARGOLIN is Head of the Day Camp Unit, Bureau of Child Health, New York City Department of Health. During the past 1.5 years Miss Margolin has held various executive positions in the field of social group work, including- that of director of resident country camps and day camps, in New York Citv.
Each summer at least 100,000 children under 16 take part in these day-camp programs. With such a large number of children involved, the Bureau of Child Health of the city's Department of Health natu- rally is concerned about their physi- cal, mental, and emotional health. And for the past 2 years the Bureau's Division of Day Care and Foste'r Homes has had a special Day Camp
this service we also collect complete data on the camps, such as their location, the number and ages of chil- dren attending, the number and quali- fications of staff, the hours per ses- sion and number of sessions per week and the fees paid by parents.
Because changes cannot be made easily while the children are at the camps, our consultation service is most effective when given during the
A good day camp offers a relaxed atmosphere, where children may use their own initiative.
Unit, including three social group workers and a public-health nurse. This Unit works to help camp opera- tors and directors offer children ex- periences that are safe, healthful, and happy.
As a step in this direction we of the Day Camp Unit observe and evaluate the programs while they are in operation, and give year-round consultation service. To help us give
periods of pre-season planning and post-season evaluation.
In evaluating the day-camp pro- grams and recommending changes, we have found helpful a set of mini- mum standards that have been recom- mended by the Welfare and Health Council of New York City. These standards, dealing with health serv- ices, physical facilities, sanitation, food, program, transportation, per-
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sonnel, insurance, and records, were described in The Child, October 1951.
Besides giving consultation service to the directors of individual camps, the staff members of the Day Camp Unit hold conferences with represent- atives of the large organizations whose affiliates conduct day-camp programs, and of the private day- camp associations. At such a meeting we analyze the particular situation of the group and seek solutions to its problems ; we enlist its cooperation in improving practices in its camps ; we explain the recommended standards, distribute literature, and answer questions.
In our consultations we make every effort to preserve the individuality of each camp. The help given depends partly on the basic philosophy of the
tempt to stereotype the programs, nor do we assume that only one method of operation is sound.
With some camps it is necessary for us to start our consultation with recommendations concerning basic minimum needs, such as for main- taining cleanliness, providing an ade- quate number of toilets and wash- basins, controlling flies and vermin, providing shelter for the children during inclement weather, and arranging for them to have whole- some food.
Other camps may not need help in such elementary matters, but may need help in developing a sound health program. To the director of such a camp we might explain the value of pre-season health examina- tions for campers and staff. Also we
Mature, creative leadership is an essential for a successful day-camp program for children.
agency that operates the camp, the type of program, and the director's readiness to accept help. Each camp has its own set of problems, its own philosophy and objectives. Despite this variety, however, some basic common denominators of sound prac- tice and principles of good living and good health apply to all the camps, for they apply to all children in all situations. Our Unit makes no at-
might show why the camp needs to have a physician .study the results of these examinations and make recom- mendations concerning them. An- other point on which we might advise the director is in regard to making provision for individual children with specialized needs, such as a child with epilepsy, or with a crippling condi- tion, or with an emotional disturb- ance. Together with the director we
might work out methods for daily inspection to detect signs of illness, and plan for dealing with accidents and sudden illness. We might sug- gest routines including rest periods, and offer ideas for interesting and nutritious meals.
Often, after the consultant has made recommendations of this kind to a camp director, other important aspects of the program will come under discussion, such as camp per- sonnel. Our Unit constantly stresses the importance of having warm, friendly, mature staff members, who understand the growth and behavior of children. We emphasize that the previous training of these workers should include some study in the field of education, or of recreation, or of social work, as well as experience with children in groups.
The Unit realizes that it is not always enough to convince a camp director that a day camp should have well-qualified personnel ; it is often desirable also to help him make the best use of the funds budgeted for staff salaries, and to suggest sources for recruiting workers. The consult- ants are ready also to help a director develop in-service training programs and methods of supervision, and to assist with personnel practices in general.
To meet needs of different children
Planning for staff is necessarily related to the number and the age group of children for whom the worker will take responsibility, as well as to the program he will con- duct. In discussing the daily routines of the group, the consultant and the director will give consideration to the need for balance between activities and quiet intervals ; and to the need for offering a variety of experiences to meet the needs of children with different interests. These experiences might include swimming, group games, arts and crafts, hikes, picnics, study of nature lore, music, dra- matics, and so forth.
"Program" includes the entire range of activities, relationships, in- teractions, and experiences, both in- dividual and group, which the direc- tor plans and carries out with the
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help of the counselor to meet the needs of the individuals and the group.
To help with program develop- ment, the Day Camp Unit compiles reading lists and offers equipment lists, and also makes specific sugges- tions, according to the location and resources of the particular camp.
In a play school in a congested slum area, for example, a plan was de- veloped through joint conferences for regular weekly trips to State parks, to farms, to the agency's resident camp, and to other rural spots. For many of these children these trips were their only opportunity to know at first hand the feel of earth and grass, to wade in a brook, to see a frog or a salamander hop out of a puddle, to climb a tree, and to know the freedom of unencumbered space.
Conditions improve
An earnest attempt is made by the consultants to consider the particular problems of a group, in relation to limitations of physical facilities, re- stricted funds, location of the camp, and the nature and extent of the serv- ice, as well as the needs of the com- munity. At the suggestion of a consultant, concrete assistance has been given in many situations by the Bureaus of Sanitary Engineering and Sanitary Inspections, both of the De- partment of Health. Advice is given by the representatives of these bureaus on how to make the best use of what is available, and this, of course, need not result in large finan- cial expenditures. Methods of obtain- ing improved light and ventilation are suggested, along with procedures for sanitary maintenance, for proper garbage disposal, and for efficient dishwashing and food storage. The know-how of experts has repeatedly resulted in improved conditions.
Representatives of the Department of Health's Bureau of Nutrition are also called in by our consultants to advise many directors of day camps. Again, no stereotyped or rigid pro- cedures are suggested by these nutri- tionists. Many factors are taken into consideration in making recommend- ations concerning the children's nu- trition. The agency's food budget is
taken into account, as well as the cultural habits and needs of the children served, and the camp's facil- ities for cooking and serving food. Many agencies are thus helped to provide interesting, well-balanced, nutritious meals for the children at a reasonable cost. Since in some camps the children bring box lunches from home, the Day Camp Unit, in cooperation with the Bureau of Nutrition, has published a leaflet entitled "Box Lunches and Snacks in Day Camps and Summer Group Programs." This pamphlet is avail- able to the camps for distribution to parents. In addition the Unit con- sultants and the nutritionists meet frequently with parent groups to discuss the food needs of children in day camps.
The work of the Unit is helped immeasurably through the broad re- sources of the Department of Health. Specialized assistance is available from other bureaus of the Depart- ment— not only the three bureaus mentioned previously, but also the Bureaus of School Health, Public Health Nursing, Public Health Edu- cation, Preventable Diseases, Records and Statistics, Foods and Drugs, and
the unit devoted to public relations and publicity.
Our consultation service is in effect an educational process, and we estab- lish ongoing relationships with many groups. In some instances the camp operators request our help; in others the consultant takes the initiative. In no case has any group refused to discuss its operation of a camp or to permit observation or inspection.
We prepare for follow-up
The information secured during consultation conferences and obser- vation visits is noted in case records. These records enable us to compile all known data, to give a complete picture of each agency concerned, in order to help in follow-up in the future and in over-all comparative studies.
During the months of July and August the Unit's year-round staff of four consultants is augmented by a part-time staff of school physicians assigned by the Department of ! Health, and by several sanitary in- spectors. This staff, working some- times in teams, sometimes individu- ally, carries on carefully planned field visits. The physicians observe, evalu- ate, and make recommendations re-
Each summer 100,000 New York City children under 16 go to day camps. And the city's Department of Health is concerned about their physical, mental, and emotional health.
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garding the health program; the sanitary inspectors concentrate their attention on sanitation and physical facilities ; the consultants observe all aspects of the program. After each visit to a camp, a conference is held with the director or other person in charge of the camp, an evaluation is given, and recommendations made. We follow each visiit with a letter summarizing the recommendations.
Standards and practices in day camps can be improved only as parents become aware of the need for such improvement. It is therefore necessary to keep parents informed about good standards and the value of having good programs.
Most parents have at least some concern about the need for clean sur- roundings, attractive facilities, and sufficient, nutritious food. But they are somewhat less aware of what con- stitutes a creative, well-rounded, well- balanced program; what qualifica- tions a competent staff should have ; what materials and equipment ought to be available. Parents need to be kept informed about new concepts of child development and modern methods of recreational program- ing.
Some parents do not realize how a highly competitive atmosphere, for example, affects their youngsters. In fact parents themselves frequently insist that their childi-en bring home evidence of their accomplishments in the form of such things as a finished ash tray or a decorative pie plate ; that they receive marks of achieve- ment in medals and awards ; and that their interest and enthusiasm be maintained by spectacular events such as carnivals.
Some parents, remembering their own camp experience, demand for their children the same regimented, readymade, overorganized programs they have known about in the past.
When parents understand the fundamental needs of children, they will not be satisfied unless the pro- gram offers a relaxed, informal at- mosphere, where children are per- mitted to use their own initiative, where there are opportunities for adventure, where the activities are interesting but not predigested and
routinized, and where the leadership is mature and creative.
The Day Camp Unit has tried to spread these ideas by means of meet- ings with parents' associations; through careful guidance of parent cooperatives that sponsor day-camp programs; through radio broadcast- ing and newspaper publicity; and through preparation and distribution of printed materials. It should be noted that parents have been very receptive to information about ac- ceptable standards, are extremely eager to be informed, and are con- stantly seeking help in selecting day camps for their children. The De- partment of Health's folder, "Point- ers for Parents," which lists factors to be considered in picking a summer day camp for children, has been widely used.
As a result of the keen interest of various associations and councils con- cerned with recreation programs for children, our Day Camp Unit receives a great deal of help. These groups help to locate and identify camps ; they distribute the pamphlets that the Department prepares for camp operators and for parents ; and they help to publicize the recommended standards. They also explain the work of the Day Camp Unit to their affiliates, and they make valuable sug- gestions to the Unit as to methods of approaching the problem as a whole. These groups have organized con- ferences and panels on day camping and similar programs, and have in- vited staff members of the Unit to take part.
Toward raising standards
In offering consultation service to the many day camps in the City of New York, the Day Camp Unit has worked to meet the needs of parents, of operating groups, of community agencies, and especially of the chil- dren attending these camps. Our experience shows that such service, given by experienced professional workers who are concerned with all aspects of recreational programs for children, is one way to bridge the gap between theory and practice, and is a practical approach toward raising day-camp standards.
FOR YOUR BOOKSHELF
RESIDENTIAL TREATMENT OF EMOTIONALLY DISTURBED CHILDREN; a descriptive study. By Joseph H. Reid and Helen R. Hagan. Child Welfare League of America, 24 West Fortieth Street, New York 18, N. Y. 1952. 313 pp. $3.50.
In this report of 12 centers for treatment of children with severe per- sonality disorders the Child Welfare League of America gives a detailed description of each center, written by a study team that spent 1 to 3 weeks at the center, observing practice, in- terviewing key personnel, and read- ing reports. Each report includes also an evaluation or critique, written by the center's director.
These descriptions offer readers an opportunity to evaluate programs un- der different types of auspices. Thus, the report should be useful in pro- moting better understanding of resi- dential clinical services and of the various studies of such services.
Treatment in residence of emotion- ally disturbed children is the major function of each of the 12 centers se- lected for study. Each provides direct psychotherapy integrated with a therapeutic living milieu. Each has control over what children should be admitted. All are considered by the workers who made the study as rep- resentative of the field. "The number of treatment centers in the United States, other than these 12, is not large," says the report, "and few, it is believed, have developed resources comparable to those described here."
Seven of the 12 centers can be con- sidered medical programs and are ad- ministered by physicians. Five are social-agency programs, administered by social workers. Some of the pro- grams were established principally for disturbed children for whom fos- ter care also must be provided. Other programs assume no responsibility for the child's foster-care needs be- yond the period he is in treatment.
Differences also may be seen be- tween centers that offer essentially service programs and those that have a major training and research respon- sibility. A later publication of the Child Welfare League of America will analyze and evaluate some of these dif- ferences in function and organization.
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RESIDENTIAL TREATMENT CENTERS FOR EMOTIONALLY DISTURBED CHILDREN; a list- ing. Federal Security Agency (now the Department of Health, Educa- tion, and Welfare) , Social Security Administration, Children's Bureau. 1952. 78 pp. 25 cents. For sale by the Superintendent of Docu- ments, Government Printing Office, Washington 25, D. C. Single copies available from the Children's Bu- reau without charge.
To obtain information that would be helpful in answering questions from agencies and parents about pro- grams for children with emotional disturbances, the Children's Bureau has assembled information from 36 centers whose directors reported that the center's primary purpose was treatment of emotionally disturbed children. The Bureau has listed these 36 organizations, along with a brief description of the services, staff, and facilities of each, in the hope that it will be helpful to professional workers using these services.
The information reflects the cen- ters' services as of the spring of 1952. No attempt has been made to evalu- ate the programs, and inclusion of them in this directory does not consti- tute an endorsement by the Children's Bureau.
AN APPROACH TO MEASURING RESULTS IN SOCIAL WORK; a report on the Michigan reconnais- sance study of evaluative research in social work sponsored by the Michigan Welfare League. By Da- vid G. French. Columbia Univer- sity Press, New York. 1952. 178 pp. $3.
This study will be of interest and value to all persons — lay and profes- sional— who have had occasion to ask one or more of the following ques- tions : "Are people being benefited by social-work services in the way they need to be benefited? Is the money which the community is investing in social-work services producing results that justify continuing or extending these services? What kinds of im- provements are possible in making so- cial-work services more effective?" Al- though the study does not purport to answer these questions, it is directed toward a better understanding of what is involved in obtaining the answers. Because the report is writ- ten with clarity and with a notable absence of technical jargon, it may be read with ease and profit by both research and nonresearch people.
Rather than undertake another venture in evaluating some aspect of
social service, the Michigan Welfare Board, which sponsored the study, decided in favor of the necessity of learning more about the basic issues and problems involved in measuring the effectiveness of practice. In ful- filling this charge, Mr. French an- alyzes critically past efforts at evalu- ation, the obstacles which these efforts have met, and the many con- siderations to be faced in planning for a continuing program of evalua- tive research. The material for this "reconnaissance" was obtained from a review and careful study of the literature on social work and social- work research, supplemented by a series of individual and group con- ferences designed to elicit material not available in printed form.
The findings of this exploratory study indicate not only that those re- sponsible for social-work programs have many questions about the effec- tiveness of welfare services, but that they look to research for the answers. A review of the questions raised by social workers brought out that some may appropriately be answered by research ; others not.
Questions about the goals and the values of welfare services must be considered by means other than re- search. As a matter of fact, one of the greatest obstacles to evaluative studies has been the lack of agree- ment about goals. Evaluation of prac- tice can only be in terms of the ends which it seeks for both the client and the community. Others among the questions raised by social workers can ultimately be answered by objec- tive research.
Mr. French's material clarifies two essential tasks which come before re- search as such : (1) The need to make explicit the assumptions and theories on which social-work practice is based; and (2) the need to phrase the questions in research terms and to organize them into a proper se- quence.
Assuming that these tasks can and will be accomplished, the next steps in a program of evaluative research are, in Mr. French's opinion: (1) An- alyzing the problems with which the service deals; (2) describing and standardizing the service; (3) meas- uring the degree of change brought about by the application of the serv- ice; and (4) determining whether the change observed is the result of the service or is due to some other cause. The realization of such a program will require, according to the author, interchange of ideas and skills among administrators, practitioners, social scientists, and social-work research workers.
Research into the effectiveness of social-work practice requires many things: (1) A desire for the answers, (2) funds, (3) know-how — to men- tion a few. More than anything else, however, an objective evaluation of social work demands a willingness to face basic issues and to raise funda- mental, and sometimes unsettling, questions. Mr. French has done a real service in making this very clear.
Sophie T. Cambria, Ph.D. Hunter College, New York City
NOTE: Although this report deals with the measurement of social work, it contains much that will be of in- terest to those concerned with pub- lic-health services. Similar needs for measurement of results, justification of expenditure, and increasing effec- tiveness exist in both fields. And, as Mr. French says, certain steps are essential to evaluative thinking, what- ever the subject under consideration. Marian M. Crane, M.D.
RECIPES FOR NURSERY SCHOOLS AND OTHER GROUP CARE CENTERS. Compiled by Edna Mohr. Elizabeth McCor- mick Memorial Fund, 848 North Dearborn Street, Chicago 10, 111. 1951. Processed. 52 pp. 50 cents.
Recipes that have been used suc- cessfully in many nursery schools are offered in this publication to help directors of child-care centers and their cooks. The recipes give the amounts of ingredients neces- sary for serving 25, 50, and 100 children.
Catherine M. Leamy
IN THE NEWS
Juvenile delinquency. Through a new grant from the Field Foundation, the life of the Special Juvenile Delin- quency Project that is working closely with the Children's Bureau has been extended until January 1, 1954. Sup- ported by voluntary contributions dis- bursed by the Child Welfare League of America, the Project aims to im- prove treatment services for delin- quent children.
For its final 6 months' activity, with an enlarged staff, the Project hopes to bring to conclusion the work it has undertaken along with the Juvenile Delinquency Branch of the Bureau in developing new standards — or statements of desirable practice — for training schools for delinquent children, juvenile courts, and juve-
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nile-police services. Specialists from all over the country are cooperating in this work.
Addition of the new staff will per- mit the Project to step up its coopera- tive efforts with the various National, State, and local groups that have been participating in the campaign for better services for delinquent chil- dren.
The Project grew out of a Confer- ence on Delinquency Control held by the Children's Bureau in Washington in April 1952. It is hoped that the Project can conclude by recalling the members of this 1952 conference in order to report to them on work accomplished and what remains to be done.
SUMMER COURSES
Columbia University. New York School of Social Work. New York 28, N. Y.
Two series of summer institutes in social work. Some of the courses : Series I (for graduates of schools of social work) : Social treatment with the adolescent; Social work with the ill and handicapped. Series II : The psychosocial development of the nor- mal child ; Casework with unmarried mothers ; and Casework with children in their own homes and in substitute homes. Series I, July 6-17. Series II, July 20-31.
Louisiana State University and A. & M. College. School of Social Welfare, Baton Rouge.
Some of the short courses: Work- shops: Children in foster care (June 5-26) ; Children and public welfare (July 20-Aug. 7).
Nursery Training School of Boston.
Boston 15, Mass.
For experienced nursery-school teachers : Child growth and guidance — a seminar ; Teacher education through nursery school — a workshop ; Nursery-school education for the physically handicapped child — a workshop. Also a try-out course for high-school students and others who are considering entering the field of early-childhood education. (June 29- Aug. 7.)
Smith College. School for Social Work. Northampton, Mass.
Graduate seminars for experienced social workers : Advanced casework ; Supervisory method in social case- work ; Ego psychology ; Psychodyna- mics of delinquency; Casework inter- pretation and writing; and Educa- tional methods in teaching casework. (July 20-30.)
University of Chicago. School of Social Service Administration. Chi- cago 37, 111.
Some of the workshops : Casework with children and adolescents (June 29-July 11): Work with parents of children in placement (July 20-25). Special lectures (daily) : Adolescence as a phase in the development of the ego. (July 6-10.)
University of Minnesota. Minneapo- lis, Minn.
Under the sponsorship of a number of the University's colleges and schools, including the School of Social Work, the Family Life Division of General Studies, the Institute of Child Welfare, and others, the Family Life Workshop will emphasize the value of teamwork among professional work- ers in family-life education — teach- ers, marriage counselors, social workers, public-health workers, re- search personnel, and others in the family-life field. (July 6-24.)
University of Pennsylvania. Philadel- phia 4, Pa.
The eleventh annual course in Family living and sex education is sponsored by the School of Education and the Institute for the Study of Venereal Diseases, University of Pennsylvania, in cooperation with the Public Health Service, Department of Health, Education, and Welfare; Pennsylvania State Department of Health ; and the American Social Hy- giene Association. It is intended for public-health workers, counselors, teachers, religious leaders, nurses, so- cial workers, group leaders, and par- ents. (June 29-July 31.)
CALENDAR
Aug. 16-22. World Federation for Mental Health. Sixth annual meet- ing. Vienna, Austria.
Aug. 25-28. American Dietetic Asso- ciation. Thirty-sixth annual meet- ing. Los Angeles, Calif.
Aug. 30-Sept. 1. American Socio- logical Society. Forty-eighth an- nual meeting. Berkeley, Calif.
Aug. 31-Sept. 2. National Council on Family Relations. Annual confer- ence. East Lansing, Mich.
Aug. 31-Sept. 3. American Hospital Association. Fifty-fifth annual con- vention. San Francisco, Calif.
Aug. 31-Sept. 3. American Legion. Thirty-fifth annual national con- vention. St. Louis, Mo.
Sept. 1-30. Sight Saving Month. In- formation from the National So- ciety for the Prevention of Blind- ness, 1790 Broadway, New York 19, N. Y.
Sepf. 3-8. United States Assembly of Youth. Sponsored by the Young Adult Council of the National Social Welfare Assembly. Ann Arbor, Mich.
Sept. 4-9. American Psychological Association. Sixty-first annual con- vention. Cleveland, Ohio.
Sept. 6-11. National Urban League. Annual conference. Philadelphia, Pa.
Sept. 10-12. American Political Sci- ence Association. Forty-ninth an- nual meeting. Washington, D. C.
Sept. 13-20. World Assembly of Youth Rural Youth Conference. Host : The Italian national commit- tee for the World Assembly of Youth. (The Food and Agriculture Organization of the United Nations is assisting in the preparatory ma- terials.) Address inquiries to: World Assembly of Youth, 6 rue Ampere, Paris 17, France.
Sept. 17. Citizenship Day. Informa- tion from the Citizenship Commit- tee, National Education Associa- tion, 1201 Sixteenth Street NW., Washington 6, D. C.
Sept. 17-19. National Conference on Citizenship. Eighth annual meet- ing. Washington, D. C.
Sept. 25-27. American Society of Den- tistry for Children. Twenty-sixth annual meeting. Cleveland, Ohio.
Sept. 27-Oct. 4. Christian Education Week. Sponsored by the National Council of the Churches of Christ, 79 East Adams Street, Chicago 3, 111.
Sept. 28-Oct. 1. American Dental As- sociation. Ninety-fourth annual session. Cleveland. Ohio.
Sept. 28-Oct. 2. National Recreation Association. Thirty-fifth National Recreation Congress. Philadelphia, Pa.
Regional conferences, American
Public Welfare Association:
Sept. 9-11. West Coast Region. Los Angeles, Calif.
Sept. 24-26. Northeast Region. Wash- ington, D. C.
Sept. 30-Oct. 2. Southeast Region. Jacksonville, Fla.
Illustrations:
Esther Bubley. Pittsburgh Photographic Library.
Pp. 154 and 157, Archie Hardy.
I'. 159, Esther Bubley.
P. 161, Philip Bonn.
Pp. 162-164, courtesy of the author.
JUNE-JULY 1953
167
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JUNE-JULY 1953
VOL.17 NO. 1 0
In This Issue
Toward Better Speech and Hearing .... Robert M. Foote, M.D., and Sylvia Steelier
page 154
Foster Parents Speak Up
Esther S. Meltzer and Miriam IVanne
158
For More Rewarding Summer Recreation Lillian Margolin
162
Published 10 times a year by the Division of Reports, Children's Bureau
Editor, Sarah L. Doran Art Editor, Philip Bonn
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