The child : monthly news summary

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Given By

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VOLUME 17

Vol. ^'l_

AUGUST-SEPTEMBER 1952

to JUNE-JULY 1953

\

U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Social Security Administration
Children's Bureau

PO BL IC

3^^-

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

i

I

1

/ ' /

/

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

2

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)

6

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

mum

'4-

UNITED NATIONS DAY, 1952

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

U. 8. SUPERINTENDENT OFITOCUMEff^

^/7 A roclamati

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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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.

56

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.

58

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

60

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)

62

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

I I I I

Korean conflic

— \ — H

-^ — \ — h

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.

86

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.

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Arthur J. Altmeyer, Commissioner

CHILDREN'S BUREAU
Martha M. Eliot, M.D., Chief

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1 ^^33/,

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

82

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.

84

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

85

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

r

^

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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MAR 10 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.

©

I ©I
'.(7)

I©

i©

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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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-

114

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.

116

THE CHILD VOL. 17 NO. 7

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-

118

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

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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

122

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]

124

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

APRIL 1953

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.

APRIL 1953

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

128

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)

APRIL 1953

129

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-

130

THE CHILD VOL 17 NO. 8

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

APRIL 1953

131

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

132

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

134

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.

MAY 1953

145

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-

146

THE CHILD VOL 17 NO. 9

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.

148

THE CHILD VOL. 17 NO. 9

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.

150

THE CHILD VOL. 17 NO. 9

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.

IL 12

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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.

154

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

156

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

157

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

158

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-

THE CHILD VOL. 17 No. 10

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)

JUNE-JULY 1953

161

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-

162

THE CHILD VOL. 17 No. 10

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

JUNE-JULY 1953

163

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.

164

THE CHILD VOL. 17 No. 10

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.

JUNE-JULY 1953

165

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-

166

THE CHILD VOL. 17 No. 10

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

United States
Government Printing Office

DIVISION OF PUBLIC DOCUMENTS

Washington 25, D. C.

OFFICIAL BUSINESS

If you do not desire to continue receiving
tiiis publication, please check here: □ ;
tear off this label and return it to the above
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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

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 bulle-
tin, has been authorized by the Bureau of
the Budget. September 19, 19.50, 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. Department of
Health, Education, and Welfare, Washing-
ton 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 per-
cent. Single copies 15 cents each. Send your
remittance to the Superintendent of Docu-

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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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