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boston  Public  Library 
Supeiintendent  of  Documents 

JAI^  2  5  1967 

DEPOSITORY 


childrer\ 


Developmental   Institutions 
Filial  Deprivation  in  Parents 
Clinicians  Learn  With  Teachers 
A  Family  Pediatric  Clinic 


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INDEXES     •     VOLUME  XIV,  1967 


children 


U.S.  DEPARTMENT  OF  HEALTH,  EDUCATION,  AND  WELFARE 
SOCIAL  AND  REHABILITATION  SERVICE     •     Children's  Bureau 


ference,  Victor  Eisner  and  Helen 
M.  Wallace,  Mar.-Apr.,  59. 

Mentally  Retarded  Children: 

A  Homebound  Therapy  Program 
for  Severely  Retarded  Children, 
Hope  G.  Curfman  and  Carol  B. 
Arnold,  Mar.-Apr.,  63. 

A  Group  Process  in  Helping  Parents 
of  Retarded  Children,  Arthur 
Mandelbaum,  Nov. -Dec,  227. 

Some  Observations  About  Mentally 
Retarded  Adolescents,  Arthur 
Segal,  Nov.-Dec,  233. 

Sex  Education: 

Helping  Children  Grow  Up  Sexu- 
ally—How?  When?   By   Whom? 


Eleanore    Braun    Luckey,    July- 
Aug.,  130. 
Starting  a  Sex  Education  Program, 
Lester  A.  Kirkendall  and  Helen 
M.  Cox,  July-Aug.,  136. 

Staff  Development: 

Learning  With  Teachers,  Albert  J. 
Solnit  and  Mary  H.  Stark, 
Jan.-Feb.,  19. 

Pediatric  Training  and  the  Man- 
power Problem,  Robert  J.  Hag- 
gerty,  May-June,  90. 

Unmarried  Mothers: 

A  Guide  for  Collaboration  of 
Physician,  Social  Worker,  and 
Lawyer,    May-June,    111. 


Unmarried  Mothers — The  Service 
Gap  Revisited,  Elizabeth  Herzog, 
May-June  105. 

Use  of  Volunteers: 

How  Volunteers  Can  Help  Dis- 
advantaged Children,  Harris  E. 
Karowe,  July-Aug.,  151. 

Volunteers  in  Institutions  for  De- 
linquents, Elizabeth  H.  Gorlieh, 
July-Aug.,  147. 

Youth  Services: 

Three  Years  of  the  Neighborhood 

Youth  Corps,  Regina  H.  Saxton, 

July-Aug.,  156. 
Youth     and     Youth     Services     in 

England,    Katherine    B.    Oettin- 

ger,  Mar.-Apr.,  75. 


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INDEXES  •  VOLUME  XIV,   1967 


US    GOVERNMENT  PRINTING  OFFICE      I96B  O  — 290-258 


VOLUME   14     •     NUMBER   1     •    JANUARY-FEBRUARY   1967 


children 

AN  INTERDISCIPLINARY  JOURNAL  FOR  THE  PROFESSIONS  SERVING  CHILDREN 


k 


Understanding  a  troubled  child, 
as  this  teacher  is  obviously  at- 
tempting to  do,  may  be  the  first 
step  toward  helping  the  child 
overcome  blocks  to  learning. 
How  a  psychiatrically  oriented 
clinical  team  is  working  with 
groups  of  teachers  to  increase 
the  understanding  of  both  teach- 
ers and  clinicians  of  the  factors 
that  affect  children's  perform- 
ance and  behavior  in  school  is 
described  in  the  article  beginning 
on  page  19. 


College  Students  and  Children  in  Developmental 

Institutions 2 

Kenneth  Keniston 

Filial  Deprivation  in  Parents  of  Children  in 

Foster  Care 8 

Shirley  Jenkins 

Family  Day  Care  for  Children  of  Migrant  Farm 

Workers 13 

Marion  L.  Sheridan 

Learning  With  Teachers 19 

Albert  J.  Solnit  and  Mary  H.  Stark 

A  Family  Pediatric  Clinic  at  a  Community 

Hospital 25 

Milton  Markowitz  and  Leon  Gordis 

A  Measuring  Rod  for  Juvenile  and  Family  Courts .  .     31 

Margaret  K.  Rosenheim 

book  notes 33 

here  and  there 36 

in  the  journals 42 

readers'  exchange 43 


children 


National  Advisers  to  CHILDREN 

William  E.  Brown,  dentistry 

Alex  Elson,  laiv 

John  H.  Fischer,  education 

Beatrice  Goodwin,  nursing 

Dale  B.  Harris,  psychology 

Robert  J.  Havighurst,  youth  development 

Robert  B.  Kugel,  pediatrics 

Hylan  Lewis,  sociology 

Helen  B.  Montgomery,  social  work, 

Bernice  M.  Moore,  community  planning 

Winford  Oliphant,  child  welfare 

Milton  G.  Rector,  corrections 

Albert  J.  Solnit,  psychiatry 

John  D.  Thompson,  obstetrics 

Samuel  M.  Wishik,  maternal  and  child  health 

Children's  Bureau  Staff  Advisers 

Kenneth  S.  Carpenter,  chairman 
Division  oj  Juvenile  Delinquency  Service 

Dorothy  E.  Bradbury 
Division  of  Reports 

Hester  B.  Curtis 

Division  of  International  Cooperation 

Elizabeth  Herzog 
Division  of  Research 

Jane  S.  Lin-Fu 

Division  of  Health  Services 

Jean  Reynolds 
Office  of  the  Chief 

Will  Wolstein 

Division  of  Social  Services 

Editorial  Staff 

Kathryn  Close,  Editor 

Catherine  P.  Williams,  Associate  Editor 

Mary  E.  Robinson,  Willamena  Samuels,  Assistants 


At  first  glance,  few  groups  seem  more  dia 
similar  than  the  talented,  privileged  student 
who  attend  residential  liberal  arts  college 
and  the  unwanted  or  neglected  children  who  live  ii 
group  residential  centei's.  Yet  behind  the  real  dif 
ferences  in  age  and  social  privilege  that  separat 
these  two  groups,  there  are  profound  similarities  ii 
their  situations.  Essentially  the  same  issues  arise  ii 
planning  for  what  one  college  dean  calls  "the  car 
and  feeding  of  college  students"  as  in  planning  fo 
the  group  residential  care  of  children. 

As  Erving  Goffman  has  pointed  out,  there  are 
few  institutions  in  modern  society  that  may  enconi 
pass  practically  all  aspects  of  a  person's  life.  H 
calls  these  "total  institutions,"  ^  for  in  them  residen 
tial  life,  social  life,  and  work  life  are  combined — off 
ten  within  the  same  walls,  certainly  within  the  sam 
institutional  framework.  As  examples  he  cites  mei 
chant  ships,  militaiy  ser\'ices,  ment<al  hospitals 
prisons,  monasteries,  and  residential  treatment  in 
stitutions.  He  might  also  have  cited  institutions  fo 
neglected  and  dependent  cliiklren. 

This  concept  of  "t<*tal  institution"  becomes  mor 
useful  if  we  distinguish  between  different  kinds  o 
total  institutions.     There  are  three  types:  (1)  thosf'^ 
institutions  that  could  be  called  instrumental  becaus  ^^' 
they  are  trying  to  get  a  job  done  in  the  outsid 
world — for  instance,   a   merchant  ship  cari-ying 
cargo  across  the  sea ;  (2)  those  institutions  whose  pui 
pose  is  at  least  nominally  thernpeutie,  preventativi 
or  corrective,  such  as  a  prison  or  mental  hospital ;  an 
(3)  a  small  group  of  institutions  whose  explicit  pui 
jDose  is  developmental,  such  as  a  residential  collegi'  l 
a  boarding  school,  or  a  residential  center  for  neglecte 
and  dependent  children. 

A  residential  college,  of  course,  is  less  "total"  thafm 
an  army  or  a  prison :  Students  are  on  the  whole  f  re  ' ' 
to  enter  and  leave  at  will.  But  for  most  college  stu  ^ 
dents,  during  the  academic  year  at  least,  their  live  i 
are  embodied  and  to  some  extent  regulated  within 
single  framework  and  a  set  of  walls.  And  obviousl; 
group  residential  centers  for  children  are  total  in 
stitutions  in  the  full  sense  of  the  word. 

Developmental  institutions,  whether  colleges  o 
children's  "homes."  have  a  number  of  common  cliai 
acteristics.  For  one,  they  at  least  nominally  accep 
as  their  primary  objective  the  promotion  of  the  "nor 
mal"  or  optimal  development  of  their  charges,  th 
residents.  They  therefore  usually  try  to  ally  them 
selves  with  what  they  take  to  be  the  natural  force 
for  growth  and  development  in  the  individual 
They  see  their  task  as  somehow  stimulating,  supportf 


« 


[Uli 


mi 


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a. 


CHILDREN     •     JANUARY-FEBRUARY  196:  On 


COLLEGE 

STUDENTS 

AND 

CHILDREN 

IN 


developmental 
institutions 


iENNETH  KENISTON 


g,  and  confii'ming  the  development  of  each  resident. 

this  respect  they  dili'er  sliarply  from  an  instni- 
eiital  institution  lilvc  an  army  or  a  merchant  sliip, 
liich  may  ignore  or  even  impede  the  individual's 
erall  development.  And  tliey  also  ditl'er  from 
erapeutic  institutions  like  good  mental  hospitals, 
liicli  have  as  a  primary  task  to  intervene  and  correct 
ulty  development.  This  does  not  mean  that  devel- 
■mcntal  institutions  like  colleges  or  institutions  for 
ildren  do  not  have  ways  of  correcting  faulty  dc- 
lopnient.  But,  on  the  whole,  their  goals  ai'e  not  so 
Lich  to  correct  failures  as  to  promote  normal, 
althy  growth. 

A  second  characteristic  of  develo]3mental  institu- 
ins  is  that  they  exercise  quasi-familial  functions, 
rdinarily,  such  institutions  arise  in  situations  where 
milies  cannot  or  are  thought  not  to  be  able  to  do 

adecjuate  job.  A  children's  institution,  for  ex- 
iple,  usually  enters  the  picture  when  there  is  no 
mily  that  can  take  cai'e  of  the  child,  or  when  the 
ild's  actual  familj^  is  exerting  a  destnictive  in- 
lence  on  his  development.  Boarding  schools  and 
■iidcntial  colleges  generally  arise  because  individual 
milies  cannot  provide  the  kind  of  "character-build- 
ir."  intellectual  stimulation,  or  environmental  en- 
hment  provided  by  a  residential  school.  This  does 
t  mean  that  developmental  institutions  should 
|inl<:  of  themselves  as  families,  for  they  can  never 
rfcirm  all  the  functions  of  a  family. 
^lany  of  the  same  kinds  of  pi'actical  and  tlieoretical 


sed  on  a  talk  given  at  the  Workshop  on  Group  Residential 
re  of  Infants  and  Young  Children,  New  Haven,  Conn., 
ril  1966. 


problems  arise  in  all  developmental  institutions, 
whether  they  are  dealing  with  adolescents  and  young 
adults  or  with  infants  and  young  children.  Some  of 
these  problems  were  underscored  in  two  studies  with 
which  I  have  recently  been  involved.  One  of  these 
was  a  study  of  "alienated"  college  students — a  small 
group  of  students  who  were  extreme  ui  their  rejection 
of  what  they  took  to  be  the  dominant  values  and  roles 
of  institutions  in  American  society.  The  second  is 
an  ongoing  study  of  gifted  students  who  drop  out  of 
college. 

The  psychology  of  alienation 

For  about  6  years,  I  was  involved  in  the  study  of 
alienated  undergraduates  at  Harvard  University. 
The  initial  research  consisted  chiefly  of  objective 
tests — the  systematic  comparison  of  alienated  and 
nonalienated  students  through  the  use  of  question- 
naires. Almost  2,000  students  were  involved,  but 
although  these  statistical  studies  yielded  useful  in- 
formation, they  did  not  take  me  very  far  toward  the 
question  I  was  trying  to  answer:  "Why  is  it  that  some 
students  are  alienated  whereas  others  are  not? 

To  try  to  answer  this  question  I  turned  to  a  more 
intensive  study  of  12  students  who  had  been  selected 
because  of  the  extreme  degree  of  their  alienation  as 
measured  by  questionnaires.  This  group  was  con- 
trasted with  another  group  of  the  same  size  at  the 
opposite  pole — "extremely  unalienated" — and  with  a 
(bird  control  group  that  was  not  extreme  in  cither 
way.  All  three  groups  were  studied  over  the  last  3 
years  of  their  college  careers. 

Each  stutlcnt  spent  altogether  about  200  hours  par- 


1)LUME  14  -  NUMBER  1 


ticipating  in  the  research.  Each  was  interviewed 
about  his  views  of  the  world,  his  current  beliavior, 
and  his  life  history,  and  each  took  part  in  a  large 
number  of  psychological  experiments. 

A  comparison  of  the  data  from  the  alienated  group 
with  that  from  the  other  two  groups  revealed  a  num- 
ber of  distinctive  patterns  of  ideology,  behavior,  life 
history,  and  fantasy  among  the  alienated  students. 
In  addition  to  being  alienated  from  American  cul- 
ture, they  were  on  the  whole  pessimistic,  distrustful, 
resentful,  and  cynical  about  human  nature.  They 
saw  themselves  as  outsiders  whose  isolation  and  alone- 
ness  was  part  of  the  hiunan  condition,  not  their  own 
personal  problem.  To  them,  the  universe  seemed  a 
formless  and  unstructured  chaos  lacking  in  meaning 
and  jDurpose.  And  they  rej  ected  all  cooperative  group 
endeavors  on  the  grounds  that  conformity  means  the 
destruction  of  individuality. 

Most  of  these  students  came  from  a  similar  family 
constellation.  Characteristically,  they  described 
their  mothers  as  magnetic,  emotional,  passionate,  and 
attractive  women  to  whom  they,  the  sons,  were  ex- 
tremely, often  excessively,  close.  At  the  same  time 
they  described  their  mothers  as  possessive,  confining, 
restrictive,  nagging,  and  intrusive. 

About  their  fathers,  these  alienated  students  volun- 
teered very  little  information.  Wlien  pressed  to 
discuss  their  fathers,  they  described  them  as  disap- 
pointed, frustrated,  detached,  outwardly  cold  men. 
However,  the  alienated  students  usually  imagined 
that  their  fathers  had,  at  one  point  in  their  own 
youth,  [)ossessed  considerable  imagination,  idealism, 
and  fire,  which  had  been  lost  in  adulthood.  So  the 
father,  as  the  son  saw  him,  was  a  man  deeply  dis- 
appointed by  his  own  failure  to  realize  his  youthful 
dreams. 

Such  a  family  constellation,  we  felt,  had  obvious 
relationships  to  the  development  of  alienation.  See- 
ing their  fathers  as  men  who  had  been  broken  by  life 
or  by  their  marriages  and  thus  defeated  by  "the 
American  way  of  life,"  these  students  were  deter- 
mined not  to  let  what  happened  to  their  fathers  hap- 
pen to  them.  In  rejecting  their  fathers,  they  also  felt 
it  necessary  to  reject  the  society  that,  as  they  saw  it, 
had  ruined  their  fathers.  In  other  words,  from  their 
fathers  these  students  had  derived  an  image  of  con- 
ventional masculine  adulthood  that  was  repugnant 
to  them,  so  they  spurned  conventional  adulthood  in 
American  society.^ 

In  further  explaining  the  alienation  of  these  stu- 
dents, I  should  point  out  that  Harvard  undergrad- 
iiates  tend  to  be  somewhat  more  alienated  as  seniors 


than  as  freshmen,  although  rarely  to  the  extreme  thai 
these  students  reached.  In  addition,  these  student 
wei'e  on  the  whole  an  unusually  imaginative,  artistic  « 
ally  oriented,  and  talented  group  of  young  men  win  k 
argued  that  American  society  was  in  general  no 
particularly  hospitable  to  talented,  creative  persons 
They  were  clearly  reacting  to  the  wider  society  a 
well  as  to  their  parents  and  family  experiences. 


k 


Fo 


ur  major  issues 


When  I  discuss  this  material,  I  am  often  aske 
a  number  of  related  questions :  Is  alienation  a  kim 
of  psychopathology  ?  Wliy  did  the  researchers  nc 
do  more  to  cure  these  students  of  their  alienation 
Is  it  not  a  dreadful  commentary  on  a  college  that  it 
students  become  more  alienated  ?  Should  the  institr 
tion  be  doing  something  to  change  such  students 
Is  alienation  a  good  thing  or  a  bad  thing  ? 

None  of  these  questions  can  be  answered  simpb 
I  mention  them  only  because  they  point  to  two  cri 
cial  issues  that  arise  whenever  we  begin  thinkin 
about  the  development  of  a  person  in  an  institutior 


11 


1.  What  is  "normal"  development? 

This  first  issue  could  be  called  the  normative  que; 
tion — that  is,  the  question  of  what  kind  of  develo] 
ment  the  institution  is  trying  to  promote.     Is  the  go; 
of  a  college,  for  example,  to  produce  well-traine 
adults  who  will  be  able  to  fit  smoothly  into  their  pos 
tions  in  society?     Or  is  it  to  promote  critical  intell 
gence  and  detacliment  from  the  immediate  pressunlr. 
and  values  of  society?     If  we  think  that  a  smooth  »i 
fit  with  society  is  the  objective,  then  obviously  an  jf, 
college  that  "alienates"  its  students  from  the  prevai 
ing  society  is  a  bad  college.     But  if  we  think  thi  !» 
critical  intelligence  and  capacity  for  detachment  f  roi 
society  is  a  good  thing,  then  we  may  very  well  aj 
plaud  a  college  that  to  some  extent  increases  alieni 
tion  in  its  students. 

The  normative  question  almost  inevitably  arist  i 
when  one  begins  thinking  about  or  planning  an  ii 
stitutional  framework  that  will  encourage  the  "no 
mal  development"  of  the  individual.     Indeed,  tl 
terms  "normal  development"  and  "the  optimal  di 
velopment  of  each   individual"  can  be  dangeroi 
phrases  since  they  may  obscure  the  underlying  vah 
questions  involved.     We  Icnow  that  individuals  calu 
be  stimulated  to  develop  in  a  great  variety  of  vei  « 
different  ways.     But  certain  pathways  to  develo{ 
ment  may  be  mutually  exclusive.     For  examjole,  if 
college  tries  to  promote  what  some  alumni  groups  ca  j 


CHILDREN 


JANUARY-FEBRUARY  196  Iffl 


101 

11] 


Itt 


Is 


oyully  und  iiuls,"  it  may  be  (iillicull  I'm-  il  also  to 
romote  such  a  quality  as  the  critical  use  ol'  intcl- 
ct.  Or  in  till'  case  of  small  ohildrcii,  major  ciii- 
liasis  on  the  jiroiip,  as  in  the  Isiaeli  kibbutzim,  may 
lake  it  very  difTicult  for  a  cliild  to  develop  the  in- 

nse  attachment  to  a  single  motherin<^  pei'son  that  is 
laracteristic  of  good  family  life  in  most  Western 
jcieties. 

It  is  not  enousi'h,  then,  to  talk  merely  about  "'iiornial 
evelopment"  as  the  goal  of  a  developmental  institu- 
on.  Wo  laiow  that  parents  have  unconscious,  pre- 
jnscious,  and  conscious  objectives  in  child  rearing, 
liey  try  to  prevent  Johnny  from  becoming  like  his 
Icoholic  Uncle  Harry ;  or  to  encourage  Gertnide  to 
ecomc  like  her  mother;  or  to  develop  orderliness, 
eatness,  and  parsimony  in  one  child,  or  grace,  free- 
om,  agility,  and  imagination  in  another.  The  enor- 
lous  variation  in  personalities  produced  by  ordinary 
healthy''  families  suggests  that  it  is  almost  im- 
ossiblo  not  to  stimulate  certain  developmental  poten- 
ils  and  to  inhibit  or  retard  others. 

But  in  a  developmental  institution,  in  contrast  to  a 
vmily,  the  normative  question — what  is  "normal" 
evelopment? — has  to  be  made  far  more  explicit  and 
inscious  in  planning,  programing,  and  evaluation, 
n  these  processes  ethical  questions  cannot  be  avoided, 
ley  can  only  be  evaded;  and  when  they  are  evaded- — 
■hen  they  are  not  openly  faced  and  rationally  con- 
dered — the  results  may  be  disastrous.  For  example, 
ne  way  of  characterizing  those  hygienic  institutions 
hose  toll  on  children's  develoijment  has  been  so  well 
ocumonted  ^'^  is  to  note  that  they  liave  answered  the 
ormative  question  with  an  unconscious  decision  to 
roduce  children  who  will  be  as  little  trouble  as  pos- 
ble.  a  goal  that  can  be  reached  only  by  sacrificing 
le  child's  individuality. 

Some  American  colleges  operate  with  a  comparable 
nconscious  goal — to  keep  their  students  out  of 
ouble  until  they  are  old  enough  to  enter  the  labor 
larket.  Fortunately,  adolescents  are  more  resilient 
id  i-ebellious  than  infants  and  can  sometimes  over- 
ime  this  kind  of  pressure.     But  the  long-mn  con- 


en  neth  Keniston  is  associate  professor  of 
-ycliology  and  associate  director  of  an  ad- 
mced  training  jtrogram  in  social  and  corn- 
unity  psychiatry  at  the  department  of 
sychiatry  of  the  Yale  University  School  of 
edicine.  He  has  also  taught  at  his  alma 
ater,  Harvard  University.  He  received 
s  doctoral  degree  from  Oxford  University. 

OLUME  14  -  NUMBER  1 


sequences  of  having  this  goal  may  be  only  sliglitly 
less  deplorable  than  the  consequences  of  having  the 
goal  of  keeping  children  out  of  trouble  in  an  anti- 
septic nursery.  In  children's  institutions  and  in  col- 
leges alike,  it  is  crucial  to  examine,  reflect  upon, 
and  make  explicit  the  specific  developmental  and  edu- 
cational  objectivesof  the  institution. 

2.  For  what  kind  of  society? 

The  second  crucial  issue  raised  by  the  study  of 
alienated  students  is  closely  related  to  the  first.  It 
has  to  do  with  the  nature  of  the  society  into  which  the 
developing  individual  will  eventually  move,  and  the 
demands,  characteristics,  and  needs  of  that  wider 
society.  If,  for  example,  it  were  clear  that  we  lived 
in  the  best  of  all  possible  worlds,  then  alienation  from 
our  present  society  would  definitely  be  an  irrational 
and  deplorable  response.  We  would  prescribe 
therapy  for  the  alienated  students  and  abolition  or 
reform  for  "alienating"  institutions.  Or  if  we  felt 
that  criticism  of  society  was  always  destructive,  we 
should  similarly  deplore  any  degree  of  alienation. 

In  other  words,  any  judgment  as  to  the  kuid  of 
human  development  we  should  ideally  promote  must 
be  closely  related  to  our  picture  of  the  nature  of  the 
wider  society,  of  the  demands  it  makes,  and  of  its 
long-range  needs.  A  developmental  institution  is 
preparing  individuals  for  a  particular  society  with 
special  characteristics,  pressures,  and  opportunities. 
It  may  be,  for  example,  that  certain  kinds  of  child 
rearing  will  produce  the  kind  of  character  structure 
and  personality  organization  that  is  well  suited  to  a 
Polynesian  village  but  profoundly  unsuited  to  Amer- 
ican society.  Or  again,  the  kibbutz  system  of  child 
rearing  may  produce  the  kind  of  adult  who  contrib- 
utes a  great  deal  to  a  kibbutz  but  one  who  would  be 
unhappy  and  improductive  in  American  society. 

Thus,  in  planning  for  the  2:)rogram  or  staffing  of  a 
developmental  institution,  we  must  consider  the  kind 
of  society  in  which  the  "products"  of  the  institution 
will  live  and  their  capacity  for  fulfillment  and  pro- 
ductivity in  such  a  society.  This  does  not  mean  that 
our  goals  should  be  to  develop  people  who  will  un- 
reflectively  "adjust"  to  society.  Obviously  society 
needs  social  critics,  independent  thinkers,  and  even 
alienated  men  and  women.  But  social  critics  also 
have  to  function  within  society. 

Another  study  I  have  been  involved  in  raises 
two  more  questions  that  are  relevant  to  program 
pliinning  in  a  developmental  in.stitution.  This  is  an 
exploratory  study  of  talented  college  dropouts. 
Everv  vear  hundreds  of  thousands  of  talented  well- 


prepared  young  Americans  drop  out  of  colleges  be- 
fore graduating.  We  are  trying  to  find  out  why. 
What  does  this  mean  in  relation  to  the  student's 
development  ?  For  whom  is  dropping  out  a  progres- 
sive step,  and  for  whom  is  it  a  regressive  step  ? 

This  research  at  Yale  University  is  in  midstream. 
We  are  not  even  sure  of  all  the  questions  we  will  ask, 
much  less  of  the  answers.  But  we  are  beginning  to 
believe  with  Anna  Freud  that  dropouts  are  people  for 
whom  the  4  years  of  college  come  at  the  worst  pos- 
sible time  from  a  developmental  point  of  view."  They 
feel,  consciously  and  unconsciously,  that  further 
psychological  development  is  impossible  as  long  as 
they  remain  within  a  collegiate  setting ;  and  in  many 
or  most  cases,  they  are  probably  right.  At  least 
those  who  return  (the  majoi-ity)  believe  that  their 
years  away  have  enabled  them  to  grow  and  mature, 
and  the  judgments  of  their  friends  and  teachers 
usually  confirm  this  belief. 

In  our  exploratory  clinical  studies,  we  have  found 
that  dropouts  often  have  difficult  problems  of  identi- 
fication with  their  parents,  problems  that  seem  to  pre- 
vent that  slow  and  gradual  development  of  commit- 
ments and  the  consolidation  of  identity  that  usually 
take  place  in  students  of  tiieir  age.  And  one  reason 
why  dropouts  find  these  problems  (which  are,  after 
all,  universal)  so  difficult  to  resolve  within  a  collegiate 
context  has  to  do  with  their  perceptions  of  the  college 
environment. 

Thus  we  find  an  almost  universal  but  often  un- 
conscious tendency  among  these  college  dropouts  to 
perceive  the  college  as  a  whole  as  if  it  were  a  large- 
scale  edition  of  their  families.  We  have  been  repeat- 
edly impressed  with  the  striking  parallel  between 
dropouts'  descriptions  of  the  college  and  their  de- 
scriptions of  their  parents.  One  sophomore,  for  ex- 
ample, was  struggling  with  great  problems  of  identi- 
fication with  a  father  who  was  overtly  sadistic  and 
brutal  but  who  at  the  same  time  manifested  through 
alcoholism  an  underlying  passivity  and  dependency. 
This  student  describes  the  college  as  being  author- 
itarian, harsh,  and  repressive,  yet  lacking  in  any  real 
strength,  decisiveness,  or  moral  purpose.  Anotlier 
student,  in  the  throes  of  attempting  to  reconcile  con- 
flicting identifications  with  warring  parents,  per- 
ceived the  college  as  containing  two  conflicting  sets  of 
pressures,  clearly  identifiable  with  his  parents. 

This  kind  of  "institutional  transference" — equat- 
ing the  institution  with  the  family — seems  to  be  par- 
ticularly vsadespread  among  students  who  drop  out 
of  college.  Students  who  persist  in  college  seem 
considerably  less  prone  to  identify  college  with  their 


parents.  To  be  sure,  they,  too,  tend  to  relate  to  th 
institution  globally,  almost  as  if  it  were  a  familj  ■■■ 
But  for  them  the  college  is  like  a  neio  family,  a  f acili 
tating,  liberating  environment  in  which  they  ca: 
escape  earlier  family  pressures  and  move  forward  ii 
their  development. 

Another  incidental  finding  of  this  study  is  hoA 
few  colleges  recognize  the  existence  of  dropouts.  O 
every  100  freshmen  entering  4-year  colleges  in  Amei 
ica,  only  40  graduate  from  the  same  college  4  yeai  »[ 
later.  Transfers  and  temporaiy  or  permanent  in 
terruptions  of  college  are  the  rule  rather  than  th 
exception.  But  most  colleges  keejD  few  figures  abou 
"dropouts,"  ignore  their  existence,  or  with  little  fac 
tual  basis  treat  them  all  as  psychological  "misfits"  o 
academic  "failures." 

This  study  of  dropouts  underscores  two  furthe 
issues  that  arise  in  all  developmental  institutions 


k 


*!, 


1? 


'I 
11 
■!I 


111 


3.  What  are  the  ejects  of  the  institution  as  a  whoh 
of  its  climate,  culture,  or  morale,  on  the  individual? 

In  the  end,  we  can  no  doubt  analyze  a  student's  pei 
ception  of  a  college  into  a  tliousand  component  intei 
personal  relationships  and  experiences.  But  the  sfci 
dent  himself  experiences  the  institution  globally  i 
an  entity;  and  he  tends  to  relate  himself  to  it  almosi  n 
as  if  it  were  a  single,  crucial  person  in  his  life.  Tli, 
fact  may  help  explain  one  of  the  puzzling  results  c 
many  studies  of  college  students.  It  has  been  show 
agam  and  again  that  probably  the  most  potent  facte 
in  determining  how  colleges  afl'ect  students'  develop 
ment  is  that  intangible  quality  called  "institutio 
morale,"  "college  climate"  or  "campus  culture."  Tli 
effectiveness  of  an  institution  in  promotmg  develoj 
ment  seems  more  closely  related  to  the  characteristic 
of  the  institution  as  a  whole  than  to  any  of  its  cor 
stituent  parts — students,  faculty,  facilities,  program; 
residential  arrangements,  or  curriculum. 

In  many  discussions  of  the  relationship  of  the  co' 
lege  to  students'  develoj^ment,  this  quality  c 
"climate"  is  neglected,  perhaps  because  it  is  so  difficul 
to  define  and  measure  precisely.  We  hear  endles 
discussions  of  curriculum  reform,  promotion  policie.' 
admissions  procedures,  and  residential  facilities,  bu 
very  few  discussions  of  how  to  create  or  facilitate  th 
right  kind  of  "climate"  or  "morale."  Yet  even  a 
unmotivated  and  unpromising  student,  if  he  is  fortu 
nate  enough  to  enter  a  first-class  college  with  ver 
high  institutional  morale,  may  find  himself  caugh 
up  in  a  general  tide  of  enthusiasm  that  pushes  him  b 
a  height  of  personal  and  intellectual  developmen 
that  he  never  before  dreamed  of.     On  the  other  banc 


CHILDREN     •     JANUARY-FEBRUARY  196 


J. 


i 


li 


(( 


'cn  a  liiglilv  iiiolivated  fro.sliiuan,  if  he  niUTs  an 
is(  it  111  ii>n  with  low  morale,  may  stagnate  or  regress. 
Ill  VDiiiio: children  llie  ability  to  relate  to  an  instilu- 
on  as  a  wliole  is,  of  course,  more  limited  tiian  it  is 
I  adolescents.  Nevertheless,  in  developmental  insti- 
itions  for  young  children,  the  climate  of  the  institu- 
on  as  a  whole  may  similarly  be  more  important 
lan  any  specific  programs,  staffing  policies,  or 
sidential  arrangements.  It  is  conceivable,  for  ex- 
nple,  tiiat  there  may  be  institutions  for  children 
here  the  physical  facilities  are  poor,  where  the  staff 
liilosojiliy  is  reactionary,  and  yet  where — for  reasons 
lat  we  do  not  quite  luiderstand — cliildren  manage  to 
nirish  and  grow.  And  it  is  al-so  possible  that  there 
•e  institutions  witli  advanced  facilities  and  modern 
leas  about  child  development  wjiere  for  lack  of  a 
3od  "I'limate"  somehow  evei'ything  seems  to  go 
rong,  including  the  children's  development. 
In  thinking  about  how  to  create  institutions  that 
icourage  human  growth,  we  must  recognize  that 
idividiuds  experience  and  respond  to  institutions  as 
whole,  not  only  to  their  parts.  We  therefore  need 
>  plan  not  merely  for  programs,  schedules,  living  ar- 
ingements,  and  so  on,  but  also  for  how  all  of  these 
arialiles  might  interact  to  produce  the  kind  of  staff 
lorale,  institutional  climate,  and  intangible  culture 
lat  nourishes  healthy  development. 

4.  Can  the  institution  deal  realistically  and  siippor- 
vely  with  individuals  who  are  "deviant"  or  "atypical" 
t  terms  of  its  ideals  and  tiorms? 

All  institutions,  and  especially  developmental  insti- 
itions,  tend  to  have  an  implicit  or  explicit  image 
f  the  "average  expectable  individual,"  the  "typical 
'ale  man,"'  or  the  "normal  child."  Procedures,  pro- 
rams,  publicity,  and  even  perceptions  are  organized 
round  this  image.  At  times  in  a  college  the  image 
f  "the  typical  student"  is  so  powerful  that  it  blinds 
dministration  and  faculty  to  the  fact  that  a  major- 
y  of  students  in  no  way  conform  to  this  image. 

Other  developmental  institutions  also  tend  to  de- 
elop  systematic  blind  spots  and  irrational  ways  of 
?sponding  to  members  who  do  not  fit  their  definition 
f  the  "average  expectable  individual."  Sometimes 
le  existence  of  person  who  do  not  fit  the  expected 
attern  of  development  is  simply  denied  by  a  refusal 
)  notici'  that  they  exist.  Sometimes  those  whose  de- 
t'lopment  tleviates  from  the  expected  are  treated  as 
lisfits,  failures,  or  malcontents.  In  either  case,  their 
ves  are  dominated  by  fear,  shame,  and  a  sense  of 
leir  own  inadequacy. 

OLUME   14  -  NUMBER  1 


One  (d'  (lie  iiiaiks  of  a  su[)i'rioi-  devi'lopiueiilal  in- 
stitution, whether  a  college  or  a  residence  for  chil- 
dren, is  its  capacit}'  both  to  recognize  explicitly  and 
support  persons  wiio.se  developmental  needs  and 
scliedules  deviate  from  the  mythical  or  actual  norm — 
without  needing  to  relegate  them  to  a  limbo  of  abnor- 
mality, psychopatliology,  failure,  or  nonexistence. 
Those  American  colleges  that  clearly  facilitate 
genuine  intellectual  and  personal  growth  are  noted 
for  their  enijihasis  on  encouraging  individuality  and 
recognizing  the  special  qualities  of  each  student. 

Such  colleges  tend  to  have  fiexible  iiisf  itutional  pro- 
grams, to  apply  their  rules  according  to  tlie  individ- 
ual's needs  and  his  development,  and  to  lie  highly 
tolerant  of  dissent  and  deviance,  both  on  campus  and 
oil'.  These  colleges,  and  I  susi)ect  those  children's 
institutions  that  facilitate  iiealthy  personality 
growth,  explicitly  recognize  that  individual  human 
beings  have  differing  needs  at  different  stages  of  de- 
velopment, that  the  rates  and  phases  of  normal  human 
growth  are  highly  variable,  and  that,  in  a  sense,  ex- 
ceptional development  is  not  the  exception  at  all  but 
the  rule  in  human  life. 

In  summary 

Thus,  despite  the  real  differences  between  children 
in  institutions  and  students  in  college,  similar  issues 
arise  with  regard  to  both  groups.  Both  groups  live 
in  "developmental  institutions"  and  the  effectiveness 
of  the  institutions  in  promoting  their  growth  depends 
in  good  part  on  how  well  these  questions  are  an- 
swered :  What  is  "normal"  development  ?  For  what 
kind  of  societj^  ?  Wliat  is  the  right  "climate"  ?  Can 
deviance  be  accepted?  Planning,  maintaining,  or 
improving  developmental  mstitutions,  therefore, 
demands  not  only  attention  to  sound  programing, 
staffing,  and  financing,  but  also  a  rational  and  in- 
formed examination  of  the  underlying  goals  for  its 
residents  in  the  context  of  \vhat  is  Iniown  about 
human  development. 


'  Goflman.  Erving:  On  the  characteristics  of  total  institutions.  In 
Asylums:  essays  on  the  social  situation  of  mental  patients  and  other 
inmates.     Anchor   Publishing  Co.,  Garden  City,   N.Y.     1961. 

^  Keniston,  Kenneth:  The  uncommitted.  Harcourt,  Brace  &  World, 
Inc.,  New  York.     1965. 

'  Provence,  Sally;  Lipton,  Rose  C:  Infants  in  institutions.  Interna- 
tional Universities  Press,  New  York.     1962. 

'Spitz,  Rene  A.:  Hospitalism — an  inquiry  into  the  genesis  of  psychi- 
atric condition  in  early  childhood.  In  The  psychoanalytic  study  of  the 
child,  vol.  1,   1945.     International  Universities  Press,  New  York. 

'  Bowlby,  John;  Maternal  care  and  mental  health.  World  Health 
Organization  Technical  Monograph  Series  No.  2.     Geneva.     1951. 

°  Group  for  the  Advancement  of  Psychiatry:  Set  and  the  college 
student,     .^thencum  Publishers,  New  York.      1966.     P.  33. 


FILIAL  DEPRIVATION 
in  PARENTS 

of  children  in  Foster  care 


SHIRLEY  JENKINS 


One  aftermath  of  the  placement  of  children 
in  foster  care,  the  effects  of  maternal  depri- 
vation on  the  child,  has  been  a  subject  for 
major  research  investigation.  The  reciprocal  aspect 
of  the  placement  transaction,  "filial  deprivation,"  or 
the  separation  experiences  of  the  parent  when  the 
child  enters  foster  care,  however,  has  not  been 
studied.  In  a  society  where  the  prevailing  expecta- 
tion is  that  parents  will  raise  their  own  children,  the 
failure  to  do  so,  with  placement  of  progeny  in  settings 
outside  their  own  homes  under  social  agency  care,  is 
likely  to  have  serious  implications  for  the  placing 
parents.  How  these  feelings  of  separation  from  their 
children  may  affect  mothers  and  fathers,  and  how 
their  response  patterns  may  be  related  to  generalized 
attitudes  of  unworthiness  or  alienation  are  imijortant 
questions.  This  paper  reports  on  a  beginning  re- 
search effort  to  explore  the  concept  of  filial  depriva- 
tion and  to  differentiate  some  of  its  dimensions  by 
identifying  feelings  expressed  by  parents  when  their 
children  enter  foster  care. 

There  are  a  number  of  reasons  why  clarification  of 
the  concept  of  filial  deprivation  is  important  to  the 
better  vmderstanding  of  parent-child  separation. 
Wlien  we  consider  the  numbers  of  persons  affected, 
the  problem  is  of  major  proportions.  There  are  over 
one-quarter  of  a  million  children  in  foster  care  in  the 
United  States  at  the  present  time,  and  any  estimate 
of  how  many  adults  have  at  some  time  experienced 
separation  from  their  children  placed  in  foster  care 


Based  on  a  paper  presented  at  the  1966  annual  meeting  of  the 
American  Orthopsychiatric  Association,  San   Francisco,  Calif. 


under  agency  auspices  would  come  to  several  million 
The  fact  that  the  placement  of  children  away  fron 
home  also  tends  to  involve  a  disproportionately  higl 
percentage  of  families  who  live  in  poverty,  includinj 
many  families  of  minority  groups,  raises  the  furthe: 
question  of  whether  this  failure  to  meet  society's  exi 
pectations  is  interpreted  by  members  of  these  group 
as  likely  to  lead  to  reprisals,  such  as  abrogation  o 
parental  rights  and  the  loss  of  decisionmaking  powei 
over  tlie  raising  of  their  own  cliildren. 

There  is  also  the  question  of  whether  the  way  par 
ents  experience  filial  deprivation  has  predictive  valu 
in  relation  to  the  eventual  return  of  the  children  ti 
tlieir  own  homes.  It  may  be  that  part  of  the  read 
justraent  problem  of  foster  children  who  go  homii 
reflects  not  only  their  own  separation  trauma,  bni 
also  the  reception  they  receive  from  their  parent 
when  they  return.  In  some  instances,  the  famil; 
may,  in  a  sense,  have  closed  in  behind  the  separate( 
child,  so  that  there  is  neither  psychological  nor  physi 
cal  space  for  him  when  he  returns  home. 

The  setting  for  this  research  is  the  Colimibia  Uni 
versity  School  of  Social  Work,  where  a  child  welfan 
research  program,  directed  by  David  Fanshel  anc 
supported  by  the  Federal  Children's  Bureau,  is  un 
dertaking  a  longitudinal  study  of  600  children  fron 
approximately  400  families  who  have  entered  socia 
agency  foster  care  in  New  York  City  in  the  calenda; 
year  1966.  The  study  sample  is  limited  to  childrei 
who  are  experiencing  initial  foster-care  placement  |; 
who  have  entered  care  before  the  age  of  13  years,  anc 
who  remain  in  care  for  a  minimum  of  90  days.  Thest 
children  will  be  studied  from  three  angles :  the  child! 
his  own  family,  and  the  agency  which  serves  him 


CHILDREN     •     JANUARY-FEBRUARY  1967 


: 


All  children  will  be  studied  for  a  miniiimin  of  5  years 
whether  they  remain  in  care  or  return  honae,  and  re- 
peated measurements  of  cliild,  family,  and  aji:ency 
will  be  analyzed.  These  will  include  psj'chological 
testing  and  behavioral  ratings  of  each  child,  and 
study  of  agency  decisions  and  methods  of  care. 

Wo  expect  the  kind  and  degree  of  filial  deprivation 
experienced  in  a  family  to  be  related  to  the  problems 
that  lead  to  foster  care.  A  recently  completed  study 
by  Jenkins  and  Sauber  ^  revealed  a  variety  of  "main 
reasons"  for  placement.  Of  425  families  from  wliich 
891  children  over  G  months  old  had  been  placed  in 
care,  from  ^laj-  through  August  1963,  as  public 
charges  in  New  York  City,  29  percent  had  had  the 
children  placed  because  of  the  j'jhysical  illness  of  an 
adult  in  the  family;  11  percent,  because  of  the 
mother's  mental  illness;  17  percent,  because  of  the 
children's  emotional  or  personality  problems;  10  per- 
cent, because  of  severe  parental  neglect  and  abuse; 
and  33  percent,  because  of  various  other  family  prob- 
lems, including  parental  incompetence,  drug  addic- 
tion, alcoholism,  arrest,  child  abandonment,  and 
unwillingness  of  caretakers  other  than  parents  to 
continue  care. 

In  the  majorit_y  of  cases,  the  families  were  living  in 
or  on  the  edges  of  poverty  and  lacked  supportive 
community  services.  Even  in  those  cases  in  which 
the  mother's  institutionalization  for  mental  illness 
was  the  main  reason  for  placement,  the  interviews 
showed  that  the  mother's  mental  breakdown  was  of- 
ten associated  with  severe  pressures  from  problems 
having  to  do  Avith  money,  health,  and  housing. 
Data  on  parents"  feelings  associated  with  placement 
of  their  children  must,  therefore,  be  looked  at  in  light 
of  the  factors  causing  stress  in  their  families. 

Review  of  the  literature 

The  literature  on  maternal  deprivation  is  singu- 
larly barren  with  regard  to  the  feelings,  reactions, 
and  roles  of  parents  when  their  children  enter  foster 
care.  Bowlby  in  "Maternal  Care  and  Mental  Health'' 
was  chiefly  concerned  with  the  effect  of  severe  depri- 
vation on  the  emotional  and  personality  growth  of 
the  child.  He  did,  however,  refer  to  the  "vicious 
circle"  resulting  from  unsympathetic  handling  by  the 
mother  when  the  returned  child  displays  regressive, 
anxious  behavior  and  note  that  "bad  behavior"  brings 
rebuffs  and  in  turn  rebuffs  result  in  further  "bad 
behavior."  -  In  a  review  of  the  literature  on  maternal 
deprivation,  Prugh  and  Harlow  discuss  "masked 
deprivation,"  in  the  parent  and  refer  to  what  they 

VOLUME  14  -  NUMBER  1 


term  "distorted  rclatedness"  and  "insufficient  related- 
ness"  on  the  part  of  parent  to  child.  As  an  example 
of  the  latter,  they  report  that  "situational  factors 
involving  current  reality  problems  may  produce  pys- 
chological  disorders  in  the  parent  which  may  affect 
detrimentally  the  development  processes  of  the 
infant."  = 

Some  experimental  studies  of  animal  behavior  con- 
tain observations  that,  although  not  immediately 
applicable  to  humans,  raise  some  relevant  questions 
about  separation  experiences.  Blauvelt,  for  example, 
in  her  study,  "Neonate-Mother  Relationship  in  Goat 
and  Man,"  describes  how  the  mother  goat  establishes 
a  territory,  or  safe  area,  near  herself  for  her  newborn 
kid.  She  suggests  that  when  the  separation  of  a 
mother  goat  and  her  newborn  is  achieved  exf)erimen- 
tally  by  introducing  unexpected  distracting  or  fright- 
ening stimuli,  "if  the  mother  and  her  newborn  are 
not  free  to  re-establish  the  normal  pattern  in  the 
ways  that  are  natural  to  them,  it  is  possible  that  the 
mother  animal  will  be  unable  to  give  the  young  the 
care  essential  for  its  sui"vival  at  a  later  period."  * 

In  describing  readjustment  problems  of  kittens 
after  an  experimental  period  of  isolation  from  the 
mother  cat,  Rosenblatt,  Turkewitz,  and  Schneirla 
note  the  changing  patterns  of  mother-young  relations 
in  the  litter  period.  They  report:  ".  .  .  the  litter 
situation  confronting  isolates  retui'ued  from  the 
brooder  at  different  times  differed  radically  from  that 
prevalent  at  the  earlier  time  of  removal,  especially 
as  concerned  the  general  behavior  of  the  female 
[mother]  and  her  responses  to  the  kittens."  The  dis- 
turbed behavior  in  formerly  isolated  kittens  returned 
to  the  litter  was  a  result  not  of  their  experience  in 
the  brooder,  but  of  their  inability  upon  their  return 
to  make  an  appropriate  adjustment  to  the  changed 
pattern  of  the  mother  cat.^ 

In  reporting  on  their  studies  of  rhesus  monkeys, 
Harlow  and  associates  identif}'  a  point  on  a  hypo- 
thetical graph  of  mother  and  infant  contact  needs 
where  intensity  is  reversed  and  the  infant's  needs 
exceed  the  mother's.  In  an  interpretation  both  al- 
literative and  lyrical  they  say,  "As  attachment  abates, 
ambivalence  arises  and  anticipates  alienation,"  and 
they  go  on  to  say : 

From  here  on  mother  does  not  care 

For  baby  fingers  in  her  hair; 
A  touch  that  once  went  to  her  heart 

Now  merely  makes  the  hair  depart.' 

The  social  work  literature,  like  the  separation  mate- 
rial, stresses  the  child  in  placement,  with  concern 
being  focused  primarily  on  practical  service  prob- 

9 


lems  and  plans  for  care.  Although  a  recent  review 
of  this  literatiu'e  conducted  by  students  at  the  Colum- 
bia University  School  of  Social  Work "  did  not  re- 
veal any  systematic  study  of  parental  reactions  to 
separation  from  their  children,  it  did  identify  sev- 
eral references  to  feelings  of  parents  when  children 
are  placed  in  foster  care. 

Aptekar,  for  example,  in  discussing  casework  with 
the  child's  own  family,  notes:  "Every  parent  .  .  . 
reacts  in  his  own  individual  way — with  his  own  per- 
sonality and  in  the  context  of  his  ovfxi  living  prob- 
lems— to  .  .  .  the  i)lacement  experience.  All  of  his 
important  problems  and  all  of  his  chief  character 
traits  will  come  out  in  relation  to  the  place- 
ment. .  .  ."'  ^ 

In  a  discussion  of  casework  techniques,  Britton 
states :  "In  all  cases  where  parents  liave  failed  to  keep 
their  children  there  is  a  tremendous  sense  of  guilt 
which  can  be  completely  paralyzing.  .  .  .  The  result 
of  this  feeling  is  apathy  and  depression  or  the  projec- 
tion of  their  feelings  onto  some  external  factor  or 
person  whom  they  feel  to  be  to  blame  for  what  has 
happened.  The  sense  of  guilt  and  resulting  hopeless- 
ness can  be  so  great  that  they  repudiate  the  relation- 
ship altogether  and  feel  no  sense  of  responsibility."  " 

Accoi'ding  to  Smith,  Ricketts,  and  Smith,  parents 
who  were  questioned  in  a  child  guidance  clinic  about 
their  experiences  on  and  after  separation  expressed 
some  relief  from  tension,  but  also  feelings  of  intense 
loneliness,  emptiness,  and  guilt.  One  parent  said 
that  the  child's  placement  felt  "like  a  death."  ^^ 

Young,  in  discussing  separation,  states  that  parents 
who  fail  become  objects  of  scorn  in  the  community 
since  child  rearing  is  a  responsibility  of  parents  in 
our  culture  and  placement  of  a  child  away  from  home 
tends  to  be  an  admission  that  individuals  have  failed 
as  parents.  ^^ 

Mandelbaum  reports  feelings  of  isolation,  lone- 
liness, and  inadequacy  in  parents  on  placing  children 
in  residential  treatment.  lie  also  reports  that  some 
parents  expect  punishment  for  having  placed  their 
children  and  express  the  fear  that,  when  the  children 
are  grown  and  are  "big  and  powerful,"  they  will 
return  to  their  homes  to  destroy  their  parents  in 
retaliation  for  this  wrong." 

These  observations  from  the  social  work  litei-a- 
ture  are  interesting  as  points  of  reference,  but  their 
value  is  limited  not  only  by  a  lack  of  systematic  study, 
but  also  by  the  varying  types  of  populations  upon 
which  they  are  based.  The  child  welfare  research 
program  at  Columbia  University  provides  an  op- 
portuntiy  for  systematic  access  to  a  large  sample  and 

10 


Til 


[p 


wide  range  of  placing  parents,  including  many  whose 
children  have  entered  care  precipitously  with  little  or 
no  parental  planning  and  even  in  some  cases  without 
their  laiowledge.  The  design  is  comprehensive 
enough  to  secure  data  broad  enough  to  derive  gen- 
eralizations useful  to  the  child  welfare  field. 

Instrument  construction 

As  the  task  of  instrument  construction  for  the  pre- 
sent study  began,  it  was  argued  that  it  was  too  soon 
to  study  "filial  deprivation"  in  itself,  that  the  first 
problem  was  to  explore  the  possibility  of  developing 
such  a  concept.  A  variety  of  ingenious  ways  of  get- 
ting at  this  in  what  one  psychologist  has  called  "re- 
verse clinical  English"  were  considered  and  dis- 
carded. The  investigators  settled  for  a  direct  ap- 
proach: After  the  interviewer  identified  the  main 
problem  that  brought  the  child  into  care,  the  inter- 
viewer said — 

We  would  like  to  understand  more  about  how  people  feel 
when  their  children  go  into  placement  away  from  home.  How 
about  you,  how  did  you  feel  the  day  your  child  was  placed? 

This  request  for  the  parents'  immediate  reaction 
on  the  day  of  placement  produces  baseline  informa- 
tion for  later  discussion  of  changes  in  feelings. 

After  the  parents  give  a  general  statement  of  theiii 
feelings  at  the  time  of  placement,  they  are  asked  tc 
describe  in  one  of  the  following  words  their  sti'ongest 
feeling  on  that  particular  day:  hurt;  angry;  re- 
lieved; nervous;  ashamed;  numb;  sad;  bitter;  thank- 
ful; worried;  guilty;  empty.  These  words  were  ob- 
tained from  1-word  summary  statements  from  14  ex- 
ploratory intei-views,  used  for  developing  a  checklist  i  a 
for  the  final  schedule. 

For  any  of  these  feelings  noted,  parents  are  then 
asked  to  indicate  intensity  by  choosing  between 
"very"  or  "just  a  little."  This  is  followed  by  an  in- 
quiiy  into  the  object  of  each  feeling.  If  a  person 
says  he  felt  thankful,  for  example,  he  is  then  asked, 
for  what?;  "guilty,"  about  what?;  "angry,"  toward 
whom?  In  this  way  responses  are  developed  in 
terms  of  the  different  dimensions  of  feelings  ex- 
pressed, including  the  nature  of  the  feeling,  the  extent 
of  the  feeling,  and  the  object  of  the  feeling. 

To  make  the  data  more  concrete,  parents  are  also 
asked  to  report  their  actions  on  the  day  the  child  was 
placed;  who  was  told  about  the  placement;  and  what 
reactions  were  expressed  by  others.  To  distinguish 
the  reaction  to  the  separation  itself  from  their  re- 
action to  the  placement  situation,  the  parents  are 
asked  if  they  would  have  felt  differently  if  the  child 

CHILDREN     •     JANUARY-FEBRUARY  1967 


S; 


uul  ri'iiiaiiii'il  ;il  1  ionic  in  I  he  cinv  of  a  lioincinal^t'i';  i  f 
lie  child  hail  been  placed  w  itli  a  foster  family  rather 
ban  in  an  institulion,  or  in  an  inslitiition  rather  tlian 

foster  i'aniily;  if  the  child  had  hcoii  cared  for  by 
elali\es  or  friends  rather  than  by  a  social  agency. 
They  are  also  asiietl  whetiier  their  feelin<rs  aliout  the 
hildren's  placement  reminded  them  of  anything 
loiii  their  own  childhood. 

The  parents  are  encouraged  to  discuss  the  changes 
n  their  feelings  al)oiit  separation  as  time  went  by 
n  relation  to  changes  in  their  social  and  family  life, 
aicli  as  changes  in  living  circumstances,  new  housing, 
lew  employment,  or  new  friends.  To  determine 
ivhether  the  feelings  they  express  are  borne  out  by 
heir  actions,  the  interviewers  ask  specific  questions 
iuch  as,  "If  you  have  moved,  do  you  have  a  i)lace  for 
he  child  to  sleep?''  and  "What  was  done  with  your 
hihTs  toys  and  clothes  after  he  went  into  place- 
uent  r'  The  ]~>arents  are  also  asked  to  finisli  a  scries 
)f  eight  incomplete  sentences  to  determine  whether 
■espouses  to  such  a  projective  device  can  give  clues  to 
he  emotional  in\estment  of  the  mother  or  father  in 
he  (•liild.  For  example:  "For  a  mother  [or  father] 
I  child  is  — 


."    "Taking  care  of  a  child  is  - 


"How  a  child  turns  out  depends  on ." 

These  questions  about  the  parents'  feelings  of  filial 
leprivation  comprise  only  one  of  six  major  subje<?t 
ireas  in  the  instrument  for  studying  the  family.  The 
esponses  to  them  will  be  analyzed  in  relation  to  tlie 
ither  factors  being  studied,  such  as  reason  for  place- 
nont,  social  attitudes,  cliild-rearing  attitudes,  and 
iocioeconomic  circumstances.  Other  phases  of  the 
)verall  research  program  will  also  provide  opportu- 
lity  for  validation  of  interview  data.  Agencj'  re- 
)orts  on  the  child's  behavior  during  placement,  for 
ixample,  and  on  the  pai-ents'  care  of  and  involvement 
vith  the  child  will  be  related  to  data  obtained  directly 
'rom  the  parents. 

ome  feeling  patterns 

Since  the  interviews  with  the  families  are  still 
mder  way,  analysis  of  the  data  from  them  will  not 
le  ready  until  the  end  of  1967.  However,  we  have 
oine  clues  about  filial  deprivation  based  on  analysis 
f  data  from  27  individual  interviews  (14  exploi'a- 
ory  and  13  pretest)  and  3  group  interviews  with 
)arents  whose  children  are  in  foster  care. 

The  first  conclusion  fi-om  this  preliminary  experi- 
nce  is  that  the  analysis  of  parental  feelings  about 
eparation  will  reveal  rather  than  any  ordinal  scale 
if  intensity  clusters  of  related  I'eactions  depending 

VOLUME   14  -  NUMBER  1 


Shirlc)  Jeniiins,  assniialc  pripl'essipr  of  social 
n'st'iircli  lit  llu>  Coliiriitiia  t'nivcrsit.v  Sclionl 
of  .Social  Work,  is  also  associate  tIirf<'toi' 
of  the  chilli  welfare  research  i)ro(;rani  there. 
She  was  formerly  an  instructor  at  the  Center 
for  Human  Relatlon.s  and  Community 
Studies,  New  York  University.  She  l.s  also 
coauthor  with  Mifmon  Snuber  of  "Path.s  to 
Child  riacenicnl  :  Family  Siliialioiis  I'rior  to  Foster  Care.' 


on  individual  personality  factors,  the  situation  that 
precipitated  placement,  and  the  role  of  the  child  in 
the  parent's  life.  Predominant  feeling  tones,  how- 
ever, did  appear  in  individual  cases.  Interviewers 
commented  on  the  "sad"  or  "glad"'  or  "mad"  or 
"scared"  groups  of  reactions.  In  addition,  the 
"nothing"  group — absence  of  feeling — appeared  to 
be  another  syndrome. 

Some  of  the  comments  of  parents  are  revealing  of 
both  personality  and  situation.  An  alcoholic  motlier 
said,  "I  was  sad,  I  was  hurt,  I  cried  all  the  way  home. 
Now  I  knew  I  would  be  alone."  Her  main  wish  was 
"to  live  until  I  am  50." 

A  mother  whose  children  were  placed  for  neglect 
because  of  a  fire  said,  "I  felt  empty,  numb,  like  the 
blackout,  like  everj-thing  was  out  of  my  hands.  Now 
I  would  have  to  prove  myself  all  over  again."  Her 
wish — nothing. 

A  father  whose  wife  was  hospitalized  said,  "I  felt 
good,  glad,  relieved.  Now  I  knew  they  would  be 
taken  care  of  until  my  wife  gets  well."  His  wish 
was  for  his  wife  to  get  out  of  the  hospital. 

A  15-year-old  unmarried  mother,  with  no  place 
to  keep  her  baby,  was  "angry,  mad,  upset,  resentful." 
"It's  my  child,"  she  said,  "and  all  those  big  shot 
people  were  telling  me  what  to  do."  Her  wish — 
"that  I  hadn't  become  pregnant  imtil  I  was  18  and 
laiew  how  to  manage." 

Each  parent  made  such  a  variety  of  respoiases  to  the 
checklist  of  feeling  words  that  "ambivalence"  might 
seem  to  be  the  predominant  reaction.  Reference  to 
the  object  feelmg,  however,  showed  that  the  reactions 
were  not  as  chaotic  as  they  appeared.  One  mother, 
for  example,  reported  that  she  was  "hurt"  by  her 
.social  worker  from  the  public  child  welfare  agency ; 
she  wa.s  "angry"  at  the  worker;  she  was  "ashamed"  at 
not  being  able  to  provide  eveiTthing  her  son  needed; 
she  was  "sad"  about  being  away  from  her  son;  she 
was  "bitter"  toward  the  worker;  she  felt  "guilty"  for 
having  fallen  into  a  trap.  Another  mother  whose 
placed  child  was  emotionally  disturbed  said  she  was 


11 


"hurt"  by  tlie  world ;  "angry"  towai-d  her  son ;  "re- 
lieved" at  not  having  to  care  for  him;  "sad"  and 
"guilty"  for  being  a  poor  mother. 

One  interesting  finding  is  the  number  of  mothers 
who  reported  that  they  "went  home  and  went  to 
sleep"  immediately  after  the  placement  was  made. 
Another  was  that  parents  who  expressed  a  great  deal 
of  love  and  concern  for  their  cliildren  frequently  told 
of  carefully  retaining  such  reminders  of  them  as  a 
christening  dress,  a  teddy  bear,  or  toy  soldiers. 

Several  parents  said  that  at  the  time  of  placement 
they  had  recalled  their  own  childhood  in  foster  care. 
One  father  said,  "I  thought  back  to  the  time  I  was 
placed  when  I  was  8  or  9  years  old.  I  felt  fimny 
inside  like  I  was  alone  again.  I  felt  guilty  because 
when  I  was  a  kid  I  felt  bad  about  going  away  and  ray 
kids  had  to  feel  the  same  way — but  they  were 
younger." 

Problems  and  possibilities 

These  examples  from  the  pretest  and  exploratory 
interviews  indicate  the  kinds  of  problems  that  will 
have  to  be  solved  in  the  coding  and  analytic  phases 
of  the  study.  There  will  be  three  critical  tests  for  use 
of  the  data:  (1)  "Wliether  a  typology  of  parents' 
feeling  reactions  to  child  placement  can  be  developed 
that  is  conceptually  clear  and  separates  clusters  of 
responses  from  each  other ;  (2)  whether  these  clusters 
are  valid  and  meaningful  in  terms  of  other  important 
study  variables  such  as  social  attitudes,  family  pa- 
thology, and  reason  for  placement;  and,  finally, 
(3)  whether  these  clusters  can  liave  predictive  value 
in  relation  to  the  child's  later  return  to  his  home. 

In  discussing  the  effects  of  the  separation  experi- 
ence on  the  child,  Mary  Ainsworth  has  reported  that 
the  child  who  has  been  placed  away  from  home  typi- 
cally goes  through  successive  stages  of  "protest,  des- 
pair, and  detachment."  "  Without  therapeutic  in- 
tervention, the  result  is  the  detached,  hard-to-reach, 
emotionally  blunted  child.  Although  it  is  too  soon  to 
predict  the  outcome  of  our  study,  one  might  wonder 
whether  the  placing  parent  might  not  go  through 
similar  stages.    Will  the  separated  parents,  depend- 


ing on  their  circumstances,  own  history,  and  expecta 
tions  for  tlie  future,  fall  into  clusters  of  those  whc 
despair,  those  who  protest,  and  those  whose  detach 
ment  is  such  that  rejection  and  denial  of  parenta 
roles  cannot  be  breached  ?  Such  findings,  if  they  d( 
occur,  might  have  implications  for  the  kind  of  servict 
provided  parents  at  the  time  of  placement  as  well  a: 
having  predictive  value  regarding  eventual  famih 
reunion. 


'■  Jenkins,  Shirley;  Sauber,  Mignon:  Paths  to  child  placement:  famil; 
situations  prior  to  foster  care.  Community  Council  of  Greater  New 
York,  N.Y.     1966. 

'Bowlby,  John:  Maternal  care  and  mental  health.  World  Healtl 
Organization  Technical  Monograph  Series  No.  2,  Geneva.     1951. 

'Prugh,  Dane  E.;  Harlow,  Robert  G.;  "Masked  deprivation"  ii 
infants  and  young  children.  In  Deprivation  of  maternal  care — a  re 
assessment  of  its  effects.  WHO  Public  Health  Papers  No.  14.  Work 
Health  Organization,  Geneva.     1962. 

*  Blauvelt,  Helen:  Neonate-mother  relationship  in  goat  and  man 
In  Group  processes — transactions  of  the  Second  Conference  on  Grou] 
Processes  (Bertram  Schaffner,  M.D,,  ed.).  Josiah  Macy  Jr.  Foundation 
New  York.     1956. 

■Rosenblatt,  Jay  S.;  Turkcwitz,  Gerald;  Schneirla,  T.  C:  Earl; 
socialization  in  the  domestic  cat  as  based  on  feeding  and  other  relation 
ships  between  female  and  young.  In  Determinants  of  infant  behavioi 
(B.  M.  Foss,  ed.).     Methuen  &  Co.,  London.     1961. 

"Harlow,  Harry  F.;  Harlow,  M.  K.;  Hansen,  E.  W.:  The  materna 
aflectional  system  of  rhesus  monkeys.  In  Maternal  behavior  in  mammal; 
(Harriet  L.  Rheingold,  ed.).     John  Wiley  &  Sons,  New  York.     1963 

'  Barnes,  Dorothy;  Clcary,  John;  Garber,  Rosalie;  Harris,  Elaine 
Marx,  Jennifer;  Waxier,  Ilene;  Ziegler,  Joan:  Part  of  an  unpublishcc 
masters  project.     Columbia  University  School  of  Social  Work.     1965 

'  Aptekar,  Herbert  H.:  Casework  with  the  child's  own  family  in  child 
placing  agencies.     Child  Welfare  League  of  America,  New  York.     1953 

"  Britton,  Clare:  Casework  techniques  in  child  care  services.  Soda. 
Casewor/i,  January  1955. 

"Smith,  Emily  A.;  Ricketts,  Betty  M.;  Smith,  Sarah  H.:  The  recom- 
mendation for  child  placement  by  a  psychiatric  clinic.  Americar, 
Journal  of  Orthopsychiatry,  January  1962. 

"Young,  Leontine  R.:  Separation:  its  meaning  to  the  child,  tht 
parents,  and  the  community.  Proceedings  of  the  New  York  State 
Conference  of  Social  Work,  1943-45.     (Annual  Volume.)      1945. 

"Mandelbaum,  Arthur:  Parent-child  separation:  its  significance  tc 
parents.     Social  Worl{,  October  1962. 

"Ainsworth,  Mary  D.:  The  effects  of  maternal  deprivation:  a  review 
of  findings  and  controversy  in  the  context  of  research  strategy.  In 
Deprivation  of  maternal  care — a  reassessment  of  its  effects.  WHO 
Public  Health  Papers  No.  14.  World  Health  Organization,  Geneva. 
1962. 


.  .  .  And  as  men  must  now  irrevocably  perish  or  survive  together,  the 
task  of  each  family  is  also  the  task  of  all  humanity.  This  is  to  cherish 
the  living,  remember  those  who  have  gone  before,  and  prepare  for  those 
who  are  not  yet  born. 

Margaret  Mead,  in  "Family,"  The  Macmillan  Co.,  New  York,  1965. 


12 


CHILDREN     •     JANUARY-FEBRUARY  1967 


FAMILY 
DAY 
CARE 


MARION  L.  SHERIDAN 


Two-year-old  Willie  spent  many  weeks  of 
his  second  summer  under  the  neglectful  eyes 
of  his  senile  gi-anchnother  while  his  mother 
worked  in  the  fields.  Willie  was  often  wet  and  him- 
ly.  His  mother  did  not  want  to  leave  him  but  she 
did  not  know  what  else  to  do.  The  family  needed  her 
wages,  and  there  was  no  one  but  the  old  grandmother 
to  take  care  of  Willie.  Each  weekday  his  5-year-old 
sister  went  to  a  day-care  center  I'un  by  the  coimty  for 
children  over  3,  but  there  was  no  place  for  Willie 
to  go. 

Willie's  third  summer  was  different,  however.  He 
spent  5  days  each  week,  from  8  a.m.  to  5  p.m.,  in  the 
care  of  a  family  day-care  mother  in  her  clean  and 
pleasant  home.  AVillie  was  never  hungry ;  his  health 
improved.  He  learned  to  play  with  other  children. 
He  was  happy,  and  so  was  his  mother. 

Every  summer  himdreds  of  migrant  farmwoi-kers 
like  Willie's  parents  come  with  tiieir  children  to  work 
in  rural  areas  of  Pennsylvania  harvesting  fruits  and 
vegetables.  The  St^te  has  supported  day-care  cen- 
tei-s  and  summer  schools  for  the  children  of  migrant 
farmworkers  since  1955,  but  until  the  summer  of  1965 
it  did  not  offer  care  for  children  under  3  years  of 
age.  A  new  service  especially  adapted  to  the  care 
of  young  children  is  now  developing,  however, 
through  which  tliey  can  be  cared  for  in  family  homes 
by  the  day.  A  pilot  project  supported  by  the  Office 
for  Children  and  Youth  in  the  State  Department  of 
Public  Welfare,  the  Pennsylvania  State  Univer- 
sity, and  the  public  child  welfare  agencies  of  three 
counties,  the  service  has  been  carried  out  for  two  sum- 
mers and  will  be  continued  in  the  summer  of  1967. 

VOLUME  14  -  NUMBER  1 


(or 

children 

o( 

misrant 

farmworkers 


The  project  was  started  after  reports  from  social 
woi-kers,  niu'ses,  and  ministers  working  with  migrant 
families  pointed  out  the  continuous  need  of  migrant 
parents  for  ways  of  caring  for  their  young  children 
while  they  worked  in  the  fields  or  for  other  reasons. 
These  reports  described  conditions  often  physically 
harmful  to  children.  Sometimes,  for  instance,  small 
children  had  to  stay  all  day  m  a  bus  parked  near  the 
field  in  which  their  parents  were  workmg  and  re- 
ceived only  occasional  attention  from  their  mothers 
as  the  crew  leaders  permitted.  Babies  might  be  left 
unfed  for  hours.  Social  workers  had  tried  to  arrange 
for  care  in  the  camps  for  these  children,  but  they 
found  that  only  the  most  elderly  or  most  irresponsible 
women  remauied  in  the  camps  at  the  peak  seasons  to 
care  for  children  or  that  other  children  between  the 
ages  of  4  and  8  who  should  have  been  in  the  day-care 
centers  were  left  behind  to  care  for  younger  brothei-s 
and  sisters. 

These  reports,  together  with  statistics  gathered 
from  year  to  year  on  the  number  and  ages  of  children 
coming  with  migrant  farm  fanulies  each  sununer  to 
Pennsylvania,  convinced  the  State  Office  for  Children 
and  Youth  that  it  should  try  to  provide  care  for 
children  under  3  as  well  as  for  older  children.  Con- 
sequently, a  pilot  project  in  family  day  care  was 
started  in  the  spring  of  1965  and  was  extended  in 
1966. 

The  project  has  several  objectives :  to  find  a  way  of 
caring  for  the  young  children  of  migrant  farmwork- 
ers helpful  to  them  and  acceptable  to  their  parents; 
to  determine  the  problems  involved  in  giving  such 
care;  to  interest  State  and  local  child  welfare  agencies 

13 


in  providing  such  care;  and  to  compare  tliis  type  of 
care  with  the  group  care  provided  for  the  older 
children. 

Three  counties  in  north-central  Pennsylvania — 
Columbia,  Luzerne,  and  Potter — were  chosen  for  the 
project.  About  1,600  migrant  farmworkers  come  to 
Columbia  County  each  summer;  about  500  to  Lu- 
zerne; and  between  500  and  600  to  Potter.  Tlie 
farms  of  Columbia  County  cover  a  wide  area  and  the 
migrant  camj)s  are  considerably  distant  from  one 
another.  For  this  reason,  services  for  migrant  chil- 
dren such  as  day-care  centers  and  summer  schools 
are  located  in  Bloomsburg,  a  community  nearly 
equidistant  to  all  camps.  In  Luzerne  County,  such 
services  are  located  in  small  villages  near  the  camps. 
In  Potter  County,  whicli  has  one  large  centrally  lo- 
cated cooperative  camp  for  migrants  and  many  small 
scattered  camps,  most  of  the  services  have  been  lo- 
cated near  the  central  camp. 

Setting  up  the  service 

These  three  counties  were  chosen  for  the  pilot  serv- 
ice project  because  they  had  well-established  public 
child  welfare  agencies  and  because  an  increasing  num- 
ber of  migrant  workers  with  small  children  come  into 
the  counties  to  harvest  their  crops  each  year.  As 
the  State  Department  of  Public  Welfare  tlirough 
its  child  welfare  program  has  supervised  these  agen- 
cies for  many  years,  it  was  not  difficult  to  work  out 
plans  quickly  and  easily.  The  department  agreed  to 
pay  for  the  entire  project  and  to  furnish  social  work- 
ers to  the  county  child  welfare  agencies,  which  in 
Pennsylvania  are  under  the  county  commissioners,  to 
carry  it  out.  Though  directly  responsible  to  the  su- 
pervisor of  special  services  in  the  State  Office  for 
Children  and  Youth,  the  social  workers  would  work 
closely  with  the  directors  of  the  comity  child  welfare 


Marion  L.  Sheridan,  supervisor  of  special 
services  in  the  Pennsylvania  State  Depart- 
ment of  Public  Welfare,  administers  a  pro- 
gram of  social  services,  including  day-care 
centers  and  family  day-care  homes,  for  the 
children  of  migrant  farm  workers.  A 
graduate  of  the  University  of  Pennsylvania 
School  of  Social  Work,  she  has  long  been  in 
the  field  of  child  welfare,  as  a  county  director,  field  repre- 
sentative, and  consultant.  She  has  also  been  a  member  of 
the  Committee  of  East  Coast  Ofiicials  on  Migi-atory  Labor. 


The  directors  of  the  county  agencies  gave  the  socia 
workers  the  names  of  persons  who  might  apply  foi 
children  for  foster  care  and  assisted  them  in  settinc 
up  a  general  policy  for  the  acceptance  and  supervi 
sion  of  day-care  homes  and  establishing  a  rate  of  pay 
ment  to  the  family  day-care  mothers  exceeding 
that  established  for  foster  care,  but  which  tin 
county  agency  thought  justifiable  for  the  service  re 
quired.  The  social  workers  and  county  director; 
together  regularly  reviewed  applications  and  ap 
proved  each  family  before  a  child  was  placed. 


or 

0 


The  project  in  operation 

Most  service  programs  for  migrant  farmworkerf 
in  Pennsylvania  last  less  than  3  months.  For  this 
reason,  it  was  difficult  to  recruit  trained  child  welfare 
workers  for  the  program,  most  of  whom  have  or  want 
permanent  positions.  We,  therefore,  employed  re- 
cent college  graduates.  What  they  lacked  in  experi- 
ence they  made  up  in  enthusiasm  for  social  work 

These  young  workers  were  assigned  to  the  counties 
2  to  3  weeks  before  the  farmworkers  were  expected 
to  arrive  to  give  them  some  time  to  become  acquaintec 
with  the  methods  and  philosophy  of  the  day-cart 
centers  for  the  children  of  migrant  farmworkers,  tc 
visit  people  in  the  community  to  find  out  their  atti- 
tude toward  the  new  program,  and  to  begin  theii 
orientation  to  the  family  day-care  program  througl^ 
conferences  with  the  directors  of  the  county  child 
welfare  agencies. 

Eecruiting  homes  for  family  day  care  for  the  chil- 
dren of  migrant  farm  families  is  no  easy  task  because 
there  is  no  way  of  Icnowing  how  many  children  wil' 
need  care  before  the  families  arrive.  To  offset  this 
uncertainty,  in  the  early  spring  of  1965,  each  public 
child  Avelfare  agency  reviewed  its  applications  for 
foster  care  of  county  children  and  considered  which 
families  might  be  interested  in  pro^•iding  family 
day-care  service  to  the  children  of  migrant  workers. 
By  the  time  the  social  worker  arrived  in  the  county, 
some  families  were  prepared  for  her  first  visit.  Hav- 
ing a  few  applicants  approved  for  study  by  the  agen- 
cies encouraged  and  helped  new  social  workers  and 
eased  the  job  of  finding  homes.  In  the  spring  of 
1966,  the  procedure  was  repeated.  Eecruitment  be- 
gan with  the  family  day-care  mothers  of  the  year 
before.     All  but  two  reapplied  and  were  accepted. 

Each  summer  when  most  of  the  migrant  farmwork- 
ers had  arrived,  the  family  day-care  social  workers 
visited  the  camps  with  social  workers  from  the  day- 
care centers  and  together  they  enrolled  the  children 


ill 

01 
\r 

ir 

id 

ii: 

m 

■Jl! 
ffi! 


U 


CHILDREN     •     JANUARY-FEBRUARY  1967 


I',  or  both  programs.    Much  of  the  groui id  work  for  I  lie 
iji  e\v  program  had  boon  done  (hiring  (lie  many  sum- 
I,  lers  that  the  day-care  centers  had  been  in  operation 
nj  a  tiiese  connties.    Farmers  and  cicw  leaders  accepted 
,.  lie  social  workers  in  the  camps,     ^fothers  ali-eady 
,|,  amiliar  with  the  work  of  the  day-care  centei-s  wel- 
omcd  them.    Over  the  years  they  liad  learned  to  trust 
he  social  wor]<crs  and  teachers  to  provide  good  cai'e 
or  their  childivn.    They  now  accepted  the  cxplana- 
ion  given  them  regarding  family  day-care  foi-  small 
hildrcn.    A  ftcr  the  children  were  enrolled,  the  social 
vorkers  made   plans  for  transporting  them  to  the 
amily  day-care  homes  and  to  hospitals  and  clinics, 
md  helped  family  day-care  mothers  aiul  the  chil- 
Iren's  own  i)arents  understand  the  problems  a  young 
;hild  faces  in  leaving  home  daily  and  in  growing  up. 
There  were,  however,  critical  moments  each  sin-ing 
IS  the  program  began  when  it  seemed  that  not  enough 
lomcs  would  be  available.    Both  years,  local  news- 
japers  carried  short  articles  about  the  family  day- 
•are  project  and  radio  stations  in  the  area  made  an- 
nouncements about  it.    The  greatest  help,  however, 
came  from  the  churches  in  the  communities.     (All 
services  for  migrant  workers  in  the  area  have  been 
achieved  with  the  close  cooperation  of  church  and 
governmental    agencies.)      The    State    Council    of 
Churches,  an  association  of  Protestant  cliurches,  gave 
wide  publicity  to  this  program  and  local  clergymen 
in  the  three  counties  made  direct  appeals  to  their  con- 
gregations for  day-care  families. 

When  the  project  began  in  1965,  two  county  agen- 
cies expected  to  provide  care  for  19  children  under  3 
years  of  age  for  10  weeks.  As  it  worked  out,  thej' 
provided  care  for  29  children  in  0  family  day-care 
homes.  In  1966,  although  a  late  harvest  season 
brought  fewer  workers  than  usual,  the  three  county 
agencies  placed  66  children  in  20  homes. 

Daily  attendance  of  the  children  in  their  day-care 
homes  both  yeai-s  was  high.  In  1965,  in  Columbia 
County,  of  the  35  days  of  care  given  27  children,  3 
attended  all  35  days;  5  attended  for  29  days;  13,  for 
25  days;  3,  for  20  days;  and  only  3,  for  less  than  20 
days.  Attendance  for  1966  was  at  about  the  same 
level.  The  good  attendance  record  seemed  to  indi- 
cate that  parents  needed  the  service. 

Quality  of  care 

Most  of  the  couples  who  applied  for  these  children 
were  young  couples  who  had  young  children  of  their 
own,  lived  in  modern,  ranch-style  homes  or  remodeled 
farmhouses,  and  had  good  incomes.    "We  had  hoped. 


A  family  day-care  niotticr  helps  one  of  the  two  migrant  chil- 
dren  in   her  care  get  ready  for  the  trip  back   to  the  camp. 


that  with  the  help  of  the  sorial  workers  the  families 
would  provide  good  child  care  for  the  migrants'  chil- 
dren, but  most  of  the  families  M-ith  whom  children 
were  placed  exceeded  our  expectations.  In  our  initial 
study  of  their  homes,  we  learned  from  the  kind  of 
care  they  gave  their  own  children  that  their  knowl- 
edge of  modern  methods  of  child  care  and  nutrition 
was  good  and  that  they  were  able  to  be  firm  with 
cliildren  without  resorting  to  punishment. 

The  comforting  they  gave  sick  or  fearful  children 
was  i^erhaps  the  best  feature  of  the  care  they  provided. 
Many  migrant  children  have  poor  health  because  of 
the  conditions  under  which  they  live.  Therefore, 
many  of  the  children  were  ill  during  the  time  of  care. 
One  day-care  mother  rocked  and  held  a  child  with 
an  ear  infection  over  and  over  for  days  until  the  con- 
dition cleared  up.  Another,  on  the  advice  of  a  pln'si- 
cian  and  the  consent  of  the  mother,  kept  a  child  who 
had  a  high  fever  in  her  home  for  several  days. 

The  day-care  mothers  were  equally  sensitive  to  the 
needs  of  fearful  childi-en.  One  social  worker,  in  tell- 
ing the  supervisor  of  an  experience  she  had  in  visiting 
a  day-care  home,  said  that  when  the  day-care  mother 
heard  a  slight  cry  from  the  bedroom  in  which  a  2- 
ycar-old  child  was  sleeping,  she  excused  herself,  went 
to  the  bedroom,  and  returned  with  the  child  in  her 
arms  saying,  "Joyce  Ann  is  always  frightened  when 
she  awakens,  so  I  pick  her  up  and  rock  her  for  a 
while." 

As  time  went  on  each  day-care  mother  expressed 
more  and  more  concern  over  the  deprivation  the  chil- 
dren suffered.    They  helped  the  parents  in  various 


VOLUME  14  -  NUMBER  1 


15 


■ways  from  time  to  time.  For  example,  on  hearing 
that  the  parents  of  the  two  children  for  whom  she  was 
caring  had  been  hurt  in  an  accident,  one  day-care 
mother  took  them  and  the  older  children  of  the  same 
family  into  her  home  and  cared  for  them  until  their 
parents  were  released  from  the  hospital. 

The  day-care  mothers'  enjoyment  in  caring  for 
these  children  was  apparent  when  12  of  the  day-care 
mothers  in  the  Columbia  County  program  met  one 
evening  last  summer.  In  exchanging  ideas  about 
child  care,  they  told  of  the  pleasure  their  work  with 
the  day-care  program  gave  them.  For  example,  one 
mother  who  had  had  a  major  operation  followed  by  a 
post-operative  reaction  the  spring  before  said  she  had 
not  taken  a  sedative  since  she  had  had  the  children  in 
her  care,  in  fact,  had  not  had  time  to  "take  pills." 
The  day-care  mothers  were  full  of  compassion  for 
and  understanding  of  the  migrant  mothers.  They 
wanted  to  know  how  the  mothers  kept  the  children  so 
clean  and  taught  them  to  be  so  polite  when  they  work 
such  long  hours.  Although  there  was  no  formal  plan 
for  the  children's  own  mothers  and  the  day-care 
mothers  to  meet,  they  did  find  many  natural  ways  of 
keeping  in  touch  with  each  other.  The  day-care 
mothers  sent  notes  home;  they  talked  over  the  tele- 
phone with  the  children's  mothers ;  and  a  few  visited 
the  mothers  in  the  camps.  Next  year,  we  hope,  mi- 
grant parents  will  be  able  to  visit  the  family  day-care 
homes. 

To  be  sure,  not  all  homes  gave  the  same  high  quality 
of  care.  One  of  the  first  applicants  in  the  1965  pro- 
gram was  a  woman  who  lived  in  a  large  farmhouse 
with  a  wide  porch  surrounded  by  plenty  of  outdoor 
play  space.  At  first  she  was  enthusiastic  about  car- 
ing for  migrant  children.  Because  she  was  a  farm 
woman  who  had  brought  up  a  large  family,  it  seemed 
likely  that  she  would  do  well  as  a  family  day-care 
mother.  However,  after  the  worker's  first  visit,  the 
woman  began  to  vacillate,  to  show  fear  about  health 
problems,  and  to  resent  having  to  have  a  liealth  ex- 
amination and  a  tuberculin  test  to  meet  agency  re- 
quirements. It  was  obvious  that  she  would  be  both 
demanding  of  and  dependent  on  the  social  worker. 
However,  because  in  working  with  migrant  children 
the  agency  has  to  work  quickly  if  the  need  is  to  be  met 
and  as  it  appeared  that  tliis  woman  could  give  good 
care  to  children,  the  social  worker  decided  she  could 
help  her  with  her  personal  problems.  So,  within  2 
weeks  we  placed  five  children  with  her.  Soon  the 
worker  found  that  the  woman  was  leaving  the  full 
responsibility  for  the  children  to  her  16-year-old 
daughter  and  her  own  mother  while  she  went  on  with 


her  usual  household  duties  without  involving  herself 
with  the  children  in  any  way  except  to  prepare  the 
noonday  meal  and  to  feed  them  witli  the  family. 
The  children  received  physical  care  to  be  sure,  but 
little  mothering  or  other  individual  attention.  The 
worker  soon  moved  all  the  children  except  one  child 
to  other  homes. 

The  problems 

Among  the  problems  the  project  expected  to  have 
to  solve,  the  first  seemed  to  be  how  to  place  Negi"0 
children  with  white  families.  Because  Negro  mi 
grant  farmworkers  had  been  coming  to  these  com- 
munities for  many  years  and  because  the  applicants 
for  migrant  children  initiated  contact  with  the  child 
welfare  agency,  we  assumed  that  each  family  offer- 
ing help  knew  that  the  children  were  Negro.  The 
social  worker,  however,  gave  each  day-care  mother 
an  opportunity  to  discuss  any  problems  she  might 
have  relating  to  the  difference  in  race;  but  no  mother 
ever  pursued  the  question  except  in  terms  of  the 
health  of  the  children  to  be  placed.  Once  the  chil- 
dren were  in  the  homes,  a  natural  relationship  devel- 
oped, as  it  does  with  almost  any  group  of  children. 
Almost  all  day-care  mothers  were  so  warm  and  loving 
that  soon  their  o^vn  children  and  the  day-care  chil- 
dren were  playing  together  freely  and  naturally. 

Some  resentment  arose  in  some  neighborhoods, 
however.  A  few  adults  asked  provocative  questions 
of  the  day-care  families  and  some  schoolchildren 
made  malicious  remarks  to  the  children  of  the  day- 
care families.  No  argument  or  insult  seemed  to  have 
much  effect  on  the  day-care  families,  however,  prob- 
ably because  they  were  convinced  that  what  they  were 
doing  was  right.  One  day-care  mother  from  an 
upper  middle  class  suburb  told  her  neighbors  that 
she  knew  of  no  better  way  of  preventing  her  children 
from  acquiring  racial  prejudice  than  to  have  them 
play  and  live  with  children  of  a  different  race  and 
culture. 

The  second  most  important  problem  seemed  to  be 
that  of  the  general  health  of  the  migrant  children. 
During  routme  examination  and  irmnunizations  at 
the  county  child  health  agency,  we  found  that  some 
of  the  children  needed  additional  medical  care  and 
that  many  suffered  from  the  complaints  of  children 
who  do  not  receive  adequate  health  seri-ices.  Eight 
of  27  cliildren  in  one  program  had  umbilical  hernias ; 
2  needed  remedial  surgery.  Most  of  the  children 
had  colds  and  coughs,  conditions  that  particularly 
plague  migrant  children,  who  must  adjust  to  constant 


16 


CHILDREN     •     JANUARY-FEBRUARY  1967 


empei-atiire  cluingos,  because,  even  in  the  fall,  nii- 
rrants  live  in  barnick-liko  houses. 

Transi^orting  the  children  to  and  from  the  family 
lay-care  homes  was  also  a  major  problem  for  the  pro- 
rram.     In  fact,  we  found  transi)orting  cliildren  to 

?!  )e  the  most  costly  and  difficult  part  of  the  program. 
[n  the  lirst  yeiir.  we  iiliinned  to  use  the  buses  that 
;arrled  older  children  to  and  from  the  day-care  ccn- 
ers  to  bring  the  young  children  to  the  foster  family 
mines.  However,  the  drivers  refused  to  be  respon- 
sible when  they  realized  very  small  children  were  to 
ride  in  the  care  only  of  older  brothers  and  sisters. 
We,  therefore,  used  several  other  methods  of  trans- 
porting the  yomig  children  back  and  forth.  At  first 
we  tried  to  use  commercial  drivers  by  hiring  small 

^  buses  and  taxicabs.  In  one  county,  when  this  proved 
too  costly,  a  few  mothers  who  had  applied  for  chil- 
dren but  -whose  homes  -were  not  then  in  use  agreed 
to  transport  children  to  the  homes  of  other  families 
until  they  themselves  had  day-care  children  to  care 
for.  One  migrant  mother  who  owned  a  car  brought 
the  children  from  her  camp.  All  noncommercial 
drivers  were  required  to  carry  extra  insurance,  and 
all  drivers  had  a  paid  assistant  who  watched  the  chil- 
dren. At  times,  lack  of  transportation  prevented  our 
offering  the  service  in  certain  camps  because  the  cost 
of  picking  up  two  or  three  children  at  a  great  distance 
from  the  homes  was  prohibitive. 

At  first,  the  day-care  mothers  were  overwhelmed 
at  the  thought  of  assuming  the  care  of  six  children, 
as  we  at  first  asked  each  to  do.  Three  children 
seemed  to  be  the  most  each  woman  felt  she  could 
manage.  A  few  day-care  mothers,  however,  after 
having  cared  for  three  children  for  a  week,  decided 


A  foster  family  day-care  father  greets  a  baby  who  has  just 
arrived  from  the  migrant  camp.  Another  migrant  baby  being 
provided  day  care  in  this  home  is  not  shown  in  the  picture. 


that  the  task  was  not  so  difficult  ;is  they  had  expected 
and  agreed  to  take  one  or  two  more.  A  few  mothers 
even  accepted  six  children. 

The  social  workers  gave  constant  support  to  the 
family  day-care  mothers  by  visiting  the  homes  abnost 
every  day.  They  helped  the  mothers  understand  the 
children's  behavior  and  find  ways  of  making  them 
happy.  They  discussed  the  health  of  each  child  and 
made  appointments  with  physicians  and  nurses  at 
nearby  clinics  and  hospitals.  They  purchased 
diapers,  training  pants,  nursing  bottles,  and  extra 
clothes  for  cold  days  with  money  collected  in  fees 
paid  for  these  necessary  articles.  Neighbors  freely 
lent  play  pens,  walkers,  and  cribs,  and  the  day-care 
centers  made  cots  available  to  the  homes. 

Mothers  and  children 

We  have  found  in  working  with  migrant  mothers 
that  they  seem  to  reach  out  at  all  times  for  any  serv- 
ice that  can  unprove  the  welfare  or  education  of  their 
children.  Some  of  the  migrant  mothers  readily  took 
the  morning  or  afternoon  off  from  the  fields  to  take 
their  children  to  child  health  clinics  at  the  request 
of  the  social  worker,  even  though  it  meant  a  signifi- 
cant loss  of  wages.  When  a  mother  received  a  note 
from  the  social  worker  or  the  day-care  mother  by  way 
of  her  child,  she  usually  returned  a  written  reply  or 
discussed  the  matter  with  the  social  worker  when  she 
saw  her  next.  During  an  outbreak  of  influenza  in 
one  camp,  the  social  workers  sent  notes  to  migrant 
mothers  describing  the  best  diet  for  their  children 
and  asking  them  to  report  any  symptoms  of  the  dis- 
ease. As  a  result,  one  mother  reported  that  her  child 
had  a  rash  on  her  leg.  The  social  worker  and  the 
family  day-care  mother  thought  the  rash  serious 
enough  to  require  a  visit  to  a  physician.  After  exam- 
ination, he  sent  the  child  to  the  hospital  to  be  treated 
for  a  staph  infection. 

The  parents  paid  the  agency  from  $1.25  to  $2  a 
week  for  the  family  day  care,  but  any  amount  they 
could  afford  was  acceptable.  Almost  all  parents 
jjaid  somethmg  willingly. 

Most  of  the  children  adjusted  well  to  the  family 
day-care  homes.  Although  the  cultural  and  environ- 
mental changes  often  seemed  too  great  for  these  little 
children  at  first,  by  the  third  and  fourth  day  the 
initial  reaction  of  most  of  them — whether  tearful, 
moody,  silent,  or  hostile — began  to  change.  They 
became  interested  in  the  family  day-care  mother  and 
the  other  children  in  her  care  and  seemed  cheerful  and 
happy  most  of  the  time.    However,  if  it  appeared 

17 


within  a  few  days  after  a  young  child  was  placed  in 
family  day  care  that  he  was  not  ready  to  be  separated 
from  his  mother,  we  helped  the  mother  make  some 
other  ari-angement  such  as  helping  her  to  see  that 
the  child  needed  her  at  home  or,  if  she  had  to  work, 
helping  her  to  find  care  in  the  camp  or  to  place  an 
infant  in  regular  foster  homes  of  the  agency. 

The  greatest  envii'omnental  change  for  the  children 
was  in  eating  and  sleeping  habits.  These  children 
seemed  to  sleep  more  than  other  children  of  their  age. 
Although  many  children  sleep  to  escape  change,  it 
was  evident  that  these  children  slept  from  exhaustion 
as  well.  Camp  life  is  noisy,  and  the  camp  settles 
down  later  than  most  communities,  especially  on  a 
weekend.  Most  of  the  children  in  family  day  care 
had  to  have  two  long  naps  a  day.  Nearly  all  seemed 
to  be  afraid  to  be  left  alone  to  sleep,  and  they  did  not 
outgrow  tliis  fear,  although  they  were  accustomed 
to  having  little  or  no  attention  paid  them  while  their 
mothers  were  working.  One  cliild,  upon  waking  and 
being  picked  up  by  the  day-care  mother,  looked  in  her 
face  with  surprise  and  asked,  "Don't  you  have  to 
work  in  the  fields?" 

After  one  little  girl  had  slept  all  day  in  the  family 
day-care  home  and  could  hardly  be  awakened  to  eat, 
the  social  worker  asked  the  child's  mother  in  the  mi- 
grant camp  whether  her  child  had  been  sick  the  night 
before.  The  mother  replied  in  surprise  that  the  child 
had  been  well  enough  to  run  around  the  camp  all 
night. 

The  family  day-care  mothers  reported  that  the 
children  ate  well  once  they  became  accustomed  to  a 
few  new  dishes.  Some  of  the  children  were  still 
young  enough  to  be  bottle  fed ;  others  brought  bottles 
as  pacifiers,  but  once  they  were  given  solid  food,  they 
gave  them  up. 

Although  only  observation  and  judgment  have 
been  used  to  evaluate  the  service,  we  believe  that  the 
purpose  of  the  family  day-care  program  was  in 
general  achieved,  particularly  in  1966.  Migrant 
mothers  accepted  the  family  day-care  homes  because 


they  trusted  the  social  workers  and  were  willing  to 
learn  from  them  and  the  day-care  mothers  how  to 
improve  the  care  they  gave  their  children.  Much 
improvement  was  accomplished  in  the  care  the  mi- 
grant mothers  gave  their  children  through  imitation 
with  no  words  spoken.  For  example,  if  a  child  went 
home  with  a  note  pinned  on  his  diaper  saying  "better 
way,"  he  was  likely  to  be  returned  the  next  day  with 
the  "better  way"  faithfully  copied. 

We  were  surprised  how  many  family  day-care 
mothers  in  the  communities  trusted  a  new  and  differ- 
ent program  when  supported  by  the  county  child  wel- 
fare agency  and,  as  a  result,  gave  intelligent  and 
loving  care  to  children  regardless  of  motivation.  Our 
need  to  find  these  homes  quickly  engaged  the  interest 
and  assistance  of  many  people  in  the  community. 
Newspapers,  radio  stations,  and  churches  not  only 
jarovided  publicity  for  the  program,  but  also  served  as 
avenues  to  good  will. 

As  for  a  comparison  between  the  value  of  family 
day  care  and  the  group  care  at  the  centers,  we  believe 
that  a  day-care  mother  caring  for  three  to  six  chil- 
dren can  meet  the  physical  and  psychological  needs 
of  young  children  more  iimnediately  and  personally 
than  teachers  providing  group  care.  This  does  not 
minimize  tlie  value  of  the  care  given  at  the  day- 
care centers,  but  it  does  point  up  that  in  family  day 
care  the  caretaker  can  identify  and  concentrate  on 
the  special  needs  of  each  child.  A  day-care  mother- 
in  her  own  home  can  be  close  to  the  fearful  child  who 
needs  to  know  immediately  on  awakening  from  a  nap 
that  he  is  not  alone,  and  she  can  comfort  a  child  dui'- 
ing  the  long  day  when  he  suffers  from  a  painful  ill- 
ness. The  physical  problems  of  children  who  have 
had  no  medical  care  can  well  take  most  of  a  day-care 
mother's  day;  yet  the  day-care  mother  must  also  al- 
leviate the  fears  that  accompany  a  new  experience. 
The  quick  response  of  these  children  to  the  change  of 
enviromnent,  methods  of  care,  and  improvement  in 
health  led  us  to  believe  that,  for  young  migrant  chil- 
dren, family  day  care  can  be  a  valuable  experience. 


.  .  .  We  owe  to  every  young  person  in  America  a  fair  start  in  life — 
and  this  means  that  we  must  attack  those  deficiencies  in  education,  train- 
ing, health,  and  job  opportunities  by  which  the  fetters  of  poverty  are 
passed  on  from  parents  to  children  .... 

President  Lyndon  B.  Johnson  to  the  88th  Congress,  January  21,  1964. 


18 


CHILDREN     •     JANUARY-FEBRUARY  1967 


wo  psychiatric  clinicians  discuss  their  experiences  in 


LEARNING 


Wl 


th 


ALBERT  I.  SOLNIT,  M.D. 


TEACHERS 


MARY  H.  STARK 


Schoolteachers  and  clinicians  from  pediatric 
and  psychiatric  clinics  for  children  have 
much  to  learn  from  each  other  about  child 
life  and  child  development.  Long  convinced  of  tliis 
fact,^'^  the  Child  Study  Center  at  Yale  University 
has  for  more  than  a  decade  been  engaged  in  a  con- 
tinuous collaboration  with  two  local  school  systems 
in  Greater  New  Haven,  Conn.  This  collaboration 
has  underscored  the  reciprocal  value  of  a  close  work- 
ing association  between  teachers  and  clinicians.  The 
experience  has  also  impressed  the  clinicians  engaged 
in  it— a  child  psychiatrist  and  a  psychiatric  social 
worker — with  the  potentials  of  the  universal  edu- 
cation system  as  a  preventive  force  in  society's  strug- 
gle against  an  alarming  incidence  of  mental  illness. 
We  began  the  experiment  with  an  effort  to  establish 
conditions  in  which  we  could  make  our  clinical  un- 
derstanding of  cliildren  and  their  families  available 
to  schoolteachers.  At  the  same  time,  we  wanted  to 
tap  the  enormous  reservoir  of  knowledge  and  experi- 
ence schoolteachers  had  gained  about  children  in 
their  daily  experiences.  Being  aware  that  teachers 
and  clinicians  possess  knowledge  derived  from  dif- 
ferent levels  of  observation  and  inference,  we  hoped 
thus  to  enrich  our  own  work  as  teachers  of  medical 
students,  pediatricians,  psychiatrists,  psychoanalysts, 
nurses,  and  psychologists. 


The  work  reported  in  this  article  has  the  endorsement  of  the 
Boards  of  Education  of  North  Haven  and  New  Haven,  Conn., 
and  is  supported  by  the  Children's  Bureau  and  the  Con- 
necticut State  Department  of  Health. 


Since  then  we  have  engaged  in  a  contmuous  col- 
laboration with  schoolteachers  in  elementally  schools 
in  the  greater  New  Haven  area — especially  in  two 
schools,  one  in  an  upj^er  middle  class  professional 
community  and  the  other  in  a  poverty-stricken  area. 
Our  work  with  the  teachers  has  focused  on  children 
with  problems  in  learning  or  school  adjustment. 

Assuming  from  the  beginning  that  the  school's 
major  mission  is  to  provide  each  child  with  educa- 
tional opportimities  that  are  optimal  for  his  develop- 
ment in  a  democratic  society,  we  have  been  mindful 
of  the  confusion  that  results  if  teachers  are  expected 
to  be  diagnosticians  and  therapists  and,  conversel}-, 
if  child  psychiatrists,  social  workers,  and  psycholo- 
gists are  assumed  to  be  experts  in  child  education. 
Nevertheless,  we  have  found  that  each  group  of  ex- 
perts can  leani  from  the  other  by  makuig  appro- 
priate and  selected  translations  and  inferences. 

Each  year  we  have  met  with  groups  of  teachers 
regularly  throughout  the  school  year  on  a  weekly, 
montlily,  or  bimontlily  basis.  In  one  school  the 
group  consisted  at  first  of  8  to  10  teachers  of  the  first, 
second,  and  third  grades ;  then  of  teachers  of  kinder- 
garten, first,  and  second  grades;  and  later  of  teachers 
of  the  second,  third,  and  fourth  grades,  and  so  on. 
The  school  nurse,  social  worker,  and  psychologist 
also  attended  the  meetings.  Thus,  over  a  5-year  pe- 
riod, all  of  the  teachers  in  this  school  (which  covei'S 
kindergarten  through  the  sixth  grade)  participated 
in  the  conferences  many  times.  In  another  school  the 
conferences  were  limited  to  six  kindergarten,  iivst-, 
and  second-grade  teachers.    In  every  instance  the 


VOLUME  14  -  NUMBER  1 


19 


principal  of  the  school  has  been  present  at  the  meet- 
ings. In  addition,  special  teachers  such  as  speech 
or  remedial  reading  specialists  have  been  included 
when  a  child  or  a  problem  of  concern  to  them  was 
under  discussion. 

From  the  beginning,  we  have  stressed  both  the 
scope  and  limitations  of  our  expertise  as  a  psychia- 
trist and  a  psychiatric  social  worker,  pointing  out 
that  we  were  interested  in  a  true  interprofessional  ex- 
change of  knowledge.  In  this  way  we  have  gained 
acceptance  of  the  jDroject  in  the  school  community — a 
prerequisite  for  fruitful  collaboration  with  the 
educators. 

The  meetings  have  been  intended  to  serve  as  a 
means  of  exclianging  opinion  and  knowledge  for  the 
benefit  not  only  of  the  child  under  study  but  also 
for  other  children,  since  the  discussions  have  usually 
generalized  from  the  particular  child  under  consider- 
ation to  others  with  similar  characteristics  or  prob- 
lems. Most  of  them  have  been  organized  to  focus  on 
a  particular  cliild  and  the  teacher's  efforts  to  help 
him,  but  the  discussion  has  often  broadened  to  a  con- 
sideration of  questions  of  general  concern  sucli  as 
discipline,  curiosity,  or  socialization  in  early  ado- 
lescence. Before  each  meeting,  a  short  statement 
about  the  child  and  his  problems  is  sent  by  the  prin- 
cipal to  the  clinical  gi'oup.  Confidential  informa- 
tion is  protected  by  measures  designed  to  insure  the 
anonymity  of  the  child. 

As  the  teachers  discussed  a  child,  his  school  experi- 
ences, and  his  background,  we  attempted  through 
questions  and  comments  to  convey  some  insights 
gained  from  our  clinical  experience  and  studies  in 
the  fields  of  psychoanalysis,  child  development,  fam- 
ily dynamics,  and  child  psychiatry.  The  discussions 
enabled  the  teachers  to  translate  these  insights  into 
working  knowledge  that  could  be  applied  effectively 
in  dealing  with  the  child  and  with  specific  learning 
situations  in  the  classroom.  Thus,  we  did  not  em- 
phasize psychiatric  diagnosis  or  referral  for  clinical 
care.  In  fact,  over  a  10-year  period  only  a  small 
proportion  of  the  children  we  have  studied  in  these 
group  meetings  have  been  refen-ed  to  community 
agencies  for  pediatric  or  psychiatric  evaluation  and 
treatment. 

Underachievement 

Underachievement  in  its  various  aspects  was  the 
most  frequent  school  difficulty  to  come  under  dis- 
cussion. The  teachers  often  implicitly  or  explicitly 
correctly  related  this  problem  to  the  child's  preceding 

20 


and  continuing  experiences  at  school.  Often  they 
also  exhibited  an  awareness  of  the  relation  of  the 
child's  family  backgroimd  and  his  parents'  attitude 
toward  education  to  his  underachievement. 

By  comparing  the  child  under  discussion  with 
others  in  his  class  and  by  comparmg  his  experiences 
and  performance  under  a  previous  teacher  with  hia 
present  perfonnance,  the  group  invited  a  careful 
study  of  the  reasons  for  the  underachievement.  Tliis 
led  to  such  questions  as :  Is  underachievement  in  this 
child  a  result  of  an  internalized  conflict,  a  reaction  to 
conditions  in  his  home,  an  adaptation  to  the  deprived 
environment,  or  a  reaction  to  his  present  teacher 
or  fellow  students  ?  In  other  words,  is  the  difficulty 
in  the  child  himself  or  is  he  reflecting  the  imder- 
achievement  of  his  family,  his  neighborhood,  or  his 
subculture  ?     For  example : 

Johnny,  age  8,  had  been  promoted  to  the  third  grade  with 
reservations  about  his  sliill  in  reading  and  writing,  subjects 
in  which  he  seemed  to  have  very  little  interest.  Johnny  and 
his  parents  had  moved  from  South  Carolina  2  years  earlier  and 
were  living  in  a  New  Haven  slum.  His  parents,  according  to 
the  teacher,  viewed  school  as  a  duty  a  child  must  accept  pleas- 
antly until  he  is  16,  when  he  is  permitted  to  drop  out  of  school 
and  go  to  work.  They  did  not  regard  reading  and  writing  as 
being  as  essential  for  adult  work  as  skills  requiring  muscular 
coordination  and  strength.  While  they  would  like  to  have 
had  Johnny  do  well  in  school,  academically  and  socially,  their 
compliant  attitude  toward  the  school's  expectations  did  not 
have  as  much  influence  on  Johnny  as  their  implicit  lack  of 
interest  in  the  goals  of  schooling.  Johnny  did  not  have  any 
notion  that  schoolwork  was  an  essential  investment  in  his 
future. 

The  teacher-clinician  group  considering  Johnny  agreed  that 
it  would  be  helpful  to  Johnny  if  someone  worked  with  his 
parents.  At  the  psychiatrist's  suggestion,  the  principal  asked 
them  to  come  to  the  school,  thus  demonstrating  his  interest 
in  Johnny  and  his  parents  and  in  Johnny's  schoolwork.  He 
talked  to  the  parents  about  how  they  might  help  Johnny  do 
better  work.  He  established  a  very  good  relationship  with 
them  and  saw  them  several  times.  In  the  ensuing  year,  Johnny 
gradually  gave  evidence  of  taking  his  schoolwork  more  seri- 
ously. His  changed  attitude,  as  well  as  that  of  his  parents',  was 
at  first  manifested  in  a  changed  appearance.  He  seemed  more 
rested,  and  his  clothing  and  bodily  cleanliness  were  obviously 
receiving  more  parental  attention.  His  schoolwork  slowly  im- 
proved, as  did  his  interest  in  demonstrating  his  proficiency  in 
learning.  His  parents  became  active  participants  in  the  PTA 
and  exhibited  a  possessive  pride  in  the  school. 

"VVlien  a  child  is  not  achieving  at  his  capacity  re- 
gardless of  the  cause  the  teacher  often  feels  that  she  is 
underachieving.  A  study  group  discussing  such  a 
child  can  encourage  the  teacher  to  balance  her  self- 
criticism  with  a  long-range  perspective  to  transform 
her  scrutiny  of  the  situation  into  a  constnictive  in- 
strument for  her  own  and  her  j^upil's  advancement. 

CHILDREN     .     JANUARY-FEBRUARY  1967 


k 


therefore,  our  questions  and  comnionts  as  clinicians 
rero  aimed  at  bringing  out  as  full  a  picture  as  pos- 
ible  of  the  child's  background,  his  different  ways  of 
jariiing  in  various  situations,  and  liis  assets  and 
labilities.  "We  would  often  start  the  discussion  with 
peculative  formulations  about  the  child's  failure  to 
unction  up  to  par  in  school.  The  teachers  would 
espond  with  additional  observations  and  with  their 
>wn  formulations.  The  dialogue  would  then  pro- 
ieed  until  the  teachers  had  devised  (he  beginning  of  a 
)lan  to  help  the  child. 
For  example: 

The  case  of  Phil,  a  very  bright  11 -year-old  sixth  grader,  was 
jresented  for  discussion  because  he  never  worked  up  to 
-apacity.  He  daydreamed  constantly  and  was  very  forgetful. 
[Each  teacher  he  had  had  for  the  past  3  years  had  made  the 
■-ame  complaints  about  him.  In  the  discussion  group  his 
iDiirth-  and  iifth-grade  teachers,  as  well  as  his  current  teacher, 
Mr.  A,  were  present.  They  reported  that  Phil  was  aware  of 
his  problem  and  often  said  with  tears  in  his  eyes  that  he  wanted 
(i>  do  well  in  school  but  that  he  could  not  concentrate.  He 
■JiJ  show  an  interest  in  science,  especially  in  relation  to  the 
human  body.  He  also  read  a  great  deal  and  was  in  the  top 
reading  group  in  his  class. 

Aslied  by  the  psychiatrist  to  describe  the  boy,  the  teachers 
said  that  he  was  slender,  average  in  height,  rather  awkward, 
and  not  skillful  in  sports;  that  he  played  with  one  or  two  rather 
unpopular  children;  that  his  classmates  often  responded  to  his 
forgetfulness  and  daydreaming  by  exclaiming,  "Oh,  Phil!  Not 
again!" 

At  the  1-equest  of  the  psychiatric  social  worker,  the 
teachers  described  PhiFs  famil)-. 

Phil's  parents  were  college  graduates.  They  had  removed 
all  distractions  from  Phil's  room  at  home  in  an  effort  to  help 
him  concentrate  on  his  homework,  but  he  had  continued  to 
daydream.  He  had  a  very  bright  sister  who  was  in  the  fourth 
grade,  a  6-year-oId  brother  with  cerebral  palsy,  %vho  was  not 
able  to  go  to  school,  and  two  sisters  of  preschool  age.  Phil's 
father  had  said  that  he  himself  did  not  "wake  up  until  he  was 
in  college.  ' 

When  the  psychiatrist  asked  if  Phil  ever  requested  help  from 
his  teachers,  Mr.  A,  his  current  teacher,  reported  that  Phil  was 
ver)'  independent  and  did  not  ask  for  help.  His  fourth-grade 
teacher  remarked  that  Phil  would  "tune  out"  the  teacher  and 
would  always  seem  to  be  interested  in  a  topic  different  from  the 
one  assigned.  Mr.  A  had  spoken  to  Phil  after  school  about  his 
daydreaming  and  forgetfulness  but  this  had  not  helped.  He 
had  also  had  a  talk  with  the  boy's  parents  but  this  approach  had 
not  helped  Phil. 

The  p.sychiatrist  commented  on  Phil's  advanced 
reading  and  on  the  miivei-sality  of  daydreaming,  a 
form  of  mental  scanning  that  ordinarily  facilitates 
problem-solving  mental  activity  and  the  acquisition 
of  knowledge.  lie  speculated  that  in  Phil's  case  the 
inability  to  concentrate  on  wjiat  the  teacher  asked 
might  be  a  bright  boy's  way  of  presenting  himself 


Both  Albert  J.  Solnit,  left, 
and  Mary  H.  Stark  nrc  ns.so- 
ciated  with  the  Yule  Univer- 
sity School  of  Medicine  and 
the  Yale  Child  Study  Center  : 
Dr.  Solnit  is  professor  of 
pediatries  and  psychiatry 
and  director  of  the  center; 

Miss  Stark  is  an  a.ssi.staiit  iirofessor  of  .social  work  in  the 
niedicnl  si-hnol's  (lepiirtiiKMit  of  pediatrics. 


as  defective.  Tlie  psychiatrist  further  suggested 
that  Piiil's  ass<K'iations  witii  going  to  school  might 
be  related  to  Jiis  concern  ajbout  his  handicapped, 
younger  brotlier,  who  had  been  born  about  the  time 
Phil  entered  kindergarten.  lie  added  that  perhaps 
Phil  had  identified  himself  with  liis  defective  brother 
as  a  way  of  coping  with  his  own  feelings  about  sei)a ra- 
tion from  his  mother  at  a  time  when  site  was  ))ainfidly 
preoccupied  witii  the  tragic  condition  of  her  new- 
born son.  The  teachers  discussed  (his  idea  as  a  pos- 
sibility worth  further  consideration. 

Mr.  A  suggested  that  as  the  first  step  in  an  educational  plan 
he  and  the  principal  might  talk  again  with  the  parents  to  try 
to  find  out  what  might  be  worrjing  Phil.  The  group  went 
along  with  this,  pointing  out  that  Mr.  A  would  then  be  in  a 
position  to  decide  how  to  deal  with  the  boy.  The  group  agreed 
that  the  teacher  should  in  some  way  convey  to  Phil  that  day- 
dreaming was  all  right  as  a  companion  of  but  not  a  replacement 
for  the  problem-solving  effort  involved  in  schoolwork. 

The  group  did  not  come  to  an  agreement  on  whether  Mr.  A 
should  bring  up  the  subject  of  the  younger  brother  in  talking 
to  Phil.  One  teacher  insisted  that  Phil's  curiosity  about  the 
human  body  offered  a  logical  opportunity  for  talking  with 
him  about  his  brother's  handicap.  The  rest  of  the  group,  in- 
cluding the  clinicians,  felt  that  the  subject  would  best  be 
broached  by  his  parents  or  physician.  Phil's  teacher,  the 
group  agreed,  should  understand  the  possible  influence  of  the 
brother's  arrival  and  condition  on  Phil  but  should  not  accept 
this  as  an  excuse  for  Phil  to  limp  along  in  his  work.  Some  of 
the  teachers  pointed  out  that  if  more  were  not  demanded  of 
Phil  in  school,  he  would  regard  his  distorted  impression  of 
himself  as  correct. 

The.  educational  plan  devised  in  the  group  was 
modified  as  a  result  of  an  ensuing  discussion  with  the 
])arents,  who  had  responded  to  the  sugge.stion  that 
Phil  might  be  concerned  about  his  handicap])ed 
brother  by  agreeing  to  help  him  attain  a  better  under- 
standing of  himself  and  his  family.  In  accordance 
with  the  plan,  the  teacher  insisted  tactfully  and 
repetitively  that  Phil  practice  and  complete  his  work 
in  a  manner  .suiting  his  capacities:  refrained  from 
criticizing  him  for  daydreaming  when  he  was  not 
reciting  or  engaged  in  problem-solving  activities ;  and 


VOLUME  14  -  NUMBER  1 


21 


conveyed  disagreement  with  Phil's  notion  of  himself 
as  a  handicapped  boy  who  could  not  perform.  The 
teacher  did  not  initiate  discussions  with  Phil  either 
about  his  brother  or  about  the  body  in  general,  but 
he  responded  to  questions  and  observations  on  these 
subjects  if  Phil  brought  them  up. 

Six  months  later,  Phil's  teacher  reported  that  the 
boy  was  performing  better  as  a  student  though  he  was 
still  occasionally  absentminded  and  socially  awkward. 
The  social  awkwardness  was  no  longer  a  major  con- 
cern, since  the  parents  had  reported  Phil  had  a  good 
relationship  with  them  and  their  other  children. 

Obstacles  to  learning  are  commonly  engendered  by 
the  child's  previous  experiences,  motivational  conflict, 
poor  impulse  control,  or  a  neurophysiological  deficit 
that  impairs  the  child's  ability  to  attend  to  and 
acquire  the  mastery  of  symbolic  expression  so  essen- 
tial for  formal  education.  We  have  observed  that  the 
effective  teacher  begins  by  providing  a  learning  ex- 
perience that  avoids  the  obstacles  to  learning  and  only 
later  talces  a  more  direct  approach  to  these  obstacles. 
For  example : 

A  teacher  noted  that  an  8-year-old  boy  became  frantic  when 
reading  out  loud.  She,  therefore,  avoided  calling  on  him  in 
class  to  read  but  did  call  on  him  to  recite  in  other  areas  in 
which  he  showed  confidence  and  pleasure,  especially  arithmetic. 
She  also  had  him  read  to  her  alone  during  several  recess  periods, 
and  after  he  showed  some  improvement  she  began  again  to 
call  on  him  to  read  aloud  in  the  class.  This  pupil  gradually 
mastered  the  difficulty.  The  teacher  did  not  know  for  certain 
what  the  origin  of  the  difficulty  was  but  suspected  that  it  was 
related  to  an  unfortunate  experience  the  child  had  had  with  a 
speech  difficulty  earlier  in  life. 

Some  teachers  intuitively  devise  a  way  of  avoiding 
the  obstacles  to  learning  by  following  clues  pre- 
sented by  the  characteristics  of  the  teacher-pupil 
relationsliip.  One  teacher  placed  a  hyperactive  9- 
year-old  boy  next  to  her  desk  because  she  noted  he 
could  pay  attention  to  arithmetic  and  its  abstract 
symbols  only  when  he  was  close  enough  to  feel  her 
controlling  physical  presence  and  interest  in  him.  In 
another  instance,  a  teacher  placed  a  12-year-old  girl 
in  the  bacli  of  the  class  when  she  noticed  that  the  girl 
had  to  show  off  if  she  felt  "too  close"  to  the  teacher. 
Initially,  she  could  learn  more  effectively  when  the 
relationship  to  the  teacher  was  not  intense. 

Inservice  training 

From  these  experiences  in  collaborative  assessment 
of  imderachieving  children,  we  have  become  aware 
of  the  value  for  teachers  of  a  planned  collaboration 
with   seasoned    educators,   child   psychiatrists,   and 


social  workers  as  a  form  of  inservice  training  or  as  an' 
internship  for  new  teachers.  Younger  teachers 
found  the  sessions  particularly  valuable,  but  older, 
more  experienced  teachers  also  gave  evidence  of  gain- 
ing from  their  participation  in  the  groups. 

We  learned  that  the  first  2  or  3  years  of  full-time 
teaching  are  crucial  in  the  professional  development 
of  young,  inexperienced  teachers.  In  a  classroom, 
the  full  professional  responsibility  of  helping  20  to  35 
children  learn  basic  tools  of  communication  and  the 
beginnings  of  conceptual  thinking  presents  a  chal- 
lenge that  is  often  overwlielming  if  the  teacher  does 
not  have  appropriate  supervision  and  opportunities 
for  inservice  training.  We  have  seen  a  bright,  witty, 
young  i^erson  who  was  given  no  supervisory  help  in 
mastering  difficult  work  problems  turn  into  a  frus- 
trated, sarcastic,  yelling  teacher.  With  supervision 
and  conferences,  the  cliallenges  a  new  teaclier  faces 
can  be  stimulating  rather  than  overwhelming  and 
they  can  result  in  professional  growth  rather  than 
constriction.     For  example : 

Mr.  B,  who  had  begun  teaching  fifth  graders  only  a  year' 
before  our  conferences  began,  at  first  constantly  tried  to  puti 
children  into  the  theoretical  classifications  he  had  learned  about 
as  an  undergraduate.  Toward  the  end  of  his  first  year  with  us, 
however,  he  remarked  that  the  children  did  not  fit  easily  into  an 
extrovert-introvert  classification  system  and  that  such  a  system 
was  not  very  illuminating  anyway.  In  the  second  year,  with 
the  support  of  his  principal,  he  began  to  present  some  of  the 
children  in  his  class  to  the  group:  an  11-year-old  girl  whose 
shyness  eluded  his  understanding;  and  a  boy  who  in  challenging 
his  authority  was  provoking  him  to  prove  that  he  could  be 
tough  and  was  the  boss.  Through  the  openness  of  the  discus- 
sion of  these  children,  which  continued  from  time  to  time 
throughout  the  year,  Mr.  B  came  to  understand  that  the  girl's 
shyness  stemmed  from  anxiety  about  her  sexual  precocity  and 
that  the  boy's  provocative  behavior  was  a  poor  form  of  sub- 
limation and  the  displacement  of  sibling  rivalry.  Through  his 
greater  understanding  of  these  children  Mr.  B  was  able  to  help 
them  in  class.  He  has  often  said  that  the  conferences,  which 
he  attended  for  3  years,  have  helped  him  build  greater  teaching 
skill  on  the  foundations  of  his  formal  training. 

In  one  school  where  the  clinicians  organized  collab- 
orative discussion  groups,  the  principal  ran  the 
school  like  a  "tight  sliip,"  partly  in  response  to  the 
threatening  unrest  in  the  surrounding  underprivi- 
leged and  disorganized  neighborhood.  However,  he 
knew  his  children's  families  and  their  neighborhood 
well  and  made  this  knowledge  available  to  the  teach- 
ers in  times  of  crisis.  In  the  first  confei'ence  at  this  j 
school,  a  young  kindergarten  teacher  described  a  cliild 
about  whom  she  was  concerned,  and  in  doing  so  made 
it  clear  that  she  was  being  aided  by  an  experienced,  j 
older  teacher  with  whom  she  shared  teaching  respon- 


22 


CHILDREN     •     JANUARY-FEBRUARY  1967 


sibilities.  As  the  conferences  proceeded,  the  clini- 
cians' questions  and  comments  stinnilatcd  the  princi- 
pal to  transmit  his  knowlod<^c  of  the  I'amilies  and 
home  life  to  his  teachers  as  a  matter  of  course  rather 
than  only  in  crises.  This  enabled  the  clinicians  to 
show  how  the  characteristic  learning  and  behavior 
patterns  of  the  child  under  discussion  were  related  to 
the  dynamics  of  his  family  life  as  well  as  to  difUculties 
specific  to  his  developmental  stage  hi  the  context  of 
the  cultural  background.  These  phase-specific  diffi- 
culties included  anxiety  ai-ising  from  the  child's  sep- 
aration from  his  parents  or  from  the  necessity  to 
control  impulses  in  the  classroom.  Thus,  the  assist- 
ance provided  to  the  young  teacher  by  her  senior 
colleagues  and  by  the  principal  became  elaborated 
and  explicit  as  we  all  extended  our  understanding 
about  underprivileged  children. 

Pupil-teacher  relationship 

Tlius  we  demonstrated  that  clinical  theory  mainly 
derived  from  psychoanalysis  can  be  translated  and 
applied  as  part  of  sound  pedagogy  when  it  is  part  of 
an  inservice  training  program  in  which  the  questions, 
discussions,  and  solutions  are  related  to  everyday 
teaching  problems  and  to  principles  of  education. 

One  theoi-y  that  seemed  to  be  especially  helpful  to 
the  teachers  we  worked  with  was  the  psychoanalytic 
concept  of  identification.  This  was  presented  as  a 
complex  psychological  process  through  which  atti- 
tudes and  motives  are  conveyed  from  one  person  to 
another  as  a  result  of  their  relationship.  "We  dis- 
cussed those  factors  that  promote  and  those  that  im- 
pede the  adoption  by  the  pupil  of  the  teacher's  atti- 
tudes toward  knowledge,  recitation,  reading,  and 
working  alone  or  in  groups. 

Throughout  the  discussions,  the  clinicians  at- 
tempted to  show  how  the  child's  capacity  to  work  at 
school  can  be  activated  through  liis  relationship  with 
his  teacher,  which,  as  Anna  Freud  has  pointed  out,  is 
not  a  replica  of  "the  child's  emotional  tie  to  either 
parent  but  something  siu  generh,  a  later,  more  com- 
plex, and  more  neutralized  relationship  to  a  group- 
leader  figure."  * 

During  this  effort,  we  observed  that  each  teacher 
had  a  unique  mode  of  describing  and  relating  to  her 
pupils.  "We  also  noted  that  each  teaclier  had  intui- 
tively formed  a  fragmentary  but  influential  relation- 
ship within  2  weeks  after  tlic  scliool  term  had  started 
with  each  of  the  pupils  with  whom  she  eventually  be- 
came effective.  "\^nien  we  called  this  to  the  attention 
of  our  educator  colleagues  in  the  groups  as  a  phe- 


nomenon worth  studying,  they  con-ected  us  by  point- 
ing out  that  in  most  instances  the  period  of  "latch- 
ing ou"  occurred  daring  the  first  week  of  school. 
Some  teachers  said  that  if  they  did  not  have  the  be- 
ginnings of  a  relationship  with  a  child  before  the 
fii-st  week  had  passed,  tliey  expected  prolonged  dif- 
ficulties in  teaching  that  child.  The  teachers  gave 
many  cxamiiles  to  show  that  their  particular  ways  of 
reacliing  or  influencing  a  child  and  a  class  of  children 
required  them  to  be  able  to  identify  in  part  witli  the 
children  without  regressing  to  poorly  organized  be- 
havior and  witliout  losing  their  leadership  of  the 
class.  Obviously,  the  full  development  of  these  al- 
liances takes  place  throughout  the  school  year.  For 
example: 

Mrs.  C,  an  experienced  teacher,  reported  that  she  had  suc- 
ceeded in  reaching  and  influencing  7-year-oId  Jessie,  who  had 
begun  school  with  a  pattern  of  tardiness,  by  insisting  that  the 
child  come  to  school  on  time.  Mrs.  C  said  that  her  insistence 
had  conveyed  to  this  underprivileged  child  that  the  teacher 
regarded  her  as  worth  troubling  about.  In  the  discussion  it 
became  clear  that  Mrs.  C's  "benevolent  nagging"  suited  her 
style  of  making  contact  and  represented  the  beginning  of  a 
positive  relationship  with  the  child  and  her  parents  through 
which  they  would  come  to  identify  with  the  school's  goals  for 
Jessie's  education.  When  Mrs.  C  was  asked  at  what  point  she 
thought  she  had  begun  to  reach  Jessie,  she  said  that  it  was 
perhaps  a  few  days  after  the  opening  of  school  when,  feeling 
"nagged"  by  Jessie's  tardiness  and  tired  appearance,  she  had 
briefly  suggested  to  the  child  that  she  get  more  sleep  and  come 
to  school  on  time  so  that  she  could  enjoy  her  schoolwork  and 
do  it  better. 

Thus,  we  learned  tliat  tlie  teacher,  even  with  a  class 
of  more  than  25  pupils,  intuitively  at  first  and  more 
consciously  later,  makes  a  unique  arrangement  with 
each  pupil  in  her  class  as  well  as  with  the  class  as  a 
group.  This  arrangement  consists  of  a  partial  al- 
liance between  the  teacher  and  pupil  in  which  they 
imi)licitly  agree  to  work  together  in  a  mutually  satis- 
fying way,  each  for  different  reasons  and  with  dif- 
ferent aims.  For  each  party  involved  this  alliance 
results  in  a  degree  of  what  psychoanalysts  call  "par- 
tial identification" — the  child  tending  to  adopt  the 
attitudes  and  expectations  of  the  teacher  and  the 
teacher  recognizing  the  individuality  of  the  child, 
through  sensitivity  to  his  special  attitudes.  Al- 
though this  mutual,  partial  identification  includes 
the  friendly  desire  to  please  each  other,  it  is  not  too 
intense  and  avoids  the  conflicts  that  are  characteristic 
and  even  desirable  in  family  relationsliips.  It  de- 
mands a  degree  of  patience  from  each  party  and  an 
ability  on  the  part  of  the  teacher  to  tolerate  failure, 
anger,  and  disappointment  while  searching  for  a  suc- 
cessful mode  of  working  with  the  child,  whether 


VOLUME  14  -  NUMBER  1 


23 


through  physical  closeness  or  distance,  verbal  or  non- 
verbal communication,  special  projects,  or  imaova- 
tions  suggested  by  teacher  or  pupil. 

We  have  already  mentioned  the  devices  teachers 
improvise  for  initially  avoiding  obstacles  to  learning 
rather  than  meeting  them  head  on.  Such  educational 
adaptations  succeed  when  the  teacher-pupil  relation- 
ship has  achieved  the  kind  of  beginning  alliance  in 
which  partial  identification  can  develop.  Tlie  devices 
themselves,  however,  are  derived  from  pedagogical 
principles  that  transcend  cultural  differences  and 
modes  of  behavior.  They  exploit  the  various  alter- 
nate senses  available  to  the  child  for  perceiving,  orga- 
nizing, and  expressing  mental  impressions  and  rely 
on  practice  rather  than  drill.  Drill  imposes  the 
adult's  motives  upon  the  child;  l)nt  practice  actively 
engages  the  child's  positive  motivation,  a  derivative 
of  his  identification  with  the  teacher  during  the  frus- 
trating, often  irritating,  repetition  of  the  ^^•ork 
necessary  for  achieving  mastery  and  iudcpendenre. 

Other  aspects  of  clinical  theoiy  developed  in  our 
inservice  training  sessions  included : 

1.  Tlie  relationshij)  and  differences  between  play 
as  a  metliod  of  learning  for  the  younger  child  and  the 
work  of  learjiing  in  the  older  child.  (For  example, 
play  can  be  interrupted  v.-\\on  it  is  no  longer  gratify- 
ing, but  studying  and  working  at  school  usually  must 
be  sustained  through  periods  of  discomfort  and  frus- 
tration before  the  desired  pleasurable  mastery  of 
knowledge  and  understanding  of  symbolic  processes 
are  achieved.) 

2.  Tlie  necessary  role  of  aggression  in  leai-ning 
and  the  way  the  child's  conflicting  feelings  about  ag- 
gression bring  about  problems  in  learning. 

3.  The  function  of  self-esteem  in  promoting  or  im- 
peding the  motivation  to  work  at  school  or  the  capac- 
ity to  adapt  socially  to  the  school  community. 

4.  Awareness  of  phase-specific  develoj^mental 
characteristics  as  essential  for  gauging  the  pressure 
of  frustration,  the  degree  of  anxiety  tolerance,  the 
function  of  daydreaming,  and  the  significance  of 
adolescent  reactions  in  a  particular  child. 

5.  The  role  of  cultural  and  developmental  de- 
terminants in  facilitating  or  blocking  a  fruitful  alli- 
ance between  pupils  and  teachers. 

6.  The   assessment  of  the  effects   on   the   child's 


leanTLing  and  behavior  of  a  temporary  or  permanent 
physical  handicap  as  a  challenge  for  innovating  edu- 
cational experiences. 


In 


conclusion 


We  believe  that  our  experience  over  the  past  10 
years  in  collaborating  with  educators  in  group  dis- 
cussions has  i^rovided  an  effective  exchange  of  knowl- 
edge about  children  and  their  families. 

Some  of  the  most  important  results  of  this 
exchange  are: 

1.  An  enrichment  and  refinement  of  knowledge 
among  the  educators  and  clinicians  alike  about  what 
jiromotes  and  what  interferes  with  a  child's  capacity 
to  learn  and  develop  in  school. 

2.  A  greater  clarification  of  the  distinctions  in 
functions,  methods,  and  content  between  the  fields  of 
pedagogy  and  of  psychiatric  clinical  services  for  chil- 
dren ;  and  a  greater  awareness  of  where  they  overlap 
in  knowledge  of  and  concern  for  children  and  their 
families. 

3.  A  heightened  awareness  of  the  advantages  of 
viewing  the  first  years  of  a  teacher's  work  as  an 
internship  requiring  supervision  and  conferences  for 
the  continuing  development  of  competence,  creativ- 
ity, and  work  satisfaction. 

4.  \  clearer  understanding  of  some  of  the  psycho- 
logical factors  that  determine  the  formation  of  alli- 
ances between  teachers  and  their  pupils. 

On  the  basis  of  these  experiences  we  are  planning 
a  more  systematic  and  comprehensive  collaboration 
with  educators  for  assuring  the  availability  to  teach- 
ers of  those  elements  of  clinical  knowledge  that  can 
serve  the  pi'imary  aims  of  education. 


'  Solnit.  Albert  J.;  Senn,  Milton  J.  E.:  Teaching  comprehensive 
pediatrics  in  an  out-patient  clinic.     Pediatrics,  November  1954. 

"  Solnit,  Albert  J.;  Stark,  Mary  H.:  Pediatric  management  of  school 
learning  problems  of  under-achievement.  T/ie  New  England  Journal 
of  Medicine,  November  12,  1959. 

^  Doris,  J.;  Solnit,  Albert  J.:  Treatment  of  children  with  brain  damage 
and  associated  school  problems.  Journal  of  tile  American  Academy  of 
Child  Psychiatry,  October  1963. 

'Freud,  Anna:  Some  thoughts  about  the  place  of  psychoanalytic 
theory  in  the  training  of  psychiatrists.  Bulletin  of  the  Menninger 
Clinic,  July  1966. 


24 


CHILDREN     •     JANUARY-FEBRUARY  1967 


A  FAMILY 

PEDIATRIC 

CLINIC 


at  a  community  hospital 


MILTON  MARKOWITZ,  M.D.  #  LEON  CORDIS,  M.D. 


In  recent  years,  increased  medical  attention 
has  focused  not  only  on  new  diagnostic  and 
tliorapeutic  techniques,  but  also  on  the  means 
of  increasing  the  availability  of  these  advances  to  the 
patient.  It  has  become  increasingly  clear  that  prog- 
ress in  techniques  has  not  been  matched  by  com- 
pai'able  progress  in  dispensing  these  benefits  to  the 
American  public.  Nowhere,  perhaps,  is  the  gap  be- 
tween medical  knowledge  and  its  general  application 
more  apparent  than  in  the  care  of  the  medically  indi- 
gent, ambidatory  patient.  While  communities  have 
usually  provided  in  some  way  for  hospital  care  for 
the  indigent,  support  for  the  medical  care  of  ambu- 
latory patients  has  been  meager.  But  even  where  the 
financial  barriers  to  care  have  been  lessened  through 
Federal  or  State  aid,  patients  are  still  confronted 
with  a  major  obstacle  to  good  care — fragmentation 
of  services. 

This  fragmentation  is  the  result  of  a  A'ariet_v  of 
factors.  Modern  subspecialization  within  specialties 
such  as  pediatrics  has  resulted  in  the  proliferation  of 
clinics,  so  that  to  receive  complete  care  the  patient 
must  often  be  seen  by  many  different  medical  special- 
ists, frequently  on  different  days  of  the  week.  Fur- 
thermore, in  clinics  attached  to  teaching  hospitals, 
the  system  of  rotating  house  staff  results  in  lack  of 
continuity  in  patient  care.    In  this  system,  there  is 


generally  no  single  physician  who  is  responsible  for 
the  total  care  of  the  patient  and  therefore  little  co- 
ordination among  the  physicians  caring  for  parts  of 
the  patient's  problem. 

Such  fragmentation  of  care  is  most  pronounced — ■ 
and  most  detrimental — in  the  care  of  the  chronically 
ill.  It  can  be  especially  detrimental  in  the  care  of  a 
chronically  ill  child.  The  impact  of  chronic  illness 
is  often  more  serious  on  a  young  patient  tlian  on  an 
adult,  since  in  a  child  the  illness  coincides  with  im- 
portant developmental  changes.  Moreover,  respon- 
sibility for  a  child's  long-term  care  rests  not  with  him, 
but  with  his  parents  who  are  often  burdened  with  the 
care  of  other  children  and  so  have  difficulty  in  taking 
the  child  to  several  different  clinics.  In  addition, 
when  chronic  illness  occurs,  particularly  among  the 
indigent,  a  cyclical  process  is  initiated:  The  impact 
of  long-term  illness  in  the  family  often  exacerbates 
many  existing  psychosocial  problems  that  in  turn 
intei-fere  with  the  ability  of  parents  to  care  ade- 
quately for  their  chronically  ill  child. 

In  an  effort  to  attack  some  of  the.se  problems  and 
to  improve  and  coordinate  the  medical  care  of  chroni- 
cally ill  children,  the  Sinai  Hospital,  a  voluntary 
hospital  in  Baltimore,  established  a  Family  Pediatric 
Clinic  in  liKi:^..  Initialed  with  a  grant  from  the 
Thomas  Wilson  Foundation  and  now  supported  by 


VOLUME  14  -  NUMBER  1 


25 


the  Children's  Bureau,  the  clinic's  primary  objective 
is  to  provide  family -centered  pediatric  care  to  fam- 
ilies with  a  chronically  ill  child.  Recognizing  the 
importance  of  the  family  as  the  basic  social  unit  in 
providing  medical  care,  the  clinic  offers  total  health 
care  for  all  the  children  in  the  family  as  well  as  for 
the  chronically  ill  child. 

Since  Sinai  Hospital  is  a  teaching  hospital,  another 
major  objective  of  the  clinic  is  to  provide  pediatri- 
cians in  training  with  the  kinds  of  experiences  they 
are  most  likely  to  encounter  in  their  future  pediatric 
practice. 

In  recent  years,  there  has  been  increasing  concern 
over  the  inconsistency  between  the  training  tiiat 
pediatricians  receive  during  their  hospital  residency 
and  the  problems  they  subsequently  encounter  in  car- 
ing for  children  in  the  community.  The  chief  reason 
for  this  inconsistency  is  that  today  pediatricians  in 
this  country  are  being  trained  almost  entirely  at  large 
university  centers.  Because  these  institutions  at- 
tract many  patients  who  have  complex  medical  prob- 
lems, the  young  physician's  learning  experience  often 
is  based  primarily  on  unusual  and  esoteric  cases  and 
on  relatively  few  of  the  more  common  conditions  seen 
in  practice.  Such  experience  with  complex  medical 
problems  is,  of  course,  invaluable  for  understanding 
disturbed  physiology.  It  sharpens  the  young  physi- 
cian's iDowers  of  observation,  and  develops  an  inquir- 
ing mind.  However,  as  Dr.  John  Paul  of  Yale  Uni- 
versity said  15  years  ago,  "Sick  people  at  hospitals 
are  isolated  specimens  .  .  .  segregated  from  their 
en^'ironment,  removed  from  the  circumstances  from 
which  they  became  ill,  and  separated  from  their  fam- 
ilies."   Wrote  Dr.  Paul: 

All  of  [this}  is  done  to  create  a  proper  atmosphere  of  diag- 
nostic study  and  careful  management  on  the  physician's  part, 
free  of  outside  distractions.  It  may  be  trite  to  point  out  that 
these  outside  distractions  are  the  very  thing  which  the  modern 
doctor  needs  to  study,  also.  In  order  for  us  to  handle  patients 
accurately,  it  is  necessary  to  bring  clinical  judgment  to  bear  not 
only  on  the  patient,  but  also  on  the  circumstances  under  which 
his  illness  arose.' 

Dr.  Paul's  comments  have  at  least  as  much  relevance 
today  as  when  they  were  written.  Moreover,  the 
more  scientific  and  the  more  automated  the  hospital 
centers  become,  the  less  emphasis  is  likely  to  be  placed 
on  teaching  doctors  the  broad  aspects  of  medical 
practice. 

As  a  hospital  resident,  the  pediatrician  is  naturally 
involved  with  the  immediate  illness.  His  contacts 
with  the  patient's  family  are  brief.  He  rarely  obtains 
an  adequate  family  history  and,  therefore,  has  only  a 


limited  awareness  of  the  family  milieu  and  the  social 
conditions  to  which  the  patient  returns  following  dis- 
charge. 

However,  most  pediatric  patients  never  need  admis- 
sion to  the  hospital  as  inpatients.  It  is  now  gener- 
ally acknowledged  by  medical  educators  that  the 
pediatrician's  training  in  care  of  the  sick  in  the  hos- 
pital must  be  supplemented  by  experience  with  am- 
bulatory patients.  But  simply  allocating  more  of 
the  resident  physician's  time  to  a  crowded,  uncom- 
fortable clinic  or  emergency  room  does  not  solve  the 
problem  because,  mif ortunately,  the  scope  of  training 
in  many  outpatient  departments  is  still  very  narrow. 
Much  of  the  teaching  is  carried  out  in  a  specialty 
clinic  environment  by  pediatric  subspecialists  who, 
although  experts  in  their  particular  fields,  do  not 
have  the  time  for,  or  the  interest  in,  the  broader 
aspects  of  child  and  family  care.  Moreover,  the  sys- 
tem of  scheduling  the  clinic  physicians  make  it  diffi- 
cult for  them  to  gain  any  long-term  experience  in 
guiding  the  physical  and  emotional  development  of 
children,  in  counseling  in  social  and  psychological 
problems,  and  in  the  use  of  community  resources. 

In  recognition  of  these  deficiencies,  the  American 
Board  of  Pediatrics  has  recommended  an  additional 
year  of  training  for  pediatricians,  after  the  2-year 
hospital  residency,  to  be  focused  on  problems  of 
behavior,  of  school  and  family  life,  and  of  chronic 
and  handicapping  illness — training  to  be  gained  "in 
contact  with  other  community  health  resources."  ' 

With  these  considerations  in  mind,  the  Family 
Pediatric  Clinic  at  Sinai  Hospital  has  been  organized 
to  serve  as  an  active  training  and  teaching  instrument 
for  pediatricians  in  training,  integrated  with  the  total 
training  opportunities  provided  by  a  community  hos- 
pital for  physicians  as  well  as  paramedical  staff. 

How  the  clinic  operates 

Families  are  admitted  to  the  Family  Pediatric 
Clinic  if  they  meet  the  following  qualifications :  (1) 
the  presence  of  a  chronically  ill  child  in  the  family ; 
(2)  evidence  of  medical  indigency ;  and  (3)  residence 
in  the  census  tracts  that  Sinai  Hospital  serves. 

The  clinic  is  directed  by  the  hospital's  assistant 
pediatrician-m-chief  and  is  staffed  by  a  pediatrician 
in  trainmg  (family  pediatric  fellow),  two  part-time 
staff  pediatricians,  a  public  health  nurse,  a  social 
worker,  a  clinical  psychologist,  and  a  speech  thera-  ■ 
pist.  Psychiatric  services  are  available,  when 
needed,  from  a  part-time  psychiatrist  on  the  Family 
Pediatric  Clinic  staff. 


26 


CHILDREN     •     JANUARY-FEBRUARY  1967 


The  clinic  differs  in  several  respects  from  Inidi- 
tional  hospital  outpatient  services.  In  the  lirst 
place,  it  does  not  focus  on  any  one  chronic  disease, 
origan,  or  particular  condition.  Chronic  disease  is 
not  viewed  jiriniarily  as  a  matter  of  classification, 
descriptive  pliysical  lindings,  or  an  array  of  labora- 
toi-y  tests,  but  rather  as  a  handicapping  condition  that 
demands  a  careful  assessment  of  the  social,  educa- 
tional, and  emotional  impai't  on  tlie  chilil  and  his 
family.  Moreover,  the  Family  Pediatric  Clinic  is 
concerned  not  only  with  treatment  of  the  illness,  but 
also  witli  the  maintenance  of  lieallli  in  the  bi-oadest 
possible  terms.  Its  care  begins  with  a  health  ap- 
praisal of  all  tlio  children  in  tlie  family  by  tlie  resi- 
dent physician,  public  healtli  nurse,  and  social 
worker.  Much  of  this  care  consists  of  preventive 
services.  However,  wlien  acute  illness  does  occur, 
care  of  the  patient  involves  an  appreciation  of  the  ef- 
fect of  the  illness  on  family  function,  rather  than  a 
limited  disease-oriented  approach. 

An  effort  is  made  to  select  those  cases  in  wliich  a 
multi disciplinary  approach  to  health  care  would  aj)- 
pear  to  be  most  beneficial.  These  include  families  in 
which  social  pi-oblems  seem  likely  to  prevent  success- 
ful medical  management  as  well  as  families  in  which 
the  chronic  illness  seems  to  lie  an  intolerable  burden 
added  to  already  overwhelming  social  jiroblems. 
Thus,  prior  to  accepting  a  referred  family  into  the 
program,  the  clinic  staff  surveys  the  medical,  social, 
and  emotional  aspects  of  its  problems  by  reviewing 
material  from  the  refen-ing  clinic  or  social  agency, 
by  personal  interviews,  and  by  discussions  in  staff 
conferences. 

In  those  families  accepted  for  care,  all  medical  care 
for  the  children,  both  in  the  clinic  and  at  home,  is  pro- 
vided by  the  family  pediatric  fellow.  Regular  clinic 
sessions  meet  four  times  weekly  for  scheduled  ap- 
pointments. In  addition,  the  clinic  is  open  for  walk- 
in  visits  throughout  the  week.  Night  and  weekend 
service  is  provided  on  a  24-hour  basis  by  telephone 
and,  when  needed,  by  home  visits.  At  least  one 
scheduled  home  visit  is  made  to  each  new  family  by 
the  fellow,  who  makes  subsequent  visits,  when 
needed,  in  times  of  acute  illness. 

Each  clinic  session  is  conducted  by  the  family  pedi- 
atric fellow  and  the  public  health  nurse.  The  public 
health  nurse  makes  a  health  survey  of  each  new  fam- 
ily through  clinic  interviews  and  a  home  visit.  The 
parents  in  each  family  are  seen  by  the  social  worker 
initially  and  as  indicated  thereafter.  In  the  initial 
interview,  the  social  worker,  in  talking  with  the 
parents  for  the  purpose  of  social  evaluation,  describes 

VOLUME  14  -  NUMBER  1 


The   family   pediatric   fellow   at   the   Sinai   Hospital   takes   the 
blood   pressure   of   a   young   patient   whose   brother   looks   on. 


the  functions  of  the  clinic  to  eacli  new  raiiiily  and  pro- 
vides them  witli  an  instniction  pampldet  for  the 
patients,  prepared  by  the  staff. 

In  providing  comjilete  medical  rare  for  :ill  the 
children  in  each  family,  the  family  pediatrii-  fellow 
becomes  in  essence  the  family  pediatrician.  Consul- 
tants in  other  specialties  are  called  upon  when  needed. 
"Wlien  this  is  done,  the  fellow  is  either  present  during 
the  specialist's  visit  or  in  close  communication  with 
the  consultant  so  that  the  specialist's  reconnuenda- 
tions  can  be  integrated  into  a  total  health  program 
foi-  the  family  on  a  continuous  basis. 

Through  his  visits  to  the  home,  the  fellow  gains  a 
firsthand  impression  of  the  environment.  He  de- 
velops a  greater  understanding  of  intrafamily  l)e- 
havior,  learns  to  identify  tlie  areas  of  strength  in  eacli 
family,  and  becomes  better  able  to  counsel  them  in 
times  of  stress.  In  tlie  day-to-day  operations  of  the 
Family  Pediatric  Clinic,  he  works  closely  with  the 
other  membei-s  of  the  clinic's  staff. 

Through  frequent  discussions  of  specific  problem.s, 
team  members  continuously  reappraise  tlieir  work 
with  each  family  and  coordinate  their  efforts.  Thus, 
when  family  crises  arise,  as  they  fretpiently  do  in  a 
clinic  i)opulation,  the  physician  is  in  a  position  to 
more  effectively  bring  to  bear  the  special  skills  of 


27 


the  various  staff  members  on  a  particular  problem. 
For  example: 

The  S  family  was  admitted  to  the  Family  Pediatric  Clinic 
because  of  a  5 -year-old  child  with  heart  disease.  During  the 
long-term  management  of  this  family,  a  crisis  developed  when 
an  older  brother  was  taken  to  court  because  of  truancy.  Eval- 
uation by  the  social  worker  and  the  psychologist  revealed  that 
this  older  boy's  problem  was  one  of  school  phobia  that  was 
being  aggravated  by  disturbed  interpersonal  relationships  in 
the  family.  This  realization  enabled  the  family  pediatric 
fellow  and  other  staff  members  to  work  constructively  with 
the  family  and  the  school  in  trying  to  manage  this  child's 
problem. 

Since  the  clinic  places  primary  emphasis  on  the 
structure  and  fmiction  of  families,  tlie  social  worker 
plays  a  vital  role  in  the  clinic's  work.  In  most  of  the 
clinic's  families,  health  and  social  problems  are 
closely  entwined.  Since  the  families  come  regularly 
to  the  clinic,  the  social  worker  has  a  satisfying  oppor- 
tunity to  do  casework  over  a  period  of  many  months 
and  even  years.  She  is  able  to  evolve  a  deeper  under- 
standing of  individual  and  family  problems  and  thus 
determine  whether  patient  and  family  can  best  be 
served  by  concrete  casework  assistance  or  by  counsel- 
ing. The  social  worker  coordinates  the  efforts  of 
other  staff  members  in  working  with  families  and 
helps  the  members  of  the  team  to  see  the  social  im- 
plications of  the  medical  problems  that  come  to  their 
attention.    For  example: 

The  M  family  came  to  the  clinic's  attention  because  of  a 
young  child  who  had  been  unsuccessfully  treated  for  severe 
eczema  in  several  hospitals.  The  intake  interview  by  the  social 
worker  of  the  Family  Pediatric  Clinic  revealed  that  the  father 
had  chronic  alcoholism  that  had  led  to  serious  marital  discord. 
The  social  worker's  support  of  the  mother  in  dealing  with  her 
husband's  problem  helped  stabilize  the  home.  This  stabiliza- 
tion was  accompanied  by  major  improvement  in  the  child's 
eczema  that  was  not  effected  previously  by  medical  therapy 
alone. 

The  public  health  nurse  attached  to  the  clinic  pro- 
vides both  well-child  and  sick-care  nursing  during 
clinic  sessions.  She  also  sees  each  family  at  home 
initially  and  at  regular  intervals  for  foUowup  as  in- 
dicated. She  heliDS  to  introduce  many  of  the  Family 
Pediatric  Clinic's  services  to  the  patients  and  in- 
creases the  effectiveness  of  the  staff's  recommenda- 
tions by  interpreting  them  to  the  families.  She  not 
only  plays  an  important  role  in  patient  care  by 
bridging  the  gap  between  hospital  and  home,  but  she 
also  keeps  the  hospital's  regular  staff  members  and 
student  nurses  to  increase  their  understanding  of  the 
effects  of  family  and  environmental  factors  on  cliild 
development. 


We  have  often  found  that  apparently  healthy 
brothers  and  sisters  of  tlie  clironically  ill  child  have 
medical  and  other  kinds  of  problems,  particularly 
in  the  areas  of  behavior  and  learning  difficulties. 
These  children,  therefore,  seem  to  represent  a 
high-risk  population  to  wliich  more  intensive  medi- 
cal services  sliould  be  directed  in  all  pediatric  clinics 
that  deal  with  chronically  ill  cliildren.  One  example 
among  many  is  the  D  family,  which  was  referred  to 
the  Family  Pediatric  Clinic  because  of  a  child  with 
pica  and  fi-equent  respiratory  mfections.  In  exam- 
ining the  other  children  in  tlie  family  the  clinic  found 
that  an  apparently  healthy  brother  had  primary 
tuberculosis  and  severe  school  problems  as  well. 

Tlie  clinical  psychologist  has  played  a  vital  role 
in  tlie  program.  Because  of  the  frequency  of  be- 
havioral and  learning  problems  found  in  these  fam- 
ilies, many  of  our  children  require  psychologic  eval- 
uation. The  psychologist  also  counsels  the  parents 
about  child-rearing  practices  that  contribute  to  learn- 
ing difficulties  and  also  works  with  staff  members 
from  the  schools  in  the  area.  In  addition,  he  pro- 
vides consultation  to  the  family  pediatric  fellow, 
the  public  health  nurse,  and  the  social  worker,  all 
of  whom  also  counsel  parents  in  relation  to  child- 
rearing  practices. 

Regular  staff  conferences  are  held  three  times  a 
week.  They  are  designed  to  accomplish  several  ob- 
jectives: (1)  to  consider  and  make  decisions  on  pros- 
pective admissions;  (2)  to  stimulate  staff  discussion 
in  the  direction  of  a  unified  family  treatment  plan; 
(3)  to  review  periodically  the  impact  and  effective- 
ness of  our  service;  and  (4)  to  provide  a  forum  for 
teaching.  Teaching  conferences  are  lield  for  hospital 
and  community  personnel  during  which  the  health 
l^roblems  of  one  family  are  presented  in  great  detail. 
These  teacliing  conferences  are  in  essence  medical- 
social  grand  rounds  for  the  hospital.  They  are  at- 
tended by  30  to  40  people,  including  hospital  staff 


i«F 


Milton  Markowitz,  left,  Is  di- 
rector and  Leon  Cordis  Is 
associate  director  of  the 
pediatric  clinic  they  describe 
in  this  article.  Both  are  also 
with  The  Johns  Hopkins  Uni- 
versity School  of  Medicine, 
where  Dr.  Markowitz  is  asso- 
ciate professor  of  pediatrics  and  director  of  children's  rheu- 
matic clinics  and  Dr.  Cordis  is  an  instructor  in  pediatrics, 


28 


CHILDREN     •     JANUARY-FEBRUARY  1967 


uid  student  nurses,  house  ofRcere,  social  workers,  and 
;onununity  visitors.  To  demonstrate  the  value  of 
ising  comniuuity  resources  in  meeting  tlie  needs  of 
jliildron,  key  personnel  from  community  agencies  are 
)fton  invited  as  discussants. 

Experience  to  date 

Thus  I'ar,  the  Family  Pediatric  Clinic  lias  admitted 
3ver  80  families  with  a  total  of  250  children.  Many 
of  tlie  families  have  been  referred  from  the  hospital's 
inpatient  service,  its  regular  pediatric  clinic,  or  its 
pediatric  specialty  clinics.  Patients  have  also  been 
referred  from  the  hospital's  recently  established  ge- 
netics counseling  unit  as  well  as  from  outside  the  hos- 
pital— from  schools,  the  courts,  and  the  Division  of 
Protective  Services  of  the  State  Department  of  Pub- 
lic Welfare.  In  1965,  there  were  over  1,000  visits 
made  to  or  by  the  family  pediatric  fellow,  893  in  the 
outpatient  department  and  125  at  patients'  homes. 
This  pliysician  also  participated  in  numerous  tele- 
phone consultations. 

Many  of  the  families  served  by  the  Family  Pedia- 
tric Clinic  have  undergone  significant  environmental 
changes  since  their  admission  to  the  program. 
Through  the  efforts  of  the  clinic's  social  worker,  some 
parents  have  secured  job  retraining  and  employment 
so  that  they  have  either  already  moved  otf  the  public 
assistance  rolls  or  shown  potential  for  doing  so. 
Some  have  been  helped  to  secure  improved  housing 
which  has  had  a  pronounced  beneficial  effect  on  the 
health  of  the  chronically  ill  child,  as  well  as  on  all 
the  children  in  the  family. 

In  addition  to  the  benefits  it  provides  directly  to  its 
patients,  the  Family  Pediatric  Clinic  has  provided 
a  valuable  educational  experience  in  family-oriented 
care  for  its  staff,  especially  for  the  pediatrician  in 
training.  The  fellow  has  the  opportunity  to  follow 
a  number  of  families  continuously  during  the  12- 
month  period  of  his  training  in  the  clinic.  Thus,  lie 
can  not  only  watch  the  growth  and  behavioral  pat- 
terns of  children  and  the  coui'se  of  chronic  illness,  but 
also  sense  the  develoiDment  of  his  own  relationship 
with  these  families.  Because  there  is  often  a  need 
to  involve  other  agencies,  he  comes  in  close  contact 
with  other  community  resources,  such  as  schools,  the 
voluntary  family  service  agency,  and  the  local  de- 
partment of  welfare.  Tliough  many  of  these  re- 
sources are  alreadj'  well  known  to  the  social  worker 
and  public  health  nurse,  for  the  physician  it  is  an 
educational  experience  not  usually  otherwise  obtained 
during  iiis  training  yeai"s. 


In  addition  to  its  educational  effect  on  its  own 
staff,  the  Family  Pediatric  Clinic  has  had  a  noticeable 
effect  on  the  regular  hospital  staff  not  directly  in- 
volved in  its  program,  especially  in  the  hospital's  de- 
partments of  pediatrics  and  psycliiatry.  Since  the 
clinic's  establishment,  many  of  the  hospital's  clini- 
cians and  nurees  have  exhibited  a  new  awareness  of 
the  social  implications  of  disease.  The  clmic's  weekly 
teaching  conferences  .are  v.ell  attended  by  the  physi- 
cians, nurses,  and  social  workers  of  the  hospital's 
other  clinics  as  well  as  by  student  nurses.  An  in- 
creasing number  of  i-eferrals  to  tlio  clinic  are  coming 
from  staff  members  in  other  departments  of  the 
hospital. 

While  at  tlie  present  time  the  Family  Pediatric 
Clinic  chiefly  involves  staff  members  from  the  hospi- 
tal's departments  of  pediatrics  and  psychiatry,  it  is 
hoped  that  other  departments  in  the  hospital  will 
participate  in  it  as  time  goes  on. 

One  of  the  great  advantages  of  the  program  of  the 
Family  Pediatric  Clinic  is  the  fact  that  it  is  housed 
and  operated  in  the  regular  outpatient  department  of 
the  hospital.  In  this  way,  members  of  the  medical 
and  paramedical  staff  not  directly  associated  with  the 
program  learn  to  consider  it  an  integral  part  of  the 
hospital's  outpatient  services  rather  than  an  extra- 
neous project.     Thus,  the  clinic's  program  has  had 


Case  conference  at  the  Family  Pediatric  Clinic.  Left  to  right: 
family  pediatric  fellow,  public  health  nurse,  social  worker, 
psychologist,  and  the  associate  director  of  the  clinic. 


VOLUME  14  -  NUMBER  1 


29 


a  much  more  profound  and  extensive  influence  on 
members  of  the  hospital  staff  than  it  could  have  had 
had  it  been  separated  in  its  own  physical  unit. 

Problems  and  the  future 

One  of  the  main  operational  problems  confronting 
the  Family  Pediatric  Clinic  has  been  the  provision 
of  medical  care  to  the  parents  of  the  children  served. 
Since  Children's  Bureau  funds  are  restricted  to  ma- 
ternal and  child  care,  it  has  been  difficult  for  the 
clinic  to  provide  the  services  of  specialists  iu  adult 
medicine,  not  only  for  the  general  preventive  medi- 
cal services  needed  by  some  parents,  but  also  to  care 
for  their  episodic  illnesses.  Such  services  have  been 
made  available  by  referring  the  patients  to  other 
hospital  clinics,  at  Sinai  Hospital  or  elsewhere,  but 
the  ideal  of  total  comprehensive  family  medical  care 
has  not  been  realized. 

Anotlier  major  problem  is  presented  by  difficulties 
in  interagency  communication.  Families  with  a 
chronically  ill  child  often  appeal  to  various  com- 
munity agencies  for  help  with  their  complex  social 
problems.  In  many  communities,  services  are  com- 
partmentalized and,  therefore,  do  not  deal  with  the 
total  family  as  an  integrated  unit.  Since  each  agency 
sees  only  its  part  of  the  family  problem  and  since 
communication  between  agencies  is  often  inadequate, 
a  family  not  infrequently  receives  conflicting,  and  at 
times  diametrically  opposite,  advice  from  different 
sources.  As  a  consequence,  the  parents  of  chronically 
ill  children  often  become  suspicious  or  completely 
alienated  toward  all  health  and  welfare  agencies. 

During  the  past  year,  the  Family  Pediatric  Clinic 
established  close  working  relationships  with  several 
public  schools  in  the  hospital  district.  As  a  result, 
the  family  pediatric  fellow,  the  psychologist,  the 
social  worker,  and  the  nurse  visit  these  schools  fre- 
quently and  confer  with  principals,  teachers,  and 
guidance  counselors  on  specific  cases  as  well  as  on  gen- 
eral problems  which  are  of  mutual  concern.  Ef- 
forts to  work  closely  with  local  community  resources 
will  be  expanded  this  year.  Nevertheless,  there  is 
need  for  considerable  improvement  in  the  clinic's 
communications  with  other  agencies.  For  example, 
because  caseworkers  of  the  State  Dei^artment  of  Pub- 
lic Welfare  are  burdened  by  enormous  caseloads 
which  preclude  their  going  deeply  into  the  many 
problems  of  the  families  they  serve,  they  do  not 
always  collaborate  with  the  clinic  fully  on  all  aspects 


of  a  family's  problem.  We  have  found,  however,  that 
having  our  weekly  teaching  conferences  open  to  the 
staff'  of  other  commmiity  agencies  has  helped  im- 
prove our  working  relationship  with  many  staff'  mem- 
bers of  the  city  welfare  department  and  other  com- 
munity agencies  in  addition  to  stimulating  referrals 
from  them. 

A  question  might  be  raised  in  regard  to  the  feasi- 
bility of  applying  the  Family  Pediatric  Clinic  ap- 
proach on  a  community- wide  basis.  We  have  been 
able  to  work  intensively  with  our  families  because 
of  the  relatively  small  load  of  jjatients  admitted  to 
the  clinic.  Efforts  to  extend  this  type  of  care  to  the 
community  at  large  inevitably  must  be  restricted  by 
both  financial  considerations  and  severe  shortages  of 
skilled  professional  personnel.  Nevertheless,  many 
of  the  principles  involved  in  the  Family  Pediatric 
Clinic  can  be  applied  on  a  larger  scale. 

In  fact,  these  principles  are  being  applied  in  the 
new  centers  for  the  comprehensive  health  care  of 
preschool  and  school-age  children  that  are  now 
being  established  in  low-income  areas  of  Baltimore 
by  the  Baltimore  City  Health  Department  and  four 
teaching  hospitals,  with  support  from  the  Children's 
Bureau  under  a  1965  amendment  to  the  Social  Secu- 
rity Act.'  Sinai  is  one  of  these  participating  hospi- 
tals, and  two  pediatricians  who  have  been  fellows  in 
its  Family  Pediatric  Clinic  are  now  working  in  the 
comprehensive  pediatric  center  which  it  administers 
under  this  program.  Their  experience  in  the  Family 
Pediatric  Clinic  will  be  of  great  value  in  making  this 
now  project  effective. 

Our  experience  at  Sinai's  Family  Pediatric  Clinic 
demonstrates  that  total  health  care  of  the  child  ex- 
tends into  many  areas  outside  the  medical  field,  espe- 
cially into  the  fields  of  public  welfare  and  education. 
We  believe  that  for  such  care  to  be  optimal,  the  health 
provisions  of  all  services  should  be  coordinated  under 
medical  leadership.  Moving  beyond  the  hospital 
walls  into  a  vital  interest  in  all  aspects  of  a  child's 
life  should  not  be  considered  a  new  departure  for 
pediatricians,  but  rather  an  integral  part  of  their 
commitment  to  child  health  care  in  its  broadest  sense. 


'  Paul.  J.  R.:  Preventive  medicine  at  Yale  University  School  of  Medi- 
cine,  1940-49.     Yah  Journal  of  Biology  and  Medicine,  January  1950. 

°  American   Board   of  Pediatrics:   Changes  in   training   requirements 
for   board   examination.     Pediatrics,  May   1966. 

'  Social  Security  Act,  Title  V,  Sec.  532. 


30 


CHILDREN     •     JANUARY-FEBRUARY  1967 


n 


a  measuring  rod  for 


an  essay  review 


JUVENILE  AND  FAMILY  COURTS 


MARGARET    K.    ROSENHEIM      Professor,  School  of  Social  Seri'ice  Adminislration,  University  of  Chicago 


•  Xotable  are  the  i>ublicalicins 
tliat,  after  12  years  in  circula- 
tion, are  deemed  worthy  of  revi- 
sion, rather  than  replacement.  "Stand- 
ards for  Juvenile  and  Family  Courts"  * 
is  in  receipt  of  just  such  a  prestigious 
distinction.  It  is  an  updated  and 
slightly  altered  version  of  the  1954 
"JStandards  for  Specialized  Courts  Deal- 
ing with  Children," '  and  anyone  ac- 
(luainted  with  this  earlier  work  can  see 
why  a  thorough  review  b.y  many  exjierts 
resulted  in  a  revision  instead  of  a  totally 
fresh  effort. 

The  Children's  Bureau  has  always 
had  an  active  interest  in  the  study  of 
juvenile  courts  and  the  promotion  of  the 
l)est  modern  practices  in  these  courts. 
Its  concern  has  broadened  over  the 
years  to  include  family  courts.  The 
title  of  the  new  "Standards"  reflects  not 
only  inclusion  of  principles  applicable  to 
courts  with  a  family-oriented  jurisdic- 
tion, but  also  a  bias  in  favor  of  their 
establishment.  The  document  retains, 
however,  an  emphasis  on  the  more 
ubiquitous  juvenile  court. 

Perhaps  it  is  imi>ortant  to  specify 
what  the  new  publication  is  not.  It  does 
not  provide  detailed  exixisition  of  the 
many  vexing  issues  both  juvenile  and 
family  courts  confront.  It  does  not  pro- 
pose particular  legislative  language — a 


•Sheridan,  William  H.:  Standards  for  Juven- 
ile and  Family  Courts.  (Prepared  in  coopera- 
tion with  the  National  Council  on  Crime  and 
Delinquency  and  the  National  Council  of 
Juvenile  Court  Judges.)  Department  of 
Health,  Education,  and  Welfare,  Welfare  .'\d- 
ministration.  Children's  Bureau.  CB  Publica- 
tion No.  -137.  1966.  130  pp.  45  cents.  (For 
sale  by  the  Superintendent  of  Documents,  Gov- 
ernment Printing  Ofhce,  Washinjiton,  D.C., 
20-102. ) 


task  already  undertaken  l)y  the  National 
Council  on  Crime  and  Delinquency  with 
the  result  that  six  editions  of  a  Stand- 
ard Juvenile  Court  Act  were  produced 
between  1925  and  19.59.  Nor  does  the 
"Standards  for  Juvenile  and  Family 
Courts"  offer  a  summary  of  the  laws  and 
practices  of  the  many  juvenile  courts, 
full  and  part  time,  in  the  United  States. 

The  purjiose  of  the  pul)lication  is  to 
expound  the  principles  of  Juvenile  and 
family  courts  and  to  set  forth  the  proce- 
dures and  practices  endorsed  by  a  group 
of  experts  as  reasonable  goals  for  all 
courts.  Thus,  it  draws  from  what  is 
best  in  the  courts  today  and  presents 
guidelines  for  tomorrow.  In  doing  so, 
the  publication  aims  at  a  diversified  au- 
dience, not  only  judges  and  others  in 
regular  contact  with  the  courts,  but  also 
"all  persons  interested  in  improving  the 
juvenile  and  family  courts  of  their  com- 
munities." Therefore,  it  seeks  to  state 
the  most  important  propositions  for  a 
wide  readership  rather  than  to  go  into 
detail  and  extended  speculation. 

The  19.54  document  was  a  ground- 
breaking statement  in  support  of  a  modi- 
fled  due-process  model  of  juvenile 
courts.  It  appeared  at  a  time  when  a 
revival  of  concern  for  juvenile  court 
operations  was  jti.st  under  way,  for  in 
1954 — as  compared  with  today — the 
number  of  knowledgeable  critics  and 
scholars  stiulying  this  institution  was 
small.  Widespread  critical  interest 
had  not  yet  developed. 

By  contra.st,  a  bibliographical  survey 
produced  toda.y  would  contain  hundreds 
of  items  representing  a  diversity  of  pro- 
fessional i»erspectives  and  ranging  from 
the  various  products  of  scholarship  to 
documents  hammered  out  in  the  heat 
of  controversy.  The  past  decade  has 
been  crammed  with  juvenile  court  ma- 


terials, bespeaking  a  wave  of  interest 
in  the  various  aspects  of  this  institu- 
tion unparalleled  since  the  days  of  its 
founding.  "Standards  for  Sijecialized 
Courts  Dealing  with  Children"  was  a 
foreruimer. 

Today's  "Standards  for  Juvenile  and 
Family  Courts"  appears  at  a  time  when 
consensus  has  developed  regarding 
most  of  the  basic  principles  espoused 
in  the  earlier  document.  It  appears, 
furthermore,  at  a  time  when  the  drama 
of  the  juvenile  court  movement  has 
shifted  from  seminars  and  conference 
rooms  to  legislative  halls  and  judicial 
chandlers,  including  the  Suiireme  (;ourt 
of  the  United  States.  Thus,  it  should 
be  reviewed  for  the  basic  soundness  of 
the  principles  and  recommended  prac- 
tices retained  from  the  1954  publica- 
tion and  of  the  modification  or  expan- 
sion of  aspects  that  have,  over  the  past 
12  years,  assumed  significance. 

I  regard  the  principles  in  the  19.54 
"Standards"  as  largely  sound.  The 
new  publication  retains  the  basic 
ones — some  in  strengthened  form.  The 
significance  of  both  versions  is  their 
clear  endorsement  of  the  practice  of  oi> 
crating  these  specialized  courts — 
whether  juvenile  or  fanul.v — in  con- 
formity with  the  requirements  of  the 
rule  of  law.  This  calls  for  empliasis 
on  the  judicial  character  of  the  insti- 
tution, but  it  does  not  preclude  the  use 
of  qualified  nonlegal  professional  prac- 
titioners whenever  legal  considerations 
are  subordinate  to  social  considerations. 

Due  process  c(  law 

As  lho.se  familiar  with  either  version 
of  the  "Standards"  must  realize,  the 
implications  of  this  commitment  to  due 
process  of  law  are  numerous  and  com- 


VOLUME  14  -  NUMBER  1 


31 


plex.  Police  handling  of  juveniles, 
the  function  of  family  or  juvenile  court 
intake,  the  conduct  of  court  hearings, 
the  place  of  the  specialized  court  with- 
in a  large  judicial  structure — these 
and  many  other  issues  must  be  resolved 
in  harmony  with  stated  ijrinciples  of 
individualized  justice. 

With  informality  a  slogan  of  many 
juvenile  court  judges  and  their  staffs, 
court  hearings  have  in  some  jurisdic- 
tions more  closely  resembled  case  con- 
ferences than  judicial  trials.  By  1954, 
it  was  beginning  to  be  recognized  that 
the  price  of  informality  was  abandon- 
ment of  certain  values  of  traditional 
courtroom  procedure.  Critics  cited  the 
thoughtless  departure  from  rules  of  evi- 
dence, the  illogic  of  proving  a  juvenile's 
need  for  State  supervision  prior  to,  or 
even  in  lieu  of,  proof  of  jurisdictional 
requirements  or  the  facts  of  an  alleged 
act.  They  also  cited  tlie  debasement  of 
intentionally  nonpublic  hearings  into 
summary  private  hearings  at  which  the 
participation  of  persons  with  legiti- 
mate interests  in  a  case — a  counsel,  a 
social  agency  representative,  a  school- 
teacher— depended  wholly  on  the  suf- 
ferance of  the  judge. 

In  short,  the  proper  protest  against 
having  the  criminal  court  handle  juve- 
nile offenders,  which  had  laid  the 
groundwork  in  1899  for  rapid  adoption 
of  a  specialized  court  for  children,  had 
resulted  in  sacrifice  of  the  values  of 
due  process  to  a  so-called  casework  or 
therapeutic  intervention  model.  Many 
Ijroponeuts  of  the  virtues  of  juvenile 
justice  had  chosen  to  ignore  the  i-eality 
of  authoritative  imposition  of  rules, 
regulations,  and  even  punishment  and 
the  stigmatizing  effect  of  adjudication 
as  a  "delinquent." 

Character  oF  hearing 

In  1954,  "Standards  for  Specialized 
Courts  Dealing  with  Children"  issued 
an  unrai.stakable  policy  pronouncement 
on  the  character  of  the  court  hearing. 
There  should  be  "two  separate  parts 
which  may  or  may  not  be  continu- 
ous .  .  ." : 

1.  The  hearing  of  the  evidence  neces- 
sary to  make  a  determination  as  to  the 
court's  jurisdiction  and  the  faas  alleged 
in  the  petition. 

2.  The  hearing  (if  the  court  should 
find  the  child  subject  to  its  jurisdiction) 
of  social  evidence,  including  recommen- 


dations of  the  probation  officer,  culmi- 
nating in  disposition  of  the  case. 

The  informality  of  the  hearing,  ac- 
cording to  this  i5olicy,  should  not  "mean 
that  the  court  ignores  rules  of  evidence 
or  fails  to  establish  procedures  for  its 
actions."  The  child's  parent,  other 
guardian  of  the  person,  or  guardian 
ad  litern  should  attend  the  hearing. 
Only  after  the  facts  alleged  in  the  peti- 
tion have  been  establi.shed  should  the 
court  move  to  the  second  part  of  the 
hearing  relating  to  disposition. 

By  these  recommendations  in  19.54, 
the  Children's  Bureau  squarely  endorsed 
the  principle  of  bifurcated  hearings  and 
certain  essentials  of  due  process — repre- 
sentation of  the  child's  interest  by  some 
related  or  specially  appointed  adult,  the 
right  of  parent  or  child  to  introduce 
witnesses  and  rebut  evidence,  and  em- 
phasis on  the  spirit  (if  not  the  legal 
letter)  of  procedural  regularity.  In  do- 
ing so,  the  Bureau  took  a  "harder"  stand 
in  favor  of  formality  than  was  evident 
at  the  time  in  many  courts,  in  the  lan- 
guage of  most  juvenile  court  acts,  or  in 
the  writings  of  other  standard-setting 
organizations. 

In  the  1966  "Standards"  a  greater 
spelling-out  of  procedural  details  is  ap- 
parent. This  is  hardly  surprising : 
Consensus  on  the  character  of  hearings 
(especially  in  contested  cases)  has 
grown  in  the  12-year  interim  and  the 
experience  with  more  formal  procedure 
in  specialized  courts  has  produced  ques- 
tions, and  demanded  answers,  on 
aspects  of  court  operation  previously 
seldom  recognized.  Evidentiary  stand- 
ards for  court  proceedings  are  now  more 
fully  stated ;  hearsay  is  inadmissible  in 
the  first  part  of  the  hearing  and  a  re- 
quirement of  "clear  and  convincing 
proof"  of  delinquency  is  impo.sed. 

One  earlier  position  is  reversed.  In 
1954,  the  "Standards"  stated :  "No  per- 
son in  the  court  should  assume  the  role 
of  prosecutor."      Now  we  are  told  : 

No  staif  memher  of  the  court  should 
assume  the  role  of  prosecutor.  This  fol- 
lows from  the  noncriminal  nature  of 
neglect  and  delinquency  proceedings. 
However,  an  attorney  to  represent  the 
State,  especially  in  contested  cases,  should 
be  available  to  the  court.  This  is  neces- 
sary in  order  to  prevent  the  judge  from 
being  placed  in  the  untenable  position  of 
being  a  party  to  the  proceedings.  ( Italics 
supplied. ) 


But,  notwithstanding  this  procedural 
emphasis,  the  draftsman  and  consul- 
tants on  the  1966  version  justifiably  re- 
tain their  faith  that  the  virtues  of  in- 
formality can  co-exist  with  the  require- 
ments of  order  and  dignity. 

...  It  should  not  be  forgotten  that 
the  real  nature  of  the  hearing  will  depend 
to  a  great  degree  on  the  ability  of  the 
judge  and  other  court  officials  to  convey 
the  court's  interest  in  the  child  and  his 
family  and  to  avoid  expressions  of  dis- 
gust, blame,  or  anger,  or  indifference. 

And,  I  would  add,  unless  we  find  a 
way  to  cope  with  the  volume  of  cases, 
the  effort  is  doomed.  Average  hearing 
times  of  7  to  10  minutes  per  case  allow 
no  room  for  "individualized  justice"  ! 

Some  compromise 

Necessarily,  a  standard-setting  docu- 
ment reflects  a  consensus — v,-hich  means 
compromise  and  complications  for  the 
reviewer.  The  1966  "Standards"  is  not 
what  I  would  have  written ;  it  is  pos- 
sibly not  what  its  author  or  his  consul- 
tants would  have  written  individually. 
It  is  brief  and  general.  In  my  opinion, 
it  should  be  examined  by  the  reader  at 
arm's  length — not  to  determine  what 
particulars  seem  less  than  satisfying  or 
have  been  omitted,  but  rather  to  dis- 
cover the  principles  appearing  in  bold 
relief. 

From  this  perspective  the  revised 
"Standards"  amply  meets  the  test  of 
time.  It  clearly  sets  forth  a  philosophy, 
function,  and  procedures  for  the  court  in 
harmony  with  the  goals  of  the  juvenile 
court  principle.  It  offers  counsel  on  the 
crucial  matters  of  organization  and  ad- 
ministration, staffing,  and  community 
relations.  It  introduces  the  court  novi- 
tiate or  curious  layman  to  the  mysteries 
of  a  beleaguered  but  useful  and  ex- 
citing institution.  And  it  lies  to  hand 
for  the  judge,  his  staff',  and  the  citizenry 
in  measuring  the  quality  of  local  courts 
and  proposing  innovations.  That  it  fails 
to  answer  all  the  questions  of  the  ex- 
perts or  to  hazard  a  reading  of  the  fu- 
ture may  leave  some  of  us  dissatisfied — 
but  just  until  we  realize  that  this  is 
meant  to  be  only  the  first  cup  of  tea. 
other  cups  are  available,  some  of  them 
with  tea  leaves  at  the  bottom. 


'  Department  of  Heahh,  Education  and  Wel- 
fare, Social  Security  Administration,  Children's 
Bureau:  Standards  for  specialized  courts  deal- 
ing with  children.  CB  Publication  No.  346. 
1954. 


32 


CHILDREN     •     JANUARY-FEBRUARY  1967 


BOOK 
NOTES 


THE  CHILDREN  OF  THE  SOUTH. 
Mni-fiaret  Anderson.  Foreword  by 
Ralph  McGiU.  Farrar,  Straus  and 
Gironx  PuliHshers,  New  York.  1966. 
20S  iip.  ?4.9r>. 

Few  jieople  in  Clinton.  Tenu.,  ex- 
pected serious  trouble  when  their  public 
high  .school  was  desegregated  in  1956, 
according  to  the  teacher-guidance  coun- 
selor who  is  the  author  of  this  book. 
Speaking  from  her  experience,  she  .says 
of  the  first  days  of  integration  :  "White 
students  greeted  .  .  .  Negroes  ...  in 
friendly  and  Informal  ways,  as  they 
had  all  their  lives.  A  Negro  girl  was 
chosen  to  be  an  officer  in  her  class." 
The  school  principal  said  to  his  staff: 
"If  we  can  get  through  the  fir.st  2  weeks, 
we  will  be  all  right." 

But  Clinton  did  not  get  through  the 
first  2  weeks  without  serious  trouble. 
The  author  describes  how  outside  agi- 
tators stirred  up  mob  violence  that 
eventually  led  to  the  destruction  of  a 
new  high  school  and  the  need  to  call 
in  the  National  Guard. 

She  also  describes  how  after  a  new 
school  was  built  the  determination  of 
the  community  leaders,  school  board, 
and  school  administration  and  faculty 
gradually  moved  the  school  from  self- 
conscious  desegregation  nearer  to  true 
integration. 

The  major  part  of  the  book,  however, 
focuses  on  the  experience  of  "these  pio- 
neers of  the  20th  century — the  Negro 
children  who  had  the  courage  to  face 
hostility,  danger,  and  social  isolation 
day  in  and  day  out  in  an  effort  to  get 
a  better  education  or  to  pave  the  way 
for  others  and  on  the  difficulties  they 
encountered  not  only  because  of  the 
turbulent  school  climate,  but  also  be- 
cause of  their  backgi'ound  of  poverty, 
the   inadequacies   in    their   elementary 

VOLUME  14  -  NUMBER  1 


education,  their  low  self-esteem,  and 
the  extreme  pressures  on  them  to  suc- 
ceed." The  emotional  toll  is  revealed 
in  the  words  of  the  children  themselves, 
as  they  poured  out  their  feelings  to 
their   guidance   counselor,   the   author. 

In  the  last  part  of  the  book,  the 
author  discusses  ways  individual  teach- 
ers in  special  educational  programs 
might  help  clo.se  the  educational  gaps 
between  Negro  and  white  children, 

Ralph  McGill  in  his  foreword  says 
that  this  book  reveals  "what  the  costs 
of  generations  of  segregation  were,  and 
are,  to  some  20  million  Americans." 

FREUD  AND  AMERICA.  Hendrik 
M.  Ruitenbeek.  The  Macmillan  Com- 
pany, New  York.  1966.  192  pp. 
$4.95. 

A  distorted  view  of  Freud's  theories 
has  influenced  both  child-rearing  prac- 
tices and  education  in  the  United  States, 
the  author  of  this  examination  of  the 
effects  of  Freud's  teaching  in  this  coun- 
try maintains.  Child-rearing  practices 
were  the  first  to  feel  Freud's  influence, 
he  points  out.  Soon  after  World  War  I, 
"sophisticated  parents,"  mostly  those 
.susceptible  to  fads,  went  overboard  into 
permissiveness,  ignoring  "the  stern  real- 
ism with  which  Freud  looked  at  human 
personality."  Today,  he  contends, 
many  children  as  well  as  parents  are 
psychology  conscious,  and  children  often 
relate  to  their  parents  not  only  as  par- 
ents but  also  as  "peers"  and  sometimes 
as  competitors. 

He  also  attributes  many  of  the  fail- 
ures of  education  in  elementary  and 
secondary  schools  to  the  dilution  of 
Freudian  theories  and  to  the  tendency 
of  many  teachers  to  act  as  though  their 
chief  function  is  to  understand  children 
rather  than  to  help  them  acquire  knowl- 


edge and  to  "learn  to  handle  the  intel- 
lectual tools  which  give  them  com- 
mand ...  of  their  culture." 

Diluted  Freudian  thought  has  also 
often  made  programs  of  p.sychological 
counseling  in  colleges  ineffective,  the 
author  contends,  and  he  recommends 
that  universities  apply  psychoanalytic 
insight  more  effectively  to  help  students 
"become  more  independent  persons  with 
more  secure  identities  while  they 
are  acquiring  their  formal  general 
education." 

In  other  sections  of  his  book,  the 
author  discusses  the  effect.?  of  Freudian 
thought  and  the  works  of  his  "forerun- 
ners and  contemporaries"  on  religion 
and  life  in  general  in  the  United  States. 

THE  SCHOOLCHILDREN :  growing 
up  in  the  slums.  Mary  Frances 
Greene  and  Orletta  Ryan.  Pantheon 
Books,  a  division  of  Random  House, 
New  York.     1966.    227  i)p.    $4.95. 

Written  by  two  elementary-.school 
teachers,  this  book  describes  the  day-to- 
day life  of  4th-grade  .schoolchildren  and 
their  teachers  in  two  New  York  City 
public  .schools,  one  in  East  Harlem,  the 
other  in  Harlem. 

The  .section  on  East  Harlem  de- 
scribes a  teacher's  day — what  it  is  like 
to  teach  culturally  deprived  children, 
some  with  severe  emotional  problems, 
and  the  reactions  of  the  children  to 
the  teacher's  authority  and  to  the  teach- 
ing program,  which  the  authors  see 
as  inadequate  and  in  many  ways 
irrelevant. 

The  report  on  Harlem  tells  in  the 
children's  own  words  what  they  think 
of  themselves,  their  homes,  the  school, 
and  the  world. 

OX  AGGRESSION.  Konrad  Lorenz. 
Translated  by  Marjorie  Kerr  Wilson. 
Harcourt.  Brace  &  World,  Inc.,  New 
York.     1966.     306   pp.     $5.75. 

The  author,  a  scientist  who  observes 
animal  behavior,  describes  the  ways  in 
which  various  kinds  of  animals  handle 
their  innate  "intraspecific"  aggression — 
aggression  toward  members  of  their 
own  species — and  shows  how  animal 
rituals  that  developed  because  of  their 
survival  value  tend  to  become  fixated 
and  to  be  performed  for  their  own  sake. 
He  then  asserts  that  the  same  process 
has  taken  place  in  the  cultural  and 
phylogenic  development  of  man,  leaving 
man  in  the  predicament  of  having  ag- 

33 


gressive  responses  to  rituals  that  not 
only  no  longer  have  survival  value  but 
also  actually  threaten  the  extinction  of 
the  spec'ies.  He  sees  the  only  hope  for 
mankind  in  an  honest  recognition  of  its 
aggressive  instincts  and  their  need  to 
be  discharged  in  some  way — either  de- 
structively or  harmlessly  sublimated. 
Implying  that  both  the  hope  and  the 
danger  for  mankind  lie  in  youth's  tend- 
ency to  develop  "militant  enthusiasm" — 
a  kind  of  "object  fixation"  that  does 
not  develop  in  later  life — the  author 
advocates  that  efforts  be  made  to  turn 
this  "militant  enthusiasm"  toward  art, 
science,  medicine,  and  other  interests 
based  on  humanistic  values,  rather  than 
toward  national  and  political  causes. 
This  directing,  he  maintains,  cannot  be 
done  by  education  alone,  but  requires 
the  development  of  a  relation  of  trust 
and  respect  between  the  generations. 


GROUP  VALUES  THROUGH  CHIL- 
DREN'S DRAWINGS.  Wayne  Den- 
nis. John  Wiley  &  Sons,  New  York. 
1966.     211  pp.     $6.95. 

Children  draw  what  they  admire  and 
their  drawings  "represent  social  val- 
ues," the  author  of  this  book  maintains. 
On  this  assumption,  he  di.scusses  and 
interprets  over  2,500  drawings  of 
"a  man"  by  school  boys  from  several 
ethnic  groups  and  most  socioeconomic 
levels  in  13  countries. 

Nearly  all  the  drawings  by  boys  in 
the  United  States,  whether  they  were 
by  white  Christians,  orthodox  Jews, 
Indians,  or  Negroes,  are  of  a  similar 
figure — a  young,  well-dressed,  smiling 
white  man,  the  author  says.  One  of  his 
conclusions,  therefore.  Is  that  these 
drawings  strongly  support  "the  idea 
that  American  culture  manages  to 
achieve  a  uniform  set  of  values.  .  .  ." 
On  the  other  hand,  he  found  that  boys 
in  Japan  drew  figures  in  Western 
clothes  but  with  oriental  faces,  a  fact 
he  interprets  to  mean  that  they  accept 
Western  ideas  but  prefer  their  own 
faces. 

Boys  in  Europe,  the  Middle  East,  and 
the  Far  East  also  tended  to  draw  white 
men  in  Western  clothes  (though  more 
Easterners  drew  men  in  native  clothes 
than  other  groups),  but  their  figures 
were  less  often  smiling  and  more  often 
suggested  an  occupation  than  those  of 
the  American  boys. 

The   author  believes  his  method   of 


studying  cultural  values  through  the 
drawings  of  children  can  be  used  in 
both  advanced  and  developing  countries, 
but  may  be  most  useful  in  the  latter. 
He  is  a  psychologist  and  a  professor 
at  Brooklyn  College. 

BRIEF  SEPARATIONS.  Christoph  M. 
Heinicke  and  Il.se  J.  Westheimer.  In- 
ternational Universities  Press,  New 
York.     1006.     255  pp.     $8.50. 

Ten  2-year-old  children  studied  by 
the  authors  of  this  report  on  the  effects 
on  young  children  of  brief  parent-child 
.separation  found  it  hard  to  ree.stablish 
an  affectionate  relationship  with  their 
mothers  after  separation  of  from  2  to 
20  weeks.  The  investigators  found  that 
none  of  the  children  could  respond  at 
once  to  their  mothers,  though  most 
quickly  reestablished  a  relationship 
with  their  fathers.  Some  children  were 
still  hostile  to  their  mothers  20  weeks 
after  reunion.  Partly  because  of  this 
reaction,  the  authors  speculate  that  it 
may  be  the  function  the  parents  per- 
form rather  than  the  per.son  the  child 
misses  during  the  separation. 

The  purpose  of  the  study,  according 
to  the  authors,  was  to  replicate  and  ex- 
tend the  findings  of  an  earlier  .study 
they  had  conducted.  In  discussing  the 
re.sults  of  both  studies,  they  include  the 
results  of  studies  on  the  same  subject 
conducted  by  other  investigators. 

THE  YOUNG  NEGRO  IN  AMERICA : 
1960-1980.  Samuel  D.  Proctor.  As- 
sociation Press,  New  York.  1966. 
160  pp.     $3.95. 

The  Negro  has  moved  through  four 
stages  from  slavery  toward  freedom 
and  is  in  his  fifth,  according  to  this 
discussion  of  the  young  Negro  and  his 
problems  and  prospects  in  the  nest  20 
years.  He  has  gone  through  social  dis- 
integration following  the  Emancipation 
Proclamation,  alienation  from  the  white 
man,  imitation  of  the  white  man,  and 
litigation  to  dbtain  his  rights.  Now, 
largely  through  the  determined  efforts 
of  young  Negroes,  he  is  at  the  base  of 
the  fifth  stage — integration. 

The  author  maintains,  however,  that 
"The  young  Negro  will  have  to  remain 
committed  to  integration  and  not  make 
a  psychological  nest  inside  the  Negro 
world  to  which  he  may  revert  when  the 
going  gets  rough,"  if  the  fifth  stage  is 
to  be  completed.  He  must  compete  with 
the  white  society  in  every  way  "to  over- 


come his  educational  deficit,  change  the 
poverty  pattern,  and  outlive  the  Ameri- 
can stereotype  of  the  Negro."  Even 
under  the  most  favorable  conditions, 
the  author  asserts,  the  going  will  lie 
difiicult,  and  "nothing  will  resist  him 
more  persistently  than  the  economic 
pressures  in  American  life."  He  points 
to  the  necessity  for  the  various  seg- 
ments of  society  to  work  together  rather 
than  against  each  other  to  effect  needed 
change. 

The  author  was  until  recently  special 
assistant  director  of  the  Office  of 
Economic  Opportunity. 

THE  HAMPSTEAD  PSYCHOANA- 
LYTIC INDEX :  a  study  of  the  ps.y- 
choanalytic  case  material  of  a  two- 
year-old  child.  John  BoUand.  Joseph 
Sandler,  et  al.  International  Univer- 
sities Press,  New  York.  1966.  203 
pp.     $4..50. 

This  monograph  describes  the  case 
history  of  Andy,  a  young  child  with  be- 
havior problems  treated  at  London's 
Hampstead  Psychoanalytic  Clinic. 
The  point  of  the  case  presentation  is  to 
demonstrate  how  a  psychoanalytic  in- 
dex developed  at  Hampstead  can  be  ap- 
plied to  all  cases  and  its  value  for  re- 
search in  psychoanalysis.  For  thiai 
reason,  the  book  is  divided  into  two^ 
parts.  Part  I  contains  Andy's  clinical 
material ;  Part  II  follows,  step  by  step, 
the  indexing  of  the  material,  according 
to  general  case  material,  ego  (general, 
anxiety,  and  defenses),  instinctual  as- 
pects, ol)ject  relations,  superego,  symp- 
toms, and  treatment. 

READINGS  PROM  CHILDHOOD  ED- 
UCATION :  articles  of  lasting  value. 
Margaret  Rasmussen,  editor.  Asso- 
ciation for  Childhood  Education  In- 
ternational. Washington,  D.C.  July 
1966.    414  pp.    $3.75. 

Forty  years  (1924-64)  of  publica- 
tion are  represented  in  this  anthology 
of  more  than  80  articles  and  poems 
taken  from  the  journal  Childhood  Edu- 
cation. Selected  from  over  500  contri- 
butions, the  articles  are  arranged  under 
6  headings :  beliefs,  the  child,  the 
teacher,  the  classroom,  past  inspira- 
tions, and  future  aspirations.  Specific 
subjects  include  such  topics  as  an 
adult's  view  of  children's  values ;  the 
role  of  love  in  preschool  education ; 
what  creative  teaching  means;  lan- 
guage in  childhood  ;  preparing  children 


34 


CHILDREN     •     JANUARY-FEBRUARY  1967 


I    I    a    woi-ld   socii'ty ;   and   the   role  of 
liiiuLiuu  ill  c'oiUempomry  life. 

A.  MOXTESSOUI   HANDBOOK.  Edi- 

tfil    by    U.    C.    Oreiii.      G.    P.  Piit- 

iiain's   Sons,   Ni'W    Vm-k.      11)0(1.  lliU 
lip.    $i.<X,. 

Till.-;  lnKik  i-(inliiin.s  Maria  Monte.-i- 
(iri's  (iw  n  iKUulhook  on  her  teachins 
mellioil  and  up-to-date  material  on 
Monlessori  theory  and  practice  in  the 
United  States.  Dr.  Montessori's  mate- 
rial is  divided  into  five  sections;  each 
is  aocompanied  by  an  introduction  ex- 
plaining in  laymen's  terms  the  content 
that   t"olli>\vs  and   by  essays  discussing 


I  be  subject-Mialter  as  apiilied  today, 
written  by  representatives  of  medicine, 
education,  and  psychology,  Accordinj; 
to  the  editor,  the  book  is  intended  for 
Montessori  practitioners  and  nonpro- 
fessional readers  alike. 

FOUND.VnO.NS  FOR  MARHIAGE 
AND  FAMILY  RELATIONS.  Dale 
L.  Womble.  The  Macmillan  Com- 
pany, New  York.  liKU;.  41!)  pp. 
.$7.9.->. 

Successful  marriage  is  neither  a  "gift 
nor  an  accident."  but,  rather,  a  "hard- 
earned  achievement,"  according  to  the 
author  of  this  text  on  preparation  for 


nuirriage  and  family  life  for  unmarried 
college  students,  lie  sees  marriage 
prei)aration  courses  as  a  means  of  help- 
ing college  students  develop  "a  basic 
philosophy  about  marriage  and  family 
relations"  consi.stent  with  the  goals  of 
our  democratic  society. 

The  21  chapters  contain  material  on 
such  topics  as  courtship,  preparing  for 
marriage,  legal  rerpiirements,  sexual 
harmony,  mixed  marriages,  husband- 
wife  relationships  during  pregnancy, 
rearing  children,  and  understanding 
family  counseling.  Each  chapter  con- 
cludes with  a  summary  and  lists  of 
(luestions  "for  further  thought"  and 
suggestions  for  further  reading. 


iims  on  c 


hiid  iif< 


Charges  for  rental  or  purchase  may  be  obtained  from  distributors. 


CHILDREN  IN  THE  HOSPITAL.  44 
minutes ;  sound  :  black  and  white  ; 
borrow,  rent,  or  purchase. 

This  lilm  shows  the  behavior  Of  4-  to  S- 
year-old  normal  children  with  acute 
medical  problems  in  a  city  hospital  as 
they  react  to  the  stress  of  hospitaliza- 
tion, illness,  and  temporary  separation 
from  their  families. 

Audience:  Doctors,  nurses,  social 
workers  psychologists,  and.  with  a  pro- 
fessional discussion  leader,  undergradu- 
ate students,  hospital  volunteers,  parent 
discussion  groups,  and  selected  lay 
groui)s. 

Prodiucil  hij:  Edward  A.  Mason.  M.D. 

Distributed  hy:  International  Film 
Bureau,  Inc.,  332  South  Michigan  Ave- 
nue, Chicago,  111.,  60G04. 

THEY  NEED  THESE  DAYS— DAY 
CARE  FOR  CHILDREN.  25%  min- 
utes ;  sound  ;  color ;  rent  or  purchase. 

Describes  a  modern  day-care  program 
tor  3-  to  5-year-old  children  of  working 
parents  in  a  ilinnesota  community. 
[Minting  out  the  importance  of  provid- 
ing preschool  children  with  opportuni- 
ties to  learn  and  to  develop  healthy 
locial  relationships. 

Audience:  Inservice    and    preservice 

VOLUME  14  -  NUMBER  1 


social  workers,  nursery  school  special- 
ists, teachers,  churches,  iutergroup  or- 
ganizations, and  parents. 

Produced  hy:  .Tames  Liebling,  Uni- 
versit.v  of  Minnesota,  for  the  Child  Wel- 
fare Division,  State  Department  of  Pub- 
lic Welfare,  St.  Paul,  Minn. 

Distributed  by:  Audio-Visual  Educa- 
tion Service,  University  of  Minnesota, 
29  AVe.sbrook  Hall,  Minneapolis,  Minn., 
55455. 

THE  PHENOMENA  OF  EARLY  DE- 
VELOPMENT. 13  minutes;  sound: 
black  and  white  ;  loan. 

This  film  depicts  the  development  of 
motor  skills  in  a  normal  infant  during 
three  periods  of  infancy — 3  to  C  months, 
6  to  9  months,  and  9  to  12  months.  It 
is  accompanied  by  an  illu.strated  book- 
let with  similar  text  which  also  dis- 
cusses development  in  the  infant's 
second  year. 

Audience:  Instructors  and  students 
in  child  growth  and  development ;  per- 
sons conducting  lectures  or  group  dis- 
cussions for  nursing  education,  public 
health  nursing,  and  medical  student 
instruction. 

Produced  by:  Ross  Laboratories. 

Distributed  by:  Ross  Laboratories. 
Columbus.  Ohio,  43216. 


PKU— PRE\ENTABLE  MENTAL  RE- 
TARDATION. 15  minutes;  sound; 
color;  borrow,  rent,  or  purchase. 

This  film  illustriites  through  case  his- 
tories the  importance  of  detecting  and 
treating  phenylketonuria  early  in  in- 
fancy to  prevent  mental  retardation.  It 
documents  the  progress  of  selected  pa- 
tients by  repetitive  sequences  obtained 
at  various  times  in  their  lives  from  6 
weeks  to  3V^  years  of  age.  In  addition, 
it  presents  general  data  about  the  dis- 
ea.se  concerning  the  signs  and  symptoms 
that  suggest  its  presence. 

Audience:  Nurses,  public  health  work- 
ers, physicians,  and  parents. 

Produced  by:  International  Film  Bu- 
reau, Inc. 

Distributed  by:  International  Film 
Bureau,  Inc.,  332  South  Michigan  Ave- 
nue, Chicago,  111.,  C0G04. 

A  NEW  LIFE  FOR  JENNIFER.  27 
minutes  ;  sound  ;  color  ;  loan. 

Depicts  the  work  of  the  Detroit 
Lutheran  School  for  the  Deaf  in  helping 
deaf  children  to  lip-read,  to  speak,  and 
to  acquire  a  language  foundation  neces- 
sary for  meaningful  communication 
and  learning. 

Audience:  Parents,  religious  organi- 
zations, and  jirofessional  persons  in- 
terested in  or  working  with  deaf 
children. 

Produced  by:  Portafilms,  Drayton 
Plains.  Mich. 

Distributed  by:  Lutheran  School  for 
the  Deaf,  C861  East  Nevada  Avenue, 
Detroit,  Mich.,  48234. 


35 


HERE  and  THERE 


Federal  legislation 


On  November  3,  the  President  signed 
into  law  amendments  to  the  Elementary 
and  Secondary  Education  Act  of  1965. 
In  addition  to  making  some  administra- 
tive changes,  the  amendments  au- 
thorize : 

•  A  new  program  of  grants  to  the 
States  for  education  of  the  mentally  and 
physically  handicapped,  to  supplement 
and  increase,  but  not  supplant,  the  level 
of  State,  local,  and  private  funds  ex- 
pended for  this  purpose.  Appropria- 
tions of  .$50  million  and  .$150  million  are 
authorized  for  this  program  for  fiscal 
years  1067  and  1068  respectively. 

•  Aid  to  schools  operated  by  the  Bu- 
reau of  Indian  Affairs  and  to  local  edu- 
cational agencies  for  the  education  of 
out-of-State  Indian  children,  through 
funds  allotted  by  the  Commissioner  of 
Education  to  the  Secretary  of  Interior. 

•  Inclusion  of  children  in  foster  homes 
and  institutions  for  neglected  and  de- 
linquent children  in  the  child  popula- 
tion counts  on  which  jiayments  to  the 
States  and  local  educational  agencies 
are  based  under  title  I  of  the  act  (pro- 
visions for  aid  to  school  districts  con- 
taining concentrations  of  low-income 
families). 


The  Demonstration  Cities  and  Metro- 
politan Development  Act  of  1966  was 
also  signed  by  the  President  on  Novem- 
ber 3.  Among  other  provisions,  the  act 
authorizes  the  Secretary  of  Housing 
and  Urban  Development  to  make  grants 
and  provide  technical  assistance  for : 

•  Comprehensive  demonstration  pro- 
grams in  cities  of  all  sizes  "to  rebuild  or 
revitalize  large  slum  and  blighted 
areas ;  to  expand  housing,  job,  and  in- 
come opportunities ;  to  reduce  depend- 
ence on  welfare  i>ayments ;  to  improve 


educational  facilities  and  programs ;  to 
combat  disease  and  ill  health  ;  to  reduce 
the  incidence  of  crime  and  delinquency ; 
to  enhance  recreational  and  cultural 
opportunities  ;  to  establish  better  access 
between  homes  and  jobs ;  and  generally 
to  improve  living  conditions  for  the 
people  who  live  in  such  areas.  These 
objectives  are  to  be  accomplished 
through  "the  most  effective  and  eco- 
nomical concentration  and  coordination 
of  Federal,  State,  and  local  public  and 
private  efforts."  Grants  are  to  be  made 
to  comprehensive  city  demonstration 
agencies  of  up  to  SO  percent  of  the  costs 
for  planning,  developing,  and  adminis- 
tering the  programs.  The  law  author- 
izes appropriations  of  $12  million  in 
planning  funds  for  each  of  the  fiscal 
years  1067  and  1068,  and  $400  million 
for  fiscal  1968  and  $.500  million  for  fiscal 
1969  for  carrying  out  the  program. 

•  Assistance  to  planned  metropolitan 
development  projects  in  the  form  of  sup- 
plementary grants  to  State  and 
local  public  bodies  already  engaged  in 
such  projects,  not  to  exceed  20  percent 
of  the  cost.  Appropriations  authorized 
are  not  to  exceed  .$25  million  for  the 
fi.scal  year  1967  and  $50  million  for 
fiscal  1968. 

Another  act  signed  by  the  President 
in  early  November  provided  the  District 
of  Columbia  with  a  mandatory  reporting 
law  in  relation  to  child  abuse.  The  law 
requires  physicians  and  hospitals  in 
the  District  to  report  cases  of  sus- 
pected physical  abuse  of  children  un- 
der 18  years  old  to  the  police  depart- 
ment and  provides  for  immunity  from 
liability  to  judicial  proceedings  for  the 
reporting  persons  or  institutions. 

With  this  law,  the  District  joins 
the  49  States  having  laws  to  encourage 
the  reporting  of  child  abuse.     Hawaii 


is  the  only  State  with  no  abuse  report- 
ing law. 

Health  monpower 

The  Nation's  hospitals  need  20  per- 
cent more  professional,  technical,  and 
auxiliary  workers  than  they  now  havt 
if  they  are  to  give  optimum  service  tc 
patients,  according  to  the  findings  of  a 
recently  completed  survey  carried  out 
jointly  by  the  American  Hospital  AssO' 
elation  (AHA)  and  the  U.S.  Public 
Health  Service  (PHS).  On  the  basis 
of  their  findings,  the  two  agencies  esti 
mate  that  hospitals  now  employ  lA 
million  professional  and  technica. 
workers  and  need  275,000  more  to  pro 
vide  optimum  patient  care. 

The  agencies  found  the  following 
The  most  urgent  need  is  for  professiona 
nurses — hospitals  need  about  83,30( 
more  than  they  now  employ.  Nex 
greatest  need  is  for  nursing  aides,  or 
derlies,  and  attendants — about  48,70( 
more  in  general  hospitals  and  anothe: 
31,300  more  in  psychiatric  institutions 
And  the  next  need  is  for  about  42,801 
more  practical  nurses  and  about  6,40t 
more  social  workers  than  the  12,1011 
they  now  employ. 

These  estimates  are  based  on   datii! 
from  4,000  of  the  7,100  hospitals  regis 
tered  by  AHA.     A  complete  report  ot 
the  study  will  be  available  in  the  nex 
few  months. 


|iivei 
III 


Two  conferences  on  the  potentia 
place  of  midwifery  or  nurse-midwifec 
in  obstetrical  programs  in  the  Unite( 
States  took  place  last  fall.  The  first 
held  in  Princeton,  N.J.,  on  October  24- 
25,  was  under  the  sponsor.ship  of  thi' 
Josiah  Macy,  Jr.  Foundation  am 
brought  together  about  25  specialists  ii 
obstetrics,  pediatrics,  maternity  nurs 
ing,  nurse-midwifery,  and  demographj 
from  the  United  States  and  other  coun 
tries.  At  this  conference  it  was  pointec 
out  that  the  United  States  was  the  onlj 
leading  country  in  the  world  where  mid- 
wives  are  not  used  extensively  in  medi 
cal  care.  One  focus  of  the  discussior 
was  whether  or  not  the  more  extensiv* 
use  of  midwives  could  help  reduce  th« 
high  infant  mortality  rates  in  sinu 
parts  of  this  country  or  alleviate  tht 
severe  shortages  in  health  manpower. 
No  consensus  in  viewpoint  emerged. 

The  second  conference  on  the  subjed 
was  the  third  nursing  roundtable  spon- 
sored  by   Ross   Laboratories   and   was 


36 


CHILDREN     •     JANUARY-FEBRUARY  1967 


lieltl  in  Columbus,  Ohio,  on  November  7. 
Ten  uiatornity  nurses  and  nurse-mid- 
ivivos  from  universities  and  profes- 
sional organizations  attended.  Witli 
:he  purpose  of  initiating  a  dialogue  be- 
:\vefn  the  two  specialities  represented. 
:he  participants  presented  papers  giv- 
ing an  overview  of  maternity  nursing 
ind  nurse-midwifery  in  the  United 
States  and  discussed  differences  in 
points  of  view  separating  the  two 
jroups.  The  chairman  was  Edith 
Anderson,  consultant  in  nursing  educa- 
ion  for  the  Children's  Bureau. 

Full  proceedings  of  both  conferences 
nill  be  published  soon  by  the  sponsoring 
agencies. 


Juvenile  delinquency 


In  19a">  about  697,000  juvenile  delin- 
quency cases,  excluding  traffic  offenses, 
were  brought  l>efore  the  Nation's  courts, 
according  to  Children's  Bureau  esti- 
mates based  on  data  received  from  re- 
porting courts.  This  number  repre- 
sents an  increase  of  2  percent  over  the 
previous  year.  In  the  same  period,  the 
number  of  children  aged  10  through  17 
increased  only  1  percent.  This  contin- 
ues the  upward  trend  in  juvenile  de- 
linquency cases  that  has  prevailed  since 
1949,  a  trend  brolien  only  in  1961.  Al- 
together, l>etween  19-57  and  1965,  ju- 
venile delinquency  cases  increased  58 
percent — almost  double  the  increase  in 
the  population  of  children  aged  10 
through  17  during  the  same  period. 

Most  of  the  overall  increase  in  1965 
over  1964  was  accounted  for  by  an  in- 
crease in  cases  involving  girls.  These 
went  up  S  percent  during  the  year  while 
the  number  of  cases  involving  boys  re- 
mained comparatively  stable.  However, 
as  in  past  years,  four  times  as  many 
boys  as  girls  were  brought  to  court,  and 
for  different  reasons.  Boys  were  re- 
ferred most  often  for  offenses  against 
property ;  girls,  for  misbehavior  such  as 
running  away  and  "ungovernable 
behavior." 

A  12- percent  decrease  in  juvenile  de- 
linquency cases  occurred  in  1965  in 
•ourts  in  rural  areas.  This  decrease, 
however,  had  little  effect  on  the  overall 
trend  since  urban  courts  handle  more 
than  two-thirds  of  all  delinquency  cases 
in  the  country. 

The  number  of  traffic  offenses  han- 
dled b.v  juvenile  courts  also  increased 
in  196.").  by  4  percent.  In  rural  courts, 
the  increase  in  traffic  cases  was  19  per- 

VOLUME  14  -  NUMBER  1 


cent.  In  all,  city  and  rural  courts 
handled  about  460,000  traffic  cases  in- 
volving 397,000  different  children. 

The  courts  also  handled  an  increased 
load  of  dependency  and  neglect  cases 
in  lOO.") — 1."(7,000  cases,  or  5  percent 
more  than  in  the  previous  year. 

These  data  and  other  statistics  on 
children's  court  cases  are  presented  in 
the  publication  "Juvenile  Court  Sta- 
tistics—19G5"  (CB  Statistical  Series 
No.  85),  issued  by  the  Children's  Bu- 
reau. Single  copies  may  be  obtained 
without  charge  from  the  Bureau. 


More  than  900  adults  in  contact  with 
juvenile  delinquents  because  of  their 
"position"  as  fathers,  mothers,  teachers, 
policemen,  or  probation  officers  defined 
their  own  and  each  others'  roles  in  the 
prevention  of  juvenile  delinquency  in 
different  terms  when  questioned  by  re- 
searchers at  the  Youth  Studies  Center 
of  the  University  of  Southern  California 
for  a  recent  study,  conducted  by  Alex- 
ander W.  McEachern  and  Edward  M. 
Taylor,  with  support  from  the  Children's 
Bureau.  The  adults  surveyed  agreed 
that  parents  have  the  prime  responsibil- 
ity for  preventing  delinquencj',  but  they 
did  not  agree  on  what  adults  in  each 
category  of  position  should  do  or  actu- 
ally do  iu  specific  situations  or  on  what 
might  be  an  effective  action. 

Each  of  the  adults  queried  was  in  one 
of  the  five  authoritative  positions  in  re- 
lation to  a  sample  of  259  juveniles  re- 
ferred to  probation  departments  in 
Southern  California.  The.y  were  asked 
to  give  their  opinions  of  specific  adult 
actions  toward  children  involving  three 
types  of  adult  behavior — physical  ma- 
nipulation, transferral  of  information, 
and  demonstration — in  relation  to 
whether  the  actions  were  appropriate, 
actual,  or  effective  behavior  for  an  adult 
in  their  own  position  and  for  adults  in 
the  other  four  positions. 

In  each  category  of  adults,  a  lack  of 
consensus  was  found  not  only  in  rela- 
tion to  the  appropriate,  actual,  or  effec- 
tive behavior  of  adults  in  the  other  cate- 
gories, but  also  in  relation  to  the  respon- 
dents' own  category.  However,  the  dif- 
ferences were  more  marked  between 
positions  than  within  them. 

Such  disagreements  in  the  way  adults 
see  adult  behavior  toward  juveniles,  the 
investigators  conclude,  seem  to  arise 
more  from  differences  in  the  institutions 
the  adults  represent  than  from  differ- 


ences in  personalities  ;  nevertheless  they 
result  in  confusing  inconsistencies  in  ex- 
pectations and  goals  for  young  people. 

The  investigators  recommend  that  so- 
ciety set  up  general  expectations  for 
each  role  the  child  must  take  and  not 
concentrate  on  problems  that  arise  when 
a  child  does  not  meet  the  expectations 
different  kinds  of  adults  have  for  him. 

Handicapped  children 

An  analysis  of  consonant  sounds  pro- 
duced by  persons  with  oral  clefts  can  be 
used  to  show  a  wide  range  in  their 
speech  ability,  to  determine  the  details 
impairing  intelligibility  of  their  speech, 
to  evaluate  changes  in  sptH?ch  following 
treatment,  and  to  compare  their  speech 
with  the  speech  of  normal  persons,  ac- 
cording to  a  study  recently  completed 
by  the  Department  of  Speech  and  the 
Speech  Clinic  at  the  University  of  Michi- 
gan. The  study  was  conducted  by  T. 
David  Prins  and  H.  Harlan  Bloomer 
with  a  research  grant  from  the  Chil- 
dren's Bureau. 

The  investigators  analyzed  the  speech 
of  20  boys  with  oral  clefts,  aged  from  9 
to  18,  enrolled  in  a  residential  program 
of  speech  therapy.  As  part  of  the  study, 
each  boy  made  a  sound  recording  of  a 
50-item  word  list  before  and  after  treat- 
ment. While  listening  to  the  record- 
ings, untrained  listeners  wrote  down 
either  the  entire  word  they  thought  they 
had  heard  or  its  initial  consonant.  Al- 
though individual  listeners  varied  con- 
siderably in  responding  to  identical 
word  lists  on  different  occasions,  the 
listeners  as  a  group  showed  good  stabil- 
it.v  in  scores  representing  mean  percent 
of  error,  the  distribution  of  error  across 
phoneme  classes,  and  the  type  of  error 
as  a  function  of  phoneme  class. 


Four  new  research  projects  on  handi- 
capped children  are  included  in  recent 
awards  made  by  the  Children's  Bureau 
for  research  in  maternal  and  child 
health  : 

•  University  of  California  at  Los  An- 
geles, to  study  the  use  of  a  response  com- 
puter in  testing  deafness  in  infants  be- 
fore they  are  old  enough  to  respond  to 
standard  tests  ($16,690). 

•  University  of  Wa.shington,  Seattle, 
to  study  the  effectiveness  of  a  multidis- 
cii)line  team  method  in  providing  serv- 
ices to  patients  in  clinics  for  handicap- 
ped children  ($52,142). 

37 


•  American  Institute  for  Prosthetic 
Researcli,  to  study  a  pneumatic  arm 
prostheses  ($65,621). 

•  University  of  Illinois-Chicago  Medi- 
cal Center,  to  develop  a  research  design 
for  studying  children  with  multiple 
handicaps  (?76,79S). 


Against  rubella 


A  test  by  which  a  physician  can  tell 
within  3  hours  whether  a  patient  is  im- 
mune to  rubella  (German  measles)  was 
recently  released  to  hospitals,  public 
health  departments,  and  diagnostic  lab- 
oratories h.v  the  developing  agency,  the 
National  Institutes  of  Health  (XIH), 
U.S.  Public  Health  Service.  Scientists 
at  NIH  report  that  the  test  is  simple, 
fast,  sensitive,  reliable,  and  inexpensive 
and  that  it  can  be  used  to  detect 
whether  or  not  immunity  exists  even 
years  after  infection. 

The  new  test,  called  hemagglutina- 
tion-inhibition  CH-I),  is  expected  to 
speed  up  the  development  of  vaccines 
against  rubella  now  under  study  at  NIH 
and  in  private  laboratories.  If  so,  a 
vaccine  may  be  available  within  the  next 
3  years — before  the  expected  appearance 
of  another  rubella  epidemic  such  as  the 
one  in  1964,  which  impaired  the  develop- 
ment of  about  20,000  unborn  babies  of 
women  who  contracted  the  disease  in 
pregnancy.  With  the  new  test,  re- 
searchers can  determine  more  rapidl.v 
than  with  earlier  tests  the  effectiveness 
of  experiments  with  attenuated  virus 
preparations,  with  which  they  are  now 
working. 

NIH  scientists  al.so  point  out  that  the 
new  test  can  now  be  used  on  pregnant 
women  who  have  been  exposed  to  ru- 
bella to  determine  whether  there  is  cause 
for  concern  or  whether  the  patient  is  im- 
mune to  the  di.sease  and  her  unborn 
child  therefore  at  no  ri.sk ;  and  that  af- 
ter the  vaccine  has  been  developed, 
women  can  be  tested  before  marriage 
and  inoculated  against  rubella  if  they 
are  not  already  immune. 


During  the  first  year  of  a  5-year  spe- 
cial project  begun  in  1965  on  the  effects 
of  rubella  contracted  before  birth,  the 
Baylor  University  College  of  Medicine 
found  that  infants  showing  the  symp- 
toms of  congenital  rubella  can  be  diag- 
nosed positively  as  having  been  infected 
with  the  disease  and  that  the  resulting 
impairment  can  be  distinguished  from 


congenital  impairment  from  other 
causes.  Such  symptoms  include  defects 
iu  vision  and  hearing ;  retardation  in 
adaptive  ability  and  in  motor  and  lan- 
guage development;  cardiac  disease; 
and  low  birth  weight. 

The  project  has  coded  information  on 
96  infants,  most  of  whose  mothers  con- 
tracted the  disease  in  the  epidemic  of 
1964.  The  infants  showed  the  follow- 
ing specific  effects :  26  had  defects  in  vi- 
sion and  hearing;  9,  defects  in  vision 
only ;  3.3,  mild  or  severe  hearing  defects 
only  ;  and  71,  cardiac  disease.  In  addi- 
tion, the  birth  weights  of  most  were  low, 
and  2.">  percent  were  still  harboring  ru- 
bella virus  at  12  to  15  months  of  age. 
Of  126  infants  originally  selected  for 
study,  20  died  during  the  first  year. 

During  the  second  year  of  the  project, 
now  in  progress,  the  researchers  will 
continue  to  follow  the  natural  history  of 
the  disease  and  to  provide  medical  serv- 
ices to  the.se  children.  In  addition,  they 
are  working  toward  developing  an  ex- 
perimental model  program  using  medi- 
cal and  community  facilities  for  150 
children  born  with  the  symptoms  of  ru- 
bella. Of  these  children,  the  research- 
ers expect  that  98  will  have  defects  of 
hearing ;  44,  defects  in  both  hearing  and 
vision ;  90,  defects  in  vision  only ;  and 
108,  cardiac  disease. 

The  project  is  receiving  Federal  sup- 
port through  a  grant  from  the  Children's 
Bureau. 


Infant  mortality 


A  recent  investigation  by  the  Chil- 
dren's Bureau,  in  cooperation  with  the 
Maternal  and  Infant  Health  Computer 
Project  at  George  Washington  Univer- 
sity, of  infant  mortality  levels  in  the 
more  than  3,000  counties  in  the  United 
States  in  the  5-year  period  1956-60  re- 
vealed that  90  percent  of  the  counties 
had  infant  death  rates  in  excess  of 
18.3  per  1,000  and  10  percent  had  rates 
of  18.3  or  lower.  On  the  basis  of  these 
findings,  the  Bureau  has  estimated  the 
number  of  "excess  infant  deaths"  for 
each  of  the  higher  rate  counties.  The 
excess  number  was  defined  as  the  dif- 
ference between  the  actual  number  of 
infant  deaths  in  the  county  and  the 
expected  number  if  the  10th  percentile 
rate — 18.3  deaths  of  infants  under  1 
year  per  1,000  live  births— had  held. 

This  analysis  indicated  that  during 
the  5-year  period  169,784  infant  deaths 
occurred  in  the  United  States  in  excess 


of  what  would  have  occurred  had  the 
10th  percentile  rate  prevailed.  Well 
over  one-third  of  these  excess  infant 
deaths  were  concentrated  in  56  counties, 
nearly  all  of  which  were  metroixilitan. 
On  the  other  hand,  counties  with  infant 
death  rates  as  low  as  or  lower  than  the 
10th  percentile  county  rate  were  with 
few  exceptions  without  urban  areas 
with  populations  as  large  as  50,000. 

Inservice  training 

"Meeting  the  Needs  of  Children 
Through  Sncial  Services,"  a  series  of 
12  films  and  guides  for  discussion  lead- 
ers used  in  South  Carolina  last  year 
as  part  of  an  inservice  training  pro- 
gram for  public  welfare  workers  is  now 
available  from  the  Department  of  Film 
Services  at  the  University  of  Tennes- 
see (Knoxville).  Both  the  films  and 
guides  were  produced  jointly  by  the 
University  of  Tennessee  School  of  So- 
cial Work,  the  South  Carolina  Depart- 
ment of  Public  Welfare,  and  the  South 
Carolina  Educational  Television  Net- 
work. The  ijroject  was  supported  in 
part  by  a  child  welfare  training  grant 
from  the  Federal  Children's  Bureau. 

The  films  run  for  30  minutes  each. 
They  illustrate  such  topics  as  social 
development  in  children,  professional 
casework  relationships,  interviewing, 
and  helping  one-parent  families.  The 
guides  were  prepared  for  persons  se- 
lected to  lead  discussion  groups  after  a 
viewing  of  the  films. 

The  films  were  telecast  last  year, 
once  a  week,  over  South  Carolina's 
closed-circuit  television  system  to  all 
county  social  service  staff  members. 
Trained  leaders  led  the  ensuing  dis- 
cussions. 


Under  a  2-year  career  development 
program,  four  recent  graduates  of 
schools  of  social  work  are  now  work- 
ing with  the  Bureau  of  Family  Serv- 
ices of  the  U.S.  Welfare  Administration 
as  interns  in  public  welfare  administra- 
tion. For  the  first  year  they  will  be  at- 
tached to  the  central  oflSce  in  Washing- 
ton. D.C.,  and  are  now  on  assignments 
in  the  Bureau's  Division  of  Program 
Operations.  For  the  second,  they  will 
be  assigned  either  to  a  division  in  the 
central  office  or  to  one  of  the  nine  re- 
gional offices  according  to  fields  of  In- 
terest, positions  available,  and  geo- 
graphic    preference.     During     their 


38 


CHILDREN     .     JANUARY-FEBRUARY  1967 


VOll 


iiilcnisliip  they  will  Imvc  (iiiiKirluiiitics 
lo  work  with  Stiitc  and  local  i)ul)li<- 
welfare  agencies  and  opportunities  I'm- 
lielil  exjiorience  as  neeiled. 

The  r.iireau  exi>eets  eveiil  u:illy  In 
have  (ii)eniiif;s  for  C  to  10  interns  each 
year  and  plans  to  sekvt  candidates 
again  next  sjirinR.  Tlioush  it  does  not 
require  applicants  to  have  professional 
exiHTience,  it  will  give  preference  to 
those  who  do  have  experience,  and  it 
does  require  the  intern  to  have  a  mas- 
ter's decree  in  social  work  l>.v  the  time 
he  conies  on  the  job. 

At  the  end  of  the  2  years,  the  interns 
will  be  ready  to  enter  careers  in  some 
field  of  public  w<'lfare  ailminisf ration. 

Child  welfare  services 

On  Jlarch  31.  196.1.  about  C07..300 
children  were  receiving  services  from 
public  and  voluntary  agencies  and  in- 
stitutions, the  greatest  number  on  rec- 
ord, according  to  reports  received  by  tlie 
Children's  I5ureau.  This  represented 
a  7-iK^rcent  increase  over  the  number 
being  served  on  the  same  date  the 
previous  year. 

Of  these  children.  CO  i)ercent  were 
being  served  primarily  b.v  public  agen- 
cies and  institutions :  31  percent,  by 
voluntary.  About  42  percent  were 
living  with  parents  or  relatives ;  30 
percent,  in  foster  family  homes ;  16  per- 
cent, in  institutions ;  10  percent,  in 
adoptive  homes :  and  2  percent,  under 
other  kinds  of  arrangements. 

The  greatest  increase  was  in  the 
number  of  children  served  by  public 
welfare  agencies:  an  increa.se  of  29,000 
children,  or  l.H  percent,  in  their  own 
homes ;  of  16,800,  or  .S  percent,  in  foster 
care:  and  of  2.t)00,  or  9  percent,  in  adop- 
tive homes.  The  services  of  voluntar.v 
agencies  rose  .substantially  only  for 
children  being  served  in  adoptive 
homes :  2.100  children,  or  7  percent, 
more  tlian  on  the  reiwrting  date  in  1964. 

For  a  fuller  analysis  of  child  welfare 
services,  facilities,  expenditures,  and 
personnel,  see  "Child  Welfare  Statis- 
tics—196,5"  (CB  Statistical  Series  No. 
84).  Single  copies  are  available  from 
the  Bureau  without  charge. 


Foster  care 

Between  JIarch  31,  1961,  and  the 
same  day  in  ItHi.'j.  the  number  of  chil- 
dren under  IS  years  old  in  foster  care 
under  public  or  voluntary  agencies  rose 

VOLUME  14  -  NUMBER  1 


COMPARATIVE  INFANT  MORTALITY 


Country 

Hate    per 

l.OOOt 
1<)G'2-U4 

1.5.0 

*1.5.  8 

Norway 

I'iiiland 

1  )cMiuark . 



*17.  1 
*1S.  .5 
*li).  3 

-Xustralia. .  . 
\e\v  Zealand. 

Switzerland 

I'nited  Kingdom. 

Jai)an . 

triilr'd  Stati-s. 
Canada .  , 


Federal  llepublic  of  Germany. 

Ireland 

lAixeinbourg..    .      


I'.).  7 

19.  7 

20.  2 
*21.  6 

23.3 
2.5.  1 
26.  1 
*27.  I 
*27.  5 
•29.5 


Percent 
change 
1902-64 

from 
1961-63 


-3.2 

-4.8 
-3.9 
-6.6 
-4.9 
-0.5 
-.5.8 
-3.4 
-•2.3 
-  10.  4 
-0.  8 
-3.3 
-7.2 
-4.2 
-1-3.  1 


tDeaths  of  infants  under  1  year  per  1,000  live  births 
*1964  data  provisional 

Source  of  data:   Demographic  Yearbook,   1964,  Statistical  Office  of   the 
United  Nations,  Xcw  York 

I'he  United  States  infant  mortality  rate  in  the  3-year  period  1962-64 
ranked  11th  in  a  selected  group  of  15  countries.  These  are  countries  with 
advanced  economies,  with  populations  (1960)  of  at  least  300,000,  and  with 
well-developed  vital  record  systems,  conforming  to  the  World  Health  Or- 
ganization's definitions.  Among  the  same  countries,  the  U.S.  rate  for  the 
period  1961-63,  as  well  as  in  1960,  was  in  10th  position  as  compared  with 
6th  in  19.50. 

The  apparent  shift  in  i)ositiou  of  the  U.S.  rate  results  from  faster  pace 
of  reduction  of  infant  mortality  in  other  countries ;  for  example,  between 
the  two  iKjriods  (1961-63  and  1962-64),  about  a  10-percent  reduction  in  the 
infant  death  rate  was  accomplished  in  Japan  while  for  the  United  States 
the  decrease  was  under  1  percent.  Other  countries,  with  rates  already 
lower  than  that  of  the  United  States,  made  more  rapid  decrease. 

— Eleanor  P.  Hunt 


from  24G..500  to  2S7.20O,  according  to 
a  recent  Children's  Bureau  analysis 
of  figures  received  from  the  States. 
If  the  increase  continues  at  this  pace, 
by  1975  about  364,000  children  under 
IS — 4.7  per  1,000 — will  be  in  foster  care 
of  some  type. 

The  figures  show  that  in  recent  years 
the  number  of  children  in  foster  care 
under  agency  auspices  has  steadil.v  in- 
crea.sed.  following  a  i>eriod  of  decline. 
The  number  dropped  after  19,33,  and 
the  level  for  that  year  was  only  reached 
again  in  1961-62.  The  rate  of  foster 
care  also  dropped  substantially  after 
1933,  but  it  has  slowly  risen  in  the  last 
several  years.  The  rate  for  19<!5  is 
two-thirds    of    the    1933    rate.     If    the 


rate  prevailing  in  1933  had  continued, 
an  additonal  l:56.(K)0  children  would 
have  been  in  foster  care  in  1965. 

Since  1933  and  1950,  there  has  been 
a  decided  shift  from  institutional  to 
foster  family  care.  On  March  31,  1965, 
about  207,800  children  under  18 — or 
2.9  per  1.000 — were  in  foster  family 
care  as  against  79,400,  or  1.1  per  1,000, 
in  institutional  care.  Those  in  foster 
family  care  were  for  the  most  part  (78 
percent)  under  the  care  of  public  agen- 
cies ;  those  in  institutional  care  for  the 
most  part  (86  percent)  under  voluntary 
agencies. 

Foster  care  under  jpublic  auspices,  in 
tenns  both  of  number  and  rate  of  chil- 
dren   in    care,    has    risen   consistently 

39 


since  1933  ;  at  the  same  time,  foster  care 
under  voluntary  agencies  or  institu- 
tions has  decreased,  the  number  of 
children  in  voluntary  care  in  1965  being 
36  percent  below  the  1933  level. 

Statistical  tables  and  a  more  detailed 
analysis  are  available  in  the  recent 
publication  "Foster  Care  of  Children: 
Major  National  Trends  and  Prospects," 
prepared  by  Seth  Low.  Single  copies 
are  available  on  request  from  the  Chil- 
dren's Bureau. 


The  Wurzweiler  School  of  Social 
Work,  Teshiva  University,  New  York, 
in  its  1966-67  winter  session  is  con- 
ducting a  pilot  project  in  the  training 
of  foster  parents.  The  foster  parents 
will  be  selected  by  the  public  and  vol- 
untary agencies  in  New  York  City. 

The  emphasis  will  be  on  child  growth 
and  behavior  and  on  the  special  devel- 
opment of  the  relationship  between  par- 
ent and  foster  child. 

Courses  for  three  groups  of  foster 
parents  will  be  held  at  the  university. 
Each  group  will  consist  of  eight  foster- 
parent  couples.  Two  will  be  for  one 
semester  and  one  for  two  seme.sters. 
The  plan  also  provides  for  prior  and 
post-training  sessions  for  agency  super- 
visors and  caseworkers  to  increase  their 
effectiveness  in  ongoing  agency  train- 
ing of  foster  parents. 

The  purpose  of  the  project,  which  is 
supported  by  a  training  grant  from  the 
Children's  Bureau,  is  to  demonstrate 
a  pattern  for  the  collaboration  of  child- 
placement  agencies  and  schools  of  social 
work  which  might  be  adopted  elsewhere. 


Adoption 


Parents  who  adopt  a  child  over  5 
years  old  appear  to  run  little  more  risk 
of  having  the  adoption  fail  than  those 
who  adopt  younger  children,  according 
to  a  study  recently  completed  by  the 
University  of  Wisconsin  School  of  So- 
cial Work,  under  the  direction  of  Alfred 
Kadushin.  The  project  was  largely 
supported  by  a  grant  from  the  Chil- 
dren's Bureau.  The  4-year  study  of  91 
children  adopted  after  they  were  5  (but 
before  they  were  12)  and  their  adoptive 
parents  found  that  over  three-fourths 
of  the  parents  were  satisfied  with  the 
adopted  child,  though  most  of  them  had 
originally  wanted  younger  children. 

Most  of  the  children  involved  in  the 
study  came  from  homes  in  which  they 


had  been  badly  treated  and  from  which 
they  had  been  removed  by  court  order. 
To  cut  down  the  variables,  the  study 
considered  only  white  children  with 
normal  physical  and  mental  health.  All 
of  the  adoptive  parents  were  from 
higher  socioeconomic  levels  than  the 
natural  parents,  and  most  were  older 
than  the  parents  who  usually  adopt 
infants. 

The  study  found  that  much  of  the 
success  of  the  placement  rested  on  the 
degree  to  which  the  parents  accepted 
the  adopted  child  and  that  many  of 
the  children  showed  a  "biological 
resiliency"  that  helped  them  make 
wholesome  responses  to  a  change  in 
environment. 

Nutrition 

About  70  public  health  nutritionists 
and  dietitians  from  27  States  attended 
a  4-day  workshop  in  Kansas  City,  Mo., 
in  early  October,  on  nutrition  services 
in  maternity  and  infant  care  projects 
and  comprehensive  health  services  for 
children  and  youth.  Sponsored  by  the 
Children's  Bureau  and  the  Division  of 
Health  of  the  Missouri  State  Depart- 
ment of  Public  Health  and  Welfare  for 
the  States  covered  by  Regions  I,  II,  V, 
VI,  VIII,  and  IX  of  the  Department  of 
Health,  Education,  and  Welfare,  it  was 
the  first  of  two  national  workshops 
planned  to  improve  and  extend  nutri- 
tion services  in  such  projects.  The 
second  will  take  place  in  New  Orleans 
in  February. 

The  discussions  focused  on  such  ques- 
tions as :  the  main  nutritional  factors 
contributing  to  a  high-risk  pregnancy ; 
current  knowledge  of  nutritional  re- 
quirements during  pregnancy  and  ways 
of  meeting  these  needs  on  a  subsistence 
income ;  nutritional  needs  of  the  preg- 
nant adolescent  girl  and  ways  of  mo- 
tivating adolescents  to  accept  a  nutri- 
tionally adequate  diet ;  the  problem  of 
iron  deficiency  anemia  in  infants ;  the 
dangers  of  overnutrition  (caloric)  in 
relation  to  weight  gain  and  growth  in 
infants  and  young  children ;  and  meth- 
ods of  interviewing,  reaching  subcul- 
tural  groups,  keeping  appropriate 
clinical  records,  and  preparing  reports 
on  nutrition. 

A  3-member  panel  of  nutritionists 
from  maternity  and  infant  care  projects 
in  Minneapolis,  Minn.,  Portland,  Oreg., 
and  Cincinnati,  Ohio,  described  a  nutri- 
tionist's   role    in    a    multidisciplinary 


team  ;  coordination  of  nutrition  services 
with  other  community  programs  such  as 
public  assistance  and  the  food  stamp 
plan  ;  and  the  use  of  home  economists  in 
training  neighborhood  leaders  as  nutri- 
tion aides  to  teach  small  groups  of 
mothers. 


Among  recent  grants  for  researcn  lu 
the  field  of  maternal  and  child  health 
made  by  the  Children's  Bureau  were 
three  to  support  new  research  on  nutri- 
tion. The  three  grants  were  awarded 
to: 

•  Children's  Hospital  Research  Foun- 
dation, Columbus,  Ohio,  for  a  study  of 
malnutrition  among  children  from  1  to 
6  years  old  in  low  socioeconomic  areas 
($1.59.860). 

•  Michael  Reese  Hospital,  Chicago, 
111.,  for  a  study  of  intra-uterine  malnu- 
trition ($36.9.30). 

•  The  Food  and  Nutrition  Board.  Na- 
tional Academy  of  Sciences-National 
Research  Council,  Washington,  D.C.,  to 
consider  special  problems  in  current  ma- 
ternity and  infant  care  programs  and 
to  develop  up-to-date  guidelines  for  pro- 
viding nutrition  in  maternal  health. 

Education 

About  56  million  children  and  young 
people  were  enrolled  in  public  and  pri- 
vate schools  and  colleges  in  the  United 
States  last  fall — a  2.6-percent  rise  over 
1965 — if  estimates  made  last  summer  by 
the  U.S.  Office  of  Education  hold  true. 

The  largest  proportion  increase  was 
expected  to  be  in  colleges  and  universi- 
ties :  6  million,  or  9.1  percent,  over  fall 
1965.  High  school  enrollment  (grades 
9  through  12)  was  expected  to  rise  to 
13.3  million,  an  increase  of  2.3  percent ; 
grade  school  enrollment  (kindergarten 
through  grade  S)  to  36.6  million,  an  in- 
crease of  1.7  percent. 

To  teach  these  students,  the  Office  of 
Education  estimates  colleges  and  uni- 
versities need  466,000  instructors,  8.6 
percent  more  than  last  year ;  grade  and 
high  schools,  2,045,000  teachers,  4.1 
percent  more  than  in  the  previous  year. 

In  the  1966-67  academic  year,  the 
schools  are  expected  to  spend  about 
$48.8  billion  as  against  .$45  billion  spent 
in  the  fiscal  year  1965-66.  In  the  latter 
year  the  Federal  Government  contrib- 
uted $6.1  billion  in  grants  to  schools 
at  all  grade  levels,  more  than  2%  times 
the  Federal  contribution  in  1963-64. 


40 


CHILDREN     .     JANUARY-FEBRUARY  1967 


These  and  other  figures  are  contained 

i)i  two  forthooniing  publiontions  of  the 
(illire  of  KduciUion  :  Dii/ext  of  Educa- 
tiiinal  Statistics  and  Projections  of 
I'.ttucational  Statistics.  According  to 
ilir  DiiH'st,  nioro  tliiin  70  percent  of  the 
VHinig  peoi)le  in  this  country  who  are 
in  their  20's  have  had  a  high  school 
iiliication. 


Elected  liy  tlicir  fellow  villagers  for 
training  as  teiuliers  for  Project  Head 
Start.  'A)  Alaskan  "natives" — Eskimos, 
Aleuts,  and  Alhapaskan  Indians — are 
presently  serving  as  teachers  in  pro- 
grams for  preschool  children  set  up  in 
their  villages.  None  of  them  had  taught 
before,  and  several  have  had  no  more 
than  a  fourth-grade  education ;  but  all 
were  chosen  as  persons  who  work  well 
with  children. 

Before  taking  up  assignments  with 
Project  Head  Start,  the  50  prospective 
teachers  completed  an  S-week  training 
course  at  the  University  of  Alaska  in 
subjects  preschool  teachers  need  to 
know  about  such  as  nutrition  and  arts 
and  crafts.  Teaching  supervisors  will 
visit    each    village    project    regularly 


to   help   these   teachers    improve   their 
competence. 

Last  year,  the  Alaska  State  Com- 
munity Action  Program  was  unable  to 
till  the  demand  from  village  councils 
for  help  in  establishing  j)reschool  pro- 
grams because  of  the  lack  of  preschool 
teachers  in  the  area.  Through  the  new 
program,  about  35  village  projects  were 
set  up  this  past  fall. 

Rehabilitation 

A  n.itional  Commission  on  Accredita- 
tion of  Ueb.-ibililation  Facilities  was 
established  last  .July  by  the  As.sociation 
of  Rehabilitation  Centers  (ARC)  and 
the  National  Association  of  Sheltered 
\Vorkshops  and  Homebound  Programs 
(NASWHP)  to  develop  improved  stand- 
ards for  rehabilitation  facilities.  The 
commission  consists  of  a  nine-member 
board  of  trustees :  three  each  from  ARC 
and  XASWIIP  and  three  chosen  at  large 
by  the  other  six  members. 

The  specific  objectives  of  the  com- 
mission are:  (1)  to  promote  and  assist 
in  the  self-improvement  of  rehabilita- 
tion facilities  by  providing  educational 
and   advisory    services;    (2)    to   adopt 


standards  for  measuring  rehabilitation 
facilities  for  accreditation;  (3)  to  pub- 
lish lists  of  rehabilitation  facilities 
meeting  the  commission's  standards; 
and  (4)  to  promote  and  conduct 
studies  that  will  improve  the  initial 
standards. 

The  plan  is  endorsed  by  the  U.S. 
Vocational  Rehabilitation  Administra- 
tion. 


Correction 

In  Van  G.  Hromadka's  article,  "To- 
ward Improved  Competence  in  Child- 
Care  Workers  :  1.  A  Look  at  What  They 
Do"  (CHILDREN,  September-October 
19C6),  the  inadvertent  omission  of  a 
"not"  from  a  sentence  descriliing  one 
criterion  for  .selecting  the  12  institu- 
tions under  study  unfortunately  re- 
ver.sed  the  fact.s.  The  sentence  begin- 
ning at  the  bottom  of  the  first  column 
on  page  181  should  have  read  :  "A  major 
basis  for  selection  was  that  the  institu- 
tion had  not  less  than  30  percent  of  its 
population  under  clinical  treatment  for 
emotional  disturbance.  .  .  ." 


guides  and  reports 


HELPING  CHILDREN  IN  INSTITU- 
TIONS :  a  report  on  26  courses  for 
child  care  workers.  Eva  Burmeister. 
Federation  of  Protestant  Welfare 
Agencies,  2S1  Park  Avenue  South, 
New  York,  N.Y.,  10010.  1966.  51  pp. 
$1. 

Describes  and  evaluates  the  basic  and 
advanced  courses  for  institutional  child- 
care  workers  in  the  New  York  area  con- 
ducted from  1!)57  through  1904  under 
the  auspices  of  the  Hunter  College 
School  of  Social  Work  and  the  Federa- 
tion of  Protestant  Welfare  Agencies. 

EARLY  CHILDHOOD:  crucial  years 
for  learning.  Margaret  Rasmussen 
and  Lucy  Prete  Martin,  editors.  As- 
sociation for  Childhood  Education  In- 
ternational,  3015   Wisconsin   Avenue 

VOLUME  14  -  NUMBER  1 


NW.,  Washington,  D.C.,  20016.     1966. 
89  pp.     $1.25. 

Contains  reprints  of  22  articles  from 
Childhood  Education  on  the  relation  of 
nursery  school  and  kindergarten  educa- 
tion to  the  intellectual  and  social  de- 
velopment of  young  children. 

DIRECTORY  OF  M  A  T  E  R  N  I  T  Y 
HOMES  AND  RESIDENTIAL  FA- 
CILITIES FOR  UNMARRIED 
MOTHERS :  a  guide  for  use  and 
selection.  National  Council  on  Il- 
legitimacy, 44  East  23rd  Street,  New 
York,  N.Y.,  10010.  May  1966.  206  pp. 
?4.50.     Discounts  on  quantity. 

The  first  revision  of  this  directory 
since  1960,  this  edition  includes  in  ad- 
dition  to   brief   descriptions   of   tradi- 


tional maternity  homes,  lists  of  the 
other  types  of  facilities  they  use — 
foster  family  homes,  mutual  service  or 
wage  homes,  and  group  homes. 

HELPING  HANDS  :  volunteer  work  in 
education.  Gayle  Janowitz.  Univer- 
sity of  Chicago  Press,  57.50  Ellis  Ave- 
nue, Chicago,  111.,  60637.  1966.  125 
pp.  .$1.75  paperback ;  $3.95  cloth- 
bound. 

A  guide  for  the  organization  and  op- 
eration of  afterschool  study  centers  for 
underachieving  children  and  the  use  of 
volunteers  as  tutors,  based  on  experi- 
ence in  a  tutorial  project  financed  by 
the  U.S.  Office  of  Education. 

STANDARDS  AND  GOALS  FOR 
METHODIST  AGENCIES  SERVING 
CHILDREN  AND  YOUTH.  Board  of 
Hospitals  and  Homes  of  The  Method- 
ist Church.  1200  Davis  Street, 
Evan.ston,  111.,  00201.  1906.  S3  pp. 
$1..50. 

The  second  revision  of  a  publication 
originally  i.ssued  in  1956. 

41 


IN  THE  JOURNALS 


Service  and  aid 

The  goal  of  the  social  reformers  of 
the  early  1900's  who  worked  for  the 
establishment  of  a  Children's  Bureau 
in  the  Federal  Government  to  integrate 
"all  public  services  and  aid  for  families 
and  children  of  all  classes"  was  lost 
sight  of  in  the  1930"s  when  new  finan- 
cial aid  and  service  programs  were  put 
under  separate  administrations  by  the 
Social  Security  Act,  writes  Archie  Han- 
Ian  in  the  November  1966  issue  of  Child 
Welfare.  ( "From  Social  Reform  to  So- 
cial Security  :  The  Separation  of  ADC 
and  Child  Welfare." )  Presenting  a  his- 
torical account  of  the  creation  of  the 
Bureau  in  1912  and  of  the  events  that 
preceded  the  enactment  of  the  Social 
Security  Act  in  1935,  he  asserts  that 
the  unifying  role  envisioned  for  the 
Children's  Bureau  became  obscured 
by  the  pressures  to  meet  the  economic 
crisis.  The  multiplication  of  Federal 
programs  in  recent  years  has  made  the 
need  for  relating  aid  to  service  pro- 
grams more  urgent  than  ever,  he  says. 

Maintaining  that  there  is  a  silence 
among  social  workers  today  in  com- 
parison to  their  vocal  espousal  of  an 
integrated  Federal  aid  and  service  pro- 
gram in  the  early  1930's,  he  attributes 
this  silence  to  skepticism  toward  the 
"sudden  wooing  of  the  poor."  Even 
if  a  unified  aid  and  service  program 
came  about  "at  this  late  date,"  he  fears 
that  it  will  only  mask  "society's  fail- 
ure to  come  to  grips  with  poverty  in 
the  midst  of  affluence." 

Stability  in  delinquency 

One  reason  why  studies  on  the  use 
of  the  casework  method  in  working  with 
juvenile  delinquents  indicate  such  poor 
results  may  be  that  society  tends  to 
push  the  young  person  who  commits 
delinquent  acts  into  a  "stable  role"  as 
a  delinquent,  William  P.  Lentz  main- 
tains in  the  October  1966  issue  of  So- 
cial Work.  ("Delinquency  as  a  Stable 
Role.")     He  points  out  that  everyone 


around  the  young  person  who  commits 
a  delinquent  act — parents,  friends, 
teachers,  policemen,  and  social  work- 
ers— whether  they  are  sympathetic  or 
disapproving,  treat  him  as  a  delinquent, 
and  that  the  caseworker  is,  therefore,  at 
a  disadvantage  in  trying  to  set  up  a 
one-to-one   relationship. 

Accepting  this  fact — that  the  .social 
climate  tends  to  push  the  young  per- 
son into  a  "stable  role"  as  a  delin- 
quent— may  help  social  workers  reshape 
their  efforts,  the  author  suggests.  It 
is  his  contention  that  if  the  system  does 
not  change — and  he  sees  no  change  in 
the  oflSng — imjjrovement  in  the  results 
of  casework  is  not  likely.  He  con- 
cludes, therefore,  that  the  problem  of 
"role  .stability"  will  continue  to  hinder 
efforts  to  help  young  people  who  com- 
mit delinquent  acts  until  agencies  are 
able  to  minimize  the  "situations  that 
contribute  to  the  development  of  the 
stable  role"  and  to  lend  their  support 
to  "proposals  that  will  lead  to  change." 

Effects  of  hospitalization 

Reporting  in  the  October  1966  issue 
of  the  American  Jotimal  of  Orthopsy- 
chiatry on  the  preliminary  findings  of 
a  study  of  the  effects  on  families  of  the 
hospitalization  of  parents  in  a  mental 
hospital.  Elizabeth  P.  Rice  and  Sylvia 
G.  Krakow  point  out  that,  though  the 
families  studied  faced  many  problems  in 
child  care,  few  tended  to  call  on  com- 
munity agencies  at  the  time  of  admis- 
sion. ("Hospitalization  of  a  Parent  for 
Mental  Illness :  A  Crisis  for  Children." ) 
However,  they  report,  these  families 
seemed  to  welcome  help  from  commu- 
nity agencies  when  it  was  offered. 

The  study  was  conducted  at  a  State 
mental  hospital  in  Massachusetts  using 
40  patients  and  their  families  as  demon- 
stration cases  and  59  patients  and  their 
families  as  control  cases.  Demonstra- 
tion families  were  assigned  to  agencies 
for  continuing  services  ;  control  families 
were  given  no  special  attention. 

The    problems    in    child    care    were 


greater  when  the  patient  was  the  mother 
and  when  the  children  were  very  young, 
the  authors  report.  In  some  cases,  the 
return  of  the  patient  to  the  home 
brought  on  additional  problems  if  the 
mother  was  not  ready  to  take  on  her 
duties.  Homemaker  services  proved 
valuable  in  supporting  both  relatives 
caring  for  children  and  parents. 

The  authors  maintain  that  the  stuiiy 
demonstrated  the  "value  of  having  a 
social  worker  at  the  point  of  admission 
to  refer  families  with  child-care  prob- 
lems to  appropriate  community  agen- 
cies" and  that  "additional  methuds  and 
skills  appear  to  be  required  to  achieve 
adequate  protection  of  children  with 
mentally  ill  parents  either  at  home  or  in 
the  hospital." 


Migrant  children 


The  greatest  service  the  physician 
working  with  the  children  of  migrant 
farm  families  can  do  for  migrant  chil- 
dren is  to  stimulate  his  community  to 
act  on  their  behalf,  writes  Earle  Siegel, 
M.D.,  in  the  October  1966  issue  of  Clin- 
ical Pediatrics.  ("Migrant  Families: 
Health  Problems  of  Children.")  To 
meet  the  complex  needs  of  these  chil- 
dren, the  community  must  invest  in 
programs  of  education,  social  welfare, 
and  medical  services,  he  maintains. 

The  first  need  of  the  parents  in  mi- 
grant farm  families  is  for  day-care 
centers  at  which  they  can  leave  their 
children  during  the  long  workday,  says 
the  author.  The  health  provisions  made 
in  the.se  centers  depend  on  local  needs, 
intere.sts,  availability  of  facilities,  and 
professional  services,  he  points  out. 

He  concludes  that  a  physician,  work- 
ing with  the  director  of  a  day-care  cen- 
ter for  the  children  of  migrants,  a 
public  health  nurse,  and  lay  volunteers, 
can  make  an  indispensable  contributinii 
toward  meeting  the  children's  needs,  by 
designating  the  tests  to  be  made;  plan- 
ning and  supervising  an  immunizatimi 
program  ;  suggesting  ways  of  improving 
feeding  habits ;  and  drawing  the  com- 
munity's attention  to  the  long-raiise 
effects  on  children  in  migrant  farm  fam- 
ilies of  growing  up  in  extreme  poverty 
and  ignorance. 


photo  credits 

Frontispiece,    Carl    Purcell,    National 
Education  Association. 

Pages  27  and  29,  Tadder,  Baltimore. 


42 


CHILDREN     •     JANUARY-FEBRUARY  1967 


READERS'  EXCHANGE 


BRITTAIN:  Start  with  the  parent 

As  Dr.  Brittiiiii's  review  indicates, 
investigators  anil  elinieians  \vorl<ing 
with  tlie  "enltiirally  deprived  cliild" 
stniijfjle  Willi  llie  i)r(ibleni  of  providing 
tlie  protective  and  i)Ieasure  enliancing 
values  so  oflen  absent  in  a  slum  en- 
vironment. ["Preschool  Programs  for 
Culturally  Deprived  Children,"  Clay 
V.  Hrittain,  (MIILDREX,  .Tnly-August 
lOCiC).  1  Many  liclieve  that  this  can  be 
accomplished  in  the  classriKim.  but  our 
clinical  exiH^rience  indicates  that  an 
educationrcl  program  must  be  predicated 
on  the  values  of  the  home  to  succeed. 

In  a  ps.vchoaualytically  oriented 
study  of  nursery  school  children  from 
an  extremely  low  socioeconomic  area, 
we  found  that  a  child,  by  association, 
will  value  what  he  knows  or  assumes  is 
of  value  to  the  caretakin.g  adult  and 
ego-ideal.  Thus.  I  he  primary  effort 
must  be  to  modify  the  value  system  of 
the  culturally  deprived  home  in  con- 
sonance with  the  concept  of  a  unified. 
Integrated,  and  strong  social  order  that 
emphasizes  self-preservation  and  the 
preservation  of  a  democratic  society. 

In  addition  to  working  with  the  val- 
ues of  the  parent  or  fwirent  surrogate. 
however,  one  must  make  him  aware  of 
the  communication  problems  inherent  in 
the  child-parent  relationship.  What 
the  child  values  is  determined  by  his 
interpretation  of  parental  values. 
Hence,  the  child  must  understand 
parental  values  as  accurately  as  po.s- 
sible  as  these  are  modified. 

We  must  also  recognize  the  communi- 
cation problem  between  the  parent  and 
the  therapist.  For  example,  the  par- 
ents' affirmation  that  "education  is 
good"  may  not  mean  what  the  educator 
may  mean  by  that  phra.se.  The  mother 
of  our  nursery  child  might  say.  "If  my 
child  learns  to  read  and  write  well,  he 
can  get  a  job  that  will  pay  him  a  better 
wage."  We  believe  that  education 
should  improve  the  child's  capacity  for 
communication,  interpersonal   relation- 

VOLUME  14  -  NUMBER  1 


ships,  and  better  understanding  with 
greater  particii>ation  in  community  life. 
Brittain's  review  of  the  studies  of 
preschool  enrichment  programs  seems 
to  indicate  that  the  focus  on  classroom 
aetivit.v  failed  to  produce  any  signifi- 
cantly lasting  results.  We  think  that 
introducing  a  reorient.ation  of  values  in 
the  home  regarding  education  and  so- 
ciety is  the  most  effective  way  of  in- 
fluencing the  child  to  place  value  on  the 
enrichment  program  and  enable  him  to 
retain  and  use  it. 

Henry  H.  Fineberg,  M.D. 

Illinois  Slate  Pediatric  Institute 
Chicago 

FINE:  Some  questions 

Regina  V.  Fine's  article,  "Jloving 
Emotionally  Disturbed  Children  from 
Institution  to  Foster  Family"  (CHIL- 
DREN, November-December  1966),  is  a 
.sound  contribution  to  the  practice  litera- 
ture on  the  placement  of  children.  She 
is  careful  to  move  children,  not  abruptly, 
but  through  sequential  steps,  smoothly 
combining  old  and  new  contacts ;  not 
arbitrarily,  but  with  explanation  and 
preparation  ;  not  as  pa.ssive  objects,  but 
with  encouragement  to  abreact  their 
thoughts  and  feelings.  Above  all,  Mrs. 
Pine  refreshingly  admits  that  she  makes 
mistakes ! 

On  another  level  of  analysis — namely, 
the  community  planning  level — I  was 
troubled  by  the  following  : 

1.  Institutions  decide  to  part  with 
children.  AVhy?  Why  can  they  not  ar- 
range living  facilities  under  single  ad- 
ministrative au.spices? 

2.  In  moving  children  who  require 
therapy  from  an  institution  to  a  foster 
home,  wh.v  is  it  neces.sary  for  the  child 
to  break  off  relationships  with  one 
therapist  and  form  new  relationships 
with  another  tlierai)ist'/ 

3.  A  child  runs  awa.v.  The  foster 
parents  are  ready  to  take  the  child  back 
and  work  the  problem  through.  Wh.y 
does  his  running  away  become  a  reason 


I'll-  relui-Ming  liim  to  ills  former  institu- 
tional placement  V 

4.  Cliildren  who  live  in  residential 
Ireatnient  institutions  are  apparently 
not  geared  to  master  life  in  normal  fam- 
ilies. Why  not'?  Why  can't  this  be 
built  into  the  residential  treatment  in- 
stitutional programs  prior  to  replace- 
ment into  foster  homes? 

These  questions  are  troubling  because 
they  illustrate  the  degree  to  which  so- 
cietal and  institutional  procedures  and 
constraints  sometimes  severely  restrict 
the  i)ra(t  it  loner's  flexibility  in  helping 
his  client.  It  is  time  to  recognize  that 
institutional  arrangements  were  not 
made  in  heaven,  and  that  if  children  are 
to  be  helped,  resources  should  be  built 
around  them,  rather  than  the  reverse. 

Norman  Herstein 

Executive  Director,  Jeimsh  Family 

and  Children's  Service 

Boston,  Mass. 

A  challenge  to  skill 

To  those  of  us  who,  like  Regina  V. 
Fine,  have  the  task  of  helping  emo- 
tionally disturbed  children  move  from 
residential  settings  to  foster  family 
care,  her  article  brings  a  statement  of 
familiar  problems  that  challenge  our 
best  diagnostic  and  treatment  skill. 

Her  article  not  only  describes  a  de- 
veloping specialized  function  of  agen- 
cies serving  children,  it  also  indicates 
the  needs  for  greater  sharing  of  infor- 
mation and  better  communication  with- 
in the  social  work  profession — as  well 
as  among  the  professions — in  imple- 
menting the  placement  process. 

Residential  centers  for  the  psychi- 
atric treatment  of  emotionally  disturbed 
children  are  finding  that  fo.ster  family 
care  and  group  homes  are  necessary  to 
the  total  therapeutic  milieu.  They  en- 
able the  child  to  experience  community 
living  in  a  suijervised,  stnictured  set- 
ting. Iliis  fact  was  recognized  at  the 
Children's  Study  Home  in  Springfield, 
Mass.,  .soon  after  its  reorganization 
into  a  residential  treatment  center  for 
emotionally  disturbed  children  6  years 
ago.  The  Home,  therefore,  began  re- 
cruiting foster  families  and  small 
group  home.s.  At  present,  the  Study 
Home  is  serving  6.")  children  :  15  in  the 
residential  center,  18  in  foster  family 
homes,  16  in  small  group  homes,  and 
16  in  the  center's  day-care  program. 
The  children  in  the  day-care  program, 
as  well  as  some  of  the  children  in  foster 

43 


families  or  group  lioines  wlio  need  spe- 
cial educational  assistance,  attend  the 
school  operated  by  the  agency  at  the 
residential  center. 

Through  individual  and  group  therapy 
programs  for  parents,  we  help  parents 
maintain  the  strength  to  allow  the 
children  to  remain  in  our  program.  We 
are  now  exploring  the  xise  of  family 
diagnosis  and  therapy  techniques. 
Mrs.  Fine's  article  lends  weight  to  the 
plea  for  exploration  of  new  approaches. 
It  is  indeed  gratifying  to  learn  about 
what  one  agency  is  doing  to  revitalize 
a  fundamental  approach  to  the  child 
who  needs  reconstructive  experience. 

Zeannette  W.  Lynch 
Grace  Spillane 

Children's  Study  Home 
Springfield,  Mass. 

WRIGHT:  Do  we  care  enough? 

The  introduction  to  Mattie  K. 
Wright's  lucid  article,  "Comprehensive 
Services  for  Adolescent  Unwed  Moth- 
ers," makes  the  old  indictment  that 
agencies  fail  to  reach  girls  from  the 
lower  socioeconomic  group.  [CHIL- 
DREN, September-October  1966.] 
Granted,  existing  services  arc  inade- 
quate, chiefly  becau.se  of  lack  of  money, 
manpower,  and  a  sense  of  mission.  But 
for  years,  The  Salvation  Army  has  been 
reaching  some  of  these  girls.  A  study 
by  Dr.  Deborah  Shapiro  in  three  Salva- 
tion Army  homes  reported  that  the  girls 
were  "fairly  heavily  concentrated"  in 
what  is  "upper  lower  class"  :  67  percent 
were  white ;  33  percent,  Negro.  Of  the 
white  girls,  about  one-third  were  from 
middle  class  families ;  two-thirds,  from 
lower  clas.s.  All  but  four  Negro  girls 
were  from  lower  class  families. 

In  Cleveland,  for  example,  The  Salva- 
tion Army  is  making  a  concerted  effort 
through  a  day  center  with  casework, 
group  work,  educational  classes,  medi- 
cal care,  vocational  guidance,  psychi- 
atric consultation  to  take  services  to 
the  people  in  their  homes  in  the  neigh- 
borhood. True  this  is  just  a  "drop  in 
the  bucket"  in  relation  to  the  needs,  but 
it  is  somclhing ! 

I  hope  Mrs.  Wright's  timely  article 
will  be  read,  studied,  and  acted  upon 
by  agency  staffs  and  boards.  It  is 
studded  with  penetrating  ideas  which 
should  move  all  of  us  to  do  more  than 
we  are  now  doing  to  reach  more  unmar- 
ried mothers,  especially  adolescents 
from  low-income  families. 

I  would  like  to  underscore  five  ideas 

44 


in  the  article:  (1)  Concern  prompted 
the  project;  (2)  the  project  is  carried 
out  through  collaboration  of  health,  ed- 
ucation, welfare,  and  recreational  serv- 
ices; (3)  the  project  is  located  cZo.se 
to  the  people  in  need;  (4)  criteria  are 
established  for  admission;  (5)  the 
demonstration  project  is  being  con- 
tinued by  a  tie-in  with  local  agencies. 

At  least  three  questions  trouble  me : 
(1)  Do  we  need  more  research  so  that 
we  can  find  more  ways  to  give  more 
help  to  girls  like  those  in  the  282  not 
accepted  by  the  project?  (2)  Can  we 
do  more  with  unmarried  fathers?  (3) 
After  the  grants  rnn  out,  what  then? 

Major  Mary  E.  Verner 

Women's  Social  Seri'ice  Secretary 

The  Sah'ation  Army  Eastern  Territory 

New  Yorl{  City 

MOSS:   Tunnel  vision 

The  article  by  Sidney  Z.  Moss,  "How 
Children  Feel  About  Being  Placed 
Away  From  Home"  [CHILDREN, 
July-August  1966],  is  valid  in  pointing 
out  the  necessity  for  helping  children 
cope  with  their  feelings  about  separa- 
tion from  their  families  if  they  are  to 
use  a  placement  experience  in  ways 
that  will  benefit  them. 

However,  the  article  remains  rooted 
to  this  factor,  only  one  among  many 
other  important  factors  to  which  all 
child  welfare  workers  must  be  sensi- 
tive. Tliis  too  readily  induces  the  type 
of  tunnel  vision  that  seriously  limits  a 
caseworker's  helpfulness. 

Many,  probably  most,  of  the  children 
coming  to  care  these  days,  whether  to 
family  or  to  a  group  care  service,  come 
as  a  result  of  complex  family  problems. 
Most  of  these  children  have  previou.sly 
been  faced  with  separation,  rejection, 
deprivation,  and  other  traumatic  ex- 
periences. Yet  in  his  article,  Mr.  Moss 
states :  ".  .  .  when  a  child  is  placed  in 
an  institution,  he  faces  two  difficult 
adjustments  :  mastery  of  the  separation 
trauma  ;  and  adaptation  to  the  institu- 
tion." 

It  is  almost  as  though  Mr.  Moss  be- 
lieves that  the  children's  first  experience 
of  crisis  is  the  placement  itself  and 
that  the  goal  of  the  caseworker  is 
merely  to  help  them  adapt  to  a  new 
environment.  Elsewhere,  Robert  Lind- 
ner has  aptly  labeled  this  point  of  view 
as  the  "myth  of  adjustment."  In  point 
of  fact,  children  usually  arrive  in  place- 
ment with  internalized  feelings  stem- 


ming from  their  past  experiences,  and 
increasingly  their  functioning  in  regard 
to  these  experiences  is  a  significant  fac- 
tor behind  their  referral  for  placement 
We  must  not  have  a  stereotyped  re- 
sponse. 

For  example,  a  teenage  daughter  of 
divorced  parents  was  recently  referred 
to  our  agency.  The  father  had  disap- 
peared. The  mother  was  trying  to  sup- 
port her  family  alone.  This  child  har- 
bors death  wishes  for  her  mother  and 
is  defiant  and  unmanageable.  Since 
the  mother  and  daughter  cannot  resolve 
the  difliculties  in  their  relationship 
while  they  are  so  close  to  each  other, 
the  motlier  is  now  seeking  placement 
as  a  means  of  providing  the  girl  with 
the  help  she  needs. 

This  child  has  already  experienced 
the  trauma  of  separation — from  her 
father  at  age  11.  In  all  likelihood  this 
loss,  having  come  at  a  critical  time  in 
her  emotional  development,  is  a  salient 
factor  in  the  emotional  separation  both 
mother  and  child  are  now  experiencing. 
Which  of  the  separation  traumas  would 
Mr.  Moss  elect  for  this  girl  to  master 
first?  That  with  father,  with  mother, 
or  that  which  comes  about  again  at 
the  time  of  placement?  There  are 
several,  and  they  need  to  be  differenti- 
ated in  the  caseworker's  understanding 
if  the  child  is  to  be  helped. 

Elizabeth  Lawder  has  pointed  out  in 
her    article,     "Can    Long-time    Foster' 
Care  Be  Unfrozen?"     [Child  Welfare, 
April  1961],  that  there  is  no  panacea 
to  the  problems  of  children  in  fosteri 
care  today,  that  much  of  what  inhibits  < 
the   creative,   purposeful,   and   produc- 
tive use  of  placement  as  a  treatment  I 
tool  is  the  "rescue  fantasy"  phenome- 
non of  professionals  in  the  child  wel 
fare  field,  and  that  the  growing  body  of 
knowledge  about    childhood   could   ex- 
pand our  understanding,  influence  prac- 
tice, and  ultimately  lead  to  a  differen- 
tial concept  of  foster  care. 

Mr.  Moss  deals  exhaustively  with  a 
part  and,  in  so  doing,  lends  weight  to 
the  "panacea  approach."  Unavoidably, 
the  price  paid  for  simple  solutions  to 
complex  situations  is  poor  service,  for 
to  deal  with  a  part  as  though  it  were 
the  whole  is  considerably  less  than  the 
competent  professional  endeavor  that 
is  mandatory  in  seeking  solutions  to 
the  problems  of  today's  children. 

F.  Herbert  Barnes 

Exfctitive  Director,  Carson  Valley 
School,  Flonrtotvn,  Pa. 


CHILDREN 


JANUARY-FEBRUARY  1967 


U.S.    GOVERNMENT   PRINTING   OFFICE:  I9S7 


r\  o^b^i ,    J?  n  /  U 


O 
O 


Q_ 

< 


I 

DC 

< 

5 


Coston  Public  Library 
Superintendem  of  Document, 

APR  1 2  1967 

DEPOSITORY 


children 


A  Foster  Grandparent  Program 
Conflicts  in  Behavioral  Research 
Home  Therapy  for  the  Retarded 
Youth  Services  in  England 


a^^ik; 


-  t!  B  '■ 


w 


VOLUME   11 


NUMBER  2 


MARCH-APRIL   1967 


children 


AN  INTERDISCIPLINARY  JOURNAL  FOR  THE  PROFESSIONS  SERVING  CHILDREN 


< 


leaching  out  for  each  other's 
ove,  this  foster  grandchild  and 
ler  foster  grandmother  meet 
Jvery  day  to  help  each  other, 
ach  in  her  own  way.  Through 
:he  program  described  in  our 
ead  article,  older  men  and 
women  and  neglected,  disturbed 
ffQung  children  are  brought  to- 
gether as  foster  grandparents  and 
oster  children  to  the  good  of 
X)th.     (See  page  46.) 


Foster  Grandparents  for  Emotionally  Disturbed 

Children 46 

Ruth  Johnston 

Conflicting  Values  Affecting  Behavioral  Research 

With  Children 53 

M.  Brewster  Smith 

A  Time  Study  in  a  Well-Child  Conference    ....     59 

Victor  Eisner  and  Helen  M.  Wallace 

A   Homebound   Therapy   Program  for  Severely 

Retarded  Children 63 

Hope  G.  Curfman  and  Carol  B.  Arnold 

Group  Counseling  of  Mothers  in  an  AFDC 

Program 69 

David  Kevin 

Youth  and  Youth  Services  in  England 75 

Katherine  B.  Oettinger 

book  notes 80 

here  and  there    83 

readers'  exchange 87 

government  publications 88 


children 


National  Advisers  to  CHILDREN 

William  E.  Brown,  dentistry 

Alex  Elson,  law 

John  H.  Fischer,  education 

Beatrice  Goodwin,  nursing 

Dale  B.  Harris,  psychology 

Robert  J.  Havighurst,  youth  development 

Robert  B.  Kugel,  pediatrics 

Hylan  Lewis,  sociology 

Helen  B.  Montgomery,  social  work, 

Bernice  M.  Moore,  community  planning 

Winford  Oliphant,  child  welfare 

Milton  G.  Rector,  corrections 

Albert  J.  Solnit,  psychiatry 

John  D.  Thompson,  obstetrics 

Samuel  M.  Wishik,  maternal  and  child  health 

Children's  Bureau  Staff  Advisers 

Kenneth  S.  Carpenter,  chairman 
Division  oj  Juvenile  Delinquency  Service 

Dorothy  E.  Bradbury 
Division  of  Reports 

Hester  B.  Curtis 

Division  of  International  Cooperation 

Elizabeth  Herzog 
Division  of  Research 

Jane  S.  Lin-Fu 

Division  of  Health  Services 

Jean  Reynolds 
Office  of  the  Chief 

Will  Wolstein 

Division  of  Social  Services 

Editorial  Staff 

Kathryn  Close,  Editor 

Catherine  P.  Williams,  Associate  Editor 

Mary  E.  Robinson,  Willamena  Samuels,  Assistants 

46 


llK 


They  wait  at  the  gate  to  greet  their  fostei 
grandparents.  Eager,  impatient  childrer 
wait  for  equally  eager  foster  grandparents 
who  will  take  them  out  of  the  group-care  unit  of  the 
county  child  welfare  agency  to  the  privacy  of  a 
vacant  sitting  room,  office,  niche  in  the  hall,  or  spot 
under  a  shade  tree  on  the  institution's  grounds. 

All  are  children  being  cared  for  by  the  Medical 
and  Emotional  Treatment  Service  Unit  of  the  Sum 
mit  County  (Ohio)  Child  Welfare  Board,  known 
by  the  staff  as  the  METS.  Most  of  them  are  of  pre- 
school age,  and  most  of  them  have  physical,  mental, 
or  emotional  handicaps,  or  a  combination  of  these 
problems.  All  are  under  the  county's  care  as  de- 
pendent and  neglected  children. 

The  foster  grandparents  come  to  the  children  for 
4  hours  a  day  through  the  Foster  Grandparents 
Project,  a  demonstration  project  to  give  employment 
to  needy  persons  who  are  over  the  age  of  60,  spon- 
sored by  the  Office  of  Economic  Opportunity  (OEO) 
and  the  Administration  on  Aging  of  the  U.S.  De- 
partment of  Health,  Education,  and  Welfare.  The 
chief  interest  of  the  Summit  County  Child  Welfareficca 
Board  in  participating  in  the  project,  however,  has 
been  in  tapping  the  potential  of  foster  grandparents 
as  treatment  agents  in  its  social  casework  efforts|ipol 
to  lielp  the  children  to  a  happier  life. 

Through  its  METS  unit,  the  Summit  County  Child  | 
Welfare  Board  provides  temporary  group  care  fouftsp 
some  young  children  who  must  be  removed  fromljr 
their  homes  for  their  protection — and  sometimes  theii 
very  survival — and  for  whom  no  other  arrangement  Ik » 
is  immediately  available.     Many  children  arrive  at  n: 
the  agency  with  such  aggravated  behavioral  prob 
lems  that  even  the  most  experienced  and  capable  fos-  ^■\ 
ter  parents  could  not  cope  with  them.     Even  some 
very  young  children  seem  so  damaged  by  their  ex-  ta 
periences  that  they  need  the  kinds  of  control  that  cam  lijii 
be  provided  only  in  group  living  before  they  can 
form  tlie  kinds  of  relationships  with  other  human 
beings  that  are  prerequisite  to  a  successful  foster 
home  experience. 

Like  most  child-care  agencies,  however,  our  agency 
has  realized  that  its  child-care  workers  could  not 
give  individual  children  enough  attention  to  provide 
them  with  the  necessary  ego-building  experiences, 
Such  children,  we  felt,  needed  the  kind  of  loving, 
personal  attention  that  a  foster  grandparent  might 
be  able  to  give  them. 

Our  agency  was  one  of  the  first  21  agencies  chosen 
by  the  Administration  on  Aging  to  participate  in 
the  Foster  Grandparents  Project.     Planning  took 


CHILDREN     •     MARCH-APRIL  1967 


id 

% 
it;: 
ft: 

tt- 

%] 


tti 


FOSTER 

GRANDPARENTS 
FOR 


some  casework  aspects  of  using 


emotionally 

disturbed 

children 


aee  in  UXij.  It  was  agreed  then  that  each  partici- 
iting  agency  wonkl  adapt  its  program  to  the  needs 
I:  the  cliiklren  under  its  care  within  the  framework 
f  policies  established  by  the  Administration  on  Ag- 
ig  and  OEO.  The  agencies  would  choose  the  grand- 
urents,  train  tliem  for  their  work,  and  assign  them 
)  specihc  children. 

The  staff  for  the  Summit  County  Foster  Grand- 
iirents  Project  consists  of  a  part-time  director  from 
le  agency's  social  service  staff,  a  part-time  supervi- 
)r  hired  especially  for  this  position,  and  a  part-time 
msultant  and  a  full-time  field  supei-visor  from  the 
liency's  institutional  child-care  staff.  In  addition, 
five-member  advisory  committee,  representing  sen- 
ir  citizens  groups,  labor  unions,  the  Summit  County 
hikl  Welfare  Board,  and  the  local  community  ae- 
on council,  meets  together  regularly  to  review  the 
rogram's  policies. 

(lection  and  orientation 

The  actual  hiring  of  grandparents  began  in  Janu- 
^'  1966.  Ten  grandparents  were  accepted  at  that 
me  from  75  applicants.  Later,  the  agency  employed 
:o  other  groups  of  foster  grandparents — 10  in  each 
roup.  Of  the  30  foster  grandparents  employed,  23 
'6  still  in  the  project — 18  grandmothers  and  5 
randfathers. 

For  acceptance  to  the  program,  the  applicants  had 
meet  the  OEO  criteria  of  having  no  more  than 

GLUME   14  -  NUMBER  2 


RUTH  JOHNSTON 


$1,800  per  year  income  (since  lowered  to  $1,500)  and 
of  being  over  60  years  of  age.  They  also  had  to  have 
their  physician's  approval  and  had  to  be  able  to  hear 
and  see  well,  to  move  around  easily,  to  pick  up  small 
children,  to  climb  stairs,  to  sit  on  the  floor,  and  to 
play  games. 

Other  criteria  called  for  the  subjective  judgments 
of  agency  staff  members  made  on  the  basis  of  personal 
interviews  and  of  study  of  the  foster  grandparents' 
written  applications:  functional  literacy;  reasonably 
good  grooming ;  pleasant  appearance ;  ability  to  listen 
and  ability  to  express  meaning;  and  some  indication 
of  having  had  enjoyable  experiences  with  children, 
their  own  or  other  people's. 

In  our  selection  process,  we  sought  evidence  of 
satisfactory  life  experiences;  adequate  adjustment  to 
age  and  financial  status;  an  interest  in  people,  espe- 
cially children:  a  wish  to  be  of  service  to  someone; 
and  an  ability  to  understand  and  accept  the  agency's 
policies.  We  tried  to  find  clues  to  these  qualities 
during  the  application  process  and  through  observa- 
tion of  the  applicants  as  they  were  shown  through 
the  ]\IETS  unit.  One  crucial  test  was  the  "touch 
test" — a  literal  reaching  out  to  children  followed  by  a 
spontaneous  and  positive  response  from  the  children. 

Before  the  orientation  program  began,  we  had 
wondered  whether  older  people  not  used  to  an  aca- 
demic approach  would  be  able  to  accept  and  benefit 
from  an  orientation  program.  We  had  wondered 
iiow  approachable  they  would  be  in  respect  to  the  staff 


47 


and  one  another  and  how  adaptable  they  wonld  be  to 
the  routine  and  policies  of  the  agency.  We  were 
pleasantly  sui-prised  to  find  that  the  foster  grand- 
parents immediately  saw  themselves  as  a  "group"  and 
began  at  once  to  participate  in  the  discussions.  They 
seemed  to  have  the  wisdom  that  comes  with  age  and 
genuine  interest  in  the  project. 

The  orientation  began  with  an  overall  description 
of  the  agency,  its  plant,  staff  plan,  and  major  policies 
regarding  child  care.  But,  the  chief  focus  was  on 
helping  the  foster  grandparents  understand  the  chil- 
dren and  how  to  work  with  them.  "Wlien  we  outlined 
the  ways  in  which  children  normally  develop,  we 
found  the  foster  grandparents  were  interested  from 
two  standpoints:  (1)  As  a  new  way  of  looking  at 
child-rearing  practices,  since  most  of  them  had  never 
before  considered  child  rearing  from  a  theoretical 
point  of  view;  and  (2)  as  an  opportunity  to  tell  of 
their  experiences  with  their  own  children  and  grand- 
children. 

After  discussing  theory,  we  focused  our  attention 
on  the  i^articular  children  with  whom  the  grand- 
parents would  be  working.  Again  we  were  pleas- 
antly surprised  at  the  general  openmindedness  and 
flexibility  shown  in  these  discussions.  However,  we 
found  out  later  that  all  the  foster  grandparents  had 
not  understood  all  of  what  was  said  and  were  not 
actually  prepared  for  the  situations  they  would  face. 
But,  in  spite  of  some  difficulties  with  the  children, 
they  stood  pat  in  their  determination  to  help  the 
chikh'en  assigned  to  them. 

We  tried  to  help  the  foster  grandparents  under- 
stand that  these  children  would  not  be  like  their  own 
grandchildren  and  that  as  foster  grandparents  they 
would  have  different  obligations  and  responsibilities 
than  as  grandparents.  We  told  them  that  a  major 
goal  of  the  project  was  to  meet  each  child's  needs 
and  help  him  solve  his  problems. 

During  the  orientation  week,  we  discerned  many 
kinds  of  strength  in  the  foster  grandparents — sin- 


Ruth  Johnston  has  been  since  1965  adminis- 
trative supervisor.  Summit  County  (Ohio) 
Child  Welfare  Board,  where  she  is  also  di- 
rector of  the  Foster  Grandparents  Project 
described  here.  Previously  she  was  for  13 
years  director  of  child  welfare  in  the  Arkan- 
sas Department  of  Public  Welfare.  A 
graduate  of  the  Columbia  University  School 
of  Social  Work,  she  has  also  worked  in  child  welfare  in 
North  Carolina. 


.•^■-"> 


cerit}^,  security,  self-esteem,  flexibility,  warmth,  anc 
stamina — that  we  hoped  would  be  passed  on  to  oui 
children.  We  also  foiuid  weaknesses  in  these  areas 
However,  by  appraising  each  individual,  we  at 
tempted  to  match  grandparent  and  child  so  that  thoii 
strengths  and  weaknesses  would  complement  out 
another's.  The  goal  was  to  provide  the  child  with  ; 
person  to  whom  he  could  relate  and  in  whom  he  wouk 
see  the  qualities  he  needed  most. 

By  the  end  of  the  orientation  week,  everybody 
was  eagerly  anticipating  the  climax — the  assignmen 
of  i^articular  children  to  particular  grandparents 
We  arrived  at  these  assignments  on  the  basis  of  inf  or 
mation  received  from  the  agency's  child-care  worker; 
and  the  children's  social  workers.  While  these  work 
ers  were  usually  in  general  agreement  about  thi 
child's  needs,  the  child-care  workers  tended  to  emph 
asize  behavioral  problems  and  the  social  workers  t( 
emphasize  inner  conflicts.  Wliere  it  seemed  neces 
sary,  we  had  conferences  with  the  workers  on  partic- 
ular children  before  coming  to  a  decision.  In  al 
assignments,  the  child's  needs  were  given  first 
priority.     No  consideration  was  given  to  race  or  age  y^ 


of  grandparents  or  child. 
Agency  team  members 


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The  first  foster  grandparents  received  their  assign, 
ments  on  January  28,  1966.  On  that  day,  the  fostei 
grandparents,  all  of  whom  had  been  introduced  t( 
all  the  children  previously,  were  literally  sitting  or 
the  edge  of  their  chairs  in  their  eagerness  to  find  out 
which  ones  they  would  get.  Without  exception  thej 
accepted  the  children  selected  for  them.  Subse- 
quently, either  the  director  or  supervisor  talked  witt 
the  grandparent,  giving  him  infonnation  about  his 
particular  child  that  would  help  him  in  working  with 
the  child.  The  grandparent  was  frankly  told  about 
the  child's  present  problems  and  what  the  agency'i 
long-term  goal  for  him  was,  given  suggestions  foi 
dealing  with  the  child,  and  encouraged  to  do  "what  Oi 
comes  naturally"  within  the  framework  of  the|i! 
agency's  rules  and  the  child's  special  needs. 

Each  foster  grandparent  and  child  were  assigned 
a  place  wliere  they  could  be  alone  together  and  were 
supplied  with  a  bag  full  of  toys  selected  for  that  par- 
ticular child  and  used  by  him  only  when  he  was  with 
his  foster  grandparent. 

The    foster    grandparents    showed    a    surprising 
ability  to  understand  and  accept  the  basic  policies  of 
the    agency    with    regard   to    the    development   of  riil 
children  and  to  help  us  implement  them.     In  fact,jlier 


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CHILDREN     •     MARCH-APRIL  1967 


t 


1)1 


Olio  of  our  ;-ta  ll"  iin'iiil)(.'rs  li;is  iisi'd  tlu'  Icnii  ■"iiii  nil  \\r 

isi'work"  (o  dcsrrilii'  what  some  of  I  In'  I'lisicr  iirainl- 
liaivnts  lia\i>  tloiu'. 

A\'o  feel,  and  let  the  {inuulparents  know  we  do,  that 
tlu\v  are  ;i  pail  of  an  aai'iu-y  team  caiung  for  chihlreii. 
They  keep  a  record  of  their  work  with  the  ehildren 
iiid  are  eiicouraii'ed  to  report  both  the  <i'ood  days  and 
bad  tlays  ami  to  e.\[)reHs  their  own  thoiiy'lits  altoiit 
he  eliikl,  his  jirohleiiis,  and  his  pron'ress.  These  rec- 
irds  arc  shared  with  the  child-care  and  social  work 
stall's.  The  entire  stall'  has  heen  pleased  to  see  how 
[lerlinent  they  are. 

A\'arni  relat  ioiishi[)s  lie!  ween  the  foster  <irandpar- 
Mits  and  their  assiiriied  children  l)e<;'an  de\'elopinj;' 
iiniiiediately,  and  the  ji'raiid[)areiits  soon  learned  at 
lirst  hand  about  the  children's  problems. 

One  grandmother  wrote  after  a  short  time: 

Johnny  was  so  glad  to  see  me.  They  told  me  he  could  hardly 
ivait  until  I  came.  We  got  our  toys  and  went  to  our  room.  I 
loticed  he  was  nervous  and  shy.  All  at  once  he  began  to  open 
ip  to  me  and  tell  me  how  his  mommy  had  come  and  brought 
lim  some  toys,  and  he  asked  me  to  please  help  him  grow  up 
iO  he  could  whip  his  daddy  for  beating  up  his  mommy.  It 
Jroke  my  heart  to  see  him  in  this  attitude.  I  think  parents' 
xoubles  shouldn't  be  pushed  on  the  child,  especially  at  this  age. 
(ohnny  is  very  smart  and  understands  more  than  most  children 
lis  age. 

This  grandmother  has  said  that  Johnny's  show  of 
feeling  came  as  a  shock  to  her  e\en  though  she  had 
)een  warned.  However,  a  warm  relationship  has 
leveloped  between  them. 

In  this  early  ]ieriod  a  foster  grandfather  wrote  of 
very  disturbed  little  boy : 

He  is  to  me  the  greatest  because  he  is  my  grandson.  He  is 
lot  what  I  would  call  a  bad,  bad  boy.  Sometimes  he  is  nice 
is  he  can  be,  otherwise  is  real  mean,  but  I  hope  to  help  to  make 
.  good  boy  out  of  him.  There  are  times  I  think  I  see  a  big 
hange.  I  hope  e\ery  day  I  can  find  some  way  to  cope  with 
lim. 

The  grandfather  has  found  a  way  to  cope,  and  the 
hange  in  the  child  is  almost  unbelievable. 

One  woman  was  assigned  a  little  girl  who  was  so 
vithdrawn  that  she  went  for  days  without  speaking. 
Vfter  a  while  this  foster  grandmother  wrote  : 

I  ha\e  noticed  a  change  in  her  personal  pride.  Now  she 
vill  ask  me  to  comb  her  hair,  give  her  a  bath,  put  her  in  a  dress 
nstead  of  pants.  These  are  things  she  did  not  even  notice 
vhen  I  got  her,  and  to  me  this  is  a  marked  improvement,  for 
,s  long  as  you  can  keep  a  child's  personal  pride  up  and  keep 
t  feeling  someone  else  cares  you  have  a  chance  of  their  trying 
o  build  a  life. 

In  general,  the  foster  grandparents  have  boon  most 
illing  to  share  their  impressions  with  other  staff 
nembei's.    Howe\'er,  as  they  isi't  to  know  a  child  they 

VOLUME  14  -  NUMBER  2 


tend  to  become  iiu-i'ca.^iiigh'  protective  of  hnii  and 
have  to  be  remimh'd  from  t  inie  lo  time  that  their  job 
is  not  to  protect  the  child  from  criticism,  but  to  work 
w  ith  everyone  else  toward  helping  him  overcome  his 
problems. 

Some  foster  grandparents  have  been  remarkably 
acute  ill  their  observations.     One  recorded: 

Every  day  I  understand  him  better  and  treat  him  as  an  indi- 
vidual. He  seems  to  be  searching  for  something  he  can't 
quite  iind,  and  to  be  inwardly  at  war  with  himself,  which 
makes  him  resentful  and  rebellious. 

Some  byproducts 

After  lu'arly  a  year  we  are  able  to  appreciate  the 
lirogram  from  the  standpoint  of  the  agency,  the  social 
work  stair,  the  child-care  staff,  the  foster  grand- 
parents, and  of  course  the  children. 

Agency  benefits.  In  addition  to  what  the  program 
has  ilone  for  our  children,  it  has  resulted  in  increased 
community  good  will  toward  the  agency.  The  30 
foster  grandparents  and  5  advisory  committee  mem- 
bers who  have  taken  the  orientation  course  and  the 
community  agencies  that  have  referred  prospective 
foster  grandparents  to  the  agency  now  ha\e  a  better 
understanding  of  the  agency  and  its  program.  And 
the  agency  has  boon  called  to  the  attention  of  the 
public  at  large  through  favorable  news  and  magazine 
stories  focused  on  the  opportunity  it  has  given  older 
people  to  work  with  children. 

Casework  benefits.  The  agency's  social  workers 
probably  had  lioth  the  greatest  hope  and  the  most 
misgivings  of  all  the  .staff  members  about  the  Foster 
(irandparents  Project.  They  realized  that  the  chil- 
dren would  bcnolit  from  a  one-to-one  relationship  that 
the  child-care  workers  could  not  provide.  They 
recognized  that  one  or  two  visits  a  week  from  a  case- 
worker was  not  enough  to  sustain  a  very  young,  dis- 
turbed child.  However,  their  training  and  experi- 
ence had  taught  them  the  value  of  skilled  casework 
based  on  investigation,  diagnosis  and  treatment,  and 
they  wondered  how  foster  grandparents  with  no  pro- 
fessional education  could  tit  into  a  casework  plan. 

The  social  workers  also  wondered  how,  with  the 
restrictions  on  age  and  income  set  by  the  Office  of 
Economic  Opportunity,  foster  grandparents  could  be 
found  who  were  not  too  physically,  culturally,  and 
educationally  limited  to  be  able  to  give  the  children 
what  they  needed.  They  also  wondered  whether  the 
children  would  be  faced  with  conflicts  in  loyalty  be- 
tween caseworkers  and  foster  grandparents  or  be- 

49 


tween  foster  graiidparents  and  the  child's  own 
parents  and  relatives.  They  wondered  whether  the 
foster  grandparents  would  have  enough  understand- 
ing and  stamina  to  bear  up  under  the  child's  expres- 
sions of  hostility  or  whether  they  would  get  enough 
satisfaction  out  of  the  job  themselves  to  be  able  to 
give  anything  of  value  to  the  child. 

Almost  without  exception,  the  social  workers'  fears 
have  been  laid  to  rest  and  their  hopes  fulfilled.  More- 
over, they  have  often  found  information  gained  from 
the  grandparents  useful  m  furthering  their  own 
understanding  of  the  children  in  their  caseloads.  For 
example,  a  grandparent  wrote  of  a  child : 

We  went  for  a  walk  today  and  she  opened  up  a  bit  by  talk- 
ing of  her  mother,  whom  she  mentions  quite  often,  but  more 
than  her  mother  she  speaks  of  her  father.  Sally  asked  me  why 
doesn't  her  daddy  get  well.  I  did  not  know  what  or  how  to 
answer  her  but  I  tried  to  make  her  feel  better.  .  .  . 

Sally  had  not  previously  revealed  her  deep  concern 
about  her  father.  Learning  of  it  through  the  foster 
grandparent,  the  social  worker  could  help  the  little 
girl  deal  with  it. 

During  the  past  year,  among  the  children  who 
were  assigned  foster  grandparents,  nine  have  been 
returned  to  their  own  homes  and  nine  have  been 
placed  in  foster  family  homes.  While  the  foster 
grandparents  cannot  be  given  the  entire  credit  for  the 
emotional  progress  that  enabled  these  children  to  go 
into  a  family  settiiig,  in  each  case  a  foster  grand- 
parent made  a  definite  contribution  toward  it.  The 
social  workers  helped  the  child  use  the  relationship 
with  his  foster  grandparent  to  find  the  strength 
for  these  moves. 

While  the  grandparents  have  felt  sad  at  the  loss 
of  the  children,  in  each  case  they  gave  them  real  sup- 
port in  moving  on.  One  foster  grandmother  wrote 
to  a  once  extremely  withdrawn  child : 

This  is  from  your  dear  grandmama,  and  I  must  say  that  I 
have  enjoyed  you  so  very  much  since  I  have  had  you  in  my  care, 
and  I  did  my  best  to  bring  you  up  to  here  with  a  secret  prayer. 
Wherever  you  go,  or  wherever  you  be,  I  pray  that  the  good 
Lord  will  be  there. 

Another  foster  grandmother  who  had  helped  a 
very  aggressive  child  establish  control  recorded: 

Bill  has  been  informed  he  is  going  to  a  foster  home  where 
he  will  have  a  mommy  and  daddy.  He  is  strong  willed  some- 
times, slow  to  obey,  but,  if  let  alone,  he  will  change  his  atti- 
tude. I  am  very  happy  that  he  has  a  mother  and  daddy  plus 
a  good  home  because  that  is  what  every  child  needs  to  develop 
a  strong  character  and  become  a  good  citizen.  I  really  am 
reluctant  to  give  him  up,  but  it  is  for  a  better  way  to  develop 
finer  character.  I  keep  telling  him  he  is  leaving  his  foster 
grandmother  for  a  real  foster  mother  plus  a  home  of  his  own 
and  so  much  else  to  make  him  feel  free  and  happy. 


50 


Some  of  the  social  workers  have  reported  that  th 
children  in  their  caseloads  are  more  appi'oachabl 
since  they  have  had  foster  grandparents,  that  the 
talk  more  to  the  social  workers,  listen  better,  are  mor 
able  to  bear  the  separation  from  their  parents,  an 
generally  have  a  better  feeling  about  people,  pai 
ticularly  the  adults  in  their  lives.  One  grandparen 
wrote  a  little  boy  who  3  months  earlier  had  had  grea 
difficulties  in  personal  relationships : 

It  has  been  a  pleasure  working  with  Dan,  also  a  real  cha 
lenge  at  times,  but  it  has  been  rewarding  just  to  see  him  groi 
in  size,  disposition,  and  temperament.  He  has  changed  froi 
the  sulky,  disobedient  little  fellow  I  met  on  May  3.  I  feel  m 
time  and  effort  have  been  well  spent. 

Child-care  benefits.  The  foster  grandparent  pre 
gram  has  meant  that  some  children  are  out  of  th 
child-care  unit  for  4  hours  a  day,  thus  giving  th 
child-cai'e  workers  more  time  to  spend  with  the  chi. 
dren  who  do  not  have  foster  grandparents.  As 
result,  the  children  in  group  care  are  happier,  moi 
relaxed,  and  more  controllable. 

The  houseparents  tell  us  that  having  a  foster  granci 
parent  is  a  "status  symbol"  among  the  children.  The< 
also  report  that  the  children  who  have  foster  granc 
parents  play  better,  eat  better,  sleep  better,  and  loO" 
better  than  the  other  children. 

Children  in  METS  who  do  not  have  grandparent' 
are  those  who  are  in  temporary  care,  who  are  to- 
young,  or  whose  particular  needs  could  not  be  met  b 
any  foster  grandparent  who  is  available  for  assign 
ment  at  the  time. 

Some  minor  difficulties  have  occurred  in  th 
METS  unit  since  the  initiation  of  the  foster  grand 
parent  program.  Child-care  workers  and  foste 
grandparents  sometimes  meet  head  on  with  conflict  i 
ing  ideas,  often  involving  housekeeping  problems 
and  occasionally  resulting  in  bruised  feelings.  How 
ever,  since  foster  grandparents  and  child-care  stai 
alike  have  genuine  concern  for  the  welfare  of  th 
children,  none  of  these  minor  difficulties  hav 
amoimted  to  anything  that  poses  any  real  problem 
Tliere  is  generally  a  friendly,  satisfying  give  and  tab 
between  foster  grandparent  and  houseparent.  If  an; 
real  difficulty  should  arise  between  them,  however,  th« 
supervisor  of  the  child-care  staff  would  be  responsibl 
for  dealing  with  it. 

Grandparent  benefits.  The  foster  grandparent: 
themselves  all  seem  to  enjoy  a  feeling  of  being  of  use 
One  foster  grandfather  said  recently  that  it  gives  hin 
a  reason  for  getting  up  in  the  morning. 

When  the  foster  grandparents  are  asked  what  th( 
experience  has  meant  to  them,  they  nearly  alwayfi 

CHILDREN     •     MARCH-APRIL  1967 


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;ito  tho  progress  (liey  see  in  the  developuiciit  of  the 
;liildren  iossigned  to  them  and  their  pride  in  their 
iccoinplishnicnts.     One  grandparent  reported  : 

Fred  was  very  good  and  played  good  and  was  in  an  unusual 
[ood  mood  all  morning.  He  did  not  bite  or  try  to  bite  me  or 
inyone. 

In  spite  of  being  bit,  liit,  kiclced,  spit  on,  cnrsed, 
run  away  from,  berated,  yelled  at,  and  disobeyed,  the 
"oster  grandparents  have  kept  perspective  and  have 
)ften  seen  the  deeper  meaning  of  the  child's  behavior 
uul  even  the  humor  in  it.  One  seriously  disturbed 
?hild  suddeidy  hit  his  grandmother  with  a  knife 
landle  and  then  complained  because  slie  bled.  Thi-ee 
nonths  later  the  same  child  accidentally  kicked  the 
grandmother  while  playing  and  was  most  solicitous 
uul  concerned.  The  foster  grandmother  reported 
)oth  incidents,  the  second  with  pride,  even  though  it 
lad  resulted  in  a  black  eye  for  her. 

There  has  been  almost  no  absenteeism  among  the 
'oster  grandparents  except  for  illness.  They  have 
some  to  the  agency  through  cold  and  heat  and  on 
lolidays.  They  have  gone  with  their  children  on  all- 
lay  picnics,  hikes  in  the  woods,  walks  in  the  park, 
sdsits  to  the  circus;  they  have  gone  wading  with  them 
;o  help  them  catch  tadpoles;  in  short  they  have  gone 
ivherever  the  children  have  gone,  without  question 
md  apparently  with  pleasure. 

he  children 

The  raison  (Tetre  of  our  program  is,  of  course,  the 
;hildren — what  they  have  needed,  what  they  have 
received,  and  what  they  have  become.  For  them  the 
>xperience  has  been  a  positive  one  physically,  men- 
ally,  and  emotionally.  We  have  followed  Erikson's 
iight  stages  of  man '  in  classifying  the  development 
Jiat  has  taken  place  in  the  children  during  this 
jeriod.  Some  cliildren  have  made  remarkable  prog- 
ress; others,  very  little.  However,  in  every  case 
some  progress  is  evident. 

Sense  of  trust.  For  many  of  our  children  the  rela- 
ionship  with  their  foster  grandparent  is  the  first 
positive  relationslrip  they  have  had  with  an  adult. 
[t  starts,  whether  the  child  is  age  2  or  8,  with  having 
I  lap  to  sit  on  and  involves  being  cuddled  and  com- 
forted. It  moves  on  to  confidence  that  tlie  foster 
grandparent  will  do  what  he  says  he  will  do. 

Before  coming  to  us  many  of  our  children  have 
jeen  given  little  in  their  own  homes  except  the  bare 
jssentials.  Yet  after  a  child's  placement  away  from 
iome,  his  parents  often  try  to  make  up  for  their 


The  attention   this   foster  grandparent  is   giving  a  sick-abed 
child    is    clearly    making    this    little    girl    forget    her    illness. 


own  hurt  and  tliat  of  the  child  by  bringing  him  gifts. 
To  the  child  these  seem  only  a  superficial  token  of 
love.  We  try  to  restore  the  proper  balance  by  having 
the  foster  grandparents  give  the  children  much  at- 
tention and  wannth  but  little  in  a  material  way. 
The  foster  grandparent  and  the  child  take  a  walk 
together  to  enjoy  one  another  and  the  outdoors  rather 
than  to  get  an  ice  cream  cone.  However,  if  occasion- 
ally the  grandparent  combines  the  two  purposes,  we 
do  not  object. 

Autonomy.  Through  their  genuine  feeling  for  the 
children,  the  foster  grandparents  have  helj^ed  absolve 
some  of  the  shame  and  doubt  brought  on  the  children 
by  the  loss  of  their  parents. 

We  believe  that  the  grandparents,  using  their  own 
experience,  interest,  initiative,  and  imagination,  have 
helped  develoj^  the  children's  personalities  in  a  more 
personal  and  intimate  way  than  could  have  been  done 
by  a  social  worker  or  child-care  worker.  They  liave 
helped  children  develop  a  feeling  of  wortli  by  oil'er- 
ing  them  wai-m  affection,  and  this  affection  has  deep- 
ened as  the  cliildren  liave  begun  to  I'eturn  it.  They 
have  demonstrated  their  sense  of  the  child's  worth 
by  doing  things  for  him — bathing,  dressing,  combing 
hair,  tying  shoes,  pulling  up  socks,  putting  on  mittens 
and  cap.  Through  words,  expressions,  and  gestures, 
tlicy  have  shown  appreciation  of  the  child  himself 
and  their  pleasure  in  the  way  he  looks,  behaves,  and 


VOLUME  14  -  NUMBER  2 


51 


achieves.  With  very  young  children,  they  have  done 
this  unconsciously  through  simple  games  such  as 
"Show  me  your  nose." 

The  fact  that  the  foster  grandparent  "belongs" 
to  the  child  adds  to  the  child's  sense  of  worth.  Chil- 
dren have  shown  their  need  and  their  appreciation 
of  this  by  being  very  possessive  of  their  grandparents 
and  very  jealous  of  their  attention. 

Initiative.  The  grandparent  not  only  encourages 
the  use  of  the  creative  toys  provided  for  the  child ; 
he  also  participates  in  imaginative  play  with  them, 
thus  helping  the  child  learn  to  use  initiative  and 
imagination.  Showing  his  appreciation  of  the 
child's  creative  efforts,  he  encourages  the  child  to 
experiment  not  only  with  what  ho  can  do  witli  his 
own  mind  and  body  but  also  with  how  he  can  control 
outside  things. 

Many  of  our  cliildren  have  insufficient  ability  to 
express  themselves  in  words.  Not  having  been  en- 
couraged to  talk  in  their  own  homes,  they  tend  to  act 
ovit  rather  than  talk  out  their  feelings.  Because  of 
this  we  have  urged  the  foster  grandparents  to  read 
aloud  to  the  children,  to  tell  them  stories,  and  above 
all  to  talk  to  them  and  to  encourage  them  to  respond. 
As  a  result,  many  of  the  children  have  learned  to 
talk  not  only  about  the  things  they  see  around  them 
but  also  about  their  thoughts  and  feelings. 

Industry.  We  have  encouraged  the  foster  grand- 
parents not  only  to  do  things  for  the  children  but 
also  to  expect  the  children  to  do  things  for  them 
and  eventually  for  other  adults  and  other  children. 
Children  willingly  run  errands  for  grandparents, 
help  them  pick  up  toys,  and  do  other  things  because 
"Grandmother  asks  you  to,"  and  they  seem  to  derive 
a  sense  of  satisfaction  from  it. 

Foster  grandparents  have  also  taught  children  how 
to  greet  people,  how  to  eat  properly,  and  how  to  take 
care  of  themselves  and  their  clothing.  Many  of  our 
children  have  had  no  previous  opportunity  to  learn 
about  such  social  amenities.  Feeling  comfortable  in 
these  areas  increases  the  child's  self-assurance,  thus 
releasing  energy  for  further  growth. 

Foster  grandparents  have  also  helped  some  chil- 
dren prepare  to  enter  school.  By  showing  their  ap- 
preciation of  the  children's  efforts  they  have  made 
learning  easier  for  the  children. 


iiCL 

0. 


One  determined  foster  grandparent  helped  a  phys- 
ically handicapped  little  girl  who  had  spent  most  of 
her  time  in  a  wheelchair  progress  first  to  a  walker 
and  then  to  crutches.  There  were  numerous  clashes 
of  will,  sometimes  ending  in  a  draw,  but  most  often 
in  the  grandparent's  maintaining  control  and  m  turn- 
ing the  experience  into  a  positive  one  for  the  child. 

Sense  of  identity.  The  foster  grandparents  have 
helped  children  establish  a  sense  of  identity  by  each 
transmitting  to  his  child  his  feeling  that  the  child 
is  special,  through  helping  him  know  what  he  can  dOj 
and  through  helping  him  accept  controls.  Many  of 
our  children  before  coming  to  us  were  controlled  too 
harshly  or  not  at  all.  The  foster  grandpartents  are 
making  a  great  contribution  in  helping  the  children 
respect  both  their  own  rights  and  the  rights  of  others 
by  establishing  a  benign  control. 

Tlie  foster  grandparents  have  also  lielped  children 
learn  to  share — for  example,  to  take  turns  on  a  tri- 
cycle. The  grandparent  is  obviously  proud  wher 
his  particular  child  awaits  his  turn,  especially  wher 
the  child  thinks  of  something  interesting  to  do  while 
waiting. 

Tlie  grandparents  have  also  helped  the  children 
become  conscious  of  the  world  around  them.  We 
have  encouraged  them  to  take  their  children  walking 
and  to  call  attention  to  the  sunlight,  fresh  air,  greer 
grass,  birds,  insects,  and  pebbles.  Last  spring, 
METS  was  ablaze  with  dandelions  in  peanut  buttei^ 
glasses 

tadpoles,  bugs,  and  pebbles 
low  leaves  lined  the  walls. 

We  believe  that  the  very  fact  of  being  taken  oui 
of  the  group  physically  for  a  period  of  quiet  anc 
relaxation  with  only  one  other  person  has  been  ol 
great  benefit  to  the  child.  It  has  not  only  allowed 
him  the  satisfaction  of  a  one-to-one  relationship  but 
has  also  given  him  an  opportunity  to  become  ac^ 
quainted  with  himself  and  to  learn  about  his  own 
areas  of  strength  and  limitation  by  experimenting  ODJI^ 
an  acceptuig  adult. 

Obviously,  we  feel  that  this  experiment  has  been 
a  success 


Last  summer  it  housed  large  collections  oJ 


Last  fall,  red  and  yel- 


I 


til 


'  Erikson,  Erik  H.:  Childhood  and  society.     W.  W.  Norton  &  Co.,  I 
New  York.     1950.  ' 


52 


CHILDREN     •     MARCH-APRIL  1967     1)11. 


U  research 
Dsychologist 
discusses 
;ome 


CONFLICTING  VALUES 
AFFECTING 

BEHAVIORAL  RESEARCH 
WITH  CHILDREN 


M.  BREWSTER  SMITH 


Wlmt  limits,  if  any,  should  be  set  on  reseax'ch 
into  children's  beluivior^     Who  should  set 
these  limits?    These,  and  other  questions  re- 
liii'd  to  them,  are  being  asked  these  days  by  many 
|M(iplo   in   and   out   of   research — parents  and  law- 
makers included. 

Unly  recently,  when  research  on  behavior  was  a 
marginal  activity  of  a  few  college  professors  and 
their  graduate  students,  carried  out  with  little  fi- 
nancial support  and  that  support  received  mainly 
from  private  donors  and  foundations,  such  questions 
liardly  arose.  From  the  professor's  standpoint,  the 
responsibility  for  decisions  about  the  nature  of  the 
research  was  solely  his — a  matter  ,of  academic  free- 
dom and  privilege  within  the  framework  of  formal 
or  informal  codes  of  professional  ethics.  Nobody 
was  likely  to  challenge  him :  The  whole  enterprise  of 
research  in  the  behavioral  sciences  was  unimportant 
ind  inconspicuous,  and  public  funds  were  not 
involved. 

Today,  however,  the  behavioral  scientist  has  to  pay 
the  penalty  for  success.  Behavioral  research  is  no 
longer  inconspicuous :  Even  though  it  is  not  as  af- 
fluent as  the  physical  sciences,  it  is  now  big  business. 
Ajid  since  most  of  its  financial  support  now  comes 
from  the  Federal  Government,  its  errors  of  judgment 
as  well  as  its  successful  results  now  attract  political 
attention.  Public  concern  with  the  methods  that 
scientists  use  in  studying  other  people  is  of  course 


warranted  on  grounds  quite  a]iart  from  the  basis  of 
funding. 

For  perspective  on  the  special  problems  of  con- 
trols on  research  with  children,  we  had  best  begin 
with  a  brief  look  at  the  anxieties  and  misgivings 
about  the  political  and  ethical  aspects  of  the  behav- 
ioral sciences  that  figure  prominently  in  the  current 
climate  of  discussion. 

Many  people,  including  U.S.  Congressmen,  are 
worried  about  many  loosely  related  issues.  Do  per- 
sonality questionnaires  violate  the  citizen's  right  to 
l)rivacy  when  used  in  government  personnel  proce- 
dures or  in  i-esearch  ?  ^  Is  it  ever  pei'missible  for 
experimenters  to  deceive  the  subjects  of  their  experi- 
ments, as  some  types  of  investigation  seem  to  re- 
quire? -  If  deception  is  used,  how  can  the  "informed 
consent''  of  subjects  be  ol)tained?^  Do  the  ]K)ten- 
tialities  for  computer  retric\al  of  data  collected  for 
administrative  purposes  (tax  returns,  census  files,  and 
the  like)  threaten  the  privac}'  and  perhaps  even  tlie 
liberty  of  the  individual  citizen?  "What  of  Govern- 
ment-sponsored research  in  foreign  countries — how 
can  the  sensitivities  of  the  citizens  of  other  countries, 
the  interests  of  the  U.S.  Government,  and  the  needs 
of  the  social  sciences  for  comparative  data  all  lie  taken 
into  account?  *  How  can  the  Goveniment  and  the 
public  be  assured  they  are  getting  their  money's  worth 
out  of  social  and  behavioral  science?  Is  adequate 
support  available  for  the  study  of  socially  important 


VOLUME  14  -  NUMBER  2 


53 


problems  ?  ^  All  these  questions  <and  many  others 
have  found  their  way  into  tlie  legislative  hopper. 
Several  congressional  committees  have  held  hearings 
that  bear  upon  them.  Suddenly,  the  social  and  be- 
havioral sciences  are  politically  visible. 

Issues  concerning  children 

Each  of  these  issues  has  its  coimterpart  for  research 
on  the  behavior  of  children,  though  issues  concerned 
with  studies  of  children  in  foreign  countries  have  not 
yet  received  much  attention.  But  the  issues  look  and 
are  different  when  children  are  involved. 

Personality  questionnaires  and  the  right  to  privacy. 
Wlien  children  are  questioned  for  research  purposes, 
the  privacy  and  sensitivity  of  parents  have  to  be  con- 
sidered in  addition  to  the  possible  effects  of  the  ques- 
tioning on  the  child.  Some  kinds  of  questions — those 
about  sexual  attitudes,  knowledge,  and  practices,  for 
example — are  likely  to  be  regarded  as  intrinsically 
inappropriate  in  questionnaires  for  use  with  children ; 
questions  about  child-rearing  practices,  on  the  other 
hand,  may  be  seen  as  invading  the  parents'  right  to 
privacy  and  perhaps  even  as  undermining  parent- 
child  relations. 

Parents  who  have  little  understanding  of  the  meth- 
ods or  objectives  or  value  of  behavioral  research  have 
objected  to  their  children's  being  asked  about  their 
parents'  education  and  other  indicators  of  socioeco- 
nomic status — seeminglj'  incidental  information  tliat 
is  often  essential  in  a  researcli  j^roject !  Very  likely 
only  a  few  parents  would  be  disturbed  by  the  kinds  of 
questions  a  responsible  inA'estigator  would  find  neces- 
sary and  proper  to  ask,  but  their  objections  have  to  be 
taken  seriously,  not  dismissed  impatiently  as  "crack- 
pot." The  narrowest  interpretation  of  what  is  per- 
nussible  would  put  many  important  problems  Iseyond 
the  range  of  possible  research.  The  most  lenient 
would  affront  many  citizens. 

Deception.  In  this  regard,  the  issues  concerning 
children  sliape  up  differently  from  those  concerning 
deception  with  college  students  and  adults.  In  a 
typical  case,  tlie  problem  under  study  requires  the 
subjects  to  undergo  a  standard  sequence  of  successes 
and  failures  on  an  experimental  task.  To  produce 
this  standard  sequence,  the  subjects  are  provided  with 
believable  false  reports  about  their  performances  of 
the  task,  according  to  the  requirements  of  the  experi- 
mental design. 

Generally,  investigators  working  witli  adults  or 
college  students  attempt  to  meet  the  ethical  problem 

54 


in  such  deception  by  carefully  explaining  the  reason 
for  the  deception  to  each  subject  after  the  experiment 
is  over.  "\^nien  the  subjects  are  students  in  psychology 
courses,  such  a  "debriefing"  procedure  usually  makes 
sense  (though  it  may  not  balance  the  harm  done  to 
the  students  by  conveying  the  idea  that  a  manipu- 
lative approach  to  people  is  acceptable) .  When  "de- 
briefing" is  carried  out  scrupulously,  the  participant 
may  learn  something  relevant  to  his  studies,  both 
about  psychological  researcli  and  about  his  own 
reactions. 

In  research  with  young  children,  however,  no  one 
can  argue  for  "debriefing"  as  an  adequate  solution  tc 
the  ethical  problem  of  deception.  A  full  explana- 
tion of  procedures  to  the  young  child  is  seldom  de- 
sirable or  possible.  In  the  example  that  we  have 
been  considering,  the  usual  scrupulous  practice  woulc 
be  to  so  contrive  matters  that  by  the  end  of  the  ses- 
sion every  child  would  leave  with  a  solid  experiencf 
of  success. 

Yet  such  a  solution  leaves  one  uneasy.  The  ex- 
perimenter who  knows  that  he  must  subsequentlj 
explain  to  his  adult  subjects  just  how  he  has  de 
ceived  them  may  be  likely  to  exercise  self-restraini 
in  his  procedures.  The  experimenter  with  children 
is  under  no  obligation  to  explain  himself  to  his  sub 
jects,  and  if  he  is  not  required  to  justify  his  procedure; 
to  others,  everything  hinges  on  his  private  judgment 
Can  the  experimenter's  unavoidably  self-interestec 
judgment  of  what  is  best  for  the  child  be  trusted' 

Consent.  The  difficult  but  crucial  issue  of  whei 
the  participant  in  researcla  may  be  regarded  as  hav 
ing  given  his  infonned  consent  appears  in  a  differeni 
guise  in  respect  to  research  with  children.  Legally 
only  parents  can  consent  on  behalf  of  children.  Bui 
when  is  parental  consent  "infonned"?  How  mucl 
do  parents  have  to  know  about  a  particular  researcl 
project  before  their  consent  may  be  so  regarded'; 
When,  if  at  all,  may  the  responsible  authorities  in 
schools  and  other  social  agencies  give  consent  in  locc 
2)arentis1  When,  if  at  all,  may  implicit  consent  bei 
assumed  ?  Any  call  for  a  rigid  enforcement  of  a  re- 
quirement for  explicit  parental  consent  present; 
serious  obstacles  to  research  studies  that  hinge  on  ob- 
taining data  from  a  representative  sample  of  children 
This  is  because,  in  ways  that  affect  their  chil- 
dren, the  parents  who  neglect  to  return  consent  forms 
may  differ  from  those  who  do  return  them.  A  nar- 
row interpretation  of  the  consent  issue  could  very 
seriously  hamper  behavioral  research  with  cliildren, 

Uses  of  information.    Wlaether  information  col-i 

CHILDREN     •     MARCH-APRIL  1967 


is; 


((6 


livit'd  for  administnilivc  purposes  that  can  be  re- 
Inovi'tl  and  collated  by  a  hifrh-spoed  computer  for 
'I her  purposes  presents  risks  to  the  privacy  and  lib- 

iiy  of  adults  is  still  a  matter  for  conjecture,  since 
-ii.il  data  banks  are  not  yet  f^enerally  available. 
I  lo\vc\or,  the  cumulative  school  records  of  children's 
psychological  tests  are  already  with  us  and  may  do 
real  harm. 

I'Seful  as  ability  tests  midoubtedly  are,  thej*  are 

Karly  a  mixed  blessing;."'  '  The  low  test  scores  of  a 
■hild  who  gets  off  to  a  poor  stai't  may  exclude  him 
t'liuu  opportunities  to  impi'ove  his  position.     Teach- 

rs  who  rely  on  the  predictive  power  of  a  poor  score 
lielp  confirm  the  prediction.  On  the  other  hand, 
without  test  results,  social  stereotyping  might  play  a 
larger  part  than  it  does  in  deciding  a  child's  educa- 

I filial  future.  ^lucli  careful  thought  and  further 
I  (search  are  needed  to  luid  ways  of  using  ability  tests 
-.  1  as  to  maximize  each  child's  educational  opportuni- 
liis  instead  of  accentuating  existing  inequalities  of 
i|iportunity.  Because  the  testing  technology  is  a 
product  of  scientific  psychology,  problems  concerned 
with  the  administrative  use  of  tests  naturally  get 
■111  angled  with  the  logically  distinct  problems  of  their 
research  uses.  It  is  important  to  keep  the  issues 
-r|iarate. 

Iiiformation  collected  from  children  for  research 
sliould  never  be  used  to  their  disadvantage.  When 
I  liii  nature  of  the  research  permits  data  to  be  collected 
;iii(l  stored  anonymously,  the  interests  of  the  indi- 
\  idual  child  can  be  readily  protected.  When,  on  the 
Ml  her  hand,  identification  of  individual  persons  is 
i'--ential  to  the  research — as  in  "longitudinal"  studies 
I  liat  follow  the  same  persons  over  a  jieriod  of  time — ■ 
eluliorate  precautions  are  essential  to  safeguard  con- 
lidentiality.  In  such  research,  protecting  the  anony- 
mity of  the  pei-sons  studied  is  an  absolute  about  which 
t  here  can  be  no  compromise. 

Competins  values 

As  we  explore  these  issues,  it  is  easy  to  become  pre- 
I"  rnpied  with  the  dangers  of  using  children  as  sub- 
ji'its  of  behavioral  research  and  the  safeguards 
iH'cessary  to  protect  them  at  the  expense  of  appre- 
'  iating  the  actual  and  potential  contributions  of 
iiehavioral  research  to  child  welfare.  The  cumula- 
ii\'o  findings  of  research  on  child  development  are 
just  begimiing  to  break  the  cyclical  fashions  in  child- 
rearing  advice.*  In  this  country  we  are  just  launch- 
ing a  host  of  new  and  expensive  programs  in  the 
-iliools  based  on  extrapolations  from  current  knowl- 


M.  Brewster  Smith  is  i)rofessor  of  psychology 
nnd  director  of  the  Institute  of  Human 
Development  at  the  University  of  California, 
Berkeley.  He  has  been  president  of  the 
Society  for  the  Psyeholoiiiiiil  Study  of 
Social  I&sues  (lO.'iS-.'i!))  and  editor  of  the 
Journal  of  Abnormal  and  Social  I'syclioloijy 
(1956-02).  His  recent  research  activities 
include    studies    of    intergroup    relations    and 


alUtudes    of 


:idolescents  and  political  activism  in  college  students. 


edge  about  behavior  that  urgently  require  monitoring 
and  rigorous  evaluation  tiirongh  research.  Now  is 
not  the  time  to  stifle  behavioral  research  with  severe 
restrictions. 

In  its  own  interest,  the  public  needs  to  make  some 
accommodations  to  the  I'equirements  of  research. 
Behavioral  scientists  and  the  agencies  that  support 
their  work  should  be  actively  involved  in  educating 
the  public  and  its  representatives  in  Government  to 
the  characteristics  and  value  of  such  research. 

The  beginning  of  wisdom  m  this  regard,  it  seems 
to  me,  is  to  recogiiize  that  we  must  come  to  terms  with 
competing  values.  Humanitarian  values  require  that 
we  never  hami  the  individual  child  and  always  strive 
to  advance  child  welfare.  Libertarian  values  require 
us  to  respect  the  integrity  and  privacy  of  the  child 
and  his  parents.  Scientific  values  prescribe  the  ex- 
tension of  knowledge  for  its  own  sake,  usually  with 
the  faith  that  in  the  long  run  knowledge  contributes 
to  hmnanitarian  ends.  Legal  values  require  us  to 
respect  the  status  of  minors  and  the  rights  and  obli- 
gations of  parents,  though  legal  rights  in  relation  to 
behavioral  research  are  still  in  the  process  of  clarifi- 
cation.^ Often  these  different  frames  of  evaluation 
point  to  the  same  conclusion.  The  cases  in  which 
they  do  are  the  simple  ones  that  pose  no  serious  prac- 
tical or  ethical  problem.  But  often  they  conflict  with 
one  another.  For  example,  the  child's  privacy  and 
perhaps  his  integrity  are  violated  for  the  sake  of  ad- 
vancing knowledge  of  a  topic  that  is  theoretically 
and  humanly  important  when,  in  a  study  of  how 
moral  character  develops,  he  is  tempted  to  cheat  and 
whether  he  does  so  or  not  is  surreptitiously  observed. 
In  such  instances,  we  need  principles  and  mechanisms 
for  adjudication. 

Both  principles  and  mechanisms  become  indispen- 
sable once  we  grant  that  decision  on  these  conflicts  in 
values  can  no  longer  be  left  to  the  unaided  conscience 
of  the  individual  investigator.  Now  that  behavioral 
science  has  grown  so  important  that  it  captures  pub- 


VOLUME  14  -  NUMBER  2 


55 


lie  attention,  forces  are  clearly  such  that  decision 
will  not  be  left  to  the  individual  investigator.  Nor 
should  it  be.  He  is  likely  to  be  a  biased  judge,  one 
who  will  set  a  higher  priority  on  scientific  values 
than  nonscientists  are  likely  to  do.  He  wants  so 
much  to  conduct  research  and  to  advance  knowledge 
that,  being  human,  he  may  underestimate  or  rational- 
ize away  the  costs  and  risks  to  his  subjects.  At  any 
rate,  he  is  oi:)en  to  tlie  legitimate  suspicion  of  being 
vulnerable  to  bias.  Anyone  who  has  been  privy  to 
discussions  among  tough-minded  behavioral  scientists 
about  the  "trade  off"  between  ethical  risks  and  poten- 
tial scientific  gain  will  have  no  doubt  that  this  bias 
exists. 

Codes  of  ethics 

Further  codification  of  ethical  principles  by  the 
scientific  disciplines  concerned  to  help  guide  decision 
in  the  difficult  cases  is  a  much  needed  first  step. 
Existing  codes  of  ethics  provide  a  good  start  but  they 
stop  short  of  some  of  the  harder  issues  before  us. 
Thus,  the  code  adopted  in  1959  by  the  Amei'ican 
Psychological  Association"  provides  for  the  confi- 
dentiality of  research  materials  and  calls  upon  the 
psychologist  to  show  "sensil)le  regard  for  the  social 
codes  and  moral  expectations  of  the  community  in 
which  he  works.  .  .  ."  In  what  is  probably  the 
critical  principle,  it  states: 

Only  when  a  problem  is  significant  and  can  be  investigated 
in  no  other  way  is  the  psychologist  justified  in  giving  mis- 
information to  research  subjects  or  exposing  research  subjects 
to  physical  or  emotional  stress. 

a.  When  the  possibility  of  serious  aftereffeas  exists,  research 
is  conducted  only  when  the  subjects  or  their  responsible  agents 
are  fully  informed  of  this  possibility  and  volunteer  nevertheless. 

b.  The  psychologist  seriously  considers  the  possible  harmful 
afterefifects  and  removes  them  as  soon  as  permitted  by  the  de- 
sign of  the  experiment.  .  .  .  [Principle  16.  Harmful  after- 
effects.'] 

Such  a  code  of  principles  typically  contains  some 
absolutes.  (Provision  a  above  approaches  an  abso- 
lute requirement  for  voluntary  consent,  though  the 
decision  about  when  a  "possibility  of  serious  after- 
effects exists"  remains  judgmental.)  More  of  the 
principles  will  point  to  strongly  desirable  or  Iiighly 
undesirable  practices  that  are  nevertheless  open  to 
some  kind  of  negotiation. 

I  would  like  to  see  some  nearly  absolute  principles 
added  that,  I  think,  are  essential  to  maintaining  a 
relationship  of  trust  between  researcher  and  human 
subject,  a  relationship  that  is  a  prerequisite  to  soci- 
ety's continued  tolerance  of  the  behavioral  scientist. 

56 


! 


Under  very  few  circumstances  is  an  investigator  jus- 
tified in  violating  a  pledge  of  confidentiality  given  to 
a  research  subject,  even  thougli  the  interests  of  the 
subject  are  fully  protected.  The  frequency  with 
which  hidden  devices  are  used  to  identify  supposedly 
anonymous  questionnaires  is  deplorable.  I  would 
also  like  assurance  that  when  an  investigator  has  em- 
ployed deception  and  subsequently  explains  his  action 
to  his  subjects  in  a  "debriefing"  session,  he  presents 
the  literal  truth — and  does  not,  as  sometimes  has?  ^. 
been  the  case,  use  the  session  for  further  experimental' 
manipulation. 

However,  in  general,  I  would  prefer  to  keep  the 
absolutes  to  a  minimum  and  would  open  even  the  few 
absolutes  proposed  to  debate  and  to  legitimate  ex- 
ceptions, under  safeguards  of  a  sort  to  be  discussed 
shortly.  Thus,  I  can  imagine  a  research  situation 
in  which  the  covert  identification  of  questionnaires  i 
might  be  an  essential  and  justifiable  method  for 
checking  on  the  effects  of  lack  of  anonymity  on 
questionnaire  responses. 

The  inherent  limitation  in  ethical  codes  is  the  lee- 
way they  leave  for  human  judgment  and  for  balanc- 
ing competing  values.     Without  such  leeway,  any 
code  would  be  unworkable ;  with  it,  the  code  is  open  i 
to  evasion.     Api^lication  of  ethical  principles  to  real  '| 
cases  is  literally  a  problem  in  casuistry  and  is  vul- 
nerable to  the  abuses  that  gave  casuistry  a  bad  name. 
In  the  principle  I   have  quoted,  what  determinesd,,^ 
"when  a  problem  is  significant"?     How  much  un- 
successful search  do  we  require  of  an  investigator    , 
before  we  allow  him  to  decide  that  the  problem  "can; 
be  investigated  in  no  other  way"  ?     How  big  a  proba- 
bility is  a  "possibility"  of  serious  aftereffect,  and  how 
much  does  the  experimenter  have  to  hurt  people  for 
it  to  be  "serious"?     And  who  is  to  decide  all  this? 

I  am  not  criticizing  the  ambiguous  wording  of  thei  j,, 
jirinciple.     Insofar  as  there  is  no  objective,  commoni  ^. 
measure  by  which  competing  values  can  be  "traded 
off,"  the  fallibility  of  human  judgment  cannot  be| 
eliminated  from  decisions  about  the  ethics  of  research.  J 
The  question  is  whose  judgment  should  it  be  and' 
under  what  safeguards.     What  we  need,  therefore,  ^ 
are  mechanisms  of  responsible  "due  process." 


uri 


JJ^ 
i. 


A  due-process  mechanism 

At  present,  universities  throughout  the  country  are 
having  their  initial  experience  with  one  type  of  such 
a  due-process  mechanism.  Through  regulations  pro- 
mulgated in  February  and  July  1966,  the  Surgeon 
General  of  the  U.S.  Public  Health  Service  requires 

CHILDREN     •     MARCH-APRIL  1967 


isli 


\ 


['> 


jvery  iiistitutiuu  receiving  ;i  USPIISgruut  to  develop 
rinciples  and  procedures  governing  the  use  of  liuiimn 
ubjects  in  rescareli.     A  crucial  feature  of  tliese  re- 

juirenients  is  a  review  of  the  judgment  of  eacii  prin- 
ipal  investigator  or  program  director  by  a  multidis- 
iplinary  conunittee  of  his  institutional  associates. 

Since    tiio    procedures    became    operative    only    on 

l^ovember  1,  196G,  it  is  too  early  to  report  the  expe- 
ience  that  universities  have  had  in  administering 
lese  controls.  After  an  era  of  laissez-faire,  an 
ttitndo  which  can  no  longer  be  justified,  I  can  safely 
redict  that  loud  complaints  from  academic  in\-esti- 

jators  will  be  heard  for  some  time.  Nonetheless, 
ith  only  slightly  less  assurance,  I  also  predict  that 
decentralized  system  of  institutional  review  on  the 
""■SPIIS  model  will  become  the  pattern  for  the  social 
ontrol  of  federally  financed  research  on  human  sub- 

ects,  including  children.     I  think  it  is  a  desirable 

jattern,  for  all  the  nuisance  it  is  creating. 
What  will  this  decentralized  system  accomplish? 

1.  It  will  assure  the  public  and  its  representatives 
lat  the  welfare  of  human  subjects  is  protected  by 
dequate  safeguards.  The  acceptabilitj-  of  an  inves- 
igator's  procedures  will  be  reviewed  by  others  and 

ill  be  justified  to  them.  The  requirement  that  the 
eview  committee  be  interdisciplinary  promotes  the 
levelopment   of  common   ethical   standards  across 

isciplines  and  professions  and  is  likely  to  have  a 
orrective  influence  on  disciplines  or  subdisciplines 
hat  have  become  habituated  to  dubious  practices. 

2.  Because  the  investigator's  possible  bias  in  re- 
ard  to  the  ethical  acceptability  of  research  proce- 
ures  is  checked  by  making  the  judgment  a  matter 
f  shared  public  responsibility,  it  will  for  the  most 
art  obviate  the  need  for  rigid  and  absolute  rules 
nd  allow  flexible  judgment  that  takes  the  particulars 
f  a  research  situation  into  account.  The  same  con- 
iderations  by  wliich  a  jury  system  is  a  jaroper  device 
or  administering  justice  "beyond  reasonable  doubt" 
lake  a  system  of  collegial  review  appropriate  to  the 
iherently  judgmental  issues  research  deals  with. 

3.  At  the  cost  of  some  initial  confusion  and  in- 
luity,  it  will  encourage  ci-eative  and  responsible 

king  within  institutions  as  they  formulate  and 
vise  the  ethical  codes  under  which  the  review  com- 
littees  will  operate.  Some  may  wish  to  keep  formal 
rinciples  to  a  minimum  and  evolve  a  kind  of  com- 
lon  law  from  the  precedents  that  are  established  in 
orderline  cases.  Others  may  try  to  spell  out  more 
illy  elaborated  codes.  Through  their  scientific  and 
rofessional  associations,  the  disciplines  concerned 
ould  be  well  advised  to  watch  these  developments 

OLUME  14  -  NUMBER  2 


cliiscly  and  tci  lake  (he  lead  in  [)repariiig  statements 
of  principles  fm'  the  institutional  conunittees  that 
reflect  the  special  prnblenis  of  tlieir  own  areas  of 
research. 

4.  It  will  avert  the  stultifying  rigidity  of  Federal 
centralized  administrative  or  statutory  control  over 
research  practices. 

I  think  the  special  problems  of  research  on  the 
behavior  of  children  can  best  be  dealt  with  in  such  a 
framework  of  decentralized  institutional  self-moni- 
toring according  to  explicit  principles  and  proce- 
dures, which  can  and  should  be  modified  as  we  learn 
from  exi)erience  in  working  with  them.  Reviewing 
conunittees  will  naturally  be  slow  to  approve  proce- 
dures that  they  are  at  all  dubious  about  when  the 
subjects  of  the  research  are  young  childron. 

A  special  problem 

The  issue  that  may  demand  the  closest  attention 
and  give  the  greatest  trouble  is  the  one  involving 
explicit  parental  consent.  In  regard  to  this  problem, 
and  to  many  others,  behavioral  research  does  not 
parallel  clinical  medical  research  "  closely  enough  for 
the  medical  research  codes  to  be  particidarly  helpful. 

The  relationship  of  physician  to  patient,  involving 
as  it  does  the  highly  charged  issue  of  life  and  death, 
can  when  it  is  diverted  to  research  objectives  be 
perverted  to  an  unspeakable  evil  (as  in  the  Nazi 
death  camps),  unless  the  strictest  controls  protect 
the  patient's  interests.  If  patients  are  to  be  able 
to  turn  confidently  to  their  physicians  for  help,  they 
must  know  that  they  will  not  be  used  in  medical  ex- 
perimentation without  their  knowledge  and  consent. 
In  the  case  of  minors,  parental  consent  is  the  legally 
required  equivalent  of  the  patient's  consent.  (Yet 
matters  here  are  not  simple  either:  advances  in 
pharmacology  that  none  of  us  would  forego  depend 
on  the  use  of  placebos  and  "double-blind''  designs, 
practices  that  are  hard  to  reconcile  with  the  principle 
of  voluntary  consent.) 

In  contrast  to  medical  research,  much  behavioral 
research,  with  children  or  with  adults,  is  concerned 
with  far  less  sensitive  matters.  "VVlien  the  require- 
ment of  explicit  parental  consent  would  defeat  the 
purpose  of  an  otherwise  important  behavioral  study 
requiring  a  representative  sample  of  children  and 
no  reasonable  person  would  expect  the  study  to  harm 
the  child  or  insult  the  parents'  values,  an  exception  to 
the  requirement  seems  justifiable. 

The  sort  of  responsible  review  of  the  investigator's 
justification    of   his   research   procedures   that    the 


57 


Public  Health  Service  is  now  requiring  makes  it  pos- 
sible to  consider  such  exceptions  on  their  merits.  Ee- 
view  groups  will  have  to  develop  their  own  guidelines 
for  deciding  when  the  explicit  consent  of  a  parent  or 
guardian  should  be  obligatory,  when  parents  should 
be  given  the  opportunity  to  consent  implicitly  by  fail- 
ing to  object  to  an  amiounced  research  plan  that 
involves  their  child,  and  when  the  responsible  head  of 
an  institution  such  as  a  school  system  or  a  school 
might  appropriately  consent  to  the  research  being 
done  without  consulting  the  parents.  School  au- 
thorities will  of  course  base  their  decisions  to  give 
or  witliliold  permission  not  only  on  their  own  judg- 
ment about  what  is  ethical  but  also  on  the  com- 
patibility of  the  research  with  the  school's  educa- 
tional objectives  for  the  child.  The  latter  judgments 
are  more  appropriately  made  by  superintendents  and 
principals  than  by  investigators,  review  committees, 
or  parents. 

Respect  for  the  subject 

Lest  I  give  the  impression  that  the  due-process 
mechanism  the  Public  Health  Service  has  decreed 
for  American  campuses  will  of  itself  fully  allay 
the  concern  about  the  proprieties  of  research  with 
children  and  other  human  subjects,  which  many  social 
and  behavioral  scientists  share  with  other  citizens, 
I  need  to  draw,  by  way  of  conclusion,  a  distinction 
between  what  is  ethically  permissible  and  what  is 
ethically  desirable.  My  own  view  is  that  the  pre- 
dominant cast  of  much  permissible  behavioral  re- 
search falls  short  of  the  desirable  in  too  often  adopt- 
ing a  manipulative  or  condescending  attitude  toward 
its  human  subjects  rather  than  a  genuinely  respectful, 
collaborative  one. 

Much  public  resentment  toward  the  behavioral 
sciences  arises,  I  tliink,  from  correct  perception  of 
this  tendency  toward  manipulation.  Eeview  com- 
mittees and  codes  of  ethics  will  not  directly  improve 
this  state  of  affairs  because  inevitably  they  are  con- 
cerned with  ruling  out  what  is  not  permissible,  rather 
than  with  making  what  is  desirable  prevail.  If  and 
as  behaviorial  scientists  come  more  characteristically 
to  grant  their  subjects  the  respect  they  accord  to  col- 
laborators in  an  enterprise  they  understand  and  ac- 
cept, they  should,  by  the  same  token,  help  create  a 


more  favorable  atmosphere  for  behavioral  research, 
The  styles  of  research  that  prevail  may  be  more  im- 
portant than  skill  in  public  relations  in  creating  a 
favorable  "image"  of  behavioral  science. 

In  research  with  children,  an  atmosphere  of  respect 
and  care  is  particularly  important.  Improvement  in 
what  is  normative  practice  in  research  in  the  be- 
havioral disciplines  must  be  the  outgrowth  of  con- 
tinued discussion  in  the  professional  societies  and  ill 
the  universities  and  of  resultant  changes  in  graduate 
training. 

Such  discussions  are  in  process  as  a  byproduct  ol 
the  review  procedures  the  Public  Health  Service  is 
requiring  of  the  universities.  As  a  result  of  par- 
ticipating in  them,  social  and  behavioral  scientists 
may  come  increasingly  to  realize  that  they  have  lost 
their  innocence.  They  can  no  longer  live  in  a  worlc 
of  simple  good  and  evil  in  which  their  research  deci- 
sions follow  unambiguously  from  academic-scientific, 
values.  Like  it  or  not,  they  are  now  faced  with  pick- 
ing their  way  among  conflicting  values  and  resolving 
the  conflicts  as  best  they  can.  It  comes  to  many  ol 
us  as  a  surprise,  though  it  should  not,  that  the  modes  P' 
of  resolving  such  conflicts  are  in  the  broadest  sens 
inherently  political. 


'American  Psychological  Association:  American  Psychologist,  Novem 
ber  1965.     (Special  issue  on  "Testing  and  Public  Policy.") 

"Kelman,  Herbert  C;  Deception  in  social  research.  Trans-Actiot 
July-August  1966. 

'Ruebhausen,  Oscar  M.;  Brim,  Orville  G.,  Jr.:  Privacy  and  behaviora 
research.     Columbia  Law  Review,  November  1965. 

'  American  Psychological  Association:  American  Psychologist,  Ma 
1966. 

"Carter,  Luther  J.:  Social  sciences:  where  do  they  fit  in  the  politic _ 
of  science?     Science,  Oct.  28,  1966. 

"  Goslin,  David  A.:  The  search  for  ability;  standardized  testing  ii 
social  perspective.     Russell  Sage  Foundation,  New  York.     1963. 

'Goslin,  David  A.;  Rayncr,  Roberta  E.;  Hallock,  Barbara:  The  us 
of  standardized  tests  in  elementary  schools.  Russell  Sage  Foundation 
New  York.     1965.     (Mimeographed.) 

'Hoffman,  Martin  L.;  Hoffman,  Lois  W.  (eds.):  Review  of  chil( 
development  research.  Russell  Sage  Foundation,  New  York.  Vol.  1 
1964,  and  vol.  2,  1966. 

"American  Psychological  Association:  Ethical  standards  of  psychol 
ogists.     American  Psychologist,  June  1959. 

"Ladimer,  Irving;  Newman,  Roger  W.  (eds.):  Clinical  invcstigatioi 
in  medicine:  legal,  ethical,  and  moral  aspects.  The  Law-Medicini 
Institute,  Boston  University,  Boston,  Mass.     1963. 


I 


Or. 


i 


Iiii 


58 


CHILDREN     •     MARCH-APRIL  196-!l 


A  TIME  STUDY  in  a 
WELL-CHILD  CONFERENCE 


VICTOR  EISNER,  M.D. 


HELEN  M.  WALLACE,  M.D. 


Long  waiting  times  in  a  clinic  are  well-known 
obstacles  to  adequate  health  care.  ^Vlien 
these  are  combined  with  uni'ealistic  appoint- 
ment schedules  and  overburdened  personnel,  the 
quality  of  care  suffers,  and  both  patient  and  staff  sat- 
isfaction is  impaired. 

One  tool  for  unproving  such  a  situation  is  a  time 
tudy.  This  tool  is  not  used  as  often  as  it  might  be 
jecause  of  a  general  feeling  that  an  effective  study 
is  both  difficult  and  expensive.  In  Berkeley,  Calif., 
however,  a  simple  time  study  has  been  used  effec- 
tively in  an  uncrowded  well-child  conference  to  pro- 
vide a  baseline  for  evaluation  and  administrative 
changes. 

The  clinic  in  which  the  time  study  has  been  applied 
is  jointly  sponsored  by  the  Division  of  Maternal  and 
Child  Health  of  the  University  of  California  School 
}f  Public  Health  and  tlie  Berkeley  Department  of 
?ublic  Health.  At  the  time  of  the  study,  the  clinic 
leld  one  4-hour  session  a  week  and  was  staffed  by  one 
sediatrician,  two  public  health  nurses,  and  a  nonpi'o- 
fessional  receptionist  from  the  local  Neighborhood 
iToutli  Corps.  In  addition,  a  nutritionist  from  the 
School  of  Public  Health  gave  demonstrations  to  pa- 
;ients  in  the  waiting  room,  consulted  on  individual 
problems,  and  participated  in  staff  conferences. 

The  clinic  sees  an  average  of  15  infants  and  pre- 
ichool  cliildrcn  each  session,  according  to  the  local 
lealtli  department  records  for  the  past  yenv.  The 
jublic  health  nurses,  under  the  guidance  of  the  pedia- 
riciun,  take  tlie  major  responsibility  for  interviewing 
ind  counseling  parents.  The  pediatrician  sees  each 
jhild  at  scheduled  intervals  for  a  history  and  physical 
sxamination  and  is  available  to  the  nurses  for  con- 


sultation or  the  evaluation  of  a  child  at  any  time. 
The  final  hour  of  each  session  is  used  for  a  staff  con- 
ference at  which  each  child  is  discussed. 

This  procedure  results  in  three  types  of  visits. 
A  mother  may  bring  her  child  for  a  "doctor  visit,"  a 
"nursing  visit,"  or  an  "immunization  visit."  llie 
"doctor  visit"  includes  the  nui'se's  weighing  and 
measuring  of  the  child,  a  conference  between  the 
mother  and  the  nurse,  and  a  physical  examination 
carried  out  by  the  pediatrician  who  also  reviews  the 
health  history  taken  by  the  nurse.  The  "nursing 
visit"  is  similar  except  that  the  child  is  not  seen  by 
the  pediatrician  unless  the  nurse  requests  a  consiilta- 
tion.  Such  consultations  or  "inspections"  as  they  are 
called  may  be  requested  when  the  child  has  a  skin 
rash  or  a  respiratory  infection,  or  when  the  child 
presents  moi-e  obscure  or  complex  symptoms  of  a 
health  problem.  The  "immunization  visit"  is  a 
return  visit  of  a  child  to  the  clinic  for  immunization 
only.  On  these  visits  the  nurse  checks  briefly  to  be 
sure  that  no  infections  exist  and  that  the  immuniza- 
tion has  previously  been  ordered  l)y  tlie  pediatrician, 
and  administers  the  immunization. 

Collection  and  analysis  of  data 

In  the  time  study,  the  time  each  child  spent  at  the 
clinic  and  the  activities  of  each  member  of  the  clinic 
staff  were  timed  during  four  clinic  sessions.  Using 
simple  forms,  the  receptionist  recorded  the  times  of 
arrival  and  departure  of  each  child,  and  the  nurses 
and  pediatrician  recorded  tlie  times  they  started  and 
finished  each  activity,  with  the  name  of  the  child  and 
the  type  of  activity  performed.    This  did  not  prove 


iTOLUME  14  -  NUMBER  2 


59 


difficult.  It  is  estimated  that  the  total  time  taken 
for  recording  was  about  5  minutes  per  recorder  for 
each  session. 

A  total  of  77  children  were  seen  at  the  4  timed  ses- 
sions, or  an  average  of  19  children  per  session,  4  chil- 
dren more  than  average. 

The  data  were  analyzed  to  find  out  how  the  chil- 
dren's time  was  spent  in  the  clinic  and  how  the  clinic 
personnel  used  their  time.  In  addition,  because  of 
the  use  of  the  waiting  room  for  nutrition  demonstra- 
tions, a  study  was  made  of  normal  waiting  room  load. 
The  nutritionist's  activities  were  not  timed  directly 
because  it  was  difficult  to  relate  them  to  specific  pa- 
tients and  because  they  did  not  influence  the  time 
spent  by  the  other  clinic  personnel. 

In  order  to  analyze  patient  time,  the  data  sheets 
were  examined  to  see  how  many  minutes  each  child 
had  spent  in  the  clinic  altogether  and  how  many  in 
each  type  of  activity.  Data  tabulated  on  "doctor 
visits"  included  the  time  the  physician  spent  taking 
the  child's  history  and  giving  the  physical  examina- 
tion, and  administering  an  immunization;  the  time 
the  nurse  spent  in  conference  with  the  child's  mother, 
in  immunization,  and  in  weighing  and  measuring ;  the 
time  spent  by  either  nurse  or  physician  during  the 
same  visit  in  an  activity  with  a  sibling  or  siblings  of 
the  patient;  and  the  time  the  child  spent  waiting  in 
the  clinic  when  no  member  of  his  family  was  being 
attended — a  figure  arrived  at  by  subtracting  the  time 
spent  by  staff  in  activities  with  the  child  and  his 
siblings  from  the  total  time  the  child  spent  in  the 
clinic. 

For  a  nursing  visit,  the  tabulations  included  the 
time  the  nurse  spent  in  conference  with  the  mother, 
in  immunization,  and  in  weighing  and  measuring,  and 
the  time  the  physician  spent  inspecting  the  child ;  the 
time  spent  by  either  nurse  or  physician  with  the 
child's  siblings ;  and  the  child's  waiting  time.  Tabu- 
lations on  an  immunization  visit  included  the  time 
spent  in  administermg  the  immunization — considered 
to  include  any  time  used  for  taking  the  history  or 


Victor  Eisner,  left,  associate 
clinical  professor  of  maternal 
and  child  health  at  the  Uni- 
versity of  Califomia  School 
of  Public  Health,  Berkeley, 
has  for  the  past  year  directed 
the  FrankUn  Well  Child  Con- 
ference he  describes  in  this 
article.  Helen  M.  Wallace  is  also  professor  at  the  school  and 
chairman  of  its  division  of  maternal  and  child  health. 


discussion — the  time  spent  in  service  to  a  sibling 
and  the  child's  waiting  time. 

The  Findinss 

Calculations  made  from  these  tabulations  produce 
an  average  physician  time,  nursing  time,  and  waitin 
time  for  each  tyjje  of  visit.  The  figures  showed  tha 
on  the  average,  each  child  spent  51.7  minutes  in  tl 
clinic,  21.9  of  which  the  child  spent  waiting,  exclusi-\ 
of  the  time  he  waited  while  other  children  in  his  fan 
ily  were  being  served.  (The  range  between  childrt 
was  20  to  90  minutes  in  the  clinic  and  no  time  to  '■. 
minutes  waiting.)  The  pediatrician  spent  an  ave 
age  of  7.7  minutes  (with  a  range  of  from  2  to  i 
minutes)  on  each  physical  examination  he  made,  i: 
eluding  the  history  taking,  an  average  of  3.5  minut 
per  immunization,  and  2.2  minutes  per  "inspection 
The  nurse  S2)ent  an  average  of  13.5  minutes  (with 
range  of  4  to  40  minutes)  in  conference  with  t]|*F^ 
child's  parent,  4.4  minutes  on  immunization  (with 
range  of  2  to  15  minutes)  and  2.1  minutes  weighii 
and  measuring. 

The  total  professional  time  per  child  spent  on 
doctor  visit  was  9.1  minutes  by  the  physician  and  14 
minutes  by  the  nurse;  on  a  nursing  visit,  0.4  minut|'''"i'i 
by  the  pediatrician  (with  a  range  of  0  to  4  minute: 
and  14.5  minutes  by  the  nurse;  on  immunizati( 
visits,  6.3  minutes.  The  average  amount  of  profe|tiii?. 
sional  time  per  child  for  all  types  of  visits  was  5 
minutes  by  the  physician  and  13.9  minutes  by  tl 
nurse. 


Use  oF  professional  time 


60 


Other  calculations  showed  the  proportion  of  eai 
staff  members'  time  in  the  clinic  spent  on  varioi 
types  of  activities.     This  was  achieved  in  two  waj 

The  first  method  was  to  total  the  amount  of  tin 
recorded  for  each  of  a  number  of  types  of  activiti 
and  to  divide  by  the  total  available  time.  Clin 
administration,  which  included  setting  up  the  clini 
cleaning  up  afterward,  and  posting  health  depar 
ment  records,  was  one  activity.  Others  were  immun 
zation,  weighing  and  measuring,  nursing  conferencefK' 
history  taking  and  physical  examination,  and  inspe 
tion  of  children.  (Recording  data  in  children 
charts  was  considered  as  part  of  these  activities. 
Time  not  spent  in  these  activities  was  recorded  i 
"waiting."  This  included  time  spent  waiting  bi  *stii 
tween  patients  and  time  spent  in  a  short  midmornin  «  t 
coffee  break.  ^  -: 

CHILDREN     .     MARCH-APRIL  19(te| 


idji 

J  V:. 


lepei 

IB  pa! 
»i 
ti 
Ttei 
ilyt* 


01,2 
iepic; 
mt  oi 
stedi 


easiir 


teiiw 
[clii 
iaii 
Ai- 
irof 
suit 
»5 


ijnihi 

It  pi 
ok 

lepa 
miij 


teti\ 
p. '_ 


The  second  method  of  calculating  the  use  of  j^ro- 

ssional  time  was  to  multiply  the  average,  profes- 

)nal  time  for  each  type  of  visit  by  the  total  number 

visits  of  each  type  in  a  year  and  divide  the  result 

the  total  working  time  in  a  year.     '\^niile  there 

re  some  discrepancies  in  the  results  of  these  two 

thods,  they  were  not  great,  probably  because  the 

idy  days  did  not  represent  an  average  for  the  year 

a  whole. 

Botli  methods  showed  that  a  large  amount  of  pro- 
ussional  time  was  being  used  on  activities  not  di- 
rt ctly  involving  patient  care.  Method  I  showed  that 
{ c  pediatrician  spent  only  57  percent  of  his  time  with 
0  patient  and  the  rest — 43  percent — in  waiting; 
aethod  II,  tliat  he  spent  only  -16.1  percent  of  his  time 
ith  the  patient. 

The  nurses,  according  to  method  I,  were  spending 
ly  G6.'2  percent  of  their  time  with  thepatient  (58.2 
srcent  according  to  method  II),  and  a  .surprising 
©portion,  16.3  jjercent,  on  setting  up  and  cleaning 
)  the  clinic,  and  in  waiting,  15.5  percent.  In  addi- 
ipn,  2  percent  of  the  nurses'  time  was  going  toward 
ieping  health  department  records.  The  66.2  per- 
nt  of  the  nurses'  time  spent  with  the  patient  con- 
3ted  of  57  percent  in  conferences,  5.5  percent  in 
imunization,  and  3.7  percent  in  weighing  and 
easuring. 

The  study  of  waiting  room  load  was  made  by  tabu- 
ting,  for  each  5  minutes  of  time,  the  number  of  chil- 
en  who  entered  and  left  the  clinic,  and  the  number 
children  actually  being  seen  by  the  nui'ses  and 
jdiatrician.  The  total  numbers  of  patients  for 
ich  5-minute  time  interval  were  divided  by  the  num- 
ir  of  sessions  to  obtain  an  a\erage  number.  The 
suits  showed  a  fairly  constant  waiting-room  load 
■om  9  a.m.  to  nearly  11  a.m.  of  one  to  four  patients. 


ignificance  of  study 


It  proved  to  be  relatively  easy  for  the  investigators 

obtain  the  cooperation  of  clinic  personnel  for  this 

udy.     Cooperation  was  solicited  in  discussions  of 

jie  purpose  of  the  study  at  clinic  staff  conferences 
iiring  the  month  before  its  initiation.  Since  the 
urpose  of  the  study  was  to  obtain  a  baseline  for  eval- 
ition  of  the  clinic,  with  the  possibility  that  admin- 
trative  changes  might  ensue,  a  discussion  of  the 
'pes  of  changes  that  might  result  also  took  place  at 
lese  sessions  during  which  it  was  pointed  out  that 

^  le  study  was  not  being  made  because  of  dissatisfac- 
on  vsdth  anyone's  work. 
In  spite  of  these  prestudy  discussions,  two  record- 

5|OLUME  14  -  NUMBER  2 
245-633—67 3 


A  family  in  the  waiting  room  of  a  well-child  conference. 


ing  difficulties  arose  at  the  start  of  the  project  due 
to  misunderstanding  on  the  part  of  staff'  members. 
The  clinic  receptionist  neglected  to  record  times  of 
the  children's  arrival  and  departure  during  one  ses- 
sion, and  on  the  first  study  day  one  nurse  failed  to 
separate  weighing  and  measuring  time  from  nursing 
conference  time.  These  difficulties  necessitated  the 
extension  of  the  study  from  the  three  sessions  planned 
to  four  sessions  and  the  discarding  of  the  defective 
data. 

The  analysis  of  this  study  required  approximately 
4  hours  of  the  investigator's  time  and  the  use  of  a 
desk  calculator.  We  required  less  than  a  full  hour, 
divided  into  several  sessions,  to  explain  the  study  to 
participating  staff  members  and  to  instruct  them  in 
the  use  of  the  data  sheets. 

Although  the  study  was  planned  only  to  provide 
Ijaseline  data,  it  elicited  certain  facts  that  are  of  sig- 
nificance to  the  field  of  public  health  practice.  For 
example,  the  fact  that  each  child  and  his  parent 
spend,  on  an  average,  21  minutes  of  their  time  in  the 
clinic  waiting  suggests  that  an  opportunity  exists  for 
the  extension  of  health  education  to  other  ai'eas  be- 
sides nutrition. 

The  use  of  the  nurses'  time,  as  found  bv  the  time 


61 


study,  deserves  comment.  When  16.3  percent  of  the 
time  of  two  nurses  is  used  to  set  up  and  clean  up  the 
clinic  and  another  3.7  percent  to  weigh  and  measure 
the  child,  a  fifth  of  the  nurses'  time  is  expended  in 
procedures  for  which  professional  training  is  not  re- 
quired. Such  duties  could  be  performed  by  trained 
volunteers  or  by  trained  subprofessional  aides.  The 
untrained  aide  who  was  working  at  the  clinic  as  a 
receijtionist  at  the  time  of  the  study  might  have 
helped  with  some  of  these  chores  and  so  have  released 
the  time  of  tlie  nurses  for  functions  requiring  profes- 
sional training  such  as  counseling  the  family  or  im- 
munization. The  study  thus  indicated  that  the  clinic 
might  absorb  an  increase  of  as  much  as  20  percent  in 
the  i^atient  volume  without  any  additional  profes- 
sional time  being  made  available. 

Equally  significant  was  the  finding  that  43  percent 
of  the  pediatrician's  time  was  sj^ent  waiting  for  pa- 
tients, obviously  a  great  waste  of  a  professional  re- 
source. From  the  viewpoint  of  time  alone,  the  study 
thus  revealed  that  a  reorganization  of  this  clinic's 
procedures  was  necessary  so  that  maximum  use  might 
be  made  of  the  pediatrician's  skill.  In  ensuing  dis- 
cussions between  the  authors  and  clinic  administra- 
tors, it  was  pointed  out  that  the  clinic  would  be  mak- 
ing better  use  of  the  pediatrician  if  (1)  he  saw  more 
children;  (2)  he  served  more  actively  as  a  consultant 
to  the  nurses;  (3)  he  performed  a  review  of  records 
as  part  of  planned  studies;  (4)  he  conducted  group 
meetings  of  the  parents  in  the  waiting  room;  (5)  the 
clinic  incorporated  medical  treatment  into  the  pro- 
gram, thus  using  the  pediatrician's  time  on  curati\e 
as  well  as  preventive  aspects  of  child  health  suj^er- 
vision  in  a  program  of  comprehensive  care. 

The  finding  on  the  amount  of  the  pediatrician's 
time  spent  in  waiting  also  raised  the  question  as  to  the 
effect  idleness  nearly  half  the  time  might  have  on  a 
pediatrician  in  any  clinic.  "Would  the  pediatrician 
remain  interested  or  become  bored?  Would  he  feel 
that  lie  was  an  integral  part  of  the  clinic,  or  a  rather 
unnecessary  appendage? 

Followup 

Several  steps  have  been  taken  in  this  child  health 
conference  as  an  immediate  result  of  the  time  study. 
Prior  to  the  study  the  pediatrician  was  considering 
wliether  the  clinic  might  not  profitably  use  another 
nurse.  The  time  study  showed  that  anotlier  nurse 
was  not  needed,  but  rather  that  the  need  was  to  use 
the  time  of  the  available  nurses  more  productively. 
The  plan  is  now  to  increase  the  amount  of  nurses'  time 

62 


Of 


available  to  patients  by  trainmg  a  volunteer  to  set  u: 
and  dismantle  the  clinic,  weigh  and  measure  all  chi 
dren,  and  fill  out  the  health  department  record 
This  step  has  been  delayed  by  the  resignation  of  th| 
Neighborhood  Youth  CoqDS  worker  to  take  a  pei 
manent  job  elsewhere,  thus  depriving  the  conferenc 
of  her  services.  Vigorous  recruiting  for  a  voluntee 
is  in  progress  in  the  neighborhood  of  the  clinic  amon 
mothers  who  are  free  during  clinic  hours  because  a 
their  children  are  in  school. 

Because  of  the  finding  on  the  amount  of  time  th 
young  patients  and  their  mothers  are  spending  in  tli 
waitmg  room,  the  nutritionist  is  spending  more  tim 
in  the  waiting  room  with  them  discussing  food-buj 
ing  practices,  general  principles  of  feeding  childrei 
and  other  problems.  The  group  discussions  of  f  ooc 
buying,  which  include  current  prices,  comparisons  c 
the  nutritive  values  of  various  foods,  and  many  su^ 
gestions  for  varying  the  family  menu,  have  prove 
especially  popular.  We  now  notice  mothers  who  n 
turn  to  the  waiting  room  after  their  children  hav 
been  seen  to  continue  to  participate  in  the  discussioi 

A  rescheduling  of  "physician  visits"  is  now  i 
process  to  allow  better  use  of  the  pediatrician's  timi 
Among  the  uses  contemplated  for  this  time  are  th 
provision  of  services  to  unreached  segments  of  th 
community,  increased  consultation  to  nurses,  teachin 
groups  of  mothers,  and  efforts  to  integrate  the  activ: 
ties  of  the  clinic  with  other  community  activities  sue 
as  health  programs  in  the  local  school  and  m  th 
health  services  supported  by  the  Office  of  Economi 
Opportunity.  Already  the  clinic  is  making  effort 
to  encourage  the  previously  unreached  Spanish 
speaking  mothers  in  the  neighborhood  to  bring  thei 
children  in  for  well-child  supervision. 

Because  of  the  demonstrated  value  of  the  tim 
study  as  a  method  of  self-evaluation  in  a  well-chili 
clinic,  the  Division  of  Maternal  and  Child  Health  o 
the  University  of  California  School  of  Public  Healtl 
has  been  working  with  its  students  and  with  loca 
health  authorities  to  encourage  the  use  of  this  simpl 
tool.  It  seems  to  us  that  the  time  study  would  havi 
particular  value  as  a  lever  for  raising  the  level  o: 
performance  in  those  well-child  conferences  that  hav( 
long  waiting  lists  and  long  waiting  periods  for  ini 
tial  registration  of  infants  after  hospital  discharge 
and  also  m  those  well-child  conferences  that  are  s( 
overcrowded  that  they  are  designed  for  infants  onh 
and  terminate  service  on  the  child's  first  birthday 
Thus,  a  time  study  could  be  one  device  used  in  tackl- 
ing the  almost  universal  problem  of  "preschool  j 
dropoff"  in  well-child  conferences. 


I 


CHILDREN     •     MARCH-APRIL  1967 


in  occupational  therapist  and  a  social  worker  combine  their  efforts  in  .  .  . 


a  HOMEBOUND  THERAPY  PROGRAM 


or  SEVERELY  RETARDED  CHILDREN 


HOPE  G.  CURFMAN 


For  the  past  year,  30  Denver  families  with 
severely  and  profoiuidly  retarded  children 
have  been  served  by  an  unusual  program 
;ombining  the  services  of  a  professionally  trained 
;ocial  worker  and  a  registered  occupational  therapist. 
rhe  progi'am  is  unusual  in  two  ways — it  serves  chil- 
Iren  not  often  reached  by  social  agencies  and  it  brings 
ts  services  into  their  homes.  The  Easter  Seal  So- 
;iety  for  Crippled  Children  and  Adults  of  Denver, 
'nc,  through  its  Sewall  Easter  Seal  Rehabilitation 
enter,  sponsors  the  program  with  the  help  of  a  grant 
Tom  the  Denver  Board  for  the  Mentally  Retarded 
ind  Seriously  Handicapped. 

Giving  each  child  an  opportunity  to  f ultill  his  po- 
»ntial  has  long  been  recognized  as  a  goal  of  educa- 
ion,  but  the  right  of  the  retarded  child  to  the  same 
sducational  opportunity  has  been  slow  to  receive 
■ecognition.  However,  many  public  school  systems 
low  include  special  programs  for  mildly  retarded 
children  (IQ's  of  55  to  67).  Denver's  school  system, 
'or  instance,  has  had  special  education  classes  for  chil- 
iren  with  IQ's  of  50  to  80  since  1948  and  last  year 
lerved  about  1,G50  children. 

But,  until  recently,  few  community  resources  were 
ivailable  to  meet  the  training  needs  of  children  con- 
iidered  moderately  retarded  (IQ's  of  36  to  51), 
»verely  retarded  (IQ's  of  20  to  35),  or  profoundly 
retarded  (IQ's  of  less  than  20).  Financially  able 
)arents  can  provide  care  in  private  schools,  but  even 
Por  them  the  needs  far  exceed  the  resources.  Parents 
with  limited  means  have  little  choice  beyond  institu- 
;ionalization  or  letting  the  child  vegetate  at  home. 

VOLUME   14  -  NUMBER  2 


CAROL  B.  ARNOLD 


Only  a  few  agencies  can  offer  more  than  minimal 
service  to  those  who  keep  their  children  at  home.^'  - 

Recognizing  that  a  gap  existed  between  the  pro- 
grams offered  by  the  public  schools  and  the  resources 
of  the  two  State  institutions  for  the  mentally  re- 
tarded, the  Colorado  Department  of  Institutions  in 
1964  requested  a  grant  from  the  State  Legislature 
for  expanding  resources  for  the  mentally  retarded, 
and  received  $200,000.  The  money  was  to  be  allo- 
cated to  boards  incorporated  by  local  communities  to 
purchase  services  from  existing  agencies  and  to  orga- 
nize community  centers  for  retarded  persons  in  the 
community. 

From  this  grant,  the  city  and  county  of  Denver 
was  allocated  $27,000,  and  in  August  1964  the  Denver 
Board  for  the  Mentally  Retarded  and  Seriously 
Handicapped  was  incorporated  to  administer  the 
fund.  The  board  conducted  a  small  project  in- 
volving nine  severely  and  profoundly  retarded  chil- 
dren, primarily  to  give  some  relief  to  the  parents,  for 
about  a  year.  Following  this,  the  board  made  a 
gi-ant  to  the  Sewall  Rehabilitation  Center  to  develop 
a  homebound  therapy  program  to  help  both  parents 
and  children. 

The  goals  of  the  program  are  these :  ( 1 )  To  assess 
and  develop  the  potentialities  of  each  child,  to  help 
him  function  with  some  independence  and,  at  a  mini- 
mum, to  help  prevent  further  physical,  mental,  and 
social  retardation  in  him;  and  (2)  to  help  the  family 
increase  its  understanding  of  its  retarded  child  and 
thereby  to  contribute  more  to  his  development  while 
learning  to  live  more  comfortably  with  the  problems 

63 


he  presents.  According  to  the  plan,  these  goals  were 
to  be  met  by  combining  the  services  of  a  social  worker 
and  an  occupational  therapist  and,  wherever  possible, 
by  providing  services  within  the  community  so  that 
the  child  might  continue  to  live  in  his  own  home. 

Tlie  social  worker  makes  the  mitial  contact  with 
the  family  to  gather  pertinent  information  on  its  so- 
cial history  and  to  acquaint  the  family  with  both  her 
services  and  those  of  the  occupational  therapist. 
After  settmg  up  an  appointment,  she  and  the  occupa- 
tional therapist  call  on  tlie  home  togetlier.  During 
this  visit,  they  try  to  exiDlain  their  worlv  to  the  family. 
The  occupational  therapist  concentrates  on  what  she 
hopes  to  accomplish  with  tlie  child;  the  social  worker, 
on  wluxt  slie  can  do  to  Iielp  the  parents.  At  the  same 
time,  however,  they  work  together  as  a  team. 

Objectives 

As  retardation  is  always  a  family  problem,  the  so- 
cial worker's  first  objective  is  to  help  the  family  find 
more  accejitable  or  easier  ways  of  living  with  a  diffi- 
cult situation.  She  varies  her  methods  as  the  needs 
of  each  family  require.  Most  parents  need  continual 
ego  support  because  they  often  feel  frustrated  and 
hopeless.  In  some  cases,  the  mother  requires  extra 
help  because  no  father  is  living  in  the  home.  The 
social  worker's  task  is  to  help  the  family  face  reality, 
to  assess  its  strength,  and  to  constantly  support  its 
members.  When  indicated,  she  introduces  other 
community  resources  such  as  a  hearing  evaluation, 
physical  tlierapy,  or  referral  to  a  day-care  center 
ofl'ering  a  structured  program.  After  she  establishes 
a  relationsliip  witli  the  parent  or  parents,  she  intro- 
duces the  services  of  the  occupational  therapist. 

The  complete  i^ictui-e  of  the  child  is  taken  into  ac- 
count in  setting  up  individual  aims  for  treatment. 
These  aims  are  to  lielp  the  child  attain  what  skill  he 


Hope  G.  Curfman,  left,  and 
Carol  B.  Arnold  until  re- 
cently worked  together  as 
social  worker  and  occupa- 
tional therapist,  respectively, 
at  the  Sewall  Easter  Seal 
Rehabilitation  Center  in 
Denver.  Mrs.  Curfman  is 
now  a  social  worker  in  the  Denver  public  school  system. 
Mrs.  Arnold  is  now  devoting  full  time  to  raising  her  two 
children.  She  was  once  director  of  occupational  therapy  at 
the  State  Home  and  Training  School,  Wheatridge,  Colo. 


64 


can  in  performing  the  activities  of  daily  living  sue 
as  eating,  dressing,  and  using  the  toilet ;  to  help  hii 
make  constructive  use  of  toys;  to  help  improve  hi 
motor  and  perceptual  development;  to  provide  sup 
port  for  the  family;  and  to  prepare  the  child  fc 
further  training  suitable  to  his  ability. 

1.  The  activities  of  daily  living.  For  the  pre 
foundly  retarded,  the  occupational  therapist  begin 
this  training  at  the  most  primary  level  of  function 
ing — feeding  and  drinking.  Many  of  the  childre 
progress  no  furtlier  than  learning  to  chew  groun 
food  and  drink  from  a  cup,  but  even  so  small  an  ad 
vance  is  important  for  nutrition  and  nursing  can 
Not  all  cases  require  training  in  feeding,  but  man 
parents  can  use  suggestions  for  improving  the  eatin, 
habits  of  their  children.  Tlie  therapist  offers  trair 
ing  or  suggestions  as  the  case  requires. 

In  some  cases,  the  occupational  therapist's  aim  i 
to  improve  skills  ranging  from  putting  on  sliirt  an 
socks  to  buttoning  large  buttons.  Many  childre, 
can  take  ojf  clothes,  and  if  the  mothers  do  not  wan 
this  ability  reinforced,  no  such  training  is  giver 

In  regard  to  toilet  training,  the  occupational  thei 
apist  advises  the  mother  about  the  length  of  time  t 
leave  the  child  on  the  toilet  and  liow  to  give  prais 
or  reward  for  accomplishments  and  encourages  hert 
have  patience  and  perseverance.  The  cultural  pal 
terns  of  the  homes  have  a  direct  effect  on  this  aspec 
of  training,  and  some  mothers  cannot  cope  with  tliei 
cliildrcn's  problems  because  of  shortcomings  in  thei 
own  backgrounds. 

2.  Constructive  use   of   toys.     In   some   cases  t! 
children  have  been  deprived  of  opportunities  to  pla; 
with  toys  and,  consequently,  of  the  experience  oil 
learning  through  manipulation  and  oral  stimulatiori 

Some  families  cannot  afford  to  buy  toys  that  th 
child  would  quickly  destroy.  Most  of  the  toys  thj 
occupational  therapist  finds  in  use  are  unsuitable  foj 
tlie  hyperactivity  and  roughness  of  many  retarde( 
children.  Most  mothers,  however,  are  eager  to  knov 
what  types  of  toys  they  should  give  their  children 
and  the  occupational  therapist  is  able  to  help  then 
select  suitable  playthings. 

3.  Motor  development.  With  the  profoundly  rei 
tarded  child  who  camiot  even  recognize  a  toy,  thi 
occupational  therapist  begins  by  using  the  idea  o: 
body  image  and  the  concomitant  awareness  of  en 
vironment.  She  used,  for  instance,  the  sitting  balj 
ance,  standing  balance,  and  the  crawl  position  td 
exercise  three  of  the  most  severely  retarded  childreni 

CHILDREN     •     MARCH-APRIL  1967 


elping  children  gain  control  of  the  lieiul  and  f  runic 
iniportiint  hocauso  witliout  it  (licir  visual  stinuda- 
on  is  liiniti'd  and  they  ari'  dillicult  to  feed. 

4.  Perceptual  developitient.  I'ercpplual  tiaiuinjj: 
limited  to  the  area  of  tactual  stimulation  through 

le  use  of  large  puzzles,  graded  pegs,  and  materials 
■  ditl'erent  consistencies  such  as  cotton  and  sand- 
iper.  The  occupational  therapist  also  uses  games 
jveloped  for  cidtin-ally  depi-ived  and  moderately 
■tarded  children  such  as  pit'tuie  lotto,  chutes  and 
dders,  and  candyland  for  teaching  picture  iden- 
fication  and  color  and  form  recognition. 

5.  Support  for  the  family.  In  some  instances,  the 
arents  have  given  uji  hope  that  anything  can  be  done 
)r  their  retarded  child.  Other  parents  are  vmroal- 
tic  in  their  expectations  of  what  their  child  could 
o  with  some  training.  The  homcbound  progi-ain 
ires  the  parents  faret-hand  experience  with  the  meth- 
iJs  that  could  be  used  to  help  the  child  and  an  o])por- 
mity  to  see  the  progi'ess  or  lack  of  progress  in  the 
lild.  After  some  experience  with  the  worker,  they 
)metimes  begin  to  think  of  ways  to  help  tlie  child 
lemselves.  For  example,  several  motliers  have  sug- 
ested  the  use  of  a  walker  or  chair,  and  several  of  the 
lore  observant  have  learned  hoio  to  play  with  their 
etarded  children  by  watching  the  occupational  ther- 
pist  at  work. 

6.  Preparing  for  the  kind  of  training  most  suitable 
or  the  child.  Whenever  possible,  the  workers  try  to 
repare  the  child  to  go  into  other  programs  such  as 
le  preschool  group  at  the  Sewall  Rehabilitation  Cen- 
sr  or  a  group  program  for  trainable  older  retarded 
hildren.  They  assist  the  families  in  making  the  tran- 
ition  in  each  case  and  supply  the  schools  with  helpful 
iformation. 

/lethods 

r)uring  her  first  visit  to  the  family  after  the  initial 
iicrview  with  the  social  worker,  the  occupational 
lii'iapist  brings  colorful  and  sturdy  toys  with  her, 
11  biding  noisemakers  and  toys  requiring  dexterity 
nd  coordination,  selected  according  to  the  informa- 
ion  in  the  social  history.  On  later  visits,  she  os- 
prtains  what  the  goals  are  for  each  child  and  what 
i|uipment  she  needs. 

I'locause  all  toys  and  equipment  used  in  the  home- 
•onnd  program  have  to  be  carried  by  automobile, 
OHO  are  heavy,  bulky,  or  messy.  But  a  small  cutout 
able,  a  kindergarten  chair,  and  a  playpen  pad  are 
■art  of  the  standard  equipment.     The  pad  is  inex- 


pensive and  easy  to  carry  and  makes  it  possible  for 
the  occupational  therapist  to  sit  on  the  floor  with  the 
child  if  lie  cannot  iialance  himself  on  the  chair.  I)e- 
]icndiiig  on  tlie  case,  she  brings  in  a  relaxal  ion  walker 
for  use  on  (rial. 

The  oecupat  ional  I  hcrapist  uses  toys  to  promote  the 
recognition  of  color,  gross  and  fine  coordination  of 
the  arms  and  hands,  form  perception,  and  so  on: 
a  color  cone;  t  wo  simple  puzzles;  a  gi'aded,  rotui<l  peg 
set ;  a  nest  of  round  color  cups ;  a  large  ball ;  a  squeaky 
animal  toy;  a  button  box;  a  string  with  beads;  a 
poinuling  toy;  and  small  blocks.  She  introduces 
other  materials,  depending  on  the  child's  needs  and 
ability,  such  as  scissors,  paper  and  paste,  clay, 
jiictiu'cs,  lacing  projects,  a  loom,  and  games. 

During  the  first  visit  the  occuational  therapist  ar- 
ranges a  time  for  regular  visits  with  the  family  every 
week.  The  agency  makes  an  exception  to  a  firm 
schedule  if  necessary,  as  in  the  case  of  a  mother  who 
works  on  shifts. 

The  mothers'  group 

In  addition  to  bringing  services  into  the  home,  the 
center  also  holds  eight  weekly  1-hour  sessions  in  group 
counseling  for  those  mothers  the  workers  think  would 
benefit  from  such  an  experience.  In  the  original 
group,  this  was  about  half.  The  other  mothers  of 
this  group  participated  in  individual  counseling  only 
because  the  social  worker  thought  they  would  not 
profit  from  group  work  or  because  they  could  not  at- 
tend the  meetings. 

The  mothers  who  attend  the  sessions  bring  their 
retarded  children  to  the  center,  and  while  they  are 
attending  the  session  with  the  social  worker,  the  oc- 
cupational therapist  conducts  a  simple  program  for 
the  children  divided  into  free  playtime,  snacktime, 
and  project  time.  The  free  play  introduces  the  chil- 
dren to  the  new  situation,  the  clinical  environment, 
and  each  other.  Snacktime  gives  them  an  opportu- 
nity to  practice  table  mannere  and  to  develop  the 
ability  to  share  with  others.  And  the  project  time 
gives  them  an  opportimity  to  leam  simple  methods 
of  coloring  and  cutting  and  gives  the  oc<?upational 
therapist  an  opportunity  to  observe  their  coopera- 
tion and  interaction.  However,  because  of  the  chil- 
dren's wide  range  of  ability,  this  part  of  the  program 
cannot  provide  the  children  with  individual  therapy. 
Xeverthele^ss,  providing  this  service  simultaneously 
with  the  sessions  has  proved  to  be  the  best  method 
of  involving  the  mothers  and  of  establishing  the  focal 
point  on  which  the  group  discussions  begin. 


OLUME  14  -  NUMBER  2 


65 


The  goals  of  the  group  program  for  the  mothers 
are  these:  (1)  To  provide  specific  help  in  living  and 
dealing  with  feelings;  (2)  to  create  an  enviromnent 
in  which  feelings  can  be  aired ;  (3)  to  provide  specific 
help  with  practical  problems  of  management ;  (4)  to 
provide  group  support  through  the  exchange  of  ideas 
between  members  of  the  group  and  the  leader  and  to 
help  minimize  the  feeling  of  isolation;  and  (5)  to 
encoui'age  the  use  of  services  offered  by  the  center 
through  the  social  worker-occupational  therapist 
team  and  those  of  other  community  organizations. 

The  specific  issues  discussed  at  these  sessions  in- 
clude ways  of  handling  questions  from  others  about 
"what  was  wrong"  with  the  children;  the  need  for 
"escape  valves"  for  anger ;  methods  of  discipline  and 
other  problems  of  management ;  and  long-range  plan- 
ning for  the  children.  The  mothers  in  the  first  group 
asked  for  a  tour  of  the  State  institution  for  the  men- 
tally retarded  near  Denver  and  nine  went  on  such  a 
tour.  At  a  meeting  held  after  the  tour  in  which 
they  discussed  their  reactions  and  expressed  their 
feelings,  all  nine  said  that  they  now  felt  better  able 
to  plan  for  placement  of  their  children  if  necessary. 

The  center  has  decided  that,  on  the  whole,  group 
counseling  as  a  part  of  the  program  for  the  mothers 
who  could  profit  is  beneficial.  The  greatest  achieve- 
ments are  the  minimizing  of  the  feeling  of  isolation, 
the  passing  on  of  practical  suggestions  for  dealing 
with  problems  of  management,  and  getting  the 
mothers  to  discuss  long-range  planning. 

Case  illustrations 

So  far  30  families  have  been  involved  but  only  20 
at  any  one  time.  As  a  beginning,  the  board  selected 
20  cases  after  review  by  its  admission  committee. 
All  20  children  originally  selected  were  severely  or 
profoundly  retarded  and  physically  handicapped  and 
lived  in  their  own  homes  (with  one  exception).  All 
were  evaluated  medically  and,  if  possible,  psycho- 
logically, before  acceptance.  Their  ages  ranged  from 
3  to  18  years,  the  average  being  8  years;  their  IQ's, 
from  "untestable"  to  50,  the  average  being  24.  All 
families  of  the  children  selected  were  living  in  Den- 
ver, and  most  were  on  the  lower  socioeconomic  levels. 
They  consisted,  in  almost  even  proportions,  of  Anglo- 
Americans,  Negro  Americans,  and  Spanish  Ameri- 
cans. The  medical  diagnoses  for  the  children 
reported  the  presence  of  Hurler's  Syndrome,  Down's 
Syndrome,  microcephaly,  postmeningitis,  "brain 
damage,"  and  "mental  retardation,  etiology  un- 
known." 


6(> 


fei' 


The  following  examples  taken  from  these  first  2 
cases  illustrate  the  methods  used  by  the  social  worke 
and  the  occupational  therapist  in  woi'king  with  thes 
children. 

Peggy  B  and  Larry  S:  These  children  present 
contrast,  though  both  are  about  8  yeai-s  old,  hav 
about  the  same  IQ — an  estimated  20 — and  both  f  unc 
tion  at  about  the  2-year-old  level.  Peggy  has  beei 
diagnosed  as  having  hyjoothyroidism,  for  which  sb 
is  receiving  treatment;  Larry,  as  having  organi 
brain  damage  with  chronic  otitis,  mild  conductiv 
heai-ing  loss,  hypospadias,  repaired  cleft  palate,  anc 
convulsions.  Both  children  had  very  limited  speak 
ing  ability. 

In  the  case  of  Peggy,  community  resources  wenf 
used  to  meet  her  needs  while  she  lived  in  her  owi 
home;  in  the  case  of  Larry,  the  goal  was  institution 
alization.  The  need  for  different  goals  became  ap 
parent  in  working  with  the  children  and  thei:," 
families  even  though  their  functional  levels  are  aboa 
the  same.  The  workers  determined  that  both  chil 
dren  could  profit  more  from  the  stimulation  receivec 
in  a  group  of  other  children  with  similar  disabilitie: 
tlian  from  being  at  home  all  the  time. 

Larry  S:  The  pressures  of  Larry's  home  increase( 
his  negative  behavior.  During  the  home  visits,  hi: 
mother  would  hover  over  him  and  prod  him  verballyi 
Though  she  said  she  knew  his  ability  was  limited,  shu 
was  constantly  seeking  confirmation  that  he  was  im. 
proving.  He  needed  to  be  out  of  this  environment 
for  therapy  to  be  effective. 

One  of  the  aims  for  Larry  concerned  feeding,  no 
as  a  function  of  motor  ability,  as  Larry  could  use  £ 
spoon  and  cup,  but  to  stimulate  his  poor  appetite 
After  a  visit  during  lunchtime,  the  occupational  ther- 
apist decided  that  the  mother  was  overfeeding  tht 
child  and  forcing  him  to  eat  larger  portions  than  he 
should  eat.  She  suggested  that,  since  Larry  enjoyed 
a  large  breakfast,  his  mother  might  omit  the  noonfflfi 
meal  or  make  it  very  light  and  give  him  his  main  meal' 
in  the  early  evening. 

Larry  had  good  fine  coordination,  but,  because  his 
balance  was  poor,  the  occupational  therapist  empha- 
sized activities  involving  gross  coordination,  activ- 
ities difficult  to  offer  in  the  home.  Larry  was  unco- 
operative much  of  the  time  and  would  not  perform  i 
the  activities  unless  he  wanted  to  end  the  therapy  r 
session.  When  the  occupational  therapist  disciplined 
liim  for  his  actions  by  showing  disapproval,  by  facial 
or  body  gestures  and  by  spanking  his  hands,  he  would 
begin  to  follow  instructions.    He  resisted  efforts  to 

CHILDREN     .     MARCH-APRIL  1967 


W*. 

it 


\ 


U'Ufh  him  to  div^ss,  however,  because  liis  mother  luul 
puiiislied  him  for  removiiif:;  liis  clothing. 

The  sociiil  woricer  memnvliile  was  couiisi'liiig  the 
parents.  Mi-s.  S,  througli  the  mothers'  group  at  the 
center,  was  able  to  air  her  feelings  regarding  Larry 
and  her  problems  concerning  a  younger  cerebral 
palsied  brother  and  a  normal  sister.  Iter  husband, 
who  was  pressuring  her  to  place  Lariy  in  the  State 
institution,  told  the  social  worker,  "It's  cither  him 
or  me."  Mrs.  S,  in  resisting  this  pressure,  had  devel- 
oped stomach  ulcers  and  had  become  obese  from  emo- 
tional overeating.  She  was  extremely  dependent  on 
her  own  mother  and  felt  torn  by  the  demands  of  the 
two  other  cliildren.  After  a  single  interview  with 
the  social  worker,  her  husband  let  up  on  his  threats. 
With  the  social  worker's  lielp,  he  recognized  that  he 
felt  under  tremendous  financial  pressure  to  provide 
for  two  severely  handicapped  children,  that  his  real 
concern  was  over  the  eti'ects  of  both  retarded  children 
on  the  normal  little  girl,  and  that  the  conflict  over 
Larry  in  the  home  was  becoming  a  wedge  between  liim 
and  his  wife. 

During  a  brief  hospital  stay  for  Larry,  the  mother 
realized  how  much  calmer  the  home  was  in  his  ab- 
sence. She  also  realized  that  the  problem  of  caring 
for  Larry  would  become  increasingly  greater.  Re- 
:ent])'  she  enrolled  the  normal  child  in  a  neighborhood 
cooperative  nursery  scliool  and  signed  the  applica- 
tion papers  to  the  State  institution  for  Larry. 

Although  there  are  still  many  unsolved  problems 
in  Lariy's  family,  his  parents  have  shown  the  capac- 
ity to  act.  The  occupational  therapist  was  able  to 
demonstrate  to  the  mother  that  she  was  making  un- 
realistic demands  on  the  child,  and  both  workers 
helped  her  face  his  limitations.  Family  friction 
essened,  and  a  realistic  plan  for  Larry  and  his  sister 
(vas  carried  out. 

Peggy  B :  Resources  within  the  community  made 
nstitutionalization  for  Peggy  B  unnecessary.  The 
jccupational  therapist  worked  with  Peggy  on  dress- 
ng  skills,  perception  techniques,  and  increased  hand 
joordination.  At  first,  slie  found  it  difficult  to  moti- 
ate  Peggy  because  of  the  child's  dependence  on  her 
'amily,  who  loved  and  accepted  her  as  "the  baby" 
)f  six  children.  Her  parents  put  no  pressure  on  her 
o  acquire  new  skills.  However,  she  would  usually 
ry  to  complete  the  activities  given  her  by  the  occu- 
jational  therapist. 

Wlien  the  mother  did  not  give  Peggy  her  medica- 
ion  as  prescribed  by  her  doctor,  the  child  was  logy, 
incoordinated,  and  unable  to  perform  satisfactorily. 

TOLUME  14  -  NUMBER  2 


Tiio  occupational  therapist  pointed  this  out  to  the 
mother  to  impress  upon  her  the  need  for  the  medica- 
tion if  Peggy  was  to  improve.  The  mother  was 
helped  b}'  the  social  worker  to  face  her  need  to  keep 
Peggy  "the  baby,"  and  when  the  occupational  thera- 
pist demonstrated  to  lier  that  Peggy  could  acquire 
new  skills,  the  mother  seldom  failed  to  administer 
the  medication.  She  became  active  in  the  mothers' 
group  at  the  center,  and  her  opinion  that  the  family 
could  provide  the  loving  care  Peggy  needed  l>etter 
than  a  large  institution  was  reinforced  by  her  tour 
of  the  State  institution.  This  completely  accepting 
family  became  interested  in  Peggy's  activities  and 
responded  accordingly. 

Lany's  pi-esence  in  the  home  caused  mounting 
friction,  but  Peggy's  was  a  focal  point  for  family 
concern.  After  working  with  the  two  for  several 
months,  the  workers  felt  that  both  children  would 
gain  from  a  gi'oup  situation :  A  group  would  relieve 
Larry  of  the  pressures  of  home  and  give  Peggy  more 
goals  to  attain.  Both  were,  therefore,  enrolled  in  the 
preschool  group  at  the  Sewall  Center. 

Donny  P:  This  child,  with  an  IQ  of  about  10,  was 
diagnosed  as  being  profoundly  retarded  and  having 
bilateral  glaucoma  and  mild  seizures.  He  had  spent 
9  years  lying  in  a  crib,  and  was  fed  by  a  lx)ttle.  His 
mother,  responsible  for  the  care  of  nine  children — five 
of  her  own  and  four  of  her  deceased  sister — had  little 
time  to  spend  working  with  Donny  on  new  feeding 
skills;  nor  could  she  participate  in  the  mothers' 
group. 

When  the  occupational  therapist  tried  to  make 
Donny  take  food  from  a  rubber-coated  spoon,  he 
resisted  violently  because  he  was  not  used  to  being 
held  upright.  Taking  his  age  and  blindness  into  ac- 
count, the  occupational  therapist  decided  not  to  pur- 
sue the  spoon  feeding  but  rather  to  concentrate  first 
on  increased  body  balance  and  body  awareness. 

She  next  began  working  on  sitting  and  standing 
balance  and  head  control.  At  first,  Donny  was  unable 
to  bear  any  weight  on  his  feet  but  would  crumple  to 
the  floor;  nor  could  he  sit  up  straight.  After  the 
occupational  therapist  had  worked  6  months  with 
him,  he  stood  with  support  and  was  bearing  weight 
for  about  5  minutes.  After  observing  the  occupa- 
tional therapist's  work  with  Donny,  the  mother  and 
older  children  started  working  with  him.  The 
occupational  therapist  introduced  the  idea  of  a 
relaxation  chair  to  tiy  out  with  Donnv.  She  ex- 
plained that  even  though  Donny  was  profoundly 
retarded  it  would  be  stimulating  to  him  to  he  in  the 

67 


living  room  with  the  family  and  that  it  ■would  help 
him  to  change  position  from  constantly  lying  in  bed. 
Wlien  the  family  showed  interest,  the  social  worker 
procured  the  chair,  made  to  specifications,  from  the 
Goodwill  Industries. 

Johnny  F :  In  the  case  of  Johnny,  a  3i/^-year-old 
child  of  about  the  same  mental  age  as  Donny  but  with 
eyesight,  the  services  of  the  homebound  program  did 
not  meet  with  success.  The  father  had  deserted  his 
family,  and  the  mother,  plagued  with  severe  emo- 
tional problems,  rejected  Johmiy. 

A  child  welfare  worker  from  the  public  agency  had 
prepared  Mrs.  F  for  the  homebound  program,  but 
she  was  unable  to  accept  the  sei*vice.  Ambivalent  at 
first,  she  did  make  feeble  attempts  to  work  with  the 
occupational  therapist  on  feeding  skills.  But  she 
consistently  broke  appointments.  Many  other  family 
prol)]oms  complicated  the  issue  and  drained  the 
mother's  limited  capacity.  The  only  contribution 
the  program  could  make  was  to  provide  additional 
diagnostic  material  for  the  child  welfare  worker  in 
her  long-range  plans  for  the  family. 

Lloyd  H :  A  9-year-old  boy  diagnosed  as  ha\ing 
brain  damage  following  meningitis,  Lloyd  H  was  at 
first  hostile  and  uncooperative.  He  had  previously 
been  placed  in  a  preschool  age  group  for  severely 
retarded  children,  but  he  had  regressed  to  the  point 
of  wetting  his  pants,  spitting,  sitting  on  his  hands, 
and  banging  his  head.  The  occupational  therapist 
spent  most  of  her  time  during  the  first  month's  visits 
talking  with  the  mother  and  letting  Lloyd  get  use  to 
having  her  in  the  home. 

She  used  Lloyd's  interest  in  playing  ball  as  the 
focal  point  for  working  with  him,  and  she  developed 
many  variations — tossing  balloons,  bouncing  clay, 
and  hitting  a  punching  toy.  He  began  to  talk,  and 
though  his  speech  was  unintelligible  at  fii"st,  in  a  few 
weeks  phrases  such  as  "bounce  the  ball"  became  clear. 
He  soon  gave  up  wetting  his  pants,  though  he  con- 
tinued to  sit  on  liis  hands  until  the  last  montli  of  the 
program.  Although  he  continues  to  hit  himself  when 
frustrated  and  angiy,  his  mother  has  become  more 
aware  of  ways  to  channel  his  negative  behavior,  and 
she  is  helping  him  overcome  this  reaction. 

The  role  of  the  social  worker  in  relation  to  Mrs.  H 
was  to  help  increase  this  mother's  understanding  of 
her  retarded  child's  behavior,  to  help  her  find  ac- 
ceptable ways  of  releasing  her  feelings,  to  help  her 
substitute  positive  for  negative  methods  of  discip- 


line, and  to  reinforce  the  activities  of  the  occupa- 
tional therapist.  Mrs.  H  was  a  member  of  the 
mothers'  group  and  was  also  seen  individually  by 
the  social  worker. 

Seven  of  the  children  in  the  first  group  in  the  home- 
bound  program  became  involved  during  the  year  in 
other  training  programs  such  as  Sewall's  preschool 
group,  a  program  for  trainable  older  retarded  chil- 
dren, and  a  program  at  a  training  school.  Late  in  the 
program,  two  children  were  accepted  by  a  private 
school  for  exceptional  children,  one  was  referred  to  a 
cerebral  palsy  center,  and  another  to  Sewall  for  fur- 
ther evaluation  and  intensive  therapy. 

Evaluation 

As  with  any  new  program  without  a  chartered 
course,  problems  have  occurred.  Some  problems  are 
inherent  in  the  program  itself.  As  the  program  cen- 
ters on  the  severely  and  profoundly  retarded  child, 
only  very  small  gains  can  be  expected.  Several  of 
the  children  who  have  been  involved  are  so  severely 
retarded  that  the  only  movement  is  regression. 

Compensations  are  found,  however,  by  the  staff 
members  in  the  favorable  responses  of  the  parents  to 
the  program.  In  it  the  parents  see  something  specific 
being  done  for  their  children,  and  usually  they  can 
see  some  progress.  They  frequently  say  to  the  work- 
ers, "At  last  someone  is  doing  something  for  Susie," 
or  "Stevie  looks  forward  to  your  visits." 

The  program  is  continuing  in  cooperation  with 
other  agencies  in  much  the  same  way.  Emphasis  at 
this  time  is  on  gi'oup  stimulation  for  the  children. 

A  program  such  as  this  does,  in  part,  fill  the  gap 
between  programs  ofl'ered  by  the  public  schools  and 
State  institutions.  Most  of  the  children  served  are 
continuing  to  live  in  their  own  homes  and  are  receiv- 
ing therapy  geared  to  their  individual  needs.  At  the 
same  time,  families  are  being  helped  to  live  more 
comfortably  with  the  problems  of  a  retarded  child  in 
the  home.  Apparently,  the  entire  needs  of  the  family 
with  a  retarded  child  are  better  met  by  the  combined 
services  of  the  occupational  therapist  and  the  social 
worker  than  they  could  be  by  either  working 
separately. 


ipa 


'  Dittmann,  Laura  L.:  Home  training  for  retarded  children.     Children,  ■•,_ 
May-June  1957. 

°Cianci,     Vincentz:     Home    training    for    the    mentally    retarded. 
Children,  May-June  1955. 


68 


CHILDREN     .     MARCH-APRIL  1967 


a  social  worker 

from  a 

child  guidance 

clinic  provides 


GROUP  COUNSELING 

of  MOTHERS  in 

on  AFDC  PROGRAM 


DAVID  KEVIN 


Several  months  ago,  a  psychiatric  social 
worker  in  a  child  guidance  clinic  (the  author 
of  this  article)  conducted  a  6-month  demon- 
stration in  group  counseling  of  mothers  selected  from 
a  public  assistance  caseload  because  of  evidence  that 
they  were  inadequately  caring  for  their  children. 
The  results  seemed  salutarj-  enough  for  this  type  of 
approach  to  the  protection  of  children  to  be  given 
serious  consideration  as  a  complement  to  individual 
counseling  both  by  child  guidance  clmics  and  by  pub- 
lic welfare  agencies. 

The  Protective  Services  Unit  of  tlie  Alameda  Coun- 
ty Welfare  Department  from  which  tlie  mothers  were 
selected  was  established  in  1961  to  jirovide  more  in- 
tensive services  to  families  on  public  assistance, 
especially  in  the  program  of  aid  to  families  with 
dependent  children  (AFDC),  in  which  there  was  evi- 
dence of  neglect  or  inadequate  child  care.  As  part 
of  its  intensive  services  to  these  families,  the  unit 
became  increasingly  active  in  making  referrals  for 
psychiatric  evaluation  and  psycliotherapy  to  the  East 
Bay  Clinic  for  Child  Psychiatry  operated  by  the 
California  State  Department  of  Mental  Plygiene. 


Based  on   a   paper   presented   at   the    1966   meeting   of  the 
American  Orthopsychiatric  Association. 

VOLUME  14  -  NUMBER  2 


Graduall}'  it  became  evident  to  the  clinic's  chief  psy- 
chiatric social  worker  that  all  the  families  refeiTed 
had  multiple  social  and  economic  problems  that  w^ere 
integral  parts  of  the  children's  emotional  and  be- 
havioral difficulties.  It  also  became  evident  that  the 
child  referred  to  the  clinic  might  not  be  the  most 
upset  child  in  the  family. 

Like  most  clinics  serving  children,  the  clinic  used 
a  lengthy  evaluation  procedure.  It,  therefore, 
seemed  possible  that  many  cases  referred  to  the  clinic 
by  the  welfare  department  dropped  out  because  of  the 
time  involved  and  because  of  the  failure  of  the  child's 
motlier  to  understand  the  evaluative  process.  At 
any  rate,  many  evaluations  were  never  completed  be- 
cause the  mother  and  child  never  returned.  This 
fact  seemed  to  imply  that  a  more  appropriate  ap- 
proach needed  to  be  taken  to  these  families. 

The  psychiatric  social  worker,  therefore,  proposed 
to  conduct  a  demonstration  of  group  counseling  of 
the  mothei-s  of  children  referred  from  the  Protective 
Services  Unit  for  treatment,  in  place  of  evaluation 
and  treatment  of  the  children.  Two  hypotheses  un- 
derlay this  proposal: 

1.  Througli  group  counseling,  the  niotliers  would 
Ije  able  to  improve  their  ways  of  coping  with  their 

ditliculties. 


69 


2.  The  effects  of  counseling  the  mothers  only 
would  noticeably  alleviate  the  children's  behavioral 
difficulties  in  school  and  in  the  home. 

Reports  from  the  unit  workers  and  the  mothers 
themselves  were  expected  to  provide  necessary  in- 
formation about  the  adjustment  of  the  children. 

Initial  planning  stage 

The  first  step  was  a  discussion  between  the  psychi- 
atric social  worker  and  the  supervisor  of  the  Pro- 
tective Services  Unit  to  work  out  plans  for  its 
implementation.  Both  agreed  on  the  necessity  for 
bringing  the  child  welfare  division's  administrators 
into  the  initial  planning,  and  therefore  arranged  for 
the  chief  and  the  assistant  chief  of  the  division  to  meet 
with  them  on  several  subsequent  occasions.  In  these 
meetings,  the  possibilities  of  the  proposal  were  ex- 
plored fully  from  the  viewpoints  both  of  the  welfare 
department  and  of  the  clinic  in  relation  to  the  de- 
mands on  the  time  of  the  unit's  workers,  the  potentials 
for  inservice  training,  and  the  possibilities  of  eventu- 
ally incorporating  the  group  counseling  method  into 
agency  structure.  The  result  was  an  agreement  that 
the  clinic  would  undertake  the  proposed  experiment 
with  the  help  of  the  division  and  that  the  adminis- 
trators of  the  division  would  be  kept  informed  of  its 
progress. 

The  next  step  was  for  the  psychiatric  social  worker 
to  hold  a  short  series  of  meetings  with  the  super- 
visor of  the  Protective  Services  Unit  and  the  unit's 
four  workers  to  determine  criteria  and  methods  for 
selecting  mothers  for  the  project;  to  discuss  problems 
related  to  the  confidentiality  of  information  that 
would  come  out  in  the  discussion  group,  especially 
information  that  would  have  a  bearing  on  the  moth- 
er's eligibility  for  public  assistance;  and  to  work  out 
methods  for  training  the  workers  for  the  group  lead- 
ership task.  The  criteria  for  selection  agreed  upon 
were : 

1.  The  mother  would  have  to  be  the  head  of  the 
family.  The  selected  mothers  would  be  those  re- 
sponsible for  the  care  and  management  of  their 
children  in  their  homes.  Therefore,  unwed  mothers 
who  lived  with  their  own  mothers  would  be  excluded. 

2.  The  mother  would  have  to  have  a  child  or  chil- 
dren under  teen  age.  The  exclusion  of  mothers  who 
had  teenage  children  only  was  based  on  the  theory 
that  little  change  could  be  brought  about  in  teenage 
children  through  counseling  their  mothers  only. 

3.  The  mother  would  have  to  have  at  least  one 


70 


child  who  was  showing  behavior  problems  at  home  or 
at  school. 

4.  The  mother  had  to  be  stable  enough  emotionally 
to  be  able  to  relate  to  other  mothers  in  a  group. 
Mothers  who  appeared  to  be  severely  retarded  or  dis- 
turbed were  excluded  because  it  was  imperative  for 
the  group  members  to  understand  each  other. 

5.  The  mother  would  have  to  be  between  the  ages 
of  20  and  40.  Those  who  were  younger  were  excluded 
as  likely  to  be  living  with  their  parents.  Those 
who  were  over  40  were  less  likely  to  have  young  chil- 
dren and  more  likely  to  be  fixed  in  their  attitudes 
toward  child  rearing. 

6.  The  mother  would  need  to  have  ready  access  to 
IDublic  transportation  because  transportation  difficul- 
ties could  discourage  attendance. 


It,: 


Following  the  establishment  of  the  criteria,  there 
was  general  agreement  that  each  worker  in  the  unit 
would  contact  all  the  mothei's  in  his  caseload  who^ 
fulfilled  these  criteria,  inform  them  of  the  possibility 
of  joining  this  type  of  group,  and  encourage  their 
voluntary  participation. 

The  question  of  confidentiality  was  regarded  as 
posing  no  problems  because  the  psychiatric  social 
worker,  who  was  to  conduct  the  group  counseling,! 
had  no  official  relationship  with  the  welfare  depart- 
ment. However,  if  any  questions  were  asked  by  thei 
mothers  relating  to  eligibility,  the  mothers  were  to  be* 
referred  by  him  to  their  public  welfare  caseworkers 
for  additional  information  or  clarification. 

The  6-month  time  limitation  was  set  on  the  basi&i 
of  several  assumptions:  (1)  That  the  mothers  wouldi 
have  trouble  making  arrangements  for  a  longer  period) 
of  time  for  transportation  to  the  clinic  and  for  the 
care  of  their  children  while  they  attended  the  meet- 
ings; (2)  that  they  would  have  difficulty  remaining 
absorbed  in  a  group  for  a  longer  period,  particularly 
one  extending  into  the  summer  when  their  children 
would  be  out  of  school;  (3)  that  6  months  would  bd 
a  sufficiently  long  time  to  produce  evidence  of  change 
if  any  were  to  occur. 


r. 


Group  composition 

The  miit  workers  suggested  participation  in  the 
group  to  34  mothers  and  pointed  out  that  this  wasi  »«. 
an  opportunity  to  talk  over  their  problems  with  other 
mothers  in  circumstances  similar  to  their  own  and 
that  through  such  discussion  perhaps  find  better  solu-j 
tions  for  their  problems  in  child  rearing  and  home 


management. 


Ten  of  these  mothers — eight  Negro, 


CHILDREN     •     MARCH-APRIL  1967( 


't' 


one  Mexican  Aincriian,  and  one  Caucasian  — agroed 
to  paHiripalf.     Thoy  iiicludcil: 

•  P\>nr  molhcrs  lionsebound  by  chronic  depression 
so  severe  that  tliey  couhl  not  maintain  tlieir  liouse- 
holds  or  provide  even  minimal  care  for  their  childifii. 

•  Two  extremely  liostile  and  siisi)ici()ns  niolheis 
wlio  were  overtly  ag-o-rcssive  towai-d  the  welfare  de- 
partment and  its  workers  and  who  in  their  cliiid  care 
were  riirid  and  demandiiii;:. 

•  Two  motliers  wlio  liad  liad  psycliotic  episodes: 
one  was  undergoing  a  severe  depressive  reaction;  the 
other  was  so  amhixalent  lliat  she  was  iinalile  to  make 
decisions. 

•  One  motlier  witli  a  severe  drinking  problem  and 
a  marked  speedi  ditriculty. 

•  One  mother  who  frequently  sulfered  from  psycho- 
somatic ailments  such  as  allergies  and  headaches. 

The  psychiatric  social  worker  sent  each  mother  a 
letter  informing  lier  of  the  purpose  of  the  counseling 
sessions  and  tiie  date  and  liour  of  the  first  session  and 
inviting  her  to  attend. 

The  attendance  fluctuated  markedly  until  the  end 
of  the  tliird  month,  at  which  time  the  group's  mem- 
bership stabilized  at  seven.  The  three  mothers  who 
dropped  out  were  the  most  ambivalent  and  suspicious 
in  the  group.  One  had  marked  difficulty  in  trans- 
posing experiences  into  words. 

There  were  several  practical  problems  that  in- 
fluenced attendance:  (1)  Numerous  medical  appoint- 
ments for  the  mothers  of  children  at  the  county  hos- 
pital that  conflicted  with  the  liours  of  the  group 
session;  (2)  a  long  rainy  spell  that  discouraged  those 
whohad  to  wait  for  buses;  (3)  unexpected  difficulties 
in  arranging  child  care;  and  (4)  a  3-week  illness  on 
the  part  of  the  psychiatric  social  worker.  By  the 
ind  of  the  third  month,  most  of  these  obstacles  had 
been  overcome. 

The  psychiatric  social  worker's  role  as  group  coun- 
selor varied  with  the  stages  of  group  development. 
;he  themes  of  the  discussion,  and  what  happened 
imong  the  members.  However,  he  always  provided 
m  urn  of  coffee  for  each  session,  thus  showing  the 
group  that  he  could  accept  them  and  give  to  them 
Birithout  making  demands.  Taking  coffee  together 
)rovided  the  group  members  with  a  pleasant  way 
o  begin  each  session,  helped  them  warm  up  to  the 
jroup  gradually,  and  offered  the  counselor  an  accept- 
ible  excuse  for  a  break  when  tlie  tension  became  too 
ligh  for  one  of  the  members  to  tolerate.  It  also 
>rovided  the  counselor  witli  some  insight  into  tlie 
lature  of  the  members'  social  interactions. 

VOLUME  14  -  NUMBER  2 


For  example,  in  one  ot  the  early  sessions  of  the 
group.  I  lie  leader  in\  iled  the  members  to  have  coffee. 
All  except  one  went  to  the  coli'ee  urn  and  chatted 
about  how  nice  it  was  to  have  the  coffee  available. 
Allhougii  it  was  only  11:30  a.m.,  the  mother  who 
refused  coffee  said  that  it  kept  her  awake.  In  this  way 
she  seemed  to  be  informing  the  leader  that  she  could 
not  be  bribed  by  an  autiiority  figure  as  could  the 
others.  However,  later  on  after  the  psychiatric 
social  worker  had  focused  the  group's  attention  on 
her  chihl-rearing  problems,  thus  giving  iier  an  oppor- 
tunity to  voice  her  frustrations,  she  arose  to  get  her- 
self a  cup  of  coffee. 

Recurrent  themes 

One  recurrent  theme  in  the  earlier-  group  sessions 
dealt  primarily  with  problems  of  child  management 
and  discipline.  While  on  the  surface  these  problems 
did  not  seem  diflerent  from  those  encountered  in 
normal  parent-child  i-elationships,  discussion  revealed 
them  to  be  much  more  intense  and,  in  some  cases, 
symptomatic  of  pathological  relationships  that 
seemed  to  arise  out  of  the  mothei-s'  status  as  heads 
of  poverty-stricken,  fatherless  families. 

Most  of  the  mothei-s  felt  overwhelmed  by  the  neces- 
sity of  having  to  take  on  the  roles  of  both  mother  and 
father  and  by  the  never-ending,  unrelieved  demands 
of  their  children  for  attention,  discipline,  affection, 
understanding,  and  time.  They  had  responded  to 
this  feeling  in  one  or  more  of  the  following  ways : 

•  Placing  older  children  in  quasi-parental  roles  in 
relation  to  themselves  and  their  younger  children. 

•  Becommg  overly  critical  of  their  children,  especi- 
ally the  boys,  and  demanding  that  they  be  inordi- 
nately obedient  and  quiet,  with  the  results  that 
yomiger  children  became  infantilized  and  adolescents 
reacted  with  rebellion  often  expressed  in  antisocial 
behavior. 

•  Being  unconsciously  seductive  with  an  older  son, 
an  attitude  that  either  led  the  boy  to  leave  home  or 
to  become  feminized  or  both. 

•  Becoming  competitive  with  a  daughter  who  had 
given  birth  out  of  wedlock  and  taking  over  the  mother 
role  for  the  daughter's  child. 

•  Sinking  into  a  state  of  hopelessness  and  apathy. 

A  second  recurrent  theme  had  to  do  with  the  moth- 
ers' feeling  that  they  had  married  or  had  alliances 
with  men  who  were  weak,  ineffectual,  deceiving, 
brutal,  ,or  alcoholic.  There  was,  in  fact,  a  recurrent 
hostile  ridiculing  of  men  in  general  as  manipulative 


71 


toward  women  and  as  having  one  goal  only  in  mind, 
their  own  sexual  gi-atification. 

A  third  recurrent  theme  was  connected  with  tlie 
mothers'  methods  of  coping  with  a  hostile  environ- 
ment. They  painted  black  pictures  of  official  insti- 
tutions— particularly  the  welfare  department  and 
the  county  hospital — and  their  staff  members.  One 
widesj^read  complaint  was  against  the  constantly 
changing  public  assistance  workers,  who,  they  im- 
plied, knew  less  about  people's  legal  rights,  privileges, 
and  limitations  under  the  welfare  and  institution 
code  than  the  clients  themselves.  They  repeatedly 
told  of  arriving  for  early  morning  appointments  at 
the  county  hospital  and  being  kept  waiting  all  day 
and  even  sometimes  being  asked  to  return  the  follow- 
ing day.  They  also  expressed  hostility  toward  the 
public  utility  companies  and  retail  credit  stores.  In 
the  mothers'  minds  there  was  apparently  little  dif- 
ference among  all  these  "enemies." 

A  fourth  theme  concerned  difficulties  in  getting 
credit  and  m  shopping  for  and  preparing  food. 

A  fifth  theme  dealt  with  the  purposes  and  effects 
of  the  group  meetings. 

Counseling  techniques 

In  counseling  the  group,  the  psychiatric  social 
worker  used  an  approach  primarily  directed  toward 
helping  the  mothers  increase  their  coping  capabilities. 
He,  therefore,  encouraged  them  to  discuss  their  ex- 
periences and  frustrations  with  each  other.  When 
they  did  so  the  group  members  became  closer  to 
each  other  as  they  found  they  had  common  experi- 
ences despite  their  different  etlmic  and  cultural  back- 
groimds.  Following  the  establishment  of  greater 
empathy  among  them,  the  worker  encouraged  them 
to  exchange  information  about  their  methods  of 
dealing  with  their  problems.  He  asked  direct  ques- 
tions about  how  they  shopped,  how  they  prepared 
food,  how  they  disciplined  their  children,  and  the 
like.  This  type  of  guided  activity  helped  keep  their 
attention  focused  on  difficulties  relevant  to  child 
rearing. 

Only  rarely  did  the  worker  feel  it  necessary  to 
directly  support  the  mothers'  feelings  since  the 
mothers  were  supportive  as  well  as  directive  in  their 
comments  to  each  other.  For  example,  the  previously 
psychotic  mother  who  was  so  ambivalent  and  inde- 
cisive in  dealing  with  her  children  was  told  by  mem- 
bers of  the  group  that  they  would  not  tolerate  con- 
stant whining  demands  from  their  children.  They 
pointed  out  that  her  way  of  saying  two  opposite 


72 


things  to  her  children  at  the  same  time  was  confusing 
to  them  and  to  herself. 

"While  the  worker  rarely  focused  the  discussion  on 
feelings  as  such,  the  mothers'  cathartic  expression  of 
feelings  of  futility,  rage,  and  cynicism  tended  to  re- 
duce the  strength  of  such  feelings.  As  a  result,  the 
members  of  the  group  became  able  to  differentiate 
among  the  targets  of  their  hostility  more  realistically. 
In  so  doing,  they  tended  to  modify  their  perception  of 
public  assistance  workers  and  began  to  see  their 
workers  in  the  Protective  Services  Unit  as  being 
well  informed,  capable,  and  genuinely  interested  in 
their  welfare. 

Late  in  the  group's  existence,  after  several  mothers 
had  reached  the  point  of  feeling  some  sense  of  mas- 
tery over  their  environment,  a  few  of  them  becamf 
involved  in  community  organization  activity  througt 
a  neighborhood  community  action  program.  They  jj 
worked  to  reduce  vandalism  in  their  neighborhoods  ^j 
and  to  attain  more  nearly  equitable  rents  and  bettei 
maintenance  from  their  landlords.  The  group  coun 
selor  encouraged  them  in  tliis  activity  and  in  discuss 
ing  its  successes  and  failures.  He  also  encouragec 
them  to  discuss  additional  steps  they  might  take  t< 
better  their  living  conditions. 

When  the  mothers  expressed  bitterness  at  exhorbi 
tant  interest  rates  in  credit  buying,  the  counselo:; 
asked  them  whether  they  would  like  to  have  an  exper 
on  credit  speak  to  them.  They  responded  with  en 
thusiasm,  and  so  the  counselor  invited  a  representa 
tive  of  a  credit  union  to  talk  to  them  at  a  subsequen 
meeting.  Similarly,  when  the  mothers  discussed  f  oo( 
sliopping  and  preparation,  the  counselor  arrangei 
for  a  home  economist  from  a  consumer's  cooperativ 
to  speak  to  them.  Obviously,  the  kind  of  practica 
information  taken  for  granted  by  middle  class  house 
wives  had  never  been  made  available  to  thes 
mothers.  The  counselor  believed  that  it  could  no  , 
only  help  them  with  their  day-to-day  managemen 
problems,  but  also  could  help  build  up  their  self 
confidence. 

Group  interaction 

The  members  of  the  gi'oup  seemed  puzzled  at  th 
early  meetings.  Their  interaction  with  each  othe 
was  highly  tentative.  They  gave  most  of  their  at 
tention  to  the  counselor  with  the  implicit  expecta 
tion  that  he  would  behave  like  most  of  the  middli 
class  authorities  they  had  encountered — that  he  woul( 
be  critical  and  tell  them  how  to  run  their  lives  an( 
to  solve  their  problems.     They  were  surprised  anc 

CHILDREN     •     MARCH-APRIL  196: 


'»  jvcu  ri'sriil  fill  w  lii'ii  he  il'ul  mil  respond  in  I  his  n  1:111 
ler  bill   li'i't  i(   up  In  tlicni  to  work  out    llicii-  own 
"•  jrohleius. 

"'  As  tlio  niotlioi's  turned  to  I'uch  odici-  and  cai'h  rar- 
*■  -ied  the  dual  role  of  helpei-  and  helped,  tiiey  became 
'  :reer  in  revealing;  (heir  current  and  past  relation- 
'*  ships  and  dillirulties.  They  went  beyond  looking  I'or 
■  nethods  in  cliild  rearing  and  began  to  seek  reasons 
''  for  tlieir  att itudes  toward  tiieir  children.  For  exam- 
"  Die,  one  mother  came  to  see  that  because  of  feeling 
"S  :.hat  she  was  getting  nothing  for  her  efforts  she  could 
"  lot  praise  or  encourage  licr  cliildren,  who  were,  there- 
fore, in  constant  seairh  for  attention  and  not  particu- 
■"  ar  about  tlie  kind  they  I'eceiyed. 

'*      Tlie  motiiers  moved  from  a  sensitive  embarrass- 

'"'  ment  at  their  common  status  as  recii)icnts  of  public 

5'  [issistanco  (o  a  pride  in  being  a  memlier  of  a  group 

*■'  of  motiiers  wlio  were  working  together  to  solve  their 

'"  problems.     Tiiey  expressed  the  feeling  tliat  because 

''  fliey  were  tiding  to  influence  their  own  lives  they 

^  were  diiVerent  from  some  otlier  mothers  in  the  AFDC 

^"  program.     Tliey  also  saw   themselves   as   different 

*  fi-om  motiiers  who  were  not  on  public  assistance. 

'      As  the  sessions  progressed  and  the  motiiers  told 

about  how  they  were  trying  to  solve  their  problems, 

the  influence  on  the  others  of  the  verbally  dominant 

membei's  of  the  group  became  apparent.     Tlierefore, 

when  the  counselor  learned  that  a  member  of  the 

group  had  achieved  some  success  in  attacking  certain 

problems  of  child  rearing,  home  management,  or  in- 

terfamily  relationships,  he  asked  that  member  to  tell 

the  group  about  her  experience  in  detail. 

As  the  members  of  the  group  became  better  ac- 
quainted, some  of  them  began  to  stay  on  for  anotiier 
cup  of  coffee  and  for  a  chat  after  the  session  had  of- 
ficially ended  and  the  counselor  had  left.  First,  two 
or  three  members  stayed  and  later  most  of  the  group. 
These  postmeeting  gatherings  led  to  real  friendships 
among  some  of  tlie  members.  What  might  seem  to 
be  an  unimportant  social  experience  was  an  important 
advance  in  socialization  for  these  isolated  mothers, 
one  that  helped  them  achieve  a  greater  sense  of  iden- 
tity as  persons  in  their  own  right. 

Mothers'  assessments 

In  the  final  sessions,  the  counselor  attempted  to  get 
the  members  to  assess  their  experience  in  the  group 
and  its  meaning  to  them.  This  turned  out  to  be  a 
very  difficult  task  for  them.  They  seemed  to  be  very 
much  embarrassed,  as  if  unaccustomed  to  looking  ob- 
jectively at  themselves  in  a  specific  situation. 

VOLUME   14  -  NUMBER  2 


David  Kevin,  a  graduate  of  the  University 

of    (jiilifoniiii    Scliool    of    Social    Welfare, 

Berkeley,    i.s    the    cliief    psychiatric    .social 

worlicr  at   tlie   East   Hay   Clinic  for   Child 

I's.vchiatr.v    in    lierkeley.      lie    has    .><erveil 

.IS  a  consultant  in  group  counseling  to  the 

.VlameiUi    County    Welfare   Doi)arlnient,    to 

the    Family    Service    Bureau    of    Oakland, 

and   to    teachcr.s   of   the   educationally   liandic.-ipiicd    in    the 

Colli ra    Costa   Count.v   schools,    all    in    California. 


Tliey  did,  liowe\er,  ex[)ress  ai)preriation  for  hav- 
ing a  time  for  themselves  once  a  week  free  from  house- 
hold chores  and  the  demands  of  children  and  a  place 
to  go.  (Few  people  realize  how  rarely  motiiers  in 
tlio  AFDC  program  liave  a  chance  to  go  anywiiere.) 
Some  of  them  also  reported,  directly  or  indirectly, 
one  or  more  of  tlie  following  effects  of  tlieir  participa- 
tion in  tlio  group  on  tliemselves  or  their  children: 

•  Some  change  in  attitude  on  the  part  of  the  moth- 
ers toward  their  children :  More  consistency  in  their 
discipline,  less  perfectionism,  more  generosity  with 
praise,  and  less  criticism. 

•  Some  evidence  of  changes  in  tlie  children's  be- 
havior: Better  behavior  in  school — or  at  least  fewer 
complaints  from  the  school  about  the  child's  behav- 
ior— and  less  tension  in  the  home. 

•  A  lifting  of  depression  and  apatliy  with  resultant 
increased  activity  in  home  and  neighborhood.  (This 
was  especially  apparent  in  the  four  mothers  who  had 
become  active  in  neighborhood  work.) 

•  Increased  understanding  of  their  riglits,  privi- 
leges, and  responsibilities  under  the  welfare  laws. 
Some  of  the  mothers  attributed  tliis  to  the  interchange 
during  their  postmeeting  discussions. 

•  A  lessening  of  a  sense  of  guilt  over  being  a  recip- 
ient of  public  assistance. 

Thus,  the  oral  reports  of  the  mothers  themselves 
indicated  that  the  group  experience  had  provided 
them,  in  vaiying  degrees,  with  mor«  accurate  knowl- 
edge of  their  environment  and  ways  to  deal  with  it, 
more  accurate  perception  of  their  relationship  with 
their  workers,  their  neighbore,  or  persons  in  author- 
ity, and  better  tools  for  cojiing  with  the  environment. 

In  the  area  of  personal  relationships,  the  mothers' 
reports  indicated  some  increase  in  understanding  of 
their  children's  needs  for  more  individual  attention, 
for  more  commendation,  for  less  unrestrained  crit- 
icism and  punishment,  and  for  more  consistent  firm- 
ness in   relation   to   unacceptable  behavior  and   in- 

73 


creased  ability  to  see  theii-  children  as  individuals 
with  individual  personality  needs. 

Improvements  in  areas  of  ego  mastery  were  indi- 
cated by  their  movements  from  pronounced  social  and 
emotional  isolation  to  involvement  in  neighborhood 
and  community  affairs. 

In  symptomatology,  the  mothers'  reports  indicated 
pronounced  decrease  of  depressive  reactions. 

Workers'  observations 

The  more  objective  reports  from  the  unit  workers 
confirmed  the  reports  of  the  mothers.  They  received 
direct  evidence  from  the  schools  and  hosjsitals  I'egard- 
ing  improved  attendance  and  behavior.  They  saw 
positive  changes  in  home  management  reflected  in 
greater  neatness  and  care.  They  saw  positive 
changes  in  self -care  and  dress  in  the  mothers.  They 
found  evidence  of  less  tension  in  the  households. 
They  observed  the  involvement  of  some  of  the  mothers 
in  neighborhood  councils  and  even  in  spearheading 
social  action,  such  as  getting  out  petitions  for  a  larger 
rental  allowance  in  their  budgets. 

The  following  are  excerpts  from  the  workers'  ob- 
servations made  a  month  after  the  group  ended: 

Mrs.  }:  She  is  more  accepting  of  the  idea  that  her  children's 
behavior  is  connected  with  her  relationships.  She  no  longer 
projects  the  blame  onto  the  school,  the  public  welfare  depart- 
ment, or  the  children's  father.  Her  teenage  daughter,  Delia, 
formerly  a  frequent  runaway,  has  not  left  home  during  the  past 
4  months,  and  has  completed  her  school  year  with  the  help  of 
the  home  instructor  and  will  be  accepted  in  the  regular  school 
session  in  the  fall. 

Mrs.  M:  Before  her  participation  in  the  group,  she  was 
frequently  depressed  and  unwilling  to  get  out  of  bed.  She 
seemed  on  the  verge  of  another  mental  breakdown.  Her 
children  were  doing  poorly  in  school  and  their  attendance 
record  was  very  poor.  Her  house  was  unkept.  After  partici- 
pating in  the  group,  she  asserted  herself  with  agency  staff  mem- 
bers and  other  people.  She  can  now  express  her  feelings  and 
talk  about  her  problems.  Her  depression  is  barely  noticeable. 
She  has   become  involved  in  the  activities  of  the   Economic 


♦ 


jl 


Opportunity  program  in  her  neighborhood  and  in  the  Bo 
Scouts  program.  She  feels  more  worthy  and  her  children  an 
proud  of  her  community  work.  She  is  now  able  to  control  he 
children  and  is  clear  about  her  parental  role.  She  feels  sb 
has  some  control  over  her  own  and  her  family's  destiny. 

Mrs.  C;  She  has  shown  a  most  dramatic  change  in  her  pel 
sonal  appearance,  in  her  abilities  to  manage  her  householi 
activities,  and  in  her  relationship  with  her  children.  She  i 
able  to  discuss  her  problems  freely  now  and  to  ask  question 
when  she  is  confused.  Before  participating  in  the  group,  sh' 
never  had  visitors.  Within  the  past  3  months  she  has  becom. 
involved  in  a  neighborhood  improvement  group  that  has  me 
at  her  home.  The  most  important  change  in  her  children  i 
their  good  school  attendance. 

In  addition  to  the  two  major  hypotheses  on  whicl 
the  project  was  based — that  group  counseling  of  thi 
mothers  only  would  (1)  improve  the  mothers'  copinj 
mechanisms  and  (2)  alleviate  the  behavioral  difficul 
ties  of  their  children — the  project  tested  a  number  o 
implicit  assumptions.  These  were  that  people  fron 
tlie  lowest  socioeconomic  bracket  could  become  full,^ 
involved  in  sustained  treatment,  could  achieve  a  de 
gree  of  motivation  tliat  would  provide  an  impetus  t^ 
attend  sessions  regularly  and  on  time,  and  couh 
achieve  an  intense  involvement  in  treatment  withou 
making  a  money  payment.  There  was  also  an  im 
plicit  assumption  that  for  these  achievements  th- 
treatment  approach  to  this  group  required  a  wide 
flexibility  than  conventional  group  psychotherapy 
All  of  these  assumptions  seemed  valid  for  the  grou] 
of  mothers  who  participated  in  the  demonstration. 

It  would  be  of  gi-eat  pragmatic  consequence  to  havi 
this  type  of  demonstration  replicated.  If  simila 
results  were  obtained  with  similar  groups,  they  woul( 
strongly  indicate  that  this  type  of  group  approarli 
as  a  complement  to  the  individual  efforts  of  public 
assistance  or  protective  services  caseworkers,  hold 
real  promise  for  helping  many  mothers  in  the  AFD(' 
program  cope  with  the  kinds  of  problems  that  impedi 
their  ability  to  provide  appropriate  care  for  theii 
children  and  thus  for  helping  them  improve  th( 
quality  of  their  own  and  their  children's  lives. 


tse 


Always  a  way  must  be  found  for  bringing  into  one's  solitary  place  the 
settled  look  from  another's  face,  for  getting  the  quiet  sanction  of  another's 
grace  to  undergird  the  meaning  of  the  self.  .  .  .  Here  at  least  one  is  dealt 
with,  encountered,  vanquished,  or  overwhelmed — but  not  ignored.  It  is 
a  strange  freedom  to  go  nameless  up  and  down  the  streets  of  other  minds 
where  no  salutation  greets  and  no  sign  is  given  to  mark  the  place  one  calls 
one's  own. 

Whitney  M.  Young,  Jr.,  to  the  International  Conference  of  Social  Work,  Washing- 
ton, D.C.,  September  1966. 


74 


CHILDREN     •     MARCH-APRIL  1967 


I 


is.-; 
itli; 


ma 


Dbservations  from  a  visit  abroad 


YOUTH   and 

YOUTH  SERVICES 
in  ENGLAND 


^  British  youth  today — especially 
■^f  English  youth — are  not  only  the 
fashion  models  but  in  many 
ways  also  the  behavior  models  of  our 
own  youug  jieople.  Their  haircuts  (or 
lack  of  them),  their  miniskirts,  their 
motorcycles,  their  music,  many  of  their 
freewheeling  ways  have  been  adopted 
with  gusto  by  the  teenage  generation  in 
this  country.  Whether  much  of  what 
our  Anglophile  youth  are  avidly  im- 
porting is  actually  a  reimportation  of 
American  exports  (as  in  the  realms  of 
music  and  fashion)  may  be  debated,  but 
what  is  clear  is  that  the  teenagers  on 
both  sides  of  the  Atlantic  often  have 
more  in  common  with  one  another  than 
ii\-ith  the  adult  generations  of  their  own 
countries. 

Therefore,  when  I  visited  England 
shortly  before  last  Christmas,  I  was 
p!irti(u!:irly  eager  to  learn  what  the 
young  people  there  were  really  like  and 
what  sijeeial  services  had  been  devised 
to    help    them    meet    their    problems. 

Actually,  except  for  speech  differ- 
ences, including  some  differences  in 
teenage  slang,  the  English  youth  seemed 
very  muc'h  like  their  American  counter- 
part.s.  And  Carnaby  Street,  the  mecca 
of  the  teenage  fashion  world,  seemed 
no  more  "far  out"  than  14th  Street  or 
oft-main  street.  U.S.A.,  except  for  the 
studied  Edwardian  or  Regency  dress  of 
its  saU'sclerks. 

Nowhere  apparent  among  the  young 
people  I  saw  was  the  once  celebrated 

VOLUME  14  -  NUMBER  2 


KATHERINE  B.  OETTINGER 


Chief,  ChiUrin's  Bureau 


English  reserve ;  they  six)ke  their  minds 
freely,  and  boys  and  girls  openly  ex- 
pressed their  affection  toward  one  an- 
other by  walking  together  hand  in  hand, 
arm  in  arm,  or  even  with  arms  around 
each  other.  This  boy-girl  behavior, 
charmingly  devoid  of  self -consciousness, 
seems  to  be  characteristic  of  the  young 
people  in  all  the  social  classes  and  to  be 
calmly  accepted  by  their  elders  as  a  sign 
that  the  English  have  finally  got  rid  of 
their  prudery  and  are  now  catching  up 
with  their  more  demonstrative  French 
and  Italian  neighbors. 

The  class  consciousness  of  the  older 
generation,  I  was  told,  has  also  almost 
vanished  among  the  young,  due  largely 
to  the  changes  in  the  educational  system 
that  came  with  the  Education  Act  of 
1944  and  made  ability  rather  than  birth 
the  touchstone  for  oijening  opportuni- 
ties for  a  high-quality  education.  But 
there  also  seemed  to  be  some  feeling  that 
class  consciousness  has  not  so  much  dis- 
appeared as  changed  into  consciousness 
of  strata  based  on  educational  achieve- 
ment— the  "outsiders"  now  being  those 
who  for  one  reason  or  another,  not  al- 
ways a  lack  of  native  ability,  fail  the 
various  examinations  that  open  or  close 
the  doors  to  grammar  (college  prepara- 
tory) school,  technical  school,  or  the 
kinds  of  jobs  that  lead  to  something. 

Most  of  the  problems  worrying  adults 
about  the  younger  generation  were  fa- 
miliar to  American  ears :  juvenile  de- 
linquency,   out-of-wedlock    parenthood, 


sexual  promi.scuity,  functional  illiter- 
acy, LSD  experimentation,  or  just  a  gen- 
eral hedonistic  attitude.  But  there 
were  some  differences : 

•  Unemployment  among  noncollege 
educated  young  people  is  not  the  prob- 
lem in  England  that  it  is  here.  Almost 
anyone  can  get  a  job  on  leaving  school, 
but  many  jobs  for  the  unskilled  are 
dead  ends  just  as  they  are  here. 

•  Proportionately,  far  more  young 
people  in  England  than  in  this  country 
leave  school  at  age  111  or  under.  About 
two-thirds  of  the  young  people  in  Eng- 
land leave  school  at  age  15 — the  age 
that  frees  them  from  compulsory  -school 
attendance — most  of  them  with  an  edu- 
cation somewhat  comparable  to  that 
achieved  at  the  end  of  junior  high  school 
here  ;  while  in  the  United  States  72  per- 
cent of  our  young  i>eople  finish  high 
school.  Only  8  percent  of  the  young 
people  in  England  go  on  to  a  degree-giv- 
ing college  or  university,  as  against  38 
percent  of  the  young  people  in  this 
country. 

•  Homosexuality,  though  probably 
not  a  greater  problem  in  England  than 
here,  is  certainly  more  talked  about  as 
a  problem — increasingly  as  one  requir- 
ing .sympathetic  attention. 

The.se  were  the  problems  I  heard  men- 
tioned most.  But  I  also  heard  praise 
for  young  people's  sjiirit  of  independ- 
ence and  freedom  of  expression  ;  their 
determination  not  to  be  "had"  by  the 
purveyors  of  specious  values ;  their  des- 

75 


perate  wish  to  make  soiuethiug  of  their 
lives. 

What  is  there  to  help  them  ? 

Educational  opportunities 

Fir.st  there  are  the  opportunities  for 
continued  education  offered  by  three 
types  of  government-supported  colleges : 
(1)  The  regional  colleges,  which  are 
open  to  all  who  can  pass  various  ex- 
aminations and  which  offer  some  tech- 
nical courses  and  some  university 
preparation;  (2)  the  area  colleges, 
which  offer  advanced  academic  pro- 
grams to  the  academically  eligible  and 
numerous  extension  courses  to  others ; 
and  (3)  the  county  colleges,  which  offer 
a  wide  range  of  vocational  or  life- 
enriching  continuation  courses  to  any- 
one who  wishes  to  enroll.  A  great  many 
teenagers  in  England  who  are  out  of 
school  are  taking  courses  of  some  kind 
somewhere,  in  efforts  either  to  pass  the 
door-opening  examinations,  to  satisfy 
an  interest,  or  to  learn  a  trade.  In 
fact,  all  young  people  under  18  who  are 
employed  may  soon  be  required  to  take 
continuation  courses  related  to  their 
work,  and  employers  may  be  required  to 
give  them  time  off  to  do  so. 

The  Youth  Service 

Then  there  are  the  youth  clubs,  hun- 
dreds of  them  throughout  the  country, 
that  provide  .voung  people  with  oppor- 
tunities for  bull  sessions,  social  activi- 
ties, the  pursuit  of  hobbies,  community 
service,  and  adventure.  The  preva- 
lence of  these  clubs  represents  an  in- 
teresting combination  of  government 
and  voluntary  efforts  on  both  national 
and  local  levels.  As  in  this  country, 
England  abounds  in  voluntary  youth- 
serving  organizations — Boy  Scouts,  Girl 
Guides,  the  TMCA,  the  YWCA,  and  a 
variety  of  sectarian  organizations. 
Along  with  the  local  education  authori- 
ties, these  organizations,  and  their  na- 
tional associations  receive  grants  from 
the  national  government  for  building 
up  programs  to  provide  "association, 
training,  and  challenge"  to  young  peo- 
ple under  20,  especially  those  who  are 
no  longer  in  school. 

The  Youth  Service  of  the  Department 
of  Education  and  Science,  through 
which  these  grants  are  made,  was  first 
established  in  1939  to  encourage  the 
coordination  of  local  services  for  young 
people  and  the  provision  of  "new  con- 

76 


structive  outlets"  for  their  energies. 
But  after  the  war,  it  lost  out  in  the 
competition  for  public  funds  so  that  by 
the  late  1950's  both  the  "constructive 
outlets"  and  the  supply  of  persons  to 
lead  youth  programs  were  obviously  in- 
adequate to  meet  the  needs  of  a  bulging, 
restless,  teenage  population.  As  a  re- 
sult of  public  concern,  in  1958  the  Min- 
ister of  Education  appointed  a  com- 
mittee, headed  by  the  Countess  of  Albe- 
marle, to  make  recommendations  on  the 
Youth  Service's  role  in  helping  young 
people  "play  their  part  in  the  life  of  the 
community"  in  the  light  of  social 
change.  This  committee's  report,  is- 
sued in  1960,  has  breathed  new  life  into 
the  Youth  Service  and  the  programs  it 
supports."^ 

In  addition  to  greatly  stepped-up 
government  financial  support  of  the 
youth  services  of  both  the  local  educa- 
tion authorities  and  the  voluntary  or- 
ganizations, the  Albemarle  report  has 
resulted  in — ■ 

•  The  appointment  of  a  Youth  Serv- 
ice Development  Council  to  advise  on 
the  10-year  development  of  the  Youth 
Service  through  two  .j-year  plans. 

•  The  construction  and  improvement 
of  clubhouses  for  young  people,  some 
as  wings  of  modern  secondary  schools, 
some  as  student  unions  on  the  grounds 
of  area  and  county  colleges,  and  some 
as  independent  facilities  operated  by 
the  voluntary  organizations.  Coifee 
bars,  similar  to  our  teenage  canteens, 
abound,  some  as  come-ons  for  diversi- 
fied activity  programs  available  to  but 
not  required  of  the  young  people  who 
attend. 

•  The  establishment  at  Leicester  of 
the  National  College  for  the  Training  of 
Youth  Leaders,  with  scholarships  for 
teachers,  social  workers,  and  other  ma- 
ture persons  interested  in  going  into 
full-time  youth  service  work ;  and  the 
establishment  or  expansion  by  volun- 
tary organizations  or  county  colleges  of 
training  programs  for  part-time  leaders. 
Through  employers'  associations,  in- 
dustrial firms  have  been  asked  to  give 
interested  employees  time  off  from  their 
jobs  to  pursue  the  courses  for  part-time 
youth  leaders,  and  some  have  agreed. 

•  New  experiments  in  programing 
with  emphases  on  opportunities  for  serv- 
ice and  adventure.  Young  people  from 
all  socioeconomic  levels  are  working  on 
a  volunteer  basis  with  the  aged,  the 
mentally  retarded,  the  deaf  and  mute ; 
they  are  serving  as  hospital  aides,  fire- 


fighters, members  of  mountain  rescu 
teams,  members  of  a  motorcycle  emei 
gency  service.  They  are  also  climbin 
mountains  ju.st  for  fun,  exploring  cave; 
going  sailing,  taking  trips  abroad. 

•  Increased  efforts  to  promote  greate 
opportunities  for  service  by  yoim 
people.  Although  many  young  pec 
pie  are  engaged  in  volunteer  com 
munity  services,  opportunities  for  sue 
service  are  said  to  be  far  fewer  tha 
potential  teenage  volunteers.  There 
fore,  a  subcommittee  of  the  Youth  Serv 
ice  Development  Council  has  proposei 
the  establishment  of  local  and  nationa 
coordinating  bodies,  to  include  youn; 
people  themselves,  to  promote  interes 
in  service  by  youth  on  the  part  both  o 
young  people  and  the  potential  users  o 
their  service,  and  to  serve  as  clearing 
houses  to  bring  young  volunteers  am 
opportunities  for  service  together." 

•  Efforts  to  learn  more  about  the  ac 
tivities  of  "unattached  young  people"— 
those  who  can  seem  to  find  no  place  ii 
societ.v — and  help  them  achieve  satis 
fying  group  experiences  based  on  thei 
own  interests.  A  3-year  study  and  dera 
onstration  project  in  this  regard,  .spon 
sored  by  the  Youth  Service  Develop 
ment  Council  °  has  provoked  some  con 
troversy  because  the  "detached  work 
ers"  failed  to  reveal  their  purpose  to  th' 
young  people  involved. 

Youth  participation 

While  there  is  much  of  the  traditioiia 
self-conscious  "character  building"  em 
phasis  in  the  approach  of  some  youth 
serving  organizations,  I  think  it  is  saf( 
to  say  that  the  trend  in  England  todaj 
is  toward  recognizing  the  moderi 
youth's  mi-strust  of  anything  in  whict 
he  does  not  have  a  hand.  Thus  young( 
people  are  being  looked  to  more  and 
more  for  participation  in  planning — as 
in  the  propo.sed  coordinating  bodies  for 
promoting  service  by  youth.  And  self- 
programing  is  the  accepted  practice  in  a 
great  many  of  the  youth  clubs — particu- 
larly those  attached  to  the  various  kinds 
of  colleges. 

The  character-building  goal  is  still 
held  by  the  sponsoring  organizations, 
but  it  is  hidden  in  an  approach  that 
stresses  the  value  of  social  interaction 
and  mastery  of  skills  in  building  the 
necessary  base  of  self-confidence  and 
self-respect.  Thus  theories  of  group 
dynamics,  while  still  hotly  debated  in 
some  quarters,  are  being  given  increas- 

CHILDREN     •     MARCH-APRIL  1967 


ii;;  wciulil  ill  VdUlli  Icailcrsliip  Iriiiiiiiis 
(iiirsi's.  'Phis  (Miipliasis  iin  "sociMi  cdu- 
iitidii"  is.  ill  fncl.  llip  nilioiiiilc  I'.pr 
it'ciiiiiK  llif  Ydulli  SiM-vifc  ill  the  De- 
iirlnicMt  111'  KdiR'iitiiiii  and  Science, 
rhich  leans  lieavily  on  local  educational 
1  uthorities  for  developing  services,  to 
;,((  he  consternation  of  some  public  welfare 
k-orkers  who  regard  leisure-time  pro- 
rams  as  social  services  and  hence  a 
esponsiliility  of  the  Home  Ollicc. 

The  Allicniarle  conimitlee's  insistence 
in  "I'halleiige"  is  rellected  in  the  variety 
f  activities  demanding  the  mastery  of 
kill  made  available  to  young  people 
hrough  the  youth-serving  organizations 
t  prices  they  can  atTord.  And  nearly 
very  yoniig  person  can  afford  a  modest 
ee,  fur  young  people  in  England  today, 

was  told,  have  more  moiie.v  in  their 
lockets  than  any  previous  generation 
f  teenagers.  I'articijiation  in  skiing, 
:oIf,  sailing,  mountain  climbing,  or 
ravel  no  longer  identifies  a  youth  as  a 

ember  of  tlie  upper  or  middle  classes. 

The  emjihasis  on  challenge  is  perhaps 
lost  clearl.v  exemplified  by  the  I>uke 
f  Kdinliui-gli"s  Award  Scheme,  begun 
n  i;).")ti.  Reaching  young  people  not 
nly  throu.gh  the  schools  and  youth- 
erving  organizations  but  also  through 

host  of  industrial  firms  that  .sponsor 
he  Scheme  for  their  young  factory  and 
ffice  workers,  it  provides  medals  for 
stickability"  and  achievement  in  four 
&isure-tinie  areas:  for  boys,  service, 
xpedition,  pursuits  and  interests  (bird 
matching,  photography,  electronics,  or 
fhatever),  and  physical  fitness:  for 
iris,  "design  for  living"  (homemaking 
kills),  pursuits  and  interests,  adveu- 
ure,  and  service.  While  the  Scheme 
las  been  criticized  for  its  heavy  empha- 
is  on  physical  prowess,  it  does  in- 
lude  some  special  programs  fur  the 
andicapped. 

,onsultation  services 

The  government  responsibility  for 
idlvidual  aud  family  welfare  in  Eng- 

nd  is  lodged  in  the  Home  Office,  but 
ere  again  there  is  a  close  partnership 
etween  governmental  and  voluntary 
fforts.  The  link  between  the  two  from 
lie  point  of  view  of  the  per.son  seeking 
elp  is  the  neighborhood  Citizens'  Ad- 
ice  Bureau,  an  outgrowth  of  a  wartime 
mergency  service  equipped  to  give  any- 
ne  who  walks  in  immediate  informa- 
ion  on  where  to  go  to  get  the  kind  of 

elp  he  needs,  whether  from  a  govern- 

'OLUME  14  -  NUMBER  2 


nieiit  agciii-.v,  a  voluntary  organizal  ion, 
or  even  a  coinmercial  enterprise. 

Young  peoi)U'  whose  obvious  need  is 
help  with  a  personal  problem  may  be 
referred  to  the  county  council's  chil- 
dren's department,  which  with  support 
from  the  Home  Office  offers  services 
comparable  to  our  public  child  welfare 
services ;  to  a  voluntary  family  advice 
service  comparable  to  our  family  serv- 
ice .•igencies ;  or  to  a  voluntary  or  pub- 
lic mental  hygiene  clinic.  Adolescents 
in  Knglaiul  are,  however,  as  elusive  as 
clients  of  casework  agencies  as  they 
are  in  this  country.  Therefore,  one  in- 
novative voluntary  service  in  Lon- 
don, the  Young  People's  Consultation 
Centre,  is  worthy  of  special  note. 

Dubbed  the  "worry  clinic"  by  its 
young  patients,  this  demonstration 
project  is  financed  through  the  Youth 
Studies  and  Research  Foundation  by 
the  Bernard  Van  Leer  Foundation  of 
Holland,  aud  was  established  through 
the  leadership  of  Mrs.  Hilary  Halpin. 
Staffed  by  psychoanalytically  oriented 
psychologists  and  social  workers,  and 
part-time  consultants  from  other  disci- 
plines as  needed,  it  provides  a  drop-in 
counseling  service  to  adolescents  on 
their  own  terms.  If  the  young  person 
does  not  want  to  give  his  address  or 
involve  his  parents,  he  does  not  have 
to.  He  can  come  back  for  future  inter- 
views or  not  as  he  chooses.  The  only 
question  asked  of  the  new  patient  by 
the  receptionist  is  whether  he  wishes  a 
man  or  woman  counselor. 

Some  young  people  come  to  the  Cen- 
tre on  referral  from  schools,  social 
agencies,  or  employers ;  many  come 
independently,  for  the  foundation  ad- 
vertised the  Centre's  services  in  news- 
papers, coffee  bars,  libraries,  youth 
clubs,  and  subway  trains  and  stations. 
The  response  became  so  overwhelming 
that  the  ads  were  discontinued.  The 
Centre's  popularity  has  continued  to 
grow  as  news  of  its  services  spreads 
by  word  of  mouth  and  newspaper 
advice  columns. 

The  foundation  has  announced  the 
Centre's  services  as  being  for  young 
people  between  the  ages  of  15  and  2.'5. 
but  adolescents  as  young  as  12  have 
turned  up  and  received  service.  Most 
of  the  young  people  who  come  to  the 
Centre,  however,  are  17,  18,  or  19. 
They  bring  a  wide  range  of  problems, 
some  related  to  immediate  crises  and 
calling  for  simple  advice  or  informa- 
tion, others  stemming  fmin  longstand- 


ing iis.vchdliigii'al  pnililciiis  of  vjir.ving 
delith.  Most  derive  I'roiii  the  gap  be- 
tween the  youth's  expectation  of  him- 
.self  and  his  experiences  in  home, 
school,  work,  and  love. 

Personal  problems 

When  ailvice  or  information  cannot 
alone  help  the  young  person  dcil  with 
his  problem,  the  Centre's  coun.selor  may 
help  him  see  the  relationship  between 
the  problem  and  (he  emotional  diflicnl- 
ties  a  person  normally  experiences  .as 
he  gropes  toward  maturity.  Often  this 
is  enough  to  relieve  the  strain  the  young 
person  has  been  experiencing.  For  ex- 
ample, a  problem  frequently  brought  to 
the  Centre  by  older  adolescents  is  guilt 
about  past  homo.sexual  activities.  Most 
of  the  young  people  who  come  with  this 
problem,  however,  have  already  moved 
beyond  homosexual  interests  and  need 
only  to  be  helped  to  understand 
their  past  behavior  as  a  not  unusual 
manifestation  of  a  phase  in  human 
development. 

Jlan.v  young  people  bring  problems 
stemming  from  the  social  change  that 
today  accentuates  the  difference  be- 
tween the  generations.  For  example, 
a  university  student  told  of  suffering 
from  constant  criticism  from  his  father, 
a  deckhand  who  could  not  understand 
his  son's  scholarly  interests  and  ac- 
cused him  of  being  less  than  a  man. 
The  student  wanted  to  leave  home,  but 
feared  hurting  his  parents.  He  was 
bellied  to  see  how  he  could  leave  and 
still  maintain  a  supportive  relationship 
with  his  famil.v. 

Other  problems  frequently  brought  to 
the  Centre  are  worry  about  extramari- 
tal relations,  pregnancy  out  of  wedlock, 
and  depression  rising  from  a  series  of 
misfortunes — parental  indifference,  fail- 
ure at  school,  a  broken  love  affair.  If 
the  young  jjerson  shows  signs  of  suicidal 
tendencies,  an  organization  called  the 
Samaritans,  which  provides  24-hour 
service,  may  be  called  on  for  help. 
Pregnant  girls  are  referred  to  appro- 
priate medical  and  social  resources,  but 
the  Centre  frequeiitl.v  continues  to  work 
with  them  around  the  emotional  prob- 
lems that  may  have  led  to  their  difficult 
situation. 

The  Centre  .sees  most  of  the  young 
jieople  who  come  to  it  onl.v  two  or  three 
times.  Its  original  plan  was  to  refer 
all  whose  problems  were  deeply  imbed- 
ded    in     their     personalities     tu     nthcr 

77 


agencies  for  psychiatric  treatment,  and 
many  are  so  referred.  However,  be- 
cause of  a  scarcity  of  agencies  geared 
to  offering  tliis  type  of  help  to  adoles- 
cents, the  Centre  is  now  providing  some 
young  patients  with  jisychotherapy  or 
psychoanalytic  treatment  through  a 
panel  of  cooperating  psychotherapists 
and  psychoanalysts. 

Another  innovation  in  consultation 
services  to  young  people  is  represented 
by  the  two  Brook  Advisory  Centres  for 
young  people  who  "want  to  discuss 
birth  control  and  sexual  or  emotional 
matters."  These  centers  were  estab- 
lished largel.v  through  the  efforts  of 
Mrs.  Helen  Brook,  a  board  member  of 
the  voluntary  family  planning  organiza- 
tion who  was  distressed  by  its  policy — 
and  the  policy  of  the  National  Health 
Services — of  refusing  contraceptive  ad- 
vice to  young  unmarried  women  and 
girls.  The  purpose  of  the  centers  is  to 
reduce  the  number  of  illegal  abortions 
and  illegitimate  births  and  to  inculcate 
a  sense  of  sexual  responsibility  in  the 
young. 

The  young  women  who  come  to  these 
centers— often  hand  in  hand  with  their 
young  men — are  not  only  given  indi- 
vidualized contraceptive  service  but 
also  an  opirortunity  to  discuss  the  qual- 
ity of  their  sexual  relationship  and  the 
emotional  problems  surrounding  it.  The 
girls  return  at  3-mouth  intervals  for 
thorough  physical  examinations  and 
reviews  of  their  total  life  situation. 

Every  girl  who  comes  to  the  Brook 
Centres  receives  a  pregnancy  test,  and 
some  come  because  they  fear  they  are 
pregnant  and  know  the  tests  are  avail- 
able. Even  if  the  fear  proves  unfound- 
ed, it  is  often  the  opening  wedge  to 
helping  a  girl  with  emotional  problems. 
When  indicated,  girls  are  referred  to 
psychiatrists  for  treatment  or  to  cler- 
gymen for  spiritual  advice. 

Sex  education 

At  what  age  and  by  whom  sex  educa- 
tion should  be  provided  to  young  people 
is  a  matter  of  debate  in  England,  as  it 
is  here.  It  is,  however,  offered  at  some 
stage  and  in  some  manner  by  most  of 
the  "maintained  schools" — those  oper- 
ated by  the  local  authorities.  There  is 
also  some  experimenting  in  this  direc- 
tion by  voluntary  organizations  and 
church  groups.  One  of  these,  the 
Catholic  Consultation  Service,  grew  in 
a  few  years  from  a  service  of  direct 

78 


counseling  offered  to  individual  boys  by 
one  priest  into  a  widespread  network  of 
individual  and  group  consultation  serv- 
ices for  boys  and  girls,  a  leadership 
training  program  for  teachers  in  paro- 
chial schools,  and  a  training  program 
for  parents.  According  to  the  Reverend 
Maurice  O'Leary,  the  founder  and  di- 
rector of  the  organization,  schoolteach- 
ing  nuns  are  much  more  responsive  to 
this  program  than  are  schoolteaching 
monks.  He  believes  this  is  evidence 
that  boys  are  more  neglected  than  girls 
in  this  respect. 

Unmarried   mothers  and  delinquents 

One  out  of  14  children  born  in  Great 
Britain  is  born  out  of  wedlock  *  (almost 
the  same  as  the  ratio  in  this  country — 
1  in  15  in  1964) .  I  have  no  figures  as  to 
what  proportion  of  these  are  born  to 
teenagers,  but  there  is  enough  concern 
about  schoolgirl  pregnancies  for  a  na- 
tional conference  on  the  subject  to  have 
been  held  in  London  last  year.  A  con- 
cern at  that  conference  was  one  also 
demanding  increasing  attention  in  this 
country — how  to  provide  continued 
education  for  girls  who  become  pregnant 
under  school-leaving  age.  Apparently 
only  a  few  local  educational  authorities 
offer  opportunities  for  this. 

As  in  this  country,  there  are  in  Eng- 
land a  variety  of  public  and  voluntary 
services  for  pregnant  girls  and  unmar- 
ried mothers  and  their  children — public 
assi.stance,  shelter  care,  maternity  care, 
social  casework,  and  adoption  services. 
At  least  one  organization,  the  Church 
Army,  is  providing  counseling  to  young 
unmarried  fathers.  But  serious  gaps  in 
service  still  exist,  as  they  do  here,  par- 
ticularly in  relation  to  the  unmarried 
mother  who  keeps  her  child. 

A  major  problem  in  England  is  find- 
ing housing  accommodations  for  such 
fatherless  families.  Because  so  few 
local  housing  authorities  include  un- 
married mothers  and  their  children  on 
their  housing  lists,  some  voluntary  agen- 
cies are  providing  special  "bedroom-sit- 
ting room"  residences  or  "flatlets"  for 
them. 

The  voluntary  organization,  the  Na- 
tional Council  for  the  Unmarried 
Mother  and  Her  Child,  is  comparable  to 
our  National  Council  on  Illegitimacy  ex- 
cept that,  in  addition  to  working  for  pub- 
lic understanding  and  better  services, 
the  British  council  provides  some  direct 
help  to  pregnant  girls  and  unmarried 


mothers  and  their  children.  At  presentp*^ 
the  council  is  working  for  better  stat< 
financial  provision  for  fatherless  ehil 
dren  and  a  wider  variety  of  public  socia 
services  "to  compensate  them  for  thei 
disabilities."  It  is  also  advocating  thi 
establishment  of  local  authority  famil; 
services  supported  by  the  Home  Office. 

This  last  recommendation  is  one  evi 
dence  of  growing  interest  in  building  u) 
the  social  services  provided  by  the  loca 
authorities  with  the  goal  of  strengthen 
ing  family  life — and  so  strengtheniuj 
the  .stability  and  moral  fiber  of  th. 
young.  This  is  a  stated  goal  in  a  whit 
paper  issued  by  the  Home  Office  ij 
August  1965  recommending  sweepinj 
changes  in  the  handling  of  juveuil 
delinquents.^  It  recommends  the  ap 
pointment  by  each  local  authority  of  i 
family  council,  composed  of  represents 
fives  of  the  local  children's  departmen 
and  others  with  a  special  understandin; 
of  children,  to  make  decisions  on  th 
treatment  of  juvenile  delinquents  unde 
16.  except  in  cases  where  the  facts  are  ii 
dispute  or  the  council's  recommenda 
tions  are  not  complied  with.  This  pre 
posal,  needless  to  say,  has  met  wit 
some  criticism  from  legal  quarters. 

The  white  paper  also  recommends  th 
establishment  of  courts  for  young  oli 
fenders  between  the  ages  of  16  and  21- 
a  proposal  that  has  al.so  met  with  somi 
adverse  criticism  for  taking  youni 
people  between  16  and  18  out  fror 
under  the  "care,  protection,  and  parol 
proceedings"  provided  for  by  the  Chi 
dren  and  Young  Persons  Act  of  1963. 


Ferment  and  change 

One  impression  that  anyone  wb 
makes  even  the  most  superficial  review 
of  services  to  young  people  in  Englam 
must  surely  come  away  with  is  a  sens 
of  ferment  and  change.  I  have  briefl; 
described  some  of  the  developments 
learned  about  on  my  visit,  but  even  as 
describe  them  they  are  changing  witl 
the  needs  and  moods  of  the  times. 

Legislation  now  before  Parliamen 
suggests  there  may  be  changes  in  poljj 
cies  of  the  National  Health  Service  re! 
garding  the  physician's  role  in  givinj 
contraceptive  advice  to  unmarriec: 
persons. 

In  1970,  the  school-leaving  age  wil; 
be  raised  to  16,  and  by  then  the  shar] 
division  between  grammar  school  an( 
secondary  modern  school,  so  criticizet 
as  the  creator  of  new  status  distinc 


lb 
Itr,; 


CHILDREN     •     MARCH-APRIL 


1965  11)1, 


ions,  will  no  ImiKor  hold  as  I  he  two 
re  mei'st'd  into  tlic  coiniu-flu'iisive 
chools  now  bfing  iiuslicd  liy  the  I.al)our 
rovernnient.  By  then  too  tUo  hotly  de- 
lated propos«il.s  for  hiuullinK  juvenile 
lelinqueuts  may  have  been  put  into  ef- 
ect  or  modified.  I'erhajjs  too  the  new 
oluntary  exi)eriment.s  in  offering  indi- 
idual  and  group  consultation  for 
roubled  young  persons,  which  now 
eein  so  limited  to  London,  will  have 
aught  on  and  spread  to  other  areas. 
I  think  it  is  safe  to  say  that  unless 
here  is  an  unlikely  reversal  of  govern- 
iient  support  for  group  programs  for 
outh,  both  the  quantity  and  variety  of 
)pportunities  for  young  people  to  de- 
elop  their  capacities  as  social  beings 
.•ill  in  the  next  few  years  greatly  in- 
rease.     Certainly  today  England  more 


tlian  the  I'nited  States  recognizes  gov- 
ernment responsibility  for  supporting 
young  jieoplo's  development  through 
providing  Ibem  with  opportunities  to 
])articipate  in  challenging  activities 
Willi  others.  Our  Nation  lias  thrown 
its  spotlight  on  young  people  who  get 
into  trouble  with  society  or  who  have 
other  serious  problems,  as  well  as  on 
the  talented  young  people  who  are  nat- 
ural loaders.  But  what  about  the  mil- 
lions in  between  V 

One  thing  about  the  future  is  clear. 
Not  only  Kiiglaiul  but  also  hero  and  all 
over  the  world  there  will  be  even  more 
teenagers  than  there  are  now.  And 
thci/  will  have  new  ideas  and  wills  of 
their  own.  And  the  adults  there,  here, 
and  everywhere  will  be  hard  put  to  keep 
up  with  tliem. 


'Ministry  of  Education:  The  youth  services 
in  Enj:l.and  and  Wales.  Report  of  the  com- 
mittee appointed  by  the  Minister  of  I'.ilucation 
in  November  1958.  Her  Majesty's  Stationery 
Office,   London.     1960.     (Reprinted    196'!.) 

^  Department  of  Education  and  Science: 
Service  by  youth.  Report  of  a  committee  of 
the  Youth  Service  Development  Council.  De- 
cember 1965.  Her  Majesty's  Stationery  Office, 
London.     1966. 

'Morse,  Mary:  The  unattached:  a  report  of 
the  3-year  project  carried  out  by  the  National 
.Association  of  Youth  Clubs.  Pelican  Book 
A-737.  Penguin  books,  llarmondsworth, 
England.     1965. 

*  The  National  Council  for  the  Unmarried 
Mother  and  Her  Child:  Annual  report,  April 
1965-March  1966.     London. 

'  Home  Office:  The  child,  the  family,  and  the 
young  offender.  Her  Maiesty's  Stationery 
Office,  London.  August  1965.  (Reprinted 
1966.) 


guides  and  reports 


iIARSHALLING  COMMUNITY  SERV- 
ICES OX  BEHALF  OP  THE 
ABUSED  CHILI).  Children's  Divi- 
sion, The  American  Humane  Associa- 
tion, P.O.  Box  1266,  Denver,  Colo. 
80201.     1906.     30  pp.     35  cents. 

Three  papers  given  at  the  1966  meet- 
ng  of  the  National  Conference  on  Social 
Welfare.  The  first  analyzes  State  laws 
or  reporting  child  abuse ;  the  other  two 
eport  on  the  implementation  of  report- 
ng  laws  in  a  State-administered  child 
velfare  program  and  in  a  county-admln- 
stered  program. 

WELFARE  AND  'O'lSDOM:  lectures 
delivered  on  the  fiftieth  anniversary 
of  the  School  of  Social  Work  of  the 
University  of  Toronto.  Edited  by 
John  S.  Morgan.  University  of  Tor- 
onto Press,  Toronto,  Canadti.  1966. 
184  pp.     $5. 

Contains  eight  lectures  on  welfare  in 
elation  to  social,  economic,  and  political 
levelopment  by  four  scholars :  T.  H. 
larshall.  professor  emeritus  of  sociol- 
gy,  University  of  London ;  Eugen 
*usic,  professor  of  public  administra- 
ion.  University  of  Zagreb ;  Malcolm 
Ldisehiah,   economist  from   India   and 

i'^OLUME  14  -  NUMBER  2 


deputy  director-general  of  UNESCO; 
and  Charles  Frankel,  U.S.  Assistant 
Secretary  of  State  for  Educational  and 
Cultural  Affairs. 

PSYCHOPATHOLOGICAL  D  I  S  O  R  - 
DERS  IN  CHILDHOOD  :  theoretical 
considerations  and  a  proposed  classi- 
fication. Committee  on  Child  Psychi- 
atry, Group  for  the  Advancement  of 
Psychiatry,  104  East  2.oth  Street,  New 
York,  N.Y.  10010.  1966.  343  pp. 
$3.50.  Discount  on  orders  of  10  or 
more. 

Proposes  a  classification  of  the  mental 
and  emotional  disorders  of  children  and 
adolescents  from  a  framework  embrac- 
ing the  psychosomatic,  developmental, 
and  psychosocial  points  of  view  and  tak- 
ing into  account  the  differences  between 
the  psychopathologies  of  children  and 
those  of  adults. 

PUBLIC  WELFARE  PROJECTED. 
American  Public  Welfare  Association, 
1313  East  60th  Street,  Chicago,  111. 
60637.     July  1966.     206  pp.     $2.75. 

Contains  23  papers  from  the  1965  bi- 
ennial conference  of  the  American  Pub- 
lic   Welfare    Association,    including 


papers  on  the  future  shape  and  goals  of 
public  welfare  programs  and  problems 
of  educating  and  deploying  staff. 

MANPOWER  IN  SOCIAL  WEH^ARE  : 
research  perspectives.  Report  of  the 
Institute  on  Research  Approaches  to 
Manpower  Problems  in  Social  Wel- 
fare Services  to  Children  and  Fami- 
lies, held  at  the  University  of  Minne- 
sota, August  23-20.  1004.  with  support 
from  the  Children's  Bureau.  Edward 
E.  Schwartz,  editor.  National  Associ- 
ation of  Social  Workers,  2  Park  Ave- 
nue, New  York,  N.Y.  10016.  1966. 
160  pp.  $3. 

The  10  institute  papers,  grouped 
under  4  headings — trends  and  projec- 
tions, the  welfare  system,  the  profes- 
sional system,  and  career  choice  and 
education — are  followed  by  a  conden- 
sation of  the  discussion  under  the  title, 
"A  Strategy  of  Research  on  the  Man- 
power Problem." 

THE  COMSTAC  REPORT:  standards 
for  strengthened  services.  Edited  by 
Frances  A.  Koestler.  Commission  on 
Standards  and  Accreditation  of  Serv- 
ices for  the  Blind,  l.T  West  16th  Street, 
New  York,  N.Y.  10011.  1966.  393 
pp.    $3,  paperback ;  $6  clothbound. 

Contains  recommended  standards  for 
administration  and  service  programs  for 
agencies  serving  blind  and  visually 
handicapped  persons. 

79 


BOOK 
NOTES 


COMPENSATORY  EDUCATION  FOR 
THE  DISADVANTAGED :  programs 
and  practices  :  preschool  through  col- 
lege. Edmund  \V.  Gordon  and  Doxey 
A.  Wilkerson.  College  Entrance  Ex- 
amination Board,  Princeton,  N.J. 
1960.     299  pp.     $4.50. 

A  comprehensive  report  on  Federal, 
State,  and  local  programs  in  compensa- 
tory education  for  disadvantaged  chil- 
dren, this  book  surveys  dozens  of  proj- 
ects, including  Project  Head.start  and 
Upward  Bound,  and  comments  on  some 
aspects  of  their  probable  effectiveness. 
For  example,  one  chapter  reports  on  a 
survey  of  compensatory  programs  in 
progress  at  colleges  and  universities : 
another  describes  programs  in  progress 
at  all  levels  of  education.  The  book 
concludes  with  a  directory  of  compensa- 
tory practices  and  a  listing  of  programs 
by  State  and  region. 

In  evaluating  the  programs,  the  au- 
thors, both  on  the  faculty  of  Yeshiva 
Universit.y,  maintain  that  teaching  dis- 
advantaged children  is  a  special  task 
and  cannot  be  left  "to  the  newest  teach- 
ers .  .  .  nor  to  the  older  teachers,  "left 
over'  in  the  center-city  schools.  .  .  ." 
They  also  maintain  that  many  of  the 
programs  they  surveyed  were  designed 
without  systematic  study  of  ends  and 
means,  despite  the  seriou.sness  of  the 
problems  of  educating  children  and 
young  people  from  disadvantaged  back- 
grounds. 

THE  DISADVANTAGED  CHILD:  Is- 
sues and  innovations.  Edited  by  Joe 
L.  Frost  and  Glenn  R.  Hawkes. 
Houghton  Mifflin  Company,  Boston, 
Mass.     19G6.     445  pp.     $4.95. 

The  characteristics  of  deprived  chil- 
dren and  of  the  education  the,v  receive 
are  the  central  theme  of  the  37  articles 

80 


carried  in  this  book.  For  the  mo.st  part 
reprints  from  periodicals  and  other  pub- 
lications, the  articles  are  presented 
under  eight  heads :  who  the  disadvan- 
taged are;  characteristics  of  the  dis- 
advantaged ;  intelligence  and  IQ  ;  educa- 
tion and  the  young  child  ;  education  and 
the  older  child  ;  teaching  communicative 
and  problem-solving  skills ;  training 
teachers  of  the  disadvantaged  ;  and  the 
individual,  family,  and  community. 
The  book  concludes  with  a  bibliography 
of  books,  monographs,  periodicals,  and 
research  studies  on  the  subject  of  edu- 
cating the  disadvantaged  child. 

Contributors  include  Robert  J. 
Havighurst,  Frank  Ricssman,  Jerome  S. 
Brnnner.  Martin  Deutsch,  and  Helen 
Heffernan. 

LEARNING  AND  ITS  DISORDERS: 
clinical  approaches  to  problems  of 
childhood,  volume  1.  Edited  by  I.  N. 
Berlin.  M.D..  and  S.  A.  Szurek,  M.D. 
Science  and  Behavior  Books,  Inc.. 
Palo  Alto,  Calif.    19G6.    295  pp.    $5.9.5. 

The  two  p.sychiatrists  who  are  the 
editors  of  this  collection  of  28  papers 
on  learning  and  its  disorders  have 
brought  together  material  they  report 
they  have  found  useful  in  teaching.  Dr. 
Berlin  is  the  author  of  12  of  the  papers  ; 
Dr.  Szurek,  of  one.  and  the  coauthor  of 
another.  The  papers  are  grouped 
under  six  general  subjects :  the  begin- 
ning of  learning  and  its  distortions ; 
the  teacher's  role  and  problems ;  com- 
munity psychiatry  and  the  schools ; 
antisocial  behavior  as  failure  and  dis- 
tortion in  learning ;  learning  as  a  thera- 
peutic tool  in  antidelinquency  projects  ; 
and  therapeutic  efforts  in  learning  dis- 
turbances. 

In  his  introduction  to  the  collection, 
Fritz  Redl  says :  "The  editors  .  .  .  are 


among  the  few  people  thoroughlj 
grounded  in  psychiatric  lore,  excep- 
tionally experienced  in  clinical  practice, 
and  at  the  same  time  respectful  of  and 
conversant  with  the  real  life  problems 
of  both  the  child  learner  and  the  class- 
room teacher.  It  is  this  aspect  which 
makes  the  volume  unique." 

CONSTANCY  AND  IQ  CHANGE:  a 
clinical  view  of  relationships  betweei 
tested  intelligence  and  personality 
Alice  E.  Moriarity,  Charles  C 
Thomas,  Springfield,  111.  1966.  22; 
pp.     $8.50. 

IQ  test  scores  from  Infancy  to  pre 
puberty  may  reflect  "dynamic  interac 
tions  between  an  individual  child  am 
his  environment,"  according  to  thii 
book  written  by  an  asisociate  of  thi 
Menninger  Foundation.  She  bases  he 
conclusion  on  a  study  of  65  children  o 
normal  intelligence  who  were  testec 
and  whose  behavior  was  observed  ove 
a  period  of  12  years  during  four  phase 
of  their  live.s — infanc.v,  preschool  age 
latency,  and  prepuberty. 

The  changes  in  18  scores  indicatei 
that  intellectual  functioning  developei 
in  the  children  in  four  ways — con 
stantly,  by  accelerated  spurts,  slowlj 
or  erratically — the  author  rejwrtJ  i 
Con.stant  development  characterize 
children  who  were  inclined  to  restric 
themselves ;  acceleration  by  spurt; 
children  with  high  achievement  drives 
slowness,  children  who  were  emc 
tionally  dependent ;  and  fluctuating  d( 
velopment,  children  highly  vulnerabl 
to  the  stress  of  environment. 

The  author  concludes  that  such  a 
analysis  of  constancy  and  change  i 
the  IQ's  of  children  could  "broaden  th 
usefulness  of  tests"  and  could  thro\ 
"new  light  on  the  old  controversy  abouj 
constancy  of  IQ." 


DIM 


DEJION  IN  MY  VIEW.  Arthur  Heni 
ley.  Trident  Press,  New  York.  19661 
181  pp.     $4.95. 

Following  a  semibiographical  method 
this  book  describes  the  work  of  Adelii 
Giuseppe  Ambruano  Pasquale  Aiitoni< 
Montanari — better  known  as  Monty- 
the  founder-director  of  a  residentia 
treatment  center  for  highly  disturbec 
children  in  Florida  used  from  time  t< 
time  by  private  and  public  agenciei 
alike.  The  author  points  out  tha 
many  of  the  children  the  center  hat 
treated  successfully  seemed  to  be  hope    t 


CHILDREN     •     MARCH-APRIL  196: 


(i)i; 


esa  casos — for  example,  a  girl  who 
lioiiglit  she  was  a  dog,  a  hoy  wlio  could 
lot  resist  stealing  Cadillacs,  and  a  girl 
vlio  Ihouglil  a  man  was  siK'akiiig  in  her 
lead. 

In  the  center,  the  aiiUior  reiwrts,  a 
;roiip  of  psychiatrists,  jisychologists, 
md  social  workers  sets  up  the  diagnos- 
ic  and  treatment  i>lan  for  each  child, 
)ivoted  on  individual  treatment.  lie 
ttrihutes  much  of  the  center's  success 
.0  the  strong,  personal  involvement  of 
;he  founder-director  and  his  willingness 
ind  that  of  his  staff  to  use  unorthodox 
nethods  when  necessary. 

OYNAMICS  OP  DEVELOPMENT: 
eutheiiie  pediatrics.  Dorothy  V. 
AVhipple,  M.D.  McGraw-Hill  Book 
Co.,  New  York.     196G.     048  pp.     $15. 

This  volume  offers  pediatricians  and 

ther  professional  men  and  women 
vorking  with  children  "a  philosophic 
)aekgroniid  and  a  point  of  view  for 
inderstanding  what  makes  children 
ick,"  rather  than  a  practical  guide  to 
>ediatrics,   according   to   its  author,   a 

linical  associate  professor  of  pediatrics 
It    Georgetown    University    School    of 
Medicine. 
With  an  emphasis  on  well-child  super- 

isioii,  the  book  discusses  both  the  phys- 
ical psychological  aspects  of  growth 
md  development  in  children  from 
leredity  and  intrauterine  life  through 
idolescence.  Its  chapters  are  grouped 
under  the  following  topics :  The  scope 
}f  pediatrics ;  the  beginnings ;  the  incre- 
ment in  pounds  and  inches;  the  devel- 
jpment  of  organic  structure ;  life  pat- 

erns  of  .sleep  and  nutrition :  the  devel- 
opment of  behavior :  horizontal  pic- 
:ures  ;  and  sociological  considerations  in 
relation  to  the  family. 

rUVENILE  DELINQUENCY  :  a  book  of 
readings.  Rose  Giallombardo.  editor. 
John  AViley  &  Sons,  New  Y'ork, 
1066.     56.")  pp.     .$8.95. 

This  textbook,  according  to  the  edi- 
;or,  "is  designed  to  introduce  the  .student 
)f  juvenile  delinrjuency  to  .  .  .  import- 
int  contemporary  literatur(>  in  the 
ield."  It  contains  selections  from 
iournals.  books,  and  monographs  that 
Teat  juvenile  delinquency  from  a  .socio- 
oglcal  viewpoint,  either  l>y  reporting  the 
results  of  research  or  by  providing 
Jieoretical  analyses  and  description. 
rhe  readings  are  grouped  under  five 
sections  :  The  data  of  delinquency  :  prob- 

^rOLUME  14  -  NUMBER  2 


Icms  of  dclinition  and  mcasiin'mciit  :  de- 
vclo|iment  of  delinquent  behavior;  the 
empirical  structure  of  delinquent 
groups  :  legal  processing  of  dcliiupiency  ; 
and  treatment  and  jirevoiUion. 

STUDIES  OP  TROUBLESOME  CHIL- 
DREN. D.  H.  Stott.  Humanities 
Press.  New  York.  l!)l>(>.  208  i)p. 
,$5.00. 

Deviant  behavior  in  children  may  be 
cause<l  b.v  a  greater  than  normal  sus- 
ceptibility to  stress  because  of  "con- 
genital impairment"  (the  result  of 
.sometliing  that  happened  before  or  at 
birth)  rather  than  by  an  unfavorable 
environment,  the  author  of  this  l>ook 
maintains.  In  evidence,  he  describes 
.several  studies  of  disturbed  children 
mad(!  in  Great  Britain,  Including  one 
on  .SOO  truants,  that  points  to  a  "con- 
sistent congenital  factor"  beneath 
deviant  behavior. 

Congenital  damage  tends  to  cumu- 
late, tlie  author  also  maintains.  The 
child  who  suffers  from  "one  form  of 
somatic-neural  impairment"  is  likely 
to  suffer  from  a  second ;  if  from  two. 
than  from  a  third,  and  "so  on  .  .  . 
until  the  point  of  uonviabilit.v  is 
reached,"  he  points  out  in  an  hypothesis 
he  calls  the  "law  of  multiple  congenital 
impairment." 

In  discussing  the  "law"  in  relation 
to  diagnosis,  prevention,  and  treatment, 
the  author  says  that  it  applies  partieu- 
larl.v  to  the  selection  of  children  prone 
to  delinquency  and  to  treatment  for 
them  by  casework. 

The  author  also  describes  a  program 
to  prevent  maladjustment  to  school, 
which  he  has  designed  on  the  basis  of 
a  mental  health  service  for  children. 

In  his  final  chapter,  the  author  ex- 
plains his  general  view  of  human  mo- 
tivation, on  which  his  law  of  multiple 
congenital  impairment  is  based. 

HOMEMAKING  FOR  THE  HANDI- 
CAPPED :  a  resource  book  in  home 
management  for  the  physically  handi- 
capped and  their  families  and  for 
jirofessional  personnel  concerned  with 
rehabilitation.  Elizabeth  Eckhardt 
May,  Neva  R.  Waggoner,  and  Eleanor 
M.  Boettke.  Dodd.  Mead  &  Co.,  New 
York.     1966.     206  pp.     .fT.SO. 

Although  12  percent  of  the  more  than 
40  million  Americans  (mostly  women) 
who  keep  house  are  physically  handi- 
cajiped.   homemaking  "continues  to  be 


I  lie  most  neglected  area  of  reh;ibilita- 
ticjn,"  according  to  the  aulliors  of  tills 
liiMik,  which  aims  at  supplying  a  guide 
to  the  handicapped  honiemaker,  her 
family,  and  tlie  rehabilitation  worker. 
The  book  explores  management  prin- 
ciples u.sed  by  women  with  phy.sical  dis- 
abilities; ways  to  simplify  tasks  in  the 
care  of  children  and  play  activities 
bandica])i)e(l  mothers  can  .supervise; 
selection  and  adaptation  of  clothing  for 
haiHlicapped  persons;  devices,  tools, 
and  methods  that  save  energj-  and 
lime:  an<l  the  adaptation  of  equii)ment 
for  child   care  and  housekeeping. 

INSTITUTIONS  ARE  PEOPLE:  a 
documentary  of  life  in  a  State  school 
for  the  mentally  retarded.  E. 
Charles  Bauer.  The  John  Day  (3o., 
New  York.     1966.     156  pp.    !f4.50. 

By  describing  his  work  as  a  chaplain 
for  7  years  at  a  State  school  for  the 
mentally  retarded,  the  author  of  this 
book  gives  a  picture  of  life  in  an  institu- 
tion for  patients  and  staff  members 
alike.  Though  puzzled  at  first  by  what 
he  could  do  to  serve  the  patients,  in  time 
he  learned  to  "help  fight  the  war  against 
mental  retardation  as  a  member  of  the 
training  and  treatment  team."  He 
points  out  that,  although  there  is  much 
room  for  improvement,  the  institution  at 
which  he  served  is  operated  by  many 
devoted  and  skillful  people. 

TEACHING  DISADVANTAGED 
CHILDREN  IN  THE  PRESCHOOL. 
Carl  Bereiter  and  Siegfried  Engel- 
mann.  Prentice-Hall,  Inc.,  Engle- 
wood  Cliffs,  N.J.  1960.  .S12  pp. 
.«7.95. 

To  help  the  disadvantaged  child  enter 
first  grade  on  a  footing  with  other  chil- 
dren, the  authors  of  this  book  have  de- 
vised a  program  based  on  the  assump- 
tion that  preschool  education  must  meet 
definite,  day-to-day  goals  and  that  direct 
control  over  the  pupil's  progress  is  nec- 
essary. Much  of  this  book  is  given  to 
a  description  of  their  plan. 

Because  they  believe  that  cultural 
deprivation  stems  largely  from  language 
deprivation,  the  authors  point  out  that 
their  plan  centers  on  strongly  structured 
courses  in  language.  By  overcoming 
language  handicaps,  they  maintain,  the 
disadvantaged  child  can  overcome  many 
other  handicaps.  In  support  of  their 
method,  the  authors  summarize  the  re- 
sults of  an  experiment  they  conducted 

81 


II 


using  it  with  a  group  of  severely  de- 
prived 4-year-old  children  who  were 
brought  up  to  the  second-grade  level 
in  arithmetic  and  to  the  first-grade  level 
in  reading  in  9  months'  time. 

CHILDREN  IN  CARE— AND  ABATER  : 

a  study  of  a  group  of  Glasgow  chil- 
dren who  came  into  the  care  of  the 
local  authority.  Thomas  Ferguson. 
Oxford  University  Press,  New  York. 
1966.     139  pp.     $2.40. 

Four  out  of  5  of  over  200  young 
people  who  had  been  hrought  into  public 
care  and  "boarded  out"  with  foster 
parents,  placed  with  relatives  (not 
parents),  or  placed  in  a  children's  home 
were  found  to  have  reasonably  good 
prospects  2  years  after  they  had  "passed 


out"  of  care  at  18,  according  to  this 
report  on  a  study  made  recently  in 
Scotland. 

The  author  reports  that  at  the  time 
of  the  study  these  young  people  were 
employed  at  about  the  same  rate  as 
other  young  people  in  the  general  popu- 
lation but  that  the  jobs  they  held  usu- 
ally required  less  skill.  However,  he 
also  found  that  based  on  IQ  scores  these 
young  people  performed  at  about  the 
same  level  as  young  people  from  normal 
homes  who  left  school  at  the  earliest 
age  permitted. 

He  also  reports  that  about  5  percent 
of  the  young  men  have  been  convicted 
of  breaking  the  law  and  that  about  11 
percent  of  the  young  women  have  had 
children  out  of  wedlock  (several  before 
reaching  18),  a  slightly  higher  percent 


on  both  counts  than  in  the  general 
population.  On  the  whole,  he  foun(| 
them  immature,  particularly  socially. 

EMERGING  CONCEPTUAL  FRAME 
WORKS  IN  FAMILY  ANALYSIS 
Edited  by  F.  Ivan  Nye  and  Felix  M 
Berardo.  The  Macmillan  Co.,  Nev 
York.    1966.    328  pp.    $7.95. 

This  book  deals  with  theories  abou 
the  family  and  approaches  to  researcl 
on  the  family.  The  11  papers  that  com 
prise  it  consider  the  family  from  th 
point  of  view  of  anthropology ;  struc 
ture  and  function ;  institutional,  inter 
actional,  and  situational  approaches 
psychoanalysis  ;  social  psychology  ;  de 
velopmental  theory  ;  economics ;  law 
and  religion  and  philosophy. 


[\ 


ms  on  c 


hiid  iif< 


Charges  for  rental  or  purchase  may  be  obtained  from  distributors. 


"M.R."  60  minutes ;  sound ;  color  ;  rent 
or  purchase. 

Depicts  the  interacting  roles  of  many 
professional  and  nonprofessional  iJer- 
sons  in  behalf  of  retarded  children,  in- 
cluding the  contribution  of  physicians 
and  others  in  a  State  crippled  children's 
program. 

Atidience:  Professional  and  lay  per- 
sons concerned  with  mental  retardation. 

Produced  by:  Bureau  for  Handi- 
capped Children,  Wisconsin  State  De- 
partment of  Public  Information ;  and 
the  University  of  Wisconsin. 

Distributed  iy:  Bureau  of  Audio- Vis- 
ual Instruction,  University  of  Wiscon- 
sin, 1312  West  Johnson  Street,  Madison, 
Wis.  53702. 

HER  NAME  WAS  ELLIB,  HIS  NAME 
WAS  LYLE.  29  minutes;  sound; 
black  and  white ;  purchase. 

Tells  the  story  of  a  high  school  boy 
infected  with  syphilis  who  is  unaware 
of  the  services  available  for  treatment. 
Stressing  both  the  physical  and  emo- 
tional consequences  of  promiscuity,  it 

82 


describes  the  infectious  nature  and 
points  out  the  importance  of  early  treat- 
ment. It  also  portrays  the  role  of  the 
physician  and  public  health  department 
in  treating  venereal  disea.se  and  in 
tracking  down  the  sources  of  infection. 

Audience:  Youth  groups  and  junior 
and  .senior  high  school  students,  with  a 
physician,  nurse,  or  other  trained  dis- 
cussant. 

Produced  by:  Louis  DeRochemont  As- 
sociates, for  the  Bureau  of  Public 
Health  Education,  New  York  City  De- 
partment of  Health. 

Distributed  by:  Louis  DeRochemont 
Associates,  18  East  48th  Street,  New 
York,  N.Y.  10017. 

BOY  TO  MAN.  16  minutes ;  GIRL  TO 
WOMAN.  18  minutes ;  sound ;  color ; 
purchase. 

Stressing  the  normality  of  individual 
differences  in  the  rates  of  physical 
growth  and  sexual  maturation  between 
boys  of  the  same  age  and  girls  of  the 
same  age,  these  films  explain  simply  the 
physiological  manifestations  of  matura- 
tion in  adolescent  boys ;  the  male  and 


female  reproductive  functions,  and  th« 
relation  of  secondary  sexual  changes  bi 
glandular  and  primary  sexual  changes 
They  employ  basic  scientific  terms 
which  are  enunciated  and  also  pre 
sented  in  written  form  on  the  screen. 

Audience:  Junior  high  school  boys  ani 
girls  I  parents;  and  science,  physical 
education,  and  health  education  instruc 
tors. 
Produced  by:  Churchill-Wexler  Films 
Distributed  by:  Henk  Newenhoust 
Inc.,  614  Davis  Street,  Evanston.  Ill 
60201. 

THE    LOSERS.     31    minutes;    sound 

black  and  white ;  rent  or  purchase. 

Aimed  at  making  young  people  mor  j 
aware  of  the  damage  caused  by  the  usi| 
of  drugs,  this  film  looks  into  an  invest! 
gation  of  the  prevalence  of  experimen 
tation  and  the  habitual  use  of  pep  pills 
goof  balls,  heroin,  and  marijuana  ant 
the  practice  of  glue-sniffing  amon; 
young  people  12  to  21  years  of  age.  Th( 
harmful  effects  of  such  practices  ar« 
shown,  and  recounts  of  actual  esperi 
ences  by  young  people  from  slums  an( 
middle-class  neighborhoods  are  pre 
sented. 

Audience:  Youth  classes  in  healtt 
education  ;  teachers  ;  guidance  counsel- 
ors ;  doctors ;  psychologists ;  sociolo- 
gists ;  and  PTA  groups. 

Produced  by:  WCBS-TV,  New  York. 

Distributed  by:  Carousel  Films,  Inc., 
1501  Broadway,  New  York,  N.Y.  10086.^ 

CHILDREN     •     MARCH-APRIL  1967 


k 


HERE  and  THERE 


Child  labor 

Between  July  1.  ll»(i">.  ami  June  30. 
1966,  nearly  ]S,r)00  children  were  em- 
ployed in  violation  of  the  child  labor 
provisions  of  the  Fair  Labor  Standards 
Act,  according  to  figures  compiled  by  the 
U.S.  Department  of  Labor,  Wage  and 
Hour  Public  Contracts  Division.  The 
law  prohibits  the  employment  in  inter- 
state commerce  or  in  the  production  of 
goods  for  interstate  commerce  of  chil- 
dren under  16  years  of  age  during  school 
hours,  of  children  under  IS  in  hazardous 
occupations  at  any  time,  and  of  chil- 
dren under  14  in  any  occupation  at  any 
time.  While  minors  14  and  15  years  of 
age  may  be  employed  outside  school 
hours  in  nonmanufacturing  and  non- 
mining  occupations,  regulations  re- 
garding hours  of  work  and  other  specific 
conditions  must  be  complied  with. 

The  law  also  prohibits  the  employ- 
ment of  children  under  16  in  interstate 
agriculture  during  school  hours,  except 
by  their  own  parents  on  home  farms. 
(Before  February  1,  1967.  the  minimum 
age  for  such  employment  was  14.) 
However,  children  of  any  age  may  work 
in  agriculture  outside  school  hours 
unless  they  are  in  occupations  declared 
hazardous  by  the  Secretary  of  Labor. 

Violations  of  the  act  were  found  in 
,725  of  the  2,880  farms  investigated  by 
the  Department.  Nearly  5..50O  of  the 
children  whose  employment  was  in 
violation  of  the  act  were  children  under 
16  working  in  agriculture  during  school 
hours.  About  18  percent  were  9  years 
old  or  younger ;  about  52  percent  were 
10  through  13.  The  total  includes 
nearly  1,300  migrant  children. 

Over  half  of  the  12,970  children  em- 
ployed iu  violation  of  the  law  in  non- 
agricultural  occupations  were  in  haz- 
ardous occupations,  most  often  as 
drivers  of  or  heliwrs  on  motor  vehicles. 

VOLUME  14  -  NUMBER  2 


Some  were  emplo.ved  in  violation  of 
more  than  one  of  the  17  hazardous  oc- 
cupations orders  issued  by  the  Secretary 
of  Labor.  Approximately  41  percent  of 
the  minors  found  illegally  employed  in 
nonagricultural  occupations  were  under 
16  years  of  age.  Children  ranging  in 
age  from  5  to  15  years  were  employed 
often  in  occupations  so  hazardous  that 
an  IS-year  minimum  age  ajiplied,  or 
were  working  excessive  hours  or  iu 
manufacturing   occupations. 

Refusee  children 

As  of  December  31,  1966,  only  395 
Cuban  refugee  children  were  still  In 
foster  care  under  the  United  States 
Cuban  refugee  program,  the  lowest  num- 
ber since  the  initiation  of  the  program 
in  1961  (see  "Cuban  Children  Away 
From  Home,"  by  Kathryn  Close, 
CHILDREN,  January-February  1963). 
Thus,  more  than  8,200  of  the  8.600  Cu- 
ban children  who  have  arrived  in  this 
country  without  their  parents  or  desig- 
nated guardian  in  the  past  6  years  have 
been  reunited  with  their  parents  in  this 
country  or  elsewhere  or  have  passed 
the  age  of  19  and  are  no  longer  eligible 
for  care  under  the  program.  Of  these, 
1,032  were  discharged  from  the  program 
during  1966  to  newly  arrived  parents, 
most  of  whom  came  from  Cuba  by  the 
United  States  Cuban  refugee  airlift. 
The  airlift,  which  began  in  December 
1965,  operates  10  planes  a  week  from 
Cuba  to  Miami. 

For  youth 

The  need  for  early  planning  of  sum- 
mer programs  for  adolescents  was 
underscored  in  an  all-day  meeting  held 
in  Washington,  D.C.,  on  January  IS 
under  the  .sponsorship  of  the  Children's 
Bureau.     The    32    participants    repre- 


scMlcil  L'l  national  voluntary  organiza- 
tions and  5  units  of  the  Federal  Gov- 
ernment. The  purpo.se  was  to  find  ways 
in  wliich  the  Fwieral  Government  and 
the  voluntary  agencies  could  work  to- 
gether to  provide  young  i)eople  with 
iipporl  unities  for  satisfying  and  creative 
leisure-time  activities  during  their  sum- 
mer vacations. 

The  participants  reiwrted  that  the 
stimulus  of  the  Federal  Government's 
interest  in  1966 — sparked  by  a  task 
force  created  by  the  President  had 
indeed  resulted  in  many  more,  and  a 
groiit  diversity  of,  opportiniities  being 
provided  young  people  during  that  sum- 
mer than  in  the  previous  summer. 
Their  agencies  had,  for  example,  not 
only  expanded  their  regular  camping, 
s))orts,  and  club  programs,  but  had  also 
provided  many  new  opixjrtunities  for 
young  people  to  have  adventure,  to 
serve  their  communities,  an<l  to  explore 
possible  careers.  However,  they  frankly 
discussed  some  of  the  obstacles  to  the 
maximum  use  of  resources  they  had 
encountered  and  most  frequently  named 
late  planning  and  fragmentation  of 
effort.  Representatives  of  voluntary 
agencies  especially  stressed  the  impor- 
tance to  achieving  greater  effectiveness 
in  1967  of  their  knowing  well  in  ad- 
vance of  the  summer  what  would  be 
expected  of  them  and  what  financial 
resources  would  be  available  to  them 
through  what  government  agencies. 

The  Children's  Bureau  accepte<l  re- 
sponsibility for  finding  out  what  sum- 
mer projects  are  being  planned  by  other 
Federal  agencies  and  for  keeping  the 
national  voluntary  agencies  informed 
as  plans  develop. 

Sex  education 

Approximately  75  professional  people 
met  together  in  Washington,  D.C.,  for 
2V2  days  in  early  Decemtier  at  the  invi- 
tation of  the  Sex  Information  and 
Education  Council  of  the  United  States 
(SIBCUS)  to  discuss  and  plan  for  the 
education  of  young  people  and  adults 
in  nuitters  of  sex.  The  conference  was 
made  possible  by  a  grant  from  the  Office 
of  Education. 

The  focus  of  the  conference  was  on 
the  preparation  of  an  interdisciplinary 
book  of  readings  on  sex  education  for 
teachers  in  training,  but  the  discussions 
ranged  far  beyond  the  hounds  of  this 
topic. 

Most  of  the  working  groups  stressed 

83 


the  necessity  of  helping  society  at  large 
as  well  as  young  people  acquire  social 
values  and  a  philosophy  about  ses  that 
can  serve  both  society  and  the  indi- 
vidual. The  discussions  underscored 
the  importance  to  the  community  of  sex 
education  for  young  people  and  the 
responsibility  of  many  social  institu- 
tions for  providing  it. 

Parent  education  was  considered  as 
central  to  any  and  all  sex  education  that 
takes  place  in  the  home.  Participants 
maintained  that  the  most  fundamental 
element  in  the  sex  education  of  children 
is  the  relationship  between  parents,  and 
that  parents,  therefore,  need  to  know 
what  their  own  values  are  and  to  be  able 
to  convey  them  to  their  children  in  the 
cour.se  of  day-to-day  living.  The  respon- 
sibility of  the  school  from  preschool 
through  high  school  was  emphasized. 
Major  obstacles  to  meeting  this  respon- 
sibility were  identified  as  a  dirth  of  edu- 
cational materials  and  a  scarcity  of 
teachers  to  carry  out  sex  education 
adequately. 

The  need  for  more  research  was  also 
stressed,  especially  in  relation  to  the 
current  sexual  behavior  of  adolescents 
and  young  adults. 


Among  the  opportunities  for  leader- 
ship training  in  sex  education  being 
offered  in  the  summer  of  1967  are  the 
following : 

•  A  6-week  institute,  June  26-August 
4,  at  the  University  of  Connecticut  en- 
titled, "The  Family  Life  Institute  With 
Emphasis  on  Sex  Education,"  and  di- 
rected to  persons  at  the  graduate  level 
of  study.  Sponsored  by  the  university's 
department  of  child  development  and 
family  relations  with  the  help  of  the 
G.  D.  Searle  Reference  and  Resource 
Program,  it  will  be  conducted  by  .special- 
ists in  family  life  education  from  both 
inside  and  outside  the  university.  The 
fee  for  the  institute  is  $9.5 ;  enrollment 
is  limited  to  60.  For  further  informa- 
tion inquire  of  Eleanore  B.  Luckey, 
Department  of  Child  Development  and 
Family  Relations,  University  of  Con- 
necticut, Storrs,  Conn.  0626S. 

•  A  1-week  workshop  at  the  Universi- 
ty of  Oregon,  June  12-17,  for  40  adults- 
teachers  in  secondary  schools,  guidance 
counselors,  social  workers — and  40 
young  persons  of  teen  age.  sponsored  by 
the  department  of  health  education. 
The  fee  for  the  adults  is  $28.  The 
young  people,  who  are  to  be  recruited 


from  local  high  schools  to  represent 
a  kind  of  "laboratory"  for  the  adults, 
will  be  provided  scholarships.  Inquire 
of  Robert  E.  Kime,  Department  of 
Health  Education,  University  of  Oregon, 
Eugene,  Oreg.  97403. 

•  Two  1-week  institutes,  June  19-30 
and  August  7-11,  at  the  University  of 
Califoi'uia  at  Davis,  sponsored  by  the 
extension  division,  the  tirst  for  both 
adults  and  young  people  (30  each)  as  in 
the  Oregon  institute,  the  second  for 
teachers  of  family  living  courses.  The 
fee  is  about  $45.  Inquire  of  Lura 
Middleton,  Extension  Division,  Uni- 
versity of  California,  Davis,  Calif. 
95616. 

Child  abuse 

Warnings  against  "abusing  the  par- 
ents" of  children  who  are  victims  of 
parental  abuse  and  so  aggravating  the 
abuse  of  the  child  were  repeatedly  given 
in  the  Governor's  Conference  on  Child 
Abuse  held  in  Raleigh,  N.C.,  November 
22,  1966.  Called  by  the  Governor  to 
focus  public  attention  on  the  problem  of 
child  abuse,  the  conference  was  spon- 
.sored  by  the  North  Carolina  Health 
Council ;  the  North  Carolina  Council  on 
Mental  Retardation ;  the  State  Depai-t- 
ment  of  Public  Instruction,  Public 
Welfare,  and  Jlental  Health ;  and  the 
State  Board  of  Health.  It  w-as  made 
possible  by  a  grant  from  the  Alfred  I. 
DuPont  In.stitute  of  the  Nemours  Foun- 
dation. The  more  than  6.50  participants 
included  physicians,  social  workers, 
health  workers,  jiolice  officials,  juvenile 
court  officials,  school  administrators, 
and  teachers. 

Speakers  at  the  conference  discussed 
the  social,  medical,  and  cultural  aspects 
of  child  abuse  and  the  roles  of  social 
work,  medicine,  the  courts,  and  educa- 
tion in  meeting  the  problem.  They 
emphasized  the  need  for  skillful  people 
to  handle  the  problem. 

Proceedings  of  the  conference  are 
available  from  the  North  Carolina  State 
Board  of  Health,  Maternal  and  Child 
Health  Section,  Raleigh,  N.C.  27602. 

Toward  coordination 

The  Department  of  Health.  Educa- 
tion, and  Welfare  (DHEW)  recently  set 
up  a  new  center  for  community  plan- 
ning in  the  Office  of  the  Secretary  to 
work  closely  with  the  Department  of 
Housing  and  Urban  Development 
(DHUD)  on  programs  aimed  at  solving 


the  problems  of  cities.  Besides  actin 
as  the  liaison  office  with  DHUD  fo 
DHEW,  the  center  reviews  proposal 
for  model  city  projects  and  provide 
technical  assistance  to  DHUD  on  th 
needs  of  cities  in  relation  to  health,  edi 
cation,  and  welfare.  The  center  als 
coordinates  the  activities  of  DHEV 
constituent  agencies  concerning  mode 
city  projects  in  providing  technical  plar 
ning  services  to  city  and  State  goverr 
ments  and  local  agencies. 


The  American  Public  Welfare  Assoc 
ation  (APWA)  is  launching  a  3-yea  ,. 
project  under  a  grant  from  the  Office  o  maj 
Economic  Opportunity  (OEO)  to  pre 
vide  technical  assistance  to  public  we  ^  ji 
fare  departments  and  local  communlt  rri;.): 
action  programs  to  stimulate  a  relatioi'  u;;- 
ship  between  them  for  the  purpose  c 
strengthening  public  welfare  programs   jj.j 

Still  in  the  explorative  stage,  th'  jj^, 
project  has  a  tentative  list  of  prioritiei 
for  consideration  with  public  welfan  (pj. 
officials.  These  include:  (1)  Develop  gt 
ment  of  "structured"  services  focusing 
on  specified  purpose,  product,  or  results 
(2)  methods  of  conniiunicating  wit' 
public  assistance  recipients  and  with  th 
organized  poor;  (3)  aspects  of  admlK 
istration  of  financial  aid  affectini  pji 
equity  and  incentive ;  (4)  opportunitie  in] 
for  employment  and  achievement  of  th  fc, 
poor  in  the  public  welfare  establisll 
ment ;  ( 5 )  the  role  of  the  poor  and  con ; 
munity  action  groups  in  public  welfai' 
policymaking  and  planning;  and  (6 
the  role  of  public  welfare  agencies  ii 
developing  better  housing. 

The  project  will  operate  under  tb(ht. 
direction  of  a  small  headquarters  stai 
and  advisory  committee.  Its  directo 
is  John  M.  Wedemeyer.  formerly  d\ 
rector  of  the  California  State  Depart, 
ment  of  Social  Welfare. 


Un 


the 


84 


married  mothers 

As  part  of  the  Children's  Burea' 
maternal  and  infant  care  project  h 
Chicago,  the  Florence  Crittenton  A: 
sociation  of  America,  Inc.,  has  recentl; 
established  the  Crittenton  Comprehen 
sive  Care  Center  to  administer  the  es 
panded  program  of  comprehensive  medi 
cal.  mental  health,  and  social  service, 
project  for  adolescent  unmarrie( 
mothers  and  fathers  that  grew  out  o: 
the  Community  Services  Project,  a  3 
year  demonstration  project  Initiated  bj 

CHILDREN     .     MARCH-APRIL  1967 


till 


ho  iiu'iilal  lu'jiltli  (livisiiiii  nf  llic  Clii- 
I  Hoard  of  llejillli.  ( See  •Toniprc- 
n'lisivi-  Services  for  Adolosceut  Unwed 
lothers,"  by  Mattie  K.  WrigUt,  CIIIL- 
>REX,  September-October  liltili.) 
)perutiug  uikUt  an  agreement  between 
Chicago  15oard  of  lleallh,  tlie 
llinoi.s  State  Department  of  Public 
Ii'altb,  and  the  Floren<-e  Crltlentou  As- 
iciation  of  America,  Inc.,  wilh  llie  Cliil- 
ren's  liureau's  financial  suiijiort,  the 
enter  is  building  up  a  staff  of  liealtli 
ducators,  psychologists,  social  workers, 
urses,  nutritionists,  obstetricians,  and 
ther  health  siiecialists.  It  is  expected 
)  serve  from  1.2(H)  to  ]..")()(•  adolescent 
inmarried  mothers  and  their  families 
niiuall.v,  including,  whenever  possible, 
he  fathers  of  their  children.  Jlrs. 
V'right.  former  director  of  the  Com- 
lunity  Services  Project,  is  its  director. 
The  new  center  works  closely  with  the 
hicago  Board  of  Education  and  refers 
regnant  girls  who  are  willing  and  able 
continue  their  schooling  to  the 
card's  family  living  center,  establishe<l 
1st  fall  to  make  this  jxissible. 


(esearch  on  child 


ren 

Seven  research  studies  In  child  de- 
elopment  and  child  welfare  have  been 
nitiated  in  Great  Britain  by  the  Xa- 
ional  Bureau  for  Co-operation  in  Child- 
)are  since  its  formation  3  years  ago  by 
Jritish  voluntary  organizations  and 
•rofes.sional  associations  concerned 
I'ith  the  welfare  of  children. 

The  bureau  has  a  fourfold  purpose: 
'o  make  existing  knowledge  of  chil- 
ren's  development,  needs,  and  iiroblems 
lore  readily  available;  to  improve  lines 
■f  communication  between  the  disci- 
lines  and  the  statutory  and  voluntary 
ervlces ;  to  explore  the  possibilities  of 
taking  better  use  of  existing  services 
nd  to  encourage  the  development  of 
ew  ones ;  and  to  help  bring  a  preven- 
ive  outlook  into  the  field  of  child  care. 
t  works  through  a  staff  headed  by  ijsy- 
hologist  M.  L.  Kellmer  Pringle,  which 
arries  out  the  research  projects,  and 
trough  local  and  area  "groups" — open 
0  persons  engaged  in  health,  education, 
r  welfare  services  to  children — which 
leet  regularly  to  di.scuss  the  needs  of 
hildren. 

Through  an  arrangement  with  a  com- 
lereial  publisher  (Longmans,  London). 
he  first  three  of  the  bureau's  research 
eports  were  published  in  19C6 :  "Four 
Tears  On,"  a   followup   study   at  age 

VOLUME   14  -  NUMBER  2 


PRESIDENT'S   MESSAGE  ON  THE  WELFARE  OF  CHILDREN 

Pointing  out  that  as  long  ago  as  I'.Ui;  when  the  Federal  Children's 
Bureau  was  established  "Congress  had  pledged  its  power  to  the  care  and 
Iiroteclion  of  America's  young  people,"  President  Lyndon  B.  .lohn.son 
seni  I  lie  Congress  a  Message  on  the  Welfare  of  Children  on  February  8, 
lIKiT  embodying  a  12-point  program  for  broadening  the  Nation's  activities 
for  the  health  and  welfare  of  children.  In  his  message,  the  President 
referred  to  studies  which  indicate  that  ignorance,  ill  health,  and  per- 
sonality disorder  are  "disabilities  oflen  contracted  in  childhood:  alllic- 
tions  which  linger  to  crijjple  the  man  and  damage  the  next  generation." 
Al.iintaining  that  "our  goal  must  be  <'lear — to  give  every  child  the  chance 
lo  fulfill  his  promise,"  the  President  recommended  measures  to — 

"1.  Preserve  the  hope  and  opportunity  of  Headstart  by  a  'Follow- 
Through'  program  in  the  early  grades. 

"2.  Strengthen  Headstart  by  extending  its  reach  to  younger  children. 

"3.  Begin  a  pilot  lunch  program  to  reach  preschool  cblldron  who  now 
lack  i)roper  nourishment. 

"•1.  Create  child  and  parent  centers  in  areas  of  acute  poverty  to  pro- 
vide modern  and  comprehensive  family  and  child  development  services. 

"5.  Help  the  States  train  specialists — now  in  critically  short  supiily — 
to  deal  with  problems  of  children  and  youth. 

"0.  Strengthen  and  modernize  programs  providing  aid  for  children  in 
poor  families. 

"7.  Increase  social  security  payments  for  3  million  children,  who.se 
support  has  been  cut  off  by  the  death,  disability,  or  retirement  of  their 
parents. 

"8.  Expand  our  ijrograms  for  early  diagnosis  and  treatment  of  children 
with  handicaps. 

"9.  Carry  forward  our  attack  on  mental  retardation,  which  afflicts  more 
than  125,000  children  each  year. 

"10.  Launch  a  new  pilot  program  of  dental  care  for  children. 

"11.  Help  States  and  conmumities  across  the  Xation  plan  and  operate 
programs  to  prevent  juvenile  delinquents  from  becoming  adult 
delinquents. 

"12.  Enrich  the  summer  months  for  needy  boys  and  girls." 


15  of  children  whose  development  had 
been  followed  between  the  ages  of  7  and 
11  when  they  wore  attending  two 
different  types  of  junior  schools — tradi- 
tional and  progressive;  "11,000  Seveu- 
Year-Olds,"  the  first  report  of  a  longi- 
tudinal study  of  children  born  in  195S 
concerned  with  their  abilities,  progress, 
behavior,  and  health  in  relation  to  en- 
vironmental factors  ;  and  "Adoption — 
Facts  and  Fallacies,"  a  review  of  re- 
search relating  to  adoption  in  the 
United  States,  Canada,  and  Great  Brit- 
ain between  1948  and  1965. 

Other  studies  still  in  progress  are  a 
longitudinal  study  of  junior  school  chil- 
dren, a  pilot  study  of  family  advice  serv- 
ices,  a   national   study   of  children   in 


foster  care,  a  national  study  of  "word- 
blind"  children,  and  a  study  of  edu- 
cational and  employment  opportunities 
for  young  people  with  multiple  handi- 
caps. 


Child 


care 


Intensive  casework  with  children  in 
foster  care  and  instruction  in  home- 
making  for  families  helped  end  or  pre- 
vent the  need  for  foster  care  for  many 
of  the  more  than  400  children  served  by 
a  .3-year,  two-part  project  operated  by 
the  Santa  Clara  County  Welfare  De- 
partment in  California  between  1962 
and  19G5,  for  families  receiving  assist- 
ance under  the  aid  to  families  with  de- 

85 


pendent  children  program,  according  to 
the  project's  report.  Through  the  proj- 
ect, the  county  welfare  department  of- 
fered intensive  caseworlj  to  families  of 
137  children  in  foster  care  and  instruc- 
tion in  child  rearing,  money  and  house- 
hold management,  health  care,  and 
parent-child  relationships  to  59  families 
with  299  children.  All  families  either 
had  children  in  foster  care  or  were 
faced  with  the  possibility  of  placing  a 
child  in  foster  care.  Most  had  only  one 
parent. 

In  drawing  their  conclusions,  project 
workers  pointed  out  that  nearly  half  of 
the  137  children  for  whom  intensive 
casework  services  had  been  provided 
had  been  taken  out  of  foster  care  by  the 
end  of  the  project.  Twenty-nine  had 
been  reunited  with  their  parents,  38  had 
been  adopted,  and  4  were  awaiting 
adoption.  The  service  was  provided  by 
professionally  trained  caseworkers  with 
special  skill  in  working  with  children 
and  their  families. 

Only  13  children  of  the  59  families  in- 
volved in  the  homemaker  part  of  the 
project  were  in  foster  care  at  the  end  of 
the  3  years. 


The  Utah  State  Department  of  Wel- 
fare recently  authorized  the  20  noni)rofit 
day-care  and  training  centers  for  re- 
tarded and  handicapped  children  receiv- 
ing State  financial  support  to  add 
trained  social  workers  to  their  .staffs 
and  agreed  to  pay  SO  percent  of  the 
workers'  salaries.  Three  centers  have 
already  employed  social  workers. 

The  centers  are  located  in  urban  and 
rural  areas  throughout  the  State.  The 
first  was  set  up  in  1956  by  the  parents 
of  the  children  who  were  later  enrolled, 
professional  men  and  women,  and  others 
interested  in  the  welfare  of  mentally  re- 
tarded and  handicapped  children.  In 
1959  the  State  began  giving  support  to 
the  centers,  at  first  through  demon.stra- 
tion  grants.  The  centers  are  now  sup- 
ported by  tuition  fees,  community  con- 
tributions, and  State  funds.  The  20th 
center  opened  last  January. 

Education 

Early  in  January  the  Office  of  Edu- 
cation issued  its  desegregation  guide- 
lines to  the  States  for  the  school  year 
1967-68.  In  an  accompanying  letter. 
Commissioner  of  Education  Harold  E. 
Howe  pointed  out  that  these  are  virtu- 

86 


ally  the  same  as  those  issued  for  1966- 
67.  The  one  substantive  change  affects 
only  school  districts  operating  under  a 
"freedom  of  choice  plan."  In  the  school 
year  1967-68,  these  districts  will  have 
more  time  in  which  to  choose  the  30-day 
period  during  which  students  may  des- 
ignate the  schools  they  prefer  to  attend. 


To  alert  high  school  students  who 
will  graduate  this  year  to  the  Federal 
programs  of  financial  assistance  offered 
to  college  and  vocational  school  stu- 
dents, the  O&ee  of  Education  early 
this  year  sent  out  a  packet  of  material 
on  such  programs  to  every  high  school, 
college  financial  aid  office,  and  library 
in  the  Nation,  to  American  schools  over- 
seas, and  to  persons  working  with  young 
people  such  as  the  directors  of  Upward 
Bound  programs. 

Single  copies  of  the  packet  are  avail- 
able from  the  Bureau  of  Higher  Edu- 
cation, Office  of  Education,  U.S.  De- 
partment of  Health,  Education,  and 
Welfare,  Washington,  D.C.  20202. 


Family  planning 


The  New  York  State  Department  of 
Social  Welfare  recently  ruled  that  case- 
workers employed  by  local  public  wel- 
fare departments  may  introduce  the 
subject  of  birth  control  to  persons  in 
their  caseloads,  when  advisable.  The 
department  had  previously  ruled  that 
caseworkers  could  not  bring  up  the  sub- 
ject, though  they  could  furnish  informa- 
tion about  where  to  go  for  contraceptive 
service  if  the  client  requested  it.  Under 
the  new  ruling,  women  who  show  inter- 
est in  birth  control  after  being  advised 
that  such  a  service  is  available  will  be 
referred  to  an  appropriate  health 
agency.  The  welfare  department  will 
continue  to  pay  for  materials  and  medi- 
cations as  "directed  or  prescribed  with 
reference  to  family  planning"  for  clients 
of  welfare  departments. 


Anticipating  a  recommendation  by 
the  population  study  commission  ap- 
pointed by  the  Governor  of  California 
in  August  1966,  the  California  State 
Department  of  Public  Health,  at  the  re- 
quest of  the  California  Conference  of 
Local  Health  Officers,  adopted  a  regu- 
lation on  December  2,  1966,  making  the 
provision  of  family  planning  services  by 
local  health  departments  a  requirement 


Itt: 


for  eligibility  for  State  subsidy.  The 
commission,  which  had  been  appointed 
to  review  and  prescribe  State  and  local 
activities  "to  increase  freedom  of  choice 
in  family  planning,"  submitted  its  re- 
port on  December  20.  Among  other  rec- 
ommendations, it  urged  that — 

•  Family  planning  services  be  pro- 
vided in  a  way  that  would  insure  com- 
prehensiveness in  personal  health  care. 

•  Family  planning  services  include 
genetic  counseling  and  fertility  service 
in  addition  to  contraceptive  advice  and 
service. 

•  Welfare  departments  assume  re- 
sponsibility for  assisting  clients  in  ac- 
quiring a  better  understanding  of  the 
problems  related  to  family  size  and  for 
referring  those  interested  in  family 
planning  to  appropriate  services. 

•  Information  about  family  planning 
be  included  in  welfare  department  in- 
service  training  programs. 

•  Information  about  family  planning  j 
services  be  included  in  the  referral  serv- 
ices of  the  State's  multiservice  centers. 

•  Medical  education  include  content 
about  genetic  counseling,  the  effect  of 
family  composition  on  health,  and  meth-i   "" 
ods  of  family  planning. 

•  A  public  information  program  be 
developed  to  promote  the  idea  that 
every  child  should  be  a  "wanted"  childl    , 

Miscellaneous 

On  January  1,  1967,  the  former  Inter- 
national Conference  on  Social  Work 
(ICSW)  became  the  International 
Council  on  Social  Welfare,  with  a  re- 
vised constitution  and  its  first  full-time 
secretariat.  Ruth  M.  Williams,  who 
was  director  of  the  New  York  office  of 
the  National  Conference  on  Social  Wel- 
fare and  half-time  executive  officer  of 
the  International  Conference  for  16 
years,  has  become  the  first  full-time 
secretary  general  of  the  Council.  Head- 
quarters for  ICSW  remain  at  the  old 
address— 345  East  46th  Street,  New 
York,  N.Y.  10017. 

The  revised  constitution  for  ICSW 
identifies  four  principal  functions:  (1) 
To  provide  a  worldwide  forum  for  the 
discussion  of  issues  in  social  welfare; 
(2)  to  foster  the  development  of  social 
welfare  throughout  the  world;  (3)  to 
promote  the  exchange  of  information 
among  social  workers  and  social  agen- 
cies; and  (4)  to  promote  cooperation  *>•: 
among  international  organizations 
concerned  with  social  welfare. 


n 


CHILDREN     .     MARCH-APRIL  1967 


t 


READERS'  EXCHANGE 


MBINDER     and    FALIK:    Collaborative 
eonsultalion 

In  their  article  "Keeping  Emotionally 
isturbod  Foster  Cliilciren  in  School" 
L'lIILIJHEN,  November-December 

100),  Walter  J.  Ambinder  and  Louis  H. 
ilik  of  the  Detroit  Foster  Homes  Proj- 
t  graphically  illustrated  not  only  nat- 
ral  ditficulties  encountered  by  a  foster 
ire  agency  when  it  attempts  to  inter- 
ne in  a  public  school's  methods  of 
Baling  with  a  foster  child,  but  also  cer- 
lin  problems  that  might  have  been 
edified  or  avoided  under  a  mode  of 
Deration  sensitive  to  the  structure  of 
iiblic  school  organization. 
When  a  mental  health  agency  at- 
impts  such  intervention  in  behalf  of 
ly  emotionally  disturbed  child,  often 
does  not  seem  aware  of  certain  facts  : 
1)  That  authority  in  public  schools 
oeeeds  in  a  direct  line  from  superin- 
ndent  to  principal  to  classroom 
aeher;  (2)  that  school  systems  need 
variety  of  educational  settings  so  that 

placing  a  disturbed  child  in  public 
hool  the  limits  of  a  particular  school 

tolerate  his  behavior  may  be  assessed 

relation  to  the  training  and  the  per- 
nality  of  the  teacher,  the  number  of 
ipils  in  each  class,  or  the  availability 

special  classes;  (3)  that  each  case 
Mds  a  realistic  estimate  of  the  poten- 
al  of  the  disturbed  child  to  function 
n  a  normal  school  setting"  based  on 
ch  factors  as  his  tolerance  to  frustra- 
on,  his  degree  of  impulse  control,  and 
le  nature  of  his  aggressive  drives ; 
I)  that  a  severely  disturbed  child 
metimes  needs  a  brief  period  of  com- 
ete  release  from  school  demands,  fol- 
wed  by  school  attendance  in  brief  but 
•adually  lengthened  sessions. 
Over  the  past  3  years,  the  Merrifield 
inter  project  in  Worcester,  Mass., 
ith  support  from  the  National  Insti- 
te  of  Mental  Health,  has  provided 
sldential  treatment  for  severely  emo- 
mally  disturbed  children  in  foster 
re.     In  working  with  public  schools, 

OLUME  14  -  NUMBER  2 


the  center's  staff  has  sought  to  promote 
collaborative  consultation  with  the 
school  to  keep  severely  disturbed  chil- 
dren in  regular  cla.sses  in  public  schools. 
This  involves  a  continuous  inter- 
personal process  based  on  the  following 
conditions:  (1)  Recognition  by  both 
school  and  agency  of  the  differential 
roles  of  educators  and  clinicians;  (2) 
development  of  attitudes  of  mutual 
trust  and  respect  so  that  a  workable 
atmosphere  is  est.ablished  in  which  rep- 
resentatives of  diverse  disciplines  can 
discuss  learning  and  behavior  difficul- 
ties of  disturbed  children;  (3)  contin- 
uing efforts  by  agency  personnel  to 
maintain  rapport  with  educators  even 
when  the  latter  exhibit  defensive  be- 
havior, ambivalence,  or  resistance;  (4) 
retention  by  the  school  of  independence 
in  decisionmaking  in  regard  to  school 
matters;  and  (5)  assumption  by  the 
agency  of  responsibility  to  interpret 
school  decisions  to  the  foster  parents. 

Mary  E.  Farragher 

Therapeutic  Educator 
Merrifield  Center 
Worcester,  Mass. 

EISENSTEIN:   An  oversight 

1  note  with  interest  the  four  objec- 
tives of  the  health  program  discussed 
l).v  Fannie  Eisenstein  in  the  November- 
December  1966  issue  of  CHILDREN 
( "A  Health  Service  Program  for  Chil- 
dren in  Day  Care")  and  wonder  how 
she  could  overlook  as  important  an 
aspect  of  child  health  as  good  hearing. 
She  does  not  mention  any  planning  to 
include  a  check  of  the  children's  hearing 
or  parent  guidance  to  prevent  hearing 
loss. 

More  lives  are  handicapped  by  poor 
hearing  than  by  almost  any  other  physi- 
cal di.sability.  National  statistics  indi- 
cate that  about  7  percent  of  children 
entering  school  have  hearing  trouble. 
of  these,  over  half  can  be  successfully 
treated  by  medical  procedures.  Three 
percent  of  these  children  have  perma- 


nent   hearing    impairments,    many    of 
which  could   have   been  prevented. 

Any  health  program  for  preschool- 
age  children  is  seriously  inadequate 
if  emphasis  is  not  put  on  hearing  exam- 
inations and  prevetition  of  hearing  loss. 

C.  E.  Torrence 

Director  of  Hearing  and  Speech 

Services,  St.  Louis  Hearing 

and  Speech  Center,  St.  Louis,  Mo. 

Author's  reply 

The  pciinl  .Mr.  Torrence  makes  about 
hearing  is  well  taken.  We  attempted 
to  locate  screening  and  preventive  pro- 
grams and  found  none  available  for  a 
universal,  group  application.  We, 
therefore,  were  limited  to  the  ongoing 
observation  of  teachers,  parent  educa- 
tion, and  the  agonizing  search  for  direct 
service  on  an  individual  basis  in  an 
area  which  lacked  both  programs  and 
persons  qualified  to  provide  the  needed 
.service. 

Fannie  Eisenstein 


for  parents 


TODAY'S  TEENAGERS.  Evelyn  Mil- 
lis  Duvall.  Association  Press,  291 
Broadway,  New  York,  N.Y.  1000". 
1966.     256  pp.     $4.95. 

THE  FIRST  BIG  STEP :  A  handbook 
for  parents  whose  child  will  soon  en- 
ter school.  National  School  Public 
Relations  Association,  National  Edu- 
cation Association,  1201  16th  Street 
NW.,  Washington,  D.G.  20036.  1966. 
34  pp.     60  cents. 

HOW  TO  HELP  YOUR  CHILD  IX 
SCHOOL.  Robert  Sunley.  Public 
Affairs  Committee,  3S1  Park  Avenue 
South,  New  York,  N.Y.  10016.  Public 
Affairs  Pamphlet  No.  381.  Novem- 
ber 1965.     20  pp.     25  cents. 

SEX  EDUCATION  IN  THE  FAMILY. 
Francis  L.  Filas.  Prentice-Hall,  Inc., 
Englewood  Cliffs,  N.J.  07632.  1966. 
112  pp.     $3.95. 

MOST  OF  US  ARE  MAINLY  MOTH- 
ERS. Carol  Bartholomew.  The 
Macmillan  Company,  60  Fifth  Ave- 
nue, New  York,  N.Y.  10011.  1966. 
203  pp.     $4.95. 

87 


U.S.  Government  Publications 

Publications  for  which  prices  are  quoted  are  for  sale  by  the  Superintendent  of  Docu- 
ments, U.S.  Government  Printing  Office,  Washington,  D.C.  20402.  Orders  should  be 
accompanied  by  payment.    Twenty-five  percent  discount  on  quantities  of  100  or  more. 


DIALOGUE  ON  ADOLESCENCE.  De- 
partment of  Health,  Edueation,  and 
Welfare,  Welfare  Administration, 
Children's  Bureau.  CB  Publication 
No.   442.     1967.     30  pp.     30  cents. 

Presents  the  highlights  of  a  1-day 
meeting  on  problems  facing  youth  to- 
day attended  by  the  14  members  of  an 
ad  hoc  committee  on  cooperative  plan- 
ning for  youth  appointed  by  the  Chil- 
dren's Bureau. 

REPORT    ON    FAMILY   PLANNING: 

activities  of  the  U.S.  Department  of 
Health,  Education,  and  Welfare  in 
family  planning,  fertilit.v,  sterility, 
and  population  dynamics.  Depart- 
ment of  Health,  Education,  and  Wel- 
fare, Office  of  the  SecretaiT.  Sep- 
tember 1966.    35  pp.    25  cents. 

The  first  in  a  series  of  annual  reports 
summarizing  the  famil.v  planning  activ- 
ities of  the  Department. 

MENTAL  RETARDATION  GRANTS: 
fiscal  year  1966.  Department  of 
Health,  Education,  and  Welfare,  Of- 
fice of  the  Assistant  Secretary  for 
Individual  and  Family  Services,  The 
Secretary's  Committee  on  Mental  Re- 
tardation. September  1966.  139  pp. 
70  cents. 

Lists,  by  State,  the  grants  awarded 
in  the  field  of  mental  retardation — for 
research  and  demonstration,  training, 
construction,  and  others — ^by  the  agen- 
cies of  the  Department  of  Health,  Edu- 
cation, and  Welfare. 

PROS  AND  CONS  :  NEW  ROLES  FOR 
NONPROFESSIONALS  IN  COR- 
RECTIONS. Judith  G.  Benjamin, 
Marcia  K.  Freedman,  and  Edith  F. 
Lynton.  Department  of  Health,  Edu- 
cation, and  Welfare,  Welfare  Admin- 
istration, Office  of  Juvenile  Delin- 
quency and  Youth  Development. 
1966.     127  pp.    40  cents. 

This  publication  describes  some  cur- 
rent experiments  in  the  use  of  nonpro- 
fessional personnel,  including  inmates, 
in  rehabilitative  efforts  in  correctional 
institutions,     and     in     probation     and 

88 


parole  work.  It  concludes  with  guide- 
lines for  introducing  nonprofessionals 
into  agency  programs,  including  sug- 
gested career  line  models. 

OBESITY  AND  HEALTH:  a  source 
book  of  current  information  for  pro- 
fessional health  personnel.  Depart- 
ment of  Health,  Education,  and 
Welfare,  Public  Health  Service,  Divi- 
sion of  Chronic  Diseases,  Heart 
Disease  Control  Program.  1966.  77 
pp.     60  cents. 

Directed  to  the  health  professions, 
this  publication  reviews  the  findings  of 
recent  re.search  on  obesity,  its  associa- 
tion with  other  health  problems,  and 
methods  of  weight  reduction. 

EDUCATING  DISADVANTAGED 
CHILDREN  UNDER  SIX;  EDU- 
CATING DISADVANTAGED  CHIL- 
DREN IN  THE  PRIMARY  YEARS ; 
EDUCATING  DISADVANTAGED 
CHILDREN  IN  THE  MIDDLE 
GRADES;  ADMINISTRATION  OF 
SCHOOL  PROGRAMS  FOR  DISAD- 
VANTAGED CHILDREN.  Helen  K. 
Mackintosh,  Lillian  Gore,  and  Ger- 
trude M.  Lewis.  EDUCATING  DIS- 
ADVANTAGED CHILDREN  IN  THE 
ELEMENTARY  SCHOOLS  :  an  anno- 
tated bibliography.  Gertrude  M. 
Lewis  and  Esther  Murow.  Depart- 
ment of  Health,  Education,  and  Wel- 
fare, Office  of  Education.  Disadvan- 
taged Children  Series  Nos.  1  through 
5.  1966.  26  pp.,  15  cents ;  52  pp.,  25 
cents ;  47  pp.,  25  cents ;  42  pp.,  20 
cents;  33  pp.,  20  cents,  respectively. 

A  series  of  reports  on  techniques  and 
practices  in  various  parts  of  the  country 
in  working  with  educationally  disad- 
vantaged children  3  to  11  years  old. 

SOCIAL  DEVELOPMENT :  key  to  the 
Great  Society.  Department  of 
Health,  Education,  and  Welfare,  Wel- 
fare Administration,  Division  of  Re- 
search. WA  Publication  No.  15. 
1966.  92  pp.  55  cents. 
Through  55  charts  and  text,  this  pub- 
lication presents  data  showing  an  im- 


balance of  social  and  economic  developi 
ment  in  the  United  States.  It  pointl 
out  that  although  the  rate  of  economi'l 
growth  has  been  rapid,  there  have  beeil 
lags  in  the  development  of  .social  well 
fare  programs  and  services  not  only  fo  I 
the  poor  but  also  for  all  groups  in  ou| 
population. 

LOW-INCOME  LIFE  STYLES.  Loll 
M.  Irelan,  editor.  Department  o 
Health,  Education,  and  Welfare,  Wei 
fare  Administration,  Division  of  Re 
search.  WA  Publication  No.  14 
1966.    86  pp.    35  cents. 

Five  papers  summarizing  researcl 
findings  relating  to  low-income  families 
general  outlook  on  life,  family  organi 
zation,  educational  training,  healtl) 
care,  and  cou.sumer  practices. 

CHILDREN'S  BUREAU  ACTIVITIES 
IN  MENTAL  RETARDATION.     Dt{ 
partment  of  Health,  Education,  ani( 
Welfare,     Welfare     Administratioi 
Children's    Bureau.      1966.      14    pi 
Single  copies  free  from  the  Bureai 

Briefly  describes  the  aspects  of  Chi'.| 
dren's  Bureau  programs  of  health  seni 
ice.s,  child  welfare  services,  and  researc  | 
and  demonstration  grants  that  are  coi« 
cerned  with  mental  retardation. 

A  GUIDE  FOR  TEACHING  POISO) 
PREVENTION     IN     KINDERGAB 
TENS    AND    PRIMARY    GRADBSI 
Department    of    Health,    Educatioii 
and  Welfare,  Public  Health  Servicii 
Division     of     Accident     Preventioi 
PHS     Publication     No.     1381.       R< 
printed  September  1966.     95  pp.     5* 
cents. 

Offers  teachers  suggestions  for  teacl 
ing  young  children  ways  of  safeguart 
ing  themselves  and  the  members  of  thei 
family  against  accidental  poisonings. 

DIRECTORY  OF  PUBLIC  TRAININ( 

SCHOOLS  SERVING  DELIN 
QUENT  CHILDREN.  Compiled  b; 
Kenneth  S.  Carpenter.  Departmen 
of  Health,  Education,  and  Welfare 
Welfare  Administration,  Children' 
Bureau.  October  1966.  112  pp 
Single  copies  free  from  the  Bureau 

An  eighth  revision,  this  edition  lists 
by  State  or  jurisdiction,  320  State  an( 
local  training  schools,  camps,  and  re 
ception-dia  gnostic  centers  that  servi 
delinquent  children  committed  by  the 

CHILDREN     •     MARCH-APRIL  1967 

U.S.   GOVERNMENT  PRINTING   OFFICE;  1967 


^/3 


< 

5 


Be««fff  f*tfbfk  Ubfsrr 

JUN  2  0 1967 


children 


Training  Pediatricians 
Violence  in  Ghetto  Children 
Services  to  Unmarried  Mothers 
Cross-Cultural  Adoptions 


^NH" 


VOLUME   14     •     NUMBER  3 


MAY-JUNE   1967 


children 

AN  INTERDISCIPLINARY  JOURNAL  FOR  THE  PROFESSIONS  SERVING  CHILDREN 


K 


Growing  up  and  showing  the 
doctor  how  fast — a  familiar  scene 
in  a  pediatrician's  office.  "For 
pediatricians  the  paramount  goal 
is  prevention  of  illness,"  says 
Dr.  Robert  J.  Haggerty,  in  the 
leading  article  in  this  issue,  and 
he  discusses  some  of  the  special 
ikills  which  he  believes  must  be 
huilt  into  pediatric  training  if 
this  goal  is  to  be  accomplished. 


Pediatric  Training  and  the  Manpower  Problem    .  .     90 

Robert  J.  Haggerty 

Inconspicuous  Familial  Disability 97 

David  Anderson  and  Eric  Knox 

Violence  in  Ghetto  Children 101 

Robert  Coles 

Unmarried  Mothers-The  Service  Gap  Revisited  .  .    105 

Elizabeth  Herzog 

A  Guide  for  Collaboration  of  Physician,  Social 

Worker,  and  Lawyer Ill 

Social  Work  Students  in  Day-Care  Settings  ....     113 

Thclma  Goldberg 

A  Groupwork  Approach  in  Cross-Cultural 

Adoptions 117 

Constance  Rathbun  and  Ralph  L.  Kolodny 

book  notes 122 

here  and  there 124 

in  the  journals 127 


children 


National  Advisers  to  CHILDREN 

William  E.  Brown,  dentistry 

Alex  Elson,  law 

John  H.  Fischer,  education 

Beatrice  Goodwin,  nursing 

Dale  B., Harris,  psychology 

Robert  J.  Havighurst,  youth  denelopment 

Robert  B.  Kugel,  pediatrics 

Hylan  Lewis,  sociology 

Helen  B.  Montgomery,  social  work, 

Bcrnicc  M.  Moore,  community  planning 

Winford  Oliphant,  child  iveljare 

Milton  G.  Rector,  corrections 

Albert  J.  Solnit,  psychiatry 

John  D.  Thompson,  obstetrics 

Samuel  M.  Wishik,  maternal  and  child  health 

Children's  Bureau  Staff  Advisers 

Kenneth  S.  Carpenter,  chairman 
Division  of  Juienile  Delinquency  Service 

Dorothy  E.  Bradbury 
Division  of  Reports 

Hester  B.  Curtis 

Division  of  International  Cooperation 

Elizabeth  Herzog 
Division  of  Research 

Jane  S.  Lin-Fu 

Division  of  Health  Services 

Jean  Reynolds 
Office  of  the  Chief 

Will  Wolstein 

Division  of  Social  Services 

Editorial  Staff 

Kathryn  Close,  Editor 

Catherine  P.  Williams,  Associate  Editor 

Mary  E.  Robinson,  Willamena  Samuels.  Assistants 

90 


Today,  the  medical  profession  faces 
pressing  need  and  an  unniatclied  opportunit 
to  examine  and  modernize  tlie  trainin. 
physicians  who  will  be  caring  for  tomorrow's  chil 
dren  are  receiving.  The  pressing  need  comes  froi 
the  increasingly  severe  professional  manpower  short 
age  and  from  the  growing  realization  that  for  manj 
people  in  this  country  the  breakdown  of  health  bf 
gins  in  early  childhood.  The  opportunitj'  come 
from  the  recent  breaches  in  the  economic  barriei 
that  for  so  long  have  kept  good  medical  care  out  o 
the  reach  of  many  families  and  children. 

In  focusing  this  article  on  postgraduate  pediatri 
education,  I  am  assuming  that  by  the  time  physician 
receive  their  medical  degrees  they  have  alread 
learned  a  good  deal  about  the  normal  growth  am 
development  of  children  and  have  developed  basi 
skills  needed  to  obtain  data  from  inten'iews,  physi 
cal  examinations,  and  laboratory  tests.  Postgrad! 
uatc  education  should  refine  such  basic  skills  anij 
add  many  more. 

It  seems  self-evident  that  postgraduate  trainiuj 
of  physicians  to  meet  the  medical  needs  of  ehildreil 
should  be  I'elated  to  the  health  problems  faced  b;j 
children  today.  However,  it  is  sometimes  difficull 
to  incorporate  this  principle  into  the  hospital  intern  i 
ship  and  residency  programs  through  which  post  i- 
graduate  education  is  obtained.  As  White  and  hi  L 
associates  have  pointed  out,  the  patients  seen  in  teach  w/j 
ing  hospitals  are  a  decidedly  biased  sample  of  all  thi  M 
sick  people  in  the  community.^  A  great  many  of  th  m. 
health  problems  of  children  do  not  automaticalll  h  \ 
come  to  the  attention  of  physicians  in  training  in  uni  m: 
versify  hospitals.  h 

Children's  health  problems  T 

Children's  health  problems  are  of  three  generajLj. 
types:  (1)  conditions  that  cause  death;  (2)  condijjiiii], 
tions  that  cause  morbidity,  acute  and  chronic;  ^  andlm 
(3)  parental  anxieties.  (Robertson^  has  demonlj,| 
strated  that  a  majority  of  mothers  of  newborn  babies  m, 
suffer  anxiety  about  the  baby's  feeding,  breathing  |,j 
bowel  movements,  or  some  other  normal  function.)  ij,. 
The  pediatrician  in  training  needs  experience  witB  ij^, 
l)roblems  of  all  these  types.  He  also  needs  experW  if, 
ence  with  the  social  conditions  of  the  families  iH  (|) 
which  children  are  reared,  for  whether  or  not  the  n; 
child  lives  in  a  healthy  family  or  social  environment  (((, 
has  a  great  bearing  on  his  present  and  future  » 
health.-"'  ^ 

Although    pediatricians    in    training   must   gain 

CHILDREN     •     MAY-JUNE  1967  Olt 


i 


PEDIATRIC  TRAINING 


and  the  MANPOWER  PROBLEM 


ROBERT  J.  HAGGERTY,  M.D. 


iiowK'dnv  oi'  ami  expi'riL'iire  in  tlii'  diagnosis  and 
inagenient  of  ciiiklren  with  illnesses  serious 
lough  to  warrant  hospitalization,  this  is  not  enough, 
or  [jedialricians  the  paranioiuit  goal  is  prevention 
■  illness;  and  prevention  requires  special  skills, 
lie  important  skill  is  the  ability  to  detect  vulnerable 
roups — the  groups  of  children  in  the  population 
ho  are  most  likely  to  develop  ill  health.  Because 
e  ha\e  yet  to  identify  all  such  children  clearly,  it 

difficult  to  teach  methods  of  prevention.  How- 
rer,  we  have  identified  some  of  these  groups.  They 
elude  premature  babies,  babies  born  to  families 
xving  a  history  of  genetic  disease,  babies  of  mothers 
ho  have  had  no  prenatal  care,  and  children  of 
auwhite,  low-income  families  in  city  slums. 
Traditionally,  hospital-based  pediatric  training 
rograms  have  emphasized  the  diagnosis  and  man- 
cement  of  the  acute  illnesses  that  cause  morbidity 
id  death  and  have  gi\-en  less  attention  to  the  tech- 
ques  of  primary  prevention  and  early  diagnosis 
:  such  common  and  treatable  i:)res3-mptomatic  prob- 
ms  as  inci])ient  vision  and  hearing  disorders  or  to 
le  management  of  eomi)lex  handicapping  coiidi- 
ons  such  as  cerebral  palsy  or  emotional  disturbance. 
hey  have  given  even  less  attention  to  training  pcdi- 
;ricians  in  the  diagnosis  and  management  of  the 
iderlying  social  and  family  proljlems  that  affect 
Iness  ]iatterns  or  to  training  in  methods  of  seeking 
it  those  families  in  the  population  who  arc  resistant 

medical  care  though  they  may  have  the  greatest 
5eds.  The  morl)idity  in  this  hidden  group  of  non- 
itients  has  been  likened  to  the  hiddeii  portion  of 
L  iceberg — much  greater  than  the  part  that  is  seen." 
All  children  need  some  preventive  services,  but  it 


is  wasteful  to  proviile  those  not  at  great  risk  the 
same  services  needed  by  those  at  high  risk  of  devel- 
oping irreversible  impairment.  Thus  a  major  task 
for  the  pediatric  profession  in  the  inmiediatc  future 
is  to  find  out  more  about  who  the  most  vulnerable 
groups  are,  how  they  can  be  identified,  what  to  do 
about  them  when  they  have  been  identified,  and  how 
to  provide  the  kind  of  setting  for  physicians  in 
training  that  will  stimulate  them  to  develop  these 
skills. 

Some  valuable  experience  in  ways  to  approach  this 
task  is  now  being  gained  in  universities  with  mater- 
nity and  infant  care  and  children  and  youth  projects 
supported  by  the  Children's  Bureau.  For  example, 
in  the  family  continuity  program  at  the  University 
of  Rochester,  pediatric  residents  are  now  learning 
skills  needed  to  care  for  "high-risk"'  children  in 
low-income  areas. 

Continuity  of  care 

Many  teachers  of  pediatrics  believe  that  the  first 
goal  of  postgraduate  training  is  to  provide  the  phy- 
sician with  enough  experience  in  diagnosing  and 
treating  the  common  serious  and  acute  illnesses  of 
children  to  make  him  thoroughly  competent  and 
comfortable  in  managing  them.  I  do  not  deny  the 
importance  of  this  traditional  aspect  of  pediatric 
care,  nor  do  I  suggest  that  training  time  spent  on 
specific  diseases  should  be  in  proportion  to  their 
frequency.  But  I  do  feel  it  important  to  emphasize 
certain  additional  aspects  that  in  many  places  do  not 
receive  enough  emphasis  toda.y. 

"With  a  good  basic  medical  school  education,  the 


)LUME  14  -  NUMBER  3 


91 


pediatrician  in  training  in  most  university  hospitals 
and  tlie  larger  community  hospitals  can  develop  skill 
in  the  diagnosis  and  treatment  of  specific  illnesses 
during  2  "core  years"  of  postgraduate  training,  con- 
sisting of  a  year  of  straight  pediatric  or  mixed 
pediatric-medical  internship  and  a  year  of  residency. 
The  problem  that  remains  in  most  training  programs 
has  been  the  inability  to  provide  the  trainee  with 
sufficient  expei'ience  in  the  management  of  consecu- 
tive episodes  of  acute  illness  in  the  same  child.  Yet 
most  pediatricians  are  convinced  (in  the  absence  of 
experimental  findings  one  way  or  the  other)  that  con- 
tinuity of  care  is  more  effective  than  episodic  care, 
that  it  requires  special  experiences  to  leam  how  best 
to  provide  such  care,  and  that  training  programs 
must  somehow  achieve  this  goal.  A  few  experiments 
are  now  under  way  to  provide  such  experience  in 
the  required  second  year  of  pediatric  residency  and 
the  recommended  third  year  of  residency. 

No  training  program  has  been  able  to  provide  con- 
tinuity of  care  for  all  of  the  patients  it  tends,  but  in 
recent  years  many  have  developed  special  programs 
for  small  groups  of  patients  under  a  variety  of 
names — "comprehensive  care,"  "family  health,"  "con- 
tinuity care."  '• '  Most  of  these  programs  provide 
physicians  with  1  to  3  years'  experience  in  caring  for 
the  same  children.  ^Vliile  this  is  admittedly  limited 
continuity  from  the  family's  standpoint,  it  is  far  bet- 
ter than  no  continuity  at  all,  the  norm  for  most  per- 
sons who  use  teaching  hospitals  as  their  central 
source  of  medical  care.  Such  medical  school  pro- 
grams as  the  family  health  care  program  at  Harvard 
University,  the  family  continuity  program  at 
the  University  of  Rochester,  and  the  family  health 
program  at  Yale  University  are  examples  of  these 
small-scale  teaching  efforts.  The  next  step  is  to  de- 
velop continuity  of  care  for  all  children  who  receive 
their  medical  care  from  hospital  clinics,  a  difficult 
but  necessary  task. 


Robert  J.  Haggerty,  M.D.,  has  been  in  the 
Department  of  Pediatrics.  University  of 
Rochester  School  of  Medicine  and  Dentistry, 
as  professor  and  department  chairman 
since  1964.  Formerly,  he  was  with  the 
Harvard  Medical  School  as  assistant  pro- 
fessor of  pediatrics  and  director  of  the 
family  health  care  program,  one  of  the 
training;  programs  in  comprehensive  pediatrics  cited 
article.  He  is  also  engaged  in  research  in  methods 
viding  health  services. 


92 


in  this 
of  pro- 


Most  of  the  new  teaching  programs  that  provic 
continuity  of  care  to  some  patients  offer  both  prevei 
tive  and  curative  services  for  the  children  included 
the  program.  True,  the  few  children  that  any  oi 
physician  can  care  for  during  his  internship  ar 
residency  training  make  these  programs  a  bit  "pr 
cious."  They  do  not  give  the  physician  a  realist  l^, 
idea  of  how  he  will  have  to  function  in  practi 
when  he  is  faced  with  the  enormous  demands  of  a 
expanding  child  population.  However,  they  do  o 
fer  the  trainee  his  fir.st.  opportunity  to  develop  ti 
skills  entailed  in  providing  preventive  services,  skil 
that  take  a  great  deal  of  time  to  acquire. 

The  training  experience 

A  key  to  the  success  of  these  introductory  coi 
tinuity  programs  is  the  provision  of  an  adequa 
number  of  competent,  experienced,  and  enthusiast 
teachers  and  the  careful  selection  of  the  families  1 
be  served.  Most  of  these  programs  stress  the  skil 
involved  in  developing  good  doctor-patient  rel: 
tions;  in  diagnosing  and  managing  development: 
disorders;  and  in  taking  into  account  the  social  con 
ponents  in  health  and  ilhiess,  the  role  of  the  famil; 
and  the  role  of  the  health  team  in  providing  co] 
tinuity  and  comprehensiveness  of  care.  To  achie^ 
their  purpose,  they  usually  try  to  give  the  pediatr 
cians  in  training  experience  with  families  froi 
various  social  classes  and  educational  background 
and  having  various  kinds  of  problems. 

In  such  programs  the  trainees  cannot  be  expe^  ti 
to  learn  "on  their  own."    To  expect  them  to  d(j  t 
denies  the  need  for  this  type  of  program  entirely,  f( 
if  no  "teaching"  were  necessary,  physicians  coul 
wait  to  develop  such  skills  until  they  are  in  prat] 
tice.     The  value  of  such  training  during  the  res 
dency  training  j^eriod  is  that  then  the  residents  ca 
test  out  different  methods  of  providing  pediatric  cai 
without  the  pressures  of  time  that  will  occur  m  prac 
tice ;  through  seminars  they  can  probe  deep  into  pres  ^ 
ent  knowledge  about  ways  of  providing  compreher 
sive  pediatric  care ;  and,  perliaps  most  important,  the 
can  work  with  the  teaching  staff  to  study  and  im 
prove  pediatric  methods,  thus  contributing  to  wha 
Romano  has  called  "cumulative  knowledge,"  ^  a  bod; 
of  knowledge  that  can  be  added  to  by  each  generatia 
i)f  doctors  and  transmitted  to  others. 

In  addition  to  teaching  methods  of  care,  the  f acult; 
of  some  of  these  programs  engages  in  research  into 
new  methods  of  delivermg  services  and  transmits  U 
the  tramees  an  ability  to  evaluate  such  methods  criti  "' 

CHILDREN     •     MAY-JUNE  1961  ^ 


m 

to 


illy  and  colli  iiiually  as  a  pari  ol'  tlii'ir  I'uiniioii  as 
iiiifians.  'J'liis  kiiul  ol'  teaching  is  expensive,  i>iit 
;)  more  so  than  the  teju'hing  of  biomedical  research, 
1  accepted  part  of  most  resiliency  training 
rograms. 


kreas  for  experimentation 


i 


IJecause  the  health  of  the  cliild  is  closely  related 
the  well-being  of  other  members  of  his  family,"' 
growing  number  of  these  special  training  programs 
e  emphasizing  a  family  focus  in  the  care  of  chil- 
|.pi,  u,  ij  jj^  these  experiments,  all  children  in  a 
imily  receive  first-contact  medical  care  from  mcm- 
!rs  of  the  same  health  team  (usually  consisting  of 
lysician,  nurse,  social  worker,  and,  in  some  instances, 
ixiliary  health  workers)  and  eli'orts  are  made  to 
cure  greater  knowledge  than  usual  about  the  par- 
its,  their  background,  way  of  living,  and  problems. 
An  experiment  is  under  way  now  in  Boston  to  de- 
rmine  how  much  difference,  if  any,  it  makes  in  the 
?alth  of  children  for  them  to  have  medical  care 
:-ovided  with  a  family  focus."  If  this  and  other 
cperiments  prove  that  family-focused  care  is  the 
tter  method,  we  shall  have  greater  incentive  to 
?velop  skill  in  family  diagnosis  and  therapy  in  a 
)ml)iiu'd  i)rogi-am  for  internists,  obstetricians,  and 
?diatricians  and  even  to  promote  the  training  of 
jneral  family  practitioners. 

After  many  years  of  teaching  continuity  care 
ithin  the  walls  of  a  teaching  hospital,  I  have  come 
•  the  conclusion  that  teaching  hospitals,  while  ad- 
irably  organized  to  care  for  and  teach  consultative 
ire,  are  not  the  best  sites  for  providing  primary  care 
Dr  for  the  training  of  house  stall'  in  these  compre- 
jnsive  familj'-focused  programs.  They  are  usually 
10  remote  from  the  patients  they  serve,  their  staff 
embers  find  it  hard  to  shift  from  consultation  to 
•imary  care,  and  they  present  unavoidable  adminis- 
ative  blocks  such  as  long  waits  to  register,  imper- 
inal  staff  attitudes,  a  size  frightening  to  many 
itients,  and  special  difficulties  in  establishing  family 
cord  systems. 

However,  the  new  neighborhood  healtli  centers 
iing  established  in  many  communities  with  the  help 
:  the  Office  of  Economic  Opportunity,  the  health 
inters  for  migrant  agricultural  workers  established 
ith  funds  from  the  U.S.  Public  Health  Service, 
ider  the  Migrant  Health  Act  of  1962,  and  the  proj- 
ts  for  the  comprehensive  medical  care  of  children 
id  youth  being  established  in  low-income  areas  with 
pport  from  the  Children's  Bureau,  under  the  1965 


aiiieiKlineiils  to  t  he  Social  Security  Act,  provide  ideal 
opportunities  for  training  pediatricians  in  the  iieigh- 
borliDods  where  their  patients  live. 

A\'eil-child  supervision,  an  activity  that  occupies 
50  to  70  percent  of  most  pediatricians'  time,  has 
geiieially  been  poorly  taught.  New  approaches  to 
this  aspect  of  [)ediatric  care,  ilerived  from  experimen- 
tation and  study,  are  especially  needed.  Prevention 
should  not  be  separated  from  curative  medicine. 
.Mi)rei)\er,  in  view  of  our  serious  shoi'tages  in  medical 
iiiaiipDwer,  it  is  unrealistic  to  teach  pediatricians  in 
tiaiiiiiig  that  the  doctor  is  the  only  person  who  can 
provide  preventive  services  or  that  such  services  must 
always  be  provided  on  a  one-to-one  basis  with  every 
patient  receiving  the  same  services.  I  believe  that, 
to  be  a  realistic  preparation  for  the  future,  pediatric 
training  must  provide  physicians  with  experience 
in  caring  for  a  large  number  of  patients  in  the  most 
eflicient  way.  Thus  a  goal  for  the  third  year  of  post- 
graduate training  would  be  to  make  the  resident 
proficient  in  the  use  of  techniques  for  screening 
children  needing  special  attention  and  for  working 
with  parents  in  groups,  although  these  processes  in 
practice  will  usually  be  carried  out  by  other  members 
of  the  health  team. 

Manpower  problems 

A  review  of  some  figures  on  medical  manpower 
will  show  why  the  physician  caiulot  be  expected  to 
provide  all  the  services  needed.  In  recent  j'ears  the 
number  of  j^hysicians  available  to  deliver  continuing 
primary  medical  care  to  children  has  steadily  de- 
clined in  relation  to  the  child  population.  "While  in 
1940  there  were  345  general  practitioners  per  100,000 
children  under  15  years  of  age,  in  1961  there  were 
only  135  per  100,000,  a  decline  that  has  not  been  offset 
by  the  increase  in  pediatricians  from  7.3  to  16.3  per 
100,000."  The  average  child  under  5  years  of  age 
receives  outpatient  attention  from  a  phj'sician  about 
six  times  a  year.  Roughly  60  percent  of  all  child- 
physician  contacts  are  in  a  physician's  office;  5  per- 
cent, in  the  child's  home;  15  percent,  in  a  hospital 
clinic;  and  20  percent,  through  parents  by  telephone.'^ 

If  the  proportion  of  general  practitioners  in  the 
]iopulation  continues  to  decline  at  the  current  rate 
and  if  children  are  to  have  from  pediatricians  the 
same  number  of  physician  contacts  they  have  now,  we 
will  need  115,000  pediatricians  by  1980  in  contrast 
to  our  present  15.000 !  Generous  estimates  indicate 
that  only  about  135,000  physicians  of  all  kinds  will 
be  practicing  between  now  and  1980.""'     Clearly  we 


OLUME  14  -  NUMBER  3 


93 


cannot  expect  the  great  majority  of  these  physicians 
to  devote  themselves  to  the  medical  care  of  children. 

True,  some  demands  on  pediatricians  may  be  nn- 
necessary.  Many  middle  class  mothers  have  been  led 
by  both  the  press  and  members  of  the  health  profes- 
sions to  expect  "magic''  cures  for  self-limiting  ill- 
nesses and  to  have  little  confidence  in  their  own  child- 
caring  abilities.  Hovrever,  we  know  there  is  a  great 
deal  of  real,  unmet  medical  need,  especially  among 
low-income  groups.  For  example,  infant  mortality 
rates  are  higher  in  this  country  than  in  10  others  and 
the  highest  rates  here  exist  among  those  portions  of 
our  population  with  the  least  amount  of  medical 
care.  Provisions  in  this  country  for  early  diagnosis 
and  adequate  treatment  of  jiresymptomatic  chronic 
conditions  such  as  vision  and  hearing  defects,  en- 
vironmentally produced  developmental  retardation, 
and  emotional  and  orthopedic  jjroblems  leave  much 
to  be  desired.  Also,  lacli  of  available  medical  care 
and  the  presence  of  social  problems  have  put  the 
early  diagnosis  and  appropriate  treatment  of  acute 
infections  such  as  otitis  media,  streptococcal  infec- 
tions, and  meningitis  beyond  the  reach  of  many  chil- 
dren. 

All  of  these  unmet  needs  will  produce  greater  de- 
mands for  health  services  as  programs  are  developed 
to  remove  the  economic  barriers  to  medical  care  and 
reach  out  to  the  unserved  portions  of  our  population. 
To  expect  to  solve  the  manpower  problem  through 
decreasing  parent  the  unnecessary  demands  of  par- 
ents is  an  illusion. 

The  health  team 

One  suggestion  that  holds  promise  for  alleviating 
the  manpower  problem  is  to  recruit  persons  other 
than  physicians  to  carry  out,  as  members  of  a  health 
care  team,  some  of  the  services  long  expected  of  the 
physician. ^^  But  this  raises  some  as  yet  unanswered 
questions:  "Wliich  of  the  physician's  current  func- 
tions should  other  health  workers  carry  out?  To 
whom  can  they  best  be  delegated  ?  What  effect  will 
this  sharing  of  the  patient  have  on  the  doctor-patient 
relationship  ? 

Nurses  naturally  come  to  mind  first  as  the  most 
approj^riate  persons  to  carry  out  such  services. 
They  have  a  long  tradition  of  working  with  physi- 
cians and  seem  more  acceptable  to  patients  than 
members  of  other  allied  professions.^®'  ^'  Unfortu- 
nately, they  too  are  in  vei-y  short  supply  and  their 
hospital-based  training  does  not  adequately  j^repare 
them  for  the  tasks  needed  in  an  ambulatory  setting. 

94 


Public  health  nurscvs,  who  are  perhaps  best  equipi)© 
to  carry  out  some  of  the  physician's  present  functions 
are  in  even  shorter  supply.  Xurses  who  have  retirei 
from  employment  to  raise  families  do  represent 
significantly  large  pool  of  unused  manpower,  how 
ever,  and  comprehensive  care  programs  might  ex 
periment  with  ways  to  recruit  and  reeducate  then 
Their  maturity  and  practical  experience  in  raisin; 
families  would  seem  to  be  advantageous  for  the  task 
that  would  be  expected  of  them. 

How  much  and  what  type  of  training  this  typ 
of  "auxiliary  physician"  would  need  is  not  luio«r[ 
nor  is  it  known  whether  it  is  better  to  give  such  a:  I 
auxiliary  worker  a  shorter  initial  training  coursi 
than  is  usual  in  professional  training  followed  bf 
continued  inscrvice  training  with  all  members  of  th  I 
health  team  or  to  continue  to  require  the  long  initini 
training  period  customary  in  our  professions.  Ex  I 
periments  are  needed  in  the  training  programs  o| 
all  health  professions  to  determine  whether  they  ca 
be  made  less  rigid  and  still  give  training  broad  ami 
deep  enough  to  enable  the  trainee  to  adapt  t] 
changing  problems  and  to  make  independent  judgl 
ments,  or  whether  they  must  continually  lengthe  ak::. 
initial  training  programs,  as  has  been  the  trend  i  '^ 
the  past  two  decades. 

But  even  though  we  experiment  with  new  way 
for  pliysicians  and  nurses  to  function  on  the  healt 
team  and  with  altering  their  training  accordingly 
there  is  little  hope  that  an  adequate  number  of  men 
bers  of  either  profession  can  be  prepared  to  meet  th . 
needs  in  the  next  decade. 

We  need  more  experimentation  in  the  training  an'(  ■ 
use  on  health  teams  for  mothers  and  children  o 
persons    indigenous    to    the    neighborhoods    bein; 
served.     Such  workers  have  been  found,  especiall;' 
in  the  developing  countries,  to  be  effective  in  bridg; 
ing  the  gap  in  communications  between  professiona' 
persons,  most  of  whom  are  of  middle  class  origins  ' 
and  the  population  with  the  greatest  health  needel  -^ 
the  low-income,  uneducated  portions  of  the  populaf 
tion.="    A  similar  communication  barrier  betweeil 
professional  workers  and  the  patients  they  serve  f re 
quently  exists  here,  especially  in  programs  serving  1] 
slum  neighborhoods. 

However,  far  from  being  only  second-class  medi  !• ' 
cine  for  the  poor  or  being  necessary  only  until  mom 
professional  people  are  trained,  a  health  team  thai 
includes  neighborhood  workers  may  result  in  mow 
effective  (as  well  as  less  expensive)  medical  care  il  fe' 
all  types  of  neighborhoods,  even  in  the  affluent  sub' 
urbs,  than  does  the  present  system. 

CHILDREN     •     MAY-JUNE  1967 


^ell-child  supervision,  as  provided  by  this  pediatrician  in  a 
iighborhood  health  center,  occupies  50  to  70  percent  of  the 
odern  pediatrician's  time,  a  fact  with  important  implications 
ir  pediatric  training  and  the  planning  of  health  services. 


For  example,  we  know  that  a  large  proportion  of 
lildren  with  acute  streptococcal  disease  do  not  com- 
lete  the  necessary  course  of  oral  penicillin,  whether 
rescrihed  in  a  clinic  or  in  private  practice.  Recent 
.udies  by  Charney  and  associates  show  that  the  per- 
>nality  of  the  mother  and  her  relation  to  the  physi- 
an  are  important  factors  in  such  negligence.-^ 
erhaps  help  in  understanding  the  need  for  such 
lerapy  could  be  given  the  mother  by  a  member  of 
le  health  team  who  as  a  mother  herself  has  experi- 
iced  problems  in  carrying  out  a  doctor's  orders, 
t  the  same  time  this  "indigenous  health  assistant" 
ight  In'ing  to  the  physician  and  nurse  a  greater 
uderstanding  of  the  needs  of  their  patients  and 
le  problems  they  face. 

With  specific  training  for  specific  tasks,  such  non- 
rofcssional   health   assistants  might   also   develop 

ill  in  advising  mothers  on  aspects  of  infant  feed- 
ig,  child  care,  and  child  rearing.     Before  launching 

.y  large-scale  training  program  for  such  workers, 
Jwevcr,  we  need  more  studies  on  what  the  needs  of 
le  patients  are  and  the  kind  of  training  it  would 
.ke  to  meet  them. 

A  major  problem  in  tlic  develojiment  of  such 
orkers,  however,  is  in  determining  the  degree  of 

OLUME  14  -  NUMBER  3 


responsibility  they  can  bo  given  for  making  decisions. 
Obviously,  nonprofessional  assistants  must  work 
very  closely  with  the  other  members  of  the  health 
care  team  not  only  to  benefit  from  continuing  on- 
the-job  training,  but  also  to  assure  the  patient  of  easy 
access  to  professional  workers  when  needed. 

P^or  example,  in  develoi)mental  testing,  nonpi'o- 
fessional  assistants  miglit  be  trained  to  perform 
simple  developmental  screening  tests  to  determine  if 
certain  developmental  tasks  have  been  achieved  by  a 
given  child — a  yes  or  no  decision.  The  more  dilli- 
cult  decision  of  what  the  results  of  the  test  mean  and 
what  should  be  done  about  them  should  rest  with 
the  professional  person. 

It  should  be  recognized  that  one  nonprofessional 
assistant  cannot  learn  to  do  everything.  Protection 
of  the  quality  of  care  requires  that  each  such  assistant 
be  trained  for  and  function  in  a  limited  and  special- 
ized area.  However,  this  looses  a  problem,  for  sev- 
eral assistants  may  therefore  be  needed  in  the  care 
of  one  child.  Determining  the  number  of  such 
assistants  acceptable  to  patients  and  staff  is  a  prob- 
lem calling  for  extensive  ex2)erimentation,  for  at 
some  point  the  size  of  the  health  team  can  l^ecome 
too  large  for  effective  communication. 

University  programs  for  training  pediatricians 
are  in  a  strategic  position  to  experiment  in  combin- 
ing such  new  methods  of  jjroviding  care  with  new 
methods  of  training.  Not  much  can  be  done  along 
these  lines,  however,  unless  efforts  are  also  made  to 
train  persons  for  teaching  and  evaluating  methods 
of  care.  Such  ti-aining  might  be  offered  through 
fellowships  to  pediatricians  who  have  completed  2 
years  of  residency  training.  Some  j^rograms  for 
training  teachers  in  ambulatory  care  are  in  fact  now 
in  existence  at  the  medical  schools  of  Harvard  Uni- 
^'ersity  and  the  University  of  Rochester  under 
Children's  Bureau  sponsorsliijJ. 

Chronic  care 

With  the  addition  to  the  health  team  of  more 
auxiliary  workers,  physicians  will  have  more  time  to 
spend  on  the  care  of  chronically  ill  and  handicapped 
children.  Here  the  skills  of  pediatricians  are  partic- 
ularly needed,  along  with  the  skills  of  those  pedia- 
t  ricians  who  have  developed  subsjjecialties  in  specific 
diseases  or  handicapping  conditions.  Under  i^rescnt 
requirements  of  the  American  Board  of  Pediatrics, 
subspccialization  in  specific  areas  such  as  cardiologA' 
or  allergy  added  to  the  broad  base  of  pediatric  train- 
ing can  be  accomplished  in  an  additional  2  years  after 

95 


the  2  core  years  of  pediatric  internship  and  residency. 
But  even  the  pediatrician  who  is  not  planning  a  sub- 
specialization  might  well  select  two,  three,  or  four 
chronic  diseases  on  which  to  concentrate  during  his 
third  year  of  postgraduate  training.  In  this  year 
he  should  also  learn  to  work  as  a  member  of  a  health 
care  team,  one  different  from  the  team  for  primary 
care  but  functioning  under  the  same  principles  for 
working  together.^^ 

It  is  becoming  increasingly  difficult  for  the  pedia- 
trician in  private  practice  to  provide  adequate  serv- 
ices in  his  office  for  the  chronically  ill  child,  for  he  is 
not  likely  to  have  there  the  teclinical  equipment  or 
the  easy  access  to  consultation  of  specialists  and  allied 
health  workers  such  as  medical  social  woi'kers  and 
physiotherapists  that  a  hospital-based  program  af- 
fords. Thus  the  training  programs  have  an  impor- 
tant role  to  play  in  helping  pediatricians  know  how 
to  work  on  such  teams  as  part-time  subspecialists 
while  they  are  in  general  pediatric  practice. 

For  example,  in  the  cystic  fibrosis  clinic  of  the 
University  of  Rochester  School  of  Medicine  and 
Dentistry,  which  has  a  full-time  staff  consisting  of 
a  pediatrician,  director,  and  consultants  in  infectious 
disease,  allergy,  metabolism,  and  other  specialties, 
the  continuing  care  of  the  children  is  the  responsibil- 
ity of  a  few  pediatricians  who  are  in  private  practice 
but  who  are  specially  trained  in  cystic  fibrosis  and 
come  to  the  clinic  regularly.  Both  they  and  their 
patients  seem  to  benefit. 

In  conclusion 

In  this  review  I  have  concentrated  on  training 
physicians  to  understand  the  kinds  of  medical  serv- 
ices needed  by  children  and  to  work  as  part  of  a 
health  team  to  meet  these  needs,  rather  than  on  the 
training  of  the  physician  per  se.  I  believe  this  em- 
phasis is  essential  if  pediatricians  are  to  be  prepared 
realistically  to  meet  the  health  needs  of  the  children 
of  this  Nation. 


^  White,  K.  L.;  Williams,  T.  F.;  Greenberg,  B.  G.:  The  ecology  of 
medical  care.     The  New  England  Journal  of  Medicine,  Nov.  2,   1961. 


'Richardson,  W.  P.;  Higgins,  A.  C;  Ames,  R.  G.:  The  handicapp 
children  of  Alamance  County,  North  Carolina.  Nemours  Foundatic 
Wilmington,  Del.     1965. 

''Robertson,  W.  O. :  An  investigation  of  maternal  concerns  by  m: 
survey.     Child  Development,  September  1961. 

'Miller,  F.  J.  W.;  Court,  S.  D.  M.;  Walton,  W.  S.;  Knox,  E.  C 
Growing  up  in  Newcasde-Upon-Tyne.  Nuffield  Press,  Oxford,  Englan 
I960. 

°  Miller,  F.  J.  W.:  Childhood  morbidity  and  mortality  in  Newcasti 
Upon-Tyne.     The  New  England  foiirnal  of  Medicine,  Sept.  29,   19f 

Cottrell,  J.  D. :  The  consumption  of  medical  care  and  the  evaluati- 
of  efficiency.     Medical  Care,  October-December  1966. 

'  Haggerty,  R.  J.:  Family  medicine:  a  teaching  program  for  medii 
students  and  pediatric  house  officers.  Journal  of  Medical  Educatit 
June  1962. 

^Snoke,  P.  S.;  Weinerman,  E.  R.:  Comprehensive  care  programs 
university  medical  centers.     Journal  of  Medical  Education,  July  1965. 

'Romano,  J.:  Requiem  or  reveille:  the  clinician's  choice.  Journal 
Medical  Education,  July  1963. 

"Haggerty,  R.  J.;  Alpert,  J.  J,:  The  child,  his  family,  and  illne 
Postgraduate  Medicine,  September  1963. 

"Silver,  G.  A.:  Family  medical  care:  a  report  on  the  family  hea 
maintenance  demonstration.  Harvard  University  Press,  Cambridj 
Mass.     1963. 

'^  Markowitz,  M.;  Gordis,  L.:  A  family  pediatric  clinic  at  a  commun 
hospital.     Children,  January-February  1967. 

"  Alpert,  J.  J.;  Haggerty,  R.  J.:  A  family-focused  child  care  experime 
Research  in  progress.  Children's  Hospital  Medical  Center,  Boston,  Ma 

"  Stewart,  W.  H.;  Pennell,  M.  Y.:  Pediatric  manpower  in  the  Unit 
States  and  its  implications.     Pediatrics,  February  1963. 

''  Department  of  Health,  Education,  and  Welfare,  Public  Health  Sei 
ice,  National  Center  for  Health  Statistics:  Volume  of  physician  vis 
United  States,  July  1963-June  1964.  NCHS  Series  10,  No.  18,  Ju 
1965. 

"  Christopherson,  E.  H.:  Pediatric  projections.  American  Acadei 
of  Pediatrics,  Evanston,  111.     1966. 

"Silver,  G.:  New  types  of  personnel  and  changing  roles  of  hean 
professionals.  Bulletin  of  the  New  Yor^  Academy  of  Medicine,  Dece 
ber  1966. 

"Connelly,  J.  P.:  Use  of  ancillary  personnel  in  children's  oil 
patient  departments:  new  trends  in  extending  medical  services.  C/<«».' 
Pediatrics,  April  1965. 

"  Siegel,  E.;  Dillehay,  R.;  Fitzgerald,  C.  J.:  Role  changes  within  ch  i 
health  conferences:  attitudes  and  professional  preparedness  of  pubi 
health  nurses  and  physicians.  American  Journal  of  Public  Health,  Jui 
1965. 

'"' Cassel,  J.:  A  comprehensive  health  program  among  South  Africi 
Zulus.  In  Health,  culture,  and  community;  case  studies  of  public  re; 
tions  to  health  programs.  (B.  D.  Paul,  ed.)  Russell  Sage  Foundatic 
New  York.     1955. 

^  Charney,  E.,  et  al.:  How  well  do  patients  take  oral  penicillin? 
study  in  private  practice.     Pediatrics  (to  be  published). 

^  Green,  M.;  Durocher,  M.  A.  L.:  Improving  parent  care  of  ham 
capped  children.     Children,  September-October  1965. 


• 


Human  development  is  a  drama  with  many  actors;  sometimes  one,  some- 
times another  player  has  the  center  of  the  stage,  but  in  this  drama  no  one 
player  is  ever  on  stage  alone. 

Dorothy  V.  Whipple,  M.D.,  "Dynamics  of  Development:  Euthenic  Pediatrics," 
McGraw-Hill  Book  Co.,  New  York,  1966. 


96 


CHILDREN     •     MAY-JUNE  196 


d 


li 


INCONSPICUOUS 

FAMILIAL 

DISABILITY 


DAVID  ANDERSON 
ERIC  KNOX 


Nodding  our  aiDologies  to  the  cai'etakers  of 
good  writing  and  good  manners,  we  have 
decided  that  we  must  begin  our  esaiy  by 
alking  about  ourselves.  AVe  are  second-year  medical 
tudents  at  the  University  of  Minnesota.  The  cur- 
iculum  here  is  set  up  to  leave  the  summer  between 
he  freshman  and  sophomore  years  free.  During 
his  free  period,  the  two  of  us,  fortified  by  back- 
grounds in  gross  anatomy,  histology,  biochemistry, 
,nd  a  smattering  of  other  sciences,  signed  up  for 
ellowships  within  the  pediatrics  department — and, 
tiore  specifically,  for  work  with  a  group  involved  in 
stablishing  an  educational  model  of  comprehensive 
lealth  care  for  the  children  of  families  regarded  as 
)Overty  stricken.  [Comprehensive  Health  Services 
'or  Children  and  Youth  in  Minneapolis,  Children's 
Bureau  Project  No.  603.] 

To  call  us  neophytes  in  the  craft  and  society  of 
Inedicine  would  be  charitaljle.    And  this  is  a  point  we 
\;int  to  establish  at  the  outset:  our  observations  in 
i)ur  encounters  with  the  people  that  are  to  be  patients 
In  the  proposed  model  clinic  were  unrestricted  by 
ilio  preformed  expectations  and  conclusions  that  edu- 
ation  and  prior  experience  might  sometimes  pro- 
luce — and  equally  lacking  in  the  acuity  that  educa- 
ion  and  experience  bestow.    We  point  this  out  to 
•~1  iiblish  our  openmindedness,  and  we  hoi^e  that  our 
laclers  do  not  at  once  dismiss  our  viewpoint  as  only 
Ignorant  and  naive. 

AVe  spent  the  first  i)art  of  the  summer  helping 
II  launcji  the  initial  phase  of  the  pi'oject.  This 
uvolved  health  screening  for  preschool-age  children 
n  the  area  the  comprehensive  care  unit  is  to  serve. 
From  the  fii-st  group  of  medical  histories  taken  in 


tho  project  (about  50  in  all),  each  of  us  chose,  with 
the  aid  of  our  advisei-s,  one  family  to  study  inten- 
sively and  follow  as  its  members  used  the  clinic. 
Our  feelings  about  one  of  these  families  prompted  us 
to  set  down  our  ideas  about  the  need  for  a  new  ap- 
proach in  dealing  with  tiie  problems  of  a  type  of 
family  we  think  will  be  more  and  more  prevalent. 

The  Smitii  family  is  noteworthy  perhaps  only  by 
its  inconspicuousne.ss.  Its  very  lack  of  notability 
seems  to  bo  its  greatest  liability.  This  family  rep- 
I'esents  to  us  a  self -perpetuating  subterranean  mode 
of  existence,  remo\-ed  from  and  unheeded  by  the 
active  currents  of  society.  This  mode  of  existence 
fits  no  labels  because  it  has  not  aroused  the  interest 
of  tho  labelmakers — the  sociologists,  psychologists, 
and  pultlic  liealth  people.  Its  "patliology"  is  just 
beginning  to  be  understood.  Those  engulfed  in  it 
are  the  school  dropouts,  tho  chronically  or  intermit- 
tently unemployed  or  unliappiiy  employed,  the  peo- 
ple of  whom  nothing  is  expected.  Wliat  is  so  strik- 
ing to  us  is  that  their  feelings  of  suspicion  and  habits 
of  withdrawal  from  society,  themselves  symptoms  of 
pathology,  seem  to  be  passed  on  from  generation  to 
generation  almost  like  a  dominant  gene,  the  pattern 
broken  only  when  the  pathology  is  starkly  mani- 
fested in  ways  that  society  recognizes  and  abhors — 
alcoholism,  crime,  and  the  other  diseases  for  which 
society  has  its  agencies.  Our  great  agencies,  praise- 
worthy as  they  are,  we  feel,  are  treating  only  the 
secondary  manifestations  of  a  pathology  whose 
origin  and  reinforcement  are  in  the  family  dj'namics 
of  the  people  involved. 

Pattern  of  selF-defcat 

Perhaps  the  best  way  of  defining  what  we  are 
talking  about  is  to  describe  what  we  saw  in  the 
Smiths.  Because  of  the  inexpert  nature  of  our  ob- 
servations we  can  hope  only  to  make  clear  the  domi- 
nant patterns  of  interaction.  The  parents  and  six 
children,  rangmg  in  age  from  Bill,  18,  to  Daniel,  2, 
occupy  a  house  in  a  shabby  section  of  the  city.  IMr. 
Smith  does  his  best  as  a  provider  though  he  is  mi- 
trained  and  must  resign  himself  to  the  uncertainty 
of  changing  needs  for  imskilled  labor.  What  he 
earns  each  year  is  enough  to  keep  his  family  from 
serious  need,  with  some  aid  from  the  city  relief 
program. 

The  caseworker  who  oversees  the  administration 
of  city  funds  for  this  family  finds  little  to  arouse  the 
enlistment  of  her  talents  since  the  Smiths  are  thrifty, 
upstanding,  and  seemingly   do  the  best  they  can. 


/OLUME  14  -  NUMBER  3 


97 


Their  condition  cannot  be  characterized  by  the  more 
colorful,  classical  picture  of  jioverty  with  its  images 
of  moiling  slums,  irresponsibility,  crime,  and  aggres- 
sion. They  are  of  the  displaced,  the  passive  and 
withdrawn,  a  segment  of  society  present  always,  but 
now,  with  the  increasing  complexity  and  speed  of  our 
world,  bound  to  include  more  and  more  people. 

(^ur  primary  concern  is  the  emerging  pattern  of 
self-defeat  we  see  in  the  childi'en  of  JMr.  and  Mrs. 
Smith.  We  realize  that  the  particular  constellation 
of  personal  traits  and  interactions  in  the  Smith  fam- 
ily is  characteristic  of  this  family  only.  But  we  want 
to  show  that  the  family  dynamics  must  be  understood 
if  we  hope  to  head  off  the  development  of  six  similar 
next  generation  Smith  families. 

The  key  to  the  problems  in  this  family  appears  to 
be  Mrs.  Smith.  Her  role  in  the  interpersonal  rela- 
tions of  the  family  is  more  active  than  her  husband's. 
In  contrast  to  the  easy-going  Mr.  Smith,  siie  is  wound 
tight  by  anxiety  and  suspicion.  Within  her  home 
she  appeai-s  to  function  competently;  keeping  the 
home  neat  and  clean  is  obviously  very  important  to 
her.  But  her  ability  to  function  evaporates  when 
she  leaves  the  security  of  her  home.  On  one  day 
that  we  visited  the  Smiths,  she  had  just  returned 
from  an  unplanned  excursion  with  her  fatlicr  to  the 
Minnesota  State  Fair.  She  had  become  exhausted 
almost  at  once,  complained  of  a  severe  headache,  and 
asked  to  be  taken  home.  She  said  she  probably 
would  not  have  gone  at  all  if  she  had  had  time  to 
think  aliout  it. 

It  seems  to  us  that  Mrs.  Smith  is  able  to  maintain 
at  home  u  rather  precarious  equilibrium  that  is  seri- 
ously threatened  if  she  ventures  away.  She  ex- 
presses a  variety  of  prejudices,  fears,  and  dislikes, 
all  of  which  excuse  her  from  having  dealings  with, 
her  neighljors.  She  retains  strong  dependency 
bonds  with  her  own  father  and  brothers  and  sisters. 

The  children 

The  same  patterns  of  dependency  we  note  in  ^Irs. 
Smith  are  developing  in  her  children.  Sui>porting 
this  is  the  same  type  of  suspicion  and  withdrawal. 

Bill  Smith  is  a  good-looking,  husky  fellow  who, 
from  outward  appearance,  should  have  the  world 
on  a  string— that  is,  if  he  were  not  a  high  school 
dropout.  As  his  mother  spoke  about  Bill,  we  began 
to  understand  the  familial  nature  of  the  withdrawal 
pattern. 

Though  tests  show  Bill  to  be  normally  bright,  he 
has  never  developed  much  interest  in  school     In 

98 


David  Anderson,  left,  ami 
Eric  Knox  are  second-year 
medieiil  students  at  the  Uni- 
versity of  Minnesota.  Their 
oljservations  are  based  on 
experience  at  a  neighlior- 
hood  i)ediatric  clinic  in  the 
Minneapolis  comprehensive 
health  care  program  for  cliildren 
the  Children's  Bureau. 


and  youth  supported  b 


\ 


fact,  he  does  not  seem  to  be  interested  in  anythinj 
at  least  for  any  length  of  time.  At  present  he  leac 
a  sedentary  existence,  lounging  about  the  house  an 
demonstrating  reluctance  to  venture  away. 

Here's  a  young  man  who  has  withdrawn  himse 
from  the  world.  He  has  quit  everj'  job  he  has  ha 
as  his  interest  began  to  pall — excejit  for  a  brief  stii 
as  a  supermarket  carryout  boy,  a  job  fi'om  which  1 
was  fired  for  being  "unfriendly."  He  has  expressf 
mixed  feelings  about  joining  the  armed  service 
feelings  that  mirror  his  mother's  own  ambivalent 
She  feels  that  a  "hitch"  in  the  Army  might  provic 
Bill  with  the  discipline  and  responsibility  he  need 
Init,  on  the  other  hand,  that  it  might  be  too  mu( 
for  him.  The  issue  was  resolved  when  Bill  faih 
the  Army  psychological  test. 

Next  oldest  is  16-year-old  Sandy,  a  high  scliO' 
junior.  She  manifests  her  fear  and  imi)lements  h 
withdrawal  through  somatization.  She  has 
atopic  allergy,  probably  for  wool,  though  the  allergi 
has  not  been  exclusively  incriminated  since  lier  sj'm 
toms  appear  in  conjimction  with  altered  emotion 
status.  The  school  nurse  feels  certain  that  the  ps 
chosomatic  elentent  is  of  the  greater  ctiologic  impc 
tance,  and  ^Irs.  Smitli  says  that  Sandy  often  uses  i 
outbreak  of  rash  as  an  excuse  to  stay  hoir 
Sandy's  world,  like  Bill's,  is  becoming  smaller  ai 
more  insulated  as  she  approaches  the  time  when  t 
healthy  tendency  for  a  young  person  is  to  mo\e  t 
ward  independence.  Like  her  mother,  Sandy  is  st 
isfied  with  no  less  than  an  impeccable  house,  but  oi 
side  of  housework  "she  doesn't  really  like  to  do  nui' 
of  anything,"  Mrs.  Smith  tells  us. 

The  most  severely  aft'ected  child  is  Tommy,  age  ] 
Tommy's  case  is  the  one  that  brought  this  family 
our  attention  and  made  the  Smiths  "interesting,"  f 
only  in  Tommy  has  the  familial  pathology'  emergi 
in  a  way  that  arouses  our  interest  as  healers — he  h 
acute  behavioral  problems.  Having  admitted  o 
lack  of  training,  we  will  not  presume  to  explain  t 

CHILDREN     •     MAY-JUNE  19 


LMSOiis  for  tlu>  lii-catcr  m'\  cnl  y  of  'rdiuiny  V  a  111  id  inn. 
\v(>  iiitiTi'stinfif  li'ads  for  more  expi'rii'ni'cd  ohsci'vci's 
ii<:hl  1)0  round  ill  Mrs.  Sniitir.s  assorl  ion  thai 
'oniiiiy's  birth  was  certainly  the  most  diflicult — "liis 

ii-ad  was  twisted  tlie  wi'ong  way" — and  in  his  once 
ose  rehitionship  with  a  maternal  uncle  who  com- 
litted  suicide  several  years  ago. 

In  Tonnny  we  see  agaTcssion  and  destructiveness, 
et  beneath  are  the  same  kind  of  fear  and  withdrawal 
s   in   other   members  of  the  family.     Except    for 

hool  he  refuses  to  leave  the  home,  unless  it  is  with 
IS  beloved  grandfather,  Mrs.  Smith's  father, 
'ommy  feels  exti'emely  threatened  by  persons  out- 
(le  his  family — including  the  neighbors  of  whom 
Irs.  Smith  is  so  suspicious.  Tonnny,  like  Sandy, 
ften  di'velops  physical  .symptoms.  lie  sutlers  from 
eadaclies,  stomacliaches,  and  backaches  with  no  ap- 
irent  organic  causes.  He  lias  been  receiving  special 
id   in  school   for    a   reading  difficulty.     Tommy's 

oblems  are  recognized  and  he  will  undoubtedly  be 
>e    subject   of   much    professional    attention.     "We 

ouder  if  he  might  not  be  the  most  fortunate  of  the 
hildren. 

The  three  younger  children,  Kathleen,  7,  Penny,  5, 
nd  Daniel.  -2,  do  not  as  yet  show  the  effects  of  the 
ittern  we  have  been  describing.  It  is,  of  course,  im- 
ossible  to  know  whether  their  emotional  state  will 

teriorate  as  they  grow  older  and  the  influences  of 
10  family  liave  had  longer  to  work. 

Vhy  Jake  them  on? 

If  the  Smiths  were  minus  Tommy,  we  wonder  it' 
lej'  would  arouse  our  nascent  professional  interest. 
Ve  also  wonder  about  how  much  attention  th  s 
amily  would  recei\e  by  those  who  share  our  values 
s  products  of  the  middle  class  from  which  profes- 
ional  healers,  nurses,  social  workers,  and  doctors  al- 
lost  always  come.  For,  at  first  glance,  the  Smiths 
rould  seem  to  be  a  benign  unit  of  society  and  any 
pecial  interest  in  them  superfluous.  Why  s]iend 
ime  on  iliem  when  they  seem  to  be  compensated  for 
leir  weaknesses  and  are  not  hurting  anyone? 

We  asked  ourselves  this  question  when  after  a 
loser  look  we  were  trying  to  formulate  pragmatic 
easons  to  back  up  our  feelings  that  the  time  should 
e  spent.  Perhaps  such  feelings  are  themselves  the 
lost  important  reason.  The  members  of  the  Smith 
amily  sutler  from  a  disease  that  makes  them  unable 
0  function  productively  in  the  world  as  it  is  today, 
i'herefore,  as  a  healer  one  has  the  responsibility  for 
reating  them  as  iiest  he  knows  how.     With  some 

'OLUME  14  -  NUMBER  3 


I  liouglit  and  proji'ci  ion  I  lie  |jraginat  ic  rea>ons  become 
clear  as  well. 

One  can  be  Min-  thai,  wiilioul  inlerveiition  in  the 
naiiiral  course  of  smli  I'amily  pathology,  society 
eventually  «ill  be  adversely  affected  by  the  more 
malignant  forms  that  such  pathology  may  take. 
When  the  suspicion  and  withdrawal  are  overlaid 
with  aggression,  as  in  Tommy's  ca.se,  crime  is  a  pos- 
sible outlet  if  the  pattern  is  not  interrupted.  Or 
when  such  traits  are  overlaid  with  self -destructive- 
ness, as  in  the  uncle's  case,  suicide  migiit  r(>sult.  Less 
spectacular  perhaps  is  the  burden  that  ISill's  expecta- 
tions as  one  of  the  chronically  unemployed  repre- 
sents as  a  future  drain  on  welfare  funds. 

Then  there  is  I  lie  fact  that  treatment  of  the  symp- 
toms—from Ihe  somatic  manifestations  of  fears  to 
the  financial  necessity  for  welfare — without  ti-ying 
to  treat  the  primary  pathology  is  bad  medicine,  and, 
we  assume,  bad  social  work  as  well. 

Lacl<s  in  treatment 

Ideally  from  here  we  should  [)roceed  to  the  solu- 
tions of  the  problem  we  have  been  discussing  and 
point  out  how  we  can  update  or  sharpen  our  methods, 
but  we  simply  do  not  have  the  answers.  All  we  can 
do  is  describe  how  the  Smiths  have  been  dealt  with 
in  the  past  and  what  we  feel  has  been  lacking  in  this 
treatment.  We  will  in  the  end  make  a  very  general 
suggestion  about  a  possible  starting  point  in  finding 
the  ways  to  remedy  this  lack. 

Briefly,  the  treatment  that  Ihe  Smiths  have  re- 
ceived up  till  now  has  been  too  late,  too  fragmented, 
and  too  inaccessible.  Both  the  nature  of  the  family 
and  the  nature  of  traditional  health  I'esources  have 
contributed  to  these  faults. 

It  seems  to  us  that  prevention  of  the  pattern  of 
self-defeat  we  see  developing  in  the  Smith  children 
is  possible,  but  only  through  early  diagnosis  and 
direct  intervention.  As  we  have  mentioned,  except 
for  Tommy  the  family  does  not  seem  remarkable 
in  the  cursory  look  that  most  busy  liealth  practi- 
tioners have  time  to  give.  However,  of  equal  im- 
portance in  the  delay  of  diagnosis  and  treatment  is 
the  Smiths'  reluctance  to  seek  outside  "interference." 
Like  many  people  in  their  condition,  they  must  be 
convinced  that  a  family  member  is  acutely  ill  before 
they  seek  help. 

For  the  Smiths  the  primary  medical  resource  is 
the  county  general  hospital  and  the  charity  facili- 
ties of  one  of  the  community  hospitals.  Both  are  ex- 
cellent est ablislmients.     Sandy's  emergency  record  at 


99 


the  general  hospital   reveals  part  of  the  problem. 

In  eight  dift'erent  entries,  spanning  4  years  between 
19G2  and  IDCti,  the  admitting  complaint  is  her  acute 
skin  symptom.  Even  tlie  first  examination  yielded 
the  diagnosis  of  neurodermatosis,  and  symptoms  of 
anxiety  were  noted  then  and  during  several  subse- 
quent examinations,  but  it  was  over  a  year  from  the 
initial  complaint  before  Sandy  was  scheduled  for  the 
allergj'  clinic.  Although  the  emotional  elements  of 
her  disease  were  suspected  from  the  beginning,  the 
expenditure  of  effort  lias  been  primarily  to  find  a 
salve  for  maintaining  her  complexion — precious  time 
has  been  lost. 

From  Sandy's  records,  and  Tommy's  as  well,  the 
fragmented  nature  of  the  treatment  they  have  re- 
ceived is  also  well  illustrated.  Again  the  attitudes 
of  the  Smith  family  toward  health  agencies — to  be 
used  only  in  acute  situations — as  well  as  the  nature 
of  the  facilities  themselves  are  implicated.  TJie 
fragmentation  we  refer  to  exists  within  the  sphere  of 
medical  treatment  and,  on  a  larger  scale,  among  the 
various  agencies  responsible  for  health  in  its  broader 
connotation.  For  families  imable  to  aft'ord  a  private 
doctor,  the  emergency  room  provides  the  only  re- 
course in  time  of  need.  For  diagnosis  and  treatment 
of  acute  illness  or  injury,  we  think,  the  emergency 
room  is  ideal.  Plowever,  for  the  chronically  ill,  for 
whose  treatment  knowledge  of  the  development  and 
course  of  the  disease  is  extremely  important,  the  nec- 
essary continuity  of  treatment  is  threatened  by  the 
turnover  of  personnel  and  sliortage  of  time  that  are 
the  conditions  of  the  emergency  room. 

The  availability  of  outpatient  specialty  clinics  does 
not  entirely  solve  the  problem.  Sandy's  attendance 
at  the  allergy  clinic  was  only  occasional,  depending 
on  the  severity  of  her  skin  condition  at  the  time. 
Tommy's  appointments  at  the  pediatrics  clinic  were 
usually  kept  only  when  he  had  one  of  his  headaches. 
A  striking  and  saddening  fact  is  that  in  almost  every 
entry  in  the  records  of  these  two  young  people  the 
examining  physician  expressed  the  opinion  that  emo- 
tional factors  were  involved  in  their  symptoms. 
That  the  traditional  facilities  are  partly  responsible 
for  the  difficulty  in  dealing  with  these  factors  seems 
to  us  an  unhappy  and  unnecessary'  situation. 

The  cross  anus  and  overlapping  aims  of  the  vari- 
ous agencies  of  the  community  that  in  the  composite 
are  responsible  for  health  in  the  larger  sense  of  the 
M'ord — OA'erall  well-being — represent  another  level  of 
fragmentation.  The  Smiths  have  not  been  the  sub- 
ject of  much  attention  from  the  various  community 
agencies.     But  through  our  concern  with  them,  we 

100 


have  seen  how  the  total  pattern  of  family  difficultie 
may  never  be  discerned  by  the  observations  mad 
from  single,  nonintegrated,  though  insightfu 
points  of  view.  The  city  welfare  worker  midoubl 
ably  knows  a  great  deal  about  the  Smiths'  financis 
expectations.  The  school  has  recognized  Tommy 
reading  and  behavior  problems.  A  high  scho( 
nurse  perceives  the  elements  of  school  phobia  i 
Sandy's  allergy  problem.  But  who  is  going  to  pi: 
these  observations  together,  relate  them  with  wha 
goes  on  in  the  home,  and  see  the  family  as  a  whole 

Intermediary  needed 

Wliat  it  all  boils  down  to  is  that  the  care  the  Smiifc 
have  received  has  been  inadequate  because  of  its  ir 
accessibility — inaccessibility  not  in  the  physics 
sense  or  even  in  the  economic  sense,  but  in  the  sens 
tliat  a  gap  exists  between  the  family's  needs  and  tli 
resources  of  the  commmiity.  The  gap  is  opened  b 
the  aforementioned  reasons  behind  the  tardy  an 
fragmented  nature  of  the  care  the  community  offer 
We  feel  that  it  might  be  spanned  and  care  made  acce; 
sible  to  the  Smiths  by  a  person  or  group  whose  priir 
function  is  to  gain  as  complete  an  understanding  i 
possible  of  the  family  and  its  dynamics,  whose  prin 
concern  is  to  prevent  disease  in  all  connotations  ( 
tlie  word,  and  whose  tools  are  the  specialized  agencin 
already  operating  in  the  community. 

What  we  have  in  mind  is  an  intermediary  betwee 
the  family  and  community  resources,  one  with  sufi 
cient  understanding  to  fit  the  care  to  the  need.  1 
attempt  to  go  beyond  this  very  general  suggestio 
would  rapidly  exhaust  both  our  space  and  our  ideas- 
indeed  the  questions  that  arise  concerning  the  ide; 
training  for  carrying  out  such  a  role,  the  proper  n 
lationsliip  of  such  an  intei-mediary  to  the  family  an 
to  the  agencies  involved,  and  financial  arrangemeni 
possible  are  those  for  which  answers  will  be  foun 
only  through  experience. 

The  Smiths,  while  unique,  have  represented  to  v 
an  example  of  a  growing  number  of  disjalaced  pec 
pie — removed  from  the  mainstream  of  today's  d( 
manding  way  of  life.  We  feel  that  the  key  to  midei 
standing  the  origin  and  propagation  of  their  patter 
of  self-defeat  and  to  averting  a  predictable  cours 
of  events  is  in  the  workings  of  the  famOy.  BeyoH' 
clearing  slums,  training  high  school  dropouts  fo 
employment,  and  instilling  hope  in  the  hopeless,  w 
in  this  country  must  find  ways  of  breaking  the  chain 
of  human  interactions  that  perpetuate  many  of  ou 
social  problems. 


CHILDREN     • 


MAY-JUNE  196|  i|)„. 

I 


• 


la  a  psychiatrist 

considers 
tne  origins  of 


VIOLENCE 

IN 

GHETTO 

CHILDREN 

ROBERT  COLES,  M.D. 


When  I  worked  as  a  child  psychiatrist  in  a 

children's  hospital,  I  spent  most  of  my  time 

with   middle  class  children   whose  parents 

iiy  often  seemed  earnest  and  sensitive;  certainly 

111  y  were  worried  about  their  children,  at  times  ex- 

i-sively  so.     The  boys  and  girls,  for  their  part,  were 

Kually  quiet  and  controlled.     They  were  suli'ering 

rom  "school  phobias"  or  the  various  fears  and  anxie- 

iis  that  have  been  described  b}'  a  generation  of  psj'- 

liiatrists.     If    they    were    disobedient    and    loud, 

is\uilly  it  was  a  specific  form  of  disobedience  I  saw, 

I  \  I'ry  particular  noisiness  I  heard,  all  connected  to 

"iiii'thing  they  dreaded  or  dared  not  to  look  at.     In 

I  -ense,  then,  the  unruliness  I  noticed  only  confirmed 

i\y  impression  of  a  general  restraint  (emotional  tidi- 

ii-s,  I  suppose  it  could  be  called)  that  middle  class 

liildren  by  the  time  they  are  2  or  3  years  old  are 

1  ,ikely  to  have  acquired,  never  to  lose. 

'    Yes,  there  are  the  usual  signs  of  aggressive  ten- 

Iciicies  in  the  "latency  years"  (the  years  preceding 

'liberty  when  sexual  urges  are  quiescent) — the  bold 

iiid  even  nasty  games,  the  play  that  seems  involun- 

aiily  brutish — until  a  long  look  reveals  how  curi- 

,  )usly  formal,  even  restrained,  the  unruliness  of  these 

S  liildren  actually  is.     Despite  all  the  "drives"  one 

•  lears  psychologists  and  psychiatrists  talk  about— the 

f  urges  of  desire,  spite,  and  hate  that  continuously 

i  VOLUME  14  -  NUMBER  3 


pre.ss  upon  the  child's  mind  antl  in  elreanis  or  day- 
time fantasies  gain  control  of  it — the  fact  remains 
tliat  by  the  time  middle  class  American  children  first 
i-each  school,  at  age  5  or  6,  they  are  rcnuirkably  in 
control  of  themselves.  As  a  result,  when  the  violence 
in  such  children  erupts  in  a  psychiatrist's  office  dur- 
ing a  session  of  drawing  or  in  the  midst  of  a  game 
played  by  the  psychiatrist  and  the  child,  it  is  almost 
a  caricature  of  violence — violence  so  safe,  so  exaef- 
ge rated,  so  camouflaged,  and  so  quai-antincd  that  the 
very  word  seems  inai)propriate. 

We  in  psychiatry  are  often  accused  of  seeing  only 
tlie  drab  and  morbid  side  of  luunan  nature.  If  it 
would  be  any  comfort  to  people,  I  suppose  we  could 
easily  make  partial  amends  for  that  morbid  bias  by 
letting  it  be  known  how  overwhelmingly  law-abid- 
ing man  is:  if  he  is  vindictive,  lie  is  likely  to  be  so 
toward  himself.  Psychiatrists  spend  most  of  their 
time  helping  people  take  a  look  at  violence  removed 
enough  from  their  own  recognition  to  be,  in  efl'ect, 
somebody  else's  property.  If  in  time  the  patient, 
whether  child  or  adult,  owns  up  to  what  he  sccretlj' 
or  temporarily  senses,  he  will  be  in  greater,  not  less, 
control  of  himself.  Thus,  I  remember  treating  a 
10-year-old  boy  wlio  drew  wild  and  vicious  scenes, 
filled  with  fire  and  death  or  at  least  an  injury  or  two. 
"\^'ll('n  I  wanlcil  to  know  about  wliat  was  going  on,  he 


101 


let  me  know  the  score  rather  quickly  by  pointing  to 
the  people  in  his  pictures  and  saying,  "I  don't  Imow, 
you'd  have  to  ask  them." 

A  different  "ball  same" 

Not  everyone  in  America  is  brought  up  to  diso^\n 
violence  so  consistently  that  its  vei-y  presence  in  his 
own  drawings  can  be  adroitly  (that  is,  innocently) 
denied.  In  the  past  few  years,  as  I  have  worked  with 
children  in  both  southern  mral  slums  and  northern 
"ghettos,"  I  have  come  to  appreciate  how  useless  it 
is  to  think  of,  or  judge,  the  growth  and  development 
of  the  children  of  the  depressed  poor  in  the  same  way 
I  ordinarily  view  the  development  of  middle  class 
children.  It  is,  as  one  boy  in  a  Boston  ghetto  re- 
cently reminded  me,  "a  different  ball  game  when 
you're  out  in  left  lield,  instead  of  in  there  pitching." 

If  we  consider  what  a  child  of  the  slums  goes 
through,  from  birth  on,  and  if  we  keep  a  special  eye 
on  what  in  his  experience  may  make  him  "violent"' 
even  at  the  age  of  7  or  8,  we  may  well  gain,  rather 
than  lose,  respect  for  the  upbringing  he  receives. 
In  fact,  I  have  seen  how  much  childbearmg  means 
to  poor  women :  it  is  the  one  thing  they  can  do,  and  do 
creatively.  It  is  the  one  chance  they  have  to  show 
both  themselves  and  others  that  there  is  hope  in  this 
■world,  as  well  as  the  next. 

By  pointing  this  out,  I  am  not  arguing  against 
keeping  families  to  a  sensible  size,  nor  overlooking 
the  impulsive,  dreary  backgi'ound  that  is  also 
commonly  associated  with  pregnancies  among  tlie 
poor,  whether  in  or  out  of  wedlock.  I  am  simply 
saying  to  others  what  a  mother  once  felt  slie  had  to 
let  me  know : 

They  all  tell  us  to  cut  down  on  the  kids,  cut  down  on  the 
kids,  because  you  can't  keep  up  with  them  as  it  is,  and  even  a 
few  is  too  much  if  you're  on  welfare  for  life,  the  way  we  has 
to  be,  like  it  or  not.  I  tries  to  cut  down,  and  I  want  to,  but  it's 
not  so  easy.  You  have  to  watch  your  step  all  the  time,  and  we 
can't  afford  the  pills  they  have  for  others. 

Anyway,  it's  the  one  time  in  my  life  I  really  feel  like  I'm 
somebody,  like  I'm  doing  something.  People  come  around 
and  expect  me  to  feel  ashamed  of  myself,  like  I've  done  some- 
thing wrong,  and  I'm  adding  to  crime  on  the  streets — that's 
all  you  hear  these  days,  our  crime,  not  anyone  else's — but  in- 
stead, I  feel  proud  of  myself,  like  I  can  at  least  make  a  baby, 
and  maybe  he'll  have  it  better  than  us,  who  knows,  though  I 
doubt  it. 

If  we  want  to  help  this  woman  keep  her  family 
small,  I  hope  we  also  want  to  give  her  what  she  needs 
to  feel  like  the  somebody  she  still  desires  to  be. 

I  know  this  woman's  children,  and  already  I  have 


102 


^ 


seen  them  readying  themselves  for  what  their  mothe 
herself  calls  "the  goddam  street."  Each  one  of  thos 
children  has  been  held  and  breast  fed  in  ways  I  thin) 
some  middle  class  mothers  might  have  cause  to  envj 
The  flat  is  cold  and  rat  infested,  but  there  is  rea 
and  continuing  warmth  between  tliat  mother  and  lie 
l)abies.  ''Symbiotic''  some  of  my  colleagues — wh 
have  a  name  for  everything — might  call  the  relation 
ship  of  that  mother  and  her  children;  it  is  also 
bond  that  unites  the  fearful  and  hungry  against  th 
inevitable  day  when  the  home  has  to  yield  to  th 
outside. 

Preparation  for  the  street 

Slum  children  do  not  go  unprepared  when  tha 
time  comes,  contrary  to  the  assumptions  of  som 
social  critics  who  can  only  see  the  life  of  the  poor  a 
aimless,  neglected,  and  always  "deprived."  Chance 
are  these  childi-en  receive  specific  and  brutal  instruc 
tion  about  the  "realities"  of  life  at  the  age  of  2,  ', 
or  i  so  that  when  they  emerge  from  the  home  th 
police,  the  hoods,  the  addicts,  the  drunks  are  alread 
familiar,  and  what  happens  in  the  schools  or  on  plaj 
grounds  is  not  disappointing  but  expected.  Th 
mother  I  have  already  quoted  has  also  testified  to  th 
morality  and  lawfulness  she  tries  to  inspire  in  he 
children : 

I  don't  know  how  to  do  it.  I  don't  know  how  to  keep  n  I 
kids  from  getting  stained  and  ruined  by  everything  outsid 
1  keep  them  close  to  me,  and  sometimes  I  feel  like  everythir 
will  be  O.K.,  because  they  know  how  much  I  want  for  it  to  b 
and  they'll  go  make  it  be,  the  way  I  thought  I  could.  But  afti 
a  while  they  want  to  go  out.  You  know  how  a  kid  is  whe 
he's  3  or  4,  he  wants  to  more,  no  matter  where,  so  long  as  1 
keeps  going.  And  where  can  he  move  in  here.'  So  I  let  the: 
go,  and  I  stop  and  say  a  prayer  every  morning,  and  ask  f( 
them  to  be  saved,  but  I  have  to  say  it,  I'm  not  expecting  n: 
prayers  to  be  answered,  not  around  here,  I  know. 

And  when  the  kids  come  back  upstairs,  I  give  them  a  loo! 
if  I  have  the  time,  to  see  what's  on  their  face,  and  what  they'\ 
learned  that'll  make  a  mess  of  everything  I  try  to  teach.  An 
I  can  tell — I  can  tell  from  day  to  day  what's  getting  into  then 
You  know  what  it  is.''  It's  the  Devil  and  he  tells  them  to  gi\ 
up,  because  there's  no  other  choice,  not  around  here  thei 
isn't. 

She  is  a  churchgoing  Nvoman,  as  are  many  of  he 
neighbors.  I  ha\e  found  that  she  knows  her  Bibl 
better  than  I  or  my  neighbors,  and  in  fact  she  doubt 
less  puts  more  store  in  proi^hetic,  messianic  Christian 
ity  than  most  Americans  do.  When  her  children  star 
walking  and  talking,  she  starts  teaching  them  rule 
and  fears — enough  of  both  to  satisfy  anyone  who  i 
worried  about  the  decline  of  "moralitv"  in  America 


CHILDREN     •     MAY-JUNE  196!    '^'- 


LtloasI  inlliiil  Ikiiiic,  and  cjiIkts  like  it  1  lia\  c  \isili'(l. 
luldri'ii  arc  nut  allowcti  I'lt'O  n'iiiii.  liistcail  tlicy 
re  tiild  Id  uln'V,  and  llicy  arc  swiftly  slappi'd  nf 
iinriu'd  ir  tlioy  I'altt'r. 

()\i'i- 1  lie  years  I  have  learned  liow  Icjyal  slum  I'am- 
ies  can  he  to  Anieriea's  ethic  of  •'nijjiceil  iiuliviihial- 
iMi."     Chiitlreii  are  taught  throuj>h  tiie  uhiiiuitous 

evisiou  to  seek  after  all  the  proihiet.s  of  our  |ir(iud 
•i'hnolo<i-y :  the  cars  that  can  speed  faster  than  any 
i\v  allows;  the  records  and  clothes  whose  worth  can 
Illy  be  seasonal;  the  bright  and  sliiny  places  to  fre- 
[Uent ;  the  showy.  i;adi;et -filled  places  that  not  only 
helter  peojile  Init  also  make  s'tatements  about,  their 
)o\vi'r,  iiilluciicc,  and  liank  accounts.  At  5  and  6  ycai's 
il<l,  y-hetto  children  in  today's  America  share 
irouiih  television  a  world  quite  similar  to  the  one 
;nowii  liy  tlieii-  wealthy  age-mates.  I  find  it  almost 
lunerxiny-  when  1  see  drawings  from  a  ciiild  not  yet 
hi  enough  to  attend  school  that  show  the  appetites 
ml  yearnings  our  advertiser  are  able  to  arouse, 
•recisely  what  do  such  children  do  with  such  wishes 
nd  fantasies,  besides  spell  them  out  on  paper  for 
>iueone  like  me? 

n  school 

When  a  chihl  of  (i  (ir  7  from  the  glietto  meets  up 
vith  the  politics  of  the  street  or  the  schoolyard,  he 
)rings  along  lioth  the  sensual  and  the  fearfully  moral 
xperience  he  has  had  at  home.  Slum  children  live 
t  close  quarters  to  their  parents  and  their  brothers 
)r  sistei-s.  They  are  often  allowed  to  be  very  nnich 
)n  their  own,  very  free  and  active,  yet  they  are  also 
mnished  with  a  vengeance  when  distracted  or  forlorn 
)arents  suddenly  find  an  issue  forced,  a  confrontation 
nevita])le.  They  face  an  ironic  mixture  of  indul- 
tence  and  fierce  curtailment. 

Such  children  come  to  school  prepared  to  be  active, 
■igorous,  pei'haps  much  more  outgoing  on  an  average 
han  middle  class  children.  But  they  are  quick  to 
ose  patience,  sidk,  feel  wrong  and  wronged  and 
heated  by  a  world  they  have  already  learned  to  be 
mpossible,  uncertain,  and  contradictory.  Here  are 
he  words  of  an  eleinentaiy-school  teacher  who  has 
vorked  in  a  nortliern  ghetto  for  3  years  and  still  feels 
,ble  to  talk  about  the  experience  with  hope  as  well  as 
)ittcr  irony : 

They're  hard  to  take  these  kids,  because  they're  not  what  you 
:hink  when  you  first  come,  but  they're  not  what  you'd  like  for 
hem  to  be  either.  (I  don't  mean  what  I  used  to  like  for  them 
o  be,  but  what  I  want  for  them  now.)  They're  fast  and 
lever,  and  full  of  life.     That  was  the  hardest  thing  for  me  to 

'OLUME  14  -  NUMBER  3 


realize — that  a  boy  or  girl  in  the  ghetto  isn't  a  hopeless  case,  or 
someone  who  is  already  a  delinquent  when  he  comes  into  the 
first  grade.  The  misconceptions  we  have  in  the  suburbs  are 
fantastic,  really,  as  I  thinly  back — and  remember  what  1  used 
to  think  myself. 

I  expected  to  find  children  who  had  given  up,  and  were  on 
the  way  to  fail,  or  to  take  dope,  or  something  like  that.  In- 
stead it  was  in  a  lot  of  ways  a  breath  of  fresh  air,  talking  with 
them  and  teaching  them.  They  were  friendlier,  and  they  got 
along  better  with  one  another.  I  didn't  have  to  spend  half  the 
year  trying  to  encourage  the  children  to  be  less  competitive 
with  one  another.  We  don't  call  middle  class  children 
"culturally  deprived,"  but  sometimes  I  wonder.  They're  so 
nervous  and  worried  about  everything  they  say — what  it  will 
mean,  or  what  it  will  cost  them,  or  how  it  will  be  interpreted. 
That's  what  they've  learned  at  home,  and  that's  why  a  lot  of 
them  are  tense  kids,  and,  even  worse,  stale  kids,  with  frowns 
on  their  faces  at  ages  6  or  7. 

Not  a  lot  of  the  kids  I  teach  now.  They're  lively  and  active, 
so  active  I  don't  know  how  to  keep  up  with  them.  They're 
not  active  learners,  at  least  learners  of  the  knowledge  I'm  try- 
ing to  sell  them,  but  they're  active  and  they  learn  a  lot  about 
the  world,  about  one  another.  In  fact,  one  of  the  big  adjust- 
ments I've  had  to  make  is  realizing  that  these  kids  learn  a  lot 
from  one  another.  They  are  smart  about  things  my  kids  will 
never  understand.  They  just  don't  think  school  is  worth  a 
damn.  To  them  it's  part  of  a  big  outside  world  that  has  a  grip 
on  them,  and  won't  let  them  get  any  place,  no  matter  how 
hard  they  try.  So  what's  the  use,  they  ask  themselves;  and  the 
answer  is  that  there  isn't  any  use — so  they  go  right  on  marking 
time  in  class  until  they  can  get  out. 

We  teachers  then  figure  they're  stupid,  or  they're  hopelessly 
tough  and  "delinquent,"  or  their  homes  are  so  bad  they'll 
always  be  "antisocial"  or  "incorrigible."  I've  found  that  when 
they're  playing  and  don't  know  I'm  looking  they  are  different 
kids — spontaneous,  shrewd,  very  smart,  and  perceptive.  Then 
we  go  back  into  the  classroom,  and  it's  as  though  a  dense  fog 
has  settled  in  on  all  of  us.  They  give  me  a  dazed  look,  or  a 
stubborn,  uncooperative  one,  and  they  just  don't  do  anything, 
unless  forced  to — by  being  pushed  and  shoved  and  made  to 
fear  the  authority  they  know  I  have. 

AVe  have  compared  notes  many  times,  this  teacher 
and  I.  One  child  we  both  know  is  a  boy  of  8  who 
does  very  poor  work  in  school.  He  is  a  belligerent 
child,  a  troublemaker.  I  see  him  in  his  home  because 
his  brother  is  going  to  a  predominantly  white  subur- 


Robert  Coles,  M.D.,  i.s  a  child  iKsycliialrist  on 

till'  research  .slalT  of  the  Harvard  Tnivcrsity 

llcaltli    Services.     He  li;is  sliulicd   iiiisnuH 

farm    children,    Negro    children    who    have 

si)enrheadt'd    .school    desegregation    in    the 

South,  and  children  in  the  North  who  are 

"bu.ssed"    from    urban    slum.s    to   suburban 

school.s.     His  book,  "Children  of  Crisis :  A 

Study  of  Courage  and  Fear,"  is  being  published  this  May 

I  Atlaiitic-T.ittlol'.rown). 


103 


ban  school,  one  of  the  very  few  children  in  the  neigh- 
borhood who  does.  Their  mother,  living  on  public 
assistance  with  six  children  and  no  husband,  has  her 
hands  full.  She  finds  her  "difficult  child"  smarter 
than  her  "model"  one,  the  boy  I  watch  riding  a  bus 
that  takes  him  away  from  the  ghetto. 

The  teacher  and  I  agree,  the  "difficult  boy"  is  a 
smart  boy,  but  an  impatient,  agile,  and  provocative 
boy.  He  is  headed  for  trouble,  but  as  I  talk  with 
him  I  find  myself  in  trouble.  I  have  asked  him  to 
draw  pictures — of  himself,  of  his  school,  of  his  home, 
of  anything  he  wishes.  I  get  from  him  devastat- 
ing portrayals:  schools  that  look  like  jails;  teachei-s 
whose  faces  show  scorn  or  drowsiness;  streets  and 
homes  that  are  as  awful  to  see  on  paper  as  they  are 
in  real  life ;  "outsiders"  whose  power  and  mercenary 
hostility  are  all  too  obvious;  and,  everywhere,  the 
police,  looking  for  trouble,  creating  trouble,  checking 
up,  hauling  people  to  court,  calling  them  names,  get- 
ting ready  to  hurt  them,  assault  them,  jail  them,  and 
beat  them  up — even  if  they  are  children. 

Once  I  asked  the  boy  whether  he  really  thought 
the  police  would  hurt  someone  of  his  age.  He  said : 
"To  the  cops,  everyone  around  here  is  a  little  Ijad 
boy,  no  matter  how  old  he  is  or  how  many  grand- 
children he  has  around." 

At  moments  like  that  my  psychiatric,  categorical 
mind  finds  itself  stunned  and  for  a  change  ready  to 
grant  that  boy  and  others  like  him  freedom  from  the 
various  diagnostic,  explanatoiy,  or  predictive 
schemes  people  like  me  learn  so  well  and  find  to  be 
(in  our  world)  so  useful. 

An  impossible  situation 

I  often  find  welfare  workers  as  well  as  the  jjolice 
present  in  the  pictures  ghetto  children  draw.  They 
stand  near  the  police  like  dogs,  caricatures  of  them- 
selves, with  huge  piercing  eyes,  ears  that  seem  as 
twisted  as  they  are  oversize,  and  mouths  eitlier  notice- 
ably absent  or  j)resent  as  thin  lines  enclosing  promi- 
nent and  decidedly  pointed  and  ragged  teeth.  To 
ghetto  children,  as  to  their  parents,  the  welfare 
worker  is  the  policeman's  handmaiden,  and  together 
they  come,  as  one  child  put  it,  "to  keep  us  in  line,  or 
send  us  away." 

I  have  listened  to  public  welfare  workers  and  their 
"clients"  talk,  and  I  recognize  the  impossible  situa- 
tion they  both  face,  the  worker  often  as  insulted 
as  the  family  he  visits  by  the  rules  and  regulations 
they  must  contend  with — and  find  a  way  around. 


I  often  compare  the  relationship  between  the  worker 
and  their  clients  with  one  that  develops  in  psycho 
therapy  as  for  a  while  powerful  foi-ces  pull  botl 
doctor  and  patient  backward  in  time  toward  thos 
early  years  when  parents  check  up  on  children,  try 
ing  to  keep  them  on  the  right  side  of  a  "line"  tha 
constantly  puzzles  the  child  and  perhaps  also  th 
parent  more  than  she  or  he  realizes. 

One  welfare  worker  recently  summarized  th 
situation  for  me : 

They  behave  like  evasive  kids,  always  trying  to  avoid  gettin, 
caught,  for  this  or  that.  And  me,  I'm  like  a  child  myself,  onl 
an  older  one — always  trying  to  take  care  of  my  poor  brother 
and  sisters,  but  also  trying  to  get  them  in  trouble  or  find  thet 
in  trouble,  so  I  can  squeal  on  them. 

No  wonder  I  encounter  anger,  frustration,  am 
violence  in  ghetto  children.  Everywhere  things  g 
wrong :  the  lights  don't  work ;  the  stairs  are  treacher 
ous;  rats  constantly  apjjear,  and  they  are  not  timid 
uniformed  men  patrol  the  streets,  certain  that  troubl 
will  ajDpear;  teachers  work  in  schools  they  ar 
ashamed  to  call  their  own,  at  work  they  judge  hope 
less,  under  a  bureaucratic  system  that  stifles  then: 
that  is,  if  they  are  still  alive;  jobs  are  few,  and  "wel 
fare"  is  the  essence  of  the  economy. 

Yet — and  I  am  writing  this  article  chiefly  to  sa; 
so — the  ghetto  does  not  kill  its  young  children.  Tha 
perhaps  comes  later,  at  age  12  or  14,  when  idlenes 
becomes  a  way  of  life,  when  jobs  are  nowhere  to  b 
had.  For  a  while,  during  the  first  decade  of  thei 
existence,  ghetto  children  huddle  together,  lean 
about  the  world  they  have  inherited,  and  go  on  t' 
explore  it,  master  its  facts,  accept  its  fate,  and  bun 
from  day  to  day  their  inner  energy  and  life,  abl 
for  a  while  to  ignore  the  alien  outside  world. 

I  find  in  these  children  a  vitality,  an  exuberance 
that  reminds  me  often  of  the  fatally  ill  I  once  treatec 
on  hospital  wards:  for  a  long  time  they  appea 
flushed  with  life,  even  beautiful,  only  to  die. 
remember  hearing  from  a  distinguished  physiciai 
who  supervised  a  few  of  us  who  were  interns 
"They're  fighting  the  battle  of  tuberculosis,  anc 
they're  going  to  lose,  but  not  without  a  brilliani 
flash  of  energy.  It's  a  shame  we  can't  intervene 
right  at  the  critical  moment,  and  help  them  win." 

He,  of  course,  had  the  faith  that  some  day  medi- 
cine would  intervene — with  one  or  another  saving! 
treatment.  Ghetto  people  have  no  such  confidence 
and  I  am  afraid  that  I,  at  least  today,  share  theii 
outlook. 


• 


104 


CHILDREN     •     MAY-JUNE  1967 


UNMARRIED 
MOTHERS  - 


the  service  gap  revisited 


ELIZABETH  HERZOG 


Very  few  flat  and  unchallengeable  state- 
ments can  be  made  about  umnarried  mothers 
and  their  cliildren.  One,  however,  seems 
immune  to  argmiient :  during  the  past  25  years,  the 
number  of  births  out  of  wedlock  has  risen  dramati- 
cally— from  about  89,000  in  1940  to  an  estimated 
291,000  in  1965.  The  "ratio"  (the  proportion  of  all 
live  births  that  are  births  out  of  wedlock)  has  also 
risen.  But  what  we  hear  about  less  often  is  that  the 
ovei-all  "rate''  (the  number  of  births  out  of  wedlock 
per  1,000  unmarried  women  of  childbearing  age)  has 
remained  relatively  constant  since  1957. 

Those  who  are  responsible  for  plamiing  programs 
and  giving  services  must  be  aware  of  mimbers. 
Tliose  who  attempt  to  understand  and  interpret  the 
nature  and  meaning  of  trends  must  be  concerned 
with  rates.  And  a  study  of  rates  tells  us  that,  al- 
though many  factors  enter  in,  the  chief  reason  for  the 
recent  increase  in  numbers  of  out-of-wedlock  births 
is  that  there  are  more  women  of  childbearing  age 
today  than  in  the  past. 

The  reasoning  behind  these  comments  on  numbers, 
ratios,  and  rates  has  been  discussed  elsewhere.^"* 
They  are  made  here  merely  as  background  to  the 
proposition  that  people  concerned  with  helping  im- 
married  mothers  and  their  children  can  aSbrd  to 
relax  their  present  anxious  preoccupation  with  each 
new  set  of  figures  on  out-of-wedlock  births.  "VVe 
know  that  numbers  have  already  outstripped  serv- 
ices. The  demographers  tell  us  that  numbers  will 
probably  continue  to  rise  during  the  years  just  ahead, 
even  if  rates  stand  still  or  dip ;  and  that  this  is  cliiefly 


because  there  will  he  more  women  of  cliildbearing 
age. 

Increasing  numbers  threaten  to  increase  the  gap 
between  services  and  needs  because  practitioners  of 
all  kmds  are  unlikely  to  multiply  as  much  as  out-of- 
wedlock  births.  Moreover,  our  ideas  about  service 
expand  far  faster  than  does  our  manpower  for 
carrying  them  out.  For  the  next  10  years,  then,  no 
new  statistics  are  needed  to  show  that  our  utmost 
efforts  may  reduce,  but  cannot  close,  the  ser\'ice  gap. 

Some  pertinent  questions 

Instead  of  questions  about  trends,  three  other 
questions  seem  more  pertinent  today: 

1.  What  factors  are  associated  with  extramarital 
motherhood  ? 

2.  "Wliat  sei-vices  are  needed  l\y  and  helpful  to  un- 
married mothers  and  their  cliildren? 

3.  What  can  be  done  to  reduce  the  rate  of  out-of- 
wedlock  births? 

Space  permits  only  a  passing  bow  to  two  of  these 
questions  and  a  brief  comment  on  the  third. 

With  regard  to  the  first,  the  salient  point  is  that 
most  of  the  imputed  causes  tend  to  dwindle  when 
other  relevant  variables  are  carefully  controlled. 
The  factors  that  so  far  do  not  apj^ear  to  stand  up 
under  analysis  as  the  major  cause  include  low  intelli- 
gence, broken  homes,  geographical  mobility,  and 
psychological   or  interpersonal    disturbances.     Any 


VOLUME  14  -  NUMBER  3 


105 


of  these  factors  may  be  involved  in  specific  instances, 
but  none  can  be  held  mainly  accountable  for  the 
problem. 

A  factor  that  so  far  does  seem  to  stand  up  against 
challenge,  not  as  the  cause  of  umnarried  motherhood 
but  as  a  major  factor  associated  with  it,  is  economic 
status.  When  statistics  are  analyzed,  economic 
status  apjjears  to  account  for  a  good  deal  of  the 
higher  incidence  of  out-of-wedlock  births  among 
nonwhite  mothers  than  among  white  mothers  in  tliis 
country.  Althougli  a  substantial  proportion  of  out- 
of-wedlock  births  is  not  connected  with  poverty  and 
social  disadvantage,  these  factors  do  figure  in  the 
majority  of  cases. 

The  second  pertinent  quastion  about  the  kinds  of 
services  needed  breaks  down  into  a  number  of  sub- 
questions.  Two  of  these  are:  (a)  Do  the  needed 
services  reach  those  they  are  supposed  to  reach? 
(h)   Do  they  help  those  they  do  reach? 

With  regard  to  the  first  subquestion,  the  answer 
for  the  United  States  at  large  is  a  resounding  "No." 
A  rough  but  educated  estimate  is  that  less  than  one- 
third  of  our  umnarried  mothers  receive  sei'vices  from 
social  agencies  near  the  time  of  the  child's  birth,  and 
fewer  still  receive  them  at  other  times. ^'  ^ 

Maternity  homes  in  the  country  at  large,  accord- 
ing to  recent  figures,  are  equipped  to  serve  less  than 
10  percent  of  the  umnarried  mothers.''  True,  some 
maternity  homes  are  making  valiant  and  imaginative 
efforts  to  expand  their  services — for  example,  by 
serving  some  girls  as  outpatients  and  some  in  their 
own  homes  and  by  allowmg  some  to  live  in  the  ma- 
ternity home  and  go  out  daily  to  jobs  in  the  com- 
munity. However,  services  are  far  from  sufficient 
and  those  we  do  have  are  not  distributed  evenly  or 
efficiently.  A  disproportionate  amount  of  social 
services  has  gone  to  those  unmarried  mothers  who 
are  above  the  poverty  line,  who  are  white,  and  who 
are  likely  to  place  their  children  in  adoption. ''^  *  In 
regard  to  health  services  the  picture  is  somewhat 
different  but  also  distressmg.'' 

Strenuous  efforts  are  being  made  to  improve  both 
the  insufficiency  and  the  imbalance  of  services  to  un- 
married mothers,  but  we  have  a  long,  long  way  to  go. 

The  second  subquestion — how  much  are  they 
helped? — is  as  painful  as  the  first  and  much  harder 
to  answer.  We  do  know  that  among  the  immarried 
mothers  reported  as  being  served  at  all,  a  good  many 
receive  somewhat  skimpy  attention.  Eather  than 
dwell  on  the  dark  side,  however,  I  would  like  to  focus 
on  one  aspect  of  the  effort  to  expand  and  improve 
services  simultaneously.     This  is  what  appears  to  be 

106 


an  increasing  determination  to  conquer  the  fragmen- 
tation from  which  services  to  innnarried  mothers 
have  suffered  and  to  achieve  service  programs  that 
are  really  comprehensive. 

Tlie  reports  of  research  and  demonstration  proj- 
ects reviewed  at  the  Children's  Bureau,  interim  re- 
ports of  projects  still  under  way,  and  the  applica 
tions  received  for  support  of  new  projects,  as  well 
as  discussions  by  people  who  work  with  unmarried 
mothers,  reflect  a  conviction  that  fragmentation  of 
services  should  be  combatted  and  that  more  compre 
hensive  services  should  be  developed.  The  effort  is 
to  coordinate,  combine,  integrate;  to  develop  prO' 
grams  that  bring  together  health,  social,  legal,  eco- 
nomic, and,  where  appropriate,  educational  and  vo- 
cational services  into  one  integrated  program.  Many 
l^eople  believe  that  such  integration  will  both  expand 
and  improve  services  and,  by  reducing  duplication, 
will  do  so  at  less  cost  than  would  be  required  by 
separate  services. 

The  patterns  and  the  sponsorship  of  attempts  at 
such  integration  vary,  but  the  impulse  toward  it  is 
strong  and  prevalent. 

A  few  years  ago,  with  the  help  of  Rose  Bernstein, 
the  Children's  Bureau  midertook  a  systematic  review 
of  reiDorts  published  before  1963  of  research  and 
demonstration  projects  concerned  with  unmarried 
mothers,  including  many  community  programs  foi 
extending  and  coordinating  services.  The  follow- 
ing impressions,  growing  out  of  these  and  latei 
projects,  draw  heavily  on  Mrs.  Bernstein's  analysis 

Comprehensive  services 

The  efforts  to  develop  comprehensive  programs 
have  been  directed  primarily  toward  three  groups 
of  unmarried  mothei-s :  ( 1 )  those  who  become  laiown 
to  hospitals  and  social  agencies  "too  late"  or  not  at 
all;  (2)  those  who  do  not  come  into  the  purview  of 
community  medical  and  social  agencies,  making  their 
medical  plans  privately  and  making  independent 
arrangements  for  adoptive  placements;  (3)  those 
who  have  need  of  special  \\q\\)  to  continue  in  school 
or  to  develojD  vocational  skills. 

One  major  value  mentioned  in  nearly  every  report 
of  efforts  to  coordinate  services  is  the  gain  in  inter- 
professional information  and  understanding.  The 
various  professions  and  discii^lines  learn  about  the 
functions,  methods,  and  goals  of  others.  They  are 
amazed  at  what  they  did  not  know  about  others  and 
what  others  did  not  know  about  them.  Among  the 
professional  groups  specifically  mentioned  in  the  re- 


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CHILDREN 


MAY-JUNE  1967 


port  of  ouo  of  the  largest,  most  eiuluring,  and  luo.st 
care  fully  documented  projects  were  social  workers, 
doclors,  liosi)ital  nurses,  public  health  nurses,  law- 
yers, I'lergynien,  school  ollicials  and  teachers,  and 
policewomen. 

Other  reports  also  note  that  social  agency  staff 
menihcrs  and  hospital  nurses  become  acquainted  with 
the  varied  and  effective  assistance  offered  by  the  pub- 
lic health  nursi's,  that  doctors  learn  more  about  social 
workiu's  and  what  they  do.  Aii  obstetrician  exclaims 
with  pleasure  that  it  is  a  boon  to  know,  before  a  girl 
is  actually  sitting  in  his  office,  what  the  community's 
social  agency  resources  are,  what  the  State  has  to 
offer  outside  of  the  community,  and  what  legal  regu- 
lations he  nuist  be  aware  of  in  advising  her  about 
where  to  go.  A  social  worker  says,  "I  didn't  realize 
how  nuich  the  schoolteachers  can  help  us!" 

A  corollary  to  increased  information  is  likely  to 
be  closer  and  more  effective  working  relations. 

Closely  related  to  increased  information  and  more 
effective  working  relations  in  the  reports  reviewed 
are  improvements  in  practices  and  policies  for  seeing 
that  unmarried  mothers  get  the  services  they  need : 
the  use  of  referral  services:  an  increase  in  referrals 
from  agencies  and  indi\idual  professional  people 
(doctors,  lawyers,  clergymen,  school  personnel,  and 
others)  ;  and  greater  followthrough  in  an  effort  to 
make  sure  that  the  referral  results  in  an  active 
contact. 

Except  in  relation  to  a  few  continuing  projects, 
it  is  not  clear  how  long  these  effects  last  since  fol- 
lowup  reports  on  the  projects  are  rare.  Apparently, 
extended  duration  depends  on  continued  efforts,  and 
m  many  cases  lack  of  staff,  funds,  and  community 
support  have  resulted  in  a  drifting  back  to  the 
predemonstration  status. 

That  understanding  and  cooperation  between  pro- 
fessions and  disciplines  are  necessary  to  coordinate 
services  goes  without  saying.  The  remarkable  find- 
ing was  that  in  so  many  communities  it  took  a  special 


Elizabeth  Herzog  is  chief  of  the  child  life 
Studies  branch,  division  of  research,  Chil- 
dren's Bureau.  Before  coming  to  the 
Bureau  in  19i54,  she  was  director  of  research 
for  the  Jewish  Family  Service,  New  York. 
In  various  books  and  articles  she  has  written 
both  on  anthropological  subjects  and  on 
pniblenis  and  research  needs  in  the  social 
welfare  field. 

VOLUME  14  -  NUMBER  3 


project  with  outside  funding  to  achieve  this  desirable 
result.  It  reminds  me  of  my  f  resliman  Latin  teacher 
in  high  school  who  had  to  teach  us  English  grammar 
before  he  could  teach  us  any  Latin,  because  we  had 
not  learned  about  grammar  in  the  elementary  grades. 
By  the  end  of  the  year,  we  did  not  know  nuich  Latin 
but  we  did  know  a  little  granniuir. 

The  projects  reviewed  were  completed  several 
years  ago,  and  it  may  l)e  that  by  now  the  professions 
know  more  "granmiar."  Certainly  efforts  in  this 
direction  have  been  made,  including  some  by  the 
Children's  Bureau  in  cooperation  with  the  medical 
and  legal  profes.gions.'"' "  Last  spring  the  Ameri- 
can College  of  Obstetrics  and  Gynecology  devoted 
a  session  at  its  annual  meeting  to  an  interprofessional 
discussion  of  unmarried  mothers  and  their  problems. 
Various  other  efforts  to  approach  tliese  problems 
interi^rofessionally  are  under  way.  One  can  only 
hope  they  will  continue  and  will  increase. 

Some  problems 

Certain  problems  are  repeatedly  mentioned  in  the 
reports.  One  derives  from  suc(;ess:  greater  efforts 
to  bring  umuarried  mothers  into  service  frequently 
succeed,  and  immediately  the  available  facilities 
become  overloaded.  Few  i^rogram  planners  seem  to 
recognize  the  need  to  be  prepared  for  n:iore  applicants 
if  one  launches  a  campaign  to  get  them,  and  even 
fewer  arrange  to  meet  the  response  by  enlarging  the 
staff. 

One  result  of  suddenly  increased  caseloads  can 
be  the  shutting  down  of  intake.  In  one  urban  dem- 
onstration i^roject,  the  pressure  made  it  necessarj' 
to  give  service  in  a  much  larger  number  of  cases  than 
had  been  expected  and  therefore  to  limit  it  in  many 
cases  to  brief  contacts.  These  brief  contacts  tended 
to  be  in  the  poorest  part  of  the  city,  where  most  of 
the  women  were  Negroes.  Pressure  of  caseload 
steered  a  large  proj^ortion  of  these  unmarried 
mothers  to  an  agency  that  already  knew  them,  the 
public  welfare  agency — where  they  tended  to  get 
oialy  the  services  they  had  received  before,  namely, 
financial  assistance  as  indicated. 

This  particular  report  was  completed  before  the 
1962  amendments  to  the  Social  Security  Act,  which 
stress  service  in  public  welfare  programs,  could 
have  an  effect.  Some  of  the  imbalance  in  services 
is  now  being  corrected  through  the  effects  of  these 
anK'udments  and  subsequent  developments.  But  the 
])r()l)li'm  of  too  few  services  for  too  many  people 
will  be  with  us  for  a  long  time. 


107 


The  most  pervasive  and  massive  problem  is 
demonstrated  more  often  than  stated  in  the  reports : 
the  administrative  and  personal  difficulties  of 
carrying  out  a  determination  to  coordinate  or  inte- 
grate services.  The  need  for  centralized  leadership 
is  evident  again  and  again,  as  is  the  fact  that  this 
kind  of  leadership  is  not  always  welcomed  or  ac- 
cepted. Some  projects  apparently  succeed  in  work- 
ing out  ways  of  integrating  health  and  welfare  and 
other  services.  Often,  liowever,  the  problems  are 
not  fully  solved  and  not  fully  faced.  One  hears  by 
the  grapevine  of  foot  dragging  by  one  department 
in  a  pi'ogram  set  up  under  another's  ausj^ices. 

For  example,  a  project  set  up  under  a  local  de- 
partment of  healtli  for  helping  pregnant  unmarried 
teenaee  o-irls  continue  their  schoolwork  found  that 
the  education  department  assigned  to  the  project  its 
least  qualified  teachers.  Only  after  prolonged  effort 
was  a  better  teaching  stall'  mustered.  Another 
project,  set  up  under  a  local  education  department, 
traveled  an  unnecessarily  thorny  path  to  building  in 
the  desired  social  services.  Occ;isionally,  also,  one 
hears  of  jurisdictional  difficulties  between  two  social 
agencies  or  two  sources  of  health  services,  even 
though  the  final  report  presents  a  rosy,  harmonious 
picture. 

Even  without  interagency  friction,  a  client  some- 
times falls  between  two  agencies.  In  one  study 
agency  A  had  repeatedly  reported  that  agency  B 
was  active  in  a  case,  but  ultimately  the  investigator 
learned  that  agency  B  was  not  actively  involved. 

Paths  to  coordination 

This  does  not  mean  to  imply  thajt  collaboration  is  a 
poor  idea,  but  rather  that  if  the  value  is  to  be  tested 
and  the  benefits  reaped  collaboration  must  really 
exist.  It  also  means  that  the  problems  of  coordina- 
tion and  collaboration  must  be  recognized  and  faced 
sooner  and  more  clearly  than  often  happens. 

To  combine,  to  coordinate,  or  to  integrate  pro- 
grams involves  different  kinds  of  processes.  Thei'e 
are  those  who  believe,  with  Alfred  Kahn,  that  only 
a  comprehensive  and  integrated  network  of  services 
will  meet  tlie  needs,  and  that  this  cannot  be  achieved 
by  putting  together  a  patchwork  of  already  existing 
activities.^^  However  this  may  be,  in  the  immediate 
present  many  commimities  find  it  more  feasible  to 
attempt  a  welding  of  agencies  and  services  already 
existing  than  to  reorganize  them  entirely  into  a  new 
multipurpose,  multiservice  organization.  I  have  no 
piTscription  for  success  in  such  efforts.     Each  com- 


108 


munity  that  attempts  to  coordinate  services  will  have 
to  solve  these  problems  in  its  own  way  according  to 
its  own  circumstances. 

A  number  of  projects  aimed  at  coordinating  serv- 
ices have  produced  gratifying  results,  sometimes  by 
coming  to  a  workable  acbninistrative  arrangement 
through  trial  and  error.  But  a  number  have 
foundered  through  failing  to  establish  a  workable 
administrative  setup  in  advance.  The  habit  of  em 
phasizing  the  positive  in  i-eports  robs  initiators  of 
new  programs  of  the  opportunity  to  benefit  as  fully 
as  they  might  from  the  lessons  learned  by  others. 

Some  essentials 

Three  points  especially  have  been  brought  home 
to  me  in  reviewing  project  reports  and  proposals: 

1.  Although  it  may  be  desirable  for  some  com- 
munities to  set  up  new,  multiservice  programs,  for 
others  it  will  be  more  realistic  to  build  on  existing 
resources  than  to  try  to  create  a  large,  new  network 
of  services  with  an  independent  structure.  A  chal- 
lenging imperative  for  the  latter  is  to  facilitate  in- 
novation within  existing  agencies  and  organizations, 
to  open  up  invnting  and  feasible  pathways  to  change. 

2.  Some  kind  of  centralized  administrative  au- 
tliority  is  essential.  One  of  several  possible  ways  to 
achieve  this  would  be  by  an  administrative  agent — 
a  director  general — operating  outside  any  constituent 
agency.  That  is,  rather  than  selecting  one  of  the 
cooperating  agencies  or  departments  to  exercise  final 
administrative  authority,  the  cooperating  group 
would  designate  a  person  to  coordinate  the  activities 
of  all.  This  person  would  need  both  program  experi- 
ence and  administrative  know-how.  The  experience 
might  have  been  gained  in  one  or  more  of  the  coop- 
erating organizations,  but  for  the  duration  of  his 
appointment  he  would  be  outside  any  constituent 
agency. 

One  would  hope  this  director  general  would  not 
be  an  evangelist  of  any  single  administrative  faith, 
be  it  group  dynamics,  management  counseling,  or 
Yoga,  but  would  have  some  familiarity  with  the 
relevant  principles  that  have  been  found  useful  in 
welding  together  diverse  disciplines  and  people — • 
drawing  these  principles  from  any  field  and  any 
experience  that  have  developed  them. 

3.  Whatever  administrative  plan  is  set  up  must  be 
worked  out  very  carefully  in  advance,  with  realistic 
recognition  of  the  kinds  of  problems  that  are  inevita- 

CHILDREN     •     MAY-JUNE  1967 


jlo  ill  8iu'li  an  uiulcrtaking.  Wliat  ami  how  serious 
hese  problems  are  probably  cannot  be  learned  fioni 
he  printed  pasje.  Fnll  anticipation  can  come  partly 
:rom  experience  and  partly  from  picking  the  brains 
)f  people  who  have  struggled  with  them.  Someone 
;ould  render  a  real  service  by  systematically  inter- 
iewing  people  who  have  been  on  the  administrative 
nd  and  those  who  have  been  on  the  practice  end 
}f  ])rograms  designed  to  offer  comprehensive 
services  to  mimarried  mothers,  as  well  as  people  wlio 
lave  been  involved  in  other  types  of  compi-ehensive 
services. 

Continuins  services 

Another  impression  left  by  our  review  was  that, 
for  the  most  part,  services  designed  for  "unmarried 
mothers"'  end  when  the  women  they  serve  become  in 
fact  uiunarried  mothers — that  is,  at  or  shortly  after 
delivery.  A  few  demonstration  programs — an  in- 
creasing number  fortunately — do  offer  help  to  such 
women  in  taking  on  the  role  of  a  mother,  in  learn- 
ing to  manage  a  household,  and,  if  necessary,  in  earn- 
ing an  income.  But,  for  the  most  part,  services  still 
focus  on  the  jarenatal  and  immediate  postnatal 
period. 

If  services  are  to  be  truly  comprehensive,  they  will 
have  to  serve  unmarried  mothers  for  several  years 
after  they  actually  become  mothers. 

It  would  not  be  feasible  or  sensible  to  try  to  trans- 
plant the  Scandinavian  pattern  of  service  into  this 
country.  Yet  in  developing  a  system  more  satisfac- 
tory than  the  one  we  have — if,  indeed,  it  could  be 
called  a  system — we  might  profit  from  the  Scandina- 
vian experience.  In  Denmark,  for  example,  an  un- 
married mother  is  given  help  in  finding  adequate  liv- 
ing quarters,  day  care  for  her  child,  and  education  or 
vocational  training  for  herself,  sometimes  for  several 
years.  According  to  reports  more  than  90  percent  of 
the  mothers  so  helped  eventually  marry  and,  pre- 
sumably, establish  stable  homes."  The  rates  of 
births  out  of  wedlock  in  Denmark  are  reported  to 
have  decreased  in  recent  years.  Without  assuming 
a  cause-and-eft'ect  relationship,  one  can  still  say  that 
apparently  the  kind  of  help  that  opens  up  a  vista 
of  stable  family  life  and  economic  independence  does 
not  increase  such  rates. 

Because  of  the  often-expressed  fear  that  effective 
help  for  unmarried  mothers  might  encourage  biiths 
out  of  wedlock,  it  should  be  recognized  that  in  this 
counti-y  also  the  scant  evidence  we  have  is  all  in  the 
other  direction.     We  have  supplied  ourselves  over  the 

VOLUME  14  -  NUMBER  3 


years  with  plenty  of  evidence  that  witiiholding  serv- 
ices and  supirort  does  not  decrease  such  births.  And 
the  few  relevant  studies  available  show  tliat  giving 
services  and  support  does  not  increase  them.  Births 
out  of  weillock  do  appear  to  be  increased,  however, 
by  programs  that  put  a  premium  on  fatherless  homes 
by  refusing  aid  to  families  containing  an  able-bodied 
man,  regardless  of  his  ability  to  support. 

And  what  of  prevention? 

That  last  comment  heads  directly  into  the  ques- 
tion I  said  I  would  skip:  the  question  of  prevention. 
And  I  will  skip  it,  too,  after  explaining  why. 

We  need  to  differentiate  sharply  between  serving 
[)eople  who  have  problems  and  forestalling  the  prob- 
lems. Service  agendas  sliould  be  able  as  well  as 
eager  to  help  those  who  have  become  pregnant  out 
of  wedlock  and  to  help  their  children  much  more 
than  at  present.  Possibly  they  can  also  reduce 
somewhat  the  frequency  of  repeated  out-of-wedlock 
pregnancies.  Some  promising  efforts  in  the  latter 
direction  are  projects  for  helping  teenage  unmarried 
mothers  to  complete  their  high  school  education,  for 
example,  in  Chicago,  Detroit,  and  the  District  of 
Columbia."' " 

Educational  and  vocational  competence  cannot  be 
guaranteed  to  reduce  "recidivism,"  but  lack  of  these 
achievements  can  be  almost  guaranteed  to  promote  it. 
Nevertheless,  according  to  some  very  convincing 
analyses,  out-of-wedlock  pregnancy  is  largely  the  re- 
sult of  social  and  economic  forces  that  service  agencies 
cannot  be  expected  to  control  or  even  to  modify 
greatly. 

Many  people  were  disturbed  by  the  study  report, 
"Girls  at  Vocational  High,"  ''^  which  concluded  that 
social  casework  services  did  not  substantially  reduce 
school  dropout,  out-of-wedlock  pregnancy,  and  other 
symptoms  of  undesired  behavior  among  the  girls  who 
received  the  services.  But  how  can  we  expect  in- 
di\idual  or  group  counseling  to  coimteract  the  tre- 
mendous weight  of  social  and  economic  deprivations 
burdenmg  these  particular  girls?  When  young  peo- 
ple have  been  as  deprived  as  were  those  who  pre- 
dominated in  the  study  group,  perhaps  the  desired 
results  can  be  hoped  for  only  after  a  couple  of  genera- 
tions have  been  reared  with  adequate  employment 
opportunity,  adequate  social  respect,  and  adequate 
self-esteem. 

But  even  then,  years  of  social  and  economic  re- 
habilitation might  only  open  the  way  for  response  to 
the  influences  that  affect  a  very  different  group  of 

109 


unmarried  mothers — the  white  and  nonpoor,  among 
whom  rates  may  have  risen  faster  in  recent  years 
than  among  the  first  group.  With  regard  to  the  so- 
cially advantaged,  a  dili'erent  set  of  social  forces  ap- 
pear to  be  operating. 

To  discuss  prevention  of  unmarried  parenthood 
at  this  time,  one  would  have  to  discuss  our  economy, 
including  the  consequences  of  poverty  for  the  poor 
and  the  consequences  of  affluence  for  the  rest  of  us. 
One  would  also  have  to  discuss  the  values  we  talk 
about  and  the  values  we  live  by,  the  discrepancies 
between  them,  and  the  impact  on  youth  of  those  dis- 
crepancies. One  would  have  to  discuss  the  effects  of 
social  and  economic  discrimination  on  Negro  men, 
women,  children,  and  families.  One  would  have  to 
discuss  the  effects  of  affluence,  our  current  life  tempo, 
and  the  status-success-money-popularity  complex  on 
all  our  young  people. 

It  is  appropriate  to  discuss  all  these  subjects  and 
a  number  of  related  ones.  But  it  is  not  appropriate 
to  hold  our  helping  services  accountable — or  for  them 
to  hold  themselves  accountable — for  changing  the 
values  and  behavior  patterns  that  our  society  has 
fostered  and  continues  to  tolerate. 

With  regard  to  prevention,  I  should  add  that 
whether  dissemination  of  information  and  resources 
for  family  planning  will  perceptibly  affect  illegiti- 
macy rates  in  the  near  future  is  a  question  not  easily 
or  categorically  answered,  even  by  demographic  ex- 
perts. However,  there  is  strong  consensus  among  its 
advocates  that  the  encouragement  of  family  plan- 
ning is  likely  to  enhance  the  quality  of  family  life 
and  therefore  to  be  beneficial  to  all  family  members, 
married  or  unmarried. 

In  summary 

I  have  been  trying  to  establish  several  points,  the 
chief  of  Avhich  are: 

1.  The  increase  in  births  out  of  wedlock  has  oc- 
curred chiefly  because  there  are  more  people  and  not 
because  the  likelihood  has  increased  that  an  unmar- 
ried woman  will  bear  a  child  out  of  wedlock. 

2.  Even  if  illegitimacy  rates  remain  constant,  or 
even  if  they  decrease  somewhat,  the  numbers  can  be 
expected  to  continue  rising. 

3.  To  the  extent  that  increase  in  numbers  exceeds 
increase  in  services,  the  longstanding  service  gap 
widens ;  and  it  also  widens  as  our  ideas  broaden  about 


the  kinds  of  services  that  should  be  available  to  unf 
married  mothers  and  their  children. 

4.  Efforts  to  coordinate  and  integrate  differen 
kinds  of  services  represent  a  promising  trend. 

5.  Such  efforts  have  the  best  chance  of  success  i 
they  are  preceded  by  concerted,  extended,  and  realis 
tic  plannmg  that  takes  account  of  the  human  an( 
organizational  problems  involved  in  fusing  the  activi 
ties  of  separate,  autonomous  disciplines  and  organi 
zations,  and  builds  on  the  experience  of  others  ii 
similar  undertakings. 


^  Campbell,  Arthur  A.:  Illegitimacy.  In  Trends  and  variations  i 
fertility  in  the  United  States.  (Clyde  V.  Kiser,  Wilson  Grabill,  an 
Arthur  A.  Campbell.)  Harvard  University  Press,  Cambridge,  Mas 
1967. 

^  Herzog,  Elizabeth:  The  chronic  revolution:  births  out  of  wedlocl 
Clinical  Pediatrics,  February  1966. 

'  Department  of  Health,  Education,  and  Welfare,  Public  Health  Ser\ 
ice.  National  Center  for  Health  Statistics:  Monthly  vital  statistics  repor 
highlights,  June  H,  1966. 

'Vincent,  Clark  E.:  Unmarried  mothers.  The  Free  Press  of  Glencoi 
New  York.     1961. 

^  Adams,  Hannah  M.:  Social  services  for  unmarried  mothers  an 
their  children  provided  through  public  and  voluntary  child  welfai 
agencies.  Department  of  Health,  Education,  and  Welfare,  Social  Secui 
ity  Administration,  Children's  Bureau.  Child  Welfare  Report  No.  K 
1962. 

"Winston,  Ellen:  Unmarried  parents  and  Federal  programs  of  assis' 
ance.  Paper  presented  at  the  Northeast  Area  Conference,  Florcnc 
Crittenton  Association  of  America,  Washington,  D.C.,  Oct.  11,  196(i 
(Mimeographed.) 

^Bernstein,  Rose:  Gaps  in  services  to  unmarried  mothers.  Childrei 
March-April  1963. 

* :    Unmarried    parents    and    their    families.     Child    Welfan 

April   1966. 

°  Herzog,  Elizabeth;  Bernstein,  Rose:  Health  services  for  unmarrie 
mothers.  Department  of  Health,  Education,  and  Welfare,  Welfare  Ad 
ministration.  Children's  Bureau.     CB  Publication  No.  425.     1964. 

'"Gallagher,  Ursula:  Interprofessional  teamwork  to  safeguard  adop 
tion.     Children,  May-June  1959. 

"  .\  guide  for  collaboration  of  physician,  social  worker,  and  lawye 
in  helping  the  unmarried  mother  and  her  child.  Children.  See  p.  1 1 
of  this  issue. 

"^  Kahn,  Alfred  J.:  Unmarried  mothers:  a  social  welfare  planninj 
perspecUve.  Unpublished  paper  presented  at  the  Northeastern  Are. 
Conference,  Florence  Crittenton  Association  of  America,  Inc.,  Boston 
Mass.,  Oct.  19,  1964. 

"Gallagher,  Ursula:  School  age  pregnancies:  a  view  from  Washingtoi 
of  a  program  of  prevention  and  care.  Department  of  Health,  Educa 
tion,  and  Welfare,  Welfare  Administration,  Children's  Bureau.     1966 

"Wright,  Mattie  K.:  Comprehensive  services  for  adolescent  unwec 
mothers.     Children,  September-October  1966. 

'^  Meyer,  Henry  J.;  Borgatta,  Edgar  F.;  Jones,  Wyatt:  Girls  at  voca- 
tional high:  an  experiment  in  social  work  intervention.  Russell  Sag( 
Foundation,  New  'York.     1965. 


I 


110 


CHILDREN 


MAY-JUNE  1967 


a  guide  For 
collaboration  of 

PHYSICIAN, 

SOCIAL  WORKER, 

and  LAWYER 

in  helping  the 

UNMARRIED  MOTHER 
and  HER  CHILD 


^^  The  need  for  close  coopex'ation  between  the 
^^  physician,  the  social  worker,  and  the  lawyer 
m  the  care  of  the  unmarried  mother  should 
)e  universally  recognized.  Each  of  these  three  is 
esponsible  for  advising  the  unmarried  mother  of 
;he  need  for  consultation  in  her  case  with  the  other 
.wo  disciplines  involved,  because  each  has  a  special 
ield  of  competence.  Wliile  recognizing  that  in  some 
urisdictions  individuals,  as  such,  may  place  or  otlier- 
-vise  facilitate  the  adoption  of  minors,  it  should  be 
emphasized,  nonetheless,  that  pliysicians,  social  work- 
srs,  and  lawyers,  individually  or  jointly,  when  acting 
IS  individuals  and  not  in  cooperation  with  a  qualified 
;hild  placement  agency,  do  not  have  the  facilities 
md  resources  necessary  to  provide  protection  and 
lervices  needed  by  all  persons  affected  by  the  adop- 
ion.  To  further  this  cooperation,  the  areas  in  which 
he  primary  responsibilities  and  those  in  which  the 
'unction  of  the  three  disciplines  overlap  must  be 
lelineated. 

The  physician  is  held  responsible  for  the  physical 
md  mental  health  of  the  pat  lent.     It  is  the  physician 


I'hysicians,  mkiuI  workers,  and  lawyers  are  the 
professional  persons  who  in  their  practice  most 
frequently  encounter  unmarried  mothers.  Where 
does  the  responsibility  of  each  begin  and  end  and 
how  can  they  most  fruitfully  work  together  to  best 
serve  the  needs  of  the  unmarried  mother  and  her 
child.' 

For  the  past  5  years  the  organizations  that  repre- 
sent these  professions,  led  by  the  American  College 
of  Obstetricians  and  Gynecologists,  have  been  work- 
ing with  the  Children's  Bureau  and  the  Child  Welfare 
League  of  America  to  formulate  an  answer  to  this 
question.  The  resulting  statement,  presented  here, 
was  completed  in  the  summer  of  1966  and  by  the  end 
of  the  year  had  been  officially  approved  by  the  fol- 
lowing organizations: 

The    American    College    of    Obstetricians    and 
Gynecologists 

The  American  Academy  of  Pediatrics 

The  American  Medical  Association 

The  American  Bar  Association,  Section  of  Family 
Law 

The  Child  Welfare  League  of  America 

The  Children's  Bureau. 


who  must  make  the  diagnosis  of  pregnancy,  deter- 
mine the  expected  date  of  delivery,  and  decide  where 
the  delivery  should  take  place.  Among  other  tilings 
he  must  decide  how  much  information  the  patient 
should  be  given  on  the  physiology  and  pathology  of 
pregnancy,  labor,  and  the  puerperium.  His  decision 
on  whether  to  advise  the  patient  to  nurse  the  baby 
(if  she  decides  to  keep  him)  will  rest  on  emotional  as 
well  as  physical  factors. 

He  must  safeguard  the  confidentiality  of  the  m- 
formation  the  patient  discloses  except  as  provided 
by  the  laws  of  his  State.  Kecognizing  the  limita- 
tions placed  on  a  minor,  he  must  be  certain  of  the 
validity  of  the  consent  the  i^atient  gives  for  any  dis- 
closures, treatment,  or  procedure.  If  social  services 
are  available,  the  physician  should  avoid  becoming 
involved  with  the  placement  of  the  infant  or  acting 
as  an  intermediary. 

The  responsibility  of  the  social  worker  includes 
helping  the  unmarried  mother  with  the  distinctive 
social  and  emotional  problems  connected  with  having 
a  child  out  of  wedlock.  To  tliis  end,  the  social  work- 
er draws  upon  the  experience  of  social  agencies  in 
working  with  unmarried  mothers,  upon  familiarity 
with  comnumity  resources,  and  upon  social  and 
psychological  diagnostic  skills  in  determining  what 
help  a  particular  client  needs  and  can  use.     Among 


VOLUME  14  -  NUMBER  3 


111 


other  things,  this  iiivoh'es  referring  the  patient  for 
early  and  competent  obstetrical  examination,  em- 
phasizing the  need  for  continued  antepartal  and  post- 
partal  care,  i-einforcing  the  medical  care  by  strength- 
ening the  faith  of  the  patient  in  the  doctor,  and, 
where  possible  or  necessary,  implementing  his 
recommendations. 

The  social  worker  counsels  the  patient  on  plans  for 
her  future  and  that  of  the  infant,  always  safeguard- 
ing the  best  interests  of  the  child.  The  social  worker 
provides  psychological  help  and  support  comple- 
menting that  given  by  the  doctor.  The  social  worker 
recognizes  and  supports  the  legal  obligations  of  the 
doctor  as  to  the  results  of  treatment  or  advice,  includ- 
ing professional  disclosures  and  the  peculiar  prob- 
lems of  a  minor. 

The  social  worker  counsels  the  unmarried  mother 
in  the  various  social  aspects  involved  and  recom- 
mends that  she  consult  a  lawyer  for  advice  on  the 
legal  aspects  as  needed  in  the  individual  situation. 

The  lawyer  for  the  unmarried  mother  is  respon- 
sible for  counseling  her  regarding  the  legal  conse- 
quences of  keeping  or  of  giving  up  her  child  and  of  her 
legal  rights  in  respect  to  the  putati^-e  father.  If  she 
releases  the  child  for  adoiDtion,  he  must  be  sure  that 
all  legal  requirements  are  met.  He  should  not  repre- 
sent the  prospective  adoptive  jiarents.  If  social 
services  are  available,  the  lawj'er  should  avoid  be- 
coming involved  with  the  placement  of  the  infant  or 
acting  as  an  intermediary. 

All  three  disciplines  recognize  the  right  of  the 
unmarried  mother  to  make  decisions  for  herself  and 
her  child  excejDt  where  such  rights  are  involuntarily 
terminated  by  court  action.  Likewise,  all  three  rec- 
ognize that  each  must  give  advice  and  guidance  to 
lier.  Wliether  giving  advice  is  limited  to  mere  clari- 
fication of  the  alternatives  between  which  the  client 
must  choose  or  extends  to  a  firm  recommendation 
for  the  course  of  action  the  patient  shoidd  take,  the 
collective  counseling,  like  parental  guidance,  must 
be  harmonious  lest  the  unmarried  mother  become 
confused.  Differences  of  opinion  which  may  arise  as 
to  the  advice  to  be  given  should  be  resolved  by  prior 
conferences. 

Broad  princijDles  have  been  established  through  ex- 
perience in  all  three  professions,  but  philosophies 
vary  in  different  communities  and  change  from  time 
to  time  not  only  within  the  same  community  but  also 
within  the  Nation. 

Furthermore,  each  case  inust  be  individualized. 


112 


particularly  with  reference  to  questions  such  as : 

1.  Shall  the  parent  of  the  patient  or  the  jDutativ 
father  be  told  of  the  pregnancy  ? 

2.  Shall  the  patient  mari-y  the  putative  father? 

3.  Shall  legal  action  be  taken  against  him? 

4.  Wliere  shall  delivery  take  place? 

5.  Shall  the  putative  father  visit  the  patient  bef or 
or  after  delivery  ? 

6.  Shall  he  ever  see  the  baby  ? 

7.  Shall  the  baby  be  photographed  and  the  pi< 
ture  made  available  ? 

8.  Shall  the  patient  be  allowed,  urged,  or  foi 
bidden  to  see  her  child,  put  him  to  breast,  or  care  fc 

him  ? 


9.  Shall  the  patient  have  psychiatric  help;  if  si 
to  whom  shall  she  be  referred  ? 

10.  At  which  point  in  the  j^regnancy  or  puej 
perium  shall  the  decision  be  made  as  to  the  child 
future? 

11.  If  the  decision  is  for  adoption,  how  and  whei 
jiliall  iinal  surrender  of  the  child  be  taken? 

12.  Shall  the  mother  be  told  of  any  deformity  c 
handicap  of  the  child  and,  if  so,  when  and  by  whom 

13.  If  the  matter  of  legal  residence  is  involved  an 
the  possibility  of  nonadoptability,  who  shall  be  r 
sponsible  for  properly  informing  and  counseling  tl 
unmarried  mother  ? 

When  the  doctor,  social  worker,  and  lawyer  ai 
mature,  experienced  individuals,  each  primarily  cor 
cerned  with  working  out  the  complex  problems  i 
any  given  case  for  the  best  interests  of  the  child  ani 
the  unmarried  mother,  each  recognizing  and  respect 
ing  the  responsibilities  and  competence  of  the  othe 
derived  from  professional  training  in  dealing  wit 
the  physical,  mental,  emotional,  social,  and  legp 
factors  involved,  there  rarely  will  be  a  difference  o 
opinion.  If  such  a  difference  does  arise,  one  wliic 
cannot  be  resolved  by  a  conference,  genuine  collaboi 
ation  requires  the  wholehearted  assistance  of  al 
three  in  supporting  the  judgment  of  the  member  ol 
the  discipline  with  primary  resi^onsibility,  namely 
for  the  physical  and  mental  health  of  the  mother  an( 
child,  the  doctor;  for  the  social  and  emotional  wel 
fare  of  the  mother  and  child,  the  social  worker ;  an( 
for  the  legal  protection  of  the  mother  and  the  child' 
the  lawyer. 

CHILDREN     •     MAY-JUNE  196 


• 


Wt. 


SOCIAL  WORK  STUDENTS 


IN  DAY-CARE  SETTINGS 


THELMA  GOLDBERG 

As  day  care  is  increasingly  recognized  as  an 
essential  child  welfare  service,  it  seems  timely 
to  examine  the  value  of  day-care  settings  for 
professional  social  work  training.  From  the  experi- 
ence of  a  student  unit  that  has  been  ojierating  for  the 
past  3  yesirs  in  the  Division  of  Day  Care,  New  York 
City  Department  of  Welfare  (under  a  Children's 
Bureau  grant  to  the  New  York  University  Graduate 
School  of  Social  Work),  I  have  been  able  to  formu- 
late some  general  principles  about  this  type  of  field- 
work  placement.  Such  principles  must  be  general  to 
be  useful  to  social  work  educators  planning  fieldwork 
placements  in  day  care,  for  day-care  services  are 
offered  under  many  different  kinds  of  auspices  and 
embedded  in  a  great  variety  of  settings. 

As  the  many  types  of  services  needed  by  culturally 
deprived  preschool  children  are  developed,  the  role  of 
day  care  as  a  preventive  child  welfare  service  be- 
comes clear.  Too  often  child  welfare  services  oper- 
ate "after  the  fact" :  the  family  is  already  separated, 
and  the  focus  is  perforce  on  the  child  away  from  his 
natural  family.  Day  care  offers  a  rare  opportunity 
for  testing,  in  the  observance  rather  than  the  breach, 
those  child  welfare  principles  that  stress  the  impor- 
tance of  the  cliild's  own  home.  This  focus  on  the 
family  goes  beyond  the  traditional  appreciation  in 
the  field  of  early  childhood  education  of  the  impor- 
tance to  the  child  of  the  parent  and  the  home.  The 
basic  distinction  between  day-care  services  and  nur- 
serj'  and  other  programs  for  preschool  children  is  the 
focus  in  day  care  on  the  needs  of  the  entire  family 
and  its  economic,  physical,  and  emotional  burdens — 
a  focus  that  may  at  times  result  in  classroom  group- 
ings, hours  of  care,  or  other  conditions  not  optimal 
for  the  child  from  an  educational  point  of  view. 
"\^Tiat  do  we  hope  to  prevent  by  offering  day  care 

VOLUME  14  -  NUMBER  3 


for  children  ?  In  extreme  instances,  we  hope  to  pre- 
vent placement  of  children  out  of  their  own  homes; 
in  other  instances,  we  hope  to  prevent  subtler  erosions 
and  impoverishments  of  family  life  vmder  social  and 
psychological  pressures.  Here,  surely,  is  a  goal  con- 
sistent with  the  basic  ethics  and  \-alues  of  profes- 
sional social  work. 

However,  evidence  of  social  work  thinking  in  the 
day-to-day  operation  of  a  day-care  sei'A'ice  is  often 
sparse.  In  few  instances  has  social  work  contributed 
its  full  share  to  the  day-care  center  team  in  an  inte- 
grated fashion.  The  profession  is  often  represented 
by  a  single,  overburdened  worker  who  can  rarely  go 
beyond  the  demands  of  intake  and  emergency  refer- 
ral services.  As  in  many  child  welfare  settings,  most 
social  service  staff'  members  of  day-care  centers  are 
not  professionally  trained.  Only  occasionally  is 
there  a  sophisticated  social  work  consultant  available 
to  staff  members  or  parents  even  on  a  part-time  basis. 

In  a  fieldwork  placement  in  a  day-care  center,  this 
situation  presents  a  problem  for  the  students'  super- 
visor, who  must  very  actively  serve  as  a  professional 
model  as  well  as  a  teacher  and  must  continuously 
plan  and  intervene  in  the  students'  expei-iences  in 
the  centers.  The  paucity  of  the  social  work  staff'  also 
means  that  sometimes  new  dimensions  in  service  are 
being  explored  in  the  agency  only  by  the  students. 
Thus,  special  delicacj'  is  called  for  in  balancing  serv- 
ice responsibilities  and  learning  opportunities. 

The  supervisor  must  shape  the  student's  caseload 
if  the  potentials  for  learning  are  to  be  tapped,  but  he 
can  do  this  flexibly  according  to  his  own  and  his 
students'  professional  proclivities.  For  example, 
the  day-care  center  provides  opportunity,  depending 
on  the  particular  situation,  to  place  more  or  less 
emphasis  on  the  ways  the  center  and  its  clients  are 

113 


involved  with  tlie  community,  on  work  with  parents' 
groups,  on  concentrated  observation  of  tlie  cliildren 
and  collaboration  witli  the  preschool  teacliers.  or  on 
casework  witli  members  of  the  child's  family. 

Uncovering  needs 

To  the  incoming  social  work  student,  the  members 
of  the  center's  educational  staff  may  appear  to  be  the 
backbone  of  the  service;  his  first  major  task  is  to 
clarify  his  own  role  for  himself,  for  them,  and  for 
the  families  being  served. 

Frequently,  a  family  tliat  needs  help  from  tlie 
community  in  the  care  of  its  young  children  may  be 
in  need  of  other  kinds  of  service  as  well.  Yet,  unless 
this  comes  out  clearly  at  the  time  of  intake,  the 
parents  may  view  the  center  as  child  oriented  and 
"not  interested  in  our  other  troubles,"  and  the  newly 
arrived  social  work  students  may  be  overly  fearful 
of  violating  family  privacy  by  offering  service  thiil 
has  not  been  explicitly  requested.  But,  as  they  come 
to  feel  more  at  home  in  tlie  center  and  become  more 
inventive  in  making  them.selves  visible  to  the  chil- 
dren's parents,  the  students  uncover  a  wide  range 
of  needs  and  reactions.  At  one  end  of  the  range 
they  linil  parents  who  are  eager  to  avail  themselves 
of  social  service  and  unable  to  get  to  an  approjiriate 
resource.     For  example,  there  was — 

Mrs.  M,  a  working  mother  with  seven  children,  who  had 
been  seeking  help  with  marital  problems  and  also  service  for 
an  acting-out,  preadolescent  child.  Because  of  a  complex 
schedule  on  her  job  and  the  lack  of  services  in  or  near 
her  neighborhood,  she  could  not  get  the  help  she  needed  until 
a  social  work  student  at  the  day-care  center  offered  to  discuss 
her  problems  with  her  at  the  time  when  she  came  to  pick  up 
her  children.  She  was  one  of  the  first  persons  to  request  regu- 
lar casework  appointments,  and  she  used  them  productively 
throughout  the  year. 

A  variant  of  tliis  help-seeking  client  is  the  isolated 
or  fearful  parent  who  finds  casework  help  more 
])alatable  if  it  is  made  available  in  a  familiar  ego- 
supportive  setting  in  a  way  that  enables  him  to 
drift  into  it  at  his  own  pace.  IMany  such  parents 
begin  with  occasional,  irregular  appointments  with 
the  social  worker  and  move  on  later  to  planned  reg- 
ular contacts;  they  may  need  to  test  the  relationship 
with  the  social  worker  for  comfort  and  viability. 

At  the  other  end  of  the  range,  the  students  find 
families  who  are  not  seeking  service,  actively  or  pas- 
sively, but  who  obviously  are  beset  with  many  prob- 
lems, often  including  child  neglect  or  abuse.  These 
unmotivated,  disorganized  families  in  many  ways 
resemble  those  found  in  a  protective  services  caseload. 


114 


With  them  the  student  is  plunged  into  experimenting 
with  tlie  reaching-out,  "aggressive  casework"  tech- 
niques that  have  been  receiving  increasing  attention 
in  social  work.  Their  concern  about  violating  tlie 
principles  of  self-determination  and  tlieir  desire  to 
minimize  and  get  beyond  rejection  make  for  consider- 
able discussion  and  debate  with  each  other  and  with 
their  supervisor. 

The  students,  however,  tend  to  feel  isolated  if  these 
issues  are  discussed  only  at  the  agency.  "Catching" 
a  caseload,  defining  one's  professional  role  and  goals, 
and  thinking  through  one's  basic  philosophic  stance 
are  demanding  exfieriences.  ]Moi-e  thought  needs  to 
be  given  in  the  schools  of  social  work  to  ways  of 
modifying  the  curriculum  so  that  what  students 
learn  in  the  classroom  will  mesh  more  closely  Avith 
the  experiences  they  are  having  in  this  and  other  new 
types  of  fieldwork  placements.  Perhaps  more  use 
could  be  made  of  the  case  material  as  it  is  fed  back 
into  the  schools. 

As  time  goes  on,  the  students  do  make  many  pro- 
ductive contacts  with  some  of  these  "hard-to-reacli" 
families  and  they  find  this  a  most  rewarding  experi- 
ence. (Some  students  have  found  the  experience  a 
valuable  foundation  for  later  work  in  community 
psychiatry  programs.)  At  times,  too,  because  their 
caseloads  are  small,  students  can  pick  up  on  the  less 
obviously  critical  needs  of  a  famih'  in  crisis. 

Mrs.  P's  young  children  had  been  brought  to  the  day-care 
center  when  their  mother,  in  a  suicidal  depression,  had  ap- 
plied for  admission  to  a  mental  hospital.  The  social  work 
student  observed  that  a  14-year-old  daughter  was  taking  on  an 
increasing  number  of  responsibilities  and  spending  nearly  alii 
of  her  time  with  her  mother.  She  seemed  to  be  taking  over 
the  husband's  role  with  the  mother  and  the  mother's  role  with 
the  younger  children,  while  unconsciously  avoiding  facing  her 
own  academic  retardation  and  isolation  from  her  peers.  The 
social  work  student  helped  the  father  become  more  directly 
involved  in  planning;  arranged  for  a  temporary  homemaker 
to  go  into  the  home;  and  offered  the  girl  casework  and 
tutorial  ser\ices  to  enable  her  to  pick  up  the  threads  of  her  own 
life  again. 

A  unique  opportunity 

The  day-care  caseload,  thus,  is  in  some  respects 
an  educational  smorgasbord.  It  offers  students  of 
social  work  some  learning  opj^ortunities  similar  to 
those  in  the  family,  child  welfare,  and  child  guidance  l 
services,  as  well  as  the  kind  of  learning  opportunities 
found  in  authoritative  or  crisis-oriented  settings. 
What  does  day  care  offer  that  is  special  and  unique? 
An  TUiparalleled  opportunity  to  observe  young  chil- 
dren in  depth  and  over  a  long  period  of  time ! 

CHILDREN     •     MAY-JUNE  1967 


^Faiiy  soi'ial  wurk  ciliirainrs  lune  loiii;'  It'll  tlial 
the  social  work  curririiluni  lacks  sufliciciit  coiitt'iit 
in  child  (U'Vi'loinncnt  ami  hehavidr  and  that  I  he  littk' 
that,  is  taiiy'ht  in  this  ivyard  is  pivscnted  in  a  Tasliion 
that  is  almost  exclusively  theoretical.  However,  in 
a  da\-carc  center,  social  work  students  are  intensively 
exposed  to  the  yonnir  child  in  action,  alone  and  in  the 
<jroup;  they  learn  intimately  the  meaning;-  oi  "aii-es 
and  slajres";  ;ind  they  aiv  cont'i-onted  with  the  subtle 
ranulications  of  child-adult  relationships.  In  such 
a  setting  they  can  observe  at  first  liand  tlie  interac- 
t  ions  between  family  members  and  the  ell'ect  of  famil- 
ial, cultural,  and  class  styles  of  child  rearin<i:  on  indi- 
vidual chiklren. 

A  child's  reaction  to  sejjaration  from  his  ])are.nts 
becomes  much  more  tlian  a  textbook  concept  when 
one  watches  children  newly  admitted  to  the  center, 
tlie  last  child  to  be  picked  up  in  the  evening,  or  the 
mother  who  is  herself  fearful  of  leaving  the  support 
of  the  center  as  her  child  approaches  school  age.  To 
see  a  3-ycar-old  child  weep  for  mommy  at  nap  time 
but  turn  his  back  on  her  in  mock  absorption  with  a 
toy  when  she  comes  for  him  in  the  evening;  to  watch 
a  fatherless  boy  repeatedly  play  grownuji  in  a  man's 
hat ;  to  notice  a  parent's  mixed  reactions  to  his  child's 
growing  mastery  of  a  language  he  does  not  speak  or 
his  envy  of  the  care  the  child  receives ;  to  see  evidence 
of  the  insatiable  yearning  of  a  4-year-old  child  in 
his  clinging  response  to  the  teacher  who  takes  him  on 
her  laji — each  of  these  everyday  experiences  in  a  day- 
care center  brings  the  real  meaning  of  a  theoretical 
conce[)t  home  to  the  student. 

At  times  the  student  may  Avork  directly  with  a 
group  of  children  or  an  individual  cliild  in  the  center; 
he  will  not  be  in  the  position  of  talking  to  a  parent 
whose  child  he  has  never  seen.  This  aspect  of  the 
placement,  combined  with  more  frequent  home 
visiting  than  is  usual  in  other  types  of  fieldwork 
placement,  makes  for  a  three  dimensional  view  of 


Thelma  Goldberg  is  an  assistant  professor 
at  tlie  Graduate  Seliool  of  Social  Work,  New 
York  Uuiversit.y.  Prior  to  her  present  posi- 
tion, she  was  the  university's  social  work 
field  instructor  who  set  up  the  day-care  stu- 
dent unit  rejiorted  on  in  this  article.  Her 
previous  experience  in<'ludes  work  in  family 
service  asencies,  child  guidance  clinics,  and 
a  residential  treatnient  center.  She  has  also  served  as  a 
social  work  <-onsultant  to  the  staffs  of  nursery  schools  and 
day-care  centers. 


family  life.  \\'ith  this  persiieclive,  the  student  can 
more  readily  recognize  the  eft'ect  of  .special  circum- 
stances.    I'"or  example: 

Mr.  L  applied  for  day  care  for  his  5-ycar-i)ld  child  after  the 
sudden  death  of  his  wife.  He  had  not  told  the  boy  of  the 
death  and  felt  the  child  was  little  disturbed  by  it.  However, 
the  social  work  student  noticed  that  in  the  classroom  the  child 
showed  increasing  preoccupation  with  fantasies  of  destruc- 
tion and  disappearance;  signs  of  depression;  phobic  clinging  to  a 
motherly  teacher;  and  "irrational"  expressions  of  rage  against 
the  father. 

Mrs.  S  complained  that  the  hospital  treating  her  son  for  a 
mild  case  of  cerebral  palsy  had  decided  that,  despite  his  ex- 
cellent adjustment  to  the  day-care  center  program,  he  could 
not  enter  a  regular  first-grade  class  because  of  a  speech  handi- 
cap. Watching  this  child  in  the  group,  the  student  saw  signs 
of  unusual  compensatory  devices  in  him.  He  was  extremely 
cheerful  and  outgoing,  reached  for  help  as  he  needed  it, 
ignored  rebuffs  and  teasing,  managed  to  communicate  despite 
his  speech  problems.  Therefore,  the  school  guidance  counselor 
was  invited  to  observe  the  child  at  the  center  and  to  evaluate 
his  functioning.  As  a  result,  the  school  admitted  the  child 
to  a  regular  class. 

Teacher  and  social  worker 

In  any  day-care  service,  a  large  percentage  of 
referrals  for  social  service  directly  iiudlve  the  well- 
being  of  children  in  the  center.  Teachers  naturally 
try  to  speak  to  the  parents  directly  about  the  things 
that  worry  them,  often  in  an  eilort  to  lielp  parents 
modify  their  handling  of  the  child.  But  many 
parents  are  so  emotionally  deprived  themselves  that 
they  themselves  must  be  "fed"  before  they  can  feed 
their  children;  their  own  worth  must  be  aflirmed; 
they,  too,  must  be  helped  to  have  fun.  Some  parents 
see  yotnig  children  as  extensions  of  themselves  and 
so  cannot  mobilize  their  parental  strength  uidess 
their  own  i)atterns  of  functioning  and  their  own  in- 
dividuality are  recognized.  Fortunately,  in  most 
day-care  centers  I  have  known,  stall  acceptance  for 
parents  is  genuine,  and  fruitful  collaboration  be- 
tween teacher  and  social  worker  takes  place. 

Mrs.  Z  was  referred  to  the  student  social  worker  by  the  teach- 
er because  she  seemed  unable  to  pick  up  her  children  on  time 
or  to  feed  and  clothe  them  appropriately.  Mrs.  Z  was  a  24- 
year-old  divorcee  with  four  children.  She  was  described  by 
the  teacher  as  gay  and  impulsive,  unable  to  control  the  children, 
"a  big  kid  herself."  She  had  been  known  earlier  to  a  family 
agency,  w  hich  had  "talked  her  out  of  placing  the  children." 

In  her  interviews  with  the  student,  Mrs.  Z  quickly  revealed, 
under  her  gay  fai^ade,  feelings  of  depression  and  worthless- 
ness,  a  sense  that  no  one  cared  for  her  except  as  the  mother  of 
her  children.  As  the  teachers  and  director  continued  to  point 
out  to  Mrs.  Z  her  maternal  responsibilities,  the  student 
focused  Mrs.  Z's  attention  on  her  own  needs  and  aspirations 


VOLUME  14  -  NUMBER  3 


115 


and  helped  her  look  into  the  reasons  why  she  needed  to  invite 
social  disapproval.  When  the  student's  fieldwork  placement 
in  the  center  ended,  Mrs.  Z  accepted  referral  to  another  agency 
for  continuing  casework  service.  Said  she:  "I  needed  a  social 
worker  to  chase  me." 

Mrs.  Z's  case  illustrates  the  value  of  spelling  out 
tlie  differences  in  the  roles  of  the  teacher  and  the 
social  worlcer  in  relation  to  a  particular  client.  Col- 
laboration is  possible  only  when  each  party  under- 
stands the  special  contribution  of  the  other  and  the 
effectiveness  of  each  is  enhanced  by  a  team  approach. 
Learning  what  teachers  can  offer  and  how  to  com- 
municate with  them  in  the  best  interests  of  children 
and  families  is  an  important  part  of  the  social  work 
education  that  takes  place  in  a  day-care  setting  and 
one  that  will  be  useful  to  the  student  in  future  profes- 
sional functioning. 

Finally,  a  word  must  be  said  about  two  important 
aspects  of  the  social  work  process  that  students  can 
learn  to  master  in  a  day-care  setting:  (1)  the  ap- 
propriate application  of  diagnostic  thinking;  and 
(2)  inventiveness  in  the  use  of  social  resources,  in- 
cluding one's  own  agency.  In  a  day-care  center 
these  processes  are  clearest  in  the  period  of  intake 
study  and  in  the  "reviews"  to  determine  what  use 
is  being  made  of  the  service. 

Miss  J  applied  for  day-care  service  for  her  3-year-oId 
daughter,  who  had  been  born  out  of  wedlock.  The  child 
was  exhibiting  bizarre  traits  in  speech  and  character  and 
seemed  to  be  reacting  to  an  extremely  confused  pattern  of  liv- 
ing. A  careful  intake  study  produced  a  great  deal  of  evidence 
that  Miss  J  was  psychotic  and  very  much  afraid  of  being  re- 
ferred for  psychiatric  help.  She  had  ambivalent  feelings  about 
having  applied  for  day  care,  for  she  was  afraid  both  of  being 
scrutinized  by  other  people  and  being  separated  from  her  child. 

It  was  decided  to  try  to  support  Miss  J  by  admitting  the 
child  to  the  center  and  so  exposing  her  to  some  healthy  in- 
fluences. Upon  admission,  the  little  girl  proved  to  be  not  too 
damaged  to  respond  to  staff  members  and  to  the  other  children 
and  quickly  made  great  developmental  strides.  The  student 
helped  the  staff  understand  the  mother's  condition  so  that  de- 
mands in  excess  of  her  ability  were  not  placed  on  her. 


Mrs.  W  applied  for  day  care  for  her  two  children  on  the 
basis  of  her  need  to  work  to  supplement  her  husband's  income. 
Soon  after  the  children's  admittance,  however,  she  lost  her  job 
and  for  a  while  thereafter  seemed  to  be  avoiding  the  members 
of  the  center's  staff.  The  teachers  suspected  that  she  was  being 
punitive  toward  the  youngest  child,  who  at  the  same  time  was 
being  overindulged  by  his  father.  The  student  arranged  for 
an  interview  with  Mrs.  W  and  told  her  that  her  loss  of  employ- 
ment did  not  affect  her  eligibility  for  the  center's  services. 
Mrs.  W  appeared  relieved;  she  indicated  that  she  was  pre- 
occuppied  with  a  serious  marital  conflict  she  did  not  wish  to 
discuss  and  that  she  wanted  her  children  to  remain  at  the  center 
primarily    to   protect   them    from   her   own   stormy    feelings. 

116 


Eventually  Mrs.  W  asked  for  counseling  service  to  work  oul 
plans  for  herself  and  the  children  following  a  long-threatened 
separation  from  her  husband. 

What  can  be  distilled  as  the  essence  of  a  student's 
experience  in  day  care  as  compared  to  fieldwork 
placements  in  other  settings  ?  Certainly  the  fact  that 
the  student  obtains  entree  to  the  family  by  means  of 
involvement  with  their  young  children  afl'ects  the 
quality  of  the  experience.  As  we  have  seen  in  such 
a  setting,  parents  may  initially  be  reluctant  to  discuss 
their  negative  feelings  toward  a  child  or  may  need 
to  test  the  genuineness  of  the  agency's  interest  in 
themselves  and  their  older  children.  However,  most 
families  seem  to  approach  the  day-care  center  in  an 
aura  of  hopefulness,  as  though  the  opportunity  to 
send  a  young  child  into  the  larger  community  for  the 
first  time  were  providing  them  with  a  second  chance 
This  hopefulness,  coupled  with  the  relief  from  stress 
the  concrete  service  provides  them,  may  make  them 
more  accessible  to  social  work  intervention  on  many 
seemingly  unrelated  levels  of  experience.  For  th« 
same  reason,  families  whose  children  are  no  longei 
in  a  day-care  center  may  return  to  the  center  in  times 
of  trouble;  it  tends  to  be  invested  for  them  with  the 
feeling  that  a  fresh  start  may  be  possible. 

I  think  there  are  two  crucial  ways  in  which  social 
work  students  are  touched  by  an  experience  in  a' 
day-care  center.  The  tirst  comes  from  operating  in  a 
setting  in  which  their  profession  is  in  the  minority 
To  function,  they  are  forced  to  examine  and  tc 
articulate,  in  a  direct  and  personal  way,  what  it 
means  to  be  a  social  worker,  how  a  person  goes  about 
being  one  when  his  service  has  not  been  requested 
by  the  client,  and  how  he  explains  what  he  does  tc 
his  colleagues  from  another  discipline. 

Tlie  second  crucial  way  in  which  social  work  stu- 
dents are  touched  by  an  experience  in  a  day-care 
center  can  be  observed  in  how  they  react  to  a  chil- 
dren's shelter  or  a  foster  home  program  or  to  a 
theoretical  discussion  of  children's  needs.  Whatever 
their  own  backgrounds  and  preconceptions,  regard- 
less of  their  particular  caseloads,  the  social  work 
students  in  day  care  unanimously  seem  to  have  a 
deep  and  burning  conviction  of  the  irreplaceability 
of  the  child's  own  family,  flawed  and  idiosyncratic 
though  it  may  be,  for  the  young  child.  In  these  times 
when  the  importance  of  his  own  family  to  the  child 
often  seems  mentioned  only  as  a  half-hearted  cliche, 
ignored  in  program  planning,  an  experience  that 
brings  it  home  so  vividly  to  social  workers  at  the 
start  of  their  careers  would  seem  to  merit  a  place  in 
professional  education. 

CHILDREN     •     MAY-JUNE   1967 


I 


biii 


A  GROUPWORK  APPROACH  IN 


CROSS-CULTURAL  ADOPTIONS 


CONSTANCE  RATHBUN 


RALPH  L.  KOLODNY 


"The  love  and  attention  of  two  new  parents 
and  the  influence  of  many  phiymates  here  in 
Massachusetts  are  turning  an  active  little 
Chinese  girl  into  an  active  American." 

In  these  terms  a  Boston  newsjjaper  describes  the 
adoption  by  a  Caucasian  couple  in  New  England  of 
a  child  from  an  orphanage  in  Hong  Kong.  Behind 
this  statement  are  a  series  of  problems  in  interracial 
adoptions,  often  thought  about  by  social  workers  but 
only  infrequently  subjected  to  careful  scrutiny. 
From  the  perspective  of  the  community,  the  experi- 
ence may  be  regarded  as  a  "huinanitarian  adventure" 
in  which  there  is  much  sincere  interest.  From  the 
adoptive  parents'  perspective,  however,  it  represents 
a  procedure  that  poses  a  host  of  dilemmas. 

Of  primary  significance  in  the  creation  of  these 
dilemmas  is  the  shift  in  the  adopted  child's  role 
from  that  of  one  child  among  many  similar  children 
in  an  institutional  setting  overseen  by  one  woman 
to  that  of  a  child  in  a  family  with  her  own  father, 
mother,  and  brothers  and  sistei-s.  Of  equal  impor- 
tance is  the  radical  change  from  ancient  Chinese  to 
contemporary  American  rules  of  conduct.  These 
transitions,  moreover,  have  to  be  made  by  the  child 
in  a  society  ambivalent  toward  racial  mixture.  The 
child's  adoptive  parents  are  in  the  unique  position 
of  having  to  prepare  their  oriental  child  for  the 
status  accorded  a  member  of  a  minority  group  while 
simultaneouslj-  attempting  to  help  him  become 
emotionally  a  part  of  a  family  that  is  part  of  the 
dominant  majority. 

These  special  child-rearing  problems  apparently 
do  not  innnobilize  most  of  the  adoptive  jiarents. 
What  followup  reports  we  have  of  this  type  of  adop- 
tion in  most  cases  do  not  suggest  severely  pathologi- 

VOLUME  14  -  NUMBER  3 


cal  adaptations  either  in  the  child  or  the  family.' 
One  can  assume,  however,  that  such  problems  engen- 
der tensions  that  must  be  expressed  and  dealt  with  if 
the  adoption  is  to  be  a  really  positive  experience  for 
all  concerned. 

The  kinds  of  tensions  that  arise  in  such  families 
and  the  kinds  of  problems  that  worry  the  adoptive 
parents  have  been  brought  out  clearly  in  the  group 
meetings  of  five  sets  of  adoptive  parents  of  five  pre- 
adolescent  Chinese  girls  who  came  to  this  country 
from  the  same  orphanage  in  Hong  Kong  and  were 
placed  for  adoption  by  the  Boston  Children's  Serv- 
ice Association.  All  of  these  parents  had  children 
by  birth  as  well  as  by  adoption  and  had  been  the 
subjects  of  a  home  study  and  casework  service  before 
the  adoptions  became  legal. 

The  discussion  group  was  initiated  shortly  after 
the  cliildren's  placement  and  continued  for  many 
months  after  the  adoption  decrees  had  been  gi-anted. 
It  was  formed  and  led  by  Carol  A.  Jenkinson,  a  mem- 
ber of  the  agency's  groupwork  staff  who  met  with 
the  group  at  the  agency's  office  for  more  than  2  yeai-s. 
During  this  period,  tlie  group  held  ten  2-hour  ses- 
sions, the  rather  wide  spacing  of  meetings  having 
been  dictated  by  problems  of  distance  and  New  Eng- 
land winter  weather. 

Age-related  problems 

One  would,  of  course,  expect  parents  of  girls  on 
the  threshold  of  adolescence  when  meeting  together 
to  discuss  their  perplexities  about  this  stage  of  de- 
velopment and  their  methods  of  coping  with  its  crises. 
Our  group  was  no  exception.  The  parents  expressed 
concern  about  ways  of  dealing  with  the  normal  nega- 


117 


tivism  of  this  stage,  aljoiit  ways  of  helpino-  a  girl  ac- 
cept, a  more  feminine  role  without  encouraging  lier  to 
act  out  sexually,  and  about  methods  of  preparing  a 
preadolescent  girl  for  menstruation.  Tliese  issues 
came  up  early  in  the  group's  existence  and  continued 
to  appear,  disappear,  and  reappear  with  varying  in- 
tensity. As  they  discussed  such  subjects,  the  group 
sometimes  sounded  like  any  other  group  of  parents 
of  pubescent  children. 

A  major  task  of  preadolescence  is  the  transition 
from  the  sexually  latent  orientation  of  the  preadoles- 
cent years  to  a  clearer  heterosexual  identity.  This 
appeared  as  a  theme  in  an  early  meeting. 

Mr.  J  turned  to  Mr.  W  to  say  how  much  Bunnie  and  his 
son  had  liked  Jill.  His  son  particularly  had  talked  about 
nothing  else  except  Jill  ever  since  she'd  been  there.  Mr.  W 
said  Jill  made  a  hit  with  the  boys  as  a  "boy"  still,  and  not  yet  as 
a  girl.  Mrs.  J  said  she  thought  Jill  had  shown  a  bit  more 
interest  in  clothes  than  she  had  the  last  time  she'd  seen  her. 
Mrs.  W  said  she  guessed  that  Jill  really  was  all  girl  but  that 
right  now  it  still  seemed  as  though  she  wanted  most  to  be  a 
boy.  Mrs.  W  said  she  hadn't  given  up  hope,  however,  that 
Jill  would  soon  develop  into  a  girl  as  her  shape  was  already 
changing  and  there  were  lots  of  other  signs  of  her  growing 
up. 

Thus,  the  group  as  a  kind  of  "affective  forum"' 
freed  the  parents  to  express  their  concern  about  the 
many  facets  of  preadolescent  sexuality  that  miglit 
otherwise  have  not  only  been  concealed  from  others 
but  also  front  themselves.  The  many  reactions  to  the 
issues  discussed  provided  oacli  parent  with  a  perspec- 
tive within  whicli  he  could  begin  to  assess  his  own 
reactions  differently.  In  the  meetings  any  attempt 
by  any  set  of  parents  to  cope  imaginatively  with  the 
pi-oblems  of  tlieir  youngsters  generally  received  sup- 
port froni  the  group. 

Impact  of  cultural  duality 

However,  the  normal  growing  up  problems  of  the?e 
children  were  not  the  problems  that  monopolized  tlie 
group's  attention.  Wliatever  their  temporary  con- 
fusion over  how  to  respond  to  prolilems  of  emerging 
sexuality  and  independence,  these  parents  obviously 
felt  confident  of  their  capacity  for  helping  the  chil- 
dren weatlier  the  normal  stresses  of  this  stage  of  de- 
veloi^ment.  Their  greatest  concern  has  been  over  the 
implications  of  the  children's  dual  cultural  heritage 
and  their  "different"  racial  background. 

In  talking  about  the  children's  transition  from 
group  life  in  China  to  family  life  in  America,  the 
parents  at  first  stressed  only  how  smooth  this  had 
been  and  how  skilled  the  agency  had  been  in  deter- 

118 


1 


Both  Constance  Rathbun, 
left,  and  Ralph  L.  Kolodny 
were  on  the  staff  of  the  Bus- 
ton  Chilrlren's  Service  As- 
sociation when  the  observa- 
tions reported  in  this  article 
were  made.  Miss  Rathbun  as 
director  of  casework  and  Mv. 
Kolodny  as  director  of  groupwork.  .Mi.ss  Rathbun  is  pres- 
ently director  of  research  and  special  instructor  at  the 
Simmons  College  School  of  Social  Work,  and  Mr.  Kolodny 
is  associate  professor  at  the  Boston  University  School  of 
Social  Work. 


4st 
in 


mining  wliicli  child  should  be  placed  in  which  adop- 
tive home.  They  admitted  the  children  liad  experi- 
enced some  difficulties  in  respect  to  language  and 
food,  but  said  these  had  soon  disappeared.  At  tlie 
first  meeting  tlie  J's,  for  example,  could  not  get  over 
"how  Mell  Bunnie  Itad  been  matched  to  them" — 
happy  and  loving,  she  trusted  everyone.  The  other 
parents  nodded  affirmatively. 

At  the  second  meeting,  however,  some  of  the  anxie- 
ties that  had  been  so  carefully  hidden  Avhen  the  gTOup 
members  first  met  each  other  began  to  emerge.  They 
were  expressed  guardedly,  but  still  with  a  great  deal, 
of  feeling.  The  children,  said  the  parents,  had  been 
displaying  some  ambivalence  about  their  new  names. 
The  parents  found  this  disconcerting,  but  were  more 
worried  about  the  fact  that  when  under  stress  some 
of  the  cliildren  occasionally  would  go  into  a  kind  of 
liypnotic  state.  For  example,  tlie  O's  daughter,  Lo 
Ming,  had  responded  with  extreme  withdrawal  when 
Mrs.  O  had  taken  a  cake  to  her  class  at  school.  Jill 
had  reacted  in  a  similar  way  when  she  had  suddenly 
hui't  herself.  Tlie  parents  of  the.se  children  felt 
helpless  in  not  knowing  how  to  reach  either  child  in 
tjiis  "trancelike"  state. 

Later  on  in  the  meeting,  tlic  group  talked  about 
the  fact  that  each  child  had  had  to  find  her  own  way 
of  adapting  herself  to  the  institution  in  Hong  Kong 
and  now  was  having  to  readapt  herself  to  an  Ameri- 
can family.  The  group  worker  pointed  out  that 
Mr.  E  had  spoken  in  their  previous  meeting  of  his 
feeling  that  Nancy  had  to  he  almost  too  good  in 
order  to  feel  that  they  would  accept  her.  Mrs.  W 
said  that  maybe  this  was  true  of  Jill  who,  in  a  way, 
also  had  to  be  too  good.  The  questions  then  arose 
as  to  how  secure  the  girls  did  feel  and  how  confused 
they  might  be.  The  girls  had  visited  at  each  other's 
homes  at  Christmas  time,  and  now  each  of  tliem  was 

CHILDREN     •     MAY-JUNE  1967 


callinu'  all  of  llic  iiicii  "I  )ailily.'"  'I'liis  con  I'iihciI  rc- 
si)()iis('  ocrasioned  considerable  distress  on  the  pari 
of  the  "daddies,"  and  led  all  of  the  iiareiits  to 
(|uestion  whether  the  ehildren  would  cNcr  separate 
einotioiially  from  their  "family  of  orisrin"— t  he 
or[)liana<^e  "family""  in  IToni:-  Koni;-. 

The  worker  wondered  if  the  children  even  knew  what  it 
meant  to  have  a  family — to  be  a  part  of  a  small  family  with  a 
mother  and  a  father  and  with  only  a  few  siblings.  Mrs.  E 
said  immediately  and  emphatically  that  she  did  not  feel  they 
understood  this  at  all  and  that  she  and  her  husband  felt  their 
task  was  to  educate  their  daughter  to  what  a  family  was. 

Mr.  O  said  that  Lo  Ming  may  be  a  little  bit  more  aware  than 
the  other  children  that  she  now  had  a  family  of  her  own. 
However,  both  he  and  Mrs.  O  said  that  they  had  to  tell  Lo 
Ming  over  and  over  again,  in  no  uncertain  terms,  that  they 
were  her  parents  and  that  she  was  there  to  stay  with  them. 

The  group  agreed  that  probably  all  of  these  children  still 
had  tremendous  fears  about  whether  or  not  they  were  really 
here  to  stay,  and  that  it  was  pretty  frightening  to  the  youngsters 
to  have  a  close  relationship  with  parent  figures  now,  particu- 
larly with  a  father.  Mr.  O  said  that  Lo  Ming  had  spoken  of 
her  father  before  she  came  to  America  as  being  "Jesus"  and  now 
she  had  two  fathers — Jesus  and  Mr.  O.  Mr.  E  said  he  was 
sure  that  Nancy  did  not  really  know  what  a  father  was.  He 
said  he  was  really  puzzled  about  whether  or  not  he  could 
educate  her  to  understand  what  a  family  really  was,  and  he 
wondered  whether  or  not  any  of  the  children  would  ever 
really  be  able  to  become  the  adoptive  parents'  "own." 

This  was  the  first  time  that  we  had  indications  in  the  group 
of  the  feeling  the  parents  might  have  about  whether  or  not 
they  ever  could  accept  themselves  as  parents  of  these  children 
or  the  children  accept  them  as  their  parents.  Mr.  W  said  that 
probably  the  children  never  would  be  the  same  as  their  own 
children  for,  after  all,  their  own  children  were  white  and 
these  children  were  oriental. 

Having  found  that  the  agency  -worker  was  not 
upset  by  tlieir  confusion  and  tension,  the  parents 
began  to  wrestle  with  the  issue  of  how  to  help  the 
children  become  "their  own"'  without  completely 
sacrificing  the  children's  previous  identity.  They 
spoke  of  the  role  of  the  Chinese  language  in  the 
children's  present  life.  This  led  to  some  questions: 
Should  or  should  not  the  parents  search  for  a 
Chinese  tutor  to  help  the  children  keep  up  their 
Chinese?  Should  they  take  the  children  on  visits  to 
the  parents'  Chinese  friends  or  not?  If  they  did, 
would  it  demonstrate  to  the  children  how  much  they 
could  love  little  Chinese  girls  ?  (Lo  Ming  had  given 
some  indication  of  feeling  she  could  not  be  lo\ed 
because  she  was  Chinese.)  What  should  they  do  if 
the  child  rejected  reminders  of  her  Chinese  heritage  i 
Do  most  of  the  schoolmates  of  these  children  regaid 
them    as    jmtential    companions    or   as    mysterious 


"racial  strangei-s"  to  he  kept  out  <d'  tlieii-  peer 
groups?  Does  the  heliav  iorof  schoolteachers  toward 
the  children  rellecX  real  acceptance? 

As  they  looked  more  directly  at  the  tension  under 
which  theii-  a<l()pted  daughters  were  functioning,  the 
parents  began  to  discuss  their  ccmfused  ideas  and 
neiiatixe  feelings  about  the  social  milieu  in  whicli 
the  girls  had  lived  in  Hong  Kong.  They  told  about 
pu/.zliug  reports  from  the  children  of  some  "sexual 
events""  in  the  ori>hanage.  It  was  tlillicidt  to  deter- 
mine what  had  stemmed  from  the  children's  very 
vivid  imaginations  and  what  had  actually  ha|)pened. 
Tlie  i)areuts  had  at  lirst  lieen  impressed  by  the  shel- 
tei'e(l  nature  of  the  childi'en's  life  in  an  institution 
run  l)y  an  all-powerful  "mama.""  Now,  having  lis- 
teni'd  more  closely  to  what  the  children  were  saying, 
tliev  began  to  wondei-  w  het  hiT  sexual  sophistication 
ratiier  than  naivete  had  chai'acterized  their  pre- 
American  life. 

Mrs.  O,  recounting  a  story  Lo  Ming  had  told  her,  wondered 
if  the  other  families  had  heard  about  the  "accident"  that  had 
taken  place  somewhere  in  Hong  Kong,  something  involving  a 
man  and  a  woman  in  the  nude.  .  .  .  Mr.  and  Mrs.  W  looked 
at  each  other  with  knowing  eyes.  .  .  . 

It  seems  that  Jill,  the  W's  adopted  child,  at  one  time  became 
very  upset  and  told  them  she  had  had  a  bad  dream.  She  had 
then  referred  to  an  experience  in  Hong  Kong  where  some  boy, 
and  it  was  not  clear  who  this  was — whether  the  gardner, 
someone  else,  or  a  mythical  person — had  actually  come  to  her 
room  when  she  was  in  her  bunk  and  had  told  her  to  take  down 
her  pants.  She  had  become  very  much  upset  about  this  and 
had  evidently  screamed. 

There  was  a  question,  as  we  looked  at  this,  as  to  how  much 
of  the  tale  was  real  and  how  much  of  it  was  based  on  the  fears 
and  questions  of  a  girl  who  knew  too  little  about  sex.  The 
parents  expressed  some  question  as  to  how  naive  their  children 
really  were  and  said  that  they  really  did  not  know  what  had 
precipitated  this  type  of  story. 

Facing  marginality 

Whatever  their  feelings  of  I'onfusion  and,  perhap.s, 
dismay  over  the  possibility  of  their  adopted  daugh- 
ters having  had  sexual  encounters  of  some  sort  in 
Hong  Kong  and  their  concern  about  what  this  might 
mean  in  relation  to  their  future  behavior,  the  parents 
were  now  ready  to  consider  the  less  "rosy""  aspects 
of  their  relationships  witii  the  girls.  In  the  group 
they  apparently  derived  enough  support  from  each 
other  to  bring  into  the  open  still  more  worries  and 
areas  of  confusion.  They  now  began  lo  talk  about 
the  implications  of  the  girls'  racial  "difference"  for 
their  heterosexual  and  general  social  relationships. 
Either  the  parents  had  not  thought  about  this  ques- 


VOLUME  14  -  NUMBER  3 


119 


tion  previously  or  had  been  blocked  by  anxiety  from 
freely  discussing  it.  By  their  sixth  meeting,  how- 
ever, they  were  showing  openly — though  some  at  the 
same  time  denied  it — their  worry  over  the  social  mar- 
ginality  of  these  children  and  their  fears  lest  the 
girls  be  left  suspended  in  a  kind  of  sociocultural 
limbo. 

Mr.  W  said  he  worried  about  what  would  happen  to  his 
adopted  daughter  if  war  with  China  should  occur.  Mrs.  J 
said,  "I'll  cross  that  bridge  when  I  come  to  it,"  but  she  ex- 
pressed unhappiness  about  the  more  immediate  experience  of 
seeing  people  stare  at  her  daughter  in  restaurants.  Mr.  W  said 
the  hard  thing  to  take  is  the  fact  that  the  children  are  not 
really  accepted  by  the  Chinese  community  here.  "The  Chinese 
don't  like  it  at  all  because  we  have  adopted  their  children." 
Mr.  J  said  he  and  Mrs.  J  had  not  had  any  experience  that  gave 
them  such  an  impression,  and  Mrs.  A  said  that  she  had  not 
either.  Mr.  W  said  he  and  his  family  had  felt  a  kind  of  cold- 
ness when  they  went  to  a  Chinese  restaurant  or  to  Chinatown 
and  that  some  Chinese  people  had  told  him  that  they  did  not 
see  why  white  people  would  want  to  adopt  Chiese  children 
and  doubted  whether  the  children  could  really  be  Chinese 
anymore. 

Mrs.  J  said  she  had  thought  about  enrolling  Bunnie  in  a 
Chinese  school  so  that  she  could  keep  some  of  her  Chinese 
cultural  background,  but  Mr.  W  said  that  the  school  would 
probably  not  accept  Bunnie  because  she  did  not  live  in  a 
Chinese  family. 

When  Mrs.  J  asked  the  worker  whether  she  thought  the 
Chinese  school  would  accept  Bunnie,  the  worker  replied  that 
she  did  not  know  and  then  asked  Mrs.  J  why  she  wanted  to 
have  Bunnie  continue  with  Chinese.  Mrs.  J  replied  that  she 
did  not  want  Bunnie  to  lose  her  cultural  heritage,  but  added 
suddenly,  "But  you  know  Bunnie  seems  more  English  than 
Chinese"  because  the  orphanage  "mama"  had  brought  the 
children  up  that  way.  She  said  she  did  not  know  what  would 
be  best  for  Bunnie,  but  she  felt  that  Bunnie  would  become  all 
American  eventually.  .  .  . 

Mrs.  J  then  said  that  Bunnie  had  often  spoken  to  her  of  the 
fact  that  she  had  three  mothers — her  own  mother,  the  or- 
phanage "mama,"  and  now  Mrs.  J.  She  did  not  feel  that 
Bunnie  was  at  all  confused  about  which  mother  was  which 
and  about  what  her  relationship  had  been  with  each.  She  felt, 
however,  that  Bunnie  was  curious  about  her  background  and 
should  be  helped  to  know  more  about  it. 

Mrs.  A  said  that  her  adopted  daughter,  Cathy,  occasionally 
asked  whether  she  could  grow  up  to  look  like  her  "mummy" 
and  to  be  an  American.  Mrs.  A  said  she  always  told  Cathy 
that  she  was  a  very  pretty  little  girl  and  would  grow  up  to  be 
a  very  pretty  Chinese  lady. 

Mrs.  W  said  that  she  usually  forgot  that  her  two  adopted 
daughters  were  Chinese,  for  they  seemed  so  American  to  her 
in  all  of  their  ways.  Her  husband  agreed  but  added  that  they 
did  worry  sometimes,  especially  about  what  would  happen 
when  the  girls  reached  dating  age.  .  .  . 

Each  parent  advanced  his  own  notions  of  how  to 
cope  with  these  problems.    The  worker  did  not  press 


120 


them  for  consensus  as  to  the  best  way  of  coping, 
but  helped  them  provide  each  other  with  a  series 
of  alternatives  that  could  be  adapted  to  the  particu- 
lar circumstances  of  each  child. 

The  J's  eventually  made  the  decision  to  send  their 
child,  Bunnie,  to  an  afterhours  Chinese  school.  The 
other  parents  then  questioned  them  eagerly  about 
Bumiie's  experience  thei-e.  The  J's  main  purpose  in 
sending  the  child  there  was  to  help  her  "realize  the 
good  parts  of  her  Chinese  background."  Bunnie's 
major  investment  in  going  was  more  personal — this 
was  a  wish  to  keep  the  tie  to  her  Chinese  sisters  in 
Hong  Kong  and  to  deepen  her  friendship  with  the 
Chinese  minister's  son,  who  is  a  fellow  student.  She 
enjoyed  the  school  and,  in  contrast  to  her  earlier  posi 
tion  at  home,  was  willing  to  be  called  by  her  Chinese 
name  there,  since  all  the  students  had  both  a  Chinese 
and  an  English  name. 

Not  all  of  the  parents  saw  the  Chinese  school  as 
a  solution  to  the  integration  of  the  children's  dis- 
parate strands  of  cultural  influence.  And  they  all 
still  wrestled  with  the  basic  question :  the  degree  tc 
which  these  children  would  forever  be  Chinese.  This 
came  out  in  references  to  the  children's  appearance 
as  they  grew  older.  Would  they  be  just  "pretty 
ladies"  or  "pretty  Chinese  ladies"  ?  "Would  they  be 
able  to  marry  whomever  they  loved,  regardless  oi 
race,  or  could  a  happy  marriage  result  only  if  the 
alliance  were  with  another  Chinese?" 

Disguised  racial  hostility 

The  parents  exhibited  a  remarkable  degree  oi 
frankness  in  their  discusion  of  these  questions.  Then 
the  latent  and  previously  quite  repressed  racial  hos- 
tility of  one  set  of  parents  found  expression  in  ration- 
alized form. 

Mr.  and  Mrs.  A  went  on  to  give  examples  of  the  ways  in 
which  they  were  reminding  their  daughter  that  she  is  Chinese. 
Mrs.  A  said  that  unconsciously  people  used  rather  derogatory 
remarks  about  Chinese  people  in  general  conversations.  They 
were  sure  their  daughter  would  run  into  this  as  she  grew  older. 
They  felt  they  owed  it  to  her  to  prepare  her  for  this,  so  that 
when  she  grew  up  she  would  not  think  people  would  just  be 
mean  to  her  but  she  would  understand  that  some  seemingly 
hostile  remarks  were  just  casual  conversational  idioms — just 
as  when  people  say  "that's  Greek  to  me"  when  they  cannot 
understand  something. 

Mr.  A  then  said,  "Yes,  like  people  say  'crazy  as  a  Chinaman,' 
or  use  the  term  'chink'  quite  often."  Mrs.  A  said  they  fre- 
quently use  such  phrases  themselves  around  the  house  so  that 
their  daughter  would  know  first  that  they  could  be  made  by 
people  who  loved  you  and  were  not  meant  to  be  deroga- 
tory. .  .  .  Mrs.  A  again  spoke  up  saying  she  was  sure  that  her 

CHILDREN     •     MAY-JUNE  1967 


daughter  understood  why  they  did  it.  Mr.  A  told  of  how  he 
unconsciously  had  made  some  remarks  about  Chinese  people  to 
a  group  of  young  people  in  church  and  then  had  suddenly 
realized  what  he  had  said  and  looked  at  his  son  who  was 
present  and  realized  that  he,  too,  was  very  conscious  of  the 
faux  pas  his  father  had  made. 

Many  of  the  anxieties  evidenced  by  these  couples, 
as  we  liave  seen,  were  simihir  to  those  that  might 
be  felt  by  any  parents  who  ado])t  older  children. 
One  would  expect  dating  and  marriage,  for  example, 
to  be  in  the  forefront  of  much  of  the  discussion. 
However,  such  worries  took  on  a  somewliat  more 
urgent  character  tlian  usual  among  tliese  parents. 
As  do  all  couples  who  adopt  older  children,  these 
couples  were  trying  to  follow  two  somewhat  contra- 
dictory paths  simultaneously — to  find  ways  to  help 
the  children  achieve  a  satisfying  integration  into 
their  own  family  patterns  and  to  prepare  them  for 
the  adolescent's  task  of  separating  from  a  family  not 
yet  wholly  theirs.  The  separation,  however,  was 
having  to  be  accomplished  in  a  social  climate  that 
made  the  parents  unsure  of  the  future  attitudes  of 
the  community  toward  the  children  because  of  their 
ethnic  origin. 

Method  and  effects 

The  members  did  not  receive  advice  from  the  group 
worker,  nor  from  each  other,  on  how  to  deal  with 
these  issues.  Such  issues  will,  no  doubt,  con- 
tinue to  trouble  them  in  varying  degrees  as  time 
goes  on.  Nor  diil  the  groupworker  explore  with  tlic 
members  any  of  the  unconscious  sources  of  tlieir 
feelings  about  the  issues  they  were  concerned  about 
or  attempt  to  induce  insight  into  the  deeper 
veins  of  ambivalence  that  are  always  present  in  in- 
terracial adoption. 

Rather,  the  groupworker  helped  each  member  to 
listen  to  the  other  and,  in  so  doing,  to  listen  to  himself 
and  thus  to  face  honestly  the  problems  bothering 
him.  She  gently  countered  the  parents'  tendency 
to  deny  the  existence  of  such  problems  by  conveying 
to  them  her  feeling  that  the  problems  could  be  man- 
aged and  a  viable  parent-child  relationship  created; 
that,  while  this  relationship  might  be  "strange"  in 
some  respects  and  at  times  not  without  some  unpleas- 
ant components,  it  could  be  nurtured  and  bring  in- 
creasing gratification;  that  fears  and  tensions  need 
not  be  covered  up  in  the  interests  of  preserving  family 
harmony ;  and  that  expressing  and  considering  them 
in  a  group  of  persons  in  a  similar  situation  could 
help  strengthen  the  foundation  of  such  harmony. 

VOLUME  U  -  NUMBER  3 


It  is  dilllcult  to  describe  precisely  the  effects  of  this 
group  experience  on  tliese  adoptive  parents.  In  the 
beginning  we  did  not  ourselves  have  any  completely 
formulated  notion  of  how  they  sliould  use  the  group, 
altJHiugli  we  were  convinced  that  it  would  give  sup- 
port to  their  attempts  at  effective  parenting.  How- 
ever, we  do  lune  evidence  that  their  feelings  toward 
the  agency  and  toward  their  role  as  clients  of  the 
agency  changed  as  a  result  of  their  participation  in 
the  group. 

Initially  the  gioup  members  saw  themselves  as 
contributors  to  the  agency,  helping  with  its  research 
into  the  workings  of  interracfial  adoption.  Although 
based  in  fact,  this  attitude  contained  an  element  of 
defense  against  exposing  themselves.  Very  soon  it 
became  clear  that  the  parents  were  beginning  to  per- 
ceive the  meetings  as  a  means  of  supporting  each 
other's  efforts  to  cope  with  the  many  problems  of 
adjustment  they  and  the  children  were  facing.  No 
longer  did  each  couple  feel  alone  in  struggling  with 
a  unique  dilemma.  To  be  able  to  talk  about  their 
anxieties  with  each  other,  with  the  catalytic  help  of 
the  gi-oupworker,  gave  them  a  healthier  perspective 
from  which  to  approach  the  task  of  building  a  stable 
family  unit. 

Testimonials  by  group  participants  are  always 
slender  reeds  upon  which  to  lean  for  evaluation,  yet 
we  cannot  help  but  assign  some  degree  of  validity  to 
them.  The  following  entry  in  the  record  of  the 
group's  10th  meeting  gives  an  example  of  a  partici- 
pant's own  feeling  about  the  group. 

Mrs.  J  said  she'd  like  to  talk  about  something  else.  She  had 
met  another  family  who  had  adopted  a  Chinese  child  and  this 
family  envied  them  for  having  a  group.  .  .  .  She  thought  all 
adoptive  parents  should  be  in  a  group  with  other  parents,  at 
least  the  first  year  they  have  the  children.  The  others  agreed 
this  would  be  helpful.  The  worker  asked  whj-  they  felt 
this  way.  Mr.  J  said,  "You  think  you  are  the  only  one  with 
problems  in  the  beginning  and  you  are  not  so  sure  you  ought 
to  admit  them  even  to  yourself,  but  when  you  know  others 
feel  the  same  way  it  helps." 

Only  a  later  foUowup  will  test  our  interpretations 
of  the  meaning  of  this  experience  to  these  parents. 
We  do  know,  however,  that  in  the  midst  of  their 
dilemmas  and,  possibly,  second  thoughts  about  the 
interracial  adoptions  in  which  they  have  involved 
themselves,  these  parents  genuinely  feel  they  have 
been  helped  by  the  group  experience. 


'Rathbun,  C;  Bennett,  C;  McLaughlin,  H.;  Garland,  J.  A.:  Later 
acliustment  of  children  following  radical  separation  from  family  and 
culture.    American  Journal  of  Orthopsychiatry,  April  1965. 


121 


BOOK 
NOTES 


THE  EMPTY  FORTKESS :  infantile 
autism  and  tlie  birth  of  the  self. 
Bruno  Bettelheim.  The  Free  Press, 
New  York.     1967.     484  pp.     $9.95. 

Many  childhood  psychoses,  particu- 
larly infantile  autism,  can  be  traced  to 
the  child's  conviction  that  his  life  is  in 
mortal  danger,  according  to  the  author 
of  this  study  of  infantile  autism.  He 
maintains  that  autism  results  from  a 
breakdown  in  communication  between 
the  infant  and  others  caused  by  over- 
whelming anxiety :  the  child  reacts  to  a 
seeming  threat  to  his  life  by  not  acting 
at  all. 

From  the  findings  of  20  years  of 
work  with  several  hundred  children  at 
the  University  of  Chicago  Orthogenic 
School,  the  author  describes  specific 
childhood  aberrations,  the  development 
and  distortion  of  the  personality  in  in- 
fancy, and  the  progress  of  therapy  with 
the  autistic  child.  He  includes  three 
detailed  case  histories  of  extremely 
autistic  children. 

The  author  also  takes  up  the  subject 
of  the  feral  child  and  argues  from  illus- 
tration that  "wolf  children"  are  prob- 
ably autistic.  In  the  book's  final 
section,  he  discusses  the  findings  and 
opinions  of  other  psychiatrists  and 
p.sychologists  on  the  nature  and  origin 
of  infantile  autism. 

DELINQUENT  CHILDREN  IN  JU- 
VENILE CORRECTIONAL  INSTI- 
TUTIONS :  State  administered  recep- 
tion and  diagnostic  centers.  Com- 
piled and  edited  by  William  E.  Amos 
and  Raymond  L.  Manella.  Foreword 
by  James  W.  Symington.  Charles  C 
Thomas,  Springfield,  111.  1966.  159 
pp.    $7.50. 

Through  10  experts  in  the  correctional 
field,  this  book  describes  the  resources 
and  services  of  the  reception  and  diag- 

122 


nostic  centers  for  delinquent  children 
12  States  were  operating  in  March  1965. 
The  contributors  discuss  the  history 
and  philosophy  of  the  centers ;  their  use 
of  p.sychiatry,  psychology,  and  social 
work  in  diagnosing  each  child's  prob- 
lems ;  the  contribution  of  teachers,  re- 
.searchers,  and  court  officials  to  the  work 
of  the  centers ;  and  the  design  of  the 
physical  plants. 

The  editors  point  out  that  the  .success 
of  the  centers  depends  on  interprofes- 
sional teamwork.  They  maintain  that 
State  governments  must  take  the  lead 
in  combating  delinquency  because  city 
and  county  governments  cannot  provide 
the  statewide  facilities,  services,  and 
programs  needed.  And  they  express  a 
strong  belief  in  the  need  for  reception 
and  diagnostic  centers  and  in  their  po- 
tential for  helping  control  juvenile 
delinquency. 

FERTILITY  AND  FAMILY  PLAN- 
NING IN  THE  UNITED  STATES. 
Pascal  K.  Whelpton,  Arthur  A.  Oami> 
bell,  and  John  E.  Patterson.  Prince- 
ton University  Press,  Princeton,  N.J. 
1966.     443  pp.     $12.50. 

About  92  percent  of  the  .3,.322  wives 
involved  in  the  1960  study  of  birth  ex- 
pectations and  family  planning  on 
which  this  book  reports  said  that  they 
and  their  husbands  wanted  from  2  to  4 
children  and  that  they  preferred  to  have 
them  early  in  marriage.  Though  many 
couples  planned  to  delay  the  use  of  con- 
traceptives until  their  families  were 
"complete,"  87  percent  of  the  wives  said 
they  had  used  or  planned  to  use  contra- 
ceptives at  some  time.  Despite  the  de- 
lay in  use  by  many  couples,  the  authors 
found  the  number  of  couples  who  used 
contraceptives  was  much  higher  in  1960 
than  it  had  been  in  1955,  when  they  had 
made  a  similar  .study. 


Education,  socioeconomic  status,  reli- 
gion, and  race  made  a  difference  in  the 
number  of  children  the  wives  expected 
to  have,  the  authors  point  out.  Those 
with  little  education,  in  low-income 
groups,  or  who  were  Roman  Catholics 
expected  to  have  more  children  than 
others.  Within  the  Catholic  group, 
however,  tho.se  in  middle  income  groups 
expected  to  have  fewer  children  than 
those  in  the  lower  and  upper  in- 
come groups.  Nonwhite  wives  in  the 
South  expected  to  have  more  children 
than  white  wives,  a  difference  not  in- 
dicated in  other  regions. 

The  authors  also  discuss  the  wives' 
responses  to  questions  about  such  sub- 
jects as  fecundity  impairment,  meth- 
ods and  effectiveness  of  contraceptives, 
and  the  timing  and  .spacing  of  births. 

CULTURE  IN  AMERICAN  EDUCA- 
TION :  anthropological  approaches  to 
minority  and  dominant  groups  in  the 
schools.  Ruth  Landes.  John  Wiley 
&  Sons,  New  York.  1965.  330  pp. 
$7.95. 

This  book  reports  on  a  project  con- 
ducted by  the  Claremont  Graduate 
School,  Claremont,  Calif.,  from  1959  to 
1961  under  the  direction  of  the  author,  | 
a  cultural  anthropologist.  This  project 
brought  together  education,  social  work, 
and  anthropology  to  help  teachers  find 
ways  of  meeting  the  needs  of  children 
from  backgrounds  "different"  from 
those  of  most  American  children. 

During  the  experiment,  teachers  and 
school  social  workers  from  public 
schools  in  the  area  were  shown  how  to 
adapt  their  methods  and  to  adjust  their 
goals  to  differences  in  the  cultural  back- 
grounds of  children  from  such  minority 
groups  as  Mexican  Americans  and  Ne- 
groes, the  author  points  out.  The  teach- 
ers were  led  to  see  how  group  customs 
"channel  human  energy"  and  how  to  tap 
this  energy  in  teaching.  In  time,  the 
teachers  came  to  realize  that  mental 
gifts  and  social  inheritance  should  be 
placed  above  "physical  or  racial  sem- 
blances," and  the  social  workers  found 
new  ways  of  working  out  each  case, 
the  author  maintains. 

The  Claremont  project  demonstrated 
the  value  of  bringing  the  three  fields  to- 
gether to  improve  education  for  the 
children  of  minority  groups,  the  author 
also  maintains,  and  she  stresses  the 
importance  of  using  cultural  patterns 
to  attain  the  ends  of  education.  Folk- 
ways "may  yield  to  our  mechanized  age 

CHILDREN     •     MAY-JUNE  1967 


I 


iihI  uiiivc'f.sul  lUi'rac.v  .  .  .  Imt  priiu-i- 
I'l.'s  of  cultural  cxisti'Mcc  will  persist," 
shr  conclndi'S. 

1>SV(1I01A)GY  IN'  COMMIXITY  SET- 
TINGS: clinical,  educational,  vix-a- 
tioiial.  social  asjiects.  Seymour  H. 
Sarasoii.  Murray  Leviuo.  I.  Ira  Golil- 
iMilx-rfT.  l>ciuiis  L.  ClicrliM.  :uiil  Ed- 
ward M.  IJeiiiictt.  Juliu  Wiley  & 
Sous.  Now  York.  1966.  714  pp. 
.<;i-_M)5. 

Writleu  liy  slalV  iiiciubers  of  tlic  I'sy- 
clio-Educatioual  Clinic  at  Yale  Univer- 
sity, this  book  describes  the  activities  of 
the  clinic  in  four  New  Haven  (Conn.) 
sctting.s — the  elementary  school  system, 
the  local  community  action  pro^jram,  a 
mental  retardation  center,  and  the  clinic 
itself.  It  also  explores  the  many  prob- 
lems faced  by  the  .schools  in  trying  to 
help  uuderprivilesjed  children,  gives  Il- 
lustrations of  work  in  the  school  and  the 
community,  and  describes  the  methods 
used  in  the  cliuic  in  day-by-day  activi- 
ties. 

The  authors'  concluding  point  is  that 
service  to  the  community  now  requires  a 


lU'W  type  of  worUcr  one  trained  Uj  .ncc 
cultural  anlhroiK)logy,  sociology,  psy- 
chology, and  psychiatry  as  one  licld  of 
knowledge,  theory,  and  method.  The 
problem  is  "liow  to  intrwluce  change 
into  ongoing  social  systems.  The  solu- 
tion will  .  .  .  depend  on  how  well  we 
understand  these  social  systems  in  their 
terms." 

THE  CAMP  PHYSICIAN'S  MANUAL. 
David  Goldring,  M.D.  Charles  C 
Thomas,  Springlield.  111.  l!Ki".  168 
pp.     ?S..'>0. 

Written  for  the  physician  at  a  chil- 
dren's camp,  this  book  discusses  the 
"tot.il  range  of  health  responsibility  in 
camping":  camp  standards  for  sanita- 
tion, safety,  and  the  health  of  workers 
and  the  medical  and  surgical  problems 
a  camp  doctor  is  likely  to  meet,  includ- 
ing injuries,  animal  and  insect  bites, 
food  poisoning,  eye  problems,  infections, 
and  common  di.seases.  Alex  H.  Kaplan, 
M.D.,  of  the  Washington  University 
School  of  Medicine,  with  which  the  au- 
thor is  a.ssociated,  contributes  a  chapter 
on  the  p.sychological  problems  the  camp 


ilijclor  may  meet,  such  as  homesickness, 
bedwetling,  anxiety,  phobias,  and  anti- 
social behavior. 

COMMIXICATION  TRAINING  IN 
ClIIl.KllOOU  lUtAIN  DAMAGE. 
Compiled  and  edited  by  Merlin  J. 
Mccliani,  Martin  .1.  Herko,  Frances 
Giden  Berko,  and  Martin  V.  Palmer. 
Charles  C  Thomas,  Springfield,  111. 
1966.    392  pp.     $11.75. 

The  contributors  to  this  volume  sur- 
vey recent  advances  in  and  current 
theories  about  training  children  whose 
abilities  to  communicate  with  others 
through  speech,  listening,  reading,  and 
writing  are  affected  by  brain  damage. 
In  eight  chapters,  tJie.v  discuss  such  sub- 
jects as  the  disorders  of  speech  and 
hearing,  the  role  of  the  speech  therapist, 
the  i>sychological  and  linguistic  mean- 
ing of  brain  damage  in  children,  and 
si)ecial  education  for  the  child  with 
brain  damage.  Their  discussion  centers 
on  the  problems  met  by  those  working 
with  such  children  in  psychological 
testing,  si>eech  and  hearing  therapy, 
and  the  classroom. 


fi 


ms  on  c 


hild  liF< 


Charges  for  rental  or  purchase  may  be  obtained  from  distributors. 


TITLE  I— OFF  AND  RUNNING.  27 
minutes  (35  mm.  filmstrip  with  mag- 
netic tape  somid  track,  and  printed 
script )  :  color ;  purchase  or  loan. 

With  .Tohnny  Clark,  a  12-year-old 
poverty-stricken  boy,  as  its  main  char- 
acter, this  filmstri])  shows  how  children 
who  are  educationally  deprived  l)ecause 
of  poverty  are  being  helped  to  learn 
through  special  educational  programs 
provided  under  title  I  of  the  Elemen- 
tary and  Secondary  Education  Act  of 
19C5. 

Audience :  School  boards,  teachers, 
parent-teacher  associations,  civic 
groups,  and  other  community  organiza- 
tions ;  and  persons  interested  in  the  ed- 
ucation of  disadvantaged  children. 

Produced  hy :  Bureau  of  Elementary 
and  Secondary  Education,  Office  of  Edu- 

VOLUME  14  -  NUMBER  3 


cation.  Department  of  Health,  Educa- 
tion, and  Welfare. 

Dislribiilcd  hii :  For  purchase,  Coe- 
Peacock,  Inc.,  8400  Wisconsin  Avenue 
NW.,  Washington,  D.C.  2(X)14 ;  also 
available  on  loan  from  most  State  libra- 
ries. 

FOR  BETTER,  FOR  W'ORSE.  28  min- 
utes ;  sound  ;  black  and  white ;  pur- 
chase. 

This  film  presents  a  study  of  the 
relationships  of  a  teenage  boy  and  a 
girl  following  their  marriage  by  docu- 
menting one  evening  in  their  lives  and 
dramatizing  some  of  the  problems  they 
were  encountering. 

Audience :  Adolescents  from  14  to  17 
in  discussion  groups  concerned  with 
family  planning,  boy-girl  relationships. 


and  sex  education  ;  adults  in  discussion 
groups  concerned  with  the  relationships 
of  parents  with  their  children. 

Produced  Vij :  TRAFCO-Television, 
Radio  and  Film  Commission,  the  Meth- 
odist Church. 

Distributed  hij :  TRAFCO-Television, 
Radio  and  Film  Commission,  1525  Mc- 
Gavock  Street,  Nashville,  Tenn.  37203. 

PLANNED    FAMILIES.     20    minutes; 
sound  ;  color ;  purchase. 

This  animated  film,  available  with 
sound  track  in  several  languages,  ex- 
plains bow  a  baby  is  conceived  and 
develops,  and  describes  in  six  detailed 
segments  all  the  medically  approved 
methods  of  birth  control. 

Audieuce:  Patients  of  maternity  and 
family  planning  clinics ;  parent  educa- 
tion groups ;  training  classes  in  family 
planning  for  i)ersons  in  the  fields  of 
nursing,  medicine,  and  social  work. 

Produced  hy:  Allend'or  Productions. 

Distrihutcd  hy :  Allend'or  Produc- 
tions, 3446  Cahuenga  Boulevard  West, 
Hollywood,  Calif.  90028. 

123 


HERE  and  THERE 


Against  discrimination 

A  children's  institution  in  Denver, 
Colo.,  formerly  restricted  under  the  pro- 
visions of  a  19th  century  will  to  the  care 
of  the  poor  white  "orphan"  boys  be- 
tween the  ages  of  6  and  10  of  "reputa- 
ble" parentage,  can  now  provide  care 
for  Negro  boys  and  others  who  need  its 
services  because  of  a  recent  court  ruling 
modifying  the  will's  restrictive  provi- 
sions. The  ruling,  made  by  the  probate 
court  of  Denver  early  in  January  in  ef- 
fect eliminated  the  age,  race,  poverty, 
and  parental  status  restrictions  in  the 
provisions  of  a  will — made  by  George 
C.  Clayton  in  1892 — under  which  a  com- 
mission of  city  oflBcials  has  been  ad- 
ministering the  "orphanage,"  known  as 
Clayton  College. 

Pointing  out  that  as  a  "public  chari- 
table institution"  Clayton  College  has 
been  enjoying  tax  benefits  not  accorded 
private  institutions  and  that  this  as 
well  as  the  involvement  of  city  officials 
in  the  administration  of  the  supporting 
trust  had  established  its  nature  as  a 
public  institution,  the  court  ruled  that 
the  provision  requiring  racial  discrim- 
ination was  in  violation  of  the  law  of 
the  land.  The  court  also  ix)inted  out 
that  if  the  institution's  tax  exemption 
were  withdrawn,  the  trust  fund  would 
be  so  depleted  that  it  could  no  longer 
serve  the  intention  of  the  testator. 

Applying  the  cij  pres  doctrine,  which 
allows  a  per.son's  testamentary  inten- 
tion to  be  carried  out  as  nearly  as  jws- 
sible  when  a  will's  provisions  cannot  be 
followed  literally,  the  court  interpreted 
other  restricting  provisions  of  the  Clay- 
ton will  as  making  it  impossible  for  the 
Clayton  Trust  Commission  to  serve  the 
needs  of  the  community  and  hence  to 
carry  out  the  testator's  intention.  The 
court  recommended  that  the  word  "or- 
phan" be  construed  to  mean  tlie  kinds  of 
children  most  in  need  of  care  and  that 

124 


the  age  limit  for  admission  to  Clayton 
be  raised  to  18. 

Witnesses — representatives  of  the 
Clayton  Trust  Commission,  the  Denver 
Welfare  Department,  and  the  Child 
Welfare  League  of  America — had  tes- 
tified that  children  who  need  group  care 
today  are  likely  to  be  older  children 
who  need  such  care  on  the  basis  of  per- 
sonal or  family  situations  other  than 
poverty  or  loss  of  a  parent  by  death. 

The  trustees  of  Clayton  College  had 
not  acted  to  expand  the  institution  for 
some  time  because  the  enrollment  had 
dropped  to  less  than  half  the  capacity 
and,  as  the  commission's  witness  testi- 
fied, was  likely  to  drop  even  more  if  the 
conditions  of  the  will  were  not  change<l. 

The  petition  to  break  the  will  was 
brought  by  the  city. 

Xegro  children  who  attend  racially 
segregated  schools  do  not  achieve  as 
well  as  Negro  children  in  integrated 
schools,  their  aspirations  are  narrow- 
er, and  they  lack  confidence  in  their 
ability  to  control  the  future,  the  U.S. 
Commission  on  Civil  Rights  maintains 
in  its  recent  report  to  President  John- 
son on  racial  isolation  in  the  public 
schools,  prepared  at  the  President's  re- 
quest. The  community  often  treats 
schools  in  which  Negro  children  are  in 
the  majority  as  inferior,  and  this  view 
is  often  shared  by  administrators,  teach- 
ers, students,  and  parents,  to  the  detri- 
ment of  the  Negro  child's  ability  to 
achieve,  the  Commission  points  out. 

Based  on  data  from  school  systems, 
research  sponsored  by  the  Commission, 
and  testimony  given  in  public  hearings 
by  school  officials,  teachers,  parents,  and 
civil  leaders,  the  report  also  includes 
these  observations,  among  others : 

•  School  segregation  is  widespread 
throughout  the  Nation  and  is  increas- 
ing as  white  people  move  to  the  suburbs 


and  leave  the  city  proper  to  the  Negro. 
Open  housing  would  help  break  up  seg- 
regated neighborhoods,  but  a  generation 
might  pass  before  it  could  change  the 
composition  of  the  schools. 

•  Xegro  children  need  special  atten- 
tion in  school  such  as  .small  classes  and 
excellent  teachers,  but,  most  of  all,  they 
need  opportunities  to  associate  with  ad- 
vantaged children.  Most  projects  to 
help  overcome  the  disadvantages  of  poor 
environment  in  large  cities  have  not 
had  lusting  effects.  Segregated  schools 
in  the  city  cannot  be  eliminated  without 
the  help  of  suburban  schools — both 
must  join  together  to  set  up  large  cen- 
ters and  educational  parks  where  chil- 
dren from  many  environments  will  have 
wide  opportunities  to  learn  together. 

•  The  U.S.  Congress  could  help  end 
the  isolation  of  the  Negro  child  by  set- 
ting up  standards  for  desegregation  and 
programs  of  financial  aid  to  States  to 
help  them  meet  the  standards. 

The  report,  "Racial  Isolation  in  the 
Public  Schools,"  has  been  published  in 
two  volumes  (the  second  volume  con- 
sists of  appendices).  (Available  from 
the  Superintendent  of  Documents,  U.S. 
Government  Printing  Office,  Washing- 
ton, DC.  20402,  $1  each.) 

Population  projections 

By  lOS.'i  the  population  of  the  United 
States  may  be  one-third  again  as  large 
as  in  1966,  according  to  recent  estimates 
of  the  Bureau  of  the  Census.  Projec- 
tions in  series  B  ( one  of  four  series  re- 
cently Issued  by  the  Bureau,  base<l  on 
different  assumptions)  show  a  popula- 
tion of  19G.S  million  for  July  1,  1966; 
207.3  million  for  1970 ;  223.8  million  for 
197.5;  and  264.6  million  for  198.5.  Be- 
hind series  B  projections  is  an  assump- 
tion regarding  fertility  :  that  the  aver- 
age number  of  children  per  1,000  women 
at  the  end  of  their  childbearing  years 
(15-44)  will  be  about  3,100,  or  at  about 
the  same  level  as  in  the  years  1964  and 
1965.  ( Provisional  figures  for  1966  sug- 
gest this  estimate  may  be  high.) 

Coupled  with  this  as.sumption  is  the 
further  assumption  of  a  gradually  in- 
creasing birth  rate  through  1984  esti- 
mated to  produce  approximately  4.64 
million  live  births  a  year  by  1970 ;  5.43 
million,  by  1975 ;  6.04  million,  by  1980 ; 
and  6.31  million,  by  1985.  On  this 
basis  the  estimated  newborn  popula- 
tion of  3.89  million  in  1966  will  increase 
19.2  percent  by  1970;  39.5  percent  by 

CHILDREN     •     MAY-JUNE  1967 


HIT.",;  ."i.i;  porct'iit  l).v  1!>S0:  iiml  G2.1 
pi'rcoiil   hy   \',*S~>. 

The  mimbor  of  wdiiu'ii  in  the  ehilil- 
bearing  ages  is  expcetfd  to  reach  o0.r> 
million  hy  IDST),  increasing  from  an  esti- 
mated .SI)..")  million  in  IDtlti. 

The  nmnber  of  children  under  15 
years  of  age  is  expected  to  increase 
from  an  estimated  (iO.l  million  in  10(56 
to  u  projected  ffl.l  million  in  IDS.',  or 
about  '.iX.S  percent.  The  number  of  peo- 
Iile  in  the  age  range  from  2."i  through 
01  will  increase  somewhat  less  rapidly. 
Thus  the  ratio  of  children  to  adults 
will  increase  from  69.5  children  mider 
l."i  per  l.()()0  MiluUs  ages  25  through  64 
in  l'.t66  to  722  per  1,000  in  19S5.  about 
a  4-perceMt  increase  in  child-rearing 
responsibility. 

The  estimates  are  reported  in  "Cur- 
rent Population  Reports,"  Series  P-2.5, 
No.  359,  issued  by  the  Bureau  of  the 
Census  on  February  20,  1967.  While 
the  figures  quoted  here  are  confined 
to  series  I?  alone,  the  report  includes 
estimates  and  projections  for  four  series 
(A..  B,  C,  and  D),  which  differ  from  one 
another  in  respect  to  assumptions  on 
fertility  after  July  1,  1966.  The  as- 
sumptions regarding  mortality  and  net 
immigration  are  the  same  in  all  series. 
These  recent  projections  differ  very  lit- 
tle from  those  published  earlier  b.v  the 
Bureau  of  the  Census  on  JIarch  10, 1966, 
in  Series  P-2.5,  No.  329.  in  which  the 
changes  are  confined  largely  to  slight 
rises  in  the  entire  population  and  in 
births. 

A  later  report  in  this  P-25  series  will 
give  complete  results  and  a  detailed  de- 
scription of  the  methodology  and  as- 
smuptions. 

Coordinated  services 

In  September  of  this  year,  the  School 
of  Social  Service  Administration  of  the 
University  of  Chicago  will  open  a  Social 
Services  Center — a  multipurpose  unit 
for  the  Woodlawn  conununity,  a  low- 
income  area  adjoining  the  university 
campus.  The  center  is  designed  to  pro- 
vide the  neighborhood  with  a  coopera- 
tive network  of  tax-supported  and  vol- 
untary agencies  working  together, 
under  the  school's  general  supervision, 
to  provide  more  effective  services,  to 
develop  new  programs,  and  to  improve 
the  quality  of  the  agencies'  staff 
through  training.  Three  public  agen- 
cies providing  programs  for  children 
and  their  families  will  operate  in  tlie 

VOLUME  14  -  NUMBER  3 


center  ill  llic  (iiilsct,  and  llic  center's 
staff  will  make  a  major  effort  to  bring 
community  agencies  not  located  in  the 
building  into  close  cooperative  program 
develoi)ment  and  c-oordination. 

The  plan  for  the  Social  Services  Cen- 
ter is  the  sequel  to  a  feasibility  study 
made  by  the  school  in  196.5-66  with  a 
grant  from  tbi'  Children's  Bureau. 
Funds  for  the  liuildiiig  are  being  simgbl 
thi'ough  the  neighborhood  fai'ilities  pro- 
gram of  the  U.S.  Department  of  Hous- 
ing and  Urban  Development,  which  has 
reserved  .$1,291,000,  pending  the  devel- 
opment of  final  plans,  for  a  grant  re- 
(luested  for  the  universit.v  by  the  city 
of  Chicago.  The  building  is  expected 
to  be  ready  for  occupancy  late  in  1908. 

The  opening  of  the  center  in  tempo- 
rary quarters  this  fall  before  the  new 
building  is  completed  has  been  planned 
to  provide  an  opportunity  for  testing 
the  center's  design  of  operation  and 
new  patterns  for  fieldwork  placement  of 
social  work  students.  The  initial  pro- 
grams to  be  included  are  the  maternal 
and  child  health  services  of  the  Chicago 
Board  of  Health,  the  program  of  aid  to 
families  with  dependent  children  of  the 
Cook  County  Department  of  Public  Aid, 
and  child  welfare,  legal  services,  spe- 
cialized education,  and  community  or- 
ganization iirograms  operated  by  volun- 
tai-y  agencies. 

Major  organizational  elements  In- 
clude provision  by  the  School  of  Social 
Service  Administration  of  a  program 
director  for  each  major  area  of  service 
to  provide  liaison  and  coordination,  the 
formation  of  a  council  of  center-related 
agencies  and  organizations,  and  the 
establishment  of  an  advisory  commit- 
tee of  Woodlawn  residents. 

The  School  of  Applied  Social  Services 
at  Western  Reserve  University  and  the 
George  Warren  Brown  School  of  Social 
Work  at  Washington  University  are 
now  developing  similar  plans  with 
grants  from  the  Children's  Bureau. 


The  Secretary  of  Health,  Education, 
and  Welfare  has  established  a  depart- 
mental committee  on  children  and 
youth  to  coordinate  all  activities  and 
programs  within  the  Department  de- 
signed to  develop  the  potentials  of 
young  people.  Under  Secretary  Wilbur 
.1.  Cohen  heads  the  committee ;  its 
other  members  are  Philip  R.  Lee,  M.D., 
Paul  A.  Miller,  and  Lisle  C.  Carter,  .Ir., 
assistant   secretaries,   respectively,  for 


lii'Mltb,  cdnc'ition.  and  individual  and 
fiimily  services.  In  addition  to  coordi- 
nating i)rescnt  programs,  the  committee 
is  charged  with  advising  the  Secretary 
on  new  proposals  for  new  programs  to 
help  meet  the  needs  of  young  people 
in  the  1970's. 

Agricultural  migrants 

Texas  was  the  first  State  to  receive 
a  Federal  grant  under  the  1966  amend- 
ments to  the  Klementary  and  Secondary 
Education  Act  of  1!)65  for  a  program 
to  improve  the  education  of  the  children 
of  migrant  farm  workers.  All  States 
except  Alaska,  Hawaii,  and  Rhode 
Island  and  the  District  of  Columbia — 
which  have  no  migrant  farm  workers — 
are  eligible  for  grants  to  improve  the 
education  of  migrant  children,  and 
nearly  all  States  have  plans  either  ap- 
proved by  or  pending  in  the  U.S.  Office 
of  Education. 

In  Texas,  the  home  base  for  the  bulk 
of  agricultural  migrants  in  the  Mid- 
west and  western  migrant  streams,  40 
schools  in  various  parts  of  the  State 
provide  20,000  children  of  migrant  farm 
workers  with  a  9-month  program  of 
schooling  in  6  months,  including  inten- 
sive work  in  English,  reading,  science, 
hygiene,  and  other  subjects.  Before  the 
Office  of  Education  grant  was  made  on 
December  22, 1966,  the  program  received 
support  from  the  Office  of  Economic 
Opportunity. 

Other  States  with  approved  plans  iu- 
clude  California,  New  York,  Indiana, 
Florida,  New  Mexico,  Washington, 
Colorado,  Louisiana,  and  New  Jersey. 
California  will  conduct  a  model  program 
of  supplementary  education  in  three 
counties :  New  York  will  offer  summer 
.school  programs  to  migrant  children: 
Indiana  will  train  teachers  for  Spani.sh- 
speaking  children;  and  Florida,  Ala- 
bama, and  Georgia  plan  to  establish 
a  coordinated  program  for  migrant 
children  to  be  administered  by  the 
Florida  State  Department  of  Education 
and  to  involve  the  development  of  re- 
gional instructional  materials,  curric- 
ulum, and  teaching  methods,  and  a 
method  of  transferring  scholastic  and 
health  records. 


A  study  of  child-rearing  practices 
among  Negro  agricultural  migrants  in 
central  Pennsylvania  has  revealed  many 
areas  of  strengtli.  according  to  the  inves- 

125 


tigator,  Mable  B.  Anderson,  who  carried 
out  the  study  while  worliiug  on  the  staff 
of  a  day-care  center  for  migrant  chil- 
dren during  the  summer  of  1962.  In 
the  study,  64  mothers  of  Si  children  in 
three  Pennsylvania  counties  were  asked 
aliout  their  child-care  arrangements 
and  child-rearing  practices. 

Over  half  the  mothers  with  children 
aged  3  to  6  used  one  of  the  two  day-care 
centers  provided  for  migrant  children 
between  3  and  11  in  these  counties. 
Many  mothers,  however,  took  their 
children  under  3,  including  infants,  to 
the  fields  with  them  because  they  had 
not  been  able  to  make  other  arrange- 
ments and  did  not  wi.sh  to  leave  the 
children  uncared  for;  and  many  re- 
ported being  unhappy  about  this  type  of 
arrangement.  All  the  children  over  11 
worked  in  the  fields,  as  did  some  chil- 
dren as  young  as  9. 

The  mothers  were  not  severe  in  their 
discipline  of  the  children,  not  even  in 
toilet  training,  the  investigator  found. 
On  the  other  hand,  they  were  not  lenient 
where  sex  was  concerned:  they  disci- 
plined the  children  for  sexual  curiosity 
and  genital  play  because  they  were  con- 
cerned about  the  children's  health  and 

safety. 

The  mothers  encouraged  the  children 
to  care  for  themselves — to  bathe  and 
to  dress,  for  instance.  In  this  respect, 
the  children  exceeded  their  mothers' 
hopes,  many  mothers  reported. 

About  two-thirds  of  the  mothers  said 
they  had  received  ideas  about  child 
care  from  "medical  sources."  and  many 
had  printed  material  at  hand. 

On  the  whole,  the  mothers  had  from 
4  to  6  years  more  education  than  the 
mothers  studied  by  other  investigators 
in  a  survey  of  east  coast  migrant 
workers  made  at  about  the  same  time 
at  another  site,  and  they  respected  edu- 
cation. While  all  expressed  the  wish 
that  their  children  would  get  more  than 
an  elementary  school  education,  about 
one-fourth  gave  some  indications  that 
this  was  either  economically  or  intel- 
lectually attainable. 

Nearly  all  the  mothers  in  the  Pennsyl- 
vania study  had  received  prenatal  care  ; 
for  about  half  of  them  the  care  had 
begun  in  the  first  3  months  of  preg- 
nancy— less  than  10  percent  of  the 
mothers  in  the  other  study  had  received 
prenatal  care  as  early  as  this.  This 
difference  the  study  director  attributed 
to  the  fact  that  the  Pennsylvania  mi- 
grants had  health  services  available  to 

126 


them  at  their  home  base  in  Palm  Beach, 
Fla. 

The  differences  in  the  findings  among 
the  two  groups  of  east  coast  migrants 
Dr.  Anderson  regards  as  evidence  that 
generalizations  cannot  be  made  on  broad 
groiips  of  people  from  local  studies. 


Child 


care 


A  cleft  palate  or  lip  in  a  child  is  not 
necessarily  a  deterrent  to  adoption,  the 
Montana  State  Board  of  Health  and  the 
State  Department  of  Public  Welfare 
have  found.  A  recent  review  by  Venus 
Tretsven,  coordinator  of  the  cleft  palate 
program,  and  Wilma  Smyth,  medical 
social  consultant,  of  the  State  Board 
of  Health's  division  of  child  health 
services,  of  the  337  children  with  clefts 
bom  in  the  State  between  19.")".  and 
10G5  showed  that  8  of  the  11  needing 
families  other  than  their  own  have  been 
pUiced  in  adoptive  liomes.  Except  for 
one  who  died  from  a  sudden  infection, 
the  children  are  getting  along  well. 
The  adopted  children  include  both  In- 
dian and  Caucasian  children,  several 
of  whom  have  more  than  one  handi- 
(.ai>— one,  for  example,  is  mildly  re- 
tarded: another  has  deformities  of 
hands,  feet,  and  neck. 

The  adoptions  followed  close  work  be- 
tween the  social  workers  of  the  State 
Department  of  Public  Welfare  and  the 
Lutheran  Social  Services,  the  agencies 
responsible  for  the  placements;  the 
specialists  of  the  cleft  palate  teams  of 
the  State  Board  of  Health;  and  the 
local  public  health  nurses. 

One  of  the  three  children  remaining 
in  foster  care — where  they  were  placed 
because  of  parental  neglect— has  been 
relinquished  by  his  parents  for  adop- 
tion also,  although  adoptive  placement 
has  not  yet  been  made. 


For  a  child-caring  agency  to  act  as  a 
"parental  force,"  accepting  responsi- 
bility for  all  aspects  of  a  child's  life  can 
effect  greater  stability  in  emotionally 
disturbed  children  in  foster  care,  ac- 
cording to  a  study  conducted  by  the 
Iowa  Children's  Home  Society,  in  Des 
Moines,  with  a  demonstration  grant 
from  the  Children's  Bureau.  Though 
the  agency,  a  voluntary  child-care 
agency,  set  out  to  determine  whether 
the  "split  case"  method— having  one 
caseworker  act  as  a  therapist  and  an- 
other   as    a    "parental    force" — or    the 


[feotin 

I  net; 
fcto 


"single  ease"  uielliod — having  one  case- 
worker perform  both  functions — was 
more  effective  in  helping  the  emotion- 
ally disturbed  children  selected  for  the 
project,  the  agency  found  that  all  the 
children  improved.  The  study  included 
24  children,  aged  7  to  10,  from  similar 
backgrounds  who  were  in  foster  fami- 
lies, group  homes,  or  residential  treat- 
ment centers  and  were  expected  to  need 
care  away  from  their  own  parents  for 
at  least  2  years.  They  were  assigned  at 
random  to  the  two  methods. 

As  the  "parentiil  force,"  the  agency 
provided  the  children  with  an  "under- 
pinning of  authority"  that  supported 
the  needs  of  the  children  and  was  a  con- 
stant factor  in  their  lives,  according  to 
the  project's  director,  Edith  Zober.  She 
reports  that  the  children  seemed  to 
know  that  the  agency  was  acting  as  a 
parent  in  assuming  ultimate  responsi 
bility  for  all  aspects  of  their  lives — 
school,  foster  home  adjustment,  peer  ad- 
justment, and,  in  .some  instances,  begin- 
ning adjustment  to  work. 

As  a  result  of  the  project,  the  agency 
has  defined  its  primary  method  of  work- 
ing with  emotionally  disturbed  children 
in  foster  care  as  reestalilishing  a  func- 
tion;il  parent  for  the  child. 

Education 

By  the  first  of  March  this  year.  64 
projects  to  improve  the  education  of  I  he 
nearly  SO.OCM)  children  attending  tlie 
schools  operated  by  the  Bureau  of  In- 
dian Affairs,  U.S.  Department  of  the  In- 
terior, had  been  approved  for  grants 
from  the  Office  of  Education,  U.S.  De-  ; 
partment  of  Health,  Education,  and ' 
Welfare,  under  the  1966  amendments  to 
the  Elementary  and  Secondary  Educa- 
tion Act  of  1965. 

Tlie  grants  have  been  made  for  im- 
provements of  clas.swork,  cultural  en- 
richment, and  the  meeting  of  special 
needs  in  day  schools  and  boarding 
schools  operated  by  the  Department  of 
the  Interior.  They  are,  for  example, 
providing  for  additional  teachers  and 
teachers'  aides  to  facilitate  language 
instruction,  summer  programs,  and  pre- 
school, remedial,  and  enrichment  activ- 
ities and  to  reduce  the  size  of  classes ; 
guidance  counselors  and  school  social 
workers ;  food  and  transiwrtation  serv- 
ices :  the  expansion  of  physical  educa- 
tion and  recreation  programs ;  special 
education  of  the  handicapped:  and 
special  services  for  pregnant  girls. 

CHILDREN     •     MAY-JUNE  1967  It 


IN  THE  JOURNALS 


Treating  the  whole  family 

I'oiiitiug  to  tlio  iiuiHirUmce  ot  having 
a  treatmeut  goal  for  each  member  of 
tho  family,  Otto  I'ollaclc,  in  the  March 
i;i(J7  issue  of  Child  Welfare,  suggests 
tliat  team  counseling  of  the  family  as 
a  group  be  useil  not  only  for  intact  fam- 
ilies with  problems  of  intrafauiily  rela- 
tionships but  also  for  broken  families, 
adoptive  families,  and  foster  families. 
( "Disturbed  Families  and  Conjoint 
Family  Ooiuiseling."  I 

The  author,  who  is  i>rofessor  of  so- 
ciology at  the  Wharton  School,  Uni- 
versity of  Pennsylvania,  also  suggests 
that  the  content  of  family  therapy  with 
the  different  types  of  families  will  vary. 
For  example,  he  says,  with  broken  fam- 
ilies it  may  include  coping  with  prob- 
lems of  guilt,  anger,  and  fatigue  not 
likely  to  appear  in  intact  families  and 
with  pressures  on  the  remaining  mem- 
bers to  take  over  the  role  of  the  absent 
member:  with  foster  families,  problems 
connected  with  the  demand  for  emo- 
tional commitment  without  the  security 
of  permanence,  the  experience  of  sibling 
rivalry  and  intimacy  without  the  cor- 
rectives of  a  blood  relationship  or  incest 
taboo,  and  the  threat  of  parental  auto- 
nomy represented  b.v  the  ca.seworker  or 
the  child's  own  parents ;  with  adoptive 
families,  some  of  the  same  problems  con- 
nected with  the  absence  of  blood  tie 
controls  as  in  foster  families,  or  con- 
cern over  an  equitable  distribution  of 
the  parents'  affection  between  their 
natural  and  adopted  children.  The  au- 
thor further  suggests  that  two  thera- 
pists— a  man  and  a  woman — working 
with  the  family  as  a  team  can  provide 
the  members  of  a  foster  or  adoptive 
family  with  a  model  for  impulse  control. 
Tracing  the  development  of  family 
group  therapy  in  the  past  decade,  from 
the  recognition  of  therapists  more  than 
20  years  ago  that  improvement  in  one 
member  of  a  family  following  individual 
therapy  of  sometimes  accompanied  by 
deterioration  of  another,  the  author 
maintains  that  conjoint  family  therapy, 

VOLUME  14  -  NUMBER  3 


whether  provided  by  a  team  or  an  indi- 
vidual therapist,  can  restore  communi- 
cation between  the  members  of  a  dis- 
turbed family  who  have  built  "walls  of 
psychological  privacy"  around  them- 
selves and  can  thus  begin  the  heal- 
ing process. 


Family  law 


A  new  journal,  Family  Laio  Qurir- 
tcrly,  published  by  the  American  Bar 
Association,  Section  of  Family  Law, 
which  made  its  initial  appearance  in 
March  of  this  year,  will,  according  to 
the  preface,  concern  itself  "not  merely 
with  those  questions  which  are  now 
clearly  in  the  domain  of  family  law 
(e.g.,  alimony,  adoption,  divorce)"  but 
also  with  subjects  "with  which  lawyers 
handling  domestic  relations  .should  be 
familiar"  such  as  marriage  counseling, 
the  rights  of  children  w-ho  do  not  live 
with  both  parents,  and  proposals  con- 
cerning a  change  in  abortion  laws. 

Among  the  articles  in  the  first  issue 
is  one  commenting  on  three  1966  cus- 
tody decisions  in  Iowa  in  each  of  which 
a  parent  was  denietl  custody  of  a  cliild 
he  or  she  had  once  voluntarily  placed 
with  the  child's  grandparents.  ("Child 
Custody :  Iowa  Corn  and  the  Avant 
Garde,"  by  David  X.  Levine.)  The 
author  points  out  that  in  each  case 
(Painter  v.  liannisfcr,  140  N.'W.  2d  151 ; 
AUfiffh  V.  Alingh,  144  N.W.  2d  134 ;  and 
HaUtcad  v.  Ualstcail,  144  N.'U'.  2d  8G1) 
the  Supreme  Court  of  Iowa  placed  th<; 
doctrine  of  "Uie  best  interest  of  tlie 
child"  above  the  "natural  right"  of  the 
parent  to  the  child.  Finding  in  these 
decisions  a  definite  advance  over  the 
"unfortunate  vestige  of  the  feudal  era." 
rigid  adherence  to  the  natural  right 
theory,  the  author,  however,  warns 
again.st  just  as  rigid  adherence  to 
a  parent  hy  associatimi.  doctrine  with- 
out giving  serious  consideration  to  psy- 
chological and  psychiatric  testimony. 
Pointing  out  the  diftii-ulties  of  arriving 
■at  the  "best  interests  of  the  child"  in  a 
case  like  the  highly  jiulilicized  Painter 


ca.sc.  in  wliirli  ihi'  suing  father,  "a 
wholly  lii.  iM-r.son"  had  iil'lcr  his  wife's 
sudden  death  relinquished  cu.stody  of 
his  son  oidy  temporarily  lo  the  mater- 
nal grand|)a rents  for  whom  the  boy  pro- 
ceeded to  develop  a  strong  attachment, 
he  concludes  that  the  linal  judgment 
must  be  th<?  court's,  but  that  judgment 
must  follow  intelligent  appraisal  of  the 
case  and  not  be  "rigidly  predetermined." 


Family  planning 


lleiaii.se  of  llie  lack  of  clarity  as  to 
the  nurse's  role  in  family  planning  to- 
day, nursing  education  i)rograms  need 
to  integrate  family  i)lanning  concepts 
and  skills  into  their  basic  nursing  cur- 
riculum, says  Si.ster  JIary  Helen,  co- 
ordinator of  maternal-child  nursing. 
University  of  San  Franci.sco  School  of 
Nursing,  in  the  March  ISWT  issue  of 
Nursing  Outlook.  ("Family  Planning 
Within  the  Curriculum.")  This  ap- 
proach, she  .says,  will  enable  nur.ses  to 
function  effectively  in  any  family  plan- 
ning program.  However,  she  adds, 
planning  for  such  a  program  must  take 
into  account  the  institution's  philosophy 
and  the  ideas,  previous  experience,  and 
cultural  background  of  the  teachers  and 
the  students  who  are  to  participate. 

The  author  descrilies  the  principles 
followed  in  incorporating  family  jilan- 
ning  content  into  the  University  of  San 
Francisco's  baccalaureate  nursing  pro- 
gram, which  is  developed  on  three  "core 
threads" — family-community  health, 
problem-solving,  and  leadership.  Slie 
cites  the  following  goals  for  the 
student : 

•  The  formulation  of  a  realistic, 
satisfying  personal  attitude  about  sexu- 
ality and  her  role  as  .a  woman. 

•  The  ability  to  apply  problem-solv- 
ing methods  to  patient  situations  as 
Well  as  to  her  own. 

•  The  development  of  skill  in 
interviewing. 

•  An  understanding  of  the  need  for 
family  limitation  as  a  social  as  well  as 
an  individual  family  i)rol>lem. 

•  Recognition  of  the  goal  of  family 
I>lanning  as  strengthening  the  family. 

•  Recognition  and  respect  for  the 
rights  of  individual  couples  to  choose 
their  family  size. 

•  Knowletlge  of  the  various  methods 
of  birth  control  and  a  demonstrated  abil- 
ity to  explain  their  use. 

•  Understanding    the   nature   of   the 

127 


nurse's    role    in    family   planning   pro- 
grams. 

•  Awareness  of  her  own  limitations, 
and  ability  to  seek  eounsel  when  indi- 
cated and  to  refer  patients  to  appropri- 
ate resources. 

Living  with  leukemia 

The  old  theory  that  the  less  children 
with  leukemia  discuss  their  problems 
and  progress,  the  less  upset  they  will  be 
is  no  longer  accepted  at  the  leukemia 
service  of  the  National  Cancer  Insti- 
tute, write  Joel  Vernick,  former  social 
worker  in  the  institute's  children's  pro- 
gram, and  Janet  L.  Lunceford,  head 
nurse  of  the  cancer  nursing  unit,  in  the 
March  1967  issue  of  the  Americati 
Journal  of  Nursing.  ("Milieu  Design 
for  Adolescents  with  Leukemia.") 

The  article  describes  the  institute's 
program  of  providing  adolescent  leuke- 
mia patients  with  opportunities  to  dis- 
cuss their  fears,  anxieties,  and  prob- 
lems in  unscheduled  individual  or  group 
interviews  with  the  nursing  unit's  so- 
cial worker  and  nursing  staff.  This 
program,  which  includes  all  children 
ages  9  through  21  admitted  to  the  serv- 
ice, has  resulted  in  lessened  anxiety  and 
in  more  healthy  emotional  functioning 
among  them,  the  authors  report. 

The  young  people  are  given  frank  an- 
swers to  their  questions  but  are  told 
there  is  always  hope  and  that  every- 


thing possible  is  being  done  to  get  them 
well  enough  to  return  home.  Questions 
that  cannot  be  answered  by  the  social 
worker  or  nursing  staff  are  referred  to 
the  chief  pediatrician. 

The  authors  also  point  out  that  the 
children  are  encouraged  to  function  as 
normally  as  possible — to  attend  school 
in  the  building  when  they  can,  keep 
their  rooms  neat,  obey  the  hospital 
rules,  and  participate  in  and  attend  rec- 
reational activities  such  as  gym  exer- 
cises, arts  and  crafts,  weekly  movies, 
band  concerts,  picnics,  sightseeing  tours, 
and  trips  to  the  drugstore.  Bedside 
programs  of  occupational  therapy  are 
offered  when  necessary. 

High  risks  of  schizophrenia 

Children  of  two  schizophrenic  parents 
have  about  a  3.5-percent  "risk  rate"  of 
developing  schizophrenia,  as  compared 
with  the  1-percent  ri.sk  rate  among  chil- 
dren in  the  general  population  and  a 
7-  to  15-percent  risk  rate  among  children 
with  one  schizophrenic  parent  only,  re- 
ports David  Ro.senthal,  chief  of  the 
laboratory  of  psychology  at  the  National 
Institute  of  Mental  Health,  in  analyzing 
five  studies  of  children  of  schizophrenic 
parents  in  the  December  1966  issue  of 
the  quarterly  Journal  of  Ptsychiatric 
Research.  ("The  Offspring  of  Schizo- 
phrenic   Couples.")      The    studies    in- 


guides  and  reports 


FAMILY  PLANNING  PROGRAMS  IN 
THE  WAR  AGAINST  POVERTY: 
a  guide  for  community  action  pro- 
grams. Planned  Parenthood-World 
Population,  51.5  Madison  Avenue,  New 
York,  N.Y.  1(K)22.     1966.     $3. 

A  kit  of  guide  materials  for  develop- 
ing a  local  family  planning  program. 

TRAINING  SERIES  FOR  SOCIAL 
AGENCIES— Vols.  I  through  VIII: 
Implications  of  Social  Change; 
Changing  Interpretations  of  Be- 
havior ;  Social  Agencies  and  Social 
Change ;  Poverty  in  the  United 
States ;  Reaching  the  Disadvantaged 

128 


Child ;  Dropouts  and  Training ;  De- 
linquency and  Treatment;  and 
Planned  Change.  Edited  by  Robert 
Schasre  and  Jo  Wallach.  Youth 
Studies  Center,  University  of  South- 
ern California,  Los  Angeles,  Calif. 
90007.    May  1966.    $1.50  each. 

A  reading  series  of  published  and  un- 
published material  focused  on  the  poor 
and  culturally  disadvantaged  for  use  in 
education  and  training  in  the  field  of 
social  service. 

REARING  CHILDREN  OF  GOOD 
WILL :  a  program  guide.  James  M. 
E  a  g  a  n.     National     Conference     of 


eluded  99  children  of  65  schizophrenic 
couples. 

The  author  presents  evidence  both 
for  and  against  the  implication  of  a 
dominant  gene  in  the  development  of  the 
disease  and  concludes  that  both  genetic 
and  environmental  factors  are  involved. 
Reflecting  on  "what  the  home  life  of  a 
child  with  two  schizophrenic  parents 
must  be  like,"  he  points  to  the  difliculty 
of  di.stingui.shing  between  the  extent  of 
the  influence  of  "domestic  chaos"  and 
of  "genetic  chaos"  on  the  rate  of  schizo- 
phrenia among  such  children. 

According  to  the  author,  the  findings 
also  indicate  that  perinatal  mortality 
is  higher  among  infants  born  to  schizo- 
phrenic parents  than  in  the  general 
population,  that  it  is  higher  among  chil- 
dren whose  mothers  only  are  schizo- 
phrenic than  among  children  whose 
fathers  only  are  schizophrenic,  but  that 
it  is  no  higher  among  the  children  with 
two  schizophrenic  parents  than  among 
children  whose  mothers  only  are  schizo- 
phrenic. Here  again,  he  suggests,  there 
is  diflSculty  in  determining  how  much 
of  the  differences  in  rate  can  be  laid 
to  the  effects  of  the  disease-carrying 
gene  on  the  fetus  and  how  much  to 
noxious  factors  derived  from  the  moth- 
er's schizophrenic  state,  such  as  the 
ingestion  of  drugs,  coma  or  convulsion 
inducing  treatment,  inadequate  diet  and 
exerci.se,  and  prolonged  anxiety. 


Christians  and  Jews,  43  West  57th 
Street,  New  York,  N.Y.  10019.  1966. 
38  pp.     35  cents. 

Offers  suggestions  for  helping  chil- 
dren in  the  home,  school,  church,  and 
community  grow  up  without  prejudice 
toward  others  of  different  race,  religion, 
or  national  origin. 


GUIDE  FOR  ESTABLISHING  AND 
OPERATING  DAY  CARE  CEN- 
TERS FOR  YOUNG  CHILDREN. 
Dorothy  Beers  Boguslawski.  Child 
Welfare  League  of  America,  Inc.,  44 
East  23rd  Street,  New  York,  N.Y. 
10010.     1966.     100  pp.     $2.50. 

Describes  the  purposes  and  program 
of  a  day-care  center  for  children,  the 
roles  of  various  types  of  staff  members, 
housing  and  equipment  needed,  the 
sources  of  financial  support,  and  the 
importance  of  a  State  licensing  law. 

CHILDREN     •     MAY-JUNE  1967 

U.S.    GOVERNMENT   PRINTING    OFFICEM967 


t/  4 


o 
o 


CO 

< 

>- 


Boston  Pubiic  Library 
^urerintenHp-n  nf  n.  .;:..-:  nts 

SEP  18  iba/ 
DEPOSITOR  Y 


childci^n 

Family  Life  and  Sex  Education 
A  Maternity  and  Infant  Care  Project 
Neighborhood  Youth  Corps  Progress 
Volunteers  in  Work  With  Children 


I 


VOLUME  14    •    NUMBER  4    •    JULY-AUGUST  1967 


children 


AN  INTERDISCIPLINARY  JOURNAL  FOR  THE  PROFESSIONS  SERVING  CHILDREN 


< 


ifoung  love — or  at  least  a  mu- 
tually interested  boy  and  girl. 
How  their  relationship  grows  and 
ow  wholesomely  they  respond  to 
ach  other  may  depend  on  what 
they  have  learned  about  sex  and 
its  place  in  a  mature  life  from 
cbeir  parents,  teachers,  or  reli- 
gious counselors.  (See  pp.  130  and 
136  for  discussions  of  sex  edu- 
ixttion.) 


Helping  Children  Grow  Up  Sexually — How?  When? 

By  Whom? 130 

Eleanore  Braun  Luckey 

Starting  a  Sex  Education  Program 136 

Lester  A.  KirkenJall  and  Helen  M.  Cox 

645  Days  of  Maternity  and  Infant  Care 141 

Kathleen  A.  Swallow  and  George  H.  Davis 

Volunteers  in  Institutions  for  Delinquents 147 

Elizabeth  H.  Gorlich 

How  Volunteers  Can  Help  Disadvantaged  Children.    151 

Harris  E.  Karowe 

Three  Years  of  the  Neighborhood  Youth  Corps  .  .     156 

llegina  H.  Saxton 

A  Focus  on  Children  of  the  Poor 163 

\'era  Shlakman 

book  notes 162 

here  and  there 166 


children 


Nafional  Advisers  to  CHILDREN 

William  E.  Brown,  Jcnlistry 

Alex  Elson,  taw 

Patricia  Garland,  social  work. 

Edwin  M.  Gold,  obstetrics 

Herman  R.  Goldberg,  education 

Beatrice  Goodwin,  nursing 

Dale  B.  Harris,  psychology 

Robert  J.  Havighurst,  youth  development 

Robert  B.  Kugel,  pediatrics 

Hylan  Lewis,  sociology 

Winford  Oliphant,  child  welfare 

Milton  G.  Rector,  corrections 

R.  Gerald  Rice,  maternal  and  child  health 

Albert  J.  Solnit,  psychiatry 

Franklin  M.  Zweig,  community  planning 

Children's  Bureau  Staff  Advisers 

Kenneth  S.  Carpenter,  chairman 
Division  of  fuvenile  Delinquency  Service 

Dorothy   E.   Bradbury 
Division  of  Reports 

Hester  B.  Curtis 

Division  of  International  Cooperation 

Elizabeth  Herzog 
Division  of  Research 

lane  S.  Lin-Fu 

Division  of  Health  Services 

Jean  Reynolds 
Office  of  the  Chief 

Will  Wolstein 

Division  of  Social  Services 

Editorial  Staff 

Kathryn  Close,  Editor 

Catherine  P.  Williams,  Associate  Editor 

Mary  E.  Robinson,  Willamena  Samuels.  Assistants 

130 


Today  many  parents  who  themselves  were 
reared  by  mothers  and  fathers  afraid  to 
educate  their  children  in  sexual  matters  are 
now  afraid  -iwi  to  educate  their  own  children  regard- 
ing sex.  Social  pressures  on  young  people  different 
from  the  kind  they  experienced  when  yoimg,  preva- 
lent attitudes  toward  sex  that  reflect  a  changing  value 
system  in  society  as  a  whole,  and  behavior  among 
many  young  people  that  they  do  not  imderstand  have 
left  today's  pai'ents  perplexed  and  anxious.  As  a 
result  they  are  eagerly  seeking  help  for  themselves 
and  for  their  children,  whom  they  want  to  achieve 
"normal  sexual  maturity." 

Community  agencies,  youth  organizations, 
churches,  and  schools  are  all  scurrying  to  initiate 
programs  of  sex  education — sometimes  called  family 
life  education,  boy-gii-1  relationshijjs,  or  interpersonal 
development.  Inservice  training  programs,  work- 
shops, and  institutes  are  being  organized  for  nurses, 
social  workers,  clergymen,  teachers,  counselors, 
health  educators,  community  youth  leaders,  and  par- 
ents. After  a  long  period  of  being  treated  with  silence 
or  half-truths,  blushes  and  snickers,  the  subject  of  sex 
can  openly  be  talked  about  in  "respectable"  society. 
Yoimg  people's  attitiides  and  behavior  toward  the 
opposite  sex — and  the  consequences — are  the  subject 
of  serious  concern  not  just  to  adolescents  and  their 
parents  but  also  to  persons  in  the  teaching  and  help- 
ing professions. 

Nevertheless,  the  goals  of  sex  education  are  not 
altogether  clear.  Nor  is  it  clear  just  whose  resjjonsi- 
bility  it  is  to  give  sex  information  to  children  and 
adolescents  and  to  try  to  shape  the  attitudes  that 
determine  their  moral  values  and  sexual  behavior. 
Dealing  with  the  sexual  problems  of  young  people  is 
especially  difficult  for  adults  brought  up  in  a  society 
confused  about  sex,  one  that  has  been  filled  with 
sexual  stimuli  and  at  the  same  time  with  harsh  taboos 
against  sexual  expression.  Social  scientists  are  not 
surprised  that  the  combination  of  stimulation  and 
repression  has  resulted  in  a  demand  for  a  "better 
way"  of  dealing  with  sex. 

In  response  to  the  demand,  persons  who  work  pro- 
fessionally with  children,  adolescents,  and  parents 
are  seeking  the  way  (if  there  is  one)  or  a  way  (if 
there  are  many)  to  help  children  grow  toward  "sex- 
ual maturity."  This  goal  in  itself  is  difficult  to  define, 
and  to  chart  a  course  leading  to  its  achievement  is 
even  more  challenging. 

Sexual  behavior  among  men  and  women  and  sexu- 
ality as  it  is  manifested  in  masculinity  and  femininity 
vary  from  culture  to  culture.  Anthropologists  tell 

CHILDREN     •     JULY-AUGUST  1967 


lA 


I'fll 


iLEANORE  BRAUN  LUCKEY 


SEXUALLY 


GROW  UP 


CHILDREN 


HELPING 


at 


us  that  tliere  is  no  sexual  practice  that  has  been  uni- 
versally sanctioned  or  prohibited;  even  incest,  the 
sexual  l)oliavior  that  comes  nearest  to  being  uni- 
versally tabooed,  has  been  approved  in  some  societies 
in  some  periods  of  history. 

In  any  cidture,  what  is  "normal"  depends  upon  the 
practices  of  the  majority.  JNIany  behavior  patterns 
that  are  quite  objectionable  in  our  society  are  sanc- 
tioned in  others;  for  example,  homosexual  practices, 
sexual  relationships  between  children,  premarital  sex- 
ual promiscuity,  find  wife  swapping  and  borrowing 
are  approved  forms  of  bel*la^•ior  in  some  societies.  It 
is  not  possible  to  speak  of  what  is  or  is  not  "normal" 
unless  we  specify  the  society  to  which  we  refei'. 

Normality?  maturity? 

Even  in  this  country  alone  the  wide  range  of  sexual 
behavior  and  values  existing  todaj'  make  "the  norm" 
impossible  to  define.  At  one  extreme  are  those  people 
who  advocate  complete  sexual  fi'eedom  amounting  to 
anarchy ;  at  the  other  extreme  are  those  who  condone 
the  use  of  sex  only  for  reproduction.  Between  these 
extremes  lies  immense  variation  in  attitude  and  prac- 
tice. For  example,  chastity  before  marriage  is  held 
to  be  a  supreme  value;  it  is  considered  "a  good 
thing";  it  is  thought  not  to  be  very  important;  it  is 
valued  not  at  all ;  it  is  considered  a  poor  thing.  Mas- 
turbation is  valued  as  a  means  of  releasing  sexual 
tension ;  it  is  considered  an  acceptable  adolescent  pas- 
time; it  is  thought  to  be  a  shameful  practice  or  a 
sin.  Marital  practices  vary:  there  is  no  consensus  on 

VOLUME  14  -  NUMBER  4 


HOW? 

WHEN? 

BY  WHOM? 


how  frequently  coitus  should  take  jjhice,  nor  on  the 
appropriate  position,  nor  on  the  amount  or  kind  of 
foreplay  that  is  accejitable.  Most  social  scientists 
agree  that  it  would  be  difficult  if  not  impossible  to  de- 
fine the  norm  of  sexual  behavior  in  contemporary 
American  society.  Even  if  such  a  norm  could  be  de- 
fined, the  definition  would  be  meaningless,  for  sexual 
exj^ression  is  a  highly  individual  matter,  an  integral 
part  of  the  total  personality. 

Sexual  maturity  rather  than  sexual  normality  may 
be  a  better  goal  for  sex  education.  Even  so,  we  must 
make  assumptions  that  cannot  be  validated  about 
the  nature  of  man  and  the  patterns  of  his  maturing. 
By  careful  measurement  and  observation  we  have 
learned  a  great  deal  about  the  physical  growth  and 
development  of  boys  and  girls;  we  know  about  many 
of  the  factors  that  contribute  to  or  detract  from 
soundness  and  roundness  of  body ;  we  have  been  able 
to  trace  general  developmental  patterns  from  the  pre- 
natal period  to  maturity  and  then  to  decadence.  In- 
tellectual growth  has  been  more  difficult  to  discover 
and  predict  in  a  sequential  pattern,  but  in  general 
We  know  a  good  deal  about  such  aspects  of  growth 
as  language  development,  concept  development, 
learning,  and  creativity. 

What  we  know  of  emotional  growth  is  still  largely 
theory  or  educated  guesses;  and  social  patterns  that 
propel  a  child  on  to  becoming  a  socially  mature  adult 
are  known  to  vary  from  generation  to  generation. 
Even  so,  through  keen  observation,  crude  but  per- 
sistent evaluation,  and  creative  speculation,  we  can 
draw  at  least  some  tentative  conclusions  about  the 


131 


1 


emotional   and   social    development   of   the   human 
being. 

Wlien  we  realize  that  sexual  growth  includes  fac- 
tors that  are  physical,  intellectual,  emotional,  and 
social,  it  becomes  clear  that  with  the  incompleteness 
of  our  knowledge  it  is  impossible  to  trace  a  sequen- 
tial pattern  of  sexual  development  and  to  predict  ma- 
turity with  any  degree  of  precision.  This  is  a  task  to 
be  explored  by  scientific  research.  We  cannot  wait 
for  the  results,  however,  to  define  our  social  goals  in 
broad  terms  and  to  plan  the  practical  steps  toward 
their  achievement. 

The  goals 

As  with  other  social  goals,  the  consideration  of  edu- 
cational goals  requires  two  foci :  the  individual  and 
the  group  in  which  he  lives.  Managing  these  two 
compatibly  is  a  constant  challenge  for  a  democratic 
society.  It  is  a  greater  challenge  today  than  ever 
before,  for  in  our  rapidly  changing  society  young 
people  are  demanding  greater  freedom  in  individual 
behavior  than  in  any  previous  generation. 

Our  society  has  not  yet  provided  an  adequate  way 
of  caring  for  children  born  out  of  wedlock;  it  is 
therefore  desirable  today  to  discourage  out-of-wed- 
lock births.  This  is  one  social  goal  on  which  we  can 
secure  a  great  deal  of  agreement.  Another  is  the  elimi- 
nation of  venereal  disease.  So  far,  we  have  found  no 
medically  satisfactory  way  of  preventing  venereal 
infection.  Both  of  these  goals  are  served  when  pre- 
marital, promiscuous  intercourse  is  avoided.  Thus,  at 
this  point  in  our  social  development,  it  is  reasonable 
to  want  to  restrict  premarital  coitus. 

However,  with  the  increased  effectiveness  and  avail- 
ability of  contraceptives  and  with  the  possible  future 
development  of  immunizations  against  venereal 
diseases,  the  social  consequences  of  promiscuous 
premarital  sexual  relationships  will  change.  Insofar 
as  morality  is  based  on  social  consequences,  when  the 
consequences  change  the  moral  values  change.  Wliat  is 
immoral  in  today's  society  may  be  moral  in  tomor- 
row's. And  what  is  right  for  today's  generation  of 
young  people  may  be  wrong  for  a  generation  to  come. 

One  way  to  avoid  getting  hopelessly  involved  in 
dilemmas  is  to  go  beyond  what  is  presently  called 
"sexual  morality"  to  a  broader  concept  of  morality, 
one  based  on  the  use  of  self  and  one's  personal  free- 
dom for  the  benefit  of  others. 

Broader  definitions  of  goals  are  approj^riate,  too, 
in  considering  the  individual's  personal  growth  and 
satisfaction.  Here  the  goal  is  not  only  a  sexually  f ul- 

132 


kiio 


filled  person  but  also  one  who  accepts  and  values  his 
total  self — a  person  who  understands  himself,  his 
behavior,  and  his  value  system  and  who  has  the  integ- 
rity to  defend  his  principles.  The  ultimate  goal  is  a 
person  who  can  communicate  with  others  without 
fear,  who  can  reveal  himself,  and  who  can  listen  to 
and  be  concerned  about  the  welfare  of  others. 

Sexuality  can  never  be  separated  from  personality, 
nor  can  sexual  morality  be  separated  from  social  mo- 
rality. For  this  reason  the  term  "sex  education"  tends 
to  be  misleading.  By  emphasizing  sex  it  pulls  the 
subject  out  of  a  total  context.  Unfortunately,  our  cul- 
ture has  for  a  long  time  treated  a  sexual  relationship 
as  a  special  and  separate  i^art  of  personal  and  social 
relationships  rather  than  a  normal,  natural  use  of 
self  in  relating  meaningfully  to  a  person  of  the 
opposite  sex. 

Now,  because  of  the  need  to  provide  information, 
to  correct  misconceptions,  and  to  break  the  spell  of 
silence,  it  will  be  hard  for  any  program  of  sex  educa- 
tion to  avoid  further  isolating  and  emphasizing  the 
sexual  components  of  personality  and  interpersonal 
relationships.  Nevertheless,  the  real  goal  of  any  i:)ro- 
gram  must  be  to  help  in  the  total  development  of 
young  people  so  that  they  will  become  the  kind  of 
secure  persons  described  above.  If  we  can  achieve 
this  goal,  we  will  not  have  to  worry  about  sexual 
behavior. 

How  and  when? 

The  questions  of  hoio  and  ichen  are  better  dealt 
with  together,  because,  except  for  always  giving 
children  frank,  honest  answers  and  explanations, 
the  most  important  point  about  sex  education  is  to 
provide  the  information  in  a  normal  context.  Sexual 
matters  need  to  be  dealt  with  as  the  natural  part  of 
a  total  picture,  whatever  that  picture  may  be.  "When 
children  are  curious  about  their  own  bodies — hands, 
feet,  elbows,  and  "tummies" — they  are  also  inter- 
ested in  their  genitals  and  need  to  know  proper  terms 
for  them.  '\A^ien  children  are  interested  in  what  hap- 
pens to  food  in  the  human  body  and  in  why  and  how 
we  breathe,  they  are  also  interested  in  the  excretory 
fmictions  and  need  proper  explanations  about  them. 

Most  of  a  child's  early  questions  about  sex  are  oc- 
casioned by  exposure  to  a  situation  that  is  new  to 
him.  He  sees  an  adult  body  and  notes  that  it  is  dif- 
ferent from  his  own;  he  wants  to  know  more  about 
it.  He  sees  a  child  of  the  other  sex  and  notes  tliat  the 
genitals  are  different;  he  wants  an  explanation.  He 
sees  a  pregnant  woman  and  wants  to  know  why  her 

CHILDREN     •     JULY-AUGUST  1967 


stoniiU'li  is  swolloii,  and  lio  also  may  want  to  know 
how  this  I'aino  about.  Tlio  cliild  usually  hriny-s  thoso 
questions  to  his  mother  because  they  occur  to  him 
before  he  readies  school  aji'e. 

The  way  in  which  these  early  (juestions  ;ire  an- 
swered largely  determines  what  other  questions  the 
child  will  asic.  how  he  will  feel  about  askin«i-  them, 
and  how  he  will  i'eel  about  the  answers.  A  parent  re- 
veals his  own  feelings  about  sex  throuirh  common, 
everyday  events  in  many  ways.  II is  attitudes  will  be 
I'ey-arded  by  his  child  as  those  of  all  adults,  so  that 
what  questions  the  child  asks  or  does  not  ask  I  hi' 
teacher  at  school  depend  a  eivat  deal  on  the  kind  of 
reception  they  would  get  if  asked  at  home. 

In  the  school  the  teacher  has  continuous  oppor- 
tunities to  answer  questions  bearinir  on  sex  that  come 
up  in  the  ordinary  events  of  the  day  and  in  the  con- 
tent of  every  subject.  From  kindergarten  through 
12th  grade,  the  child  can  be  encouraged  to  develop 
a  normal  progression  of  interest  in  and  an  increasing 
body  of  information  about  family  relationships  and 
sex  differences  and  functions  and,  in  doing  so,  to 
foi'm  values  and  make  decisions  about  behavior.  In 
the  elementary  grades  imparting  information  about 
animal  and  human  reproduction  is  becoming  a  rou- 
tine part  of  instruction.  However,  helping  children 
understand  their  own  developing  masculinity  or  fem- 
ininity is  more  difficult  for  the  teacher  because  it 
involves  a  personal  concept  that  can  be  discussed 
more  naturally  in  the  home  than  in  the  schoolroom ; 
nonetheless,  much  thought  about  the  meaning  to  one- 
self of  one's  sex  can  be  stimulated  at  school  through 
units  in  self-understanding  and  personality  growth. 

Many  persons  believe  that  the  school  has  a  better 
opportunity  than  the  home  to  present  the  child  with 
information,  regarding  sex.  This  is  partly  true,  at 
least,  because  teachers  tend  to  be  more  knowledge- 
able than  many  parents  about  physiology,  anatomy, 
health,  psychology,  and  social  problems.  It  is  true, 
also,  because  as  the  child  progresses  through  the 
grades  the  teaching  becomes  concentrated  into  sub- 
ject areas,  many  of  which  relate  specifically  to  sex 
and  reproduction,  to  social-sexual-psychological 
development,  and  to  social  problems  and  health.  Thus 
information  about  sex  is  not  only  a  normal  part  of 
the  subject  matter  in  junior  and  senior  high  schools 
but  is  also  an  integral  part  that  has  to  be  conspicu- 
ously avoided  if  it  is  nof  to  be  included. 

Every  school  subject,  even  one  not  directly  con- 
cerned with  sex  information,  has  its  contribution 
to  make  in  helping  children  and  young  people  luider- 
stand  interpersonal  relationships,  familial  roles,  and 

VOLUME  14  -  NUMBER  4 


A  special  consultant  to  the  Cliildron's  Bn- 
roiui  on  fiunily  life  edueiition,  Eleanore  Braun 
Luckey  is  a  profossor  at  and  Iwad  of  the  De- 
IiMrliMciit  of  Cliild  Dovelopiiii'nt  and  Fiuiiily 
Ui'liitioiis,  University  of  Conncc-ticut.  She 
earned  her  I'h.  D.  in  psychology  from  the 
University  of  Minnesota,  where  she  has  also 
been  an  instructor.  She  is  on  the  executive 
cominitteo  of  the  National  Council  on  Family  Relations. 


ilie  relation  of  one's  sex  to  these.  Literature,  music, 
art.  liistory,  and  the  social  sciences  especially  offer 
such  opportunities. 

The  homo  and  the  school  are  not  alone  in  having 
o]iportnnities  to  help  the  child  develo])  a  mature 
understanding  of  sex.  Groups  such  as  the  Boy  Scouts, 
Boys'  Clubs,  Girl  Scouts,  Girls  Clubs,  Camp  Fire 
Girls,  Young  Men's  Christian  Associations,  Young 
Women's  Christian  Association,  and  -t-H  Clubs  are 
dedicated  to  helping  young  people  develop  healthy 
bodies  and  well-rounded  personalities.  Most  of  these 
organizations  work  informally  with  adolescents  or 
preadolescents  in  small  groups  over  a  span  of  a  few 
years.  They  offer  the  young  person  an  excellent  op- 
portunity to  develop  a  self-confident  personality, 
including  an  acceptance  of  his  sexual  identity ;  they 
also  offer  him  practice  in  forming  intimate,  mean- 
ingful relationships  with  others,  both  of  his  own  and 
the  opposite  sex.  The  sexual  aspects  of  interpersonal 
relationships  become  especially  important  during 
adolescence  when  cultural  expectation  pushes  young 
people  toward  dating,  and  their  own  heightened  sex 
drive  urges  them  toward  exploration. 

It  is  not  possible  to  give  information  without  at 
the  same  time  conveying  attitudes,  and  the  attitudes 
of  adults  determine  the  values  of  the  young,  which  in 
turn  determine  their  behavior.  The  values  that  young 
people  hold  are  those  that  have  been  demonstrated 
by  the  persons  they  respect. 

The  churches,  of  course,  are  specifically  concerned 
with  the  values  in  our  society  and  more  than  any 
other  institution  except  the  home  are  expected  to 
take  responsibility  for  the  development  of  attitudes 
in  keeping  with  their  religious  and  moral  precepts. 
However,  such  value  positions  are  only  meaningful 
to  young  people  if  they  are  clearly  enunciated  and 
are  demonstrated  as  useful  in  today's  society. 

Perhaps  the  most  consistent  informers  about  adult 
attitudes  and  builders  of  young  people's  ideals  to- 
day are  not  the  traditional  institutions  that  purpose- 
fully  outline   and    pursue   programs  or  policies  of 


133 


education  but  rather  the  mass  media  of  communica- 
tion :  the  television  that  the  child  watches  from  the 
time  he  is  too  small  to  respond  to  much  more  than 
the  movement  and  the  sound  to  the  time  he  is  able 
to  sit  for  several  hours  absorbed  in  its  entertainment 
programs  and  its  advei-tisements  that  use  sexual  ap- 
peal to  sell  products ;  the  magazine  illustrations,  the 
comic  strips,  the  paperback  book  covers,  the  films 
that  make  the  sparsely  clad  body  a  common  sight  and 
the  seductive  female  or  male  an  appealing  personal- 
ity. The  child  exists  so  constantly  in  the  midst  of 
these  stimuli  that  as  his  own  understanding  grows 
they  become  increasingly  meaningful  to  him.  This  is 
sex  education  in  the  context  of  commercialism,  of 
entertainment,  and  the  message  it  conveys,  while 
often  indirect,  is  powerful. 

All  these  agencies  of  society — the  home,  the  school, 
the  community  agency,  the  church,  the  mass  media — 
bring  their  messages  to  tlie  child  in  one  way  or  an- 
other almost  from  infancy.  Some  of  the  messages 
are  direct,  some  are  subtle ;  they  are  seen,  heard,  felt. 
Some  of  tliem  are  quiet,  some  loud;  some  are  con- 
spicuous chiefly  because  of  their  absence.  Some  are 
true;  some,  half-true;  some,  false.  Altogether  they 
are  very  inconsistent.  As  a  result  our  children  come 
to  adolescence  confused,  curious,  and  often  deter- 
mined to  find  out  on  their  own. 

If  the  adults  who  touch  the  lives  of  children  could 
determine  what  their  own  values  are,  if  they  could 
know  beyond  question  why  they  hold  these  values, 
and  if  they  could  demonstrate  them  in  their  daily 
living,  children  would  get  their  message.  If  adults 
themselves  could  put  sexual  matters  into  the  normal 
context  of  living,  young  people  would  be  better  able 
to  do  the  same.  The  ultimate  pi'oblem  for  adults  is 
not  so  much  how  to  educate  children  and  adolescents 
as  how  to  work  out  their  own  problems  and  how 
to  convey  their  attitudes  to  the  young  people  whose 
lives  they  influence.  That  adults  who  are  significant 
for  them  do  not  readily  have  all  the  solutions  will  not 
distress  the  children  nearly  so  much  as  people  seem 
to  think.  Children  will  not  feel  confused  about  seek- 
ing many  of  their  own  answers  to  the  problems  of 
interpersonal,  intersexual  relations  if  they  realize 
that  adults  too  are  honestly  seeking  solutions. 

By  whom? 

l^lio  it  is  that  is  responsible  for  sex  education 
becomes  clearer  when  we  recognize  that  sex  educa- 
tion is  a  segment  of  an  individual's  total  preparation 
for  living  in  a  complex  world  of  interrelatedness, 

134 


and  that  information  and  attitudes  specifically 
regarding  sex  are  normal  j^arts  of  knowledge  and, 
of  a  social  value  structure.  Every  adult  who  deals 
with  children  or  adolescents  in  any  way  is  likely 
at  some  time  or  another,  in  some  way,  to  influence 
significantly  the  attitudes  that  help  determine  how 
a  child  will  use  himself — sexually  as  well  as  in  other 
ways — in  relation  to  other  people. 

Because  most  adults  today  have  not  had  the  ad- 
vantage of  growing  up  in  a  society  in  which  the  kind 
of  sex  education  advocated  here  was  available,  manj 
adults  find  it  difficult  to  deal  with  their  own  attitudes 
and  to  communicate  them  in  an  open  way  to  childrer 
and  adolescents.  Some  adults,  however,  are  able  t( 
do  this  better  than  others,  and  those  who  can,  must '. 
The  opportunity  that  adults  have  to  do  so  wil; 
largely  be  determined  by  their  role  in  relation  to  tl» 
young.  The  parent  has  the  longest  and  most  intenst 
relationship  with  the  child  and  so  the  greatest  op- 
portunity; the  teacher,  the  school  nurse,  the  schoo 
counselor,  and  the  principal  each  has  significam 
opportunities  from  time  to  time,  as  does  the  youtl ' 
leader,  the  clergyman,  and  the  religious  educator.  So 
too,  does  the  advertising  man,  the  sales  manager,  thi 
editor,  the  journalist,  the  filmmaker,  the  television  o 
radio  director. 

Where  to  begin? 

In  a  wilderness  that  seems  so  vast,  adults  who  an 
concerned  with  helping  children  and  adolescent; 
grow  up  sexually  are  likely  to  feel  that  it  is  all  bu 
a  hopeless  task.  This,  it  is  not.  In  addition  to  settinj 
his  own  house  in  order  and  examining  his  own  value; 
and  behavior  and  being  open  about  them,  the  jjersoi 
who  works  professionally  with  young  people  cai 
take  a  number  of  steps  toward  furthering  a  progran 
of  education  that  will  make  for  mature  sexual  be 
havior  in  our  society : 

1.  He  can  help  other  professional  workers  defin( 
their  values  and  learn  how  to  convey  them  to  others 
One  of  the  most  helpful  tools  for  this  kind  of  learn 
ing  is  the  sensitivity  group,  sometimes  called  the  T 
group.  Composed  usually  of  about  10  persons  with  8 
professionally  trained  leader,  the  group  is  designee 
to  encourage  its  members  to  explore  their  feeling.'; 
and  to  interact  in  such  a  way  that  insight  and  self-l 
understanding  develop.^ 

2.  He  can  take  part  in  inservice  training  sessions.! 
workshops,  and  institutes  that  provide  the  partici 
pants  not  onlj'  with  information  but  also  with  an! 

CHILDREN     •     JULY- AUGUST  1967 


>Ci[ 


opportunity  to  clarify  their  own  attitudes  for  them- 
selves. Because  acquiring  information  is  usually  ac- 
:omplis]ied  much  more  quickly  than  acquiring  in- 
sight into  one's  own  feelings,  tlie  empliasis  in  the 
most  elTective  groups  is  on  the  exploration  of  the 
participants'  attitudes. 

Many  universities  and  colleges  are  now  offering 
3uch  courses,  and  many  more  would  set  them  up  if 
requested. 

3.  Ho  can  focus  much  of  his  educational  efforts  on 
parents,  especially  parents  of  infants  and  very  young 

hildren.  Because  the  parental  influence  is  so  con- 
stant and  so  intense,  what  parents  believe,  what  they 
convey,  and  what  they  know  are  crucial  influences  in 
the  development  of  the  child's  sexual  attitudes. 

Parents,  however,  often  have  uncertainties  and 
fears  about  their  own  sexuality  that  inhibit  their 
ability  to  help  their  children — for  example,  a  mother 
who  docs  not  value  her  femininity  will  find  it  hai'd  to 
help  her  daughter  grow  up  to  accept  and  value  her- 
self as  a  woman. 

Parents  also  often  need  some  of  tlie  skill  that  pei-- 
sons  in  the  helping  professions  have  in  giving  direct 
answers  to  questions  about  sex,  and  often  they  also 
need  the  information  itself.  Some  parents,  for  ex- 
ample, have  misconceptions  about  the  effects  of  mas- 
tui-bation  on  the  developing  child;  some  do  not  un- 
derstand the  physiology  of  menstruation;  and  some 
have  fears  and  apprehensions  about  their  own  sexual 
functions,  the  use  of  contraceptives,  the  effects  of 
menopause,  or  their  marital  compatibility. 

Thus  many  parents  might  benefit  from  the  same 
kind  of  sensitivity  group  suggested  for  professional 
persons.  The  opportunity  for  parents  to  discuss  such 
problems  in  a  safe,  accepting  group  of  other  adults 
could  help  them  clarify  their  own  feelings  and  think- 
ing and  learn  how  to  deal  with  intimate  matters 
openly  and  frankly.  Such  groups  might  be  formed 
through  a  neighborhood  house,  an  elementary-school 
guidance  program,  a  parent-teacher  association,  a 
church,  or  any  other  local  organization.  A  trained 
professional  leader,  however,  is  a  irvust. 

4.  He  can  make  Imown  to  the  molders  of  the  nuiss 
media  his  convictions  regarding  the  use — and  mis- 


use— of  sexual  stimuli,  pari iruhirly  in  advertising 
and  in  entertainniont.  If  he  finds  tluit  young  people 
are  being  given  a  false  or  unclear  picture  about  the 
meaning  of  sexual  maturity  through  any  form  of 

masscoiiiiiiunii'at  ion,  he  can  protest. 

More  inii)ortant  than  all  tliese  steps,  however,  is 
the  professional  person's  way  of  dealing  directly  with 
young  people.  Can  he  be  open  and  willing  to  share  his 
time,  thoughts,  and  knowledge  with  the  questing 
young?  Anything  less  is  not  enough.  The  young  have 
the  right  to  honest  answers — even  when  tlie  adult's 
answer  must  be  that  he  does  not  know  or  is  himself 
confused. 

And  so — 

Helping  children  giow  into  sexual  maturity  is  not 
easy  for  a  generation  of  adults  who  have  grown  up 
in  a  society  frightened  of  sex.  It  can  only  be  done 
by  breaking  through  the  silence  and  half-truths  that 
have  obscured  their  own  knowledge  and  feeling  and 
by  establishing  a  broader  objective  than  mere  "sex 
education."  This  means  striving  for  the  development 
of  the  whole  personality,  for  producing  a  man  or 
woman  able  to  feel  genuine  concern  for  the  welfare 
of  others,  eager  and  able  to  establish  intimate  re- 
lationships with  others,  desirous  of  parenthood,  and 
capable  of  assuming  the  responsibility  of  his  own 
freedom. 

Professional  workers  concerned  about  young  peo- 
ple need  to  clarify  their  own  attitudes  and  values  and 
to  develop  ways  of  commmiicating  them  to  others. 
When  they  do,  they  can  be  of  special  help  to  parents 
and  to  otlier  professional  workers — teachers,  nurses, 
school  comiselors,  principals,  social  workers,  youth 
leaders,  clergymen.  They  can  influence  the  mass 
media's  interpretation  of  sex  and  interpersonal  rela- 
tionships. They  can  help  young  people  with  the  prob- 
lems troubling  them,  always  keeping  sexual  informa- 
tion in  the  context  of  the  whole  person,  being  honest 
and  frank,  and  admitting  that  along  with  the  young 
people,  they,  too,  are  seeking. 


'Bradford,  L.  P.;  Gibb,  J.  R.;  Benne,  K.  D.   (cds.):  T-group  theory 
and  laboratory  method.  John  Wiley  &  Sons,  New  York.    1964. 


A  good  motto  for  any  investigator  of  the  subject  [the  sexual  behavior  of 
adolescents]  would  be  this:  whoever  asks  questions  must  expect  to  be  told  lies. 

D.  W.  Winiiicolt,  child  psychiatrist,  Paddiiiglon  Green  Children's  Hospital,  London,  in 
"The  Family  and  Individual  Development,"  Basic  Books,  Inc.,  New  York,  1965. 


VOLUME  14  -  NUMBER  4 


135 


some  practical  suggestions  for  the  school 


starting  a 


SEX 

EDUCATION 

PROGRAM 


LESTER  A.  KIRKENDALL 


HELEN  M.  COX 


Growing  public  interest  in  sex  education 
across  the  Nation  has  resulted  in  efforts  to 
"start"  sex  education  programs  in  many  com- 
munities. Typically,  these  efforts  are  involving  phy- 
sicians, nurses,  social  workers,  religious  leaders,  and 
members  of  civic  groups,  as  well  as  teachers  and 
school  administratoi's,  many  of  whom  are  puzzled 
about  where  and  how  to  begin  a  program  on  a  topic 
often  denied  formal  recognition  because  of  repression 
and  fear.  Since  our  experience  has  been  with  sex 
education  programs  in  the  schools,  our  discussion  will 
center  on  what  we  have  found  to  be  successful  methods 
of  developing  sex  education  for  both  the  community 
and  the  school. 

The  school  "starting"  a  sex  education  program  can 
"start"  in  a  relative  sense  only-  Sex  education, 
broadly  defined,  occurs  inevitably  in  both  home  and 
school.  The  student  learns  something  about  repro- 
duction in  biology  class;  about  family  life  in  social 
studies ;  and  about  love  between  the  sexas  in  literature 
classes  through  poems,  plays,  and  novels.  Both  at 
home  and  at  school  he  sees  men  and  women  relating 
to  each  other  with  love  or  hostility.  He  notes  that  sex 
is  treated  openly,  ignored,  or  evaded.  Though  much 
of  his  learning  is  nonverbal  and  attitudinal,  it  is 
learning.  For  this  reason,  any  school,  any  community 
is  fully  warranted  in  saying  that  it  is  "expanding  and 
improving"  rather  than  "starting"  a  sex  education 
program.  In  presenting  the  idea  of  formal  sex  educa- 
tion in  the  school  to  the  public,  school  officials  would 
do  well  to  keep  this  in  mind.  The  public  is  less  afraid 
of  expanding  than  of  innovating  and  has  more  con- 

136 


I.-! 


fidence  in  the  judgment  of  school  officials  who  ha\ 
forged  ahead  than  of  those  who,  because  of  fear  o 
indifference,  have  neglected  an  important  aspect  o 
education. 

Scope  and  content 

For  almost  everyone,  "sex  education"  means  teacl" 
ing  what  is  actually  the  "physiology  of  the  reprodu(  j 
tive  systems,"  an  essential  aspect  but  far  from  a 
of  it.  "We  need  a  broader  idea  of  sex  education  tha 
this — such  as  that  offered  by  the  Sex  Informatio 
and  Education  Council  of  the  U.S.  (SIECUS),  a; 
interdisciplinary  organization  founded  in  1964  t 
"establish  man's  sexuality  as  a  health  entity"  an' 
"to  dignify  it  by  openness  of  approach,  study,  ann 
scientific  research."  ^  SIECUS  maintains  that  ever' 
comprehensive  sex  education  program  should  presen 
these  six  aspects :  biological ;  social ;  health ;  persona 
adjustments  and  attitudes;  interpersonal  associa 
tions ;  and  the  establishment  of  values.- 

Most  school  authorities  are  reluctant  to  commi 
themselves  to  a  course  only,  and  we  think  rightly  so 
If  sex  education  could  be  limited  to  a  course  m  re 
production  or  to  one  explaining  the  "facts  of  life' 
and  these  "facts"  would  meet  all  the  child's  need; 
throughout  his  school  years,  giving  sex  education  ii 
one  large  dose  might  be  practical.  But  this  is  im 
possible,  we  believe.  Sex  education  should  be  i^re 
sented  from  many  angles.  It  should  keep  pace  witl 
the  child:  it  should  grow  as  he  grows  and  widen  a) 
his  experience  widens. 

CHILDREN     •     JULY-AUGUST  196 


I'lui  idc.i  dial  si'\  fdufaliiiii  should  l)t'  wovoii  into 
fdiical  idii  I'rDiii  I  he  kiiidcrii'arti'ii  (hr(iui;'h  the  sec- 
.iii(hirv  si'hools  and  sliould  in\()l\o  all  pupils  and 
iiKist  tearluTs  lias  rocontly  gained  great  momentum. 
Sometimes,  specific  units  on  reproduction  are  appro- 
priate; at  otliers,  information  alxiut  sex  is  part  of 
otlier  courses  sucli  as  lionie  economics,  literature,  and 
social  studies.  ]ioth  elcnientary  and  secondary 
schools  can  show  films  on  puberty  in  health  classes 
and  can  hold  discussions  on  reproduction  on  a  level 
with  the  age  of  the  pupil.  For  example,  the  program 
offered  by  the  San  Diego  school  system  includes  sex 
education  in  its  health  education  program  in  grades 
6  through  12.  Specially  prepared  teachers  provide 
the  instr\iction,  and  in  junior  high  school  boys  and 
girls  are  separated  bj^  sex  for  most  instruction.  The 
San  Diego  .system  lias  found  that  separation  permits 
frank  discussion  of  such  matters  as  masturbation  and 
homosexual  play.  A  class  at  Longview,  Wash.,  did 
a  survey  and  an  analysis  of  sex  slang.  Many  schools 
include  sex-related  topics  for  discussion  in  a  "senior 
problem"  course.  Still  others  include  instruction  on 
attitudes  toward  and  standards  for  .sex  in  secondary 
school  courses  in  family  living.  The  Toms  River,  N.J., 
high  school  has  had  such  a  course  since  1938. 

The  scliool  system  of  Anaheim,  Calif.,  provides  a 
5-week  program  of  instruction  in  family  life  and 
sex  education  for  each  grade,  7  througli  12.  The 
teachers  for  the  program  are  prepared  through  spe- 
cial inservice  programs,  and  the  instruction  time  is 
taken  from  that  allowed  for  physical  education.  Em- 
phasis changes  from  grade  to  grade:  in  the  seventh, 
it  is  on  self -understanding;  in  the  eighth,  philosophy 
of  life  and  ethics;  in  the  ninth,  dating;  in  the  10th, 
sex  standards;  in  the  11th,  communication  and  solv- 
ing problems;  and  in  the  12th,  family  life  and  child 
development.  Boys  and  girls  attend  together. 

Since  1946,  the  high  schools  of  Hayward,  Calif., 
have  offered  a  family  life-sex  education  program  in 
the  social  studies  curriculum  running  through  the 
entire  4  years.  Each  student  as  he  enters  high  school 
is  assigned  to  a  teacher-adviser  who  will  be  his  "coun- 
selor" on  all  educational  and  personal  matters 
through  his  4  years.  This  same  teacher-adviser  will 
also  teach  a  ninth  grade  unit  in  personal  adjustment 
and  self-understanding  and  a  12th  grade  course  in 
family  living  for  all  the  students  he  advises.  In  this 
instruction,  attention  is  given  systematically  to  sex 
information  and  attitudes.  At  the  same  time  personal 
help  is  available  through  the  counseling  relationship 
the  teacher  has  with  the  students  he  advises. 

Each  school's  program  will  lie  unique  according 

VOLUME  14  -  NUMBER  4 


to  its  own  needs  ,iinl  the  capacity,  interests,  and  in- 
service  training  of  its  teachers.  It  will  change  as  the 
scIkkiI's  needs  change  and  as  new  teachers  join  the 
staff  and  others  leave  it. 

Does  this  mean  that  a  ])lanning  committee's  hope 
for  iiatterning  a  program  on  some  curriculum  as  out- 
lined by  some  other  school  is  illusory?  We  say,  yes 
and  no!  It  is  illusory  if  the  committee  thinks  it  will 
find  the  answer  to  all  its  jiroblems  in  the  jilan  of  an- 
other school;  it  is  real  if  by  studying  the  plan  of  an- 
other school  the  committee  finds  guidance.  Each 
school  or  community  will  need  to  work  out  its  own 
program. 

A  few  guides  giving  general  directions  are  avail- 
able, however.  The  education  and  health  de]iartments 
of  several  States,  New  Jersey  and  Illinois,  for  ex- 
ample, and  the  school  systems  of  several  cities,  in- 
cluding Detroit,  San  Francisco,  Denver,  and  St. 
Louis,  are  preparing  or  have  prepared  guidelines  on 
sex  education  and  family  life  programs.  The  Ameri- 
can School  Health  Association  has  just  issued  a  docu- 
ment setting  forth  principles  tested  by  several  com- 
munities ^  that  includes  suggestions  on  teaching  for 
each  grade,  an  extensive  bibliography,  and  an  anno- 
tated list  of  films  and  lilmstrips.  The  Joint  Commit- 
tee on  Health  Problems  in  Education  of  the  National 
Education  Association  and  the  American  Medical 
i\.ssociation  have  published  a  series  of  pamphlets  on 
sex  education  for  the  schools  and  for  parents.  Many 
Catholic,  Protestant,  and  Jewish  groups  have  pre- 
pared materials  concerning  sex  education.  The  na- 
tional board  of  the  Young  Women's  Christian  Asso- 
ciation has  prepared  a  "sex  morality  teaching  kit" 
for  discussion  leaders.  And  SIECUS  publishes 
guides,  reprints  of  articles,  and  a  quarterly  news- 
letter on  new  research,  publications,  and  inservice 
education. 

Dispensing  with  fear 

Efforts  to  start  sex  education  programs  run  over 
and  over  again  into  the  same  kinds  of  fear  and  un- 
certainty, the  same  misconceptions  that  have  ham- 
pered effective  sex  education  programs  for  years, 
particularly  the  fear  of  the  sex  impulse  itself  and  of 
harsh  public  criticism. 

The  fear  of  the  sex  impulse  itself  originates  in  the 
widespread  belief  that  this  impulse  is  extremely  diffi- 
cult to  control  and  will,  at  the  slightest  oiiportunity, 
express  itself  in  irresponsible,  ex[)loitative,  damag- 
ing behavior.  Freudian  concepts  support  this  view; 
our  experience  does  not !  We  believe  rather  that  hon- 

137 


est,  objective,  open  consideration  of  sex  allays  fears 
and  curiosity,  makes  gliding  the  sexual  impulse 
easier,  and  works  toward  a  responsible  outlook. 

Adults  often  think  that  embarrassment  in  a  child 
when  sex  is  discussed  means  he  is  "taking  it  wrong" 
or  is  "not  ready  for  so  much."  But  we  think  it  means 
that  he  was  ready  for  proper  sex  education  some 
time  in  the  past  but  got  only  the  miseducation  that  is 
ine\dtable  when  fear  blocks  positive  education. 

The  requests  we  have  received  from  school  officials 
for  carefully  graded  curriculum  material  seem  to  re- 
flect fear.  These  officials  are  seeking  absolute  cer- 
tainty when  they  ask  what  should  be  taught  at  each 
grade  level.  Sometimes  the  inability  of  the  "author- 
ity" to  whom  the  reqiiest  is  made  to  be  specific  is 
used  by  school  officials  to  rationalize  the  contention 
that  "we  just  aren't  ready  for  sex  education." 

Parents,  too,  are  often  immobilized  by  the  fear  of 
sex  and  their  own  ignorance  of  how  to  handle  the 
subject  with  their  children,  and  they  carry  their 
fears  over  when  dealing  with  the  school. 

Fear  of  adverse  public  opinion  often  hamstrings 
school  officials  in  their  efforts  to  start  sex  education 
programs.  They  may  not  realize  that  most  opposi- 
tion comes  from  vocal  persons  representing  a  small 
minority.  Some  critics  object  to  sex  education  in  the 
school  because  they  fear  that,  as  a  consequence,  their 
children  will  confront  them  with  questions  about 
sex,  or  they  fear  that  the  school  is  usurping  parental 
rights.  Others  have  a  grievance  against  the  school  in 
general,  and  the  sex  education  program  provides  a 
convenient  point  of  attack. 

The  elementary  schools  of  Bethel  District,  Eu- 
gene, Oreg.,  after  5  years  of  work,  offer  a  sex  educa- 
tion program  that  has  been  strongly  supported  by 
parents  and  community  leaders.  Efforts  to  obtain 
supjiort  for  the  pi'ogram  began  when  a  school  nurse 
held  informal  discussion  groups  with  parents  to  help 
them  handle  sex  education  at  home.  Her  work  pointed 
up  the  need  for  sex  education  and  led  the  parents 


Lester  A.  Kirkendall,  left,  is 

professor     of     family     life. 

School  of  Home  Economics, 

Oregon  State  University,  Cor- 

vallis.     Helen   M.    Cox   has 

been  on  leave  of  absence  from 

the  Kansas  City,  Mo.,  public 

school  system  during  the  past 

school  year  to  participate  in  the  fellowship  program  in  health 

education  at  the  University  of  Oregon. 


to  request  the  schools  to  offer  formal  sex  education. 
School  administrators  at  first  thought  that  efforts 
to  meet  their  request  would  court  adverse  reactions 
from  the  community  and  hesitated  to  move.  At  this 
point  the  parents  from  whom  the  request  had  come 
turned  to  other  parents  to  get  their  support.  Wlien 
the  administrators  found  that  the  public  was  for  the 
program,  they  met  with  the  public  to  discuss  what 
the  schools  should  do.  The  supporters  of  the  proposed 
program  exhibited  salacious  magazines  along  with 
the  one  sex  education  book  in  the  school  libraries 
and  showed  a  film  on  human  growth  to  parents,  who 
were  then  asked  whether  they  were  for  or  against 
showing  the  film  in  the  schools.  The  parents  voted 
overwhelmingly  in  favor. 

School  officials  can  often  forestall  or  minimize  op- 
position by  involving  the  community  in  planning; 
informing  the  public  in  advance  of  the  jiurpose  and 
objectives  of  the  program;  and  carefully  selecting 
teachers.  I^Hien  sex  education  is  well  handled,  the 
public  rarely  criticizes.  For  example,  in  4  years  the 
Petaluma,  Calif.,  public  school  system  received  only 
three  adverse  teleplione  calls  about  its  sex  education 
program  for  nintli  grade  students.  In  this  system 
tlie  school  administrators  presented  the  idea  of  sex 
education  to  the  parents  and  showed  one  film  before 
the  program  started.  Sensing  no  objection,  they  went' 
ahead  with  the  progi'am.  Parents  were  kept  informed 
at  the  meetings  of  the  parent-teacher  association, 
and  students  were  urged  to  keep  their  parents  in- 
fonued  about  what  was  going  on  in  class  and  to  show 
them  the  books  and  pamphlets  being  used.  Similarly 
the  Kansas  City,  Mo.,  public  school  system  received 
in  about  4  years  only  two  calls  critical  of  its  open- 
circuit  television  lessons  for  junior  high  school  stu- 
dents— and  these  calls  were  critical  of  the  followup 
discussion  only,  not  of  the  broadcasts  themselves. 
The  schools  made  the  sex  education  matei'ial  an  in- 
tegral part  of  all  instruction  and  tried  no  harder  to 
prepare  the  community  for  the  broadcasts  than  they 
would  have  tried  if  the  material  had  been  on,  say, 
]3roper  dieting. 

The  best  way  to  obtain  public  support  for  a  sex 
education  j^rogram  is  through  the  school's  normal 
relations  with  the  public.  The  more  sex  education  can 
be  set  within  the  normal  program  the  less  it  will  be 
singled  out  as  unusual  and  threatening. 

In  many  localities  parent-teacher  associations  will 
help  explain  the  program  to  the  community.  Or  a 
citizens  advisory  group  may  be  helpful,  for  it  can 
speak  with  more  authority  and  with  less  defensive- 
ness  than  school  administrators  or  members  of  the 


%i 


138 


CHILDREN     •     JULY-AUGUST  1967  i'tl 


clu)i>l  board.  Tlie  scliool  system  in  Analiciiii,  Calif., 
or  example,  set  up  a  successful  family  life  and  sex 
dueatiou  proaram  with  the  holp  of  a  citizens  ad- 
'isory  group  repro.'^enting  a  family  service  organiza- 
ion,  tlie  ministerial  association,  and  civic  groups.  It 
ill  Iso  holds  a  yearly  orientation  meeting  for  parents 
luring  whicii  school  odicials  thoroughly  discuss  the 
)rogram  with  them.  This  measure  has  helped  offset 
,he  influence  of  a  ''radio  attack''  on  the  program. 

We  do  not  favor  asking  parents  to  decide  whether 
heir  cliildren  may  attend  a  sex  education  program. 
5uch  a  policy  implies  fear  and  uncertainty  in  school 
uthorities  and  brands  sex  education  as  something 
'different."  Sex  education  should  be  ctmsidered  as 
uuch  a  part  of  the  school  program  as  courses  in 
lealth,  English,  science,  and  social  studies — in  fact, 
t  should  be  part  of  these  courses,  as  we  have  said.  If 
t  is  an  integral  part  of  these  courses,  wliy  should  per- 
Tiission  to  attend  be  asked  for  or  granted '(  Also,  who 
letex'mines  when  "sex  education"  is  being  conducted 
iif  rather  than  "health"  or  "science"  ?  If,  however,  school 
ill  [idministrators  feel  that  the  issue  of  parental  per- 
mission cannot  be  bypassed,  we  favor  making  it  neces- 
sary for  the  parents  who  object  to  write  the  school  to 
this  effect.  Putting  the  responsibilitj-  on  the  parents 
will  probabl}'  encourage  them  to  give  serious  thought 
to  the  matter  before  they  make  a  formal  request. 


0th 


er  consi 


derati 


ons 


Overcoming  fear  is  only  one  aspect  of  setting  up  a 
sex  education  program.  Other  aspects  to  be  considered 
include  teacher  competency,  whether  teaching  reli- 
gion is  involved,  possible  conflicts  between  the  school 
and  the  home,  the  contribution  young  people  can 
make,  the  public's  expectations,  whether  to  hold  sepa- 
rate classes,  and  the  support  that  can  be  expected. 

Teacher  competency.  Whenever  possible,  the  school 
should  select  teachers  with  the  ability  to  communicate 
effectively  with  children  and  young  people.  If  they 
are  not  prepared  when  selected  to  conduct  sex  educa- 
tion, they  can  make  up  for  their  lack  of  experience  in 
summer  workshops  and  inservice  programs.  The 
training  they  receive  should  offer  more  than  just 
facts,  however;  it  should  give  them  opportunities  to 
analyze  their  own  attitudes  and  to  resolve  the  prob- 
lems this  analysis  raises.  Furthermore,  school  systems 
are  recognizing  that  a  continuing  need  for  inservice 
programs  exists.  The  Anaheim,  Calif.,  school  system 
has  offered  inservice  training  to  its  teachers  since 
its  sex  education   program  began.  The  schools  of 

VOLUME  14  -  NUMBER  4 


Ilinsdalo  and  Downers  Grove,  111.,  are  including  in- 
service  education  in  the  plan  they  are  developing. 

Experience  and  research  show  that  effective  teach- 
ers for  se.x  education  programs  may  come  from  any 
field ;  they  may  be  men  or  women,  married  or  single, 
parents  or  childless. 

Is  religion  involved?  Some  argue  that  sex  educa- 
tion cannot  be  conducted  in  the  school  because  sex 
education  without  moral  education  is  dangerous.  In 
their  view,  moral  education  cannot  be  included  in  sex 
education  because  "moral"  education  means  "reli- 
gion" to  them,  and  the  teaching  of  religion  is  forbid- 
den in  public  schools.  Yet  moral  principles  governing 
property,  truth,  and  respect  for  the  rights  of  others 
are  taught  in  public  schools  without  involving  reli- 
gion. Sexual  morality  is  no  different  from  the  moral- 
ity involved  in  other  human  relations  in  a  society 
emphasizing  responsibility  to  others. 

Developing  in  the  young  person  the  ability  to  make 
responsible  decisions  is  one  of  the  most  imi)ortant 
objectives  of  sex  education.  A  sex  education  program 
for  young  people,  therefore,  should  present  contrast- 
ing views  on  such  issues  as  early  marriage,  divorce, 
abortion,  family  planning,  pornography,  homosexu- 
ality, population  control,  and  the  control  of  venereal 
disease.  A  frank  discussion  of  all  issues  will  give 
young  people  a  basis  for  making  decisions  when  they 
are  adults. 

Home  as  opposed  to  school.  Does  the  school  usurp  the 
responsibility  and  rights  of  the  home  when  it  offers 
sex  education  ?  Those  who  say  it  does  assume  that  if 
the  school  offers  no  instruction  parents  can  and  will 
do  the  job  adequately,  an  accurate,  realizable  assump- 
tion in  very  few  cases.  But,  even  were  they  right, 
they  do  not  see  that  the  school  miseducates  if  it 
evades  all  reference  to  sex  and  that  it  cannot  always 
ignore  sex :  incidents  with  sexual  comiotation  occur 
from  time  to  time  in  the  school  and  school  officials 
have  to  respond  to  them.  Moreover,  the  school,  far 
better  than  the  home,  can  prepare  young  people  for 
the  wide  range  in  attitudes  about  sex  they  will  meet. 

Sex  education  programs  offered  by  schools  and 
community  agencies  outside  the  home  can  afford 
3'oung  people  opportunities  to  talk  franklj'  with  un- 
derstanding adults  in  ways  that  will  improve  their 
self-esteem  and  hasten  their  maturity.  Such  pro- 
grams can  also  provide  opportunities  for  young  per- 
sons to  talk  among  themselves  in  a  wholesome  atmos- 
phere, can  give  them  the  guidance  and  knowledge 
they  need  to  discuss  sex  among  themselves,  and  can 
help    them    internalize   a    value   system   based   on 

139 


democratic    interpersonal    relations    through    these 
discussions. 

Participation  by  young  people.  We  find  that  includ- 
ing young  people  in  the  planning  of  a  sex  education 
program  in  the  secondary  school  can  greatly  improve 
the  program.  Young  people,  by  their  frankness  and 
objectivity  in  discussions,  can  allay  the  qualms  of 
many  adults  about  their  attitudes  and  motivations. 
We  have  seen  this  happen  during  planning  sessions, 
on  youth  panels,  and  in  public  meetings.  Young  jDeo- 
ple  can  interpret  the  program  to  their  families  and 
to  the  community  and  they  can  help  determine  what 
the  program  should  include.  To  plan  a  program  with- 
out their  help  may  be  a  waste  of  time  and  effort. 
Adolescents  and  adults  live  in  different  cultures,  and 
there  are  subcultures  within  the  adolescent  world 
based  on  race,  socioeconomic  status,  and  religious  and 
family  background.  Program  planners  can  be  aware 
of  the  special  needs  of  each  adolescent  group  only 
through  young  people  themselves. 

Public  expectation.  Sex  education  programs  are 
often  "sold"  to  the  public  in  a  way  that  excites  over- 
optimism  about  what  they  can  do  to  reduce  the  rate  of 
venereal  disease,  premarital  pregnancy,  homosexu- 
ality, and  other  ills  associated  with  sex.  Although  we 
can  all  hoj^e  that  sound  sex  education  will  help  over- 
come these  ills,  their  causes  are  so  complex  and  their 
roots  so  deep,  it  will  take  far  more  than  sex  education 
to  rid  us  of  them.  To  use  data  on  their  prevalence  to 
obtain  support  for  sex  education  programs  without 
recognizing  the  social  pathology  associated  with 
these  ills  is  to  arouse  false  exi:)ectations. 

Mixed  or  separate  classes?  Many  people  are  uneasy 
about  having  boys  and  girls  together  when  sex  is 
discussed.  In  many  schools  direct  instruction  on  sex 
is  given  by  the  physical  education  or  home  economics 
teachers  because  boys  and  girls  are  separated  natu- 
rally in  their  classes.  No  hard-and-fast  rule  can  be 
laid  down  on  the  issue  of  separate  instruction,  how- 
ever. Ideally,  successful  sex  education  will  enable 
boys  and  girls  and  men  and  women  to  discuss  sex 
objectively  with  one  another  and  in  groups.  How- 
ever, because  boys  and  girls  mature  at  different  ages 
and  teachers  vary  in  their  ability  to  deal  with  mixed 
classes  and  the  subject  itself,  separation  for  discus- 
sion of  some  aspects  is  sometimes  desirable.  In  fact, 
boys  and  girls  may  seek  opportunities  for  separate 
discussions,  probably  because  they  feel  freer  in  un- 
mixed groups  to  discuss  such  subjects  as  masturba- 
tion, menstruation,  and  the  functioning  of  the  sex 


140 


1 

.) 

organs.  But  the  need  for  separate  discussion  group^ 
should  practically  vanish  by  the  time  students  reacH 
senior  high  school,  for  the  idea  that  the  sexes  should 
be  sejjarated  because  sex  is  being  discussed  is  out- 
moded, it  seems  to  us. 

Support  for  sex  education.  School  officials  woulc 
feel  less  uncertain  about  the  effects  of  such  programs 
on  the  public  if  they  knew  how  much  support  for  ses 
education  there  really  is.  To  illustrate: 

Several  Federal  agencies  have  been  giving  active 
support  for  some  time  to  programs  preparing  young 
people  for  marriage  and  family  living.  The  Public 
Health  Service,  in  its  regional  conferences,  has  beer 
urging  the  schools  to  offer  sex  education.  The  Office  ol 
Education  makes  grants  to  support  programs  to  pre- 
pare teachers  for  sex  education  programs  and  tt 
educational  institutions  and  community  agencies  tc 
start  or  to  improve  programs  in  family  life  educatior 
and  sex  education,  and  last  year  helped  SIECUS  hold 
a  national  meeting. 

Many  national  organizations  are  supporting  ses 
education  programs.  The  American  School  Health 
Association,  at  its  national  meeting  in  1966,  urged 
the  schools  to  develop  suitable  programs  of  sex  edu- 
cation for  all  children  and  young  people.  The  Amer- 
icaia  Association  for  Health,  Physical  Education,  and 
Recreation  has  also  passed  a  resolution  to  the  same 
effect.  Several  divisions  of  the  National  Educatior 
Association  and  the  National  Congress  of  Parents 
and  Teachers  also  have  policies  supporting  sex  edu- 
cation programs  in  the  schools,  and  SIECUS  is  sup- 
porting national  efforts  to  promote  sex  education 

The  sttccess  ok  failtjee  of  these  efforts  or  of  any 
others  is  determined  at  the  local  level.  If  good  public 
relation  principles  ai'e  followed,  if  young  people  and 
adults  in  the  community  are  involved  in  the  plan- 
ning, if  the  public  is  fully  informed  of  the  scope  and 
purpose  of  the  program,  and  if  teachers  have  an 
opportunity  to  overcome  their  hesitation,  the  fear 
regarding  sex  education  i^rograms  can  be  overcome 
and  a  school  can  offer  a  good  sex  education  program. 


% 


'Fulton,  Wallace  C:  Why  is  there  a  Sex  Information  and  Educ-ition 
Council  of  the  U.S.?  why  a  new,  separate  organization?  Journal  of 
School  Health,  May  1965. 

"Kirkendall,  Lester  A.:  Sex  education.  Sex  Information  and  Educa- 
tion Council  of  the  U.S.,  New  York.  Discussion  guide  No.  1.  October 
1965. 

"American  School  Health  Association:  Growth  patterns  and  sex  edu- 
cation: a  suggested  program  for  kindergarten  dirough  grade  twelve. 
Supplement  to  The  lottrnal  of  School  Health,  May  1967. 


CHILDREN     •     JULY-AUGUST  1967 


645  DAYS 


of  MATERNITY  and  INFANT  CARE 


KATHLEEN  A.  SWALLOW,  M.D.     •     GEORGE  H.  DAVIS,  M.D. 


Care  for  tlie  medically  indigent  mother  and 
c'liiltl  in  most  large  cities  has  been,  by  tradi- 
tion, provided  by  two  separate  services.  The 
)bstetrical  care  has  generally  been  hospital  orien- 
ited;  the  pediatric  care  has  generally  been  given  in 
,vell-i)aby  clinics  and  hospital  outpatient  depart- 
nents;  and  there  has  been  little  continuity  in  either. 
Much  of  this  is  changing  under  the  impetus  of  the 
naternity  and  infant  care  projects  for  mothers  and 
nfants  in  high  risk  of  morbidity,  financed  by  the 
r'hildrcn's  Bureau.^  Each  project  has  its  own  way  of 
joing  about  providing  continuity  of  high-quality 
nedical  care  for  such  mothers  and  infants.  The  de- 
iign  in  Baltimore,  to  be  described  here,  was  devel- 
)ped  to  cope  with  the  particular  problems  in  that 
:ity.  It  was  based  on  the  theoiy  that  continuity  of 
^are  is  necessary  from  conception  through  the  40 
kveeks  of  gestation,  delivery,  and  in  the  following 
months  until  the  infant  is  1  year  of  age — a  total  of 
34.>  days. 

Since  1950,  Baltimore  lias  experienced  a  change 
n  population,  with  a  decrease  in  the  higher  social 
jconomic  poi'tion  and  an  increase  in  the  culturally 
deprived,  medically  indigent  portion,  situated  large- 
y  in  the  core  of  the  city.  These  changes  are  reflected 
in  the  indicators  of  maternity  care.  In  1962,  Balti- 
more City  maternal  mortality  was  5.4  per  10,000  live 
)irths,  as  compared  with  3.8  for  all  the  counties  of 
Marjdand,  excluding  Baltimore  City.  Infant  mortal- 
ity was  32.9  per  1.000  live  births,  compared  with 
22.6  for  the  counties.  Perinatal  mortality  was  42.1 
per  1,000,  compared  with  30.5  for  the  counties.  The 
premature  birth  rate  was  12  percent  of  all  live  births 
in  the  city,  compared  with  7.8  percent  in  the  coun- 

VOLUME  14  -  NUMBER  4 


ties;  and  in  some  areas  in  the  city  was  as  high  as 
30  percent.  In  19G1,  little  or  no  prenatal  care  was 
reported  for  about  30  percent  of  the  mothers  living 
in  19  census  tracts  in  thecenter  of  thecity. 

P>fl'orts  to  improve  maternity  care  for  the  low- 
income  population  of  the  city  had  started  in  1954 
with  the  local  health  department's  establishment  of 
a  maternity  interviewing  center  stalled  bj'  an  ob- 
stetrician, a  public  health  nurse  supervisor,  two 
clerks,  and  a  maternitj'  interviewer  (a  high  school 
graduate  trained  by  the  health  deiDartment  to  take 
obstetrical  and  medical  histories).  At  that  time,  the 
centei-'s  physician  examined  only  emei'gency  pa- 
tients. Others  were  referred  for  examination  and 
care  to  the  health  department's  seven  prenatal 
clinics,  the  maternity  service  of  the  public  Baltimore 
City  Hospitals,  and  the  three  voluntarj'  hospitals  that 
would  serve  Negro  patients. 

From  1954  to  1964,  as  the  other  hosj^itals  in  the 
city  lifted  their  racial  restrictions,  new  obstetrical 
beds  became  available  to  Negro  patients.  Sixteen 
hospital  maternity  services — including  those  of  15 
voluntary  hospitals — now  make  no  racial  discrimina- 
tion against  patients,  and  these  are  all  participating 
in  the  project,  as  are  the  health  department's  pre- 
natal clinics,  now  consolidated  into  six. 

ilothers  in  the  project  can  choose  among  the  par- 
ticipating hospitals  for  delivery — and  in  some  in- 
stances for  prenatal  care — except  in  cases  in  which 
a  specific  hospital  is  indicated  by  a  condition  found 
in  the  mother  at  the  time  of  her  registration  and 
examination  at  the  new  maternity  center,  which  was 
established  with  the  initiation  of  the  project  in  1964. 
For  example,  mothers  with  known  psychiatric  prob- 

141 


lems  are  delivered  at  hospitals  with  psychiatric 
services.  About  half  the  mothers  in  the  project  re- 
ceive their  prenatal  care  from  the  health  depart- 
ment's prenatal  clinics  and  ai-e  delivered  at  the 
Baltimore  City  Hospitals. 

The  risk  register 

The  legislation  under  which  the  project  gets  Fed- 
eral support — the  Maternal  and  Child  Health  and 
Mental  Retardation  Planning  Amendments  to  the 
Social  Security  Act  (1963) — encourages  the  provi- 
sion of  high  quality  comprehensive  maternity  and 
pediatric  care  for  mothers  and  infants  in  low-income 
areas,  especially  mothers  and  infants  at  high  risk  of 
developing  physical  or  mental  handicaps."  Therefore, 
the  Baltimore  project  has  created  a  maternal  "high- 
risk  register"  that  lists  those  conditions  known  to 
have  had  deleterious  effects  on  mothers  and  infants. 
This  list  is  used  to  screen  out  for  special  attention — 
first  by  the  examining  obstetrician  and  then  by  rep- 
resentatives of  the  project's  nursing,  social  work, 
nutritional,  and  dental  staffs — those  mothers  wlio 
have  high-risk  conditions  of  any  kind.  High-risk 
conditions  that  develop  or  become  apparent  at  any 
time  after  the  mother's  registration  are  reported  from 
the  clinics,  and  appropriate  action  is  taken. 

Use  of  the  "risk  register"  permits  clear-cut  assign- 
ment within  the  project  of  responsibility  for  follow- 
ing through  to  meet  the  mother's  special  needs, 
whether  through  the  family,  community  agencies, 
or  the  various  services  within  the  project.  For  ex- 
ample, the  register  clearly  indicates  that  all  mothers 
aged  16  or  under,  all  over  35  having  their  first  preg- 
nancy, all  over  40,  and  all  of  any  age  wlio  register 
late  or  who  have  histories  of  poor  clinic  attendance 
must  have  intensive  nursing  followup,  as  must  moth- 
ers with  such  chronic  conditions  as  kidney  disease, 
diabetes,  malnutrition  or  obesity,  or  mental  retarda- 
tion; and  that  of  these  groups  all  mothers  16  or 
under  as  well  as  all  mothers  who  are  mentally  re- 
tarded must  see  a  social  worker  and  all  mothers  with 
kidney  disease  or  diabetes  must  be  offered  intensive 
consultation  by  a  nutritionist. 

Eighty  percent  of  the  6,243  pregnant  women  atIio 
came  to  the  center  in  1965  were  found  to  be  at  risk 
for  one  or  more  medical  conditions.  Ten  percent 
were  at  risk  for  obstetrical  reasons  only  such  as  tox- 
emia, pelvic  dystocia,  previous  Caesarean  sections 
previous  delivery  of  low-weight  infants,  stillbirths 
or  miscarriages.  Thirty  percent  had  obstetrical  risks 
combined  with  medical  or  social  risks.  Five  percent 

142 


had  combinations  of  risks  of  all  three  types.  Anemi: 
of  pregnancy  occurred  alone  in  approximately  6  per 
cent  of  the  mothers.  Approximately  40  percent  o 
those  registering  were  19  years  of  age  or  under; 
percent  were  15  or  imder. 

With  the  initiation  of  the  project,  the  maternit 
center,  its  point  of  intake  and  the  springboard  fo 
the  645  days  of  continuity  of  care,  was  moved  fror 
its  original  location  in  a  former  city  garage  to 
warehouse  in  the  center  of  the  city  accessible  to  a 
city  dwellers.  Furnished  comfortably  to  help  th 
patient  relax,  it  has  sufficient  staff  and  equipmer 
to  make  it  possible  to  give  complete  medical  an 
dental  examinations  to  all  registering  mothers  an 
to  plan  a  program  of  followup  care  for  each. 

SiaH  and  services 

The  project's  staff  includes  nurses,  nurse  midwive: 
physicians,  interviewers,  social  workers,  nutritionistl 
laborator}'  technicians,  health  aides,  and  clerical  an 
statistical  woi-kers,  some  assigned  to  the  center,  som 
to  the  district  prenatal  clinics,  and  some  to  the  hoi 
pital  clinics.  It  also  includes  a  health  informatio 
officer  whose  job  is  to  make  the  project's  services  an 
the  importance  of  early  prenatal  care  laiow 
throughout  the  city,  especially  in  neighborhoods  tlu 
have  shown  poor  use  of  health  services. 

All  expectant  mothers  who  come  to  the  center  ai 
given  an  obstetrical  examination  by  an  obstetriciaj 
Those  fomid  not  to  have  high-risk  medical  or  soci; 
conditions  are  helped  to  make  appropriate  arrangi 
ments  for  their  medical  care  through  resources  ou 
side  the  project. 

Wlien  the  patient  comes  to  the  centei',  the  fir; 
person  she  sees  after  tlie  receptionist  and  the  labor; 
tory  technician  is  an  interwiewer,  a  nonprofession; 
person  tramed  to  take  medical  histories.  The  histor 
is  sent  in  to  the  obstetrician,  who  reviews  it  with  th 
patient,  gives  her  a  complete  exammation,  and  ej 
plains  his  findings  to  her.  This  takes  from  15  to  3 
minutes. 

After  the  medical  examination,  the  patient  see 
representatives  of  whatever  other  services  the  initia 
interview  and  the  obstetrical  exammation  have  ind 
cated  she  needs — social  work,  dental,  nutritional,  o 
financial  assistance.  Her  last  interview  at  the  cente 
is  with  a  public  health  nurse,  who  makes  certain  th 
patient  knows  where  she  is  going  for  prenatal  car 
and  delivery.  The  total  amoimt  of  time  required  o: 
each  case  for  the  obstetrical  examination,  laborator; 
tests,  the  initiation  of  services,  and  the  making  o 

CHILDREN     •     JULY- AUGUST  196- 


0:i 


dn 


cliair' 


siriiii' 


oy  [11 


lii  iUTangenieiiis  lui-  iircnutal  caiv  and  delivery  usually 
runs  fioiu  -2  to  liV"  liours. 


Dental  service.  Dental  services  were  added  to  the 
maternity  center  in  June  1965.  The  denial  suite  con- 
tains a  small  reception  area,  a  room  with  three  denial 
chairs,  an  X-ray  developing  area,  a  recovery  area, 
and  an  ollice.  The  service  is  stalled  by  Hve  dentists — 
one  full  time  and  four  part  time — a  dental  hygienist, 
and  a  dental  assistant. 

Every  high-risk  mother  has  a  dental  examination 
on  her  initial  visit  to  the  center.  Her  mouth  is  ex- 
amined, instruction  is  given  \wv  on  the  proper  care 
of  the  teeth  and  gums,  and  if  she  needs  dental  work 
she  is  given  an  ajjpointment  lor  another  visit.  The 
clinic  does  periodontal  therajjy,  iillings,  and  abstrac- 
tions, emphasizing  the  prevention  of  periodontal 
disease,  treatment  of  gingival  disease,  and  the  pres- 
ervation of  teeth.  Dentiires  when  necessary  are  made 
by  private  dentists  on  contract  with  the  project. 

The  mothers  keep  their  dental  appointments  better 
than  any  other  type  of  appointment. 

Nutrition  services.  The  project's  nutrition  services 
have  been  created  because  the  nutritional  state  of  the 
population  of  the  core  of  a  city  like  Baltimore  leaves 
nnich  to  be  desired.  Rents  absorb  much  of  the  family 
butlget  and  leave  little  for  food.  For  example,  a  fam- 
ily of  live  with  an  income  of  $200  a  month  may  be 
paying  as  much  as  $100  for  a  two-bedroom  apart- 
ment, leaving  $100  for  food,  gas,  light,  clothes,  and 
incidentals.  Moreover,  stores  in  slums  offer  food  of 
lower  quality  and  less  variety  than  stores  in  outlying 
shopping  centers,  and  their  prices  tend  to  be  higher. 
The  same  kind  of  meat  may  be  10  cents  more  a  pound 
in  the  Dniid  Hill  central  city  neighborhood  than 
in  the  suburbs.  Then,  the  food  habits  of  many  people 
in  the  shuns  do  not  lead  to  optimal  nutrition:  they 
tend  to  prefer  the  starchy,  filling  foods  like  bread 
and  potatoes  to  green  and  yellow  vegetables,  and 
cannot  easily  change  their  diets. 

The  nutrition  staff  consists  of  five  nutritionists. 
One  is  always  available  at  the  maternity  center  to 
jirovide  individual  counseling  to  high-risk  patients. 
In  the  districts,  the  nutritionists  work  with  the 
jjliyslcians,  nurses,  and  directly  with  the  mothei-s  in 
the  pediatric  assessment  clinics,  in  the  postpartum 
clinics,  and  in  all  prenatal  clinics. 

The  dearth  of  simple  nutritional  material  directed 
to  persons  with  little  reading  ability  has  stimulated 
the  creation  of  a  number  of  simple  pamphlets  to  ex- 
plain the  basic  rules  of  good  nutrition  and  the  modi- 

VOLUME   14  -  NUMBER  4 


lications  in  diet  rci|uircd  by  picgnam  y  ami  \arious 
other  physical  cniuliiions.  The  service  has  also  de- 
velopeil  recipes  and  menus  using  inexpensive 
nutritious  foods. 

The  nul  rit  ionists  have  observed  that  the  main  nu- 
tritional problem  of  low-income  pregnant  women  is 
how  to  obtain  adequate  amounts  of  protein,  iron,  and 
\itamin  C.  Foi'ms  are  being  developed  to  help  pin- 
point the  patients  who  are  lacking  in  these  dietary 
elements  and  for  what  reason. 

The  project's  chief  nutritionist  attempts  to  co- 
ordinate the  nutritional  instruction  given  the  pa- 
tients in  the  health  department  and  hospital  prenatal 
clinics,  a  ditlicult  process  because  it  entails  the  cooper- 
ation of  the  dietit  ians  and  doctors  at  the  IG  hosi>itals. 
The  puriDose  of  the  liaison  is  to  achieve  continuity  in 
nutritional  advice  throughout  pregnancy. 

Nursing  services.  Because  of  the  heavy  demands 
on  the  obstetricians  and  pediatricians  manning  the 
clinics  and  hospital  wards  used  by  the  project,  it 
seemed  not  only  impractical  but  also  unpossible  to 
assign  each  patient  to  a  specific  jihysician  for  a  con- 
tinuous followthrough  from  her  first  appearance  for 
prenatal  care  through  the  first  year  of  her  child's  life. 
Thus  the  decision  was  made  to  rely  on  the  nursing 
services  to  achieve  the  goal  of  pi'oviding  continuity 
of  care  to  each  jjatient  in  a  one-to-one  relationship 
with  a  professional  person.  This  is  achieved  through 
the  nursing  staff  of  the  Baltimore  City  Health  De- 
l)artment,  augmented  by  30  project  nurses.  The  latter 
include  two  nursing  consultants — one  in  maternity 
nursing  and  the  other  in  pediatrics — five  nurse  mid- 
wives,  one  nursing  supervisor,  and  22  public  health 
nurses.  The  project  nurses  are  melded  into  the  staff 
of  the  city  health  department's  division  of  nursing, 
which  includes  about  250  nurses  in  all. 

The  public  health  nurse  assigned  to  the  neighbor- 
hood in  which  the  patient  lives  is  the  person  who 
provides  this  continuous  one-to-one  relationshij:)  to 


Kathleen  M.  Swallow,  M.D.,  has  been  direc- 
tor of  the  iiiiiteriiity  and  infant  care  i)roject 
of  the  Baltimore  City  Health  Department 
described  in  this  article  .since  1000  and  is  an 
assistant  professor  of  pediatrics  at  Johns 
Hopkins  University  School  of  Medicine. 
George  H.  Davis,  M.D.,  is  associate  director 
of  the  Bureau  of  Child  Hygiene  of  the  Bal- 
timore City  Health  Department  and  has  been  the  project's 
consultant  on  maternal  health  since  its  beginning. 


143 


" 


the  patient  by  visiting  her  in  the  home  and  being 
available  to  her  through  the  district  health  center 
where  the  health  department  clinics  are  located.  Be- 
fore she  leaves  the  maternity  center,  the  patient  is 
told  by  the  nurse  there  that  the  district  public  health 
nurse  will  be  her  source  of  help  for  any  problems  that 
arise,  whether  medical,  social,  or  financial. 

To  provide  continuity  of  care  for  patients  who  re- 
ceive their  prenatal  care  at  hospital  clinics,  as  well 
as  for  other  patients  at  the  time  of  delivery,  the  proj- 
ect has  placed  "liaison  nurses"  in  the  four  hospitals 
caring  for  the  most  patients.  The  liaison  nurse  has 
many  contacts  with  the  mother  and  her  baby.  She 
attends  the  hospital  prenatal  clinics  so  that  she  can 
alert  the  district  nurse  to  the  additional  needs  of  the 
patient;  she  is  alerted  in  turn  by  the  district  nurse  to 
the  special  needs  of  patients  coming  from  the  health 
department  clinics  to  the  hospital  for  delivery.  She 
is  aware  of  the  needs  of  the  frightened  primipara  or 
the  seriously  ill  patient,  and,  when  possible,  she  ac- 
companies such  patients  to  the  hospital's  delivery 
floor.  She  visits  the  hospital's  postpartum  wards  and 
the  nurseries  for  premature  and  newborn  babies.  One 
of  her  most  important  functions  is  to  encourage  the 
new  mother  to  return  to  the  clinic  for  her  postpartum 
visit  and,  if  the  mother  wishes,  for  family  planning 
service. 

The  nursing  service  also  provides  continuity  to  the 
project's  family  planning  program.  In  the  maternity 
center,  a  volunteer  woi-ker  from  the  Planned  Parent- 
hood Association  acquaints  the  mother-to-be  with 
the  services  and  methods  available.  Later,  an  inter- 
ested mother  has  an  opportunity  to  discuss  the  plan- 
ning of  her  family  with  the  public  health  nurse  on 
home  visits,  the  liaison  nurse  in  the  hospital,  and 
again  with  the  pulilic  health  nurse  at  the  postjiartum 
examination,  which  is  given  4  weeks  after  the  birth  of 
the  baby.  At  that  time,  if  she  decides  she  wants  such 
service,  it  is  given  immediately.  She  has  her  choice  of 
three  methods  of  birth  control.  At  the  present  time, 
"pills"  are  the  number  one  choice  of  the  patients,  but 
the  number  of  women  choosing  "lUD"  insertions  is 
steadily  rising.  Foam  is  available  but  is  not  often 
selected.  Patients  desiring  other  methods,  such  as  the 
rhythm  method,  are  referred  to  the  appropriate  clin- 
ics. About  4,.500  women  have  received  family  plan- 
ning services  since  the  beginning  of  the  project. 

The  nursing  service  also  provides  continuity  be- 
tween the  home  and  hospital  in  the  care  of  prematures 
born  at  the  Baltimore  City  Hospitals.  The  liaison 
nurse  attends  the  hospital's  conference  to  evaluate 
prematures.  Here  the  medical,  social,  nutrition,  and 


144 


nursing  services  are  coordinated  so  that  by  the  time 
the  infant  is  discharged  the  hospital  staff  knows  that 
the  home  is  prepared  to  receive  him  and  the  district 
nurse  has  accurate  information  on  how  to  continue 
the  care  of  mother  and  child  in  the  community.  The 
liaison  nurse  also  attends  the  hospital's  followup 
clinic  for  prematures.  At  the  end  of  each  clinic  ses- 
sion, she  meets  with  the  chief  of  the  premature  serv- 
ice, the  chief  pediatric  resident,  and  the  hospital 
social  worker  assigned  to  this  clinic  to  discuss  the 
problems  of  the  infants  examined. 

Usually  only  about  half  of  the  60  or  so  babies 
sclieduled  for  this  clinic  are  brought  in.  Those  who 
do  not  appear  are  given  new  appointments  at  the 
clinic  or  are  visited  at  home  l)y  the  district  nurse.  If 
the  records  indicate  that  the  premature  infant  is 
developing  satisfactorily,  his  case  is  referred  to  the 
city  well-baby  clinic  nearest  his  home. 

Pediatric  services.  Pediatric  care  is  provided 
through  the  health  department's  ?A  well-baliy  clinics, 
nine  special  pediatric  assessment  clinics,  the  partici- 
jiating  hospitals'  premature  nurseries  and  outpatient' 
departments,  and  private  physicians  practicing  in 
the  neighborhoods  served  by  the  project. 

In  planning  the  pediatric  services,  a  second  "risk 
register"  was  developed.  This  lists  conditions  from 
the  mothers'  "risk  register"  not  resolved  by  delivery, 
conditions  arising  out  of  delivery  that  may  influence 
the  infant's  development,  and  conditions  that  may 
occur  in  the  next  .'565  days  to  change  his  develop- 
mental course.  With  the  help  of  the  district  nurse, 
close  followup  is  made  on  all  liabies  born  to  high-risk 
mothers  as  well  as  on  other  infants  with  conditions 
listed  on  the  infant  risk  register.  The  most  common 
high-risk  conditions  found  in  babies  delivered  under 
the  project  are  low  birth  weight  and  iron  deficiency 
anemia.  "Failure  to  thrive"  occurs  frequently  enough 
to  be  considered  a  major  prolilem  requiring  the  pro- 
vision of  many  coordinated  services — nursing,  nutri- 
tion, social  work,  psychiatry — and  a  working  to- 
gether of  hospital  inpatient  and  outpatient  divisions. 

The  pediatric  record  includes  pertinent  informa- 
tion from  the  hospital's  record  made  at  the  time  of 
the  infant's  birth:  information  on  sex,  race,  weight, 
length,  head  circumference,  any  physical  defect  noted 
in  the  newborn  examination,  the  Apgar  rating  (based 
on  observations  of  the  infant  at  birth  and  5  minutes 
later),  results  of  laboratory  tests,  and  any  illness 
arising  in  the  newborn  while  in  the  hospital. 

Followup  of  each  infant's  progress  involves  sys- 
tematic observation  and  evaluation,  with  the  use  of 


CHILDREN     •     JULY-AUGUST  196711 


[ 


tlnvi^  I'onns  l);istMl  liii'i:i'ly  mi  I'lU'ins  (l('\ cliipi'il  liy  I  lie 
Collahorative  I'criiKital  licsciiicli  rroji'd  ;U  llic  Na- 
tioiial  Institutt^  of  N'i'iir()l()t;-ic:il  1  )iscas('s  and  lUiiid- 
iH'ss,  Xalioiial  Institutes  ol'  Health.  'Two  ol'  these 
forms  are  tilled  out  l>y  tlie  iinrse,  tlie  tliird  liy  the  |ie- 
diatriciau.  Eacii  time  the  nurse  sees  tiie  iiilanl  at 
home  or  in  tiie  weli-liahy  elinic.  she  uses  a  form  on 
wiiicli  slie  notes  illnesses,  accidents,  or  any  pertinent 
events  that  have  occui'red  since  she  last  saw  the  in- 
fant. This  foi'Ui  also  provides  for  notations  about  the 
physical  and  human  en\  ironmeiil  of  the  home.  Thus, 
it  provides  the  pediatrician  who  reviews  it  with  im- 
portant information  about  the  infant's  progress  and 
environment  as  seeu  throuii'h  the  nurse's  eyes.  At 
o-month  intervals  the  nurse  also  niid<es  notations  on 
another  form,  called  the  dexclopmeut  achievement 
form,  which  indicateswhotlier  the  infant  has  achieved 
the  expected  performance  level  for  his  age.  The  re- 
viewing pediatrician  can  then  correlate  whatever  lags 
are  noted  witli  the  prenatal,  delivery,  and  illness 
expei'iences  of  the  infant  in  making  a  plan  for  action. 

The  third  form  is  the  (i-month  examination  form. 
This  is  tilled  out  l>y  the  pediatrician  in  whichexcr  of 
the  nine  special  pediatric  assessment  clinics  the  in- 
fant is  examined.  This  form  is  used  to  assess  the 
child's  physical  and  neurological  condition  and  the 
mother-child  relationship.  It  is  precoded  to  reduce 
writing  time  to  a  minimum  to  leave  the  major  part 
of  the  physician's  time  for  examination  of  the  infant 
and  considtation  with  the  mother. 

All  infants  with  high-risk  conditions  or  born  to 
mothers  who  had  high-risk  conditions  during  preg- 
nancy are  given  appointments  for  pediatric  examina- 
tions at  these  special  clinics  at  about  (J  months  of  age. 
A  hematocrit  is  taken  on  each  infant  at  the  time  of 
the  examination.  The  infant  is  also  seen  by  a  nutri- 
tionist who  counsels  the  mother  concerning  feeding. 
"WHien  conditions  indicate  that  special  attention  is  re- 
quired, the  pediatrician  refers  the  case  to  the  proj- 
ect's social  services,  the  nursing  division,  or  a 
connnunity  resource — hospital,  physician,  or  social 
agency. 

Each  infant  is  given  a  screening  test  for  auditory, 
motor,  and  visual  defects  at  about  8  to  10  months  of 
age  by  the  United  Order  of  True  Sisters.  One  method 
tests  both  hearing  and  motor  development.  Infants 
who  fail  to  pass  this  test  on  two  occasions — about 
8  percent  of  all — become  "high  risks"  and  are  seen 
by  a  project  pediatrician  who  decides  whether  re- 
ferral to  an  otological  or  a  neurological  clinic  is  in- 
dicated. The  visual  test  is  focused  on  the  presence  of 
strabisnnis.  The  records  are  reviewed  by  an  ophthal- 

VOLUME   14  -  NUMBER  4 

265-214—67 3 


■^^^ 


■'^"  "  ••  ^ 


./■■  ■■ 


i 


Keeping  tabs  on  baby — a  normal  procedure  with  all  infants 
born  in  Baltimore's  maternity  and  infant  care  project. 


mologist.  who  sees  suspected  cases.  Thus,  treatment 
can  b<'  started  early  to  preserve  binocvdar  vision. 

Sci-eening  tor  inlnirn  errors  id'  metabolism  is  con- 
lined  to  eli'oi'ts  to  detect  iihenylketonuria.  Each  new- 
boi-n  is  given  the  (iuthi'ie  bliKtd  test  before  flischargc 
from  the  hospital,  a  i)rai'lice  now  compulsory  in  the 
State  of  ^faryland.  In  addition,  the  public  health 
nurse  following  the  child  tests  his  urine  with  ferric 
ihloride  several  times  during  the  following  6  months. 

All  the  foims  filled  out  on  the  infants  are  turned 
in  immediately  to  the  maternity  center.  There  the 
chief  pediatrician  reviews  them  along  with  pre\i- 
ously  obtained  records  and  makes  decisions  on  what 
further  services  are  needed.  Action  in  the  distrii-t  can 
be  obtained  from  the  maternity  center  in  a  few 
days — 1  day  if  requested  by  telephone,  3  or  -1  if  by 
memorandum. 

At  the  end  of  the  305  days,  the  project  pediatrician 
reviews  all  findings,  noting  what  lags  in  development 
exist  and  the  inununizations  and  screening  proce- 
dures tlie  infant  has  lieen  through:  summarizes  the 
events  of  the  year;  and,  if  continued  supervision 
seems  to  be  reciuired,  refers  the  case,  with  a  sununary 
of  the  findings,  to  ai)pro])riate  community  sendees. 

Social  services.  The  project's  social  service  section 
has  three  major  functions:  identifying  cases  with 
social  or  fanuly  problems  recpiiring  special  services, 
referring  such  cases  to  appropriate  community  agen- 
cies for  help,  and  stinudating  the  development  of 
community  resources  to  meet  the  patient's  needs. 
These  functions  are  carried  out  by  a  stall'  of  nine  so- 
cial workers.  One  social  worker  interviews  at  the 
center  all  i)atients  having  conditions  designated  for 
social    service  attention   on   the   maternal   hii!:h-risk 


145 


register,  as  well  as  other  patients  referred  by  the  ob- 
stetrician; one  acts  in  a  liaison  capacity  between  the 
project  and  the  social  service  departments  of  the  par- 
ticipating hospitals;  one  works  with  community 
agencies  to  develop  the  kinds  of  services  needed  by 
the  project's  patients;  one  works  with  the  pediatric 
nui'sing  consultant;  and  the  others  work  with  the 
nurses  in  the  health  districts. 

The  high-risk  register  designates  for  interviews 
with  a  social  worker  at  the  center  the  mimarried,  ado- 
lescent, mentally  retarded,  alcoholic,  or  epileptic  pa- 
tients; patients  with  a  history  of  psychosis;  patients 
who  express  a  desire  to  give  the  coming  baby  up  for 
adoption ;  and  patients  with  serious  financial  or  fam- 
ily problems. 

Many  community  agencies,  public  and  voluntary, 
are  called  upon  to  bring  the  patients  the  services  they 
need,  but  overall  responsibility  for  resolution  of  the 
problems  remains  with  tlie  project.  The  center  avoids 
duplication  of  effort  by  keeping  concisely  writt-en 
information  flowing  to  and  from  the  agency  or  hospi- 
tal involved.  When  no  community  agency  is  available 
to  provide  social  casework  service  to  the  patient  in 
need  of  it,  as  when  a  hospital  to  which  the  patient 
is  assigned  lacks  a  social  service  deiiartment,  the  serv- 
ice is  provided  by  one  of  the  project's  district  social 
workers. 

Social  needs  that  arise  or  first  become  apparent 
after  the  patient  leaves  the  center  are  referred  by 
the  nurses  or  pediatricians  to  the  project  social  work- 
ers at  the  district  liealth  centers.  This  happens  es- 
pecially when  infants  appear  to  be  neglected  or 
mothers  exhibit  no  warmth  toward  their  children  or 
fail  to  bring  tliem  to  tlie  clinic — all  indications  of  a 
deficit  in  mother-child  relationship  that  may  be 
detrimental  to  the  child's  healthy  development. 

When  the  child  is  a  year  old,  a  social  assessment 
is  made  to  determine  whether  the  social  services  pro- 
vided have  improved  the  outlook  for  health  of  both 
mother  and  child. 

Psychiatric  services.  From  eight  to  10  women 
already  diagnosed  as  mentally  ill  register  at  the  cen- 
ter every  month.  Others  show  symptoms  of  severe 
emotional  disturbance — often  connected  with  an  un- 
wanted pregnancy — or  develop  such  symptoms  as 
the  pregnancy  advances.  A  psychiatrist  on  the  proj- 
ect's staff  part  time  works  with  the  obstetricians, 
nurses,  and  social  workers  to  help  them  in  identify- 
ing, assessing,  dealing  with,  and  finding  the  appro- 
priate treatment  for  such  patients. 

Prior  to   the   establishment  of  the   project,  the 


146 


liealth  department  had  no  means  of  referring  mater-i 
nity  patients  to  hospitals  with  emergency  psychiatric 
services.  Now  four  of  the  project's  participating  hos- 
pitals will  accept  such  emergency  admissions,  and 
consequently  delays  between  the  outbreak  of  symp- 
toms and  treatment  are  reduced.  In  such  cases  the 
psychiatrist  assumes  responsibility  for  following 
through  with  the  hospital's  recommendations  on  the 
patient's  release  to  the  community. 

Toward  evaluation 

Tlie  project's  record  system  is  designed  to  fulfill 
three  needs :  (1)  to  have  all  medical,  hospital,  dental, 
social,  nutritional,  and  financial  information  about 
the  mother  and  infant  readily  available  in  one  file; 
(2)  to  keep  pertinent  information  flowing  smoothly 
between  the  maternity  center  and  the  district  health 
centers  and  the  participating  hospitals;  (3)  to  pro- 
vide statistics  that  will  not  only  show  volume  of  care- 
but  also  help  in  evaluating  the  service. 

A  master  index  with  each  mother's  registration 
number  makes  it  possible  to  locate  any  mother's  rec- 
ord in  the  file  within  a  few  minutes.  It  also  alerts 
the  project  when  records  are  due  from  hospital,  pre- 
natal, postpartum,  pediatric,  or  family  plannings 
clinics,  so  that  patients  are  not  lost  to  followup  care. 

The  project  is  gathering  data  on  the  occurrence 
among  its  patients  of  maternal  mortality,  infant 
mortality,  fetal  wastage,  prematurity,  congenital 
anomalies,  and  physical  and  neurological  lags  in  nor- 
mal development  in  the  first  year  of  life.  At  this 
writing  final  results  are  not  in,  but  we  have  some 
indications  that  the  screening  methods  used  and  the 
high  quality  of  interdisciplinary  obstetrical  and 
pediatric  care  provided  throngh  the  project  have 
given  the  infants  of  high-risk  motliers  a  better 
chance  of  survival. 

But  we  know  that  many  infants  would  have  an 
even  better  chance  of  survival  if  there  were  adequate 
community  welfare  services  for  patients  who  are  at 
high  risk  chiefly  because  of  social  problems — as  in 
cases  of  pregnancy  out  of  wedlock  or  in  adolescence 
or  of  anemia  stemming  from  inadequate  food  intake. 
To  lower  such  risks,  much  more  has  to  be  done  by  the 
community  as  a  whole. 


m 


{ 


'Close,  Kathryn:  Giving  babies  a  healthy  start  in  life.  Children,  Sep 
tember-October  1965. 

=  Lesser.  Arthur  J.:  Accent  on  prevention  through  improved  service. 
Children,   January-February    1964. 

CHILDREN     .     JULY-AUGUST  1967 


VOLUNTEERS 


in  INSTITUTIONS 


for  DELINQUENTS 


ELIZABETH  H.  GORLICH 


"I  just  want  to  write  and  let  you  know  that 
I  am  very  pleased  with  my  volunteer  visitor 
and  I  also  want  to  thank  you  for  making  it 
possible  for  me  to  be  engaged  with  such  a  wonderful 
person." 

So  wrote  a  girl  to  the  superintendent  of  a  Califor- 
nia institution  for  juvenile  delinquents.  Through  the 
institution's  volunteer  i^rogram,  this  girl,  whose  own 
famil)-  could  not  or  would  not  visit  her,  had  been 
reassured  that  someone  on  the  outside  cared.  After 
all,  the  staff  is  paid  for  the  attention  they  give;  the 
volunteer  gives  her  attention  free — because  she  cares. 
The  administrator  of  this  institution  has  no  ques- 
tion about  the  positive  values  of  using  volunteers  in 
direct  service  to  the  girls.  Unfortunately,  however, 
while  much  of  the  standard-recommending  literature 
in  the  institutional  lield  advocates  tlie  use  of  volun- 
teers,'' ^  only  a  few  institutions  have  well-developed 
volunteer  programs. 

The  number  of  persons  who  work  as  volunteers  in 
the  broad  health  and  welfare  field  would  be  difficult 
to  estimate,  but  a  figure  in  tlie  millions  would  not  be 
an  exaggeration,  and  the  nmnber  seems  to  be  increas- 
ing.^ There  are  many  reasons  why  institutions  for 
juvenile  delinquents  have  not  fared  so  well  as  other 


types  of  agencies  in  benefiting  from  their  services. 
Such  institutions  have  traditionally  been  located  in 
areas  remote  from  the  centers  of  po|)ulation,  thus  cre- 
aliiig  problems  of  transportation.  Tlie  children  they 
contain  do  not  attract  the  sympatiiy  of  volunteers  so 
readily  as  ilo  the  children  in  other  progi-ams.'  Most 
people  find  it  much  easier  to  share  their  time  and 
energy  with  an  abandoned  or  bedridden  child  than 
with  a  child  who  causes  the  conuminity  all  kinds  of 
trouble  by  stealing,  nuiggiiig,  or  shoplifting.  Never- 
theless, delinquent  children  need  the  warmth,  under- 
standing, and  pei'soiial  intei'cst  from  an  adult  as  much 
as  an}'  other  child. 

Another  deterrent  to  the  use  of  volunteers  in  insti- 
tutions for  juvenile  delimiuents  is  reluctance  on  the 
part  of  the  administrators.  Some  fear  the  possibility 
of  conflict  arising  between  paid  staff  members  and 
\olunteers.  They  know  that  the  staff's  failure  to  mi- 
derstand  the  role  and  responsibilities  of  the  volunteer 
can  prevent  the  volunteer  from  making  as  valuable  a 
contribution  as  he  might.  Distrust  of  the  volunteer 
has  not  only  thwarted  some  volmiteer  programs  but 
has  also  caused  the  potential  contribution  of  volun- 
teers to  be  underestimated.'* 

The  question  sometimes  raised  is  whether  this  po- 
tential contribution  is  worth  all  the  careful  planning, 
interpretation,  and  supervision  required  to  overcome 
staff'  antagonism  toward  the  use  of  volunteei-s  and 
help  the  volunteers  to  be  effective.  When  the  volun- 
teer is  regarded  as  filling  a  need  only  a  volunteer  can 
fill  rather  than  as  just  providing  an  extra  hand  for 
the  paid  staff,  the  answer  can  only  be  in  the  affirma- 
tive. A  look  at  some  of  the  needs  of  children  and  ado- 
lescents who  have  been  committed  to  institutions  and 
at  some  of  the  ways  volunteers  have  helped  meet 
these  needs  will  indicate  how  distinctive  the  volun- 
teer's contribution  can  be — and  sometimes  is. 

The  special  contribution 

The  overwhelming  burden  of  institutionalization, 
especially  for  juvenile  delinquents,  is  the  removal 
from  normal  community  life.  Most  States  have  only 
two  institutions  for  deliu(|uents,  one  for  boys  and  one 
for  girls.  This  means  that  the  young  people  committed 
to  them  by  the  courts  are  removed  some  distance  from 
their  home  comnnmities  to  places  where  the  only  peo- 
I>le  they  see  daily  besides  the  institution's  staff'  mem- 
bers are  other  young  people  who  have  been  adjudi- 
cated as  delin(juent.  Their  opportunities  to  relate  to 
persons  who  live  in  normal  communities  are  few,  yet 
their  need  for  continued  communication  with  the 


VOLUME   14  -  NUMBER  4 


147 


outei'  world  is  great.  Volunteers  and  staff  members 
bring  the  outer  world  into  the  institution  on  ditTerent 
bases. 

In  some  places,  as  in  the  institutions  for  ju\enile 
delinquents  in  California  and  Massachusetts,  \-olun- 
teers  come  to  the  institution  just  to  talk  to  the  young 
people  assigned  to  them  or  to  lead  or  take  i)art  in 
some  group  activity  such  as  hobby  clubs,  Scoiit 
ti'oops,  self-imjirovement  classes,  and  holiday  parties. 
The  very  fact  that  they  are  doing  this  without  being 
paid  for  their  efforts  gives  the  young  jjeople  the  feel- 
ing that  someone  cares  about  them.  Too  often  the  fam- 
ily, the  school,  the  church,  and  the  comnuinity  have 
rejected  the  young  people  who  ha\e  been  committed 
to  institutions  for  delincpients.  Some  young  i)eople 
never  have  any  visitors  from  home.  J'or  them,  rcgu- 
lai-  \isits  from  an  intei-ested  volunteer  can  play  a 
major  i)art  in  counteracting  feelings  of  comi)lete 
rejection. 

Hut  \-olunteers  offer  more  than  friendliness  to  the 
rejecte<l  youngster.  They  also  piovide  the  young  per- 
son with  a  model  of  responsiljlc  adult  beluwior.  Many 
juvenile  delin([uents  ha\e  never  been  close  to  anyone 
who  has  concern  for  f)thers.  In  the  volunteer's  rela- 
tionship with  them  and  with  the  other  yomig  people 
in  the  institution,  they  may  for  the  lirst  time  become 
aware  of  the  possibility  of  caring  what  happens  to 
persons  other  than  tliemsehes. 

In  addition  to  serving  the  young  peo))le  with  whom 
they  work  directly,  \-olunteers  ser\e  the  institution  as 
a  whole  by  spreading  the  word  about  its  programs 
and  needs.  Any  ])rogram,  whether  tax-supported  or 
voluntary,  needs  connnunity  support  to  function 
eft'ectively.  A  volunteer  familiar  with  an  institution's 
])rograms  and  problems  can  become  a  more  ert'ecti\-e 
spokesman  for  the  institution  than  anyone  on  the  iiaid 
staff',  for  he  is  less  suspected  of  self-interest. 

Despite  staff  eft'orts  to  individualize  programs, 
young  i)eoi)le  can  become  "institutionalized";  to  pre- 
vent this,  they  need  to  be  away  from  the  institution 


Elizabeth  H.  Gorlich  is  an  institutional  and 
community  iilacement  fon.sultant  in  tlie 
Children's  Bureau's  Division  of  Juvenile 
Delinquency  Service.  Before  eomins  to  the 
Bureau  in  1903,  she  was  assistant  adminis- 
trator of  the  Cedar  Knoll  School,  the  District 
of  Columbia's  institution  for  older  deliniiueut 
hoys  and  girls,  where  she  also  served  as  as- 
sistant superintendent  and  supervisor  of  the  girls'  program. 
She  has  also  worked  in  comnuinity  agencies  in  New  York  City 
and  Akron,  Ohio. 


from  time  to  time.  Therefore,  some  institutions 
encourage  v'olunteers  assigned  to  specific  children  to 
take  them  off'  the  institutional  grounds — on  shopping, 
or  pleasure  trips — to  give  them  the  ''feel''  of  life  on 
the  outside.  Some  institutions  have  even  let  volunteers 
take  young  people,  particularly  those  soon  to  be 
released,  into  their  homes  for  a  day  or  a  weekend  to 
give  them  a  chance  to  test  their  ability  to  live  up  to 
tile  standards  of  the  outside  world. 


>ome 


pitfalls 


148 


With  such  obvious  advantages  in  the  use  of  volun- 
teers, why  do  many  administrators  of  institutions 
for  delinquents  fail  to  even  try  to  develop  volunteer 
programs^  The  answer  may  be  that  they  fear  the 
pitfalls  that  can  render  a  volunteer  j^rogram  not  only 
ineff'ective  but  actually  harmful.  These  pitfalls  do 
exist,  but  they  can  be  avoided  with  careful  planning. 
They  lie  in  the  following  areas: 

1.  The  selection  of  volunteers.  While  there  may  be 
\dliinteer  tasks  of  some  kind  suitable  for  nearly 
everyone,  tiiis  is  not  true  of  direct  work  with  juvenile 
delinquents.  Some  people  cannot  work  effectively 
with  delinquents  because  they  are  so  basically  hostile 
to  the  idea  that  a  young  person  could  behave  in  the 
way  deliiHiuents  do  that  they  cannot  give  them  the 
warmth  and  understanding  they  need.  Such  persons, 
however,  sometimes  do  volunteer  to  help  delinquents 
"reform."  For  the  sake  of  the  program  and  the  young 
people  in  it,  they  must  either  be  turned  down  or 
diverted  to  tasks  not  involving  direct  contact  with 
the  young  jieople. 

Equally  to  be  avoided  as  candidates  for  direct 
work  with  deliiKiuents  are  persons  who  are  oversen- 
timental  about  children.  Helping  delinquent  children 
requires  firnniess  as  well  as  warmth.  Persons  who 
cannot  place  realistic  controls  on  youitg  people's  be- 
havior will  end  in  frustrating  both  themselves  and 
the  young  people. 

A  third  type  of  person  to  be  avoided  in  selection  is 
tlie  person  who  cannot  discipline  himself  enough  to 
accept  the  institution's  rules.  If  a  person  cannot  fol- 
low a  schedule,  keep  appointments,  or  complete  train- 
ing, he  will  bring  more  confusion  than  help  to  the 
young  person  and  the  institution. 

Administrators  have  found  irregular  attendance 
to  be  one  of  the  most  difficult  problems  in  running  a 
volunteer  program.  Most  juvenile  delinquents  ha\e 
already  experienced  so  much  rejection  that  they  have 
a  decidedly  negative  attitude  toward  adults.  This 

CHILDREN     •     JULY-AUGUST  1967 


I 


:i(lilu(li'  liccdiiifs  rciiirnrreJ  when  ;iii  I'xpccicil  \()liiii- 
Iccr  (liH's  111)1  liini  ii|i,  for  tlii'  yoiiui:-  |ifi>iiii  who  is 
ii-nl  lo  lii'iiiii-  rcjoctod  will  iiiti'i-prct  tin-  voluiiti'cr's 
iliM'Uct'  ;is  unotliei'  rejiH'tion.  To  i)i-()(oct  tlie  youiifr 
|ic'(i|)ii'  from  such  a  sliatlcriuii-  (wiuTifiic-i'.  instil  ii 
iiDiis  with  \-ohiiiti'i'r  pi-oiiraiiis  June  t'oiiiul  it  iiii]ior- 
^uiit  not  only  to  si'U'rt  their  xolnnti'i'i-s  as  rari'i'ully 
lis  thi'\'  Would  paid  >lall'  nn'inhcrs.  Iml  also,  in  orient  - 
\]\>^  and  su[)t'rvisin<i-  the  Nolnnleers  they  select,  to 
stress  the  necessity  for  reguhir  attendance. 

Screening;'  ont  from  prospective  volnnteers  those 
iinsnitalile  for  the  ]iroi;ram  and  selectiiii;-  those  witli 
warmth,  lirnmess,  and  dependability  recpiire  skill 
in  learning;-  alioiil  peo[ile  thronyh  the  infer\'iew 
process. 

2.  Administrative  policies.  One  reason  some  volmi- 
teer  proirranis  run  into  trouble  is  a  tenilency  amoni;; 
institutional  administrators  to  <rive  tliem  oidy  half- 
hearted support.  Too  often  responsibility  for  tlie 
pre])aration  and  i;uidaiice  of  a  volunteer  ])ro<irain 
is  a^sifiiied  to  an  already  overburdened  staff  mem- 
ber— often  the  assistant  adnunistrator — who  c;in 
oidy  give  time  and  attention  to  the  volunteers  at  the 
expense  of  his  other  responsibilities  toward  the  entire 
institutional  program.  The  result  is  frustration  on 
the  part  of  everybody — the  administrator,  the  child- 
care  workers,  antl  the  volunteers  themselves. 

However,  when  the  administrator  demonstrates 
that  he  is  in  w  hole-hearted  support  of  the  volunteer 
program  by  assigning  responsibility  for  it  to  a 
person  with  both  the  competency  and  the  time  to 
work  closely  with  the  volunteers  and  staff  members 
toward  meshing  their  etfoi'ts,  the  prestige  of  the 
volunteer  program  is  enhanced  within  the  institution 
and  the  grounds  for  its  effectiveness  are  laid."  Un- 
fortunately, few  institutions  for  juvenile  delinquents 
have  established  either  a  part-time  or  full-time  posi- 
tion of  volunteer  service  coordinator — a  common  one 
in  mental  hospitals. 

Whether  or  not  the  institution  needs  a  staff  person 
to  devote  full  time  to  the  volunteer  program  depends, 
of  coursi\  on  its  size.  A  small  institution  might  well 
assign  this  function  to  a  person  with  other  tluties 
if  these  are  not  so  j)ressing  or  so  numerous  as  to 
monopolize  his  attention;  or  it  might  find  an  admin- 
istratively gifted  volunteer  wlio  is  willing  to  direct 
the  volunteer  program  on  a  part  time  basis. 

Another  way  in  which  an  institution's  adminis- 
trator shows  his  sujiport  or  iuditl'erence  to  a  volun- 
teer program  is  in  his  action  or  inaction  in  setting 
clear-cut  policies  in  respect  to  xolunteers  who  work 

VOLUME  14  -  NUMBER  4 


with  I  he  young  people  -for  example,  in  relation  to 
insurance  coverage,  reimbursement  for  expenses,  the 
use  of  the  institution's  i-ars,  acce[)tingor  giving  gifts, 
taking  a  resident  olf  the  institution's  grounds,  the 
n>e  of  case  records,  the  volunteer-supervisor  relation- 
ship, and  procedures  for  handling  complaints.  Much 
confusion  is  also  a\i)ided  when  specilic  job  descrip- 
tions for  the  \(ilmilccrs  have  been  established  and 
are  periodically  evaluated  in  the  light  of  the  institu- 
tion's needs.  Such  a  procedure  gives  both  the  volun- 
teer and  his  snpeixisor  a  clear  picture  of  what  is 
expected  of  the  Nolunteer  in  relation  lo  the  young 
people  in  the  institution  and  in  relation  to  the  mem- 
bei'sof  the  insl  it  ution's  stalV. 

Sources  of  recruitment 

h\  spite  of  the  reluctance  some  potential  volunteers 
may  feel  about  working  with  institutionalized 
jn\'enile  delin(|uents,  a  determined  director  of  an 
institution's  volunteer  program  can  Kiid  many  sources 
for  recruitment  if  he  makes  the  lu'ed  and  the  purpose 
of  his  program  known  lo  the  outside  community — 
especially  church  groups,  vohinteer  bureaus,  service 
clubs,  and  other  sources  oi  volunteer  manpower  such 
as  affiliates  of  national  orgaiuzations  interested  in 
correctional  work.  For  e.\ami)le,  the  Boy  Scouts  of 
America  is  uroing;  its  local  councils  to  establish  Scout 
troops  at  institutions  for  delinquent  boys  and.  to  this 
end,  has  appointed  a  staff  member  at  its  national  head- 
ipiarters  to  work  with  the  National  Association  of 
Training  Schools  aiul  Juvenile  Agencies.  The  Big 
lirothers  of  America  has  long  encouraged  the  men  in 
its  local  affiliates  to  provide  personal  friendshij)  to 
boys  in  institutions  or  just  relea.sed  from  institutions 
to  hell)  <hem  find  better  ways  of  relating  to  the  world 
around  them.  Similar  work  is  being  done  by  a  Ken- 
tucky affiliate  of  the  Optimists. 

.Sometimes  volunteers  can  be  recruited  because  of 
their  special  interests  or  talents.  For  e.xanq)le,  an 
automobile  distributor  in  an  Oregon  conunmiity  is 
gi\-ing  driving  lessons  to  the  yomig  [jcople  in  a  nearby 
training  school.  The  Society  of  Illustrators  in  New 
York  works  with  groups  of  institutionalized  boys. 
Several  nmrals  at  one  of  the  State's  institutions 
ff)r  boys  give  evidence  of  this  group's  contribution 
to  the  training  school  and  to  the  boys'  sense  of  ac- 
complishment. Volunteer  nuisicians  have  contributed 
to  several  New  York  institutional  programs  both  as 
entertainers  and  instructors. 

Some  institutions  are  finding  new  or  unusual 
sonr<'es  of  vohinleer  manpower,  especially  for  work- 

149 


ing  directly  with  individual  young  people.  For 
examiDle,  a  Maryland  institution  has  recruited  volun- 
teers from  a  nearby  naval  installation.  Assigned  to 
specific  boys  in  the  institution,  the  Navy  men  fre- 
quently visit  them  or  take  them  to  see  the  naval  center. 
Separated  from  their  own  families,  some  of  the  men 
have  indicated  that  giving  friendship  to  a  boy  badly 
in  need  of  a  "father  figure"  gives  them  a  sense  of 
"family." 

In  California,  two  correctional  institutions  are 
cooperating  with  the  San  Diego  State  College  in  pro- 
viding "internships"  for  sociology  students,  thereby 
not  only  providing  the  students  with  a  greater  under- 
standing of  correctional  work,  but  also  giving  the 
residents  of  the  institution  the  benefit  of  the  students' 
work  in  group  counseling  and  in  occupational  and 
music  therapy.  Some  students  have  become  so  inter- 
ested in  the  work  that  they  have  decided  upon  careers 
in  corrections.^ 

Students,  in  fact,  represent  a  large  and  relatively 
untapped  source  of  volunteer  manpower  for  institu- 
tions for  juvenile  delinquents.  Tlie  success  in  recruit- 
ing and  using  them  in  mental  hospitals  and  with 
delinquents  on  probation  suggests  that  tliey  might 
serve  in  juvenile  correctional  institutions  much  more 
widely  than  they  do.  In  the  probation  program  at 
Boulder,  Colo.,  for  example,  college  stiidents  serve  as 
tutoi's,  interviewers,  and  discussion  leaders.*  Because 
alienated  young  people  usually  trust  other  young 
people  much  more  than  they  do  adults,  another  young 
person  can  often  breal<  through  their  barriers  to 
friendship  more  easily  than  an  older  person. 

There  are  many  other  ^^otential  sources  of  volun- 
teers that  could  be  but  are  iiot  yet  being  tapped  by 
institutions  for  juvenile  delinquents.  For  example. 
Volunteers  in  Service  to  America  (VISTA)  has  not 
yet  sent  any  volunteers  to  training  schools  for  juvenile 
delinquents.  It  has,  however,  put  a  number  of  volun- 
teer teachers  in  an  institution  for  young  offenders 
(aged  18  to  26)  at  Lorton,  Va.,  as  part  of  a  demon- 
stration project  in  job  training,  counseling,  and  fol- 
lowup  being  carried  out  in  cooperation  with  the  Na- 
tional Committee  for  Children  and  Youth. 

There  is  a  trend  today  to  look  among  the  neighbor- 
hoods from  which  delinquents  come  and  even  among 
former  delinquents  for  staff  members  for  projects  to 


combat  or  control  delinquency."  At  least  one  cor- 
rectional institution  has  some  of  its  former  residents 
on  its  staff  as  child-care  workers.  This  suggests  that 
ex-delinquents  might  also  provide  valuable  volun- 
teer service  in  institutions  for  delinquents. 

Thus  the  source  of  volunteers  has  become  the  wide 
American  public — and  not  just  the  prestigious  "up- 
2)er  crust"  of  Lady  Bountiful  days.  In  these  times  of 
shorter  workdays  and  workweeks,  our  communities 
are  full  of  men  and  women  with  sufficient  time,  gooc 
will,  and  sensitivity  to  offer  creative  friendship  tc 
young  people  whose  lives  have  been  especially  de 
ficient  in  this  essential  spiritual  nutrient.  All  that  i; 
needed  is  the  catalyst — the  institutional  administra- 
tor with  the  conviction,  courage,  skill,  and  willing- 
ness to  tap  the  source. 

The  Joint  Commission  on  Correctional  Manpowei 
and  Training,  a  private  organization  composed  of  9( 
representatives  of  various  national  and  regional  or 
ganizations  in  the  correctional  field,  has  recognized 
the  potential  value  of  volunteers  in  correctional  worl 
by  establishing  a  task  force  to  study  the  use  of  volun 
teers  in  corrections.  This  study,  now  under  way,  maj 
be  an  important  spur  to  action. 


m 


'  Department  of  Health,  Education,  and  Welfare,  Welfare  Adminis 
tration.  Children's  Bureau:  Institutions  serving  delinquent  children 
guides  and  goals.  CB  Publication  No.  360.  Revised  1962. 

■  National  Conference  of  Superintendents  of  Training  Schools  ant 
Reformatories:  Institutional  rehabilitation  of  delinquent  youth;  manua 
for  training  school  personnel.  Delmar  Publishers,  Albany,  N.Y.    1962 

'  Thursz,  Daniel:  Some  views  on  volunteers:  past  relic  or  futuri 
asset?  Rehabilitation  Record,  January-February  1963. 

^  Kobrin,  Solomon:  Values  and  problems  in  the  use  of  the  indigenou: 
volunteer  in  delinquency  prevention  programs.  In  100,000  Hours  i 
week:  volunteers  in  service  to  youth  and  families.  National  Federatioi 
of  Settlements  and  Neighborhood  Centers,  New  York.    1965. 

^  Phclan,  Joseph  F.,  Jr.;  Anderson,  Virginia:  The  volunteer  as  a  mem- 
ber of  a  therapeutic  team.  Child  Welfare,  May  1963. 

°Mecum,  Ethel  D.:  Bringing  training  school  and  community  to- 
gether. C/wWrfn,  March-April  1961. 

'Kirby,  Bernard  C;  Sher,  Daniel  L.:  An  experiment  in  student  intern- 
ing in  corrections.  Crime  and  Delinquency,  July  1966. 

"  Department   of  Health,  Education,   and   Welfare,   Welfare  Admin- , 
istration:  Antidelinquency  project  measures — effectiveness  of  volunteers 
Welfare  In  Revietv,  March  1966. 

"Otis,   Jack:   Correctional   manpower  utilization.   Crime  and  Delin-'t 
qiiency,  July  1966. 


m 


I 


m 


150 


CHILDREN     •     JULY-AUGUST  1967 


3  psychiatrist  gives  some  basic  principles  on 

HOW 

VOLUNTEERS 

CAN  HELP 


HARRIS  E.  KAROWE,  M.D. 


Many  people  are  skeptical  about  the  ability 
of  nonprofessional  persons  to  work  success- 
fully with  other  people's  children,  especially 
when  those  children  give  signs  of  being  mentally, 
emotionally,  or  socially  handicapped.  They  do  not,  I 
think,  respect  the  importance  of  the  intuitive  proc- 
ess— the  personal  sensitivity  and  perceptiveness 
through  which  a  gifted  person  builds  up  a  positive  re- 
lationsliip  with  a  child.  In  his  preface  to  August 
Aichhorn's  book  "Wayward  Youth,"  ^  Sigmund 
Freud  attributed  Aichhorn's  remarkable  ability  to 
work  with  dissocial  boys  to  his  warmth,  sympathy, 
and  intuitive  understanding  of  them.  Freud  implied 
that  all  of  Aichhorn's  psychological  training  had  not 
been  of  much  practical  value  to  him  but  chiefly  gave 
him  some  theoretical  justification  for  what  he  did 
naturally. 

Carefully  selected  volunteers  may  be  as  intuitively 
gifted  as  professional  persons  and  often  are  freer  to 
follow  what  their  intuition  dictates.  Herein  lies  their 
strength.  But  any  person  who  works  directly  with 
children  can  sharj^en  his  intuition  and  facilitate  his 
deliberate  actions  if  he  understands  some  principles 
of  helping  a  child  deal  with  his  problems.  This  is 
especially  true  if  the  person  is  working  with  an  edu- 
cationally and  socially  disadvantaged  child  whose 
life  experiences  have  been  and  are  ven'  different  from 
those  of  the  children  he  knows  in  his  own  home  or  his 
neigliborhood.  The  following  comments  are  therefore 


Adapted  from  a  talk  made  at  a  meeting  on  school  volunteers 
sponsored  by  the  Onondaga  County  Mental  Health  Board  and 
die  Syracuse  (N.Y.)  School  District,  October  1965. 

VOLUME  14  -  NUMBER  4 


disadvantaged 
children 


offered  as  an  elementary  guide  for  volunteers 
engaged  in  such  work. 

What  are  some  of  the  important  elements  in  help- 
ing relationships?  Barrett-Lennard,-  an  Australian 
psychologist,  has  dealt  with  this  question  in  a  very 
useful  f  asliion.  First,  there  is  the  element  of  empathj', 
which  means  understanding  the  cliild  from  the  child's 
own  frame  of  reference.  Empathy  is  different  from 
sympathy,  although  both  imply  a  caring  for  the 
child.  When  a  person  has  empathy  for  a  child,  he 
appreciates  how  tlae  child  feels,  liow  things  are  for 
him,  but  he  does  not  make  the  child's  feelings  or 
troubles  his  own. 

Another  element  cited  by  Barrett-Lennard  as  im- 
portant in  helping  a  child  is  that  of  having  respect 
for,  of  caring  for,  tlie  child  as  unconditionally  as  pos- 
sible. For  the  volunteer  assigned  to  help  a  child  with 
a  leai-ning  problem,  this  means  showing  him  he  is 
respected  as  an  individual  despite  his  learning  dis- 
ability. This  is  done  by  showing  compassion  without 
being  over-emotional,  by  being  understanding 
but  not  indulgent,  and  by  showing  genuine  regard  for 
the  child's  development. 

The  achievement  of  continuous  and  complete  re- 
isi^ect,  of  course,  can  be  only  a  goal ;  and  it  is  not  one 
which  anj'one  can  hope  to  attain.  But  one  can,  at 
least,  compliment  a  child  unconditionally  when  one 
does  compliment  him  and  not  say,  ''That's  good, 
hut.  .  .  ."  However,  in  the  long  run,  the  less  a  relation- 
ship with  a  child  is  overrun  by  evaluation  and  judg- 
ment, the  moi'e  the  child  will  be  able  to  reach  the  re- 
alization that  the  center  of  responsibility  lies  within 
himself. 

Another  element  in  a  helping  relationship  men- 

151 


tioned  by  Biirrett-Lennard,  perhaps  the  most  impor- 
tant of  all,  is  trustworthiness.  This  means  being  gen- 
nine,  dependable,  and  internally  as  well  as  externally 
consistent.  To  understand  why  consistency  is  so  im- 
portant in  working  with  a  child,  it  is  necessary  to 
know  a  little  about  how  children  learn  to  relate  to 
other  people  from  their  earliest  infancy  on. 

Of  consistency  and  hope 

Engel  ^  has  remarked  that  soon  after  birth  the  in- 
fant begins  to  show  cyclical  behavior.  The  sleeping 
baby  gradually  changes  from  being  quiet  and  motion- 
less to  showing  restlessness  and  some  sucking  mo- 
tions. Then  his  level  of  awareness  rises,  his  move- 
ments increase,  and  he  awakens  and  begins  to  cry.  If 
his  mother  picks  him  up,  he  may  quiet  down,  but 
soon  he  will  cry  again  and  he  will  not  be  quieted  until 
he  is  fed.  During  feeding  he  sucks  actively  for  a 
while,  and  then  his  sucking  begins  to  slow  down  and 
finally,  as  he  achieves  satisfaction,  stops.  He  becomes 
quiescent  again ;  he  may  be  wakeful  for  an  interval 
between  satisfying  his  hunger  and  falling  asleep,  but 
then  he  is  quiet  for  a  few  hours  until  his  feeling  of 
need  awakens  him  again  and  the  cycle  is  repeated.  In 
this  process  the  infant  uses  the  most  primitive  form 
of  communication,  his  cry,  and  this  elicits  a  response 
from  his  mother,  who  by  feeding  him  introduces  the 
external  world  into  this  otherwise  entirely  internal 
cyclical  process. 

But  in  a  few  weeks  the  sight  of  the  mother's  face 
and  the  sound  of  her  voice  become  enough  in  them- 
selves to  quiet  a  hungry,  crying  baby,  even  if  only 
for  a  minute  or  two.  This  is  important :  the  liaby  has 
showii  the  beginning  of  his  cajiacity  for  anticipation  : 
he  has  begun  to  be  able  to  wait;  there  is  now  a 
future,  not  only  a  present.  Thus  begins  tlie  develo])- 
ment  of  one  of  the  most  important  ftnictions  of  tlie 
ego,  the  ability  to  interpose  delay  Ijetween  the  aware- 
ness of  a  need  and  the  acting  u])on  that  need.  Some- 
thing that  is  not  directly  a  part  of  nutrition  has 
become  an  anticipatory  signal  indicating  that  satis- 
faction v)ill  occur.  As  this  experience  happens  over 
and  over  again,  the  baby  develops  confdence  in  the 
signal,  or  in  this  early  symbol,  that  tells  liim  his  dis- 
comfort, hunger,  will  be  followed  by  satisfaction. 
And  out  of  this  confidence,  with  further  jjsycholog- 
ical  growth,  the  baliy  later  develops  hope. 

The  basic  instinctual  need,  that  of  satisfying 
himger,  is  of  course  only  one  kind  of  childliood  need. 
As  the  child  develops,  his  needs  become  increasingly 
complex,  but  they   always  include  the  element  of 

152 


consistency  in  his  world — and  his  world  is  composec  N*^ 
of  the  people  around  him.  Consistency  is  a  quality 
characteristically  absent  in  the  lives  of  children  oi 
seriously  deprived  families; — as  is  also  its  end  result  O"' 
hope.  Children  in  such  families,  and  their  parents, 
frequently  function  as  if  there  is  no  hope,  no  confi- 
dence, no  future.  Hence  they  tend  to  brook  no  delay  lep'i* 
in  gratification  of  desires. 

Consistency  is  therefore  of  utmost  importance  in 
working  with  a  child.  To  be  of  value  to  the  child; 
a  volunteer  must  be  consistent  in  his  attitudes  most  "'^ 
of  the  time,  though  not  always,  for  that  is  impossible 

Being  tridy  consistent  means  being  honest  and  nolj*''- 
pretending,  at  least  with  oneself.  As  Michal-Smith 
says,  to  make  the  child  feel  that  one  is  dependablt 
one  does  not  have  to  be  a  model  of  virtue,  or  loving 
at  all  times,  or  entirely  consistent  in  mood,  or  readj 
to  gratify  the  child's  every  need  and  wish.  Every 
body  feels  different  on  dift'erent  days;  this  makes  iijottii 
impossible  to  have  the  same  attitudes  on  every  day( 
To  try  to  convince  oneself  that  one  feels  accepting 
of  a  child  when  in  fact  one  is  feeling  annoyed  oi 
hostile  is  being  internally  inconsistent.  Sooner  oi  «fi 
later  this  inconsistency  will  be  perceived  by  the  chile  nrJ 
and  will  be  interpreted  as  untrustworthiness. 

The  important  point  is  to  l)e  aware  of  whateve) 
feeling  or  attitude  one  has  when  working  with  i 
child.  When  a  person  is  not  aware  of  his  feelings 
he  is  likely  to  send  out  contradictory  messages;  tin 
child,  confused,  does  not  know  whether  to  believl  i 
tlie  kind  words  or  tlie  not-so-kind  tone  of  voice  oj 
expression.  'Tier  talk  is  a  whisper,  but  her  looks  yel 
at  you,"'  said  Dennis  the  ^lenace  to  his  buddy  in  ! 
recent  cartoon  depicting  the  two  children  outside  i 
librai-y  from  which  they  have  obviously  just  beei 
ejected  by  the  ]ibr;irian  who  stands  grimly  at  tin 
door. 

In  working  with  a  child,  of  course,  a  person  canno 
tell  or  act  out  all  his  true  feelings.  But  he  can  beconn 
as  aware  as  possilile  of  what  his  true  feelings  are 
Then  he  can  integrate  these  with  his  conscious  at 


ItlliT 

iluJe 
111 


lomi 


Harris  E.  Karowe,  .M.D.,  is  tlirortor  of  the 
Schenectady  Cliild  Guidance  Center  in  Sche- 
nectady, X.Y.,  and  clinical  associate  profes- 
sor of  psychiatry  at  .Mhany  Jledical  College. 
In  addition,  lie  serves  as  a  consultant  to  the 
New  York  University  School  of  Edvicatinn 
on  curriculum  for  students  preparing  to  he- 
come  teachers  of  emotionally  disturhed 
children. 


CHILDREN     •     JULY-AUGUST  1967 


%VC[ 


I 


itudt's  unci  so  lessen  Iho  ctnitriust  hi'lwci'ii  c.xpri'ssi'd 
ml  unexpressed  attitudes.  Wlien  this  is  done,  both 
111'  iididt  and  tlie  child  feel  more  at  ease  with  one 
noliier.  True  consistencj'  lies  in  inner  iionesty, 
viiicli  I  lie  child  perceives  and  feels  as  dependability. 


)eprivation  and  learnins 

Children  fail  to  learn  well  for  a  variety  of  rea- 
ons — neurological,  neurotic,  characferoloii-ical.  and 
ocial.  I  shall  comment  here  chiefly  on  (he  last  kind, 
ince  the  children  whose  diflicultics  stem  I'l-diii  social 
easons  are  I  hose  most  often  assigned  to  volunteers 
or  help. 

Thei'e  seems  to  be  a  relationship  between  school 
djustment  and  whether  or  not  a  child's  mother  is 
niployed  outside  (he  home.''  Ilowevei',  it  has  been 
ound  that  the  mei'e  fact  of  tlie  mother's  working  is 
lot  the  important  ditl'erence  between  the  cliildren 

ho  do  well  ill  scliool  and  those  who  do  not,  but 
iither  the  mother's  iiiotixes  for  woi-king  and  her  at- 
itude  toward  the  child  and  the  school."  It  also  has 
)eeii  found  that  a  negative  attitude  in  parents  to- 
vard  school,  an  attitude  occurring  more  often  in  par- 
nts  of  low  socioeconomic  status  than  in  middle  class 

irents,  is  related  to  children's  poor  academic  per- 
ormance."  "Wlien  the  values  of  family  and  school  are 
ontradictor\',  children  have  little  incentive  for 
chool  achievement. 

Tliere  also  is  evidence  that  the  material  environ- 
iient  in  the  home  has  an  eft'ect  on  pupil  perform- 
nce,  that  a  varied  environment  and  a  variety  of 
timuli  during  early  development  favor  greater  use 
f  the  child's  intellectual  potential.* 

The  volunteer  can  make  a  significant  contribution 
n  both  these  respects.  In  broadening  the  variety  of 
timuli,  the  volunteer's  contribution  is  chiefly  one 
)f  activity,  of  doing  things  with  the  child.  But  in 
ounteracting  the  deleterious  effect  of  the  child's  pcr- 
eption  of  his  parents'  negative  attitude  toward 
chool,  the  relationship  between  the  child  and  volun- 
eer  is  itself  the  important  element.  In  this  respect, 
•f  course,  the  \olunteer  does  what  the  good  teacher 
loes :  he  furnishes  the  emotional  reward  and  support 
or  school  success  that  encourage  the  pupil  to  like 
nd  do  well  at  school  despite  lack  of  support  at  home 
or  his  scholastic  efforts. 

Deutsch  ^  has  pointed  out  that  language  is  the  pri- 

ary  avenue  for  communication,  absorption,  and  in- 
erpretation  of  the  environment.  Between  the  ages 
f  five  and  eight,  children  begin  to  use  words  as 
nstruments  in  their  conceptualization;  a   language 


handica])  at  I  hat  t  iine  may  becoiiie  a.  haiidii-ap  in  gi'li- 
eral  problem  solving.  Deutsch  also  notes  that  the  ac- 
tive verl>al  engagement  of  the  people  who  surround 
the  child  seems  to  be  (he  inlluential  force  in  the  child's 
language  development. 

Bernstein"  points  out  that  in  many  families  of 
low  socioeconomic  status  language  is  used  largely  in 
a  restrictive  fashion.  An  imperative  or  an  incomplete 
.sentence  frequently  substitutes  for  an  explanation  or 
a  complete  sentence:  if  the  child  asks  for  something, 
too  often  he  gets  merely  "yes,"  "no,"  "go  away," 
"later,"  or  just  a  nod  or  a  shake  of  the  head.  More- 
over, many  .such  families  have  few.  if  any,  organized 
family  activities;  the  parents  and  children  do  little 
talking  together  at  meals,  for  meals  are  seldom 
regularly  scheduled  affairs. 

Deutsch  found  that  by  the  fifth  grade  children 
from  fatherless  homes  generally  score  significantly 
lower  on  IQ  tests  than  children  from  intact  homes; 
however,  this  may  be  not  so  much  a  consequence  of 
the  father's  absence  as  of  the  diminution  of  organized 
family  activity  in  fatherless  families." 

Deutsch's  study  of  language  ability  and  usage  in 
first-  and  fifth-grade  children,  white  and  Xegro, 
lower  and  middle  class,  indicated  that  the  language 
deficit  among  children  of  low  socioeconomic  status 
was  cumulative.  While  significant  differences  accord- 
ing to  race  and  to  socioeconomic  status  existed  in 
the  first-grade  children,  these  differences  were  more 
marked  by  the  time  the  children  were  in  the  fifth 
grade.  However,  the  language  of  children  from  fami- 
lies of  low  socioeconomic  status  is  poorer  not  in  quan- 
tity, but  in  complexity ;  it  does  not  have  an  elaborated 
sentence  structure  witli  grammatical  order,  logical 
modifiers,  frequent  use  of  prepositions,  impersonal 
pronouns,  and  discriminately  selected  adjectives  and 
adverbs.  It  therefore  is  out  of  time  with  what  the 
children  meet  in  school. 

Deutsch  suggests  that  these  children  as  they  first 
come  to  school  are  aware  of  their  grammatical  inept- 
ness,  and  that  this  leads  to  reluctance  to  comnnmicate 
across  social-class  lines  and  hence  to  reticence  in 
school. 

The  volunteer  can  interfere  with  this  breakdown 
in  connnunication  and  help  prevent  the  child's  lan- 
guage from  becoming  class  contained.  He  can  do  this 
merely  by  talking  with  and  to  the  child  in  the  kind 
of  language  expected  of  the  child  in  school.  Tlie  vol- 
unteer will  find  it  useful,  however,  and  jierhaps  even 
necessary  to  become  ac(iuaintcd  with  the  language 
used  in  lowei' socioeconomic  neighborhoods. 

Pavenstedt  '^  has  reported  on  an  admirable  study 


VOLUME   14  -  NUMBER  4 


153 


of  family  life  in  lower  socioeconomic  groups.  She 
found  that  the  style  of  living  among  the  stable  "upper- 
lower  class  group"  (factory  workers,  house  painters, 
truck  drivers,  and  so  forth)  was  very  different  from 
the  style  of  living  among  the  disorganized  families 
identified  as  the  "lower-lower  class."  This  latter 
group,  in  which  imemployment,  separation,  deser- 
tion, divorce,  abandonment  and  neglect  of  children, 
and  dependency  upon  public  aid  are  most  frequent, 
furnishes  our  schools  with  children  who  very  fre- 
quently fail  to  leai-n.  These  are  the  children  badly  in 
need  of  the  personal  help  of  volunteers. 

On  superficial  examination,  it  might  not  be  easy 
to  distinguish  between  the  children  of  Pavenstedt's 
two  groups.  They  came  from  the  same  neighborhood 
and  were  equally  well  dressed.  But  their  lives  had 
been  radically  different.  Pavenstedt's  vivid  and  mov- 
ing description  of  the  disorganized  families  and  the 
way  of  life  they  endure  points  up  the  innumerable 
deficits  in  their  lives  of  which  the  volunteer  needs  to 
be  aware  in  working  with  sucli  a  cJiild.  Excerpts  from 
her  rei)ort  follow : 

.  .  .  The  outstanding  characteristic  in  these  homes  was  that 
activities  were  impulse  determined;  consistency  was  totally 
absent.  The  mother  might  stay  in  bed  until  noon  while  the 
children  also  were  kept  in  bed  or  ran  around  unsupervised. 
Although  families  sometimes  ate  breakfast  or  dinner  together, 
there  was  no  pattern  for  anything.  .  .  .  We  saw  children  cry- 
ing from  some  injury  dash  into  the  apartment,  run  past  mother 
to  their  bed  and  continue  to  scream  there.  The  mothers  seldom 
inquired  about  their  injuries  or  attempted  to  comfort  them. 
Ridicule  was  as  likely  to  be  the  response.  .  .  . 

.  .  .  None  of  the  children  owned  anything;  a  recent  gift 
might  be  taken  away  by  a  sibling  without  anyone's  intervening. 
The  parents  often  failed  to  discriminate  between  the  children. 
A  parent,  incensed  by  the  behavior  of  one  child,  was  seen  deal- 
ing a  blow  to  another  child  who  was  closer.  Communication  by 
means  of  words  hardly  existed.  Directions  were  indefinite  or 
hung  unfinished  in  midair.  .  .  . 

Children  in  such  an  environment  have  to  learn  to  cope  for 
themselves,  and  these  children  were  extraordinarily  adept  in 
certain  areas.  Extremely  skillful  at  reading  their  cues,  they 
focused  on  adults  and  manipulated  them  so  as  to  obtain  the 
attention,  praise,  food,  money,  or  whatever  else  they 
wanted.  .  .  . 

.  .  .  The  children  masked  pleasure  by  clowning  and  grimac- 
ing and.  showed  no  distress  when  hurt.  They  wore  wide  smiles 
quite  inappropriately.  When  disappointed  or  angry,  they  would 
fade  away.  When  upset  or  anxious,  they  might  become  para- 
lyzed or  engage  in  some  frantic  repetitive  activity.  Nevertheless, 
many  of  them,  surprisingly  well  dressed  for  nursery  school,  had 
a  certain  charm. 

Many  of  them  formed  their  words  so  poorly  that  it  was  at 
first  almost  impossible  to  understand  them  at  3  and  4  years  of 
age.  Words  were  used  imitatively  and  often  quite  out  of  con- 

154 


text.  Instructions,  when  attended  to,  were  at  times  repeated 
but  not  translated  into  action.  Concrete  demonstrations  were 
necessary.  .  .  . 

The  saddest,  and  to  us  the  outstanding,  characteristic  of  this 
group  with  adults  and  children  alike  was  the  self-devaluation. 
One  little  boy,  when  encouraged  by  the  teacher  to  have  her  put 
his  name  on  his  drawing,  wanted  her  to  write  "shitty  Billy." 
Their  lack  of  confidence  in  their  ability  to  master  was  painfully; 
reenacted  with  each  new  encounter.  .  .  . 

.  .  .  The  children  seemed  to  have  no  individual  personality 
for  the  parents.  They  never  learned  to  trust  and  were  constantly 
on  the  alert  for  the  adults'  reaction.  Without  anyone  to  relate  to, 
they  failed  to  learn  communication  and  came  to  grips  only  with 
certain  very  circumscribed  areas  of  their  reality.  .  .  . 

...  In  large  classes  with  their  extreme  concreteness  ol 
thinking,  they  failed  to  grasp  directions.  Suspicion  and  anxietj 
concerning  the  adult's  intentions  made  them  unable  to  attenc 
to  the  teacher's  instructions.  As  failure  followed  failure,  thej 
grew  very  anxious  and  shunned  any  learning  task.  .  .  . 


m 


Pa\eustedt  points  out  that  the  first  priority  in  help 
ing  such  children  may  be  to  raise  their  parents'  self 
esteem,  for  only  then  can  they  find  value  in  their  chil 
dren — and  only  then  will  their  children  be  able  t< 
sustain  feelings  of  self-confidence  and  self-esteem 
There  is  great  truth  in  this,  but  I  also  believe  than 
until  this  is  accomplished  the  children  need  direc- 
l^ersonal  sujiport  and  help  from  anothei'  adult  as  well 
-Vnd  here  is  where  the  volunteer  comes  in — witJjior 
attention  to  the  child,  his  words,  and  his  luivoicet 
wishes,  with  consistency  and  warmth,  and  in  man; 
instances  with  real  liking  and  love. 

Some  warnings 


Cytryn  and  Uihlein  ^-  give  some  special  warning 
to  volunteers  working  with  children  who  have  spe 
cial  handicaps.  Like  the  teacher,  the  volunteer  has  t 
avoid  becoming  unrealistic  in  his  expectations.  H 
cannot  expect  success  with  all  children.  He  has  to  tr 
to  avoid  feelings  of  hopelessness  and  futility  pro 
voked  by  the  overwhelming  nature  of  the  child' 
problem  or  because  the  child  does  not  respond.  More 
over,  he  need  to  keep  in  mind  the  impulse-ridden  pat 
tern  of  some  children's  lives,  their  inability  to  tol 
erate  delay,  their  orientation  toward  the  present  an( 
toward  immediate  rather  than  future  gratification 
their  essential  lack  of  hope  and  of  confidence.  He  ha 
to  wait  for  the  trusting  relationship  to  develop  and 
then,  as  the  child  slowly  begins  to  identify  with  him 
for  some  of  his  own  personality  characteristics  to  b 
unconsciously  adopted  by  the  child. 

For  some  children  the  volunteer  can  provide  i 
"corrective    emotional    experience" — the    voluntee 

CHILDREN     •     JULY-AUGUST  196 


wlu)  is  a  \\()iiian  ran  Ir'l'oiui'  a  warm  luotlu'r-sub- 
stitiue  for  the  child  of  a  severely  emotionally  dis- 
turbed mother  such  as  one  who  is  schizoj^hrenic  or 
very  depressed  or  very  obsessive-compulsive.  Or,  for 
tlie  child  of  an  overpossessive,  overprotective,  or 
anxious  mother,  a  volunteer  can  furnish  a  close  one- 
to-ono  relationship  without  the  intense,  smothering 
emotional  involvement  the  mother  oft'ers. 

In  any  case,  the  volunteer  needs  to  avoid  excessive 
emotional  involvement  with  the  ciiild,  something 
that  certainly  can  occur  and  tiiat  may  manifest  it- 
self in  a  tendency  to  monopolize  the  child  or  in  a  fear 
tliat  the  teacher  or  tlie  i)arents  will  spoil  his  good 
work  wit  ii  t  he  child.  On  the  other  hand,  the  parents — 
and  sometimes  the  teacher  too — may  distrust  the  vol- 
unteer or  may  fear  criticisna  by  the  volunteer.  A 
mother  wlio  is  not  close  to  her  child  may  resent  the 
volunteer's  ability  to  get  close  to  the  child  as  well  as 
the  child"s  obvious  enthusiasm  for  the  volunteer.  Of 
course,  the  volunteer  has  to  be  aware  of  the  possi- 
bility that  he  is  indeed  unconsciously  vying  with  the 
parents  or  with  the  teacher  for  the  child's  aft'ection. 
Most  peoiile,  adults  as  well  as  children,  love  to  be 
loved. 

Sometimes,  in  the  initial  contact  with  the  child  and 
for  as  long  thereafter  as  necessary,  the  volunteer  can 
oti'er  a  "surprise"  type  of  emotional  experience  by 
virtue  of  having  a  personal  relationship  with  the 
child.  For  example,  the  failure  to  learn  by  some  chil- 
dren— though  generally  not  the  children  of  the  low- 
est socioeconomic  groups — is  a  passive-resistive 
measure  against  parental  pressure  to  learn.  Wlien 
assigned  to  help  such  a  child  learn  to  read,  the 
volunteer  might  shock  the  child  at  the  outset  by 
avoiding  all  mention  of  reading.  The  child  thus  dis- 
covers that  he  is  acceptable  in  spite  of  his  unwilling- 
ness to  I'ead.  He  may  thus,  in  his  increasingly  close 
relationship  with  the  volunteer,  come  to  put  into 
words,  rather  than  into  a  passive-aggressive  failure 
to  learn  to  read,  his  hostility  toward  his  parents  and 
toward  the  teacher  who  by  virtue  of  her  professional 


position  nii/s/  ilirect  herself  toward  his  reading — 
and  then  he  may  be  ready  to  give  up  his  symptom  of 
hostility  to  adults,  his  failure  to  learn.  This  kind  of 
\olunteer  treatment  might  never  be  called  psycho- 
therapy, but  its  success  would  be  psychotherapeutic 
nonetheless. 

The  volunteer  lias  a  speci;il  advantage  in  his  rela- 
tionship with  a  child,  an  advantage  that  generally 
redounds  only  to  the  psyciiiatrist.  As  a  psj'chiatrist, 
1  have  always  felt  that  I  am  in  a  very  special  posi- 
tion. What  adult  other  than  a  psychiatrist  ever 
gives  a  child  his  undivided  attention  for  a  whole 
hour — and  docs  it  not  once  but  again  and  again  ^ 
AVell,  volunteers  may  do  this  too — and  in  a  way  that 
can  plav  a  kev  role  in  tlic  child's  life. 


'  Aicliliorn,  August:  Wayward  youtli.  Ttie  Viking  Press,  New  York. 
1935. 

■  Barrett-Lennard,  G.  T.;  Significant  aspects  of  a  helping  relationship. 
Mental  Hygiene,  April  1963. 

^Engel,  George  L.:  Psychological  development  in  health  and  disease. 
W.  B.  Saunders  Co.,  Philadelphia,  Pa.   1962. 

'  Michal-Smith,  Harold:  It  takes  self-understanding.  XE.'l  foiirnal, 
April   1960. 

^Burchinal,  Lee  G.;  Rossman,  Jack  E.:  Relations  among  maternal 
employment  indices  and  development  characteristics  of  children.  Marriage 
and  Family  Living,  November  1961. 

°  Sussman,  Marvin  Bernard:  Needed  research  on  the  employed  mother. 
Marriage  and  Family  Living,  November  1961. 

Luszki,  Margaret   Barron;    Schmuck,  Richard:   Pupil   perceptions  of 
parental  attitudes  toward  school.  Mental  Hygiene,  .\pr\\  1965. 

'Hunt,  Joseph  McVicker:  Intelligence  and  experience.  Ronald  Press 
Co.,  New  York.    1961. 

*  Deutsch,  Martin:  The  role  of  social  class  in  language  development 
and  cognition.  American  Journal  of  Orthopsychiatry,  January  1965. 

'"Bernstein,  Basil:  Language  and  social  class.  British  Journal  of 
Sociology,  September  I960. 

"  Pavenstedt,  Eleanor:  K  comparison  of  the  child-rearing  environment 
of  upper-lower  and  very  low-lower  class  families.  American  Journal  of 
Orthopsychiatry,  January  1965. 

"  Cytryn,  Leon;  Uihlein,  Audrey:  Training  of  volunteers  in  the  field 
of  mental  retardation — -an  experiment.  Aryierican  Journal  of  Orthopsy- 
chiatry, April  1965. 


Some  of  the  disadvantaged  children  have  reality-oriented  strength  of 
survival  and  independence  which  middle  class  youngsters  might  well  learn. 

A  public  school  teacher  as  quoted  in  "Ec/tiality  Through  Integration:  A  Report  on 
Greenburgh  Scljool  District  No.  8,"  Anti-Defamation  League  of  B'nai  B'rilh,  New 
York,  1965. 


VOLUME  14  -  NUMBER  4 


155 


three  years  of  the 

NEIGHBORHOOD 
YOUTH  CORPS 


REGINA  H.  SAXTON 


Three  years  ago  this  summer,  tlirough  the 
Economic  Opportunity  Act  of  1964,  Con- 
gi-ess  established  the  Neighborhood  Youth 
Corps  (NYC)  to  provide  work  experience  and  train- 
ing to  yovuig  people  from  low-income  families. 
Through  March  19G7,  tlie  program  had  provided 
work  experience  for  910,946  young  people:  589,424 
who  were  still  in  school;  321,522  who  were  out  of 
school.  Of  the  total,  518,095  were  boys  and  392,851 
were  girls.  For  many  young  people,  this  experience 
has  led  to  the  realization  that  if  they  are  to  get  on  in 
the  world  they  should  go  back  to  school,  and  they 
have  done  so,  and  some  have  stayed  on  to  the  finish. 
For  others,  the  experience  has  led  to  regular  jobs 
in  the  community — even  to  careers.  Some,  unfortu- 
nately, have  landed  back  on  the  streets,  again  disillu- 
sioned. What  has  happened  to  all  these  young  people 
has,  of  course,  had  something  to  do  with  the  young 
people  themselves — their  determination,  their  stick- 
to-itiveness,  their  motivation.  But  most  of  all,  per- 
haps, it  has  had  to  do  with  the  kinds  of  opportuni- 
ties that  were  available — at  school,  in  their  com- 
munit}^,  and  in  their  Neighborhood  Youth  Corps 
assignment. 

The  goal  of  the  Neighborhood  Youth  Corps  is  to 
provide  young  people  with  options  through  which 
to  secure  a  better  future.  They  may,  while  remaining 
in  school,  earn  income  and  through  the  work  they 
perfoi-m  gain  valuable  experience.  They  maj^,  if  al- 
ready out  of  school,  receive  special  training  to  help 
them  develop  their  occupational  potential.  These  op- 
portunities are  provided  through  three  types  of 
projects: 


stay  in  school  until  graduation  by  providing  them 
with  part-time  work,  up  to  15  hours  a  week  during 
tlie  school  year,  and  with  counseling  to  help  them 
understand  the  importance  of  continuing  their  edu- 
cation and,  at  the  appropriate  time,  to  help  them 
make  the  transition  from  school  to  work  or  occupa- 
tional training. 

2.  Summer  projects,  to  provide  part-time  summer 
employment,  averaging  about  26  hours  a  week  for  12 
weeks,  for  young  people  who  need  to  earn  some 
income  during  vacation  in  order  to  return  to  school 
or  wlio  need  sunmier  jobs  to  enhance  their  employ- 
ment potential. 

3.  Out-of-school  projects,  to  jn'ovide  j'oung  people 
wjio  have  left  school  with  work  experience  that 
will  increase  their  employability  or  help  them  see 
the  importance  of  returning  to  school  for  more 
education. 

The  pay  in  all  Neighborhood  Youtli  Corps  proj- 
ects is  at  least  $1.25  an  hour.  Ninety  percent  of  the 
cost  of  each  project  is  met  tiirough  Federal  funds. 
For  the  first  2  years  the  program  was  lijnited  to  young 
people  between  the  ages  of  16  and  22,  but  under  the 
1966  amendments  to  the  Economic  Opportunity  Act 
the  lower  age  limit  has  recently  been  dropped  to  14. 
The  degree  to  which  the  Neighborhood  Youth 
Corps  program  makes  a  significant  difference  in  the 
lives  of  young  people  depends  not  only  on  the  yomig 
people  themselves  but  also  on  the  commitment  and 
concern  of  the  citizens  in  each  local  community.  For, 
while  largely  federally  financed,  the  projects  are 
community  planned  and  community  run.  The  spon- 
1.  In-school  projects,  to  help  high  school  students      sors  are  local,  private,  nonprofit  organizations  and 


156 


CHILDREN     •     JULY-AUGUST  1967 


No  longer  a  school  dropout,  a  Neighborhood  Youth  Corps 
enrollee  is  being  taught  to  repair  tjpewriters — a  skill  that  will 
give  him  a  chance  to  become  self-sufficient  and  productive. 


local  and  State  governments  that  have  entered  into 
agreements  witli  the  U.S.  Department  of  Labor  to 
establisli  XYC  ^jrojects. 

In  the  agreement  with  the  Department  of  Labor, 
the  sponsor  specifies  the  programs  in  which  tlie  en- 
rollees  will  work,  tiie  jobs  they  will  perform,  the 
supervision  tiiey  will  receive,  and  the  enrichment 
services  tiiat  will  be  provided  them.  In  connnunities 
with  connnnnity  action  agencies  established  under 
the  "war  on  poverty."  the  A'eighborhood  Youth 
Cor[)s  jn-oject  is  usually  an  integral  part  of  that 
agency.  Where  no  community  action  agency  has  been 
formed,  the  sponsor  may  Ije  a  local  council  of  social 
agencies,  a  local  "Y,"  or  a  local  or  State  welfare,  edu- 
cation, oi-  healtli  department. 


Th 


e  enrollees 


Enrollees  in  the  Neighborhood  Youth  Corps  must 
come  from  families  whose  incomes  are  imder  tiu' 
poverty  line" — $3,000  a  year  for  a  family  of  fnnr. 
Thus,  it  is  not  surprising  that  enrollees  from  minority 
groups — Negroes,  Spanish-speaking  Americans,  and 
Indians — comprise  over  .50  percent  of  the  enrollment. 

VOLUME  14  -  NUMBER  4 


for  I  lie  share  of  "iion crty"  aiiiong  t  I;cm'  groups  is  dis- 
proportionately iiigh.  About  GO  percent  of  the 
N'egro  youth  in  this  country  (H)mc  fi-om  families  below 
this  "poverty  level."  Moreover,  unemployment  is 
liiglu'i'  among  Ncgi'o  youth  than  among  white  youtli. 
.Vs  of  Marcii  liXiT,  in  the  1(>-  through  l!)-year-old  age 
group,  the  uiu-mploynient  rate  for  white  boys  was  10.1 
percent,  and  for  wiiite  girls,  9.2  percent;  but  for  non- 
white  boys,  it  was  21.8  percent,  and  for  nonwhite 
girls,  2-i  percent. 

In  their  personal  attril)utes,  eni'oilees  are  the  young 
])eople  of  America  in  microcosm.  They  are  responsive 
and  ajjathetic;  interested  and  disinterested;  bright 
and  slow  lo  learn  ;  iiidiist  ri((us  and  indifferent;  ideal- 
islic  and  cynical;  couragecjus  and  afraid.  They  in- 
clude young  people  who  believe  eiu)ugh  in  themselves 
to  make  maximum  use  of  their  Neighborhood  Youth 
Corps  experiences.  They  also  include  the  poorly 
motivated,  the  apathetic,  the  uneducated,  the  victims 
of  generations  of  discrimination.  The  latter  are  the 
young  people  who  present  the  greatest  challenge. 

The  sjiecial  targets  of  the  out-of-sciiool  phase  of 
the  program  are  the  disenchanted  young  people  who 
have  come  to  believe  that  school  for  them  will  open  no 
doors  to  a  better  future.  They  frecjuently  shield  their 
tender  hopes  of  what  they  can  become  behind  a  facade 
of  apathy  and  cynicism,  called  "lack  of  motivation" 
by  the  adult  world. 

•Terry,  a  Neighborhood  Youth  Corps  enrollee  with 
whom  I  talked  recently,  expressed  it  this  way  : 

I  found  out  why  John  don't  want  to  go  back  to  school;  be- 
cause he  is  a  dropout.  If  he  goes  back,  he  is  going  to  drop  out 
again,  because  they  are  going  to  o£Fer  him  the  same  thing  they 
offered  him  before. 

You  go  to  a  job  nowadays,  they've  got  wall-to-wall  carpet- 
ing; they've  got  beautiful  pictures  on  the  walls.  You  walk  in  the 
door.  The  man  stands  there.  He  is  looking  at  you  through  his 
nose  and  he  hands  you  a  bunch  of  papers  for  a  test. 

He  throws  you  in  a  room.  You  come  out  of  the  room.  He 
says,  "Okay,  go,  we'll  call  you  later."  Now  I  mean,  this  is  cold. 
This  is  really  cold.  I  mean,  as  far  as  I  know,  he  don't  want  you 
at  all. 

Many  young  people  like  Jerry  cling  to  the  "hollers" 
of  Appalachia,  meander  the  rural  roads  that  dot  the 
countryside,  and  "hang  around"  on  the  city  streets — 
dropouts  not  only  from  school  but  often  from  society 
itself.  Many  are  not  sufficiently  attracted  by  the  NYC 
program  to  take  the  first  faltering  steps  toward  find- 
ing out  what  it  is  all  about  and  how  it  can  help  them. 
Hut  thousands  have  taken  the  first  steps,  and  these 
have  been  assigned  work  that  otherwise  would  not 
have  been  done,  in  public  and  private  nonprofit  or- 
ganizations, most  freriuently  schools  and  health  and 


157 


social  agencies.  While  on  tlie  job,  many  liave  received 
personal  counseling,  remedial  education,  and  other 
supportive  services  from  local  community  agencies 
that  liave  been  integrated  into  the  projects  locally. 
We  now  know  that  54  percent  of  the  out-of-school 
young  people  wlio  leave  the  Neighborhood  Youth 
Corps  do  so  to  take  jobs  or  specialized  training  or  to 
return  to  school  full  time ;  2  percent  leave  to  enter  the 
Armed  Forces. 

Work  and  supervision 

The  kind  of  work  that  cnrollees  perform  is  limited 
only  by  tlie  needs  of  the  community,  the  imagination 
of  the  sponsor,  and,  of  course,  the  ability  of  the  en- 
rollee.  For  example,  in  Koanoke,  Va.,  eni'ollees  in  the 
out-of-school  project  are  working  as  auto  mechanics' 
aides,  laboratory  aides,  maintenance  aides,  neighbor- 
hood workers'  aides,  nurses'  aides,  ofEce  aides,  store- 
keepers' aides,  teachers'  aides  in  nursery  schools,  ve- 
hicle service  aides,  and  X-ray  laboratory  aides.  Those 
in  the  in-school  projects  are  working  as  auto  mechan- 
ics' aides,  clerical  aides,  draftmen's  aides,  food  prep- 
aration aides,  hospital  orderlies,  librarians'  aides,  and 
teachers'  aides.  In  addition  to  these  typical  job  clas- 
sifications, NYC  projects  during  the  past  year  have 
included  conservation  and  beautification  aides,  youth 
and  community  service  aides,  and  police  aides. 

Two  major  requirements  for  project  approval  are : 
(1)  the  jobs  need  to  be  done;  and  (2)  the  enroUees 
are  supervised,  either  by  a  regular  staff  member  of 
the  sponsoring  agency  or  someone  especially  em- 
ployed for  the  purpose.  Often  the  work  is  routine, 
but  when  this  is  so  in  a  well-thoughtout  and  well- 
supervised  project  it  is  planned  to  lead  to  more  de- 
manding and  satisfying  tasks.  Undoubtedly,  however, 
some  of  the  enrollees'  assignments  hold  less  potential 
for  developing  a  transferable  skill  than  others. 

Last  summer,  througli  the  impetus  of  the  summer 
opportunity  campaign  initiated  by  the  President's 


Regina  H.  Saxton  is  a  special  assistant  to  the 
administrator  of  the  Bureau  of  Worlv  Pro- 
grams, Manpower  Administration,  U.S.  De- 
partment of  Labor,  of  which  the  Neighbor- 
hood Youth  Corps  program  she  describes 
here  is  a  part.  Slie  has  been  a  tield  worlc 
supervisor  at  the  Jane  Addams  Graduate 
School  of  Social  AVork,  University  of  Illinois, 
a  Full)right  fellow  in  France,  and  a  group  leader  in  Operation 
Crossroads  Africa  in  the  Federal  Republic  of  the  Camerouns. 


U 


ti' 


Council  on  Youth  Opportunity,  sponsors  of  NYC 
projects  received  money  to  take  on  additional  NYC 
enrollees  for  placement  in  "Operation  CHAMP,"  a 
nationwide  program  to  provide  organized  athletics 
and  otlier  recreational  activities  for  children  and 
young  people  and,  at  the  same  time,  work  for  thous- 
ands of  young  jobseekers.  In  some  instances  it  stimu- 
lated NYC  enrollees  to  think  about  pursuing  careers 
in  the  recreational  field. 

One  enrollee  wrote  to  a  pi'oject  sponsor : 

While  working  in  this  new  program,  Operation  CHAMP,  I 
have  learned  to  understand  things  more  vividly — children  are 
very  easily  led  and  we  NYC's  are  a  great  influence  on  them.  I 
have  never  really  held  important  responsibilities  because  I've 
never  worked  before.  But  this  job  gave  me  a  degree  of  leader- 
ship and  independence.  Working  with  the  children  brought  out 
my  ability  to  work  with  an  open  mind.  I  found  that  while  work- 
ing it  brought  out  a  value  of  my  maturity  and  it  helped  me  to 
control  myself  as  well  as  the  children. 

Another  enrollee,  after  working  in  Operation 
CHAMP,  wrote  his  project  sponsor : 

This  year  I  decided  to  step  my  foot  out  into  the  world  and 
make  something  of  myself. 

Many  ongoing  community  programs  liave  also  pro- 
vided satisfying  work  experiences  to  NYC  enrollees, 
For  example,  a  young  woman  from  a  small  mid- 
western  town  recently  wrote  the  sponsor  of  a  project 

I  started  to  work  through  this  organization  because  I  wantec 
to  know  if  I  really  wanted  to  be  a  nurse.  They  got  me  on  at  thi 
hospital,  and  I  decided  my  future  while  my  job  helped  pay  foi 
my  high  school  education.  I  know  now  that  I  probably  wil 
become  a  nurse  when  I  graduate. 

Unfortunately,  not  all  NYC  enrollees  have  had 
such  constructive  experiences.  Some  have  been  placec 
in  jobs  that  are  "made  work"  offering  little  promise 
of  increasing  their  employability,  and  some  have  beer 
working  under  mediocre  supervision. 

A  major  aim  of  the  program  is  to  help  young 
people  become  self-propelling  who,  because  of  dep 
rivations  in  their  past,  cannot  sell  themselves,  can 
not  read,  and  cannot  communicate  well.  This  takes 
more  than  just  giving  them  a  chance  to  earn  $1.2E 
an  liour  for  32  hours  per  week  at  a  necessary  but 
routine  job.  A  young  per.son  so  handicapped  needs  t( 
be  buttressed  by  understanding  adults  with  whon 
he  can  identify  and  with  whom  he  can  talk  over  his 
own  self-doubts.  Experience  has  shown  that  an  adult 
who  supervises  such  young  people  on  the  job  needs 
to  know  much  more  than  how  the  job  should  be  done 
lie  needs  to  know  how  to  teach  a  skill  to  an  untutorec 
adolescent  and  how  to  help  another  human  beingl 
experience  success  in  doing  a  job  well.  This  requires; 


iipf 


158 


CHILDREN     •     JULY-AUGUST  196:1 


)f  tlio  supervisor  a  dpsrrpc  of  sensitivity  and  sivill 
jeyoiul  that  usually  reijuired  in  work  su]icrvision. 
low  far  the  NYC  supervision  lives  up  to  this  ideal 
varies  with  the  projects. 

Supportive  services 

Important  allies  to  sensitive  sujiervision  in  hel]v 
mji'  a  youaj;:  person  (o  tifrow  through  an  NYC  cx- 
lerience.  are  the  supportive  services  provided 
hrouph  the  projects  with  the  aim  of  increasinp;  the 
mrollees'  cmployahility  or  their  interest  in  remain- 
ng  in  or  returning  to  school.  These  services  vary 
^ith  the  projects  in  mnuher  and  quality,  and  theii' 
ong-term  elYectiveness  is  often  related  to  what  else 
he  community  has  to  oifer  the  young  person  when 
le  leaves  tlie  project.  Counseling  and  remedial  educa- 
ion  are  the  services  most  frequently  provided. 

Services  have  been  found  to  be  most  effective  when 
hey  have  been  designed  to  complement  each  other 
n  a  way  that  makes  it  possible  to  meet  the  individual 
nrollee's  need.  In  other  words,  the  work  experience, 
he  job  activity,  the  training,  and  the  supportive 
ervices  bear  a  dynamic  relationship  to  one  another. 
Vs  the  enrollee  progresses,  some  services  are  added 
ind  others  are  dropped.  For  example,  take  the  ex- 
Derience  of  Johnny,  a  17-year-old  Philadelphia  boy. 
IS  reported  by  the  sponsor  of  the  NYC  project  there : 

When  the  Houston  Community  Center  started  a  unit  of  the 
Neighborhood  Youth  Corps,  Johnny  was  assigned  as  a  com- 
nunity  service  aide,  helping  VISTA  volunteers  in  their  com- 
nunity  programs.  The  NYC  counselor  talked  with  Johnny 
ibout  his  need  for  training.  He  was  subsequently  referred  to 
he  State  Bureau  of  Vocational  Rehabilitation  (Johnny  had  lost 
he  sight  of  one  eye  in  a  gang  fight),  and  this  agency  paid  for 
fohnny  to  take  courses  at  a  technical  school  that  trained  drafts- 
nen. 

Johnny  completed  his  time  with  the  Neighborhood  Youth 
Corps.  He  was  still  discouraged.  He  was  not  sure  if  he  was  good 
"nough  to  fill  a  drafting  job.  His  counselor  arranged  a  job 
ntcrview  and  went  with  him  to  the  interview.  He  was  hired  as 
>ne  of  the  two  draftsmen  in  a  small  electronics  firm,  making  a 
jood  salar>'. 

Johnny  is  now  married  and  has  a  child.  He  likes  both  his  job 
md  his  bosses,  and  he  is  proud  of  himself. 

Since  this  report  was  made,  Johnny's  employers 
lave  asked  him  if  he  would  like  to  go  to  engineering 
school  at  night.  Thej-,  along  with  others,  have  as- 
sured him  that  he  can  succeed  there  if  he  decides  that 
IS  what  he  wants. 

The  kind  of  support  Johnny  received  has  unfoi-- 

unately  not  lx>en  available  to  the  NYC  enrollees  in 

ill  projects.  However,  the  Department  of  Labor  is 

Slow  insisting  on  the  integration  of  supportive  serv- 

j  ices  into  the  projects.  Thus  many  more  young  people 

VOLUME  14  -  NUMBER  4 


While  ministering  to  the  comfort  of  hospital  patients,  these 
three  Neighborhood  Youth  Corps  trainees  are  acquiring  skills 
that  may  lead  to  permanent  careers  in  the  health  services  field. 


may  be  able  to  break  out  of  the  cycle  of  poverty 
and  self-distrust  which  enchains  them. 

Perhaps  the  aspect  of  service  most  frequently 
neglected  in  the  local  NYC  projects  is  the  provision 
of  health  services.  Although  the  Federal  Govern- 
ment will  pay  $10  per  enrollee  toward  health  services, 
based  on  the  use  of  existing  resources,  few  projects 
thus  far  have  given  much  attention  to  the  health 
needs  of  enrollees.  One  notable  exception  is  in  Berke- 
ley, Calif.  There  the  sponsoring  agency  established 
a  budget  to  provide  for  medical  examinations  of  the 
1G5  enrollees,  all  between  the  ages  of  16  and  22.  The 
results,  analyzed  in  a  report  bj'  Dr.  Victor  Eisner, 
of  the  University  of  California  School  of  Public 
Health,  showed  that  -10  percent,  or  66,  required  no 
medical  care;  18.8  percent,  or  31,  required  only  dental 
care;  25.5  percent,  or  42,  required  medical  care;  15.7 
percent,  or  26,  required  both  dental  and  medical  care. 
Thus,  60  percent  of  the  enrollees  needed  health  care 
they  were  not  getting. 

Among  the  conditions  needing  attention  were 
severe  respiratory  infections,  hypertension,  venereal 
disea.se,  and  dental  problems — all  conditions  allect- 
ing  efficiency  on  the  job.  Unfortunately,  there  has 
been  no  followthrough  within  the  project  to  see  that 
the  needed  care  is  provided  in  the  community. 

Most  of  our  large  comnnmilies  today  have  many 
resources  for  medical  care  available,  manj'  of  them 
supported  by  various  types  of  Federal  aid,  but  young 
people  in  need  have  difficulty  finding  their  way 
through  a  maze  of  uncoordinated  services.  By  calling 


159 


on  a  combination  of  these  resources  in  a  creative  way, 
a  local  NYC  sponsoring  agency  would  be  cai'rying 
out  a  major  aspect  of  its  responsibility  to  enhance  the 
employability  of  NYC  enroUees. 

Some  sponsors  have  been  creative  in  mobilizing 
available  community  resources  to  work  with  tliem  to 
provide  opportunities  to  enrollees.  For  example,  the 
Sacramento,  Calif.,  sponsor  has  reported  that — 

•  The  !McClellan  Air  Force  Base  provides  work 
training  for  enrollees  and  facilities  for  use  in  their 
orientation  and  education. 

•  The  local  department  of  education  provides  free 
health  examinations  to  each  enrollee. 

•  The  county  pro\'ides  three  teachers  to  conduct 
regular  school  courses  once  a  week  leading  to  a  high 
school  diploma  and  to  give  remedial  school  work  to 
those  who  need  it. 

•  The  YAVCA  also  provides  remedial  education 
and  individual  counseling  as  well. 

More  and  more  sponsors  are  succeeding  in  relating 
community  resources  to  each  otlier  and  to  the 
enrollee.  Others  have  jirovided  opportunities  for  work 
training  Imt  have  lieen  frustrated  in  their  attempts 
to  make  connections  with  the  local  institutions. 

However,  even  where  there  are  good  supportive 
services,  a  constructive  NYC  experience  may  come  to 
naught  when  tlie  basic  community  institutions  do  not 
provide  what  these  young  people  need  at  the  time  they 
leave  the  program.  Many  enrollees,  for  example, 
retvirn  to  school  as  a  result  of  positive  experiences  in 
an  NYC  project,  but  they  do  not  always  remain  in 
school.  A  project  in  an  eastern  industrial  city,  with 
250  enrollees,  succeeded  in  getting  147,  or  59  percent, 
of  them  to  return  to  school,  only  to  have  112,  or  76 
percent,  drop  out  again  before  the  end  of  the  school 
year.  One  suspects  that  they  found  in  school  the 
same  drab  experiences  that  they  had  previously  fled. 

Job  development 

Similarly,  enrollees  often  do  well  in  the  program 
but  flounder  in  seeking  subsequent  employment. 
However,  those  projects  which,  like  the  Philadelphia 
project,  have  built  up  some  interest  in  local  employ- 
ers have  been  able  to  help  their  "graduates"  to  suc- 
cess during  that  critical  period  of  job  hunting  which 
can  mean  the  difference  between  a  continued  growtli 
in  self-confidence  or  a  sinking  back  into  despair. 

Nevertheless,  it  has  been  all  too  clear  that  efforts 
to  create  bridges  to  permanent  careers  for  NYC  en- 
rollees have  needed  to  be  greatly  strengthened.  Some 

160 


important  steps  in  this  direction  already  have  been 
taken  nationally. 

Experience  in  an  NYC  assignment  might  in  a  sense 
be  compared  to  "basic  training"  for  a  new  recruit  in 
the  Armed  Forces :  it  provides  the  basic  training  for 
working  on  any  job.  "WHien  NYC  enrollees  finish 
their  assignments,  many  of  them  need  further  train 
ing  in  more  complex  occupational  skills  to  be  ready 
for  career-type  jobs — jobs  that  provide  more  than  th( 
minimum  wage  and  a  cliance  to  move  upward.  Tc 
assure  them  of  this  opportunity,  the  Manpower  Ad 
ministration  of  the  U.S.  Department  of  Labor  has 
in  the  past  year  tiglitened  the  coordination,  at  all 


onea 


Dflr. 


pre^ 


■I 

levels  of  operation,  between  the  Neighborhood  Youth  Cor] 
Corps  and  the  Manpower  Development  and  Train-  ofen 
ing  Program  (MDTA),  thus  making  it  possible  foi^ 
a  young  person  to  go  from  the  Neighborhood  Youth 
Corps  to  vocational  training  under  the  MDTA  oi 
even  to  participate  in  both  programs  at  once. 

Other  opportunities  are  provided  under  the  1966 
amendments  to  the  Economic  Opportunity  Act 
which  set  up  three  new  manpower  programs :  Specia 
Impact  Program,  New  Careers,  and  Operation  Mainjis 
stream,  the  first  two  of  which  will  be  closelj 
coordinated  with  tlie  Neigliborhood  Youtli  Corps 
Tlie  Special  Impact  Program  will  focus  on  worl 
training  for  young  people  and  adults  in  neighbor 
hood  improvement  programs  in  low-income  urbai  I 
areas.  Operation  Mainstream  will  provide  work  ex 
perience  and  training  for  adults  with  histories  o: 
"chronic  unemployment."  The  New  Careers  progran 
holds  the  most  promise  as  a  career  outlet  for  yount 
adults  who  have  had  NYC  experience,  for  its  goa 
is  to  demonstrate  the  effectiveness  of  permaneni 
nonprofessional  jobs  in  the  human  services,  particui  ''"'' 
larly  liealtli,  education,  and  ptiblic  safety,  classifiec 
in  a  way  that  will  provide  opportmiities  for  f 
progression  in  pay  and  responsibility.  The  progran 
is  open  to  unemployed  adults  of  22  or  over  from  f am 
ilies  with  incomes  below  the  poverty  line. 

Tliese  amendments  also  make  it  possible  to  phici 
NYC  trainees  in  profitmaking  organizations  and  ii 
this  way  should  increase  the  opportunities  for  youiifi 
people  to  work  from  their  NYC  assignments  intc 
permanent  jobs  in  industry.  Some  large  industries 
have  already  given  pi'eferences  to  NYC  enrollees  in 
luring  people  for  entry  jobs,  for  example,  Quaker 
Oats,  Burroughs,  General  Motors,  and  Ford. 

In  some  States — Illinois,  Michigan,  Missouri,  for 
example — through  the  efforts  of  both  the  NYC  staff 
and  project  sponsors,  exceptions  have  been  made  in 
State  civil  service  requirements  for  NYC  enrollees. 

CHILDREN     •     JULY-AUGUST  1967 


tax 


In  odier  situations,  the  NYC  experience  in  a  fiovcrn- 
mont  job  assignment  is  equivalent  to  a  more  Imnial 
traininc:  period  and  tlierefore  may  be  substituted  for 
education  or  experience.  Tlie  U.S.  Department  of 
T)etVnse  bas  used  NYC  enrollees  and  in  some  cases 
has  upijraded  them  as  jiermanent  civilian  employees. 
However,  civil  service  eligibility  i-equirements  still 
present  blocks  to  NYC  placement  in  Federal  jobs. 

:ffects  and  promise 

As  Secretary  of  T.,abor  W.  "Willard  Wii'tz  bas  said, 
The  ultimate  success  of  the  Neighborhood  "\'outb 
Corps  will  iKit  be  measured  in  terms  of  the  numbere 
of  eni'ollees  but  only  by  the  number  of  them  we  have 
standing  up  and  who  stay  standing  up." 

It  woidd  take  a  tremendous  research  project  to 
find  out  what  idtimately  liappens  to  the  more  than 
[lOd.OOO  young  people  who  have  had  NYC  experience. 
But  there  can  be  little  doubt  that  experience  in  the 
Xeigbborhood  Yoiith  Corps  has  been  a  positive  force 
in  the  lives  of  many  thousands  of  young  people  in 
this  coinitry.  For  many,  perhaps,  it  may  have  been 
the  turning  point  from  an  antisocial  to  a  constructive 
orientation  to  society.  Reports  are  coming  in  from 
many  communities  of  a  decline  in  delinquent  be- 
havior among  those  young  people  reached  by  the 
program.  For  example,  a  city  recreation  director  in 
Covington,  Ky.,  has  observed: 

Since  NYC,  property  destruction  in  our  city  playgrounds  has 
shown  a  fantastic  decrease  and  is  now  quite  negligible.  I  might 
also  add  that  the  general  crime  rate  in  our  city  prior  to  May 
1965  was  showing  a  steady  increase  in  the  16  through  21  age 
bracket.  Happily,  since  NYC,  the  city's  crime  rate  has  been  on 
the  decline  overall,  more  markedly  however  in  the  16  through 
21  age  bracket.  In  my  view,  the  net  positive  result  has  been 
(1)  more  efiFective  utilization  of  the  recreation  dollar  with  less 
having  to  be  spent  to  replace  material,  equipment,  and  facilities 
caused  by  the  high  rate  of  vandalism;  (2)  beautification  of  parks 
and  playgrounds  that  are  now  more  attractive  and  also  safer 
to  visit  and  use  than  previously;  (3)  less  need  for  police  work  in 
these  areas;  and  (4)  most  importantly,  the  youths  themselves 
could  see  their  accomplishments  and  feel  the  inner  satisfaction 
about  their  work.  I  believe  some,  for  the  first  time,  could  sense 
that  they  were  building  themselves  up  rather  than  allowing 
their  lives  to  be  destroyed.  They  were  beginning  to  prove  to 
themselves  and  others  that  the  unemployed  school  dropout 
could  become  a  useful  citizen  in  his  own  right  and  perform  a 
useful  service  to  the  communitj-. 

The  community  action  agency  in  San  Antonio, 
Tex.,  SANYO,  released  a  report  in  Febi'uary  1967 
indicating  that  in  slum  areas,  where  it  has  some  30 
neighborhood  centers  employing  NYC  enrollees,  ju- 
venile delinquency  declined  12.6  percent  in  1966.  In 

VOLUME  14  -  NUMBER  4 


some  areas  in  San  Antonio  w  here  SANYO  does  not 
operate,  there  was  a  5.5-percent  increase  in  juvenile 
delinquency  during  that  same  period.  Although  the 
county  as  a  whole  showed  a  decrease  in  delinquency 
in  1966,  the  report  states,  ".  .  .  it  was  only  the  fan- 
tastic reduction  in  the  poverty  areas  that  accoimted 
for  the  overall  countywide  decline  of  '.'>.7  percent." 
County  probation  oflicers  have  made  an  effort  to  place 
as  many  juvenile  oll'enders  as  tliey  can  into  the 
SANYO  program. 

In  May  1966,  the  Neighboi-hood  Youth  Corps  held 
a  conference  in  St.  Louis,  Mo.  Among  the  delegates 
were  130  young  people  who  were  enrolled  in  NYC 
projects  coming  from  all  regions  of  the  United  States 
and  from  Puerto  Rico  and  the  Virgin  Islands.  Asked 
to  look  ahead  with  the  stall  and  chart  a  course  of 
action  for  the  Neighborhood  Youth  Corps  that  will 
go  beyond  anything  yet  accomplished,  the  young  dele- 
gates formed  a  committee,  which  ivported  in  part: 

There  should  be  a  pretraining  period  to  prepare  new  en- 
rollees for  jobs  they  have  been  assigned.  They  should  also  have 
more  opportunity  to  move  from  job  to  job  to  gain  experience 
to  enhance  their  human  relations  and  their  ability  to  get  along 
with  people,  and  to  increase  their  knowledge  of  the  world  of 
work. 

Thus  the  enrollees  themselves  put  their  lingers  on 
some  of  the  missing  links  in  many  of  the  projects.  In 
doing  so  they  demonstrated  tlie  imj^ortance  of  involv- 
ing the  young  participants  in  planning.  In  recom- 
mending rotation  from  job  to  job  within  a  project — 
for  example,  from  laboratory  aide  to  teachers'  aide  to 
mechanics'  aide — they  recognized  one  of  the  greatest 
potential  values  of  the  Neighborhood  Youth  Corps : 
giving  the  young  person  a  chance  tlirough  close  asso- 
ciation with  a  variety  of  occupations  to  learn  what 
they  really  involve,  thus  providing  him  with  a  sound 
basis  for  choosing  the  direction  of  a  future  career.  A 
number  of  larger  projects  are  now  doing  this. 

In  the  last  analysis  the  Neighborhood  Youth  Corps 
can  never  be  anything  to  the  young  person  but  a 
chance — a  chance  to  know  what  working  means,  what 
kinds  of  occupations  there  are,  where  they  lead,  and 
what  it  takes  to  get  ready  for  them,  but  most  of  all  a 
chance  to  build  up  confidence  in  one's  ability  to  per- 
form a  useful,  necessary  job — in  other  words  a  chance 
to  participate  in  what  Thomas  Wolfe  has  called  the 
promise  of  America :  "to  every  man  the  right  to 
live,  to  work,  to  be  himself,  and  to  become  whatever 
thing  his  manhood  and  his  vision  can  combine  to 
make  liim — this,  seeker,  is  the  promise  of  America."  ^ 


'  Wolfe.  Thomas:  You  can't  go  home  again.  Harper  &  Brothers,  New 
York.    193-1. 


161 


BOOK  NOTES 


THEORIES  OF  CHILD  DEVELOP- 
MENT. Alfred  L.  Baldwin.  John 
Wiley  &  Sons,  New  York.  1007. 
618  pp.  $8.95. 

Seven  theories  of  child  development 
are  examined  and  compared  in  this 
book :  what  the  author  calls  the  "com- 
mon-sense theory"  and  the  six  "scientif- 
ic" theories  of  Lewin,  Piaget,  Freud, 
Werner,  Parsons  and  Bales,  and  the 
stimulus-response  theorists  (Baudura, 
DoUard,  Hull,  Miller,  Sears,  Skinner, 
Walters,  and  Watson).  The  author  he- 
gins  with  a  description  of  the  "com- 
mon-sense notions"  of  behavior  and  de- 
velopment, which  he  sees  as  the  founda- 
tion on  which  other  theories  are  built. 
He  then  compares  the  six  "scientific" 
theories  with  each  other  and  with  the 
common-sense  theory. 

The  "scientific"  theories  overlap  very 
slightly  and  "talk  pa.st  each  other,"  he 
says.  This  fact  suggests  to  him  that  an 
"eclectic  integration  of  the  theories"  is 
possible  if  the  language  each  uses  can 
be  reconciled,  ,Tnrt  that  "a  kind  of  pro- 
to  theory  of  child  development,"  which, 
though  incomplete,  badly  defined,  and 
"surely  wrong  in  some  respects,  is  a 
feasible  .  .  .  basis  for  further  research 
and  for  more  refined  theory  building." 

DEVIANT  CHILDREN  GROWN  UP: 
a  sociological  and  psychiatric  study 
of  sociopathic  personality.  Lee  N. 
Robins.  The  AVilliams  &  AVilkins  Co., 
Baltimore,  Md.  1966.  340  pp.  $11.50. 

This  book  reports  on  a  study  com- 
paring over  500  adults  in  the  St.  Louis 
area  who  as  children  had  been  referred 
because  of  deviant  behavior  to  child 
guidance  clinics  with  over  100  adults 
whose  childhood  behavior  had  been 
considered  as  normal. 

The  author  finds  that  the  best  predic- 
tor of  sociopathic  personality  in  these 
adults  would  have  been  the  degree  to 
which  they  had  exhibited  antisocial  be- 
havior in  childhood.  He  points  out  that 
by  all  his  criteria   the  adults  who  as 

162 


children  had  been  referred  to  clinics  for 
antisocial  behavior  were  much  more 
maladjusted  than  were  adults  who  as 
children  had  been  referred  to  clinics  for 
other  reasons.  The  latter  as  adults  were 
actually  much  like  the  adults  who  had 
had  normal  behavior  in  childhood.  The 
maladjustment.s  of  the  former  showed 
up  in  high  rates  of  arrest,  occupational 
failure,  hospitalization  for  mental  ill- 
ness, divorce,  alienation  from  family 
and  friends,  and  alcoholism. 

The  author  maintains  that  povert.v 
alone  Is  not  responsible  for  antisocial 
behavior  but  rather  the  "salient  char- 
acteristics of  family  structure  in  the 
matrix  of  poverty."  Many  of  the  socio- 
pathic adults  involved  in  the  study,  for 
instance,  had  had  fathers  with  the  same 
characteristics  and  they  seemed  to  be 
passing  on  these  characteristics  to  their 
own  children.  The  author  recommends, 
therefore,  that  society  plan  for  early 
treatment  of  children  showing 
sociopathic  traits. 

The  author  is  a  research  professor  of 
sociology  in  ps.vchiatry  at  Washington 
University  School  of  Medicine. 

TWINS  AND  TWIN  RELATIONS. 
Helen  L.  Koch.  The  University  of 
Chicago  Press,  Chicago,  111.  1966. 
302  pp.     $6.95. 

Nearly  three-fifths  of  the  90  pairs 
of  5-  or  6-year-old  twins  whose  charac- 
teristics this  book  discusses  were  born 
prematurely,  the  author  points  out. 
And,  she  maintains,  the  handicaps  of 
prematurity  rather  than  any  inherent 
weakness  in  twins  may  account  for  the 
poorer  health  and  less  keen  mentalit.v 
of  many  of  the  twins  she  studied  as 
compared  with  a  control  group  of  boys 
and  girls  boru  singly.  All  the  twins 
were  attending  regular  classes  in  public 
schools  and  were  the  only  children  in 
their  families.  They  included  both 
fraternal  and  identical  boy  twins  and 
girl  twins  and  fraternal  boy-girl  twins. 
The  conclusions  the  author  presents  are 
based  on  interviews  with  the  children's 


mothers  and  teachers  and  with  the  chil- 
dren themselves ;   on  tests  for  mental '  ■ 
ability  and  apperception  given  the  chil- 
dren ;  and  on  ratings  given  by  the  teach- 
ers on  the  children's  social  behavior. 

Other  observations  the  author  makes 
about  the  twins  include  the  following: 

•  The  twin  bom  first  was  usually  the 
larger  and  healthier  of  the  pair. 

•  Although  the  boys  are  usually  less 
sturdy  than  the  girls,  the  boys  of  boy- 
girl  twins  were  usually  born  first  and 
were  in  better  condition  than  theii 
sisters. 

•  Rivalry  between  twins  did  not  seem 
liigher  than  that  between  children  borr 
singly  in  other  families. 

•  One  twin  dominated  the  other  ii 
about  61  percent  of  the  cases,  usuallj 
through  social  ability  rather  than  hrut< 
force. 

•  Twins  were  more  popular  witl 
their  classmates  when  they  attendee 
classes  together,  probably  because  o: 
the  attention  twins  often  get. 


CHILD  WELFARE  SERVICES.  Alfre 
Kadushin.  The  Macmillan  Co.,  Ne's 
York.  1967.  625  pp.  $9.95. 

Prepared  for  use  in  both  gradual  J 
and  undergraduate  courses  and  by  prai 
ticing  child  welfare  workers,  this  text 
book  centers  on  three  types  of  welfar 
services  for  children:  supportive  (sue 
as  family  services,  child  guidance,  an 
protective  services),  supplemontar 
(such  as  day  care,  homemaker  service: 
and  social  insurance),  and  substitutiv 
(such  as  foster  care,  adoption,  and  ii 
stitutional  care).  Each  section  include 
a  history  of  the  service,  descriptions  c  i 
case  studies,  an  evaluation  of  each  sen 
ice,  and  references  to  research  liter: 
ture.  The  concluding  chapters  are  o 
services  in  other  countries  and  on  socij 
work  as  a  career.  The  author  points  on 
that  his  aim  is  to  develop  knowledg 
about,  concern  for,  and  understandin 
of  child  welfare  services,  not  profes 
sional  skill. 


READINGS  IN  THE  PSYCHOLOG" 
OF  PARENT-CHILD  RELATIONE 
Gene  R.  Medinnus,  editor.  John  Wile 
&  Sons,  New  York.  1967.  371  pp.  $4.5( 

This  collection  of  research  reports 
reprinted  from  33  professional  journals 
are  presented  under  six  headings  :  metl 
odology ;  parental  attitude  and  beha\ 
ior ;  parental  influence ;  parents  in  thei 
children's  eyes ;  effects  of  social  class 
and  effects  of  cultural  practices. 


CHILDREN     •     JULY-AUGUST  196 


%•!•! 


□n  essay  review 

a 

focus 
on 


CHILDREN 

OF  THE 

POOR 

VERA  SHLAKMAN 

Associate  Projessor 
School  of  Social  Work. 
Columbia  University 


•  It  was  inevitable  that  the  grand 
inquiry  iirompted  by  the  redis- 
covery of  poverty  in  the  sixties 
shovild  have  moved  income  mainte- 
nance policy  to  center  stage.  Why  has  so 
much  poverty  escaped  the  social  insur- 
ance net?  Why  have  our  massive  in- 
come transfers  not  lifted  more  i>eople 
out  of  poverty?  Has  our  social  security 
system,  in  fact,  been  conferring  more 
benefits  on  middle  class  people  than  on 
the  poor?  Has  the  public  welfare  system, 
designed  for  the  poorest,  been  binding 
them  to  continuing  deprivation?  Why 
has  the  indignity  of  poverty  in  the  midst 
of  affluence  been  reinforced  by  the  in- 
dignities of  welfare  program  proce- 
dures? And  why  are  the  children  par- 
ticularly disadvantaged  when  one  might 
have  supposed  that  thoy  would  be  the 
preferred  beneficiaries  of  our  social  wel- 
fare efforts? 

In  the  years  following  passage  of  the 
Social  Security  Act,  coverage  under  the 

VOLUME   14  -  NUMBER  4 


old  agi'  and  survivors  iiisuraiici-  pro- 
gram was  extended,  additional  risks 
were  included,  and  (lualifications  for 
benefits  were  liberalized  until  only  a 
tenuous  attachment  to  the  labor  marljot 
and  nominal  "conlriliutions"  were  re- 
(luired  for  entitlenient.  Tlius,  through 
niodilicatioii  of  original  principles  social 
insurance  l)enefits  came  to  be  more  eas- 
ily acquired  than  was  originally  planned 
and  more  widely  distributed.  But  en- 
titlement as  a  right  has  remained 
unimpaired,  and  the  receipt  of  pensions 
or  hospital  services  is  free  of  stignni. 

This  improvement  in  old  age  and  sur- 
vivors protection  for  insured  workers 
was  not  paralleled  by  equally  liberal  de- 
velopments in  the  public  assistance  pro- 
gram on  which  the  poorest  families 
have  had  to  rely,  families  consisting  of 
children  deprived  of  the  support  of  a 
father,  with  their  mothers  or  other 
"caretakers."  Indeed,  this  Federal-State 
program.  Aid  to  Families  with  De- 
pendent Children  (AFDC),  fell  into  dis- 
favor and  even  became  a  vehicle  of 
discrimination  against  children.  The 
approximately  3.5  million  children  de- 
pendent on  AFDC  today  receive  far  less 
than  do  the  adult  recipients  in  other 
federally  aided  programs.  Moreover, 
rigid  restrictions  on  "eligibility"  leave 
out  most  of  the  15  million  children  who 
have  been  estimated  to  be  living  in 
lioverty. 

Contradictions  in  jwlicy  have  haunted 
the  AFDC  program  from  the  beginning. 
The  social  welfare  community  has  been 
well  aware  of  the  dysfunctional  and  dis- 
incentive characteristics  of  the  laws 
providing  for  this  program  and  of  their 
administration  and  of  the  poverty  im- 
posed on  the  recipients.  Yet,  in  1962, 
the  basic  physical  needs  of  AFDC  fami- 
lies were  apparently  judged  to  be  less 
urgent  than  their  need  for  rehabilita- 
tion :  in  that  year  Congress  provided 
Federal  support  for  expanded  social 
services  but  failed  to  remove  the  built- 
in  discrimination  against  children  in 
the  Federal  reimbursement  formula  for 
cash  assistance. 

This  neglect  of  children  and  the  policy 
alternatives  available  for  ending  it  is 
what  Alvin  L.  Schorr's  new  book,  "Poor 
Kids:  A  Report  on  Children  in  Pov- 
erty,"* is  about.  An  appreciation  of  its 


•Schorr,  Alvin  L.:  Poor  Kids:  A  Report  on 
Children  in  Poverty.  Basic  Books,  Inc.,  New 
York.   1966.  205  pp.   S5.95. 


contributiipti  can  In-  licttcr  understood 
by  a  reminiscent  look  at  the  road  we 
have  been  traveling. 

The  background 

The  search  for  effective  antipoverty 
I)olicy  has  been  conducted  under  in- 
creasing iiressure  from  the  civil  rights 
niovenu'Ml,  the  persistent  and  uneciual 
distribution  of  unemployment,  the  prob- 
lems of  urban  life,  and  the  fear  that 
automation  would  make  unskilled  and 
semiskilled  labor  obsolete  thus  con- 
demning large  numbers  of  unskilled,  un- 
educated persons  to  chronic  unemploy- 
ment on  a  scale  that  could  be  coped  with 
by  no  less  a  change  in  our  economic 
system  than  the  separation  of  work 
ami  income. 

The  public  debate  that  shaped  the 
development  of  today's  antipoverty 
policy  as  well  as  criticism  within  the 
social  welfare  community  raised  ques- 
tions about  the  debilitating  effects  of 
relief  levels,  the  degrading  nature  of 
the  means  lest,  and  the  rights  of  .social 
welfare  beneficiaries.  Eligibility  deter- 
mination procedures  were  branded  as 
socially  wasteful.  AFDC  caseloads  were 
seen  as  being  too  large ;  public  welfare 
staff  as  in  short  supply  ;  individualized 
calculation  of  budgetary  deficiencies  as 
too  expensive. 

Moreover,  there  was  growing  dis- 
enchantment with  the  quality  and 
quantity  of  services  that  qualify  for 
7.5-percent  Federal  reimbursement.  It 
began  to  be  suggested  that  rehabilita- 
tion of  program  and  policy  might  take 
precedence  over  rehabilitation  of  the 
client.  So,  in  a  new  context,  there 
evolved  a  new  version  of  the  theory  that 
public  welfare  is  one  of  the  sources  of 
the  poverty  it  is  supposed  to  relieve, 
that  it  helps  to  fasten  the  shackles  of 
"intergenerational  poverty"  on  its 
clients,  that  its  rules  stifle  incentive  and 
inflict  disabling  indignities  through  ap- 
plication of  "suitable  home"  and  "man 
in  the  house"  regulations. 

Public  discussion  of  the  issues  identi- 
fied a  cluster  of  objectives  with  which  it 
might  be  possible  to  reconstruct 
the  public  welfare  function,  including : 
more  dignified  treatment  of  the  recip- 
ient ;  agency  and  worker  caseloads 
small  enough  to  permit  meaningful 
delivery  of  social  services ;  relief  stand- 
ards at  least  up  to  the  defined 
poverty  line ;  determination  of  eligi- 
bility  through   simplified   and   reason- 

163 


ably  impersonal  procedures.  Thus,  a 
climate  of  opinion  receptive  to  the  intro- 
duction of  new  methods  of  income  main- 
tenance was  created. 

Most  attention  has  been  captured  by 
the  most  glamorous  of  the  proposals 
designed  to  compensate  for  lack  of  in- 
come, namely,  the  guaranteed  minimum 
income  (GMI),  a  term  that  expresses 
aspiration  and  goal  rather  than  spe- 
cific plan.  The  particular  device  through 
which  the  GMI  may  be  attained  and 
that  has  in  turn  captured  attention  is, 
of  course,  the  negative  income  tax 
(NIT).  Simply  stated,  the  NIT  pro- 
poses to  use  the  Internal  Revenue  Serv- 
ice to  pay  income  (or  negative  taxes) 
to  families  whose  income  is  so  low  that 
they  qualify  as  "tax  receivers"  rather 
than  as  taxpayers.  It  is  not  always 
clear  to  what  extent  the  various  advo- 
cates of  NIT  see  it  as  a  supplement  to, 
or  sub.stitute  for,  the  social  insurance 
and  public  assistance  programs,  or  if, 
indeed,  they  have  considered  the  possi- 
ble effects  of  its  coexistence  with  these 
programs. 

The  social  goal  of  setting  a  national 
family  income  minimum  inheres  in  any 
income  maintenance  polic.v ;  it  is  im- 
plicit whenever  social  assistance  is  pro- 
vided in  any  systematic  way.  It  could, 
therefore,  be  achieved  through  existing 
public  welfare  programs.  But  since 
these  programs  are  prime  targets  of 
criticLsm  by  the  advocates  of  GMI,  it 
seems  that  their  objective  is  to  achieve 
not  only  higher  relief  standards  based 
on  presumed  average  need  for  all  who 
fall  below  the  official  poverty  line,  but 
also  new  terms  of  entitlement  ranging, 
with  the  various  advocates,  from  a  lib- 
eralized and  humanized  test  of  need 
to  universal  entitlement  without  test 
of  need  and  based  only  on  some 
demographic  characteristic. 

The  "demogrant,"  as  such  a  universal 
allowance  is  called,  has  the  advantage 
of  not  stigmatizing  the  recipient  be- 
cause it  separates  need  from  benefit. 
The  poor  and  the  nonpoor  would  be 
treated  alike.  Some  NIT  advocates, 
however,  have  much  more  modest  goals. 

Focus  on  "kids" 

Alvin  Schorr  makes  a  valuable  con- 
tribution to  this  debate.  The  focus  of 
his  concern  is  not  so  much  GMI  as 
"poor  kids"  and  what  we  have  to  do 
to  bring  a  coherent  social  policy  for 
families  into  being.  He  is  not  uninter- 

164 


ested  in  the  GMI,  but  says,  rather,  "let 
us  begin" — by  first  turning  our  atten- 
tion to  meeting  the  needs  of  the  children 
in  poverty. 

The  deprivation  of  children  is  intol- 
erable to  Schorr.  He,  therefore,  main- 
tains that  antipoverty  policy  should 
give  priority  to  children.  In  effect  he 
then  asks  :  What  are  the  life  conditions 
of  poor  children,  and  what  means  do 
we  have  for  lifting  them  out  of  poverty 
and  insulating  them  from  its  damaging 
effects?  What  means  are  available  for 
providing  support  to  families  at  those 
vulnerable  points  in  their  lives  where 
the  "income  squeeze"  catches  them  and 
inflicts  irreparable  damage? 

In  a  powerful  chapter,  "The  Family 
Cycle  and  Income  Development,"  Schorr 
lays  the  basis  for  consideration  of  what 
a  family  support  policy  might  be.  He 
takes  a  simple  cost-benefit  approach  to 
analyzing  the  relative  merits  of  NIT, 
insurance  against  the  risk  of  family 
breakdown,  and  a  universal  demogrant 
for  children.  He  is  concerned  not  only 
with  the  most  practical  way  of  reduc- 
ing poverty  but  also  with  how  to  do  it 
so  as  to  shield  the  family  from  dis- 
integrative social  and  economic  forces. 
He  looks  for  the  flexible,  preventive 
device,  designed  to  relieve  income 
stresses  as  they  appear  in  the  life  cycle 
of  the  low-income  family. 

A  policy  instrument 

To  attain  these  goals,  Schorr  con- 
cludes that  the  most  effective  device  is 
the  children's  (or  family)  allowance. 
This  is  a  device  for  spreading  some  of 
the  costs  of  child  rearing  in  use  in  most 
industrial  countries.  Canada  has  had 
a  system  since  World  War  II  that  pays 
all  families  $6  to  $8  per  month  for  each 
child  under  16.  For  this  country,  Schorr 
proposes  a  preschool  allowance  of  $50 
per  month  payable  for  each  child  under 
6  and  financed  out  of  general  revenues. 
He  sees  much  of  the  State  and  local 
portions  of  assistance  expenditure  thus 
saved,  thereby  making  it  possible  to 
divert  these  funds  to  improve  public 
assistance  for  older  children  through 
higher  money  payments  and  an  expan- 
sion of  public  social  services. 

A  children's  allowance  system  is  a 
singularly  useful  instrument  in  the 
development  of  social  policy  for  the 
family.  It  avoids  the  disincentive  prob- 
lem because  it  flows  to  all  families, 
regardless  of  the  parents'  level  of  earn- 


|i*r.' 


Bfl* 


ta  ] 


ings.  It  provides  more  income  without 
changing  the  relative  iwsitions  of  wage 
earners  of  different  skills :  work  effort 
always  increases  income  by  the  full 
amount  of  earnings.  It  meets  the  prob- 
lem of  the  wage-earning  heads  of  fam- 
ilies whose  earnings  are  no  match  foif*- 
their  family  responsibilities.  Hence  it 
serves  to  reduce  the  disadvantage  of  the 
child  in  the  large  family. 

Since  60  percent  of  our  poor  children, 
as  Schorr  points  out,  are  members  of 
families  with  four  children  or  more, 
this  system  would  be  a  powerful  in- 
strument for  achieving  welfare  goals, 
It  could  divert  a  portion  of  our  na- 
tional income  to  the  poor  in  a  dignified 
manner.  At  the  same  time  it  could  re 
duee  caseloads  of  public  welfare 
departments  to  more  manageable  pro 
portions,  thereby  permitting  them  t(  - 
concentrate  on  the  provision  of  socia 
services  to  children  and  their  familiesp'''' 
unimpeded  by  eligibility  determination 

About  costs 


Demogrants.  such  as  children's  al 
lowances,  are  sometimes  opposed  be 
cause  they  are  not  restricted  to  thosi 
who  "need"  them  and  are  therefon 
more  expensive  than  benefits  precisel; 
adjusted  to  need.  However,  social  in 
surance  also  delivers  income  to  thosw 
who  do  not  "need"  it,  and  this  is  on 
reason  for  its  popularity.  Moreover,  th^ 
United  States  does  have  a  restricto( 
form  of  children's  allowances,  exclu 
sively  reserved  for  those  who  do  no 
need  them.  They  are  provided  as  ta: 
subsidies  only  to  those  who  have  sul 
ficient  income  to  pay  an  income  tax,  am 
hence  the  largest  benefit  goes  to  fauii 
lies  who  need  it  least.  The  value  to  i 
family  of  dependent's  exemption  range; 
from  $84  for  a  child  of  the  poorest  tax 
payer  (one  in  the  14  percent  taj 
bracket)  to  .$420  for  a  child  of  parent: 
with  the  highest  incomes  (in  the  7( 
percent  tax  bracket ) . 

The  cost  of  adopting  a  universal  chil 
dren's  allowance  system  without  refer 
ence  to  need  runs  high,  even  if  we  alloM 
for  the  sums  that  would  be  recapturee 
by  income  tax  and  saved  by  the  elimi 
nation  of  dependency  exemptions.  The 
nonfinancial  benefits  are  less  tangible  t 
and  difficult  to  measure  and  translate 
into  monetary  terms,  but  are  real  none 
theless.  Because  receipt  of  benefits  i; 
not  dependent  on  the  family's  willing- 
ness to  undergo  a  test  of  need,  no  chile 


E 


t- 


CHILDREN     •     JULY-AUGUST  196: 


n  need  is  li'l't  nut.  Tlu"  removal  of 
tii;iim   is  ;ils(i  :iii   iinp<>iiMiit   licnofit  to 

I  If  fiiinilies. 

Almost  overytliin;;  in  the  life  of  the 
Hinr  -housiii;;,  consumer  goods,  medi- 
il  cMre.  ])Ulilic-  services — is  imor  in  (lual- 
ty  and  a  standing  accusation  ol'  pcr- 
onal  failure.  Even  the  public  school, 
listorically  the  first  social  utilit.v  for 
11  children,  has  been  deficient  in  what 
t  lias  delivered  in  basic  and  vocational 
lucation  to  the  poor.  Thus,  the  hisher 
osts  of  lienelits  divorced  from  need 
lay  lie  regarded  as  a  necessary  price 
(J  pay  for  a  reduction  of  intMiuality : 
he  poor  and  the  nonpoor  would  not  he 
et  apart. 

An  income  transfer  program  of  the 
intension  here  implied   (Schorr  offers 

more  conservative  prescription)  will 
ot  solve  all  the  problems  of  children. 
lU  initial  program  might  not  do  more 
ban  prevent  gross  deprivation.  How 
list  we  move  would  depend  on  tJie  ex- 
ent  to  which  we  are  willing  to  transfer 
iicome  from  the  childless  members  of 


society  to  those  with  children  to  sup- 
l)ort,  from  the  rich  to  the  poor.  Hut 
even  with  such  a  transfer  the  greatest 
gains  in  eliminating  i)overt.v  in  the  coun- 
tr.v  must  come  tlirougli  e<'onomic  prog- 
ress as  parents  liecome  full.v  employed. 
Historically,  such  progress  has  been  the 
great  reducer  of  poverty.  Hope  there- 
fore lies  in  economic  expansion  planned 
to  encourage  upward  pressure  on 
wages,  downward  pressure  on  unem- 
ployment, and  pressure  in  all  directions 
against  want  and  squalor. 

Schorr,  in  his  treatment  of  the  prob- 
lem of  children  in  poverty,  directs 
analysis  toward  the  "big"  proposals, 
but  he  does  so  in  the  context  of  the 
needs  of  low-income  families  at  differ- 
ent points  in  their  history  and  in  aware- 
ness that  if  there  is  basic  provision, 
then  a  range  of  options  are  opened  from 
which  supportive  family  services  can 
be  chosen. 

Should  we  not,  then,  be  examining 
the  comparative  costs  and  benefits  of 
household  grants  to  start  young  fam- 


ilies, housing  subsidies  on  a  scale  suffi- 
cient to  contribute  widely  to  family 
welfare,  maternity  grants,  subsidies  to 
reduce  the  jiriccs  of  milk  and  children's 
books,  vacations  and  work  opportuni- 
ties for  adolescents?  And  is  there  not 
something  absurd  about  imposing,  as 
we  do,  a  combined  social  security-in- 
come tax  of  about  $250  a  year  on  the 
employed  head  of  a  young  family  of 
three  with  earnings  of  .$3,150  a  year? 
There  is  more  than  one  way  of  in- 
creasing family  income.  What  we  do  to 
and  for  poor  families  is  made  up  of 
man.v  different  components,  often  con- 
tradictory. Therefore,  many  different 
lines  of  attack  are  possible.  Whether  or 
not  one  agrees  with  Schorr's  particular 
formula,  those  concerned  with  the  chil- 
dren of  poverty  and  with  the  welfare  of 
all  children  will  join  the  search  for 
new  policies.  One  can  do  no  better  than 
to  start  with  "Poor  Kids,"  which  pre- 
sents the  issues  with  the  creative  imag- 
ination that  we  have  learned  to  expect 
in  Schorr's  work. 


guides  and  reports 


'HE  SOCIAL  WELFARE  FoRUM. 
lOGG  :  official  proceedings  ;  SOCIAL 
WORK  PRACTICE,  1966:  selected 
papers.  03d  annual  forum  of  the  Xa- 
tional  Conference  on  Social  Welfare, 
Chicago.  111..  May  20-June  3,  1966. 
Columbia  Universit.v  Press,  2900 
Broadway,  New  York,  X.Y.  10017,  for 
the  National  Conference  on  Social 
Welfare.  1966.  219  pp.  $6 ;  216  pp.  $6, 
respectively. 

The  first  volume  contains  selected 
apers  concerned  with  trends  and  issues 
1  developing  policy  in  social  welfare : 
le  second,  selected  papers  dealing  with 
evelopments  in  theory  and  application 
1  the  methods  of  social  work  jiractice : 
isewiirk,   groupwork.   and   comnnniity 

rganization. 

Tl 

HE  DAY  AFTER  SUMMER :  a  report 
on  the  Conference  on  Plainiing  for 
Washington's  Children  und  Youth,  Oc- 
tober 1.^20.  1966.  Dorothy  R.  Stef- 
fens.    Summer   Planning   Committee, 

OLUME  14  -  NUMBER  4 


Washington,  D.C.  1967.  72  pp.  Limited 
copies  free  on  request  from  the  United 
Planning  Organization,  1100  Vermont 
Avenue  NW.,  Washington,  D.C.  20005. 

Summarizes  the  work  of  a  conference 
devoted  to  an  evaluation  of  summer  pro- 
grams provided  children  and  youth  in 
the  District  of  Columbia  in  1966  and 
the  development  of  plans  for  more  ef- 
fective and  comprehensive  summer  pro- 
grams for  the  future. 

MOTHERS-AT-RISK  :  the  role  of  social 
work  in  prevention  of  morbidity  in 
infants  of  socially  disadvantaged 
mothers.  Perspectives  in  Social 
Work.  Vol.  1,  No.  1.  Florence  Ha.sel- 
korn.  editor,  Adelphi  University 
School  of  Social  Work,  Garden  City, 
N.Y.  11530.  1966.  126  pp.  A  limited 
number  free  on  request. 

The  proceedings  of  an  institute  co- 
sponsored  by  Adelphi  University  School 
of   Social   Work   and    United   Cerebral 


Palsy  Associations,  Inc..  with  a  grant 
of  maternal  and  child  health  funds  from 
the  Children's  Bureau. 

REPORT  OF  THE  COMMITTEE  ON 
SCHOOL  HEALTH  OF  THE 
AMERICAN  ACADEMY  OF  PEDI- 
ATRICS. American  Academy  of  Pedi- 
atrics, P.O.  Box  1034.  Evan.ston.  111. 
C0204.  1966.  128  pp.  $2.  Discount  on 
orders  of  six  or  more  copies. 

Presents  guidelines  for  school  admin- 
istrators and  physicians  on  the  essential 
components  of  school  health  programs 
and  the  roles  of  the  participating  phy- 
sician and  school  personnel  in  carrying 
them  out. 

RECREATION  AND  SOCIALIZATION 
FOR  THE  BRAIN-INJURED 
CHILD.  Sol  Gordon  and  Risa  S. 
Golob.  editors.  New  .Jersey  Associa- 
tion for  Brain  Injured  Children,  Cen- 
tral New  Jer.sey  Section,  61  Lincoln 
Street,  East  Orange,  N..T.  07017. 
1966.     110  pp.  $2. 

Presents  guidelines  for  |)lanning  and 
organizing  theraiieutieally  oriented  rec- 
reational and  socialization  programs  for 
brain-injured  children. 

165 


HERE  and  THERE 


Juvenile  delinquency 

The  Supreme  Court  of  the  United 
States,  by  an  S-to-1  decision,  ruled  on 
May  15  that  the  constitutional  guaran- 
tee of  due  process  of  law  is  applicable 
to  court  cases  involving  minors  charged 
with  being  "delinquents."  In  a  detailed 
opinion,  written  by  .Justice  Abe  Fortas, 
the  Court  ruled  that  in  delinquency 
hearings  before  juvenile  court  judges 
children  must  be  accorded  the  constitu- 
tional protections  of  due  process  in  re- 
gard to  the  right  to  remain  silent,  to  re- 
ceive an  adequate  notice  of  hearing,  to 
counsel,  and  to  confront  witnesses,  and 
the  privilege  against  self-incrimination. 
That  is,  they  must  be  given  specilic  no- 
tice of  the  charges  and  adequate  time 
to  decide  on  a  course  of  action  and  to 
prepare  a  defense ;  be  clearly  advised  of 
their  right  to  counsel  and  be  provided 
with  counsel  by  the  State  if  the  parents 
are  unable  to  afford  a  counseV;  be 
warned  that  their  testimony  can  be 
used  against  them ;  and  have  an  oppor- 
tunity to  face  their  accusers. 

Ju.stice  Fortas  made  clear,  however, 
that  the  decision  applied  only  to  the 
trial  of  a  juvenile  and  would  not  affect 
the  handling  of  juvenile  cases  before  or 
after  trial.  The  decision  states  that  the 
"high  crime  rates  among  juveniles 
.  .  .  could  not  lead  us  to  conclude  that 
the  absence  of  constitutional  protec- 
tions reduces  crimes,  or  that  the  juve- 
nile system,  functioning  free  of  consti- 
tutional inhibitions  as  it  has  largely 
done,  is  effective  to  reduce  crime  or 
rehabilitate  offenders  .  .  .  ."  But,  he 
added,  •'.  .  .  the  features  of  the  juve- 
nile system  which  .  .  .  are  of  unique 
benefit  will  not  be  impaired  by  constitu- 
tional domestication." 

The  case  on  which  the  decision  was 
made  involved  a  15-year-old  boy  ac- 
cused of  making  obscene  telephone  calls 
while  on  probation.  No  notice  was  left 


at  his  home  of  his  being  picked  up  by 
the  police  and  taken  to  a  children's 
detention  home,  though  both  his  par- 
ents were  at  work.  No  notice  of  the 
bearing  was  served  on  the  parents, 
though  the  mother  was  informed  ver- 
bally by  the  police.  The  complainant  did 
not  appear  at  the  hearing,  and  no  rec- 
ord was  made  of  the  proceedings.  The 
judge  committed  the  boy  to  a  State  in- 
dustrial school  for  his  minority  "un- 
less sooner  discharged  by  due  process 
of  law."  (An  adult  tried  for  the  same 
offense  would  have  been  fined  from  ifr. 
to  $50  or  sentenced  to  2  months  in  jail. ) 

Child  welfare 

The  Commission  on  International 
Social  Welfare  of  the  National  Associa- 
tion of  Social  Workers  (XASW)  re- 
cently wrote  to  the  President  of  the 
United  States  to  express  the  associa- 
tion's concern  over  the  proposal  of  a 
citizen.s'  group  to  bring  war-injured 
Vietnamese  children  to  this  country  for 
medical  treatment.  The  letter,  signed 
by  .Tames  R.  Dumpson,  the  commission's 
chairman,  pointed  out  the  danger  in 
such  a  proposal  of  overlooking  the  right 
of  every  child  to  be  brought  up  in  his 
own  family  and  in  his  own  culture  and 
of  violating  good  child  welfare  prin- 
ciples. It  urged  the  President  to  appoint 
a  group  of  experts  to  help  the  Vietnam- 
ese determine  the  best  way  of  attaining 
better  family  and  child-care  service  in 
South  Vietnam  and  pledged  its  full 
support  to  such  a  group. 

Any  plan  to  help  the  children  of  Viet- 
nam, according  to  the  commission, 
should  be  based  on  the  following 
principles : 

•  The  greatest  effort  should  be  di- 
rected to  reuniting  children  with  their 
own  families. 

•  Institutional  care  of  children  out- 
side  the  family   should  be   considered 


only  as  a  last  resort  and  a  temporary 
measure. 

•  Children  should  only  be  removed  to 
other  countries  for  needed  service  in 
exceptional  circumstances,  and  then  all 
human  rights  of  the  children,  including 
the  right  to  return  home,  must  be  firmly 
protected. 

•  Under  no  circumstances  should 
children  and  their  needs  be  used  to  in- 
fluence political  opinions  in  regard  to 
U.S.  involvement  in  Vietnam. 


In  fi.scal  year  1907,  the  Children's 
Bureau  awarded  $oV-!  million  in  child 
welfare  training  grants,  in  the  fifth  an 
nual  series  of  such  grants  since  theii 
authorization  under  the  1962  public 
welfare  amendments  to  the  Socia 
Security  Act.  These  grants  to  institu 
tions  of  higher  learning  to  train  socia 
workers  for  the  field  of  child  welfari 
include  741  traiueeships  to  suppor' 
graduate  education  leading  to  a  mas 
ter's  degree  in  social  work  and  4' 
trainee.ships  for  training  beyond  th 
master's  or  study  leading  to  the  doctora 
degree. 

Teaching  grants  were  made  to  6!' 
schools  of  social  work  to  employ  17; 
faculty  members. 

Grants  were  also  made  to  fund  21! 
short-term  training  projects  which  in 
elude  seminars,  workshops,   institutef'   "t 
and  conferences. 

The  poor 

To  provide  a  means  of  disseminatinj 
the  findings  of  its  research  on  the  urbai 
poor,  the  Health  and  Welfare  Counci 
of  the  National  Capital  Area.  Washingi 
ton,  D.C.,  has  established  a  project 
Cross-Tell,  under  the  direction  o 
L\ither  P.  Jackson.  Cross-Tell  is  cor 
cerned  exclusively  with  issuing  and  ir 
terpreting  the  findings  from  a  no\ 
completed  council-sponsored  project 
the  Child  Rearing  Study  (CRS)  of  Lo^ 
Income  Families  in  the  District  o 
Coliunbia,  carried  oxit  by  a  team  o 
anthropologists,  sociologists,  and  socia 
workers  between  1960  and  1964  unde 
the  direction  of  Hylan  Lewis.  For  bot 
projects  the  council  received  suppor 
from  the  National  Institute  of  MentJ 
Health.  '  | 

The   materials    of   the   CRS    projec   \ 
include     participant-observer     report: 
taped  interviews,  and  detailed  deserii 
tions  of  family  life  and  interperson: 


166 


CHILDREN     •     JULY- AUGUST  196  J 


elatioiis  niiiciiif;  llic  Imvest  socio- 
conomic  iMirtiiPiis  i)f  Wiisliington's 
opulatinii.      Fniiii      tlu'se      materials, 

ross-Tc'll  lias  thus  far  issued  four 
ublications.  The  most  reoeut,  "Culture, 
llass,  and  Poverty,"  contains  three 
alters  by  Dr.  Lewis  pointing  out  some 
eneral  implieations  emerging  from  the 
tudy. 

The  other  puMiiations  are:   "Three 

enerations,"  by  Camille  .Teffors,  which 
mploys  case  materials  in  the  words  of 

single  low-incoMie  family  ;  "Telling  It 
ike  It  Is  I"  which  is  in  the  form  of  a 
rama  with  dialog  drawn  from  verbatim 
nterviews  with  CRS  respondents  and 

as  the  basis  of  a  performance  given 
1st  September  by  the  actors  Ossie 
)avis  and  Ruby  Dee  at  Howard  Univer- 
ity ;  and  "Poverty's  Children,"  by  Jlr. 
ackson,  which  presents  some  main 
RS  findings,  often  su|)portcd  by  the 
espondents'  words. 

Cross-Tell  publishes  an  occasional 
lewsletter  providing  Information  about 
esearch  relating  to  the  urban  poor.  It 
Iso  holds  institutes  and  seminars  for 
Indents  and  practitioners  in  the  "help- 
ng  professions." 

The  CRS  publications  may  be  ob- 
ained  from  Cross-Tell.  0.5  M  Street 
JW.,  Washington,  D.C.  20024. 


"or  youth 

By  the  end  of  April,  many  national 
oluntary  youth-serving  agencies  had 
)lans  well  underway  for  expanded  pro- 
rams  for  young  people  this  summer. 
Phey  reported  on  these  at  a  meeting  in 
Jew  York  on  April  27,  called  by  the 
fatlonal  Social  AVelfare  Assembly  at 
;he  request  of  Vice  President  Hubert 
5.  Humphrey.  Participants  included 
•epresentatives  from  3.5  voluntary 
igencies,  the  Office  of  the  Assistant 
Secretary  (HEW)  for  Individual  and 
B^mily  Services  and  the  Children's  Bu- 
«au  (delegated  repre-sentatives  of  the 
OfSce  of  the  Vice  President),  and  the 
Jffice  of  Education's  New  York  regional 
>fiSce. 

Among  the  agencies  that  reported 
dans  to  expand  residential  camping 
'acilities  were:  The  Boys'  Clubs  of 
iimerica,  which  will  have  facilities  to 
ccommodate  15  percent  more  campers 
;han  in  10(10 ;  the  Boy  Scouts  of  Amer- 
,ca,  which  will  take  non-Scouts  from 
11  cities  into  its  camps ;  the  National 
^H  Clubs,  which  will  provide  camping 
tor  158,000  young  people  of  low-income 

VOLUME  14  -  NUMBER  4 


families:  and  Encanipniciit  for  CilizcM- 
ship.  which  will  operate  three  encamp- 
ments fur  about  'M'lO  campers,  70  of 
whom  will  be  from  low-income  families. 

Some  agencies  also  reported  plans  to 
step  up  recreational  programs  within  the 
cities.  For  exainiile,  the  tJirl  Scouts  of 
America,  as  part  of  its  program  Special 
Area  Services,  will  operate  day  camps 
for  girls  in  the  inner  city  and  inchide 
lran.si)ortation  to  and  from  camji.  The 
Boys'  Clul).s  of  America  will  increase 
ci|ierating  hours  of  club  facilities  from 
25  to  .50  hours  a  week,  on  a  7-day  basis ; 
expand  its  recreational  program  ;  and 
extend  the  operating  hours  of  its  115 
indoor  and  100  outdoor  pools  and  add 
portable  pools  in  20  to  30  locations.  The 
Xalional  Recreation  and  Parks  Associa- 
tion will  enlarge  its  "Life  Time  Sports 
I'rogram"  started  in  lOGl!  to  operate  in 
111  locations  with  the  expectations  of 
reaching  over  a  half  million  young  peo- 
ple, as  compared  with  last  year's  opera- 
tion in  eight  locations  for  84,000  young 
Iteople. 

A  number  of  agencies  reported  plans 
to  increase  opportunities  for  youth  par- 
ticipation in  volunteer  services.  The 
Young  Men's  Christian  Associations' 
National  Council  Student  Department 
will  recruit  and  place  500  more  student 
volunteers  than  in  1966  :  some  will  work 
in  Operation  SPECTRUM  (a  program 
in  which  college  students  help  inner-city 
residents  with  their  problems),  which 
has  been  extended  to  11  communities : 
40  will  work  in  the  Appalachian  area  ; 
and  1.800  will  work  on  the  Indian  Res- 
ervation at  Ro.sebud.  S.  Dak.,  and  in 
the  Cal-Tech  Project,  which  focuses  on 
Iiroblems  of  rural,  migrant  Mexican- 
Americans  living  on  the  Mexican 
border. 

The  American  Red  Cross  will  expand 
Project  RE.VCH  ( teams  of  eight  to  12 
youth  working  w'ith  two  adult  leaders 
to  provide  programs  and  services  in 
communities),  to  be  10  times  larger 
than  in  1066.  The  National  Federation 
of  Catholic  College  students  will  send 
about  200  student  volunteers  to  work 
in  the  Christian  Appalachian  Project  in 
McKee,  Ky.,  to  help  residents  learn  to 
develop  woodshops,  greenhouses,  and 
other  facilities  as  a  means  to  gain 
economic  indeiiondenee. 

The  Commission  on  Youth  Service 
Projects  has  published  a  directory  of 
o|iportunities  for  volunteer  work  in  the 
human  services  for  high  school  and  col- 
lege students.  Tlie  U.S.  Youth  Coiincil 


is  prcjiaririg  a  list  of  10,000  college 
students  who  are  willing  to  work  In 
cummunily  service  programs  in  the 
inner  city  this  suiiimer. 

Many  summer  employment  opportu- 
nities for  young  people  will  be  provided 
through  the  agencies.  For  example,  the 
Boys'  Clubs  of  America  will  provide  job 
opiiorlunities  for  about  2,500  boys  in  its 
<lubs  and  2,,500  in  its  camps,  as  well  as 
job  opportunities  for  Neighborhood 
Youth  Corps  workers  in  25  to  30  camps 
and  in  six  or  more  clubs.  The  National 
4-H  Clubs  is  working  with  State  em- 
ployment offices  in  an  employment 
oriented  project  in  which  about  104,000 
young  people  will  have  opportunities 
to  acquire  skills  in  landscape  gardening, 
<liild  care,  auto  mechanics,  tour  con- 
<lucting.  caring  for  animals,  and  operat- 
ing tractors. 

Child  health 

A  research  conference  on  the  problem 
of  dyslexia  (impairment  of  reading 
ability)  and  related  disorders,  support- 
ed by  a  Federal  grant  from  the  Office  of 
Education,  was  held  May  1.5-lG,  at 
Southwest  Texas  State  Teachers  Col- 
lege, San  Marcos.  Tex.  Among  the  26 
persons  who  attended  were  neurolo- 
gists, pediatricians,  child  psychologists, 
geneticists,  speech  pathologists,  audi- 
ologists,  and  educators.  The  purposes  of 
the  conference  were  to  assess  the  state 
of  knowledge  about  dyslexia  and  the 
sco|)e  of  the  problem  and  to  make  recom- 
mendations for  attacking  it. 

Conferees  reported  that  prevalence  of 
dyslexia  ranges  from  1  percent  to  20 
percent  of  the  population,  depending 
upon  whether  the  term  is  used  broadly 
to  cover  reading  difficulties  from  any 
cause — including  sensory  impairment, 
emotional  problems,  mental  retardation, 
eye  dominance,  deprivation  of  cognitive 
stimulation  in  early  childhood,  or  spe- 
cific brain  or  neurological  impairment 
affecting  word  perception — or  narrowly 
to  include  only  the  last  named  cause. 

The  educators  pointed  out  that  about 
one-third  of  the  .school  children  have 
some  degree  of  reading  difficulties, 
though  not  all  are  severe  enough  to  be 
labeled  as  dyslexia.  Stressing  the  im- 
portance of  careful  diagnostic  evalua- 
tions to  determine  the  etiology  and  help 
classify  the  nature  of  the  reading  diffi- 
culty more  precisely,  the  conferees  rec- 
ommended the  Initiation  of  a  nationwide 
action  program,  combining  medical  and 

167 


educational  efforts  to  provide  remedial 
programs  for  both  preschool  and  school- 
age  children. 


Over  the  next  3  years  the  University 
of  Colorado  Medical  Center  at  Denver 
will  test  the  hearing  ability  of  about 
450  infants  and  children  under  5  years 
of  age  by  conventional  methods  and  by 
a  new  method  using  a  computer  to 
determine  the  effectiveness  of  the  new 
method  and  to  develop  guidelines  for 
its  use.  The  computer  analyzes  brain 
waves  recorded  by  an  electroencephalo- 
graph (EEC)  after  eliminating  all  but 
those  emanating  from  auditory  activity. 
This,  the  center  expects,  will  give  the 
new  method  advantage  over  conven- 
tional methods  of  testing  hearing  that, 
because  they  require  the  subject  to  re- 
spond, cannot  be  used  effectively  with 
young  children  or  with  persons  who  are 
uncooperative.  The  National  Center  for 
Chronic  Disease  Control,  U.S.  Public 
Health  Service,  is  sponsoring  the  test- 
ing program. 

The  children  whom  the  Denver  cen- 
ter will  test  will  be  drawn  from  those 
screened  by  local  hospitals  and  clinics 
and  from  patients  referred  by  private 
physicians  in  Colorado  and  surround- 
ing States.  Plans  call  for  about  1.50  chil- 
dren to  be  tested  each  year,  about  75 
percent  of  them  under  2  years  of  age 
and  about  1.5  percent  from  2  to  4  years 
old.  The  guidelines  are  being  prepared 
to  enable  audiologists  and  otolaryngol- 
ogists to  determine  the  degree  of  hear- 
ing loss  in  children  by  reading  brain 
waves. 


If  lead  poisoning  from  the  ingestion 
of  paint — still  a  problem  among  chil- 
dren living  in  the  slums  of  old  cities — is 
to  be  prevented,  concerted  efforts  must 
be  made  to  eliminate  environmental  ex- 
posure to  lead-containing  paint  and  to 
treat  pica  (the  desire  to  eat  nonfood 
sub.stances).  So  concluded  the  partici- 
pants of  a  Symposium  on  Management 
of  Chronic  Lead  Intoxication  in  Chil- 
dren, held  in  Baltimore  on  April  24, 
1967,  by  the  Happy  Hills  Hospital,  a 
nonprofit  convalescent  facility  for  chil- 
dren in  Baltimore.  About  175  public 
health  workers,  including  nurses,  social 
workers,  and  physicians,  attended. 

In  speaking  of  the  ultimate  effects 
of  the  disease,  Dr.  Randolph  K.  Byers. 
of  the   Children's  Hospital  of  Boston, 

168 


told  of  a  foUowup  study  of  45  children 
who  had  been  hospitalized  for  lead  pois- 
oning in  which  seven  were  found  to 
have  persistent  psychological  irregu- 
larities, eight  were  found  to  be  retarded, 
and  four  to  have  died.  In  another  group 
he  cited,  all  the  children  after  diagnosis 
of  lead  poisoning  had  continued  to  in- 
gest lead — usually  in  the  form  of  old- 
type  wall  paint — and  all  had  become 
retarded.  Examples  were  given  of  chil- 
dren in  which  lead  poisoning  had  led 
to  death  or  permanent  brain  damage. 

In  describing  the  length  of  time 
needed  for  treatment  and  the  dangers  of 
reexposure.  Dr.  J.  Julian  Chisolm,  Jr., 
of  the  Baltimore  City  Hospitals,  empha- 
sized the  importance  of  specific  meas- 
ures to  protect  children  from  reexpo- 
sure after  the  diagnosis  has  been  made. 

Other  speakers  discussed  the  causes 
of  pica  in  children,  most  often  found  in 
the  low  socioeconomic  groups. 


Investigations  at  the  National  Insti- 
tute of  Arthritis  and  Metabolic  Dis- 
eases of  the  National  Institutes  of 
Health  have  recentl.v  pinpointed  the 
cause  of  Le.sch-Nyhan  disease,  a  dis- 
order of  childhood  associated  with  the 
production  of  excess  uric  acid  and  re- 
sulting in  cerebral  palsy,  mental  retar- 
dation, and,  eventually,  death.  Children 
afflicted  with  the  disease  chew  away 
their  lips  and  fingers  and  seldom  live 
beyond  puberty. 

The  disease  has  been  found  to  stem 
from  a  biochemical  defect  in  the  way 
the  body  handles  purines,  the  sub- 
stances from  which  uric  acid  is  derived. 
Patients  afflicted  with  it  are  deficient 
in  an  enzyme  of  purine  metabolism, 
hypoxanthineguanine  phosphoribosyl- 
transferase. 

The  disorder  was  first  described  in 
1964  by  the  two  physicians  whose  names 
it  now  carries.  Since  then  more  than 
.30  cases,  all  in  young  boys,  have  been 
reported  in  the  United  States,  accord- 
ing to  records  at  the  Institute.  Many 
cases  go  unrecognized  because  the  blood 
levels  of  uric  acid  are  seldom  deter- 
mined in  young  children. 


Miscellaneous 


The  U.S.  Committee  for  UNICEF  has 
set  up  an  Information  Center  on  Chil- 
dren's Cultures  in  its  New  York  City 
headquarters  (331  East  3Sth  St.,  New 
York  10016)    under  the  direction  of  a 


librarian  experienced  in  children's  liter- 
ature. The  center  will  provide  a  mail 
reference  service :  issue  lists  of  books 
about  children  in  other  lands :  conduct 
programs  for  children  demonstrating  the 
cultui-al  activities  of  children  in  various 
countries ;  and  give  assistance  to  re- 
search workers,  teachers,  librarians, 
writers,  television  producers,  publishers, 
and  parents,  and  others  interested  in 
finding  and  assessing  such  materials. 


Seven  institutions  of  higher  learning 
are  combining  their  research  efforts  in 
early  childhood  education  in  a  new  na- 
tional program,  known  as  the  National 
Laboratory  in  Early  Childhood  Educa- 
tion, supported  in  part  by  the  U.S.  Office 
of  Education,  under  the  Elementary 
and  Secondary  Education  Act  of  196.5. 
The  purpose  of  the  "laboratory" — a  i 
term  u.sed  in  this  instance  to  denote  col- 
laborative association  rather  than  a 
physical  facilit.y — is  to  coordinate  and 
develop  research  in  this  field  to  improve 
the  education  of  young  children. 

The    participating    institutions    are 
Cornell  University,  George  Peabody  Col- 
lege  for  Teachers    (Nashville,   Tenn,), 
New  York  University,  S.vracuse  Univer- 
sity, the  University  of  Arizona,  the  Uni- 
versity of  Chicago,  and  the  University 
of  Illinois,  which  is  serving  as  the  co- 
ordinator.    They  will  launch  new  proj- 
ects as  well  as  work  together  on  proj- 
ects already  under  way.     Among  others, 
the.se  include  or  will  include  inquiries  ( 
into  the  educational  assets  and  deficits  i 
of  Mexican-American  children,  ways  of 
helping   mothers   of   deprived   children 
assist  in  their  education,  the  effects  of  ' 
home    environment    on    children    from  i 
middle  and  lower  economic  groups,  and 
the    extent    of    social    segregation    in 
nominally  integrated  classrooms. 


Correction 

Under  the  "Films  on  Child  Life"  list- 
ing in  the  March-April  1967  issue  of 
CHILDREN,  Churchill- Wexler  Films  is 
erroneously  cited  as  the  producer  of 
the  films  "Boy  to  Man"  and  "Girl  to 
Woman"  and  Henk  Newenhouse,  as  the 
distributor.  The  producer  of  "Girl  to 
Woman"  and  the  distributor  of  both 
films  is  Churchill  Films,  662  N,  Robert- 
son Blvd.,  Los  Angeles,  Calif.  90069. 
Henk  Newenhouse  is  the  Midwest  agent 
for  Churchill  Films. 

CHILDREN     •     JULY-AUGUST  1967 

U    S     GOVERNMENT   PRINTING    OFFICE-  1967 


03 

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Sv,pev—""'l!>'-^t  of  Documents 

SEP  2  0  i9S7 
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children 


Homemakers  as  a  School  Service 
Abused  Parents  of  Abused  Children 
Group  Learning  for  Foster  Parents 
Louisiana  Family  Planning  Project 


''•illWlIK 


VOLUME   14     •     NUMBER   5     •     SEPTEMBER-OCTOBER   1967 


children 

AN  INTERDISCIPLINARY  JOURNAL  FOR  THE  PROFESSIONS  SERVING  CHILDREN 


Schoolmates  with  a  common  in- 
terest reflect  the  pleasure  of  an 
easy  friendship  in  their  smiles. 
In  schools  where  real  integration 
of  the  races  has  long  been  an  ac- 
cepted practice,  color  conscious- 
ness among  young  pupils  is  dim. 
How  vivid  it  has  been  in  some 
aewly  desegregating  schools  and 
the  ways  children  have  coped 
with  it  have  been  poignantly  de- 
scribed by  Dr.  Robert  Coles  in  a 
book  discussed  on  pages  197-199- 


The  Teaching  Homemaker  in  a  School  Project    ...  170 

Mary  E.  Burns  and  Julia  Ann  Goodman 

The  Abused  Parent  of  the  Abused  Child 175 

Sidney  Wasserman 

Group  Learning  for  Foster  Parents 

I.  In  a  Voluntary  Agency 180 

Harriet  Goldstein 

II.  In  a  Public  Agency 185 

Adolin  G.  Dall 

Introducing  Family  Planning  Clinics  to  Louisiana  .  .  188 

Joseph  D.  Beasley  and  Carl  L.  Harcer 

An  Educational  Psychologist  in  a 

Psychiatric  Clinic 193 

Robert  Friedman 

Children  Cope  With  Crisis 197 

Lois  Barclay  Murphy 

Child  Care  in  Other  Countries 201 

Martin  Gula 

book  notes 200 

here  and  there     203 

in  the  journals    207 

readers'  exchange     208 


children 


National  Advisers  to  CHILDREN 

William  E.  Brown,  dentistry 

Alex  Elson,  law 

Patricia  G.  Morisey,  social  tvor\ 

Edwin  M.  Gold,  obstetrics 

Herman  R.  Goldberg,  education 

Beatrice  Goodwin,  nursing 

Dale  B.  Harris,  psychology 

Robert  J.  Havighurst,  youth  development 

Robert  B.  Kugel,  pediatrics 

Hylan  Lewis,  sociology 

Winford  Oliphant,  child  welfare 

Milton  G.  Rector,  corrections 

R.  Gerald  Rice,  maternal  and  child,  health  _ 

Albert  J.  Solnit,  psychiatry 

Franklin  M.  Zweig,  community  planning 

Children's  Bureau  Staff  Advisers 

Hester  B.  Curtis,  chairman 

Division  of  International  Cooperation 

Grace  M.  Angle 
Office  of  the  Chief 

Dorothy  E.   Bradbury 
Division  of  Reports 

Kenneth  S.  Carpenter 

Division  of  jurcnile  Delinquency  Service 

Hyman  Goldstein 
Division  of  Research 

Jane  S.  Lin-Fu 

Division  of. Health  Services 

Will  Wolstein 

Division  of  Social  Services 

Editorial  Staff 

Kathryn  Close,  Editor 

Catherine  P.  Williams,  Associate  Editor 

Mary  E.  Robinson,  Willamena  Samuels,  Assistants 

170 


111  Highland  Park  (Michigan),  the  public 
school  system  has  found  that  the  provision  of 
a  teaching  homemaker  service  within  the 
school  system  to  help  improve  conditions  in  the 
homes  of  socially  maladjusted  pupils  has  made  a  big 
difference  in  the  way  such  children  take  advantage 
of  the  schools'  social  and  educational  opportunities. 
For  years,  the  system  tried  without  notable  success 
to  cope  with  the  problems  of  socially  maladjusted 
children  in  its  elementai-y  schools  through  psycho- 
logical services,  special  material  in  its  curriculum, 
and  the  use  of  community  agencies  such  as  a  child 
adjustment  clinic  and  a  neighborhood  service  orga- 
nization. The  behavior  of  maladjusted  children,  often 
characterized  by  aggressive  acting-out  towai'd  other 
children  and  complete  lack  of  respect  for  adults, 
was  often  so  great  that  the  children  got  little 
or  nothing  from  attending  regular  classes  and  so 
unacceptable  that  they  were  excluded  from  regular 
classes  and  sent  to  special  classes.  Unfortunately, 
their  parents  usually  interpreted  exclusion  as  mean- 
ing rejection  and  were  unwilling  to  woi'k  with  the 
school  in  providing  treatment  for  the  family.  In 
these  instances,  the  school  attempted  part-time 
schooling  or  referral  to  the  court  or  to  a  community 
treatment  agency. 

To  meet  these  problems,  in  1964  the  school  system 
turned  over  the  Lincoln  Avenue  School  to  a  Pupil 
Adjustment  Project  to  which  all  children  in  elemen- 
tary school  having  problems  of  social  adjustment 
were  assigned.  The  3-year  project,  supported  by  a 
grant  from  the  Office  of  Education,  U.S.  Depart- 
ment of  Health,  Education,  and  "Welfare,  set  out  to 
demonstrate  that  a  public  school  system  can  provide 
the  psychoeducational  services  necessary  to  treat  or 
pre\ent  social  maladjustment  in  children. 

Highland  Park,  a  politically  independent  unit  en- 
closed by  the  city  of  Detroit,  faces  the  same  problems 
most  inner  cities  of  large  urban  areas  are  now  facing : 
it  is  in  social  transition  and  is  inhabited  by  people 
of  several  racial,  religious,  and  national  backgrounds. 
For  these  reasons,  it  presents  conditions  that  make  it 
nearly  ideal  as  a  laboratory  in  which  to  examine  social 
and  educational  problems  and  to  test  and  demon- 
strate solutions  to  them. 

Correction  and  prevention 

The  project  has  a  two-pronged  goal :  through  re- 
medial work,  to  help  the  children  assigned  to  the 
school  learn  to  use  educational  opportunities  effec- 
tively; and,  through  preventive  measures,  to  modify 

CHILDREN     •     SEPTEMBER-OCTOBER  1967 


th( 


TEACHING 
HOMEMAKER 

in  a  school  project 


MARY  E.  BURNS    •    JULIA  ANN  GOODMAN 


pultenis  of  famil_y  life  that  encourage  the  develop- 
ment of  social  maladjustment  in  children. 

To  achieve  this  goal,  the  project  drew  up  a  three- 
oart  plan.  The  first  part  called  for  a  school  progi'am 
ising  special  educational  methods,  small  classes,  and 
lulividual  attention  to  help  the  ciiildren  learn  how 
to  benefit  from  the  school  socially  and  educationally. 
The  second  part  called  for  social  casework  and 
ffroupwork  sennces  for  all  children  at  Lincoln  and 
for  their  families  to  efl'ect  positive  relations  between 
the  child  and  the  scliool,  the  family  and  the  school, 
and  the  child  as  a  member  of  a  schoolclass  and  other 
children  in  the  class.  The  third  part  called  for  the 
entire  staff  of  the  project,  both  educational  and 
clinical,  to  involve  all  parents,  both  mothers  and 
fathei-s,  in  social  and  educational  activities  in  the 
scliool.  These  activities  were  to  include  special  meet- 
ings between  parents  and  staff  members;  parent- 
teacher  conferences  in  place  of  report  cards;  and 
involving  parents,  usuallj^  in  groups,  in  planning  for 
[school  activities  such  as  picnics,  camping  trips,  holi- 
day dinner  parties,  and  field  trips. 

The  third  part  of  tlie  plan  also  included  setting 
up  a  teaching  homemaker  service  to  offer  individual 
pai-ents  and  parents  in  groups  a  progi-am  aimed  at 
helping  tliem  make  their  homes  adequate  and  orderly, 
qualities  missing  in  most  of  the  homes  of  children 
;vssigned  to  Lincoln,  througli  instiiiction  on  home- 
making  in  the  home.  Lincoln's  staff"  believed  that 
orderly  homes  would  provide  children  with  the  kind 
of  orderly  model  of  the  world  they  needed  to  bring 
more  order  into  their  behavior.  The  use  of  a  home- 
maker  to  instruct  a  familj-  in  homemaking  rather 
than  as  a  mother's  helper  or  substitute  was  an 
unusual  feature  of  the  project. 

VOLUME  14  -  NUMBER  5 


The  school's  homemaking  service  began  in  Sep- 
tember 1965.  Lincoln  Avenue  School  had  83  children 
from  26  families.  Six  families  were  not  intact;  one 
mother  was  dead,  five  fathers  were  absent.  Four  fam- 
ilies had  acute  housing  problems;  li  families  had 
insufficient  income;  13  families  had  acute  health 
problems.  Both  parents  worked  in  10  families. 

The  project's  staff  included  three  social  case- 
workers. In  addition,  a  professor  of  social  work  at  a 
nearby  university  served  as  a  permanent  consultant 
to  the  clinical  staff.  To  recrait  homemakers  for  the 
program,  the  school  contacted  nearby  agencies  such 
as  the  United  Conununity  Services  of  Metropolitan 
Detroit,  which  was  itself  setting  uji  a  homemaker 
service  in  Detroit;  the  Merrill-Palmer  School,  where 
candidates  for  the  new  Detroit  homemaker  agency 
were  being  trained;  the  local  office  of  the  U.S.  Em- 
ployment Service;  and  local  Highland  Park  agen- 
cies, including  the  depai'tment  of  home  economics  of 
Highland  Park  High  School  and  the  local  visiting 
nurse  association. 

In  September  1965,  two  young  women  were  en- 
crasred  as  teachino;  homemakers.  Both  had  been 
married  over  10  years  and  each  had  two  children. 
One,  a  native  of  Detroit,  had  been  a  case  aide  for  the 
Detroit  Department  of  Welfare  before  moving  to 
Highland  Park.  The  other,  from  West  Virginia,  is  a 
home  economist.  Both  had  worked  for  the  Co-opera- 
tive Nursei-y  School  Program  run  by  the  Highland 
Park  public  school  system. 

At  the  onset  of  the  program,  the  staff  received 
lielp  from  a  consultant,  the  director  of  a  homemaker 
service  in  Washington,  D.C..  in  pi-eparing  statements 
of  purpose  and  policy  and  in  designing  the  pro- 
gram's structure.  At  this  time  the  role  of  the  home- 

171 


maker  was  defined  as  that  of  a  "teaching 
homemaker"'  wlio  uses  a  variety  of  educational 
methods.  Tlie  chief  social  worker  was  made  respon- 
sible for  supervising  the  homemakers  and  for  as- 
sio-nine  the  cases.  The  homemakers  worked  as 
integral  members  of  an  interprofessional  team  of 
caseworkers,  psychologists,  and  teachers  and  their 
services  were  a  key  adjunct  to  the  casework  process. 
The  caseworker  assigned  to  the  family  was  respon- 
sible for  direct  work  with  the  family. 

Knowins:  that  the  homemakers  and  caseworkers 
were  pai-t  of  a  team  calling  for  unusual  relationships 
and  that  there  were  few  guidelines  to  insure  eii'ective 
interaction  among  team  members,  the  staff  met 
weekly  to  discuss  these  aspects  of  the  service : 

1.  Clarification  of  the  distinct  and  the  overlapping 
areas  of  the  work  of  homemakers  and  caseworkers. 

2.  Development  of  ways  in  which  liomemakers  and 
caseworkers  can  work  together  effectively  to  carry 
out  casework  plans  for  particular  families. 

3.  Ways  to  break  down  socioeconomic  and  cultural 
and  lay  and  professional  bias  that  might  be  reflected 
in  the  work  of  the  caseworkers  and  homemakers. 

4.  The  need  for  the  homemakers  to  be  accepting, 
flexible,  and  adaptable  and  to  use  imagination  and 
sensitiveness  in  helping  families  with  their  problems. 


Kinds  oF  tasks  - 

In  reportmg  on  their  first  days,  the  teaching  home- 
makers  made  these  comments : 

When  we  were  asked  to  be  teaching  homemakers,  a  number 
of  questions  came  to  our  minds.  What  would  we  wear?  Would 
we  be  accepted?  If  not,  how  could  we  sell  ourselves  to  our 
clients?  What  kinds  of  problems  would  we  encounter?  What 
should  our  goals  be?  We  defined  our  goals  as  "to  gain  the 
confidence  of  the  parent,  to  help,  to  teach,  and  to  create  an 
interest  in  upgrading  family  life."  (An  easy  task — on  paper!) 

Ij:        *        * 

It  took  many  weeks  of  preparation  before  going  into  the 
homes.  We  read  case  histories  to  familiarize  ourselves  with 
identifying  family  data  and  existing  problems  and  to  try  to 
decide  what  services  would  be  needed.  We  gathered  material 
on  household  hints,  child  care,  meal  planning,  marketing, 
budgeting,  proper  cleaning  techniques,  and  recipes  which 
would  fit  limited  food  budgets  and  meet  the  nutritional 
requirement  of  the  family. 

After  18  months  of  experience  in  the  use  of  the 
educational  homemaker  program,  the  staff  of  Lincoln 
can  now  place  the  activities  of  the  teaching  home- 
maker's  job  under  these  three  categories : 


172 


1.  Teaching  good  methods  of  home  management, 
child  care,  and  personal  care  to  families  individu- 
ally. Here,  the  teaching  homemaker's  task  as  part  oi 
the  team  is  to  help  set  up  and  maintain  equilibrium 
in  the  family.  (For  example,  a  homemaker  helped 
a  mother  draw  up  a  budget  for  her  food  money.) 

2.  Helpmg  individual  families  use  medical  and 
health  resources  to  correct  and  prevent  severe  family 
problems  and  the  related  problems  of  children.  (Foi 
example,  in  a  home  where  the  mother  had  a  severe 
skin  disorder  and  the  children  had  it  intermittently 
the  teaching  homemaker  got  the  mother  to  take  steps 
to  prevent  the  spread  of  the  infection.) 

3.  Setting  up  broad  group  educational  programi 
that  allow  the  homemaker  to  use  her  talents  anc 
creativity.  (For  example,  the  teaching  homemakeri 
introduced  a  program  for  small  groups  of  mothers 
to  show  them  how  to  jDlan  meals,  mend  clothing,  anc 
refinish  furniture.) 

The  teaching  homemakers  worked  a  7-hour  day 
for  5  days  a  week.  Usually  each  homemaker  was  ir 
two  homes  a  day  for  3  hours  each.  The  other  houi 
was  taken  up  with  travel  and  writing  brief  report; 
of  activity,  including  an  evaluation  of  the  service 
and  how  the  homemaker  was  received  in  the  home 
To  confiiie  the  homemaker  as  much  as  possible  t( 
teaching,  the  policy  was  not  to  allow  the  homemakei 
to  stay  in  any  home  for  a  full  7  hours,  except  ii 
an  emergency.  Because  some  families  attempted  tc 
use  the  homemaker  as  "domestic  help,"  the  two  home 
makers  visited  the  same  home  alternately. 

After  their  first  visits  to  several  homes,  the  home- 
makers  fomid  they  needed  many  supplies.  Thej 
reported : 

.  .  .  we  realized  we  needed  our  own  cleaning  supplies  anc 
equipment.  Not  only  was  there  lack  of  money  in  the  home  fo) 
this  kind  of  equipment,  but  also  a  lack  of  knowledge  o) 
supplies  needed.  For  our  own  protection,  antiseptic  soap  headeo 
the  list.  Many  of  the  homes  had  no  workable  laundry  equi|>< 
ment;  washing  machines  were  either  absent  or  broken;  irons: 
outdated  or  broken.  We  found  we  needed  two  sewing  machines! 
a  console  to  be  used  in  the  school  and  a  portable  to  take  tc 
homes. 

Thereafter,  they  carried  necessary  cleaning  sup- 
plies and  equipment  in  their  automobiles  to  and  from 
each  home.  Equipment  was  never  left  in  a  home 

The  homemakei-s  never  gave  money.  If  a  family 
was  without  food  or  other  essentials,  they  reported 
the  need  to  the  casewoi-ker  assigned  to  the  family 

The  teaching  homemakers  wore  distinctive  uni- 
forms of  blue-and-white  striped  cambric  pinafores| 


(onpj 


CHILDREN 


SEPTEMBER-OCTOBER  1967 


rlcconitcil  with  :ui  emblem  reading  "Tcacliiag  lluiuo- 
luiikers  Lincoln  Avenue  School."  They  also  -wore 
long-sleeved  navy  blue  coat  sweatere  when  working 
in  unheatod  homes. 

The  first  home 

Xo  words  can  tell  better  than  the  homemakers' 
own  wliat  the  first  home  they  visited  was  like  and  the 
problems  it  presented : 

Going  into  our  first  home  (a  family  of  six  children,  mother, 
and  father)  and  seeing  the  conditions  of  the  home  and  the 
number  of  problems,  we  wondered  if  we  had  accepted  jobs  too 
complicated  for  our  abilities.  This  home  was  roach  infested. 
There  were  mounds  of  mildewed  clothes  piled  in  the  basement. 
The  two  younger  children  in  the  home  were  hungry  and 
naked;  they  were  both  ill  with  diarrhea.  The  mother  suffered 
from  a  severe  skin  disorder  and  could  not  put  her  hands  in 
water.  The  house  was  in  complete  disorder.  In  addition  to  the 
clothes  in  the  basement,  soiled  and  clean  clothes  mixed  together 
were  piled  on  the  living  room  sofa,  chairs,  and  floors.  Bread, 
jelly,  peanut  butter,  and  dry  cereal  were  strewn  on  the  floor 
from  the  front  door  to  the  back  door. 

This  family  was  in  a  state  of  nearly  complete  dis- 
organization. In  addition  to  chaotic  conditions  in  the 
house,  the  personal  relations  between  mother  and 
father  and  between  parents  and  children  were  both 
aggressively  and  passively  hostile.  The  mother  never 
talked  to  the  children  except  to  swear  at  them  and  to 
call  them  obscene  names.  She,  more  than  the  father, 
disciplined  the  children  severely.  The  parents  met 
neither  the  emotional  nor  the  basic  physical  needs  of 
the  children.  Health  problems  were  rampant,  but  no 
medical  care  was  ever  sought.  The  father  provided 
income,  but  no  other  physical  or  emotional  help  for 
the  family.  lie  and  the  mother  had  a  severe  marital 
problem,  and  he  was  absent  from  the  home  more  than 
he  was  present.  The  mother  was  almost  completely 
immobilized  by  her  physical  and  emotional  problems. 

The  children  of  the  family  who  were  referred  to  our 
school  were  markedly  withdrawn,  could  hardly  speak 
except  in  obscene  expletives,  and  were  failing  in  their 
schoolwork.  Psychological  testing  at  the  time  of  the 
referral  indicat<'d  that  they  had  potentially  average 
intelligence  but  that  their  ability  to  function  was 
impaired.  Psychiatric  evaluation  indicated  that  they 
were  sufToring  from  severe  emotional,  as  well  as  phys- 
nal.  il('pri\-ation  and  that  they  were  distrustful  and 
fearful  of  interpersonal  relationships  and  had 
jiritential  for  marked  aggressive  behavior. 

To  meet  this  family's  needs  required  all  of  our 
?choors  services:  intensive  casework;  groupwork; 
homemaker  services;   and  special  educational  pro- 


grams, including,  in  addition  to  special  cla.s.ses,  spe- 
cial educational  diagnoses  and  tutoring  from  our 
reading  specialist.  In  addition,  through  our  casework 
service,  we  called  on  other  community  services  such 
as  the  public  health  nurse  and  visiting  nurse  services, 
a  dennatological  clinic,  and  an  adult  psychiatric 
clinic  for  help.  Through  our  own  pediatric  service, 
each  child  received  a  complete  physical  examination. 

When  the  homemaker  first  entered  the  home,  the 
mother  could  not  think  of  what  help  the  homemaker 
could  be.  Finally,  she  asked  the  homemaker  to  throw 
out  an  open  jar  of  peanut  butter,  covered  with 
roaches,  which  had  been  on  the  table  for  weeks.  From 
this  beginning,  the  homemaker  moved  step  by  step 
with  the  mother  to  do  the  laundry  and  clean  the  house. 

Each  week  the  homemaker  gave  the  mother  a  little 
more  responsibility  for  doing  tasks  in  preparation 
for  the  homemaker's  visit :  The  first  week  she  was  only 
asked  to  gather  the  soiled  clothes  in  one  place ;  but  in 
the  weeks  following  she  \\as  asked  to  also  sort  them 
by  color  and  by  kind,  to  run  water  in  the  machine,  and 
to  put  the  clothes  in  without  getting  her  hands  wet. 
Finally,  with  encouragement,  the  mother  could  han- 
dle the  laundry  herself.  The  husband  was  induced  to 
mend  and  put  up  a  lini'  that  had  been  down  for  sev- 
eral years  on  which  the  clothes  could  be  hung  to  dry. 

Casework  with  the  parents  was  directed  at  mod- 
ifying the  hostility  toward  the  children ;  changing  the 
pattern  and  forms  of  discipline;  and  supporting  the 
parents'  continually  improving  ability  to  act  as 
parents,  through  the  mother's  pregnancy  and  the 
birth  of  a  seventh  child.  Homemaker  and  caseworker 
often  got  in  touch  with  each  other  to  share  informa- 
tion and  diagnostic  understanding  and  to  discuss  im- 
mediate and  long-range  goals  for  treatment.  They 
carefully  coordinated  treatment  plans  and  activities. 

After  many  months  of  receiving  intensive  case- 
work sei-vice  durmg  which  both  teaching  homemakei-s 
worked  with  the  family,  this  family  showed  marked 
improvement  in  many  ways— the  marital  relation- 


I 


VOLUME  14  -  NUMBER  5 


Mary  E.  Burns  (right),  a  pro- 
fessor at  the  University  of 
Michigan  School  of  Social 
Work,  is  social  work  con- 
sultant to  the  clinical  staff 
of  the  Highland  I'ark  imlilic 
school  .system's  pniiil  adjust- 
ment    project     reported     on 

here.  Julia  Ann  Goodman,  a  certified  consulting  psychologist, 
serves  as  the  project's  clinical  coordinator. 

173 


ship,  child  care,  home  management,  and  physical  and 
emotional  health  of  tlie  parents  and  children.  The 
parents  even  joined  in  gi'oup  activities  at  the  school. 

The  positive  influence  of  this  method  of  working 
with  the  whole  family  was  reflected  in  the  children's 
behavior.  They  became  more  spontaneous,  talkative, 
and  comfortable  with  other  people.  And  they  began 
to  respond  well  to  remedial  education. 

The  parents'  change  in  attitude  toward  the  school 
and  their  acceptance  of  the  school  program  brought 
about  another  important  gain.  Their  positive  attitude, 
which  they  transferred  to  their  children,  gi-eatly  in- 
creased the  children's  ability  to  do  good  school  work. 
Problems  with  other  families  ranged  from 
simple  to  complex,  from  the  need  of  a  mother  to  learn 
how  to  prepare  appealing  and  nutritional  meals  to  a 
father's  need  for  help  in  finding  a  housekeeper  for  his 
motherless  family.  In  some  families  the  homemakers 
together  gave  as  many  as  156  hours  of  service;  in 
others,  only  8  or  10  were  required.  Many  families 
continue  to  need  teaching  or  supportive  services. 

As  the  homemakers  became  more  familiar  with  the 
families,  they  found  that  similar  problems  existed  in 
several  of  them.  In  the  belief  that  the  mothers  in 
these  families  would  respond  to  the  group  method  of 
treatment,  they  planned  activities  for  the  mothers 
that  resulted  in  weekly  meetings  to  consider  many 
aspects  of  homemaking.  The  homemakers  found  the 
group  meetings  had  good  results  in  many  cases. 

The  value  of  groupwork  was  particularly  notice- 
able in  one  family.  The  mother  had  received  many 
hours  of  teaching  homemaker  service  in  her  home  but 
showed  little  evidence  of  changing  until  she  attended 
a  group  meeting  on  refinishing  furniture.  Through 
her  interest  in  the  work,  she  changed  her  run-down 
house  to  a  bright  and  pleasant  home.  In  turn,  her 
husband,  responding  to  the  change  inside  the  house, 
repaired  and  painted  the  outside. 

Part  of  casework 

In  reviewing  the  work  of  the  teaching  homemak- 
ers, the  members  of  the  team  see  the  service  as  a  part 
of  casework  service.  It  is  oriented  to  change;  it  has 
specific  goals  within  the  caseworkers'  goals;  and  its 
methods  are  on-the-spot  teaching  about  and  demon- 
stration of  effective  home-  and  child-care  practices. 
The  effective  use  of  such  a  service  presupposes  that 
these  requirements  are  being  met : 

1.  A  diagnostic  evaluation  of  the  family  and  of  the 
role  of  each  member,  including  an  evaluation  of  each 


174 


mtde 


I 


member's  motivation  and  capacity  for  improving 
and  a  clinical  judgment  that  the  parents  are  not  pro- 
viding adequate  homemaking  and  child  care. 

2.  Based  on  this  evaluation  and  judgment,  a  seleC' 
tion  of  what  further  services  are  needed  anc 
available. 

3.  A  continuing  evaluation  of  family  need  anc 
changes  in  goals  and  services  as  required. 

Kesponsibility  for  diagnosing  the  family's  prob- 
lems and  for  decidmg  whether  to  use  the  homemake) 
as  a  teacher  rested  with  the  caseworker,  as  set  fortt 
in  the  casework  plan.  As  teachers,  the  homemakeri 
showed  the  contribution  this  kind  of  service  coulc 
make  to  help  the  Pupil  Adjustment  Project  attain  its 
goals.  The  nature  of  the  problems  presented  by  th( 
families  required  the  homemakers  to  assist  families 
in  ways  besides  teaching.  In  addition  to  working 
with  parents  directly,  they  had  to  help  make  plans 
for  medical  care,  care  for  children  when  a  mothei 
could  not,  stabilize  families  in  a  crisis,  and  reliev( 
overburdened  mothers. 

As  we  see  it,  the  success  of  the  teaching  home 
maker  program  depended  on  the  following  factors 

1.  From  the  homemaker,  acceptance  of  the  paren 
to  be  taught;  conviction  that  jDarents  want  to  be  gooc 
l^arents;  skill  in  working  together  with  parents  (do 
ing  tififh  rather  than  for)  ;  ability  to  demonstrati 
good  homemaking  and  child-care  methods  directb 
and  indirectly;  and  ability  to  recognize  the  parents 
attainment  and  to  praise  them  for  it. 

2.  The  kind  of  team  i-elationsliip  that  prevents  thi 
development  of  rivalry  or  dissension  between  casfr    i 
workers  and  homemakers  from  overlapping  respon 
sibilities. 

3.  Careful  selection  of  the  teaching  homemakers 

4.  Conviction  on  the  part  of  the  entire  staff  that  s 
teaching  homemaker  service  is  worthwhile. 

Under  these  conditions,  teaching  homemakers  pro- 
vide a  treatment  resource  that  can  be  useful  in  many 
instances.  They  have  certainly  helped  many  of  the 
children  of  Lincoln  Avenue  School  and  their  par- 
ents. The  demonstration  at  Lincoln  School  of  what] 
such  a  service  can  do  has  prompted  the  Highland 
Park  public  school  system  to  provide  a  homemaker 
program  for  its  entire  school  district  under  a  special 
grant  from  the  State. 

CHILDREN     •     SEPTEMBER-OCTOBER  1967 


understandins 
comes  first 
in  helping    .    . 


the  ABUSED  parent 
of  the  ABUSED  child 


SIDNEY  WASSERMAN 


Willful  intent  in  parents  to  injure  their  own 
children  is  an  "unthinkable  thought''  for 
most  of  us.  Even  physicians,  persons  who 
seem  to  ha  in  a  position  to  judge  whether  violence 
has  been  done  to  a  child,  are  often  unwilling  to  accept 
the  "reality  of  willful  child  abuse,"  according  to  a 
recent  survey  among  physicians  in  the  Washington 
metropolitan  area  conducted  b}'  a  group  of  psychi- 
atrists.^ A  fifth  of  the  nearly  200  physicians  ques- 
tioned said  they  rarely  or  never  considered  the  ''bat- 
tered child  syndrome"  when  seeing  an  injured  child, 
and  a  fourth  said  they  would  not  report  a  suspected 
case  even  if  protected  by  law  against  legal  action  by 
the  parents.  Apparently,  they  did  not  believe  the 
evidence  would  stand  up  in  court. 

To  accept  as  fact  that  some  parents  intentionally 
injure  their  children  is  difficult  and  upsettuag.  Thus, 
we  all  tend,  like  the  physicians  studied,  to  give  the 
parent  "the  benefit  of  the  doubt."  There  may  be  many 
reasons  for  our  reluctance,  but  one  is  certainly  this — 
when  we  accept  willful  intent  as  a  fact,  we  must 
face  our  anger  at  such  parents  and  our  desire  to  pro- 
tect the  child,  even  if  we  harm  the  parent.  But  we 
cannot  effectively  intervene  to  protect  an  abused 
child  and  prevent  abuse  from  recurring  unless  we 
imderstand  what  it  is  like  to  be  a  "battering  parent." 
One  of  the  dangers  of  using  the  label  "battering 
parent'"  is  the  possibility  of  increasing  bias  and 
prejudice  against  the  parent.  Labeling  a  particular 
person  as  a  "battering  parent"  can  release  us  from 
the  responsibility  of  making  our  response  to  and 
attitude  toward  his  actions  sensitive  to  his  needs.  The 


temptation  is  great  to  think  of  him  as  being  far 
removed  from  those  of  us  who  do  not  batter  our 
children.  In  so  thinking,  we  keep  intact  our  image  of 
ourselves  as  righteous. 

How  easy  it  is  to  deny  that  within  all  of  us  lies  a 
potential  for  violence  and  that  any  of  us  could  be 
unreachable!  "Wliat  is  more  repugnant  to  our 
rational,  "mature''  minds  than  the  thought  of  com- 
mitting impulsive,  violent  acts  against  a  helpless 
child?  We  tell  ourselves  that  the  primitive,  untem- 
pered  instincts  responsible  for  such  acts  could  not 
erupt  in  us.  But  stripped  of  our  defenses  agamst  such 
instincts  and  jDlaced  in  a  social  and  psychological 
climate  conducive  to  violent  behavior,  any  of  us  could 
do  the  "unthinkable."'  This  thought  should  humble 
us:  perhaps  we  are  not  battering  parents  only 
because  conditions  do  not  lead  us  to  commit  "lui- 
natural*'  acts. 

No  class  monopoly 

Writers  on  social  phenomenon,  lawyers,  social 
scientists,  and  others  interested  in  social  problems 
have  long  recognized  that  the  phenomenon  of  parents 
physically  abusing  their  children  has  been  with  us 
since  the  begimiings  of  mankmd.  Only  since  World 
War  II,  however,  has  much  been  written  on  the  sub- 
ject of  unexplamed,  shocking,  and  traumatic  injuries 
to  children.  Since  then,  too,  much  has  been  said  and 
written  about  the  legal  confusion  surrounding  the 
use  of  authority  and  sanctions  in  instances  of  ap- 
l^arent  abuse  of  children  by  their  parents. 


VOLUME   14  -  NUMBER  5 


175 


Historically,  the  helping  professions  have  viewed 
physical  abuse  of  children  by  their  parents  as  the 
result  of  poverty,  life  in  the  slums,  ignorance,  and 
the  hardships  produced  by  immigration,  war,  indus- 
trialization, and  urbanization.  No  one  can  deny  that 
these  conditions  can  be  a  cause  of  child  abuse.  Never- 
theless, we  are  finding  that  the  phenomenon  can  be 
found  anywhere  in  society.  Once  we  regarded  vio- 
lence against  a  child  as  chai-acteristic  of  parents  in 
the  lower  socioeconomic  classes.  Now  we  are  finding 
that  such  behavior  is  not  exclusive  with  any  particu- 
lar social  class  but  that  "better"  families  can  more 
easily  conceal  the  problem  than  poor  ones.  In  other 
words,  a  sociological  explanation  by  itself  is  inade- 
quate and  simplistic. 

Through  sometimes  frustrating  and  bitter  experi- 
ence, the  professions,  and  particularly  that  of  social 
work,  have  come  to  see  that  prosecuting  the  battering 
parent  solves  the  problems  of  neither  the  child  nor 
the  parent.  Helping  the  abused  child  leads  us  inevi- 
tably to  the  need  to  help  the  battering  parent  and 
family.  As  pointed  out  by  Delsordo,-  Boardman,^ 
Nurse,"  and  others  in  studies  of  child  abuse,  prac- 
tically all  cases  of  abuse  involve  longstanding,  severe 
interpersonal  conflict  either  between  the  parents 
themselves  or  between  one  parent  and  another  mem- 
ber of  the  family. 

Because  we  are  dealing  with  a  complex  subject 
involving  many  social,  psychological,  medical,  and 
legal  elements,  we  must  narrow  our  scope  and  take 
first  things  first.  Nothing  precedes  understanding 
who  the  battering  parent  is  and  what  he  is.  Studies 
point  out  that  battering  parents  and  families,  regard- 
less of  class,  have  certain  psychological  and  social 
characteristics  in  common;  for  example,  we  are 
learning  more  all  the  time  about  the  severe  damage 
to  personality  these  people  sufTer.  Few  are  psychotic, 
but  all  have  marked  inability  to  set  up  a  genuine 
relationship  with  another  human  being.  Absorbed 
by  their  own  hurt  feelings,  they  cannot  sympathize 
with  the  feelings  of  others.  The  nonpsychotic  batter- 


Sidney  Wasserman  lias  recently  moved  to 
Eng-lantl  to  become  a  lecturer  at  the  Under- 
graduate School  of  Studies  in  Applied  So- 
cial Studies,  University  of  Bradford.  For 
the  past  3  years,  he  has  been  associate  pro- 
fessor at  the  Smith  College  School  of  Social 
Work.  He  received  both  his  master's  and 
doctor's  degrees  in  social  work  from  West- 
ern Reserve  University. 

176 


ing  parent  seldom  shows  remorse  for  having  hurt  liis 
child,  but  he  can  be  very  much  concenred  about  the 
harm  a  person  in  authority  might  inflict  on  his  own 
person.  When  facing  a  person  in  authority,  he  cries 
out:  "What  are  you  going  to  do  to  me?" 

"Done  to" 

Obviously,  something  went  haywire  or  was  not 
touched  in  the  humanization  process  when  such  per- 
sons were  growing  up.  Apparently,  they  never  had 
the  kind  of  relations  with  other  people  that  offers 
incentives  for  delaying  pleasure  or  gratification  or 
the  feeling  that  it  is  worthwhile  to  yield  an  immedi- 
ate, antisocial  pleasure  for  the  love  and  acceptance 
of  another.  They  have  been  "done  to"  both  socially 
and  psychologically.  A  battering  adult  goes  about 
his  daily  life  with  the  gnawing,  unfulfilled  feeling 
of  having  been  unloved  or  not  having  been  loved 
as  much  as  he  should  have  been  as  a  child.  His  life 
is  focused  on  his  own  needs,  and  he  cannot  tolerate 
any  frustration  to  the  gratification  of  those  needs. 
What  else  can  he  feel  but  his  own  hurt,  his  own 
hunger  for  love?  He  is  anesthetized  against  feeling 
compassion  for  others. 

This  kind  of  person,  according  to  Reiner  and  Kauf- 
man,^ is  unaware  that  he  has  a  buried  feeling  of 
"imbedded  depression"  because  he  was  emotionally 
or  psychologically  abandoned  by  his  parent  as  a  child, 
an  act  he  interpreted  as  rejection  of  himself.  Unable 
to  understand  such  a  distressing  emotional  event  and 
not  psychologically  strong  enough  to  bear  it,  as  a 
child  he  buried  the  feeling  of  rejection  deep  within 
himself  and  with  it  the  accompanying  depression. 
Because  his  use  of  language  was  not  developed,  he 
expressed  his  feelings  by  the  only  means  he  had— his 
behavior.  Explosive,  violent  behavior  became  his 
means  of  communicating  with  those  around  him. 
When  he  was  violent,  he  was  unable  to  feel  his  hurt, 
his  sense  of  worthlessness,  his  depre^ssion.  Denied  a 
consistent,  supportive  relationship  with  an  adult,  he 
set  up  a  life  pattern  of  aggression  and  violence — and 
is  now  inflicting  on  others  what  was  inflicted  on  him. 
For  hun  the  world  is  hostile  and  dangerous;  it  is  a 
place  where  one  attacks  or  is  attacked. 

Studies  also  suggest  that  the  battering  parent  feels 
his  parents  were  punishing  him  when  they  rejected 
him  and  that  he  is  longing  for  a  mother.  He  wants  to 
be  loved,  yet  does  everything  to  prevent  another  from 
loving  him.  Instead,  he  is  caught  in  a  cycle  of  vio- 
lence and  rejection.  When  speaking  of  his  physical 
attacks  on  his  child,  the  battering  parent  strongly 

CHILDREN     •     SEPTEMBER-OCTOBER  1967 


dofends  his  right  to  act  as  he  luis.  lie  se<.'ius  unuble 
to  feel  love  for  and  protcctiveness  toward  his  child. 
He  can  be  extremely  compulsive  in  his  behavior  and 
make  unreasonable  demands  on  his  cliild.  Cleanli- 
ness, for  instance,  may  be  an  obsession  with  some.  I 
have  heard  of  a  child  being  mercilessly  beaten  for 
putting  chicken  bones  on  a  clean  tablecloth  and  of  an 
IS-month-old  baby  being  seated  with  his  buttocks  un- 
covered on  a  hotplate  whenever  he  soiled  liiinself. 
Such  people  are  way  o\er  their  heads  when  they 
become  parents.  How  can  they  give  a  child  what 
tiiey  have  never  had  themselves — security,  safety, 
and  love? 

The  hosfility  sponge 

This  description  is  supported  by  a  growing  amount 
of  evidence  that  when  a  battering  parent  becomes 
violent,  lie  apparently  is  releasing  his  rage  on  a  par- 
ticular child,  selected  to  act  as  the  ''hostility  sponge" 
for  that  rage.  The  parent  views  the  child  as  a  com- 
petitor, as  someone  taking  and  getting  what  belongs 
to  him.  The  child  is  an  unconscious  symbol  of  some- 
one or  something  that  once  caused  him  pain — a  com- 
petitive brother  or  sister,  a  distrusted  parent,  his 
rejected  self.  Sometimes  the  parent  is  reliving  a  child- 
hood experience  that  left  him  traumatized.  Some  of 
tliese  parents  talk  about  being  rejected  by  their  own 
parents  in  favor  of  a  brother  or  sister. 

In  many  instances  the  abused  cliild  lias  been  con- 
ceived out  of  wedlock.  The  pai'ent  is  now  punishing 
him  for  being  the  cause  of  an  unwanted  marriage. 
Sometimes  a  stepfather  is  the  otiender.  He  beats 
the  child  for  reminding  him  of  his  wife's  "badness." 
Or  the  mother  may  beat  the  child  because  he  reminds 
her  of  her  '"badness"  or  of  that  "bad"  man,  his  father, 
who  deserted  her  when  she  was  pregnant.  By  beating 
out  the  "badness"  in  the  child,  the  parent  beats  out 
his  own  badness  or  that  of  another  person  who  has  in- 
jured him.  In  other  words,  the  parent  is  reacting  to 
his  own  imier  feelings,  not  to  the  behavior  of  the 
child.  The  child  is  the  provoker  by  being  what  he  is — 
an  infant  or  a  child  demanding  attention.  It  is  this 
demand  that  provokes  the  parent. 

The  use  of  the  child  as  a  hostility  sponge  may  be 
absolutely  essential  to  the  mental  balance  of  the  par- 
ent, and,  thus,  the  child  is  sacrificed  to  that  mental 
balance.  Removing  the  child  from  the  home  without 
a  well  thought-out  plan  to  help  the  parent  and  the 
family  may  only  invite  the  parent  to  shift  his  rage 
to  another  child.  We  can  easily  get  caught  up  in 
symptom-shifting  without  getting  to  the  bottom  of 


the  problem-  tiie  parent's  need  to  be  protected  from 
himself. 

To  really  help  such  a  parent,  we  must  break  the 
cliains  he  has  inherited.  To  do  that,  we  must  clearly 
understand  that  intervention  should  act  as  a  brake 
on  the  parent's  behavior  and  that  the  injuries  he 
inflicts  on  the  child,  injuries  that  bring  the  attention 
of  tlie  community  to  join  them,  are  his  way  of  say- 
ing— "Stop  me  !"  The  act  of  rusliing  a  child  to  a  hos- 
pital or  of  beating  him  in  front  of  neighbors  or 
strangers  carries  a  message  to  the  conununity — 
"Please  save  me  from  going  out  of  control.  Stop  me 
from  going  out  of  my  mind.  Keep  me  from — killing !" 

We  are  gradually  realizing  tliat  in  such  cases  we 
are  dealing  not  only  with  a  seriously  disturbed  per- 
son but  also  with  a  disturbed  family.  Once  the  exist- 
ence of  abuse  is  ascertained  and  the  degree  of  immi- 
nent danger  determined,  the  parent  and  the  family 
must  be  dealt  with  whether  or  not  the  child  is  re- 
rao\-ed  from  the  home.  Even  in  cases  where  law 
enforcement  has  been  effective  and  community  serv- 
ices have  been  well  coordinated,  problems  in  helping 
the  battering  parent  and  the  family  remain. 

According  to  Zalba,"  battering  parents  tend  to  deny 
their  actions,  the  husband  or  wife  of  the  battering 
parent  protects  the  other,  or  the  children  are  too 
young  to  explain  to  outsiders  what  has  occurred  in 
the  home.  The  parents  also  tend  to  deny  the  existence 
of  personal  or  family  problems  and  to  provoke 
judges,  lawyers,  and  social  workers  by  making  im- 
possible demands  on  them ;  or  they  rage  at  everyone 
in  authority  and,  sometimes,  physically  attack  them. 

Firmness  above  all 

In  reaching  out  to  the  battering  parent,  we  must 
keep  in  mind  an  important  key  to  his  behavior — his 
fear  of  a  close  relationship.  Because  he  suffered  re- 
jection in  early  life,  he  wards  off  human  relation- 
ships.' He  has  emotionally  divorced  himself  from 
the  significant  i)eople  in  his  life.  He  fe«ls  safer  with 
and  responds  more  readily  to  a  relationship  that 
clearly  offers  authority — firm  but  not  punitive.  In 
other  words,  the  battering  parent  can  often  be 
reached  by  setting  firm  limits  and  controls  on  his 
behavior.  Whatever  he  may  say,  he  needs  firm  con- 
trol— and  wants  it.  In  the  early  stages  of  trying  to 
reach  the  battering  parent  and  family,  the  social 
caseworker  or  other  helper  must  make  realistic  judg- 
ments and  decisions  for  and  with  the  parents  and 
family  to  gradually  help  them  develop  a  sense  of 
reality. 


VOLUME  14  -  NUMBER  5 


177 


To  provide  this  basic  treatment  requires  long-term 
help  from  a  consistent  relationship  with  one  person 
only.  Shifting  the  parent  from  one  worker  to  an- 
other only  stirs  up  his  basic,  deep-seated  belief  that 
to  get  close  to  another  human  being  is  to  expose  one's 
self  to  hurt  and  abandomnent.  Deep  within,  he  sees 
himself  as  the  kiss  of  death  in  personal  relations.  He 
wants  to  get  close  to  another  person,  but  lie  thinks 
that  if  he  does  the  person  will  learn  to  dislike  him 
and  will  break  off  the  relationship.  For  a  long,  in- 
definite period,  the  helping  person  must  stand  by  and 
suppoi-t  the  parent  by  setting  limits  and  by  provid- 
ing services  tlirough  community  resources.  He  must 
not  try  to  get  too  close  to  or  expect  such  a  person  to 
unload  his  innennost  feelings,  especially  feelings  he 
is  hardly  aware  of.  For  such  a  person,  having  limits 
set  on  explosive,  violent  behavior  provides  the  kind 
of  protection  a  good  parent  would  give.  The  batter- 
ing parent  mu.st  be  constantly  assured  that  he  will 
not  be  allowed  to  get  out  of  control.  At  the  same 
time,  he  must  be  assured  that  the  worker  believes 
that  he  does  not  want  to  hurt  his  child,  that  he  is 
capable  of  change,  and  that  he  wants  to  be  a  better 
parent.  He  needs  to  learn  what  the  community  ex- 
pects of  him  and  what  clioices  he  has.  He  needs  to  be 
helped  to  understand  clearly  tliat  consequences  will 
follow  his  violent  act  and  what  those  consequences 
will  be. 

A  long  process 

In  this  long  and  trying  process,  such  a  parent  will 
continually  test  the  patience  of  the  helping  person 
and  will  use  evei-y  means  to  provoke  rejection  to  re- 
assure himself  that  he  will  not  be  rejected.  For  a 
long  time  he  will  reveal  only  his  unlikeable  side. 
Wlien  he  is  reassured,  he  will  niake  feeble  attempts 
to  plant  the  seeds  of  a  relationship.  Reaching  out  to 
such  a  person  makes  a  very  great  emotional  and  intel- 
lectual demand  on  the  helping  person.  The  battering 
parent  is  very  perceptive  and  can  immediately  sense 
insincerity.  Actually,  the  helping  person  must  be- 
come the  "hostility  sponge"  instead  of  the  child  by 
letting  the  parent  test  him,  yet  he  must  never  let 
the  parent  get  out  of  control. 

Psychiatrists,  psychologists,  social  caseworkers, 
and  other  persons  trained  for  this  work  have  ob- 
served that  as  treatment  progresses  and  a  basic  trust 
is  established  the  battering  parent  gradually  faces 
up  to  the  depression  within  himself.  With  extreme 
caution,  he  talks  about  his  deep-seated  fear  that  he 
is  a  loser  and  that  people  always  desert  him.  Only 

178 


when  his  need  for  violence  abandons  him  and  he  stops 
expressing  himself  through  it  can  he  talk  about  his 
childhood  and  begin  to  come  to  grips  with  his  prob- 
lems. Though  he  improves,  he  continues  to  try  to  pro- 
voke the  helping  person,  for  he  is  never  convinced 
that  he  will  not  be  rejected.  However,  he  does  move 
cautiously  toward  having  a  relationship  with  the 
helping  person,  gives  up  or  modifies  Ms  violent  out- 
bursts, and  lets  himself  be  guided  toward  patterning 
his  actions  after  the  standards  of  the  helping  person. 
In  time,  the  pattern  becomes  a  part  of  him  and  a 
new  self  appears. 

To  start  and  set  in  motion  such  a  long,  painstaking 
pr'ocess  requires  a  firm  commitment  by  the  commu- 
nity to  providing  excellent  service,  a  goal  not  easily 
attained.  To  obtain  qualified  staff  members  and  to 
train  persons  specifically  as  workers  are  expensive 
and  time-consuming.  Often  efforts  to  reach  the  batter- 
ing parent  are  obstructed  because  workers— nurses, 
social  workers,  volunteers — come  and  go  frequently 
on  the  staffs  of  agencies.  For  the  battering  parent  is 
likely  to  regard  a  change  in  workers  as  another 
experience  in  rejection.  The  helping  person  may 
leave  the  staff  at  the  most  critical  moment— just  as 
the  parent  is  testing  the  worker  to  find  out  if 
rejection  will  follow  his  actions.  The  parent  takes 
the  worker's  leaving  the  agency  as  proof  that  it  never 
pays  to  get  close  to  another  person.  If  only  a  com- 
munity or  agency  could  insure  iwrmanent  service 
for  such  troubled  human  beings ! 

But  life  affords  few  opportunities  for  permanency. 
We  are  all  only  temporary  to  each  other.  That  is  a 
human  condition,  and  most  people  accept  it.  The  bat- 
tering parent  cannot.  Plans  for  helping  him  must 
include  ways  to  help  him  accept  this  tiiith.  We  must 
be  ready  to  test  various  methods  of  working  with 
Inm,  always  keeping  in  mind  his  deep  fear  of  in- 
volvement and  loss.  We  must  continue  to  direct  ef- 
forts to  alert  the  medical,  legal,  and  social  work 
professions,  and  all  groups  who  might  come  in  con- 
tact with  the  battering  person  to  the  need  for  con- 
tinuity in  helping  him.  The  challenge  is  not  a  small 
one;  social  workers  are  finding  that  cases  involving 
battering  parents  as  well  as  other  hard-to-reach 
families  are  making  up  more  and  more  of  their 
caseloads. 

In  addition  to  individual  treatment,  working  with 
groups  of  battering  parents  and  their  spouses  is  also 
proving  effective.  Many  of  these  parents  are  isolated 
from  the  community.  Having  an  opportunity  to  so- 
cialize in  a  group  of  similarly  troubled  parents 
tends  to  lower  their  resistance  to  facing  and  discuss- 


«« 


CHILDREN 


SEPTEMBER-OCTOBER  1967 


le: 


iwj  their  problems."  Workiiiir  witli  sucli  families  as 
iMiiiily  groups  has  also  proved  eil'eotive.'' 

jjThe  community  must  learn 

Beyouil  tlu>  al)iisoil  chilil.  liis  inirciils,  and  his 
fainilv  is  tiie  community  around  tliom.  Hatti'i'iuc; 
parents  and  tlieir  families  sutler  from  a  not  uucom- 
inou  malaise  often  called  "conununity  exclusion."  In 
various  ways,  whether  econon)ically,  politically,  jjsy- 
chologically,  or  socially,  these  families  fre(iuently 
sutler  exclusion.  Unfortunately,  when  such  persons 
vent  their  rage  on  their  children  and  the  shocked 
conmiunity  retaliates  inunediately,  the  family's 
sense  of  rejection  is  increasetl.  A  cycle  of  recipi'ocal 
airtrression  is  set  in  motion  and.  once  set  in  motion,  is 
dillicult  to  halt.  The  battering  parent  often  succeeds 
in  provoking  hospitals,  the  police,  the  courts,  and  so- 
cial agencies  into  treating  him  as  his  parents  once 
treated  him — the  opposite  of  what  he  needs.  Com- 
munities must  constantly  reexamine  ways  to  set  up 
controls  and  limits  while  bringing  all  families  into 
the  comnuuuty  life.  When  a  battering  parent  has 
only  laiown  "community  exclusion,"  he  desperately 
needs  '"inclusion"  to  break  the  cycle. 

Finally,  we  cannot  examine  our  attitude  as  a  com- 
numity  toward  the  battering  parent  without  exam- 
ining what  it  means  to  be  part  of  a  whole — a  State, 
a  nation,  or  the  world.  Like  it  or  not,  we  are  bound 
each  to  the  other  and  our  destinies  are  interwoven. 
As  we  try  to  understand  the  battering  parent,  we 
must  look  into  ourselves  to  find  out  what  there  is  in 
each  of  us,  in  our  community,  our  Nation,  and  the 
world  that  the  battering  parent  takes  as  a  sign  that 
what  he  is  doing  is  permissible. 

To  answer  this  question  we  must  face  up  to  the 


jjaradoxes  in  our  moral  code  that  condemn  violence 
in  oni^  form,  permit  it  in  another.  Many  Americans 
seem  to  persistently  dismiss  from  tlieir  thoughts  and 
acts  a  basic  truth — there  is  nothing  uu)re  precious 
than  hinnan  life,  or  so  it  seems  to  me. 

riic  people  of  tlie  United  States  have  yet  to  learn 
liow  to  convert  their  tendency  to  violence  into  com- 
]iassiou  and  tenderness.  AVe  are  in  danger  of  losing 
sight  of  one  of  this  Nation's  major  .social  goals,  one 
on  wiiich  it  was  founded,  that  is,  to  tap  the  humanity 
and  creative  potential  of  all  citizens  and  to  provide 
the  cnv  ironment  and  resources  necessary  for  the  in- 
dividual citizen  to  realize  his  creative  potential.  We 
possess  the  potential  both  for  violence  and  for  hu- 
maneness, and  arc  capable  of  acting  in  brotherhood 
and  with  understanding.  If  this  were  not  so,  we 
would  not  now  be  seeking  new  and  dili'ereut  ways  of 
helping  our  less  fortunate  citizens.  By  seeking  to  tap 
the  humanity  and  potential  for  growth  of  the  batter- 
ing parent  and  family,  we  are  tapping  our  own  po- 
tential for  personal,  community,  national,  and  inter- 
national growth.  AVe  must  ever  encourage  the  tap- 
ping of  this  potential. 


'Silver,  L.  B.:  Barton,  \V.;  Dublin,  C.  C:  Child  abuse  laws — are  they 
enough?  Tiie  Journal  of  the  American  Medical  Association.  January  9, 
1967^ 

"Delsordo,  J.  D.:  Protective  casework  for  abused  children.  Children, 
November-December  1963. 

•'Boardman,  H.  E.:  A  project  to  rescue  children  from  inflicted  in- 
juries. Social  Wor\,  January  1962. 

'Nurse.  S.  M.:  Familial  patterns  of  parents  who  abuse  their  children. 
Smith  College  Studies  in  Social  Wori^,  October  1964. 

^Reiner,  B.  S.;  Kaufman,  I.:  Character  disorders  in  parents  of  de- 
linquents. Family  Service  Association  of  .'Vmerica,  New  York.   1959. 

"Zaiba,  S.  R.:  The  abused  child:  II.  A  typology  for  classification  and 
treatment.  Social  Work.,  January  1967. 


The  hardest  work  in  the  world  is  being  out  of  work.  There  is  nothing 
more  difficult  or  tragic  than  for  a  father  to  return  home  night  after  night 
after  an  unsuccessful  day  hunting  for  a  job — a  job  requiring  skills  which 
he  does  not  possess.  There  is  nothing  harder  than  sending  one's  children 
to  school  on  an  empty  stomach.  There  is  nothing  harder  than  living  in  a 
slum,  than  fighting  the  rats,  than  pleading  with  the  landlord  for  heat, 
than  freezing  in  winter,  or  than  sweltering  in  summer. 

Whitney  M.  Yoiiiig,  Jr.,  Executive  Director,  National  Urban  League,  to  the  1965 
forum  of  the  National  Conference  on  Social  Welfare. 


VOLUME  14  -  NUMBER  5 


179 


GROUP  LEARNING  FOR  FOSTER  PARENTS 


I.  IN  A  VOLUNTARY  AGENCY 


HARRIET  GOLDSTEIN 


Over  the  past  7  years  the  foster  parents 
who  care  for  cliildren  phiced  with  them  by 
the  Association  for  Jewish  Children,  a  vol- 
untary agency  in  Philadelphia,  have  helped  the 
agency  develop  a  broad  program  of  group  activities 
designed  to  imjjrove  their  competence  as  foster  par- 
ents and  enhance  their  status  within  the  agency.  The 
program  has  not  only  contributed  to  the  foster  par- 
ents' confidence  in  their  ability  to  cope  with  the  chil- 
dren in  their  care  but  also  to  the  jDrofessional  work- 
ers' understanding  of  the  problems  and  feelings  of 
foster  parents  and,  hence,  their  skill  in  working  with 
them. 

At  any  one  time,  the  agency  has  about  100  chil- 
dren— most  of  them  severely  emotionally  disturbed 
— in  the  care  of  70  to  75  couples  whose  liomes  have 
been  approved  for  foster  care. 

While  the  agency  had  long  operated  on  the  prin- 
ciple that  work  with  foster  parents  requires  tlie  use 
of  both  casework  and  groupwork  methods,  until  1960 
its  efforts  to  work  with  foster  parents  in  groups  were 
sporadic  and  brief.  By  the  end  of  1959,  its  group 
program  for  foster  parents  had  been  reduced  to  two 
events:  an  annual  meeting  for  them  at  the  agency 
and  an  annual  party  given  in  their  honor  by  the 
board  of  directors.  However,  because  of  its  previous 
experience  and  the  many  expressions  of  interest  from 
foster  parents  in  having  opportunities  to  come  to- 
gether more  often,  the  agency  never  lost  its  convic- 
tion that  a  broader,  more  dynamic  group  program 
for  foster  parents  was  desirable. 

Early  in  1960  the  agency  took  steps  to  get  the  fos- 
ter parents'  own  ideas  on  the  subject.  It  submitted 

180 


a  questionnaire  to  all  its  foster  parents,  seeking  their 
frank  opinion  about  (1)  whether  they  wanted  a 
group  activities  program;  (2)  whether  they  would 
be  willing  to  help  the  agency  develop  a  new  pro- 
gram; (3)  what  suggestions  they  had  for  its  form 
and  content;  and  (4)  what  they  thought  were  the 
reasons  why  the  former  group  programs  had  not  been 
sustained. 

Eighty  percent  of  the  foster  parents  responded  to 
the  questionnaire,  most  of  them  indicating  a  strong 
interest  in  participating  in  an  expanded  group 
program. 

Getting  under  way 

The  agency  was  determined  not  to  produce  another 
short-lived  group  program.  It,  therefore,  re-exam- 
ined its  previous  experience  with  groujD  programs  in 
the  light  of  the  foster  parents'  I'esponses  to  the  ques- 
tionnaire and  identified  10  major  points  that  would 
have  to  be  kept  in  focus  in  developing  and  operating 
an  expanded  group  program. 

These  points  were : 

1.  Staff  members  have  to  be  available  to  the  foster 
parent  groups  on  a  sustained  basis. 

2.  The  staff  members  have  to  be  flexible  enough 
about  their  working  time  to  participate  in  evening 
meetings  or  Sunday  events. 

3.  Agency  suggestions  about  programing  camiot 
be  imposed  on  the  foster  parents  but  can  only  be 
introduced  as  the  foster  parents  are  ready  for  them. 

CHILDREN     •     SEPTEMBER-OCTOBER  1967 


4.  Out  of  respect  for  their  "quasi-professional" 
>i  atus,  the  foster  parents  must  be  encouraged  to  as- 
>iiine  responsibility  for  planning  and  handling  their 
meetings. 

5.  To  function,  adequately  as  "quasi-professional" 
persons,  the  foster  parents  need  to  have  a  complete 
picture  of  the  agency's  operations  and  some  Ivuowl- 
edge  of  the  other  child  welfare  i)rograms  in  the 
community. 

6.  Because  foster-parenting  is  a  specialty  for 
which  formal  training  has  not  been  developed,  one 
goal  of  a  group  piogram  must  be  to  teach  the  par- 
ticipants how  to  fultill  better  their  role  as  foster 
parents. 

7.  Pai'ticipation  in  a  group  progi-am  can  help  fos- 
ter parents  who  have  few  opportunities  for  socializa- 
tion compensate  for  this  deficiency  by  giving  them  a 
closer  identification  with  the  agency  and  the  broader 
community  of  child  welfare  services  than  they  had 
when  they  became  foster  parents. 

8.  Through  participating  in  programs  with  other 
couples  who  are  caring  for  foster  children,  foster 
parents — who  often  feel  isolated  in  their  work  with 
children — can  come  to  see  the  problems  of  foster 
children  and  their  natural  parents  in  a  broader 
perspective. 

9.  All  foster  parents  cannot  be  expected  to  partici- 
pate in  the  group  activities,  but  in  order  not  to  cause 
confusion  for  those  who  do,  communication  needs  to 
be  kept  open  between  the  caseworker  in  charge  of  the 
group  activities  and  the  caseworkers  who  work  indi- 
vidually with  the  foster  parents. 

10.  The  principle  of  confidentiality  of  infonnation 
must  be  respected  in  regard  to  children  and  foster 
parents,  although  in  group  activities  the  foster  par- 
ents will  inevitably  come  to  know  a  good  deal  about 
each  other. 

To  involve  the  foster  parents  in  planning  the 
group  program,  the  agency  called  a  meeting  of  eight 
couples  who  had  expressed  an  interest  in  participat- 
ing in  such  planning.  At  the  meeting,  the  group  was 
officially  designated  as  the  Foster  Parents  Planning 
Board.  This  board,  now  expanded  to  include  12 
couples,  still  contains  five  of  the  original  eight.  Over 
the  years  it  has  worked  with  the  staff  in  developing 
and  coordinating  the  educational  and  social  activi- 
ties in  a  greatly  expanded  program  for  foster  par- 
ents.  Step  by   step,  the  program   lias  grown   until 

VOLUME   14  -  NUMBER  5 


today  it  iuchules  an  annual  institute,  monthly  dis- 
cussion groups,  an  annual  series  of  study  workshops, 
and  a  variety  of  informational  and  social  activities. 

Experience  in  learnins 

The  animal  foster  i)arents'  institute  was  the  first 
project  planned.  The  first  institute  was  held  in  Octo- 
ber 1900;  the  eiglitii  will  be  lield  in  Seiitember  19C7. 
The  institute  is  alw;iys  held  on  a  Sunday  evening 
and  is  attended  by  foster  parents,  staff,  and  board 
members.  The  foster  mothers  take  complete  responsi- 
bility for  2)reparing  a  dinner  for  the  entire  group. 
In  doing  so,  they  have  learned  to  work  well  together. 

Following  the  dinner,  a  topic  for  discussion  is  pre- 
sented through  a  film  showing  or  a  production  of 
one  of  the  Plays  for  Living,  or  by  a  speaker.  After 
the  feature  pi-esentation,  small  groups  led  by  staff 
members  and  foster  parents  provide  opportunities  to 
discuss  the  points  made.  Subjects  selected  for  the 
institutes  have  been:  (1)  The  "Normal"  Needs  of 
Children;  (2)  The  Foster  Parent,  Casew-orker,  and 
Community;  (3)  The  Placed  Child;  (4)  The  Reli- 
gious Life  of  the  Child  in  Placement;  (5)  Handling 
the  Adolescent;  (6)  The  Unmarried  Mother  in 
Today's  Society;  (7)  The  Deep  Well— Life  in  Foster 
Care;  and  (8)  The  Educational  Deficits  in  the  Placed 
Child. 

In  developing  the  format  for  these  institutes,  the 
agency  considered  the  following  points :  This  type  of 
meeting  might  satisfy  the  needs  of  those  foster  par- 
ents who  wanted  some  agency  connection  and  some 
opportunity  to  learn  more  about  the  principles  of 
caring  for  foster  childi"en,  but  who  did  not  neces- 
sarily wish  to  attend  a  series  of  meetings.  It  might 
whet  the  appetite  of  other  foster  parents  for  more 
programs  of  an  educational  nature.  It  might  break 
down  some  of  the  barriers  between  foster  parents, 
caseworkers,  and  tlie  agency's  board  and  contribute 
to  a  cross-fertilization  of  ideas  among  them.  It  might 
help  fill  the  social  void  in  the  lives  of  some  of  the 
foster  parents  and  lielp  them  develop  an  esprit  de 
corps.  It  might  give  the  members  of  tjie  Foster  Par- 
ents Planning  Board  a  sense  of  accomplishment. 

Subsequent  experience  indicates  that  this  annual 
event  achieves  a  measure  of  all  these  goals. 

Stimulated  by  the  first  institute  to  want  more 
group  activities,  the  Foster  Parents  Planning  Board 
asked  for  a  series  of  discussion  meetings  open  to  all 
foster  parents  focused  on  foster  family  life  educa- 
tion, and  followed  by  a  coffee  hour.  Such  meetings, 
initiated  in  19G1,  are  now  held  every  month  for  G 


181 


months  of  the  year.  Held  in  the  evening,  they  are 
attended  regularly  by  about  a  third  of  the  parents. 

At  first,  these  discussion  meetings  centered  almost 
entirely  on  two  topics,  the  agency  in  general  and  the 
natural  parents  of  children  in  care,  both  topics 
emotionally  charged  for  the  foster  parents.  In  the 
early  sessions,  they  revealed  a  lack  of  Imowledge 
about  the  agency,  its  staff,  and  its  place  in  the  com- 
munity's social  welfare  structure.  In  discussing  the 
natural  parents  of  children  in  foster  care,  most  of 
what  the  foster  parents  had  to  say  was  negative  and 
hostile. 

As  time  went  on,  the  foster  parents  who  attended 
these  meetings  developed  a  deepening  appreciation 
of  their  place  in  the  agency's  constellation  of  serv- 
ices. They  also  began  to  examine  more  realistically 
the  source  of  their  hostility  toward  the  children's 
parents  and  to  show  an  increasing  awareness  of  how 
their  negative  attitude  tended  to  loosen  the  chil- 
dren's ties  to  their  parents  and  to  themselves.  They 
also  gradually  became  interested  in  learning  more 
about  the  "why"  of  children's  and  adults'  behavior, 
including  their  own. 

Over  the  years,  the  foster  parents  have  revealed 
in  their  group  discussions  an  increasing  thirst  for 
knowledge  about  the  origin  of  behavior  and  a  desire 
to  identify  themselves  more  closely  with  the  agency. 
In  these  meetings,  they  have  learned  much  about  the 
structure  of  the  agency  and  its  services  from  mem- 
bers of  the  agency's  staff,  including  the  casework 
supervisor  who  conducted  the  meetings,  the  agency's 
administrator,  the  psychologist,  the  psychiatrist,  and 
the  tutor;  and  about  the  dynamics  of  children's 
behavior  and  ways  of  handling  behavior  problems 
from  other  professional  persons  in  the  Philadelphia 
area,  as  well  as  from  members  of  the  agency's  staff. 

The  workshop  scries 

In  1965,  some  of  the  foster  parents  expressed  an 
interest  in  having  an  opi^ortunity  for  a  deeper  learn- 
ing experience.  They  were  backed  by  the  Foster 
Parents  Planning  Board,  which  pointed  out  that  most 
of  the  foster  parents  had  never  participated  in  the 
kind  of  planned  educational  program  professionals 
are  used  to.  Plans  for  an  exiDerimental  workshop 
series  ensiied.  This  was  designed  to  cover  eight  li/o- 
hour  sessions  centering  on  an  analysis  and  discussion 
of  case  material,  under  the  leadership  of  a  caseworker, 
at  the  end  of  which  each  foster  parent  would  turn  in 
a  written  report.  It  was  decided  to  restrict  partici- 
pation in  the  workshop  to  10  couples  who  were  caring 


Harriet  Goldstein  is  assistant  director  of  the 
Association  for  Jewisli  Children,  Philadel- 
phia. She  is  also  a  field  instructor  at  the 
Bryn  Mawr  College  School  of  Social  Work, 
a  member  of  the  executive  committee  of  the 
foster  homes  educational  project  of  the 
Health  and  Welfare  Council,  Philadelphia, 
and  a  member  of  the  publications  committee 
of  the  Journal  of  Jewish  Communal  Services. 


ibe: 


for  preschool  or  school-age  children  and  to  select 
those  who  were  the  first  to  apply  after  the  series  was 
amiounced. 

As  a  topic  for  the  series,  the  planning  board  chose 
"The  "World  of  Foster  Care"  as  one  broad  enough  to 
give  the  leader  leeway  in  the  presentation  of  materia] 
and  to  provide  many  stimuli  for  discussion. 

Four  more  couples  applied  for  the  workshop  than 
could  be  accommodated.  Of  the  10  couples  selected 
six  had  been  foster  parents  from  8  to  13  years.  Sever 
couples  attended  regularly;  three  had  to  drop  out 
because  of  unforeseen  circumstances  that  arose  in 
their  families. 

The  case  material  centered  on  a  5-year-old  fostei 
child,  Jiinmj-.  Before  each  session  the  participating 
foster  parents  were  sent  portions  of  the  case  to  read 
and  were  asked  to  consider  certain  aspects.  They  alsc 
received  a  suinmary  of  the  previous  session,  prepared 
by  the  leader. 

The  discussion  focused  on  the  following  aspects 
of  the  case : 

1.  The  child:  liis  behavior  patterns  before  and 
during  placement;  the  possible  meaning  of  this  be- 
havior; the  "normal"  behavior  jDattern  of  a  5-year-old 
child  and  what  constitutes  deviant  behavior;  the 
developmental  tasks  of  children  from  ages  1  to  5; 
the  modes  of  exj^ression  used  by  a  child  to  release 
fears  and  anxieties — his  grief  and  "mourning"  fol 
lowing  placement  and  his  demands  on  the  foster  par 
ents  during  this  period;  a  child's  feeling  of  guilt  be- 
cause he  created  the  problem  necessitating  the  place- 
ment. 

2.  The  natural  parents:  the  background  and  his- 
tory of  Jimmy's  parents;  the  cause  and  effect  of  the 
interaction  between  his  parents;  parental  attitudes 
affecting  Jimmy's  development;  the  meaning  to 
parents  and  child  of  the  parents'  impaired  capability 
for  being  parenting. 

3.  The  foster  parents:  examination  of  the  attitude 
of  Jimmy's  foster  jaarents  toward  his  own  parents 


182 


CHILDREN 


SEPTEMBER-OCTOBER  1967 


aiul  tlioir  reasons  I'm-  bcroming'  foster  parents;  dis- 
cussion of  tlio  possibilities  and  limits  in  foster  parent- 
hood as  a  way  of  contiiuiinii'  to  lia\i'  the  satisfaction 
of  heinir  a  jiarent ;  discussion  of  what  I'oster  parents 
expect  of  a  foster  child. 

■i.  The  caseworker:  the  role  of  the  social  woria-r  in 
the  child's  experience  before  and  during  placement; 
the  siirnificance  of  the  social  worker  to  the  child,  the 
natural  parents,  and  the  foster  parents. 

-Vs  anticipated,  in  the  discussion  most  of  the  par- 
ticipants' understanding,  sympathy,  and  compassion 
went  to  Jimmy.  Afterward,  the  foster  parents  citeil 
this  part  of  the  workshop  as  being  especially  helpful 
as  a  ''baseline"  for  dealing  with  their  foster  children. 
As  one  i)ointed  out,  "We  tend  to  forget  all  tiiat  we 
go  through  in  growing  up." 

In  the  sessions  on  the  natural  parents,  the  foster 
parents  exhibited  surprisingly  little  anger  toward 
the  parents  of  foster  children  and  a  great  deal  of 
empathy  with  them  as  people.  Perhaps  this  empathy 
developed  in  part  as  a  result  of  their  previous  discus- 
sions in  the  monthly  group  meetings.  Perhaps  it  was 
not  impeded  by  feelings  of  hostility  because  tlie 
parents  being  discussed  were  not  those  with  whom 
any  of  the  foster  parents  in  the  group  had  to  deal. 
Perhaps  it  also  came  from  learning  about  the  experi- 
ences these  parents  had  endured  and  recognizing  in 
them  elements  of  their  own  life  experiences. 

On  the  whole,  the  workshop  participants  revised 
their  attitude  toward  the  caseworker  durino-  the  dis- 


cussion of  Jimmy's  case,  although  they  continued  to 
express  lingering  fear  that  the  caseworker's  clo.seness 
to  Jimmy  could  impair  his  relationship  to  his  foster 
parents.  The}'  frequent  ly  observed  that  the  caseworker 
was  the  connecting  link  between  all  parties  in  the 
case  and  that  her  work  was  especially  important  in 
the  prejjlacement  period — a  new  idea  for  two  of  the 
foster  parents  who  hatl  once  been  u.sed  chielly  for 
emergency  placements.  They  also  observed  that  the 
positive  relationship  that  evolved  between  the  case- 
worker and  Jinnny,  a  highly  mistrustful  child,  was 
a  first  step  in  de\'el()ping  his  i-apacily  to  relate  to 
adtdlsataU. 

'I'lie  greatest  struggle  that  took  place  in  the  work- 
shop revolved  around  (he  foster  parents'  ideas  about 
themselves  and  their  reasons  for  becoming  foster 
[larents — the  question  of  whether  they  did  so  to  "do 
good"  to  another  person  or  to  achieve  self-fulfillment. 
In  trying  to  face  the  question  squarely,  they  talked 
about  the  way  foster  parents  seek  to  avoid  hurt  by 
not  allowing  themselves  to  h>\v  the  foster  child  com- 
pletely lest  the  child  be  returned  home,  and  about 
their  pain  at  being  frequently  reminded  that  the 
child  is  not  really  their  own. 

This  first  series  of  workshops  underscored  the 
importance  to  both  the  pai'ticipating  foster  parents 
and  the  agency  staff  of  continuing  efforts  to  develop 
the  skill  and  understanding  of  the  foster  parents. 
The  foster  parents  found  that  the  series  had  helped 
them  to  bring  out  and  deal  with  their  anxieties  as 
foster  parents.  The  minutes  of  each  workshop  session, 
jjrepared  by  the  leaders  and  shared  with  the  foster 


Foster  parents  meet  at  the  office  of  the  Association  for  Jewish  Children,  Philadelptiia,  to  discuss  their  problems  in  foster  care. 


}W^s 


mf 


parents  and  their  individual  caseworkers,  deepened 
the  caseworkers'  insight  into  the  motivations  of 
foster  parents  and  hence  increased  their  ability  to 
build  2)ositive  relationships  with  them. 

At  the  foster  parents'  request,  workshop  series 
were  again  held  in  1966  and  1967  with  the  respective 
topics,  "The  Home  Study,"  and  "Children's  Behavior 
Formation  and  Common  Causes  for  Misbehavior." 

In  the  1966  series,  again  led  by  an  agency  case- 
worker, the  discussion  centered  on  the  record  of  an 
actual  foster-home  study  and  emphasized  the  many 
factors  and  interrelationships  involved  in  the  eval- 
uation of  a  foster  home,  an  analysis  of  tlie  matching 
process,  and  the  weighing  of  positive  and  negative 
qualities  in  a  family  in  determining  whether  and  how 
their  home  will  be  used  by  the  agency.  The  partici- 
pants in  this  series  underscored  their  need  for  agency 
support  in  dealing  with  a  difficvdt  child  and  showed 
increasing  appreciation  of  the  similarities  and  differ- 
ences between  caring  for  foster  children  and  one's 
own  children. 

The  1967  series,  led  by  a  psychiatrist,  focused  on 
normal  and  abnormal  child  development,  the 
parental  role  in  the  creation  of  aberrant  behavior, 
the  deviations  in  behavior  to  be  expected  of  children 
separated  from  their  parents  for  any  reason,  what 
can  be  expected  of  children  placed  in  foster  care,  and 
ways  of  dealing  with  difficult  behavior  in  such  chil- 
dren. So  many  foster  parents  expressed  interest  in 
participating  in  this  workshop  that  the  enrollment 
limit  was  extended  from  the  usual  10  to  15  couples. 

Other  activities 

In  addition  to  the  educational  program,  the 
agency,  with  the  help  of  the  Foster  Parents  Planning 
Board,  has  developed  a  number  of  other  activities 
designed  to  bring  the  foster  parents  closer  to  the 
agency  and  to  each  other.  These  include: 

Welcome  teas,  held  intermittently  to  introduce  new 
foster  parents  to  the  activities  for  foster  parents,  are 
organized  by  a  committee  of  foster  parents.  As  soon 
as  the  agency  has  approved  a  couple's  home  as  a 
foster  home,  the  foster  parent  who  lieads  this  com- 
mittee sends  the  couple  a  not«  of  welcome,  following 
it  shortly  afterward  with  an  invitation  to  a  tea. 

A  newsletter,  issued  every  3  montlis  to  keep  foster 
parents    informed    about    the    agency,    the    foster 


184 


parents'  activities,  and  commmiity  programs  con- 
nected with  child  welfare.  It  is  written  by  tlie 
agency's  public  relations  director  with  the  help  of 
an  advisory  editorial  committee  of  foster  parents. 

A  manual  for  foster  parents,  developed  at  the  sug- 
gestion of  the  Foster  Parents  Planning  Board,  de- 
scribing the  principles  and  procedures  of  foster  care. 
A  committee  of  foster  parents  met  regularly  with  a 
member  of  the  staff  for  18  months  during  1965-66 
to  write  the  manual. 

A  transportation  committee,  composed  of  foster 
parents,  arranged  transportation  to  activities  for 
foster  parents  for  those  who  otherwise  could  not 
attend. 

In  conclusion 

No  formal  evaluation  has  been  made  of  this  pro- 
gram of  group  activities  for  foster  parents.  However, 
the  agency  is  convinced  that  it  has  strengthened  the 
foster  parents'  identification  with  the  goals  of  the 
agency — particularly  among  the  44  couples  (ap- 
proximately 60  percent)  who  have  consistently  j^ar- 
ticipated  in  some  part  of  the  educational  progi-am. 
The  agency  is  also  convinced  that  the  placements  of 
several  deeply  troubled  children  have  been  sustained 
througli  tlie  support  and  understanding  their  foster 
parents  have  gained  though  the  program  and  the 
hazards  of  replacement  thereby  avoided.  Many  foster 
parents  have  said  that  they  feel  better  equipped  to 
cope  with  their  foster  children  and  more  certain  of 
their  ability  to  carry  out  the  role  of  a  foster  parent 
because  of  their  participation  in  the  program. 

As  the  foster  parents  have  experienced  recogni- 
tion as  quasi -professionals,  they  have  broadened 
their  interest  in  the  welfare  of  children  in  general. 
Some  of  them,  at  their  own  suggestion  and  with  the 
approval  of  the  agency's  board  of  directors,  conduct 
a  yearly  campaign  called  the  Donor  Fund  Project 
to  raise  money  for  the  agency's  scholarship  fund. 
Others  are  working  with  civic  groups  in  behalf  of 
children,  writing  to  legislators  to  secure  better  pub- 
lic programs,  including  better  standards  for  public 
assistance.  Bringing  the  foster  parents  closer  to  the 
agency  has  increased  their  awareness  of  the  com- 
plexity of  personal,  interpersonal,  and  social  prob- 
lems behind  a  child's  need  for  placement  away  from 
home. 


CHILDREN     •     SEPTEMBER-OCTOBER  1967 


GROUP  LEARNING  FOR  FOSTER  PARENTS 


II.  IN  A  PUBLIC  AGENCY 


ADOLIN  G.  DALL 


Five  years  ago,  tiio  Bureau  of  Child  Welfare, 
New  York  City  Department  of  Social  Serv- 
ices, faced  with  a  loss  of  foster  parents,  be- 
gan a  program  which,  though  small,  has  demon- 
strated the  possibility  of  helping  discouraged  foster 
parents  tlirough  group  discussions  to  renew  their 
confidence  in  their  ability  to  handle  difficult  be- 
havior. Among  the  foster  parents  who  have  partici- 
pated with  intense  interest  have  lieen  several  who 
had  become  strongly  resistant  to  help  from  the  super- 
vising caseworker. 

The  bureau  established  the  Division  of  Foster 
Home  Care  18  years  ago  to  make  direct,  long-term 
placements  of  children  needing  care  away  from 
home.  Until  then,  all  such  placements  in  New  York 
City  had  been  made  by  voluntarj^  agencies  under  a 
purchase-of-care  arrangement  with  the  bureau,  but 
these  agencies  had  been  imable  to  meet  the  needs  of 
many  children,  particularly  Negro  Protestant  chil- 
di'en.  Because  most  of  the  children  placed  by  the  di- 
vision in  its  early  years  were  infants  or  toddlers, 
many  of  them  are  still  in  foster  care.  Therefore, 
many  of  the  1,200  young  people  in  the  division's 
care  today  are  adolescents. 

Over  the  years,  the  rapid  turnover  of  social  work- 
ers on  the  agency's  staff,  the  lack  of  professional 
training  and  experience  of  the  new  caseworkers,  and 
the  growing  number  of  adolescents  in  care  combined 
to  make  many  of  the  foster  parents  resistant  to  work- 
ing with  the  caseworkers  in  their  behalf.  An  increas- 
ing number  of  foster  parents,  especially  those  with 
teenage  foster  children,  began  to  doubt  their  ability 
to  continue  to  care  for  their  foster  children.  Some 


Based  on  a  paper  presented  at  the  1967  Forum  of  the  National 
Conference  on  Social  Welfare. 


discontinued  care,  thus  requiring  the  agency  to  re- 
place the  cliildren.  These  foster  parents  were  mature, 
dedicated  i)eople,  but  they  were  overwhelmed  by  the 
diiliculties  of  dealing  with  the  erratic  behavior  of 
adolescents — behavior  aggravated  in  many  instances 
by  early  childhood  deprivations  and  by  the  racial  un- 
rest in  the  neighborhoods  where  many  of  the  foster 
parents  lived. 

Therefore,  in  1962,  the  foster  care  division  initiated 
a  series  of  group  discussions  with  selected  foster 
parents,  using  as  group  leaders  two  members  of  its 
supervisory  stafT,  both  professionally  trained  social 
caseworkei's.  With  the  help  of  inservice  training  and 
consultation  from  a  faculty  member  of  the  Columbia 
Univei-sity  School  of  Social  Work,  these  caseworkers 
have  met  regularly  for  periods  of  6  weeks  with  groups 
of  foster  parents,  usually  in  the  communities  where 
the  foster  parents  live.  Thus  far,  only  45  of  the 
agency's  550  foster  parents  have  participated  in  the 
group  discussions,  but  these  have  included  some  of 
the  agency's  most  discouraged  and  frustrated  foster 
parents. 

From  the  beginning  of  the  program,  the  group 
leaders  have  kept  the  caseworkers  who  deal  individ- 
ually with  the  foster  parents  informed  of  their  plans 
and  of  the  groups'  progress.  No  foster  parents  have 
been  invited  to  participate  in  the  groups  without  pre- 
liminary discussion  between  the  group  leaders  and 
the  foster  parents'  caseworkers. 

At  first  some  of  the  caseworkers  expressed  fears 
about  what  group  participation  might  do  to  the  indi- 
vidual relationship  they  had  built  up  with  the  foster 
parents,  but  these  fears  ol)viously  diminished  as  the 
group  sessions  proceeded.  The  gi'oup  leaders  have 
always  been  available  to  the  caseworkei's  for  individ- 
ual   conferences    about    particular    case    problems 


VOLUME  14  -  NUMBER  5 

271-nsi — 07 " 


185 


that  liave  come  to  light  during  group  discussions. 
A  brief  description  of  the  Center  Village  Grouj) 
will  illustrate  both  the  objectives  and  the  effectiveness 
of  this  group  discussion  program. 

The  sroup 

The  Center  Village  Group  consisted  of  14  fostor 
mothers  and  two  foster  fathers  whom  the  case- 
workers had  had  difficulty  "reaching."  All  resided 
outside  the  city,  far  from  the  agency's  office.  They 
were  primarily  of  low-middle  socioeconomic  status. 
Twelve  were  Negroes  and  four  (two  couples)  were 
Caucasians.  Nearly  all  had  been  foster  parents  for 
many  years,  and  many  of  their  foster  children  were 
teenagers. 

Some  of  the  group  leader's  goals  were: 

•  To  give  the  foster  parents  an  oi^portunity  to 
express  and  work  out  their  anxiety  about  foster  care. 

•  To  give  the  members  an  opportunity  to  gain  sup- 
port from  the  experience  of  finding  that  other  foster 
parents  had  problems  similar  to  their  own, 

•  To  heighten  the  foster  parents"  identification 
with  the  agency. 

•  To  improve  the  care  provided  the  foster  children 
by  increasing  the  foster  parents'  skill  in  child  rearing. 

•  To  increase  the  foster  parents'  sense  of  self-worth 
and  so  to  enable  them  to  accept  their  foster  children 
more  fully. 

•  To  strengthen  and  supplement  the  caseworker's 
efforts  to  help  the  foster  ]iarents  with  their  child- 
rearing  problems. 

At  the  first  meeting,  the  leader  told  the  group 
members  that  they  would  be  meeting  for  six  sessions 
at  2-week  intervals  to  work  together  on  their  child- 
care  problems.  She  pointed  out  that  the  meetings 
belonged  to  the  foster  parents  and  that  all  discussion 
would  be  based  on  what  they  felt  was  important. 
From  the  beginning  of  the  discussion,  the  foster 
parents  recognized  that  the.y  had  difficulties  in  com- 
mon. The  following  is  a  condensed  cxcei'i^t  from  a 
report  of  their  first  meeting: 

The  group  members  talked  for  a  while  about  how  difficult  it 
was  for  them  to  tell  their  foster  children  about  their  real 
parents.  Then  Mr.  T  spoke  up.  His  voice  was  calm  when  he 
started,  but  as  he  proceeded  it  became  chocked  with  emotion. 
He  said  that  he  was  a  stepchild,  but  as  a  child  he  had  not  been 


told  of  this.  Until  he  was  13  years  old,  he  thought  that  his 
stepmother  was  his  real  mother.  Then  a  distant  relative  had 
told  him  that  his  real  mother  was  not  only  still  living,  but  was 
living  in  his  own  neighborhood. 

Describing  the  pain  of  this  sudden  discovery,  Mr.  T  said  he 
would  never  want  this  to  happen  to  his  foster  children.  There 
was  a  hushed  silence  in  the  room;  but  the  expressions  on  the 
faces  of  the  foster  parents  showed  that  Mr.  T  had  the  mem- 
bers' sympathetic  understanding.  The  leader  supported  Mr.  T 
by  saying  that  being  told  about  this  experience  had  helped  the 
group  members  to  comprehend  more  fully  what  a  foster  child 
may  have  to  face  if  he  does  not  understand  who  he  really  is. 

At  subsequent  meetings  the  group  members  helped 
each  other  with  their  common  problems  in  child  care 
in  many  ways.  They  also  helped  the  agency  learn 
more  about  what  foster  parents  were  up  against  and 
as  a  result  brought  about  some  changes  in  agency 
policy.  For  example,  at  the  fourth  group  session, 
they  decided  to  petition  the  agency  to  increase  its 
(•lothing  grant. 

A  foster  mother  spoke  of  the  inadequacies  of  the  clothing 
grant.  She  said  her  lO'/i-year-old  foster  daughter  wears  very 
large  sizes  ...  yet  the  money  the  agency  gives  her  for  clothing 
is  computed  on  the  basis  of  the  child's  age  rather  than  her  size. 
Then  nearly  all  the  group  members  complained  that  clothing 
their  foster  children  properly  was  a  real  problem  for  them. 
One  said,  "If  you  buy  cheap  clothing,  it  does  not  wear."  An- 
other pointed  out  that  older  children  have  to  have  a  "say  so" 
in  the  selection  of  their  clothes  or  they  just  won't  wear  them. 
One  foster  mother  said  angrily:  "It  is  impossible — the  clothing 
allowance  must  have  been  figured  out  15  years  ago."  Another 
said  that  the  problem  was  that  "the  agency  expects  you  to  buy 
at  inexpensive  chain  stores,  and  those  cheap  things  will  not 
last.  It's  throwing  the  money  out." 

Pointing  out  that  all  of  the  group  members  seemed  to  have 
the  same  problem,  the  leader  asked,  "What  have  you  done 
about  it?"  One  foster  mother  responded  bitterly,  "We  tell  our 
caseworkers." 

Mrs.  A,  the  most  hostile  group  member,  said  that  her  case- 
worker just  tells  her  if  she  spends  more  money  than  she  should, 
she  can  take  it  out  of  the  next  clothing  check.  She  pointed  out 
that  this  was  no  solution,  since  it  would  only  shorten  the 
amount  of  the  next  check,  and  she  added,  "It  just  doesn't  work 
out.  I  have  to  use  my  own  money." 

The  leader  asked,  "What  do  you  think  you  might  do  about 
it.'"  A  group  member  answered  helplessly,  "What  can  we  do?" 
Then  one  foster  mother  asked  hesitantly,  "Could  we  send  a 
petition  to  the  director?" 

The  rest  of  the  meeting  was  spent  in  drawing  up 
the  petition.  The  agency  had  been  considering  in- 
creasing the  foster  children's  clothing  allowance,  but 
the  foster  parents'  petition  undoubtedly  helped  has- 
ten the  process. 

As  the  meetings  of  the  Center  Village  Group  pro- 
gressed, the  themes  introduced  by  the  foster  parents 
included  the  meaning  of  the  foster  child's  therapy 


186 


CHILDREN     •     SEPTEMBER-OCTOBER  1967 


Id  the  I'osU'r  rainily  and  the  I'ostur  child,  iho  prohli'ia 
i)f  frequent  ehangcs  in  caseworkers,  the  trauma  ex- 
perienced by  the  foster  eliildrcn  and  foster  parents 
when  separation  takes  phice,  and  the  problems  of 
atlolescence.  The  gi-oup  members  expressed  their 
o[)inions  and  IVelinus  candidly.  Most  of  them  beiran 
to  see  how  frustrated  they  felt  when  they  failed  to 
meet  the  needs  of  their  foster  children. 

The  leader  learned  not  to  get  ahead  of  the  group, 
but  rather  to  help  the  members  to  delve  more  deepl}' 
into  each  "theme"'  or  problem  introduced  into  the 
discussion.  When  appropriate,  she  confronted  a  groni) 
member  with  the  meaning  of  what  ho  had  said  or 
suijporteil  an  emotionally  overwrought  foster  parent, 
but,  for  the  most  part,  she  concentrated  on  helping 
the  group  members  help  each  other.  Periods  of  silence 
became  less  threatening  to  the  leader  as  she  came  to 
realize  that  nuicli  of  what  happened  at  a  group  meet- 
ing was  not  verbal,  that  facial  expressions,  gestures, 
and  withdrawal  were  all  revealing  signs  of  the  degree 
of  a  person's  progress. 


In 


conclusion 


Because  of  the  great  variety  of  circumstances  and 
events  that  can  ati'ect  what  happens  in  foster  care, 
evaluating  the  overall  effects  on  the  welfare  of  child- 
ren of  a  group  program  for  foster  parents  is  difficult, 
if  not  impossible.  However,  we  ha\e  found  that  well- 
conducted  group  discussions  can  sustain  the  interest 
of  foster  parents,  for  the  attendance  record  in  three 
of  our  four  series  has  been  excellent.  Moreover,  case- 
workers ha\-e  noted  improvements  in  their  relation- 
ships with  some  foster  parents  after  they  have  at- 
tended the  group  meetings. 

Our  observations  lead  us  to  believe  that — 

1.  Foster  parents  who  felt  threatened  by  their 
neighbors'  negative  attitude  toward  foster  care  have 
gained  a  feeling  of  support  from  identifying  with 
each  other  as  members  of  a  group. 

2.  Foster  parents  who  have  been  hostile  and  diffi- 


Adolin  G.  Dall  is  a  senior  supervisor  in  the 
Division  of  Foster  Home  Care,  Bureau  of 
Cliilfl  Welfare,  Xew  York  City  Department 
of  Social  Services.  She  joined  the  depart- 
ment 14  years  ago  as  a  caseworlier  in  its 
Bureau  of  I'ublic  Assistance.  In  1962  she 
received  her  master's  in  so<-ial  science  from  jg^ ' 
A<lcli)hi  fniversity. 


f\ 


cult  to  work  with  in  a  one  lo-onc  relationship  have 
been  willing  to  discuss  I  heir  |iri)blcms  (if  diild  man- 
agement with  oilier  foster  [jarents. 

3.  In  genei-al,  the  part ici])at ing  foster  parents 
have  gainetl  i)erspecl  i\c  on  their  foster-care  problems 
through  learning  about  I  he  problems  of  other  foster 

parents. 

4.  The  foster  ])arents  have  often  worked  out  ways 
together  of  handling  the  typical  behavior  problems 
of  childhood  and  adolescence. 

5.  Some  of  I  he  pari  icipat  ing  foster  parents  have 
formed  friendships  with  each  other  that  have  led  to 
friendships  between  their  foster  children. 

The  learning  has  not  all  been  on  the  side  of  the 
foster  parents,  for  through  this  experience  the  agency 
has  increased  its  understanding  of  the  needs  of  foster 
parents  and  ways  of  dealing  with  them.  For  example : 

1.  Certain  aspects  of  foster  care  stood  out  as  prob- 
lems with  which  even  foster  parents  of  long-standing 
need  continuing  help — especially  the  foster  child's 
need  to  achieve  a  clear  conception  of  his  identity 
and  the  foster  parents'  fears  about  losing  the  child. 

2.  Many  significant  aspects  of  foster  care  remained 
untouched  or  came  up  only  wheii  the  participants 
were  leaving,  thus  indicating  a  need  for  continuing 
the  groups  beyond  the  allotted  six  sessions. 

Thus  far,  the  agency  has  held  four  series  of  group 
discussions  for  foster  parents,  each  group  containing 
from  eight  to  16  members,  chiefly  foster  mothers. 
Because  the  meetings  are  held  during  normal  working 
hours,  only  two  foster  fathers  have  been  able  to 
attend  regularly.  This  we  see  as  a  shortcoming,  par- 
ticularly because  of  the  importance  of  the  role  of  the 
foster  father  in  the  life  of  the  adolescent  foster  child. 

The  agency,  however,  has  a  real  commitment  to 
the  group  method  as  a  helping  process.  In  addition 
to  its  work  with  groups  of  foster  parents,  it  is  now 
holding  group  counseling  sessions  with  adolescent 
foster  children  and  is  planning  meetings  with  the 
natural  parents  of  children  in  foster  care.  One  of  the 
latest,  groups  formed  consists  of  foster  parents  of 
adolescent  boys  who  are  having  their  own  group 
counseling  sessions  with  an  agency  staff  member.  The 
aoency"s  <roal  is  to  have  the  staff  members  of  the 
foster  care  division  eventually  develop  such  skill  in 
working  with  both  individual  jiarcnts  and  groups 
that  tliev  will  feel  free  to  use  either  method. 


VOLUME   14  -  INUMBER  5 


187 


research  and  service  have  been  combined 

introducins 
FAMILY 

PLANNING 
CLINICS 


in 


to  LOUISIANA 


JOSEPH  D.  BEASLEY,  M.D. 


CARL  L.  HARTER 


In  these  days  of  mushrooming  social  re- 
search, many  people  have  voiced  concern 
about  the  amount  of  research  effort  that  re- 
sults only  in  tomes  on  library  shelves,  the  implications 
of  their  findings  for  community  action  buried  in  the 
stacks.  Researcli,  however,  tliat  is  specifically  related 
to  a  service  goal  can  become  the  foundation  not  only 
for  identifying  community  needs  but  also  for  build- 
ing the  services  to  meet  those  needs  in  a  way  that  offers 
opportunity  for  further  research.  Thus,  in  Louisiana, 
an  inquiry  into  the  attitudes  of  various  groups  of  the 
State's  population  toward  family  planning  has  re- 
sulted in  the  creation  of  the  first  family  planning 
clinics  in  the  State.  These  clinics  are  not  only  provid- 
ing poor  people  with  a  service  never  before  available 
to  them  but  are  also  producing  data  that,  when  sys- 
tematically analyzed,  may  have  important  implica- 
tions for  the  design  and  operation  of  family  planning 
clinics  for  disadvantaged  people  elsewhere. 

The  background 

In  1964,  no  organized  family  planning  clinics, 
either  public  or  private,  existed  in  Louisiana,  and  the 
State's  progress  toward  formulating  a  policy  con- 
cerning this  type  of  health  service  was  at  a  standstill. 
At  that  time,  section  14 :88  of  the  Louisiana  Criminal 
Code,  as  interpreted  by  the  attorney  general  in  1932, 
made  it  a  felony  to  disseminate  information  about 
contraceptives  or  any  birth  control  measures.  While 


188 


persons  who  received  medical  attention  from  private 
physicians  could  usually  get  help  with  family  plan- 
ning if  they  so  desired,  the  "medically  indigent" 
people  who  attended  public  health  centers  and  public 
hospitals  had  no  way  of  obtaining  such  service.  Leg- 
islative efforts  to  change  the  situation  were  of  no  avail. 
A  bill  introduced  in  the  lower  house  to  authorize  the 
State  Board  of  Health  to  start  and  maintain  com- 
munity educational  programs  focused  on  family 
planning  was  reported  out  of  committee  with  no  rec- 
ommendation and  was  thus,  in  effect,  killed.  Thus,  it 
became  obvious  that  if  any  break  was  to  be  made  in 
this  stalemate,  reliable  information  about  the  need 
for  family  planning  services  would  have  to  be  secured. 
Therefore,  the  Population  and  Family  Studies  Unit 
of  the  Tulane  University  School  of  Medicine's  Divi- 
sion of  Maternal  and  Child  Health  applied  to  the 
Children's  Bureau  for  Federal  funds  to  support  such 
an  investigation. 

The  project's  first  effort  was  to  obtain  data,  through 
a  questionnaire  administered  by  personal  interviews, 
from  a  "probability  sample"  of  368  men  who  had 
ever  been  married  and  540  women  who  had  ever  been 
married  or  i^regnant,  aged  15  through  45,  in  New 
Orleans.  (A  "probability  sample"  is  a  group  selected 
through  a  special  sampling  technique  to  be  accurately 
representative  of  the  total  population.  In  this  in- 
stance, 42  percent  of  the  908  persons  in  the  sample 
were  Protestant;  56  percent,  Roman  Catholic;  and 
2  percent,  subscribed  to  other  faiths.)  The  questions 

CHILDREN     •     SEPTEMBER-OCTOBER  1967 


ilwy  wiTf.  M.skL'd  wciT  designed  to  elioiL  iul'onnatiuii 
oil :  ( 1 )  The  respondents'  knowledge  of,  attitude 
toward  and  practice  of  family  planning;  (2)  tlio 
diUercnce^s  in  fertility  among  dill'erent  segments  of 
the  population;  and  (3)  the  family  structure  and 
family  stability  in  two  generations.  Preliminary 
analysis,  made  in  the  summer  of  10G5,  of  the  data 
secured  from  these  questionnaires  provided  the 
following  statistics: 

•  71  percent  of  the  women  interviewed  and  Si 
percent  of  the  men  did  not  know  enough  about  the 
ovulaloiy  cycle  to  know  that  the  fertile  period  in 
(lie  woman  is  approximately  the  middle  7  days  be- 
tween tw<i  miMislrual  Hows. 

•  :]i  percent  of  the  women  and  32  percent  of  the 
men  did  Jiot  know  that  pregnancy  results  not  just 
from  intercourse  but  from  the  union  inside  the 
woman  of  a  male  sperm  with  a  female  ovum. 

•  12  percent  of  the  women  and  5  percent  of  the 
men  did  not  know  of  any  natural,  mechanical,  or 
chemical  methods  of  preventing  conception;  another 
12  percent  of  the  women  and  15  percent  of  the  men 
knew  of  only  one  method. 

•  iO  percent  of  the  women  and  -40  percent  of  the 
men  said  they  would  like  to  have  more  information 
about  family  planning  methods;  and  38  percent  of 
the  women  and  '15  percent  of  the  men  either  said  they 
had  sufficient  knowledge  of  family  planning  methods 
or  were  sterile  or  in  a  sterile  union. 

•  91  jjercent  of  the  women  and  91  percent  of  the 
men  said  they  believed  that  couples  had  the  right  to 
decide  for  themselves  when  to  stop  having  children. 

•  92  percent  of  the  women  and  94  percent  of  the 
men  said  they  believed  that  family  planning  services 
should  be  made  available  to  the  medically  indigent. 

•  The  number  of  pregnancies  reported  by  the 
women  came  to  an  average  of  3.30;  their  unplanned 
pregnancies,  to  1.62.  The  men  reported  having 
"fathered"  an  average  of  3.39  pregnancies,  1.35  of 
them  unplanned. 

These  findings  suggested  that  a  large  majority  of 
the  population  believed  that  more  family  planning 
services  should  be  availaljle,  especially  for  people 
who  cannot  afl'ord  private  medical  care.  Many  of  the 
women  had  indicated  that  they  woidd  use  clinic  serv- 
ices if  they  were  available. 

The  data    also  .showed   that  one-half  of  tin-    1  12 

VOLUME  14  -  NUMBER  5 


Negro  women  in  tlie  saiii|)k'  hail  iiccn  pregnant  be- 
fore marriage,  and  that  31  of  thciii  were  still  single 
at  the  time  of  the  bii-tli  of  their  first  child.  Among 
the  398  white  women,  25  .said  they  had  had  premarital 
pregnancies,  and  2  said  they  had  had  a  child  out  of 
wedlock. 

Although  further  examination  of  the  data  is  re- 
quired to  be  sure,  preliminary  analysis  suggests  that 
women  who  begin  theii-  families  with  ])regnancy  be- 
fore marriage  are  contributing  more  to  the  Negro 
bii-lli  rate  than  are  those  who  begin  with  marriage. 
Such  families  tend  to  remain  disorganized,  for  when 
a  young  girl  gives  birth  to  a  child  out  of  wedlock 
her  chances  of  forming  a  stable  union  are  delayed  if 
not  considerably  reduced — prospective  husbands 
must  be  able  to  su])port-  a  child  as  well  as  the  mother. 
Therefore,  an  economic  drain  on  the  mother's  fam- 
ily usually  continues  for  some  time.  Moreover,  the 
family  hardly  has  time  to  recover  from  the  economic 
drain  of  raising  one  generation  before  it  must 
turn  to  the  problem  of  supporting  still  another 
generation. 

There  is  also  some  evidence  to  suggest  that  the 
children  of  families  that  begin  with  an  out-of-wed- 
lock birth  early  in  the  mother's  life  in  turn  tend  to 
begin  families  out  of  marriage  at  an  early  age,  thus 
making  for  a  rapid  turnover  in  generations.  As  a 
result,  disorganized  families  become  an  increasing 
proportion  of  the  population  as  a  whole.^ 

Armed  with  these  findings,  the  Population  and 
Family  Studies  Unit  worked  with  the  State  Board 
of  Health  to  secure  a  reinterpretation  of  section 
14:88  of  the  Louisiana  Criminal  Code.  In  August 
1965,  the  State's  attorney  general  issued  a  reinter- 
jn-etation,  subsequently  approved  by  the  Governor, 
making  it  legally  permissible  to  operate  family  plan- 
ning clinics  in  Louisiana  if  they   were  under  the 


Joseph    D.   Beasley,   M.D. 

(right),  and  Carl  L.  Harter, 

Ph.   D.,  have  been   director, 

and        associate        director, 

respectively,  of  Tiilane  Uni- 

versit.v's    Population    and 

Famil.v  Studies  Unit  since  its 

creation  in  April  196G  within 

the  Division  of  Maternal  and 

Child  Health.  Department  of  Tropical  Jledicinc  and  Public 

Health,  School  of  aie<licine.  In  .Tune  1967,  the  department 

became  the  School  of  Public  Health  and  Tropical  Medicine, 

and  the  "unit."  a  "center"   in  its  Department  of  Maternal 

and   Child   Health   and   Population.    Dr.    P>casley   is  a   full 

professor  in  the  new  soUool. 


189 


supervision  of  physicians.  This  paved  tlie  way  for 
the  establishment  of  pUot  family  planning  clinics 
for  the  study  of  the  medical  and  social  factors  in  the 
acceptance  or  rejection  of  family  planning  methods 
and  services.  Within  a  month,  the  Lincoln  Parish 
Family  Planning  Clinic  was  in  operation. 


Th 


I  clir 


e  rural  clinic 

The  Lincoln  Parish  Family  Planning  Clinic,  the 
first  family  planning  clinic  in  the  State,  was  estab- 
lished by  the  project  in  cooperation  with  the  Loui- 
siana State  Board  of  Health  as  a  part  of  the  regular 
services  of  the  Lincoln  Parish  Health  Unit.  Lincoln 
Parish,  a  rural  parish  (county)  in  northern  Loui- 
siana, was  selected  as  the  site  for  the  first  clinic  and 
program  because  (n)  the  "clinic  eligible"  population 
was  small  enough  (approximately  1,000)  that  evei-y- 
one  in  it  could  be  contacted  and  sei'ved  in  less  than 
2  years  and,  also,  small  enough  to  permit  trial-and- 
error  changes  in  the  program's  operation  without 
disrupting  service;  (b)  there  was  a  high  degi'ee  of 
cooperation  lietweeii  the  personnel  in  the  public  and 
private  health  agencies  in  the  area ;  and  (c)  the  parish 
had  characteristics  typical  of  other  rural  and  semi- 
rural  areas  in  the  South. 

During  the  first  6  months  of  its  oj^eration,  the 
clinic  restricted  its  service  largely  to  mothers  who 
were  in  the  postpartimi  period  of  childbirth.  During 
this  period,  the  project  also  conducted  a  survey 
among  249  Lincoln  Parish  couples  who  had  had  a 
child  in  the  previous  5  years.  (In  this  probability 
sample,  99  percent  of  the  couples  were  Protestant  and 
1  percent.  Catholic.)  The  same  questionnaire  was 
used  as  in  the  New  Orleans  survey  and  for  the  same 
purpose :  To  obtain  data  that  could  be  used  as  a  base- 
line in  establishing  procedures  and  guidelines  for  a 
parishwide  family  planning  program.  Completed  in 
December  1965,  the  sui-vey  produced  the  following 
preliminary  data : 

•  87  percent  of  the  women  and  82  percent  of  the 
men  did  not  know  enough  about  the  ovulatory  cycle 
to  know  that  the  fertile  period  is  approximately  the 
middle  7  days  between  two  menstrual  flows. 

•  47  percent  of  the  women  and  37  percent  of  the 
men  did  not  know  that  pregnancy  results  from  the 
union  inside  the  woman  of  a  male  sperm  with  a 
female  ovum. 

•  15  percent  of  the  women  and  3  percent  of  the 
men  did  not  know  of  any  natural,  mechanical,  or 

190 


chemical  methods  of  preventing  conception;  and  an 
other  19  percent  of  the  women  and  40  percent  of  the 
men  knew  of  only  one  method. 

•  71  percent  of  the  women  and  66  percent  of  the 
men  said  they  would  like  to  have  more  information 
about  family  jjlanning  methods;  another  21  percent 
of  the  women  and  32  percent  of  the  men  said  they 
had  sufficient  knowledge  of  family  plamiing  methods 
or  were  sterile  or  in  a  sterile  union. 

•  96  percent  of  the  women  and  87  percent  of  th( 
men  said  they  believed  that  couples  had  the  riglit  tc 
decide  for  themselves  when  to  stop  having  children. 

•  99  percent  of  the  women  and  98  percent  of  th( 
men  said  they  believed  tJiat  family  planning  services 
should  be  provided  for  the  medically  indigent. 

On  the  basis  of  data  from  this  stirvey,  as  well  as 
data  from  tlie  healtli  department's  vital  records  thai 
identified  mothers  at  ''high  risk"  of  having  compli- 
cations in  the  event  of  another  pregnancy,  the  proj 
ect  decided  to  broaden  the  scope  of  the  clinic'; 
services.  Therefore,  on  March  1,  1966,  tlie  service; 
were  opened  to  all  medically  indigent  motliers  anc 
married  women  in  Lincoln  Parish.  Before  this  wx 
done,  however,  the  project's  director  got  in  toucl 
with  the  religious,  political,  civic,  and  medical  lead 
ers  of  the  area  to  inform  them  of  the  reasons  for  thi 
clinic's  establishment.  All  agreed  to  the  principle: 
that  were  to  govern  the  clinic's  operation. 

In  the  clinic,  all  patients  receive  instruction  on 
(1)  the  meaning  of  family  planning  and  its  rela 
tionship  to  family  welfare;  (2)  tlie  mechanism  o: 
fertilization  and  subsequent  fetal  development;  (3) 
tlie  types  of  available  medically  sound  birth  con 
trol  methods  and  the  advantages  and  disadvantage: 
of  each;  and  (4)  the  official  positions  of  the  largei 
religious  denominations  on  family  planning.  After 
this  comprehensive  instruction,  all  patients  have  th( 
opportunity,  in  private  consultation  with  a  clinic 
staff  member,  to  decide  individually  wjiich  birtl 
control  method  they  want  to  use,  if  any.  Patients 
who  choose  the  rhythm  method  are  given  detailed 
instructions  and  continuing  consultation  on  its  use. 
Similarly,  patients  who  elect  the  use  of  a  contracep- 
tive are  provided  with  the  appropriate  equipment, 
instruction,  and  service.  Since  the  j^rogram  was  de 
veloped  as  an  integral  part  of  a  comprehensive 
maternal  health  service,  all  patients  receive  pelvic 
and  breast  examinations,  a  test  smear  for  cancer,  and, 
when  appropriate,  a  postpartum  evaluation. 

CHILDREN     •     SEPTEMBER-OCTOBER  1967 


le 


f: 


Of  (lie  csliinahMl  l.iiiKi  ••rliiiic  cliii-ilili's,"  :'.n  pci' 
I'll!  had  |-rc('i\fil  lainily  planning  ililniiiial  ion  ami 
iurxici's  liV  Septciiiber  1,  19(j('>;  that  is,  within  (i 
noiitlis  alter  tiio  clinic  began  full-scale  operation. 
This  amount  oi'  response  in  such  a  short  period  after 
he  openinif  of  the  service  suggests  that  the  desire 
,j  for  family  ]>lanniiig  services  indicated  in  the  surxey 
kvas  real. 

The  project  is  now  making  tlie  following  studies 
n  Lincoln  I'arish:  (1)  an  experimental  study  of 
he  elVect  of  the  method  of  recruitment  and  of  the 
>(Vecl  of  "parily""  (iiinnhcr  of  j)i-evious  childbirths) 
)n  a  woman's  participation  in  a  jiublic  lieallli  family 
)lanning  j)rogram;  (2)  a  comparative  study  o(  the 
(I'ectivene.ss  of  two  types  of  intrauterine  devi<'es  in 
I  publi<'  health  family  planning  program;  and  (.'5) 
V  fertility  analysis,  cost  analysis,  and  analysis  of 
service  statistics. 

The  urban  prosram 

The  next  step  in  furthering  the  project's  researcli 
:in  fertility  and  family  planning  was  to  tiT  to  e.stal)- 
ish  and  study  a  family  plaiming  program  for  the 
medically  indigent  population  of  a  large  urban  area, 
specifically  New  Orleans. 

The  plan  of  action  consisted  of  seven  steps: 

1.  Determine  the  AcceptahiUty  of  such  a  program 
to  the  community. 

2.  Design  a  program  that  would  smiultaneously 
provide  adequate,  efficient  service  to  all  eligible  and 
interested  patients  and  accumulate  detailed,  system- 
itic  data  for  medical  and  behavioral  scientists. 

3.  Secure  the  Support  of  the  community  leader- 
ship— religious,  civic,  and  political — for  such  a 
program. 

4.  Obtain  the  necessary  Money  to  establish  the 
program. 

5.  Put  the  program  into  Operation. 

6.  Evaluate  the  Results  of  flie  progi-am  and  use 
;hese  results  not  only  to  enhance  the  program  but 
ilso  to  keep  the  community-at -large  informed. 

7.  jMake  plans  to  Extend  the  program's  services  be- 
yond the  period  of  lime  encompassed  by  the  study 
phase. 

"\^nicn  the  initial  letters  of  each  key  word  in  these 
teps  are  combined,  the  result  is  the  acronym  "ADS 

VOLUME   14  -  NUMBER  5 


.M(  )1M''."  We  belie\  (i  t  hat,  sucli  a  |)r()gram  will  indeed 
aihl  ni<ire  to  the  health  caro  and  economic  and  social 
well-being  of  persons  in  the  conununity. 

With  regard  to  the  acceptability  (step  1)  of  a 
family  jdanning  program  to  the  ])eople  of  New 
Orlean.s,  the  Unit  had  already  found,  through  the 
family  and  fertility  survey  made  thei'e,  that  nine- 
teiilhs  of  both  Protestants  and  (.'atholics  believed 
that  family  ])lanning  services  ought  to  be  available 
to  the  medically  indigent.  Furthermore,  a  majority 
of  the  respondents  from  the  lowest  sfx'ioeconomic 
group  had  said  they  would  like  to  ha\('  more  family 
jilanning  information.  In  sli(»rt,  the  opinions  ex- 
pressed by  the  people  in  the  survey  sain])le  indicated 
not  only  that  a  public  health  family  ])lanning  pro- 
gi-am  would  be  acceptable  but  also  that  such  a  pro- 
gram was  actually  needed.  In  fact,  84  percent  of  the 
people  in  the  sample  had  said  they  were  in  favor  of 
the  establishment  of  either  a  tax-sup])ortcd  or  a  vol- 
untary family  planning  program. 

In  drafting  the  design  of  the  proposed  program 
(.step  2),  the  Unit  had  two  main  objectives:  (1)  to 
provide  clinical  services  to  interc.stetl,  eligible  persons 
in  a  maimer  consistent  with  the  dictates  of  their  con- 
sciences; and  (2)  to  pi-oduce  data  for  evaluative 
purposes. 

The  clmical  program  was  designed  to  provide  the 
same  type  of  individualized  sei'vice  as  the  Lincoln 
Parisli  clinic,  but  to  do  this  through  a  central  clinic 
and  five  satellite  clinics.  Similarly,  the  plan  for  ac- 
cumulating detailed,  systematic  medical  and  behav- 
ioral data  was  based  on  the  experience  gained  in 
designing  data-gathering  forms  for  the  Lincoln 
Parish  Family  Planning  Clinic.  This  consists  of  a 
system  of  recording  data  needed  for  both  following 
the  patient's  progress  and  evaluating  the  program. 

From  the  beginning  of  its  research  on  fertility  and 
family  planning  in  New  Orleans,  the  Population  and 
Family  Studies  Unit  kept  appropriate  city  offices, 
including  the  mayor's  office  and  the  local  health  and 
welfare  departments,  appropriate  \oluntary  orga- 
nizations, and  the  two  large  univereities  in  the  State, 
informed  of  what  it  planned  to  do  and  why  and 
presented  them  with  findings  from  the  survey  as 
these  were  obtained.  Building  relationships  with 
these  groups  took  2  years,  but  the  raj)port  thus  estab- 
lished brought  strong  conununity  sujjport  for  the 
proposed  clinical  program.  The  Population  and 
Family  Studies  Unit  received  letters  endorsing  the 
principles  of  its  proposal  from  the  Orleans  Parish 
Medical  Society,  the  Family  Life  Apostolate  of  the 
Archdiocese  of  New   Orleans,  the  Orleans  Parish 


191 


Department  of  Public  Welfare,  the  City  of  New 
Orleans  Department  of  Health,  the  Louisiana  Asso- 
ciation for  Mental  Health,  the  Charity  Hospital  of 
Louisiana  at  New  Orleans,  the  schools  of  medicine 
of  both  Louisiana  State  University  and  Tulane  Uni- 
versity, Total  Community  Action  (the  local  com- 
munity action  program,  or  CAP,  in  the  "war  on 
poverty"),  and  the  Greater  New  Orleans  Federation 
of  Churches.  The  proposed  pi'ogram  also  received 
approval  from  the  Social  Welfare  Planning  Council, 
which  represents  the  major  voluntary  health  and 
welfare  organizations  in  the  city,  and  tlie  local  affil- 
iates of  the  National  Association  for  tlie  Advance- 
ment of  Colored  People,  the  Congi-ess  of  Racial 
Equality,  and  the  National  Urban  Ijeague. 

To  operate  a  service  and  research  program  on  the 
scale  envisaged  for  New  Orleans,  money  had  to  be 
secured  to  supplement  the  funds  the  Population  and 
Family  Studies  Unit  was  receiving  from  the  Chil- 
dren's Bureau.  Additional  support  was  eventually 
secured  (step  4)  through  gi-ants  made  by  tlie  Ford 
Foundation  and  the  Rockefeller  Fomidation  to  the 
Population  and  Family  Studies  Unit  and  by  the 
Office  of  Economic  Opportunity  to  Total  Community 
Action.  By  A\)v'\\  13,  1967,  the  Unit  could  count  on 
$2.1  million  for  operating  the  Orleans  Parish  Family 
Planning  Demonstration  Program  for  3  years.  To 
receive  such  funds  and  administer  the  program,  a 
new  nonprofit  corporation  was  formed,  the  Louisiana 
Family  Planning  Program,  Inc.,  with  a  board  of 
directors  composed  of  members  of  the  faculties  of  the 
medical  schools  of  Tulane  and  Louisiana  State  uni- 
versities and  of  community  representatives. 

Program  operation 

The  central  family  j^lanning  clinic  opened  in  New 
Orleans  on  Jiuie  27, 1967.  Tliis  marked  the  beginning 
of  step  5 — putting  the  plan  into  operation.  The  five 
proposed  satellite  clinics  are  expected  to  be  provid- 
ing services  by  late  fall  1967  or  early  winter  1968.  At 
present,  tlie  project's  staff  is  preparing  a  procedural 
manual  for  use  in  training  clinic  personnel  and  to 
furnish  to  persons  interested  in  learning  about  the 
details  of  the  program.  A  similar  manual  has  been 
prepared  for  the  Lincoln  Parish  family  planning 
program. 

The  basic  data  needed  for  evaluating  the  results  of 
the  proposed  program  (step  6)  will  be  gathered  with 
the  use  of  a  form  for  i-ecording  compreliensive  data. 
In   addition  to  the  types  of   information  usually 


192 


sought  in  evaluation  of  a  family  planning  serv- 
ice— for  example,  rates  of  acceptance  and  continu- 
ance of  the  various  methods  of  birth  control  and 
changes  in  the  fertility  rate  in  the  neighborhood 
served — tlie  Unit  plans  also  to  conduct  inquiries 
into:  (1)  what  is  involved  in  the  acceptance  or  re- 
jection of  a  family  planning  clinic  by  members  of  a 
medically  indigent  population;  (2)  the  effects  of  in- 
formal communication  on  the  use  of  a  family  plan- 
ning clinic;  and  (3)  tlie  effectiveness  of  instructions 
about  family  planning. 

With  regard  to  step  7,  making  sure  the  program's 
services  extend  beyond  the  research  period,  the  serv- 
ice aspects  of  the  programs  have  been  designed  as 
integral  parts  of  the  regular  health  progi-ams  of  the 
participating  agencies — the  two  medical  schools,  the 
city  health  department,  the  Orleans  Parish  Depart- 
ment of  Public  Welfare,  and  the  State  Charity  Hos- 
pital at  New  Orleans.  The  principles  and  methods  of 
operation  and  the  record-keeping  systems  worked 
out  by  the  Population  and  Family  Studies  Unit  as  a 
result  of  its  exi^erience  with  the  Lincoln  Parish  and 
New  Orleans  family  planning  programs  will  be  the 
guidelines  to  be  followed  by  the  State  Board  of 
Health,  the  State  Department  of  Public  Welfare  and 
the  State  Department  of  Hospitals  as  they  makei 
plans  to  include  family  planning  services  as  part  of 
their  developing  health  programs.  The  Population 
and  Family  Studies  Unit  and  the  Louisiana  Family 
Planning  Program,  Inc.,  will  sei-ve  as  the  coordinat- 
ing agents  for  the  development  of  a  statewide  fam- 
ily i^lanning  program.  Plans  are  also  underway  for 
the  design  to  be  used  in  an  expanded  and  coordinated 
program  of  maternal  and  child  health  for  the  indi- 
gent mothers  and  children  of  New  Orleans. 

In  summary,  the  family  planning  activities  of  the 
Population  and  Family  Studies  Unit,  Tulane  Uni- 
versity, have  simultaneously  provided  a  laboratory 
for  scientific  investigations  and  an  avenue  through 
whicli  the  university  could  be  of  service  to  the  com- 
munity. The  objective,  both  in  research  and  service, 
is  to  make  it  j^ossible  for  couples  to  secure  the  infor- 
mation and  services  they  need  to  plan  their  families 
so  that  they  will  be  in  a  better  position  to  develop  the 
potential  of  each  of  their  children. 


^Fischer,  Ann;  Beasley,  Joseph  D.;  Harter,  Carl  L.:  The  occurrence 
of  the  extended  family  at  the  origin  of  the  family  of  procreation;  a 
developmental  approach  to  Negro  family  structure.  Unpublished  paper 
presented  at  the  annual  meeting  of  the  American  Anthropological  As- 
sociation, Denver,  Colo.,  November   18-22,  1965. 

CHILDREN     •     SEPTEMBER-OCTOBER  1967 


an 

EDUCATIONAL 
PSYCHOLOGIST 


ROBERT  FRIEDMAN 


Poor  schoohvork  leads  the  list  of  complaints 
parents  bring  to  orthopsychiatric  clinics.^ 
This  is  understandable,  for  our  culture 
highly  values  formal  learning.  Success  or  failure  in 
scliool  greatly  influences  the  behavior  of  cliildren 
and  the  imju'essions  they  have  of  themselves  and  can 
critically  affect  the  development  of  the  ego.  Clinical 
educational  psychologj%  with  its  emj^hasis  on  tlie 
healthy  de\-elopment  of  the  ego,  has  a  special  and 
essential  contribution  to  make  to  psychiatric  serv- 
ices for  children  and  adolescents.  Tlie  psyclio- 
educational  program  described  here  is  based  on  that 
proposition. 

The  setting 

Tlie  program  is  unusual  in  that  it  operates  not  in 
a  university,  a  hospital,  or  an  independent  agency,  as 
psychoeducational  programs  usually  do,  but  in  a 
psychiatric  clinic.  The  Department  of  Psychiatry  at 
the  Southern  California  Permanente  Medical  Group 
of  Los  Angeles,  which  conducts  the  program,  offers 
comprehensive  psychiatric  inpatient  and  outpatient 
sei^vices  at  a  central  clinic  on  contract  with  several 
local  labor  unions,  including  the  Retail  Clerks  and  the 
United  Auto  Workers,  AFL-CIO,  and  with  Federal 
and  State  cmployeas  for  service.  In  addition,  the 
department  provides  consultative  and  educational 
services  to  the  Kaiser  Foundation  Center  for  Child 
Psychiatry  in  Los  Angeles,  an  agency  offering  low- 
cost,  short-term  psychiatric  services  to  all  5-,  6-,  and 
7-year-old  children  in  the  communit}'  who  are  not 

VOLUME  14  -  NUMBER  5 


in  a 


PSYCHIATRIC 
CLINIC 


adapting  well  in  school.  The  department  has  more 
than  40  professional  workers,  including  psychiatrists, 
clinical  psychologists,  psychiatric  social  workers,  and 
a  speech  therapist. 

The  psychoeducational  program  was  set  up  late 
in  lOG-i  after  the  department  liad  explored  the  idea  of 
mcluding  psychoeducational  evaluation  in  the  clinic's 
regular  program  and  had  found  that  the  staff  was 
very  much  interested.  Its  first  act  toward  this  end 
was  to  engage  me  as  an  educational  psychologist 
specializing  in  the  clinical  evaluation  and  treatment 
of  children  and  adolescents  of  normal  intelligence 
who  have  been  doing  poor  schoolwork  and  as  a  con- 
sultant to  develop  and  supervise  clinical  educational 
services.  An  educational  therapist  was  added  to  the 
staff,  part  time,  in  May  1965,  in  response  to  the  grow- 
ing use  of  the  psychoeducational  service  by  the  regu- 
lar staff  members  of  the  department.  Psychoeduca- 
tional consultation,  evaluation,  and  therapy  were 
made  part  of  the  regular  program  of  the  department 
and  the  center  shortlj-  after  the  therapist  was  hired, 
and  in  September  1965  the  department  started  a 
training  program  for  school  psychologists  and  took 
on  two  interns  from  a  nearby  university. 

In  effect,  the  inclusion  of  a  psj'choeducational 
consultant  in  the  traditional  clinical  team  of 
psychiatrist,  social  worker,  and  clinical  psychol- 
ogist adds  a  fourth  member  who  contributes  ex- 
pert knowledge  in  the  area  of  learning  disorders  and 
tlie  problems  of  school  adjustment.  The  person  in  this 
position  is  responsible  for  psychoeducational  evalua- 
tion ;  supervision  of  psychoeducational  therapy ;  spe- 


193 


cial  consultation  with  parents,  staff  members,  and 
school  officials;  and  the  training  program. 

Some  overlapping  of  duties  among  specialists  is 
inlierent  in  the  structure  of  a  traditional  clinic  team, 
and  the  work  of  the  two  psychologists  at  first  did 
overlap.  Our  clinical  psychologist  is  responsible  for 
psychodiagnostic  services,  inchiding  treatment,  con- 
sultation, and  training;  the  duties  of  the  educational 
psychologist  are  described  above.  Although  both 
specialists  often  give  the  same  tests  to  measure  in- 
telligence, personality,  and  perceptual-motor  skills, 
close  cooperation  between  them  has  eliminated  dupli- 
cation and  has  improved  the  effectiveness  of  the  work 
of  the  team. 


The  prosram 

Our  program,  modified  and  improved  through  ex- 
Ijerience,  falls  under  four  major  heads — evaluation, 
consultation,  treatment,  and  training. 

Evaluation.  Complaints  about  a  chikrs  schoolwork 
are  particularly  frequent  at  intake  and  may  come 
from  the  child  himself  as  well  as  from  his  parents  or 
officials  of  his  school.  To  properly  consider  these  com- 
plaints we  must  often  do  a  compreliensive  psycho- 
educational  evaluation  of  the  child's  academic  skill 
and  intellectual  ability,  the  psychological  correlates 
of  learning  applicable  to  him,  the  effect  of  his  per- 
sonality on  his  attitude  toward  and  involvement  in 
the  learning  process,  and  what  his  family  expects  of 
him  in  school  and  its  attitudes  toward  achievement  in 
school.  A  key  issue  in  this  evaluation  is  the  way  in 
which  the  child  relates  to  the  demands  of  a  learning 
task — the  degree  of  anxiety  it  arouses  in  him,  the 
means  he  takes  to  reduce  stress,  the  degree  of  passivity 
or  affo-ressiveness  he  exhibits  toward  the  task  and 

OCT! 

toward  the  examiner  as  a  figure  of  authority,  and  any 
other  behavior  r-elated  to  schoolwork. 

In  addition  to  giving  standard  educational  tests, 
we  also  follow  informal  evaluation  procedures.  For 
example,  we  use  sample  schoolwork  sessions  as  a  test 
because  they  call  for  much  interaction  between  the 
child  and  the  examiner  and  afford  the  examiner  an 
opportmiity  to  study  closely  the  child's  reactions  to 
stress  and  frustration.  Through  interviews  with  the 
family — individually  and  as  a  group — the  examiner 
can  determine  the  effect  the  family  as  a  group  and  its 
members  as  individuals  have  on  the  child's  perform- 
ance in  school.  We  discuss  his  problems  with  his 
parents  or  with  his  brothers  and  sisters,  separatelj^ 
or  with  the  child  present.  Now  and  then,  we  ask  par- 

194 


ents  to  explain  or  demonstrate  the  methods  they  use  to 
help  the  child  with  his  homework  to  determine 
whether  the  parents  are  providing  the  help  in  a  con- 
structive way.  Interviews  with  the  family  as  a  group 
often  luicover  a  specific  relation  between  family  dy- 
namics and  a  child's  performance  in  school. 

In  the  first  18  months  of  the  program,  clinicians 
requested  over  60  evaluations.  Although  specific  rec- 
ommendations for  psychoeducational  intervention  or 
planning  often  followed  these  evaluations,  sometimes 
the  evaluation  of  a  learning  problem  uncovered  a 
condition  calling  for  nothing  more  than  a  reassuring 
word  to  a  child  or  his  parents. 

Consultation.  We  use  the  I'esults  of  the  evaluation 
in  several  ways.  Sometimes  we  only  report  them  to 
the  referring  clinician  or  discuss  them  at  intake  staff 
meetings.  Frequently  it  is  helpful  for  me  to  explain 
the  results  directly  to  parents  in  a  conference  with 
the  clinician  because  the  word  of  an  "educational 
authority"  often  carries  more  weight  than  that  of  a 
clinician  with  parents  who  find  it  difficult  to  accept 
results  and  follow  through  on  recommendations. 

We  often  share  with  the  school  through  written 
reports  or  informal  meetings  findings  that  teachers, 
principals,  or  school  guidance  workers  can  use  to 
advantage. 

I  am  available  to  the  staff  for  special  consultation 
about  the  many  needs  of  their  patients.  For  example, 
they  may  consult  me  about  the  merits  of  a  school, 
for  the  right  school  is  often  critical  in  planning  for 
some  of  the  children  we  serve.  Wlien  the  issue  oi' 
school  placement  is  raised,  I  review  information  on 
available  resources,  including  the  experience  we  have 
had  with  these  resources,  and  recommend  a  specific 
public,  private,  or  residential  school. 

Occasionally,  I  have  the  unusual  duty  of  acting  as 
a  cotherapist  in  a  family  therapy  program  wheii  a 
case  involves  school  problems  that  are  exacerbating 
family  tension,  or  when  therapy  for  the  child  can 
be  speeded  up  by  involving  the  family  more  fully 
in  treatment  through  concentrating  on  school 
problems. 

Another  of  luy  duties  is  to  make  presentations  to 
and  to  participate  in  staff'  meetings  and  seminars. 

Treatment.  With  our  patients — children  and  ado- 
lescents having  trouble  in  school — we  use  psychoed- 
ucational therapy,  a  method  of  treatment  centering 
on  learning.  (The  term  "psychoeducational  therapy" 
as  used  here  reflects  a  theoretical  position  put  for- 
ward by  my  colleague,  Edwin  Strickler,  and  my- 
self.) Our  treatment  includes  the  use  of  a  wide  range 

CHILDREN     •     SEPTEMBER-OCTOBER  1967 


Robert  Friedman,  im  oilucatioiuil  iisycluilo- 
gisl  ill  privuto  practice  iu  Los  Angeles, 
serves  as  a  consultaut  ou  educational  psj- 
cliology  to  a  number  of  psychiatric  and  child 
guidance  clinics  in  the  area:  the  Southern 
Caliltunia  I'erniauente  Medical  Group,  the 
Kaiser  Foundation  Center  for  Child  Psy- 
chiatry, Ihe  Keiss-Davis  Child  Study  Center, 
and  the  Mental  Ileallh  Development  Center  of  the  local 
atliliate  of  the  Ketail  Clerks  Union,  AFI^CIO. 


t^^ 

^•J. 


of  practices,  iiicludiiiii-  rcmciliiil  work,  counsel iup-, 
play  Ihorupy.  ami  laiiiily  therapy. 

Remediiil  work  to  correct  a  lack  of  skill  a  child 
needs  in  school  is  an  important  part  of  treatment, 
but  its  results  are  not  themselves  the  major  goal.  We 
emphasize,  rather,  making  a  positive  change  in  the 
child"s  attitude,  increasing  his  motivation,  and  mod- 
ifying personality  traits  that  negati\el3'  afl'ect  his 
adjustment  to  school.  Our  treatment  is  unusual  in  the 
scope  of  its  tlieoretical  conception  and  in  the  degree 
to  which  it  is  an  integral  part  of  a  complete  psychi- 
atric service.  For  example,  we  provide  psychoeduca- 
tional  therapy  as  a  single  treatment-of-choice  and 
consider  it  as  a  primary,  not  an  adjunctive,  service. 
When  the  child's  learnmg  difficulty  can  apparently 
be  resolved  by  tutoring  only,  we  refer  him  to  a  school 
or  another  community  resource  offering  the  kind  of 
service  he  needs. 

More  than  35  children  and  adolescents  have  been 
involved  in  the  therapy  to  date.  The  therapeutic 
method  we  must  frequently  use  at  first  is  this :  we  try 
to  establish  a  warm,  accepting  relation  between  the 
child  and  the  therapist  and  to  strengthen  the  relation 
bj'  giving  the  child  an  opportunity  to  attain  success 
in  school.  To  help  the  child  achieve  this  success,  we 
must  usually  combine  remedial  teaching  with  op- 
portunity for  cathartic  release  of  feelings  by  the 
child  and  for  exploration  and  interpretation  of  emo- 
tions and  behavior  by  the  therapist.  Getting  the 
cliild  to  talk  about  his  feelings  concerning  school- 
work  and  then  getting  him  to  see  and  understand 
the  interaction  between  his  feelings  and  his  school - 
work  is  frequently  the  next  step  in  therapy.  As  the 
child's  relation  with  and  confidence  in  the  therapist 
grow,  his  academic  skill  usually  improves.  We  find, 
however,  that  a  skill  mastered  in  a  therapy  session 
is  not  always  used  in  the  classroom.  If  it  is  not,  then 
the  discrepancy  between  performance  in  the  clinic 
and  in  the  school  becomes  the  focus  of  attention  and 
of   the   process  of   "working  through.*'   Exploring 


fears,  inhibitions,  disturbed  ideas  of  object  relations, 
a  negative  attitude  toward  iiuthority,  and  difficult 
relations  with  family  and  other  children  niiiy  at 
limes  be  the  "content"  of  treatment.  The  therapist 
is  always  free  to  work  with  whatever  behavior  or 
feelings  come  out  in  the  therapy  session. 

Tlic  case  of  Don  D  illustrates  our  usual  method 
t)f  working  with  children: 

When  Don  began  treatment  at  the  age  of  8,  he  was  an 
extremely  nervous  boy  and  was  very  much  afraid  of  facing 
schoolwork,  especially  reading.  At  first  we  gave  him  very  easy 
material  to  read,  which  he  was  soon  able  to  do.  With  success 
in  reading,  his  stress  diminished  and  he  was  able  to  reflect  on 
and  accept  his  feelings  about  reading — and  even  to  say  "I  don't 
uuiit  to  read."  We  then  explored  the  reasons  for  his  resistance 
to  learning  and  found  that  his  reading  problem  was  tied  up 
with  denial  of  many  important  emotions,  including  his  reac- 
tions to  his  mother's  overprotectiveness  and  his  father's  harsh- 
ness. We  also  found  that  Don  thought  that  learning  to  read 
meant  growing  up  and  growing  away  from  his  mother.  Also, 
Don  had  linked  the  denial  of  sexual  matters  and  the  ignoring 
of  issues  raised  by  curiosity  about  sex  in  his  home  to  resistance 
to  seeing  words  and  sentences. 

Gradually,  the  therapist  helped  Don  overcome  his  sensitivity 
to  visual  stimuli  conneaed  with  mother-son  and  man-woman 
relationships  through  the  use  of  picture  stories  and  puppet  play. 
To  help  Don  see  that  his  negative  attitude  toward  school  was 
keeping  him  from  reading  as  well  in  the  classroom  as  in  the 
clinic,  we  had  him  attend  tutoring  sessions  with  another  boy 
with  similar  problems.  The  boys'  spontaneous  interaction  and 
their  comments  about  school  and  therapy  focused  attention  on 
the  attitude  toward  school  that  was  keeping  them  from  doing 
better  work.  These  sessions  helped  Don  become  more  comfort- 
able with  learning  tasks  at  his  grade,  and  after  19  months  of 
treatment,  he  did  satisfactory  schoolwork.  We  also  found  that 
he  was  able  to  recognize,  tolerate,  and  handle  long-repressed 
and  troublesome  feelings  and  fear — an  improvement  we  con- 
sidered at  least  as  important  as  the  improvements  he  has  made 
in  his  schoolwork. 

Other  examples  of  the  use  of  these  or  similar 
methods  in  treating  such  children  exist  in  the  liter- 
ature,="^  but  the  case  of  Stuart  S,  one  of  our  clients, 
illustrates  the  use  of  an  unusual  method  of  treating 
a  child  with  a  problem  in  learning. 

Stuart,  a  9-year-old  boy  who  exhibited  great  passive  re- 
sistance to  learning,  had  been  exposed  to  much  intellectualized 
talk  in  the  home  about  feelings,  emotions,  and  attitudes.  A 
psychiatric  social  worker  was  seeing  both  his  father  and  mot'ner 
in  individual  therapy  sessions.  From  the  beginning  of  Stuart's 
treatment  at  the  clinic,  his  therapist  met  his  resistance  force- 
fully and  tenaciously  with  an  attitude  that  said  in  effect,  "You 
can  do  this  hard  work  if  you  try,  and  I  expect  you  to  try." 
After  a  long  struggle,  which  included  many  sessions  in  which 
the  two  said  very  little  of  meaning  to  each  other  (but  in  which 
there  was  much  transactional  content,  that  is,  the  child  and 
the  therapist  "communicated"  by  silence,  actions,  or  motions 
with  each  other),  the  boy  was  able  to  see  the  connection  be- 


VOLUME  14  -  NUMBER  5 


195 


tween  his  wish  to  remain  an  infant  and  his  poor  achievement 
in  school. 

The  therapist  speeded  up  the  therapeutic  process  by  involv- 
ing the  mother  in  several  sessions  with  Stuart,  getting  the  father 
to  take  part  in  the  treatment  hour  as  a  teacher-authority,  and 
holding  several  family  group  meetings.  As  a  result,  the  father, 
who  had  been  passive  toward  his  son  before  treatment  started, 
eventually  assumed  his  duties  as  a  father  with  Stuart  and  his 
change  helped  the  child  take  a  more  aggressive  attitude  toward 
learning  and  improve  his  attitude  toward  and  achievement 
in  class. 

Although  we  conduct  most  psychoeducational 
therapy  individually,  we  do  carry  on  some  work  with 
small  groups  because  we  recognize  the  potential 
value  of  work  in  a  small  group  as  a  transition  from 
individual  therapy  to  the  classroom,  especially  for 
children  who  have  been  excluded  from  a  public 
school  because  of  their  unacceptable  behavior.  For 
the  most  part,  such  children  are  hyperactive,  highly 
distractable,  and  disturbed,  and  they  find  it  very 
difficult  if  not  impossible  to  share  the  teacher's  atten- 
tion with  other  pupils,  to  work  when  other  children 
a,re  present,  or  to  work  or  play  with  other  children. 
If  a  child  can  acquire  enough  control  to  act  as  a  so- 
cial being  in  a  classroom,  at  first  with  only  one  other 
child,  later  with  several  cliildren,  the  probability  of 
his  returning  to  the  classi'oom  permanently  will  be 
greater.  Our  experience  with  a  group  set  up  for  this 
purpose  is  encouraging,  and  group  treatment  is  now 
part  of  our  program. 

Training.  Recently  revised  reqvurements  for  school 
psychologists  in  California  increase  the  emphasis  on 
supervised  internships.  Because  we  concentrate  more 
than  most  clinics  on  school  problems,  our  clinic  offere 
an  appropriate  placement  for  advanced  graduate 
students.  The  training  experience  our  clinic  offers 
includes  opportunities  to  attend  intake  sessions, 
treatment  sessions,  and  seminar  staff  meetings,  as 
well  as  to  complete  assignments  for  psychoeduca- 
tional diagnostic  studies,  coimsel  parents,  and  con- 
duct psychoeducational  therapy.  As  a  consultant,  I 
closely  supervise  the  work  of  the  interns. 

In  addition  to  giving  breadth  and  depth  to  clinical 
study,  the  internship  enables  the  trainees  to  acquire 
a  realistic  idea  of  how  a  psychiatric  clinic  operates, 
because  such  a  clinic  is  the  kind  of  service  to  which 
they  will  make  many  referrals  in  their  later  work. 


In  turn,  they  can  pass  on  a  better  understanding  of 
both  the  merits  and  limitations  of  psychiatric  serv- 
ices to  teachers  and  other  school  people. 

At  present,  we  have  in  training  one  school  psychol- 
ogy intern  from  the  University  of  Southern  Cali- 
fornia and  one  from  the  University  of  California  at 
Los  Angeles. 

A  summing  up 

To  sum  up  this  report  on  the  clinic,  our  experi- 
ence with  the  program  supports  earlier  findings  re- 
garding the  merit  of  clinical  educational  services  in 
the  orthopsychiatric  clinic.''"^  Li  addition,  I  find  that 
research  on  such  significant  questions  as  the  influence 
of  personality  on  learning  and  on  the  potential  for 
treatment  with  psychoeducational  therapy  needs 
to  be  designed  and  carried  through  systematically. 

The  link  between  education  and  psychology  offers 
many  opportunities  to  use  creative  methods  in  work- 
ing with  a  child  in  the  clinic  and  m  the  school.  I  am 
firmly  convinced  that  clinical  educational  psychology 
can  make  a  significant  contribution  to  a  greater 
understanding  of  the  dynamic  interaction  of  teacher 
and  pupil.  What  is  the  real  challenge  such  a  program 
must  meet  but  to  help  all  schoolchildren  fulfill  their 
potential  for  growth? 


'Rablnovitch,  R.  D.:  Reading  and  learning  disabilities.  In  American 
handbook  of  psychiatry  (Silvano  Arieti,  ed.)  Basic  Books,  New  York. 
1959. 

"Axline,  V.:  Nondirective  therapy  for  poor  readers.  Journal  of  Con- 
sulting Psychology,  March-April  1947. 

'Ephron,  B.  K.:  Emotional  difficulties  in  reading.  Julian  Press,  New 
York.  1953. 

*  Friedman,  S.  S.:  Remedial  therapy  with  a  12-year-old  incarcerated 
delinquent.  TAe  Reading  Teacher,  April  1966. 

°  Prentice,  N.  M.;  Sperry  B.  M.;  Therapeutically  oriented  tutoring  of 
children  with  primary  neurotic  learning  inhibitions.  American  Journal 
of  Orthopsychiatry,  April  1965. 

°  Blom,  G.  E.;  Rudnick,  M.;  Searles,  J.;  Some  principles  and  prac- 
tices in  the  psychoeducational  treatment  of  emotionally  disturbed  chil- 
dren. Psychology  in  the  Schools,  January  1966. 

'Miller,  D,  D.:  Language  and  learning  skills:  functions  of  the  educa- 
tional psychologist  in  a  psychiatric  setting  for  children.  American 
Journal  of  Orthopsychiatry,  March  1962. 

^American  Association  of  Psychiatric  Clinics  for  Children:  Tutorial 
program  for  troubled  children.  Netvsletter  of  the  American  Association 
of  Psychiatric  Clinics  for  Children,  February  1963. 


196 


CHILDREN     •     SEPTEMBER-OCTOBER  1967 


an  essay  review 


•  Dr.  Uobort  Colt's  dedicates  his 
lioolc  "Children  of  Crisis:  A 
Study  of  Courage  and  Fear"* 
"to  the  children  of  a  coming  South," 
and  he  quotes  the  Biblical  verse :  "And 
Moses  sent  them  to  spy  out  the  land  of 
Canaan,  and  .said  unto  them  .  .  .  see 
the  land  .  .  .  and  the  people  that 
dwelleth  therein,  whether  they  be 
strong  or  weak."  Thus  he  sets  the  tone 
of  his  observations  and  reflections.  He 
is  concerned  with  the  sources  of 
strength  and  the  ways  in  which  chil- 
dren and  their  supportive  parents, 
grandparents,  and  teachers  struggle 
with  the  fear  generated  by  the  strife 
aroused  during  the  process  of  school 
desegregation. 

He  writes  as  a  man  of  deep  sensi- 
tivity, reflectiveness,  and  love,  and  with 
the  insight  of  an  "anthropological 
psychiatrist"  uncommonly  receptive  to 
people's  feelings.  His  own  strength 
includes  an  unostentatious  autonomy 
and  integrity  that  make  it  natural  for 
him  to  describe  children  very  simply, 
through  their  own  language  of  picture 
and  word,  without  substituting  com- 
plex diagnostic  cliches  for  fresh  formu- 
lations based  on  insight. 

Dr.  Coles  undertook  his  studies  of 
the  children  caught  up  in  the  de.segrega- 
tion  movement  and  "the  people  who 
nurture  them,  teach  them,  and  on  oc- 
casion fail  them  terribly"  in  1958.  He 
has  continued  to  see  many  of  the  chil- 
dren and  families  periodically  over  the 
ensuing  9  years.  His  method  of  study 
is  that   of  direct   observation,   "talking 


•Coles,  Robert:  Children  o£  Crisis:  A  Study 
of  Courage  and  Fear.  Little,  Brown  and  Co., 
Boston,  Mass.  1967.  401  pp.  S8.50. 


CHILDREN 

COPE  WITH 

CRISIS 


LOIS  BARCLAY  MURPHY 

Director,  Division  of  Dei'elopment  Research 
The  Menninger  Foundation,   Topelia,  Kans. 


with  people,  listening  to  them,  watch- 
ing them — and  being  watched  by  them" 
and  "taking  a  long  time :  enough  time 
to  be  confiused,  then  absolutely  certain 
and  confident,  then  not  .so  sure  but  a 
little  more  aware  of  why  one  or  another 
conclusion  seems  the  best  that  can  be 
argued   [for].  .  .  ." 

Dr.  Coles  tried  to  find  out  how  chil- 
dren managed  under  stress,  that  is,  ab- 
normal and  dangerous  circumstances. 
Children  and  adults  who  entered  the 
mainstream  of  the  desegregation 
process,  or  were  caught  up  in  it,  he 
believed,  have  "disc'^rnible  cause  to  feel 
nervous,  to  develop  .  .  .  symptoms  in 
both  mind  and  body."  He  was  inter- 
ested in  whether  they  did  so  and,  if 
they  did,  how  and  w-hen  they  did ;  and 
also  who  chooses  which  kind  of  danger 
and  for  what  reason.  His  deepest  in- 
terest was  in  learning  what  makes  "for 
survival  under  stress,  for  endurance, 
for  courage  against  grim  odds ;  indeed, 
for  plain  good  health.  .  .  ." 

He  was  also  interested  in  what  the 
child's  mind  makes  of  the  world — of 
politics,  race,  and  the  power  of  money — 
and  why  one  person  is  satisfied  to  make 
peace  with  the  world  while  another 
takes  the  world  on  and  tries  to  change 
it.  He  felt  that  as  a  clinician  inter- 
ested in  what  goes  on  "inside"  others, 
he  was  "as  qualified  as  anyone  to  go 
back  and  forth,  to  see  how  the  two 
worlds  (outside,  inside)  connect,  blend, 
engage.  .  .  ."  That  is,  he  wanted  to  un- 
derstand the  connection  between  a 
child's  or  a  man's  thinking  and  the 
world's  state  of  affairs.  So,  he  went 
into  phii-cs  where  certain  people  were 
up  against  difficult  times  "so  that  their 
lives,  like  those  of  the  sick,  may  have 
[had]  something  to  teach  the  rest  of 
us." 


Dr.  Coles'  intellectual  heritage  is 
rich.  He  draws  deeply  from  Erik  Erik- 
son's  concepts  and  vision  of  the  every- 
day relatedness  of  the  human  mind  to 
social  institutions  and  to  history,  and 
from  the  simplicity  of  Anna  Freud's 
observations  of  English  children  under 
air  attack  and  children  .salvaged  from 
concentration  camps,  and  her  examples 
of  combining  observation  with  prac- 
tical service.  He  also  draws  perspec- 
tive from  Tolstoi  and  a  sharpened 
awareness  from  Oscar  Lewis,  Bruno 
Bettelheim,  Faulkner,  and  Kaflia. 
Doubtless  these  writers,  along  with  an 
apparent  Biblical  heritage,  contributed 
to  the  poise,  grace,  and  dignity  of  his 
writing  and  of  his  feeling  for  people. 

Self-imase 

Dr.  Coles  gives  us  vivid  action  por- 
traits of  young  children,  both  Negro  and 
white,  who  participated  in  the  desegre- 
gation of  schools  in  Atlanta  and  New 
Orleans  and  of  their  teachers  and  par- 
ents. Protesting  and  nonprotesting  in- 
tegrationi.sts  in  the  South  and  even 
segregationists  are  all  presented  with 
understanding. 

He  includes  pictures  dr.iwn  by  two 
first-grade  children,  Negro  Ruby  and 
white  .Jimmie,  as  direct  evidence  of  the 
everyday  stress  of  being  a  Negro  child 
in  a  rejecting  white  world.  The  draw- 
ings reveal  both  children's  sense  of  the 
Negro  child's  incompleteness,  inade- 
quacy, or  distortion  through  small  fig- 
ures drawn  with  shaky  lines,  missing 
fingers  and  features,  and  lack  of  vivid 
detail. 

I  found  Kuby's  pathetic  representa- 
tion of  her  self-image  especially  shock- 
ing in  contrast  to  the  clarity,  vigor,  and 
spontaneity    of   colored   children  in   a 


VOLUME   14  -  NUMBER  5 


197 


colored  ivorld — as  with  cbildren  in  Ni- 
geria— and  even  in  contrast  to  the  vigor 
of  many  Negro  children  in  a  town  like 
Topeka,  Kans.,  where  schools  have  been 
integrated  for  a  dozen  years. 

Dr.  Coles  learned  about  the  coping 
patterns  of  the  Negro  children  not  only 
from  them  but  also  from  observant 
white  children  aware  of  their  experi- 
ences. He  learned  that  before  desegre- 
gation George,  who  told  about  crying 
when  a  beloved  Negro  maid  left  his 
family  when  he  was  5  years  old,  had 
completely  identified  with  the  Southern 
attitude  toward  race  and  with  the 
Southern  resentment  towai'd  Northern- 
ers who  do  not  realize  the  love  some 
Southerners  have  for  the  individual 
Negroes  they  live  close  to.  He  suggests 
that  perhaps  this  background  of  early 
attachment,  along  with  a  native  intel- 
ligence, underlay  George's  sensitivity  to 
the  behavior  of  Lois,  the  new  Negro  girl 
in  his  class. 

George  understood  the  girl's  anxiety 
but  was  confused  by  her  good  humor. 
He  observed  her  vigilance  as  she  tried 
to  see  what  happened  around  her  while 
she  was  afraid  to  move  her  head  and 
look.  He  was  aware  of  the  tension  in  the 
room,  "i-o  thick  you  can  almost  cut  it," 
and  said  that  the  teachers  were  as 
nervous  as  the  pupils.  He  thought  that 
perhaps  the  girl's  "silly  smile"  reflected 
her  awareness  that  the  white  chil- 
dren were  suffering  too.  He  was  aware 
of  her  loneliness :  only  one  or  two 
would  sit  near  her:  no  one  would  work 
with  her  in  the  "lab''  but  the  teacher. 
George  thought  at  first  that  the  pres- 
ence of  Lois  ruined  everything  for  his 
class's  last  year  at  school.  However,  as 
time  went  on,  he  developed  increasing 
empathy  for  her.  He  felt  J;he  strain  was 
beginning  to  tell,  that  .she  tried  hard  to 
find  a  reason  to  smile  but  could  not,  so 
she  sat  there  most  of  the  time  pretend- 
ing to  read  or  write.  He  even  admired 
her  way  of  holding  back  from  revealing 
how  smart  she  was  because  she  was 
afraid  it  would  make  the  others  .jealous 
and  mad.  He  became  aware  of  how 
strong  her  staying  powers  were. 

In  such  reports,  Dr.  Coles  shows  us 
how  deeply  human  both  the  white  and 
Negro  children  were ;  how  inexorably 
their  human  respect  for  courage,  for 
one  another's  decency,  slowly  brought 
some  of  them  together ;  how  in  many 
instances  the  experience  of  being  to- 
gether melted  the  rigidity  of  prejudice. 
He  tells  about  a  white  mother  who  in- 

198 


voked  the  Lord's  name  to  give  strength 
to  her  belief  that  every  human  being 
deserves  respect;  and  about  a  Negro 
mother  who  drew  support  from  the  idea 
of  an  all-loving  Lord  and  told  her  chil- 
dren when  they  asked  about  their  color 
that  "the  Lord  likes  everyone  because 
He  makes  everyone.  .  .  .  No  one  knows 
what  color  He  is." 

But  the  Negro  child  rejected  by  the 
white  world  struggles  not  only  with  the 
question  of  whether  he  is  all  right ;  he 
also  struggles  to  get  an  explanation.  A 
little  Mississippi  girl  said,  after  draw- 
ing a  picture  of  herself,  "That's  me,  and 
the  Lord  made  me.  When  I  grow  up  my 
momma  says  I  may  not  like  how  He 
made  me,  but  I  must  always  remember 
that  He  did  it,  and  it's  His  idea.  So 
when  I  draw  the  Lord  He'll  be  a  real 
big  man.  He  has  to  be  to  explain  about 
the  way  things  are." 

We  see  here  the  alert,  .sensitive  child 
trying  to  make  sen.se  of  an  incompre- 
hensible situation,  part  of  the  effort 
every  child  makes  to  achieve  an  orderly, 
intelligible  conception  of  the  world.  The 
children  were  observant :  "The  colored 
don't  get  good  streets  with  cement  on 
them  as  easy  as  the  white." 

Supporting  resources 

The  Negro  parents  tried  to  teach  their 
children  how  to  cope  with  discrimina- 
tion. Said  one  mother  :  "We  have  to  live 
with  one  anotlier,  black  with  white  .  .  . 
you  have  to  teach  your  children  to  know- 
what's  dangerous  and  how  to  stay  away 
from  it.  .  .  ." 

Tessie  and  two  other  Negro  girls  were 
the  only  pupils  at  school  during  their 
first  year  of  "desegregation."  All  the 
white  pupils  had  boycotted.  Her  grand- 
mother remarked  shrewdly  :  "I  kept  on 
telling  Tessie  she'd  never  have  it  as  good 
again,  all  that  building  and  teachers  to 
herself  and  everything.  Take  advantage 
of  the  white  man's  mess,  because  it'll 
work  for  your  gain,  that's  what  I  said 
to  her  when  I  thought  she  needed  a  little 
helping  word  here  or  there." 

Tessie's  mother  wanted  her  daughter 
to  go  to  a  desegregated  school  but  she 
worried  about  the  strain  of  it  upon  her 
daughter  and  herself.  "The  truth  is  I 
might  have  taken  Tessie  out.  ...  I 
held  firm  because  my  husband  held  firm, 
and  we  both  held  firm  because  of 
Tessie's  grandmother  .  .  .  she  never 
gets  scared.  .  .  ."  Tessie's  mother  said : 
"I  try  not  to  go  beyond  each  day  ...  if 


you  can  get  your  strength  up  for  the 
present,  the  future  will  take  care  of 
itself."  She  answered  abu.se  with  silence. 
Tes-sie's  grandmother  told  her,  "It 
doesn't  even  matter  if  it's  easy  or  hard 
for  you  at  school.  It's  going  to  be  hard, 
some  time  or  other  it's  going  to  be  hard 
in  this  world  and  Tessie  girl,  you'd  just 
as  well  start  getting  used  to  it  now."  To 
Dr.  Coles,  the  grandmother  .said,  "Tes- 
sie and  I  eat  grits  before  going  through 
those  mobs  and  we  eat  ice  cream  after 
we  come  home  from  them."  Thus  the 
wise  grandmother  helped  with  perspec- 
tive and  earthy  sustenance  to  maintain 
the  nerve  of  her  beleaguered  grand- 
daughter. 

Tessie  had  her  own  resources,  too ; 
she  was  a  fierce,  stubborn,  willful  child. 
But  she  became  more  contained  once 
she  started  school  under  the  watchful 
eyes  of  the  mob.  "She  liked  to  draw 
.  .  .  .she  could  give  representation  to 
her  tormentors,  to  her  dread  of  their 
vengeance,  to  her  feelings  of  weakness, 
to  her  natural  wish  to  escape,  to  be  a 
little  white  girl  living  a  less  tiirmoil- 
fllled  life."  This  capacity  to  clarify  her 
feelings  and  thus  to  master  them  was 
for  her  another  major  resources  for 
coping. 

She  kept  the  drawings  for  a  while, 
looked  at  them  from  time  to  time,  and 
absorbed  them  ;  then  when  she  had  come 
to  terms  with  the  fantasies  they  repre- 
sented, she  gave  them  to  Dr.  Coles.  "I 
know  it's  scary  sometimes  .  .  .  but  not 
as  scary  as  what  I  can  dream  up.  .  .  . 
So  I  told  Granny  that  as  bad  as  they 
make  it  for  us,  the  stronger  I'll  get,  be- 
cause I'll  beat  them  to  the  punch  by 
imagining  it  even  worse  than  it  is  .  .  . 
everything  goes  fine  with  the  whites 
until  I  get  sick  and  stay  home.  Then, 
when  I  come  back  to  school,  it  takes 
them  a  day  or  so  to  get  used  to  me,  all 
over  again."  She  helped  herself  by  con- 
trasting reality  with  fantasy.  Having 
mastered  her  own  fear,  she  could  even 
understand  the  plight  of  the  white 
children. 

Effects  on  children 

Dr.  Coles  makes  the  nature  of  the 
struggle  vivid  to  the  reader — the  con- 
stant threats  "We'll  kill  you  .  .  .  poi- 
son you  .  .  .  choke  you.  .  .  ."  He  gives 
accounts  of  terror,  humiliation,  repudi- 
ation beyond  any  told  in  newspaper  or 
T\'  accounts.  Yet,  he  reports  little  evi- 
dence of  children  being  overwhelmed  by 


CHILDREN     • 


SEPTEMBER-OCTOBER  1967 


tlioir  exporienoo  or  boooining  physically 
or  iiii'Mlully  ill.  ilisdi-KMiiIzcil,  assrf^SJ^ive. 
Perhaps  no  brcaUdDwn  occurrod  bpranso 
of  the  solf-solPctii)ii  process  that  per- 
mitted only  the  most  confident  Xegro 
parents  to  sign  n|)  for  their  children  (o 
attend  desegregating  schools:  or  be- 
cause of  the  "screenini;"  process  used  in 
some  schools  to  eliminate  "poor  risks" 
and  select  the  most  stable  children. 

llr.  Coles  is  also  concerned  with  an- 
other problem:  to  what  extent  is  it  all 
rii;ht  to  allow  children  to  participate  in 
the  movement,  to  face  the  mobs?  His 
answer:  "When  we  find  out  what  hap- 
pens t(i  tlicni  if  they  don't  protest,  we 
will  lind  out  about  children  in  daily 
sulijeetion  who  have  been  asl^ed  to  for- 
feit their  freedom  by  the  decision  that 
they  must  endure  tyranny  rather  than 
face  'danger'  or  'trauma'.  .  .  .  What 
can  be  worse  p.sychoIogieally  and 
spiritually   for  any  child?" 

Yes,  but  .  .  . 

It  may  seem  strange  for  me  to  add  a 
"Yes,  but  .  .  ."  to  Dr.  Coles'  pre.senta- 
tion.  But  I  wonder  whether  this  em- 
phasis does  not  overlook  the  question 
of  who  can  afford  to  battle  for  the 
group.  The  Armed  Services  with  good 
reason  exclude  men  vulnerable  to 
breakdown.  In  the  internal  war  of  de- 
segregation, some  such  screening  may 
also  be  needed.  In  the  South  it  has  been 
provided  directly  by  some  principals 
and  indirectly  by  others  who  a.sked  for 
applications.  In  the  North,  where  some 
large-scale  integration  has  been  at- 
tempted by  arbitrarily  assigning  chil- 
dren to  schools  out  of  their  own  neigh- 
borhoods, there  may  be  more  serious 
effects  on  isome  children :  fatigue  or  a 
divided  life  in  which  the  range  of 
standards  and  life  styles  in  different 
settings  is  too  great  for  young  children 
to  integrate. 

Dr.  Coles  reminds  us  that  children 
participated  in  the  Underground  in 
Europe,  boycotted  Quisling's  teachers  in 
Norway,  sang  .songs  of  protest  in  Danish 
schools,  helped  derail  German  trains  in 
Holland,  and  even  murdered  Gestapo 
agents  in  France.  They  fought  for  sur- 
vival and  formed  gangs  to  seek  food 
and  shelter  to  support  one  another. 
Some  learned  in  German  concentration 
camps  the  "value  of  freedom  and  of 
life  itself."  But  many  did  not  survive, 
and  we  must  not  forget  this. 

Uugged  children  may  thrive  on  chal- 

VOLUME  14  -  NUMBER  5 


lenge.  Bvit  when  we  focus  on  the  strong, 
we  forget  children  all  over  the  world 
who  do  not  survive — tho.se  who  die  of 
marasmus  or  are  mentally  stunted  and 
depressed  in  foundling  hosi)itals ;  those 
who  nil  our  child  p.sychiatry  clinics 
uilli  more  troubles  than  can  be  eased; 
those  who  grow  into  adults  without 
hope,  who  join  the  raidis  on  skid  row  or 
fill  our  prisons. 

The  value  of  emphasizing  the  tough- 
ness of  the  survivors  is  to  illustrate  how 
amazingly  wide  the  range  actually  is 
from  strength  to  vulnerability,  how 
hard  it  is  to  gauge  the  line  between  ad- 
versity that  strengthens  and  adversity 
that  destroys  I  and  to  challenge  us  to 
study  still  more  intently  the  coping  ef- 
forts and  support  that  contribute  to 
survival.  Dr.  Coles'  eloiiuent  account  of 
the  survival  techniques  of  the  strong  is 
a  gift  to  the  science  of  human  develop- 
ment, of  child  psychology  and  psychia- 
try,  of   social   change. 

But,  to  have  a  complete  picture,  we 
need  a  comparably  sensitive  record  of 
what  has  happened  to  all  the  children 
in  New  York  City  who  were  "bussed" 
out  of  their  home  neighborhoods  to  in- 
tegrated schools.  Here  we  might  find 
not  only  heroes  like  those  Dr.  Coles  has 
described,  but  abso  victims  of  desegre- 
gation in  terms  of  educational  and  emo- 
tional los.ses. 

As  I  read  the  book,  I  was  impressed 
by  several  recurrent  themes : 

1.  The  support  given  by  Southern 
mothers,  Negro  and  white,  to  their 
children  who  were  carrying  the  burden 
of  integration — a  support  often  rooted 
in  a  deep  commitment  to  a  good  educa- 
tion ;  the  tough,  sometimes  stubborn 
realism,  frustration  tolerance,  capacity 
to  take  risks,  typical  of  these  mothers 
and  their  husbands  (often  more  pas- 
sive) and  in  some  ca.ses  the  children's 
grandmothers  or  their  teachers  and 
ministers. 

2.  The  struggle  of  children  to  learn 
to  accept  and  understand  the  different 
colors  "God  made"  people  to  be. 

3.  The  learning  process  and  adapta- 
tional  steps  involved  in  coming  to  terms 
with  desegregation,  especially  as  these 
steps  were  imposed  upon  a  few  re- 
calcitrant fathers  who  at  first  opixjsed 
their  sons'  going  into  the  civil  rights 
movement. 

4.  The  role  of  empathy,  comiiussion, 
and  affection  in  helping  white  children 
and  adults  appreciate  the  exjierience 
of  the  Negro  children — both   in   those 


who  were  freely  moved  by  these  feel- 
ings and  those  with  immobilizing  con- 
flicts between  such  feelings  and  their 
prejudice. 

5.  The  suffering,  disillusionment,  and 
despair  that  sometimes  overcame  but 
did  not  stop  the  young  iwople  who  had 
hoped  to  accomplish  visible  changes 
rapidly  .-md  who  came  to  realize  that 
the  task  of  integration  would  take 
years  or  a  generation  or  two. 

6.  The  inner  vitality,  release  of  en- 
ergy, and  integration  of  iiersonality 
that  so  many  children  seemed  to  derive 
from  the  experience  of  living,  acting, 
feeling  in  a  way  consistent  with  their 
ideals  and  beliefs.  I  have  seen  this  in 
other  groups  deeply  conjmitted  to  a 
goal — in  Israel  in  the  early  years  of 
independence  and  in  a  new  college  com- 
mitted to  uniquely  individualized  edu- 
cation. Fighting  for  what  one  believes 
to  be  right  mobilizes  energies  from  all 
layers  of  the  personality — conscience, 
ego,  and  primitive  forces  of  love  and 
aggression.  Moreover,  the  opportunity 
to  defeat  an  enemy  such  as  prejudice 
in  righteous  battle  helps  a  person  to 
tran.scend  the  small  bitter  conflicts  that 
so  often  block  the  full  use  of  personal 
resources. 

7.  The  progressive  stimulus  of  prog- 
ress itself. 


collected  readings 

PERCEPTUAL  DEVELOPMENT  IN 
CHILDREN.  Edited  by  Aline  H. 
Kidd  and  .Teaune  L.  Rivoire.  Inter- 
national Universities  Press,  New 
York.     19G6.     548  pp.     $1'2.50. 

REVIEW  OF  CHILD  DEVELOP- 
MENT RESEARCH,  vol.  2.  Edited  by 
Lois  Wladis  Hoffman  and  Martin  L. 
Hoffman.  Prepared  under  auspices  of 
the  Society  for  Research  in  Child 
Development.  Russell  Sage  Founda- 
tion, New.  York.  19G0.  598  pp.  $8. 

MONTESSORI  FOR  THE  DISADVAN- 
TAGED :  an  application  of  Montes- 
sori  educational  principles  to  the  war 
on  poverty.  Edited  by  R.  C.  Orem. 
G.  P.  Putnam's  Sons,  New  York.  1967. 
191  pp.  $4.95. 

THE  UNWED  MOTHER.  Edited  by 
Robert  W.  Roberts.  Harper  &  Row, 
New  York.  1966.  270  pp.  $3.25. 


199 


BOOK  NOTES 


CHILDREN  :  development  and  relation- 
ships. Mollie  S.  Smart  and  Russell  C. 
Smart.  The  Macmillan  Co.,  New  York. 
1967.  582  pp.  $7.95. 

A  textbook  for  students  preparing  for 
professional  work  with  children,  this 
book,  according  to  its  authors,  inte- 
grates the  teachings  of  Erik  Erikson 
on  the  stages  of  personality  develop- 
ment and  of  Jean  Piaget  on  the  stages 
of  intellectual  development.  The  first 
chapter  gives  a  general  view  of  growth 
and  development;  the  others  center  on 
the  prenatal  period  and  infancy,  the 
preschool  years,  the  elementary  school 
years,  and  adolescence. 

POVERTY  IN  CANADA  AND  THE 
UNITED  STATES:  overview  and 
annotated  bibliography.  Benjamin 
Schlesinger.  University  of  Toronto, 
Pre.ss,  Toronto,  Ontario,  Canada. 
1966.    211pp.    $5. 

By  way  of  introduction  to  this  book, 
four  social  work  educators — one  Cana- 
dian and  three  Americans — present  a 
"critical  overview"  of  the  efforts  of  their 
nations  to  end  poverty.  The  annotated 
bibliography  of  nearly  000  articles, 
books,  summaries,  and  monographs  de- 
scribing these  efforts  that  follows  is 
divided  under  such  topics  as  family  life, 
economics,  education,  social  services, 
social  work,  heajth,  housing,  and  law. 

INTERNATIONAL  BIBLIOGRAPHY 
OF  RESEARCH  IN  MARRIAGE 
AND  THE  FAMILY,  1900-64.  Joan 
Aldous  and  Reuben  Hill.  University 
of  Minnesota  Press,  Minneapolis,  for 
the  Minnesota  Family  Study  Center 
and  the  Institute  of  Life  Insurance. 
1966.  508  pp.  $15. 

This  volume  is  the  product  of  the 
first  phase  of  the  Minnesota  Inventory 
of  Published  Research  on  Marriage  and 
Family  Behavior — "identification  of 
the  topics  which  have  been  empirically 
investigated   by   marriage   and   f.nmily 

200 


researchers."  It  lists  12,850  research  re- 
ports and  theoretical  essays  published 
from  1900  to  (November)  1964  in  the 
United  States  and  abroad  in  which 
marriage  or  the  family  figured  in  some 
way.  Prepared  with  the  use  of  a  compu- 
ter, the  volume  has  five  sections :  a  key- 
word-in-context  (KWIC)  index;  a  sub- 
ject index ;  a  complete  reference  list ;  an 
authors  list ;  and  a  periodicals  list. 

THE  DEVELOPMENT  OF  THE  IN- 
FANT AND  YOUNG  CHILD  :  normal 
and  abnormal.  R.  S.  Illingworth.  The 
Williams  &  Wilkins  Co.,  Baltimore, 
Md.  1966.  378  pp.  $10. 

The  third  edition  of  a  work  first  pub- 
lished in  1960,  this  book  describes  the 
mental  development  of  the  infant  and 
preschool  child  from  the  point  of  view  of 
everyday  pediatric  practice. 

The  author  has  enlarged  the  chapters 
on  prenatal  and  environmental  factors 
to  include  recent  information  and  has 
added  new  chapters  on  reflexes  and  re- 
actions of  the  newborn  child,  the  assess- 
ment of  maturity,  and  the  assessment 
for  adoption. 

ROOM  TO  GROW:  a  study  of  parent- 
child  relationships.  Carroll  Davis. 
University  of  Toronto  Press,  Toronto, 
Ontario,  Canada.  1966.  214  pp.  $6. 

Illustrating  her  points  with  the 
"emancipation  profiles"  of  seven  chil- 
dren she  followed  in  a  longitudinal 
child  development  study  from  the  ages 
of  5  to  20,  the  author  presents  a  theory 
about  the  process  in  which  a  child 
grows  from  dependency  into  a  self- 
directed  person  who  is  "emancipated" 
from  his  parents'  direction.  She  points 
out  that  a  child  seems  to  become  free  of 
his  parents  by  taking  "portions  of  his 
life  into  his  own  hands"  as  he  gains 
confidence  and  competence,  and  that  the 
attitude  of  the  parents  toward  the 
process  is  a  force  greatly  affecting  the 
child's  progress  and  one  around  which 
other  influences  seem  to  cluster. 


Individuality  and  emancipation  are 
inseparable,  as  they  are  both  derived 
from  the  quality  of  the  parent-child  re- 
lationship, the  author  contends.  This 
relationship  is  constantly  changing,  and 
its  balance  and  freedom  determine  the 
degree  of  reciprocal  trust  between  child 
and  parent,  she  adds. 

EARLY  CHILDHOOD  DISTURB 
ANCES,  THE  INFANTILE  NEURO 
SIS,  AND  THE  ADULTHOOD  DIS- 
TURBANCES :  problems  of  a  devel- 
opmental psychoanalytic  psychology. 
The  Psychoanalytic  Study  of  the 
Child  Monograph  No.  2.  Humbertc 
Nagera,  M.D.  International  Univer 
sities  Press,  New  York.  1966.  95  pp 
$3. 

The  author  of  this  monograph  ap 
preaches  the  question  of  childhood  dis 
turbances  from  a  developmental  poini 
of  view.  After  expressing  his  dissatis 
faction  with  the  content  of  today's 
thinking  on  diagnosis,  he  maintain.' 
that  analysts  cannot  continue  to  call  al 
childhood  disorders  "infantile  neuro 
sis"  or  to  look  for  solutions  in  "anj 
one  phase  of  development."  He  also  re 
jects  the  idea  that  "faulty  object  rela 
tionships"  and  "faulty  ego  develop 
ment"  are  the  only  sources  of  disorder 

He  reports  that  his  method  of  analyz 
ing  childhood  disorder  is  to  give  dm 
attention  to  the  developmental  proc 
esses  in  all  aspects  of  the  personalit; 
(drives,  ego,  superego,  and  object  re- 
lationship) "to  enable  the  clinician  t( 
test  pathology  against  the  right  devel 
opmental  background  and  to  take  int(' 
account  the  ideal  picture  of  normalcy.' 

ROLE  PLAYING  FOR  SOCIAL  VALI 
UES :  decision-making  in  the  socia 
.studies.  Fannie  R.  Shaftel.  Stories  bj 
George  Shaftel.  Prentice-Hall,  Inc. 
Englewood  Cliffs,  N.J.  1967.  431  pp 
$5.75. 

As  defined  in  this  textbook  for  the 
classroom  teacher,  role  playing  serves 
two  major  functions  in  the  classroom 
It  can  help  the  teacher  in  educating 
children  for  citizenship  and  in  conduct 
ing  group  counseling  in  her  class.  Th( 
authors  have  divided  the  book  betweer 
theory  and  methodology  and  materials 
(problem  stories  that  present  situations 
for  children  to  work  out  in  class  con 
cerning  individual  integrity,  group  re- 
sponsibility, self-acceptance,  and  man- 
aging personal  feelings). 


CHILDREN 


SEPTEMBER-OCTOBER  196; 


observations  from 
a  visit  abroad  .  .  . 

CHILD  CARE 
IN  OTHER 
COUNTRIES 


MARTIN  GULA 


specialist  on  Croup  Care,  Children 's  Bureau 


•  Politip.il  commentators  have 
noted  in  recent  years  a  growing 
universality  in  the  social  and 
economic  conditions  influencing  families 
and  children  in  economically  developed 
countries,  despite  their  political  struc- 
ture. But,  is  there  universality  in  the 
kinds  of  social  services  provided  in 
these  countries  to  assist  families  and 
children  who  are  handicapped  by  these 
conditions? 

I  wondered  about  this  during  a  3- 
week  visit  recently  to  the  British, 
Danish,  and  Israeli  parliamentary 
democracies  and  the  Polish  and 
Yugoslav  socialist  republics.  Three 
weeks  is  too  short  a  period  for  pro- 
found observations.  However,  my  im- 
pression is  that  where  a  child  lives 
makes  some  difference  in  the  services 
his  country  develops  because  of  diver- 
sity in  political  philosophy,  tradition, 
and  culture ;  but  also  that  these  differ- 
ences are  beginning  to  be  less  apparent 
as  nations  are  faced  with  common 
problems. 

The  most  highly  populated  country  I 
visited  was  England,  which  has  about 
l.j  million  children  under  IS  years  of 
age.  The  smallest  was  Israel,  which  has 
less  than  a  million  children.  But  social 


workers  in  all  five  countries  reported 
the  same  conditions  affecting  families 
and  children — increasing  urbanization; 
rising  living  costs;  inadeiiuale  housing; 
employment  of  mothers ;  shortage  of 
day-care  resources;  need  for  new  pat- 
terns of  social  work  leadership ;  and 
inadequate  delivery  of  welfare  services. 
These  conditions  as  they  exist  in 
many  parts  of  the  world  have  been  re- 
ported on  previously  in  CHILDREN.''" 
Therefore.  I  will  confine  my  comments 
to  resources  for  day  care  and  foster 
care  and  social  work  leadership  as  re- 
ported to  me  by  government  officials 
and  social  work  leaders  in  these  par- 
ticular countries. 

Day  care 

Various  types  of  day-care  arrange- 
ments are  available  in  each  of  these 
countries,  but  nowhere  in  sufficient 
quantity  to  meet  the  need.  In  Denmark, 
for  example,  an  infant  or  toddler  may 
accompany  his  employed  mother  to  the 
establishment  where  she  works ;  a  day 
nursery  is  provided  within  the  estab- 
lishment; the  mother  nurses  and  feeds 
the  child  there ;  she  may  also  be  called 
upon  to  substitute  for  an  absent  or  sick 
member  of  the  nursery  staff ;  and  she 
picks  up  her  child  immediately  at  the 
end  of  the  workday.  Danish  employers 
like  this  plan  because  it  reduces  em- 
ployee turnover,  fatigue,  and  absences. 

Other  mothers  use  a  community  day 
nursery  or  day-care  center.  In  all  types 
of  centers,  the  operator  is  required  by 
Danish  law  to  have  2  years  of  full-time 
training,  which  they  usually  get  at  gov- 
ernment expense.  The  training  includes 
classroom  and  supervised  practice  in- 
struction. However,  with  a  population 
of  only  5  million  people,  Denmark  still 
needs  day-care  facilities  to  accommo- 
date about  30.000  more  children. 

In  Warsaw,  the  toddler  of  the  em- 
ployed mother  in  many  instances  can 
remain  home  because  his  "babcha" 
(grandmother)  lives  with  him  and  his 
parents.  But  the  proportion  of  grand- 
parents living  with  married  children 
or  sons-in-law  is  decreasing  as  the  hous- 
ing shortage  eases.  Grandparents  are 
beginning  to  find  .iobs  or  they  become 
eligible  for  retirement  income  and  find 
it  possible  to  live  alone.  Thus,  more 
demand  is  made  by  mothers  for  day 
nurseries,  baby  homes,  nursery  schools, 
and  0-day  boarding  "crfiches."  Poland 
doubled  the  number  of  its  cr&ches  and 


nursery  schools  during  the  19r)0's  to 
serve  over  350,000  children.  The  num- 
ber is  steadily  increasing. 

In  Israel,  the  toddler's  mother  en- 
counters more  diflSculty  in  finding  day- 
care resources.  Unless  she  lives  in  a 
kibbutz  (only  5  percent  of  the  popula- 
tion do),  she  will  have  to  seek  out  a 
relative  or  neighbor  to  care  for  her 
child  or  a  commercial  nursery  or  a  vol- 
untary organizational  day-care  center, 
just  as  a  mother  in  the  United  States 
does. 

If  the  mother  lives  in  a  kibbutz,  her 
toddler  lives  in  a  "children's  house" 
with  four  or  five  other  toddlers  during 
the  day.  He  visits  with  his  mother  for 
several  hours  in  the  early  evening  and 
returns  to  sleep  in  the  children's  house 
at  night.  But  these  traditional  kibbutzim 
child-rearing  practices  are  beginning  to 
change.  Young  kibbutzim  couples  are 
pressing  to  be  allowed  to  keep  their 
young  children  at  home  with  them  over- 
night and  to  use  the  children's  house  for 
day  care  only. 

In  most  of  these  countries,  many  day- 
care facilities  rely  on  untrained  per- 
sons to  care  for  the  children.  But  in 
each  country,  social  work  leader.?, 
aware  that  the  early  years  of  child- 
hood are  the  formative  years,  are  work- 
ing to  have  such  facilities  improved 
or  replaced  by  centers  run  by  trained 
personnel  who  can  contribute  positively 
to  the  child's  social,  emotional,  and  ed- 
ucational development. 


Foster 


care 


As  in  this  country,  physical  or  eco- 
nomic breakdown  in  families  is  report- 
ed to  be  decreasing  as  a  major  reason 
for  placing  children  in  institutions  and 
foster  families.  But  psychological 
breakdown  in  families  is  increasing  in 
such  cities  as  London,  Tel  Aviv,  and 
Belgrade  with  the  result  that  grow- 
ing numbers  of  emotionally  disturbed 
and  mentally  retarded  children  are  in 
need  of  care  and  treatment  beyond  their 
family's  capacity  to  provide.  The 
cities  are  also  experiencing  an  in- 
crease in  the  number  of  adolescents  who 
need  care  away  from  home  because  of 
their  family's  inability  to  cope  with 
them. 

Because  most  of  these  children  pre- 
sent difficult  behavior  and  complex 
problems,  the  countries  are  facing  a 
need  to  improve  the  quality  of  tradi- 
tional foster  homes  and  child-caring  in- 
stitutions at  a  time  when  they  are  find- 


VOLUME  14  -  NUMBER  5 


201 


ing  it  difficult  to  recruit  urban  foster 
homes  and  staff  members  for  the  in- 
stitutions. 

England  has  more  children  in  foster 
family  homes  (30,000)  than  it  has  in 
institutions  (24,000).  Foster  family 
programs  are  relatively  small  in  the 
other  counti'ies.  Poland,  for  example, 
has  only  about  2.")0  foster  families,  but 
it  has  about  360  chikl-caring  institu- 
tions caring  for  more  than  42,000  chil- 
dren. 

Denmark  is  increasing  the  public  pro- 
portion (99..5  percent)  of  the  financing 
of  its  300  child-caring  institutions ;  de- 
veloping smaller  group  homes :  and  op- 
erating a  national  training  program  for 
infants'  nurse.s,  day-care  and  kinder- 
garten staff,  leaders  for  boys'  and  girls' 
clubs,  and  institutional  child-care  staff. 

Denmark's  national  training  program 
for  child-care  staff  was  established  in 
1958  in  a  former  90-room  royal  palace  in 
Jaegerspris.  About  7'>  young  men  and 
women  are  trained  there  annually  for 
work  in  pTi))lic  or  voluntary  institutions. 
A  full-time  director  and  five  faculty 
members,  provide  the  students  with 
1,300  hours  of  classroom  instruction  and 
supervised  practice  over  a  12-month  pe- 
riod. Plans  are  to  develop  six  more  of 
these  "colleges"  to  train  400  students 
annually.  An  advanced  training  pro- 
gram, also  run  by  tlie  government,  is 
available  in  Copenhagen.  The  Children's 
Department  of  the  British  Home  Office 
operates  a  similar  and  even  larger  train- 
ing program. 

In  Yugoslavia,  several  rural  villages 
have  been  made  into  "fo.ster  family  vil- 
lages." The  un.sophisticated  nature  of 
the  peasant  families,  however,  pre- 
cludes their  being  used  for  the  care  of 
children  with  complex  developmental 
problems. 

In  Bristol,  England,  public  child  wel- 
fare officers  are  experimenting  with  a 
ring  of  small,  public  agency-owned 
group  homes  near  the  perimeter  of  the 
city.  These  homes  are  used  for  many 
purposes,  such  as  emergency  shelter  and 
foster  care  of  adolescent  homeless  chil- 
dren, family  groups  of  children,  and 
children  too  disturbed  for  traditional 
foster  family  homes. 

Professional  leadership 

Denmark,  Poland,  and  Yugoslavia 
have  I'elied  heavily  on  volunteers,  citi- 
zens committees,  and  factory  welfare 
committees  to  respond  to  the  needs  of 

202 


the  family  with  a  child  in  distress.  Eng- 
land and  Israel  have  trained  social 
workers  in  undergraduate  college  pro- 
grams. 

But  none  of  these  countries  has  de- 
veloped graduate  professional  schools 
of  social  work  similar  to  professional 
social  work  schools  in  the  United  States. 
However,  in  England,  Denmark,  Poland, 
and  Israel  perhaps  more  creative  use  is 
made  than  in  this  country  of  undergrad- 
uate-trained workers  and  citizen  vol- 
unteers in  responding  quickly  to  fam- 
ilies in  distress. 

In  all  five  countries  the  ministries  of 
welfare  and  the  social  work  leaders  are 
pressing  for  new  patterns  of  profes- 
sional leader.ship,  but  in  each  the  pat- 
terns are  developing  in  different  ways. 
Denmark,  for  example,  has  a  central 
children's  bureau  and  about  50  citizen 
volunteer  district  children's  committees 
to  .serve  a  total  of  about  750,000  chil- 
dren and  youth  under  21  years  of  age. 
Recently,  its  parliament  passed  legisla- 
tion to  train  and  introduce  "family 
coun.selors"  in  urban  areas  especially 
for  disturbed  and  delinquent  children 
and  their  parents. 

In  Warsaw  and  Poznan,  universities 
are  developing  undergraduate  training 
schools  for  "social  assistants"  who  will 
help  coordinate  the  efforts  of  the  60,000 
volunteers  in  Poland  who  work  with 
families  and  children  in  the  400 
"poviats"  (counties). 

In  Israel,  institutions  for  dependent 
and  delinquent  children,  as  well  as  a 
new  day-care  center  for  retarded  chil- 
dren, are  experimenting  with  group- 
work  and  casework  services  for  children 
and  parents. 

In  all  five  countries,  national  min- 
istries and  voluntary  child  welfare  or- 
ganizations express  deep  interest  in  and 
special  concern  for  the  welfare  of  chil- 
dren without  parents.  The  question  they 
all  face  is  how  to  develop  community 
services  and  resources  to  strengthen  the 
family  and  improve  foster  family  and 
residential  group  care  for  children  who 
must  live  away  from  home  and  in  doing 
so  to  use  all  local  health,  education,  and 
mental  health  resources. 


'  Close,  Kathryn:  Social  strategists  for  ur- 
ban development.  Children,  November- 
December  1966. 

"Oettinger,  Katherine  B.:  Youth  and  youth 
services  in  England.  Children,  March-April 
1967. 


Guides  and  Reports 


CHILDREN  AND  YOUTH  AT  MID- 
DECADE:  the  report  of  the  Mid- 
Decade  Conference  on  Children  and 
Youth,  Washington,  D.C.,  April  12-15, 
1966.  National  Committee  for  Chil- 
dren and  Youth,  1145  19th  Street 
NW.,  Washington,  D.C.  20036.  1967. 
217  pp.  $2. 

Includes  the  texts  of  addresses  and 
reports  made  at  the  conference  and  sum 
maries  of  the  work  groups. 

SUCCESSFUL  FOSTER  HOMES:  an 
exploratory  study  of  their  character- 
isrtics.  Patricia  W.  Cautley,  Martha 
Jean  Aldridge,  and  Bernard  Finifter 
Foster  Homes  Research  Project,  Wis- 
consin Department  of  Public  Welfare, 
Madison,  Wis.  53702.  .June  1966. 
232  pp.  A  limited  number  free  on 
request  from  the  Department. 

Reports  in  detail  on  a  study  whose- 
flndings  were  summarized  in  the  No- 
vember-December 1966  Issue  of  CHIL- 
DREN, p.  247. 

UNMARRIED  PARENTHOOD:  clues 
to  agency  and  community  action.  Na- 
tional Council  on  Illegitimacy,  ii 
East  23d  Street,  New  York,  N.Y 
10010.  1967.  90  pp.  $2.50. 

The  nine  papers  included  discuss  as-> 
pects  of  parenthood  out  of  wedlock  in 
the  AFDC  program,  in  urban  ghettos. 
and  in  rural  areas ;  problems  in  and  ai)-i 
proaches  to  the  provision  of  services 
the  legal  rights  of  unwed  parents ;  and 
sex  education  as  a  way  to  prevention. 

ENQUIRY  INTO  SUDDEN  DEATH  IN 
INFANCY.  Ministry  of  Health.  Her 
Majesty's  Stationery  Office,  London, 
Available  from  British  Information 
Service,  845  Third  Avenue,  New 
York,  N.Y.  10022.  Reports  on  Public 
Health  and  Medical  Subjects  No, 
113.     1966.     52  pp.     90  cents. 

Reports  on  the  findings  of  studies  oi 
sudden  and  unexpected  deaths  of  in- 
fants in  Cambridgeshire  and  in  12 
boroughs  of  London,  conducted  mainly 
between  January  1958  and  October  1964 
by  a  steering  committee  appointed  by 
the  Ministry  of  Health. 


CHILDREN     •     SEPTEMBER-OCTOBER  1967 


1. 


HERE  and  THERE 


Nursins  education 


The  Xational  Leiigue  for  Xursing  and 
the  American  Nurses'  Association  have 
set  up  an  autonomous  commission  to 
study  the  needs  in  and  objectives  of 
nursing  education.  Called  the  National 
Commission  for  the  Study  of  Nursing 
Education,  Inc.,  the  15-niaii  commission 
represents  many  fields,  including  busi- 
ness, health,  education,  aud  social  sci- 
ence.s.  W.  Allen  Wallis,  president  of  the 
University  of  Rochester,  will  head  tlie 
3-year  study.  Grants  from  the  Avalon 
Foundation  aud  the  W.  K.  Kellogg 
Foundation  and  an  anonymous  gift  are 
supporting  the  study. 

The  objectives  of  the  commission  are  : 
to  determine  what  community  needs  in 
nursing  care  and  sei-vices  the  profession 
can  reasonably  meet ;  to  determine  what 
resources  are  necessary  to  provide  nurs- 
ing education  and  good  economical 
nursing  services ;  to  evaluate  nursing 
education  and  .services  in  terms  of  the 
preparation  and  leadershij}  prerequisite 
to  good  nursing  care ;  and  to  determine 
ways  of  making  good  nursing  care 
available  wherever  it  is  needed. 


fay  care 

Some  200  persons  who  attended  a  1- 
day  conference  on  day  care  in  Wash- 
ington. D.C.,  last  June,  agreed  that  the 
need  for  day-care  services  for  children 
grows  larger  every  day  but  that  the 
means  of  meeting  it  lags  far  behind. 
The  conference  was  called  by  two  Fed- 
eral agencies — the  Women's  Bureau  of 
the  Department  of  Labor  and  the  Chil- 
dren's Bureau  of  the  Department  of 
Health,  Education,  and  Welfare — and 
Directions  Seminar,  a  group  repre- 
senting nine  voluntary  organizations. 
In  all,  GO  organizations  and  agencies 
concerned  with  the  welfare  of  children 
sent  representatives. 


Participants  pointed  out  that  a  great 
block  to  providing  suflBcient  day  care 
to  meet  the  needs  is  the  national  am- 
bivalence toward  the  working  mother. 
On  the  one  hand,  her  services  are  wel- 
comed where  men  are  not  available  for 
jobs ;  on  the  other,  many  people  frown 
on  mothers  working  outside  the  home. 

The  participants  agreed  that  the 
agencies  working  to  make  day  care  for 
children  available  wherever  it  is 
needed  should  take  their  case  to  the 
Nation.  "We  must  spell  out  the  cost  and 
say  what  we  want  and  why,"  one  par- 
ticipant said  in  summary. 

Other  participants  recommended  the 
establishment  of  an  agency  to  coordi- 
nate the  efforts  of  all  agencies  working 
for  day  care  and  to  publish  a  news 
sheet  about  activities  affecting  day  care. 
Others  recommended  the  establishment 
of  an  organization  in  every  State  to 
work  for  day-care  facilities. 


Anti-delinquency 


A  strong  determination  in  young  peo- 
ple to  have  some  say  in  planning  and 
executing  the  programs  that  affect  them 
was  expressed  during  and  after  a  con- 
ference on  juvenile  delinquency  held  in 
Washington,  D.C.,  June  1-2,  1967,  at  the 
call  of  the  Secretary  of  Health,  Educa- 
tion, and  Welfare,  John  W.  Gardner.  In 
addition  to  200  professional  persons 
from  the  fields  of  juvenile  corrections 
and  youth  guidance,  the  conference  par- 
ticipants included  4.j  teenagers  and 
young  adults  who  are  .serving  as  "indig- 
enous workers"  or  otherwise  participat- 
ing in  anti-delinquency  or  anti-poverty 
programs. 

The  focus  of  the  conference  was  on 
planning  and  evaluating  programs  to 
combat  delinquency  with  s[)ecial  empha- 
sis on  the  possibilities  of  building  on 
lessons  learned  from  the  projects  sup- 
ported  under   the   expiring    (June   30, 


I'JOT)   Juvenile  DeliM(|uency  and  Youth 
Offenses  Control  Act  of  I'JOl. 

Secretary  Gardner  pointed  out  that 
.^47  million  li;id  gone  into  those  projecis 
to  test  new  methods  of  combating 
delin(pieucy — including  work  training 
for  jobless  young  people,  the  revitaliza- 
tion  of  neighborhoods,  the  expansion 
of  legal  services  to  the  poor,  the  estab- 
lishment of  multi.service  neighborhood 
centers,  and  Iho  effort  to  involve  local 
people  in  the  planning  and  e.vecuting 
of  community  programs.  Other  speakers 
ideiitilied  the  major  contribution  of 
such  projects  as  their  empha.sis  on 
preplanning,  comprehensivenes.s,  aud 
integration  of  services  and  on  the  par- 
ticipation of  the  consumers  of  service. 
Some,  however,  criticized  the  projects 
for  an  overemphasis  on  delinquency  pre- 
vention to  the  comparative  neglect  of  re- 
habilitative efforts,  a  failure  to  relate 
to  the  existing  structure  of  services  in 
a  way  that  would  assure  continuance, 
and  a  lack  of  built-in  methods  for 
evaluation. 

Several  of  the  young  participants 
told  of  their  difficulties  in  getting  adults 
to  listen  to  their  suggestions  for  im- 
proving the  conditions  that  spawn 
delinquenc.v.  For  example,  one  young 
girl  told  of  a  neighborhood  youth  or- 
ganization in  a  Brooklyn  neighborhood 
that  has  worked  for  desegregating  the 
extracurricular  programs  in  the  local 
high  school.  State  support  to  help  the 
children  of  public  welfare  clients  go 
to  summer  camp,  group  homes  for  de- 
pendent adolescents,  a  desirable  site  for 
a  new  school — all  to  no  avail :  "The  only 
thing  we  succeeded  in  changing  so  far  is 
ourselves." 

Other  young  participants  spoke  of 
their  efforts  to  help  delinquents  or 
potential  delinquents  work  to  meet  the 
needs  of  their  communities.  Advi.sed 
one,  "Go  back  and  ask  the  young  peo- 
ple of  your  comminiity  'what  do  you 
want  so  you  can  stay  out  of  jail?'  .  .  . 
Talk  to  the  kids,  they  have  something 
to  give,  but  they  can't  give  it,  if  you 
don't  listen." 

This  sense  that  the  adults  are  not 
listening  prompted  the  young  partici- 
pants, under  the  leadership  of  these  in 
the  Washington  community  action  pro- 
gram, to  hold  a  conference  of  their  own. 
called  A  Youth  Rap.  on  the  day  follow- 
ing the  delinquency  conference.  Their 
agenda  contained  three  items :  .vouth 
problems,  youth  programs,  and  youth 
federation.    There,    however,    the    dis- 


■VOLUME  14  -  NUMBER  5 


203 


cussiou  was  not  so  much  on  problems — - 
"We  all  know  what  the  problems  are" — 
as  on  the  development  of  a  mechanism 
for  exerting  influence  on  "all  the  youth 
work  being  done  in  this  country."  As  a 
first  step  they  decided  to  work  for  a 
national  conference  of  young  people, 
organized  by  young  people  themselves 
"with  no  strings  attached." 

Child  health 

Provisional  figures  on  infant  mortal- 
ity for  the  12  months  that  ended 
April  30,  1967,  show  a  5-percent  drop 
from  the  previous  12-month  period — 
from  24.2  per  thousand  live  births  to 
23.0  per  thousand — according  to  figures 
from  the  National  Center  for  Health 
Statistics,  Public  Health  Service.  This 
is  an  even  greater  decrease  than  the 
one  shown  by  provisional  rates  for  the 
12-month  periods  which  ended  April  30, 
1965,  and  April  30,  1966—24.6  and  24.2 
respectively — a  drop  of  2  percent. 


Adoption  service 


The  Indian  Adoption  Project  spon- 
sored b.v  the  Bureau  of  Indian  Affairs, 
U.S.  Department  of  the  Interior,  and 
the  Child  Welfare  League  of  America 
in  cooperation  with  State  and  local 
public  and  voluntary  child  welfare  serv- 
ices placed  67  Indian  children  in  adop- 
tive homes  in  1966,  the  highest  number 
in  any  one  .year  since  the  project  began 
in  1958.  As  of  May  15,  the  project  had 
placed  325  Indian  children  in  adoptive 
homes,  mostly  non-Indian.  The  children 
ranged  in  age  at  time  of  placement  from 
birth  to  11  years,  but  nearly  half  were 
under  a  year  old.  The  project  at  present 
reports  having  more  prospective  adop- 
tive parents  than  children  referred  for 
adoption,  although  it  has  found  through 
a  survey  of  90  registered  placement 
agencies  that  more  than  400  Indian  chil- 
dren are  in  need  of  adoptive  homes. 

All  the  Indian  children  placed  through 
the  project  have  come  from  Midwestern 
or  Western  States,  but  more  than  half 
of  the  adoptive  homes  are  in  the  East. 


The  Midwest  Adoption  Facilitating 
Service,  a  regional  agency  to  help  local 
agencies  in  seven  States  and  a  neigh- 
boring province  of  Canada  bring  chil- 
dren in  need  of  homes  and  prospective 
adoptive  parents  together  anywhere  in 
the   region,   was  recently   incorporated 


in  Minnesota  with  headquarters  in 
Minneapolis-St.  Paul.  More  than  90 
agencies,  both  local  and  statewide,  took 
part  in  setting  up  the  service.  The  re- 
gion includes  the  States  of  Illinois, 
Iowa,  Minnesota,  Nebraska,  North 
Dakota,  South  Dakota,  and  Wisconsin 
and  the  province  of  Manitoba. 

The  new  agency  grew  out  of  the  work 
of  the  Indian  Adoption  Service  con- 
ducted by  the  Child  Welfare  League 
of  America  (CWLA)  and  the  Bureau 
of  Indian  Aflfairs,  U.S.  Department  of 
the  Interior,  which  places  Indian  chil- 
dren from  one  region  of  the  country 
in  homes  in  another  if  no  homes  are 
available  where  the  children  live.  The 
service  will  also  assist  in  the  work  of 
CWLA's  national  adoption  exchange. 

The  service  will  not  place  children 
itself.  Rather,  it  will  work  to  improve 
the  lines  of  communication  between 
local  agencies  and  their  policies  and 
procedures  and  to  modify  State  laws 
that  make  interstate  adoption  difficult 
(only  Illinois  and  Wisconsin  now  have 
interstate  adoption  laws).  It  will  stress 
service  for  all  children,  including  those 
called  "hard-to-place."  A  survey  of  the 
States  involved  indicated  that  over 
2,000  children  had  been  waiting  more 
than  90  days  for  adoption. 

Milt  Erickson  of  the  Lutheran  Social 
Services,  Sioux  Falls,  S.  Dak.,  has  been 
lected  president  of  the  board  for  the 
service.  His  agency  has  been  particu- 
larly active  in  working  for  an  inter- 
state adoption  facilitating  agency. 

Unmarried  mothers 

The  first  regional  conference  on  con- 
tinuing education  for  pregnant  teenage 
girls  took  place  in  Detroit,  Mich.,  May 
4-0,  under  the  auspices  of  the  Office  of 
Education,  U.S.  Department  of  Health, 
Education,  and  Welfare,  and  the  De- 
troit public  school  system.  The  partici- 
pants included  175  persons — chiefly  edu- 
cators and  staff  members  of  health  and 
welfare  agencies  from  both  urban  and 
rural  areas  in  Illinois,  Indiana,  Michi- 
gan, Ohio,  and  Wisconsin.  They  focused 
their  attention  on  the  school's  role  in 
providing  continuing  education  and  sup- 
portive services  for  teenage  pregnant 
girls  and  unwed  mothers,  the  kinds  of 
interdisciplinary  and  interagency  com- 
prehensive programs  now  available  to 
them  in  some  places,  and  resources  for 
financing  program  development  and 
expansion. 


Speakers  described  programs  in  Chi- 
cago, Detroit,  Los  Angeles,  and  Wash- 
ington, D.C.,  stressing  the  importance  of 
coordination  of  health,  education,  and 
social  services  and  of  interprofessional 
efforts  on  behalf  of  the  girls.  They  also 
discussed  ways  of  dealing  with  negative 
attitudes  in  the  community  and  pointed 
to  the  importance  of  involving  repre- 
sentatives of  all  segments  of  the  com- 
munity in  getting  a  program  underway. 
In  a  discussion  of  the  educational  con- 
tent of  a  program,  courses  in  nutrition, 
baby  care,  and  physical  and  emotional 
development  were  recommended  to  be 
added  to  the  regular  .school  curriculum. 

Education 

About  3,000  children  who  enrolled  in 
kindergartens  and  first  grades  this  fall 
are  receiving  special  educational  atten- 
tion through  Follow  Through  projects 
in  30  school  districts  in  25  States  and 
the  Commonwealth  of  Puerto  Rico. 
They  are  the  participants  in  the  pilot 
phase  of  a  new  Federal  program  to  help 
schools  sTistain  the  intellectual,  social, 
and  physical  gains  made  by  disadvan- 
taged children  in  preschool  educational 
programs,  especially  the  preschool  cen 
ters  established  under  Project  Head 
Start.  The  new  program  is  administered 
by  the  Office  of  Education  with  funds 
provided  by  the  Ofiice  of  Economic 
Opportunity. 

Participating  schools  are  using  new 
teaching  methods  and  the  services  ol 
teaching  specialists,  teacher  aides,  psy- 
chologists, social  workers,  and  medical 
.specialists  to  meet  whatever  needs  the 
children  have  that  affect  their  ability 
to  get  ahead  in  school.  In  addition, 
parents  are  taking  part  in  Follow 
Through — as  aides  or  volunteer  helpers 
in  the  classroom  and  on  field  trips  and 
as  members  of  polic.v  advisory  commit- 
tees. Most  of  the  children  involved  are 
attending  regular  classes  where  they  re- 
ceive special  attention.  In  addition 
many  schools  are  providing  the  children 
with  help  in  extended  day  classes — that 
is,  after  regular  schoolhours. 

According  to  present  plans,  Follow- 
Through  assistance  will  eventually  be 
provided  to  children  through  the  third 
grade.  As  experiments,  the  programs 
are  open  to  visitors  from  other  school 
districts,  and  evaluation  reports  on 
them  will  be  sent  to  other  school 
di.striets. 

The  States  with  Follow  Through  pro- 


M- 


v, 


204 


CHILDREN 


SEPTEMBER-OCTOBER  1967 


FOR  CHILDREN  OF  THE  AMERICAS 


Wlien  the  Couucil  of  the  Organization 
of  Aiiieritiiii  States  (OAS)  on  June  7, 
I'.HiT,  saw  linal  approval  to  the  budget 
of  the  ran  Anierifan  L'nion  (PAU)  and 
certain  speoializod  organizations  for  the 
fiscal  year  ending  June  30,  1968,  the 
largest  percentage  increase  authorized 
for  any  agency — 14.04  percent — was  for 
the  Inter-American  Children's  Institute 
(lACl)  which  is  celebrating  its  40th 
anniversary  this  year.  (The  increase  for 
I'AII  as  a  whole  was  3.02  percent.)  The 
lACI  budget  for  the  19158  fiscal  year  is 
$1.39.939,  as  compared  with  .$122,706  for 
1967, 

Kecent  lAl'l  activities  have  included 
three  regional  seminars  to  develop 
standards  for  family  and  child  welfare 
in  integrated  programs  of  national  de- 
velopment :  seminars  on  vocational 
training  of  adolescents  in  Brazil  and 
Venezuela  ;  a  nutrition  course  for  train- 
ing workers  to  combat  malnutrition  in 
Haiti ;  courses  on  legislation  pertaining 


to  minors  in  Bolivia  and  Paraguay  ;  an 
advisory  service  to  the  national  coun- 
<-ils  for  minors  in  Argentina  and  Peru; 
a  training  cour.se  for  .social  workers  spe- 
cializing in  child  and  family  welfare,  in 
cooperation  with  the  University  of 
Costa  Rica ;  cooperation  with  the  In- 
ternational Children's  Center  of  Paris  in 
a  course  for  schoolteachers  on  under- 
standing child  behavior,  given  in 
Brazil ;  seminars  in  Bolivia  and  the 
Dominican  Republic  for  officials  of 
civil  registry  offices,  with  the  objective 
of  improving  birth  registration  and 
other  statistics  on  children. 

lACI  has  just  created  a  section  on 
mental  retardation  and  will  soon  hold 
a  seminar  on  the  subject.  Another 
lACI  innovation  this  year  wi'l  be  a  se- 
ries of  courses  for  juvenile  court  judges 
and  auxiliary  court  personnel,  the  first 
of  the  kind  in  Latin  America.  lACI  is 
also  carrying  responsibility  for  the  prep- 
aration of  working  documents  for  the 


XIII  Pan  American  Child  Congress  to 
be  held  in  Quito,  Ecuador,  early  in 
19(>,S.  The  basic  theme  uf  the  Congress 
will  be  "Population  Growth  and  Us  In- 
cidence i>n  Planning  fur  riii]<ln'n  and 
Vonlh." 

The  input  into  lACI  activities  from 
cooperating  organizations  far  exceeds 
lACPs  budget.  UNICEF  contributes 
fellowships  for  some  of  the  seminars 
and  training  courses ;  WHO,  PAHO, 
FAO,  and  the  Unitarian-Univer.salisl 
Service  Committee  supply  experts  and 
funds  for  nutrition  cour.ses  and  semi- 
nars ;  UNESCO  helps  with  vocational 
training  activities.  The  services  of  a 
small  technical  staff  at  lACI's  head- 
quarters in  -Montevideo  are  supple- 
mented as  needed  by  contracts  with  ex- 
perts, thus  utilizing  and  making  better 
known  the  technical  resources  already 
in  the  American  Republics. 

— Elisabeth  Shirley  Enochs 


grams  are  California,  Colorado,  Con- 
necticut, Florida,  Georgia,  Hawaii, 
Iowa,  Kentucky.  Maryland,  Massachu- 
setts, Michigan,  Minnesota,  Mississippi, 
Missouri,  New  Hampshire,  New-  York, 
North  Carolina,  Oregon,  South  Dakota, 
Tennessee.  Texas,  Utah,  Vermont,  West 
Virginia,  and  W'isconsin. 

Mental  retardation 

Students  in  schools  of  social  work 
had  more  opportunity  in  academic  year 
1965-66  than  ever  before  to  obtain  ex- 
perience in  working  with  mentally  re- 
tarded children,  the  American  Associa- 
tion on  Mental  Deficiency  found  in  a 
survey  of  mental  retardation  as  a  focus 
in  social  work  education.  From  a  ques- 
tionnaire sent  to  the  07  member  schools 
of  the  Council  on  Social  Work  Educa- 
tion, the  association  received  55  replies, 
only  16  of  which  indicated  that  the 
school  had  no  students  placed  in  mental 
retardation  programs.  The  other  39  re- 
ported 330  full-time  students  (or  5.6 
percent  of  their  total  enrollment)  in 
fleld  units  or  individual  placements  in 
mental    retardation    programs    during 


academic  year  1965-66.  Most  of  these 
placements  had  been  set  up  since  1963. 

The  survey  showed  that  32  schools 
had  57  field  units  for  264  students  us- 
ing the  three  basic  social  work  methods  ; 
about  half  were  in  residential  institu- 
tions. Seventy-two  students  were  in  in- 
dividual placements — the  majority  do- 
ing casework — in  10  mental  retardation 
programs  in  40  agencies,  most  of  them 
residential  institutions  and  developmen- 
tal and  evaluation  clinics.  Both  types  of 
placements  received  some  Federal  sup- 
port, either  from  the  Vocational  Reha- 
bilitation Administration,  or  the  Public 
Health  Service,  or  the  Children's 
Bureau. 

The  survey  also  fomid  that  37  schools 
had  faculty  ixisitions  for  fleld  instruc- 
tors in  mental  retardation  units;  27 
schools  had  full-time  faculty  members 
and  10  had  part-time  faculty  members. 
Relevant  mental  retardation  content 
was  included  in  the  basic  curriculum 
sequences  and  research.  The  content 
was  presented  through  ca.se  teaching 
methods,  formal  lectures,  assigned  read- 
ings, audiovisual  aids,  field  observa- 
tions, and  assigned  cases  in  field  place- 


ments. In  1965-60,  10  .schools  also  con- 
ducted short-term  training  xerograms  in 
mental  retardation  such  as  work.shops, 
seminars,  and  institutes  for  faculty 
members  and  practitioners. 

The  schools  indicated  that  they  need- 
ed teaching  material  concerning  mental 
retardation,  that  they  had  had  difficulty 
recruiting  field  instructors  with  experi- 
ence in  social  work  with  the  retarded, 
and  that  students  had  difliculty  integrat- 
ing what  they  were  learning  in  the  fleld 
with  what  they  were  learning  in  the 
classroom. 


Several  State  agencies  in  Iowa  and 
many  private  social  agencies  in  the 
State  are  developing  a  short-term  train- 
ing project  for  the  foster  parents  of 
mentally  retarded  children.  Twelve  in- 
stitutes w-ill  be  held  between  October 
and  December  of  this  year.  The  State 
agencies  involved  include  the  State  Uni- 
versity of  Iowa  School  of  Social  Work  ; 
the  State  Department  of  Social  Wel- 
fare ;  the  two  State  institutions  for  the 
mentally  retarded;  the  Iowa  Welfare 
Association  ;  and  the  State  mental  re- 


VOLUME   14  -  NUMBER  5 


205 


tardation  planning  agency,  Progressive 
Action  for  tlie  Retarded. 


To  expand  and  improve  foster  family 
care  for  mentally  retarded  children,  tbe 
Minneapolis  Association  for  Retarded 
Cbildren  is  recommending  that — 

•  Licensing  standards  be  developed 
specifically  for  foster  family  homes  for 
retarded  children. 

•  The  fee  structure  for  such  homes 
be  modified. 

•  Agency-owned  foster  homes,  run  by 
agency  personnel,  be  established. 

•  Training  programs  be  conducted 
for  the  foster  parents  of  mentally  re- 
tarded children. 

•  Staffing  requirements  be  estab- 
lished for  foster  boarding  homes  that 
care  for  more  than  five  children. 

These  and  other  recommendations  are 
the  results  of  an  inquiry  the  associa- 
tion made  into  the  use  of  foster  board- 
ing homes  for  mentally  retarded  chil- 
dren by  the  Hennepin  County  Welfare 
Department.  The  association  found  that 
the  quality  of  the  program  was  im- 
paired by  the  manipulation  by  place- 
ment agencies  of  standards  developed 
for  the  foster  care  of  normal  children ; 
the  shortage  of  available  foster  homes 
for  mentally  retarded  children  ;  and  the 
lack  of  other  types  of  residential  facili- 
ties for  mentally  retarded  children  in 
the  county. 

As  a  result  of  this  study,  the  Minne- 
apolis Department  of  Public  Welfare  is 
now  developing  new  standards  and 
guidelines  for  foster  group  homes  car- 
ing for  mentally  retarded  as  well  as 
"normal"  children. 

The  report  of  the  study,  "Foster 
Boarding  Care  for  Mentally  Retarded 
Children."  by  Sheldon  R.  Schneider,  is 
available  from  the  association  (2401 
West  66th  Street,  Minneapolis,  Minn. 
55423). 


Mentally  retarded  children  placed  in 
foster  families  made  greater  improve- 
ments over  a  3-year  period  in  all  as- 
pects of  development,  including  intelli- 
gence, than  did  children  with  the  same 
degree  of  retardation  who  were  placed 
in  an  institution,  according  to  the  find- 
ings of  a  .study  recently  completed  in 
Kentucky.  Conducted  by  the  Kentucky 
Department  of  Child  Welfare,  with  the 
cooperation  of  the  Kentucky  Depart- 
ment  of    Mental    Health    and    support 


from  the  Children's  Bureau,  the  study 
focused  on  30  children  placed  in  foster 
family  homes  and  29  placed  in  a  State 
institution  for  the  retarded. 

The  two  groups  were  matched  at  the 
beginning  of  the  study  according  to 
age,  sex,  IQ,  and  previous  experience  in 
foster  care.  Both  groups  of  children  i-e- 
ceived  training  through  special  educa- 
tion programs  during  the  study  period, 
and  both  groups  made  progress  in  social 
behavior.  Whether  or  not  the  children 
had  been  diagnosed  as  functionally  or 
organically  retarded  bore  no  significant 
relation  to  their  degree  of  intellectual 
improvement. 

As  a  byproduct,  the  study  demon- 
strated that  foster  famil.v  homes  can  be 
found  and  sustained  for  mentally  re- 
tarded children.  In  selecting  foster 
parents,  the  project  relied  heavily  on 
the  social  worker.s'  evaluation  rather 
than  outside  references ;  foster  parents 
were  not  excluded  because  of  negative 
characteristics  if  they  .showed  counter- 
balancing kinds  of  strength  :  the  reports 
of  family  physicians  on  the  health  in- 
stead of  the  findings  of  public  health 
clinics,  as  is  usual. 

The  agency  provided  the  foster 
parents  with  casework  counseling,  in- 
dividually and  in  groups,  on  a  more 
highly  concentrated  basis  than  is  usu- 
ally provided  foster  parents. 

The  project  was  directed  by  Marjorie 
Wilson.  Robert  Fishman  was  its  re- 
search director. 


Foster 


care 


The  Iowa  Children's  Home  Society, 
a  voluntary  agency  in  Des  Moines,  has 
developed  two  programs  involving 
foster  parents  that,  it  reports,  have 
greatly  heli)ed  the  agency  in  its  work. 
One  offers  group  consultation  to  foster 
parents  in  place  of  individual  case- 
work ;  the  other  is  a  public  relations 
program  through  which  foster  parents 
interpret  the  agency's  work  to  civil  and 
religious  groups. 

Under  the  first  program,  about  130 
foster  mothers  and  fathers  are  now  as- 
signed to  nine  consultation  groups, 
which  meet  at  hours  convenient  to  them. 
During  the  meetings,  conducted  by  an 
agency  caseworker,  the  parents  discuss 
their  problems  as  foster  parents  and 
their  relations  with  the  agency. 

The  agency  also  reports  that  both 
parents  and  staff  members  have  ac- 
cepted the  group  discussion  as  a  sub- 


stitute for  individual  casework  and 
that  it  has  made  the  method  part  of  its 
continuing  supportive  services  for 
foster  parents. 

Under  the  second  program,  now  in 
its  fourth  year,  a  panel  of  four  foster 
mothers,  each  caring  for  a  different 
kind  of  child,  give  brief  talks  about  the 
problems  and  rewards  of  giving  foster 
care  and  how  they  and  the  agency  work 
together.  If  the  program  is  at  night,  a 
foster  father  may  join  the  panel  to  ex- 
plain his  duties  as  a  foster  father.  The 
community  relations  worker  from  the 
agency  talks  briefly  about  the  agency, 
the  supervisor  of  foster  care  moderates 
the  panel,  and  together  with  the  panel 
members  they  answer  questions  from 
the  floor. 


Foster  grandparent  programs  to  pro- 
vide employment  for  the  elderly  and  the 
warmth  of  individual  grandparent  rela- 
tionships to  neglected,  dependent,  dis- 
turbed, or  mentally  retarded  children 
have  demonstrated  great  value  both  for 
the  elderly  persons  and  the  children  in- 
volved, according  to  a  study  recently 
reported  by  Greeuleigh  Associates,  a 
nonprofit  research  organization.  The 
study  was  made  for  the  Office  of  Eco- 
nomic Opportunity  (OEO)  of  10  of  the 
22  foster  grandparent  programs  being 
supported  by  OEO  in  1006. 

The  organization  found,  on  the  basis 
of  "professional  observations,"  that  70 
percent  of  the  children  served  showed 
some  physical,  .social,  and  emotional  im- 
provement and  that  this  improvement 
in  more  than  90  percent  of  the  cases 
could  be  attributed  in  part  to  foster 
grandparent  care.  It  also  found  that 
weaknesses  in  administration  and  op- 
eration were  often  offset  by  the  strength 
of  the  goals  and  the  design  of  the  pro- 
grams ;  and  that  the  programs  relied 
on  leadership  from  OEO  and  the  Ad- 
mini.stration  on  Aging,  U.S.  Department 
of  Health,  Education,  and  Welfare,  be- 
cause they  received  little  local  support. 

The  study  was  conducted  through  in- 
terviews with  members  of  the  sponsor- 
.ing  and  host  agencies  (hospitals  and 
institutions  for  neglected,  dependent, 
disturbed,  or  mentally  retarded  chil- 
dren), site  observations,  and  studies  of 
primary  resource  material.  All  of  the 
foster  grandparents  had  been  in  the  pro- 
gram for  at  least  2  months ;  all  of  the 
children,  for  at  least  2  weeks.  Most  of 
the  children  were  about  5  or  6  years  old, 


206 


CHILDREN 


SEPTEMBER-OCTOBER  1967 


Miniigh  llR'ir  ngos  raiiscil  from  uiulor  1 
■  ver  13. 
of  the  396  ohildren  involved,  70  per- 
cent were  reported  to  have  improved  in 
their  behavior  or  in  their  health ;  5G 
percent  sliowed  improvement  in  their 
relationslii|)s  with  others;  52  percent 
showed  improved  emotional  adjust- 
ment ;  38  i)ercent  showed  improvement 
in  physical  health  and  in  sleeping 
and  eating  habits,  and  38  percent, 
In  physical  mobility,  motor  skills,  and 
self-care.  The  extent  of  these  improve- 
ments was  found  to  be  similar  in  all 
types  of  institutions,  except  in  an  insti- 
tution for  emotionally  disturlied  teen- 


age children,  wliere  only  19  percent  of 
the  children  with  foster  grandparents 
seemed  to  show  improvements. 

Most  of  the  2C9  foster  grandparents 
in  the  i)rograms  studied  were  women, 
though  bolli  men  and  women  had  been 
sought  in  recruitment  efforts.  Most  of 
the  elderly  persons  learned  alxnit  the 
program  through  the  newspapers, 
friends,  or  social  agencies ;  only  a  very 
few,  through  employment  agencies. 

The  programs  studied  were  in  At- 
lanta, Ga.,  Denver,  Colo.,  Fort  Wayne, 
Ind.,  Madison,  Wis.,  Morganton,  N.C., 
Nashville,  Tenn.,  New  York,  N.Y.,  I'hila- 
dclphia,  Pa.,  St.  Cloud,  Miiui.,  and  San 


l''i':nii'isrii.  Calif. 

The  study  organization  recommends 
that  the  foster  grandparents  program 
be  greatly  expanded  to  reach  more  com- 
munities and,  through  the  sponsors,  as 
wide  a  variety  of  agencies  as  possible. 
Among  other  recommendations,  it  also 
urges  that  the  one-to-one  relationship 
between  child  and  foster  grandparent 
be  kept  wherever  possible  and  that 
greater  efforts  be  made  to  reach  poten- 
tial foster  grandparents  in  low  socio- 
economic neighborhoods. 

(For  a  description  of  a  foster  grand- 
parent program,  see  CHILDRKX 
March-April  1907,  pp.  47-52.) 


th 


in  rne  |Ournais 


ii 


School  nursing  services 

The  efforts  of  parents  in  low  socio- 
economic areas  of  Oakland,  Calif.,  to 
make  and  keep  their  children  healthy 
increased  appreciably  after  school 
nurses  in  a  special  demonstration  proj- 
ect worked  more  closely  with  them  than 
is  usual,  according  to  Doris  S.  Bryan 
and  Thelma  S.  Cook  in  the  July  1907 
issue  of  the  American  Journal  of  Public 
Health.  ("Redirection  of  School  Nurs- 
ing Services  in  Culturally  Deprived 
Xeighboi'hoods." )  The  school  system 
found  that  assigning  trained  clerical  as- 
sistants to  nurses  to  handle  routine 
duties  such  as  running  the  office  and 
keeping  records  on  pupils  and  assisting 
in  visual  screening  gave  the  nurses 
more  time  to  work  with  pai-ents,  par- 
ticularly those  whose  children  had  spe- 
cial health  problems,  the  authors  re- 
port. The  three  nurses'  assistants  em- 
ployed for  the  project  received  20  hours 
of  formal  inservice  training  in  addition 
to  continuing  supervision  from  the 
nur.ses. 

The  parents  of  children  in  three 
kindergartens  received  special  counsel- 
ing and  parent  education  services  from 
the  nurses ;  those  of  children  in  three 
others,  who  did  not  receive  special  serv- 


ice, were  studied  for  comparison.  Con- 
tacts with  parents  were  made  in  the 
home  and  in  the  school. 

The  authors  report  that  the  school 
system  found  that  an  urgent  need  exists 
to  identify  the  ways  in  which  the  serv- 
ice should  be  redirected  to  meet  the 
needs  and  problems  of  pupils  and  par- 
ents, the  goals  the  nursing  service  can 
attain,  and  the  knowledge  and  skill 
needed  by  nurses  in  such  a  program. 
"Nurses  may  need  ...  to  research 
nursing  problems.  .  .  ." ;  and  "Redirec- 
tion may  be  toward  the  development  of 
a  more  highly  skilled  school  nur.se  prac- 
titioner." the  authors  maintain.  The 
program  was  supported  in  part  by  a 
research  grant  from  the  Children's 
Bureau. 

Grownup  child 

Xew  Generation  is  the  new  name  of 
the  American  Child,  bulletin  of  the  Na- 
tional Committee  on  Employment  of 
Youth,  itself  a  tran.sformation  of  the 
National  Child  Labor  Committee.  The 
publication  originally  appeared  over  50 
years  ago  as  the  Child  Labor  Bulletin. 

In  its  first  issue  as  the  Xeiv  Genera- 
tion (summer  1907),  the  bulletin 
focuses  attention  on  possible  strategy 


for  sustaining  the  war  on  poverty  by 
presenting  a  symposium  of  diverse  views 
on  what  should  be  done  about  the  struc- 
ture and  programs  of  the  Office  of  Eco- 
nomic Opportunity  (OEO).  The  con- 
tributors: Richard  W.  Boone,  executive 
director.  Citizens'  Crusade  Against 
Poverty ;  Congressman  Charles  E. 
Goodell  of  New  York ;  Hyman  Book- 
binder, assistant  director,  OEO ;  Ken- 
neth E.  Marshall,  vice  president.  Metro- 
politan Applied  Research  Center,  Inc. ; 
S.  M.  Miller,  program  adviser,  Ford 
Foundation. 


Emergency  parents 


An  around-the-clock  emergency  par- 
ent service  has  ended  the  need  for  sud- 
denly taking  children  out  of  their  homes 
for  the  Children's  Aid  and  Society  for 
the  Prevention  of  Cruelty  to  Children  in 
Erie  County  (Buffalo),  N.Y.,  the 
agency's  executive  director  Norman  W. 
Paget,  reports  in  the  July  1907  issue  of 
Child  Welfare.  ("Emergency  Parent — 
A  Protective  Service  to  Children  in 
Crisis.")  In  the  first  11  months  of  the 
program,  the  agency  sent  emergency 
parents  into  32  homes  where  128  chil- 
dren had  been  left  alone,  he  says.  In 
every  ca.se,  the  emergency  parents, 
sometimes  in  relays,  were  able  to  care 
for  the  children  until  their  parents  or 
guardians  assumed  their  parental  re- 
sponsibilities or  until  the  agency  could 
find  the  right  foster  homes,  he  points 
out. 

The  agency  recruits  both  men  and 
women  and  sometimes  couples  as  emer- 


VOLUME   14  -  NUMBER  5 


207 


geiicy  parents,  the  author  reports.  They 
are  on  call  except  while  at  work  for  a 
week  at  a  time  and  receive  a  small  fee 
while  on  call  and  pay  at  an  hourly  rate 
while  in  actual  service.  Each  is  care- 
fully instructed  regarding  the  duties  of 
emergency  parents.  This  instruction  in- 
cludes describing  the  limits  of  these  du- 
ties— the  emergency  parent,  for  in- 
stance, does  not  deal  with  the  parents  in 
any  way. 

An  emergency  parent  brings  a  kit  of 
such  items  as  cookware,  light  bulbs,  and 
insect  spray  with  him  when  he  goes 
into  a  home,  and,  as  instructed,  he  uses 
an  agency  staff  car  equipped  with  a 
radio-telephone  in  case  the  home  has 
no  telephone,  as  many  do  not.  He  also 
carries  an  aerosol  spray  for  protection, 
if  needed.  However,  though  parents  are 


often  hostile  toward  emergency  par- 
ents when  they  return  home,  none  has 
ever  been  violent,  the  author  reports. 
The  author  points  out  that  while  the 
agency  has  a  homemaker  service  to 
serve  families  in  crises  such  as  a 
mother's  illness  homemakers  are  not 
expected  to  go  into  homes  in  which 
there  is  a  potentially  dangerous  situa- 
tion or  in  which  there  is  no  responsible 
adult  with  whom  to  plan. 

Birth  weight  and  blindness 

Perinatal  factors  and  low  birth 
weight  seem  to  be  associated  with 
blindness  in  the  newborn  infants,  ac- 
cording to  an  article  in  the  June  1967 
issue  of  Public  Health  Reports  report- 
ing on  a  study  of  553  blind  children  in 


New  York  State.  ("Association  of  Peri 
natal  Factors  With  Blindness  in  Chil- 
dren," by  Irving  D.  Goldberg,  Hyman 
Goldstein,  Dana  Quade,  and  Eugene 
Rogot. ) 

Of  the  children  studied,  a  greater 
proportion  than  in  the  general  popula^ 
tion  weighed  less  than  normal  at 
birth — indeed,  low  birth  weight  char- 
acterized them — and  more  were  of  twlD 
birth,  the  investigators  found.  They 
also  found  a  greater  proportion  than 
usual  of  mothers  who  were  at  the  ex- 
tremes of  the  maternal  age  span  (un- 
der 20  or  over  35),  had  had  complica- 
tions of  pregnancy  or  labor,  were  primi- 
paras,  or  had  had  stillbirths. 

The  authors  report  that  the  most 
common  type  of  blindness  in  the  chil 
dren  was  from  congenital  cataracts. 


readers*  exchange 


HAGGERTY:   Comprehensive  core 

I  want  to  commend  the  emphasis  in 
Dr.  Haggerty's  article  on  the  need  to 
incorporate  the  concept  of  comprehen- 
sive care  into  medical  training.  ["Pedi- 
atric Training  and  the  Manpower 
Problem,"  by  Robert  J.  Haggerty,  M.D., 
CHILDREN,  May-June  1967.] 

Each  person's  potential  for  physical, 
cognitive,  and  sociobehavioral  health 
and  competence  must  be  nurtured  and 
protected  during  the  formative  years  in 
utero  and  childhood  if  the  citizens  of 
our  Nation  are  ever  to  attain  high-level 
wellness  of  body  and  mind.  Tliat  we  are 
far  from  achieving  this  goal  is  obvious 
from  the  high  incidence  of  physical, 
intellectual,  and  behavioral  disabilities 
among  the  youth  of  our  Nation. 

The  causes  and  consequences  of  many 
of  these  disabilities  lie  as  much  in  the 
social  and  behavioral  disabilities  as  in 
the  biologic  and  physical.  Yet,  we  con- 
tinue to  educate  medical  students, 
house  officers,  and  residents  as  though 
most  of  the  important  maladies  of  man- 
kind could  be  cured  or  prevented  by 
biophysical  means   alone.   This   is   not 

208 


surprising,  for  it  takes  a  great  deal  of 
effort  and  skill  to  alter  deeply  rooted 
traditions  in  fields  as  firmly  established 
as  medical  education. 

It  may  be  advantageous  and,  perhaps, 
essential  to  incorporate  the  elements 
of  comprehensive  health  care  into  the 
medical  curriculum  at  its  outset.  Other- 
wise, students  may  continue  to  be  so 
strongly  conditioned  to  think  only  in 
biophysical,  curative  terms  that  by  the 
time  they  come  to  the  final  stages  of 
residency  training  they  will  have  little 
awareness  of  the  significance  of  social 
phenomena  in  medicine  and  little  in- 
centive to  invest  in  a  career  of  com- 
pi-ehensive  health  care. 

This  relatively  undeveloped  segment 
of  medicine  is  loaded  with  fascinating 
and  challenging  opportunities  for  imag- 
inative research.  The  possible  topics 
range  from  developing  methods  for  the 
systematic  identification  and  measure- 
ment of  social  and  behavioral  factors  of 
critical  importance  in  human  develop- 
ment, health,  and  disease  to  identifica- 
tion of  the  important  variables  in  the 
politics,  staflBng,  financing,  delivery, 
and  evaluation  of  comprehensive  health 


care  for  segments  of  the  population. 

Some  medical  students  might  be  at- 
tracted to  university-based  careers  asi 
investigators  and  teachers  in  this  fieldi 
More  important  perhaps,  many  others 
might  be  attracted  to  careers  as  physi 
cians  whose  knowledge  and  skill  in  tht 
field  of  comprehensive  health  care  iii 
at  least  equal  to  the  skill  of  physicians 
who  are  subspecialists  in  various 
sharply  delimited  areas  of  medicine' 
Thus  physicians  trained  to  provide  com-i 
prehensive  care  could,  with  the  support 
of  allied  health  workers  and  modern 
technological  devices,  take  over  where 
the  general  practitioners  of  the  past 
have  left  off,  and  raise  the  standards 
of  medical  care  in  our  coimtry  to  new 
heights. 

Thanks  to  the  Children's  Bureau  and 
the  National  Institute  of  Child  Health 
and  Human  Development,  these  excit- 
ing possibilities  are  already  being  con- 
verted into  reality,  thus  providing 
pediatrics  with  new  opportunities  to 
lead  the  way  in  solving  some  of  the 
Nation's  pressing  contemporary  health 
problems  as  it  has  in  the  past  in  con- 
trolling the  infectious,  nutritional,  and 
related  diseases  that  used  to  kill  or 
maim  so  many  children. 

Nathan  B.  Talbot,  M.D. 

Charles  Wilder  Professor  of  Pediatrics 
Harvard  Medical  Sc/ioot 


CHILDREN 


SEPTEMBER-OCTOBER  1967 


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How  Young  Children  Learn 
Behavior  of  Disturbed  Blind  Children 
Discussion  Groups  of  Adoptive  Parents 
Mentally  Retarded  Adolescents 


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VOLUME   14     •    NUMBER  6    •    NOVEMBER-DECEMBER   1967 


children 


AN  INTERDISCIPLINARY  JOURNAL  FOR  THE  PROFESSIONS  SERVING  CHILDREN 


k 


An  adopting  couple  and  their 
new  baby"  regard  each  other 
with  delight  and  curiosity.  The 
joy  of  finally  receiving  a  child 
lit  ten  obscures  the  anxiety  such 
couples  may  feel  about  the  spe- 
cial problems  of  being  adoptive 
parents.  How  one  agency  is  help- 
ing groups  of  such  new  parents 
help  each  other  face  some  of  the 
problems  they  are  concerned 
about  is  described  on  pages  223- 
226. 


Spontaneous  Ways  of  Learning  in  Young 

Children 210 

Lois  B.  Murphy 

Patterns  of  Change  in  Disturbed  BNnd  Children  in 

Residential  Treatment 217 

John    R.    Ross,   Jr.,    Bernard    B.    Braen,    and 
Ruth  Chaput 

Helping  Adopting  Couples  Come  to  Grips  With 

Their  New  Parental  Roles 223 

Edith  M.  Chappelear  and  Joyce  E.  Fried 

The  Group  Process  in  Helping  Parents  of  Retarded 

Children 227 

Arthur  Mandelbaum 

Some  Observations  About  Mentally  Retarded 

Adolescents 233 

Arthur  Segal 

Extending  a  Hand  to  Parents  of  Disturbed 

Children 238 

Joyce  Edward 

book  notes 244 

here  and  there 245 

readers'  exchange 247 


children 


National  Advisers  to  CHILDREN 

William  E.   Brnwn.  deiilistry 

Alex  Elson,  law 

Patricia  G.  Moriscy,  social  worJ[ 

Edwin  M.  Gold,  obstetrics 

Herman  R.  Goldberg,  education 

Beatrice  Goodwin,  nursing 

Dale  B.  Harris,  psychology 

Robert  J.  Havighurst,  youth  development 

Robert  B.  Kugel,  pediatrics 

Hylan  Lewis,  sociology 

Winford  Oliphant,  child  welfare 

Milton  G.  Rector,  corrections 

R.  Gerald  Rice,  maternal  and  child  health 

Albert  J.  Solnit,  psychiatry 

Franklin  M.  Zweig,  community  planning 

Children's  Bureau  Staff  Advisers 

Hester  B.  Curtis,  chairman 

Division  of  International  Cooperation 

Grace  M.  Angle 
Office  of  the  Chief 

Dorothy  E.  Bradbury 
Division  of  Reports 

Kenneth  S.  Carpenter 

Division  of  fiivenile  Delinquency  Service 

Hyman  Goldstein 
Division  of  Research 

Jane  S.  Lin-Fu 

Division  of  Health  Services 

Will  Wolstein 

Division  of  Social  Services 

Editorial  Staff 

Kathryn  Close,  Editor 

Catherine  P.  Williams.  Associate  Editor 

Mary  E.  Robinson,  Willamena  Samuels,  Assistants 

210 


for  those  who  would  help  young 
children  build  a  foundation  for  later 
learning,  a  psychologist  describes  the 


^lany  doctors  and  psychologists  used  to  be 
lieve  that  the  young  infant  was  so  busy  feed- 
ing and  sleepmg  tliat  not  much  learning  went 
on;  they  thought  tliat  his  development  came  about 
almost  entirely  as  a  result  of  his  physical  matura- 
tion. By  contrast,  recent  child  development  researcl" 
and  observation  of  both  well-stinudated  and  deprivec 
cliildren  provide  a  basis  for  far  more  respect  for  thd 
spontaneous  ways  in  which  the  infant  leams  aboai 
liimself  and  about  the  world  and  how  he  can  functioi 
m  it.  In  one  article,  I  cannot  review  all  the  data  ano 
theory  relevant  to  infant  learning.  I  will,  however 
sketch  some  of  the  ways  in  wliich  the  relatively  lui 
organized,  passive  newborn  infant  becomes  the  mucl 
more  organized,  curious,  competent  2-year-old  wh 
copes  ingeniously  with  many  problems. 

By  the  time  the  child  is  2,  he  has  learned  to  adap 
his  body,  his  needs,  and  his  wants  to  the  readymad 
schedules,  demands,  and  opportunities  of  the  world 
he  has  also  learned  the  value  of  protest,  of  fendinj 
otf  excessive  pressures,  and  of  wooing  the  respons 
of  adults.  He  continues  to  master  a  wide  range  o 
motor,  cognitive,  language,  and  social  skills  in  thi 
next  3  years  before  engaging  in  the  fonnal  learnin/ 
process  provided  by  school. 

Discussions  of  the  learning  processes  in  a  chiL 
have  generally  taken  their  departure  from,  or  hav 
beeii  carried  on  in,  the  context  of  learning  in  schoo 
through  formal  lessons  and  drill.  The  thrust  towan 
activity  initiated  by  John  Dewey's  dynamic  idea 
did  not  evoke  a  comprehensive  study  of  the  range  o 
spontaneous  learning  i:)rocesses  that  go  on  in  the  firs 
years  of  life  in  children  growing  uj)  in  stimulating 
and  responsive  environments.  Piaget's  studies  of  ir 

CHILDREN     •     NOVEMBER-DECEMBER   196 


I- 


♦ 


♦ 


SPONTANEOUS  WAYS 
OF  LEARNING 


^ 


♦ 


*      IN  YOUNG  CHILDREN 


LOIS  B.  MURPHY 


fants  '  iukleil  to  the  recognition  of  the  role  of  certain 
aspects  of  sensory -motor  and  cognitive  learning  but 
left  many  gaps. 

The  followuig  list  of  some  first  steps  in  leaniing  is 
basetl  upon  my  observations  of  children  in  different 
settings  and  conditions  of  life  in  various  parts  of  the 
world,  as  well  as  on  results  of  research. 

1.  Learning  to  me  reflex  equipment  more  efficiently. 
The  newborn  infant's  ellort  to  perfect  his  sucking 
ability  points  to  one  of  the  first  types  of  learning. 
Some  babies  are  inefficient  at  first  and  have  to  prac- 
tice to  achieve  skill,  an  effort  quickly  rewarded  by 
more  satisfying  intake  of  milk.  The  improvement  of 
feeding  reflexes,  including  sucking,  chomping,  and 
chewing,  is  paralleled  bv  effective  integration  of  the 
mternal  digestive  fmictions. 

The  Gestalt  principle  of  closure  - — the  tendency  of 
each  functional  system  to  become  more  orderly  as  a 
result  of  gi-owth  or  practice,  or  both — is  involved  at 
all  stages.  Tlie  pleasure  principle  is  probably  also 
involved  insofar  as  improved  functioning  eliminates 
bhe  pain  of  fmstration,  delay,  conflict,  and  ineptitude 
md  results  in  "function  pleasure" — pleasure  in  the 
well-fimctioning  activity  itself.  The  achievement  of 
smooth  and  satisfying  organic  fmictioning  provides 
lasic  conditions  helpful  to  orderly  cognitive  leani- 
ng.^ This  probably  involves  the  equilibration  proc- 
Jsses  discussed  l)y  Piaget.' 

2.  Passive  looking,  listening.  Young  infants  can 
)ften  be  observed  within  tlie  first  days  of  life  staring, 
istening,  attending  to  a  siglit  (bright  light)  or  sound 
hat  impinges  upon  their  senses.  They  may  not  ac- 

^OLUME  14  -  NUMBER  6 


♦ 


♦ 


* 


♦ 


♦ 


tively  reach  out  for  stimulation  until  they  have  ex- 
perienced some  satisfaction  from  their  first  passive 
learning. 

The  first  step  is  orientation.*  Just  as  sucking  and 
other  oral  patterns  \va\&  to  be  refined,  so  does  the  co- 
ordination of  external  and  internal  eye  muscles  have 
to  be  improved  with  practice.  But  the  baby  begins  to 
stare  and  to  look  almost  from  birth.^'  As  a  residt,  he 
learns  to  connect  things  seen  together  and,  later,  to 
compare  and  test. 

3.  Learning  to  actively  select  and  turn  toward  stimuli 
follows  uijon  reflex  orientation.  "We  can  see  this  in 
some  vei7  young  infants  whose  motliers  respond  to 
their  indications  of  restless  "wanting  to  see  more."  A 
i-week-old  infant  in  the  group  studied  by  Escalona 
and  Leitch  "couldn't  be  held  lying  down."  '^  I,  too, 
liave  held  babies  who  were  not  relaxed  until  held  in  a 
position  from  which  they  could  see  around. 

The  baby's  turning  toward  new  i^atterns  or  toward 
particular  colors  or  faces,  well  documented  in  re- 
search,"- ^  is  a  step  beyond  passive  looking  at  what- 
ever is  there.  "We  often  see  very  young  babies  in  their 
mother's  or  fatlier's  anns  visually  exploring  a  strange 
environment.  I  have  seen  older  bal>ics,  of  8  months  to 
a  year,  twist  and  tuni  to  maximize  their  visual  range 
as  they  looked  ahead,  behind,  to  each  side,  and  up  and 
down.  This  visual  searching  probably  leaves  traces, 
or  engrams,  whicli  in  turn  lead  to  fresh  movements 
of  the  eyes  aj;  if  to  keep  on  catching  still  more. 
Rerlyne"  and  otiiers  have  discussed  the  intrinsic 
need  for  fresh  stimulation,  a  need  flagrantly  disre- 
garded in  much  institutional  care. 

People  are  observed  more  vigorously  and  often 


211 


than  things  by  many  babies,  probably  because  some 
peoi^le  provide  gratification  of  their  needs  and  also 
because  faces  and  bodies  are  complex  rather  than 
simple,  are  constantly  moving,  and  provide  multi- 
sensory  rather  than  unisensory  stimulation.  Pleasure 
derived  from  colors,  shapes,  and  voices  is  also  behind 
the  baby's  people-watching. 

4.  Exploration  of  a  wider  environment  as  the  baby 
grows  older  and  is  able  to  move  around,  "casing  the 
joint"  and  peering  into  things,  is  a  still  more  active 
way  in  which  infants  and  small  children  successively 
"find  out  about"  the  world  and  its  possibilities.  This 
very  active,  self-initiated  effort  to  learn  about  every- 
thing around  them  can  be  observed  in  infants  and 
children  growing  up  in  interesting  and  varied 
environments.  But  it  is  usually  lacking  in  children 
growing  up  in  barren,  dull  environments.  The  baby 
has  to  learn  that  active  attempts  to  learn  are 
rewarding. 

5.  Cognitive  mapmaking  as  described  by  Tolman '"' 
is  another  aspect  of  learning  in  infants.  The  baby 
uses  the  results  of  his  active  exploring,  organizes 
them,  and  holds  onto  them  as  an  aid  in  orientating 
himself  to  the  world,  managing  it,  and  getting  around 
in  it.  The  creeping  baby  soon  learns  that  he  can  find 
mother  in  the  kitchen  even  though  he  does  not  know 
the  word  for  kitchen. 

The  baby  learns  by  listening  as  well  as  through 
visual-motor  and  tactual  activities.  One  4-month-old 
baby  I  knew  learned  to  recognize  the  sound  of  her 
father's  footsteps  and  bounced  in  her  carriage  vigor- 
ously when  she  heard  him  coming.  Some  infants  learn 
to  recognize  musical  pieces  and  have  favorites  be- 
fore they  are  a  year  old.  Babies  in  our  longitudinal 
research  sample  at  the  Menninger  Foundation  in 
Topeka,  Kans.,  showed  wide  individual  differences 
in  their  responses  to  different  kinds  of  sounds.  Some 
babies  seem  to  make  an  "auditory  map"  along  with  a 
visual  map  of  their  surroundings — that  is,  they  learn 
to  associate  certain  sounds  with  places  and  actions. 

6.  Combining,  bringing  two  things  together  acci- 
dentally or  intentionally,  helps  the  child  to  discover 
wTiaf  happens — what  sound  results,  for  instance,  if 
lie  bangs  a  wooden  spoon  against  liis  crib.  This  re- 
sults in  the  baby's  "learning  to  make  something  hap- 
pen," as  Thorndike  put  it  long  ago,  tying  it  in  with 
the  baby's  "pleasure  in  being  a  cause."  "  Today  we 
think  of  the  dynamics  of  elementary  feedback  and 
the  enhancement  of  self-awareness  and  of  power  as 
implied  in  Charlotte  Biihler's  observation  of  the 


212 


"triumphierender  Blick"  of  the  nearly  1-year-old 
baby." 

Perhaps  taking  apart  or  opening  up  is  also  a  form 
of  experimenting  to  see  what  can  be  done  with  things. 
This  type  of  activity  begins  with  some  babies  at  about 
the  same  time  as  combining.  Pulling  at  things  and 
tearing  up  paper,  wool,  or  cotton  batting  contribute 
to  the  baby's  learning  about  textures  and  the  vari- 
ously yielding  or  resistant  qualities  of  materials. 

7.  Organizing  all  of  the  oral,  auditory,  visual, 
tactual,  and  visual-motor  processes  of  learning  goes 
on  at  different  levels  of  complexity.  Bits  of  raw  stim- 
uli become  familiar  and  are  organized  into  mean- 
ingful, complex  uiiits  of  experience  and  built  into 
transactional  structures,  that  is,  internal  patterns 
that  become  automatically  available  in  a  relevant  sit- 
uation. The  overall  pattern  of  such  structures  may  be 
seen  as  the  infant's  "primary  adaptational  style."  ^' 
One  baby's  style  is  very  different  from  that  of  an- 
other. But  these  structures  are  not  static  and  fixed. 
As  the  baby  continues  to  learn  more,  he  modifies 
his  cognitive  map,  Ms  coping  skill,  his  self-image, 
and  his  relation  with  others — and  this  modification 
increasingly  contributes  to  how  and  what  he  learns. 
More  efficient  structures  displace  the  early,  less  in- 
efficient ones. 

We  can  see.  from  the  way  a  child  as  young  as  2  or  3 
years  spontaneously  organizes  toys  presented  to  him 
in  a  random  fashion  that  the  tendency  to  give  struc- 
ture to  scattered  materials  is  part  of  the  human  pack- 
age of  potentials  ^*  and  gives  the  child  what  Berlynej 
calls  "epistemic"  curiosity."  The  child's  ability  toi 
structure  depends  on  the  degree  of  his  pi-evious  as- 
similation of  and  accommodation  to  many  kinds  oi 
forms  and  structures  in  the  environment. 

8.  Mastery  of  the  body,  as  in  rolling  over  or  holdinj 
up  the  head,  exemplifies  the  same  principles  as  th( 
improvement  of  the  functional  i-eflexes,  but  includes 
an  integrative  quality  not  present  in  the  reflexes^ 
Body  mast«ry  is  involved  in  the  development  of  "egc 
functioning"  in  the  psychoanalytic  sense — that  is 
perfecting  the  motor  skill  is  paralleled  by,  or  fol 
lowed  by,  use  of  the  skill  in  an  ego-controlled,  oi 
purposeful,  bodily  activity. 

Learning  to  make  oneself  comfortable  may  tak( 
place  at  the  same  time.  In  the  Escalona-Leitch  sam 
pie,  a  1-month-old  infant  wiggled  herself  to  a  cozj 
corner  of  her  crib  and  stayed  there."  Wiggling  anc 
turning  the  body  around  a  little  can  often  be  ob 
served  in  an  infant  before  he  is  able  to  turn  ovei 
from  back  to  front  or  vice  versa.  By  the  age  of  3  oi[ 


111! 


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CHILDREN 


NOVEMBER-DECEMBER  196; 


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Ilia 


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4  months,  babies  have  learned  to  stretcli,  push,  turn, 
or  otlierwise  adjust  their  bodies  wiieu  held.  Turuinji- 
away  from  unpleasant  stimuli  by  turning  the  face  or 
bod}'  away  may  be  seen  in  even  younijer  infants.  This 
is  one  early  way  of  aclaptiny  to  the  woi-ld. 

9.  Learning  more  complex  body  and  motor  skills 
continues  steadily  from  early  infancy.  Learnino-  to 
pull  oneself  up  when  somebody  is  holding  one's 
hands,  to  turn  over,  sit  up,  creep,  stand,  walk  holding 
on,  and  walk  alone  are  steps  that  occur  with  practice 
as  muscles  achieve  the  necessary  degree  of  coordina- 
tion. 

Eacli  level  of  body  management  brings  new  learn- 
ing possibilities.  The  baby  may  learn  to  cooperate  in 
various  kinds  of  gymnastic  play  with  his  body, 
initiated  by  his  mother  or  father,  and  may  bounce  to 
rhj'^thm  when  sung  to.  Such  activities  may  involve 
learning  to  balance  in  order  to  maintain  equilibrium 
while  participating.  For  example,  a  4-month-old  baby 
I  knew  spontaneously  learned  to  spread  out  her  arms 
and  legs  to  balance  herself  while  her  father  held  her 
aloft,  supporting  her  abdomen  on  the  palm  of  his 
hand. 

Increasingly,  the  baby  is  able  to  use  his  improved 
motor  skills  to  cope  with  restlessness  and  boredom 
or  to  satisfA'  his  expanding  interests.  He  may  learn 
that,  by  himself,  he  can  slide  down  his  high  chair  and 
slip  free  of  it  or  climb  out  of  his  crib.  He  may  learn 
to  creep  downstairs  backward  before  he  can  manage 
to  go  down  forward. 

All  of  these  forms  of  body-learning  not  only  de- 
velop increased  flexibility  in  the  baby,  they  also  pre- 
pare the  baby  for  learning  more  complex  skills  as  he 
grows  older. 

10.  The  development  of  curiosity.  Progress  through 
tlie  early  stages  of  sensory  and  motor  learning  devel- 
ops resources  that  contribute  to  further  learning, 
rri-owing  up  in  a  richly  rewarding,  varied  environ- 
ment leads  to  an  interest  in  further  scanning  and  ex- 
ploring. This  is  made  possible  by  the  extension  of  the 
riinge  of  motor  skills  that  enable  the  baby  to  get  into 
everything  from  the  floor-level  kitchen  cupboards  to 
tlie  bottom  drawers  of  his  mother's  dresser.  Thus,  he 
ile\-elops  curiosity  from  the  gratifying  discoveries 
made  in  his  widening  world.  The  child  deprived  of 
stimulation  usually  does  not  show  such  curiosity. 

We  can  say  with  Bateson  "  that  through  all  the 
first  phases  of  learning  the  adefpiatoly  stimulated 
baby  accomplishes  important  secondaiy  or  "deutero- 
leaming" — that  is,  he  learns  to  loarn,  learns  that  it 


Following  a  normal  developmental  pattern,  this  happy  infant 
has  learned  to  select  and  turn  toward  stimuli.  Apparently,  the 
activities  of  the  photographer  interested  him  more  than  the  toy. 


is  fun,  interesting,  and  exciting  to  learn.  Tlie  pre- 
school children  in  our  Topeka  sample  of  middle-class 
children  from  at  least  moderately  rewardmg  homes 
typically  explored  each  new  situation  with  eagerness, 
curiosity,  and  interest.  In  contrast,  the  children  from 
disadvantaged  homes  did  not  do  such  exploring  until 
after  many  months  of  encouragement  and  stimula- 
tion. Even  then,  they  did  not  ask  questions  with  the 
same  degree  of  curiosity  as  the  middle-class  children. 
When  the  deprived  children  began  to  ask  "why" 
questions,  they  asked  chiefly  about  the  teachers  they 
had  learned  to  trust,  not  about  the  world  at  large. 

Thus,  learning  to  want  to  ham,  to  respond  to  new 
situations  with  interest  rather  than  passively  or  in- 
ertly or  fearsomely,  is  another  aspect  of  the  early 
development  of  leanimg.  This  includes  learning  to 
■practice,  which  may  actually  begin  when  the  infant 
first  "works  at"  improvmg  his  suckutg  and,  later, 
other  motor  patterns.  But  the  baby's  spontaneous 
practicing  becomes  more  conspicuous  as  he  repeats 
syllables  or  assiduously  struggles  to  master  a  motor 
skill. 

11.  Learning  from  pain.  Many  observers,  including 
the  mothers  of  children  in  our  Topeka  sample,  have 
reported  instances  of  very  young  children  learning 
from  pain.  The  child  learns  not  to  put  his  hand  on 
a  hot  radiator  after  one  painful  trial.  The  cat 
scratches  and  maybe  the  child  does  not  pull  his  tail 


VOLUME  14  -  NUMBER  6 


213 


again.  Levy,"  in  a  study  of  ^,000  infants  given  a 
series  of  inoculations,  found  tliat  after  the  first  inocu- 
lation infants  under  6  months  cried  at  the  total  situa- 
tion, including  the  office  and  the  doctor  in  a  white 
coat;  the  youngest  infant  who  cried  only  at  the 
approach  of  the  needle  was  6  montlis  old.  Tliis  implies 
develojjment  of  the  ability  to  differentiate  a  specific 
pain-producing  stimulus  from  the  whole  context  in 
which  the  pain  was  experienced.  However,  learning 
to  avoid  unpleasant  innnediat©  stimuli  begins  almost 
from  birth. 

Wliile  the  baby  searclics  and  reaches  out  for  stim- 
ulation, lie  also  has  to  protect  Iiimself  from  overstim- 
ulation. Benjamin  "  has  observed  that  the  baby  be- 
tween 4  and  8  weeks  old  becomes  more  sensitive  to 
visual  and  other  kinds  of  stimuli.  While  the  percep- 
tive mother  helps  protect  him,  he  also  learns  to  pro- 
tect himself  by  various  methods  of  avoidance  or 
protest.  Infants  4  weeks  old  or  younger  Iiave  been 
observed  to  sliut  their  eyes  or  turn  their  heads  away 
from  bright  lights.^^ 

12.  Learning  what  to  enjoy  is  similar  to  learning 
from  pain.  The  youngest  baby  spits  out  bitter  tastes 
and  accepts  sweet  tastes.  By  the  age  of  4  or  5  months 
he  smiles  or  reaches  for  pleasuraljle  stimuli.  At  this 
age  the  babies  in  our  Topeka  sample  had  already  de- 
veloped preferences  among  foods,  colors,  toys,  and 
other  objects.  Babies  have  subtly  different  prefer- 
ences— some  of  them  enjoy  a  rapid,  \igorous  rhythm 
while  others  prefer  a  slower,  gentler  one.  Some  enjoy 
longer  and  more  intensive  tactile  stimulation  tlian 
others  can  tolerate.  As  they  grow,  they  acquire  new 
tastes,  that  is,  they  learn  to  like  things  they  did  not 
originally  like. 

13.  Learning  to  evoke  rewards  is  related  to  learning 
to  love.  "N^Hien  a  baby  repeats  such  syllables  as  "da- 
da"  or  "ma-ma,"  he  gets  delighted  smiles  and  hugs 
from  responsive  adults.  Learning  to  evoke  pleasant 
experiences  is  similar.  At  20  weeks,  one  of  the  babies 
in  our  sample  would  bounce  or  rock  on  his  mother's 
lap  in  order  to  stimulate  her  to  bounce  him  in  re- 
sponse. The  mother's  gratifying  response  in  such  a 
situation  is  part  of  the  conditioning  that  goes  on 
through  much  of  early  childhood. 

Another  infant  at  the  age  of  8  montlis  would  make 
a  blowing  soimd  with  his  mouth  in  order  to  get  an 
adult  to  put  a  record  on  the  phonograph ;  he  was  ac- 
customed to  seeing  his  mother  blow  the  dust  oft"  a  rec- 
ord before  playing  it.  The  baby  always  smiled  in 
pleasure  at  the  music  or  moved  rhythmically. 

The  baby's  social  learning  does  not  begin  with  his 


214 


f 


smile,  but  is  accelerated  by  it,  since  the  smile  provides 
stimulating  feedback  from  the  mother  and  other  per- 
sons. "Wliile  the  smile  itself  is  an  "innate"  response 
released  by  sensory  stimuli  of  various  kinds  °  and 
by  seeing  the  smile  of  another  person  or  simply  his 
eyes  and  forehead,  the  baby  has  to  learn  what  his 
smile  can  do  for  him  and  how  it  brings  forth  atten- 
tion and  satisfying  stimulation. 

Ix)ving  is  a  complex  outcome  of  much  learning. 
Out  of  the  early  tactile  and  kinaesthetic  experiences 
of  being  cuddled  and  exchanging  smiles,  the  baby 
learns  to  love  and  be  lo\'ed."  This  mutual  process 
gives  rise  to  tlie  learning  of  many  patterns  of  ex- 
pression in  a  more  complex  manner  than  the  earliest 
conditioned  responses  are  acquired. 

14.  Trial-and-error  approaches  to  learning  grow  out 
of  the  child's  accunudation  of  sensory  learning,  de- 
velopment of  motor  skills,  evoked  curiosity,  and  m 
pleasure  in  making  things  liappen.  For  example,  a  jt 
year-old  baby  will  try  this  way  and  tliat  to  fit  a  cap  d 
onto  a  bottle  or  to  put  something  into  something  k 
else.  Iiv 

15.  Learning  through  contagion  has  been  noted  ir  *' 
babies  by  both  Escalona  -"  and  Anna  Freud. ^^  This  ' 
tendency  is  related  to  a  baby's  anxious,  tense  respons«  " 
to  a  tense  mother.  In  such  situations,  the  baby  may  bt  * 
learning  tlirough  skin  and  muscle  sensations  as  wel  "" 
as  from  facial  expressions.  Long  ago  Preyer  reporteo  '" 
on  a  very  young  baby's  ah'd'ify  to  imitate  a  protruding  ■ 
tongue  although  he  cannot  see  his  own  tongvie.^-  Thi  "" 
type  of  learning,  still  an  obscure  process,  may  bd  Ii 
related  to  the  process  of  learning  by  contagion.  if 

16.  Learning  by  participation  takes  place  when  thil  "*' 
mother  plays  with  the  child,  for  example,  showing  i  *■ 
9-month-old  baby  how  to  play  pat-a-cake  by  holding  "" 
and  moving  his  liands.  All  of  the  early  mutual  bodi  ^ 
adjustments  between  mother  and  infant  have  jDre]  iili 
pared  the  way  for  this.  Older  children  also  learn  u 
this  way.  I  have  seen  tiny  newcomers  to  Israel  helpeo  £..) 
at  an  induction  center  to  learn  to  feel  at  home,  to  de  iJt 
velop  a  sense  of  belonging,  and  to  acquire  some  o:  k\ 
the  language  through  participating  in  singing  an«  iin 
marching  games,  with  adults  taking  them  by  thi 
hand  and  leading  them  through  the  movements 
Many  children  who  find  it  hard  to  enter  a  new  situa 
tion  can  be  helped  in  this  way. 

17.  Learning  by  imitation  involves  the  use  of  skil 
in  observation  and  interest  in  and  responsiveness  t(  ui 
new  activities.  A  simple  form  is  parroting.  This  typi  iit 
of  response  shows  the  essential  humanness  of  thi 

CHILDREN     •     NOVEMBER-DECEMBER  196^ 


?I 


Icainiiig  processes  since  it  involves  not  only  sensory, 
motor,  unci  perceptual  learning,  but  also,  probably, 
as  Piajiet  has  noted,  the  assimilation  of  the  motiier's 
art  ions  :uul  acconnnodation  to  them.' 

18.  Learning  by  identification  is  a  more  comi)i'elieu- 
sive  and  deeper  kind  of  learning.  It  includes  imita- 
tion, l)ut  it  also  includes  a  i'eelin<i;  with,  an  adoption 
of  role,  a  fantasy  of  being  the  mother  or  father,  and 
serves  as  rehearsal  for  taking  on  the  real  role  in  later 
life.  Identification  requires  the  capacity  for  organiz- 
ing sequences.  It  was  reflected  in  the  behavior  se- 
quences of  an  18-month-old  toddler  I  observed 
who  busied  iierself  wrapping  up  her  "baby"  (doll), 
putting  it  into  bed,  covering  it  up,  and  saying  "Night- 
night,"  while  her  mother  cared  for  the  new  baby  in 
an  adjoining  room. 

19.  Learning  to  cope  with  frustration  usually  in- 
volves some  combination  of  learning  to  delay  grati- 
fication  until  a  later  time,  learning  to  accept 
substitutes  for  the  specific  object  desired,  and  learn- 
ing to  shift  interests.  Some  infants  and  young  chil- 
dren learn  to  deal  with  frustration  more  easily  than 
othere. 

Even  when  only  a  few  weeks  old,  some  infants  who 
at  first  frown,  ci*y,  or  turn  away  when  a  bottle  is 
offered  them  instead  of  the  breast  finally  learn  to 
accept  it.  In  our  Topeka  sample,  most  mothers  con- 
sciously tried  to  help  their  babies  learn  to  adapt  to 
the  nuisances  of  infant  life  by  tempering  the  discom- 
fort with  soothing  pats  or  cuddling. 

In  helping  babies  learn  to  ^''get  used  to''''  new  s'ltua- 
tions  and  exjDeriences,  mothers  also  use  conditioning 
methods.  The  alert  mother  helps  the  baby  by  provid- 
ing opportunities  to  associate  the  new  exjaerience 
with  familiar  types  of  gratification,  or  by  presenting 
the  thing  that  is  new  to  the  baby,  such  as  an  unfa- 
miliar food,  in  small  amounts  until  he  learns  to  like  it. 
A\'lien  a  child  responded  to  a  rabbit  with  fear,  Maiy 
C.  Jones  ^^  gi'adually  reconditioned  his  response.  In 
a  series  of  stages,  she  brought  the  rabbit  into  tlie  room 
wliere  the  child  was  happily  eating,  until  he  finally 
learned  to  accept  it. 

20.  Learning  to  be  comforted,  to  accept  soothing 
from  others,  may  depend  on  the  skill  of  the  mother- 
ing person  in  imding  the  soothing  teclmique  that  is 
most  relaxing  to  the  infant.  (Some  babies  may  be 
soothed  by  jouncing  or  patting,  but  others  will  only 
Ix'come  more  annoyed  by  such  treatment.)  A  corol- 
lary to  this  is  the  expectation  that  one  can  be  com- 
forted— the  baby  learns  that  hurts  need  not  last  very 


long  and  tluit  he  can  evoke  comfort  from  someone 
else. 

21.  Learning  to  amuse  oneself  is  not  the  same  as  the 
simple  process  of  learning  to  make  something  hap- 
pen. It  depends  rather  on  the  "deutero-learning"  that 
when  one  is  alone  one  can  still  engage  in  some  satis- 
fying activities.  Finding  this  out,  the  baby  then 
learns  to  initiate  such  activities. 

22.  Learning  to  fear.  The  capacity  to  be  afraid  and 
anxious  is  inborn,  but  the  baby  leanis  what  to  fear  in 
the  same  way  he  learns  to  avoid  pain.  He  may  even 
learn  how  afraid  he  must  he  in  order  to  evoke  support 
from  someone. 

Fear  of  strangeness  may  be  innate ;  strong  negative 
reactions  to  strangers  have  been  seen  even  in 
chickens."^  But  the  fact  that  different  babies  show 
fear  of  strangeness  and  strangers  at  such  vaiying 
ages  as  8  weeks  and  8  months  shows  that  fear  of  the 
stranger  is  also  related  to  how  much  the  baby  has 
learned  to  differentiate  between  the  familiar  and  the 
strange  and  also  whether  he  has  previously  experi- 
enced discomfort  with  strangers  (in  contrast  with  the 
comfort  he  associates  with  mother)." 

23.  Learning  anger.  The  newborn's  screams  of 
hunger  and  pain  somid  so  angi-y  that  we  may  think 
of  anger  as  the  first  strong  emotion  expressed.  It  is 
evident  before  any  expression  of  pleasure.  But 
the  baby  learns  rapidly  what  Ms  angi-y  protests  wall 
do  for  him.  They  are  at  first  vocal,  then  physical :  He 
learns  to  slap  or  hit,  to  stiffen  or  rear  back,  and  to 
combine  various  other  bodily  behavior  patterns  in 
angry  resistance.  Breath-holding,  head-banging, 
smearmg  feces,  and  other  types  of  behavior  may  be 
included  in  the  range  of  resources  he  learns  to  use  in 
order  to  get  attention  or  to  make  the  adult  stop  doing 
something  he  finds  unpleasant. 

Any  of  these  behavior  patterns  may  arise  spon- 
taneously at  first  and  then  be  quickly  reinforced  by 


A  psychologist  who  has  concentrated  on 
studying  the  personality  development  of 
children,  Lois  B.  Murphy  is  director  of  the 
division  of  dovelopniental  studies  at  the 
Menninger  Foundation.  Topeka,  Kans.  She 
Is  also  senior  consultant  to  the  infancy  proj- 
ect being  conducted  by  the  Children's  Hos- 
pital of  the  District  of  Columbia.  Among 
Dr.  Murphy's  many  publications  is  "The  Widening  World  of 
Childhood:  Paths  Toward  Mastery"  (Basic  Books,  19(!2). 


VOLUME   14  -  NUMBER  6 


215 


the  consequences,  including  the  sensations  they  give 
the  baby  himself.  (Some  babies  are  careful  not  to 
hurt  themselves  when  banging  their  heads  against 
the  wall  or  floor.)  Pathological  uses  of  such  behavior 
patterns  sometimes  develop,  especially  in  neglected 
babies,  arising  from  a  combination  of  self-gratifica- 
tion and  masochistic  enjoyment  of  pain.  More  nor- 
mally, a  baby  learns  to  use  such  behavior  as  an 
effective  method  of  discharging  angry  feelings  and 
"getting  over  it  fast." 

24.  Learning  to  trust  the  world,  as  derived  from  the 
basic  relationship  of  motlier  and  child,  has  been  em- 
pliasized  by  Erikson."^  The  balance  of  trust  and 
distrust  of  the  world  is  also  a  global  fonu  of  "deutero- 
leaming"  growing  out  of  everything  the  baby  has 
previously  learned.  The  predominantly  distrustful 
child  will  later  learn  chiefly  those  things  that  relate 
to  danger  and  are  perceived  by  him  through  vigilant, 
anxious,  rather  than  open,  eager  observation. 

25.  Learning  to  unlearn,  to  give  up  old  patterns, 
is  a  major  learning  process  of  infancy  and  early 
childhood.  Giving  up  the  bottle  as  new  feeding 
methods  are  mastered,  giving  up  creeping  as  one 
learns  to  walk,  giving  up  babbling  as  one  learns  to 
talk,  and  giving  up  crying  as  one  learns  to  express 
wants  verbally  are  only  a  few  of  the  important  ex- 
amples of  learning  to  outgrow  early  forms  of  be- 
havior. Sometimes,  as  when  the  child  gives  up 
creeping  for  walking,  the  principle  of  dominance 
supported  by  improved  efficiency  makes  the  giving- 
up  easy ;  sometimes,  as  with  weaning,  the  giving-up 
process  has  to  be  assisted  by  the  mother  vising  the 
pleasure  and  pain  technique. 

Outgrowing  babyislmess  brings  new  rewards, 
among  which  is  an  expanded  horizon  for  learning; 
for  satisfying  the  sensory,  motor,  and  manipulative 
urges,  curiosity,  eagerness  for  mastering  the  en- 
vironment, and  the  wish  for  autonomy. 


'  Piaget,   J.;   The   origins   of   intelligence   in   children.   International 
Universities  Press,  New  York.  1952. 

°Koffka,  K.:  Principles  of  Gestalt  psychology.  Harcourt,  Brace  &  Co., 
New  York.  1935. 


Murphy,  L.  B.:  Preventive  implications  of  development  in  the 
preschool  years.  In  Prevention  of  mental  disorders  in  children:  initial 
exploration.  (G.  Caplan,  ed.)  Basic  Books,  New  York.  1961. 

*  Sokolov,  Y.  N.:  Perception  and  the  conditioned  reflex.  Pergamon 
Press,  New  York.  1963. 

^  Wolff,  P.  H.:  The  causes,  controls,  and  organization  of  behavior  in 
the  neonate.  Fsvc/wlogicai  Issues,  vol.  5,  no.  1,  1966.  (Monograph 
no.  17.) 

"Escalona,  S.;  Leitch,  M.:  Unpublished  records  of  infant  behavior  at 
the  Menninger  Foundation,  Topeka,  Kans. 

Franz,  R.  L.:  Pattern  vision  in  young  infants.  Psychological  Record^ 
April  1958. 

Berlyne,  D.  E.:  The  influence  of  complexity  and  novelty  in  visual 
figures  on  orienting  responses,  [oiirnal  of  Experimental  Psychology, 
March  1958. 

Conflict,  arousal  and  curiosity.  McGraw-Hill,  New  York. 


1960. 

"Tolman,  E.  C:  Cognitive  maps  in  rats  and  men.  In  Behavior  and 
psychological  man.  University  of  California  Press,  Berkeley.  1958. 

"^Thorndike,  E.  L.:  The  original  nature  of  man.  In  Educational 
ps\chology  (vol.  I).  Teachers  College,  Columbia  University,  New  York. 
1913-14. 

"  Buhler,  C:  The  first  year  of  life.  John  Day  Co.,  New  York.  1930. 

"Murphy,  L.  B.;  Moriarty,  A.  E.;  Raine,  W.:  Development  and  adap- 
tation. To  be  published  bv  Jossey-Bass,  Inc.,  San  Francisco,  Calif.,  in 
1968. 


"  Murphv, 
York.  1956. 


L.  B.:  Personality  in  young  children.  Basic  Books,  New 
Naven.   Stanford    University   Press,    Stanford,   Calif. 


'■"  Bateson,   G.: 
1958. 

'"Levy,  D.  M.:  The  infant's  earliest  memory  of  inoculation.  Journal 
of  Genetic  Psychology,  March  1960 

"Benjamin,  J.  D.:  The  innate  and  the  experiential  in  development 
Lecture  to  the  Topeka  Psychoanalytic  Societv,  Topeka,  Kans.,  Jan.  26- 
1961. 


Hei 


^'Heider,  G.  M.:  Vulnerability  in  infants  and  young  children:  a  pilot 
study.  Genetic  Psychology  Monographs,  February  1966. 


"Murphy,  L.  B.:  Some  aspects  of  the  first  relationship.  Internationm 
Journal  of  Psychoanalysis,  vol.  45,  pt.  1,  1964. 

^Escalona,  S.:  Emotional  development  in  the  first  year  of  life,  h 
Problems  of  infancy  and  childhood.  (M.  J.  E.  Senn,  ed.)  Josiah  Macy 
Jr.,  Foundation,  New  York.  1953. 


id 

101 


^  Freud,  A.:  Comments  in  a  case  conference  at  the  Menninger  Founda' 
tion,  Topeka,  Kans.  September  1962. 

^Preyer,  W.:  Die  seele  des  kindes.  Leipzig,  Fernan.  1882. 


SO 

I 


°^  Jones,  M.  C:  The  elimination  of  children's  fears.  Journal  of  Experi- 
mental Psychology,  October  1924. 

"*  Levy,  D.  M.:  The  strange  hen.  American  Journal  of  Orthopsychia^     r 
try,  April  1950. 


°°Erikson,  E.  H.:  Childhood  and  society.  W.  W.  Norton  &  Co.,  New 
York.  1964.  (Revised  edition.) 


216 


CHILDREN     •     NOVEMBER-DECEMBER  1967 


in 


k 

h 


PATTERNS  OF  CHANGE 

in  DISTURBED  BLIND  CHILDREN 

in   RESIDENTIAL  TREATMENT 


JOHN  R.  ROSS,  JR.,  M.D. 


BERNARD  B.  BRAEN 


RUTH  CHAPUT 


About  -t  years  ago,  the  authoi'S  of  this  paper, 
charged  with  the  task  of  rehabilitating  an 
institutionalized  group  of  20  severelj'  dis- 
turbed blind  children,  ranging  in  age  from  6  to  12 
years,  began  to  formulate  and  test  hypotheses  about 
the  factors  impeding  the  development  of  these  chil- 
dren and  the  methods  by  which  they  could  be  psycho- 
logically rehabilitated.  We  assumed  that  because  of 
their  blindness  the  children  had  from  infancy  been 
deprived  of  the  stimuli  necessary  for  development 
and  the  experiences  that  lead  to  a  mutually  satisfying 
mother-child  relationship  and  that  such  deprivation 
had  led  to  the  deviations  we  obsei-ved  in  all  aspects  of 
ego  functioning — in  intellectual  achievement,  emo- 
tional stability,  physical  competence,  ability  to  en- 
gage in  satisfying  interpersonal  relationships.  In 
some  instances,  the  deviations  had  already  been 
aggravated  by  congenital  defects  affecting  the  central 
nervous  system. 

On  the  basis  of  this  hypothesis,  we  assmned  that 
experiences  could  now  be  provided  that,  if  appropri- 
ately matched  to  the  developmental  levels  of  the 
child,  would  provide  him  with  more  effective  meth- 
ods of  adaptation  than  he  had  previously  adopted 
and  would  thus  facilitate  more  normal  development. 
We,  therefore,  have  concentrated  our  efforts  on  car- 
rying out  an  educational  tlierapeutic  program  that 
would  provide  such  experiences  and  will  here  de- 
scribe some  of  the  changes  that  have  taken  place 
in  the  children.  The  institution  that  has  been  in- 
volved is  the  Children's  Division  of  the  Syracuse 
Psychiatric  Hospital,  located  in  Fainnount,  a  suburb 
of  Syracuse,  N.Y.  Thus  far,  all  the  cliildren  in  this 


residential  unit  have  been  blind  children,  though 
plans  are  now  underway  to  accept  other  children. 
The  staff  has  consisted  of  a  cliild  psychiatrist,  a 
clinical  child  psychologist,  a  supervising  psychiatric 
nurse,  a  staff  nurse,  a  recreation  director,  four  special 
education  teachei-s,  a  psychiatric  social  worker,  an 
occupational  therapist,  and  several  previously  un- 
trained child-care  workers. 

The  children 

The  children  were  admitted  to  tlie  program  over 
a  2-year  period,  beginning  414  years  ago.  Thus,  we 
have  known  all  of  them  for  more  than  2  years  and 
many  of  them  for  more  than  4.  Wlien  admitted  most 
of  them  appeared  to  be  functioning  at  a  severely 
retarded  level;  in  fact,  the  parents  of  several  of 
them  had  been  told  they  were  retarded.  However, 
after  the  children  had  been  with  us  for  some  time 
and  had  developed  trust  in  the  staff,  manifestations 
of  their  intellectual  cai^acity  became  evident  and  we 
realized  that  most  of  them  were  of  at  least  average 
intelligence  and  many  were  very  bright.  Because  of 
technical  difficulties,  in-evious  testing  of  them  had 
been  misleadmg. 

The  impression  of  severe  retardation  was  aug- 
mented by  several  behavior  patterns,  some  of  which 
seem  to  be  characteristic  of  blind  children.  There  was 
a  great  deal  of  rhythmic  rocking,  head  rolling,  body 
rolling,  head  banging,  and  whirling.  Fingers  or  fists 
were  constantly  being  stuck  in  eyes.  Language  was 
almost  always  used  in  private  ways  incomprehensible 
to  members  of  the  staff  or  other  persons.  There  was 


VOLUME  14  -  NUMBER  6 


217 


meaningless  parroting  of  television  commercials, 
phonograph  recortls,  or  statements  the  children  had 
heard  people  make.  Pronouns,  when  nsed,  were  often 
.  reversed ;  "I"  was  never  used.  Mutism  with  ocx^asional 
guttural  sounds  was  frequent.  Thus,  the  children 
isolated  themselves  from  both  peers  and  adult  staff. 

Among  other  characteristics  were  suspicion,  hostil- 
ity, fright,  withdrawal,  and  extreme  negativism.  The 
most  ordinary  ex^^eriences  would  be  regarded  as 
teri'ifying.  Though  many  of  the  children  had  learned 
the  necessary  skills  for  self-help,  they  retreated  into 
helpless  dependency. 

Very  few  of  the  children  had  developed  any  skill 
in  moving  about ;  most  of  them  released  their  motor 
energy  while  remaining  almost  in  the  same  spot  by 
using  rhythmic  or  whirling  movements.  Some  tended 
to  overbreathe  when  excited,  and  some  vented  their 
feelings  through  screaming,  scratching,  and  l)iting. 
Two  or  three  retained  feces;  one  had  developed  an 
enlarged  colon  as  a  result. 

None  of  the  children  had  had  any  successful  school 
experiences.  Two  or  three  had  learned  a  little  braille, 
but  none  had  been  able  to  profit  in  any  consistent 
manner  from  a  planned  and  sequential  educational 
process.  Those  who  had  been  to  school  had  been 
dropped  out  and  the  others  had  either  remained  at 
home  or  had  been  sent  to  institutions  for  the  retarded 
or  mentally  ill. 

Wien  we  encountered  the  children,  tlieir  interest 
in  the  external  world  and  in  learning  seemed  non- 
existent. Their  attention  span  was  short,  and  their 
frustration  tolerance  was  extremely  low. 


The  prosram 

The  heart  of  the  program  lay  in  an  expectation 
that  each  staff'  member  would  show  the  same  respect  to 
each  child  regardless  of  his  individual  develojimental 
level ;  would  provide  the  child  with  interpereonal  and 
other  kinds  of  experiences  to  help  guide  him  to  the 
next  step  in  development ;  and  would  patiently  allow 
him  to  achieve  that  step  at  a  speed  consistent  with 
his  specific  needs. 

Such  impartial  respect  was  not  easy  to  achieve. 
Many  of  the  children  developed  subtle  and  skillful 
methods  of  attracting  the  staft''s  attention  not  only 
to  meet  their  own  needs  but  also  to  find  out  whether 
they  could  render  staff  members  less  effective  in  treat- 
ing some  children  than  others.  Other  children,  be- 
cause of  their  silence  and  self -eff'acement,  made  it  easy 
for  the  staff  to  forget  about  them.  Nevertheless,  all 
the  children  were  enonnously  sensitive  to  any  degree 


of  difference  in  a  staff  member's  attitudes  toward  par- 
ticular children.  They  obviously  felt  far  more  secure 
when  they  knew  appropriate  care  was  being  j^rovided 
equally  for  all.  In  spite  of  the  difficulties,  the  staff 
did  achieve  a  high  degree  of  imi^artial  respect,  and 
tliis,  more  than  any  other  element  in  the  program, 
may  have  helped  the  children  realize  that  they  were 
free  to  experiment  with  many  forms  of  Ijehavior  in 
search  for  patlis  to  identity  and  development. 

The  program  has  also  placed  emphasis  on  continu- 
ing the  children's  relationship  with  their  parents, 
largely  through  weekend  visiting.  Most  of  the  chil- 
dren have  gone  home  almost  every  weekend  since 
their  admission.  This  has  meant  that  they  have  con- 
tinuously had  to  adapt  to  the  contrasting  personal 
environments  of  home  and  hospital.  The  psychiatric 
nurse,  the  psychiatrist,  and  the  psychiatric  social 
worker  have  also  maintained  contacts  with  the  par- 
ents, usually  infonnally  but  occasionally  in  formal 
appointments,  at  their  own  or  the  parents'  request. 
Some  changes  in  attitude  have  occurred  in  many  of 
the  parents,  especially  as  the}'  have  come  to  recognize 
that  their  children  are  not  retarded.  But,  on  the 
whole,  the  parents  have  not  altered  their  basic  rejec- 
tion of  the  children  and  continue  to  wish  for  a  child 
that  is  "normal"  in  every  respect. 

Some  of  the  children  have  learned  to  perceive  tlieir 
parents'  rejection  of  them  without  having  to  give  up 
an  emerging  sense  of  identity  in  favor  of  utter  com- 
pliance and  without  having  to  accept  the  idea  that 
they  are  peculiar  and  incompetent.  With  the  lielp  of 
the  psychiatrist  and  selected  staff  members,  they  have 
teen  working  through  fe«lings  of  extreme  anger  to- 
ward their  i^arents,  anxiety  about  such  anger,  and  an 
increasing  sense  of  separation  from  them  accom- 
panied by  intense  grief.  A  few  have  emerged  from 
this  emotional  struggle  with  greater  tolerance  for 
their  parents  and  greater  confidence  in  their  ability 
to  adapt  to  them.  None  of  the  children,  however,  has 
actually  completed  this  working-through  f)rocess. 

One  aspect  of  the  ])rogi-am  that  has  helped  to  de- 
crease anxiety  in  the  children  has  been  the  provision 
by  the  psychiatrist  of  all  medical  care  and  supervi- 
sion, except  in  instances  of  severe  illness  or  injuiy. 


le 


[01 

m 
w 
ill 
.1 
nr 

ilf! 

yi 

fei 

ii! 
k 

p 

(ii 


John  R.  Ross,  Jr.,  M.D.,  and  Bernard  B.  Braen,  Ph.  D.,  are 

professor  and  associate  professor,  respectively,  in  the  Divi- 
sion of  Child  Psychiatry,  Upstate  Medical  Center,  State  Uni- 
versity of  New  York,  Syracuse.  Ruth  Chaput  is  the  supervising 
psychiatric  nurse  in  the  Children's  Division  of  the  Syracuse 
Psychiatric  Hospital,  Fairmount,  N.Y. 


218 


CHILDREN     •     NOVEMBER-DECEMBER  1967  Pti 


All  tlio  childroii  iil  lii-st  were  terrilii'd  of  cmmi  puin- 
K'ss  medical  procedures.  As  they  became  familiar 
with  the  psycliiatrist  throuo-li  frequpiit  contacts  witli 
liiin,  they  developed  enough  trust  in  iiini  to  accept, 
and  in  some  instances  even  to  participate  actively  in, 
iiii'dical  prwoduros.  inoludino-  the  physiwil  cxamina- 
tiiins  t-irried  out  by  him.  Tliis  led  to  some  children 
Irarning  to  cooj^erate  readily  with  the  dentist  and 
\\  ilh  the  ]iediatri('ian  when  he  is  called  in. 

Regression  and  progress 

In  spite  of  careful  preadnii.ssion  preparation,  the 
children  always  reacted  to  achnission  with  a  great 
deal  of  separation  an.xiety  and  grief,  which  each  re- 
vealed in  his  own  way.  8ome  cliildi'cn  on  admission 
wept  quietly,  withdrew  comjiletely,  behaved  fran- 
tically, or  talked  constantly  about  gratifying  experi- 
ences they  had  once  had.  None  attempted  to  cling  to 
staff  membere  for  comfort. 

Members  of  the  .staff  could  do  little  at  this  time 
other  than  to  tell  the  children  about  the  care  they 
would  receive  and  when  they  could  next  be  with  their 
parents  and  to  help  them  with  the  daily  tasks  of 
bathing,  washing,  toileting,  dressing,  and  eating.  No 
physical  examinations  were  attenuated. 

After  admission  (shortly  afterward  or  long  after- 
ward) some  regression  occurred  in  most  of  the  chil- 
dren and  was  accepted  by  the  staff'.  Many  of  the 
children  gave  up  skills  they  had  painfully  acquired 
over  yeai-s  of  home  training.  They  ate  with  their 
fingci-s,  refused  to  eat  altogether,  or  demanded  spe- 
cial foods.  They  refused  to  wash,  bathe,  or  dress 
themselves,  although  nearly  all  had  perfonned  these 
tasks  with  skill  before  admission.  Many  of  them 
began  wetting  and  soiling  themselves,  although  they 
had  not  been  doing  this  jjreviously. 

Psychological  testing  was,  of  course,  imiDOssiblc  in 
;his  period,  as  was  group  or  individual  psychotherapy 
in  the  usual  sense.  As  in  the  admission  jjeriod,  the  at- 
tempt to  establish  meaningful  relationships  was  made 
through  giving  the  children  practical  help  in  the 
iaily  tasks  of  living  such  as  cutting  up  their  food, 
serving  and  feeding  them,  bathing  them,  cleaning  up 
;heir  vomitus  and  feces,  and  making  their  beds.  All 
itaff  membci-s,  pixjfessional  and  nonprofessional, 
jarticipated  in  these  tasks. 

During  their  regressed  phase,  most  of  the  children 
)egan  exploi-ing  the  environment,  primarily  by 
)ouching  and  listening.  A  child  who  seemed  com- 
)let6ly  out  of  contact  with  reality,  for  example,  would 
)6  found  whispering  something  he  had  heard  some- 


body say  in  peison  or  on  the  radio  or  phonograj)!!, 
minute.s,  houi-s,  or  days  before.  Some  children  would 
mimic  staff  membei"s  or  other  children  without  inter- 
acting with  tiiem  in  any  other  way.  Some  clapped, 
stamped,  whistled,  or  clucked  as  tiicy  went  about 
orienting  themselves  by  sound  or  (ourii  to  their 
environment. 

Very  gradually,  a  few  children  began  to  evince  an 
interest  in  having  nuitual  relationships  with  people. 
Others  only  seemed  to  be  "with"  people;  they  initi- 
ated contacts,  were  compliant,  and  talked  relevantly 
but  their  interaction  was  superficial  and  manipula- 
tive. Usually,  a  relationship  was  begun  by  a  staff 
member  making  himself  available  to  a  child  either  to 
help  him  with  a  task  such  as  dressing  or  to  give  him 
an  experience  sucli  as  going  for  a  walk,  swinging, 
jumping  on  the  trampoline,  or  playing  a  record.  The 
child  would  at  first  simply  move  closer,  touch  the 
adult,  or  talk  in  obscure  phrases.  Some  children 
valiantly  tried  to  comply  with  the  adult's  wLsh  even 
when  they  did  not  want  to  participate  in  the  sug- 
gested activity.  Others  responded  negatively,  ob- 
viously expecting  reproach  and  punishment. 

Some  children  who  seemed  to  be  relating  with 
adults  best  because  they  knew  how  to  talk  intelligibly 
achieved  the  least  genuine  relationships.  As  time 
passed,  they  failed  to  progress  past  the  stage  of  ask- 
ing and  reasking  questions  or  talking  about  irrelevant 
and  meaningless  topics.  Other  children  who  at  first 
seemed  much  less  ready  for  human  contact  because 
they  proceeded  so  cautiously  eventually  formed 
meaningful  relationships  both  with  staff  members 
and  other  children. 

After  breaking  tlu-ough  their  isolation  to  make 
a  contact  with  another  person,  the  children  would  be- 
gin experimenting  with  others — at  first,  u.sually,  only 
adults.  They  would  gradually  learn  to  distinguish 
between  the  roles  of  the  various  staff  members  and 
to  relate  differently  to  different  persons,  dopendently 
with  some  and  independently  or  even  negatively  with 
others.  As  they  became  more  confident,  they  would 
usually  attempt  to  manipulate  adults  by  conversa- 
tion, compliance,  defiance,  or  negati-\dsm,  and  often 
mimicked  the  admonitions  and  reproaches  they  had 
received  at  home  and  thereby  revealed  much  about 
their  previous  relationships.  From  such  responses, 
the  staff  could  begin  to  recognize  the  carefully  con- 
cealed personalities  of  the  children  and  their  highly 
individual  ways  of  looking  at  life  and  people. 

At  some  time  during  the  course  of  this  experi- 
menting with  relationshij^s,  each  child  would  begin 
to  pay  attention  to  other  children  and  to  tlie  sur- 


fOLUME  14  -  NUMBER  6 


219 


rounding  environment.  No  child  remained  completely 
aloof  and  isolated ;  all  formed  relationships  of  some 
kind  with  several  persons.  But  these  relationships 
were  developed  by  some  children  more  rapidly  than 
by  others  and  were  constantly  changing.  The  chil- 
dren would  identify  first  with  one  adult  and  then 
with  another  as  though  they  were  attempting  to  work 
out  different  ways  of  feeling,  thinking,  and  being  as 
they  made  their  way  toward  less  distorted  concep- 
tions of  themselves.  A  whispered  word,  an  inter- 
rupted gesture,  a  slight  change  in  the  verbal  pattern 
heralded  major  changes  to  come.  As  the  children 
grew  self-confident  because  of  many  staff-planned 
experiences  of  success,  they  began  to  develop  genuine 
respect  for  each  other  and  to  forna  strong  friend- 
ships. Eventually  they  came  to  know  each  other  very 
well  and  in  some  cases  far  better  than  the  staff  knew 
them.  They  were  extraordinarily  aware  of  each 
other's  feelings  and  actions.  They  were  tolerant  of 
each  other's  behavior  and  often  perceived  the  mean- 
ing behind  it.  Sometimes  even  when  a  child  was  at- 
tacked by  another  and  his  feelings  deeply  wounded, 
he  could  be  objective  about  why  the  other  child  had 
behaved  as  he  had.  Gradually  some  children  revealed 
themselves  as  followers  and  others  as  leaders;  some 
as  passive  and  submissive  and  others  as  active  and 
dominating;  some  as  quiet  and  others  as  noisy;  some 
as  given  to  intellectuality  and  others  as  given  to 
intuitive  responses;  some  as  humorless  and  others  as 
full  of  humor. 

The  struggle  for  a  sense  of  identity  met  with  ob- 
stacles, too.  For  example,  Jane,  a  severely  disorga- 
nized psychotic  child,  was  made  intensely  anxious  by 
an  even  more  disorganized  child,  Mary  Ann,  and 
would  immediately  leave  the  room  when  she  became 
aware  that  Mary  Ann  had  entered.  Whenever  Mary 
Ann  would  scream,  stamp,  and  bite  herself,  Jane 
would  become  panicky  and  burst  into  tears. 

Use  oF  language 

The  children's  growing  ability  to  relate  to  people 
and  to  identify  their  own  individuality  was  revealed 
in  their  changing  use  of  language.  At  first  nearly  all 
the  children  spoke  to  staff  members  only  in  meaning- 
less phrases;  they  used  language  not  to  communicate 
but  to  conceal.  But  gradually,  as  they  learned  that  the 
staff  members  could  be  trusted  and  were  trying  to 
understand  them,  many  of  the  children  learned  to 
respond  with  some  relevance  and  intelligibility,  with 
less  secretiveness,  and  with  a  more  appropriate  use  of 
pronouns. 


220 


In  their  increasing  interactions  with  eacli  other, 
the  children  used  language  to  mimic,  ridicule,  tease, 
manipulate,  or  simply  to  play  with  a  kind  of  code  that 
they  all  seemed  to  understand  and  to  enjoy.  Perhaps 
what  they  enjoyed  most  was  the  knowledge  that  they 
knew  what  they  were  talking  about  but  the  staff  mem- 
ber in  attendance  did  not. 

The  children's  use  of  language  has  provided  an 
instrument  for  measuring  changes  in  self-concept 
and  levels  of  anxiety.  Wlien  we  first  knew  them,  most 
of  the  children  referred  to  themselves  by  name,  or  by 
the  pronouns  "he"  or  "she"  or  "you."  Some  have 
gradually  begun  to  say  "I,"  altliough  even  those  who 
have  improved  most  still  have  only  a  tenuous  hold  on 
this  self -identifying  pronoun. 

Reduced  anxiety 


p: 


» 


As  the  children  developed  relationships  with  stafl 
members  and  with  other  children,  their  anxietj 
notably  decreased.  They  showed  fewer  signs  of  panic 
when  introduced  to  new  experiences  or  to  strangers 
Their  reactions  became  less  extreme  and  more  con- 
trolled in  expression.  They  began  to  exhibit  defense- 
mechanisms  against  anxiety.  Perhaps  the  most  im- 
portant influence  in  reducing  anxiety  was  their  cer- 
tainty that  they  would  be  dealt  with  candidly  bj 
the  staff.  Some  children,  in  an  effort  to  master  theii 
anxiety,  began  to  talk  constantly  about  situations 
that  provoked  anxiety  in  them.  Some,  when  in  anxii 
ety-pi-ovoking  situations,  would  talk  about  previous 
situations  that  had  been  comforting  to  them. 

As  the  cliildren's  anxiety  decreased,  they  reacteo 
with  less  negativism,  accepted  limitations  on  theii 
behavior,  tolerated  frustration  better,  and  begar 
vokmtarily  to  explore  the  space  aromid  them.  Since 
the  unit  is  in  an  open  building  situated  on  spacious 
grounds  and  the  childi'en  have  been  free  to  go  in  anc 
out,  opportunities  for  exploration  have  been  exten- 
sive. A  few  of  the  children  have  explored  the  whok 
area  thoroughly,  and  most  of  them  have  become  wel 
enough  acquainted  with  it  to  be  able  to  get  abouli 
in  it  efficientlj'.  They  often  go  outside  to  seek  privacj 
and  so  reduce  the  anxiety  generated  by  increasing, 
contacts  with  others.  } 

Thus  it  is  obvious  that  another  respect  in  whicl 
the  children  have  changed  is  mobility.  Apjjarently 
anxiety  and  fear  of  aggression  had  as  much  to  dc 
with  the  extremely  constricted  mobility  they  hadj 
shown  on  admission  as  did  fear  of  injury  or  disori 
entation  in  space.  While  the  whirling,  rocking,  ano-I] 
rhythmic  movements  have  persisted  in  most  of  the 


CHILDREN     •     NOVEMBER-DECEMBER  196 


m 


cliiltlrfii.  till'  IVi'tiiu'iicy  aiul  iiilfiisitv  nf  this  type  of 
licliavior  lune  siTOutlv  dccn'usfil  ;iiul  tlio  childrcirs 
:il)ilit_v  to  iU()\o  in  a  ivlaxed,  coordiiialod  I'asluon  in 
play,  exploration,  oi-  aggression  has  noticeably 
inipi'oNeiL 

Oilier  children  have  learned  to  roller  slcate  and 
to  danre.  However,  the  motor  experience  in  which 
thii  children  seem  to  feel  most  free  is  swimming. 
They  have  been  taken  regularly  to  a  nearby  indoor 
pool  in  the  winter  and  to  a  lake  in  the  summer.  Many 
of  them  rajiidly  lost  all  fear  of  the  water  and  espe- 
cially seemed  to  enjoy  the  three  dimensional  freedom 
of  underwater  swinuning.  Howe\er,  they  responded 
negatively  to  attempts  to  fea-ch  them  to  swim;  they 
wanted  to  learn  to  manage  the  watery  environment 
on  their  own  or  at  least  to  control  what  the  adults 
did  with  them  in  the  water.  Only  after  many  months 
of  exploring  to  iind  out  what  they  could  do  by  theni- 
sehes  were  anj-  children  ready  to  learn  to  swim  in 
the  usual  way. 

Changes  in  aggression 

As  the  children's  anxiety  decreased,  so  did  their 
fear  of  aggression,  their  own  and  others'.  When  they 
lirst  came  to  the  unit,  most  of  the  children  made  at- 
tacks only  on  themselves — biting  their  arms,  vio- 
lently slapping  their  faces,  or  banging  their  heads 
against  objects.  At  the  same  time,  they  were  very 
much  afraid  of  being  attacked  by  someone  else  and 
asually  would  move  rapidly  away  if  anyone  at  all 
touched  them.  After  a  while,  they  began  tentatively 
to  attack  objects — a  toy  or  something  metal  that 
made  lots  of  noise,  like  a  window  screen.  Gradually 
they  became  destructive  of  things  and  eventually  they 
began  directing  their  aggression  against  staff  mem- 
bers hj  scratching,  pinching,  biting,  kicking,  and 
hitting  them.  '\Miile  the  staff'  members  often  jirotected 
themselves  by  moving  quickh'  out  of  range,  they 
responded  with  equanimity,  thus  helping  the  children 
to  feel  safer  in  directing  their  aggression  outward. 

As  the  children  developed  relationships  with  other 
iliildren,  they  learned  to  assert  themselves  aggres- 
-iively  with  each  other.  They  still  try  to  control  the 
inxiety  they  feel  about  their  own  aggi'essive  actions 
liy  finding  reasons  why  the  other  child  "desen-ed  it" 
I  or  by  setting  up  rules  under  which  aggression  might 
lio  expressed.  Often  the  whole  thing  is  turned  into  a 
janie  in  which  a  child,  known  by  the  others  to  h& 
1  iry  angry  but  completely  incapable  of  showing  it 
nid  unwilling  to  defend  himself,  is  playfully  at- 
acked.  Sometimes,  rather  than  engaging  in  combat 


iiimseU',  a  child  w  ill  direct  others  to  tease  or  attack 
the  object  of  his  anger.  The  children  talk  a  lot  about 
aggression  and  whether  or  not  people  who  engage 
in  it  are  "good"  or  "bad."  At  times  a  child  will  at- 
tempt to  keep  his  feelings  of  aggi'ession  from  getting 
out  of  his  control  by  asking  permission  to  pull  some- 
one's hair  or  bite  him. 

After  a  while  the  childi-en's  primitive,  liighly  ag- 
gressive outbreaks  began  to  decrease.  They  were  re- 
placed by  more  ritualized  and  controlled  forms  of 
aggression  in  some  children  and  by  a  redirecting  of 
energies  into  environmental  exploration,  program 
activities,  and  learning  in  others. 

Limits  and  demands 

As  these  developments  have  taken  place,  the  staff 
has  attempted  to  keep  pace  with  the  developmental 
needs  of  the  children,  providing  new  experiences  of 
all  kinds — physical,  emotional,  social,  and  intellec- 
tual— in  an  increasingly  more  controlled  and  directed 
program.  For  example,  the  children's  participation 
in  making  or  listening  to  music  has  increasingly  been 
directed  to  specific  ends. 

Most  of  the  children,  before  coming  to  the  unit, 
had  had  extensive  experience  with  record  players. 
Some  had  had  piano  lessons  and  had  learned  to  play 
well.  However,  the  children's  musical  experiences 
often  had  been  associated  with  some  unpleasant- 
ness— being  pacified  or  isolated  or  having  an  ability 
exploited  to  the  neglect  of  important  needs. 

As  the  children  began  to  show  more  interest  in 
music,  the  staff  began  to  impose  limits  both  on  pho- 
nograph lilaying  and  the  use  of  the  pianos.  The  music 
teacher  made  advance  schedules  for  playing  records 
or  tapes  and  selected  those  to  be  played,  expos- 
ing the  children  to  a  wide  variety  of  music.  The 
children  now  listen  intently  during  the  music  period 
and  are  often  heard  spontaneously  humming  tunes 
from  the  music  that  has  been  presented  to  them.  They 
have  completely  accepted  the  restrictions  placed  on 
their  handling  of  the  musical  equipment. 

As  specific  children  indicated  they  were  read}'  to 
learn,  the  teacher  scheduled  formal  music  lessons  and 
practice  periods  for  them.  However,  some  of  the 
children  who  asked  for  music  lessons  were  denied 
this  privilege  because  of  indications  that  they  would 
then  have  given  up  all  efforts  to  develop  in  other 
ways,  or  because  they  were  interested  not  in  learning 
but  in  competing  with  other  children. 

The  music  teacher,  like  the  rest  of  the  staff,  has 
been  heavily  involved  in  all  aspects  of  the  cliildren's 


VOLUME  14  -  NUMBER  6 


221 


development.  He  helps  them  make  their  beds,  dress, 
and  clean  their  rooms,  and  he  goes  on  expeditions 
with  them.  The  children  have  thus  learned  of  his  in- 
terest in  their  development  as  a  whole  and  have 
acquired  sucli  confidence  in  him  that  they  can  accept 
teaching  from  him  witliout  having  all  of  their  nega- 
tivism irmnediately  aroused. 

As  the  children  have  moved  toward  greater  related- 
ness,  an  increasing  complexity  of  perfonnance  has 
been  demanded  of  them.  The  staff  has  shown  its  re- 
spect for  their  cajjacity  to  grow  by  insisting  that 
those  who  are  able  to  do  so  make  their  own  beds,  put 
away  their  own  clothes,  dress  themselves,  use  table 
utensils,  and  assiune  such  chores  as  setting  the  table, 
carrying  their  own  dishes  out  to  the  kitchen,  helping 
to  serve  food,  and  washing  dishes.  Such  demands 
have  not  been  made  on  all  children  simultaneously 
but  only  on  specific  children  as  they  have  shown 
readiness  for  assuming  some  responsibilities.  Of 
course,  there  has  been  much  resistance  on  the  part 
of  the  children  to  such  demands,  but  as  they  have 
carried  out  the  tasks  involved,  their  respect  for  them- 
selves and  for  each  other  has  appreciably  increased. 
All  the  children  are  now  actively  participating  to 
some  degree  in  their  own  physical  care,  and  a  few  are 
helping  in  the  care  of  the  more  dependent  ones. 

Presently,  about  half  of  the  original  group  are 
participating  effectively  in  an  educational  curriculum 
including  French,  Englisli,  biology,  history,  braille, 
and  music  appreciation.  Four  are  learning  music 
theoi-y  in  addition. 

Contribution  of  the  staff 

The  most  important  ingredient  in  bringing  about 
the  changes  noted  has  been  the  willingness  of  staff 
members  to  work  as  a  team,  to  see  beyond  their  own 
specific  professional  identities  to  the  idtimate  im- 
portance of  biiilding  in  each  child  a  capacity  to  trust 
and  to  relate  to  other  people.  This  has  meant  that 


everybody  on  the  staff  has  Iiad  to  take  part  in  meet- 
ing the  child's  particular  needs  of  the  moment, 
whether  this  involved  cleaning  up  a  mess,  bathing, 
dressing,  or  feeding.  It  was  only  through  giving  the 
children  such  elemental  forms  of  patient  attention 
that  they  coidd  helj)  the  children  learn  to  trust. 

At  first,  the  staff'  had  no  comprehension  of  this  fact 
and  could  not  function  as  an  integrated  team.  There 
was  little  agreement  as  to  how  the  cliildren  should  be 
treated  or  about  the  nature  of  their  problems.  There 
was  much  confusion  and  intrastaff  hostility,  par- 
ticidarly  in  relation  to  problems  of  professional  iden- 
tity and  theories  of  cliild  care.  Some  staff  members 
left,  unable  to  adapt  at  all  to  the  team  approach. 
Others  adapted  sufficiently  for  the  staff  to  be  gradu- 
ally welded  into  a  smootlily  coorduaated  therapeutic 
team,  adjusting  flexibly  to  the  changing  develop- 
mental levels  of  the  children,  picking  up  and  acting 
on  cues  from  each  other,  and  being  mutually  sup- 
portive in  tn'ing  times.  There  have,  of  course,  been 
some  weak  Imks,  for  to  achieve  an  ideal  coordmation 
in  working  with  such  children  is  a  difficult  task. 

We  have  found,  liowever,  that  when  a  central  core 
of  professional  persons  retains  responsibility  foi 
coordination  and  planning  in  relation  to  each  child! 
the  children  can  learn  to  adaj^t  to  tliose  staff'  mem- 
Ijers  who  find  themselves  temporarily  or  permanentlj 
at  odds  with  the  team's  generally  accepting  and  en  ] 
couraging  approach.  We  have  also  found  that  th( 
staff'  members  who  can  be  noncoercive  and  at  the  sarat 
time  can  encourage  children  to  have  new  experience; 
are  those  who  best  avoid  feelings  of  depression  and  in 
adequacy  in  themselves  and  are  those  most  trusted  bj 
the  chikh'en. 

In  the  near  future,  the  unit  is  to  become  the  Fair 
mount  Institute  of  the  Division  of  Child  Psychiatrj 
of  the  State  University  of  New  York,  Upstate  ]\Iedi 
cal  Center.  Syracuse.  It  will  be  greatly  expanded  anc 
will  include  sighted  as  well  as  blind  children  in  botl 
residential  and  day  treatment. 


.  .  .  Increasing  specialization  of  professions  and  agencies  calls  for  in- 
creased skills  and  increased  facilities  in  the  coordination  of  services,  and 
this  coordination  is  dependent  both  on  a  willingness  to  cooperate  and  an 
ability  to  communicate.  Here  lies  an  ever-present  challenge  for  all  of  us 
working  on  behalf  of  the  world's  children. 

Gunnar  Dybtvad,  director,  Mental  Retardation  Project,  International  Union  for 
Child  Welfare,  in  a  report  to  the  Union's  General  Council,  September  1966. 


illfil 


222 


CHILDREN     •     NOVEMBER-DECEMBER  1967  ii 


'Oil 


helping 

ADOPTING  COUPLES 

COME  TO  GRIPS 

WITH  THEIR  NEW 

PARENTAL  ROLES 


EDITH  M.  CHAPPELEAR 
JOYCE  E.  FRIED 


"When  a  husband  and  wife  learn  that  their 
application  to  adopt  a  child  has  been  ap- 
proved,  it  is  for  them  as  though  their  fondest 
dream  has  come  true.  But  ■when  the  child  is  actually 
placed  with  them,  questions  that  ought  to  have  been 
resolved  througli  the  home  study  process  may  arise. 
However,  their  reluctance  to  share  anxiety  with  a 
caseworker  after  placement  often  makes  it  difficult 
to  help  tliem  prepare  for  the  special  problems  they 
may  face  as  parents  of  adopted  children.  The  IMont- 
gomeiy  County  (Md.)  Department  of  Public  Wel- 
fare has  found  the  group  discussion  method  an  effec- 
tive way  of  breaking  through  such  reluctance. 

The  agency  has  had  professionally  trained  social 
workers  on  its  adoption  statl'  for  the  past  i  years.  Dur- 
ing this  time  it  has  emphasized  the  preparation  of 
applicant  couples  during  the  home  study  for  the 
problems  they  may  face  as  adoj^jtive  parents. 

Over  the  years,  the  agency  found  that  the  early 
period  of  plaronicnt  is  tlie  most  crucial  to  the  rpiality 
of  parent-child  and  child-parent  adjustinenl.  Un- 
fortunately, it  also  found  that  this  was  the  ])eriod 
when  social  workers  face  the  greatest  difficulty  in 
finding  a  meaningful  relationship  with  adopting 
parents.  At  tliis  jwint,  parents  were  iisually  most  un- 
willing to  discuss  or  come  to  grips  in  :uiy  way  with 

VOLUME   14  -  ^^JMBER  6 


I  lie  problems  tiiey  might  ha\('  willi  their  cliildrcn. 
The  caseworkers  felt  etlectively  siiut  out  by  couples 
w  ho  had  participated  actively  during  the  home  study 
iiiid  preplacemcnt  period.  For  the  adopting  parents, 
iince  tliey  had  the  baby,  the  focus  seemed  too  narrow 
to  include  only  tiiemselves  and  tiic  cliild.  In  talking 
\\  itli  the  caseworker,  they  tended  to  gloss  over  their 
|n(>l)leins  and  to  make  only  platitudinous  observa- 
tions such  as  "It  is  as  tliough  lie  had  been  witli  us 
always." 

Knowing  that  initial  parent  child  adjustment  is 
rarely  so  idyllic,  tlie  adoption  unit  considered  the 
Following  po.ssible  reasons  for  the  failure  to  get  a 
true  picture  of  what  was  going  on  in  tliese  homes. 

1.  The  worker's  visits  in  the  supervisory  jjeriod 
seemed  threatening  to  adoptive  j)arents.  The  coujjles 
felt  that  sine*  the  agency  .still  I'etained  guardianship 
over  the  child  it  might  use  its  authority  to  remove  the 
child  if  the  social  worker  thought  the  placement  was 
not  proceeding  satisfactorily.  Parents,  therefore,  felt 
a  great  need  to  emphasize  the  positive. 

2.  The  couples  unconsciously  felt  that  discussion 
of  the  strangeness,  fears,  and  changes  involved  in  the 
new  experience  of  adoptive  parenthood  would 
sharpen  their  awareness  of  the  differences  between 
adoptive  and  natural  jiarenthood.  They  preferred  to 
a\oid  the  pain  of  speaking  of  something  they  would 
like  not  to  exist.  It  is  easier  to  deny  an  unpleasant 
fact  than  to  face  it,  particularly  in  talking  to  a  per- 
son vested  with  authority. 

Realizing  that  both  these  leasons  were  probably 
o})erating  to  a  certain  extent,  we  wondered  whether 
the  parents  might  be  able  to  help  one  another.  We, 
therefore,  instigated  the  program  of  group  meetings 
to  supplement  the  social  workers'  individual  inter- 
views with  the  parents.  Under  the  plan  each  couple 
was  to  attend  two  group  meetings  in  the  office  in  the 
supervisory  period:  one,  6  weeks  to  2  montlis  after 
the  placement,  and  the  other,  1  week  after  that.  One 
home  visit  was  made  by  the  caseworker  within  2 
weeks  after  placement. 

The  new  jirogram  got  underway  in  October  1965. 
Each  jueeting  was  attended  by  five  or  six  couples  and 
lasted  about  an  hour  and  a  half.  Discussion  was  led 
by  a  caseworker,  who  encouraged  the  couples  to  par- 
ticiiDate  and  gradually  turned  the  meeting  over  to 
them  as  much  as  possible,  intervening  only  with  occa- 
sional guidance.  Xo  two  meetings  were  exactly  alike. 
They  varied  with  the  group's  composition  and  the 
leader's  experience  in  stimulating  discussion. 

223 


The  only  bases  for  membership  in  specific  groups 
were  the  date  the  couple  had  received  a  child  and  the 
age  of  the  child.  Parents  who  were  adopting  children 
over  4  years  of  age  met  in  separate  groups.  Some 
couples  were  having  their  first  experience  with  par- 
enthood; some  already  had  one  or  more  adopted 
children;  some  had  children  who  had  been  bom  to 
them  in  addition  to  one  or  more  adopted  children. 
The  age  range  among  the  couples  was  wide :  from  the 
early  twenties  to  the  forties. 

The  only  common  denominator  among  the  couples 
was  the  similar  situation  they  were  in :  they  had  all 
undergone  a  home  study  and  had  a  child  placed  in 
their  home  by  an  agency — usually  the  Montgomery 
County  Department  of  Public  Welfare,  but  some- 
times an  out-of-State  agency  for  whom  the  depart- 
ment was  carrying  the  supervisory  responsibility. 

The  discussions  were  always  concerned  with  the 
adjustment  involved  in  becoming  an  adoptive  parent, 
the  kinds  of  problems  that  could  be  anticipated,  and 
how  they  might  be  met. 

The  meetings 

The  first  of  the  two  meetings  each  couple  attended 
was  focused  on  the  subject  "Being  Adoptive  Par- 
ents"; the  second,  on  "P>eing  an  Adopted  Child." 
The  discussions  covered  the  following  aspects  of 
adoption : 

1.  The  difference  between  adoptive  and  biological 
parenthood. 

2.  Helping  a  child  to  an  acceptance  and  under- 
standing of  his  adoptive  status. 

3.  The  adoptive  parents'  feelings  toward  the 
child's  biological  parents. 

4.  The  adoptive  parents'  feelings  about  ille- 
gitimacy. 

5.  Letting  persons  outside  the  family  know  that 
the  child  has  been  adopted. 

The  group  leader  always  opened  the  first  of  the 
two  meetings  by  explaining  the  purpose  of  having 
them — giving  the  couples  an  opportunity  to  discuss 
a  common  experience  and  problems  of  common  con- 
cern. She  pointed  out  that  the  agency's  workers  were 
always  ready  to  be  of  help,  but  that  in  a  way  they 
w^ere  on  the  outside  looking  in  and  that  the  agency 
believed  the  participants  as  new  adoptive  parents 
might  have  something  to  say  to  each  other.  In  almost 


224 


Botli  Edith  M.  Chappelear, 
left,  and  Joyce  E.  Fried  were 
on  the  staff  of  the  Montgom- 
ery County  (Md.)  Depart- 
ment of  Public  Welfare  when 
they  wrote  this  article,  Mrs. 
Chappelear  as  adoption  su- 
pervisor and  Mrs.  Fried  as  a 

caseworlser  in  the  adoption  unit.  Both  have  recently  left 
agency  because  of  family  responsibilities. 


every  group,  the  parents  in  their  first  meeting  began 
to  discuss  questions  their  friends,  relatives,  and  ac- 
quaintances had  raised — questions  they  resented  and 
did  not  know  how  to  answer.  Almost  all  had  been 
asked  what  they  knew  of  the  child's  backgroimd.  To 
this,  many  of  them  had  given  angry,  evasive  answers 
such  as  "none  of  your  business."  Some  had  even  been 
asked  if  they  could  really  love  an  adopted  child  as 
they  would  a  child  of  their  own. 

Often  during  the  first  meeting  a  parent  would 
express  concern  about  how  his  adopted  child  would 
look  on  him  and  whether  the  child  would  feel  he  had 
no  need  to  respect  or  obey  him  because  adoptive 
parents  are  not  "real"  parents.  In  discussing  this  pos 
sibility,  the  group  members  usually  decided  that  it 
might  happen,  but  then  someone — sometimes  the 
group  leader,  sometimes  one  of  the  parents — would 
point  out  that  even  children  living  with  their  "real' 
parents  often  had  moments  of  rebellion,  and  ex 
amples  would  be  cited  of  such  children  who  had  ac 
cused  their  parents  of  not  being  their  "real  parents.' 

The  parents  were  nearly  always  unanimous  in  feel 
ing  that  they  would  have  difficulty  in  discussing  the 
subject  of  adoption  with  their  child.  In  the  first  meet 
ing,  the  group  leader  did  not  usually  make  specific 
suggestions  in  regard  to  this  problem  but,  rather,  sug- 
gested that  the  parents  think  a  lot  about  what  thej 
might  do,  read  about  what  others  had  done,  and  plan 
to  discuss  the  subject  again  in  the  second  meeting. 

The  second  meeting  usually  started  with  a  reading 
of  tlie  minutes  of  the  previous  meeting  after  whicl: 
the  group  leader  would  ask  whether  the  participants 
had  any  questions  they  would  like  to  discuss  further 
Often  the  first  question  raised  was  whether  it  is  im- 
portant to  discuss  the  fact  of  adoption  with  the  child 
All  of  the  parents  had  be«n  encouraged  to  exploK 
the  subject  in  their  individual  interviews  with  the 
social  worker  before  a  child  had  been  placed  with 
them.  The  questions  of  "when"  and  "how"  usuaUj 
elicited  much  difference  of  opinion.  In  one  group,  foi 

CHILDREN     •     NOVEMBER-DECEMBER  1967 


c'-xaiiiple,  a  man  wlio  hail  adopted  fotir  diildren  from 
ilillVruut  agi'iicies  saitl  lie  I'clt,  he  rould  tell  tJiom  all 
that  tlu'ii'  parents  were  dead. 

"To  me,"  lie  said,  "they  arc  dead.  IT  the  eliildren 
believe  they  are  liviiiy  they  will  go  to  the  ends  of  the 
earth  to  lind  tliem." 

His  wife  i-litl  not  iigree  with  him.  Other  couples 
.said  they  uuderstooel  his  wish  to  "hiiry  tlie  parents" 
but  tried  to  e.\2)lain  to  hiiu  why  this  would  not 
"work."  They  said  that  they  couKI  not  in  good  con- 
science falsify  the  facts,  that  it  would  be  easier  for 
them  to  help  a  chikl  face  and  accept  the  fact.s  behind 
his  placement  than  to  ]i\e  with  a  lie.  Some  parents 
said  they  felt  that  "truth  will  out"  anyway,  that  as 
the  child  got  older  and  learned  more  about  the  fre- 
quent association  between  illegitimacy  and  adoption, 
he  would  begin  to  woniler  if  his  adoptive  parents  had 
been  entirely  truthful  with  him.  All  of  the  parents  in 
the  group  indicated  they  felt  they  could  not  com- 
fortably repeat  an  earlier  falsification,  nor  did  they 
wish  to  jeopardize  their  relationship  with  the  child 
by  admitting  they  had  lied  originally  to  protect  him. 

The  group  leader  always  encouraged  the  partici- 
pants to  talk  about  why  it  would  be  difficult  for  them 
to  bring  up  the  subject  of  adoption  with  their  child. 
Usually  it  turned  out  that  their  difficulty  was  closely 
related  to  their  feelings  about  the  child's  out-of-wed- 
lock birth.  As  one  participant  expressed  it:  "It's  hard 
enough  to  talk  to  a  child  about  sex  without  having 
to  talk  about  birth  out  of  wedlock."  Some  parents 
tried  to  reassure  themselves  that  out-of-wedlock  birth 
would  have  no  stigma  by  the  time  their  children  were 
old  enough  to  ask  questions. 

The  leader  would  then  encourage  the  participants 
to  discuss  their  feelings  about  illegitimacy  in  gen- 
eral, how  these  feelings  wore  affecting  their  feeling 
about  the  natural  mother  of  their  child,  and  what 
other  feelings  they  had  about  this  "unlaaown" 
(as  far  as  thej-  were  concerned)  woman  or  girl.  The 
reactions  were  as  varied  as  the  personalities  of  the 
|)articipants.  There  was  usually  at  least  one  parent 
who  said  the  mother  "didn't  care"  that  she  had 
"dumped  the  baby  with  the  welfare."  This  was  al- 
ways countered  by  other  with  compassion — "She  will 
always  remember,"  "The  birthday  will  be  terrible 
for  her,"  "She  tried  to  give  the  baby  what  she  coukhi't 
gi\"e  by  herself — a  family." 

When  the  discussion  revealed  the  parents'  negative 
feelings  about  luimarried  mothers  and  even  some 
fear  that  their  adopted  children  might  become  as  "ir- 
resjionsible"'  as  the  women  who  Ijore  them,  the  group 
leader  would  ask  the  ]Kirents  why  they  themselves 

VOLUME  14  -  NUMBER  6 


had  come  to  the  agency  and  tlieu  would  try  Id  help 
them  see  that  an  unmarried  mother  who  has  released 
her  baby  to  an  agency  for  adoption  has  shown  the 
same  sort  of  rcsjjonsible  concern  for  the  child's  future 
as  has  the  couple  who  has  come  to  a  social  agency 
to  secure  a  child  for  adoption.  AVhen  the  group  leader 
asked  what  kind  of  inhumalion  abcjul  the 
mother  oi'  their  child  might  be  helpful  to  them,  the 
parents  would  usually  respoml  that  they  did  not 
want  to  l<now  very  much. 

\\'liile  the  major  part  of  both  meetings  was  spent 
discussing  the  ellects  of  adoption  on  the  parent- 
child  relationship,  the  group  leader  would  always 
make  a  point  of  bringing  the  discussion  around  to 
the  d;inger  of  overemphasizing  the  fact  of  adoi)tion 
both  in  the  parents'  direct  dealings  \vith  the  ihild 
and  in  their  search  for  causes  of  whatever  belunior 
difficulties  may  arise. 

The  leader  always  closed  the  second  meeting  by 
expressing  the  agency's  belief  in  the  ability  of  adojj- 
ti\e  families  to  become  closely  knit,  loving  families. 

Because  only  two  postplacement  meetings  were 
held  with  each  group,  we  did  not  attempt  to  do  any- 
thing more  in  these  meetings  than  to  raise  questions 
and  to  help  adoptive  parents  talk  about  them  to- 
gether so  that  they  might  become  more  comfortable 
in  their  new  parental  role. 

After  nine  series  of  meetings,  we  sent  a  letter  and 


Alert  to  ttie  wonders  of  a  new  environment,  ttiis  little  girl,  just 
placed  for  adoption,  is  in  a  home  of  her  own  for  the  first  time. 


225 


78-54:3—67 


a  questionnaire  to  the  44  couples  who  had  attended 
them  in  an  attempt  to  evaluate  the  program.  The 
couples  were  not  asked  to  sign  the  questionnaire.  The 
letter  explained  that  the  meetings  had  grown  out  of 
the  agency's  desire  to  help  the  parents  discuss  prob- 
lems of  concern  to  all  of  them.  Thirty  of  the  couples 
lilled  out  and  returned  the  questionnaires. 


Parents'  opinions 

The  following  is  a  list  of  the  questions  with  a  sum- 
mary of  the  parents'  responses : 

1.  We  did  (or  did  not)  find  the  postplacement 
group  meeting  helpful — 21,  did;  7,  did  not;  2,  "some- 
what helpful." 

2.  Did  the  meeting  evoke  any  new  questions  in  your 
minds  concerning  adoption  ?  If  yes,  what  are  they  ? — 
1,  yes;  25,  no;  4  returns  showed  no  response  to  this 
question.  A  specific  question  was  not  mentioned. 

3.  Did  you  find  the  subject  matter  stimulating? — 
14,  yes;  repetitive? — 5,  yes;  moderately  interest- 
ing?— 7,  yes;  not  pertinent? — 2,  yes;  a  waste  of 
time? — none;  no  response — 2. 

4.  Did  the  questions  raised  cause  you  to  worry? 
If  yes,  which  ones? — 1,  yes;  28,  no;  1,  no  response. 
(The  respondent  who  answered  "yes"  did  not  ex- 
plain.) 

5.  Please  check  which,  if  any,  of  the  follow-ing 
subjects  seemed  appropriate  to  your  present  experi- 
ence and  worth  talking  over  in  a  group:  (a)  Ad- 
justments involved  in  becoming  a  parent — 7;  (6) 
difference  between  adoptive  and  biological  parent- 
hood— 4;  (c)  helping  a  child  to  an  acceptance  and 
understanding  of  his  adoptive  status — 23;  (d)  adop- 
tive parents'  feelings  toward  child's  biological  par- 
ents— 5;  (e)  adoptive  parents' feeling  about  illegiti- 
macy— 3 ;  (/)  sharing  knowledge  of  child's  adoption 
with  outsiders — 12. 

6.  Did  you  feel  free  to  express  your  opinions  and 
feelings  at  the  meetings  ? — 26,  yes ;  4,  no  response. 

Twenty  couples  offered  suggestions  of  topics  they 
would  like  to  discuss  in  future  meetings.  Most  fre- 
quently mentioned  was  the  desire  to  speak  with  a 
couple  who  had  been  adoptive  parents  for  some  time. 

The  four  caseworkers  who  conducted  the  meetings 
regarded  them  as  varying  in  their  effectiveness.  In 
some  of  the  sessions,  the  discussion  was  very  lively ; 
in  others,  the  leader  was  hard  put  to  stimulate  any 


226 


kind  of  discussion.  In  general,  we  found  that  cou- 
ples whose  ages  and  family  situations  were  analogous 
and  whose  adoptive  children  were  of  similar  ages 
seemed  to  have  more  to  say  to  each  other  than  to 
couples  whose  family  situations  were  markedly  dif- 
ferent from  their  own.  We  found,  too,  that  the  cou- 
ples were  often  more  interested  in  exchanging  pic- 
tures of  and  pleasant  anecdotes  about  their  children 
than  in  thinking  out  loud  about  the  problematic  and 
emotional  aspects  of  adoption.  Several  parents  said 
at  the  meetings  that  the  problems  seemed  "so  far 
in  the  future"  that  they  found  it  difficult  to  theorize 
about  how  they  would  meet  them  when  and  if  they 
occurred. 

Nevertheless,  the  answers  to  the  questionnaire 
showed  that  23  of  the  30  responding  couples  found 
topic  5c — helping  a  child  to  an  acceptance  and  un- 
derstanding of  liis  adoptive  status — the  most  "appro- 
priate to  their  present  experience  and  worth  talking 
over  in  a  group."  This,  of  course,  is  the  crux  of  the 
problem. 

"Wliat  of  the  14  couples  who  did  not  answer?  Since 
we  did  not  require  the  returns  to  be  signed,  we  have 
no  way  of  knowing  who  responded  and  who  did  not. 
Perhaps  in  some  instances  the  questionnaire  was  not 
received  because  of  changes  of  address.  For  the  ma- 
jority of  those  who  did  not  respond,  however,  one  or 
the  other,  or  both,  of  the  following  assumptions  may 
apply : 

1.  The  couple  was  reluctant  to  indicate  a  negative 
response  and,  therefore,  did  not  reply. 

2.  The  child  seems  to  have  become  so  much  a  part 
of  the  adoptive  family  that  the  parents  have  not 
wanted  to  be  reminded  of  the  adoptive  status. 

In  either  case,  it  is  difficult  if  not  impossible  to  tell 
whetlier  the  meetings  were  of  value  to  these  couples. 

Some  of  the  agency's  caseworkers  who  have  not 
lieen  directly  involved  in  the  group  meetings  have 
expressed  some  skepticism  about  their  value.  They 
have  not  relished  the  possibility  of  being  exposed  to 
criticism  from  a  group  of  parents  who  by  and  large 
have  resisted  their  efforts  to  be  of  service  in  individ- 
ual interviews.  The  agency  has,  however,  come  to  the 
conclusion  that  it  is  better  to  help  adoptive  parents  in 
a  group  situation  than  in  a  one-to-one  relationship. 
It  is,  therefore,  continuing  to  carry  on  group  meet- 
ings, and  at  the  same  time  it  is  seeking  ways  to  im- 
prove its  service  to  adoptive  parents  through  a  com- 
bination of  individual  and  group  approaches. 


CHILDREN 


NOVEMBER-DECEMBER  1967 


THE 

GROUP 

PROCESS 


in 


hel 


pins 


PARENTS  OF  RETARDED  CHILDREN 


ARTHUR  MANDELBAUM 


When  parents  are  confronted  with  the  fact 
that  their  child  is  retarded,  they  often  enter 
a  period  of  mourning  and  grief,  accompanied 
by  emotional  isolation  and  lonelmess.  They  feel  like 
exiled  aliens  in  a  world  that  has  turned  suddenly  and 
unexpectedly  cruel  and  harsh.  Such  loneliness,  tinged 
with  vague,  obscure,  and  little  understood  feelings 
of  guilt  and  shame,  tends  to  lead  to  silence.  Commu- 
nication becomes  unbearably  difficult  and  isolation 
increases. 

The  human  spirit,  however,  with  its  vast  capacity 
for  enduring  stress,  develops  inner  defenses  and 
methods  of  dealing  with  sorrow.  One  human  attribute 
is  restlessness,  a  refusal  to  be  content  with  the  world 
as  it  seems.  Parents  of  retarded  children  have  a  way 
to  express  their  discontent,  their  wish  for  creative  ac- 
tion, by  joining  together  in  an  association  of  parents 
of  retarded  children.  The  purpose  of  such  an  associ- 
ation is  to  sustain  and  strengthen  ijidividual  parents 
who  are  trying  to  handle  similar  problems  and,  thus, 
to  halt  the  imbearable  feelings  of  being  alone  and 
isolated.  By  thus  joining  together,  parents  not  only 
meet  important  needs  they  have  in  common,  but  also 
use  their  collective  strength  to  help  their  retarded 
children.  They  organize  and  build  day-care  facilities 
and  training  centers,  urge  the  public  schools  to  in- 
clude  special    classes   for   retarded   children,  raise 


Based   on   a  paper   presented   at    the    1967    meeting   of  the 
American  Association  on  Mental  Deficiency. 


money  for  research,  and  persuade  legislatures  to  pass 
laws  aimed  at  improving  State  institutions. 

All  these  efforts  have  salutarj^  effects — the  parents 
ejnerge  from  their  isolation,  and  services  for  retarded 
children  improve.  But  what  of  the  parents'  interior 
life,  their  inner  feelings?  As  Bernard  Cohen  has 
noted  "the  stability  of  the  interior  environment  is 
the  condition  of  free  life."  ^  How  can  such  troubled 
parents  be  helped  to  find  inward  stability  and 
freedom  ? 

One  way  found  to  be  effective  in  helping  such 
parents  come  to  terms  with  themselves  is  to  bring 
them  together  in  small  selected  groups  under  the 
leadership  of  a  professional  person  who  can  help 
them  share  common  educational,  social,  and  emo- 
tional experiences  in  a  way  beneficial  to  each  member 
of  the  group. 

The  following  analysis  of  the  process  that  takes 
place  in  such  groups  is  based  on  my  experience  as  a 
social  caseworker  who  has  worked  with  several  small 
groups  of  parents  of  retarded  children  in  the  past  7 
years — some  made  up  of  mothers  and  fathere,  some 
of  mothers  only.  The  groups  met  once  a  week  for  11/4 
liours  each  session.  Some  groups  ran  for  six  sessions; 
some  for  10  or  12  sessions;  some,  even  longer.  The 
members  of  the  groups  themselves  determined  how 
long  they  needed  to  continue  meeting  together. 

The  group  process  is  used  to  help  each  member  tx) 
bring  forth  his  concern,  auger,  and  thoughts  so  that 
gradually  his  strength  comes  to  the  fore  and  he  can 
use  it  more  creatively  and  independently  in  handling 


VOLUME  14  -  NUMBER  6 


227 


the  social  and  emotional  problems  stemming  from  his 
child's  retardation.  If  the  group  members  can  exj^i'ess 
both  their  positive  and  negative  feelings  and  the 
leader  is  not  critical,  hostile,  authoritative,  or  judg- 
mental and  is  skillfully  able  to  ease  commimication, 
then  each  can  grow  through  the  experience.  As  each 
member  gradually  gains  more  knowledge  of  himself 
and  of  the  others  in  the  group,  he  expresses  himself 
with  greater  freedom  and  sj^ontaneity.  He  leams  his 
wife  has  feelings  he  did  not  know  she  had  and  had 
not  recognized  in  himself.  He  also  leams  that  she  and 
others  have  feelings  that  he  thought  existed  only  in 
himself.  He  begins  the  difficidt  task  of  learning  to 
listen  to  others  talk  about  their  feelings,  not  only 
to  himself.  He  listens  to  ideas  expressed  in  a  con- 
tinuous, evolving  process  and  gradually  becomes 
aware  of  the  intense  feelings  behind  them  and  of  how 
little  he  knew  of  this  before.  He  may  then  come  to 
understand  some  of  the  sources  of  his  own  angry  feel- 
ings and  to  sense  that  they  are  rooted  in  irrationality, 
disillusionment,  and  failure  to  realize  his  dreams. 


Some  themes 

Perhaps  the  most  significant  aspect  of  a  group 
process  is  the  opportmiity  it  gives  the  pai'ent  to 
further  resolve  his  grief.  This  is  necessary  before  the 
parent  can  release  his  capacity  for  profound  mider- 
standing.  As  Solnit  and  Stark  have  said:  "Coping 
with  the  outer  reality  of  a  child  with  a  congenital  de- 
fect and  the  inner  reality  of  feeling  the  loss  of  a 
desired  normal  child  requires  a  great  deal  of  mental 
work.  Such  psychic  work  is  slow  and  emotionally 
painful,  and  it  proceeds  through  the  gi'adual  and 
repeated  discharge  of  intense  feelings  and  memories. 
These  mental  and  emotional  reactions  enable  the 
parent  to  recognize  and  adapt  to  the  reality  of  the 
retarded  child."  - 

In  many  yomig  or  comjjarati^'ely  young  parents 
who  have  the  major  jDart  of  their  lives  still  ahead, 
the  traimaa  they  experienced  when  they  first  learned 
of  their  child's  mental  defect  remains  a  raw  wound. 

Mrs.  A.  spoke  dramatically  of  a  dream  she  had  had  several 
months  before  the  birth  of  her  child.  In  the  dream  she  climbed 
up  to  a  balcony  and  then  dropped  the  baby  over,  shattering 
him  to  bits. 

Several  persons  in  the  group  gasped,  and  several  other 
mothers  said  quickly  that  they  too  had  had  premonitions  of 
disaster  before  the  birth  of  their  children. 

Mrs.  A.  said  that  while  she  was  pregnant  she  had  seen  a  TV 
program  concerning  the  mercy  killing  of  a  mongoloid  baby.  She 
recalled  being  greatly  upset  and  thinking,  "How  dreadful  if  my 


228 


baby  would  be  like  that."  She  described  her  feelings  when  she 
learned  that  her  baby  was  "like  that":  "I  was  in  shock,  I  couldn't 
believe  it,  I  couldn't  think." 

Mrs.  E.  told  of  an  experience  her  sister-in-law  had  had  with 
an  impersonal  and  busy  doctor.  His  way  of  letting  her  know 
of  her  misfortune  was  to  remark  casually  as  he  left  her  hospital 
room,  "You  have  a  retarded  child." 

A  shocked  silence  followed.  Mrs.  F.  said  softly,  "I  imagine  it 
must  be  hard  for  the  doctors  also." 

After  some  moments  of  further  discussion,  the  worker  asked 
whether  the  parents  thought  it  was  hard  for  a  doctor  to  tell 
parents  they  had  a  retarded  child. 

Mrs.  G.  said  her  doctor  had  tried  to  tell  her  a  little  every  day 
about  her  baby's  condition.  She  thought  he  was  afraid  she  might 
not  be  able  to  take  it.  Finally  one  day  she  said  to  him,  "For 
goodness'  sake,  tell  me  the  truth."  He  did.  Her  husband,  who 
already  knew,  brought  her  books  on  the  subject.  But  that 
proved  to  be  the  wrong  thing  to  do.  Her  husband  meant  well, 
but  some  of  the  books  contained  wrong  information. 

Mrs.  B.  said  she  also  read  books  about  retarded  children; 
some  of  these  books  were  sentimental  and  phony,  but,  "I  did 
learn  a  little  about  the  subject." 

Mrs.  C.  shrugged,  "I  was  in  shock,  but  I  got  over  it  right 
away." 

Mrs.  G.  laughed  in  a  challenging,  anxious,  skeptical  way. 
Mrs.  C.  insisted,  "But  I  did.  I  realized  it  was  not  too  bad  to  have 
a  blind  child  because  they  can  do  many  things  for  a  blind  child. 
I  didn't  know  then  he  was  also  retarded." 

Mrs.  D.  said  that  for  a  long  time  her  doaor  did  not  know 
about  her  child's  condition  because  "doctors  still  don't  know 
many  things." 

Mrs.  G.  described  how  hard  it  was  for  her  to  tell  her  mother 
about  her  child's  condition.  Tears  came  to  her  eyes  as  she  re- 
lated how  both  she  and  her  mother  wept.  This  led  her  to  talk 
about  how  the  child  cried  almost  incessantly.  She  said  she 
needed  to  keep  faith  in  God. 

Some  parents  express  their  fear  of  having  more 
children  and  their  env3'  of  other  parents : 

Mrs.  A.  said  that  when  she  sees  other  couples  having  healthy 
babies,  a  pain  hits  her;  she  thinks  she  is  jealous.  Mrs.  B.  said 
she  is  jealous,  too,  but  that  she  knows  it  is  wrong  to  have  such 
feelings. 

The  discussion  then  turned  to  parents  who  have  normal  chil- 
dren and  complain  about  them  or  abuse  them.  The  feeling  that 
"they  do  not  know  how  lucky  they  are"  was  expressed 
vehemently  and  often. 

Some  themes,  common  to  all  discussion  groups  of 
parents  of  retarded  children,  are  introduced  with 
insistent  force  eai'ly  in  the  group  process:  feelings 
of  isolation,  of  loneliness,  and  of  inability  to  com- 
municate with  others  are  quickly  recalled. 

Many  parents  tell  about  how  imj^ossible  they  found 
it  to  speak  to  anyone  after  the  shock  of  learning  about 
their  child's  condition.  It  seemed  to  them  then  that 
there  was  no  one  available  to  listen,  at  least  no  one 


CHILDREN     •     NOVEMBER-DECEMBER  1967 


Id! 


Hi; 


L  .  iipable  ol'  uiulerstuiuliiig.  Pi"ofession;il  pi'uplc  could 
not  understand — they  seemed,  in  a  sense,  like  tlie  par- 
ents themselves,  human,  fra<2:ile,  fearful,  lackiiij>-  tlie 
courage  to  face  the  problem,  to  sjieak  al)()ut  it,  to 
talk  honestly,  directly,  and  kindly.  As  outsidei's,  they 
conkl  not  rcalbj  mulerstand. 

Tlien  tlie  parents  begin  gi'adually  lo  bring-  up  (heir 
feelings  of  anger  and  frustation,  forbidden,  dreadful 
feelings  that  produce  a  sense  of  guilt  they  haA^e  tried 
to  control  or  tleny.  Some  parents  think  that  perhaps 
the  angry  feelings  within  themselves  ha\t'  a  magical 
power  aiul  may  liave  impaired  the  fetus  at  concep- 
tion or  during  gestation.  8onu>,  wonder  whether  their 
child's  retardation  is  not  a  punishment  from  God 
because  of  tlieir  past  sins,  or  whether  God  has  not 
blessed  them  by  giving  them  a  retarded  cliild  as  a 
symbol  of  innocence,  purity,  and  holiness. 

Parents  always  express  these  thoughts  about  God, 
tentati\ely,  with  awe  toward  mysterious,  seemingly 
irrational  forces  and  at  the  same  time  with  bitteniess, 
irony,  and  doubt.  The  question  persists:  "What  did  I 
do  to  have  had  this  happen  to  me  ?" 

Feelinss  toward  the  children 

Feelings  toward  tlie  retarded  children  gradually 
emerge.  Some  paients  see  the  cliildren  as  grotesque 
objects  to  be  hidden  from  public  \aew  and  from 
friends  and  relatives.  As  such  feelings  come  to  light, 
they  become  attached  to  the  parents'  self-image.  The 
parents  feel  inwardly  grotesque  and  are  afraid  of 
being  regarded  as  genetically  imperfect,  contami- 
nated, and  inextricably  identified  with  the  damaged 
child. 

Mrs.  Z.  said  angrily  that  before  her  retarded  child  was  born, 
her  mother-in-law  boasted  that  among  her  14  grandchildren 
there  was  "not  one  crooked  finger." 

Mrs.  Z.  said  with  a  laugh  that  she  thought  there  was  a  little 
of  the  mongoloid  in  all  of  her  other  children  too,  as  several  of 
them  had  the  simian  line  and  blunted  fingers.  After  the  birth 
of  the  retarded  child,  her  mother-in-law  would  not  go  near 
him.  She  suggested  that  the  Z.'s  place  the  child  in  an  institution 
and  was  disappointed  when  they  took  him  home.  Once  when 
the  father  was  going  to  visit  a  relative,  she  urged  him  to  take 
one  of  the  normal  children  along  so  that  "they  could  see  you 
are  capable  of  having  normal  children." 

A.S  the  parents  descril)e  the  cru.elty  of  others  toward 
them  in  their  misfortiuie,  manj'  reveal  their  own 
larsli  and  jninitive  views  of  themselves.  Tlie.se  are 
gradually  modified  h\  tlie  gentle,  kind,  perceptive 
judgments  olTered  by  otlier  memliers  of  the  group. 

Mr.  S.,  in  an  angry  voice,  told  about  taking  her  retarded 
daughter  to  a  party  and,  after  leaving  her  side  for  onl)'  a  few 

VOLUME   14  -  NUMBER  6 


minutes,  being  accused  by  the  child  of  trying  to  abandon  her. 
Mrs.  J.  described  her  embarrassment  when  she  took  her  re- 
tarded son  to  get  a  haircut  and  he  tried  in  his  jumbled  speech 
to  talk  with  the  barber.  Mrs.  V.  told  how  her  son  had  run  ex- 
citedly into  the  living  room  speaking  incoherently  when  the 
family  was  entertaining  company.  When  she  tried  to  calm  him 
down,  he  had  become  so  excited  that  she  had  to  send  him  to 
the  basement.  Mr.  and  Mrs.  F.  admitted  rather  shamefacedly 
that  they  never  took  their  daughter  anywhere  because  she  was 
so  obviously  retarded.  Mrs.  S.  confessed  that  when  she  took  her 
daughter  anywhere  she  had  a  strong  impulse  to  shout,  "She's 
a  retarded  child!"  and  had  real  difficulty  in  controlling  it.  The 
group,  shocked,  fell  silent. 

The  worker  pointed  out  that  all  the  parents  apparently  had 
these  feelings  of  embarrassment  and  discomfort  and  asked 
what  understanding,  what  thoughts  they  had  about  them. 

Mrs.  F.  said  "shame  and  humiliation."  She  said  she  felt  like 
hurling  something  at  them,  those  who  looked  at  the  child, 
those  who  thought  she  was  different;  she  wanted  to  attack  them 
and  defend  her  child.  Mr.  V.  said  "resentment  and  anger"  for 
having  such  a  child.  Mrs.  E.  said,  "I  want  to  say  to  them,  well, 
what  are  you  looking  at.'"  Mrs.  T.  said,  excitedly,  "I  used  to  do 
that,  think  that.  I  used  to  stare  at  them,  but  now  I  avert  my 
eyes."  Mr.  F.  said,  "I  am  guilty  of  that,  too.  Inside  you  feel 
inferior,  ashamed." 

Mr.  T.  said  they  had  left  their  daughter  Betty  at  a  party  that 
night  with  great  apprehension,  for  they  had  never  left  her  at  a 
party  before.  "My  mind  is  there  while  I  am  talking,"  he  said. 
"Betty  talks,  talks,  talks.  The  people  we  usually  leave  her  with 
when  we  come  here  are  out  of  town.  It  is  important  to  come 
here;  we  have  never  talked  about  our  feelings  about  her  with 
anyone  else  before,  never  even  with  relatives  or  friends."  Mr.  F. 
said,  "We  come  here  for  the  child  as  well  as  ourselves." 

Mr.  E.  said  he  wondered  whether  all  these  feelings  we  were 
talking  about  were  not  due  to  the  hurt  inside  the  parents.  The 
child,  he  thought,  does  not  suffer  so  much  as  the  parents.  Mr.  T. 
agreed,  "It  is  because  you  feel  there  is  something  wrong  with 
you  that  you  should  have  a  retarded  child." 

Mrs.  F.  spoke  of  knowing  a  19-year-old  retarded  boy  whose 
parents  take  him  everywhere.  "Maybe  it  is  our  fault  when  our 
child  embarrasses  us.  Maybe  he  picks  up  our  feelings  about 
him." 

Eventually,  the  group  enters  a  period  of  alter- 
nating grief  and  solace:  themes  of  loss  and  death 
alternate  with  themes  of  how  gentle  and  lovable  re- 
tarded children  are  and  the  solace  they  otfer  the 
family.  The  parents'  fears  that  the  children  might 
die  are  based  on  reality,  for  many  retarded  children 
have  other  congenital  defects  that  add  to  the  difficulty 
of  caring  for  tlicin  and  fill  their  parents'  days  and 
nights  with  apprehension. 

The  parents  praise  each  other's  children,  and  dur- 
ing the  expression  of  such  jjositive  feelings  they 
slowly  venture  to  speak  of  their  anger  and  fright  at 
the  persistent  intrusion  of  intense  death  wishes.  Many 
say  in  ell'ect,  "Having  a  retarded  chihl  is  like  having 
a  death  in  the  family,  only  worse;  at  least  you  can 
get  over  a  death,  but  this  is  never  behind  you.  You 


229 


have  to  live  with  this — for  tlie  rest  of  your  life." 

When  the  group  members  become  awcire  of  the 
intense  feelings  this  theme  arouses,  they  move  away 
from  it.  Many  indicate  they  do  not  want  to  look  ahead 
very  far.  Groups  are  often  quite  free  from  expecting 
false  assurances  and  are  quick  to  challenge  plati- 
tudes. The  retarded  child  is  an  inescapable  reality. 
Tlie  future  is  feared  because  the  child  must  surely 
present  more  difficulties  as  he  grows;  his  faults  and 
defects  will  be  magnified.  Some  parents  express  the 
wish  that  the  child  will  remain  an  infantile  love  ob- 
ject to  be  cuddled  and  pampered,  of  whom  little  need 
be  demanded.  Conversely,  some  parents  note  that  in 
remaining  like  an  infant  the  child  will  be  an  ever-in- 
creasing burden,  tyrannical  in  his  need  for  attention 
and  care. 

Each  parent  in  a  couple  seems  to  fear  that  the  other 
will  be  drawn  to  the  retarded  child  so  strongly  that  all 
others  in  the  family  will  be  neglected.  This  leads  to 
anger  and  a  sense  of  guilt  in  an  alternating  repetitive 
cycle. 

Parents  often  screen  their  doubts  and  misgivings 
about  the  extent  to  which  they  might  express  their 
innermost  thoughts  in  the  group  with  expressions  of 
concern  about  what  to  tell  their  other  children,  rela- 
tives, friends,  and  other  persons  in  the  community. 
However,  parents  frequently  say  they  feel  both  re- 
lieved and  surprised  after  they  have  expressed  a 
strong  negative  feeling  or  fear.  They  wonder  that 
tliey  have  been  able  to  say  things  in  a  group  that  they 
had  never  been  able  to  say  to  a  husband  or  wife  or  a 
best  friend.  Their  feeling  of  relief,  however,  is  soon 
followed  by  further  doubts  and  fears  of  revealing 
deeper  feelings. 

So  great  is  the  need  among  such  parents  to  protect 
their  self-esteem  that  a  group  sometimes  subtly  di- 
vides into  sections :  one,  parents  of  children  who  are 
only  mildly  or  moderately  retarded  and  have  only 
slight  or  no  physical  defects;  the  other,  parents  of 
children  who  are  severely  retarded  or  whose  retarda- 
tion is  also  apparent  in  their  physical  appearance,  as 
with  mongoloid  children. 


Signs  of  strensth 

Each  member  of  the  group  feels  defeat,  but  many 
have  also  had  experiences  that  have  given  them  a 
sense  of  victory — moments  of  small  triumph  whose 
import  they  feel  the  "outside  world"  is  not  equipped 
to  understand.  For  example,  a  parent  may  say,  "Our 
retarded  children  are  diffei'ent;  we  can  shed  tears 
together.  But  we  are  alert  to  and  take  pride  in  every 


230 


Ci 


Arthur  Mandelbaum  is  the  chief  social 
worker  at  the  Menninger  Foundation,  To- 
peka,  Kans.  He  Is  ahso  secretary  of  the 
American  Association  of  Residential  Centers 
for  Children  and  second  vice  president  of  the 
National  Association  of  Social  Workers.  He 
received  his  master's  degree  in  social  work 
from  the  University  of  Denver  in  Colorado. 
He  has  written  many  articles  for  professional  publications. 


\i 


sign  of  small  improvement  in  them.  Every  slight  step 
forward,  wliich  would  be  umioticed  in  our  normal 
children,  is  a  major  triumph  in  the  handicapped 
child." 

The  group  members  usually  identify  with  one  an 
other  in  an  intense  and  binding  fashion.  They  seem 
to  feel  that  since  their  children  are  unusual,  thej 
themselves  are  unusual  also  and  belong  together 
Sometimes  they  are  united  against  the  "outsidf 
world";  sometimes  against  the  leader  of  the  group 
a  representative  of  that  outside  world. 

Mrs.  T.  said  that  for  2  years  she  would  not  admit  to  hersel 
that  her  child  was  retarded.  She  recalled  the  first  doctor  she  hae 
consulted  about  the  child,  and  she  said  she  hated  him.  Mrs.  Ni 
suggested  that  perhaps  Mrs.  T.  hated  the  doctor  because  he  wai  It; 
the  first  person  to  tell  her  about  her  child's  retardation.  Mrs.  T  k; 
agreed.  The  discussion  then  became  heated  as  the  group  mem 
bers  spoke  of  doctors,  how  they  were  told  about  their  child' 
handicap,  and  their  need  for  someone  to  talk  with. 

For  the  first  time,  two  or  three  parents  spoke  at  once.  Th 
worker,  raising  his  voice  slightly  to  be  heard,  pointed  out  tha 
the  parents  were  saying  three  important  things:  first,  that  th; 
doctor,  by  giving  them  the  diagnosis,  had  hurt  them;  seconc 
that  the  doctor  had  failed  to  help  them  in  the  way  they  hai 
wanted  at  the  time  of  their  first  deep  shock;  third,  that  they  ha« 
found  consolation  in  talking  with  others  with  the  same  kind  o 
problems  through  the  parents'  association  and  that  outsiders  di  ™ 
not  understand  and  could  not  help  very  much. 

The  parents  agreed  to  this.  Then  the  worker  pointed  out  tha  ""^^ 
several  times  previously  he  had  tried  to  get  into  the  discussioi  ort 
but  that  they  had  been  so  intent  on  getting  their  points  acros 
that  he  had  not  been  able  to  do  so.  He  asked  whether  they  wer 
aware  of  this  and,  if  so,  whether  they  could  understand  whj 

Mr.  P.  quickly  said,  "You  are  an  outsider,  too."  The  worke 
said  he  thought  this  was  an  important  point.  Mrs.  T.  pointec 
out  that  one  of  the  "professionals"  on  the  staff  of  the  parent! 
association  was  supposed  to  attend  a  meeting  of  the  schoc 
board  but  had  been  "too  busy"  to  do  so.  If  he  were  a  parent  o 
a  retarded  child,  he  would  have  been  there,  she  added,  bu 
professionals  did  not  have  the  same  kind  of  concern  as  parents 
Mrs.  N.  said  that  the  man's  absence  probably  had  nothing  to  di 
with  his  being  a  professional  person;  even  some  parents  had  ti 
be  pushed  to  attend  meetings. 

When  the  group  session  ended,  the  parents  remained  stand 
CHILDREN     •     NOVEMBER-DECEMBER  196: 


BOl 

bi 
n 


te 


ing  outside  the  building  as  the  worker  drove  away.  Mrs.  S. 
waved  goodbye,  saying,  "You  see,  we  arc  going  to  continue 
outside  in  the  cold." 

As  tlie  discussion  explores  the  labyiinlli  ol'  reel- 
ings, the  parents  grope  toward  mature  ways  of  view- 
ing beliavior  in  an  attempt  to  find  a  value  sj^stem 
that  is  right  for  them,  one  that  will  sustain  autl 
nourish  them.  They  support  one  another,  bring  out 
feelings  for  the  scrutiny  of  the  group,  question  irra- 
tional ideas,  point  up  the  inefficiency  and  dubious 
value  of  certain  kinds  of  behavior,  and  gradually 
iurrea.se  the  ability  of  each  pei-son  in  the  group  to 
look  realistically  at  the  problems  presented  by  his 
retarded  child  and  ways  of  dealing  with  them.  The 
worker  must  have  faith  in  the  inherent  ability  of 
the  individual  parent  to  release  his  capacity  to  do 
this — a  capacity  previously  blocked  by  anger,  con- 
flict, and  fantasies.  If  he  does  not  have  such  faith, 
he  will  intervene  hastily  in  the  groups "s  discussion  and 
become  authoritative  and  didactic,  and  in  doing  so 
dilute  the  emotional  intensity  of  the  experience  for 
the  parents. 

The  leader's  role 

Using  the  group  process  to  help  parents  is  an  in- 
creasing clinical  practice  in  service  to  the  mentally 
retarded.  The  worker  who  attemjDts  the  process  must 
be  skilled  in  dealing  with  persons  in  one-to-one  inter- 
views, preferably  hefore  he  attempts  to  deal  with 
them  in  groups.  If  he  chooses  the  group  method  be- 
cause he  is  discontent  with  the  one-to-one  method,  he 
should  know  that  in  tn'ing  to  help  individual  parents 
through  the  group  process  he  takes  on  a  task  of 
2;reater  complexity,  one  requiring  an  understanding 
of  the  dynamics  not  only  of  individual  behavior,  both 
normal  and  abnormal,  but  also  of  the  behavior  of 
croups.  If  he  is  discontent  with  the  slow,  cautious 
movement  in  the  one-to-one  process  and  expects  a 
nore  rapid  progress  in  working  with  a  group,  he  will 
16  disillusioned.  In  either  method  the  worker  must 
56  aware  of  the  recurrent  nature  of  grief  in  parents 
3f  retarded  children  and  of  the  adhesive  quality  of 
Jieir  inner  conflicts.  He  must  know  that  he  will  win 
Jie  group's  confidence  and  trust  only  after  repeated 
;rial  and  error  and  that  each  member  of  the  group 
rows  at  his  own  pace. 

It  is  tempting  to  use  the  group  meeting  to  teach 
)arents  facts  about  mental  retardation,  to  answer 
heir  questions  about  their  children,  and  to  discuss 
.t  length  the  reasons  for  their  children's  slow  de- 
velopment. Listening  and  observation,  however,  will 


f[uickly  show  the  worker  that  many  parents  in  the 
group  are  very  well  read  on  the  sul)ject  of  retardation 
and  that  some  have  become  learned  on  specific  aspects 
of  the  problem  and  are  much  closer  to  being  masters 
of  the  subject  than  the  worker.  Instead  of  teaching, 
the  worker  lieljjs  the  i)arents  deal  with  their  inner 
[)roblems  by  using  his  knowledge  that  sorrows  can 
be  borne  if  they  can  be  put  into  words  or  into  a  story ; 
can  be  absorted  or  dissolved  if  they  can  be  expressed 
in  words  to  those  who  face  the  same  inescapable  ad- 
\orsity  and  who  wish  to  examine  that  adversity  as 
it  affects  their  inner  selves.  His  task  is  to  help  the 
parents  see  the  imj)ort  of  what  they  are  saying  and 
feeling  as  the  discussion  weaves  back  and  forth  be- 
tween the  way  individual  members  feel  about  being 
parents  of  a  mentally  retarded  child  and  how  and 
what  they  understand  about  their  world,  thems-elves, 
and  each  other. 

To  the  group  the  worker  is  an  outsider.  As  the 
parents  speak  about  professional  people  not  under- 
standing, about  their  treating  parents  abruptly  and 
harshly  and  not  helping  in  the  way  the  parents  want 
and  expect,  the  worker  must  use  the  strictest  self- 
discipline  to  control  his  anger,  for  it  becomes  clear 
that  the  parents  also  consider  him  an  outsider  in- 
capable of  helping  them  and  unable  to  understand 
their  feelings  because  he  has  not  had  the  same  shat- 
tering experience  as  they. 

The  worker  is  like  a  screen  against  which  are 
projected  the  parents'  feelings  toward  all  outsiders 
as  critical,  uncaring,  judgmental,  and  punitive.  He 
represents  all  authoritative  figures  who  have  failed 
to  protect  the  parents  from  an  irrational  and  malig- 
nant fate,  who  will  not  give  answers,  and  who  force 
them  to  think  for  themselves. 

"Will  no  one  give  us  answers  to  our  grief,  will  no 
one  hear  us?"  The  cry  at  first  silent  is  soon  voiced 
more  and  more.  The  language  of  the  group  is  com- 
monplace. It  is  concerned  with  the  ordinary  aspects 
of  experience,  but  suddenly,  and  sometimes  without 
warning,  it  slips  into  expressiveness  or  expressions 
that  give  the  speakers  themselves  a  shocking  glimpse 
into  their  deeper  feelings — 

"Do  you  ever  get  over  it,  the  depression,  I  mean?" 
"I  felt  that  being  around  friends  who  were  pregnant  was  like 
some  curse." 

"What  did  I  ever  do  to  have  had  this  happen  to  me?" 

"Sometimes,  I  wish  he  had  died  at  birth;  the  doctor  should 
have  killed  him  and  not  told  me." 

"When  I  did  bring  the  baby  into  the  store,  the  clerks  all 
admired  her  and  cooed.  I  wondered  whether  they  knew  she 
was  retarded  and  they  did  that  just  to  please  me.  Then,  when  I 


i^OLUME  14  -  NUMBER  6 


231 


didn't  bring  the  baby,  they  asked  about  her.  I  felt  guilty  and 
wondered  whether  I  had  left  her  home  because  I  was  angry. 
Maybe  the  fact  is,  I'm  too  sensitive." 

The  conversation  is  sometimes  drab,  superficial ;  tlie 
speakers  grope  to  convey  information,  search  rest- 
lessly for  contact,  for  understanding,  for  an  illumi- 
nating exijlanation  of  the  myths,  theories,  and  con- 
flicting beliefs  about  retarded  children.  In  this  search 
they  express  fear  that  the  worker  will  see  them  as 
damaged,  inferior,  and  ill  and  will  not  see  their 
strength.  Then,  of  coui'se,  they  hesitate  as  though 
wondering  how  much  it  is  safe  for  them  to  see  and 
understand. 

They  become  angry  and  seem  to  feel  that  the  group 
process  means  they  are  to  devote  their  lives  and  their 
dreams  exclusively  to  the  retarded  child,  to  the  ne- 
glect of  their  other  children  and  themselves. 

They  seem  to  wonder:  Are  they  in  bondage?  Will 
the  worker  let  them  go?  If  they  express  the  full 
measure  of  their  thoughts,  their  anger,  will  they  be 
able  to  control  those  feelings  after  they  leave  the 
group  and  do  not  have  each  other  for  support? 

They  seem  to  wonder,  too,  about  the  worker  and 
his  relationship  to  them :  Will  he,  because  of  the  in- 
tensity of  their  concern  and  anger,  become  overbur- 
dened and  ill?  Is  he  preoccupied  with  his  work,  too 
professional,  insensitive,  and  unobservant  to  know 
how  they  really  feel?  When  a  meeting  is  canceled 
because  he  has  to  be  away,  where  does  he  go  and  to 
whom  does  he  give  tlie  words  of  wisdom  that  he  is 
denying  them?  How  can  they  make  him  do  their  bid- 
ding and  gain  mastery  over  him  so  that  he  can 
gratify  them  more? 

These  and  other  questions  the  pai'ents  sometimes 
ask  directly,  sometimes  imply  in  their  questions  or 
statements  about  their  retarded  children,  their  fami- 
lies, and  their  lives  outside  the  group.  But  little  by 
little  they  delve  beneath  the  cliches  and  superficial 


questioning  to  deeper  layers  of  meaning  until  they 
can  see  tlie  iiitlierto  undreamed  of  nature  of  their 
own  true  feelings. 

Time  and  time  again,  parents  express  surprise 
about  their  former  narrow  views  of  their  families, 
other  people,  and  the  institutions  of  society  and  what 
needs  to  be  done  about  them.  They  also  express  hope 
al)out  finding  ways  to  handle  the  tasks  aliead  of  them. 

The  end  of  these  sessions  is  like  the  tennination  of 
a  voyage.  The  passengers  have  come  together;  have 
talked,  laughed,  cried,  struggled  to  share  feelings 
and  to  achieve  deeper,  wider  understanding  of  them- 
selves and  their  children.  They  ha\e  formed  close 
friendships.  Xow  it  is  time  to  say  goodby. 

The  memljers  of  the  group  express  I'egret  that  tlie 
groujD  camiot  continue  in  its  present  form.  They  ex- 
press fear  of  letting  go  of  something  that  has  been 
lielpfid  and  of  being  alone  again.  Each  member, 
however,  as  a  member  of  the  larger  association  of 
parents  of  retarded  children  has  an  opportunity  to 
lielp  formulate  and  work  in  behalf  of  retarded  chil 
dren.  Having,  through  the  group  process,  focusec 
his  attention  on  liimself  and  on  others  in  a  series- 
of  interactions  in  which  he  both  gained  insight  and 
lost  some  of  his  exclusive  preoccupation  and  self- 
intei'est,  he  is  tlie  more  ready  for  social  action.  Foi' 
as  Aldous  Huxley  has  noted,  "The  more  inward  we 
are,  the  more  we  may  luidertake  outward  activities 
the  less  inward,  the  more  we  sliould  refrain  fi'oin 
doing  good."  ^ 


'Cohen,  Bernard:  In  the  foreword  of  "An  introduction  to  the  stud; 
(if  experimental  method"  (Claude  Bernard).  Dover  Publications,  Nev 
York.  1957. 

^Solnit,  A.  J.;  Stark,  M.  H.:  Mourning  and  the  birth  of  a  defectiv( 
child.  In  The  psychoanalytic  study  of  the  child,  vol.  16.  (Ruth  S 
Kissler  et  al.,  cds.).  International  Universities  Press,  New  York.   1961 

"Huxley,  A.;  The  devils  of  Loudon.  Harper  &  Bros.,  New  York.  1953 


Youth  will  not  be  well  served  if  we  assume  tomorrow's  world  as  an  un- 
changeable "given" — a  mere  .  .  .  extension  of  the  world  we  presently 
know.  ...  I  find  no  joy  in  being  adjusted  to  measureless  violence,  hand- 
to-mouth  and  catch-as-catch-can  existence,  or  to  a  deepening  phoniness 
which  embitters  the  mind,  blights  the  spirit,  and  saddens  the  dreaming 
heart  of  man. 

Rev.    Dr.    Joseph    Siller,    Professor    of    Theology,    Viiiversily    of    Chicago,    to    the 
1960  White  House  Conference  oh  Children  and  Youth. 


232 


CHILDREN 


NOVEMBER-DECEMBER  1967 


SOME 

OBSERVATIONS 

ABOUT 


MENTALLY 

RETARDED 

ADOLESCENTS 


ARTHUR  SEGAL 


The  term  "adolescent"  usually  produces  an 
image  of  a  young  person  struggling  to  leave 
childhood  for  adulthood.  We  think  of  his 
"search  for  identity"  ^  and  his  use  of  relationships 
with  his  peers  to  support  his  ego  during  this  period 
of  confusion.-  AVe  have  come  to  regard  adolescence 
as  a  distinct  developmental  period  with  its  own  norms 
and  cultural  values;  a  stage  when  the  young  person 
compares  and  challenges  the  forms  and  meaning  of 
his  own  and  others'  behavior.^ 

Parents  and  other  adults  significant  in  an  adoles- 
cent's life  often  try  to  help  him  through  this  tense 
period  by  providing  him  with  opportunities  to  ex- 
plore ideas  and  initiate  plans  for  the  future.  But  what 
of  the  mentally  retarded  adolescent?  Does  he  feel 
the  same  kind  of  tension  from  the  conflicting  pulls 
toward  both  childhood  and  adulthood  as  the  normal 
adolescent  ?  Does  he  too  begin  to  question  the  familiar 
and  to  wonder  about  the  future? 

Observations  of  young  people  in  the  work-training 
and  recreation  programs  operated  by  the  San  Fran- 
cisco Aid  Eetarded  Children,  Inc.  (SFARC),  have 
convinced  me  that  they  do.  There  are,  however,  subtle 
differences  between  the  forms  and  degrees  of  their 
questioning  and  tension  due  not  only  to  the  degree 
of  their  retardation  but  also  to  the  amount  of  self- 
confidence  they  have  been  able  to  develop  through 
the  supjjort  and  understanding  of  adults.  In  many 
of  them  the  normal  tension  of  adolescence  has  been 
aggravated  by  the  realization  that  somehow  they  are 
"different"  and  tliat  this  will  make  a  difference  in 
the  opportmiities  they  will  find. 

The  mildly  retarded  adolescent  (IQ  between  53  and 


68)  speaks  the  language  of  the  adolescent  culture. 
He  wants  a  job  and  wants  to  earn  a  salary.  He  is 
aware  that  he  has  been  classified  as  a  mentally  re- 
tarded child  and  he  resents  this.  He  resents  being 
expected  to  limit  his  career  to  work  in  a  sheltered 
workshop  and  longs  for  the  kind  of  job  held  by  his 
father  or  friends.  He  speaks  of  sex  and  marriage  and 
wants  to  date.  The  kind  of  heterosexual  relationships 
he  has  is  probably  affected  more  by  the  standards  of 
his  friends  than  by  his  level  of  intelligence. 

Mildly  retarded  young  people  are  sufficiently 
aware  of  their  deviance  to  be  angrj'.  However,  their 
limited  ability  to  understand  abstract  social  relation- 
ships and  to  plan  and  control  their  participation  in 
community  activities  often  leads  to  difl'use  expres- 
sions of  emotion.  They  do  not  know  where  to  direct 
their  anger — at  themselves  or  at  the  adults  who  do 
not  believe  in  them.  One  girl  described  her  confusion 
about  where  she  stood  as  a  person  by  saying,  "Some- 
times I  feel  like  a  child  is  holding  on  to  me  and  won't 
let  go." 

The  moderately  retarded  adolescent  (IQ  between  36 
and  53)  also  shows  awareness  of  the  values  and  cus- 
toms of  his  community  and  indicates  a  desire  to  par- 
ticipate in  them.  However,  the  participation  he  ex- 
pects may  be  on  another  level.  He  is  usually  less 
socially  adept  and  independent  than  the  mildly  re- 
tarded adolescent.  His  manner  of  expression  is  often 
closer  to  the  preadolescent  than  the  adolescent  form 
and  his  display  of  interest  in  adult  customs  usually 
reflects  this.  He  regards  work  as  fim  but  play  as 
more  fun.  He  approaches  bo}-girl  relationships 
shyly,  usually  with  a  lot  of  giggling  and  i^erhaps 


VOLUME   14  -  NUMBER  6 


233 


some  hand  holding.  He  tries  to  imitate  the  adult  he 
sees  on  television,  the  adult  he  believes  he  should  be, 
and  his  inability  to  do  so  is  evident  to  him. 

The  moderately  retarded  adolescent  is  also  aware 
that  the  activities  and  accomplislmients  exiJected  of 
him  m  "school" — for  liim  a  sjjecial  class  for  "the 
trainable  mentally  retarded" — differ  from  those  ex- 
pected of  his  brothers  and  sist«rs  in  regular  classes, 
and  he  speaks  of  wanting  to  learn  to  read  and  to 
acquire  other  academic  skills.  He  is  aware  that  chil- 
dren become  adults  when  they  complete  secondaiy 
school.  He  has  a  general  idea  of  the  tasks  and  rela- 
tionships expected  of  adults,  and  as  a  result  he  feels 
somewhat  in  limbo — no  longer  a  child,  yet  barred 
from  adultliood.  Then  what?  One  IS-year-old  boy, 
upon  graduation  from  the  school's  program  for  train- 
able mentally  retarded  children  and  adolescents, 
summed  up  his  state  as  now  "half  a  man  and  half 
a  kid." 

The  severely  retarded  adolescent  (IQ  between  20  and 
36)  also  has  some  awareness  of  his  "difference,"  but 
he  usually  has  some  difficulty  expressing  himself. 
He  has  fewer  words  at  his  command  and  his  xmder- 
standing  of  others  appears  to  an  observer  to  be  limited 
to  their  connection  with  his  familiar  routine.  How- 
ever, what  seem  superficial  to  the  observer  of  a  se- 
■\'erely  mentally  retarded  adolescent  may  reflect  the 
obsei-ver's  inability  to  commimicate  with  him. 

At  SFARC  we  learned  through  various  techniques 
such  as  the  casework  intei'view,  role  play,  and  pup- 
petry that  an  older  teenager  who  is  severely  retarded 
niay  still  have  specific  interests  related  to  his  chrono- 
logical age  rather  than  to  his  level  of  intellectual 
development.  For  example,  one  girl  let  us  know  in 
very  few  words  that  she  liked  to  play  checkers  with 
her  6-year-old  cousin  but  that  she  did  not  play  with 
dolls  because  "they  are  for  kids." 

However,  the  ability  of  a  severely  or  moderately 
retarded  adolescent  to  recognize  that  he  is  different 
does  not  mean  that  he  necessarily  understands  the 
nature  of  this  difference.  When  a  group  of  such  yoimg 
people  are  together  their  discussion  often  reveals 
their  identity  confusion,  their  desire  io  be  adults,  and 
their  limited  understanding  of  adult  ways.  This  is 
illustrated  by  an  excerpt  from  a  record  of  a  meeting 
of  the  Hawks,  a  recreation  club  of  moderately  re- 
tarded adolescent  boys. 

When  the  group  voted  to  visit  the  zoo,  Jerry  suggested  that 
they  also  visit  the  adjacent  playground.  The  boys  thought  this 
would  be  fun.  Then  Tom  asked  about  activities  at  the  play- 
ground. Jerry,  who  had  visited  the  playground  several  times, 
answered,  "swings,"  and  smiled  with  a  look  of  anticipation. 

234 


There  was  a  momentary  silence.  Then  Ron,  Tom,  and  several 
other  boys  pointed  out,  sneeringly,  that  swings  "are  for  kids" 
and  they  were  adults.  Jerry  looked  confused,  and  Bill  said  he 
thought  adults  could  go  on  swings.  However,  the  majority  of 
the  boys  voiced  strong  negative  feelings  about  acting  like  kids, 
and  the  decision  veered  in  the  direction  of  adult  behavior. 

But  what  is  adult  behav'ior?  ^Vliile  these  yomig 
people  obviously  saw  it  as  "not  cliildish  behavior," 
they  coidd  not  easily  say  what  it  was  nor  follow 
through  in  a  determined  way. 

The  confusion  among  severely  and  moderately  re- 
tarded adolescents  about  what  an  adult's  role  consists^ 
of  may  be  due  not  only  to  their  low  level  of  intelli 
gence  but  also  to  their  lack  of  opportunity  to  learn 
the  things  that  other  adolescents  leani  incidentally 
in  their  daily  lives.  For  example,  in  one  of  the  discus- 
sion groups  of  moderately  retarded  adolescents  con- 
ducted at  SFARC  to  promote  a  greater  degree  of 
self-confidence  in  the  retarded,  some  of  the  young 
people  talked  about  how  much  they  would  like  to  live 
alone,  but  tliey  showed  almost  complete  ignorance< 
about  what  a  jx-rson  who  lives  alone  has  to  know  and 
do.  They  knew  almost  notliing  about  the  prices  of  foodi 
and  rent  or  the  tasks  involved  in  getting  in  supplies,i 
preparing  meals,  and  cleaning  house.  But  after  they 
were  taken  by  the  social  worker  on  trips  to  gi-ocery 
and  department  stores  and  listened  to  a  landlord  talk 
about  rents  and  the  kind  of  care  a  tenant  has  to  take 
of  the  rented  unit,  they  begin  to  show  a  more  realistic 
miderstanding  of  what  it  means  to  be  an  independent 
adult. 


Effects  of  labeling 

Identity  confusion  may  stem  from  a  midtitude  ol 
inconsistent  and  distortmg  experiences  in  the  men 
tally  retarded  person's  life.  From  the  time  he  has  ,[, 
been  labeled  as  mentally  retarded  he  has  been  re- 
garded as  a  social  deviant.  As  a  result  he  has  teen  putl|,f 
into  a  mold  wliich  inevitably  has  shaped  his  per 
sonality.  For  example : 


Mr.  and  Mrs.  L.  have  "a  cheerful  little  girl,"  Penny,  whom 
they  dearly  love.  Penny  has  Down's  syndrome,  and  from  the 
time  the  diagnosis  was  made  the  parents  have  been  subtly  in^t 
fluenced  to  use  the  mold.  Their  daughter  will  remain  a  child; 
she  will  never  grow  up,  they  have  been  told  by  physician^ 
teacher,  neighbor,  and  relative. 

The  L.'s  have  a  good  marriage,  and  have  other  children  of 
normal  intelligence.  They  have  decided  that,  since  Penny  can- 
not grow  up  and  cannot  understand  adult  concepts,  they  will 
always  respond  to  her  as  though  she  were  a  small  child.  They  a 
have  always  laughed  at  her  antics  and  given  her  the  secure 
care  a  child  needs,  and  they  have  continued  to  do  this  after  she 
is  well  into  adolescence.  ti: 

Thus,  Penny  has  learned  to  expect  easy  forebearance  and   fj, 


CHILDREN 


NOVEMBER-DECEMBER  1967 


111 


close  supervision  from  her  parents.  Since  she  has  never  had  any 
friends  of  her  own  age,  she  has  had  neither  socialization  exjicri- 
ences  nor  parental  encouragement  to  guide  her  into  adulthood. 
Therefore,  she  does  not  learn  new  socialization  methods 
appropriate  for  an  adolescent. 

Penny  could  Icurn  social  beha\  ior  more  ai)propri- 
ato  to  lier  ayv,  for  many  young  people  witli  Iier  con- 
dition liave  (lone  so.  But  as  long  as  lier  paients  and 
otlier  people  in  tlie  coinniunity  and  she  heisell'  believe 
she  is  a  child,  she  will  remain  a  child. 

The  same  molding  process  takes  jdace  in  some  fam- 
ilies with  a  mildly  retarded  child,  though  much  less 
frequently.  Our  experience  at  SFAEC  with  adoles- 
cents who  are  only  mildly  retarded  or  who  arc  on  the 
borderline  between  retardation  and  low  normal  intel- 
ligence suggests  a  different  set  of  dynamics. 

Many  parents  who  have  an  adolescent  child  who 
can  almost  make  it  academically  do  not  wish  to  dwell 
on  or  even  admit  to  the  fact  of  mental  retardation. 
They  tend  to  push  the  child  toward  greater  academic 
achievement  or  job  finding.  They  do  not  wish  to  be 
counseled  on  ways  of  dealing  with  a  retarded  adoles- 
cent. Some  parents  only  allow  themselves  to  refer  to 
their  child  as  retarded  because  the  agency  accepts 
only  the  mentally  retarded  in  its  job  training  pro- 
grams. Some  only  agree  to  accept  comiseling  for 
themselves  if  this  will  guarantee  their  child  a  job. 
Some  insist  that  their  child  is  just  lazy. 

A  mildly  retarded  adolescent,  therefore,  is  apt  to 
be  caught  in  a  vise  of  conflicting  images  and  exi)ecta- 
tions.  The  school  labels  him  as  mentally  retarded  and 
puts  him  in  a  special  class.  His  parents  say  he  is 
lazy.  He  liimself  may  be  sure  he  is  neither  lazy  nor 
mentally  retarded.  But  he  has  to  live  with  both  labels, 
a  task  made  more  difficult  by  his  limited  intellectual 
ability  and  its  eifects  on  his  social  judgment.  When 
he  shows  the  typical  tension  and  cpiestioning  attitude 
of  adolescence,  he  receives  little  pertinent  guidance 
from  adults  because  tliey  either  see  everything  he  does 
in  terms  of  his  retardation  or  fail  to  recognize  the 
difficulties  his  retardation  causes  him. 

Many  mildly  retarded  adolescents,  while  \aguely 
aware  that  they  have  trouble  learning,  do  not  look  on 
themselves  as  abnormal.  Therefore,  when  they  enter 
a  training  program  in  an  agency  whose  name  itself 
shows  that  it  serves  oidy  the  retarded,  they  have 
added  to  the  usual  difficulties  of  adolescence  the  psy- 
chological problems  that  come  with  labeling.  Many  of 
them  rebel  and  leave  the  agency. 

At  SFAEC  we  have  seen  many  mildly  retarded 
adolescent  boys  and  gii-ls  who,  having  dropped  out  of 
school  or  completed  a  program  of  special  classes, 


have  agreed  to  allrml  I  he  slicltcred  workshop  for 
training  but  have  not  agreed  to  be  mentally  retarded. 
They  stay  on  in  the  workshop  as  long  as  they  tliink  it 
will  lead  to  an  outside  jol). 

A  survey  of  mentally  retarded  pei-sons  known  to  31 
agencies  in  San  Francisco  shows  a  discrepancy  of 
several  thousands  between  the  number  of  jjersons  of 
school  age  identified  as  mentally  retarded  and  the 
number  over  IS  years  of  age.  The  following  case 
story  may  oiler  a  clue  to  this  discrepancy  : 

Dan  B.,  a  mildly  retarded  18-year-old  school  dropout,  reg- 
istered at  the  SPARC  workshop.  His  parents  placed  a  high  value 
on  work  and  independence.  Mr.  B.  insisted  Dan  was  lazy.  Mrs. 
B.  hoped  Dan  could  get  a  job.  She  was  not  certain  he  was 
retarded. 

At  the  workshop,  Dan  was  sullen  and  apathetic.  He  did  not 
like  the  program  nor  the  trainees,  most  of  whom  were  more 
retarded  than  he.  He  became  embroiled  in  many  fights.  The 
staff  tried  to  give  him  special  work  activities,  but  he  would  not 
stay. 

The  agency  lost  track  of  Dan  for  about  2  years.  Then  one 
day  he  appeared  at  the  workshop  beaming.  He  had  a  job  with 
a  service  station  and  was  earning  a  union  wage.  He  was  married, 
and  his  wife  was  pregnant.  He  returned  again  the  day  after  his 
wife  gave  birth,  a  happy  father,  obviously  no  longer  identified 
as  mentally  retarded. 

When  will  I  get  a  job? 

Eveiy  adolescent  we  meet  in  the  SFARC  training 
[)rogram  asks  the  same  question :  When  will  I  get  a 
job?  Behind  this  question  are  many  influences:  cul- 
tural standards,  tradition,  the  inner  need  for  identifi- 
cation, and  the  need  to  be  a  productive  person.  Some 
trainees  expect  jobs  in  specific  occupations  in  the  com- 
munity ;  others  are  content  to  remain  in  the  sheltered 
workshop.  Some  ex2>ect  a  higher  wage  than  the  work- 
shop oif ers ;  others  want  a  wage  oidy  as  a  symbol  of 
adulthood  and  are  not  concerned  with  its  size. 

The  severely  retailed  adolescent  usually  wants  to 
remain  in  the  workshop  where  he  has  a  meaningful 
task  he  can  accomplish. 

The  moderately  retarded  adolescent  is  more  likely 
to  speak  of  a  "real  job,"  though  he  has  little  notion  of 
the  requirements  for  such  a  job.  He  may  want  to  be- 
come an  electrician,  a  policeman,  a  teacher,  or,  after 
some  interviews  with  the  agency's  caseworker,  a 
social  worker.  He  wants  to  be  regarded  as  adult,  a 
state  he  ec^uates  with  having  the  same  kmd  of  job 
as  a  particular  adult  he  knows  and  admires.  Most 
moderately  retarded  trainees,  as  they  form  positive  re- 
lationships  with  the  agency's  stall'  members  and  gain 
lu^w  skill  and  a  degree  of  independence,  are  able  to 
relinquish  their  original  voc^ational   <r<>als  and  take 


VOLUME   14  -  NUMBER  6 


235 


jobs  in  the  workshop  or  the  community  that  are  with- 
in their  competence. 

The  mildly  retarded  adolescent  usually  has  less  un- 
cer'tainty  about  his  ability  to  become  an  adult  and 
more  realistic  vocational  aims.  He  wants  a  job  in  the 
community  that  pays  good  wages  instead  of  work- 
shop employment,  though  he  may  be  completely 
lacking  in  any  vocational  skill  and  in  the  social  skill 
it  takes  to  get  along  with  fellow  workers  and  a  boss. 
Mildly  retarded  adolescents  are  well  aware  of  the 
puritan  principle  that  commands  the  "worthy"  to 
work,  and  so  they  feel  greater  pressure  often  exerted 
by  their  parents  to  seek  work  in  the  community. 


.ove 


and 


marriage 


Like  most  young  people,  mentally  retarded  adole,s- 
cents  are  interested  in  the  opposite  sex.  In  the 
SFARC  workshop  we  often  heard  conversations 
among  the  young  people  about  "boyfriends"  and 
"girlfriends,"  about  dating,  marriage,  and  sex.  Plow- 
ever,  love  and  marriage,  though  talked  about  by  al- 
most all  the  young  people,  have  different  meanings 
for  different  persons. 

Among  the  moderately  retarded  talk  about  love  or 
marriage  is  usually  only  an  expression  of  a  cultural 
expectation.  For  example,  for  John,  who  is  moder- 
ately retarded,  getting  married  is  something  adults 
do.  Since  he  is  approaching  adulthood,  he  too  will 
have  to  marry,  or  so  he  fears.  Wlien  he  speaks  of 
marriage  he  is  really  expressing  his  search  for  an 
adult  image. 

Mary,  also  moderately  retarded,  is  a  very  lonely 
girl  who  has  lived  in  a  number  of  foster  homes.  She 
met  a  boy  at  the  sheltered  worksliop  and  soon  began 
to  speak  of  love  and  marriage.  Her  desire,  we  ob- 
served, was  for  a  comforting  relationship  with  a  male 
figure.  Mary  and  her  boyfriend  will  both  remain 
satisfied  if  they  can  continue  their  friendship. 

Young  people  who  are  mildly  retarded,  or  near  the 
borderline  of  dull  normal  intelligence  have  a  more 
sophisticated  view  of  marriage.  They  speak  of  find- 
ing a  job,  an  apartment,  and  of  all  the  things  young 
people  normally  consider  before  marriage.  And  many 
of  them  do  get  married. 

Many  persons — especially  parents  of  the  mentally 
retarded  and  professional  persons  who  work  with 
them — raise  strong  objections  to  the  idea  of  mental- 
ly retarded  persons  getting  married.  The  objections 
raised  most  frequently  are:  (1)  mentally  retarded 
persons  cannot  make  realistic  plans;   (2)  they  may 

236 


produce  mentally  retarded  children;  and  (3)  they 
may  be  unable  to  care  for  childi"en  properly.  The 
tendency  is  to  approach  the  subject  negatively  with- 
out recognizing  the  varying  degrees  of  retardation 
and  personality  development  among  persons  who 
score  low  on  IQ  tests  or  the  lack  of  evidence  that 
successful  marriage  bears  any  relationship  to  specific 
levels  of  intelligence.  Moreover,  nobody  has  ever  de- 
veloped a  standard  model  of  a  successful  marriage 
against  which  the  marital  adjustment  of  a  retarded 
person  could  be  measured. 

There  ai'e  two  rejjorts  in  the  social  work  literature 
of  studies  involving  inquiries  into  the  marital  ad- 
justment of  persons  who  were  mildly  retarded.  Both 
show  an  association  between  marital  adjustment  and 
the  pei-sonalities  of  the  marriage  partners — a  result 
tliat  one  would  certainly  expect  to  find  in  a  study  of 
marital  relatioiiships  among  nonretarded  persons. ■'■ ' 

Concern  about  the  progeny  of  a  marital  imion  be- 
tween mildly  retarded  adults  may  be  overemphasized. 
The  etiology  of  mental  retardation  is  complex.  Only 
a  small  proportion  of  cases  can  be  linked  to  known 
genetic  factors.  But  the  presence  or  absence  of  cer- 
tain enviromnental  factors  in  childhood  and  adoles- 
cence decisively  influences  opportunities  for  intel- 
lectual achievement  and  social  growth  whether  or  not 
retarding  genetic  factors  are  present." 

The  ability  of  parents  to  provide  and  care  for  their 
cliildren  properly  is  determined  by  several  factors 
other  than  intellectual  ability.  These  include  emo- 
tional stability,  economic  security,  and  comnumity 
acceptance.  Since  marriage  does  occur  between  men- 
tally retarded  persons  and  some  of  these  unions  do 
produce  children,  whether  or  not  skillful  guidance 
is  available  to  them  is  an  appropriate  concern. 


The  parents 


f 


Parents  of  mentally  retarded  adolescents  often 
need  guidance  to  help  them  help  their  retarded  child 
achieve  a  greater  level  of  maturity.  They  may  be 
unable  to  let  the  child  grow  np,  not  because  thej'  do 
not  want  him  to,  but  because  they  are  afraid  that  he 
cannot  and  will  be  hurt  if  he  assumes  more  independ- 
ence in  getting  around  the  commmiity,  going  shop- 
ping alone,  or  taking  a  job.  Parents  have  many  deep 
and  lasting  feelings  of  grief  and  sorrow  about  their 
retarded  child  that  must  be  understood  and  respected 
by  anyone  who  wishes  to  help  the  mentally  retarded 
adolescent.'  Such  feelings  cannot  be  dispelled,  but 
parents  can  be  helped  to  explore  their  mentally  re- 

CHILDREN     •     NOVEMBER-DECEMBER  1967 


I»t( 


eifi 


Fonnerly  oliicf  of  scK-iiil  service'.  Iiuk-pciiilont  fCj 
Living  Itohiibilitaliou  I'ro^'rain,  San  Fian- 
cisco  Aid  KelarJed  Children,  Inc.,  Arthur 
Segal  is  field  worlt  supervisor  for  tbe  School 
of  Social  Welfare,  University  of  California, 
Berkeley,  and  a.  board  member  of  the  San 
Francisco  Coordinating  Council  for  the  Men- 
tally Retarded.  A  graduate  of  tbe  Columbia 
University  School  of  Social  Work,  be  has  also  worked  in 
rehabilitation  agencies  in  New  York. 


tardt'd  child's  ahilitips  and  to  permit  him  to  jirow  up. 

Pai-eiits  wlio  luvve  liad  no  guidance  (hiring  the 
child's  formative  years  are  usually  not  prepared  for 
understanding  and  helping  their  child  when  he  be- 
comes an  udole^scent.  We  have  faiown  parents  who 
childishly  teased  and  chided  their  retarded  adolescent 
child  on  tlie  as.^umption  that  he  did  not  understand 
them  enough  to  care.  At  SFARC  we  were  able  to 
show  such  parents  tliat  tlie  young  person  does  under- 
stand them  and  no  longer  wants  to  be  treated  as  a 
child.  I  use  tlie  word  "show"  literally.  Some  parents 
have  had  to  be  shown  their  teenage  child  actually 
working  at  a  productive  task  or  participating  in  a 
group  discussion  before  they  coidd  believe  in  his 
potential  for  functioning  more  maturely. 

In  contrast,  some  parents  of  mildly  retarded  ado- 
lescents express  disbelief  in  their  child's  retardation. 
This  is  often  true  if  the  child's  retardation  was  not 
recognized  by  anyone  until  he  reached  school  or  even 
later  when  the  school  belatedly  placed  him  in  a 
special  class.  Such  placements  are  frequently  made 
with  little  or  no  interpretation  or  guidance  being  of- 
fered the  parents.  If  they  have  a  poor  understanding 
of  English  or  little  concern  for  academic  achieve- 
ment, they  may  not  worry  about  their  child  until 
he  grows  older  and  exliibits  an  inability  to  compete 
socially  and  in  job  getting.  Parental  misunderstand- 
ing of  the  young  person's  behavior  may  then  lead  to 
friction  and  tension. 

At  SFARC  we  encouraged  parents  to  come  to- 
gether in  discussion  groups  as  one  means  of  helping 
them  get  a  clearer  picture  of  their  retarded  children's 
potentials  as  young  people  growing  into  adulthood. 
In  discussing  together  the  meaning  of  independence 
to  specific  retarded  adolescents  (their  own  child  and 
each  other's) ,  the  ability  of  these  young  people  to  as- 
simie  responsibility  for  decisions,  the  pros  and  cons 
of  allowing  them  to  date  members  of  the  opposite 
sex  and,  eventually,  to  get  married,  and  their  chances 
of  employment,  the  parents  often  come  to  see  that  the 


poUniialitie^s  of  each  retarded  adolescent  are  differ- 
ciil  ami  to  (hop  the  tendency  to  say  that  "the  re- 
tai-ili'd  can"  or  "the  retarded  cannot''  do  something. 

For  example,  a  mother  of  a  girl  employed  in  the 
sheltered  workshop  rei)eatedly  expressed  the  fear 
that  something  would  happen  to  her  daughter  be- 
cause she  was  taking  long  walks  with  another  girl 
after  work  instead  of  coming  directly  home  every 
day.  This  mother  gradually  relaxed  when  other  mem- 
bers of  the  group  kept  telling  her  that  her  daughter 
wiis  behaving  like  other  teenage  girls  and  was  in  no 
greater  danger  than  they  in  taking  a  walk  with  a 
friend. 

We  found  that  parents  who  refuse  to  permit  their 
retarded  adolescent  son  or  daughter  to  develop 
greater  independence  tend  to  be  those  who  are  un- 
comfortable in  their  relationships  not  only  with  their 
retarded  child  but  also  with  their  normal  children. 
When  we  have  been  able  to  help  these  parents, 
through  the  group  and  through  individual  casework 
interviews,  to  relax  their  attitudes  toward  their  re- 
tarded child,  we  have  found  that  their  attitudes  to- 
ward their  other  children  have  also  changed.  When 
they  finally  could  permit  their  retarded  adolescent 
child  to  assume  some  independence,  they  could  also 
encourage  greater  independence  in  their  other 
children. 

If  ketaeded  adolescents  are  to  be  helped  to 
achieve  more  satisfactory  lives,  all  those  who  are 
working  in  their  behalf — parents  and  professional 
persons  alike — must  recognize  that  these  yoimg 
l)eople  are  adolescents,  with  all  the  desires,  expecta- 
t  ions,  and  confused  emotions  that  come  with  adoles- 
cence, and  at  the  same  time  are  indiruluals,  each  with 
his  own  personality,  own  special  way  of  looking  at 
things,  and  own  degrees  of  strength,  weakness,  and 
potentiality. 


'Erikson,  E.  H.:  Childhood  and  society.  W.  W.  Norton  &  Co.,  New 
York.  1950. 

"Sherif,  M.;  Cantril,  H.:  The  psychology  of  ego-involvements,  social 
auitudes,  and  identifications,  John  Wiley  &  Sons,  New  York.  1947. 

'Maier,  H.  W.:  Adolescenthood.  Social  Casetvork,  January  1965. 

'Peck,  J.  R.;  Stephens,  W.  B.:  Marriage  of  young  adult  male  retard- 
ates. American  Journal  of  Mental  Deficiency,  May  1965. 

"Wolfson,  I.  N.:  Follow-up  studies  of  92  male  and  131  female 
patients  who  were  discharged  from  the  Newark  State  School  in  1946. 
Amaican  Journal  of  Mental  Deficiency,  July  1956. 

"Gruenberg,  E.  M.:  Epidemiology;  Anderson,  V.  E.:  Genetics  in 
mental  retardation.  In  Mental  retardation.  (H.  A.  Stevens  and  R.  Heber, 
eds.)  University  of  Chicago  Press,  Chicago,  111.  1964. 

'Olshansky,  S.:  Chronic  sorrow:  a  response  to  having  a  mentally  de- 
fective child.  Social  Caseworl{,  April   1962. 


VOLUME  14  -  NUMBER  6 


237 


EXTENDING 
A  HAND 


I 


to  PARENTS  of  DISTURBED  CHILDREN 


JOYCE  EDWARD 


d 

W- 

im 


Now  that  the  riglit  of  the  emotionally  dis- 
turbed child  to  education  is  firmly  established, 
those  of  us  who  work  in  special  education  can 
direct  our  efforts  toward  the  challenge  of  insur- 
ing that  every  emotionally  disturbed  child  likely 
to  profit  from  special  education  receives  it.  To  meet 
this  challenge  is  not  so  easy  as  it  may  appear.  Parents 
can  be  the  greatest  obstacle.  Some  parents  resist  ac- 
cepting a  reliable  diagnosis  of  their  children's  dis- 
order as  disturbed  and  are  unable  to  follow  recom- 
mendations for  special  class  placement. 

Ten  years  of  experience  as  a  psychiatric  social 
worker  in  the  eleonentaiy  school  division  of  the 
Luther  E.  Woodward  School  for  Emotionally  Dis- 
turbed Children,  Inc.  (LEW),  in  P'rceport,,  N.Y., 
which  takes  children  aged  4  through  16  years, 
has  made  me  much  awaT'e  of  the  problems  of  the 
parents  of  disturbed  children  and  of  the  measures  an 
agency  can  take  to  help  these  parents  accept  their 
children's  special  needs.  At  LEW,  casework  with 
families  is  an  integral  part  of  the  program  from  in- 
take to  discharge.  We  have  found  that,  though 
placement  of  the  child  in  a  special  class  is  usually 
painful  for  parents,  it  is  a  process  through  which 
they  can  be  helped  to  reach  a  better  understanding 
not  only  of  their  child  and  his  needs  Init  also  of 
themselves.  "Wliat  the  pi"ofessional  worker  does  can 
have  a  great  deal  to  do  with  whether  the  parents'  ad- 
justment to  the  child's  placement  impi-oves  as  the 
child  impi'oves  or  whether  it  disintegrates,  leaving 
the  parents  even  less  effective  than  before  in  helping 
their  child. 

Basic  to  the  professional  worker's  efforts  is  the 


recognition  of  both  the  conscious  and  imconscious 
effects  the  disturbed  child  has  on  his  family.  The 
problems  jiarents  expose  to  professional  workei-s  re- 
flect their  individual  personalities,  the  interactions 
of  the  entire  family,  and  the  actual  difficulties  they 
face  in  rearing  a  disturbed  child. 

The  severity  of  the  symptoms  of  such  a  child  can 
of  themselves  make  even  healthy,  stable  families 
anxious  and  defensive.  The  child's  hyperactivity, 
impulsi\eness,  bizarreness,  regression,  and  obsessive- 
ness,  to  mention  only  a  few  characteristics  that  may 
occur  singly  or  in  combination,  place  an  inordinately 
heavy  strain  on  family  life.  The  behavior  that  makes 
a  child  luimanageable  in  a  I'egular  school  class  makes 
him  no  less  so  at  home.  His  care  is  taxing;  his  be- 
havior is  incomprehensible;  his  conduct  can  be  em- 
barrassing; the  medical  attention  he  requires  is 
costly;  the  social  services  he  requires  are  difficult  to 
secure;  and  the  time  his  care  requires  is  excessive. 
His  illness  is  a  severe  blow  to  the  parents"  self-esteem, 
and  their  feeling  of  guilt  for  having  produced  such  a 
child  is  accentuated  by  the  hostility  and  anger  the 
child  provokes.  It  is  difficult  for  them  to  air  their  feel- 
ings or  to  separate  themselves  from  him.  Even  the 
most  mature  parents  worry  about  how  to  handle  an 
emotionally  disturbed  child  without  hanning  liira 
further.  They  worry  not  only  about  the  present  but 
also  about  the  future. 

In  addition  to  having  problems  directly  related  to 
the  child's  disorder,  parents  may  be  beset  by  other 
kinds  as  well.  Some  have  serious  psychiatric  disor- 
ders themselves.  Complicated  pathological  relation- 
ships may  exist  in  the  family,  of  which  the  child's 


ilu 
ifi 

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si: 


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ti|i 

If 
lil 

m 


IT: 

ids 


238 


CHILDREN     •     NOVEMBER-DECEMBER  1967 


^1 


illness  iiiav  li;i\i'  lii'coiiu' an  iuti'i:ral  paii.  Soiiif  par- 
I'liis  caiinol  vii'w  llicir  cliilcrs  disordi'i-  realistically 
Ix'causo  tlicv  identify  thonisehes  witii  ids  bidiavior. 
(  XluTs  are  so  lindted  inteliet'tually  that  they  cannot 
understaiul  wliat  pi'ofessional  people  tell  them  aliout 
I  lu'ir  children.  SiM'ial  and  cultural  dcprivat  ion  Idiuler 
I'lliers  iVoin  understandiii<;.  Or  daily  prolilenis  stem- 
nii  lie-  from  economic  want,  had  Ilea  ll  h,  or  ]inor  marital 
relations  may  c.onlrihute  to  the  parents'  iiiahility  to 
let   wisely  for  their  child. 

Of  coui-se,  the  school  is  not  responsible  for  he]i)in<r 
parentis  solve  all  their  problems,  but  Tndes.s  the  school 
recognizes  that  many  influences  alfect  the  ability  of 
the  parents  to  come  to  fjrips  with  their  child's  dis- 
order, attempts  to  secure  their  cooperation  will  not 
succeed.  There  is  an  important  dillerence,  for  ex- 
ample, between  a  parent  who  fails  to  keep  an  appoint- 
ment because  he  has  no  transportation  or  c^an  get  no 
one  to  care  for  other  children  and  a  parent  wlio  fails 
because  he  fears  the  school  or  is  hostile  toward  his 
child.  There  is  also  an  important  difference  between 
a  father  who  in  momentary  anxiety  and  defensiveness 
denies  that  the  acting-out  behavior  of  his  son  repre- 
sents a  serious  problem  and  a  father  who  denies  the 
existence  of  the  problem  because  he  himself  is  psy- 
chotic and  sees  his  son's  actions  as  justifiable  retalia- 
tion for  an  imagined  insult  to  the  family,  "\^^^at  we 
as  professional  people  do  to  enlist  the  parents'  sup- 
port is  determined  by  the  degree  to  which  we  recog- 
nize that  their  actions  are  as  symptomatic  of  their 
needs  as  are  the  child's  of  his. 

Sometimes  parents  are  unable  to  comprehend  the 
explanation  we  offer  them  about  their  child's  illness 
or,  if  they  do,  they  cannot  act  positively  on  the  infoi-- 
mation  for  various  reasons.  The  emotionally 
depre.ssed  father  who  is  told  that  his  .son  needs  more 
attention  may  never  have  been  able  to  form  a  mean- 
ingful relationship  with  another  i)erson  and  cer- 
tainly^ does  not  know  liow  to  form  one  with  his  dis- 
turbed child.  The  disorganized,  perhaps  mentally 
retarded,  mother  .who  is  told  that  her  child  could 
benefit  from  sound  eating  and  sleeping  habits  may 
be  completely  unable  to  put  this  suggestion  into  prac- 
tice without  a  gi-eat  deal  of  .support. 

It  is  not  enough  for  the  helping  person  to  be 
aware  of  the  parents'  feelings,  however.  As  profes- 
lional  persons,  we  must  lie  cognizant  of  the  kinds  of 
feelings  parents  arou.se  in  us.  Our  reactions  to  par- 
nts  contribute  as  much  to  the  climate  of  interdiange 
as  the  parents'  reactions  to  us.  We  all  have  feelings 
,bout  parents  as  such,  for  we  liave  all  been  children. 
We  may  transfer  either  positive  or  negative  feelings, 


depending  on  our  own  experienee.  To  work  success- 
fully with  parents,  we  have  to  control  our  own  un- 
sound reactions.  We  may,  for  example,  react  to  the 
pai-ents  of  disturbed  children  with  hostility  because 
w(^  think  they  are  responsilde  for  their  children's 
troubles.  We  may  have  a  feeling  that  if  we  could  only 
rid  tlie  child  of  his  noxious  parents  and  ha\e  him  to 
our.selves  we  could  effect  a  "cure." 

TTnfortiinately,  such  feelings  are  often  communi- 
cated to  parents,  and  their  recognition  of  these  feel- 
ings may  account  for  some  of  their  resistance  and 
liostility.  When  we  realize  that  mental  illness  in 
childhood  is  the  result  of  a  complex  interplay  of 
biological  and  enviromnental  forces,  we  will  no 
longer  assume  that  all  parents  of  disturbed  children 
are  alike.  Whatever  contribution  the  parents  make 
to  the  child's  problem  are  most  likely  unconscious 
reflections  of  their  own  psychic  difficulties.  Our  anger 
at  the  parent  only  increases  his  anxiety  and  impedes 
even  more  his  ability  to  improve  the  quality  of  the 
care  he  gives  his  child.  To  control  our  own  reactions 
to  these  parents  is  no  easy  task,  for  their  behavior 
is  often  provocative  and  productive  of  irritation. 

Parental  an.xiety 

It  has  been  my  experience  that  where  the  parents' 
anxiety  is  primarily  a  reaction  to  tlie  child's  disorder 
and  not  symptomatic  of  pathology,  an  understand- 
ing attitude  on  the  part  of  the  professional  person 
promotes  the  development  of  a  positive  relation  be- 
tween famity  and  school.  In  time,  this  relation  be- 
comes the  cornerstone  for  the  work  between  the 
family  and  the  school  and  enables  tlie  parents  to  tiaist 
the  school's  judgment  and  to  acce])t  the  educational 
plan  the  school  recommends  as  a  logical  outcome  of  a 
joint  endeavor.  This  is  never  an  easy  jirocess,  how- 
ever. When  the  child  enters  school,  parents  must  face 
the  child's  problems  squarely.  The  school  must  be 
prepared  to  work  with  families  in  a  crisis  and  to  give 
even  healthy  parents  the  support  they  need  to  i-esolve 
their  problems  and  enough  time  in  which  to  do  it. 
Accepting  the  fact  that  one's  child  does  not  fit  into 
the  i)ublic  school,  one  of  the  most  basic  institutions  in 
society,  cannot  be  worked  througli  in  one  session.  We 
must  be  prepared  to  help  parents  through  a  i)ainful 
time  when  their  thinking  may  be  muddled  by  pn'm. 
We  must  remmd  ourselves  that  some  conditions  in 
life  are  never  really  accepted  but  are  only  tolerated 
by  those  who  must  face  them,  and  that  for  most  fam- 
ilies of  clironically  handicapped  children  sorrow 
persists  throughout  life. 


TOLUME   14  -  NUMBER  6 


239 


For  mature  families  the  process  of  working  with 
persons  from  the  school  to  secure  the  right  educa- 
tional plan  is  in  itself  helpful,  for  it  tends  to  lessen 
anxiety.  The  knowledge  we  share  with  the  family 
about  the  nature  of  the  child's  disorder,  the  educa- 
tional plan  recommended,  and  the  child's  develop- 
ment help  them  learn  to  control  their  anxiety  through 
intellectualization.  It  also  gives  them  enough  time  and 
experience  to  correct  distortions  about  the  child 
through  consistent  ojDportunities  to  test  reality.  Reg- 
ular, planned  meetings  with  parents  are  basic  to  a 
good  special  education  program,  and  they  can  be 
as  important  to  mature  parents  as  to  immature. 

Parents  who,  despite  the  sensitive  professional  ef- 
fort extended  to  them  by  the  school,  continue  to  deny 
the  problem  and  project  their  difficulties  onto  the 
school  cause  great  concern  in  professional  workers. 
If  the  diagnosis  of  the  child's  condition  is  accurate, 
the  parents'  reactions  to  it  often  indicate  the  degree 
of  disturbance  in  the  family.  The  parents  may  them- 
selves require  special  help.  However,  whatever  blocks 
their  ability  to  accept  assistance  for  their  child  is 
also  likely  to  block  their  willingness  to  seek  help  for 
themselves.  Nevertheless,  schools  must  work  with 
these  parents  to  the  best  of  their  ability  if  the  right 
educational  plan  is  to  be  made  for  the  child. 

Two  cases  of  work  with  parents  of  children  sent 
to  LEW  back  up  my  points.  In  these  cases,  each 
couple's  problems  were  reflected  in  the  difficulty  they 
had  in  accurately  sizing  up  and  solving  their  sons' 
problems.  Both  members  of  the  first  couple,  Mr.  and 
Mrs.  G.,  have  emotional  problems  of  long  standing 
that  have  resulted  in  marital  discord.  They  are  intel- 
ligent and  are  sophisticated  about  psychological 
problems.  The  other  couple,  Mr.  and  Mrs.  L.,  are 
both  paranoid  and  extremely  witlidrawn,  hostile,  and 
suspicious.  They  are  not  intelligent  and  are  econom- 
ically and  culturally  deprived.  Despite  difficulties, 
however,  their  family  is  intact  and  self-supporting. 
Both  families  are  concerned  about  their  children  and 
their  education. 

Fred's  parents 

Mr.  and  Mrs.  G.  at  first  greatly  resisted  the  idea 
of  placing  their  10-year-old  schizophrenic  son  Fred 
in  a  special  program  for  mentally  disturbed  children 
and  had  difficulty  tolerating  the  placement  for  a  long 
time.  Psychiatric  and  sdiool  reports  indicated  that 
the  school  had  tried  to  help  Fred  and  had  kept  him 
in  regular  class  as  long  as  possible.  Wlien  the  parents 
came  to  LEW,  they  were  agitated  and  quarrelsome, 

240 


accused  each  other  of  being  at  fault,  and  showed  the 
resentment  they  felt  against  the  school  for  recom- 
mending special  placement.  Mrs.  G.  soon  took  over 
the  interview.  Although  Mr.  G.  seemed  more  realistic 
than  his  wife,  he  only  contributed  to  the  interview 
when  questioned  directly.  But  as  Mrs.  G.  always  con- 
tradicted whatever  he  said,  he  gradually  grew  silent. 

Mrs.  G.,  wliile  admitting  there  was  something 
wrong  with  Fred,  said  he  was  not  so  ill  as  the  chil- 
dren in  our  classes.  As  the  interview  progressed,  it 
became  apparent  that  Mrs.  G.  hoped  the  caseworker 
would,  on  the  basis  of  the  referral  material,  confirm 
her  belief  that  the  school  had  failed  the  boy  and  that 
all  he  needed  was  a  regular  class  of  higher  quality. 

Tlie  caseworker  acknowledged  that  it  was  difficult 
to  accept  a  special  class  like  ours  but  said  she  felt  that, 
despite  their  doubts,  Mr.  and  Mrs.  G.  knew  that  Fred 
needed  something  more  than  a  regular  class  or  they 
would  not  have  kept  the  appointment.  Because  the 
caseworker  felt  that  they  were  afraid  of  our  program, 
she  tried  to  help  them  leaiTi  something  about  the 
program  while  she  tried  to  learn  something  about 
them. 

The  caseworker  said  she  knew  from  the  referral 
material  that  they  had  already  spent  time  and  money 
on  psychiatric  help  for  Fred  and  counseling  for  them- 
selves. She  told  them  she  inferred  from  this  that  they 
felt  great  concern  for  Fred  and  that  he  had  a  serious 
problem.  "Was  his  difficulty  only  something  that 
manifested  itself  in  relation  to  a  poor  school  situa- 
tion?" she  asked. 

After  this  question,  Mrs.  G.  relaxed  a  little  and 
both  parents  described  in  detail  Fred's  sickness  and 
the  great  problems  he  imposed  on  family  life. 

The  caseworker  pointed  out  that  their  observations 
confirmed  the  reports.  Slie  tlien  said  that  she  won- 
dered if  it  were  possible  for  a  child  like  Fred  to  learn 
in  a  group  of  28  children  in  a  regular  school.  Both 
parents  agreed  that  he  had  not,  although  the  teacher 
had  tried  to  help  him.  The  caseworker  said  that 
Fred's  school  seemed  to  have  tried  its  utmost  and  that 
it  was  unlikely  that  Fred's  needs  could  be  met  in  an 
ordinary  school. 

The  caseworker  then  pointed  out  that,  from  the  de- 
scrijjtion  they  had  given,  Fred's  case  sounded  like 
those  of  some  of  the  children  at  LEW,  and  she  de- 
scribed some  of  them.  "How  did  you  feel  he  might 
differ  from  the  pupils  desci'ibed?"  she  asked.  Mrs.  G. 
said  she  was  afraid  that  neither  the  other  children 
nor  our  academic  jirogram  would  stimulate  Fred. 
"What,"  the  caseworker  asked,  "has  happened  in  the 
past  4  years  while  he  was  with  children  who  per- 


CHILDREN 


NOVEMBER-DECEMBER  1967 


§1 


fOl 


JniiniMl  :i(li'(iuati'l_v  r'  llo  liinl  I'itiii'r  witlulra wii  coiu- 
jilclclv  or  acted  out  in  an  extremel}'  disruptive  way, 
ilio  parents  admitted.  Mrs.  G.  felt  Fred  was  l)riij;lit 
and  that  with  j)roper  liandlinc;  he  could  be  brought 
up  to  yiadc  level  in  a  short  time.  The  caseworker  de- 
scribed LKWs  academic  program  and  said  with  em- 
l>liasis  that,  while  the  school  oll'ered  stimulation,  it 
\\  as  impossible  to  predict  how  a  child  would  progress 
and  that  disappointment  was  often  inevitable.  This 
statement  seemed  to  free  Mr.  and  Mrs.  G.  to  discuss 
their  ilisappointment.  Mrs.  G.  cried;  Mr.  G.  looked 
into  space. 

I?y  the  end  of  the  interview,  their  fear  was  some- 
\\  hat  allayed  but  they  still  liad  doubts.  The  case- 
worker told  them  that  she  felt  they  should  come  in 
aiiain  to  observe  the  classes  and  to  discuss  the  mattei' 
mice  more  before  bringing  Fred  in  for  an  interview 
w  ith  the  psychiatrist.  She  pointed  out,  however,  that 
i>n  the  biisis  of  their  description  and  the  referral  ma- 
terial she  was  sure  Fred  needed  special  schooling. 
AVhether  our  program  was  suitable  remained  to  be 
seen.  She  also  told  them  that  she  realized  they  were 
full  of  doubts  and  weie  disappointed,  but  she  stressed 
hdw  important  it  was  to  go  slowly  because  much  of 
I  lie  success  of  any  program  would  be  their  feeling 
t  hat  it  was  right  to  try  it.  They  did  return  for  another 
interview,  and  after  we  worked  slowly  with  them, 
they  decided  to  place  Fred  with  us. 

When  Mrs.  G.  brought  Fred  to  school  for  the  first 
day,  she  was  upset.  She  wept  during  the  interview 
and  said  that  the  other  children  "looked  sick  but  not 
her  son."  The  caseworker  told  her  she  understood  the 
anxiety  she  was  going  through  and  that  other  parents 
were  also  anxious.  The  caseworker  held  to  the 
liclief,  however,  that  Fred  did  belong  in  the  program. 
The  caseworker  made  plain  to  her  that  the  school  be- 
lifved  that  Fred  could  be  helped.  She  said  that  in 
lime,  after  Fred  had  begun  to  adjust  to  the  school 
I  ud  ]\Irs.  G.  could  see  improvement,  she  would  find  it 
easier  to  accept  the  placement.  The  caseworker  re- 
minded her  that  she  had  had  similar  feelings  when 
Fred  had  had  other  services  and  that  she  had  come 
through  the  experience  all  right.  The  caseworker 
made  another  appointment  for  her  for  a  week  later 
and  told  her  to  telephone  if  she  had  questions  before 
ilien.  At  the  next  appointment,  Mrs.  G.  said  she  had 
i^otten  through  the  week  and  that  while  she  still  did 
not  like  our  program,  her  concern  had  lessened  and 
the  children  looked  better.  The  caseworker  continued 
In  see  her  once  every  3  weeks  for  several  months,  and 
-lie  gradually  became  more  accepting.  Mrs.  G.  still 
dues  not  like  Fred's  being  at  LEW,  but  she  has  been 

VOLUME   14  -  NUMBER  6 


I 


able  to  support  the  piai-einent  for  o  years  in  a  con- 
.structive,  meaningful  way.  From  time  to  time  the 
caseworker  must  reinterpret  Fred's  needs  to  her,  give 
her  an  opportunity  to  air  her  disappointment  that 
he  is  still  ill,  and  answer  her  questions. 

The  personal  and  marital  problems  in  this  family 
have  not  changed  because  of  our  eil'oi'ts,  but  our  ef- 
forts were  influenced  by  the  knowledge  of  these  prob- 
lems. If  we  had  not  understood  what  was  behind  the 
parents'  behavior,  we  could  have  easily  become  an- 
noyed with  them,  particularly  with  the  mother,  be- 
cause Mrs.  G.  displayed  her  anxiety  through  excessive 
talkativeness,  hostility,  and  projection.  Our  basic  at- 
tempt to  help  was  focused  on  using  tiie  family's  posi- 
tive characteristics — their  concern  for  the  child  and 
their  intellectual  awareness.  We  gave  them  an  op- 
portunity to  express  their  disappointment  and  pain 
and  to  raise  their  doubts  and  fears  about  what  a  spe- 
cial class  might  do  to  their  son.  We  always  focused 
our  eti'orts  on  reality :  their  son  could  not  be  provided 
for  in  a  regular  class  despite  all  reasonable  attempts 
to  help  him  adjust.  We  did  not  attempt  to  get  them 
to  like  the  placement,  only  to  face  it  with  tolerance. 
And  we  gave  them  the  continuing  support  they  re- 
quired. Ultimately,  the  boy's  gains  enabled  them  to 
accept  the  placement  with  less  pain. 

Darren's  parents 

Mr.  and  Mrs.  L.  were  referred  to  a  special  pro- 
gram for  their  10-year-old  son  Darren  because  of 
his  destructive  behavior  and  failure  to  learn 
throughout  4  years  in  school.  One  year  before  refer- 
ral, he  had  drawn  a  knife  on  another  student  and 
as  a  consequence  had  been  excluded  from  school.  The 
parents  regarded  this  exclusion  as  a  plot  by  the  school 
to  get  rid  of  Darren,  who  to  them  was  a  quiet,  respect- 
ful son.  To  a  quiet,  withdrawn  family,  his  silence 
seemed  a  virtue.  The  parents  considered  Darren's 
flareup  in  school  as  a  justifiable  response  to  provoca- 
tion. They  resisted  special  placement,  disagreed  an- 
grily with  psychiatric  reports,  and  threatened  to 
secure  legal  counsel.  When  referred  to  a  special  pro- 
gram for  emotionally  disturbed  persons,  they  refused 
to  apply.  Darren  was  out  of  school  a  year.  Diligent 
efforts  by  the  school  psychologist  and  the  social 
worker  for  the  special  program,  coupled  with  the 
family's  concern  for  Darren,  finally  brought  the  par- 
ents to  LEW  for  an  interview. 

All  of  the  problems  already  described  were  evident 
in  the  interview.  Both  parents  appeared  withdrawn, 
hostile,  and  suspicious.  The  caseworker  made  clear 

241 


For  the  past  10  years,  Joyce  Edward  has 
been  a  psychiatric  social  worker  in  the  ele- 
mentary school  division  of  the  Luther  E. 
Woodward  School  for  Emotionally  Dis- 
turbed Children,  Inc.,  Freeport,  N.Y.,  where 
she  works  chiefly  with  the  families  of  severe- 
ly disturbed  children.  She  received  her  mas- 
ter's degree  in  social  work  from  Western 
Reserve  University,  School  of  Applied  Social  Sciences. 


to  tliem  that  she  shared  their  concern  about  Darren's 
beinfj  out  of  school.  "What  has  happened  since  we 
spoke  to  you  on  the  telephone  last  year?"  the  case- 
worker asked.  Mrs.  L.  answered  by  recounting  all  of 
Darren's  virtues  and  placing  special  emphasis  on  how 
helpful  he  was  with  the  family  ironing.  The  only 
problem  he  faced,  she  said,  was  not  being  able  to  go 
to  school.  The  caseworker  agreed  that  this  was  a  seri- 
ous problem.  She  said  their  keeping  this  appointment 
was  a  positive  step  on  Darren's  behalf,  whether  or  not 
they  found  LEW's  program  suitable.  Mr.  and  Mrs. 
L.  quickly  launched  into  an  angry  discourse  on  Dar- 
ren's former  scliool.  The  caseworker,  after  listening 
for  a  few  minutes,  said  that  she  understood  their  an- 
ger but,  as  they  had  gone  over  this  many  times  before 
without  Darren's  getting  into  school,  it  would  per- 
haps be  more  helpful  to  consider  the  kind  of  schooling 
Darren  required  now. 

"You  have  spent  a  lot  of  time  with  him  in  the 
last  year;  what  do  you  tliink  of  his  ability  to  leani? 
How  did  he  do  at  school  until  excluded?"  the  case- 
worker asked. 

Mrs.  L.  said  that  she  was  surprised  that  he  had  not 
learned  to  read.  Even  when  she  taught  him,  he  did 
not  grasp  things,  she  admitted.  "WHien  the  caseworker 
asked  her  if  she  felt  he  might  need  .special  handling, 
Mrs.  L.  said,  "Yes."  The  caseworker  then  asked  if  she 
ever  felt  that  a  large  class  might  confuse  him.  "I 
guess  it  could,"  Mrs.  L.  admitted.  At  this  point  her 
hostility  seamed  to  lessen,  and  she  began  to  ask  ques- 
tions about  the  special  school.  The  caseworker  an- 
swered her  questions  by  citing  facts  about  LEW  and 
indicated  that  the  program  was  for  children  with 
problems,  some  similar  to  Darren's. 

Later,  when  they  visited  classes,  Mr.  and  Mi-s.  L. 
said  that  some  children  looked  different  or  "spoke 
funny."  The  caseworker  agre«d  that  the  children 
were  troubled,  but  she  pointed  out  that  she  thought 
Darren  had  some  problems,  too.  They  replied  that 
they  did  not  think  he  was  like  the  other  children, 

242 


but  Mrs.  L.  felt  he  should  go  to  school  and  perhaps 
it  would  be  best  to  place  him  in  LEW. 

The  caseworker,  moving  slowly,  in  some  ways 
mirrored  their  resistance.  She  said  she  could  not  say 
imjuediately  whether  this  was  a  good  plan  for  Dar- 
ren; the  scliool  psychiatrist  and  psychologist  would 
have  to  see  him  and  give  a  lot  of  thought  to  the  mat- 
ter. Perhaps  home  teaching  was  best.  At  this  the  par- 
ents inunediately  suggested  that  the  intake  study  be 
conducted. 

Darren  was  accepted,  and  his  parents  were  willing 
for  him  to  go  to  LEW  by  the  time  he  was  placed. 
In  the  hrst  interview  after  placement,  j\Irs.  L.  came 
alone;  she  said  that  her  husband  would  not  be  able 
to  come.  As  she  saw  it.  the  family's  problems  with 
the  school  were  really  her  responsibility.  We  did 
not  insist  upon  the  father's  coming,  although  we 
usually  try  to  work  with  both  parents. 

Mi-s.  L.  immediately  complained  that  Darren's 
sweater  had  been  torn  in  class,  and  she  asked  whether 
the  teacher  was  supervising  the  class  properly.  The 
caseworker  told  Mrs.  L.  she  Imew  how  hard  it  must 
be  for  her  to  have  Darren's  clothing  torn,  with  prices 
as  high  as  they  are  and  a  large  family  to  clothe.  Mrs. 
L.  then  related  in  detail  the  concern  her  many  bills 
gave  her.  The  caseworker  let  Mrs.  L.  know  that  shei 
felt  her  concern  was  realistic  and  her  management  on 
a  small  income,  competent.  After  this,  Mrs.  L.  seemed' 
less  hostile.  Darren  had  made  a  good  start,  and  thei 
caseworker  gave  her  examples  of  what  he  was  doing. 
She  admitted  that  he  appeared  plestsed  about  school, 
which  was  miusual  for  him.  Mi-s.  L.  said  she  guessedl 
that  with  boys  one  had  to  expect  a  tear  or  two.  Thei 
case.worker  agreed,  but  told  her  she  woiUcl  bringi 
the  matter  of  the  tear  to  the  attention  of  the  teacher. 
The  caseworker  then  asked  her  if  she  would  like  to 
meet  the  teacher  and  see  Darren's  class.  She  said,. 
"Yes."  The  visit  delighted  her,  especially  Darren's 
pleasure  in  introducing  her  to  his  class. 

Mrs.  L.  now  has  appointments  monthly  with  us, 
which  she  always  keeps.  During  these  interviews  the 
caseworker  shares  with  her  information  about  Dar- 
ren's progress  in  school,  which  has  been  slow  but 
consistent.  Darren  no  longer  acts  out  as  he  used  to, 
a  change  that  has  confirmed  his  need  for  the  program 
to  the  parents.  Mrs.  L.  has  been  gratified  by  the  aca- 
demic gains,  too.  The  causes  of  some  of  Darren's 
problems  come  to  light  now  and  then  in  what  she 
says.  We  asked  her  once  about  Darren's  laughing  at 
times  when  nothing  seems  to  be  happening.  Mrs.  L. 
said  she  had  noticed  this  and  thought  she  laughed 
the  same  wav.  Often  she  has  funnv 


thoughts  that 


CHILDREN     •     NOVEMBER-DECEMBER  1967 


fi 


cause  her  to  laugh  iiiul  she  tliought  everyone  el^-e  did 
too.  We  did  not  pursue  this  matter,  nor  ditl  we  deal 
witli  other  ()b\i()us  iiidiialions  of  family  pathology. 
Mrs.  L.  develofjetl  a  friendly  feeling  for  tlic  sciux)!. 
She  told  us  how  mueli  it  meant  to  her  that  lliere  were 
no  complaints  about  Darren.  Although  she  continued 
to  feel  he  was  not  like  tlie  otlier  children,  slie  thought 
that  he  was  learning  and  that  since  we  were  not  mak- 
hig  liim  angry  he  should  remain  another  year. 

AVe  never  attemjited  to  help  Mrs.  L.  to  understand 
Darren's  real  i)robleni.  All  jjrevious  etl'orts  in  liiis 
direction  had  only  stimulated  her  anxiety  and  lend 
ency  to  act  out.  We  worked  with  her  as  slie  was  and 
tried  to  make  the  most  of  her  concern  for  Dar- 
ren's education.  As  lie  improved  her  anxiety  lessened. 

A  focus  on  responsibility 

There  still  are  and  will  continue  to  be  many  ]irob- 
lems  in  these  families.  Xo  basic  alteration  in  the  per- 
sonalities of  the  parents  have  been  made,  nor  have 
we  touched  the.  core  of  tlieir  relation  with  tlieir  chil- 
dren. We  have,  instead,  ti"ied  to  enable  them  to  allow 


tlieir  cliihbi'u  lo  take  advantage  of  au  opportunity 
for  special  education  without  interference.  We  have 
focused  our  ell'orts  on  stimidating  feelings  of  respon- 
sibility rather  than  stirring  feelings  of  guilt.  A\'e 
believe  that  through  this  process  some  of  the  parents' 
anxiety  was  diminished  and  that  a  more  pleasant 
atmosphere  was  created  at  home,  thus  lessening  the 
strain  that  builds  up  when  tension  between  home 
and  school  is  strong. 

When  we  assume  i-esponsibility  for  the  education 
of  the  emotionally  disturbed  child,  we  assiune  an  im- 
I  losing  task.  It  is  not  placing  a  child  in  a  "special" 
class  that  makes  his  education  "special,"  however; 
rather  it  is  the  recognition  of  his  many  complex  needs 
and  an  interweaving  of  the  insight  and  skill  of  vari- 
ous professions  to  meet  these  needs.  To  do  this,  we 
must  have  concern  for  many  aspects  of  the  child's 
life,  including  the  role  his  family  plays  in  relation  to 
his  schooling.  The  most  capable  teacher,  the  finest 
curriculum,  the  most  expert  clinical  service  will  be  of 
little  avail  if  the  child's  family  refuses  to  accept  a 
program  for  him  or,  in  placing  him,  sabotages  the 
school's  eii'orts. 


guides  and  reports 


FAMILY  LIFE  EDUCATIO  X— A 
CAUSE  FOR  ACTION.  American 
Social  Health  Association,  1740 
Broadway,  New  York,  N.Y.  10019. 
November  1966.     64  pp.     $2. 

Reports  on  a  demonstration  project 
conducted  over  9  years  by  the  American 
Social  Health  Association  in  23  States 
and  the  District  of  Columbia  through 
which  family  life  education  programs 
were  incorj)orated  in  the  curriculums 
of  public  schools  and  teacher  traininj; 
institutions. 

BIRTH  CONTROL  POLICIES  AXD 
PRACTICES  IX  FIFTY-EIGHT 
CALIFORNIA  COUNTY  WELFARE 
DEPARTMENTS.  Carl  Reiterman. 
Planned  Parenthood  of  Alameda 
County,  4S2  West  MacArthur  Boule- 
vard, Oakland.  Calif.  94609.  19C<J. 
102  pp.     $4. 

Reports  on  a  survey  of  the  policies 


of  California's  county  welfare  depart- 
ments concerning  the  provision  of  con- 
traceptive services  or  advice. 

CHILD  LIFE  PROGRAMS  IN  91 
PEDIATRIC  HOSPITALS  IN  THE 
UNITED  STATES  AND  CANADA. 
Robert  H.  Dombro.  Child  Life  Pro- 
gram, Children's  Medical  and  Surgi- 
cal Center,  Johns  Hopkins  Hospital. 
Baltimore,  Md.  21205.  1966.  18  pp. 
.")()  cents.     (Mimeographed.) 

Reports  the  lindiugs  of  a  survey  of  the 
characteristics  of  recreational  and  edu- 
cational programs  for  children  in  91 
children's  hospitals. 

LISTEN  EVERYBODY!  YOUTH 
PARTICIPATION  IN  COMMUNITY 
ACTION :  report  of  a  demonstration 
training  project.  California  Depart- 
ment of  the  Youth  Authority,  401 
State   Building    No.    1,    Sacramento, 


Calif.  9d814.  1907.  66  pp.  Copies  free 
on   request  from   the  Department. 

Reports  on  a  1-year  demonstration 
project  in  which  182  young  people  from 
impoverished  areas  in  California  were 
trained  to  work  in  community  improve- 
ment programs.  Sponsored  by  the  Gov- 
ernor's Advisory  Committee  on  Chil- 
dren and  Youth  and  financed  by  the 
Office  of  Economic  Opportunity,  the 
project  was  administered  by  the  Cali- 
fornia Department  of  the  Youth  Au- 
thority. 

UNDERSTANDING  THE  DISADVAN- 
TAGED :  a  source  book.  School  of 
Home  Economics  and  Extension  Di- 
vision, University  of  Missouri.  Avail- 
able from  the  Technical  Education 
Services,  University  of  Missouri,  417 
South  1.5th  Street,  Columbia,  Mo. 
6.-)201.     1966.     187  pp.     $1. 

The  proceedings  of  a  short,  inter- 
agency. inter(lis(ii)linary  course  in 
studying  the  disadvantaged  held  at  the 
university  of  Missouri,  July  13-15, 1965. 


VOLUME  14  -  NUMBER  6 


243 


BOOK  NOTES 


TOUGH  TIMES  AND  TENDER  MO- 
MENTS IN  CHILD  CARE  WORK. 
Eva  Biirmeister.  Columbia  University 
Press,  New  York.  1967.  274  pp.  $6. 

Through  child-care  worliers'  own  de- 
scriptions of  incidents  that  have  oc- 
curred in  their  worlc  with  institution- 
alized children  as  well  as  through  the 
author's  comments,  this  book  not  only 
presents  some  of  the  problems  and  prin- 
ciples of  caring  for  groups  of  children 
living  away  from  home  but  also  gives  a 
picture  of  the  emotional  needs  and  con- 
fusion common  among  such  children. 
The  incidents,  originally  described  by 
the  child-care  workers  as  assignments 
in  Inservice  training  classes,  are  pre- 
sented by  the  a\ithor  as  illustrations  of 
points  she  makes  in  regard  to  specific 
aspects  of  a  child-care  worker's  re- 
sponsibility, such  as  the  relation.ship 
with  the  child  ;  finding  the  feelings  be- 
hind a  child's  verbal  communication ; 
recognizing  and  dealing  with  the  mood 
of  the  group ;  understanding  a  rejected 
child's  mixed  feelings  about  his  par- 
ents ;  encouraging  creativity  in  the  chil- 
dren ;  and  handling  difficult  behavior. 

In  the  final  chapter,  the  author  points 
to  the  importance  of  providing  training 
opportunities  for  houseparents,  who  in 
many  Instances  themselves  feel  an 
urgent  need  for  more  competence  in 
helping  the  unhappy  children  have  hap- 
pier lives.  She  points  out  that,  increas- 
ingly, the  children  placed  in  institu- 
tions arrive  with  serious  emotional 
problems  derived  from  their  previous 
experience  in  family  and  community. 

JUVENILE  GANGS  IN  CONTEXT: 
theory,  reiseareh,  and  action.  Edited 
by  Malcolm  W.  Klein  in  collaboration 
with  Barbara  G.  Myerhoff.  Prentice- 
Hall,  Inc.,  Englewood  Cliffs,  N.J. 
1967.  210  pp.  $3.50. 

The  15  papers  in  this  symposium  dis- 
cuss the  nature  and  causes  of  gang  ju- 
venile delinquency  and  the  effectiveness 
of  methods  of  working  with  street  gangs 
through   "detached"  workers   to   bring 

244 


about  constructive  change.  They  are 
presented  under  four  heads :  patterns 
of  gang  behavior,  relation  between  per- 
ceptions and  behavior,  sociological  con- 
texts, and  action  programs.  The  authors 
include  administrators,  practitioners, 
and  research  workers  in  programs  of 
delinquency  prevention.  The  last  section 
describes  programs  in  New  York  City, 
Chicago,  and  Washington,  D.C. 

ADOLESCENCE  :  care  and  counseling. 
Edited  by  Gene  L.  Usdin,  JI.D. 
J.  B.  Lippincott  Co.,  Philadelphia, 
Pa.  1967.  23S  pp.  .$7. 

Stressing  the  need  for  understanding 
(and  the  "desire"  to  understand)  the 
adolescent  in  his  struggle  to  find  his 
identity  in  today's  world,  this  group 
of  papers  by  psychiatrists  and  other 
physicians  is  directed  to  professional 
persons,  especially  physicians,  to  whom 
adolescents  are  most  likely  to  turn  for 
help  with  problems.  The  papers  dis- 
cuss the  normal,  physical,  and  p-sycho- 
logical  changes  of  adolescence  and 
adolescents'  relation.ships  with  adults, 
as  well  as  the  effects  of  social  change 
on  adolescents  and  on  the  nature  of 
the  adolescent  subculture. 

Some  of  the  specific  problems  dis- 
cussed are  religious-psychological  con- 
flicts, sexual  moralit.v,  disguised  depres- 
sions, learning  problems,  antisocial 
tendencies,  the  effects  of  drugs  used 
in  treating  emotional  disturbance,  and 
parents  of  adolescents  with  problems. 

In  his  introduction,  the  editor  finds 
"healthy  signs"  in  the  increased  open- 
ness of  adolescents  about  their  be- 
havior and  values,  which  he  sees  as 
representing  "an  honest  groping  toward 
a  new  and  more  complete  maturity." 
Calling  for  more  responsible  leadership 
from  adults  in  helping  adolescents  to 
reach  this  goal,  he  points  to  the  often 
overlooked  opportunity  presented  to 
physicians  to  provide  them  with  effec- 
tive counseling.  Adults,  he  points  out, 
should  not  lose  sight  of  the  "ageless 
truth"  that  adolescents  "are  the  product 


of  the  times  and  not  the  source  of  our 
difficulties." 

These  papers  were  pre-sented  at  a 
symposium  on  adolescence  held  in  De- 
cember 1966  by  the  Touro  Community 
Mental  Health  Center  of  New  Orleans 
with  a  grant  from  the  National  In- 
stitute of  Mental  Health. 

PARENTS,  CHILDREN,  AND  ADOP- 
TION :  a  handbook  for  adoption 
workers.  Jane  Rowe.  Humanities 
Press,  New  York.  1966.  294  pp.  $6. 

The  unmarried  mother  and  her  child 
are  the  central  figures  in  this  book, 
which  brings  together  information  from 
the  fields  of  medicine,  genetics,  psy- 
chology, law,  and  social  work  in  dis- 
cussing the  theory  and  practice  of  social 
casework  in  services  to  unmarried  moth- 
ers and  in  child  placement  for  adoption. 
In  discussing  work  with  the  natural 
parents  of  a  child  born  out  of  wedlock, 
the  author  stresses  the  importance  of 
working  with  the  father  as  well  as  with 
the  mother.  The  aspects  of  adoption  she 
discusses  are:  heredity  and  environ- 
ment as  they  affect  the  child  ;  homefind- 
ing,  planning  for  placement,  and  place- 
ment ;  the  legal  procedures ;  and  super- 
vision of  the  adoptive  home. 

The  author  has  worked  in  the  child 
welfare  field  both  in  her  native  Eng- 
land and  in    the  United  States. 

CASEWORK  WITH  FAMILIES  AND 
CHILDREN.  Edited  by  Eileen 
Young-husband.  University  of  Chi- 
cago Press,  Chicago,  111.  1966.  175 
pp.     $1.75  (paperback). 

A  collection  of  14  articles  reprinted 
from  British  and  U.S.  social  work  I 
journals  and  other  publications,  this 
book  discusses  the  family  from  three' 
viewpoints,  indicated  by  the  titles  of 
its  three  sections:  (1)  concepts  of  the 
family;  (2)  toward  a  deeper  under- 
standing; and  (3)  treatment.  Among 
the  topics  of  papers  in  the  first  section 
are  "Concepts  Relevant  to  Helping  the 
Family  As  a  Group"  and  "Social  De- 
terminants of  Family  Behaviour" ;  in 
the  second,  "The  Normal  Family — 
Myth  and  Reality,"  "Chronic  Sorrow: 
A  Response  to  Having  a  Mentally  De- 
fective Child,"  and  "Children  at  Risk" ; 
and  the  third,  "Treatment  in  the 
Home,"  "Helping  a  Child  Adapt  to 
Stress :  The  Use  of  Ego  Psychology  in 
Casework,"  and  "Applying  Family  Diag- 
nosis in  Practice." 


CHILDREN     •     NOVEMBER-DECEMBER  1967 


till 


HERE  and  THERE 


Against  poverty 


Thirty-six  communities  have  applied 
to  the  Office  of  Econoiuie  Opportunity 
for  plauning  grants  of  $10,000  each  to 
develop  programs  of  comprehensive 
services  for  families  with  young  chil- 
dren under  the  pilot  jirogram,  "parent 
and  child  centers,"  announced  by  the 
President  last  February  in  his  message 
to  Congress  on  the  welfare  of  children 
(see  CHILDREN,  Marc-h-April  1967,  p. 
85).  Their  plans  will  focus  on  helping 
families  living  in  areas  of  poverty  who 
have  childreTi  under  3  years  of  age  meet 
whatever  needs  may  be  interfering  with 
the  children's  healthy  development. 

To  be  approved  for  operational 
grants,  the  plans  must  be  submitted 
within  6  months  after  the  planning 
grant  has  l>een  received  and  must  in- 
clude built-in  methods  for  evaluating, 
which  are  tied  into  a  univer.sity  in  some 
way.  A  portion  of  the  funds  for  Project 
Head  Start  has  been  earmarked  for  the 
new  program. 

The  36  communities  were  invited  to 
apply  on  the  recommendation  of  a  Fed- 
eral interdepartmental  steering  commit- 
tee representing  the  Office  of  Economic 
Opportunity,  the  Bureau  of  the  Budget, 
and  three  Federal  departments — Hous- 
ing and  Urban  Development,  Labor,  and 
Health,  Education,  and  Welfare.  Geo- 
graphically, they  are  located  in  various 
parts  in  the  United  States,  from  Hawaii 
to  Vermont,  and  include  22  cities  and  10 
rural  communities.  Among  the  latter  are 
an  Indian  reservation  in  South  Dakota. 
a  community  of  agricultural  migrants 
based  in  Pa-sco,  Wa.sh.,  and  an  Eskimo 
village  in  Alaska.  Fourteen  of  the  cities 
will  develop  multiple-service  neighbor- 
hood centers  under  another  program, 
and  the.se  will  be  coordinated  with  the 
parent  and  child  programs. 


The  OVA)  and  the  cooperating  Federal 
agencies  held  a  2-week  orientation 
seminar  in  Washington,  D.C.,  Septem- 
ber 11-22,  for  persons  who  would  be 
involved  in  the  local  planning  and  in 
program  evaluation.  Thirty-one  of  the 
thirty-six  communities  sent  such  rep- 
resentatives, and  a  few  also  sent  rep- 
resentatives of  the  potential  users  of 
the  services.  Also  attending  the  seminar 
were  part-time  "project  officers,"  ap- 
pointed by  OEO  to  give  consultation  to 
the  communities  on  both  planning  and 
program  operation,  and  membei'S  of  an 
HEW  consortium — composed  of  per- 
sons from  the  Children's  Bureau 
(representing  the  Social  and  Rehabilita- 
tion Service),  the  Office  of  Education, 
and  the  Public  Health  Service — which 
has  been  working  with  OEO  on  the  de- 
velopment of  program  standards.  A  spe- 
cial feature  of  the  seminar  was  site 
visits  by  .small  groups  to  Rochester  and 
Syracuse,  N.T.,  New  York  City,  and 
Greensboro,  N.C.,  to  see  various  types 
of  programs  for  parents  and  young  chil- 
dren, including  group  day-care  and  fam- 
ily day-care  programs. 

The  Ventura  County  (Calif.)  "Wel- 
fare Department  has  adopted  as  a 
l>ermanent  program  a  work  experience 
and  training  project  that  provides  work 
training  for  mothers  receiving  assist- 
ance under  the  Aid  to  Families  with 
Dependent  Children  (AFDC)  program 
and  low-cost  day-care  service  for  their 
children  while  they  are  in  training. 
Completely  supported  for  2  years  with 
Federal  funds  under  the  Economic 
Opportunity  Act  through  the  Welfare 
Administration,  U.S.  Department  of 
Health,  Education,  and  Welfare,  the 
program  now  receives  State  and  local 
support  matched  by  Federal  funds 
under  the  Social  Security  Act. 


Through  two  centers,  one  in  Oxnard 
and  the  other  in  the  city  of  Ventura,  the 
priiject  offers  mothers  in  the  AFDC 
Iirogram  opjiortunity  to  obtain  basic 
education ;  high  school  e<iuivalency 
courses ;  on-the-job  training  as  teacher 
assistants  and  general  education  aides ; 
instruction  in  child  care,  the  prepara- 
tion of  food,  home  maintenance,  and 
housekeeping;  broad  .social  services  to 
ln'I|p  tbeni  solve  family  pmhlems ;  and 
V()c.iti(in;il  and  educatioiuil  counseling 
and  guidance.  Each  center  j)roviiles  day- 
care service  for  the  trainees'  children, 
staffed  by  other  trainees  under  profes- 
sional supervision.  For  this  the  mothers 
are  charged  .$.5  a  month;  the  project 
absorbs  the  rest  of  the  cost.  This  low- 
cost  day  care  is  available  to  the  mothers 
even  after  they  become  self-supporting. 

During  the  first  2  years  of  the  pro- 
gram, when  it  was  a  Federal  project, 
over  132  mothers  took  part.  Of  the  47 
completing  the  course,  nearly  all  have 
found  employment  and  23  have  been 
able  to  withdraw  from  the  AFDC 
program. 


Against  smoking 


How  to  protect  the  public  from  the 
health  hazards  of  smoking  received  the 
concentrated  attention  of  nearly  500 
persons  from  30  countries  meeting  to- 
gether in  New  York  City  on  Septem- 
ber 11-13,  at  the  World  Conference 
on  Smoking  and  Health. 

The  c-onference  was  held  under  the 
auspices  of  the  Interagency  Council  on 
Smoking  and  Health,  an  a.ssociation  in 
this  country  of  national  voluntary  and 
governmental  agencies  concerned  with 
the  effects  of  cigarette  smoking  on 
health.  Its  participants  included  ad- 
ministrators and  health  educators  from 
governmental  and  voluntary  health 
agencies ;  biological  and  behavioral 
scientists  and  science  writers;  educa- 
tors ;  leaders  in  agencies  serving  youth  ; 
and  repre.sentatives  of  the  tobacco  in- 
dustry, the  press,  and  the  radio  and 
television  industries. 

Featured  speakers  outlined  congres- 
sional proposals  for  regulating  cigarette 
advertising  and  the  tar  and  nicotine 
content  of  cigarettes;  presented  re- 
search findings  showing  a  higher  inci- 
dence of  morbidity  among  smokers  than 
nonsmokers ;  reported  on  efforts  to  pro- 
duce a  "safer"  cigarette;  and  discussed 
ways  of  heli)ing  iwople,  particularly 
young  people,  to  refrain  from  smoking. 


VOLUME  14  -  NUMBER  6 


245 


In  10  work  groups  the  partit-ipants 
focused  their  attention  on  various 
aspects  of  the  smoking  problem,  includ- 
ing research  on  how  the  habit  is  formed, 
the  resiwnsibility  of  the  media  of  mass 
communications,  and  antismoking  pro- 
grams in  school  and  other  ways  of  in- 
fluencing young  people. 

Thi-oughout  the  conference  there  was 
a  strong  emphasis  on  the  importance  of 
influencing  young  people  against  smok- 
ing before  they  start  to  smoke,  on  the 
necessity  of  getting  at  the  young  peo- 
ple through  "exemplars,"  the  adults 
and  peers  whom  they  admire. 

The  American  Heart  Association 
has  recently  issued  a  leaflet,  "What  To 
Tell  Your  Parents  About  Smoking," 
which  is  being  distributed  through  local 
heart  associations  to  children  and  young 
people  through  elementary  and  second- 
ary schools.  Girl  Scout  and  Boy  Scout 
groups,  4-H  Clubs,  church  groups,  and 
parent-teacher  associations.  With  the 
purpose  of  helping  "convince  both 
youngsters  and  their  parents  that  cig- 
arette smoking  is  a  health  menace."  the 
leaflet  cites  .scientific  studies  pointing 
to  the  relation  between  smoking  and 
heart  disease,  lung  cancer,  emphysema, 
and  chronic  bronchitis. 


Child  welfare 


The  majority  of  adolescents  who  run 
away  from  suburl)an  homes  are  re- 
sponding in  a  parti<ular  way  to  prob- 
lems common  among  adolescents — 
diflicult  relations  with  their  parents. 
their  schools,  and  their  peer.s — accord- 
ing to  the  findings  of  a  study  carried 
out  in  Prince  Georges  County,  Md.  (ad- 
jacent to  Washington,  D.C.),  by  the 
National  Institute  of  Mental  Health. 
For  only  a  small  portion  of  those 
.studied  was  the  running  away  con- 
nected with  individual  or  family 
pathology. 

The  investigators  gathered  data  on 
the  social  and  family  characteristics  of 
(i31  children  aged  10  through  17  who 
had  run  away  from  home  in  the  year 
ended  July  31,  1904,  and  similar  data 
on  a  control  group  of  1,350  students  at- 
tending 11  local  public  secondary 
schools. 

The  data  collected  were  obtained 
from  police  reports  on  missing  persons ; 
in  followup  interviews  with  parents  and 
the  runaways  themselves ;  from  school, 

246 


police,  and  court  records :  and  from 
que.stionnaires  filled  out  by  the  students 
in  the  control  group.  Three-fourths  of 
the  riuiaway  children  never  got  beyond 
the  Washington  metropolitan  area; 
almost  two-thirds  were  foimd  within 
48  hours ;  half  returned  home  on  their 
own. 

Only  .52  percent  of  the  runaways 
lived  with  both  natural  parents,  as  com- 
pared with  82  percent  of  the  student 
respondents.  However,  over  80  percent 
of  the  student  respondents  reported  hav- 
ing troulile  at  home.  About  75  percent 
of  the  runaways  had  conflict  within  the 
family,  mainly  over  issues  such  as  the 
child's  school  performance,  choice  of 
friends,  and  rejection  of  family  rules 
and  values,  according  to  their  parents' 
reports. 

Two-thirds  of  the  runaways  had 
school  problems,  according  to  their  par- 
ents :  an  equal  proportion  of  the  stu- 
dent respondents  said  they  had  school 
problems.  School  records,  however, 
showed  that  runaways  had  more  school 
problems  than  student  respondents. 
Among  the  runaways,  58  percent  were 
.school  dropouts  at  the  time  they  ran 
away. 

About  40  percent  of  the  runaways  be- 
longed to  clubs,  as  compared  with  SO 
percent  of  the  student  respondents. 
Only  50  percent  of  the  runaways  had 
paid  employment,  as  compared  with  85 
percent  of  the  controls.  One  out  of  three 
rimaways  had  had  one  or  more  contacts 
with  the  police  in  the  2  years  preceding 
the  missing  persons  report,  according  to 
juvenile  bureau  records.  Tli(>  same  pro- 
portion of  contacts  with  police  was  re- 
ported by  the  control  group ;  but  one 
out  of  every  six  runaways  had  had  a 
charge  placed  against  him,  as  compared 
with  only  one  out  of  25  in  the  control 
group. 

Of  the  runaways,  220  were  repeaters. 
Among  the  repeaters,  63  percent  came 
from  families  who  had  incomes  between 
.$6,000  and  ,$12,000,  as  compared  with  56 
percent  of  the  total  group  of  runaways. 
In  both  groups,  28  percent  came  from 
families  with  incomes  under  $6,000. 

Three-quarters  of  the  repeaters  were 
said  by  their  parents  to  be  having 
trouble  in  school,  as  opposed  to  one-half 
of  the  one-time  runaways.  School  rec- 
ords also  showed  that  repeaters  had 
more  school  problems  than  one-time 
runaways. 

The  study  is  reported  in  detail  in  a 


monograph  issued  by  the  Society  fur 
Research  in  Child  Development  entitled 
"Suburban  Runaways  of  the  1960's" 
(available  from  the  University  of  Chi- 
cago Press,  57.50  Ellis  Avenue,  Chicago, 
111.  00637,  price:  .$3). 


The  Presbyterian  Institute  for  Hu- 
man Development,  located  in  Louisville, 
Ky.,  recently  set  up  a  national  child- 
care  information  center  to  collect,  store, 
retrieve,  and  "package"  material  on 
residential  group  care  for  children  ;  and 
the  School  of  Social  Work  of  the  Uni- 
versity of  North  Carolina,  Chapel  Hill, 
has  developed  a  preliminary  system  of 
indexing  and  processing  for  the  center 
to  use  to  prepare  the  most  urgently 
needed  material.  The  first  material  to 
be  processed  will  be  on  group  care  for 
dependent  and  disturbed  children  and 
on  services  to  their  families  provided  by 
public  and  voluntary  child  welfare  in- 
stitutions and  agencies. 


The  Child  Welfare  League  of  Ameri 
ca  recently  issued  a  memorandum  to 
its  members  jiointing  out  that  the 
league  "views  the  development,  exten- 
sion, and  improvement  of  child  welfare 
services  for  the  mentall.v  retarded  child 
and  his  family"  as  an  appropriate  and 
timel.v  concern  for  league  affiliates.  The 
memorandum  points  out  that  only  a 
fraction  of  the  children  known  to  be  re- 
tarded are  receiving  child  welfare  serv- 
ices. It  maintains  that  where  such 
services  have  been  provided  b.v  child  i 
welfare  agencies  they  have  proven  to 
be  beneficial,  and  that  providing  them 
has  involved  only  .slight  adaptation  of 
basic  child  welfare  principles,  knowl- 
edge, and  methods. 


B 


ussing  a 


ndb 


uses 


Children  who  transfer  under  a  de- 
segregation plan  from  scho(jis  in 
disadvantaged  areas  to  .schools  in  ad- 
vantaged areas  are  still  entitled  to  the 
special  educational  benefits  offered  by 
title  I  of  the  Elementary  and  Sec- 
ondary Education  Act  of  1964  for  chil- 
dren from  low-income  families,  accord- 
ing to  a  policy  statement  recentl.v  sent 
by  the  U.S.  Commissioner  of  Education 
to  all  chief  State  school  officers.  Under 
title  I,  schools  in  designated  poverty 
areas  offer  children  special  programs 
in  health,  nutrition,  and  social  services; 


CHILDREN 


NOVEMBER-DECEMBER  1967 


uiiiihiiK-i'  mill  ciiuMsolinn :  mikI  rciiirdial 
wnrU.  Each  school  disti-ict  will  work  cmi 
ii^  own  motliod  of  having  title  I  i>ni- 
l:i:ihis  follow  childri'ii  who  transfer 
li'iiu  one  school  to  anotlior  hy  plan,  the 
I '-■miiiissionor's  staloniiMil  iHiints  oul. 


I'cw  sclioolliuscs  adequately  iiroteet 
■  liildren  from  injury  or  even  death  in  a 
'  illision,  accordiiiR  to  the  findings  of  a 
siudy  of  sehoollms  passenger  protection 
made  last  year  hy  the  Instilute  of  Trans- 
portation and  Traftie  Engineering  and 
the  Department  of  Engineering,  I'niver- 
sity  of  California  at  Los  Angeles,  with 
support  from  the  U.S.  Public  Health 
Service  and  the  National  Safety  Coun- 
I  il.  The  .study  indicated  that  tlie  great- 
est protection  for  a  child  in  a  schoolhu.? 
(luring  a  collision  is  a  high-strength, 
lii:.'h-back  safety  seat,  and  that  few 
I'uses  had  them. 


'J"o  gage  the  .safety  of  schoolbuses  and 
to  determine  ways  to  make  them  safer, 
the  institute  staged  three  accidents  by 
niechanical  means  involving  .school- 
buses:  two  sdioolbuses  were  made  to 
meet  head  on  at  .'{O  ni.p.h. ;  a  passenger 
car  traveling  at  (>0  m.p.li.  was  made  to 
strike  a  stationary  bus  from  the  rear; 
and  a  passenger  car  traveling  at  60 
ni.p.h.  was  made  to  strike  a  stationary 
bus  from  the  right  side.  Each  bus  car- 
ried anthroiiometric  dummies  of  chil- 
dren corresponding  to  ages  3,  G,  and  l.'i, 
and  of  adults.  After  the  collisions,  the 
experimenters  checked  seats,  restraint 
systems,  and  the  performance  of  the 
buses  and  analyzed  the  effects  on  the 
dummies,  seat  by  seat. 

The  institute's  recommendations  for 
imjiroving  tlie  safet.v  of  schoolbu.ses 
include  the.se  : 

•  Seats,  in  addition  to  being  very 
strong  and   having   backs   at   least   28 


inches   high,   should   have   well-padded 
armrests  and  harnesses  or  lap  belts. 

•  The  passenger  compartment  should 
he  .securely  attached  to  the  frame  of  the 
bus  by  shear  bolts  i)laced  at  fre(|uent  in- 
tervals from  front  to  rear  and  along 
both  seats  in  a  frame. 

•  Protruding,  rigid  structures  should 
be  eliminated. 

•  Drivers  of  schoolbuses  should  al- 
ways wear  at  least  a  lap-type  safely  belt 
when  the  bus  is  in  motion  to  insure  that 
the.v  will  remain  behind  the  wheel  dur- 
ing an  accident. 

•  Buses  should  have  at  least  four 
clearly  marked  exits. 

•  Schools  should  conduct  emergency 
exit  drills  for  children  who  ride  school- 
buses  to  insure  quick  evacuation,  par- 
ticularly in  case  of  fire. 

Nearly  3,700  children  were  injured  in 
schoolbus  accidents  in  1965,  according 
to  estimates  of  the  study. 


READERS'  EXCHANGE 


VIETNAMESE  CHILDREN:  two  different 


The  position  taken  by  the  Commis- 
sion on  International  Social  Welfare  of 
the  National  Association  of  Social 
Workers,  as  reiwrted  in  tlie  '"Here  and 
There"  section  of  the  July-August  1967 
issue  of  CHILDREN  ("Child  Welfare," 
p.  16G),  regarding  war-injured  Vietna- 
mese children  is  regrettable,  to  say  the 
least. 

Let  me  address  myself  to  three  of  the 
four  points  the  Commi.ssion  made: 

1.  "The  greatest  effort  .should  be  di- 
rected to  reuniting  (hildren  with  their 
own  familie.s." 

2.  "Institutional  care  of  children  out- 
side the  family  should  be  considered 
only  as  a  last  resort  and  a  temptjrary 
measure." 

4.  "I'nder  no  circumstances  should 
children  and  their  needs  be  used  to  in- 
fluence iKilitical  opinions  in  regard  to 
United  States  involvement  in  Vietnam." 

All  three  of  these  points  may  be  dis- 
missed. The  Committee  of  Respon- 
sibility, Inc.  (COR),  which  has  been 
attempting  to   bring   critically   injured 


Vietnamese  children  to  this  country  for 
treatment,  is  composed  of  persons  who 
are  willing  to  set  aside  their  varied 
lier.sonal  views  on  Vietnam  in  a  very 
real  concern  for  those  child  victims  of 
the  war  for  whom  the  expert  medical- 
.surgical  care  needed  is  simply  not  avail- 
able in  Vietnam. 

When  confronted  with  this  fact, 
points  one  and  two  are  meaningless — 
as  meaningless  as  though  the  Commis- 
sion were  to  apply  them  to  a  severely 
physically  handicapped  American  child 
and  conclude  that  the  child  should  re- 
main with  his  family  rather  than  receive 
the  medical-surgical  care  he  needs, 
available  only  at  a  distant  hospital. 

Regarding  iH>int  four,  let  me  assure 
the  Commission  that  our  financial  con- 
tributions come  from  both  conserva- 
tives and  liberals. 

The  one  jioint  that  is  appropriate  is 
three : 

."{.  "Children  should  only  be  removed 
to  other  countries  for  needed  service  in 
exceptional  circumstances,  and  then  all 
human  rights  of  the  children,  including 
the  right  to  return  home,  must  be  pro- 
tected." 


This  is  the  exact  position  of  CUR. 

From  July  29  to  August  7,  two  phy- 
sicians representing  COR  were  in  Viet- 
nam to :  conclude  arrangements  with 
the  Minister  of  Health  for  evacuation 
of  four  war-injured  children  selected  by 
COR's  medical  team  ;  and  establish  a 
formal  basis  for  a  continuing  program  of 
case  selection  and  evacuation.  Neither 
of  the  two  goals  was  achieved,  although 
general  principles  of  operation  w-ere 
agreed  upon  and  a  joint  communiciue 
was  issued  from  the  Minister  of  Health 
and  the  COR  physicians  outlining  areas 
of  concurrence. 

The  failure  to  achieve  immediate  suc- 
cess was  induced  by  an  evermore  com- 
plex labyrinth  of  ministry  regulations. 
The  COR  doctors  were  particularly  dis- 
mayed by  these  administrative  difficul- 
ties in  view  of  the  needs  they  witnessed 
at  the  six  provincial  hospitals  they 
visited  in  I  Corps,  where  much  of  the 
recent  fighting  has  occurred. 

In  these  hospitals  the  load  of  civilian 
casualties  with  amputations,  burns,  in- 
fections, wounds,  and  fractures  of  all 
descriptions  precludes  any  but  short 
range,  life-saving  care.  While  the  doc- 
tors there — American  militar.v  doctors, 
European  and  American  volunteers — • 
are  dedicated,  con.scientious.  hard  work- 
ing, they  cannot  meet  the  neetl  with 
their  inadequate  staff  and  facilities. 

COR  cannot  meet  the  needs  of  all 


VOLUME  14  -  NUMBER  6 


2^ 


such  civilian  casualties,  for  their  num- 
bers increase  with  every  increase  in  the 
war.  However,  there  are  many  wounded 
children  for  whom  a  chance  to  function 
again  could  be  provided  through  the 
skills  and  technology  of  the  hundreds 
of  U.S.  medical  specialists  and  the  20 
major  medical  centers  that  have  volun- 
teered to  serve  them  in  the  U.S.A. 

We  have  aslved  the  president  of  the 
National  Association  of  Social  Worliers 
to  ask  the  board  of  directors  of  XASW 
the  following  question :  When  an  in- 
jured Vietnamese  child  desperately  re- 
quires treatment  not  available  in  Viet- 
nam, will  NASW  support  the  COR 
program  of  transportation  to  the  United 
States  for  treatment? 

Rex  Ragan 

BoarJ  Member,  Los  Angeles 

Com  miltee  of  Responsibility,  Inc. 

A  reply 

It  is  to  be  regretted  that  Mr.  Ragan 
has  chosen  to  base  his  comments  on  out- 
of-contact  excerpts  from  the  letter  sent 
to  President  Johnson  by  NASW's  Com- 
mission on  International  Social  Wel- 
fare concerning  the  care  of  children  in 
Vietnam.  I  believe  it  is  important  to 
restate  in  full  all  four  of  the  principles 
"of  child  welfare  as  they  apply  to  Viet- 
namese children  and  their  families"  as 
set  forth  in  the  Commission's  letter : 

"1.  All  efforts  must  be  made  to  have 
every  child  grow  up  within  his  own 
family  as  a  healthy  human  being.  To 
this  end,  greatest  and  primary  emphasis 
must  be  placed  on  keeping  or  reuniting 
children  with  their  own.  including  their 
extended,  families.  Families  need  to  be 
assisted  in  keeping  their  children 
through  a  vastly  extended,  improved 
network  of  social  services  and  institu- 
tions, including  if  possible  a  system  of 
family  supports  (in  kind  and  in  money). 
Institutional  care  of  children  outside 
the  family  is  sometimes  necessary  to 
meet  immediate  needs.  However,  this 
kind  of  child  care  should  be  considered 
as  the  last  resort  and  as  a  temporary 
means  only  and  should  be  used  to  facili- 
tate the  reintegration  of  the  child  into 
normal  family  life. 

"2.  The  efforts  of  the  American  social 
work  profession,  the  American  public, 
and  the  United  States  Government 
should  be  directed  toward  strengthen- 
ing, extending,  improving  and  financing 
such  services  in  Vietnam.  Except  in  ex- 
ceptional circumstances  children,  as  a 
matter  of  principle,  should  not  6e  re- 

248 


moved  to  other  countries  to  receive 
needed  services.  When  children  are  re- 
moved from  their  countries,  all  of  their 
individual  human  rights,  including  the 
right  to  return  home,  must  be  safe- 
guarded. 

"3.  To  strengthen,  expand  and  im- 
prove needed  services  in  Vietnam,  the 
training  of  professional  and  semipro- 
fessional  personnel  is  an  urgent  neces- 
sity. Therefore,  training  programs  for 
such  personnel  should  be  vastly  and 
immediately  expanded  in  Vietnam  and 
in  this  country. 

"4.  Under  no  circumstances  shall 
children  and  their  needs  be  used  as 
means  of  influencing  iwlitical  opinions 
concerning  our  country's  involvement 
in  Vietnam." 

I  cannot  dismiss  these  points  as 
"meaningless"  as  they  relate  to  the 
needs  of  children  I  observed  in  a  4- 
week  visit  to  South  Vietnam  this  past 
summer.  We  have  an  obligation  to  see 
that  children  are  not  separated  from 
their  families  or  torn  from  their  cul- 
tural moorings  except  as  a  very  last 
resort.  Children  in  Vietnam  need  a 
variety  of  specialized  services.  An  al- 
ternative to  bringing  a  few  children  to 
this  country  to  receive  these  services  is 
to  seek  to  make  these  services  available 
to  them  in  their  own  country.  Children 
need  their  own  families,  or  those  who 
can  best  substitute  for  them,  especially 
when  they  are  in  need  of  medical  care. 

In  its  letter  to  the  President,  the 
Commission  made  it  clear  that  "Amer- 
ican social  workers,  like  other  Ameri- 
cans, differ  in  their  views  about  this 
country's  involvement  in  Vietnam,  but 
are  united  in  their  deep  concern  for 
the  plight  of  the  Vietnamese  people,  and 
especially  their  children."  The  answer 
to  any  request  to  NASW  concerning  sup- 
port of  any  program  for  children, 
whether  here  or  abroad,  I  hope,  will  be 
dictated  solely  by  that  concern. 

James  R.  Dumpson 

Chairman,  Commission  on 

International  Social  Welfare 

National  Association  of  Social  Worl(ers 

BURNS  AND  GOODMAN:  some  ques- 
tions 

The  article,  "The  Teaching  Home- 
maker  in  a  School  Project,"  by  Mary 
E.  Bums  and  Julia  Ann  Goodman, 
[CHILDREN,  September-October 
1967]  illustrates  the  versatility  of  the 
many  elements  in  homemaker  service. 
The  teaching  of  better  methods  of  child 


rearing  and  of  household  management 
has  been  an  implicit  function  of  this 
type  of  service  for  a  long  time,  but  in 
this  experiment  of  the  Highland  Park 
.school  system's  Pupil  Adjustment  Proj- 
ect, teaching  was  selected  as  an  explicit 
function. 

The  efforts,  skill,  and  imagination  of 
all  participants  in  this  thoughtfully  de- 
signed and  professionally  well-fortifled 
program  converged  in  helping  children 
from  disorganized  families  and  their 
parents  to  develop  their  capacity  for 
achieving  social  health,  thus  freeing 
children  to  learn  and  increasing  the 
self-respect  of  parents  and  their  in- 
volvement in  the  mainstream  of  educa- 
tional and  social  activities. 

Recognizing  that  the  description  of 
any  project  raises  more  questions  than 
can  be  an.swered  in  one  article,  I  still 
should  like  to  have  learned  more  about 
the  dynamics  of  family  participation 
and  change  in  this  program.  For  ex- 
ample, how  were  the  services  of  the 
teaching  homemakers  presented  to  the 
families  and  what  were  their  reactions 
to  liaving  been  selected  to  participate 
in  them?  What  help  was  given  to  the 
families  when  situations  arose  that  re- 
quired other  forms  of  homemaker 
service?  What  plans  were  made  for 
helping  families  to  sustain  their  gains 
after  the  teaching  homemakers  left  the 
home? 

Although  casework  was  the  founda- 
tion of  the  program,  apparently  the 
homemakers  carried  out  some  respon- 
sibilities that  belonged  to  the  case- 
workers such  as  helping  the  families  in 
their  use  of  community  resources.  Since 
helping  families  with  their  needs  for 
other  services  and  their  feelings  about 
these  needs  and  motivating  them  to 
effectively  incorporate  these  services  re- 
quire casework  competence,  how  was 
the  duplication  in  responsibilities 
resolved  ? 

The  tangible  services  of  the  two 
teaching  homemakers  helped  to  build 
practical  bridges  connecting  the  chil- 
dren and  their  families  with  the  com- 
prehensive services  of  the  school  system. 
I  hope  that  a  detailed  report  of  this 
creative  project  will  soon  be  available, 
for  it  would  undoubtedly  provide  re- 
freshing topics  for  staff  discussions, 
seminars,  and  workshops  as  well  as 
ideas  for  planning  services. 

Nora  P.  Johnson 

Assistant  Executive  Director 

The  Children's  Aid  Society 

New  York,  N.Y. 


in 
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CHILDREN     •     NOVEMBER-DECEMBER  1967 


U.S.    GOVERNMENT  PRINTING   OFFICE:  1967 


U.S.  Government  Publications 

I'ublications  for  which  prices  are  quoted  are  for  sale  by  the  Superintendent  of  Docu- 
iiunts,  U.S.  Government  Printing  Office,  Washington,  D.C.  20402.  Orders  should  be 
jncimpanied  by  payment.  Twenty-five  percent  discount  on  quantities  of  100  or  more. 


I  IlILDREN  WHO  XKED  PROTEC- 
'PIOX :  an  annotated  liibliogrnphy. 
I'dnipikHl  by  Dorothy  M.  Jones.  De- 
partment of  Health,  Education,  and 
Welfare,  Welfare  Administration, 
Cliiblren's  Hnreau.  lOCi!.  ?•'.  pp.  30 
'cnts. 

Lists  4(i:5  selected  publications  on 
.  liihl  neglect,  most  of  them  published 
ill  iho  last  2.J  years.  The  subjects  in- 
rliide:  child  abuse;  child  welfare;  fos- 
iir  home  care:  homemaker  services: 
jiiviMiile  and  family  courts;  maternal 
(b  privation ;  medical  aspects;  mental 
Ih.ilth;   parent-child   relations;   protec- 

I I  ve  services  ;  social  casework. 

^^1•DIES  IX  DELIXQUEXCY;  AL- 
i'KUXATIVES  TO  IXCARCERA- 
I'loX.  La.Mar  T.  Empey.  THE  RE- 
i:XTKY  OF  THE  OFFEXDER  IXTO 
THE  COM.MPXITV.  Elliot  Studt. 
I'HE  CCLTU15E  OF  YOUTH.  Marvin 
i:.  Wolfgang.  Department  of  Health, 
lOducatiou,  and  Welfare,  Welfare  Ad- 
ministration, Office  of  Juvenile  Delin- 
quency and  Youth  Development.  JD 
Publication  Xos.  0001,  9002,  and  0003. 
1007.  .SS  pp.,  40  cents ;  22  pp.,  20  cents  ; 
20  pp.,  20  cents,  respectively. 

The  first  report  analyzes  the  correc- 
tional process  and  examines  efforts  con- 


cerned with  establishing  alternatives  to 
incarceration;  the  .'second  examines  the 
parole  process  and  focuses  on  conditions 
affecting  the  offender's  success  or  fail- 
ure as  a  parolee  in  the  community ;  the 
third  discusses  beliefs  and  standards  of 
young  people  and  their  influence  on 
deviant  behavior. 

IIOME.MAKEU  .SERVICE:  how  it 
helps  children.  Department  of  Health, 
Education,  ,'ind  Welfare,  Welfare  Ad- 
ministration, Children's  Bureau.  CB 
I'uldiration  Xo.  4-13.  1007.  24  pp.  35 
cents. 

Explains  what  a  homemaker  service 
is,  why  it  is  needed,  how  it  is  used  to 
help  families,  and  what  the  develop- 
ment of  such  a  service  in  a  community 
involves.  Includes  case  histories. 

A  DEVELOPMEXTAL  APPROACH 
TO  CASEFIXDIXG  WITH  SPE- 
CIAL REFEREXCE  TO  CEREBRAL 
PALSY,  MEXTAL  RETARDATIOX, 
AXD  RELATED  DISORDERS.  Una 
Haynes.  L^epartment  of  Health,  Edu- 
cation, and  Welfare,  Welfare  Ad- 
ministration, Children's  Bureau.  CB 
Publication  Xo.  449.  1907.  S5  pp. 
$1.25. 

A  guide  to  assist  nurses  in  early  rec- 


ognition of  deviations  in  normal  pat- 
terns of  growth  and  development  of 
infants  and  young  children  that  are 
syni[)toniatic  of  anomalies  or  dysfunc- 
tions, especially  in  the  basic  neurological 
rellex  patterns  and  the  maturation  of 
the  central  nervous  .system.  Includes  a 
wheel  guide  sliowing  normal  milestones 
In  devebiiiment  in  the  lirst  .'{(i  months 
of  life. 

"RED  IS  THE  COI/)R  OF  HURT- 
IXG"— PLAXXIXG  FOR  CHIL- 
DREX  IX  THE  HOSPITAL:  based 
on  proc'cedings  of  the  workshop  on 
mental  health  planning  for  pediatric 
hospitals  at  the  annual  meeting  of 
the  American  Orlhopsychiatrie  Asso- 
ciation, Xew  York,  April  1005.  Milton 
F.  Shore,  editor.  Department  of 
Health,  Education,  and  Welfare,  Pub- 
lic Health  Service,  Xational  Institute 
of  Mental  Health.  PHS  Publication 
No.  1583.  1907.  94  pp.  55  cents  (paper- 
back). 

Contains  six  papers  and  discussions 
ensuing  from  them  on  changes  needed  in 
hospital  pediatric  inpatient  facilities 
and  in  patterns  of  caje  to  help  young 
children  through  the  stress  of  short- 
term  hospitalization. 


photo  credits 

Frontispiece    and    page    225,    James 
Foote,  for  the  Children's  Bureau. 

Page  213,  Belter  Homes  and  Gardens. 


CHILDREX  is  published  by  the  Children's  Bureau  six 
times  a  year.  Use  of  funds  for  printing  this  publication 
was  approvetl  by  the  Director  of  the  Bureau  of  the  Budget, 
September  21. 1962. 

NOTE  TO  AUTHORS:  Manuscripts  are  considered  for 
publication  only  if  they  have  not  been  previously  published. 
Speeches  from  conferences  should  carry  appropriate  identifi- 
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Communications  regarding  editorial  matters  should  be 
addressed  to : 

CHILDREN 

Children's  Bureau 

U.S.    Department    of   Health.    Education,    and    Welfare 

Washington,  D.C.     20201 

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