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offered its services. It also had no control over the policies of these institutions while consigning children to their care.
Fourth, it encouraged institutional staffs and boards to construe their responsibilities to be merely the care of the child within their walls, cutting them off from that fine opportunity of dealing with the child comprehensively as part of his family. It lifted from the institution's shoulders the decision as to whether a given child was a proper charge for it and if not what disposition of him should be made, thereby limiting their chances of knowing at first hand the communities' resources and limitations.
It has been a history (certainly as far as a group of institutions is concerned) of a struggle which has been largely guess work with a group of children they did not and do not know, punctured by cries for help to the Bureau which has been expected to bear the brunt of responsibility and remove the offender. There has been no contact with the family save that afforded through occasional visits from relatives (and these visits in the case of one institution I have in mind are limited to once a month); and since the investigating agency carrying the burden of new work cannot possibly do follow-up work, keeping in touch with the family situation, there is practically no tie save the one the family chooses to preserve and many of these families neither visit nor pay board for their children.
Part of the original Bureau organization was the formation of a joint shelter to be used for temporary care of children who were wards of the Children's Aid Society, the Society for the Prevention of Cruelty to Children, and the Children's Bureau, i.e., children destined for institutions but not admittable at once, or children needing only temporary care because perhaps of mother's illness, etc. None of the social agencies using the shelter retained any supervision of the child after it was admitted to shelter care and as little of their experience (with the child) was communicated to the shelter staff, the child was practically a stranger to the worker or to the staff which was temporarily responsible for his treatment.
I will not go extensively into the dark history of this experiment which is familiar to anyone acquainted with conditions that obtain where children of every type are crowded together, exposed to every unfavorable chance that can befall such an assembly, some of them known delinquents, others taken from parents declared unfit by court action, others brought from homes of good standard because of illness perhaps, or death, under-nourished, feebleminded, mentally unadjusted, and normal children, were held in the shelter, sometimes for a period of months, or distributed among fifteen or more shelter homes, according to sex or age of the child desired, or the literal bedspace for the moment available.
The experience emphasizes too the interdependence of investigation and treatment branches of the work. Under the old plan Seybert, which controlled the shelter care and medical work, depended on the Bureau for adequate history and the Bureau depended on Seybert for proper treatment, and the link between was a 6X8 gray sheet on which the history was outlined; a significant illustration in its pale inadequacy of the failure both on the part of the shelter and the Bureau to understand the necessity for the most complete mutual understanding of family and child, an understanding that never could be reached through the perusal of a 6X8 form.
Out of this maelstrom grew the present placing-out department of the Bureau. The Society for the Prevention of Cruelty to Children and Children's Aid Society
recognizing the futility of the shelter system, took over the care of their own wards and both societies withdrew as supporting members of the Bureau. The Society for the Prevention of Cruelty to Children was compelled by its charter to handle its cases direct and the Children's Aid Society had grown to such an extent that it was advisable for them to have their own reception and investigation department.
Because of the community's acceptance of a low standard of foster care in families, and an insistent emphasis on quantity rather than quality, the Children's Bureau in addition to acting as reception agent for a number of institutions, undertook placement work as demonstrative of what might be accomplished through careful initial case investigation and the art of intelligent supervision and treatment in wisely selected foster homes, this with a group sufficiently limited to make such an experiment and demonstration possible. The Bureau then agreed with the Children's Aid Society to confine its services to the following four types of cases: babies under two; children for temporary care for a period not exceeding six months; children presenting serious health or conduct problems; a limited number of unmarried mothers and their babies.
The Bureau planned in addition, an educational campaign with the institutions which it continues to serve; first, through advice to their boards; second, through supplying duplicate copies of all inquiries referred by them to be kept permanently in their files; third, through personal conference with the case worker and admission committee on each application, which will enable them to better visualize the situation and see the child as a personality and put upon them the responsibility for decision as to the disposition of the problem; fourth, through encouragement to do continuous treatment on a careful, scientific case work basis, not only of their child, but of his family, pointing up to the necessity of institutions having their own case worker to make careful study of their intake and to keep in close touch with the changing family situation.
With the withdrawal of the Society for the Prevention of Cruelty to Children and Children's Aid Society from the Bureau a new plan of support had to be worked out. The Seybert Institution which had originally organized the Bureau agreed to contribute about half of the estimated budget of the Bureau under the new plan. The remaining half is to be met by board paid by parents and by public authorities and from contributions from private individuals, and as in the past year the Welfare Federation has been organized in Philadelphia, an amount considerably in excess of that previously raised from private sources will be paid through the Federation. In addition the institutions who are asking the Bureau to make inquiries for them will gradually be asked to pay for such services, either in a lump sum or on a case basis. Part of the responsibility for social treatment after the child has been accepted by them was that the institutions should be responsible for collecting the board for their own children, either from parents, or in the case of dependent children, from the public or court. The old plan of having payment made through the Bureau had been most unsatisfactory. As there was no follow-up work done on the child, unpaid board accumulated and parents and relatives who visited children in the institution were not approached on the subject of payment by the institutional staff because as board was paid irregularly they had no way of knowing who was paying and who was not and in many instances parents failed to visit children in the institution because the board had not been paid.
The medical clinic was recognized the early part of 1920 into the Associated Medical Clinic and its staff enlarged to meet the needs of a larger number of children to be served. This clinic is supported jointly by the Children's Aid Society, Society for the Prevention of Cruelty to Children, and the Bureau and is doing their reception and follow-up medical work and its services are available to the agencies and institutions that will use it, the aim being to provide a central medical bureau. For each child there is a complete physical examination, treatment is suggested and follow-up supervision given either through return visits to the clinic, or visits to the foster home by a doctor or nurse. The clinic was first organized and then perfected in order that all of the children of the member agencies could have a complete physical examination. Moreover these examinations were to be directly related to the question of admission and the social treatment of the child. But for this clinic there would have been no other way of getting this service. Physicians could not, in their offices, handle a volume of 1,600 to 2,000 children a year and the hospital clinics were not examining so called "well children." The results of the clinic have been most valuable in presenting a picture of the physical needs of the child as a whole and have been of the greatest service in raising standards of foster care.
One of the outstanding contributions in the perfecting of social case work for children was the Seybert Department of Child Study, organized in 1918 as an observation school, under the direction of Dr. Jessie Taft. In July, 1920, it was reorganized as a child study department to serve the wards of the Children's Aid Society, the Society for the Prevention of Cruelty to Children, and the Burea ̈ and other agencies, the Children's Aid Society carrying half of its support.
A number of children who come to us belong to the group that calls for correction of conduct difficulties, and this group needs a very scrupulous interpretation of the forces that have been responsible for their misconduct. Of inestimable value to the visiting staff whose work if skilful, must be interpretive as well as analytical, is a close tieup with the psychologist, who not only can insist on adequate case history as a necessary aid to just diagnosis, but can help immeasurably in interpreting the emotional forces of the child so that his treatment may be related to his real needs.
If foster care is to approach the ideals of a normal home and the fostering care of normal parents, one must thoroughly know the child in transferring him to his new background, and as thoroughly know the home that is chosen for him. The placing department is dependent upon the findings of the other departments; on the reception department for careful, accurate history and a clear picture of the child against the background of his own home, on the mental hygiene and medical clinics department for analysis and diagnosis, and on the home finding department for a complete and accurate picture of the new environment and its personalities. Treatment will depend entirely on good home finding and the art of supervision, calling for appreciative understanding of child and foster mother and the fine ability to interpret each to the other. It will include working with the child's family as well as with the child, for it availeth little or nothing to put time and money into treatment only to put the child back eventually into a home situation that has not improved in his absence.
Babies taken into care represent every variety of physical problem. The majority of them are undernourished, and many are syphilitic and tubercular, and call for a kind of service on the part of the foster mother requiring patience and persistency and intuitive skill, which cannot be adequately paid for. Feeding and medical treatment
are supervised by the medical director of the clinic, whose directions are carried out in the foster home with the assistance of a graduate nurse who works closely and sympathetically with the foster mother. The zeal with which these women work over sickly, fretful, unlovely babies, and their pride in exhibiting after months the fat and dimpled products of their patient care, fills one with wonder and respect.
Is it worth while? Well, we shall see for we have only taken the first steps in the new order. There are certain conclusions however, to which we are forced back: first, that a central investigation bureau in a city of Philadelphia's size would be too gigantic to operate in a personal human way; second, that institutions therefore should be encouraged gradually to do their own case work and thereby taught to regard their children more individually and with more personal and direct understanding than will ever be possible through the medium of another agency; third, that the expense of good social work for large numbers of children is prohibitive, at least under present financial conditions and that therefore increasing effort should be made to stimulate preventive work of any sort that aims to keep family life intact and that reaches the child before he becomes a problem.
One word more in emphasis of the value of a unit of organization small enough and simple enough in its organism and sufficiently limited as to volume of the work to afford its staff members opportunity to exercise in their work and its varied relationships those spiritual qualities without which the effort has neither meaning nor worth. More than one person was struck, two years ago, with the aspect of the staff-the survivors, one might call them of the old organization, a bewildered, dispirited, discouraged group. Several indeed had fallen by the wayside, broken down physically under a burden impossible to carry (and the consequent strain) and those who remained worked mechanically, without vision or direction or a glimmering of the spirit with which one marches to music or so it seemed. I mention this because I believe it can be blamed largely to the organization; to a system that was fundamentally wrong, which in its unwieldy mechanism (for it had become a mere machine) gave no opportunity for the fine, painstaking, careful service that has significance and meaning-the personal giving which is the measure of joy in all creative work. The insistence, too, on a small unit of organization, distributes responsibility by forcing it back where it belongs, challenging a community's support, not only of modern methods and decent work, but of those preventive measures which will reduce the need for such service to a minimum. And finally, to put emphasis on the quality of service is an economic measure. One child definitely healed represents an investment which any number of children glossed over, does not. It also stresses a standard of service, a standard which is too seldom attained but which can unfailingly be aimed at, for one's reach must ever exceed one's grasp-"Else, what's a Heaven for?"
THE PLAN OF A GENERAL BUREAU OF INQUIRY
The Children's Bureau of Cleveland was established April, 1921, as a result of the Children's Survey of 1920, made under the direction of Mr. Thurston. The results of that survey of Cleveland's nineteen child-caring institutions showed that in our so-called orphanages only 8 per cent of the children were full orphans; i.e., 91 per
nad at least one parent responsible for their care. Even more astonishing, how, it was found that 47 per cent, or almost one-half of the children, had both parents g, proving that the problem was not that of death, as had always been supposed, rather that of the home, broken through neglect, divorce, or desertion. It also >wed that of all children leaving institutions 67 per cent were returned to parents or atives, raising the question whether the child's home had improved and the original use for its removal had been remedied. It also showed the turnover in the various rphan asylums varied from 23 to 232 per cent a year; i.e., one institution could care or eight times as many children as another institution with equal capacity and caring for exactly the same type of child. A case study made of some 5,000 cases proved conclusively the need of a common planning and investigation center serving all of the institutions. It was felt the primary need was more thorough investigation before admission and more careful follow-up after discharge to insure the good results of the institutional stay not being lost.
Accordingly, the Children's Bureau is serving a threefold purpose. First, it aims to act as the investigating center for the various agencies with particular emphasis on institutional placements. It aims to thoroughly investigate all requests for admission to children's institutions to secure the fullest possible facts concerning the family and the child as a basis for a constructive plan. Through trained and expereinced workers the facts concerning the child and his family are secured from social agencies, relatives, schools, doctors, dispensaries, and so forth. Through trained visitors working on a community basis, knowing other agencies and resources intimately, it is possible to learn the facts and to develop plans for the best interests of the child in a way not possible by institution superintendents, so busy with institutional management, or by board members no matter how self-sacrificing or well-intentioned they may be. With twenty-three institutions many of which are small, it is not financially possible for each to have an adequately trained social worker, but through co-operation on a city-wide basis it is possible to serve them all efficiently. The facts gathered in this way are presented to the superintendent or admission committee of the institutions in whose hands the full responsibility for admission or rejection rests. The Cleveland Humane Society, the other children's agency, retains its own investigation staff, although necessarily it realizes it receives for placement some children in which investigation has been made by the Children's Bureau.
Experience has shown that only one in four or five of the direct applications, i.e., requests made directly by the family, require institutional care, there being usually need for some other kind of service, such as financial aid to keep the family together, court action for neglect, medical and mental care, placement with relatives, return to legal residence, etc. Cleveland, through its Community Fund, has now reached the place where institutions are refusing to accept children of deserted women or widows purely for economic reasons, but through the family agencies and Mothers' Pension adequate aid is being provided to keep children with their own parents.
It has been intensely interesting to note that as the central investigation idea has developed the number of direct family applications has decreased, but the number of applications for institutional care from social agencies has increased. Due to joint investigation service it has been possible to cut the unnecessary placements and to afford room for the children in most need of care. Through centralized service it has been possible to place the most needy children of such agencies as the Associated Chari