ORGANIZATION AND TECHNIQUE IN CHILD COMMUNITY ORGANIZATION FOR CHILD GUIDANCE Grace F. Marcus, Supervisor of Case Work Methods, National I object to my topic. There is something oppressive and ponderous about it. The term "community organization" represents to most of us an unmanageable abstraction. We have met it but embodied negatively in political and religious antagonisms, in social cross-purposes organized against each other, in unwieldy outworn machinery immovably blocking our way. We know communities that face organization as a necessity and are doing their best to function as social wholes, but if we analyze that best, what can we see in it but the bare bones of a community dream? Certainly so far as child guidance clinics are concerned, we have learned from experience that community organization must be regarded as an experimental process, that plans for it should not be concerned with wholesale solutions and ultimate goals, but with those immediate, troublesome realities to which some adjustment must be made. We all know that child guidance is a very new, but not necessarily a final, development; that it is not superior to all the sordid realities of budget, case load, and inadequate social resources with which other organizations are struggling; that its welfare is largely determined by the status of other social, medical, and educational agencies, that it too is a creature of environment, and that it neither has nor wants a splendid isolation. Organized to assist in the individual adjustment of children presenting problems in personality and behavior, employing to this end the techniques of psychiatry, psychology, medicine, and case work, it naturally enters a community as something formidably different from any of the other agencies handling children. This difference is real, valuable, and dangerous. For the very fact that child guidance clinic technique is a composite implies its fundamental dependence on each of the fields from which it derives. It has no final formulations to offer. It starts as an assimilator, an assimilator of many developing techniques into a balanced, coordinated whole which can be socially applied. It waits on further growth in allied fields for material to be placed at the service of case work. It needs the cooperation and understanding of specialized agencies to effect this assimilation, since the treatment which they will help it to carry out is the only laboratory at its disposal. It must begin, then, from the beginning to strip its techniques of strangeness, to make them part of the familiar thinking of other agencies, to submit them to the evaluation other agencies must give them, if the clinic is to discover where its work is of practical value and where it is not. All this entails community organization. There is, of course, another side to the question. The clinic can only make itself understood in terms of its understanding of the methods, aims, assets, and liabilities of other organizations. It cannot convey the relevance of its problems to theirs unless it first knows just what their problems are and how they regard them. Any agency is simply an aggregate of human beings, and it is natural for human beings to be defensive about even inevitable handicaps, to magnify successes, and dodge the issues raised by failure, to erect professional walls, and shut out interference. Isn't it this tendency which makes community organization a matter of truces and treaties rather than a super-case work in which agencies join for a persistent study of the whole situation? Of course every agency, however independent it may be in its special field, realizes that its life is conditioned by community interrelationships, and that its professional privacy is only a nominal affair, but the child guidance clinic, by its very constitution, must face from the start the fact that its actual identity as a child guidance clinic depends on its integration into the group that it serves; that if it is to achieve its reason for being it must recognize itself as part of the community's nervous system, must discover the possibilities and limits of its function, and must adapt itself to the necessities of the organism that maintains it. The central problem of a child guidance clinic is to define its diagnostic function, since it is this service for which it exists. Its rôle in the community and the policies on which its relationship will rest are very largely determined by the meaning attached to this word "diagnosis." It is perhaps the one surviving form of magic in which we moderns believe. The dictionary describes it modestly as an art, but about it hangs an enchantment the most sceptical of us still feel. We seek it as an open sesame, as the royal road to cure, and even when it comes to us in the elaborate guise of a Chinese puzzle we derive a certain satisfaction from having it in our possession. Possibly our respect for it as a final pronouncement springs from the primitive's superstition that difficulties could be banished by names. As a matter of fact diagnosis is an art, and not a single final opinion; it is merely a critical process, the running accompaniment to investigation and treatment, inextricably bound up with them, subject to the reversals and developments in situation they create, not final until there is nothing left to investigate and nothing left to treat. In actual practice, diagnosis is not an absolute, but a variable, a continuous changing series of analytical judgments formulated to clear the way for the next step. It serves us best when we realize that it is only a compass which tells us where we have arrived in following the circuitous path of treatment, and where we are going next. Dissociated from treatment, unmodified by the new perspectives treatment gives, diagnosis becomes a stumbling-block, an irrelevant signboard which hides rather than reveals the complicated progressive phenomena with which all case workers have to deal in treating human personality. Real diagnosis means then that a child guidance clinic has to accept a responsible share in treatment, and that in serving other agencies in a diagnostic capacity it must participate in their work and must recognize an interdepend ence that will make cooperation not a mere diplomatic bargain but a dynamic flexible alliance of forces. It will want to deal in diagnosis as a recognized part of treatment, will want to discover with each agency the best ground for the exercise of a profitable diagnostic function, and will hope by mutual consent to steer clear of those hopeless cases in which diagnosis, from the point of view of social treatment, is simply a tombstone. All of this entails community organization, not as a single-handed engineering activity of the clinic, but as the union of all interested agencies in securing each for itself the maximum service the clinic can render. In the best sense, any agency's policies are not simply defensive assertions of its own individuality, but the result of mutual agreement with those agencies in the community whose interest it is to preserve their stake in its activity. A child guidance clinic, a limiting its case load and selecting its cases, has again to take cognizance not only of its own situation but of that of its cooperators, so that its policies may be formulated not in a spirit of exclusiveness, or to establish property rights, but in the light of what other organizations can or cannot do in diagnosis and treatment. It cannot handle all the problem children in the community, even if it were asked to do so by the agencies responsible for them. It cannot bridge all the gaps in the social structure. It has to enlist the services of its community partners in determining for what immediate ends it may constructively be used if it is not to lose itself in trying to meet the millennium. The millennium is always with us, and if we concentrate too attentively on its demands, we risk our immediate function. That of a child guidance clinic is limited, largely because it depends on sciences and arts still in embryonic stages of development, and partly because it is not staffed to deal with all the cases that might conceivably fall within its jurisdiction. It can, however, compensate in some measure for its inadequacies by placing at the disposal of the agencies involved in its work all the data it accumulates which are relevant to their problems. It can enter into an exchange of techniques, and take part in that intercommunication of ideas which alone saves each agency from stagnating in its separate wilderness. It should be able to bring reinforcement to those agencies on whose growth its own depends. It might help the schools to make the community appreciate the need for grading facilities, special classes, free curricula, and vocational training. It might work with the family agency for resources which will strengthen pivotal work in the home, with the child placing societies for facilities for providing normal home life, with institutions for realizing real institutional functions, with medical groups for developing preventive work. Operating in four fields; medicine, psychiatry, psychology, and case work, the child guidance clinic should be able to give the specialized agency functioning in each field a perspective on its interrelation with the others, and assist in securing support for the full development of each group to whom it is organically related. The machinery of community organization is relatively unimportant. Most communities suffer from the natural tendency to erect machinery which eventually balks the ends for which it was devised, which is too rigid to be modified, and too expensive to be discarded. Community organization should be seen in psychological terms, in terms of modest social experimentation, functional giveand-take, mutual adjustment to achieve a common immediate purpose. We all agree about distant goals and uniformly disagree about how we shall attain them. We have to face reality. There is no reality but the immediate situation, and this we, as communities, have to face from a case work point of view, our plans tentative, our minds open, and all our tools common property. COMMUNITY AGENCIES AND THE CLINIC Edward D. Lynde, Secretary, Associated Charities, Cleveland If one believes in case work he must believe in the child guidance clinic, for case work is one of its essential functions. There are at least five ways in which the case work of the clinic differs from that of almost all other case working agencies: first, its case work reaches many more middle-class families and is, therefore, better appreciated by the public; second, it focuses attention on the child, studying his life from every aspect; third, it employs the case conference plan in a unique way, holding on every case a conference of the social worker, physician, psychologist, and psychiatrist; fourth, it utilizes psychiatry and psychology to a greater degree than the general case worker in her everyday work; fifth, and most important, its work is, on the average, more intensive. Let us address ourselves to each of these points in turn. Case work ordinarily is not appreciated by the layman. It does not appear vital to him because he has not yet recognized that even he and his family may have a personal need for it. The most devoted supporter of an anti-tuberculosis movement is often the man or woman who has had in his personal life some bitter experience with the ravages of that disease. But organized case work has grown up largely in connection with dependency. The clinic is a means of bringing home to the average man, through a direct personal experience, its universal value. When a father has seen this type of case work effect a transformation in his own child, then he may more readily appreciate its value as applied to other families. He may become enthusiastic for the case work approach-the plan of dealing with an individual as influenced by his emotional make-up and by environment. Those who are conducting clinics can render great service to the case work movement if, in their group education of parents in child care and their frequent talks before other lay people, they will make clear the connection between the case work of the clinic and that of other case work agencies; if they will explain why their work is such as the local agencies also need to do and which those agencies are, under heavy handicaps, striving to do. Secondly, the clinic is particularly helpful to general case workers because it aids us to focus on the individual child, causing us to practice to an even greater degree the thing we have always advocated and which, for example, the Cleveland Associated Charities has striven for several years to promote through a staff child study committee, namely, individualization in diagnosis and treatment. On the other hand, the clinic must exercise care that it does not minimize the importance of the lives of other members of the family. The third distinctive feature of the clinic is the employment of the case conference plan in a unique and strikingly effective manner. The clinic has a staff conference on every case examined, in which the clinic's social worker, psychiatrist, psychologist, and physician all participate, together with any local social worker interested in the case. True, without any such conference the local case worker might in turn consult a psychiatrist, a psychologist, and a general practitioner regarding Johnnie. But that method does not have the same effect that is obtained by group thinking on the part of these four workers after they have made a painstaking study of the mental, physical, and emotional make-up, and the social background of the individual child whom they are discussing. Do not assume that this plan of theirs is entirely original. For years, case committees of the family agencies have likewise afforded an opportunity for the social case worker, the physician, often the psychologist, sometimes the psychiatrist, to meet with the lawyer, the minister, and the housewife in working out a plan of treatment on behalf of a family. Then, also, the staff conferences of many agencies, and even the case conferences consisting of representatives of different agencies, all interested in the same family, bear striking similarity to the clinic's staff conferences. But they must be less intensive. None achieves exactly the thing which the clinic staff conference accomplishes. A fourth characteristic of the clinic is that it is employing psychiatry and psychology to a marked degree. For most case workers, no demonstration is required to convince us of the immense contribution of psychiatry to case work in problem cases, and in affording us a deeper insight into all human behavior. However, there are few, if any, other social agencies where a psychiatrist is participating in every case. The clinic certainly makes the psychologist more accessible to the local agencies than he is in most cities, and it insures the availability of a social psychiatrist. In a talk which I gave last year in this section of the National Conference, I asserted that there are ordinary psychiatrists and social psychiatrists, and that the only one that is of much help to the case worker is the social psychiatrist. One or two people, after the meeting, challenged this classification, saying that one who is not a social psychiatrist is not a true psychiatrist. I cannot refrain from the retort that I know psychiatrists who seem |