licity, no matter how well focused, could scarcely touch. Last month the Ne York Charity Organization Society had sixty-eight volunteers active on I staff. A great many of these had taken the training course for volunteers wh the Society conducts every year, and are well able to uphold the standards: the Society in the community, for they themselves are doing work comparab to paid staff members. It has been the experience of the Society that the m that is expected of the volunteer in the way of study, effort, and seriousness d purpose, the more she contributes. The day of giving busy-work to the volum teer is fortunately on the wane in the most up-to-date social work organizations On the side of the volunteer, one finds that the volunteer of today is not willing to be a rubber stamp. She wants to "know what it's all about." Certain these are healthy signs. There is no better interpreter than the keen, wide awake, trained volunteer.

Now we come to the board members. This group, like our donors, are to often not given a balanced diet by the social agency. They get, regularly square meals on questions of finance, but professional principles and standard form but the occasional demi-tasse. Let us face the facts squarely. We may refine and improve our technique all we wish, but if we do not keep the boar with us, one day, when the deficit presses too heavily, a development which w have worked on for years will be cut off in its prime, unwept and unsung by them. By the measure in which we have brought our board with us to shar our hopes of progress and uphold our standards of work will we ultimate stand or fall.

The last group who are by way of being our interpreters are our staf We haven't trained them to be, and don't think of them as such, but interpret they do, daily, over a far-flung territory of college classmates, family, business and professional acquaintances, relatives, and friends. What do they say of us How are we being interpreted by the rank and file in social work? Let me tel you a personal anecdote at this point to show the way one staff member inter preted her social agency to the community. A decade ago I first entered social work fresh and green from the college campus. It was at the holiday season. when impulses are overgenerous and sentiment runs high. I was sent up, the night before Christmas, to tell a rooming-house case that the organization coul do nothing more for her. There was pressure of work and lack of time, so I was not permitted to read the record, but got only a scanty idea of the situation through a brief talk with my supervisor. I was grist to the mill of the "rooming house case." She wept piteously; when I was eating my Christmas dinner, she said, she would be sitting on a cold park bench, homeless and alone. I hesitated then weakened, and parted with my entire savings, ten dollars, assuring the woman it was from me personally, and not from the organization, but at least it would carry her over the holiday. I returned to the family of my college das mate and poured the story in their ears. My erstwhile campus room-ma in high dudgeon over it. She would take action at once. Her boss, the

large New York publishing house, was on the board of my society. He should hear how sweet charity ran her course between board meetings. The day after Christmas was an exciting one in my life. The board member, hearing the tale, betook himself to the director of my society; I was called down on the carpet to a weighty conference, at the end of which several people, including myself, were sadder and wiser. The facts of the "rooming-house case" were produced, and I learned that I had been duped. I learned that I should be in full possession of all the facts before attacking a social problem, and that, once having them, I was representing an organization, and was not a free lance. The society learned, I imagine, that, of a kind, I was an interpreter of social work, and that it behooved them to teach other incipient interpreters like myself "what it was all about."

In other words, the processes of interpretation are going on all the time, whether through donor, volunteer, board member, or staff, or other channels. Interpretation, then, is not the exclusive function of the executive, the extension secretary, or even the lay publicity committee. The part they play is rather one of stimulating participation on the part of all those who touch the society at any point of its work. And, having roused this participation, theirs is then the task of integration. Every social agency has an organism through which the blood stream should be kept flowing free and clear.

Not only must the different parts of the organization be made aware of the whole, but aware of the part each one plays. Social work organizations form themselves too easily in layers: the board, central office, subexecutives, and rank and file. To get normal growth out of the organization, such isolation of groups must be broken up.

As new ideas surge in from different parts they must be analyzed, integrated, and given out again, so that the flow of life through the entire organization will be vital and continuous. To aid in this process we should each re-examine and restate our task to ourselves and each other every so often, and the results, when integrated, make for a constant reinterpretation of ourselves to our public. Only this way can growth come. That which is static dies. We cannot, or should not, hope to interpret ourselves for once and all time. It is a continuous process in which there should be a complete sharing of all the elements involved.

Really successful interpretation of social work standards can only be had through a democratic form of organization in which there is an opportunity for everyone to be articulate for each part of the organization to be aware of what the other parts are thinking and feeling and doing.

Of course, your executive has an obligation to do formal publicity through public speaking and newspaper columns. This we take for granted. It is these other and more indirect aspects of interpretation which seem more likely to be neglected. Here your executive's job, or someone's job who is at the central core of things, is one of harnessing up all his potential interpreters and, through team work, fitting each into the scheme of things as a whole, so that the organi

zation will have a tremendous pulling power for progress. To harness them he must first know them, appreciate the value of each and the pulling power of each. As it is now, it would seem as though the staff were running up the road in one direction, with the volunteers straggling along in an effort to catch up, while the board graze along beside, leaving the donors and the public far in the rear, entirely outrun by the rest, feeding on the canned emotional fodder we have prepared for them.

Isn't today's challenge in social work the fact that, while we are comparatively strong on content, we are weak on interpretation? Let those who are unwilling to admit the interpretative obligation of social work look to the limb on which they sit.

RECENT STUDIES OF PROFESSIONAL NEEDS

EQUIPMENT NEEDED BY THE MEDICAL SOCIAL WORKER

Mary Antoinette Cannon, School of Social Work, New York

This paper is not a report of research made, nor of the work of a committee. It is rather an attempt to set in order the ideas which have come to me auring the past year as the result of my own efforts at training hospital social workers at the New York school plus service on two committees on training, one, of the American Association of Hospital Social Workers, the other, of the American Association for Organizing Family Social Work.

It seemed possible at one time during the past year, through a combination of interests, to have an analysis made for the sake of determining the elements necessary to education for hospital social work. Two questions at once arose: first, what hospital should be chosen for analysis; second, how should we know that the job as it is done is the job as it should be done.

Radical differences of policy exist among hospitals as to what is done under the name of social work. There are historical as well as logical reasons for such differences, but many of them represent fundamentally different conceptions of the function to be performed by the social worker in the hospital. Clearly, no study of what is being done will tell us what the standard equipment of the medical social worker should be, beyond the requirements for any human task— native intelligence, strength, and all the virtues. Rather, the whole hospital and community must be surveyed and special services defined according to economy of activity. What division of labor will give the best results? In a field so new and so controversial as social work there is still time for experiment.

There are two distinguishable concepts as to what social service the hospital needs to make its health work complete. One is that this service should be a variety of public health nursing; the other, that it should be a specialty of social work.

According to the first theory, the hospital needs to provide an extension of

nursing care for its patients which will reach their homes. With this is needed health teaching and the recognition of signs of social disorder indicating the services of a social worker. Such service is best supplied from the agencies of the community, family, children's court, school, according to the problem, location and affiliation of the family. The line of organization is drawn between the recognition of the existence of a social problem and the study and treatment of that problem. This is arbitrary, I think the advocates of this theory admit, but so is any boundary between special fields.

This form of service requires the equipment of nursing training plus an understanding of the importance of social background and setting, a knowledge of social work agencies, and such knowledge of their possible uses as perhaps the family social worker has of the uses of medical agencies. For years we have discussed methods of adding such social education to the nurse's training. Now some leading nursing educators are saying that what is needed is not an addition to a nurse's training, but a new and "socialized" kind of nurse's training in which social elements in sickness are pointed out all along the line, and social judgment developed, together with skill in nursing technique. The plan in operation at the Yale School of Nursing illustrates this kind of socialized nursing training.

The training courses for hospital social workers which exist today in schools of social work and in universities have been shaped according to the second theory of the job, namely, that it is a special field of social work. According to this idea the hospital requires, to complete its service to the sick, a person or group, forming part of its professional organization, whose function is to study the social elements in problems of sickness and to take part with physicians in making and carrying out health programs for the sick under hospital care. In order to make such a contribution as this to the hospital's service one must be equipped with knowledge and judgment in regard to social relationships and institutions, and practiced skill in handling people and stirring them to participation in their own programs. Health teaching is a large part of this kind of medical social work, but nursing procedures take a minor place, and social treatment is a recognized essential. The training is in social case work, with varying amounts of instruction in the sciences and arts of health, and practical field work in hospitals. We have struggled with the question of adding to a course in social work certain parts of nursing training, a year or more of nursing, or drill in certain techniques, the whole to come within a practical time limit, probably not more than three years. Such a combination is actually urged by some medical social workers, but it is opposed by nursing educators on the one hand, and certain medical social workers on the other, on the grounds that it will tend to produce a person who is not a nurse nor yet a thorough social worker, and both professions will suffer, and, more fundamental, that such training will not equip one to meet the requirements of care of the sick.

I believe that social training can and should be "medicalized," as medical

training can be socialized; that all social workers would do better social work for having a clear understanding of the physiological factors of social life; and that better preparation along this line will help in meeting the community's whole social problem. So, no doubt, will the "socialized" nursing training. The hybrid course, on the contrary, it seems to me, will not produce a practitioner of either sort.

Wherever the lines are drawn between professions or specialties within professions, when the fields are thrown together, they must cover a series of needs something like this: first, medical diagnosis and treatment; second, nursing care; third, health teaching; fourth, prevention of disease by public measures; fifth, the overcoming of personal, family, and environmental obstacles to health, as, for example, ignorance, vice, resourcelessness, etc., by such means as education, work, play, legal aid, insight, money, opportunity; sixth, overcoming of sickness, as an obstacle to work, independence, and social fitness, by means of health resources, including doctors, nurses, and hospitals; seventh, improvement of social fitness, apart from health, by such means as education, work, play, legal aid, insight, money, opportunity, etc.

These needs are not separate in experience; the priest perhaps once met them all, in so far as they were met; yet today it is impossible for any ordinary practitioner to combine mastery of all of medical and social science and art. Medicine is a focus at one end of the series, and social work at the other. The middle grounds show the interrelationships of the two, and it is in these middle grounds that we must pick out the services of the nurse and the medical social worker. Upon our understanding of the interrelationship depends the integration of medical and social work in such a way as to meet the human need for health and fitness. Neither service can be complete in itself alone.

What are the case problems which medical social workers have found in the hospital? By what means have they tried to meet them, and with what results? I want to refer in answering to two studies which have been going on during the past year and which have played a part in the field work experience of some of my students. One is the study of function instituted by a committee of the American Association of Hospital Social Workers, the other, an attempt at social classification now in process at the Presbyterian Hospital in New York.

Hospital social workers are familiar with the questionnaire and schedules of the Function Committee. They require the devoted worker to state in terms of "yes," "no," "not attempted," or "inapplicable," whether or not certain actions have been completed in a fair sample of her cases. For a certain group of fifteen cases I find the following results: On all but one the worker "conveyed the patient's social setting to the physician"; in all but one or two, the worker made an examination of personal history, family life and relationships, and sources of support, which contributed, not to the specific medical diagnosis, but to an "understanding of the entire health problem of the patient"; in all cases investigation of personal history, social setting, and sources of support