tions which play so great a part in the life of the foreign mother, to discover the cause of maladjustment in the problem child, and to study the successful mother.

SOME TESTS FOR THE EVALUATION

OF CASE WORK METHODS

Elinor Blackman, Assistant Executive Director, United Hebrew
Charities, New York

It is inevitable that a profession which is concerned entirely with people and their relations to each other and society shall be continuously and persistently criticized and checked up by people concerned therein. Thus the community, the families concerned, the agencies and individuals carrying on the work, are constantly, and always will be, performing an evaluation function which, however crude and intangible it may be, will nevertheless have its definite influence in the growth and development of case work philosophy and technique.

It is a more formal and definite method of evaluation with which this paper is concerned, however, and one which can be developed and practiced only by the agencies and case workers themselves.

Beside a variety of sources from which the evaluation process may emanate, such as the community, the family, and case workers themselves, there are various phases of the work toward which it may be directed, i.e., technique of investigation, analysis, diagnosis, and treatment; or the evaluation may consist in an estimate of actual results. The direction of the process will depend on its objective, which may be a test of technique, or a test of accomplishment in terms of actual adjustments in individuals and families. Until case work technique has been more scientifically established than it is at present effective and valid evaluation cannot be practiced on technique alone, for at the present stage of its career, technique is dependent on actual accomplishment for the proof of its validity and effectiveness. Thus, evaluation of results together with evaluation of technique should, and undoubtedly will, become an instrument in the development of case work technique.

Most family agencies are undoubtedly familiar with a method of checking problems and services on a statistical card which was devised in 1915 by a special committee on statistics of the American Association for Organizing Family Social Work. It is a further expansion and use of this system which, in the experience of one family care agency, has seemed to demonstrate evaluation possibilities, particularly in the field of executive treatment.

For the benefit of any who may be unfamiliar with the statistical card to which I refer, I will describe it briefly. The back of the card contains a list of problems, such as unemployment and related problems, lists of physical ailments, mental diseases, social problems such as domestic infelicity, family desertion, juvenile delinquency, bad housing, etc., with a corresponding list

of services, such as employment secured, physical treatment, institutional care, mental examination and treatment, imprisonment of deserter, support order, adjustment within family group, juvenile court action secured, removal to better quarters, etc., secured. In this system, however, though the lists of problems and services seem to correspond, there was no means or method of actually correlating these problems and services in the checking, so that it could not be determined, for instance, whether in an individual instance a case of tuberculosis had received physical care or sanitorial care, or, taking a group of cases, how many had received physical treatment or how many had received sanitorial

care.

Furthermore, the checking method did not provide any means for indicating effort but incompleted service. Thus, though the method provided some means of evaluating service, in that services were enumerated, there was no means of evaluating service in relation to the problems, nor was there any way of estimating degrees of service.

Last year a family agency, with some trepidation, to be sure, introduced a method of checking which attempted to meet both of these deficiencies. I say the method was introduced with trepidation because in the beginning it seemed complicated, and the fear was expressed that the burden of carrying it might be heavier than any case worker could or should be asked to carry. Fears on this score were allayed by experience, however, and the system now seems to be established on a permanent basis which is quite satisfactory to all concerned.

The card to which I am referring makes it possible definitely to relate services to problems. This is accomplished by means of a number system whereby the problem and the corresponding service are given the same number, i.e., unemployment is numbered 1; the corresponding services are marked 1a and 1b, which are, a, employment secured through an agency, and b, employment secured directly. Problem 3 is insufficient earnings; the services read 3a, wage increase secured, and 36, better employment secured. Problem 5 is indebtedness; the services read 5a, advice which enables family to meet debt; 5b, debt paid through another source; 5c, extension of credit or debt cancelled. A group of medical problems, such as tuberculosis, asthma, cardiovascular, etc., the numbers of which on the card range from 7 to 21, have a group of services which are labeled 7-21, which read, a, physical treatment; b, physical treatment through specific a, local source; c, institutional care; d, persuading patient to remain in institution; e, bedside care-public health nurse; f, dental care; g, optical care; h, prenatal, postnatal care; i, nutrition class. Another problem, called educational or vocational need, has a list of the following services which correspond to it: a, vocational; b, guidance; c, scholarship; d, trade or industrial training; e, occupational adjustment; f, English classes; g, children kept in school beyond work age. Beside the list of services which correspond to the list of 51 problems, there is a list of miscellaneous services, each of which may apply to any one, to none, or to a group of problems. They are: 52, connection with

relatives strengthened; 53, settlement contact; 54, recreational or cultural opportunities; 55, religious training; 56, fresh-air care and vocations; 57, temporary shelter; 58, day nursery care; 59, business equipment; 60, restored to self-support; 61, psychometric test; 62, general physical examination. The question will be raised as to what happens when a problem exists in two members of a family and two kinds of services are given for the same problem. This difficulty is met by a number column where a number corresponding to the number of the family member on the front of card is recorded. Numbers 1 and 2 refer to the man and the woman, and the children are numbered in order of their ages. Thus, if the father and the second-oldest child in the family were suffering from tuberculosis, and the father were receiving sanitorial care and the child clinic care, these facts would be recorded as follows: Problem 7, tuberculosis, would be checked; in the member column would be recorded numbers 1, for the father, and 4, for the child. On the service side, institutional care would be checked with the number "1" recorded in the member column opposite it, and physical treatment would be checked with the number "4" recorded in the member column opposite it. In instances where the problem and the service which was given are not in corresponding groups, the service is related to the problem by means of a note after the service, which gives the problem number. This happens most infrequently, however, so that it is but very seldom that it is necessary to use this device.

The other significant features of this card is a method of checking which indicates effort, or some explanation of a failure to give service. Thus, a check indicates complete service; a cross, service initiated; a circle, service offered and refused; a dash, care not given because of lack of community resources; another device for care given in a previous month.

Some figures based on the experience of 1924 and the first months of this year may indicate some of the possibilities of this method of evaluation. First, let us consider the five methods of checking, with their indications of service completed, initiated, offered and refused, not given because of lack of community resources, and given in a previous month. The figures for 1924 cover ten months only, as the plan was not in actual operation until March. In that period, 57,606 problems were recorded, on which there were recorded 11,094 completed services, a ratio of 19.3 per cent; 3,991 services initiated but not completed, a ratio of 6.9 per cent; 961 services were offered and refused, a ratio of 1.6 per cent; and 145 services were recorded as not having been given because of lack of community resources, a ratio of .2 per cent.

It takes but little imagination to realize the infinite analyses to be made and deductions to be drawn from sets of figures like these.. First we find variations for the organization as a whole, as to ratio of services to problems at different times of the year, i.e., services were at their height in June, with a ratio to problems of 29.8 per cent, with a drop to 18.2 per cent in August, when the staff was depleted by vacations. March, 1925, is a distinct improvement over

March, 1924, with an increase in ratio from 29.3 per cent to 35.9 per cent, a condition which is certainly encouraging, and one which would seem to have some connection with an increased staff. Variations in different districts have their significance and demand explanation. One district, which had been running an average of 40 per cent services to problems, suddenly dropped to 21 per cent one month and then shot up to 51 per cent the next month. It is likewise significant to note a contrast in ratios between a district which was suffering from a depleted staff one month and a district which was very adequately staffed that same month, the one showing a ratio of 11.6 per cent, the other, one of 40.6 per cent. All of these figures may seem to point out very obvious facts, but it is often reassuring to have factual proof of the obvious, particularly when it is a board of directors that is to be convinced of the validity of those facts. From the supervisory point of view, the trends and fluctuations in work from month to month, district by district, presented by figures such as I have quoted, are often some which might never have appeared in any other way, with the consequence that the facts underlying them might never have been revealed. So much for the evaluation possibilities of statistics of problems and services as a whole group, of which, I will again state, we have barely scratched the surface. We find our next evaluation opportunity in studies of individual problems and their services. The fact that the problems of unemployment and underemployment in the statistics for 1924 showed a higher proportion of services offered and refused than any other problem made it seem worth while to analyze those figures a little further. This further analysis revealed the facts that 35.6 per cent of the cases of unemployment received treatment either through an agency or indirectly; in 5.9 per cent of instances, services were offered and refused; and in .8 per cent care was not given because of lack of community resources. The query is, What happened to the other 56.7 per cent? When figures like these are presented to a staff of workers I am wondering if they will not stimulate thought and action.

The study of the problem labeled "Domestic Infelicity" and the treatment thereof yielded some interesting results. In 15.7 per cent of instances, treatment called "social adjustment" was either initiated or completed. In one instance the family was referred to the family court, and in three instances families were referred to the National Desertion Bureau. In 8 per cent the service of social adjustment was complete, and in 7.7 per cent it was initiated. In 2.5 per cent it was offered and refused. Apparently the community had no responsibility in the solution of this problem, as there were no recordings of service not given because of lack of community resources!

In March, 1925, statistics in regard to the treatment of educational or vocational need were of interest, since they showed a marked increase over March of the year before. Problems in March, 1924, numbered 186; in 1925, 331; while services jumped from 77 to 179, showing an increase in percentage of services to problems from 41.4 per cent to 54 per cent, and this in spite of the

increase in recognized problems. These figures were of particular significance, since they followed a decision by the staff to take over the responsibility for doing vocational guidance work with children, with advice of, and in consultation with, the specialized department to which this responsibility had formerly been relegated, and which had been able to give this service to only a limited group. The increase in service figures is gratifying. There still remains, however, the question as to how its quality may be estimated.

And this last question raises another as to what contribution this statistical system does make to the evaluation process. That the figures contain an infinite mass of material for study, analysis, and interpretation is evident. That they are open to criticism because of lack of scientific foundation, due to inaccuracies of checking, of variations in interpretations of terms, is also evident. But without doubt we can accept the idea that they do indicate trends, emphases, and fluctuations in activities with pretty definite indications of degrees of success, and that in so doing they are actually one means of evaluating case work processes.

In introducing this method of evaluation for discussion, the statement was made that it applied chiefly to the evaluation of the executive aspect of treatment. Its effectiveness in indicating leadership treatment must not be overlooked, however.

Some degree of evaluation of the leadership aspect of treatment is implied in the two following methods of analysis of individual pieces of work. The first is a closing entry form which is used by a family care agency. It contains two items of significance to us: (a) problems in the home up to the time of closing, (b) solution of problems, which is followed by the statement that this topic should include a somewhat detailed statement as to how nearly problems were solved and as to why other problems were left unsolved. The other is an outline which was drawn up for evaluation purposes by the Committee on Content of the American Association for Organizing Family Social Work. It reads: (a) What has this piece of case work accomplished for the family group as a whole? (b) What has it accomplished for each individual in the group, with special reference to his or her future? (c) What does this particular piece of case work for this family signify to the community in general and to the progress of the community? (d) Wherein was the work successful; for whom, and what factors contributed to its success? (e) Wherein was the work unsuccessful; for whom, and why? (f) If the failure is to be accounted for by inadequate community resources, in what way are we trying to meet the need? Should the society assume leadership in effort or should others? (g) Does this particular record illustrate in any way the advisability of the society's doing an extended research job as to how they are meeting a particular problem, or does the record indicate that the community itself is partially meeting a need and the society is not giving proper support to the movement because of lack of training of workers, insufficient number of workers, etc.?