had but a slight contact. Two sisters visited the patient in the hospital, one a Catholic, the other a Protestant. Their advice regarding the child differed. All the history was got while the woman was in the hospital, much of it from interviews in the hospital. As between possible plans for the child, namely, commitment, Catholic placement, Protestant placement, and temporary shelter, the worker chose the last. When the mother's physical condition improved, she was sent temporarily to a rather strict church home. Here she responded unexpectedly well. Her indifference altered. She may assume responsibility for her child.

I do not say that this case presents a proved satisfactory outcome. I do not say that it could not have been handled differently with equally good results. I realize that the leadership elements of treatment are not explained. I quote it to illustrate something of the content of the work referred to in the broader study of function, and also because it illustrates (a) what can be done to utilize the hospital opportunity for social help and (b) some of the complexities of the problem of transfer.

The Presbyterian Social Service Department is finding enough recurrence of recognizable social factors in case problems to make it possible to start a classified index. The department's research worker calls it a "rough classification," but it is also a live interest and influence among the workers and students. I do not need to labor to prove to this audience that all varieties of social trouble are found in combination with bad health. The point I have in mind is that ability to analyze social elements in health problems requires a preparation of study of whatever is basic in social case work.

What is basic in social case work? Fortunately, we have another report devoted to answering that question and the question of what is special. Miss Kempshall's committee has, I think, done us all a service in assembling the thought of a group representing the special fields and trying to state their

common content.

Whatever we decide upon as basic to case work ought, I believe, to be included in the training of the social worker who is to exercise social judgment in that middle ground of medical social work. Analysis itself demands it, as medical diagnosis or nursing judgment requires a basic professional preparation.

The line between special services may be drawn so as to include a social case worker within the medical institution or to leave her outside. In either case her professional judgment and skill are needed in the scheme of service to the sick, and must be united in some way with the judgment and skill of the medical profession. Wherever she has her foothold, she will need an equipment of whatever is basic in social work, always including an understanding of the elements of physical and mental health and disease as factors in every social situation.

TENTATIVE OBSERVATIONS ON BASIC TRAINING

Anna Kempshall, Associate Director, International
Migration Service, New York

The statement, recently made, that "everyone believes in coordination, but no one knows quite what it is," might well be applied to basic training. When I have finished these brief observations, either you won't agree with me in the least, or else you will say, "but we have always known this sort of thing." To articulate the obvious is a thankless task, but I am encouraged by the hope that basic training may not be so obvious after all, or even more exciting; it may not even be practicable. It is more fun, however, to be a visionary than a platitudinarian.

I have been associated now for three years with the Committee on Training of the American Association for Organizing Family Social Work. During this period we made strenuous attempts to get at training through the contemplation of our procedures in training; that is, we considered what we gave the student on the first day, and the second, and the seventh; we considered the analysis of records, "first interviews," blocked, or two-day-a-week periods of field work; how much time the supervisor should give to each student; personality equipment, and the function of a sense of humor. But not being able to see the woods for the trees, we finally decided that we ought first to determine what it was we were teaching students in case work, and afterward we might come to describe ways of "putting this case work across" to students. Our emphasis became "what is in this field work experience," not "how does one teach it."

For some time, then, the committee concerned itself with the content rather than the procedure of training for social case work. Laying aside our method outlines, we asked ourselves what were the objectives and ideals of case work practice.

In order to get at this the committee put itself to discussing what might be called "basic concepts in case work," believing that these basic concepts could then be modified in training procedures according to the student, whether apprentice, or student of a school of social work or of a university, and that this training could be modified also, if necessary, according to the equipment of the trainer, the resources of the agency and community, and whether training be blocked or no.

The committee hoped that the description of objectives and practice would suggest the basic principles out of which generalized, psychiatric, family, children's hospital, and other forms of social case work are created.

Realizing that family case work, traditionally an all-inclusive institution, can no longer be isolated, but is, as Miss Libbey said at Toronto, "a sharing process," it seemed wise to call together several fields to explore and try to express ideas of basic content. Hospital, children's, psychiatric, and family workers each tried to state what they were doing in case work and why they did

it; and the other members of the committee, representing the International Migration Service, the Travelers' Aid, and the National Probation Association, also tried to describe the purposes underlying their activities. The statements were made informally, and perhaps the chief value lies in their unpremeditated character. The very simplicity of the descriptions restrained us from trying to impress the group, each with his own superior traditions and methods!

As we compared, then, our several objectives, family welfare case work appeared to us as being a specialization of basic social case work, with perhaps the economic maladjustment generally the presenting symptom, just as there are characteristic presenting symptoms for psychiatric, or probation, or any other form of case work, and special techniques developed for the several treatments. All are conditioned environmentally rather more than philosophically. All evolve from a common background, but with differentiations or slightly different emphases; all tend toward similar or identical goals. I realize that the use of the terms "family case work," in a generic sense, and "family case work field," in a special sense, is inevitably confusing. The fault lies, I think, in the term "family case work" not being as functionally descriptive as child placing, visiting teaching, and so on.

Clearly, the concepts of basic case work had to be agreed upon before we could arrive at concepts of basic training. Once arrived at, it should be possible to discuss such additional topics as personal and professional equipment of the worker, methods in training, objectives of training. As I said before, I am only presenting today the first of these topics, that is, basic case work; its subjectmatter, methods, and goal.

I suppose you will agree readily enough that, as to subject-matter, case work concerns itself with the conscious attempt to make adjustments between people and their social environment. Common maladjustments with which case work deals are implied in such problems as ill-health, mental and physical; behavior, conduct disorders and delinquency; unfavorable personality traits; faulty industrial economic structure, legal entanglements, inadequate education or recreation, migration difficulties, inferior housing or living habits, and problems of the larger community interpreted locally, nationally, or internationally.

The family case workers stated that although the economic maladjustment was often for them the presenting symptom, economic adjustments were not their only objectives, but that any of life's maladjustments or unadjustments were of concern to them. Other presenting symptoms and emphases were noted by the other fields, the International Migration Service saying, for instance, that the characteristic of their subject-matter was that the "maladjustment" generally involved separated families and, always, two or more countries; and the hospital workers, that while health was of course their special concern, health was not their sole objective, but rather that all problems incident to the social adjustments of sick human beings were of concern to them. For lack of

time I have been able, however, to indicate only a few of these slightly shifting emphases.

After considering subject-matter, the committee turned its attention to certain underlying principles common to all case work interpretation, in the light of which social maladjustments can be understood and treated.

The first of these concepts was an appreciation of people as individuals. This involves, we thought, recognizing that every individual is the result of his particular heredity and environment; and this further involves understanding the relationship of past and present factors in the history to the individual's present situation and behavior-in particular, understanding also the relation of the individual to his family, and the family to the individual—and, still again, involves understanding the relation of the family and individual to the community, with emphasis on the way in which treatment may be affected by community conditions.

Next, basic concept requires that all this understanding should be applied to a program of action which will affect better adjustments as well as enhance the opportunities for development of the individual, the family, and the community.

Again, it is fundamental to realize that treatment, since it involves changing habits and attitudes, is a slow process, but we hold that worker, client, and community should be active participants in the entire adjustment process.

While the committee agreed on the foregoing, it was observed that a characteristic of family case work, whether United Hebrew Charities, Charity Organization Society, or International Migration Service, was that the family was the unit around which the action centered; in Childrens' or Travelers' Aid work, on the other hand, the child or the traveler was, generally speaking, the center of work, and the environment was adjusted to the central figure, or vice versa. This is even more true, perhaps, in hospital or psychiatric case work. In this type of agency the patient would be apt to be the center of the case work adjustment, while the family case worker has generally two or more foci in his circle.

After subject-matter and general principles, it was relatively easy to agree on processes and technique for various types of case work, for example, that there should be analysis and evaluation of material prior to an interview, and that each interview should have a definite objective. It was agreed that, between worker and client, certain characteristic professional relationships were set up, so-called "good contacts," "transference," "winning confidence"relationships consciously directed that there was, or should be, the art of interviewing; that there was methodology of investigation; that scientific evaluation and diagnosis were prerequisite to treatment; that the major kinds of treatment included modifying or changing external factors, sometimes called "executive" treatment, and the changing of habits and attitudes, sometimes

called "leadership" treatment; that records and recording had functional importance in the whole case work scheme, not only for the individual, but for research and other community purposes.

A few special techniques were noted here, such as knowledge of medical, or psychiatric, or legal procedures, or of the economic factors. But one so naturally assumes special knowledge in one's own daily practice that I will not stop over details of emphasis except to say that it was felt desirable for students in case work to have practice in two or more fields, basic training being naturally a part of one or all of them. It might not always be advantageous to have one's basic training in the field in which one is going to work. In the smaller communities, where "undifferentiated" case work is essential, the best-fitted person obviously would be one whose training had not been confined to one agency, but this, perhaps, is equally true in larger cities.

It was significant that in considering basic concepts of ethics, the group put itself solidly on record that there were no special ethics binding on any one group of case workers, and that it was to the interest of the profession to have a common code of ethics. It was also unanimously agreed that there was an obligation upon all case workers to join in concerted social endeavor as regards legal, educational, industrial, and public health programs, and to strive to form fair, sound, social philosophies.

The group finally agreed that in the past basic case work had been more carefully articulated and programed in the family field than elsewhere, and this was one reason why "specialized" fields have been wont to ask for family case work training. This does not imply that family case work is "preliminary" or "elementary," but that basic training is essential. Moreover, basic case work is not static nor completed. Day by day original contributions to this same basic case work are being made, both by the older groups and by recent additions and interpretations of such newer groups as the psychiatric. But when procedures common to basic training have been worked out, basic training should be possible to acquire in any field, and special techniques, wherever needed.

To sum up, it seemed clear to us that when the content of training had been fully defined, as we hope the discussion at this conference will help us to do, and certain general procedures for translating this to students articulated, which a number of training groups have already done-but not, I think, in the sense of a complete job analysis-these procedures could then be adapted according to the needs of volunteer, apprentice, or student. A trained person would be one who had knowledge of life's familiar maladjustments, appreciation of the individual, the family, and the community, scientific methods, ethical standards, and the sort of personality equipment which-well, we hope this will one day be defined. At present, as you all know, the only absolutely basic and generalized concept seems to be a sense of humor.

But one word in closing as regards prerequisite equipment for basic training: Has not the time come when we must reconsider training programs? Do you