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contribute to the lack of adjustment, and all of the factors in his environment with particular reference to those dynamic portions of the environment, the personalities to whom he must adjust, before we can be very certain of the steps to be taken in readjustment.

It is, in my opinion, a mistake for such a clinical group to attempt to carry under treatment any considerable proportion of the cases it studies. To do so would not only reduce its opportunities to deal with the constantly increasing stream of cases which the community sends to it, but would prevent the development in other agencies of their own treatment attack and of their use and understanding of mental hygiene principles in their own work. Wherever possable it is clearly desirable to carry on treatment measures cooperatively, the agency of primary responsibility for the child carrying out the social-manipulative measures, and the clinic carrying on the more technical psycho-therapeutic measures. The bulk of the clinic's cases should always be, it seems to me, those which we call consultation cases, meaning thereby that after the study a report and recommendations are given to the agency of primary responsibility, and further contacts made by the clinic to follow up and see what the outcome of the situation has been, or, on request of the agency, as new situations arise. to make this consultation service effective it is necessary to have a very clear understanding between the agency and the clinic, and there must be constantly developing a greater and greater realization of each other's problems, points of view, worker's attitudes, technique, and vocabulary, so that the report to the Agency has meaning in terms of functional effectiveness. Because of the ease with which this can be started, the point is often overlooked that to make it estective demands a great deal of careful, patient, slow work, not only in this particular held of agency and clinic contacts, but in many others, and that the deaned results are not to be obtained in a day. The most necessary item for it accine to be that the clinic shall not pursue a policy of "splendid isolation," but shall actually be integrating itself into the work of the agencies to which it gives

Oor clinic staff, then, must provide for the community, both direct and indirect case services which shall be functionally useful to those whose continuous CAMA with the life of the child are so important in shaping the individual into which the child will develop. In the Cleveland plan both direct and indirect AVAC 40 provided for, and as the plan stands at present there would be, for ethoden coming into the hands of social agencies for a long-time placement, a towing mental health study with report to the agency, but with no assumption ot vesponsibility for the final plan on the part of the clinic. It would give to the elocational system, agencies, and court a problem service concerned with the acy of chilchen who present known problems in adjustment, and the development there of the treatment of such defects. It is hoped to provide for the court 4 special sort of routine mental health survey through which cases would be

chosen for more intensive study and treatment in cooperation with the probation staff.

We have come to the conclusion that there is a definite technique in the setting up of adequate cooperative relationships with another agency. This technique, in our opinion, involves three steps: Through lectures or group discussions the mental hygiene principles involved in work with children may be presented to the entire staff of the agencies with whom one wishes to work. If this is a very large staff, this preliminary work should be done with the supervisory group, since through them all of the case workers in that agency may be effectively reached. It becomes necessary also to develop in the agency one or more people who, through some six months of work at the clinic, have become completely familiar with it and have acquired a great deal of information concerning mental hygiene principles as applied to their own work. The second step, then, in the evolution of cooperation is the provision either of the mental health study type of service or the workers' consultation service, through either of which further diffusion of mental hygiene principles and technique becomes possible. Not only does this result, but the clinic staff itself becomes increasingly familiar with the problems and technique of the agencies with which cooperation is established. The third step, then, is actual cooperative study and treatment of individual cases. Of course, many times these three steps are going forward simultaneously.

It is clear that in the clinical services, as outlined so far, there is constantly being carried forward a mutual education between agencies and clinic which in the long run increases the effectiveness of clinic work and increases its case load capacity. It is not possible, perhaps, in any community, and has not been possible here, to develop these cooperative services with all the agencies that might use them. It has recently been pointed out that we have done far too little work with the settlement houses, with the recreation workers, and with the orphanages; yet until satisfactory cooperative work with case working agencies, the court, and the special divisions of the schools has been established, it is impossible to do very much with the other groups, and in a community plan I would not advise trying to reach all of the groups at once, but instead, attempt to reach first those groups with which satisfactory working relationships are the most important.

Beyond these clinical services there is the large issue of education, which means primarily the education of adults concerning mental hygiene and concerning the children with whom they must deal. It is imperative to recognize the need for a carefully laid plan for such educational work, else the drain upon the time and energy of the staff may seriously interfere with its central objective. There is a great appeal to the individual in being invited to address a women's club or a men's club which is of importance and standing in the town. Such invitations are apt to be numerous and apt to be so numerous that they become a

serious problem. Organization is necessary in advance if the work is really to be effective. As a group we have discarded the single lecture idea as a means of really contributing to the mental hygiene education of the community. It is useful, and we use it, and we try to make our single lectures as educational as possible; but we do not rely on it, and regard it as wasteful. Instead, we have pursued the policy steadily of arranging for talks in series to be given to groups of organizations, such as groups of parent-teacher associations, in such a way that we reach a great many more organizations and reach them more effectively than if we went to each with a single talk. This is the explanation of the fact that in the past one and a half winters we have been able to reach all but fifty-six of the one-hundred-forty-odd parent-teacher associations in Cleveland and its immediate suburbs, and that there is no important woman's club in the city of Cleveland which has not been reached in some way. The problem which now confronts the community clinic is, on the basis of this broad foundation, to do a more definitely educational job in such a way that a considerable group of people will be reached, and yet the time of the staff conserved. So far as the plan has been evolved, there would be during the coming winter a series of sixteen to twenty lectures to one large group of mothers. Realizing as I do the unsatisfactory nature of the lecture as a means of mental hygiene education, it is further planned to split this large group into small groups of twenty with a leader for each. The person who gives the lectures will afterward meet with the group leaders for a round table discussion of the material presented in the lecture, and each leader will then have a round table with her group of twenty to discuss the lecture and relate the material thereof definitely to the problems of the people in the group. From what I know of the Cleveland public and of the group of women who, as a subcommittee of our board of trustees, have evolved this plan, there is no reason to doubt that such a series will be largely attended and will have a pronounced effect upon the community attitude toward children and their problems.

So far we have been speaking only of parents. The parents are not the only group in the community for whom educational work must be provided. The next largest group of people who come intimately and constantly in contact with children is the group of teachers, and here we are confronted with two issues: first, the teacher in the classroom, daily confronted with the problems in adjustment and behavior of the children, harried and torn by the demands of her job, who recognizes her needs for mental hygiene principles and technique in her work. Then there is the teacher in training, who is soon to be confronted by these same problems that harass the teacher in the classroom, and means must be found for reaching this group as well. Then there are the social workers, those in the field and those in training, particularly the latter; and various other student groups that should be reached had we the time and the opportunity. Particularly, courses for medical students seem imperative, if medicine is to make its proper contribution to the whole field. For education and for social service

definite courses have been, and will be, given in the schools of education and applied social sciences. At Western Reserve, which has many advantages, both for students and clinic staff, the method of the formal course is time conserving for the staff and reaches a large group in an orderly fashion, at the same time giving the students university credit. It should be pointed out that other courses in mental hygiene and child training are available, such as the course for parents given by Professor Myers at Western Reserve, and that the clinic group is greatly interested in stimulating attendance at these courses and in increasing the number that are available. In other words, the clinic does not compete with established work, but attempts merely to supplement it by courses dealing with the special phase of behavior presented chiefly from that clinical point of view which is so essential in mental hygiene education.

To carry out all this work in the community demands a high-grade, stable organization as a background for these clinical workers. In Cleveland this organization will probably be an independent board of trustees, appointed in part by the Welfare Federation and in part by the board of trustees of the Children's Aid Society. Our present board, by its own vote, automatically expires on February 1, 1927. The new board probably will follow along the lines laid down in the make-up of the present board, which includes a wide representation from the Board of Education, parochial schools, the Juvenile Court, the several women's clubs, the Parent-Teacher Council, the Welfare Federation, the Jewish Welfare Federation, the Cleveland Foundation, the board of trustees of the Children's Aid Society, the Federated Churches, the Academy of Medicine, several departments of Western Reserve University, and the boards of a number of cooperating organizations. There is a principle involved in the selection of such a board, which is that it should be widely representative of community interests, and particularly should be an interlocking directorate. Not only should the board stand for something in the community, but it should stand for something in the clinic, and it is imperative that such a board should be well informed concerning the operations of the clinic, for which reason a series of standing committees should be constantly at work.

With such an organization of board and of clinic, with constant interchange between the two, with clinical and educational services provided, with constant up-building of cooperation with other agencies, and constant resistance against the common trends toward isolation and jealously, it seems to me the community is organized so that mental hygiene work may go effectively forward and help, as it undoubtedly can, in procuring for the individuals in the community a better mental health than they already have, and so increase community mental health.

THE SOCIAL CASE WORKER'S ATTITUDES AND PROBLEMS
AS THEY AFFECT HER WORK

Elisabeth H. Dexter, Director of Social Service, Board of
Education, Newark, New Jersey

Personality is the case worker's stock in trade. The personal element which denreduces into her contacts is essential for the development of the rapport that must be established if she is to gain a real understanding of the client's obiem and work out with him a new orientation. The interplay of her persenality, and of her client's forms the medium of her work and sets in operation the case work process of disintegrating the present situation for the purpose of reintegrating it on a new and better level. Her entrance into the case precipitates Ĝis process, and because she herself becomes a part of the experiment, she cannot deal with her clients as laboratory material, and must take into account her own reactions as part of the total reaction that requires constant testing.

Cise work technique embraces the knowledge of certain sciences and what may be termed case work crafts, but the reason why that technique is still intangible and unformulated is that its essence rests on the worker's personality. Net sight into the motivations not only of others, but of herself, determines what she sees, how she sees it, and how she deals with it. None of us can take for granted the accuracy of our understanding. It can be maintained only by self examination, which should continue throughout the treatment of the case. tu chout, since the case worker is part of the case work situation, she has to keep 48 perøstent track of herself as she does of her clients.

the social worker is often accused of entering social work from motives that would be disconcerting were they recognized. This is equally true of the motive that lead to the choice of any profession. The urge is the same: the sexiong of satisfaction which in itself is an essentially healthy motive. The impored at consideration becomes the sort of satisfaction one is looking for, since tvs will not only determine whether the job is a healthy or an unhealthy experapace fou the worker, but will determine the quality of her work.

Camly the choice of a case work career calls for no apology, for it offers a vaxxptionally rich and constructive experience. The case worker has an oppomponry, to become acquainted with every aspect of life. She sees life as a wede, becomes aware of its underlying forces, and with a more realistic underaraling van view it with detachment. If personal development comes from ang ang reality, certainly the case worker, alert to the realities that abound in ay we &. Max every chance for personal growth. It is only in literature that portunity to extend one's personal boundaries to anything like ice, and social work has the advantage over literature of affording Nomre active participation.

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Lany other profession, social work may be used as a refuge. Through it

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