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term patient than the social worker would be entitled thereto. A patient, whether medical or social, is somebody who from the social point of view is almost always, if not always, in the passive voice. Somehow this whole question of society is bound up in the question of the passive voice. What the socialists and even the anarchists want is not more than what everybody wants: such a freedom as will permit each person to be duly and profitably active in such wise that his activity is consistent with that of others. What is the source of inactivity, perverted activity, passivity, counteractive effort based on felt passivity, and the like? I have intended to suggest that the basis might lodge in disease, in ignorance, in vice, or bad habits, in delinquency or legal entanglements, and in poverty or other forms of resourcelessness, each one of which forms of evil is by itself removable or in some way to be wholly or partially compensated for. But whether you concede the philosophical basis of this subject, whether you regard its logic as not all well founded, whether you see in my contentions a great deal of medical prejudice and not too much social service insight, I hope you will concede that there ought to be some orderly approach in social case analysis, with or without the artificial aids proposed in my little arrangement of Regnuni M alarum.
Miss Agnes Murray of Denver and Carl De Schweinitz of Philadelphia also participated in the discussion, informally.
CASE WORK ABOVE THE POVERTY LINE
Agnes L. Murray, Assistant Director of Civilian Relief,
In discussing a subject of this sort, our first question is, "What is the poverty line, and at what point does case work fall above or below it?" We have, of course, the text-book definition of the poverty line as the point below which a family cannot live in health and efficiency. We have also in our own practical experience, in C. O. S. work, in childplacing, in medical social service, in organizations dealing with delinquents, and in almost every form of family case work, cases which we recognize as being above the poverty line. What is the distinction which we make in our own minds between these cases and those others which, for most of us, form the bulk of our work?
Is it not really the distinction between the people who come to us or who continue to accept our services of their own free will, and those who are driven to accept the services we offer, by circumstances over which practically they have no control? The largest group of familes with whom we deal is, unfortunately, the group who come to us because they lack the bare necessities of existence. They have to accept what we offer them, whether they like it or not. But, we will all say, no good social case worker will force any plan on a reluctant or unwilling family. True, but do we always realize the constraint that the very fact of their necessity places upon them. In many of them, it seems to me, far more than among the social workers, is the feeling that they must take what is offered, without complaining or explaining, for fear they may get nothing. And on the other hand, the feeling prevails among many workers that only through the giving of relief and its implicit threat, can constructive work be accomplished. This feeling is seldom formulated, even less often admitted, but it nevertheless exists. It is illustrated by the question put to a Red Cross Home Service worker who was addressing a group of social workers, and who stated that the government was taking most of the financial burden of the soldiers' and sailors' families, so that a very small part of the Red Cross work would be relief work. "But," said the questioner, "how will you have any hold on them?"
The line between these families on whom we have a "hold," in plicit or expressed, and those on whom we have only the hold that personal influence and real helpfulness as recognized by them, can give us, is the poverty line. And this distinction is the great fact which we must recognize in social work above the poverty line, and in the light of which all the other facts concerning our work must be reviewed.
First of all, we must realize that work with both types of families is the same in method and spirit,—in that spirit of developing resources and overcoming disabilities which constitutes case work. This fact is is the same in method and spirit, in that spirit of developing resources particularly important in its relation to the understanding and general acceptance of the case work method. There are many people who can, and sometimes do, express their disapproval of our methods and our failure to get their full sympathy and understanding for the work we are doing, by refusing our services. Nearly all dispensary patients, for instance, if they do not appreciate the value of the services which are offered them there, have the choice of going to a private doctor, and not infrequently exercise it. Nevertheless, the great majority of them are coming back to us again and again for help and advice, are sending their friends to us, and are acting as advertisers and boosters of the very methods which many people still believe are employed only in behalf of those who can neither resist or resent them. It would seem that this fact ought to be given wider publicity than it has received in the past, both to the general public and among possible contributors. Many people still think of the methods of organized charity as being a detective agency investigation to determine the worthiness of those whose statements are found to be true, and to protect contributors from the possibility of giving money to those who have departed from the straight and narrow path. That the recipients of organized charity choose those methods when other paths lie open to them would be an eye-opener to those who realized it.
Necessary Distinctions in Treatment
In spite of the fact that the method of dealing with both types of families is in essence the same, there are many minor differences. Case work above the poverty line is absolutely dependent for its existence on the satisfaction of its clients. In a certain sense this is true of all social work. But in relief work, that sense of necessity, the feeling that beggars may not be choosers, which, more often than we realize, is present in the mind of the client, leads him to cover up a dissatisfaction. The average family has overcome whatever dislike it may have had for investigation before making any appeal. And there is a real temptation to the busy worker to go ahead with the steps of her investigation without the close cooperation that ought to be present. Too often we use the word only of the family falling in with our plans, rather than of the working out of a plan together with them.
On the other hand, work above the poverty line has also its temptation to the busy worker. We are in danger of losing our power of giving any assistance to a family if we take a step without their full consent and understanding. The moral of this is, of course, to take time for full explanations of every necessary point in the investigation. But sometimes it is easier to leave a visit unmade, a relative unseen, than to go through the lengthy process of explanation. This is the danger of which we must beware.
Case-work below the poverty line is often apparently more effective than that above the line, as paternalism is often more effective than democratic government. We can do for people only what they will let us do, and people below the poverty line are, on the whole, more susceptible, more ready to accept ideas and suggestions. The exceptions among them —the few people whom we find clinging to their own opinions and refusing to accept assistance until they themselves are convinced that it is the best thing for them—go to prove that work which makes these demands, as most work above the poverty line does, although more slow in results, is, in the long run, more fruitful.
The Opportunity of the Red Cross
It is along these lines that the tremendous opportunity of the Red Cross, in its Home Service work, lies. The opportunity is great not only because of the newer and larger group of people whom it reaches, but because of the tremendous extent of the work. Home Service, with its gospel of the case-work method, is reaching not only the large towns and cities where it is striking because of the new group of families which are being served in this way; it is reaching also the hundreds and thousands of small towns, villages and countrysides where the county poor-house or the undirected effort of church or neighbor to bring a little relief to the utterly destitute, have been heretofore the only social agencies known.
The fact that it is so easy to demonstrate that Home Service does not fall under the head of charity as that word is understood by the average individual, gives a great educational opportunity. Little by little, as people come to see the ideals of constructive helpfulness which are a part of the Home Service work, they will come also to see, with a little suggestion on our part, that these ideals are not confined to work with soldiers' families—that they are the only true way of helping any family in difficulty. As we explain to the inquirers about Home Service that it is not charity, but a part of our effort to show that the whole community must share the burden left by the man who has gone to fight the community's battles, so we may later be able to make them see that the whole community must share, not as a matter of charity, but of social justice, with the man for whose failure the community, directly or indirectly, is responsible.
Again, as the job of the Home Service worker concerns itself frequently with personal social service to many who under no circumstances can be considered as having problems due to poverty, so the time may come when rich as well as poor will seek the services of the social interpreter and assist in solving their family problems. In past days, the priest, the clergyman, the family doctor or the family lawyer were the recipients of these confidences and the adviser in all kinds of troubles. Now few families maintain such relationships. We have realized for a long time that there was no reason why social service should be confined to the poor. May not this be a way of showing those above the poverty line the possibilities of helpfulness in the job of the social expert, and of making that job one of the assurances of the future? This is perhaps too far to look ahead. But that case-work above the poverty line, as well as the whole case-work method, will receive a tremendous impetus through this war work, is a fact which no one can doubt.
CO-OPERATION OF THE HOME SERVICE DEPARTMENT OF THE AMERICAN RED CROSS WITH OTHER SOCIAL AGENCIES
Harriet E. Anderson, Field Supervisor of Civilian Relief, Lake Division, American Red Cross, Cleveland
The great inspiration to co-operation in this present year, 1918, is found in the number of new people who are engaging in some branch of social work. People who could not be persuaded to work for pay are now seeking service because of their desire to help win the war. College graduates and others, well equipped to give a fine grade of service, may now be secured in many lines of social effort. The Home Service department has an undreamed-of opportunity, not only to interest new workers in Home Service families, but to awaken an abiding social consciousness through the contact with these families and the permanent and established social agencies of the community. To understand and definitely face the purpose of co-operation may help to secure it.
The Home Service department of the American Red Cross exists to minister to the families of men in the service and to maintain their morale, so that they will encourage rather than discourage the men at the front. It is expected further that the family will not be suffered to lose its former standard of living, but on the contrary that the family shall be benefited mentally and physically, as the government strives to improve the men in service. To this end co-operation with other social agencies is necessary. The specialized service of these agencies will be needed to supplement the best efforts which the Home Service worker can give. No organization nor individual can be all things to all men.
Two New Agencies of Education for Family Welfare
Two new social forces should be used especially in this time of stress in the industrial world and of mounting prices of the necessities to maintain life; namely, the child welfare committee of the Council of National Defense and the demonstrators of the Food Administration. The child welfare committee of the Council of National Defense, with its work of reducing the death rate of children under five years, as instituted by the Children's Bureau, gives invaluable impetus and publicity to a fundamental social aim, that of not only keeping the baby alive but of giving him a basis of health on which to grow. The Home Service worker should use this new group of enthusiastic and specialized workers by bringing babies within the range of their influence. The mother finds new interest in caring for her baby and adding to his weight and stature if she is in competition with other mothers.
No opportunity like the present to teach proper feeding has ever before been given to the worker with families. The curtailment of certain foodstuffs forces a consideration of the matter of food, regardless of the income of the family. The large numbers that have made their diet of bread and coffee are seriously affected. In this crisis, we have at our doors literally the demonstrator of the Food Administration.
As I see these fine college girls penetrating into every hill and valley of Kentucky with their message of what to eat and how to prepare it, it seems too good to be true. There seems to be no school house too small nor no cross roads too remote for them to visit. They have the message. It remains for the Home Service worker not to lose this opportunity to help to bring health and strength for the future to the families under her care.
The country school is another resource which we might almost call new, because so little is known of it and the rest of us give so little attention to its encouragement. This is the time for the Home Service worker of the rural district to give some measure of appreciation to the country school teacher. Many of the men in service will be taught to