t#s6l;%^^ IS'*-: *m H^se?^-^«^"M. «'" 'm^^-\:f- rift .,**i* ^f;^!*-- ^^ ,^^ Hatt G^nllEgc of ^Agriculture Kt (Sarnell MmacrattH Dtliaca, N. 1. Siibrarg Cornell University Library HV 40.A51S Social work with families; social case tr 3 1924 013 793 959 Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924013793959 mammmmmmmmmmmmmtmmmmmmimmmmKmimmmmmmmm»i THE AMERICAN AmDEMY OE POLITICAL tyiND St>CIAL SCIENCE ''-'-:':'/ - -VolSxXJiiL: . : M4F, i&iS Whole No. 166 Sdcidl W^ WiMi Farmlies ''-■' IsSmd Birl^oMftlpby ihe^ Amer'^t)^ Academy of Political ■and Socicd $«^imce a(€mcord,, New ..EMtmp.ld;fftce^Wi,bdl^td .^^^ c. - ■ -:''■''.' ■', ''■'"■ i -:-.:■• ■:"' ' - '■:"' '. August HJi, 191^. '■ '■ '';.''- '-' V , ■•, -,. - \'. 'Cloth,, 51:1 ;Pas^« ;■.!,.;■,.' /","^''^,^' . ■^i'ice;'.$2.b0.r«|,et'' v " ' /■;;^^^^V!^.;F6UR PRINTINGS J|^^TW1^LVE„ MONTHS: ''■; ; ,A,Boak pn Sojqiil. Evidence if or ill wib /make tfecisidas effecting the J ^elfarfe of individual?..; ''" ■„■ ' ", '■ '"< -'',';'■ ,'-,'',,■■■■,., ■ V, Adoptfd,i4,i5 a text in many College Courses and Msefut j«»t «iily for social Cia^ewopers. but for ^tose who are j^t^wsted m the social side of i^tAitia^yia^stf^ti^a^^ ', "'.v ''''',■" ■''/ \ RUSSELL SAGE FOUNDATrON , 130 EyySt 22wd I^TREET, NEW^^V^ THE AMIERIC: AN ACADEMY OF POLITICAL AND ASOCIAL SCIENCE ; M«»*ibeJ'»liiJ>. . , T^ THE AWNALS of the htmrvi&n kc?Li%ra$ of ; I^pUticali^aiid /Sociai Sdence is $6.00 per year. Single cdpies sure soid^ are sent to all ifl€iiribe%s of,the Atiadetty^ JR4.bo (or iflj&te) oftlie aionual membersh^ fee of S5.00 beitig'for;^;Stibsciiptioti to the publicationvv Membership . in the Academy; amy .^fe;.^^ t>y applying to the Secretary, 36th Street and .W^ob^laiad AveilW/ Phik^elphia, the membership fee is $5;oo, life membershilp fee, $ipo. , Members not only receive all the regvilafpubHca^dnSoift^e Academy,, >^^^ als6 invited tb attend and, take part in the {scientific inbcHi^gs, iuid have the privilege ,of applying to tiieEditbrtal Council if or, lisfOrn^ current political and /soiti^l,cfue^ttonsv\' ''''\'A^'V' ''''',' :''■;■■'■■.; STATEMBiJT OF THIS OWWERSHlPi MANA^BMENT, BTC.OF TBK ARHAL8 OF THE ; AiSJEmcAjl ACADEMY OF POLrTICAt ANb SOClAL SCIENCE , ^Mlshed bl-moatllily $X Concord,' N. H>i as reduired ^ the Xcl of Au«u^ 34, 1913. KiHaeof iStockhoMwa or OWep^s , ' i ■ Post Office Addross ;^lt6t. Clyde tyndon King, XoOW B*U, West PbilideliihU, Pa. ; Managing Editot (none). ,• Buaioem lillaiutger (nx>n«), ' < , w ' (to Depot Street, Coacbrd, N, H. Pablisher, AmerteaA AMdcmy of Roliti«al and Social Science, J jeth and Woodland Avenue. " ' ' , •' ' -,' ''.,;■, . {'■':■-■'" I ■ We'st.PhUadelphia.Pa. •:'• Ovg'ners (if a ciu'pacatitm, giye-nit^eti ahd addressed of, stockholders holding i per cent or more of tdtal' , ampimt of atoqlOj The Am«ricaa Ajeadetny ofPaUlicaland Social Science,!.. S. Rowe, President, J, P; ticht<;nberger, Seo'et^ry, Ch«rles J. Rhofifles, Treasurer,, to D^pot Street, Consord, N. k., 36th and Woodland Avenue, >A^eBtTJilla4etphl«, Pa, ' ' , ' < KnowA bondholders, mortgagees, arid other^ Se«(iri' Anterlcao Academy of Political and Social Science. , ' i ' ' ,' CLYDE L. KING, Editor. Sv6rn to ai^d Bu))SCrih<:il before me this 8(h day Of October, 1917. :'''",,.: ^,,'- ;:■''■''■ \ ' '•"',', ■' ■ ,' ■' G.'E.;mTZSCHB. Notary Ptiblic.' Tarii'exiRir^s January'S8,;t9ii. ■■ '' ''/ ^ir. 13 Margaret F. Byington, Associate Secretary, American Association for Organizing Charity. PART II— SOCIAL CASE WORK WITH THE PHYSICALLY OR MENTALLY HANDICAPPED OFFSETTING THE HANDICAP OF BLINDNESS 28 Lucy Wright, Associate Director, Boston School of Social Work. • THE CRIPPLE AND HIS PLACE IN THE COMMUNITY 36 Amy M. Hamburger, Formerly Assistant and Associate Director, Cleve- land Cripple Survey. THE- SICK 45 Edna G. Henry, Director, The Social Service Department of Indiana University. PRINCIPLES OF CASE WORK WITH THE FEEBLE-MINDED. . . 60 Catherine Brannick, M.D., Psychologist, Massachusetts Reformatory for Women. y- r CASE WORK IN/THE FIELD OF MENTAI+, HYGIEN? 71 Elndra E. Thomson, Executive Secretary, Illinois Society for Mental Hygiene. PART III— SOCIAL CASE WORK WITH THE SOCIALLY HANDICAPPED THE FATHERLESS FAMILY 79 Helen Glenn Tyson, State Supervisor, Mother's Assistance Fimd of Pennsylvania. iii iv Contents DESERTION AND NON-SUPPORT IN FAMILY CASE WORK. . . 91 Joanna C. Colcord, Superintendent, New York Charity Organization Society. THE ILLEGITIMATE FAMILY 103 Amey Eaton Watson, Chairman, Philadelphia Conference on Parent- hood. THE FOSTER CARE OF NEGLECTED AND DEPENDENT CHIL- DREN 117 J. Prentice Murphy, General Secretary, Boston Children's Aid Society. ESSENTIALS OF CASE TREATMENT WITH DELINQUENT CHIL- DREN 131 Henry W. Thurston, Member of Staff, The New York School of Phil- anthropy. THE HOMELESS 140 Stuart A. Rice, Formerly Superintendent, New York Municipal Lodging House. ALCOHOL AND SOCIAL CASE WORK 154 Mary P. Wheder, Secretary, Clinton District, New York Charity Or- ganization Society. THE IMMIGRANT FAMILY 160 Eva W. White, Director, the Extended Use of the Public Schools, Boston. THE SOLDIERS' AND SAILORS' FAMILIES 171 W. Frank Persons, Director General of Civilian Relief, the Americaii Red Cross. BOOK DEPARTMENT 185 INDEX 195 Contents BOOK DEPARTMENT THE BUSINESS MAN'S LIBEARY Bailbt and Ctjmmings — Statistics (R. Riegel) 186 Kemmerek — Postal Savings (F. Parker) 185 LBPFiNGWELli — Scientific Office Management (M. Keir). 185 Secrist — An Introduction to Statistical Methods (R. Riegel) 186 WiCEWABB (Ed.) — The American Year Book, 1917 188 ECONOMICS Bullock — Selected Articles on Single Tax (C L. King) 188 HoBSON — Democracy after the War (E. M. Patterson) 188 Kellogg and Taylor — The Food Problem (H. R.,M. Landis) 189 Nicholson — War Finance (E. M. Patterson) 190 Phelps — Selected Articles on the Income Tax (C. L. King) 188 political science Freund — Standards of American Legislation (F. G. Bates) 190 KETTLEBOROUGH-^T^e State Constitutions (C. H. Crennan) 191 Robinson and West — The Foreign Policy of Woodrow Wilson, 1913-1917 (L. P. Fox) , 191 sociology Calhoun — A Social History of the American Family from Colonial Times to the Present, Vols. I and II (J. P. Lichtenberger) 193 Carter — The Control of the Drink Trade (E. G. Lowe) 194 Steinbk — The Japanese Invasion (C. Kelsey) 194 FOREWORD The development of the principles and methods of social case work has been a slow and almost unconscious evolution. Only re- cently have social case workers become articulate in the technique of their field. They have been such "deadly doers" that little time has been left to analyze critically the technique of the day's work. Miss Richmond's book, "Social Diagnosis," is monumental not only because of its scope and scholarship but because it marks the beginning of that painstaking analysis of the methods and principles of social case work which must obtain generally before social case workers can call their chosen field a profession. Miss Richmond's book deals exclusively with social diagnosis, treatment being omitted except in the sense that all diagnosis is a part of treatment. A volume on Social Case Treatment is therefore opportune, espe- cially in view of the urgent need at this time of an authoritative statement of the best thought and practice in the field of treatment, because of the many social problems incident to the war. While the war may have created no new type of social problems, it has increased them many fold and has given some entirely new settings. The inevitable dislocation of industrial life with its migrations of workers, the disruption of family life in many homes following the departure of the father or son for war service, the readjustment to industrial life of the soldier returning from the front, possibly crippled, or handicapped by bUndness, all make a knowledge of the principles and methods of -social case treatment of paramount importance. It is hoped that the present volume in addition to being of interest to the general reader will prove not only a reference book to which social case workers generally may turn for new light on some of their oldest problems but that it will also serve as a store- house of knowledge based on tested experience for all Home Service workers and all those other workers, professional and volunteer, who have been drafted in the ranks of social case workers because of the unprecedented demand for this type of work incident to the war. It should never be lost sight of in this connection that the problems of "civilian relief" differ in no essentials from the problems which social case workers throughout the country have been meeting in their Viii FOBEWOBD day's work before the war and that the methods of helping to solve them differ in no essential details from the methods followed in the past by the best of our case-working agencies. Human nature does not change over night nor during a war. The big problems of a widow's family are the same, whether the husband has lost his life in the military or industrial army. The readjustment of a man to industrial life is much the same, be he crippled by a bursting shell or by a bursting fly wheel in the factory. Questions of care for orphaned children are much the same be the cause of their orphan- hood sickness and anxiety incident to war or death following occu- pational disease. While certain articles like that by Miss Hamburger on "The Cripple and His Place in the Community," that by Miss Wright on "Off-Setting the Handicap of Blindness" and that by the Director- General of Civilian Relief on "Soldiers' and Sailors' Families" may seem to have more direct bearing on the problems of the Home Serv- ice worker, it is felt that all the articles throw light on problems with which Home Service workers will sooner or later have to deal. In fact the principles and methods of social case work are imiversal in their apphcation. Not only is the corner-stone of all case work, — individualization of treatment, — revolutionizing the science of penology, but it is profoundly modifying our educational practice. Small classes, more frequent promotions, special classes for the backward and for the handicapped as well as the movement for industrial education, all reflect the growing recognition among edu- cators of the principle of individualization. Even in our home life, we must use this principle if we are to understand the developing life of our own children. Come what may in the future evolution of our social life, this principle will stand as vital, and the time and thought and patience that are put into this delicate work will re- ceive more and more recognition as the parent, the teacher and the social worker can show the results that come from its application. A volume on social case treatment covers but a section, though an important one, of the whole field of social work. The unity of social work is such that the effectiveness of any piogram of social workers is materially affected by the quality of work done in any part of the field. All good social case work has a double value. It not only makes possible work with a given individual or family, help- ing them to solve their own problems, but with its first hand know!- Foreword ix edge of social and industrial conditions and of the action and re- action of environment and heredity, it affords a valuable fund of information for scientific research and thus lays the foundation for effective propaganda looking toward the creation of an intelligent public opinion which is important for all wise legislation and essen- tial for all effective law enforcement. Social case work when well done is therefore not only constructive but preventive as well, both for the individual and for society. The articles in this volume have been divided into three groups : those which afford an approach to social case treatment; those articles which discuss social case work with the physically or men- tally handicapped; and those articles which deal with social case work with the socially handicapped. The last article in the first group, "The Normal Family," affords a perspective for all workers with family problems and so adds materially to the value and unity of the volume. While there is no fundamental difference in the technique of social case work as found in the various articles, they do , exhibit some adaptations in case work technique that are of significance. Certain points of view characterize all or almost all the articles. The many references to the war show what a big place this cataclysm is occupying in the thoughts of all the writers. Almost all the articles breathe an impatience with the point of view that a social case worker's job is done when the individual or family in question has been helped. There is a sense of humility pervading the articles, though each is written by one chosen for his or her wide experience in social case work in his or her particular field. The thought con- stantly recurs that workers in each field are still breaking new ground. All the articles reflect a great truth which is constantly borne in on all social case workers but often missed by those who believe that any one panacea can remedy all our social evils. This truth is that the causes of our various social problems are exceed- ingly numerous, varied and complex, subtile of analysis and diffi- cult of appraisement and that the solutions of these problems are as many and varied as the causes themselves. This may prove dis- quieting to some. It nevertheless remains true that there are few if any short-cuts in the field of the social sciences and that a sympa- thetic understanding of the complexity of our social life is the first step in all real progress. Frank D. Watson. THE OPPORTUNITIES OF SOCIAL CASE TREATMENT By Karl deSchweinitz, G eneral Secretary, Philadelphia Society for Organizing Charity. The door of the examining room opened and two young men came into the recruiting office, each with a slip of paper in his hand. They looked about uncertainly for a moment; then catching sight of an "information" sign, walked over to the desk which was thus labeled. The soldier who sat behind it glanced at the memorandum that the first man handed him. "You've a double hernia," he announced. "Same with you," he added, turning to the second volunteer. "You can't enter the army unless you have it fixed," he con- tinued, addressing both of the young fellows who apparently desired further information. "Here, I'll give you the name of a hospital where you can have an operation for nothing. If you weren't going into the army it would cost you $120." He scribbled the address upon the back of the memorandum. "Even if I wasn't going into the army I'd have the operation. I wouldn't go around with a thing like that for anything. Why you're liable to wake up some morning and find yourself dead." The soldier paused, but not long enough for a reply. "There's nothing to the operation. I've assisted at hundreds of them in the military hospital. It doesn't amount to much more than taking an anesthetic. I've seen men up and about in eight days. It won't cost you a cent and if you want to get into the army it's the thing to do." The first young man looked at the second. "Come on," he said and picked up the slip with the address of the hospital upon it. Together the two volunteers left the office. Admit that the soldier urged a course of action without hav- ing any fundamental knowledge of the needs of those whom he advised. Admit that his method of doing this was crude. He nevertheless was following a procedure that should be most sug- gestive for those who are interested in the development of social case treatment. 2 1 2 The Annals of the American Academy The men came to him in a predicament. That is precisely what brings people to the case worker, whether the predicament be called trouble, distress, a situation or misfortune; whether it be a prison record, truancy, poverty or sickness; whether the case worker be a representative of the court, the children's society, the society for organizing charity, or the hospital social service department. What the soldier did and what the case worker must do are basicly the same. The soldier, first of all, told the men just what their predicament involved ; — they could not enter the army because they were suffering from hernia. Second, he pointed a way out of the difficulty — the hospital. Third, he suggested various motives which might help the men to take that way. He appealed to their sense of economy, or rather to that fundamental desire to get some- thing for nothing which seems to be part of everybody — "If you weren't going into the army it (the operation) would cost you $120." He aroused their sense of fear on the one hand — ^they might wake some morning and find themselves dead — ^and he allayed it on the other — ^the operation "doesn't amount to much more than taking an anesthetic." Study of almost any record of successful case treat- ment will show a procedure similar in its rudiments to that which the soldier observed. Consider, for example, the predicament of the family of Herbert Jones. They were without food. Nearly all of their furniture had been sold. Mrs. Jones and one of the children were sick. Mr. Jones was out of work. He had been arrogant toward his fellow workmen, so arrogant that the union to which he had belonged was unwilling to help him. He was drinking heavily. He abused his wife and had been brought at least once before the Domestic Rela- tions Court. The case worker discovered that Mr. Jones was an extremely sensitive man who craved friendship and affection. As often happens with such men his arrogance was the unfortunate result of fear of injury to his feelings and of his unconscious efforts to protect himself. He had taken to drink because he thought that in that way he could become a good fellow among the men of the neighborhood. He abused his wife partly because of remorse for his intemperance and partly because he was jealous of what he thought was her too great devotion to two children whom she had had by a former marriage. The first step in treatment was to show the man and the woman Opportunities of Social Case Treatment 3 what was involved in their predicament. The case worker inter- preted the husband to the wife, helping her to see that the man's abuse and his jealousy were really caused by his affection for her. Next came the suggestion that, were the source of irritation to be removed, the family life could become happy once more. The way out lay in an arrangement to have the stepchildren live with their grandparents, and the woman's desire for a happy association with her husband provided the motive for doing this. With the man, treatment involved a frank facing of the facts of his situation. His baseless jealousy and the unpleasant effect which his arrogance had upon those who knew him were made plain to him. His predicament was himself. The remedy lay in a struggle against himself. The social worker offered him assistance in this struggle. His home would be reestablished. His wife would be helped back to health. The union officials would be placated so that he could once more obtain work. The motive suggested to the man was the possibility of achieving the kind of family life and companionship among his fellows for which he longed. Accompanying this was the encouragement and the sense of assurance afforded by the in- terest of the case worker in his welfare. The method of treatment here was precisely the method of the soldier in deaUng with the two volunteers. First, the case worker showed the family what was involved in their predicament, second, she pointed to the way out, third, she supplied a motive. Often the steps in this method follow each other so closely as to render analysis almost impossible. Thus the realization of the predicament may furnish the motive. Again, the man or the woman may have decided upon the remedy but may need motivation; or realizing their predicament they may need both a way out and a motive to inspire them to take that way. A teamster who liked horses too much to want to learn how to operate a motor-truck, found himself reduced to such odd jobs of driving as he could find. Gradually he became accustomed to irreg- ular work until unemployment became a habit. He realized what was wrong but knew no remedy, and even if he had known one he lacked initiative enough to lift himself out of his predicament. The solution lay in a job on a stock breeding farm and the motive which led him to take this solution was the adventure of going to a new and a rural environment. 4 The Annals of the Amebican Academy Although it may not always be necessary to show a man either directly or by implication the elements of his predicament it is essen- tial, of course, for the case worker to understand them. This means investigation, and after investigation diagnosis. The method of investigation is well defined. The importance of the first inter- view, the value of seeing relatives, former employers, and the other factors in this phase of case work are admitted. Social workers, however, must do more than follow these steps. They must take them without for a moment forgetting that the end of investigation is diagnosis and that diagnosis is the beginning of treatment. Treat- ment depends for its success upon an investigation conducted with this in mind. Diagnosis, moreover, is made primarily, it should be remem- bered, for the benefit of the person xmder treatment, not for the in- formation of the case worker. Here, again, inspiration and sugges- tion can be obtained from study of the methods of the medical pro- fession. The tendency among physicians, evidenced by the in- creasing stress which is being laid upon personal hygiene, is to make the patient understand his trouble in order that he may adjust his life so as to overcome his disease — of com-se, with the help of what therapeutic or surgical assistance may be necessary. This also must be the method of social case treatment. The way out or the ways out which are opened to the family or the individual after they have been shown the impUcations of their predicament are really opportunities to develop the kind of personal equipment and environment that will enable them to reestablish themselves. The job in the country was not the solution for the teamster who had acquired the habit of unemployment. It was merely the offering of a new environment in which he could reach the solution. The solution itself lay in the development of character, of the habit of industry, of a greater measure of initiative. The re- moval of the stepchildren to their grandparents and the obtaining of a job for the man who had been abusing his wife was not the solu- tion. He had had many different jobs before and conceivably the stepchildren might have left his home without producing the desired result. The ultimate solution lay in his victory over himself. The job and the change in domestic arrangements served merely to pro- vide him a more favorable environment. The elements involved in securing such an environment and in Opportunities of Social Case Theatment 5 making possible the development of a better personal equipment are as well defined as are the processes of investigation. They are health, education, mental hygiene, home economics, work, play, spiritual influence. These things are the means which the case worker uses in administering social treatment. They must not be considered as ends in themselves but only as influences in helping the family and the individual to readjust their lives. Case work agencies which in their annual reports list the num- ber of people for whom they have obtained jobs or hospital care tell only a small part of the story. Indeed, better case work is implied when a man secures employnient for himself than when the social worker finds the job. The purpose that the job or the other element in treatment is to serve is the important consideration. Thus, a family is persuaded to move to another neighborhood in order that the oldest boy may be better able to resist the temptation to join a street gang. The boy is invited to become a member of a settlement club so that he may be provided with a legitimate outlet to his desires. His mother is induced to take more care in the keep- ing of the house that he may find the home more interesting. The school teacher is asked to find what studies appeal most to the boy in order that opportunity for development in a congenial direction may be given to him. These efforts are all designed to enable the boy to grow to be a useful citizen. They are not ends in themselves, desirable though they may be. Again, the administering of social case treatment does not mean that the case worker must fulfill the function of nurse, teacher, clergyman, or housewife. To open the opportunity of health to a man one need not be a physician or do the work of a physician. Recognizing the importance of health to the well-being of the in- dividual, the case worker's task is to help the family to realize this also, and then if necessary to suggest the place where the essentials of health may be obtained. Similarly, the case worker by intro- ducing the clergyman or the friendly visitor endeavors to provide the spiritual and personal influence which her diagnosis shows that the man, or the woman or the family needs. It is not necessary for the case worker to be able to teach a housewife how to cook or to scrub. Case workers have scrubbed floors and cooked meals for families under treatment, but when a case worker has done this it has not been for the purpose of teaching the family how to do these 6 The Annals of the American Academy things but for the influence which such an action might have upon her relationships with the household. This must not be understood to be an underestimating of the importance of health, education, mental hygiene, work, play, home economics and spiritual influence as ends in themselves. To obtain them is so important that more and more attention must be focused upon them if social case treatment is to realize its opportuniticB. Indeed, it is most desirable that effort be made to change the method of recording case work in order that the need for these things may be emphasized even more clearly. Porter R. Lee has criticized the case record as being too much a diary of how the case worker has spent her time and too little a statement of facts upon which treat- ment is being based. It might well be rearranged so as to segregate the various steps that are necessary to develop the personal equip- ment and the environment of the family under care. Thus the case worker in looking over the reports of her work would be able to see at a glance whether or not the need for work, play, health, and the like had been supplied. The opportunities which may make it possible for the individual to readjust his life having been pointed out to him there remains the last element in social treatment — motivation. Often the strong- est motive operating upon a man is the misery of his own predica- ment. This motive may be the knowledge that someone cares, that there is someone interested in seeing him make good. There is not one of the myriad impulses which influence men to action that the social worker is not called upon to use. The supreme art of treatment is knowing what motive to use in a particular situation. Perhaps the best preparation for a proper choice at such a time hes in a study of the daily experiences that mark the cburse of case work. What is it, for example, that caused a family to become self-support- ing after years of dependence on the gifts of neighbors? Why is it that a man who has been a drunkard since his youth suddenly de- cides not to touch alcohol again and holds to his decision? What has caused a woman who has neglected housekeeping to take a new interest in the care of her home? What induced the truant to re- turn to school, the deserter to support his wife, the consumptive to go to the sanatorium which he had been resolved to see no more? Study in other fields should also prove suggestive. Whatever voca- tions have to do with the art of dealing with people can make a con- Oppoetunities of Social Cask Tbeatment 7 tribution to case work. The teacher the neurologist, the student of the psychology of behavior, the salesman will all be of help. Perhaps of these the art of the salesman seems to be the most remote from that of the social worker. Yet the imderlying philos- ophy of his method is the same as that of the person who is trying to help families. The salesman's effort is to make the prospective customer conscious of his need of the article that is to be so|d. Hav- ing created a demand, or if one exists already, having called atten- tion to it, the salesman shows that his goods will fill that demand. Then he clinches his order by giving reasons why the customer should buy, and buy immediately. Thus he uses the predicament, sometimes artificially constructed, the way out and motivation. The psychology of salesmanship has indeed many suggestions for the case worker. One suggestion, however, it must not have. That is the conception of compulsion. The salesman is obliged to bespeak his goods with all the energy at his command. He wants the customer to take his, i.e., the salesman's way out. The case worker, on the contrary, does the best work when, having faced a man with the facts of his situation, she urges him to plan his own way out. Only when the man is unable to suggest a plan of his own does the case worker propose a remedy. When possible, she suggests several remedies so that in making a decision the man has a choice. Moreover, the days when the case worker forced her opinion upon a family are passing, if indeed they are not already past. Is not the use of discipline in the withholding of relief often a confes- sion of the inability of the 'worker to suggest motives that will encourage a man to act for himself? The best social case worker is she who has the greatest faith in people and in their right to make their own decisions. The more nearly motivation becomes not a forcing of the will of the case worker but an inspiration and en- couragement by her to the man after his decision has been made, the more it approaches the true ideal of social case treatment. The art of social case treatment, then, is threefold. It starts with making clear to the family or the individual the nature of the predicament and what that predicament involves. It continues by showing a way or ways out of the trouble and it concludes by appeal- ing to the motives which will help the person to decide to master his predicament and to carry out that decision. The opportunities for social case treatment lie in the recognition 8 The Annals of the American Academt that such a thing as social case treatment exists, and that it is for the purpose of social case treatment that investigation and diagnosis are made. The development of social case treatment depends largely upon the interest with which case workers analyze their own work and profit by experience in alUed fields. They may, indeed, learn much from such examples as that set by the soldier in the recruiting oflSce. His success, crude and unpremeditated though it was, is suggestive for the future of social case treatment. CASE WORK AND SOCIAL REFORM By Mahy Van Kleeck, Director of the Women's Division, Industrial Service Section, Ordnance Department. The case worker is authoritatively defined as one who plans different things for different people. The social reformer, con- sidered as one concerned with movements rather than individuals, aims to secure an identical benefit for an entire group. The case worker fixes attention on the individual. The social reformer devotes his energies to the conditions of the community. In in- terests, immediate purpose, method, and even in spirit and phil- osophy, the two would seem to be far apart. Far apart they some- times seem to each other. The social reformer accuses the case worker of blindness in attending exclusively to the immedate task ahead, — patching up his neighbor's affairs without changing the conditions which have caused his misfortunes. To the case worker, on the other hand, the social reformer seems sometimes to be a dreamer^ thinking about a changed order and neglecting the people who now suffer from it, and who must be reckoned with in an effort to change it. To the outsider these distinctions would probably seem to be a mere quibble, lacking in significance, or at best merely a portrayal of contrasts between two types who must together make up a world. To the social worker, however, it frequently becomes a practical question how most wisely to proportion the emphasis given to the mass movement and to the individual in trouble. In social work as a whole, if we may view as a whole so diverse and com- plicated a set of activities, a fruitful relationship between the two types of effort is a practical necessity. The case worker must be blind who can see no possibility of social and organized effort to change the conditions surrounding one individual after another whom he aims to help. The social reformer who does not draw his conclusions from the actual experience of individuals is in danger of being an unsafe guide in social action. Granted, however, the necessity for a two-fold view of the indi- vidual and the mass if progress is to be made, practical questions 9 10 The Annals of the American Academy arise as to how this relationship can be achieved. The word "co- operation" is not enough. Its terms need analysis in connection with the concrete tasks which the social case worker, or a re- former of conditions, has set for himself. Two of these large tasks may serve as illustrations, — the public health movement and industrial reform. Certainly sickness and a low standard of living would be regarded as giving rise to a large proportion of the prob- leniis of the social worker. Health, or the lack of it, has made necessary the care of the sick as individuals, institutions caring for groups, ofl&cial departments to protect the community, educational campaigns to train individuals in the care of their own health, and bodies of laws estabhshing safe- guards, or controlling conditions, such as quarantine regulations or sanitary codes. The social and economic effects of sickness have resulted in plans for health insurance, which mark a new phase of effort in the health movement. The health movement in its social aspects is a part of social work, broadly conceived. In its medical aspects it affords an illuminating parallel. Medical research is to the practicing physician what social research should be to the case worker. Individual experience should be both a source of informa- tion and a goal of effort. Facts gathered in daily practice may be the basis of laws which in turn are a guide in daily practice. The case worker is both an observer and a practitioner. The social reformer may be a research student studying the laws of social re- lationships or a propagandist, — a practitioner for communities instead of for individuals. The health movement, like other social effort, has three main branches: research for the discovery of knowledge; education, in- cluding the training of individuals and the dissemination of knowl- edge; and reform, or the change in conditions producing disease. It is significant that neither the case worker nor the social reformer would wish to be denied a share in any of these three branches of effort. Each of them, too, has its starting point in individual ex- perience, while the individual is the final test of achievement of the ends sought. The effort to prevent tuberculosis is a good illustration. Medi- cal research showed this to be a disease curable and preventable largely through education of individuals and through control of their environment. Thus its cure and prevention are essentially Case Work and Social Refoem 11 tasks for the joint efforts of case workers and social reformers. Certainly organizations concerned with individuals and families have had an important share in the development of general educa- tional work, and in the establishment of sanatoriums. On the other hand, social reform in relation to the prevention of tubercu- losis, which we think of as including both public education and efforts to improve working and living conditions, has estabhshed a certain foundation for case workers. < In the prevention of tuberculosis, however, as in all other public health work, neither case workers nor social reformers have finished their tasks and it is the unfinished task which challenges them to more united effort. Tuberculosis is essentially a disease of poverty, fostered by under-nourishment, by congested quarters for living, by long hours of work, by dust in workshops, by lack of fresh air, good food, and exercise. The accumulated experience of all the case workers, if it were really to be made to appeal as it should to the public imagination, would be an irresistible force in changing for the better the present conditions of life and work. One reason why the task continues to be unfinished is that the individual experience is not made to count as it should in social reform. The same lack is illustrated in industrial reform, and the many obstacles in the way of its accomplishment. It is a temporary or permanent inability to maintain a normal standard which con- stitutes the characteristic problem of the case worker. Thousands of case workers in many parts of the country are trying to see the way out in this problem as it recurs day after day. It is met in good case work by the establishment of new relationships for the individual, or the vitalizing of old ones, and by a general sharing of burdens, as well as by a new stimulus to the individual. The ap- portionment of burdens, however, is not always clearly appreciated. The time is not long past when charitable societies and relatives bore the whole economic burden of industrial accidents. Now in many states, in Workmen's Compensation Laws, it has been recog- nized that industry must meet the consequences of its own hazards. Health insurance is advocated for the same reason,— to bring about a more just apportionment of burdens. The significant fact about health insurance in relation to this discussion of case work is that case workers have contributed so 12 The Annals of the American Academy little to the movement, either in the way of warning or reinforce- ment. Full realization of what sickness means as a cause of pov- erty should have led long ago to a far more effective organization of the community for preventing sickness and for dealing with its results. On the other hand, the case worker, with a knowledge of all the comphcated factors which are involved with sickness as a cause of poverty, could check too great optimism as to the prob- able results of any one plan of 'reform. The case worker can con- tribute information to social reform, and to this end careful records and frequent and regular interpretation of their meaning are ob- viously necessary. But case workers can contribute something much more important and somewhat rare, — a constructive imagina- tion. Just because they deal so constantly with real conditions, they may be in danger of growing accustomed to them and forgetting any possibility of change. Case workers cannot be content with accepting the established standards of the community, if they are to contribute their share of planning and acting to bring about desirable changes. But the social reformer in contrast must be watchful of a tendency to forget that a plan is not enough, and that it must bear some relation to established standards and the accus- tomed habits of mind in the community. The war, with the violent changes which it produces in na- tional life, demands the constructive imagination in social work. The goals of effort in the past seem to be swept away. Those whose work has been the precise carrying forward of a program are aghast at the apparent destruction of the things for which they have struggled. Change in purpose which becomes inevitable seems to be a compromise in principle. Rehabilitation of family life is now opposed by the nation itself, whose demands show a claim greater than family life. Social reform seems to be a mockery when all effort for individual welfare must now be subordinated to the national good. Yet a new conception of the national good and a new organization of forces for achieving it, may be the great op- portunity for a new conception of individual welfare, — ^the im- mediate interest of the case worker, and community welfare, — the goal of the social reformer. THE NORMAL FAMILY By Margaret F. Byington, Associate Secretary, American Association for Organizing Charity. There is in history nothing more dramatic than the persistence for uncounted generations, through changes in industrial life, through experiments and failures in political organization, through the growth, decay and rebirth of religions, of the essential family unit — \ "Oh 'im and 'er and it, Our blessed one in three." as Kipling phrases it. There has been variation enough indeed in the relation between the man and the woman, a relation which has sometimes been considered purely temporary, sometimes eternal. Underneath all these changes, however, we find the persistence of the essential bond, the physical dependence of the child on the foster- ing care of the mother and the reliance of both on the greater energy and courage and physical freedom of the father for protection and for sustenance. The family as a unit has indeed functioned in many ways dur- ing these centuries; it has been the religious unit, especially in an- cestor worship, the father serving as priest; it has been the prop- erty holding unit to which the right of inheritance was limited; it has been the industrial unit, the household forming a cooperative enterprise; it has been the educational unit, the custodian of the earlier experiences of the race; it has provided for the physical nurture of the child. It has varied in form and in legal status, moulded by changing industrial, social, and religious life. It has likewise been a factor of great value in securing stability of progress, on the one hand by preserving the traditions and experiences of the past, and on the other, by securing within the shelter of the home the chance for greater variability. If we are to understand the moderniamily we must see it in its relation to this historical devel- opment. By noting which characteristics of family life have per- sisted through these changes, which have weakened and which grown stronger, we get a truer idea of what does, indeed, con> titute 13 14 The Annals of the American Academy a "normal family." In other words we shall not identify the "nor- mal family" with the ideal family or with any one of the varied types of family life now existing in our own country. We shall attempt lather to express it in terms of certain fundamental personal relationships and habits of life and thought, which have char- acterized family life throughout its history. Primitive Family Life Students of the family have disagreed widely as to what was probably its earliest form. Their theories have been based on his- torical documents which throw light on early family history or on reports of conditions among present day savage tribes. But even these sources are difficult of interpretation. We do not, for in- stance, know whether modern savage tribes are not degenerate rather than primitive groups; whether in fact, as Mrs. Bosanquet suggests, they did not fail to advance in civilization just because they had not developed a sound form of family life. There seems to be, however, a growing tendency to agree that the primitive family, in all probability, resembled somewhat the unit which exists among those apes which are closest to man in type. The meat eating animals find little advantage in group activity since hunting, to be successful, must be carried on by in- dividuals. So we find among certain apes, a very simple family unit: the female caring for the child during its period of weakness and helping to provide food by seeking roots, nuts, etc., near the home; the male, possessing freedom and greater energy and mobil- ity, providing the main food supply by hunting, and serving as protector to the female and her young. This probablj- indicates the status of the primitive family, a temporary union, but one which, while it lasted, presented already those elements which have always constituted the basis of family life: the protection and care of the weak, the provision for physical maintenance, the joint sense of responsibility for the children. In other words, even this elemen- tary family life had a psychological as well as an economic basis. The great significance in the development of the human race of even this simple family unit has "been stressed by Prof. John Fiske. The willingness of father and mother to sacrifice personal freedom for the care of their offspring made possible the prolongation of the period of infancy. While a chick can begin scratching for its own The Normal Family 15 food a few hours after it emerges from the egg, the human child can- not even feed itself for many months, and is now forbidden, by law, to try to earn its living for fourteen or sixteen years. This slow process of growth makes possible the variation on which progress depends; it gives time for education, so that each generation may begin its active life equipped with the knowledge won by its for- bears, instead of beginning over again where they began. Out of the prolongation of infancy in the shelter of family life, civilization has been made possible. The way in which this simple, un-self-conscious group devel- oped into our modern family is too long and complex a story even to outline in such a paper. I would emphasize the fact, however, that for those who are doing case work, the history o"f the family, and its changing status possess genuine significance. We may think of this development from two angles. Viewed externally it is a social and legal institution, comparable in impor- tance to our governmental institutions, having prescribed forms and functions. Viewed from the inside, it forms the intimate back- ground of the life of every individual, the most vital force in his personal development. The Family as an Institution First let us consider a few of the factors which have influenced the development of the family as an institution. As far back as history records, and in practically all of the present savage tribes, marriage is considered in some degree a matter of social concern. The fixing of the degree of kinship within which marriage may take place, the formal rites which accompany it, the limitation of the rights of divorce, are evidence that it was never considered a purely personal affair. Custom, rehgion, and law have all been invoked as means for securing a stable family life against the explosive force of personalities which refuse to be held by any tie. The increasing legal control of marriage probably followed the development of private property on a large scale, since this made it necessary to arrange for the control of the wife's property and to determine the legal status of the heirs. Property rights have had more to do than moral standards with the attitude of the law toward ' the illegitimate child. Nevertheless, these legal sanctions, even though based on no higher motive, did stabilize family life during a 16 The Annals of the American Academy ' period when it might have been engulfed by the tide of lax moral standards. Another stabiUzing force has been the attitude of religious teaching toward the family, every, great rehgion having sanctioned some form of the marriage relation. The family has a peculiar significance in those nations whose religion is that of ancestor worship since on the rites performed by his descendants depend the man's happiness in his future life, not for one generation only, but for an indefinite future. In the development of the Christian ichurch, marriage came to be looked upon as one of the sacraments and an indissoluble bond. This has, of course, been one of the strongest elements making for stabiUty in the modem family. Since the separation of church and state, the civil law has regiilated. marriage though the religious service still serves to strengthen the- sense of the sacredness of the marriage tie. Families, moreover, tend to maintain a joint religious life and in "mixed marriages" the difference in rehgious faith is a potent source of instability. The present variations in divorce laws in our different states simply indicate the general questioning state of the public mind as to how permanent this bond should be. It is, nevertheless,, clearly established that the family is so important a social institu- tion that the law must at least control the conditions imder which it may be created or dissolved. The reaUty of family life, is, of course, based on something far deeper than legal regulation. As Dr. Goodpell phrases it, "Marriage grew out of the family, not the family out of marriage. " The law will sanction but cannot create a genuine family life. Marriage has always, as now, nevertheless, been considered a matter not solely of personal, but also of public concern and control. The Relation of Parents and Children Not only the relation of. husband and wife, but also that of parents and children has been influenced by legal and social stand- ards. From the beginning, the family had its bond in the weakness of the child and in the simple feelings of affection and responsibility which that evoked. Naturally, however, this affection, which was instinctive not reasoned, died as the weakness which called it out was followed by strength and independence. Observers seem ta agree that some sort of concern for the welfare of the child exists The Normal Family 17 among savages while the children are little, though, with their quick passions, they are often unnecessarily cruel to them. Later, the relation of parents and children became a matter of legal definition. In patriarchal times and in the Roman and Greek families, we find that the child was really considered a chattel sub- ject to his father's will; that no individual had any standing before the law except as part of a family group; that absolute power for life or death often rested with the father who was also priest and judge. This tradition has, of course, given way until modern law restricts in many ways the rights of parents over their children, yet also calls for increased responsibility on the part of the parents for giving their children proper training. An enlightened court, for example, will take a child away from his parents' control if they persistently fail to provide a public school education or badly needed medical care. The training of the child is now considered a matter of joint concern on the part of state and parents, the former requir- ing the latter to live up to the major responsibilities for its welfare. Law, which formerly buttressed the family as a property holding unit, is now concerned rather with its educational and cultural value. This change in the law's attitude toward the responsibilities of parents for their children is in part the crystallization of a new ideal of parenthood. In looking back on primitive life, we perceive a great reversal in the relation of parents to their children. Aside from the feeling of personal affection children were then consciously desired mainly for their service to their parents; now parents center their efforts and ideals on the future of their children. In the early family chil- dren were desired because, economically, they were an asset, either in the household and industrial activities of the family, or later, as wage-earners; religiously because there would be no happy life after death unless there were children to carry on the ancestor worship. Now, a man struggles to earn enough to give his children op- portunities for education and for development which he missed. We are even attempting to restrict marriage to those who are capable of passing on a sound physique. The modern family is more and more centering its emphasis on the future of the race. It is, how- ever, well for us as case workers, to realize that this is a recent change in the angle of vision and that especially on the economic side the old attitude still persists. 18 The Annals of the American Academy The Ndrture of Child Life A social worker who is a grandmother said to me the other day, "I resent it so when people speak of children as a burden, they are the great joy of life. I often think that the very poorest of our families have in them the elements of the greatest joys, — the love of man and woman and the presence of little children, — if they only knew how to take advantage of them. " Out of this interest and this joy in caring for children in their weakness and watching that weakness grow to strength, family life came into being, and has persisted. There is hardly a home so de- graded that the spark is not there. Yet the question is not infre- quently raised as to whether the family is the best place to train a child or whether substitutes more intelligent cannot be found. Cer- tainly, experiments with the care of children indicate that in infancy at least, children need mothers of their own. Institutions, however scientific, apparently cannot give the infant just the kind of per- sonal attention that it needs, as their high mortality rate indicates. "Mothering" is of value to the delicate little mechanism. As a child grows older, it seems physically less dependent on family life, as witness the fine development of many boys who go to a boys' school in winter and boys' camp in summer. It may be doubted, however, whether sufch good physical care can be given anjrwhere nearly as cheaply by such institutions as in a good home. ^ But it is for the other factors of home life, its educational value in a broad sense; that no substitute has been found. We shall indi- cate some of the ways in which the home provides essential training, the practical education, the growth in self-control and self-sacrifice, the sense ofjvalues. Because there are two parents, the family gives the valuable influence on both boy and girl of both man and woman. It provides the normal contact between one generation and the next. Economic Indkpendence . In the first place economic cooperation within the family has provided some of its greatest educational opportunities ever since that first primitive group that persist etl because of the need of mother and child for food. During the Massachusetts Commission for the Blind, 1 1th .Annual Report 1916-1917 Offsetting the Handicap of Blindness 33 of talent. The plans so excellently carried out at St. Dunstan's, England, for soldiers disabled by blindness, and the carefully laid plans for American soldiers who may be so disabled, all provide for curative occupation early. Visitors from St. Dunstan's go to the blinded in hospital wards early "for good comradeship." All of the nurses, including the superinterident, in some of our base hos- pital units have voluntarily equipped themselves with knowledge of principles and practice of occupation therapy, and the government has laid careful plans for each succeding step to the point where the handicapped individual comes bacfi to live out his life in the community. Canadian experience tells us that the principle of helping a man back to his former vocation holds in 90 per cent of cases of all disabled soldiers in Canada. Only 10 per cent need complete re- education. Placement takes on a new aspect when the country can- not afford to lose the labor of a fraction of a man. Work for the handicapped is transformed, and it is for us to see that the basis of transformation is brought over permanently into our community pro- grams. Only ignorance of the true possibilities for individuals, and the dangers of emotional and poUtical exploitation stand in the way. In the meantime, for the worker with individual cases, there are suggestions out of past experience that may be helpful. The in- formal use of some simple classification, in arranging all the facts about the man and the situation may help both the man and the social case worker to face things together. Dr. Southard's discus- sion of classification in his course on Social Psychiatry at the Boston School of Social Work this winter has stimulated many of us to put in more orderly shape haK-crystallized ideas and methods in social case work. The plan outUned in the footnote for rearrangement of all the facts in the situation is one we are in process of trying out at the School both as a help towards making a plan and getting at larger implications.^ ' It presupposes that all the necessary facts 2 Social Diagnosis, Social Case Work and Problems of Unity, Stability, Bal- ance or Adjustment in situation of Unit: Individual Classification of information about unit: 1. Self Defects ~ Powers Physical, viz. MentaJ, Psychological, Character, (apparently) 34 The Annals of the American Academy have been gathered and recognized, and that only questions of actual diagnosis and trjeatment remain. It seems to be most helpful in the matter of proportions and emphasis. The individual as unit, and the offsetting of defects by powers are perhaps the most important points about it in relation to the blind. In speaking to various groups this winter, students and others, it has seemed to me that it was more important to direct them to acquaintance with the life stories of handicapped individuals — in fiction (when truly interpretative), in biography, autobiography and in fact — than it was to dVell on points of special technique, in the education and employment of the bhnd. Nothing will replace this knowledge. The part of the blind in work with the blind has been its characterizing feature from the start. Often the best thing you can do for a newly blind man is to put him in touch with some other man who has been through similar experiences, and worked out for himself a recognized place of usefulness and a philosophy of life. For suggested reading, to prepare the mind for "what blindness is hke from the inside out," a short list is given below.^ Many 2. Relation to immediate environment and to others Environmental Defects Powers (immediate) Educational Industrial-Social Legal-Social Unclassified Diagnosis : Self-adjusting Requires interference Temporary — Continuous — ^Permanent Prognosis: Helpable from point of view of Treatment: Social Implications. 'Suggested Reading KeUer, Helen, "The World I Live in." Montague, Margaret P., "Closed Doore. " (Stories of blind and deaf children.) Duncan, Norman, "The Best of a Bad Job." Har/yer's Magaziyie, 1912, p. -112. Hawkes, Clarence, "Hitting the Dark Ti-ail. " Holt, \\inifred, "A Beacon for the Blind." Tl\e Ufe of Henry Fawcett, the blind postmaster-generiil of England. The Outlook foi- the Blind, a, quarterly magazine in ink print devoted to the interests of work for the blind in this niul other countries; edited by Charles F. Camp- bell, Columbus, Ohio. Offsetting of the Handicap Blindness 35 more might be given. These are selected because they seem to me to help towards imagining what life in the dark may be like. The titles, even here, often stress what is gone, like "Closed Doors" and "Hitting the Dark Trail." Two suggest both sides of the case in quite a remarkable way, — "A Beacon for the Blind" and "The Outlook for the Blind." The two most genuine and help- ful titles to me are "The Best of a Bad Job" and "The World I Live In." "Closed Doors" and "The World I Live In" do not relate to employment problems of men, but they, perhaps, set you right, at the start, better than any others. To summarize briefly, there are seven suggestions towards helping to find the man behind the handicap that seem most im- portant to "put over" at this time. They are the following: 1. Acquire confidence in other senses than those of sight. 2. Try to understand the real possibilities of intellectual life without sight. 3. Consider character as well as economic values. Professor Amar has made this point very clear in saying, "The mutil6 possesses always a perfectly utUizable capacity for some kind of work He may actually compensate for his physical defect by an active good wiU, which'in- creases his social value. This is a psychologic fact which must be turned to advantage. '' 4. Help the handicapped to measure themselves, not only against the handi- capped, but against all those with whom they must compete. 5. Make plans for offsetting handicap on the basis not of "something for nothing" but of "something for something." 6. Test the facts to be faced with some simple classification that can be talked over by you and the blind man together. 7. Look for your inspiration to the lives of the blind themselves. General Reading with references to the blind: — Recalled to Life, an English quarterly, devoted to the care, reeducation and return to civil life of disabled soldiers and sailors. Reconstruction, monthly bulletin, Military Hospitals Commission, 22 Victoria Street, Ottawa, Canada. Shairp, L. V., "Refitting Disabled Soldiers, a Lesson from Great Britain." The Atlantic Monthly, March, 1918. THE CRIPPLE AND HIS PLACE IN THE COMMUNITY By Amy M. Hambuhgeb, Fonnerly Assistant and Associate Director, Cleveland Cripple Survey. For many generations the cripple has occupied a rather obscure place in the community, and has not had suflScient chance to share equally in all opportunities offered to normal children and adults. It is true that many individuals representing various organizations have been interested in the cripple and have helped in securing' proper medical treatment for both crippled children and adults in some communities and limited educational advantages in other?. Yet they have been unable, because of very apparent and justifiable reasons, to interpret to the community the real individual behind the handicap. However, through industrial accident boards the needs of the adult cripple have become increasingly more apparent. As a re- sult of recent infantile paralysis epidemics some of the immediate and pressing needs of children have also become apparent, stimu- lating in the community a deeper interest in both these groups. Although industrial accidents and infantile paralysis, — both serious causes of crippling conditions, — have increased the total cripple population, the community has not been aroused until the present time, to take any active steps in carrying out a constructive pro- gram, thus indicating their recognition of the significance of this group in community life. Now, because of the war, the care of the returned crippled soldier forces the community to immediate action. Already, plans for his medical care, for educational, vocational, and industrial opportunities are well organized. Everything is being done to assure him of a permanent place in the normal Ufe of the community. As a prospective idle dependent he is realized to be an undesirable citizen, so every chance for expressing himself in the kind of work he is best fitted for, by education, training, and physical condition, is to be open to him. It has even been said that a plan for some read- justment of the Workmen's Compensation and Liability Act is to be made, thus releasing the employer from the extra rates of in- surancf^ — an expense incurred by employing handicapped labor. 36 The Cripple and the Community 37 All this means that the industrial world will be open to him and it is for him to choose his place. He will not have to face an un- kindly and prejudiced community because of a slight physical dif- ference. Such has often been the fate of the peace-time cripple. These new developments, naturally, have an indirect influence upon the future of the peace-time cripple. They assure him that the cripple will no longer be judged by his slight physical differ- ence, but by what he can offer to, the community. It is true that many peace-time cripples have lived out their lives heroically and successfully and are holding positions of responsibility. This mean^ that they made the most of the chances that came their way. Sto- ries are often told of the successful individual cripple but such stories have never been accumulated in any available form that might serve as an inspiration and guide to other cripples, and to interested persons in this field of work. At a meeting in Boston a member of the Committee on Voca- tional Training for Disabled Sodiers in discussing their work said that, at the very beginning of work before definite plans were made, they had asked for such material. They wished to know what crip- ples have been doing all these years; whether they had been suc- cessful in large numbers; if so, whether cripples with the same type of disabihty showed any tendency to follow any particular line of occupation; and whether they had been successful in that. Such contributions would have been invaluable as a guide. They soon learned, however, that information of this kind was not available in this field in the United States; therefore they were compelled to look to France and other alUed countries for advice. Social agencies, institutions, or whatever may be the type of organization working with cripples are the natural sources to look to for whatever information may be had about this group. It is, however, true that they are working with a limited number of cripples in their field and can, therefore, judge of their limitations and abihties by highly selected facts only. "Unfortunately, it is the many varieties of human failures which come as a grist to the social worker's mill and diagnostic studies are essential for the deter- mination of what can be done by this or that treatment of the human material at hand. '" For lack of time and funds it has not '"Psychology and Social Case Work" by Dr. William Healey, National Conference of Social Work, 1917. 38 The Annals of the American Academy been the custom to diagnose an entire field of work — such as crip- ples — in order to get a background and learn from those who have no reason to come to the knowledge of any of these sources. At once the question might be asked if this is a feasible plan and if it has ever been tried. ^ The Cripple Survey in Cleveland For such information it would be well worth while to look tO/ the City of Cleveland, Ohio, a typical American city, which has made a diagnosis of its cripple problem and so knows all its cripple children and adults, their failures and their successes. A group of persons, representing five different types of agencies, working with cripples were interested in child welfare work; the general condition of the handicapped; and the industrial chances of the handicapped. Having reached a stage in the development of their work where it seemed impossible to serve the conununity and cripples helpfully unless they could obtain some further hght on their particular problem they too looked about for information on cripples in general, but could find nothing available in the United States. At this' point they were advised to diagnose the entire problem in their city in order to get a clear idea of what had been done and what was needed. This seemed a colossal task but plans were soon under way for a city-wide house-to-house canvas, includ- ing both rich and poor. It was to be a democratic survey in every sense of the word and looked to the Uving sources of the community to contribute their share to make it a successful undertaking. The social agencies of Cleveland, at first, thought that they surely knew all the cripples in their city. But after trjang out a fairly typical section of the city, they were convinced by the results that they had in the past judged the problem by limited groups. The same proportions of new cripples — 65 per cent unknown to social agencies — were found by the surveyors in all districts. A larger proportion of unknown crippled adults was found. This at once suggested that the adult cripples are not the dependents that one is led to think. It is so easy for the uninformed public to judge the entire crippled population by the unfortunate cripple who may '"Education and Occupations of Cripples, Juvenile and Adult," by Lucy Wright and Amy M. Hamburger, Published for Welfare Federation, Cleveland, Ohio, by Douglas C. McMurtrie, New York, City, 1918. The Cripple and the Community 39 ■wish to spend "his Ufe seUing shoe-strings and pencils on the street corner because he finds it profitable to do so. In the whole city about ly50,000 families were visited and the total number of cripples recorded, including those known to social agencies, schools, hospitals, homes, almshouses, etc., was 4,186. The response from the cripples themselves was most gratifying. When they were asked to contribute frOm their successes or ex- periences in life, to the encouragement and inspiration of others similarly crippled, or to tell the obstacles to be overcome before the cripple could be assured of any encouragement, they most graciously and joyously responded. Some were amazed that they should be considered cripples, even though they were without an arm or leg, or perhaps seriously crippled as a result of infantile paralysis. They had never considered themselves handicapped in any sense. I remember well my visit to a man who had lost his .right arm to the elbow and who was actually amused at being considered a cripple. His home was in a very respectable neighborhood of de- tached cottages. In response to my knock a man's voice bade me come in. I entered a large sunny kitchen, where this cripple was busily "washing up," as he called it, for dinner. He continued while he asked me who I was, where I came from, the purpose of such a survey, and the source of the financial support of such an under- taking. He emphatically said he wished to be connected with no philanthropic scheme. I explained everything from the purpose to the source of finances including the names of our committee mem- bers. As I finished he said, "I call that a fine piece of educational work, for you are not only learning about us but you are teaching the people of Cleveland that we are not an idle, begging lot, but men and women like the rest of you, with your good qualities and your failings, and that we want the same chance. We want you all to see us as we are, — real men and women with a shght physical difference but the same otherwise, and able to hold our own with you if given the chance. " He then invited me to join his wife in the living-room where he told me his story. He was one of a large family, whose parents were respectable, hard-working people. After graduating from grammar school, feel- ing the necessity of earning money and having a marked mechanical interest, he decided to learn the machinist's trade. Unfortunately at the age of 24 years, — he was than a skilled steamfitter, — he met 40 The Annals op the American Academy with an accident which resulted in the loss of his arm. The com- pany made no settlement, as they considered the accident due to his own carelessness, and as he could not continue in his present work "he grit his teeth" and determined to use his savings for "educa- tional help." He took a special course in mechanical engineemg in a technical college, which he soon reaUzed was beyond him be- cause of his meager preparation. But he was not easily discouraged and went to an institution in a distant city where he took a course- in mechanical drawing. At the completion, in a year, he asked to be given a chance in their workshop ; they at first refused but later consented to employ him. Here he did all kinds of drafting. After a few years he went back to his home city, studied to be a first-class marine engineer, got his license and applied for a job. From now on he met his greatest obstacles. Unconsciously he had a habit of putting his disabled arm in his pocket and often was on the point of securing a much desired job, when the arm would as unconsciously come out of his pocket and the possibilities of work were gone. One day in sheer desperation, after being refused many times, he re- turned to one employer and said, "How do you know what a one- armed man can or can not do? You have never hired one. Whj' don't you hire one and give him the chance to show what he can do? " He was hired, at his own risk, as first-class engineer on one of the lake boats, where he remained for about 15 years. He earned $175 a month. Because of his wife's ill-health he recently gave up his work. He, however, carries on a small business as automobile repairer and installer of heaters. He can handle all kinds of tools and do all the necessary processes of work in both jobs with the ex- ception of cutting pipes. ' In discussing the problem of cripples he gave from his own experience and good judgment much helpful advice. Among other things he said : Don't judge all cripples by the loafei-s on the street corners. They are usually so from their own choice, or ill-advised help of their friends, and often would be just the same if they were not handicapped. Don' t make us a separate class. We are the same as the rest of you. Judge us by what we have left, not by what we have lost. Put aside philanthropic schemes but stand ready to give us helpful advice when we are first disabled. This -is the time we need it and need the right kind of friends. Steer us into the right occupation. Tell us about others who have been successful. Provide educational opportunities and training for children. The Cbipple and the Community 41 This successful cripple, with his fine philosophy of life and determination of character was a type of many men and women constantly being found through this survey. Consequently, the first definition of cripple: "A person whose muscular movements are so far restricted by accident or disease as to affect his capacity for self-support, " was gradually abandoned and the purpose of the survey became: "To discover the economic and educational needs, capacities, and possibilities of children and adults in Cleveland who are handicapped because they lack the normal use of skeletal or skeleton muscles." This latter made it possible to carry out the original plan of making it a democratic survey. As a result of such a broad purpose, the types of handicap con- sidered were many, from loss of two or more fingers or a thumb, to a combination of most disabling conditions. This brought the work into a varied field of occupations, — so varied that there seemed to be no prevailing type of crippled persons following one special line of work. It is interesting to know that among 3250 persons over 15 years of age including 400 housewives, who were considered self- supporting, 58 per cent were employed and they represented every known disability recorded. These industries and occupations were carefully classified in the hope that some further light might be found about the choice of occupations of the one-armed, or armless cripples; the one-legged or legless cripples; the cripples with other kinds of disabling conditions. However, the successful cripples most obviously adapted themselves to the type of work they were qualified to do. Three armless men were found following three distinctly different Hnes; one is a beggar, spending his time on the street corner; the second, a street peddler who, with reins about his neck, drives a small team through the streets; and the third, a judge in the Dis- trict Court who wrote his bar examinations holding a pencil between his teeth. This is his only method of writing because his arms are amputated close to his shoulders, thus preventing the use of arti- ficial arms. Among the legless cripples were: a beggar of fine physique, unfortunately, undisciplined in youth, sitting in the hotel doorway, asking alms under the pretext of seUing gum, and averaging from $15 to $30 a week, according to his mother's statement; a successful stenographer employed, by a real estate company, earning $17 a 42 The Annals of the American Academy week; a successful salesman in the employ of an artificial limb com- pany earning $100 a month, who said he could run and dance Uke a normal man, although to the keenly observant person, a slight Ump and sUght stiffness of one limb could be detected. There was also the skillful cartoonist with a congenital paralysis of one arm, and a defect of one leg, whose entire life has been as much Uke that of a normal person's as his judicious parents could make it. So unac- customed was he to thinking of his handicap that he was almost startled when he was informed by his mother that she had reported him as a cripple to the surveyor. He dances, swims, play tennis with one hand, and enjoys the usual activities of the normal man. These are merely types of innumerable cripples visited in this survey. Each is different, showing clearly character defects and the variable mental attitude that plays such an important part in direct- ing the failures or successes of the cripple in the economic world, — ^as important a part as his physical disabiUty and in some cases more. Of the total number at work 54 per cent were earning a hving for themselves. Over one-half of this number were supporting themselves in addition to others. Only a small number of those unemployed were receiving industrial pensions, which immediately raises the question as to whether industry is bearing its just burden in relation to the number of accidents. The number unemployed, of course, was greater among those having the heaviest kind of handicap although large numbers of those with serious disabilities were at work. The man with double club hands and club feet illustrates the latter type. His parents were Polish immigrants who were illiterate and who never learned to speak Enghsh. This man was the oldest of 21 children born in a remote town in Kansas. Although his parents reaUzed his deform- ity, no doctor was consulted until he was about five years old — his mother had a midwife at birth. As his father was a laborer earning $1.10 a day, the doctor's price was beyond their means, and no further medical advice was sought. Until 12 years of age he was dragged about in a cart by his younger brothers and sisters. About that time the family moved to Cleveland. A shoemaker in the neighborhood offered to make shoes for him which would enable him to walk. He also taught him to make his own shoes, which he does to this day. From that time he was no longer dependent, and, best of all, he could go to school, an unexpected but longed-for joy. Be- The Cripple and the Community 43 cause the family income was so small, he felt after five years of schooling that he must go to work. During this time no suggestion of public hospital was made to him or to his parents by teacher or neighbors. Therefore, with practically no use of his hands, selling newspapers seemed the only opening. He is now 35 years old, and with the exception of a year when he tried the experiment of keeping a cigar store which was not a prof- itable business venture he has sold papers on a street corner. He has also some regular customers in office buildings. Both parents are dead and he is the support of a sister and two children, and two young sisters whom he hopes to send to high school. Very frankly he said: My parents were simple, ignorant people who did the best they knew how. I have no complaint to make. I am strong and vigorous. I like to work and am thankful for the opportunity because I must support my family. It is not too much of a care and it gives me something to be responsible for, and a reason to make a home. Think of the types of people with whom I come in contact; think of the side of life that has beeii revealed to me and from which I can guide my family. No, I have no complaint to make but I trust all cripples may have proper medical treatment; that they may have educational advantages; and that you may interpret us to the community, especially to employers. Both are strongly prejudiced and unwilUng to take us for what we are. This kind of occupation with no future to it would not be ad- visable for every cripple to follow, but no one watching this man at his work could doubt his businesslike attitude in close competition with the very alive young newsboys who frequent his corner. The results of this survey may seem so optimistic that one might easily assume that no further plans are necessary for cripples. But when it is known that one-half the total number were crippled in childhood, and that one-fourth of the total crippled population were under the age of 15 years at the time of the survey, very im- portant plans suggest themselves and are already under way in Cleveland. The importance of making such a survey cannot be overesti- mated either for Cleveland or other cities. It has not only given the interested groups and social workers in Cleveland a general knowledge of their crippled population in all its phases, but has also given them and others undisputable facts by which to judge this problem fairly. From now on mistaken ideas about cripples 44 The Annals of the American Academy can be dropped. Here is an opportunity to put them right, so to speak, in the minds of their neighbors who are apt to have very- wrong ideas about the ambition, abiUty, and economic status of those who do not present the same outward appearance. From Cleveland, a city largely without industrial training either before or after disablement, where cripples unaided have contributed to their own successful economic independence, much can be learnt. The Uves of unknown cripples are much more normal than had been supposed, although, because of unequal chances, they have un- doubtedly often .followed the line of least resistance. The important fact to be faced is that cripples must be divided into two large classes, — the helpable by normal educational means and the helpable by specially devised means . By the former is meant those who are able physically and mentally to share normal oppor- tunities of life; by the latter is meant those who are unable physically and mentally to share normal opportunities of life and whom it is not human to force beyond their ability. They should be aided to live out their lives happily with the limited equipment they have. With this division it will be much simpler to estabhsh the normal place of the cripple in the community. To accomplish this means something more than case work with individuals; it means more surveys like Cleveland's'^ and educational campaigns, legislation, etc., as a basis for needed plans. What do the cripples themselves want? Turning again to the life stories of the successful ones, they want: 1 — Not to be confused with the begging type of cripple. 2 — Not to be forced into a special class. , 3 — An opportunity to be judged by what is left and not by what is gone. 4— To be given an opportunity to make the contiibution of which each is capable. 5 — To share equally in all chances offered to normal individuals. This is the appeal from normal, thoughtful cripples to inter- ested individuals, organizations and social workers for an active share in life. The task then, is to extend permanently to all the advantages of community life. THE SICK By Edna G. Henry, Director, The Social Service Department of Indiana University. Social work, unlike medicine, still suffers lamentably from a want of precise and sufficient knowledge. More complete statistics upon poverty, pauperism and mere iliisery, their nature, extent and causes must be collected and made available before any social worker can speak with authority. Of two facts, however, he is already con- vinced. Prevention, and teaching for prevention, are as essential in social work as in medicine. Neither can there be any good social work without access to expert medical practice. This is true equally in the prevention of suffering or in its rehef, and true whether the concern is with mass betterment or with individual improvement. Whatever special line of activity occupies the worker, be it public or private, institutional or case work, the situation is the same. Lessons from the Medical Profession In seeking to remedy bad social conditions, they (the workers) have come to recognize more fidly the great handicap of bad physical conditions and have learned to welcome, in the effort to remedy these, the aid of a newer and more con- structive medical science. Their awakening is due, in part, to their own deepened experience of human need but even more is it due to the socialized members of the medical profession who have led the way in many departments of social endeavor .' Social workers today are a bit too proud of having socialized the physician. They feel that they have opened his eyes, so that he is aware nol only of the fact that a man's heart may not be treated without complete consciousness of the rest of his body but also of the additional truth that he cannot be considered or cured apart from the larger social unit of which he is a fraction. The condition of his lungs and legs may well be less impbrtant than his income or his wife's tastes and temperament. Any visiting nurse or social worker can name a dozen points the physician sees now which formerly were invisible to him. Physicians, upon the other hand, do not see, or are too busy to note, how social work has improved since it 1 Mary E. Richmond, "Social Diagnosis," p. 204. 4.5 46 The Annals of the American Academy realized and admitted to itself its dependence upon medicine. If the social worker has learned nothing else from the medical pro- fession, there is at least the new value of records and more scientific method. Many will be inclined to deny that the value of any record has been enhanced by contact with doctors. They point with scorn, and alas, with truth, to the deficiencies of dispensary records. But medical work has made records more valued. For long the best social case workers have known that their records, and the use they made of them, in the end determined the quality of their work. They did not have to point to the obscure and forgotten careers of missionaries to prove that work, no matter how good, is lost and as if never done unless recorded. They regarded as sacred and confi- dential records which might embarrass individuals or ruin reputa- tions but when medical facts appeared on them, they learned that people's very lives and entire futures might depend upon a date and a diagnosis, or be lost through carelessness. It was then that records became as precious as babies. Unconsciously, too, workers now follow methods long con- sciously practiced and taught by physicians. It is not without signi- ficance that a bookf or social workers is called " Social Diagnosis," but only recently have students and new workers been called upon to test their labors with a medical outlme. It is beyond dispute that for social woes, the doctor's outline for physical ills should be followed. The order should never vary. ReUef of symptoms should always precede, but should be followed by diagnosis, prognosis, treatment, scientific research and public education for prevention. Even the most unthinking layman will agree to the necessity for any immediate relief of symptoms. No doctor will refuse to allay pain before he knows its cause. The trained social case worker must always have a plan which involves temporary relief first, with investigation afterwards. But this worker also, Uke the doctor, now demands diagnosis before further treatment. Some seek a prog- nosis also, although few are courageous enough to act upon it. Treatment, as with the physician, depends upon the individual worker, upon his knowledge and his acquaintance with reme- dies. Like most physicians, the majority of case workers stop at treatment and do not proceed to the further research and consequent possible public education for preventipn. The Sick 47 Not only do the best methods of physician and social case ■worker thus resemble each other; either to succeed must imitate the other in borrowing from all science and all available knowledge. The one may belong to the finest type of the recognized professions, and the other, as Abraham Flexner asserts, may be of none, but both of them must recognize their mutual need. A great painter, a violinist, or an aviator may accomplish his full purpose with naught but the technical knowledge needed for his own pursuit, certainly without all knowledge or without that charity the absence of which makes all wisdom as nothing. No physician and no social worker, however, any more than the mother of ten children, ever knew any- thing which at some time did not prove essential or invaluable. The social case worker must do more than imitate the physican in his method and in his tireless pursuit of learning. He must obtain from him also that technical medical knowledge which he alone possesses and the instruction and advice concerning its social appli- cation which he alone can give. Peesent Aims of Social Work Four centuries ago that ancient modern, Juan-Luis Vives, said : "It is not only those without money who are poor; but whoever lacks strength of body, or health, or capacity or judgment," and "a common peril besets the citizens from contact with disease. . . . . It is not the part of a wise government solicitous for the common weal, to leave so large a part of the community not only use- less but actually harmful not only to itself but to others." He also said, than which there has been no truer word written: "the law of nature does not allow that anything human should be foreign to man, but the grace of Christ, Hke fast glue, has cetnented all men together." Yet, after all these centuries, only three years ago, Dr. Richard C. Cabot was compelled to say, with truth, "We have dealt with man's estate extensively. We are now in the heyday of the dis- cussion of health of the body. We have just begun to see that the mind is the greatest of all questions for social workers. But that is for the future; we are still in the center of interest in health." He had to say also: "Health is still a separate section because it has not yet been welded into the whole thought of social workers." Cen- turies ago Montaigne declared that a man could not be divided for 48 The Annals of the American Academy the purpose of educating him but apparently it is not yet clear that he cannot be divided for any purpose whatever, even by the most competent and well-intentioned social worker. Unfortunately, outside of the large cities, there not only is but little concern for health but too little provision for its maintenance. No social worker any longer listens with patience to the statement that the best comes from the country. So it does. Also the worst comes from the country — or the little town. Mark Twain possibly was right about its-origin. A country-born baby may have a better chance to be healthy, if he lives; but he and his mother have less chance to live. The social worker, hke the plain citizen, is not constantly aware that men's Uves and habits are determined by the ways in which they make their hving; and that the ways in which they make their Hving are decided all too often by their physical condition or by mental conditions growing out of disease. Only the rich, and the •poor of cities, may have adequate medical attention. This proposes to the social worker who knows it, all sorts of indi\adual health prob- lems and induces serious thought concerning the possible alterna- tives of social insurance and the complete pubUc control of health. Even ardent believers in democracy, in the equal chance for all, too often fail to see the necessity for primary physical fitness. Per- haps war will open some eyes. Men who beheve in the power of in- come discount health. Those who know that health is important agree with Benjamin Ide Wheeler and discredit the character-making possibihty of sickness rightly handled. But the social worker must deal with the whole man, his environment, his body and his mind and soul — his character. Necessary Medical Knowledge In trying to improve a client's enviroiunent, the social case worker needs to know something of neighborhoods, schools, the local housing problem, industries, the employment situation, the compara- tive chances in certain lines of labor for a Jew, an Irishman or a Swede, for men or women, hours, wages, and the best way to ap- proach an employer, actual or prospective. All social case workers know this but they do not all realize the same necessity for learning the prevalence of disease, the consequences of physical conditions, the character of the water and milk supplies, the existence and meeh- The Sick 49. anism of their medical institutions and the most effective manner of deahng with physicians and surgeons. Yet, where a few years ago foui -fifths of all the reference calls of the best known agencies were work references, today they are, or ought to be, medical references. But how, one may well ask, can a social case worker know his own business and medicine also? Is it fair to require so much and such varied knowledge? Is it possible to obtain it? No, and no again. Neither is it necessary to do so. The most serious mistake a social case worker can make is to appear to know anything about medicine. Nothing is so maddening to a physician oi so discourag- ing to the medical social worker as one who knows more about medi- cine than does the doctor. The inquiring social case worker who knows that an afternoon temperature always means tuberculosis, that osteopathy will cure epilepsy, that a patient with paranoia is "as smart as I am," that a skin eruption is syphilis and that syphilis at all times is a menace; a school nurse who herds in children for glasses and the removal of tonsils and adenoids — and nothing else; a city missionary who converts and protects girls but ignores theii sicknesses; — these are pests and regarded as such in any medical quarter. Equally obnoxious is the child welfare worker who cannot beUeve that a boy is feeble-minded; the relief agency which insists upon a positive diagnosis on a first visit; or the probation ofiicer who holds an epileptic responsible for all of his acts. Can these workers learn enough not to make such mistakes if they have no knowledge of medicine? They can. Social case workers need only to realize in the beginning that nothing will save the situation unless good medical service is available. If such serv- ice cannot be obtained, the social worker's first business should be to create an agitation which will result in the provision of doctors and nurses. If they are available already, or can be found, then the social workers must trust them. They must know their own job so well and engage in it for such fine motives that they can believe in the skill and sincerity of others. A social worker has a right to smile when a doctor says: "This man needs his rent paid"; and surely the doctor may smile when a social worker says: "This man has tuberculosis." The medical social worker learned long ago to say, not, "this man has heart trouble," but "This man complains of his heart. " Social workers need no knowledge leading to medical diagnosis 50 The Annals of the American Academy or treatment. They should know, however, the causes and cost of those diseases which are social problems in themselves. They should know what these diseases are and why they entail a social burden. They should be concerned, not with disease, but with health. They should be able to recognize health and to learn what there is in the community which will maintain it for all. It is not necessary for anyone but the doctor to recognize or to treat tuberculosis but many in addition should know that tuber- culosis costs the community more in money and in sorrow than does any other one disease; The value of early diagnosis should be known and, for the individual case, what has been advised medically. A social case worker does not have to decide whether or not a patient needs hospital care but should know what hospital facilities there are and what will happen to the home of the patient should he leave it. No social agency has to conduct a hospital, oaly to know how hospitals are conducted, or, if there are none, how to get or reach them. It is still more worth while to create, in any commimity, sdch health as will decrease the demand for hospitals. In other words, social work must recognize the character and extent of dis- ease, its own dependence upon the physician and the possibility of full cooperation with him. It must not encroach upon his territory or permit him to dictate unwisely outside of it. Purpose of the Federal Childrex's Bureau The three times in a man's life when the social worker can ac- complish most for him are the same periods at which the physician can do the most also. These are when he is a babj' — with his mother — when he enters school and when industry claims him. It was Bernard Shaw who said that if the world and its affairs were as they should be, a man would need a doctor but once in his life, and that for his mother, when he was born. This is so true as to be tragic when the truth of it is ignored. Could every mother have proper prenatal care, inspection (for, after all, birth is not disease), instruc- tion, confinement care, nurse and physician, the health problem would be more than half solved. In America, 300,000 children under five years of age die each year. Over half of them need not die. This is a waste of life, of vital energy, of time, and a cause of needless suffering which the country is no longer willing calmly to tolerate. The Children's Bureau proposes to save these babies through individual effort, by: The Sick 51 1. Registration of births. 2. Complete care, nursing and medical, for every mother, whether she can afford it herself or not. 3. Children's conferences and clinics. 4. Organization of local bureaus of child hygiene. 5. Pure milk. 6. Adequate incomes. The Children's Bureau was born of the child labor movement and fathered by the Department of Labor. Why has it deserted its own field, to enter that of health? It has not. This is but a logical step from its inception to the attainment of its owft purposes. It looked into its own questions, made some research, and has turned to the right beginning, to the babies, and to public education for prevention of ill to them. Immediately, it finds itself leaning upon the doctor, the public health man, for instruction and guidance and upon the workers in each locality to look after each individual baby and, in the process, to educate the mothers. Nothing so clearly illustrates the circle around which one travels for the maintenance of health, the perfecting of industry and the consequent betterment of living. There has been enough of vicious circles. This golden one is to succeed them. The Social Worker and the Health Problem When the social workers, however, reach health problems, they ( come to them in many ways. There are workers within institutions, workers in the community, workers concerned with morals, with education, with relief, with health and those whose whole business is with sickness itself. The chief object of the workers necessarily modi^es the manner of attacking the health problem. The social worker should define clearly to himself his own job, realize in precisely what way health is necessary to its successful accomplishment and act accordingly. The worker in an institution should know that he or she has an opportunity to get everyone in the house thoroughly examined and treated and consequently may perhaps send them out in better health than they otherwise ever could have had. This is his business. A girls' school which does not examine all sent in for immorality, a prison which fails to learn who is feeble-minded, who is insane and who tuberculous, is a curse, not a safeguard, for its people. An orphans' home which ignores the physical condition of any child is unfair to all of them. A jail 52 The Annals op the American Academy usually is more dangerous than any mediaeval plague spot. But the whole business of a social worker in an institution is to see that his charges are placed in the hands of a good doctor and to enforce that doctor's orders when given. He needs to know, not medicine, but the comparative value of health and the social destructiveness of disease. For the attendance oflficer, the charity organization agent, or the children's worker in the community, the affair is not so simple. In a large city where there are well-known and excellent dispensaries and hospitals with social service departments, all the worker has to do is to learn their location, mechanism and peculiarities. After that, the word of the medical social worker in the medical institu- tion may be sufficient. In the smaller commimity, the affair is more serious. An attendance officer who is now a medical social service worker was asked where she got her first medical experience. She said that she had obtained it when a truant officer in a village. Then she had had to learn, not how to enforce a compulsory school law, but how to rid her clients of vermin and how to distinguish impetigo for cancer. She had learned further that it was easy to find doctors, to ascertain their hours and the extent to which she coidd impose upon them. Such imposition is justifiable and neces- sary as yet and the doctors have never complained, but social workers certainly should reaUze, whether anyone else does or not, how much free service the average physician gives, and how desirable some better and fairer methods is than the one now in use. Outside of the institution the social case worker then needs to know thor- oughly all of the medical and nursing resources of the community and how to use them with the least trouble to busy doctors and nurses and with the maximum results for his own people. A social case worker should also try to inform himself concerning some of the simpler questions of hygiene and the common and best known facts about disease. There is no doubt that, other things being equal, the worker today who has had some experience or train- ing in a medical social service department is more valuable than any other for any variety of case work. This is not because he has learned medicine but because he has come to know how to use the medical knowledge which is available and has acquired something of the medical point of view toward the patient. "Social workers have been handicapped even in their use of The Sick 53 these sources of information by their lack of knowledge of even the most elementary facts of disease and by their lack also of under- standing of the organization and discipline necessary in a hospital or dispensary."^ Moreover, the organization and discipline to ■which a good medical social worker yields is in itself training too often denied the average social worker who, to be effective, is neces- sarily something of a free lance. A student who has had to observe dispensary rules and to remember that every one is sick, never makes the stupid blunders about health and doctors of which other workers are certain to be guilty, although he may make worse. The medical worker is always as much interested in incomes, housing and occupa- tion, as is the relief agent ; but the latter is not always equally con- cerned about health questions. More and more, therefore, where it is possible, general social workers are acting more closely with nurses and the medical social workers in hospitals and dispensaries. It is easier and more effective thus to divide the job. Perhaps the greatest concern of any worker in the community should be to see that there are enough and the right sort of medical institutions properly equipped with medical social workers, while most certainly the chief concern of all should be that prevention of disease which alone will decrease the necessity for so much medical care. Objection is made to such cooperation. It is claimed that the visiting nurse is too often blind to social and relief situations and most untaught in social procedure. She will ask for eggs without number, no matter what the price. Worse, she may insist wrongly upon unwise aid for a sick woman whose husband has deserted her. Upon the other hand, it is the nurse alone who knows efficient, and therefore economic, forms of relief for the sick and she may be the first to discover some sorts of illuminating information never given to any but doctors or nurses. Objection is made further that the necessity for such coopera- tion works for harm because it sends too many people into one family. The layman is always aroused by such so-called duplica- tion of work and the intrusion upon the individual's privacy. To be sure, until the war is over, less will be heard about intrusion upon privacy. As for sending too many people into one family, it is well to remember the answer of a certain Boston worker when the ques- ' Mary E. Richmond, "Social Diagnosis," p. 255. 54 The Annals of the Ambeican Academy tion of referring unmarried mothers to other agencies was dis- cussed. She alone thought it all right to transfer such a patient and added, "You only give her another friend." That is the point. The relief worker who tells a client who is going to the dispensary as a patient to be sure and see Miss B , the social worker^^ makes another frignd for a woman who has too few acquaintances wiser than herself. This has a further point, if it is remembered that in the final analysis the social worker can justify his existence in but two ways, by what he can teach and by what social chasms he can bridge. The Social Worker as Teacher What any single worker can do for an individual person, all that he can accomplish in one long day, will never prove his value unless he also is always a teacher, and one who remembers that the best teaching is by example. The social worker is the modern neigh- bor. He must not only be a teacher but at all times an additional connecting link between the normal and the abnormal, between the fortunate and the unfortunate in a world which grows too complex for most. It is, therefore, an advantage to specialize in social work as well as in any other profession. The client may have as many friends as he has varieties of troubles and each will make an additional link in the chain which binds him to a better part of the commimif y which he represents. Such a social worker, primarily concerned with other than health problems, needs only to remember the value of health, its relation to his own questions, to recognize its absence, to know where to go for it and how to obtain the nurses and medical social workers as well as doctors who are needed for the maintenance of health and the prevention of disease in his community. ■ A very just objection to this attitude is the fact that it cannot apply to rural communities. These force upon the social worker, even one interested only in sick individuals, not only local problems of nursing and medical attention but the larger ones of education for health and public control. Such a violent departure from the pres- ent situation may well arise from agitation in long neglected country districts. The medical social worker has a certain value another has not, both for health problems and for social problems connected with them. From the doctor she' learns what social relief must be added ' " She " rather than " he" is here used in referring to the medical social worker as in the vast majority of cases if not universally, such workers are women. The Sick 55 to medicine for the alleviation of physicial pain; she knows not only the medical diagnosis but in how far the social diagnosis depends upon the condition of the patient's body. She is better able to say what the social prognosis will be for a sick man; and she certainly can give not only to other workers but also to legislators and even to doctors, illustrative arguments for new social laws and procedures. Not only that, she sends her patients out to teach health even as other social workers send theirs out to teach facts about labor, housing and community life. If one good housekeeper in a city block may teach ten, the woman who has all of the babies "measured" is the one who should be converted to the use of pure milk. The medical social worker was born not only of the public's increased desire to alleviate misery, to make medical work more effective or to teach for prevention rather than to relieve. She came into existence primarily as a "logical result of the recent ad- vance in medicine."* No better explanation can be given than to continue : The social service department has a still higher office .... namely, the aggressive campaign toward the prevention of disease. The recent advance in medicine shows that nearly all of the most serious conditions are easily curable if treated early enough, while many others are more easily prevented than cured . . . . and since the most important cause of social dependency is sickness, those charitable organizations whose function it is to relieve conditions of poverty, see in hospital social service an agency which in time will lighten their burdens, although in the beginning it may appear to increase them. Indeed it may be said with confidence that social service departments in connection with our busy hos- pitals and dispensaries will in the future be the most potent means for the pre- vention o£-disease, and, therefore, of the miseries which so often are the result of disease. The medical social worker differs from other social workers only in that she deals with sick people, 'and that, unlike all others, she is always found within, if not as an integral part of, another institution, a medical institution. A man may be poor or immoral or a woman may be in distress but unless there is also physical suffer- ing their care is no more the concern of a medical social service worker than of a church or of a reUef agency. Moreover, they come to the attention of the social worker within the institution of which she is a part and haye themselves sought that institution, and * Charles P. Emerson, "Social Service and Medicine,'' Report of the Social Service Department, Indiana University, 1911-1912. 56 The Annals of the American Academy consequently the worker, first. This worker extends into the sur- roundings of the institution the ever widening circumference of its influence, instead of attacking similar problems in the community itself. The Point of Attack Like charity organizations and the church, a medical social service department concerns itseK with the whole man but its point of approach and the method of attack are different from that of either. The primary business of the medical worker is with the cure or relief of disease but to obtain her results she must consider character quite as carefully and sacredly as does the church; prize education as does a school; join public health movements and daily distress herself with problems of relief. While medical social serv- ice is one, and the most recent, manifestation of the growing public health movement, and is a part of the pubUc demand for the aboli- tion of poverty and the decrease of all needless suffering, it must never be forgotten that, above all, it is the latest outgrowth of mod- ern medicine. Today, therefore, advancing social work of any sort must be Hnked with scientific medical work. The hospital and the dispensary which cannot give a high type of medical service should waste no time on social service. The social worker in a community which offers no fine medical service is wasting most of her time and money. If communities are to deal with the social problems which have been in their midst for centuries but are being revealed slowly by city life or swiftly brought under the limeUght by war, these com- munities must have trained social workers, conscious of the value of health as well as of economic and spiritual good, and must also have splendid medical work. What Problems Are Most Important In this connection it may be interesting to note what social problems loom large to the medical social workers. One department furnishes a list of the social ills which have come most often to its attention and have made for it 1>he most work or the most anxiety. These are: alcoholism, babies born in hospitals, broken families, cardiac troubles, cripples, children, drug habitu6s, epilepsy, eye troubles, feeble-raindedness, foreigners, gonorrhea, illegitimacy, industrial accidents, diseases and maladjustments, sick inmates of The Sick 57 state institutions, insanity, negroes, sex problems, suicide, syphilis, tuberculosis, unmarried mothers and vagrants. This classification of social ills, most of them recognized only as diseases, is peculiarly worthy of note at a time when the government and the Red Cross also are trying to maintain health and social equilibrium. A certain army surgeon lately stated that in his opinion the greatest problems after thewarwould be: broken families, crippled soldiers, tuberculosis,' mental and nervous complications, heart disease and venereal dis- eases. The social service department which offered the above list had found to its astonishment that its greatest problem was the broken family. It had more broken families than any other one trouble.. Next to broken families and children, it was most con- cerned about cardiac patients, mental and nervous cases, and after them, the tuberculous and syphilitic. In other words, the war will create no new problems for social workers, but will only reveal or emphasize those already existing, especially those of death and disease. Social workers who are in the habit of thinking of their social problems in other terms, economic, moral or mental, should notice how closely their ills are interwoven with these medico-social ques- tions. It is worth while also to see which of these have been aban- doned by the case worker. No social worker any longer believes that the time and money spent in an effort to reform a single drunk- ard are spent most worthily. She wants to see prohibition tried. There is no medical social worker who is not ready to ask for the public control of venereal disease, and for more institutional care for the feeble-miinded, insane and epileptic. Because of the tragic cardiacs and the tuberculous she cries aloud for prevention and education rather than cure. The proved decrease of blindness, with the increase of eye troubles which keep children from school and impair the efficiency of workers, even more illustrate the crimi- nality of indifference to prevention. It has been said that every patient who enters the door of a dispensary is a social problem. Thus far, this is true. It is equally true that all social problems involve questions of health. Some day the public will be as impatient with people who are not well, who are not able-bodied for their jobs, as it is now with the man who cannot reach work Monday on account of Saturday's drink. All social workers must take more and more into consideration 58 The Annals of the American Academy the problems of health, both for the individual and for his com- munity, while the medical social worker should study more and more the larger social questions. If no social worker can know too much, no medical social worker ever knew half enough. In the beginning it was thought that such a worker must be a nurse. In some cities she still must be. Nevertheless, it is an admitted fact pointed out even by their leaders, that the nurses who make good social workers do so, not because they are nurses, but because they have ability in another profession as well. Social work, even medi- cal social work, is not nursing. The average nurse, moreover, lacks general knowledge of people and affairs and is less likely to have the necessary broad education. Not only that, her training tends to close her eyes and dull her natural initiative; whereas, a social worker, if she succeeds, must have and use science, imagination, daring and ingenuity. As yet, she is most often a woman, and all • of the .qualities which a great mother or a successful teacher needs should be hers. For the patient's sake she should have imagina- tion, sympathy and good judgment. She should be just, as well as kind. For he' own sake she should have good sense, good health, wholesomeness of spirit, a sense of humor and unconquerable faith in folks. She should have a true knowledge of the texture of normal society, of modern social problems, of the inter-relation of depend- ence and disease. She should know humanity, out of her own ex- perience with it or her behef in One who knew. "He looked out from his Cross upon a jeering multitude, sjonbol of the vaster multi- tude who forever jeer and crucify the good, and there He performed His supreme miracle. He believed in them. He saw what was in them." 5 Such a worker will never be blind to, nor lose sight of, any of the ills of her client or patient; never fail to seek the underlying cause of his trouble, either in his own life or in the society of which he is a part. She will never fail to seek medical care or advice for all who need it. But she also will advise and urge more education concerning health, more frequent routine examinations of babies, school children and workers. She will insist upon measures to lessen the state's vast expenditure for social wreckage due to disease and to increase those for the promotion of universal health. Such • William Lowe Bryan, "He Knew What Was in Man." Indianapolis: The BobbB-Merrill Company, 1913. The Sick 59 a worker will argue with wisdom concerning the just expenditure of effort and money and the possibility of success with the individual case, or, in losing it, will be comforted by the use of it as educative material which may serve to save others from similar fates. Any social worker who would obtain the greatest result, socially or medically, must forget himself in the pursuit of good for his client. He will get for him all that he can of income, health and happiness; but he will never forget that what he does or fails to do, if recorded, will add to human knowledge and echo to the end of time. PRINCIPLES OF CASE WORK WITH THE FEEBLE-MINDED By Catherine Bbannick, M.D., Psychologist, Massachusetts Reformatory for Women. The subject of feeble-mindedness is now recognized as one of the most important educational and social problems of the day be- cause of its relation to other social problems. Various researches have shown that it complicates practically every one of our social questions, poverty and dependence, delinquency, vice and crime, inebriety, vagrancy, unemployment and industrial inefficiency. Numbers and relative increase are the important factors in the prob- lem: it is estimated that three in every one thousand individuals in the United States are feeble-minded, making a total on this basis of 275,000; in proportion to their population they are increasing at practically twice the rate of the normal population. The burden is heaviest in the fields of delinquency and crime: 48,000 feeble- minded persons are committed yearly to correctional institutions in the United States, and the percentage of feeble-minded within these institutions is variously estimated from 15 per cent to 50 per cent. As research has demonstrated the widespread significance of the problem, methods of meeting it have multiplied, with the idea of prevention leading. At present thirty-two states make some provision for this group in special institutions. In many cities special classes have been established under the pubhc school system providing a curriculum adapted to their needs. A few states have passed permissive laws providing for sterilization and in effect debarring marriage under certain conditions. The depart- ment of immigration has recognized the problem by more careful examination and observation of the immigrant. An educational campaign has been directed by numerous organizations throughout the country interested in eugenics and mental hygiene and a special committee, national in scope, was organized in 1915 with objects "to disseminate knowledge concerning the extent and menace of feeble- mindedness and to suggest and initiate methods for its control and ultimate eradication from the American people." All forms of treatment revolve about the special institution for 60 Case Work with the Feeble-minded 61 training and segregation, but it has come to be accepted that it is impracticable and even undesirable to work for such provision for all members of the group. There can be no question but that in- stitutional treatment is the most economical and the only rational one in the case of the low grade, the intractable and the clearly un- protected. On the other hand, it is quite as evident that given proper personal and social treatment, many more of the group will be safe and fairly useful members of the community. These two ideas, segregation Umited or permanent, and special training with directed oversight in the community, are the guiding principles of the plan of treatment outlined by the mature and progressive stu- dents of the problem. In Massachusetts, which already leads in its provision for the feeble-minded, a state program has been outlined by the League for Preventive Work which methodizes these ideas. The program, known as the Fernald plan, provides care for the known defectives according to their individual needs and methods of finding others. It includes: (1) A state commission (a) for friendly guidance of mental defectives who under supervision can live wholesome lives in the community, (b) with authority to safeguard in a state school those who cannot. (2) A state-wide census of the uncared-for feeble-minded (3) Clinics for mental examination easy to reach from all parts of the state (4) Special classes in public schools for mentally defective children (5) Special treatment by the courts of mentally defective delinquents (6) Completion of a third school for the feeble-minded In addition, the State Board of Education is "planning a State- wide investigation to determine the number of subnormal children not being provided for in institutions," with the idea of formulating a state-wide pohcy for the special training of these children. It is hardly probable that such a model plan can soon be carried out in its entirety even in the most progressive states. Certain of its most important principles can be tried out, however, even in those states which are most backward in providing for the feeble-minded and chief of these is the principle of individualization of treatment. The idea of applying this principle to work with mental de- fectives is new and as yet not very acceptable to the general social worker. In the words of one of these workers, "there's no such animal as case work with the feeble-minded." The assumption has 62 The Annals op the American Academy been that once an individual has been diagnosed as mentally defec- tive, there is nothing more to be done unless he can be shut up in an institution. This attitude disregards the facts that variations and types of mental defectives are as many as among the normal; that many who must be graded as mentally defective are in a limited degree socially competent, are making a poor but adequate living, and so have escaped the attention of the social agencies; that social incompetence or inability to manage one's own affairs as used in the definition of feeble-mindedness may be modified by special training and oversight. Recent figures of psychological tests given to the drafted men of the United States Army show that approximately 2 per cent of the men are mentally inferidT. Their services, nevertheless, are to be used within the army in forms of work suited to their intelhgence, — in the care of horses, carting, road repairing, etc. The inference is that there had been no expression of social deficiency, to any degree, in these men previously. Feeble-mindedness is best defined as "social incompetence due to arrested mental development." It is therefore more inclusive than the term "mentally defective" and is used in a double sense, — a psychological and a social one. It does not imply an absolute lack of possibility for social competence, but only a limited or relative one. The definition of the British Royal Commission (1908) specifically defines an individual of the highest grade of feeble- mindedness as one "capable of earning a living under favorable circumstances, but incapable from mental defect existing from birth or from an early age of competing on equal terms with his normal fellows, or of managing himself and his affairs with ordinary pru- dence." In practice, the two aspects of feeble-mindedness, defec- tive intelhgence and social deficiency, are found combined in vary- ing degrees. Many of the relatively low grades of intellectual de- fect show no special anomaly of temperament and disposition and grade fairly high by the social test; many others who grade rela- tively high in the psychological sense show such temperamental eccentricities as to make social adjustment impossible. Although constructive work with the feeble-minded outside of institutions is as yet comparatively new and undeveloped, it has already demonstrated the possibilities of modifying the social in- efficiency in certain types so that they are acceptable and fairly Case Work with the Feeble-minded 63 useful members of society. Classes for subnormal children in Springfield, Massachusetts, in Boston, New York and other cities not only have given specialized education and training, but through the personal interest of the teachers or specially appointed visitors from the schools, the children have been followed into their working life and the necessary help and supervision given in industrial adjustments. It is well to dwell on the hopeful and positive aspects of individ- ual treatment of this group for, whether the eugenist arid social reformer will or no, the feeble-minded will still remain in the community. In Massachusetts, the leading state in institutional provision for the feeble-minded, there are as yet only one-fifth of the estimated number in the state so cared for. Since institutional care for all of the group is obviously out of the question, the next consideration is the classification of types to fit the two main divisions of treatment, institutional and com- munity. This classification would be based on considerations covering in general the personal and social factors in the make-up and immediate surroundings of the individual, as : (a) Age (b) Degree of mental defect (c) Inherent and innate characteristics other than the purely intellectual (d) Possibilities for special training in the community (e) Possibilities for protection and supervision (f) Development or no of anti-social habits Feeble-minded women who have passed the active sexual period and show no special emotional irregularities should be able to fit into community life under supervision. Men with no anti- social tendencies are often found self-supporting and fairly useful workers in many of the lower forms of industry. These are the men so often described by their employers as "honest, faithful and industrious, but not over bright." Very young children should not be allowed to crowd the institutions for the feeble-minded, to the neglect of more urgent and suitable cases. Frequently parents ask for the comnaitment of such children to be rid of their care, and social workers are often found aiding or encouraging this, though the case may present no special problem in itself nor even in its rela- tion to the family problem. It is of course self-evident that the lowest grades of mental 64 The Annals of the American Academy defectives, even young children, unless physically and socially well cared for, should be in institutions. This is the type which fits very fairly into other institutions than the special ones for defectives. Above these grades, the decision as to the form of treatment wiU be based more largely on the temperament and disposition of the feeble-minded individual than on the degree of purely intellectual defect. Even when the community offers good opportunity for special training, the decision between institutional and community care will still depend on the individual, on the probabihties that he can be made industrially and socially efficient to some degree. Is there possibility of adequate protection and supervision? Has he the physical capacity to get on outside an institution? Are his in- nate tendencies such that he is unlikely ever to fit into community life? Is he lazy, cruel to his weaker companions, sexually over- active? Is he innately irritable, stubborn, destructive and abusive in temper? Is he untruthful, sly or thieving? If these or other innate tendencies that have an anti-social bearing are present in the feeble-minded, then institutional treatment is the choice, irrespec- tive of degree of mental defect, or sppcial ability along industrial lines, or opportunity for training in the community. Any industrial or reform school can give plenty of evidence that it is not the intellectually higher types that should be kept out of institutions for the feeble-minded. The directors of these schools complain that most of their troubles of a disciplinarA- nature can be traced to these defectives, and one director goes so far as to say that there is no incorrigible prisoner in his reformatory who is not sub- normal. As found on commitment, there is no doubt but that the ma- jority of these defective dehnquents are troublesome beings, but there is always the question whether a certain number might not have been improved to the point of relatively fair social competence by individual treatment in the community earlier When a feeble- minded boy or girl is recognized as such for the first time in a reform school, it is sometimes difficult to separate innate chai-acteristics from acquired bad habits and influence of environment. Mental dfefect and mental instability frequently are present in tlie same individual, but the instability observed in the adult feeble-minded is undoubtedly due in some instances to environmental over-stimula- tion acting on defective inhibitory powers. This is illustrated in Case Work with the Feeble-minded 65 reformatory experience the opposite of that of the superintendent's described above, and it sometimes happens that a feeble-minded individual, whose conduct in the community kept his relatives and the police busy, gives no trouble when under restraint in an even environment. The classification of defectives for the purpose of outlining treatment should form a part of the diagnosis in every case, and for this reason is work for the expert, capable of giving clinical considera- tion to all the characteristics of the individual, physical, mental and temperamental, and of evaluating them in their relation to his en- vironment. A simple diagnosis without recommendation is not much more helpful in the fields of psychology and psychiatry than in the field of general medicine. Any one who has had to deal with problems of delinquency or other forms of conduct disturbance, knows that when the psychologist has said that an individual is or is not feeble-minded, he has said the least that can be said. If the person is feeble-minded, the conduct disturbance may or may not be directly related to the mental defect, while the bald statement that he is not feeble-minded leaves his conduct disturbance wholly unexplained. An interpretation of the individual is the only help- ful diagnosis and is as important in the case of the feeble-minded as with the intellectually normal who present behavioristic problems. Such interpretation is absolutely essential to the inteUigent handling and oversight of the feeble-minded in the community. The outlook at best may not be encouraging but the problem is there and must be met. All too frequently it happens that the institu- tion is non-existent and that the community form of treatment is the only possible one. When one knows the individual, that he is defective to a stated degree, that his defect is or is not transmissible, that he has certain socially favorable characteristics that must be deliberately fostered or socially negative tendencies that must be deliberately repressed, it is possible to work with hope that is not overhopeful. In the handling of feeble-minded children in the community, one can do no better than borrow from the principles and methods of the special institutions and classes that have already been suc- cessful with them. The most successful of these appear to have applied education to defective children in its hteral sense, a "draw- ing out" what is in the child more than a "pouring in," irrespective 66 The Annals op the American Academy of ability to hold or digest, as seems to be the interpretation of edu- cation in the ordinary school. They search out special aptitudes and develop them; tl^ey deliberately take advantage of the strongly imitative and suggestible qualities, and exercise these qualities for good; in the absence of any ability. on their own part to build up a true morality, the children are given a superficial morality by pun- ishment or deprivation when they do wrong, and reward or praise when they do right. If the child is in the regular graded school room, it is very neces- sary to watch lest he be given tasks that are quite beyond him and pushed to the point of mental irritability. The knowledge acquired in school is much less important than the habits formed and the atti- tude toward life and work. A habit of failure acquired in school is as bad for the ieeble-minded child as for the dull normal, and quite as often follows the child into his working life. If he is the type of defective who has insight into his own dulness, the habit of failure may be accompanied by a discouragement which is very difficult to overcome. Two excellent examples of individual work with feeble-minded children in the community were observed by the writer in connection with work in an open air school, having two teachers for fifty pupils, and a resident nurse. One of these was a girl of thirteen and a half years who had been in the school for three years and in that time had completed only one grade. Physical examination on entrance and at the time observed showed nothing more than poor general condir tion. At the time of observation she had been promoted to the fiftli grade, but was not by any means doing the work of that grade. By all forms of psychological tests she graded as feeble-minded, passing just over nine years by the Binet (1911) scale. The teach- er's report was that she was abnormallj' quiet and reticent when she entered the school, but a likeable girl on the whole. Her dulness had been recognized, and she herself seemed quite as conscious of it as the teachers. The school's efforts to overcome her reticence showed excellent results in the girl's general attitude, though she was still very sensitive to her dulness. Some fear was felt when she left school at fourteen that her old reticence might make it difficult or impossible for her to fit into industrial life, but she found factory work at seven dollars a week and still kept the work when last heard from eight months later. Case Work with the Feeble-minded 67 The other pupil was a girl about whose age there was some fioubt, — the school giving her age as thirteen and a half- and her mother as fourteen and a half. This girl was recommended to the open au" school primarily as a conduct problem, although the groiinds for admission were present in the very poor general physical con- dition. The history as given was that she had been growing more and more troublesome for a year past, and recently had become quite incorrigible in the class room. She would thrust her tongue out at the teacher, make faces at the other pupils, etc. The prin- cipal referring the girl thought it a case of beginning psychosis. She was in the fifth grade. An older brother had also been very trouble- some during his last year at school, in the fifth grade, and had been transferred to the industrial room. Psychological examination showed an unmistakably feeble- minded girl, mental age by the Binet scale being less than nine years. When first admitted to the open air school she reacted in the class room as in the previous school, and gave considerable trouble even in the recess and rest periods. After two weeks trial, it was decided to take her out of the class room, but to let her remain in the school, taking her rest periods with the other pupils and helping the school matron dming her class periods. Her improvement was so marked that the consent of the principal was asked for the continuance of the plan. There was no further conduct disturbance though she continued to be noisy and boisterous in play for the first few months. She remained for that school year, her only school work in that time being selected reading. On leaving school she found work in a factory at $7 . 50 a week and was at the same work when last heard from eight months later. The home as a factor in the training of a feeble.-minded child is of course even more important than the school. Where the home is not in itself capable of giving adequate oversight, the assent and cooperation of the parents are manifestly necessary for supervision from the outside. Under authorized supervision from a central state agency, the question of cooperation would probably never arise, even though the actual visiting were delegated to local private agencies. It is unlikely, however, to arise in the case of any home that is capable of properly training and protecting a feeble-minded child. With the children themselves there is rarely any difficulty in approach, — they do not question motives as the normal child. 68 The Annals op the American Academy The parents should be told very frankly any special points in the diagnosis and recommendation and be given specific instructions from time to time as to methods of handling the child. Especially should they be warned of the necessity for the formation of regular habits and the dangers of overstimulation. Ways of fostering the socially positive qualities of the child and combating the negative qualities should be gone over in "words of one syllable," if need be. All work should be directed to the formation of good habits and the avoidance of bad. Ways of keeping the child's interest in the home should be devised; a habit of reading should be encouraged and books selected for their possibilities of pointing a simple moral without any special stimulation; simple games that give the child a fair chance to win should be provided from outside if the family cannot provide them. Any musical ability or interest of the child should be fostered. While the child is still in school the question of the kind of work he is likely to do later should be considered. It is well to plan for this as near the home as possible to avoid the expense of carfares and the many undersirable distractions that car-riding involves. Lack of ability to do certain forms of work does not handicap the feeble-minded so much as lack of ability to attend to the job. For the child who has been deliberately trained to a fair degree of stick- to-itiveness, this will be much less of a handicap and he should fit very fairly into many forms of unskilled factory work. Possible employers should be interviewed and interested in the practicabiUty of employing such children. Their response is often surprising. They take the rather sensible stand that it is as well to employ people about whom the worst is known as to run the chance of getting the same people through the regular employing channels and know nothing of them. One of the most encouraging and heartening experiences that come to the tired social worker is the encounter with the kindly employer or foreman who says he is will- ing to give the defective child a chance and who gives much more than a chance; the effect of his friendly supervision is shown later in his confidential opinion that the doctor who said that particular child was feeble-minded doesn't know his business. This kind of an employer and especially this kind of a foreman is really not an isolated instance. A point to be especially emphasized in work suitable for the Case Work with the Feeble-minded 69 feeble-minded is the possibility for supervision. The best and most complete special training can never make of the defective anything but a helper. There is no exception here even in the case of those defectives who have special abilities along certain lines, for although they may be able to do the actual work done by a carpenter or a plumber, they cannot plan as a carpenter or a plumber, or work independently. Both social, workers who give supervision and even more the families of the feeble-minded persons are apt to forget that a fair amount of recreation is as necesary for the defective as for the nor- mal, and that it is quite natural that he should desire the particular forms of recreation the rest of the community enjoy. Games in the home, music, reading, fancy work, are not sufficient when all the rest of the world, including other members of his own family, are attend- ing moving pictures or a band concert. Outside recreation should be planned for in a degree which does not cause overstimulation, and under supervision which is not so obvious as to arouse antagonism. In dealing with the adult feeble-minded individual who has been recognized as such for the first time as an adult, one realizes that the most important part of the program of work for the feeble-minded is the provision for methods of early diagnosis. As found, he pre- sents a problem of mental defect with all that it implies of lack of judgment and control plus well estabUshed habits that are difficult or impossible to break. If these habits happen to be actively anti- social we have what is so popularly known as .the defective dehn- quent. Treatment of this type outside an institution is practically Hfever successful and institution directors who have dealt with them will say that treatment within any ordinary institutions is quite as unsuccessful. Mental instabiUty is more prominent than mental defect in practically all of these cases, — ^they are not merely un- trained feeble-minded. The mental defect, however, is there, and the community should treat them not as delinquents but as the doubly defective individuals that they are. Work to make the defective safe for the community should go side by side with effort to make the community safe for the defect- ive. This to be effectual must cover a wide range, from education of the community on the significance of feeble-mindedness and the necessity of special provision, to the enforcement of all laws for the protection of children and the security of public morals. '70 The Annals of the American Academy Just as the methods found specially adapted to the teaching of the feeble-minded have contributed much to the educational niethods applied to the normal child, so the social treatment of the defective on the individualistic basis is bound to point the way for better methods of dealing with social problems among the normal. So-called individual work with the normal group is much more fre- quently personal than individual, and failure in the social handling of the normal individual is undoubtedly often due to this fact. The obvious defects in the feeble-minded make it necessary to search out and determine the value of any positive quahties that he may possess and weigh them against the defects. The psychologist or psychia- trist in interpreting the individual furnishes a basis upon which truly constructive work may be done, when the social worker knows the best and can foster it and knows the worst and can fight it. CASE WORK IN THE FIELD OF MENTAL HYGIENE By Elnoea E. Thomson, Executive Secretary, Illinois Society for Mental Hygiene. The attitude of mind of the social worker — perhaps especially in the field of mental hygiene — cannot be better stated than in the words of Dr. Meyer quoted by Miss Richmond: "A wilHngness to accept human nature and human doings as they are before rushing in with the superior knowledge of how they ought to be. The first need is to know what they are." The motto of every social worker and investigator should be that of Terence's Heauton Timoru- menos: ". . . . One who investigates must be ... . ready to accept .... anything human beings think, feel or do as not altogether strange to human nature : ' I am but human and I do not consider anything foreign to me'; it is at least worthy of human consideration." This implies forbearance with the patient, the relatives, espe- cially those by marriage, other agencies, — -already wearied with much effort in the patient's behaK — the courts and the state offi- cials. It imphes also an ability to reflect the patient's point of view and not one's own, to report symptoms and to know facts. Above all it implies honesty and straightforwardness in deaUng with all concerned. Patients are referred to the mental hygiene social worker in many different ways: in person, through other agencies, through rel- atives, physicians, institutions, neighbors, courts, schools, etc. and al- ways because of some form of unusual behavior which may manifest itself in an inability to adjust to surroundings, or to acquire knowl- edge, deep melancholy, addiction to drugs or to alcohol, unreUable or irrelevant statements, ideas of persecution, unusual demands, threats against individuals or groups, etc. It necessarily follows that any plan for investigation must be elastic to meet the deniands of the individual case. The first contact with the patient is often extremely difficult and the successful worker in this field must be resourceful and a responsive listener. Miss Richmond writes : 71 72 The Annals of the American Academy The important things in initial interview are privacy, absence of hurry, frequent change of topic with some deliberate padding to ease the strain, particu- larly "when irritation begins to adulterate the account," and yet through all a clear conception on the part of the interviewer that a certain goal must, if possible, be reached, and a slow, steady, gentle pressure toward that goal — this, in brief is our program. Giving the patient all the time he wants often leads to that fuller self-revelation which saves our time und his in the long run. Pressure of work! Lack of time I How many failures in treatment are excused by these two phrases! But wherever else the plea of lack of time may be valid, it is pecuharly inappro- priate at this first stage, for no worker ever has leisure enough in which to retrieve the blunders that result inevitably from a bad beginning. If the first interview is successful a friendly relation with the patient will have been estabUshed and can be maintained during the period necessary for further study before making a plan for examination and treatment for, unless this interview or the history obtained from other agencies has brought out symptoms which indicate that the patient is a definite menace to himself or the com- munity, it is usually wise to delay a cUnical examination until the social history is complete, for the recommendation of the specialist as to treatment whether institutional or otherwise is often dependent on the social history. In other words, a chronic mental case in which treatment is unlikely to be of benefit and only custodial care is required, is institutional or not according to the reaction to the hallucinations or delusions as shown by the social history. The modern clinician with his well developed social attitude is unwilling to make a recommendation without such history. Thus the. social service worker in the mental hygiene field must know the value of evidence. All the primary work must be for the purpose of the mental examination and must be truthful and exact. Curious experiences are often founded upon fact and must not be termed delusional until their unreasonableness is clearly established. Symptoms of physical disease must be noted and if indicated a thorough physical examination secured and the findings submitted with the social history at the time of the mental examination. In the gathering of this history which must take into account both heredity and environment, the well trained worker knows the evils arising from too much questioning of the patient and avoids anything which simulates a mental examination. An indiscretion here may make more diflBcult the later examination and the treat- ment which is to follow, for an examination that does not lead to a Case Work in Mental Hygiene 73 plan for treatment is of little value. A word here should be added against the very common practice of taking a patient from clinic to clinic. This is not only unprofessional on the part of the worker but often results disastrously for the patient, who soon loses confi- dence in both social workers and physicians and becomes an even more puzzling social problem. Numerous difficulties, however, are likely to be encountered in efforts to work out plans for treatment. Frequent statements like the following will be given the worker: "This patient is not in need of institutional care but needs congenial work in a good environ- ment with understanding direction." Practically the only way to meet the need of such patients is to establish, in connection with the field work, an occupational department where training and employment under skilled supervision can be provided. In estab- lishing such a department the prime necessity is, of course, the director, who must be a well trained teacher who understands abnormal individuals and not only knows various handicrafts but can also teach her pupils to produce articles which have a sale value; for such a.department will not be a success unless the patients have the incentive of economic return for their efforts while working in the department. The result hoped for is such a readjustment of the individual as shall later make possible positions in regular industrial lines. This will be possible in a considerable number of cases, but if this cannot be accomplished at least there will be brought out the reasons why the patient cannot readjust and so make possible a working plan for continued treatment in or out of an institution. Some patients can get on very well under such continued super- vision as a department of occupation gives and can contribute largely to their own support while they would otherwise be entirely dependent. Another group of patients will be found, after a period spent in the department, to be a menace to themselves or to the community, and with the information gained in daily contact, commitment to a state hospital is made possible. Still other pa- tients needing hospital care, who will not at first consider it, can later be induced to go as voluntary patients. Then there is a group who are not a menace to themselves or the community, living in their own homes, chronic shut-ins, whose lives can be made much happier by occupations which can be taught 74 The Annals of the American Academy them by a field teacher; the economic return may be .very little or nothing, but there is a distinct therapeutic effect which will at least make for less complicated family situations and certainly add to the sum total of human joy. The following case histories taken from our records may serve to illustrate. Prophylactic In the fall of 1914, a Syrian, 30 years of age, came to the United States with his wife and duldren. He was unable to speak the EngUsh language and such friends as he had were unable in tha,t time of financial depression to find any work for him. He had a httle money which gradually disappeared. He had been trained to work in metals and had brought with him to this country a little stock of silver jewelry, thinking by the sale of this he could increase his capital, but he could not sell it because he knew of no market. He became more and more de- pressed and finally so deeply melancholy that his wife, fearing he would take his own life, appealed to some Syrians whom he knew. One of these Sj-rians was a patient of the Mental Hygiene Society and brought this man to the office. He was sent to a physician for physical and mental examination and returned witfc a statement that his melancholy was probably due to his inability to obtain em- plosmient and the prescription was work. Work was provided for him in his own line in the occupational department. It was possible to find individuals interested in the silverware and some was sold ' almost immediately bringing in a little money; orders were secured and the man gradually came to look upon life from an entirely different viewpoint. During this time the statements made by the patient were verified and at the end of six weeks a position was found for him. Very shortly he was promoted and things have gone well with him ever since until now he is part owner of a prosperous grocery business in a neighboring city and is very sure that, but for the under- standing aid given at his time of special stress, he would have t^en his own life, for he was convinced that if he were out of the way his wife and-children would be cared for by kindly disposed individuals, but that an able bodied man should be self-supporting. Voluntary Patient referred by another agency in the following letter: We would like to refer to you the case of A. P., Ujyesis old, living at There is a history of insanity in the family and one of the younger girls is very nervous. A has lately developed a mania for cleaning every- thing around her. She had a position in an office but finally could not be persuaded to do anything but clean her desk, etc., and had to be dismissed. She does the same thing in her home and her mother feels she is getting worse. She is perfectly quiet so far. Will you kindly let us know what you can find out about her. Her sister G., 13 years old, is one of our patients at one of the dispensaries. Case Work in Mental Hygiene 75 A call was made at the home and an interview with the mother brought out the following facts: Parents born in Germany, no relatives in America. Father, brilliant but very erratic, well-born but not in favor with his family. Had been addicted to the use of alcohol for a great many years. Four years before had deserted his wife and children. Mother, hard-working, plodding, of peasant parents, inter- ested in her children, and anxious to do all she could for them. Mother stated patient had been very bright in school, stood at the head of her classes but was always inclined to be nervous. She left school when in the seventh grade at 14 years of age to go to work in order to help out the family income. At first she did piece work in a factory but it had seemed very hard for her and was given-up when a position in an office was found. A few months previous to our worker's visit, a girl in this office had suffered from some eruption on her face and body. Patient worried a great deal about this and began constantly cleaning her desk and the things about her. Finally she had to leave her work and at home was always shaking and cleaning her clothes. She would sit in only one chair in the house which she frequently washed and would not allow any one to handle any of her things. She realized her own nervous condition, felt that she was growing worse and was anxious for treatment. Appeared to be very anemic and was extremely emotional. An examination by a ne^lrologist was arranged and he suggested sanitarium treatment. The parish priest was interested and the patient was sent for six weeks to a sanitarium for special treatment. At the end of that time she returned greatly improved and upon advice of the neurologist was given work in our occu- pational department. She was still somewhat emotional but was soon interested in the work. It was discovered that she had considerable artistic talent. This was developed and through the sale of baskets which she made and children's toys which she painted, she was able to earn from $7.00 to $9.00 a week.- Improve- ment was gradual and treatment extended over a period of eight or nine monthsi At the end of that time, however, recovery seemed to be complete and the patient was able to return to her former position in an office where after two years she is still employed giving satisfaction and earning a good wage. In addition to this she is taking certain courses in an art school. Borderline Referred by Bureau of Occupations where patient had gone frequently to secure employment. She was a woman 50 years of age, born in the United States, had received high school and normal school education and had followed the occupation of practical nurse. She was unmarried and a Protestant. When interviewed she was very nervous and excitable. It was discovered that her eye- sight was considerably impaired but she refused to see an oculist. The landlady where she had lived for some time had found her very difficult and peculiar. She was in arrears some thirty or forty dollars for room rent but the landlady stated she was strictly honest and that if she secured employment would pay her debts but that she had been idle many months. She would not do nursing in a family where there was any house work and would not even take care of her own room. 76 The Annals of the American Academy It was the landlady's opinion that the patient was incapable and inefl5cient. It was found that she was making an effort to bring suit against an emplajrment bureau for having referred her to a position as a domestic. Work at sealing and stamping envelopes was secured for her but her employers were unable to keep her as she was so extremely difficult. At oiu: request she was examined by a neurologist who stated that she had decided defects and was a social problem but hardly an institutional case. He advised work in our occupational depart- ment. As it was extermely doubtful that her earnings would support her an interested relief agency cooperated with us in this experiment so that the patient would have an adequate income during the period. In the work in this depart- ment it was found that not only eye-sight biit also hearing was defective and that she was utterly unable to adjust herself to any ordinary stiuation. She would make no attempt to do the work provided and was constantly complaining of work, teachers, other workers and food. She became very indignant when it was suggested that an examination of her eyes might make it possible for her to secure glasses which would make things easier for her. She was unwilling to take any type of work but that of companion to an elderly couple and unable to see that her special defects would make it impossible for her to get on in such a posi- tion. It was discovered that she was known to many physicians who all felt that she was not responsible, and finally she had become firmly convinced that her inability to get work was due to persecution. An old friend of her family was interviewed but stated that he was unable to do anything for h^ and could not put us in touch with anyone who would. He was quite sure her family history was negative. She had been in one of the city hospitals two years previous to this time as the result of an injury, had been very difficult and irritable and had been considered a mild mental case. Her eyes had been examined with diagnosis of cataract but she had indignantly left the hospital when an operation was suggested. Six years before she was in another hospital and in two different convalescent homes. In each instance she was reported erratic and difficult. After several months of effort to adjust her to conditions some relatives were found living in Chicago but she would have nothing to do with them as she con- sidered them her bitter enemies . Finally a position was found for her in a depart- ment store for the hoUday season but she remained only one day as they put her in the toy section and she said she knew nothing about toys. Again she made many complaints ^n regard to the people with whom she worked, stating that she was the victim of a system of persecution in which she included a physician who had recently befriended her and all of the agencies with which she had any deal- ings as well as her relatives and other individuals. The matter was again taken up with the old friend of her family who still felt unable to do anything. Her physician, after this period of intensive study, felt justified in issuing a certificate stating mental illness and papers were taken out for commitment to the psycho- pathic hospital. When this was reported to the old friend of the family he was inclined to be indignant as he did not feel that she was insane and thought that some other provision should be made. Even the liistory which had been obtained covering nine years of inability to adjust to any sort of living conditions was not convincing to him. He was told that any arrangement he might make for her care which included the necessary financial aid and supervision would be satis- Case Work in Mental Hygiene 77 factory and arrangements could be made to have her dismissed in the care of any one whom he would designate. At the end of a week the patient was dismissed in the care of a woman who had consented to room and board her, the old friend agreeing to supply the funds. This is probably only a temporary arrangement, but the fact is estabhshed that she is physically and mentally unable to be self- supporting and it may be reasonably expected that no further effort will be made in that direction in a community having a well organized confidential exchange. Danger to Self or Community This case was referred to us by a legal society whose representative stated over the telephone that a patient was in their office much excited, declaring he could not hold a position because wherever he worked his enemies followed him and made his employers discharge him; that recently he had been in the Bride- well, having been sent there through the work of his enemies and no fault of his own. This patient reported at our office and proved to be an Egyptian, 30 years old, who had been in the United States eight years and who had for some years followed the occupation of ship steward or house man. He was able to make himself understood in many languages but unable to read or write, had never attended school and had no relatives in this country. He thought one sister stiU lived in Paris but had not heard from her for years. All of his other immediate relatives were dead, one brother having been killed in the Boer war. He had been naturalized while living in New York, had held positions in different cities of the United States and had apparently never stayed a great while in any one position but had been more than one year in Illinois. As he was out of a position and needed work, he was employed as janitor in our office while an investigation of his statements was being made. He was found to be a very good worker but in- clined to be sullen and easily offended. The fact was brought out that he had been employed in one family in Chicago for six months. Nvunerous statements which he made in regard to this family were found to be without foundation, and as he was persuaded to talk more freely of his trouble it was discovered that he felt this family, particularly the mistress of the household, was responsible for all of his difficulties, and that he had made up his mind that it would be necessary to take her life if he was to have any more peace of mind. With these facts established he was examined by a specialist who issued a certificate for his commitment to the psychopathic hospital where he was per- suaded to go by one of our field workers. Later he was committed to a state hospital for the insane, where he is now under care and treatment. After Cake This was a young woman, 37 years of age, born in the United States, who had a high school education. Her history was one of considerable instabihty during her childhood and early womanhood and she was committed to the state hospital in maniac state. Paroled during the first year of hospital residence, she was retmmed within a few weeks in a highly excited condition and had been in the hospital ten years with no history of any mental abnormality after the first year. She was very agreeable, anxious to be helpful and did excellent needle work. Her relatives 78 The Annals of the American Academy were persuaded to give her a trial outside of the institution when given assurance that they could have the help of a specially trained social worker. She was furnished employment in needle work and later was given training in certain special classes in work for which she seemed to have a liking. At first frequent visits were made to both relatives and patient in order to reassure them. The patient has had no recurrence of her mental difficulty and has been self-supporting for the past six years except during two very severe physical illnesses during which time she was cared for in a general hospital. Both relatives and patient have relied for advice upon the social service worker. Case work in mental hygiene, then, is of benefit to the individual and, in cooperation with other agencies, to the family and to the community. But it has another and even more far-reaching func- tion — for the records honestly made with proper regard for "the value of evidence" are an important contribution to the research worker in the mental field where so much still remains to be Ascer- tained as to the causes of certain forms of mental disease and methods for prevention. THE FATHERLESS FAMILY By Helen Glenn Tyson, State Supervisor, Mother's Assistance Fund of Pennsylvania. Before the movement for mothers' pension legislation spread over the United States after 1911, there were two general forms of administering relief to fatherless families. The first was through private agencies, many of which have for more than a decade realized that the only constructive solution of the poverty problem presented by the fatherless family is a regular allowance on which the widow can depend to free her from worry and overwork and enable her to give her children real home care. The other form of admin- istering aid was through the public agency for outdoor relief. Under the old Poor Laws, meager allowances had always been granted to widows, but never on any adequate basis; nor had the public offi- cials administering this relief formulated any pohcies as to standards of family life to be required in the families aided, nor defined the quality of service to the children that could reasonably be demanded from the mother. While a few states have developed their mothers' pensions system simply through an extension and re-interpretation of the old outdoor relief laws, the general form of the new public adminis- tration of relief has been through the courts. This seemingly chance development was probably due to the fact that in a number of states the courts still have jurisdiction over dependent children and that one of the best-known Juvenile Court judges in the coun- try was the first to make an effort to have the jurisdiction of this court extended over such dependent families. Then, too, there was the greatest distrust and dissatisfaction with the old outdoor relief agencies among those interested in public welfare, and it seemed to be the easiest solution to divorce them entirely from the new adminis- tration of this form of aid. The states that have recently passed mothers' pension legislation, however, have realized how unsatis- factory administration of relief through the court is apt to be, a,nd recent mothers' pension laws — notably those of New York, Pennsylvania, Delaware, and New Jersey — have created an en- 79 80 The Annals of the American Academy tirely new piece of administrative machinery based on the plan of county organization, but with state supervision or control. These efforts to separate this group of dependent families for special treat- ment reveal a new reahzation that the community as a whole is largely to blame for the ills-that afflict individuals, and a growing conviction that from the point of view of self-interest alone, the state must assume greater responsibility for the welfare of its children. In 1909 the Royal Commission on the Poor Laws of England recommended unanimously that the old poor law machin- ery be abandoned and a new public assistance authority be created. This year, 1918, in the midst of England's most costly war, this plan has been actually carried out and the new plan comprehends all forms of relief and special provision for dependents and de- fectives.^ Our new Mothers' Assistance legislation, haphazard and un- standardized though these efforts to meet the needs of fatherless famihes through public action have seemed, has nevertheless these significant effects: definite opportunity is offered to the state to discover the causes of the untimely deaths of the fathers, at the very time of their greatest usefulness to society, industry and the fam- ily; also, the chance is given to estimate the cost to the state of preventable deaths of the breadwinner and the loss entailed by the subsequent dependency of the helpless family.^ With these facts as a basis for further action mothers' pension legislation should soon be taken over as an integral part of the larger and more construstive plan for social insurance.' Yet even under such a system of state organization a certain number of young fathers will continue to die untimely deaths, leaving their families unprotected by any form of insurance and in need of organized assistance. When the average individual hears the term "widow" if he does not think of the fictitious person named to obstruct any economic reform, there instantly flashes into his mind a type picture of the "poor widow" of sentimentalism : a frail, hard-working devoted 'Bruno Lasker, "The Dcatli Blow to England's Poor Law," The Sim-cy, Feb. 23, 1918, pp. 563-564. 2 Report of Special Inquiry Relative to Dependent Families in Massachu- setts Receiving Mothers' Aid, 1913-17, Senate No. 244, pp. 77-141. ' Final section of report on work of Mother's Assistance Fund in Pennsyl- vania, pamphlet of State Board of Education, in press. See also, Commons, J. R., and Andrews, J. B., "Principles of Labor Legislation," pp. 406-409. The Fatherless Family 81 mother, bending over a wash-tub and surrounded by a large group of hungry children. While there are no more innocent and pitiful sufferers from our unorganized social system than the widow and orphan, social workers know that there are as many kinds of widows as there are kinds of women. At one end of the line is the capable mother who will make any sacrifice to keep her children with her and rear them in decency and comfort ; at the other, the weak or vicious woman who will exploit, neglect or abandon her children on the slightest pretext. For the purposes of this paper the family with adequate finan- cial resources is not considered; nor is the one where deterioration in the values of family life (whether due to environmental causes or individual defect) has compelled the breaking up of the family to save the individuals that compose it. The following discussion is limited to those fatherless families, where, with adequate income, the children bid fair to become normal useful citizens under their mother's care. Whether relief to a fatherless family is administered through a public or a private medium, there are certain prerequisites of as- sistance which all agencies endeavoring to follow modern methods of social service have established. Investigation should not stop — as all too frequently in the past,^ — with the proof of the fact and degree of need of the family. A full consideration of the financial resources available in the way of help from relatives, property or money owned by the widow, her own or her children's abihty to contribute without harm to the support of the family is of course essential. But the value of the family life measured through a con- sideration of the mother's mental, moral, and physical fitness to bring up her children must also be determined by investigation. Assistance should not be given in famiUes where the mother is mentally unsound or defective, morally weak, or physically unable to give the children decent home care. Finally, investigation should show the basis of a plan for the future welfare of the family. After the decision to grant assistance is made, the social case treat- ment of the family should be organized about this plan. In any family the elements of normal life are disrupted by the death of the breadwinner. His loss is more than the loss of a pay envelope. At this stage of the social and economic development of woman the removal of the father of the family is apt to have a 82 The Annals of the American Academy very serious effect upon the family's solidarity. His loss is felt in the making of plans for the spending of the income effectively as well as in the loss of the income itself. There is great need of his discipline and advice in the training of the children, especially in the case of growing boys. In certain foreign groups particularly, where the status of woman is regarded as so much lower than that of man, it seems almost impossible for a mother no matter how de- voted and earnest, to control and guide her restless, adolescent son. Often, too, the father has been the one to attend to such business details as the payment of rent and insurance dues, the one to ar- range for necessary medical care for the children. The father also gives the family a certain social and economic status in the com- munity through his relation to labor organizations, employers, and pohticians. His advice at the time the children begin to enter in- dustry and to choose occupations for themselves is usually sorely needed. To supply all these weaknesses in the family life is the task of the social worker who administers relief to the family and supervises their welfare. In many ways the fatherless family offers the ideal group for a demonstration of the value of social case treatment provided that the assistance given is adequately and wisely planned. The Home Service of the Red Cross baises its strong claim to serve the families of soldiers and sailors on similar grounds.'' A growing family of normal children offers every opportunity for constructive study and guidance. The mother is free from the strain of child bearing and as the children grow older can give more attention to the development of family life. The fact that the income is adequate and steady and not open to fluctuations due to unemplojaiient, illness of the bread- winner, or personal weaknesses on his part such as drunkenness and brutality, enables the mother to gain habits of foresight and thrift that she has perhaps never been able to develop before. A study of the social records of families adequately assisted and well super- vised shows that in many cases a rise in the sta^idard of living of the family has actually been achieved. Certainly there can be no more satisfying result in social case treatment than the "graduation" of a widow's family into complete independence, ^^■ith fuller social con- tacts, good educational grounding, and a well-rounded family life. After investigation has established the fact and degree of need • A. II. C. 201 "Manual of Home Sorvicc." Seoond edition, pp. 31-46. The Fatherless Family 83 of the family, discovered all available and legitimate resources to meet that need, and found that the mother is mentally, morally, and physically fit to perform her normal duties to her children, the first step in the plan for future supervision is the consideration of a sound financial basis on which the family should be maintained. Unfortunately it is still true that most fatherless families do not come to the attention of any social agencies, public or private, until some time after the death of the man. This period is almost sure to be one of family deterioration. The strain of the father's illness and death, the pressing need of the necessities of life, the demands on the mother's time and strength from her effort to support the family and maintain the home all tend to involve her in difficulties that she could not surmount alone. Through the widow's short sightedness or total ignorance of the world of business, the insurance money sUps in a few weeks through her fingers. Dozens of instances can be described by social workers where a designing "friend" of the husband has taken advantage of the widow's ignorance to ap- propriate the larger part of the small lump of insurance, or where well-meaning -neighbors or friends have given her just the kind of advice most certain to deplete her httle fund. The usual bad in- vestment of this sort is either the buying of a home under a heavy mortgage in a congested or neglected neighborhood, chosen with no consideration of sanitation, neighborhood conditions, or nearness to work and school; or the expenditure of the few hundred dollars for stock for a Uttle store. In hundreds of such instances the stock has soon been sold; there is of course no capital to replenish it; and finally the Uttle store closes and the family's small reserve fund vanishes with it. It is surprising to social workers to find how frequently women have not been allowed by their husbands to handle money even for the household needs. Obviously it takes a certain amourit of fore- sight to save ahead for the rent and insurance and even more to realize that furniturfe or other household necessities bought on the installment plan are not a good investment. Before working out a budget of living expenses for the family, the case worker usually must spend some days in discovering what the family's habilities are, and in straightening out a tangle of unpaid bills, lapsed in- surance poUcies, and installment charges. After the existing economic resources of the family are dis- 84 The Annals of the American Academy covered, the next consideration involves deciding which of these are legitimate assets that can be counted on for the future, and which part of the income should be cut off or decreased for the well- being of the family. In many states the law determines the max- imum amount of property and money a widow may have and still be eligible for assistance. There is some difference of opinion and legal provision on this question, varying, for example, from the law in Illinois where a mother is disqualified for assistance if she possesses any property and money, to California, where a maximum of five hundred dollars in cash and a thousand dollars in property is allowed. The consensus of opinion seems to be that some equity in property, provided it is the widow's own home, tends to add to the self-respect and thrift of the family and to keep them in the neigh- borhood and town where they have become established and where all their natural social contacts have been made. The sacrifice of a home to most people brings great discouragement and the feeling of loss of social standing. Then too, many instances prove that it would have been actually cheaper to assist a mother who owns her home, provided the home was suitable to the family's' needs and not deteriorating in value, than to insist that she sacrifice it at a forced sale only to become a heavier charge on the community later. In the matter of money in the bank, since for the sake of econ- omy in the distribution of available funds the amount of the monthly grant must be based on a necessity standard of living, a little surplus is invaluable for meeting emergencies of sickness and accident that constantly arise in a family of young children. This small reserve sum, however, should never be regarded as a source of income to be drained gradually through an inadequate grant; and the undei^ standing with the mother should be that it is only for emergency needs. Yet there is no doubt that its possession adds to her feeling of independence and security from want. In considering the question of relatives as a source of income the tendency seems to be for public agencies to take a different attitude from that held by private societies. If rehef is given by a public agency the attitude of the community usually is that a widow's rela- tives like other citizens of the state are contributing to her need through taxes and, except where the law holds them legally respon- sible for her support, that they have a right to claim exemption from that responsibility. There are of course many cases in which rela- The Fatherless Family 85 tives, not responsible under the law, have willingly shared with a public agency a part of the economic burden of the family. The insistence of private agencies on the fullest possible aid from rela- tives is founded on the belief that only through the enforced sense of mutual responsibility can family solidarity be maintained, and that loyalty to one's own kin is a human value which must not beallowed to go to waste. Whether such human values are actu- ally enhanced by insistence on financial help from relatives already struggling to make ends meet is open to question." There is no question, however, that the financial and social status of the rela- tives should be determined and their help, particularly in other than financial ways, enlisted for the family. One of the first methods of increasing income to which the needy widow turns is the keeping of men lodgers. Through bitter experi- ence over many years and with a large number of famiUes, social workers are unqualified in their disapproval of this method of adding to the iocome. Aside from the fact that the presence of any stranger has a disrupting effect upon Ae family life there are many general considerations that render the policy a bad one. The effect of the men's influence on the growing boys is often bad, the difficulty of making decent sleeping arrangements in a small house, and the ac- tual danger of physical violence to the woman or the Uttle girls in the family must be considered. Quite often gpmpanionship and pro- pinquity lead to intimacy; and illegitimate children make the fam- ily problems more difficult. Even close supervision cannot ward off these dangers. In the case record of a family which has been under the supervision of one of the best private agencies in the country since 1911 we find the following significant entries: 10/2/11, Widow a particularly sweet, appealing person. Children clever and most attractive. On account of high type of woman it seemed safe to allow her to keep her three boarders. They are a good class of men, interested in the children and helpful with them. When the children need treatment, Nick, one of the boarders, takes them to the hospital. 10/20/13, State Dispensary reports that they suspect pregnancy. This was confirmed later by a private physician. 2/17/14, Henry, 12, removed by Juvenile Court. 5/2/14, Toney, 10, removed by Juvenile Court. 7/7/16, Polney, 10, removed by Juvenile Court. 6 See discussion "A Misplaced Burden," Charities and the Commons, Oct. 13, 1906, p. 118. See also I. Rubinow, "Social Insurance," pp. 313-315. 86 The Annals of the American Academy According to the other entries in the record this family shows a slow but steady deterioration. If a firm stand on the lodger ques- tion had been taken in the beginning, immediately after the hus- band's death, it is possible that the breakdown might not have occurred. Another usual source of income for the family and one to be considered most carefully is the mother's own earnings. In judg- ing whether or not a mother receiving assistance should contribute to the family's support, exactly the same considerations,should hold that govern any mother's decision about work outside the home. That is, the question of whether she should add at all to the family income and to what extent, should be decided by a study of the age and number of the children, the condition of the mother's health, the provision of care for the children during her absence, and also her own inclination, capacity and past habits. No intelligent plan about the mother's work can be made unless the amount which she adds to the family budget be regarded as of secondary importance to these other determining questions. Study of the industrial conditions of working mothers has shown that the large majority are employed in unskilled, un- standardized work at the lowest wages and for the- longest hours.* OfRce cleaning seems to be the work usually condemned by social workers for the mothei^of young children on the ground that it is extremely fatiguing and comes at just the time of day, morning and evening, when she is most needed by the children. Of course, a busy mother, who works at night, finds it very difiicult to get the proper amount of sleep during the day and at the same time perform her household duties and give her children the proper care. There is also a frequent temptation to the fatigued mother in going through the streets in the cold and dark to take a stimulant or make un- desirable acquaintances. The fact that even trained social work- ers are sometimes strangely blind to the dangers involved in per- mitting the mother to do this kind of work is shown in the following extracts from the case record of an assisted family : Mother with 6 children, ranging from 15 months to !)J years. 6/5/15 M. working at K. & B. Dept. store 4 hours every evening. Receives SI a day. "Katherine Anthony, "West Side Studies: Mothers Who Must Earn." R. S. F. Survey Asxociales, June, 1914, p. 153. The Fatherless Family 87 1/18/16, Visitor found a man sitting at the kitchen table in the evening. Said he lodged in the same house and watched the children evenings while the mother worked. 3/29/16, Petition filed in Juvenile Court. Children neglected. Mother illegitimately pregnant. While other factors than the mother's night work probably con- tributed to the deterioration of this family it is clear from the entries in the record that it was the chief cause. If it is necessary and de- sirable that the mother supplement the income, the consensus of opinion seems to be that sewing, fine laundry, or the care of other dependent children are more desirable than the usual forms of work because these occupations do not demand fixed hours of labor, and can be carried on at home while she is attending to her family's needs. The question of the contribution of working children to the family income is one that can be summarized briefly. In order to increase the family income, no child should be forced into work pre- maturely, or under conditions that jeopardize its health or future development. It is equally true that a child should not be permit- ted to contribute more than a reasonable amount of its wages to the support of the family and should not be made to feel that the family is dependent on its earnings to an undue degree. After the family resources in property and money, financial help from relatives, and ways in which the mother and children may safely add to the family income are considered, the question of the budget on which the family may be expected to maintain a good family standard must be decided. There is no doubt that contin- uous and adequate relief can be used as a lever to lift family stand- ards of living, and that it is not money aid in itself but the method of administering it that may do harm . One of the arguments against public assistance is that it lacks the elasticity of private relief and cannot easily be adapted to the changing needs of the family. But this is equally true of the weekly wage of the father, and the average family must plan on a fixed sum. The feeling of security which a fixed monthly or weekly allowance gives to a widow enables her to develop those qualities of foresight and thrift by which she may plan ahead for the winter's coal or the next month's rent. So much scientific and detailed work has been done on budget planning for assisted families that it is unnecessary to describe it here 88 The Annals of the American Academy The one basic principle, however, is that the amount granted, if ex- pended with reasonable care, must be adequate to ensure mainte- nance of health, working efficiency, and a good standard of family- life. It is no exaggeration to say that there is hardly a family apply- ing for assistance in which at least one member does not show signs of malnutrition or disease. In the mothers the strain of child bearing, overwork, worry and enforced neglect of the simplest rules of hygiene have often resulted in chronic functional disorders or in conditions requiring surgical care; varicose veins, gynaecolog- ical and digestive disorders, flat feet and cardiac trouble are ailments common to these mothers. Among the children, disorders due to neglect and under-nourishment are prevalent and there is great need for the medical treatment of skin diseases, throat conditions, anemia, eye strain, and other disorders that may result in serious retardation in school and later in industrial efficiency. To meet these health needs the aid of private physicians, hospitals, conva- lescent homes and sanatoriums must be enhsted. In outlining a plan for supervision for a fatherless family it is well to decide what changes in the family life should be made at once. Even if emergency aid only is given for a few days, it is often wise to withhold regular assistance until a child who has been illegally employed is back in school, the man lodger eliminated, and in some cases until a member of the family in urgent need of medical care is actually under treatment. When regular assistance begins, the mother's hours of work should be changed at once to meet the plan for proper home care of the children. Other changes, such as the improvement in the school records of the children, training the mother in budget keeping, and securing dental care for the family, may require months of regular visiting and patient effort. In this attempt to ensure the progress and welfare of the fam- ily it is perhaps unnecessary to say that the advice and help of clergymen, school teachers, former employers and relatives are needed. Other social agencies can often render the special kind of service that is required to fit some particular need. A housing as- sociation may be consulted about a sanitary home in a good neigh- borhood; a visiting nurse called in if there is sickness in the family; a vocational guidance bureau requested to advise the children as they approach working age; the interest of a settlement or commun- The Fatherless Family 89 ity center enlisted to secure recreation and wider social contacts for the family. The reading of a considerable number of records of assisted f a,milies in several cities that had been under the care of either a pub- lic or private agency showed that there are still valuable opportuni- ties in supervision that have hardly been touched. In many cases the influence of the personality and ideals of the dead father is a vital "factor in the family life, yet only in isolated instances was there any reference to his plans and ambitions for his children. While many records show an attempt to regulate the hours and working conditions of the mother, there were practically no instances where she was offered the opportunity of training for more highly skilled and better paid work. In view of the fact that she is usuallly quite young and will often be obliged to contribute to her children's support for many years to come, it would seem a wise economy to consider this pos- sibility of increasing her earning power. While the children are often put in the way of obtaining healthful pleasures and forming helpful friendships, the same need in the life of the mother is not considered. In one agency a special effort was made to encourage the mothers of assisted families to join mothers' clubs, attend night school, and seek some social connection outside the home. A study ~ of one hundred records of this agency showed that at the time the grant was made eighty-five of the one hundred mothers were highly nervous and depressed.^ After the families had been supervised and aided for a year only fifteen of the eighty-five had failed to be- come cheerful and self -controlled. Certainly this remarkable change must have been due to some extent to the social contacts the mothers had made. i Assistance and supervision of fatherless families under existing community organization can only be rendered successfully by trained social workers; but in most communities there is not only no devel- oped social consciousugss, but no one who knows the technique of social service. It is clear that a full measure of state supervision and state aid is badly needed in all such communities: A social reform measure, introducing an intricate new mechanism, but left to the isolated local community to administer, is doomed to in- efficiency. Payment for adequate investigation and supervision in most communities must be made out of state funds, and be under state control if the work is to be successful. ' 90 The Annals of the American Academy It has been repeatedly pointed out that the only just way to solve the problem of the widow and orphan is to reduce their number by seeking to keep the wage-earner alive. The really preventive remedy here is social insurance. The insurance principle makes premature deaths expensive and so tends to reduce their number. The insurance method is also effective in making it possible for the wage-earner to provide for his own wife and children in case of his death, without leaving them to be cared for by any relief agency, private or public. The theory and even the practice of the mothers' pension work are more closely identified with public relief than with the preven- tive measure of insurance. It provides state grants for dependent families, on proof of destitution, for the purpose of enforcing a measure of state guardianship over the health and education of its wards. As has been shown, emphasis is placed on moral considera- tions as well as financial need. Where it has been successfully ad- ministered it represents a new and fine piece of pubUc machinery, made effective by its use of the approved methods of private agencies. With the thorough-going social reform that is likely to follow the war, and which is in fact already under way in England, our antiquated poor laws will be done away with. The unemployed, the old, the sick, the invalid, and the widow and orphan as well, may soon be cared for democratically by social, or contributory, insur- ance. Yet even under such as advanced social organization there will still be a residuum of individuals and families requiring social case treatment. It is to be hoped that out of America's significant new experiment in public charity^ — the mother's assistance work — may ultimately come a superior piece of pubhc relief machinery re- placing the old and discarded outdoor relief, and embodying all the principles of case diagnosis and treatment that have been worked out so carefully by the private agencies in the past. DESERTION AND NON-SUPPORT IN FAMILY CASEWORK By Joanna C. Colcord, Superintendent, New York Charity Organization Society. Legalistic Conchptton Of Desertion An examination of the existing literature on family desertion brings to light surprisingly little regarding the problems it presents to the social case worker. There have been several statistical stud- ies of its occurrence, and innumerable discussions of its treatment from the legal side, but the case worker in search of technical advice and direction browses over a wide field with comparatively small result. This is probably due to the fact that the rise of the domestic relations courts in late years has tended to turn the thoughts of those interested in the problem toward the legal and judicial reme- dies which are being developed. It may further be due to the fact that workers in the field of adult probation, who constitute the speciaUzed group of case workers most directly interested in family desertion, are still breaking new ground and have not as yet been able to make the contribution to the literature of the case work movement that we may confidently expect to have from them in the course of the next few years. Whatever the cause or causes, it seems true that desertion is generally written about as a breach of the law, to be dealt with through the correctional agencies of the community. This is not so much an erroneous as a distorted view of the problem. It fails to take into account the loss and wastage in human life, and em- phasizes rather the financial burden of dependency which is laid upon society. Both elements of course exist, and must be recog- nized no less by lawyers and judges than by social workers in any effective program for the treatment and prevention of desertion. It may as well be admitted that the hopes which social workers entertained at the beginning of the domestic relations courts move- ment have not been in all respects realized. What the social worker hoped for was an institution which would administer justice based upon the principle,s of social case work; but while much has been gained, we still fall far short of this. The law still insists upon 91 92 The Annals of the American Academy regarding the important element in family desertion to be the deserter's evasion of his financial responsibility and the rendering of his family a public charge. That there can be degrees of culpa- bility in the deserter, aside from the financial question, is not always apparent to the legal mind. The chairman of a case com- mittee, a lawyer, and one of the most large-hearted and compassion- ate of men, maintained that the graver fault of a young deserter who had left his mfe and two infants penniless in a strange city, while he went on a three-weeks pleasure trip, lay in the fact that he had embezzled fifty dollars from his employer to finance the excursion! There is still much confusion as to the location and extradition of deserters, and in most cities the burden of finding the missing husband and serving the summons upon him is still unrelentingly placed upon the shoulders of the wife. Extradition from without the state is made difficult by lack of appropriations, and by the indifference of district attorneys who feel that no good end is served by bringing a man back on a felony charge to serve a prison sentence, on the ground that "he will be of no more use to his family here than there. " A study made by Mr. William H. Baldwin of prison terms served by returned deserters indicates that these are not usually long enough to act as a real deterrent. Indeed, so involved is the ques- tion of extradition, that one sympathizes with the bewilderment of the social worker in New York, who said: "As far as I can see, if a man deserts and goes across the ferry to Jersey City he is guilty of a felony, but if he gets as far as Buffalo he is only a disorderly person! " Another anomaly is that contained in the proposition that the wife can claim abandonment only on behalf of her children. A man living with his wife and five-year-old boy in an eastern city, eloped with another woman to a city in the middle west. The couple kid- napped the boy and took him with them, and the distracted mother, bereft of both husband and child, had no recourse in any court, since the father was continuing to provide for his son. These are instances, however, of shortcomings in the law rather than in the technique of dea,ling with desertion by correctional means. Under the latter heading, unsatisfactory results are most often to be ascribed to the reliance which some of the courts stUl place upon the contrasted statements of the husband and wife, sup- ported it may be by the testimony of their respective friends. To the legal mind it may seem an heretical statement, but the social Desertion and Non-Support 93 worker is convinced that testimony concerning family desertion which is drawn out in court, and unsupported by any careful social investigation by a trained worker, is often worse than useless. The causes of this particular form of family breakdown are often too obscure to be apparent to the persons immediately concerned, even if both are honestly trying to give a straight account, and if one or both are not making such effort, the advantage goes to the side that can put up the better story. When a sufficient number of well- trained probation officers are attached to the court to make the neces- sary preliminary investigations, this danger does not exist; otherwise it is always present. There is something about the factors involved in desertion cases, that seems naturally to arouse the prejudices of the individual who deals with them. Women social workers are notoriously prone to take the part of the woman without giving the man a hearing in cases of marital difficulty; employers are equally likely to feel that there is much to be said on the man's side, espe- cially if they have never seen the wife. The only way in which this perfectly human tendency can be corrected is either to make or have made for one a careful, skilful and painstaking inquiry into the real facts of the case, obtained from as many well-informed and dis- interested sources as possible. In other words, until the courts which deal with social problems like desertion and non-support will consent to abandon their traditional dislike for "hearsay evidence" presented and gathered by social workers, they will fall short of administering the highest quality of social justice. Social Conception of Desertion The effect of centering the treatment of deserters and their families in the courts has brought about, even in the mind of the social worker, the feeling that they constitute a class by themselves, presenting problems different from those of other famihes, and call- ing for an entirely different technique in their handling. Dr. E. W. Eubank, who has recently made a careful survey of the problem in Chicago and other cities of the United States, makes as one of his leading recommendations the suggestion that social agencies dealing with families, attempt, so far as possible, to center the handhng of desertion cases in one person or department. There is room for a good deal of difference of opinion on this point, and its advisability may well be questioned for more than one reason. While a certain 94 The Annals of the American Academy facility is gained through having the dealings with the courts, dis- trict attorneys, etc., in the hands of one or a few people, the plan necessarily prevents other members of the staff engaged in general case work from the opportunity of handling the whole problem in desertion cases. Furthermore, it only confirms and extends the tendency to regard deserters and their families as a class apart. The experienced case worker knows that desertion is in itself only a symptom of some more deeply seated trouble in the family structure. It constitutes a "presenting symptom" which does, indeed, indicate some one of a few specified forms of treatment at the outset, but which also involves all of the foresight, patience and skill which the ' social case worker knows how to apply, if any sort of permanent reconstruction is to be accomphshed. Behind a man's abandon- inent of his home and family there is sure to be a wide variety of causes, some external and easily to be recognized; others rooted deeply in the subconscious instincts and aversions of the people concerned. What these individuals are able to tell is often strangely petty and inadequate without the interpretation which applied psychology is able to give. One man stated that what gave him the final impulse to leave home was his wife's filling his bed with ashes. As legal evidence, this would seem ridiculous; to the social worker who had studied the two temperaments closely, it was an interesting and significant detail. In this way a great number of widely different family problems seems to be superficially ahke only because the breakdown has be- come so acute that the actual physical disruption in family life has begun. The case worker recognizes that while the absence of the man involves certain difficulties in the finding of him and in the possibility of gtetting information from him, the case problem which he and his family present is not essentially different from what it would have been before his departure if the problem could have been recognized and brought to her attention earUer. She recog- nizes that the causes of desertion are as numerous and varied as the causes of poverty, if these could be ascertained, and that they are likely to be even more subtle and difficult of appraisement. Many influences from without are impinging on the home and the family at the present time to bring about a slackening in the bonds which hold it together. Considering the unrest and unnat- ural stresses and strains of urban life, the wonder probably is that desertion has not increased more rapidly than it has. Desertion and Non-Support- 95 Keeping in' mind all this, the case worker sees desertion as only an acute form of the symptoms of weakened and crumbling family life. She is unwilling to accept the common theory which divides the treatment of desertion into two fields: one, the location, appre- hension and punishment of the man through the courts, and the other, the charitable relief of his family during the process. Instead, she holds that the technique of the case treatment of the deserter and his family is no different in essentials f roni social case treatment in general except perhaps in the one particular of locating the ab- sconder. She does not believe that reconciliatiohs can be brought about by short-cut methods. Most social workers have a deep- seated distrust, not of the principle that a function of the domestic relations courts is to bring about such reconciliations, but rather of the way in which such efforts have been made in connection with many of them. The wholesale attempt to patch the tattered fabric of family life in a series of hurried interviews held in the court room, and without any information about the problem except what can be gained from the two people concerned, can hardly be of perma- nent value in most cases. It is natural that case workers, keenly aware as they are of the long, slow, and difficult process involved in character-rebuilding, look askance at court-made reconcili- ations. With the best will in the world the people who attempt this delicate service very often have neither the time nor the facts about the particular case in question to give the skilful personal service necessary to reconstruction. As a result many weak-willed wrong-doers are encouraged to take a pledge of good conduct which they will riot, or cannot, keep; and other individuals who feel themselves deeply wronged go away with an additional sense of those wrongs having been underestimated and of having received no redress. The results are written in discouragement and in repeated failures to live in harmony, each of which makes a permanent solution more and more difficult. The case worker to whom the results of the externally imposed reconciliation come back again and again has reason to be confirmed in her distrust of short-cut methods. In order to demonstrate which contention is right there is great need for a careful study, made one or two years after the reconciliation has taken place, of a large group of couples, the solution of whose troubles has been attempted in this way. Unless there should be supervision for a considerable period by a 96 The Annals of the American Academy skilful and resourceful probation officer all experience points to the conclusion that the percentage of permanent reconciliations would be low. Social Case Treatment op Desertion While it is true that the deserter and his family present no unique problem to the case worker, it is nevertheless true that cer- tain adaptations in case work technique are usually advisable and that certain points must be especially kept in mind in the course of the investigation.' Disparity of age, of race or nationality and of religion are significant factors when they are found in connection with this form of family -breakdown. Not less important is a con- ception of differences which may exist between the couples in the matter of education, habits, social status and moral and ethical concepts. A history of the background of the man and the woman from childhood on, keeping all these factors in mind, is essential to an understanding of the problem. One extremely important fact to have in mind, and one which should be proved or disproved where possible in connection with every desertion case by means of records of vital statistics, is whether or riot the marriage was a forced one. There can be little doubt from the experience of case workers that people who contract this type of marriage later find their way in large numbers to the courts of domestic relations. A piece of research quite as desirable as the investigation of quick reconcilia- tions recommended above, would be a study of the married life from the point of view of the community of several hundred families in which a forced marriage had been brought about through the urg- ing of relatives, the church, the court, or those social workers, now diminishing in numbers, who still beUeve that to legitimatize the child and to "give the girl a name" are desiderata sufficiently im- portant to justify forcing together against their inclination the pro- spective parents of more children. In the treatment of desertion and similar problems the sex factor is, of course, an extremely important one. The tendency of most social workers is either to ignore this as largely as possible or to theorize about it to such an extent that it serves, as with the Freudians, for an explanation for every phase of human behavior. 'See questionnaire on The Deserted Family, "Social Diagnosis, " by M. E. Richmond, p. 396. Desertion and Non-Support 97 It is on the whole safer to embrace the first alternative than the second, but the best work in the.handling of desertion cases will be done by the person who neither shuts his eyes to this phase of the matter nor unduly emphasizes it. The majority of social case workers are unmarried women under forty, and in this particular respect they frequentlyfind themselves handicapped by the natural reluctance of the deserter to discuss his conception of the marital relation in such a way as to be enhghtening to them, as well as by the chivalrous attitude which the married woman of the tenements often adopts toward her unmarried visitor. The decisive statement "You have never been married so you cannot understand" often proves at least a temporary barrier in dealing with deserted wives just as the similar statement "You have never been a mother so you cannot know the feeUngs of one" is used to block her efforts in another direction. If it is found impossible to carry on the neces- sarj' discussions rationally and without too serious embarrassment, it is often possible to call upon the socially-minded physician or clergyman for help along this line. This, of course, presupposes that the man in the case has been located and can be interviewed; but the fact that in the majority of cases of desertion this cannot be attained without great difficulty is in itself the most serious handicap which the case worker meets in the treatment of desertion. In the location of absconding hus- bands undoubtedly the greatest single contribution has been that made by the National Desertion Bureau, a private organization which speciahzes in the location of deserters of the Jewish faith. Its use of widespread newspaper publicity, including the publishing of photographs of missing men, has been widely imitated by other social agencies. In locating absconding husbands it is more than usually important to learn accurately facts concerning their trade connections, membership in social organizations, employment records, etc. Foreign language newspapers are usually willing to print personal inquiries, or even photographs, and trade journals have been successfully employed in the location of even non-union men connected with the trades. The Post Office Department, if convinced that the public welfare demands it, might be induced to entrust reputable social agencies with forwarding addresses. If the husband has deserted for financial reasons, or has left home as the result of a quarrel, his location is a much easier matter than if there s 98 The Annals op the American Academy is reason to believe he has absconded with another woman. Al- though the clues are in this instance doubled since two persons are involved, the pains taken to elude detection are usually greater. Under ideal police conditions all this ground work of tracing deserters could be done by detectives, who already secure from the post office and all the other sources mentioned, information that furnishes clues. After the man is located through cooperation between the detective bureau and the case worker in charge the man can be interviewed by her or her correspondent. In the attempt of social workers to locate missing husbands they are somewhat at a disadvantage. The general tendency to believe that the man is invariably in the wrong, and the policy. of arresting him first and perhaps letting him explain afterwards, make even a man who has a good deal of excuse to offer for his course, reluctant to permit himself to be communicated with. Case workers are now beginning seriously to question whether in the long run the best policy is not after all to interview the man, or to have him inter- viewed and to give him an opportunity to state his side of the case before causing a warrant for his arrest to be taken out. The at- tempt to do this will sometimes result in a second disappearance, but if the man's return can be accompUshed voluntarily there is many times the basis upon which to build. The deserter, or at least the first-time deserter, must not be prejudged without a hearing. In spite of the discouraging average of desertion cases, this particular man may not be in the average class, and in that case it would spell injustice both to him and to his family to treat him as though he were. Some years ago a charity organization society, which main- tained a special bureau for the treatment of desertion cases, was asked by a Mrs. Clara WiUiams to help her find her husband, John, who had left her some years previously and was living with another woman, so that she might force him to contribute to the support of herself and her two children. Mrs. Williams- was a motherly appear- ing person who kept a clean, neat homo", and seemed to take excellent care of her children. She was voluable concerning her husband's misdeeds and very hitter toward him, which seemed only natural. The fact of the other household was corroborated from other sources, and Mr. Williams' work references indicated that he had been quar- ' These names nrf fictitious. Desertion and Non-Support 99 relsome and difficult for his employers to get along with, although a competent workman. The problem seemed to the desertion agent a perfectly clear and uncomplicated one and he proceeded to handle it according to the formula. Some very clever detective work fol- lowed, in the course of which the man was traced from one suburban city to another, and his present place of employment found in the city where his wife lived, although he lived in another state. The warrant was served upon the man as he stepped from the train on his way to work, and he appeared in domestic relations court. He did not deny the desertion but made some attempt to bring counter charges against his wife. When questioned about his present mode of living he became silent and refused to testify further. He was placed under bond, which was furnished by the relatives of the woman with whom he was living, to pay his wife $6.00 a week. No probation was thought necessary and the case was closed, both the court and the charity organization society crediting themselves with a case successfully handled and terminated. About a year later Mrs. Williams again applied, stating that her husband's bond had lapsed, that his payments had ceased, and that she had no knowledge of his whereabouts. Although her home and children were still immaculate she failed to satisfy the social worker who this time visited her home with the plausible statements which she had made before. The children's health was not good and they seemed unnaturally repressed and unhappy. Ugly reports con- cerning Mrs. Williams' drinldng habits came to the society. The school teacher deplored the effect which the morbid nature of Mrs. Williams was having on her youngest child, a daughter just entering adolescence. The son, a boy a little older, was listless and unsatis- factory at his work, and defiant and secretive toward any attempt to get to know him better. He spent many nights away from home and was evidently not on good terms with his mother. As soon as Mrs. Williams saw that real information was desired she began indulging in fits of rage in which she displayed such an exaggerated ego as to cause some doubts as to her mentality. Baffled at every turn the case worker decided to see the man, if possible, and have a long talk with him to see if thi-ough him any clue to the situation might be gained. The first step was to gain the confidence of a former fellow-worlonan and friend of his who now maintained liis own small shop. This was done" after several visits, and upon the 100 The Annals of the American Academy social worker's solemn promise "not to have a policeman hidden behind a tree" the deserting husband consented to an evening meet- ing in his friend's shop. A most illuminating interview followed. Mr. Williams was found to be an intelligent though melancholj^ and self-centered man. The couple had married somewhat late in life, it being Mrs. Williams' second marriage. She had been strongly influenced by her mother to marry him and had never had any real affection for him. It became very evident from his story that the strongly developed egotism of both the husband and wife had made a real marriage impossible between them, and the visitor became convinced of the genuineness of Mr. Williams' protestations that he endured the constant abuse and ill-treatment of his wife as long as it had been possible to do so. As her drinking habits took more hold upon her and he had realized that the break was coming he had endeavored to place the children in homes, and had once had his wife taken into court where her plausible story and good appear- ance resulted in the case being dismissed with a reprimand to the husban4. He then left home but continued to send her money at intervals, although as he got older he was able to earn less at his trade. SociaUsm was his rehgion, and it was his preaching of this doctrine in season and but to his fellow-workmen which had earned him the ill-will of his employers. He defended his present mode of living vigorously, putting up a strong argument that it was a real marriage, whereas the other had only been a sham. He spoke in terms of affection of the woman who was giving him the only real home he had ever known, and only wished that the state of public opinion would permit his taking his young daughter into his home. The boy, he reaUzed, had grown entirely away from him and they could never mean anything to each other. It was his habit to make frequent trips back to the region where his family Uved in order that he might stand on the corner and watch his children go by. He gave readily much information about his own and his wife's past connections, including the addresses of many of her relatives whose existence she had denied, and he successfully proved that her claims as to his lapsed payments were false by producing the entire series of post office receipts covering his remittances to her and ex- tending down to the very week of the interview. It is true that this is not a " typical desertion case" such as Miss Brandt describes in her study of deserted women, but is it not Desertion and Non-Support 101 equally true that the handling of this one case problem according to legalistic and juridical formulae meant a real miscarriage of justice and the possible sending to shipwreck of two young lives to follow the old? It is experiences such as these which have confirmed in the case worker a determination to avoid formulae and to treat each case problem, in so far as possible, as something entirely new. Desertion in Relation to the Community It must not be denied that there is basis for the contention that just as a community can regulate its own death rate within limits, so it can by repressive measures regulate its desertion rate. The sort of prevention, however, that keeps the would-be deserter in the home which constantly grows less of a home, simply through fear of the consequences if he left it, hardly seems so desirable from the social point of view as that form of prevention which would provide fox such homes and families the wise, skilled and sympathetic treat- . ment which is the ideal of social case work. There are no figures to show that either method has been sufficiently brought into play in any one community to bring about any marked change in the num- ber of desertions. Dr. Eubank, in preparation for his pamphlet, circularized charity organization societies in a number of cities and got widely different opinions as to whether desertion was on the decrease, was stationary, or was on the increase. These were merely opinions and not the result of statistical studies. In New York City, Dr. Devine made a study of five thousand cases known to the Charity Organization Society in the years 1906 to 1908 and of this number exactly 10 per cent were deserted wives. Ten years later, in 1916, a somewhat similar study was made of three thousand families known to the same society in the course of that year. The percentage of deserted wives was found to be almost the same, namely 9.9 pfer cent. The statistics of the New York Charity Organization Society for the last year show 492 deserted wives out of 4,204, or about 11.7 per cent. This nearly stationary percentage over the eleven-year period is probably only a coincidence as these particular ten years have seen marked population changes as well as the establishment in the city of a Domestic Relations Court, the Bureau of Domestic Relations and the National Desertion Bureau. It may, however, be taken to indicate that the type of desertion which leads to dependency is not markedly on the increase. 102 The Annals of the American Academy Echoes which have reached us already from Europe point to great and sweeping changes in the conceptions of family life which are likely to result from the great war. .Inevitably our own stand- ards must be affected since we are learning that not only in a polit- ical sense is it true that the lives of all the nations are one. Home Service workers are recognizing that no small part of their task is to help keep strong and firm the bonds which bind the soldier on another continent to his family on this. Perhaps never before has there been the need for careful study and alert watchfulness on the part of the social workers in this country, so that the changes which come are not unanticipated. No one group in the community, surely, is in better position to bear testimony as to the strength and weakness of family life, the changing conceptions regarding it, and the strains and stresses from which it may still be protected. THE ILLEGITIMATE FAMILY By Amey Eaton Watson, Chairman, Philadelphia Conference on Parenthood. In the following discussion, the phrase "the illegitimate family" is used deliberately. Hitherto our attention has been very largely confined to the illegitimate child and its mother and we have ignored the fact that there is in every case a. family involved, father, mother and child or children, and that they must all be considered before any adequate plan can be made with them. True as it is that in the eyes of the state no family has been formed, yet" it is equally true that biologically the child has a father as well as a mother and it is being realized more and more clearly that socially too the child has a father with definite responsibilities and privileges. This point of view goes hand in hand with the scientific attitude toward the illegitimate mother which instead of destructively con- demning or scorning any woman who has brought a child into the world without the legal sanction of her group, rather seeks to under- stand the underlying causes of heredity and environment which have brought her (and likewise the father of her child) to the illegal conduct in question. Illegitimacy is the result of biological, psycho- logical and social causes following definite scientific laws and there is a responsibility of the community as well as of the individual for its occurrence. So firmly has this point of view become fixed in our thinking since Leffingwell's consideration of it in 1892 that there would be no value in emphasizing it here, did we not find the old point of view lurking in the otherwise excellent "Questionnaire Regarding an Unmarried Mother," by Mrs., Ada Eliot Shefiield.^ Here the term "her shame" would seem to indicate on the part of even our most advanced thinkers in this field an occasional lapse to the less scientific and more inhuman attitude of condemnation and reproach. "Moral indignation," says Mr. Britling, "is the mother of most of the cruelty in the world, " and J. Prentice Murphy voiced this thought at the National Conference of Social Work in Pitts- burgh when he said "Much of what we have done and are doing 'M. E. Richmond, "Social Diagnosis," p. 414. 103 104 The Annals of the American Academt for the unmarried mother in contrast with other mothers is steeped and saturated in a superheated, emotional, pseudo-moral atmos- phere and I submit to you the observation that no such atmosphere can really make for helpfulness."^ While this point of view has taken a firm hold of our thinking, it is only just being applied to our case work with the illegitimate family, which is still decidedly in the experimental stage. Case work with the illegitimat'5' family is seeking to work out principles whereby the interests of the illegitimate child and those of both its father and mother may be harmonized with the best interests of society. This end will be secured when the responsibiUty for the illegitimate child is more evenly shared by the father and mother as well as by the state. The Castberg law of Norway is being watched with great interest by social case workers as probably the most advanced experimentation in this field, inasmuch as it gives to the illegitimate child among other things the right of paternal in- heritance, of paternal name and of the standard of Ufe of that parent which is better situated. The Minnesota Children's Code is also advanced in that it makes the state the ultimate guardian of all its disadvantaged children, including the illegitimate, and therefore it is the work of the State Board of Control to institute proceedings to establish paternity or to see that such proceedings are instituted, as well as to seek in other ways to secure for the illegitimate child the nearest possible approximation to the care, support and education that he would be entitled to if born of lawful marriage. Further and better standards of case work in this field must be established by studying experimentally the question of removing the evil effects of the stigma in illegitimacy. Only injustice is done in allowing this to attach to an innocent child and we must get evidence to show us when the welfare of society is furthered by having a stigma placed on one or both parents. Above all, in line with the findings of modern criminology, emphUsis must be placed upon the reeducation of the individuals involved, not upon either punishment or stigma. Information Needed In gaining the necessary information for a diagnosis in working with any illegitimate family, the case worker, utilizing the same sources of information as worked out for all forms of social diagnosis, ' From an unpublished paper. The Illegitimate Family 105 must exercise the greatest tact and consideration. She must make unusual efforts to gain the friendship and confidence of the inother; on account of pubhc opinion, the chent has undoubtedly been put on her guard, feeUng that everyone is against her. Sympathy and understanding are needed to win her and for these reasons it follows that investigation must be gradual. In some cases it will be nec- essary to find out the most intimate facts of any individual's life, facts which it is often not necessary to inquire into in any other kind of case work. This is all the more reason for going slowly and care- fully with deep consideration and with a realization that harm may be done if the client feels that she is being probed or that she is being forced to reveal information which may be used against her or against the father of her child. It must also be realized that many girls may become morbid and an effort must be made to keep their minds off their experiences rather than to allow them to dwell on them. It is vital that our investigation should be thorough, tapping every re- source. Failure to learn all possible facts at the proper moment has undone years of effort. The writer calls to mind a case which had been handled by a relief agency with high standards over a period of seven years during all of which time it was taken for granted that the man and woman were legally married and it was only at the end of this time when an illegitimate child was born to the daughter of the family by her supposed step-father that it was discovered that he was not her step-father and had never been mar- Tied to her mother. Had this been known earlier, precautions could have been taken to protect this girl and this case of illegitimacy might have been prevented. It is particularly important that in all ■case work marriage and birth records should be consulted among the first sources of information; they involve the telling, of no se- crets, are entirely trustworthy and should never be neglected. It is hoped the following outline for a minimum investigation may be suggestive:' ' The Boston Conference on Illegitimacy has also worked out a minimum in- ve"stigation which may be obtained from the President, Miss Mary Byers Smith, Andover, Mass. An outline for a maximum investigation has been worked out by the Inter-City Committee of the Boston Conference. See also Questionnaire by Mrs. Ada Eliot Sheffield in "Social Diagnosis" by M. E. Richmond, p. 414, re- ferred to above. 106 . The Annals op the American Academy I. The Girl or Woman 1. Her family a. Heredity and health of family b. Social history of family (1) Occupations (2) Earnings (3) Marital history (4) Type of family life, including size of family, education of both parents, religion, etc. (5) Boarders, lodgers, etc. (6) Relatives other than immediate family 2. Her general history a. Date of birth. b. Place of birth c. Race d. Residence e. Civil condition f . Marital history and composition of family, if any 3. Her health a. Past history b. Present condition (1) Doctor's examination (2) Wasserman or other test if advised 4. Education and mentality a. Length of time in school b. Age, grade and reason for leaving c. Vocational or other training d. Mental examination 5. Occupational history a. Occupations and how long held b. Earnings in each c. Capability as learned from teachers, employers and others 6. Recreation a. Kinds and extent b. How supervised 7. Religion a. Church connections, their extent, duration and influence 8. Sex life a. Was her adolescence normal? b. Was she ever given instruction in matters of sex and if so, by whom and when? c. What has been lior sex experience, including her relations with the father of her child? The Illegitimate Family 107 9. Other facts a. Age at leaving home, reasons and conditions under which she has since lived b. Court record c. Institutional record d. Known to other agencies 10. Relations to child a. Ability to care for child b. Desire to care for child II. The man All of the above facts, with special emphasis on marital history, com- position of family if any, and economic capacity III. The Child 1. Date of birth 2. Place of birth 3. Physical condition a. Doctor's examination 4. Dispositions 5. Mentality as soon as child is old enough for this to be ascertained In making our inferences from the facts which have been learned by the investigation, great precautions must be taken. In the field of sex there is much prejudice and likewise much that is pathological. We must utilize the help of experts wherever possible.^ "And a little child shall lead them." In our work with the illegitimate family, our strongest ally is the child. How frequent it is mTh& experience of every social worker that while during the pregnancy of an illegitimate mother, everyone turns against her, when the child comes, it makes an irresistible appeal and wins its own way into the hearts of those who should care for and protect it. Therefore our first effort should be to give the child every oppor- tunity to be seen and loved and cherished, first by its mother, then by its father and. lastly by its other relatives. Removing the Child's Handicap After all it is the child that is our real interest and it is his or her welfare that we are most vitally interested in securing. We have emphasized above that the illegitimate family is a unit and as social workers we consider all the members together. This does not * See Chapters IV and V of "Social Diagnosis" by M. E. Richmond; also Will- iam Healy, "Mental Conflicts and Misconduct." 108 The Annals of the Ameeican Academy vitiate the fact that the welfare of the child is supreme and that we work for the welfare of the father and mother largely in order that we may do our utmost for the child. This plastic little creature, full of possibilities, must have its future safeguarded; we must seek to give him or her the best possible nurture and support, as nearly as possible as if he had been born in wedlock.. It is our privilege and our problem to see how we can conquer social conditions so that he will be handicapped as little as is humanly possible. How shall we accomplish this result? We mus{ take into account the character and potentialities of both parents, arousing them if possible to make a ^lan of their own. We must meet them on their own level, working with them in order that they may understand their own problems and develop their own resources and character to meet their situation. It has been pointed out that we must remember that the father as well as the mother may be in vital need of our help, that he too may be passing through a moral and spiritual crisis needing friendship and guidance. Above all we should not make a plan for our clients and seek to force it upon them regardless of their cooperation.- Such work is pedagogically unsound in that it fails to arouse the individuals to self-help and independence. Having eliminated the idea of punishment, we shall trj- to arouse in both parents a love for and a responsibility for the child. We shall help the mother to get away from a sense of shame and arouse pride and joy in the life of the child; we shall try to inspire or liberate the father's protective instinct toward his child, arousing any paternal feelings that he may have. We shall reconcile out of court whenever possible, first considering marriage (if both the man and woman are unmarried). This however must never be forced. When in such cases there is genuine affection or respect between both parents or when in both a real affection for or interest in the child appears, then marriage may be the best solution if both parents so decide. If marriage is not the best solution, then seek to arrange voluntary agreements, legally sound but out of court, thus doing away with the undesirable publicity which has to occur even in our best courts. Such voluntary agreements out of court should not be accepted if the amount agreed upon is much less than it would be if the case were won in court. As a last resort the majority of cases should be taken to court, The Illegitimate Family 109 the paternity of the child established and a court order placed upon the man. It is remarkable in how many cases the self-respect of a girl is increased when the paternity of her child is established. This must be done also because every illegitimate child has a right to know who its father is. Are we not in this country beginning to feel that the Norwegian ideal of securing support in every case is practicable and desirable or at least that it should be secured far more generally than it now is? This means that better court meth- ods and more humane ways of dealing with the mother will have to be devised and also better machinery for enforcing the orders which many of our courts are placing upon many fathers of illegitimate children. The amount of these court orders will inevitably be in- creased, especially in the case of any men who are economically well off and in such cases the period over which such orders shall be paid will undoubtedly continue to increase. In all of these court orders we must differentiate between the just claim of society for the eco- nomic support of the child by its father and the questionable claim of the mother for damage done her or the equally questionable claim of society for punishment of the individual man for violating its moral code. Economic support from the man (as well as from the woman) is to be enforced, for failure to support any child is a crime which the state cannot tolerate for its own well-being. Individualization of Treatment So far in our discussion of treatment, we have failed to stress a principle of case work which is as vital in work with the illegitimate family as it is with the legitimate. This principle is individualiza- tion of treatment. The day is past when all illegitimate mothers were sent to a rescue home as they were considered to need moral reformation to atone for the sin they had committed. It is still true, however, "that there are few tasks requiring more individuali- zation and there are few in which has been so little."^ Indi- vidual differences are the basis of social life. So complex is human nature, so varying are the threads that combine to make up an individual lifg'that in no two cases will our diagnosis be the same and in no two cases will our treatment be identical. One test of good case work with this group as with any other is the ability to be flexible, to adjust ourselves to the changing needs of the individuals whom we 5 M. E. Richmond, "Social Diagnosis," p. 413. 110 The Annals of the American Academy are to help. This being so, we must hesitate to lump any of these groups into classes or a series of classes. The affixing of a label may apparently simplify our work, and we yearn for simplification in a fijeld so fraught with difficulties. We therefore question the classi- fication Mr. Carstens made in his discussion at the National Con- ference at Pittsburgh when he divided illegitimate mothers into three classes, the good, the vidous and the defective. It is true of course that those illegitimate mothers who are diagnosed as feeble-minded by a psychologist do constitute a group by themselves. This, how- ever, is the only group thp,t can be scientifically measured off, and even within this group we must to a certain extent apply the prin- ciple of individuaUzation of treatment. In the main the dangers of classification more than offset the advantages. From the first, it is vital that the health of the mother and baby be protected. The infant mortaUty of illegitimate babies is three times that of legitimate. For this reason we must encourage the illegitimate mother to seek medical advice as soon as possible after conception and to continue it regularly during pregnancy and after the birth of her child. For this reason as well as for others some social agency should continue care of both mother and baby as long as possible. Under the Minnesota Children's Code, the State Board of Control may offer to the unmarried woman about to be- come a mother its aid and protection even before the birth of her child and it is further provided that where a woman is received in a hospital expecting the maternity of an illegitimate child, the person in control shall at once notify the State Board of Control. In other places where there is no such provision, it is disputed whether one central agency should handle all the cases of this kind or whether those agencies that naturally first come into contact with them should continue their care. Some hospitals are doing unusual work with this type of case, e.g., the Social Service Department of the Massachusetts General Hospital which works with the mother a long time before the birth of the child, endeavoring to instill in her an interest in keeping the child when it is born, preparing her mind and her mode of life. It seems vital in the majority of cases to keep the mother and child together at least for the first six months of the child's life, when the mother should be helped to nurse the baby. Nursing a child successfully, however, is so largely a psychological matter that it is The Illegitimate Family 111 not enough merely to keep mother and child together but we must so place the mother that she may have the maximum of content as well as of physical well-being. One questions whether a mother can be forced to nurse her child. Should we not rather bring her to see it as a joy and a privilege in order to safeguard her baby's life? The problem of supplying work for her at this time is a difficult one. In some cases it is possible for the mother to act as wet-nurse to other children and thus to support herself and her child. Some maternity hospitals are keeping the mother in the hospital long enough to train her in some form of employment and to assist her in securing the same, allowing her to live in the hospital and to keep her child there while she begins her work. Permanent Work for the Mother The problem of the best regular work for the mother after the nursing period is a pressing one." In the past, domestic service has been the usual solution. Domestic service, however, supplies more illegitimate mothers than any other occupation. Is this not because domestic service is the most unstandardized of all types of work? Its hours of work are excessive, there is little opportunity for rec- reation or normal companionship and it is an occupation that is con- sidered menial by the average person of intelligence, with the conse- quence that the most unskilled workers enter this field. If domestic service seems the occupation. fitted to a given individual's tastes and abilities, should we not seek to give them training first in this field and then to find them opportunities to work with employers who will understand their need of a sane, wholesome life, including standardized hours, recreation and companionship? The problem of recreation and social life for the domestic employe is one which intelligent women must solve. Until we can find more socially minded employers, should we not hesitate to place, illegitimate mothers at domestic service but rather seek to find other types of employment fitted to the individual's capacity and training? How the mother is to do various types of work and still keep her child is a problem. The ideal solution is where the mother can live in her own paren- tal home, doing part time work in the home or going out to work while some member of her own family looks after her child. If this is not possible, it is sometimes feasible to find a boarding home where the 112 The Annals of the American Academy mother may live with her child, going; out to work by the day and leaving her child in the care of the woman with whom she is boarding who may herself be the mother of small children. The more normal such a home life, the better for our client and for the child. What- ever work is found should be interesting, with adequate remunera- tion and allowing some chance for advancement. Wherever pos- sible an effort should be made to secure funds either from relatives or from scholarships to give the mother vocational training to equip her for a more highly skilled and more interesting type of work A Normal Life foe the Mother Above all we should aim in treatment to reinstate the mother in normal life, that is, to place her in such a way that in addition to interesting, remunerative work, she will have normal social contacts, companionship with others of her own age, if possible of both sexes under supervision. She needs wholesome recreation supplied to her through clubs, in settlements or church or trade union groups. She needs to feel herself a personahty with possibihties of life ahead. And all of the above must be suppUed to the child as he grows up. In, addition we must seek to make for both mother and child the normal reUgious contacts, helping the mother to find her place in her church group if she at one time belonged or, if not, opening up this possibility for her in whatever way may best fill her need. For both mother and child strength from this source may do much in helping them to facethe extreme difficulties of their lives which we at best can but soften. If the above conditions can be fulfilled and the mother and child can be kept together, there must be a gain for both. The relation of parent and child when it really exists is basic and is one which should never be broken until every effort has been made to strengthen it and test out its reality. The child needs the family life and ties and the mother needs the child. Yet, as in the case of marriage, we should not force the external living together if it is only the shell of the relationship which is existing. Keep mother and child together, then, if the mother is fitted to give physical, mental, moral and at least part of the financial care to her child and to be happy in doing it. Under such conditions it would seem as if no other plan could so securely safeguard the child's future. If, however, the mother is not fitted to give such care to the child, and cannot be trained for The Illegitimate Family 113 it while the child is with her, it seems unwise to keep mother and child together. Perhaps a temporary separation may be the solu- tion, in order that the mother may be trained for more adequate parenthood in the future. If she is incapable of being trained under any circumstances, it seems clear that a plan should be made for the child away from its mother, with her relatives if possible, with the father or the father's relatives or in some other situation where it will have as nearly as possible normal home life. In the case of a defective mother the baby should be separated from her just as soon after birth as the physician deems wise. In cases where there is no relative who can adequately care for the child, we are faced with the question of adoption. In this vol- ume of The Annals J. Prentice Murphy has outlined certain ques- tions which must be answered before the legal adoption of any child is arranged for.^ We must stress the fact that this should never be encouraged until we know all the, facts about the child's own parents and relatives and are reasonably sure that they can never offer it a suitable home. The writer has in mind a case where a social service worker made only a cursory examination into a child's home situation before securing its adoption by a wealthy doctor. At the time she thought that the father had deserted and she knew nothing of the possibilities of his returning and the family being restored to normal life. Although it later turned out that the child was illegitimate, it was by no means clear that the child's own rel- atives could not have cared for it adequately. Untold harm may be done in this way. Another aspect of the matter that should be considered is that, of disease and heredity. No child, that is of dis- eased and no child of feeble-minded parents should be placed in any home for adoption until the foster parents know the full facts of the case and are ready to take every precaution to see that the disease is not passed on to others and that later in life the defective germ- plasm is not mated with normal stock, thereby passing on the defect and causing much preventable misery. Dealing with the Illegitimate Family Should case work with the illegitimate family be conditioned by exactly the same considerations as case work with the legitimate ' See his article in this volume on "The Foster Care of Neglected and De- pendent Children." 114 The Annals of the American Academy family? This question has been variously answered : in one way in a paper at the recent National Conference in Pittsburgh, and in various ways by the different conferences on illegitimacy in their more inti- mate councils. Our answer is that it both should and should not be. In the main "the methods and aims of social work are or should be the same in every type of service. ' ' ' The individuals constituting the illegitimate family do not necessarily differ in any wise in physique, character or ability from those constituting the legitimate family.' The principle of individualization of treatment applies equally in our work with both groups. There is, however, one factor which is pres- ent in every case of illegitimacy which in the opinion of the writer inevitably affects our case work with this group. That fact is that the man and the woman have both broken the law or the "mores" of the larger social group in which they live. It is true that the laws concerning illegitimacy have varied in a most interesting way as we follow down the pages of history, but failure to conform is a distinct social phenomena which must be studied. Therefore in every case of illegitimacy we have as added consideration to study, i.e., why did both the father and mother break the law and bring a child into the world without the legal sanction of their group? In the widowed group the specific maladjustment which brings the woman to our attention is of a different kind; in the deserted wife group the man and woman have followed the law at least to the extent of legally forming their family and the man has given the woman and child his protection for at least a period. In the illegit- imate family the psychological attitude of both the man and the woman will inevitably reflect the fact that they have broken the law and we must understand in just what way this is so. In the second place, case work with the illegitimate family will be conditioned by different considerations than that with the legit- imate family group in that treatment with the illegitimate mother must always bear in mind and depend upon what society's attitude is toward the girl. Public opinion is such a stiong force and can punish so severely those whom it condemns that we must leekon ' M. E. Richmond, "Social Diagnosis,'' p. ii. ' Undoubtedly u certain percnitngc of unnuirried mothers are feeble-minded but this is also true of married mothers. There are probal)l.\- more feeble-minded among the illegitinmto mothers tiian among tlic legitimate but this tells us nothing concerning any individual in either class. The lLLEGiTiM.iTE Familt 115 with it, no matter how unjust we may consider its decisions to be. This is well illustrated by the ease of Mrs. B, a widow with five children whom a relief agency had been assisting since the death of her hiisband. When calling on the undertaker to learn the number of her husband's grave, he assaulted her with the result that she became pregnant. From previous experience with this woman and from all that could be learned, she was entirely innocent of any wrong, but the problem that faced the case workers was inevitably very different from that which would have faced them under any other conditions. The coming child had been conceived contrary to the laws of society and pubUc opinion must be reckoned with in our work with this mother, with her child and with its father. The social case worker in this case has a definite responsibiUty thrust upon her to educate pubUc opinion by her case work to a more just attitude. It may be a great temptation to do the easy thing, to help the mother move to a different locahty and to start life afresh, but two conferences which deUberated long and carefully on this case felt that such a plan would be cowardly and that it was a defi- nite responsibility to help the mother through her confinement and to return her to the community in which she Uved. Then with economic help from the father of her child, as well as from the social agency, she could show that the mother of an illegitimate child can be worthy of confidence and can in every sense of the term be a good mother to her illegitimate child as well as to her legitimate children-. Social case workers then who are working with the illegitimate family must do much hard and careful thinking. They must have in mind the historical development of the family, must be in touch with the findings of modern criminology and above all, must have courage and sympathy to work with their cUents, on the one hand reeducating them and, on the other, reeducating pubUc opinion. The maladjustment which results in the problem of the illegitimate family is part of our evolving standards of family life. May we not therefore emphasize the need of a higher concep- tion of parenthood and of family life as a means of preventing this very evil? The maladjustment which resulted in the birth of an illegitimate child came partly at least through ignorance or the failure to reaUze the wonderful responsibilitj'^ and great possibilities of sex in its finest sense. We must see that the right kind of sex education is given to the illegitimate child in its turn in order that 116 The Annals of the American Academy he may see the full measure of his possibilities. But if our case work is to be truly sound, we cannot stop by applying this only to the illegitimate child but we will do all in our power to supply every child with a sound foundation in health, vocational education, nor- mal social contacts and recreation, and, above all, to give it the vision of what life may mean when every individual man and woman keeps sacred and untouched this creative power of sex until its exercise will bring only joy to the individual and welfare to society. THE FOSTER CARE OF NEGLECTED AND DEPENDENT CHILDREN By J. Prentice Murphy, General Secretary, Boston Children's Aid Society. More than fifty years of controversy on the part of children's workers as to which offers the better care,— the family or the institu- tion, — would never have taken place if all the parties interested had enjoyed a common understanding of the significance of what the modern social worker calls case work, that elastic, imagiaative, penetrating understanding of each individual in need, that process of interpretation that never looks upon the individual as a solitary, isolated being, but as very closely related to many people and things and difficult to Understand. Most of the workers engaged in the children's field of service have for years past developed systems of care and methods of treat- ment which they felt were indisputably right. One of the interest- ing developments of a good case work job is the discovery that it becomes increasingly difficult to classify rigidly the children or people you study. One child will be considered by an ineffective social worker as dependent^but by a much more skilled worker as representing a variety of conditions other than dependency. There are copious illustrations along this line in society's treatment of adult delinquents. The more we know of the conditions causing crime, the more do we understand that pure delinquency as such is a very rare condition in any individual's life. Just so we discover through case work that pure dependency and pure neglect are equally rare conditions in the lives of children. They may be neglected ; they may be in need of foster care; but they are also a series of different entities, some intelligent, some unintelUgent, some capable of great growth, others not, some well, some sick, some properly trained, many improperly trained, some in need of a certain special indi- vidual touch, others equally in need of a radically different over- sight and supervision. The laboratory method has prevailed less in children's work than in most other fields of social work. There has been httle actual 117 118 The Annals of the American Academy studying of methods and results, little open-mindedness; but on the contrary, often a fierce and violent contentiousness on the part of advocates, irrespective of the system in question, who were con- vinced that those differing from them were entirely in the wrong. We are here considering foster care of children who by reason of sickness, death, incompetency, improper guardianship or wilful neglect on the part of their parents or relatives, must be provided for in foster homes. We are not including in this group children whose ■ parents are suffering solely from poverty. Such children do not properly come within the, scope of an organization giving foster care, but fall within the field of organizations giving relief in any form or able to advise and otherwise assist in the carrying out of plans which relieve the condition of poverty without giving material relief. We are not eliminating from this neglected and dependent group, children who by reason of the parental treatment they have received present special problems in the way of discipline but who do not fall within the so-called delinquent class. All of the countries of western Europe, and the United States and Canada have for two generations been engaged in the process of developing certain special methods looking to the best care of chil- dren who for any reason must be taken from their own families. The time has arrived, however, for a proper understanding of the only dependable method of approach to the care and treatment of such children. The whole controversy between institutions and agencies engaged in children's work and giving different types of care can be settled only through the application of good case \york. Only in this way can there be carved "out for each child that type of care which it most needs, and for each institution or agency that task or service which the community where it' operates most needs. The introduction of case work has meant the revolution of medi- cine and law and is meaning the revolution of social work. Every branch of social work which is touched by case work methods, is in process of revamping its technique, with such results as make the newer type of service a very diiferent thing from the service of even a few years ago. The problems of the destitute, of the sick, of the insane and mentally defective, of the delinquent, of the dependent, are now being expressed in terms of hopefulness and understanding such as were almost entirely absent in the past. This case work ap- proach to work with children has particular significance because Foster Care of Children 119 children more than any other members of society will most benefit from it. The approach to any neglected or dependent child, as to any other individual, adult or child, should be made only in the spirit of understanding his needs, of trying to meet them rather than with a feeling that his needs have already been interpreted; that he has already been classified; and that rigid and inelastic methods of treat- ment are always proper and wise. With such diverse groups of children, whose needs arise by reason of certain conditions in their own homes, the children's organization must deal, and it must so adjust its work as to be able to provide the special and intimate service, sympathies and understanding, which are the right of every child and without which no child can develop normally. It is the task of the social worker to know the children with whom he or she is dealing, to see things from their standpoint as much as from the standpoint of the adults and others who have affected the life of the particular child, and then to try to provide through social treatment the essentials which careful study shows the child to have lacked. Therefore, every children's organization which expects to do an effective, helpful service to the children and to the community which it reaches, must be provided workers who are competent to understand the social problems which the children present, to get their right relationship, and then to apply the most effective social treatment. This better type of care will in many instances apparently cost more than less thorough work, but actually the best and most com- plete service to an individual in need, no matter how great the cost, is in the end the least expensive. Moreover, on the cost side, the war has fastened upon many people of all social positions this one great idea; that if so much money can be spent for a special national protective work, then with equal justice may society publicly or privately spend far larger sums than we have thought advisable in the past for the proper care and training of thousands of children who through no fault of their own stand in need of development and opportunities which their parents cannot or will not give to th^m. As has been noted, we are not concerned in this paper with the problem of care for children in families where poverty is the chief cause of distress. One general principle should control all work for children, namely, that the child's own family ties with parents or 120 The Annals of the American Academy other relatives, if it is living with the latter, should be broken only as a last resort. Because good case work does not hold with all children's agencies, this principle is not observed; action is often taken in ignorance of the child's real home conditions and resources, and he is injured rather than helped; for foste^ care, although it may- be of the best, is nevertheless, in many instances, a poor substitute for the care which parents could and would have given if the means, opportunities or advice, had been provided. Even applications for temporary care of children should be carefully studied because often the thing asked for is not what is needed and other than temporary care may be necessary and imperative. The work of the Bureau of Investigation of the Department of Public Charities, New York City, under Commissioner Kingsbury, is proof of how more careful case work means the keeping of many children with their own people. Fewer children were committed by the Department to the children's institutions in New York City during the last years of Mr. Kingsbury's term than were committed during the term of the previous Commissioner, the decrease being the result of a more careful understanding of family problems affect- ing thousands of children. Case Methods Applied Let us apply case methods to the following special problems which concern every social worker and especiallj- every children's worker. Consider the question of adoptions. A study of the reports of certain children's home and children's aid societies and certain institutions scattered all over the country, shows a surpris- ingly large number of complete adoptions of children for each year of their work. A study of the reports of other organizations, often in the same localities and usually dealing with the same types of children and caring for equally large numbers of children, shows almost no adoptions. Why is this so? Careful study leads one to feel that the difference is due largely to the lack of adequate case treatment on the part of the first class of agencies and to the use of good case methods on the part of the second class. The case work approach to the adoption problem presents a series of very special difficulties. First, the more one studies intake (that is, the more one studies the appHcations for care presented by parents, relatives, interested friends, and cooperating agencies, Foster Care of Children 121 public and private), the more one finds out that there are relatively- few children without some ties of relationship which should be pre- served. This holds equally true for the child who is usually adopted and for the child who is given long time free home or boarding care, either in institutions or families. The great majority of children now given for adoption are illegitimate children. However, a large number are the children of lawfully married people, who for a variety of reasons are wiUing to give up their children or to permit their children to be taken from them uijder curiously illegal legal agreements entered into with the caring agency. The well trained social worker will try to preserve for a depend- ent or neglected child such ties of relationship as will help it. She will also understand that full knowledge about the child she is help- ing will inevitably mean better care. The adoption of a child should mean the answering of at least these questions : 1. Is an injury being done to its parents or relatives in taking it from them or keeping it from them? 2. Are they quite unable, with proper assistance, to train their own chUd? 3. Are we certain that the adoption proceedings do not represent an escape from proper responsibilities on the part of a parent? 4. Is the child well physically? Is it well mentally? 5. Have we fully satisfied ourselves as to why in each particular instance the relationship, provided the parents are living, is being severed? 6. Are we trying where possible to keep alive the relationship between broth- ers and sisters, assuming that the child considered for adoption has brothers and sisters? Our failure as communities to apply case work methods to the adoption problem has meant that courts, communities, governing bodies and social agencies have quite underestimated the significance of their large adoption rates. Social conditions are not right in a community that year by year is agreeing to adoptions of large num- bers of children. Each unmarried mother takes on an entirely new significance if we survey the adoption of her child in the manner suggested. The maternity homes get into a right relationship to their jobs when case work methods are applied. Our failure to apply the case method to illegitimacy has meant our failure up until now to get the real signif- icance of our illegitimacy situation. Only as innumerable stories 122 The Annals of the American Academy are studied and analysed will we get beyond the stage of simply passing out illegitimate babies without knowing exactly why they come and how the tragedies back of each little child may largely be prevented. Careful case work with unmarried mothers shows a high percent- age of capable mothers who, if given the opportunity, have training possibilities which would benefit their babies. Careful case work also shows that many unmarried mothers are feeble-minded or suffering from syphilis or gonorrhea, and frequently that babies of the latter class suffer from syphilis. How necessary does it become to see that babies with this inheritance of feeble-mindedness or disease are not placed in families where the opportunities offered will be wasted upon them. Our tendency to provide foster care for illegitimate children sa easily and so constantly, in ignorance of the conditions from which the child has' sprung, is evidence of the fact that legal injusticea with reference to illegitimate children and social injustices with reference to mother and child still persist. When each unmarried mother and her child are studied wdth a view to their best development, there will be many instances in which it would seem wisest to arrange for the adoption of the child, and these children will then be most accurately placed in families according to their abilities based on physical and mental health. More mothers will receive support from the fathers of their babies, more mothers will be assisted in getting from the experience of un- married motherhood that protection which will help them and their children and the state. At the present time the failure to apply case work generally to the illegitimacy problem lueans a ruinous shifting of responsibilities to other parties who do not always con- tinue with them. The best societies for the protection of children from cruelty are constantly removing children from adoptive homes where conditions of neglect hold, the primary reason for the condi- tion of neglect often being due to the fact tliat some agency or person at the time of adoption did not know the whole story with reference to the child's physical and mental history. All students of the problem of child care agree that the normal family is the ideal place for .the rearing and training of children. This position was emphatically affirmed at the White House Con- ference in 1909, and has been constantly reaffirmed since then Foster Care of Children 123 by children's workers of all interests, including institutions and placing-out societies. The chief difficulty on the part of the leading institution people is their fear that there are not enough good families. An adequate understanding of neglected and dependent children oh the basis of good case work, prevents one from sajang that either. family or institutional care exclusive of the other com- pletely meets our needs. However, the more carefully the children's organization, whether institution or placing-out society, studies its applications in terms of case work, the more constantly does it see that it must continuously base its major services on something approximating family life. It was case work, although this term was not used, that led to the development of the cottage type of institution; it was case work that drove home the idea that the congregate prison is an evil and a terribly injurious institution; it was case work that showed the courts that community life and family life may be tried with increas- ing numbers of those charged with delinquencies and with helpful results; it was case work that carried the hospital contacts from bed-side or clinic out into the family and the community; it is case work that is making each progressive children's agency see every child it receives as having a variety of needs which can best be met by family life or its approximation if they are within an institution, and that the desirable thing is to strive to transfer the training task as rapidly as possible to family centers. Thorough case work, as apphed to home-finding or more specif- ically the securing of foster family homes for children, is of very recent growth. The fact that home-finding methods generally have contained so many elements of chance has made many institution people feel that good institutional care is a much more certain and definite thing to follow. If potential foster homes are studied in exactly the same way that other families known to social agencies are studied, the element of chance is increasingly eUminated and then is there possible that adjusting of particular children to particu- lar families which so many of us have talked about and so seldom realized. If the home-finding job had always been what some of its advocates have said it was, there would be few types of institu- tional care in existence. The application of case methods to this division- of children's work will effect as great a revolution on the home-finding side as on the institutional side. 124 The Annals of the American Academy It is a fact that most families into which neglected and depend- ent children finally go for care are selected in a pretty superficial way. Even reputable children's agencies which exercise great care in determining the children they will receive are content with much less thorough service in selecting the foster families to which the children are to go. Most well organized cities throughout the country now have confidential exchanges and yet it is rare to find the children's organizations using these exchanges for their foster homes. A potential foster home should be studied with the utmost care and everyone having important knowledge as to its training ability or disability should be searched out. In too many instances work- ers are prone to let the question of approval rest on a small fund of information furnished by the family plus a few references which they have given, and occasionally information from independent sources known only to the society. It is no wonder that the most thought- ful students believing in the institutional methods — ^who see only the work of these agencies — look with questioning on such a procedure. Family home work for babies is largely a matter of getting ex- pert physical care. Yet an organization paying regard only to the physical factors may by reason of faulty work do great injury to the unmarried mother of a baby in such a home. One society reported the family of a physician who with his wife was able to give most intelligent care to certain babies placed with them, and there were no difficulties offered until the baby of a young unmarried mother was placed in this home. Then the discovery was made that the physician was a man of low morals and had gravely tempted the girl immediately on his learning that she was unmarried. Where famihes are being sought for the foster care of babies, it is not necessary to search only for good disciplinarians, or for people of unusual education, but the home life must be good, especially where there are contacts with unmarried mothers. Often the most effective work done is through the foster mother rather than the visitor, who is most directly concerned with the supervision of the mother and baby. For quite a long while a difference of opinion has existed among the children's workers most interested in the care of children in fami- lies, with regard to the value of free homes as against boarding homes. The advocates of the free type of home have contended that they Foster Care of Children 125 used a better type of home than was true of the type largely engaged in boarding out. If one approaches the dispute with a view to ascer- taining all the facts, or in other words follows the case method, certain things- will stand out: first, that free homes are generally restricted to very httle children who are without family ties or whose family ties can be severed without opposition from parents or others. These children are supposedly well and must generally be attractive; that is, sick,, diseased or unattractive children do not come within this class. Second, older children, generally over twelve, are re- ceived into free homes because of certain services they may render. It therefore becomes evident that a great many children whose family ties cannot be severed, or children who are unattractive and come from poor, low grade homes, who are sick or impaired phys- ically or mentally, must be provided for in other than free homes. In many states which have developed strong free home agencies, agencies that do almost no boarding out, there has also grown up a number of institutions which under this system have to take over the job of caring for children whom no one is desirous of fitting into families. Moreover, many of the free home organizations have felt strongly that to dev,elop a boarding out service, that is to provide board in families for these children whom they could not place in free homes, would tend to decrease the scope of their free home work.' ' The situation in Massachusetts has been pointed to as bearing this out. This state has approximately 10,000 children in families under the care of public and private organizations. Of the 10,000 approximately two-thirds are in board- ing homes. There is none of the free home development in the state such as holds in other states, but there is likewise none of the institutional development, because the public and private organizations are quick to give family care to a child even if board has to be paid when they are certain that such children cannot secure opportunity for free care. The situation in New York illustrates the resvdts of a non-boarding out devel- opment of the children's field. There has grown up alongside the importanj; free- home children's agencies an increasing institutional population. Part of this institution growth has no doubt been due to the subsidy system, but a large part has been due to the fact that there were no private agencies standing for the board- ing out idea. In other words, the case work method, involving elasticity and ad- justment to the needs of a particular situation, was not in evidence. The development of the children's Home Bureau of the New York City De- partment of Public Charities and the placing of many hundreds of children in families at board during the first year and a half of the Bureau's existence, is strik- ing proof of the wisdom of this addition to the free home equipment in the state and has suggested to some of the best institution people opportimities for growth and a transfer of activities from the institution to the family plan. 126 The Annals of the American Academy It is utterly useless to say that family care is better than insti- tutional care for a particular child, unless we are prepared to give continuing, penetrating supervision. A children's society placing its wards in families and giving inadequate supervision is offering no arguments against institutional care but may be offering many in fayor of it. Good case work in the children's field, among other things involves seeing an accepted responsibility through to its conclusion, yet it is not good case work so to load a visitor with children placed out in families as to make it impossible for her to do more than pay a few fleeting visits in the course of a year. The standards set by a small number of children's organizations of forty to fifty children to a visitor are simply not accepted by children's agencies generally. If the development of opportunities for free home care is checked, the fault is due to the neglect of the workers rather than to the in- j urious results of the boarding out plan. Almost none of the agencies using either method exclusively have accumulated important history records for the children in their care. This has meant, of course, a lack of accurate and complete data which must preclude any scien- tific study. It cannot be stated too frequently that this whole ques- tion of child care is capable of scientific interpretation and unsup- ported opinions must give way to statements based on facts. On the other hand, few institutions have kept records of their work in such shape as to make it possible to study now the results of their services and determine wherein certain types can best be cared for in institutions rather than in famiUes. A careful study of case histories of children in need of temporary care, conducted by both institutions and family agencies, ought to disclose data as to which has brought the more helpful service to the children. The executive officers of the Massachusetts Trustees for Train- ing Schools, who have in charge the three state industrial schools for children, feel very strongly that whereas probation for a child in the community represents a procedure that should be tried in almost every instance where a .juvenile delinquent is involved, yet the dividing line between what a family can do and what a training or industrial school can do for a child is not clearly and definitely under- stood by very many children's workers. This same indefiniteness holds in the matter of institutional and family care where neglected and dependent children are involved. The doctors and lawyers Foster Care of Children 127 are constantly expressing naedical and legal problems in terms of cases. Dr. Richard C. Cabot's "Differential Diagnosis" is an evidence of something that we should have in social work. The problem of the best kind of foster care, whether in families or in institutions, could best be stated and understood if we had mono- graphs giving histories and treatments of given groups of children: children related; children without relatives or brothers or sisters; children with no special problems, others with very special problems of health, impaired minds, or bad habits. Returning to the matter of adoptions, it would throw great light upon a most important question if certain organizations dealing with neglected adoptive children could study and re-state for the public the histories and treatment of the children involved and give especially the reasons why these children had to be removed a second time often from homes of neglect. The case method is also admirable for use in weighing the ad- vantages and disadvantages of the community in which an effort is to be made to place children in families as against giving them institutional care. There are many communities in the United States offering less than a proper minimum in the way of social life. The schools are poor, the terms are short, industrial opportunities are nil, housing is bad, the country is sparsely settled, — it is foUj' for any children's worker to contend that where such conditions prevail proper family life with necessary neighborhood contacts will be found in sufficient quantity always to provide for all the children in need of care. The tendency of many of the child-placing agencies to sing the praises of the ideal home and then to dodge so far as actual work is concerned the care and adequate training of the more difficult chil- dren referred to them, with particularly serious results at the time of adolescence, has thrown upon the institutions a very difficult task. This has particular reference to the giving of care to dependent or neglected older boys and girls. Every well-informed child-placing agency knows that when children of twelve or thirteen or fourteen years are referred for care, the problem of treatment, and the cer- tainty of good results, are very different from the cases of much younger children. The family agency in receiving a child at this age has a much more difficult if not impossible task in building it into the texture 128 The Annals of the American Academy of a family. Years of neglect make most necessary for the particular child very intensive, special care and not every good home, good from the standpoint of morals, cleanliness, intelUgence, etc., is able to provide that accumulation of interests which the adolescent child demands and has to have. The psychology of this particular chil- dren's situation has not been shaped up, at least so as to affect the work of children's organizations as a whole. A certain type of institution, the Uke of which is rare, might be so effective in giving care to these older children, or children who arrive at a period of dependency at a late age, as to be in advance of the family agencies; but there should be no uncertainty ^bout it and either of the plans can be entered upon with certainty only if the histories and treatment of each child involved are studied and the combined experiences properly interpreted. The extent to which institutional care is given by the Catholic Church to its children is a cause for constant comment, especially as this holds with reference to little children, because if there is flexibility in methods, these are the very children that are most easy to place in families. The difficulty of getting enough Catholic families into which these children might go has been offered by some as a reason for the institutional emphasis. The experience, however, of the New York Department of Charities in placing large numbers of Catholic children in homes of their own faith and in a district as congested as the area surrounding greater New York would seem in a measure to dispute this contention. It is also important to note the work of the Massachusetts State Board of Charity in placing its wards in homes of their own faith. In the giving of foster care, whether in institutions or families, there are other special considerations having a paj'ticular religious significance. With this constant emphasis on training along certain sectarian Unes as laid down by various religious denominations, there is interjected a special difficulty from the placing out stand- point. Good case work, irrespective of any interest in any particu- lar religious creed, will see to it that a child is placed generally in a home of its own rehgious belief; that is, a Catholic child in a Cath- oUc hoine, a Protestant child in a Protestant home, a Jewish child in a Jewish home. Now, it frequently happens that a home thought of for a particular child is good on every count except that it is of a different religious belief. Frequently the argument is heard that Foster Care of Children 129 placement in this home for the child in question can have no serious effect on the child. It will be allowed to continue its own rehgious life, and the utmost respect will be paid to its own rehgious opinions. Holding Uberal religious views, the writer of this article feels that such an argument is wrong. Growing out of experience with a variety of children's problems, one does realize that the statement made above that few children are without ties of relationship which can be severed completely, is indisputably true. The child's early religious training results in the formation of certain interests and possessions which cannot be lightly dropped. Therefore, while a child will benefit physically and in many ways socially by care in a good home of other than its own faith, conflicts are presented to the child which affect it most seri- ously in its later reunion with family and friends. An element of doubt on a hitherto undebatable subject is injected at a time when the child is often least able to get his proper bearings. This would seem to lead to the plan that familiar religious atmospheres and training must be continued for a child when receiving foster care, involving as it may institutional care. There is the further argu- ment that unless a child is placed in his old religious atmosphere, he will wander from a particular rehgious denomination and may thus be lost to the membership of a particular church, a spirit of propaganda for which the writer has no sympathy. Careful follow-up records should be kept by every family or institutional organization of the foster homes in use; that is, after the initial reception investigation with all of its ramifications has been made and a decision to use the home has been reached, then all further contacts with that home should be summarized and entered on the record, so that the home's training and development under the direction of good family visitors, the results of care given to the different children received into the home, and the reasons for success or failure in given instances, should all be there. The records should also show changes in the family structure. In so many instances the children's agencies are prone to forget that the family organization as presented at the time when first used will not last forever, and that a very good home, good because certain members were there, may become a very bad home because certain members have died or left. An illustration of this is the home of a deserted wife whose husband had long been away, and whose children showed 10 130 The Annals of the American Academy the effects of her good trainmg. Her home was an excellent training place for children who had been deprived of their own parents, but became a very bad place especially for girls when the husband re- turned and the wife, out of a mistaken sense of responsibility, felt she could not turn him out of doors. Under such a record system, the visitors would be so accurately and completely informed as to choose the foster homes with greater certainty of success. If a number of children's organiza- tions were to keep such family records, it would then be possible to show under what family conditions the children, with all of their varying personalities, best develop. It would also be possible to show the homes that had been rejected or later disapproved because of the development of conditions which were not evident or were not discoverable at the time of their acceptance. Monographs on such records of experience would help all children's workers and every intelligent social worker dealing with children's problems would have a new value placed on her best work. The country is in the midst of its greatest social crisis. No children's organization need feel that more careful study will lead to its elimination for if it base all of its work on good case studies the treatment will be of the right sort. Case work with children means knowing them and when intelligent people know them they treat them wisely. Knowledge here is power to do the right thing. ESSENTIALS OF CASE TREATMENT WITH DELINQUENT CHILDREN By Henry W. Thurston, Member of Staff, The New York School of Philanthropy. So far as case treatment of delinquent children depends upon the authority of courts it is necessarily limited and colored by the- provision of the law establishing those courts; by the personality and judicial methods of the judges; and by the public opinion that created and sustains the laws; It is, therefore, a first requisite to continuous good case treatment of juvenile delinquents that there be a right attitude of the public mind, and that this attitude be ex- pressed in laws and court procedure which will permit and encourage good case treatment of the individual delinquent. A brief reference to the public opinion whioh found legal expression in the Roman law, the penal code of France and the English common law, com- pared with the American law which in many states gives a juvenile court chancery jurisdiction, will illustrate the necessity of a right attitude of the public mind towards young offenders as a basis for right case treatment. The Basis of Case Treatment in Public Opinion and Law The Roman criminal law treated the adult differently from the child by making a gradation from non-punishability-^seven years, through stages of "impuberes" (for boys till 14, for girls till 12) and "minority" to full maturity at 25 years, The amount of pun- ishment varied according to these gradations in age though not by a definite scale. There was no special judicial procedure or special punitive institutions for juvenile offenders. The penal code of France similarly distinguished between an adult and a child, placing the dividing line at 16 years. For offenders under 16, the law provided that if a child acted without " discernement " he was to be acquitted and either returned to his parents or sent to a house of correction for a definite time which must end when the offender reached the age of 20 years. If the offender under 16 acted with " discerpement " he was to be pun- 131 132 The Annals of the American Academy ished to a less degree than an adult according to a graduated scale. There was no minimum age for punishability and no special judicial procedure. The common law of England which has been followed by the statute laws of many American states gave seven years as the low- est limit of punishability. Above this age and below maturity during most of the nineteenth century, England and the United States have graded punishment according to the judicial opinion of the degree of responsibility of the young offender for his offense. Of this groping of the Roman, French and EngUsh public opinion toward discrimination in the treatment of juvenile offenders, as expressed in their laws, Philip Klein says: ' The law went half way toward treatment of the cause in acknowledging that lack of responsible, mature thinking is partly the cause of the offense, and in es- tablishing the presumption of only partial responsibility in the case of juveniles, but failed to go the rest of the way, however, to find that youthfulness being the cause of the lowered responsibility, it was this youthfulness or inmiaturity that had to be dealt with, rather than the remstining'ajnount of responsibility. . . . Though technically an offender against the law (the child) is really primarily a neglected child. Because of his irresponsibility and immaturity the child needs protection and training. When no protection and training are given the child it is likely to. act upon its own impulses, and these, often, in cases of destitution nearly always, take the form of an offense against the law.' The same attitude of pubUc opinion as formulated in law is authoritatively expressed by Judge Julian W. Mack. The underlying conception of our criminal law, despite all the reforming in- fluences that have come in, is still that of vindication, that the state must vindi- cate by punishing. This ought to be completely eliminated when we deal with children A child who has committed an offense, no matter what the natiu-e of the offense may be — even what we call murder — should be dealt with by the state, not as an adult is, merely to punish, but for the purpose of correction, for the purpose of training, for the purpose of education.^ That courts in states where public opinion toward juvenile delinquents has not yet become formulated in chancery law and in judicial practice for children's courts, are handicapped in their efforts to develop social case treatment of children, the testimony of . Presiding Justice Franklin Chase Hoyt bears convincing testimony. 1 "The Treatment of the Delinquent Child in the United States," an unpub- lished paper which traces the trend above summarized. ' Address before Judiciary Committee of the Constitutional Convention of New York State, June 29, 1915. Delinquent Children 133 One of the handicaps which retards the Children's Court development at present is the impossibility of obtaining a comprehensive method of legal procedure under constitutional conditions. The court should have broader powers, and the present system of trials in children's cases should be done away with. It savors too much of the strict, narrow, criminal trial. If chancery or equity powers could be conferred on the court it would be possible to inquire into the facts and circumstances of each case at the first hearing to see whether the child is in need of the care and protection of the state without first having to make a technical finding of juvenile delinquency." Social case treatment of juvenile delinquents needs first of all, then, the baclcing, not only of public opinion but of public opinion formulated in law and carried out in practicfe. A second need, hardly less essential, is a similar public opinion formulated in law and judicial procedure which makes it possible that adults who are responsible for the neglect and delinquency of children can be reached either directly by the juvenile court, or by another court on the initiative of the juvenile court. In practice this means one of three things. (a) A juvenile court with jurisdiction over adults in theit domestic relations and in other cases of adults involving children. (b) A domestic relations court with jurisdiction in case of juvenile deUn- quents. (c) Two courts, one for juveniles and one for adults in close administrative cooperation. Case Treatment from the Time of the Offense until A Delinquent Is Placed on Probation There are two primary essentials in good case treatment during this stage. First, the delinquent should be so treated that the proc- ess itself tends to make him better. Por example, if personal cus- tody away from his home is necessary, that it shall be in separation from offenders and custodians who incite him to further wrong and in company with those who call out what is good in him. If home custody pending court hearii^g is even reasonably sure of producing the delinquent when wanted, and is not of itself a further encourage- ment to delinquency, it should be allowed. The second essential is that all the pertinent facts be found out, not only about the offense but about the offender and his habitual experiences and activities. The approved procedure from the time of the offense to the time • Annual Report of the Children's Court of the City of New York, 1916, p. 36. 134 The Annals of the American Academy the delinquent is put upon probation (or dismissed or committed to an institution) is suggested by the following typical case: Three boys during their habitual street activities of a Saturday forenoon found out that the grocer was away for the day and that the transom was open. They agreed to go home to luncheon and to meet at 1.30 and go into the store. This they did, thus becoming in the eyes of the law burglars and thieves. They carried off sweet chocolate, Nabiscoes, cigarettes, gum, candy, cookies, etc., and hid their booty in a shanty back of one of their houses. The next day, Sunday, they went far into the open country and ate their plunder. Meanwhile a smaller boy who had seen the burglary told on them. On Monday the pohceman .filed a petition for each of the three boys with the clerk of the juvenile court. This petition stated on oath that (name, age, address of boy) to the best of the knowledge and belief of the petitioner is a delinquent boy in that (description of the offense). The clerk acting for the judge then issued a sum- mons upon the parents of these boys, stating that petitions had been filed charging them with delinquency and that a hearing had been set on a certain day and hour in the juvenile court, and direct- ing that they appear at that time with the boys. Pending this hearing a probation officer made an investigation of all the necessary personal, developmental, family, neighborhood, and school facts relating to the boys, so that the habitual activities, trend and opportunities of each boy became clear. The boys were also examined by a doctor and a mental specialist. Specialists in the study of delinquents agree that the short period between the detection of a child in deUnquency and the hear- ing before a judge who is to decide what is to be done with him is the best psychological time to secure the maximum degree of coopera- tion of the juvenile delinquent in efforts to understand the real reasons for his own misconduct and the essentials of the best plans to prevent recurrence of wrong- doing. In cases such as the above, with all these facts summarized in writing, — so that the judge can visualize not only the particular offense but the personality, habitual life, and future opportunities of the child, — the parents, the child, the probation officer, the com- plainant, friends and witnesses file up and stand before the judge. Here there are as many different variations in procedure as there are different judges and juvenile delinquents, but good case treatment Delinquent Children 135 demands of the judge that when the hearing is ended he shall have produced certain very definite impressions on the delinquent and on his parents and friends: 1. That they have had "a square deal" and a fair chance to tell the judge whatever seems to them important. 2. That the judge has found out the real facts — that nobody has "put one over on him." 3. That in his decision, even to commit to an institution, he acted not in anger or in an arbitrary way, but so far as his duty as a judge and the law permit, from a desire to help the offender "to do better" — "to give him a real chance." 4. That if the delinquent is put on probation the judge has made clear that the probation officer is his representative who, like the judge, is not easily tooled amd will always give a square deal. Unless a majority of those who file out of the court room have in substance received the above four impressions, the judge has lost much of his psychological opportunity to make his contribution to . good case treatment of juvenile delinquents. In this process the juvenile court judge who is compelled to work under the criminal court law is sadly handicapped for the reasons that at the first hearing all that can be taken is testimony for and against the delinquency of the child; and that a remand of the case for a second hearing is necessary in order to secure the social investi- gation and physical and mental diagnosis upon which alone a sound plan of action can be based and stated in the decision by the judge. In short the judge is almost compelled either to decide upon a plan of treatment, on incomplete information, or to call the child and his parents back for a second hearing after hfe has had time to have the necessary facts collected. A decision upon insufficient information tends to the impression upon the child and his family either that they did not get a square deal or that the judge was fooled. A remand for an investigation often works real hardships upon poor people in causing loss of time and money and seems to them unfair. The remand also sometimes arouses contempt for a court that calls the child and his parents to its bar without knowing or getting at all the facts in the case. In other words, it is harder for a judge under a criminal court pro- cedure to send a majority of children and adults out of his court feeling both that they have had a square deal and that the judge can- not be easily fooled than it is for a judge under the chancery law. 136 The Annals of the American Academy This is true even if the average decisions of the two judges are equally wise from a case treatment point of view. Returning now to the decisions of the judge re the three boys who were mentioned above as having burglarized a store on a Satur- day afternoon and who had been brought into court on petition and summons as before described, after all the necessary facts had been found out before the hearing, the judge was able to produce the four impressions above emphasized as important, although he made a different decision in each case. The investigation in the case of No. 1 showed a normal nin^-year-old boy from a good home. He was mischievous and active but not vicious. He was in fourth grade in school and regular in attendance. His parents nbt only had a good home but now that they were alert tp the need of more careful plans and supervision for his spare time, were able to connect him with Boy Scouts and probably to secure a change of behavior without further aid from the court. The judge, therefore, dismissed him to the care of his parents. The facts in case No. 2 were that he was a twelve-year-old boy in the sixth grade. The father had deserted and the mother and boy were living with the boy's grandfather who ran a milk depot and route. The boy helped some in spare time but was much on the street. Once, after saving money for months, he had run away with other boys who planned to go south where they coiild see "tropical fruits and waving grain." The- judge, therefore, explained that he would allow the boy to continue at home on condition that he and his mother and grandfather and the probation officer would work together to prevent further wrong-doing. He was to be kept busy and happy, not only at his work, but also during his spare time activi- ties, which thus far had been unsupervised. The facts in case No. 3 were that the boy had previously been in trouble for truancy and also for joining with other boys in stealing inner tubes of automobile tires from a shed used as a garage. His mother was dead and his stepmother was afraid of being too hard on him. The father was brutally severe at times but away from home most of each week. The judge explained that he must see that this boy's habits and home were changed and that the boy's best chance to reform was in an institution unless a family home under more favorable conditions was possible. At this point an older brother who was married and whose home had been visited Delinquent Children 137 by the probation officer offered his home, Iuh personal service and new school associations, together with membership in a Junior Y. M. C. A. which offered swimming and other recreations. Ac- cordingly No. 3 was put on probation to live at the home of his brother. In a group case like this some judges are careful to have only one deUnquent and his friends present at the time his decision is given, but even if all three boys and their friends are present, the emphasis of the judge, not alone upon the wrong-doing of each, but upon such conditions of home, play, school and work opportunity and supervision as will give each boy a real chance to conquer his de- linquent tendencies, gives all an impression of a square deal in the light of facts as they are. Good case treatment of several delin- quents who have been caught in the same offense does not often demand identical decisions by the judge, but usually a different decision in some particular for each. To the degree that the differ- ences in decisions are based on accurate knowledge of facts, under- stood by the delinquents themselves as well as by the judge, they and their friends will approve these variations in decision. Such variations in the judge's decisions, however, are not likely to be ap- proved by the dehnquents and their friends if the major emphasis, as is too often true in criminal courts, is laid on the offense rather than on the task before each offender of so living in future that no other offense will be committed. Case Treatment by the Probation Officer The case treatment now passes into the hands of the probation officer. The equivalent of the first interview (in family cases need- ing a social worker), of investigation, of analysis of facts, of diag- nosis, and of the formation of the outlines of a plan has already been taken. It is now the task of the probation officer to work out with the delinquent and his parents or guardians the details of a course of life and conduct that will lead to prevention of further delinquency and to right habits and ideals of life. Right here is where too many probation officers fail to do good work. The delinquent knows he has done wrong. He usually has at least a brief desire and intention to do right. What he needs and his parents need is a clear but elas- tic program for the week which will give the deUnquent such good 138 The Annals of the American Academy times as boys and girls ought to have, without constant temptations to evil and further delinquency. In other words he needs a pos- sible program of things to do which seem to the delinquent worth doing in all his spare time. To this end a careful study of the re- sources of home, school, playground, club, park, library, etc., needs- to be made by the probation officer, the delinquent and his parents, until it is clear how a week can be spent without doing wrong and yet in such ways that the delinquent can enjoy most of it. Unless such a program can be fairly definitely, but with great elasticity, laid out and approved by the delinquents, the chances for over- coming serious delinquencies are poorer than they ought to be. It is essential to the success of probationary care of delinquents that they be helped to see and to choose possible right courses of action at the precise points where before they have once, or fre- quently, chosen wrong courses of action. It is plainly futile to ex- pect reform under probation unless the child himself can be led to see and feel that right action is not only possible but worth while from his own point of view. Not alone what the probation officer thinks is right and desirable for the child, but what the delinquent himself can be led to see is right, desirable and possible, will be really effective in changing his behavior. To this end the relation of probation ofiicers to probationers must become one of reciprocal confidence and sympathy. Underneath this, but rarely used, is of course the authority of the court. The probation officer should also have such an intimate knowledge of the habitual life of the de- linquent at school, at home, in playground, street, and spare time, that the delinquent will feel the probation officer, while his friend, cannot be fooled. Whether the probation officer should be the same person who made the investigation of the delinquent's home and habits for the hearing is a secondary question. The success of a good probation officer depends upon his skill in influencing the probationer and changing wrong behavior into right behavior, not on the mere fact that4ie came into the life of the delinquent before or after the hearing before the judge. A similar question is that of reporting to the probation officer by the probationer. In some way the delinquent must be led to act honestly and on his own responsibility toward his own reform. In many cases to report to the probation officer at a certain time and Delinquent Children 139 place tends to develop his honesty and sense of responsibility. The probation officer must, however, have many other sources of inform- ation and means of guidance of the probationer. If he relies on the report alone, he will often be fooled and his influence be reduced to less than nil. Good case treatment means an adoption of available means to the end that habit and voluntary behavior become right with each child. No general rules are applicable to all cases of sick morals any more than to sick bodies. Until a probation officer learns this he is not so successful as he ought to be. The application of this principle of individualization of treat- ment explains what the right time and method of ending the proba- tion period are. If opportunities for right choices of behavior for 24 hours a day for seven days in the week are found impossible for a delinquent in his home and neighborhood; or if, although good choices are possible, his actual choices are habitually wrong, the probationary period ought to end by commitment so that control may be enforced, or by some change of environment or supervision that promises ji^rogress toward reform. On the other hand, when not only real opportunities for right choices of behavior have been seen by the delinquent but he has learned to choose them for himself, the probation officer should give the delinquent -the encouragement of knowing that the authority of the court has been ended. Like- wise this termination of probation should be entered on his record at the court. HeiShould know that henceforth he is thought strong enouglTto do righf with merely the personal encouragement of the probation officer. Whether or not this close of the period of proba- tion shall be celebrated by having the delinquent released in person by the judge cannot be stated without knowledge of the case. Plainly some girls who have left sex offenses far in their past, should not be compelled to go again to court. Good case treatment of de- linquents demands, at the close, as at the beginning and all through, that the process of release from probation should be not a matter of cold routine, but an act of "constructive friendship." The final step is that the probation officer should be a voice in his commuity urging, in season and out of season, the suppression of causes and conditions which make for delinquency and also urging with still greater earnestness the provision of adequate facilities and agencies that make for wholesome juvenile life and education. THE HOMELESS By Stuart A. Rice, Formerly Superintendent, New York Municipal Lodging House.' Intelligent treatment of homeless men and women requires a vivid understanding of the reasons for their homelessness. Under present methods of industrial management this condition is de- manded of a vast number of workers. By becoming or remaining homeless, they render specialized services of great importance to society. Nevertheless, the living and working conditions imder which the services are performed react disastrously upon their character, even to making them subjects of social case treatment! The truth of these statements is to be illustrated in the employ- ment office districts of any large city. A recent inspection of the labor agencies from Fourteenth Street to Chatham Square, along the Bowery in New York, disclosed, in all, opportunities forfourteen men with families! And these were required to be "foreigners!" The thousands of other jobs offered (tacitly understood, not openly stated) were for "homeless men only." The Homeless in Relation to Society and Industry The writer has been a member of one of thoSfe unkempt com- panies you have seen slouching along the %tregj; from the labor agency to the railroad depot. He has made his abode in the bunk houses provided for these men. His experiences have led him to a real appreciation of the abnormal living conditions that are forced upon great masses of casual and seasonal workers throughout America. Many of the evils inevitably resulting from these un- natural conditions may be removed in individual cases by careful diagnosis and persistent social treatment. But tjie background of industrial organization (or disorganization) will in nowise be altered by the most careful case work. Either the men and women re- corded in our own case files, or thousands of others like them, will still be compelled to live abnormal lives in order that they may live at all. ' At the time of writing this article Mr. Bice was still holding this position. — ^Editor. 140 The Homeless 141 Homeless men are demanded to build the bridges and tunnels, the irrigation systems and railroads, to harvest our forests and em- bank our rivers. They are the pioneers of modern industry. They go hither and thither to the rough, unfinished, uncomfortable places of the world, to provide homes and civilized comforts for those of us who follow. Meanwhile they hve in bunk houses. Homeless women are preferred to do the "dirty work" in our public institu- tions and to scrub and clean at night in our hotels. Generally only they are willing to accept the work and the hours demanded, Homeless men, for the most part, make up our "labor reserve." This reserve is highly essential. If some workers were not unem- ploj^ed in slack or normal conditions of industry, additional hands could not be employed in periods of increased activity. The home- less are usually the less efficient. Furthermore, they are without dependents. Socially and economically, therefore, as things now are, it is advantageous for society that they shall be the first em- ployes discharged when reductions in force are essential and likewise the last to be reemployed. Homelessness and intermittent employment, therefore, go together. They are the major characteristics demanded by society of a large number of its workers. But certain other characteris- tics are encouraged. In the absence of organized social control over industry a restless instability of temperament is desirable to afford fluidity to the labor supply. Employes' indifference to cleanliness is fortunate for numerous employers who find it im- practicable to supply bunk houses with running water. Even the periodical debauch in the city after pay day has psychological re- sults which prove convenient to the employer. Men or women without money are docile. How otherwise could they be induced to return to jobs affording no chance of normal living? These unfortunate developments of habit and character we attempt to combat in individuals by social case treatment. Yet, they are in a sense vital elements in our patients' professional training! Classification of the Homeless It is convenient to use the following grouping employed by Mrs. Alice Willard Solenberger:^ (1) the self-supporting; (2) the tempo- rarily dependent; (3) the chronically dependent; (4) the parasitic. 2 A. W. Solenberger, "One Thousand Homeless Men," p. 10. 142 The Annals of the American Academy We may say with approximate correctness that in the order named, these classes mark the degrees of progressive deterioration through which every homeless individual tends to pass. That more men and women of the first two groups do not actually pass into the third and fourth is a sure evidence of fundamental human character. Everything in the lives of homeless men and women drives them in the direction of chronic dependency and parasitism. Many fight on against odds, day after day,~to retain, their precarious foothold upon the social ladder; others go down in the struggle, their spirits unbroken to the end. Still others, "exhausted by three or four generations of overwork, on the slightest menace of lowering prices the first to be discharged," ' prove easy victims to the disin- tegrating tendencies of their environment. The Genebal Aims of Case Tbeatment The first requirement in social treatment of the homeless adult is to check his progressive deterioration toward chronic dependency or parasitism. Existing faciUties for constructive treatment are very meagre. Our efforts are everywhere counteracted by the encouragement which "society gives to the very tendencies in our patient that we desire to eliminate. If we are dealing with large numbers of the homeless we cannot expect a restoration to normal living in more than a small proportion of cases. The best work we can do at present, therefore, is to assist the bulk of our patients to "hold their own." Another general objective is in reality a matter of diagnosis rather than of treatment. In any group of homeless individuals there may be singled out proper cases for specialized treatment in which homelessness is a factor of minor significance. The sick, in- sane, feeble-minded, blind, handicapped, inebriate and immigrant are regarded as such typical cases in the volume of which this article forms a part. All of these are found among the homeless appli- cants for shelter or relief at any municipal lodging house or charity application bureau. Many lost and broken fragments of famiUes may be recovered from among the homeless. Married men or women, and boys who have run away from homes, will always be discovered if applicants are carefully interviewed. As soon as the 'Edmund Kelly, "The Elimination of the Tramp," p. 4. The Homeless 143 -facts in these cases are ascertained, the problems become those of family case treatment and should be referred to a family agency. With the development of facilities for diagnosis and with the building of additional agencies for specialized treatment, the social function of an agency or institution for the homeless will become primarily that of a clearing house. In every way afforded them social case workers should further the breaking up of our homeless group into its component parts. Treatment of the Self-Supporting The most numerous group of homeless, employed persons with whom I am acquainted is that which is known at the New York Municipal Lodging House as "the Saturday night clean-ups." The registration of applicants is proverbially largest on Saturday nights. The men responsible for the increase are generally employed through the week, usually at odd jobs that must be "caught" each morning. Consequently, by seeking a free bed and meals at the Municipal Lodging House on Saturday night, the earnings of that day may be reserved for Sunday's living expenses. Some wish to "see the doctor"; others want to "get a bath and fumigation," in- order to rid themselves of vermin acquired in cheap commercial lodging houses; still others desire to have their clothing washed in the laundry of the institution. Women frequently are led to our doors from the same motives. The problem here represented is primarily one of labor and housing rather than of social case work. , There is no formula of social case treatment for the needs of these men and women. Most of them are independent in attitude and fairly self-satisfied regard^ ing their economic and social status. They will not accept services from the institution other than those they request. If molested by "social service busy-bodies" they will not return, and whatever opportunity existed for their physical and moral sanitation will have been lost. However, if their "clean up" is supplemented by a friendly but,iny)ersonal welcome the institution may at,least con- tinue to be a very important agent in community sanitation. A group of self-supporting men and women more susceptible to case treatment than those described above, is illustrated by the low paid hospital helper employes of the public charitable institu- tions of New York City. Customarily they are recruited from the 144 The Annals of the American Academy patients and inmates of the institutions themselves. They work for a much lower rate of compensation than is paid for equivalent serv- ices elsewhere, and they are recognized officially by the City of New York as a distinct type of semi-dependent employe. In his dual capacity of employer and landlord, the head of an institution is in a position to render social service to these employes of a kind impossible when they are patients, inmates, or applicants for relief. The Municipal Lodging House recognized this fact in the formulation of a definite policy regarding the filling of positions within the institution; so far as efficiency in administration permits, the Social Service Bureau is the employing agency for these house positions. Lodgers who show possibilities of reclamation become our employes. As soon as possible they are promoted, and even- tually are placed in permanent outside employment, carefully selected for its influence upon their habits. In this manner, similar opportunities are continually made for other lodgers. It is most essential for the success of this program of social serv- ice to employes that group loyalty, and group interests be developed. Frequent meetings of employes should be held at which common 'problems of organization and management may be discussed in a democratic way. Outdoor athletic sports are invaluable as a means of promoting loyalty. Holidays may be the occasion of gatherings at which songs, instrumental music, recitations and special features will supplant the institutional atmosphere with that of a community festival. If regular recreational and educational opportunities are not to be had at the institution they will be sought in the comer saloons. Various clubs are practicable. A large reading and smoking room provided with books, papers, magazines, writing materials and games is a popular success at our Municipal Lodging House. I was once complimented by an unpaid employe for the choice selection of Greek and Latin poets upon our shelves. He chanced to be a former Yale man. The books (received in a donation of cast-off materials) had given him many hours of intellectual pleasure! • - Supervision of employes' expenditures is helpful in many in- stances. Some have never learned the value of money and spend it foolishly. Others are unable to withstand the temptations of drink. Employes at the Municipal Lodging House are encouraged to deposit their earnings with me for the purchase of necessities, for transfer to The Homeless 145 a bank, or for investment in War Savings Stamps. A positive gain in self-respect is evident in the individual who has purchased cloth- ing or accumulated savings. In some cases I have found it desir- able to keep employes continuously in debt to me by advancing them money for legitimate objects. The amount due is later de- ducted from their salaries. The invitation to membership in the Red Cross was recently accepted by five-sixths of the hospital helper employes of the Municipal Lodging House, but a small pro- portion of whom were receiving in excess of twenty dollars per month. The development of a system of credit or of token money, such as has been found effective at Sing Sing, would be of the utmost value in the rehabilitation of these men and women. The object of such a system would be to pay employes in the things they re- quire — ^tobacco, clothing, shoes, moving picture tickets, etc. The present cash salary payment is in reality an inducement to spend the month's wages in one grand debauch. Saloon keepers in the neighborhood of public institutions habitually ascertain when em- ployes are to be paid and are shortly after in possession of a large part of their earnings. Appeals for assistance are often received from men or women who have paid employment but who are temporarily without funds. It should be the policy of a social agency to extend whatever credit is needed by these individuals for necessities. This should be a business transaction throughout and the suggestion of charity ehmi- nated. The individual to whom credit is advanced may be placed upon his honor to repay the loan when he is paid. Upon their verbal promise to repay the institution, a number of men. holding positions receive maintenance at the New York Municipal Lodging House every month. The independent and self-respecting manner in which some of these men walk up to the counter to pay their bills speaks for the effectiveness of the method. The Tempobarily Dependent The demoralizing effect of involuntary unemployment on in- dividual character is not due to the absence of employment itself, but rather to the inevitable consequences of its absence. It is due to the enforced lowering of Uving standards and to the worry and uncertainty of seeking another job. Even the most callous man or 146 The Annals of the American Academy I woman is sensitive to continued rebuiifs in a fruitless search for work. I know of nothing that will so quickly shatter the self- respect that is essential to a freeborn individual. A period of unemployment from which these consequences are removed, in other words a vacation, — ^is considered to be of greatest value for the worker's reinvigoration. It follows that if unem- ployment could be relieved of its present psychical and material results, it might become a boon rather than a curse to the worker. The responsibility for finding a new job, therefore, must be lifted from the individual who is out of work, and placed upon an employment exchange. It logically follows that the responsibility for his efficient physical maintenance while unemployed must also be removed from the individual. He may then utilize his period of unemplojrment as a time of physical and mental reinvigoration. Good food, recreational facilities and positive educational oppor- tunities in a broad sense may result in a refreshed, better equipped individual when the next job is found, rather than in a weakened, discouraged- and less efficient worker. There is an apparent danger that in this shifting of respon- sibility the unemployed individual may become pauperized. No system which maintains a worker in physical and mental efficiency during idleness can have this result to the same degree as one which allows him to deteriorate and lose physical and mental efficiency. Nevertheless, he should be made to feel his own responsibility toward the agency that has assumed the risks of his unemployment. A work requirement clearly sufficient to paj' the costs of the advan- tages received is one means of avoiding any pauperizing tendency. If this is impracticable, the individual should be obligated to repay this expense when he is once more employed. Many periodical drinkers may be classed as temporarily de- pendent during lapses from sobriety for the reason that during the greater part of the time they are self-supporting. Their contact with social agencies usually occurs immediately following a periodi- cal spree while they are still recovering from its effects. The victim is invariably repentant. Advice, moral suasion and " preach- ing" at this time are usually quite useless, as the convalescent will go farther in his self-denunciation than the social worker in his "preaching." The first necessity is to restore him to a condition of physical effciency. Good food, sleep, rest and fresh air are The Homeless 147 essential. When he is once more ready to take work his choice of a position becomes of utmost importance. Factors of his old en- vironment may have been responsible for his downfall. If em- ployment can be obtained where these factors do not exist, the next spree may be averted. Even if sprees continue, but the intervals between them are lessened, there is a net gain for society and the individual. It may even be necessary to accept our patient's periodical necessity for drink as a fact, and attempt to arrange his employ- ment so that it may be obtained without interference with his work. The following example is in point. A male stenographer with whom the writer is well acquainted lived for some time in a charitable in- stitution where he was employed. Because the head of the insti- tution was both employer and landlord, sobriety and good behav- iour on seven days per week were required of employes. Each few weeks brought the stenographer's inevitable fall from grace. Finally, when all interested in his case despaired, he obtained a posi- tion with a commercial house where employers cared nothing for his habits outside of working hours. For two years he has con- tinued to give good satisfaction to this firm, has not missed a day and has received promotions. The interval between Saturday noon and Monday morning has been sufficient to enable him to follow a drinking schedule that has not interfered with his work. The writer views pragmatically the question of religious in- fluences in the case of drinking men and women. Without doubt there have been many complete and successful "conversions." On the other hand, I have known a number of men who were most de- vout testimony-givers at mission services who were elsewhere loud in their blasphemy and religious ridicule. Likewise, I have known deeply religious men to be hopeless inebriates. Where early envi- ronment affords a basis of appeal, religious instincts may prove an effective starting point for rehabilitation. Applications are continually received at the Municipal Lodging House of New York from hospital convalescents, pre-confinement cases and dispensary patients. The first have often been dis- charged prematurely from over-crowded hospitals. The second and third ought many times to be admitted to a hospital but are excluded for the same reason. In the meantime the problem is forced upon agencies for the homeless. 148 The Annals of the Amebican Academy These cases emphasize the necessity for a competent medical examiner on the staff of the agency for homeless. Our Municipal Lodging House physician must continually assume the r61e of an advocate. He must prove clinically, and sometimes dialectically, that certain homeless inmates are sufficiently ill to make their admission to the hospital imperative. This situation is vaguely understood by many of our homeless applicants, who come to us requesting to be sent to hospitals. Convalescent, dispensary and maternity cases should be provided with light. work suited to their physical conditions. Great care is essential, however, lest overwork result. The Chronically Dependent Very few persons who have once become chronically dependent ever regain a place among the self-supporting. The result is pos- sible by intensive personal work with a minor number of cases. The study at present being given to the problem of reabsorbing war- cripples into industry will doubtless shed much light on the possi- bilities of rehabilitation of certain types of chronic dependents. "Shell shock" and battle wounds undoubtedly have their counter- parts in occupational disease and industrial accidents. The devel- opment of plans for training war- wrecked men and finding employ- ment openings suited to their individual handicaps, will be of quite the same advantage to men who have been similarly wrecked in the struggles of peace. The aged and infirm are conspicuous among the chronically dependent. It is customary to consign them promiscuously to the almshouse. Yet many of them to avoid this "disgrace" are attempting under terrible handicaps to remain self-supporting. Employment may be found for some in positions where age is no great detriment. The first placement made by the Employment Bureau of the New York Municipal Lodging House was of an elderly woman who was to have been sent to the almshouse. She is still in this position. There are many such cases. In spite of these possibilities of delaying the inevitable approach of death or complete dependency, the majority of the aged and infirm men and women who appear at institutions for the homeless must be sent to the homes for aged and infirm. A great deal of tact, good judgment and sympathy is often necessary to persuade these pitiful individuals that this is their only possibility. The Homeless 149 Men and women with physical handicaps are infrequently- doing the work for which they are actually best fitted. A man who lacks an arm or fingers may be trying to make a living by truck- ing in a freight house. Men with weak eyes register for positions as clerks. The struggle for existence is severe and discouraging for those who are thus handicapped, and who have no one to guide them into employment for which they are better suited. Great care is required to prevent them from following the easy road into mendicancy, — a road continually opened by the unthinking but well-intentioned almsgiving of the public. A desirable readjustment of employment may sometimes be made in a placement agency. The weak-eyed clerical worker may be led to discover that he is adapted to employment where the intensive use of sight is not essential. The one-armed longshore- man may be given work as a watchman where the loss of an arm is not an important disqualification. If the handicap be serious and the individual discouraged or unenterprising, however, the assistance of special agencies may be necessary. The New York Lighthouse for the Blind, The Association for the Aid of Crippled Children and The Old Men's Toy Shop maintained by the Association for Im- proving the Condition of the Poor have demonstrated something of what may be accomplished in readjusting the lives of the handi- capped. Mental deficiencies are responsible for much chronic depend- ency. Many instances might be cited of morons and even medium grade imbeciles, aimlessly drifting from one social agency to another over extended periods of time, without any attention being paid to their mental conditions. During the early spring of 1914 the writer lived for a number of days in the New York Municipal Lodging House disguised as a homeless applicant. While he was employed one morning upon one of the institutional "work details" to which he was assigned, his attention was attracted by a boy whose physical degeneracy and mental feebleness seemed apparent at the most casual glance. The boy stated that he was twenty-one years of age and had just been put out of his father's home in Long Island City. His responses showed the mental development of a child. Two years later, after the writer had become Superintendent of the Municipal Lodging House, the self-same boy was observed one night at our registration 150 The Annals of the American Academy window. Inquiry developed the amazing fact that for these tw( years he had been drifting about the streets of New York, working at occasional odd jobs, a frequent applicant at social agencies Yet never in that time had any one taken the trouble to have his mentality tested. The mental clinic to which he was subsequentlj sent classed him as an imbecile with a mental age of six years! Whenever mental deficiencies in a patient are clearly estab- lished, institutional care under strict supervision is the only satis- factory solution. But the insufficient capacity of appropriate in- stitutions renders the solution unavailable in multitudes of cases When the commitment to institutions of morons and harmless psychopaths has been impossible, we have found it of value to send them to employment in menial capacities in pubUc hospitals with the full cooperation of the hospital authorities. Although employes, they are then under an informal supervision by superiors of profes- sional experience. Where habits of drink appear to be the predominant factoi among the causes of chronic dependency, we must again turn tc institutional treatment as offering the only probabihty of cure, But available facilities for homeless inebriates are even less ade- quate than facilities for the feeble-minded. The City of New York provides a farm colony for inebriates and drug addicts at Warwick. This is the only public establishment in New York where farm colony treatment for inebriety may be obtained. Yet it has a permanent capacity for one hundred men only. The Municipal Lodging House could furnish this number of men who need its method of treatment on almost any day of the week! Mental deficiency, illiteracy and alcoholism are sometimes combined together, in varying degree, in a single homeless indi- vidual. No one of the three factors may be sufficiently pronounced to make possible specialized , treatment for that handicap alone. Yet in combination they produce an individual of general incom- petence who seems quite hopeless as a subject for constructive effort. Many of these general incompetents are the products of child-caring "homes." Condemned to institutional existence at the beginning of their lives, as adults they appear to have no po- tentialities for anything better. Some were constitutionally in- ferior at the start. They have insufficient ambition or persistence to follow of their own volition any program which they, or someone The Homeless 151 for them, may outline. Forcible commitment to a farm colony and vocational school constructed after the Swiss type would offer the best means of benefiting the individual and making him self-sup- porting. There is idle agricultural land in abundance for such colonies, while the importance of increasing our agricultural out- put gives a powerful additional argument for their establishment. Proposals for the creation of such colonies were made in New York last sprmg. The proposals oontemplated the use of the Municipal Lodging House as a clearmg center from which individ- uals m need of farm colony treatment would be presented to the magistrates' courts and by them committed on indeterminate sentences to the farm colon>'. The Parasitic Many men and women, normally self-supporting and inde- pendent, will become temporarily parasitic under certain circum- stances. The migratory worker en route to the harvest fields is an illustration. Valuable and respected employes of the Municipal Lodging House when drinking have been seen begging promiscu- ously upon the streets. A large minority of homeless men, therefore, are occasional beggars, as well as occasional applicants for charitable assistance. But the professional mendicant is seldom seen at charitable agencies. He is invariably "wise," and can "work the public" much better. Furthermore, his income is usually sufficient for his support. The need or desire for obtaining money without work is un- doubtedly the initial occasion for mendicancy. But this desire soon becomes only one of the impulses which keep beggai's at the trade. Mendicancy has its roots in gambling instincts and it satisfies a certain cravmg for adventure. The constant possibility of a large gratuity, the never ending speculation as to the next benefactor, the fascinating game of "hide and seek" with the police, all give to the mendicant's Ufe a daily feverish adventure, the counterpart of which is found only in gambUng, prospecting, and other hazardous occupations. Suice a thrist for adventure m the mendicant's soul is satisfied by his maimer of living, no mere assurance of a Hvelihood equal to or exceeding that which he obtains from begging will suffice to 152 The Annals of the American Academy wean him away from it. Only a legitimate occupation offering the equivalent in chance and adventure will serve the purpose. Many street trades do offer an approach to this equivalent. A news-stand where th^ crowds are surging past may prove the means of restoring the mendicant to productive life. In the cases where age or extreme physical handicaps render self-supporting employ- ment impossible, the mendicant must be committed to an alms- house. Severe measures, if necessary, are justified to break up the wasteful and fraudulent practice of street begging. The " I won't work," at least among the lower strata of society, is largely a popular superstition. I have seen very few men, not classed as mendicants, vagrant psychopaths or mental defectives, who would not work under conditions which they considered to be just. Not long ago it was generally believed that some men and women preferred unemployment, homelessness and himger to honest labor. This opinion seems to have been definitely aban- doned by thinking people. In January, 1915, 2,500 homeless de- pendents were sheltered in the Municipal Lodging House of New York each night. This population was reduced within eighteen months to little more than 100 per night. The same relative re- duction occurred in similar institutions throughout the country. It is very evident that the great majority of the alleged "I won't works" of three years ago secured work and are still employed. Yet this rule, Uke all others, is occasionally proved by its exceptions. It is sometimes found necessary to refuse the privileges of the Municipal Lodging House to men and women who will not avail themselves of honest opportxmities for employment. The charity rounder, the last of. the parasitic types wliich I have particularized, is usually a rounder because he has never learned to do anything effectively. He follows the easiest way. When placed at some simple task within his experience and intelli- gence, he may serve faithfully and well over considerable periods of time. Definite training for simple tasks, followed up by careful supervision when employment is obtained, may definitely remove him from the parasitic class. The methods of case treatment described above are crude and undeveloped. We have hardly gone further than attempts to define our problem. Among the human gains that may come from the world war, will be new and better methods for the treatment The Homeless 15c ■of the homeless. For stiU greater gains may we hope: that out o the slaughter may come a new estimate of the value of human Ufe "that homelessness as a condition demanded of workers in returi for existence may be banished; that the right to normal living maj become imbedded in the social conscience of our people. ACLOHOL AND SOCIAL CASE WORK By Mary P. Wheeler, Secretary, Clinton District, New York Charity Organization Society Like all other problems in social case work, the problem of the excessive use of alcohol is seldom if ever found alone. It is almost invariably bound up with other complications. Granted that either the father or the mother of a family uses alcohol, there is inevitably connected with that fact a chain of events which often brings social, physical and mental problems with them. We are frequently so engrossed with the fact that our clients use alcohol to excess that we forget to see the other problems involved; or we may see the other problems first and come to the fact of alcoholism after much time has beeri spent planning for the family's welfare along other lines. In our investigation in all cases we should be building up a group of facts both physical and social which when put together should forewarn of a possible hidden drink problem. The combinations of problems in which drink is a factor which seem to occur most often are drink and immorahty, drink and a mental defect or mental weakness, and drink and a physical defect. The following example illustrates the first combination: Through failure to provide for his wife and child, Mr. D. who was obviously a drinking man, had lost a good home. The family was found living in a miserably furnished room. The investigation confirmed the story of degradation through drink. There was a painstaking period of treatment which included both institu- tional and home care and also the religious influence of his church. It was learned finally, instead of at the outset, that Mrs. D. was also a drinker, a secret one, and immoral. As Mr. D. had no confidence in his wife, there could of course be no real incentive for a home. The mixed problem should have been recognized at the beginning. In the following instance we have an illustration of drink and a mental defect. Mrs. W. talked freely of her condition and admitted she could not take alcohol without its immediately affecting her. We knew her husband earned good wages, yet we found them living in a basement, having scarcely any furniture. It devel- oped that a sister continually tempted Mrs. ^^'. to drink and the husband himself deliberately brought alcohol into the house. But most important, we found that Mrs. W, was worried because she " heard voices." We then took her to a mental 154 Alcohol and Social Case Work 165 clinic where she was given medical attention and careful advice. Her interest was aroused in freeing herself. She insisted on staying at home, attending to her house and children. In a frank talk with her husband we made him face the fact that he had been doing a large share in dragging his family down. With everyone working together with equal knowledge of the facts and the goal to be reached, this family won out. Surely, however, this wasnot a simple case of a drink problem. In the third case, Mr. X. said he drank because he felt sick all the time. We found the real trouble was tuberculosis, following years of drinking and unsteady habits. The plan of treatment was not made primarily for the man who drank. It was for the man with a communicable disease. It is indeed imperative that treat- ment begin with a correct diagnosis. If it is true that the problem of alcohol is seldom if ever unat- tended by other complications, it follows that one can never gen- erahze regarding the users of alcohol. The principle of individuali- zation of treatment applies in this field as in every other field of social case work. Our plan of treatment is further comphcated by the fact that the user of alcohol is often a member of a family group which must also be taken into account. Too much stress therefore cannot be laid on the importance of studying the client, of getting to know his background socially and physically. Although much may be learned from our client himself, it is often preferable to gain much information before any decisive interview with him takes place, in order that the worker may be more free at that time to begin treat- ment. Such information should include knowledge of whether this is his first breakdown or whether he has made and forgotten good promises before. The age of our client is another important factor. If he is young, he has no doubt taken to drinking for social reasons, or to try to prove how manly he is. If he is middle-aged, it may be the result of a social habit formed in his youth. If he is older, he may be trjdng to forget that he is past his best working period or he/ may be trying to keep himself stimulated to compete with younger men. If our client is a woman; this should be gone into even more carefully and special attention should be paid to her nervous organi- zation. / . While in most case work it is coTiBidered best to interview our client in his or her own home, in case work with the man or woman who drinks, it is usually wiser to plan for an office interview. The elements necessary to make an interview successful are privacy, 156 The Annals of the American Academy lack of interruptions, feeling of freedom, candor, openness and plenty of time. In the office the worker can better control the situation to include these desired elements and can also bring the interview to a close at the psychological moment. The atmosphere there is more conducive to coming to conclusions. The drinker, if he is a man, must feel the thrill in carrying out an agreement made in a business-like manner. His pride is aroused. He feels in a very real sense that he is chiefly responsible. Such a sense of responsibiUty, strengthened by simple encouragement from some- one in whom the client has confidence, is one of the most potent factors in success. A vital principle in working with individuals who drink, as in other forms of case work, is to work with the individuals in question, allowing them every opportunity to express their own opinion as to the difficulties in which we find them and helping them to make their plan for the future. Our treatment should as far as possible be based on their plan, or if we cannot accept their plan, we should make every effort to lead them to our plan so gradually and care- fully that it becomes their own. The following will illustrate: In the past we had been good friends of the G. family. We had not seen them in some time, however, till Mr. G. came in of his own accord to tell us about the days of hard drinking which had preceded his waking up to find his family literally broken up and separated. When asked his plan for the future, he shot back a reply which showed that his experience had really touched him, and that it had vitalized him into making a plan to which he had mentally committed himself. Its chief elements were change of habit, a new routine of life and the objective of a reconstructed home. His wife, broken down from overwork and worry, was in a hospital. His children had been taken by the S. P. C. C. Be- cause he felt that the responsibility was all his, he wanted to start off immediately trying to rectify his errors. His plan was sound in every resf)ect and we co- operated with him to the end of making it possible for him to succeed. In the case of Mr. B., his plan included the breaking up of his own home, hav- ing his wife committed through court for a cure, having the S. P. C. C. take his children in order to bring his wife to a realization of her responsibilities and oppor- tunities and banishing himself and his oldest son to a furnished room life until the family could be re&stablished on a firm foundation. Getting Mr. B. to put into words the long road ahead of him was perhaps the biggest possible help both to himself and to the case worker. In making our plans for the individual who drinks, we find two possible lines of action, care at home or institutional treatment. Before we decide on either course of action, we want to have our Alcohol and Social Case ^^'oRK 157 facts vei-y clearly in mind. In his Report of the Inspector under the Inebriates Act for the Year 1909, Mr. Branthwaite places every alcohol user in one of three groups. They are as follows: 1. Tlu> occasional drinkor, thoso who ,'iio are strictly niodonite in their indulgence. 1!. The free drinker or ocoa.sional linmkard, those wlio drink more freely than is consistent with strict moderation or who arc occasionally drunken. 3. The habitual drunkard or inebriate, those who are habitually drunken or beins: usually sober, arc subject to occasional outbui-sts of uncontrollable drunkenness. It is tlie individuals who fall in the first two classifications who give us our best opportunity for care at home. This plan of treat- ment undoubtedly has some disadvantages which must be realized at the outset. For example, we are hampered in a large city, no less than in a small community, by the attitude of the pubhc towai'ds the persons who are trying to cure themselves at home. On the one hand, there is tlie public which sentimentalizes: on the otJaer, the public which is hai'sh and sees no hope for the drinker. Both of these attitudes are manifestly unfair to the individual; we must seek to educate the pubUc, on the one hand asking people to give the individual a chance, on the other, expecting tliem to hold the in- dividual up to standai'ds, to demand of liim that he attain the best of which he is capable. There are, on the other hand, undoubted advantages in home caxe of which we must take account. Among otlier things, the indi\'idual's pride and self-respect are saved; there has been less of a break with the past, there ai-e fewer explanations and apologies to be made. This appUes especialh- in regard to the children of our client, pai'ticularly the younger ones. Above all, if the individual can remain in the home and continue in tlie support or care of the family, the psychological effect is very great. Such a coui-se of action builds up self-confidence and self-respect, both of which are vitally important. Weighing the advantages against the disadvantages, we still can not choose liome care unless we are sure of otlier facts. Is such a plan conducive to the welfare of tJie family as a whole or will the family life be materially injured? Furtiier we must be sm^ of the sincerity of our cheiit in his effort to get hold of liimself and we must be sure that we can direct his plans, if not actually control them. "We must be sure tJiat we have the needed resources to make home 158 The Annals of the American Academy care a success in the given case. First among such resources is the proper medical care. It is vital that from the outset we know the physical condition of our client in order that we may build up his or her health in every possible way. The plan of a good physician for sound health must be the foundation stone on which we build up our other plans for treatment. Special medical treatment may also be used, depending upon the needs of the patient. Mr. Bran- thwaite, however, does not believe that any of the cures for alcohol have an inherent value. If the patient believes that the drug will cure him, then by all means try it. This beUef will strengthen his will. Other resources sometimes tried are suggestive therapeutics, electrical treatment, hypnotic suggestion and religious influence. With some this latter may be a strong help; with others the gospel mission may do better work.' Above all, interesting and remunera- tive work and relaxing diversions are invaluable. All these re- sources may be tried in the effort to gain our end which is the ability of the individual to break his past habits and to establish self-control. "There may be more control there than anyone thinks," says Branthwaite. "Awake the dormant self-control." It is the persons who fall in the third classification above quoted who constitute the group for whom institutional care is most often needed. It is therefore essential to have clearly in mind the char- acteristics of this group. Dr. Irwin H. Neff of the Norfolk State Hospital, Massachusetts, say that inebriety is an expression of nervous weakness and that upon this weakness is founded a habit which we call drunkenness. In other words, there is in the inebriate a definite pathological condition which predisposes him to an e;xces- sive use of alcohol if he drinks at all. It is possible that inebriety may be acquired by long continued indulgence but usually inebriety is inherited as a nervous condition, remaining latent or becoming evident according to circumstances of habit and. environment. Dr. Neff concludes that inebriety is a definite disease and must be treated as such, although much can be done along the line of estab- lishing new habits and by personal influence as in the case of both the occasional drinker and free drinker. Because there is a definite pathological condition in the case of the inebriate, his or her only hope lies in having the possibility of drinking entirely removed, at ' For a brief discussion of the value of gospel mission, see American Red Cross Publication 200, July 16, 1917, pp. 41 and 42. Alcohol and Social Case Work 159 least temporarily. It is for this reason that institutional care (in- cluding farm colonies) is advisable for this type of clients. The place of institutional care in the treatment of inebriety has been so well covered in the article on "The Practical Treatment of Inebrity in a State Institution" by Irwin H. Neff^ as to make further dis- cussion unnecessary here. The reader will there find a full discus- sion of after care in which work all the skill of the finest type of social case work is involved. In all types of cases in which drink is a factor, be they the occa- sional drinker, the free drinker or the inebriate, it is essential that there should be given to the man a definite objective in life to help him overcome his battle with drink. This objective must be chosen with a full knowledge of the possibilities of the individual and must never be beyond his reach. It is needless to add that the objective should be such as to call forth the very best efforts of the client, awakening his imagination and arousing him to a new life. 2 Proceedings of the National Conference of Charities and Corection, 1915, pp. 396-407. THE IMMIGRANT FAMILY By Eva W. White, Director, The Extended Use of the Public Schools, Boston. The test of a good case worker is found in the many-sided field of social treatment as it relates to the immigrant. Not only is high skill demanded in analyzing personal diflSculties but a knowledge of the customs and traditions as well as the inner hopes and aspira- tions of the immigrant is also imperative. It is agreed that only a beginning has been made in social diagnosis in general, but it is not so certain that the same htmibleness of spirit exists in regard to the plotting of a plan of action in relation to our foreign residents. Else why are so many philanthropic organizations found in immigrant communities still carrying on their case work in the rudimentary, undifferentiated fashion of consider- ing certain human traits to be so basic that reactions are identical whether a man be a Russian or an Armenian, a French Canadian or a Pole? Societies recognize the fine gradations of analysis that are coming to be required in getting at the variations of mental power and of manual aptness. They draw on the knowledge of the psychiatrist, the psychologist, the vocational coimselor, and yet most of these same societies meet the problems of the immigrant apparently in complete innocence as to the play of dominant racial experiences. There has been a curious lapse in this respect in the building up of case work technique. In going about the country- the writer has been interested in inquiring in regard to this question of speciaUza- tion in case work for the immigrant and it would assist the general cause considerably if readers of this article would do the same. It will be found that in the majority of our large industrial areas where the issues, both personal and social, are intense, as well as in many of the foreign sections in our cities, organization after organization is functioning almost exactly as it would function in an American- born community. Two or three of the more important members of the nationalities living in the towns or districts of cities may serve on committees or boards of management and interpreters may be 160 The Immigrant Family 161 used, but the executives who are intrusted with leadership will be found far too often to have had no experience that fits them to under- stand European customs. They have neither traveled abroad nor resided in local foreign colonies, and often they are amazingly lacking in an intelligent grasp of the fundamental issues involved in the adaptation of the personnel of their districts to the require- ments of American living. Maximum results in the way of assisting the immigrant and his family will never be obtained so long as this holds true, nor will the community be stimulated as it should be. It must be said to the credit of social work that in certain of its branches it has shot ahead of education. Americanization societies, immigrant protective leagues, and travelers' aid groups have shown how inadequate school work for immigrants has been and is. Cruel as much of the hyphenated American propaganda was, it roused the country into realizing what it had not done and an important part of the national defense program is now concerned in working for the best interests of the immigrant and, therefore, of ourselves. Night school procedure is gradually changing. Day classes in English and in other branches of study are operated for the benefit of night workers. Far greater attention is paid to instructing the non-English speaking mother. The schools are throwing their doors wide open for lectures, forums, civic clubs and discussion groups, as well as for musical Societies, so that the thought life may be expressed and the refining elements of dormant art consciousness may be developed and brought out. Larger Aspects op Case Work The war has caused the question of immigration to be faced squarely, and every social, civic or philanthropic society that has had to do with the immigrant should take account of stock. The argu- ments pro and con for immigration are many. Economists take sides; the sociologists are not in one camp; those who are interested in political science are found to be divided. Among the general citizenship are those who believe in restricting immigration and those who do not. Where do the social workers stand? Sentiment, in- tuition, generalizations by only a few observers over only short periods of time will not help. Massed experience in which the varied elements of physical standard, mental power, industrial success, political effectiveness and ethical outlook are gauged not as sepa- 12 162 The Annals of the American Academy rate ends in themselves nor through abstraction but in the blend of personalities known, is the contribution demanded of social workers. Social workers may well ask whether their case work is in the hands of persons with the requisite breadth of understanding. Is case work so organized as to give the necessary data? Is the range of contact of secretaries such as to enable these data to be interpreted in their relatedness, not merely from the point of view of the indi- vidual but in order to contribute to problems such as the immigrant and labor, the immigrant and the race stock? These are some of the larger aspects of case work. It is not the object of this paper to stand as an essay for or against any of these opinions on immigration but rather to point out that the case worker who does day to day work in immigrant com- munities and who is not viewing each day's experience as material to assist in the shaping of public policy toward the alien, not only negates social work but also becomes a deterrent factor in the prog- ress of our knowledge of a subject which has untold influence on the future of America. ' No society should be satisfied with a worker whose results are merely tabulated by jobs found, medical assistance given, or the number of children's difficulties that have been straightened out. A certain proportion of successful results is to be taken for granted by any one who has been trained for availing.. Efficiency comes from what is played up out of personal contacts. Here is where a case worker falls down unless the tangled scope of the immigration problem is clearly sensed and unless the bristling questions that are being faced by outlying sciences as they play into the field of social work are understood well enough to be tested by each individual need of family necessity. For example, what policy does the worker advocate in regard to industrial adjustment as a result of experience with out-of-work cases? How do the immigrant cases differ from similar cases which involve the American-born? What is the statistical comparison of disease between a given race and the American-born? If the immi- grant is more resistant than the native-born, why? If less resistant, why? Do local case histories tally with available statistical ma- terial? If not, why? A contribution may be lurking in such a search for fact within the range of the sphere of the case worker. The Immigrant Family 163 Proper Qualifications for Case Workers Granted that this interplay between the actual needs of men and women is known and that the issues involved affecting our social structure are recognized; granted that the method is adopted of analyzing each person's difficulties in the light of the group prob- lems of a given nationality; and granted finally that so wide a re- sponsibility is assumed as that of attacking such an assumption as national deterioration in the light of local knowledge, — a question still arises as to the qualifications and training of persons who are to serve public and private agencies in the field of action of the immi- grant. As to the personal qualifications of a worker with immi- grants, certainly there should be no ray of prejudice. The worker who is so caught by the romance of difference as to see every immi- grant problem in high fights is quite as much against the cause of the immigrant as the one who cannot shake off the shackles of Anglo-Saxon provincialism. In other words, the balanced, scien- tific mind that searches and waits is of importance : not, however, the scientific mind of the recluse but of the individual who lives with men. Absolute science plays its part on the elemental plane; beyond are all those ranges of thought and association which make our civilization, the change of emphasis of which can only be known by close contact with people. If it be permitted to recoginze tempera- ment, a social worker with immigrants, more even than those in other fields, should have that intangible power of winning confidence and of rousing belief in self which breaks down all barriers and brings about understanding on the basis of human nature. This is especially important in the case of a worker whose race stock is different from the race stock of the community which is served. This leads to a mooted point. Which will do the better, a per- son whose parentage reaches, back far enough to be considered a real product of our country or one who, if not an Americanized immi- grant, was born in this coimtry of immigrant parents? If it were positively stated that only Italians should work among Itafians, Bohemians among Bohemians, such a statement would be far afield. This error is made by certain societies organized on a racial basis . On the other hand, society after society in this country is crip- pled because the staff is made up of persons with no affiUations with 164 The Annals of the American Academy the racial groups among which they are working. The fact of the matter is that a member of a given race has certain marked advan- tages over a person not of that race. The ability to talk freely in a mutually understood language, appreciation of a common tradition, the understanding of racial or religious customs, are tremendously important and are of immediate advantage in the first days of con- fusion and inquiry when the immigrant arrives in this country. As soon as the immigrant has gained a footing, however, another consideration enters in and that is the obligation to bring the immi- grant into such contact with Americans and American ways as will lead to an appreciation of the American outlook. The history of the Slavs has made the Slav. The history back of America has made the American. It is incumbent upon us that we understand those who come from Europe. It is equally neces- sary that they appreciate the type of person born and bred here for generations and reared under our institutions. This is fair play and the faults of both in relation to our coimtry can only be eradicated by mutual cooperative effort based on imder standing; and this can- not be brought about at arm's length. Therefore, the person of American descent whose background of experience justifies the claim of understanding the alien, has a place on the staff of societies organ- ized to assist the immigrant. When residents of a locality take the attitude that no straight American should be engaged in their district, they are to be con- demned as missiiig an opportunity, not only directly for themselves but also in the way of interpreting their contribution to that larger circle called the public on whom after all their welfare depends. The ideal combination of workers would include both persons who have immigrant ties and those who have not. Under no considera- tion should a person be made a secretary for the mereTeason that it is thought advisable to have a representative of a certain racial group on the staff for that reason alone. Standards of efficiency have too often been let down when it was decided to appoint persons who are members of alien groups so that truly representative agents have not been chosen. The foreign-speaking agent should have inborn qualities of a high order and should serve an apprenticeship over a period of time long enough to know well the resources of a com- munity. Certainly no novice should ever be plunged into an immi- grant district. A secretary not of European parentage should not The Immigrant Family 165 ■only have a wide range of experience in case work but also the asset of long-term residence in a foreign colony in order to appreciate the norm of a race and also in order to know the special difficulties the immigrant meets with in this country. This subtle vmderstanding does not come in one week or two. The training of a case worker among immigrants should be con- •cerned not only with the usual methods of social diagnosis and treat- ment but with the working of the institutions that have been or- ganized particularly for immigrants. The operation of -our laws should be studied and tested. What public officials can and cannot do should be known. No one should begin to do case work among immigrants who is not thoroughly familiar with the method by which aliens are admitted into this country and guided to their destinations ; with the operation of the courts as they affect the im- migrant ; with the steps that lead to citizenship ; with the employ- ment offices as they serve in getting work. The weak and strong points of both public and provate agencies must be known and a per- son should have become expert in using available resources or in supplementing the same before an appointment as an executive can be expected. Types of Immigrant Problems Compared with case work in the main, individual and family immigrant problems that an agency is called upon to face are not of the degenerative type. The immigrant gets into trouble and needs assistance most often because of a failure to understand American requirements or because of imperfect adaptation to our conditions. Of course, certain immigrants drink to excess. Of course, there are the shiftless among them as well as those who neglect their homes and those who fail to go forward. Sickness, too, plays its part in our case work for the immigrant. In general, however, it can be taken as a fair presumption that the needs of immigrants who apply for aid can be discovered with comparative ease and that the proportion of successful results to failures will be high. This statement should not for a moment be taken as inferring that our native stock presents more difficulties or difficulties of a kind that do not yield to ready solution, but it must be frankly admitted that those who are native bred will not go to a charity except as a last step. 166 The Annals of the American Academy On the other hand, the immigrant tends to turn to local agen- cies for assistance for no other reason than to be sure that the right track has been chosen. This is more and more true now that the races coming to us are finding us far different from themselves. The immigrant arrives with a humble trust in the helpful personal in- terest of Americans. Even police officers are often asked to decide upon the most intimate matters of family policy. In short, a worker among immigrants can take it for granted that an immigrant in entering an office has come for information or guidance as such, that there is no drag of personal weakness or broken ties of family or group to be faced in the majority of instances. An illustration. A man out of work and physically run down had been work- ing as an unskilled helper in a factory. Wages at the time he was interviewed were $2.50 per day. He had been in the United States two years and said he had been a draftsman in Europe. The man was given a pencil and to the surprise of the agent drew the picture of a cottage in which he had lived in Italy and when asked how the rooms were arranged in the cottage, drew a floor plan. The man was asked if he was in need of money. He replied that he was not but he was greatly worried because he would be in a couple of weeks. He said he had heard that the agent could help him to get another position where his work would not be as hard. Action on the case. An appointment was made with an Italian physician who reported that the man needed rest and that he was unstrung nervously because he did not like his work which had been too heavy for him. An architect was tele- phoned to. By a stroke of good fortune he said he would see the man. Result. Eight (8) years from that date, the family was living in a suburban home which was being paid for through a cooperative bank. It is to be noted in connection with this case that ■ very few questions were asked. The record might be considered incomplete, yet certainly^the art of a good case worker consists in knowing what not to ask quite as much as what to ask. With immigrants it is of prime importance that their confidence be won. Great care should be taken not to cause self -consciousness through too close an inquiry into personal affairs. Many an immigrant has been turned aside by too incisive a method on the part of case workers, and the un- cooperative attitude of immigrants who have been in this country for a time is undoubtedly due to prejudice engendered by the lack of appreciation by an agent of the need of care in a first approach. It would be a fair guess to state that societies in which immigrant needs factor largely, will testify that 90 per cent of their cases will revolve around such matters as advice regarding where work can be The Immigrant Family 167 found, or better jobs obtained; questions as to our savings institu- tions; problems involving their own desire to learn English and to educate their children; matters concerned with sending for rela- tives or getting in touch with members of their families who are supposed to have arrived in this country or are expected; questions in regard to becoming citizens and matters which concern medical care. Immigrants need to be told where to go for work and to be put in touch with the leaders of their race who can be trusted. They need to be directed to public agencies that will assist them, such as immigration bureaus, night schools and recreation centers, and the skill with which this is accomplished means everything for the future of those who come to us. Every inquiry carries with it the responsibility of so answering that the immigrant leaves with a clear understanding of the matter in which 'he is interested and feel- ing encouraged to return if again puzzled. Enough has been said to make the point that in immigrant case work more frequently than not the problem is one of putting persons in touch with resources that are unknown to them. The immigrant comes to us strong, eager, ambitious. Give him a chance and he will do the rest. Difficult personal idiosyncrasies do not play a large part in case work with the alien nor jdoes family discord. Would that the same were true of the second generation! The Second Genebation of Immigrants Our contact with the immigrant straight from the old country convinces us that he is seldom unable to care for himself. His children, however, are found on our relief lists and in the ranks of the unemployed to too large an extent. No fair-minded person can lay this fact to anything other than our own American neglect. Two Unes of effort open up here for the case worker. First: a far more refined fitting of individual ability to op- portunity than has been carried out and a more drastic attack on certain environmental conditions which weigh heavily upon the immigrant. At present the immigrant is fed into industry as noth- ing more than a unit of man power. The time is approaching when the government employment agency will use the vocational method of considering special aptitudes for particular jobs. Immigration brings in a mass of unskilled labor it is true, but there have been hundreds of instances of men whose skill as machinists or craftsmen 168 The Annals of the American Academy has been wasted because they have not known where to go for guid- ance or because an employment agency has not taken the pains to con- sider anything but the fact that a man needed work and that any job would do. Not only are the government employment agencies moving on toward the point of greater care in classifying workers, but industry itself is concentrating on lessening the labor turnover and is engaging persons to test out special abihty. Further, considering the European environment from which certain of our immigrant groups come, it is essential that we get those with an agricultural bent out on to the land. Although some gain has been made in this matter of distribution during the past few years, we have only begun to attack the problem so that the case worker with immigrants will find a fertile field in this direction for individual suggestion and individual encouragement. Case work records of an agency tell their own story of difficulty. They present the effects of heredity, the overpowering result of dis- organized family life and the insuperable difficulties of environ- mental conditions. With the immigrant we find not so much difficul- ties of heredity as lowered family unity. We find bad housing, the evils of congested areas and industrial exploitation playing their part in breaking down the natural mental power, moral rectitude and physical tone of the immigrant. Since this is true, efforts to assist individuals stand indicted unless, coupled with these, case workers use every means for attacking environmental handicaps. A native of this country is often not in close enough touch with European family standards to realize fully how very important it is to go back continually to the family relationship in given indi^^dual difficulties or in thinking out a plan of action for a boy or girl, man or woman. Two extremes are often faced in immigrant situations: the instances where persons have no relatives in this country^ and so are free from all family restraints, and the instances where fam- ily dominance is so strong as completely to submerge the individual and create an almost insuperable obstacle to necessary freedom of action. The case worker should work sympathetically with the latter situation, remembering how important a part the family has played in the history of certain foreign races and in a negative way reason- ing back from forms of anti-social traits which, particularly in The Immigrant Family 169 young people, develop because parental respect and the ideal of the home circle has broken down. The family ceremonial should be honored and interpreted to our young foreign citizens in its Ameri- can setting. Important Factors in the Problem It is never safe in any form of problem not to reason from the physical, mental and the moral responsibilities of a person back to assets or defects in family situations as well as to consider the Jielps or handicaps that may spring from association. With the immigrant the surrounding groups of which he is one are all important. Custom has at once a binding effect which may need to be modified and at the same time a protective influence that must be brought to bear on many a situation, and in this regard no two nations are alike. There is all the variation of temperamental reactions as well as tra- ditional code. A case worker is treading on dangerous ground un- less these distinctions are recognized. With a person who has no family ties, the building up of ac- quaintanceships among those who have enough at stake in a neigh- borhood to be acted upon by public opinion cannot be brought about too quickly. It is moi'e and more coming to be accepted that the judgment of one's peers acts as a centripetal force in holding one up to accepted standards of thought and action. When persons are free from the obligations of family and are outside the pale of the effect of community requirements, a decidedly unnatural situa- tion is created. Example after example could be given where the building up of community ties has swung persons from danger into resistant self-assertion. By way of summary we may say that aside from the usual iden- tifying data of the name, address, et cetera, which need not be de- tailed here, it is essential not only to get the country from which a person comes but also the section of the country. Occupational circumstances should be gone into carefully since in many parts of Europe lines of work may be similar to lines of work here and yet vary greatly as to the technical requirements and the conditions under which labor is carried on. Moreover, it is not always safe to assume that an immigrant is uneducated, in its broadest meaning, even though he may have had little schooling. In certain sections, the folk organizations of the 170 The Annals op the American Academy people have for many years been such as to develop a depth of thought and a sort of philosophy, to say nothing of a practical kind of reasoning. Only a limited training in symbols of languages is needed to remove such a person far from the illiterate group. It must be remembered, too, that the importance of the church varies markedly in certain parts of Europe. Oae of the most important considerations is getting at the reason why the person came to this country. These factors are extremely important in helping to bring out the right kind of assets in a case of need or to make possible connections with persons who would be willing to extend the advantages of good fellowship to a stranger or to connect a person with any of our organized forces of civic or social life. In facing any given problem one reasons first in terms of the power of the individual. What has he within himself? What has been given him by nature? What has been added by training? What does he possess in the way of experience and how does he fit into his circle of associates? Then, what is there in the family sit- uation which will push him forward or draw him back? What does the community offer in the way of giving play to the possibilities made apparent by these two lines of deduction? THE SOLDIERS' AND SAILORS' FAMILIES By W. Frank Persons, Director General of Civilian Relief, the American Red Cross. Although in the very nature of the case, soldiers and sailors are separated from their families, the Home Service of the American Red Cross reaches both the men, wherever they may be, and their loved ones at home. It is at once the means of sustaining the spirits of our fighting men and of preserving the welfare of their families. It is a tie that binds them together. Men may be the best soldiers in the world, but if things are not well with their families at home they lose efficiency through worry, and. the morale of the army — that all-important factor — begins to fail. So it is the patriotic duty as well as the humanitarian oppor- tunity of Home Service workers of the American Red Cross to care for the lonely famihes of our fighting men. They must be en- couraged to " carry on " without faltering. Their families must not be allowed to bear personal privation and so to double the willing sacrifices they have made. Every report from the training camps and from the French front mentions the excellent spirit of our troops. Will they maintain this morale while thousands of miles from home, through trench-life and battle, to the victorious end? The answer will be determined largely by the Home Service of the Red Cross, which must be the nation's assurance that no enhsted man's family will suffer for any essential thing that Hes within its power to give. There are representatives of the Home Service of the Red Cross in every training camp for soldiers and sailors in this country; they are with our troops in France; and their offer of help is on the bulletin- board of every ship of the Navy. They invite the confidence of the men, and win and deserve it. They learn of the anxieties of the enlisted men and of needs in their homes. Such messages are then pronrptly sent to the Home Service Sections of the Red Cross Chapters and their famihes are visited and helped. Then the en- couraging news goes back t6 the husband or brother. He also is helped. That result is not hidden from those on this side the trenches. Daily letters are received like the following: 171 172 The Annals of the American Academy Camp December 10, 1917. To the American Red Cross: I wish to extend my sincere tlianks to you for going to aid my wife and child whom I asked you to help last week. My wife wrote me that you came to see her. I highly appreciate that. / can soldier better now. Yours sincerely, No argument is necessary to show that Home Service must give the assurance that the soldier and sailor must have, if he is to , do his best,— the assurance that in trouble or misfortune the Red Cross will do what he would do if he were at home instead of at the front or on the sea. The Home Service of the Red Cross may assistr through morale, to shorten the conflict and so to lessen the consequences of battle, but it may do even more to save the social consequences of war at home. It may protect the homes left lonely and unprepared for emergencies; bring comfort and cheer to the homes left in anxiety and privation; safeguard the health of women and children; uphold the standards of child care, of working conditions and of recreation and education. So far as is hunjanly possible it may help to main- tain the essential standards of home life, so that when the soldiers and sailors return from the war, their families shall be found ready to help and to encourage them to honor further the country which they have so nobly served. Nothing less than this will measure up to American ideals, and on these ideals the Red Cross has founded its conception and its plans for Home Service. Oppobtunities op Home Service Home Service is not relief in the sense of money payments or doles of food or clothing, though such assistance may be necessary even to the families of soldiers and sailors. The enactment of the War Risk Insurance Law, heartily advocated by the Red Cross, has placed the responsibiUty for financial aid in large measure upon the government, where it justly belongs. The provisions of that act make liberal money allowances to the families of men in the armed service. These allowances do not diminish but rather multiply the opportunities for usefulness of Home Service, though these were manifold before allowances were granted. Home Service is now able to turn its full power upon its own real task. Soldiers' and Sailors' Families 173 The greatest opportunity of Home Service lies in conserving, liutaan resources in the famiUes left behind. The majority of these famihes are in position to maintain good standards of health, edu- cation, industry, and family solidarity without recourse to outside help of any kind. A considerable minority, on the other hand, find their powers of self-helpfulness strained to the breaking point by lack of opportunity, by ill health, or by the sudden changes in their way of living brought about directly by war conditions. In no instance must the standards and ideals of home life be lowered. The social consequences of war must be anticipated and all ten- dency to deterioration must be checked. The second opportunity for Home Service, for which the government in the very nature of things cannot make provision, is relief in emergencies, such as temporary financial aid while legal claims are being adjusted, or while, the receipt of a government allowance is delayed. The chief requirement here is promptness. This kind of service has not been a heavy burden, although the Red Cross Home Service undertook it during the first seven months of the war when there were no government allowances. In every instance Home Service is careful to continue its relations of confi- dence and friendship with the families it has aided in this way and to conserve the welfare of these families in every possible manner. The third opportunity, like the first, will be not only a con- tinuing but an increasing one. It is the giving of regular allowances when needed, to those who have no legal claim to the federal allow- ances, but a moral claim to Red Cross interest, owing to the fact that they have been accustomed to depend upon men now in the service. Another large group, who have no legal claim oa the United States government but who have been formally accepted by the Red Cross as a special responsibility, are the famihes resident in the United States of men who are in the armies or navies of our allies. This is no small matter. On Manhattan Island there are many hun- dreds of these families receiving Home Service. It is the aim 'of Home Service to discharge scrupulously in each community this duty to the families whose men are fighting side by side with our own. The fourth opportunity for Home Service will increase in im- portance with each month that our forces are engaged in actual war- fare. It relates to the returning soldier or sailor, more especially when he returns disabled. Whatever can be done through special- 174 The Annals of the American Academy ized hospital and institutional treatment will be done by the govern- ment, supplemented so far as may be appropriate by the Red Cross and by other agencies. The supremely important thing is the pre- vention of permanent disability. In this, many forces must co- operate. In so far as these forces are local, Home Service will have to carry forward the work begun in government hospitals and training shops. The non-institutional side, the readjustment to actual home conditions, the fitting of men back into industry after discharge, the interesting of individual employers^ the organizing of local resources for further training, and the development of a helpful and stimulating attitude towards these men throughout the whole community, — these are recognized as definite Home Service tasks. It is not merely a just, humanitarian service to individuals, but also a duty to the country, to put forth every effort to conserve the energies of partially disabled soldiers and sailors, and to read- just them to civilian and industrial life. The fifth opportunity for Home Service lies in the desire of relatives of enlisted men for information of many kinds. Already this service is widely extended through Home Service advising how mail should be addressed to soldiers and sailors; how information may be obtained concerning those sick, wounded, or missing; what the Wiar Risk Insurance Law means and how to take advantage of its provisions. This work is being constantly extended and is saving untold anxiety and suffering. It will serve furthermore in a very substantial way to maintain the comfort and health of those families who have given their breadwinners and protectors to the service of their country. Finally, a sixth opportunity for Home Service is to help families to keep pace, in ambition and achievement, with the man who is surrounded, often, with new chances for education and advancement. The growing importance of this work is realized by Home Service workers. Men who have had but limited opportunities in life are suddenly obliged to travel, to accept mental discipline as well as military discipline, and to associate with men such as they have never met before in close contact. And they are advancing. For example, one Home Service Section is now caring for the large family of a naturalized citizen who voluntarily enlisted as a private but who is already top sergeant. He has made good in remarkable fashion. If he should return home to find his family in the same Soldiers' and Sailors' Families 175 forbidding home life in which he left them, he would most surely be disheartened and discouraged. So the Home Service worker has moved the family to pleasant comfortable/ quarters. The wife and children have now the recreation and advantages which will in- sure a home life worthy of this soldier's ideals when he comes back. Organization Concerning the organization of the Red Cross for Home Service, perhaps it is sufficient to say that the work is organized in each lo- cality as a separate, distinct activity of the local Red Cross Chapter. As a part of the Civilian Rehef Committee of the Chapter, there is constituted a Home Service Section whose membership is as repre- sentative as possible of various local interests — business, profes- sional, church and social work. The .Home Service Section is responsible to the officers of the Chapter for the proper conduct of its work in behalf of the families under its care. It decides mat- ters of policy as to its own work; prepares and submits the budget , required for carrying on its activity; employs the clerical and visiting staff; enlists its volunteers; organizes its office system and makes its own required reports to the Chapter and to the Department of Civilian ReUef. Where the work is considerable, a Consultation Committee is appointed which includes persons engaged locally in public health work and social service, and others with special ex- perience and knowledge of local social conditions. If possible there is also appointed someone familiar with the military and naval af- fairs, who can advise the Section concerning proper procedure in such matters. There is also usually appointed a lawyer who can instruct the Home Service workers about municipal and state laws. The principal function of the Consultation Committee is to con- sider difficult problems which arise in the course of work with in- dividual fainiUes. It is designed to facilitate cooperation between the Red Cross and the agencies and persons regularly engaged in family work. Each Home Service Section draws its budget from the funds of its Chapter, raised locally, the responsibility for raising funds for Home Service resting with the Finance Committee of the Chapter. There is the minimum of red tape and formality, the minimum of control so far as the Department of Civilian ReUef in Washington is concerned. 176 The Annals of the American Academy It is the purpose of the Red Cross Home Service that each Chapter shall have such a Home Service Section, no matter how few men may have entered the service from its territory and no matter how self-sufficient their families may appear to be. By no other means can the responsibility for Home Service be fixed. The Home Service Section in each community is much more apt to have the cooperation of local social agencies, and to enlist the ini- tiative, the cordial spirit, and the sympathy in fullest measure of the neighbors and friends of soldiers' and sailors' families, if the responsibility for organization and direction of this work remains in local hands. Without a group charged with this responsibility for Home Service, there wiU be soldiers' children dropping out of school or deprived of timely medical treatment; there will be soldiers' wives wheedled out of their income by shrewd agents or cheated out of it by fakers; and there will be soldiers' homes broken up during their absence by misfortune of one kind or another which the strong will and informed mind of a friend at hand might have overcome. Ten families have just as much right to Home Service as have one hundred families. It is not the volume but the character of the work that counts. How Home Service Learns Where Help is Needed Home Service endeavors to be very careful about the method of approach to these families. It is not intended or permitted that all families of soldiers and sailors shall be called upon, and asked if they require assistance. No home is to be visited in the name of Home Service without a definite invitation from the family or from some responsibile person competent to speak for them. Home Service has no desire to intrude or to expose people to comment. For this reason, the wearing of a specialcostiune by Home Service workers has been discouraged; for this reason also, unconfirmed, anonymous requests to visit families are ignored, though each such request is made a matter of record. It is purposed that the work of the Home Service Section be so well understood, and its work so natural and neighborly, that those who need help of any kind will be drawn to avail themselves of it. There are many ways, of course, in which the Home Service worker may come into contact with these families. At every camp and cantonment the Home Service Director, Soldiers' and Sailors' Families 177 who everywhere enjoys the fullest support and approval of the military authorities, takes every means to let the men know of this phase of Red Cross work. Sailors on every vessel of the Navy get the message. Many requests come from soldiers and sailors through such pubhcity. Through publicity in the local press, and through their friends, Home Service comes to the attention of other members of the soldier's or sailor's family who may ask help for the wife or the mother of the household. These have been very- frequent means of approach to those who have needed assistance. Home Service Sections learn of emergencies in families, and find ways of offering help, in the natural course of fulfilling the Information Service which has proved to be one of its great op- portunities. Helpful relations have been established with famihes in which there were children, by securing the assistance of school teachers to whom the aims and the scope of Home Service are being everywhere explained, not by general circularizing but in quieter ways which have resulted in mutual understanding and the secur- ing of prompt information about children who are wayward or sick or neglected, or withdrawn from school prematurely because of the war service of a father or other near relative. Again, the various religious and social organizations of the community have many contacts with the families. To these agen- cies the Red Cross has given full information about the work of Home Service. This is not done by formal approach through cir- cular or advertisement but by personal contact and association and by drawing into the Home Service Sections, as members, repre- sentatives of these social agencies and religious societies. Home Service Sections have estabUshed friendly relationships with the vari- ous state and local Councils of Defense, who notify them promptly of homes where Home Service is required. Finally, Home Service Sections have established contacts with Exemption Boards, and have in many instances learned thereby of the needs of families of drafted men. How Home Service is Given Home Service has demonstrated its ability to conserve human resources in thousands of homes by helping to maintain there good standards of child care, of physical and mental health, of education, and of working conditions. In some communities these standards 13 178 The Annals of the American Academy have been achieved only after long toil. Home Service is helping to maintain them. Living is more difficult for everyone in war times, and the first thing a Home Service visitor comes to understand in trying to conserve the welfare of children, is that their mothers are, beyond everything, often lonely and discouraged. Whatever will give the mothers courage to "carry on" helps the children. From many different parts of the country comes the story of women whose outlook is suddenly darkened, whose need is for sympathetic under- standing of their plight, for the development of new interests and cheerful companionship. Some are facing the birth of a first child alone; some have displayed symptoms of mental depression that require the promptest attention and, in a few cases, hospital care. The absence of the man deprives the family of the interest which he brings home with him from the world of trade and industry. This lack and loss of companionship must, so far as possible, be re- placed. Various forms of recreation, including clubs and classes, become, therefore, very important for the mother as well as for the children. The chairman of a Home Service Section reports one instance in which discouragement led a mother to write to the department of soldiers' aid in her state, asking her husband's release from the army; her three boys, she stated, were so unruly that she could do nothing with them. A Home Service visitor, asked to report upon this request, found the family in no financial difficulty, but the mother so worried that she lacked the mental energy to cope with three little lads all of whom were full of life and high spirits. The visitor's first suggestion was a vacation for the mother and a tem- porary housekeeper for her children. But the boys would have none of this, protesting that they wanted their own mother and no one else. This new attitude upon their part gave no small degree of comfort to the discouraged woman. She began to enter into the recreational plans for the children, whioh were proposed and carried out by the visitor, but seemed to respond most of all to the chance to talk over personal affairs at frequent intervals with someone who was really interested in them. The health of young children is a matter of constant concern on the part of the Home Service worker who is urged to consult the physician advising the Section about the obvious indications of Soldiers' and Sailors' Families 179 malnutrition, adenoids, and other frequent ailments of infants. Speaking generally, any sign of debilitation, such as persistent cold, cough, loss of weight and appetite, mouth breathing and pallor prompts the visitor to urge the parent that medical advice be secured. All available resources for the health-care of the school child are brought to bear when at all needed. Home Service workers make full use of the services of the infant welfare nurse, the school nurse, and the tuberculosis nurse, and of any visiting nurse or public health nurse in the community. Such nurses are sometimes asked to advise about dietaries and food economies as well as concerning matters of health. A representative of the national Children's Bureau says that the chief measure for protecting babies is to insure their care and nursing by healthy mothers in their own homes. Helping mothers to plan their affairs so as to remain at home most of the time while the children are small is a health measure for both mother and child, though a woman's temperament and her standard of home care before the enlistment of the breadwinners should be taken into con- sideration. Faithful school attendance is often assured by arranging, when necessary, for regular reports from teachers. When the age for leaving school approaches — in fact, long before it has krrived — Home Service seeks the best vocational guidance obtainable for the boy or girl. Its workers discourage entrance into occupations in which there is no future, no skill to be acquired, no good chance of advancement, or in which the processes menace health. Problems of boys and girls in their early teens — in the years of adolescence — often require the wisest advice available from teachers, club leaders, and from others experienced in child helping. Sometimes the mother is unable to manage the family affairs as she should. She may even be the victim of a bad habit. Then it is important that the allotment of pay and the family allowance be expended by someone else who will administer it for her and her children's best welfare. Soldiers and sailors have had to appeal to Home Service Sections in such situations, the solution requiring court intervention in some cases and in others not. Another difficult situation is that of the father whose wife has died. A widower, drafted into the army, appealed to the Home 180 The Annals of the American Academy Service Section in his city to arrange for proper care for his one child. This was done with the help of a child-placing agency, and the child's board being paid by the father through the Home Service Section. The question has been asked whether unmarried women who are the mothers of soldiers' children come within the scope of Home Service. Such mothers do, and so do their children. The legal rights of both mother and child should be known. In handling such cases, a denial by the man must be investigated, remembering, however, the possibility of blackmail and so being very careful to deal fairly with both man and woman on the basis of all the facts obtainable, and with the competent advice and service of a good lawyer of sympathetic mind who should be a member of each Home Service Section. Many people become so accustomed to a low health standard that they actually regard ill-health as a normal thing. Home Service visitors try to accustom families to a higher standard, and to attend to dental defects, eye defects, nose and throat defects in time, bringing them promptly to the notice of the proper medical and dental specialists. It is necessary, in particular, to guard against an increase of tuberculosis. The experience of foreign countries, especially of France, in this war, indicates the possible rapid spread of this disease. Accordingly, especial attention is directed (1) to any loss of weight in members of the families visited, (2) to a persistent cold or cough, (3) to fever or loss of appetite. Suspected cases are referred to a doctor or to the local tuberculosis dispensary. " In families where we have found a history of tuberculosis in the past," writes the secretary of one Home Service Section, "we have had examinations made and have been able to give treatment to patients who had not known they required a physician's care." Here is an extract from the notes of one Home Service visitor. We were asked to furnish crutches in this family for the lame boy of thirteen- He lives with his father, mother and five brothers and sisters, of whom the oldest boy has enlisted. I found all the others in bad physical condition owing to a combination of insufficient income, poor management, and lack of knowledge of food values, so I took every one of them to a dispensary, where they were examined by specialists. Two doctors examined the boy wlio "needed crutches." With the consent of his parents and his priest, he was operated upon with satisfactory results. I am teaclung the mother how and what to cook. There is an aston- ishing physical improvement in every member of the family.^ Soldiers' and Sailors' Families 181 Mention has been made of the importance of keeping children in school and assuring regular attendance there, but Home Service Sections are doing more than this. Children who had been re- moved and put to work to meet a shrinkage in the family income are being returned to school promptly, as soon as Home Service is called in. One Home Service Section reports a boy, found to be working illegally nearly fourteen hours a day, who has been re- turned to school. This Section is making special provision to keep children between the ages of fourteen and sixteen in classes where they will receive a good preparation for earning their living later. Another is taking children out of "bhnd alley" occupations and providing special aid to give them training for better work. An- other reports upon a wayward boy who has been introduced to the Boy Scouts and is now doing well in school. Still another made it possible for a young man to complete his last year in college by paying the necessary tuition after his father entered the national army. One member of a Home Service Section is getting a great deal of pleasure out of giving free music lessons to three children whose father has died. Unless we are able to learn by the mistakes of Great Britain in the earlier years of her present struggle- — mistakes which she recog- nizes now — we shall be confronted with attempts to speed up in- dustry at the expense of the health and strength of the workers. The strict administration of the laws now on our statute books for the protection of workers against long hours and unwholesome processes is placed upon the conscience of those engaged in Home Service. First of all, the Home Service worker is expected to know what the national, state, and local provisions are — not only the laws regulating working conditions, but the agencies and officials re- sponsible for their enforcement. What provisions are there about maximum hours? What is a standard working day for men, for women, for children of working age? Is one day's rest in seven provided for by law? Is night work prohibited for women? For children? What hazardous employments are prohibited for either or both? Children who work are required to have employment certificates in almost all of our states. Have these been issued legally? Women need special protection from overwork before and after childbirth. Lawyers interested in Home Service are 182 The Annals of the American Academy asked to advise about the laws applicable to these matters. By order of the Quartermaster-General of the Army, uniforms for soldiers cannot be worked upon in any tenement house or dwelling. Home Service workers give valuable help in the enforcement of the order by making it known to the families with which they have to deal. Home Service Sections are systematically avoiding the practice of thrusting women into industry who can serve the family better at home. Before family allowances made earning outside the home less necessary, they were assuming extra financial burdens cheer- fully in order to keep mothers with their children and this is im- portant to safeguard home life on this side. The Red Cross beheves that it owes consideration to the agencies in each locality which are carr3dng permanently the responsibility for social service. At its annual meeting in Decem- ber, 1917, the Red Cross adopted a resolution which in substance is as follows: That while the Red Cross needs and must use immense sums of money for unusual purposes, it does not wish to receive that money at the expense of the permanent social work of this country but desires that the support, of the Red Cross shall be in addition to that work. The Red Cross believes that the work of the local social agencies in each community must continue during the war, not only with full vigor, but with increased resources, in order to meet needs that are becoming greater; and the Red Cross holds that these local agencies must be ready to do their full part in social reconstruction when the war is over. It is the purpose of the Red Cross that the awakening sense of social responsibility shall be utilized by the agencies which are permanent and necessary, and that these organizations shall increase in membership and resources during the war, as their needs may require. The desh-e of the Red Cross, especially in its work of Home Service, is that everywhere there be the most cordial cooperation. Training of Home Service Workers Successful Home Service work depends, indeed, not so much upon the extensiveness of the knowledge and experience of those relatively few persons who will be actively engaged in it, as upon their ability to utilize the knowledge and experience of others. They levy a claim upon the expertness of the whole community to which Soldiers' and Sailobs' Families 183 the possessors of special knowledge and skill have been only too glad to respond with enthusiasm, once it has been made clear that the Red Cross intends to do its fair share and that it makes good that intention. In order that there may be a larger number of trained and competent executives for Home Service Sections, the Depart- ment of Civilian Relief has established at twenty-five strategic centers, representing every section of the country, Home Service Institutes. The Institutes are open to executives and members of Home Service Sections, and to other qualified volunteers. The courses of the Institutes require the full time of those who attend for a period of six weeks. The programs of all the Institutes are practically the same. They are prescribed by the Red Cross and are given under its auspices. The course includes four hours of lectures and discussion each week, required readings, and the bal- ance of the time — about twenty-five hours each week — is spent in supervised practical field work in the Home Service of the Chapter in whose city the Institute is held and in the local societies that do similar work. The membership of each Institute is limited to twenty-five, in order to assure adequate personal attention in class- room discussion and in the field work. A . certificate is granted by the Red Cross to those who complete the work with credit and, in the field work, show qualities fitting them to assume responsibility in Home Service and aptitude for it. Wherever possible, the In- stitute is aflaliated with a well-established University, College, or Training School for social work. For those unable to attend the Institutes, Chapter Courses are held in those cities where competent instruction and field work are available. These courses conform to a general standard prescribed and published by the Red Cross, but which may readily be adapted to local conditions and needs. Chapter Courses are always re- lated intimately to the work of the local Chapters. Many Chapters have conducted such courses and many more are planning to do so. The Red Cross strongly endorses the organization of such courses and believes that the volunteers connected with Home Service Sections will work longer and do more if they are given such train- ing. The eager response which has been made to the Chapter Courses and to the Institutes proves that people no longer feel that 184 The Annals of the American Academy good intentions are qualifications enough for Home Service. They want to learn how to do this work in the best possible way. Those who have taken up Home Service have been quick to see that it requires a familiarity with new problems and a facility in dealing with them which can be acquired only through training. To be sure, the Home Service Institute, to say nothing of the Chap- ter Course, does not make social workers, but it does make informed people in the communities from which the students come. In short, the Red Cross, realizing its responsibihty and its opportunity, is trying to fit itself to discharge that responsibility by beginning at the obvious point of departure — through a campaign of education. It is the earnest hope of the Red Cross, as it is the test of its stand- ards, that through Home Service in cooperation with other agencies, the family of no soldier or sailor shall suffer a lowering of its stand- ards nor lack any essential thing within the power of the nation to give. Home Service is solicitous about the welfare of the families of men in the service because it reaUzes that upon the success achieved in this task depends the kind of problems that will con- front the nation when the war is over. It is the hope of the Red Cross that its Home Service may help to awaken a national spirit of social responsibility so that when the war is ended, America shall have not a new. social problem, but instead a new and greater social force in working out its destinies. INDEX Adoption, factors in, 113, 120. Agencies, social, 89, 125, 127, 144, 149. Alcohol and Social Case Work. Mary P. Wheeler, 154-8. Altruism, basis, 22, 26. Army, tests, 62. Beggars, professional, 151. Blind; case work with the, 28, 35; exploitation of, 29. Blindness, Offsetting the Handi- cap OF. Lucy Wright, 28-35. Boston School of Social Work, outhne suggested by, 33. Brannick, Catherine. Principles of Case Work with the Feeble-minded, 60-70. Budgets, family, 83, 87. Byinqton, Margaret F. The Nor- mal Family, 13-27. CaUfornia, mother's pension laws, 84. Canada, war conditions, 25, 33. Case treatment: basis, 131; forms, 35, 39, 43, 46, 62, 65, 72, 89, 92, 96, 104, 113, 117, 121, 126, 130, 133, 142, 155, 169; individualization, 31, 61, 62, 101, 109, 139, 155; medical pro- fession and, 4, 52; method, 1-5, 31, 34, 36; results, 118, 123; successful, 2, 5, 7, 117, 166. Case Treatment, The Opportunities of Social. Karl de Schweinitz, 1-8. Case Work and Social Reform. Mary Van Kleeck, 9-12. Case worker: duties, 23, 95; qualifica- tions, 7, 9, 163. See also Social worker. Charity, pubUc, new experiment in, 90. Children: adoption, 120, 125; case work with, 117, 126, 130, 133; death rate, 50; defective, 65; delinquent, 133; earnings, 87; family life, 18, 82, 120, 129; feeble-minded, 65, 68; foster care, 119, 123, 127; health, 179; illegitimate, care of, 104, 110, 122; institutional, 126, 128. Children's Bureau, purpose of, 50. Clergyman, social services, 97. Cleveland; Cripple Survey, 38; educa- tion of the blind, 29. CoLCOKD, Joanna C. Desertion and Non-support in Family Case Work, 91-102. Courts: illegitimacy and, 108; juvenile, 17, 133; deUnquency and, 131; de- sertion and, 93. Criminology, modern, 115. Cripple and His Place in the Com- munity, The. Amy M. Hamburger, 36-44. Cripple Survey, Cleveland, 38. Cripples, classification, 40, 44. Defectives, classification, 65, 73. Delaware, mother's pension legisla- tion, 79. Delinquent Children, Essentials OF Case Treatment With. Henry W. Thurston, 131-39. Dehnquents, case treatment of, 131. DeSchwbinitz, Karl. The Oppor- tunities of Social Case Treatment, 1-8. Desertion: attitude toward, 91, 93; causes, 94; National Bureau of, 97; percentage, 101. Desertion and Non-support in Family Case Work. Joanna C. Colcord, 91-102. Diagnosis: importance, 4, 46, 65, 155; medical, 46, 55; social, 46, 55, 65, 69, 72, 104, 142. Disease: prevention, 53, 55; super- vision, 88, 113. Divorce, state laws, 16. 185 186 Index Domestic relations court, case work and, 91. Drink, effects, 99, 146. Drinkers: classifications, 146, 157; medical treatment, 158. Education, home, 21. EflBciency, in the handicapped, 32, 64. Employment, for the handicapped, 30, 32, 42, 68, 73, 140, 168. England: juvenile punishment, 23, 132; poor laws, 80, 90; soldiers, 33. Environment, effects, 27, 65, 130. Families: The Soldiers' and Sail- ors'. W. Frank Persons, 171-84. Family, The Fatherless. Helen Glenn Tyson, 79-90. Family, The Immigrant. Eva W. White, 160-70. Family, The Normal. Margaret F. Byington, 13-27. Family, as an institution, 15, 168. agency, difficulties of, 128. life: primitive, 14; problems, 20, 81, 83, 85, 96, 155, 168, 174; star bility, 25; value, 81. Farm colonies, for the homeless, 151. Fatherless Family, The. Helen Glenn Tyson, 79-90. Feeble-minded: classification, 63; neg- lect, 149; treatment, 60, 69. Feeble-minded, Principles op Case Work with the. Catherine Bran- nick, 60-70. Feeble-mindedness: definition, 62; in- crease, 60. Fernald plan, purpose, 61. Foster care, institutions v. families, 126. Foster Care op Neglected and Dependent Children, The. J. Prentice Murphy, 117-30. Foster homes: disadvantages, 124; for illegitimate children, 122; investiga- tion, 129. France: Home Service, 171 ; penal code, 131; tuberculosis, 180. Germany, juvenile delinquency, 23. Hamburger, Amy M. The Cripple and His Place in the Community, 36,44. Handicapped, problems of the, 28, 36, 41, 68, 107, Health: England, 181; problem, 51, 88; provision for, 48; standard, 180. insurance, advantages, 11. movement, public, 56; scope, 10. Henry, Edna G. The Sick, 45-59. Heredity: effects, 103; illegitimate child and, 113, 122. Home: education, 21, 30, 67; institu- tions and, 18, 126; safeguards, 182; stability, 25, 172. Service: aims, 171; desertion and, 102; opportunities, 173; organizar tion, 175; work, 82. ^ workers, training, 182. Homes: children in, 122, 124, 125; re- construction, 27. Homeless, The. Stuart A. Rioe, 140- 53. Hospitals: maternity, 111; need for, 50. Illegitimacy: causes, 103; desertion and, 96; fatherless families and, 85; investigation, 105, 114; significance, 121. Illegitimate Family, The. Amey Eaton Watson, 103-16. Illinois, mother's pension laws, 84. Immigrant Family, The. Eva W. White, 160-70. Immigrant problems, type^, 165. Immigrants: schooling for, 161; second generation, 167. Industrial reform, social workers and, 11. revolution, effects, 19. schools, for children, 126. Industry: feeble-minded in, 63; home- less, in, 140. Inebriates, treatment, 150, 158. Index 187 Institutions: for the handicapped, 60, 64, 123, 126, 156; health problems in, 52. Interviews, successful, 72, 155. Investigation, method, 4. Labor, employment of handicapped, 36, 41, 63, 149. reserve, make-up of, 141. Law: on desertion, 92; effect on mar- riage, 157; juvenile delinquents and, 131. Marriage: control, 15, 60; forced, 96, 112; illegitimacy and, 108. Massachusetts: foster care, 125; pro- vision for the feeble-minded, 61. Comnlission for the Blind, meth- ods, 30. General Hospital, work, 110. Medical profession, social work and, 4,50. Mendicancy, evils of, 151. Mental Hygiene, Case Work in the Field op. Elnora E. Thomson, 71-8. Minnesota Children's Code, provisions, 104, 110. Mothers: earnings, 86; unmarried, 110, 124, 180. Mother's pension legislation, adminis- tration, 79, 89. Moral code, development, 23. Mortality, infant, 50, 110. Municipal lodging house, applicants, 143. MuKPHY, J. Prentice. The Foster Care of Neglected and Dependent Children, 117-30. New Jersey, mother's pension legis- lation, 79. New York: foster care, 120, 125; mother's pension legislation, 79; inebriates, 150. Charity Organization So- ciety, desertion cases, 101. Non-support in Family Case Work, Desertion and. Joanna C. Col- cord, 91-102. Norway, Castberg Law, 104. Nurses: Home Service, 179; social workers and, 49, 53, 58. Parents, children and, 16, 23, 24, 119. Pennsylvania, mother's pension legis- lation, 79. Persons, W. Frank. The Soldiers' and Sailors' Families, 171-84. Physician, social service, 46, 52, 97. Poor laws, provisions, 79, 80, 90. Probation officer: delinquency and, 137; desertion and, 93; duties, 134. Prognosis, medical and social, 46, 55. Psychiatrist, psychologist and, 70. Psychology, applied, 94, 103, 114, 128. Records, importance of case, 12, 46, 78, 129. Red Cross, Home Service, 82, 171-84. ReUgion, effect on marriage, 16. ReUgious influence: drunkenness and, 147, 158; in foster homes, 128. Rice, Stuart -A. The Homeless, 140—53. Sailors, famiUes, 82. Sailors' Families, The Soldiers' AND. W. Frank Persons, 171-84. Sanitation, community, 143. Schools, enlarging scope, 21. Secretaries, quahfications, 164. Segregation, for the feeble-minded, 61. Sex, as social factor, 96, 107, 116. Sick, The. Edna G. Henry, 45-59. Social Case Treatment, The Op- portunities OF. Karl deSchwein- itz, 1-8. Social Case Work, Alcohol and. Mary P. Wheeler, 154-58. Social insurance, value, 48, 90. problems, classification, 56. Social Reform, Case Work and. Mary Van Kleeck, 9-12. 188 Index Social reform, definition, 9. work, scope, 27, 47, 56, 144. worker: desertion and, 94; duties, 48, 55; health movement and, 11; medical knowledge, 48; illegiti- mate families and, 115; qualifica- tions, 45, 58, 71; as a teacher, 54. See also Case worker. Soldiers: disabled, 28, 36, 148, 173; families, 82, 102; mentality, 62. Soldiers' and Sailghs' Families, The. W. Frank Persons, 171-84. Thomson, Elnora E. Case Work in the Field of Mental Hygiene, 71-78. Thubston, Henry W. Essentials of Case Treatment with Delinquent Children, 131-39. Tuberculosis: case treatment, 50; pre- vention, 180. Ttbon, Helen Glenn. The Father- less Family, 79-90. Unemployment, consequences, 145. Van Kleeck, Mary. Case Work and Social Reform, 9-12. War: general effects, 25, 36, 102, 119, 148; social problems after, 57, 90. Risk Insurance Law, provisions, 172, 174. Watson, Amey Eaton. The Illegiti- mate Family, 103-16. Wheeler, Mary P. Alcohol and Social Case Work, 154-8. White, Eva W. The Immigrant Family, 160-70. Widow, types, 81. Workmen's Compensation and Liabil- ity Acts, proposed readjustment, 36. Wright, Lucy. Offsetting the Handi- cap of Blindness, 28-35. tais ma!rk on GPOD pOOKS The following books are in close; relatipii to the topics discussed in this issue^ofTlic! Anh£^?l YOUR Part IN poverty^^ oEORbf lanspury ,"No one who. wishes to understand the labor movemeht in, Eng'and c^n afford' to miss this' book,;, few, who read at can fail .to be captiyated by its; charni. ,It i$ the picture of a ,; ,, . b'raVe' and kindly 'soul who loves, life for its possibilities and iSfrnah enough Jto be dissatisfied until alf who toil can share also in the gai^n of life,"--HAROU> laski in The J^eip Republic. 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