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Michigan State University 1"7 '
SCHOOL OF SOCIAL WORK

s.w. 899

CHIID GUIDANCE CLINIC
FOILOW-UP STUDY

 

presented by

Bruce M. Ledewyk
MICHIGAN STATE UNIVERSITY
East. Lansing, Michigan

J. W. Heffernan
Assistant Professor May 24. 196“

THESE

 

OUTLINE

I. Purpose and Background
1. Description of type of children chosen for this study.
2. Beacons that these subjects were referred for treatment.

3. Description of the great number of variables involved in conducting
such a study. .

h. The need for such a study and why it was conducted.
II. Methods of Study
A. Collection of Data
1. Case record and content description.
a. Face sheet data and its basic components
b. Diagnostic evaluation and its use in treatment selection
c. Reasons for referral to the clinic
2. Court Record description

a. Type of information being gained and the method of
securing

B. Definition of variables
1. Characteristic of clients chosen for study
a. Age, I. Q., and referral reason for clients being seen
2. Type and size of universe used in this study

3. Adequacy and representation of the universe being used in this
study

a. Treatment methods and importance of

5. Definition of treatment variable and the significance to the
studies definition

6. Therapy type evaluations
a. Therapy type correlated to outcome

7. 'Hobile shortcoming as a Specific variable is described as being
a ”controlled” variable

0. Methods and Analyzing Data

 

1. Method of recording
a. Summary sheets and their specific use
b. Ranking and classification of the data collected
2. Age categories as related to recividism
3. 'Hethod of recording to yield classification
a. Felony types and the definitions according to this report
h. Possible significance of association
a. Design type
b. Data type that will be collected for study
c. Chi square tabulation and why it was used
III. Results of Study

Includes only findings, and contains no inferences from data collected -
such information will follow

A. Components of universe
1. Total size of the universe when calculations were made
2. Hake-up of universe and age variables involved
3. Age classifications according to young and old age groupings
B. Age and Recividism .
1. Percentage rates of recividism in adult life
a. Young grouping (age 8 to 12 years at treatment)
b. Old grouping (13 to 16 years at treatment time)
c. Combined groups and tabulation of recividism
2. Comparisons of age groupings and recividism

3. Significance of association not present in this study in a
statistical sense

C. Prison Records and Crime Range
1. Total felonies committed
a. Type of felonies according to records
b. Type of sentence handed out

2. Introduction to the actual discussion of the findings
IV. Discussion of Findings
1. no statistical significance of associations present

a. Chi square .20 but inadequate because of lack of minimum of
10 subjects in 2 cells

2. Inadequacy of records used for study
a. Face sheet shortcomings and not always filled in
b. Department of’Mental Health's view presently in records

3. Possible Speculated trends from percentage figures on timing of
treatment at age of treatment and recividism

a. Possible trend to less recividism when treated early - good
area to focus for future researchers

h. Importance of not separating one single variable for the complete
answer

a. This problem will only be observed correctly when the realization
of the presence of numerous important variables are realized

V} Conclusion
A» Recapitulation of previous section
1. Possible area of importance for further research

a. The possible trend of treating children at an earlier
age, thereby possibly limiting amount of recividism

VI. Changes In Scope and'lethod
A. The focus is generally the same throughout this study
B. Changes that were especially important in the study
1. Due to size of universe, sampling method was changed
a. Total universe used
2. Chi square not used
a. Due to smaller universe than originally expected
b. He method to test significance of association was used
c. Two cells lacked the minimum requirement of ten subjects
VII. Appendix B. (Table)

I.

V.

TABLE OF CONTENTS
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”Galas Of the Study......."no........o.............................
A» Collection of the Data and Analysis...............................
B. mfinitions Of variabIOSOOOOOOOOOOOOO0.00000000000000000000000000.
C. Hathals Of Analyzm Data.........................................

Results Of th’ StWOOOOOOOOOOOCOOOCOOOO0.0.0.0...OOOOOOOOOOOOOOOOOOO.

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C. Prison Bacards am Cm! Rangeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee

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Conclusion........nun..............................................
Appendixes............................................................

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CHAPTER I

PURPOSE AND BACKGROUND

This study emplored what happened to children who were previously seen for
treatment at the Flint Child Guidance Clinic. Circuit Court records were re-
viewed and an attempt was made to discover if these individuals had committed
any felonies since release from treatment.

The study was limited to 5b children who were between the ages of 8 and
16 years at the time of their first clinical contact with the Flint Child Gui-
dance Clinic. In order to include as long a period time as possible between
the original clinic contact and the present followaup study, cases were selected
that had been known to the clinic between December 1, 1948 and November 30, 1949.

The reasons for these boys being referred for treatment were many. The ma-
jor classifications included: delinquent behavior, undesirable habits, undesir-
able mental attitudes, physical symptoms and educational problems. These nup
'merous variables in the above classification.merely reflected past literature
regarding followaup studies. Such studies demonstrated that a great number of
'variables and methods were to be dealt with or at least recognizedl. To deal
'with the total multiple variables, however, was impossible because of the time
and money involved.2

Since any attempts to generalize findings had proven futile3, in the past,

this study merely searched for a few specific variables. The study located

 

1Robbins, Lee R. and O'Meal, Patricia, TMortality, Mobility, and Crime'Thirty

‘Iears Later," American Sociological Review, (1938) XXIII p. 163.

2Pearl, R. E. and Simon, A. J., "Criteria of Success and Failure In Child
Guidance," Anerfi can Journal of Orthopgychiatgz, III (19%) p. 653.

3Stein, Herman, "Factors In Psychiatric Clinics for Children," The Social
Segige Review, (March, 1956), p. 11.

 

.‘2-

these fommer patients 16 years later via public records. A systematic approach
‘was incorporated to search for objective evidence of convictions of felonies.
Interestingly enough, only in the last 15 years had there been concern with the
occurance of deviant social behavior in adults with a childhood behavior problem.“
Locally, such a study was never attempted. The need for this study was quite
obvious. FCGC5 had no information that pertained to clients after they were
treated at the clinic. The undertaking of this project, therefore, was accepted
with the ultimate hepe that other followbup studies would follow - studies that
would segmentally increase one's understanding as to what happened to client's

after they left treatment.

 

“Robbins and O'Neal, loc. cit.

5Historically, the first contribution to the present day Flint Child Guidance
Clinic (FCGC) was made in September, 1930. In the summer of 19146, the Michigan
State Department of Mental Health decided to have a child guidance clinic. By
the fall of l9h6, the Flint Child Guidance Clinic was in Operation. Present day
has found the AdultuMental Health Clinic of Flint being combined with.the child
gmddance unit. Today, the clinic functions under the auspices of the Flint Adult
and Child Guidance Clinic.

CHAPTER II

METHODS OF THE STUDY

A. mean

Data was collected from case records. These records were comprised mainly
of face sheet data. Such data primarily described the particular client's age,
sex, marital status, and referral.

These records also contained a diagnostic evaluation whichciescribed the
client's initial contact with the clinic. There was an evaluative statement
of the immediate problem involved and possible recommendations of what steps
were taken; such as referral, treatment or psychological testing.

All data within was recorded by both the psychiatric and social forces of
the clinic. This was used to determine what was the best course or alternative
available to the client seeking help. If such data was used within the clinic
for treatment its primary purpose was for a psycho-social diagnostic evaluation
and weighed heavily on the type of treatment used.

Public records, circuit court, were used as an analogy to the above. The
information collected included: presence of any recorded felony; any prison
record; and all major convictions against society. The above information was
easily secured with the coOperation of the Identification.Bureau, Flint Police
Department, under the direction of Chief Paul.

B. Definition ggivariables

The patient group was selected from the clinical records within the speci-
fied period who met the following criteria: age under 16 years at first clinical
contact; I. Q. not less than 75; referral because of problem behavior.

A total universe was drawn from those patients seen at the clinic for the
year 19n7-l9h8. Those meeting the definitional term treatment for that single
‘year numbered 54 patients.

There was no reason to believe that the children seen at that particular
time differed basically from those seen in other years. This allowed an assump-

-3-

-h-

tion that the period of time and patients seen, were both adequate and repre-
sentative of patients seen at other time intervals.

There was no attempt to correlate any type of treatment with the end re-
sult. After intense investigation it was concluded that even if statistical
evidence would have been in favor of one particular type, it would not prove
precluded the use of other methods which happened to have been successful in a
smaller number of cases.

Past studies indicated no set pattern for the definition of the term
treatment. An attempt was made in this present project to combine a defini-
tion to satisfy all aspects. It was decided, therefore, that the term treatment
*would be 10 interviews or more for the child. Such 10, one hour sessions, were
to be with any one clinician of any of the three disciplines.

Since past research.demonstrated that one would be hard pressed to define
'what "superior” meant in a therapy evaluation, it was decided that the plain
fact was that there was no set of consensually validated definitions of the out-
come of therapy. Since there were no validated definitions of outcome, one must
‘be aware while reading this report that this project included only those under
'treatment persay.

There was on limited variable which must be observed and recalled as one
reads this report. Due to limited time, there was no further study to see if
any of the universe had since moved to another town or city.

C. Methods gf_ Analging 2.35

The age of the group was recorded on summary sheets, then ranked and classi-
.fied in two age groupings. The age variable was correlated to recidivism and
classified as young and old. 01d was defined as entering treatment between 13
and 16 years of age. The category of young was interpreted as those beginning
treatment between 8 and 12 years of age. Therefore, the analogy of age of
‘treatment and adjustment in later adult life was compared to obtain a possible

significance of association.

-5-

Recidivism was recorded on summary sheets by case and characterisitcs.
The primary classification was divided into those individuals who were convicted
of a felony in their adult life and those who did not. This information was
then coded to yield the classification of recidivism as described earlier.

The data was then arranged in a C cell design. Nominal data was ordered.
Chi square was tabulated to discover if there was any significance of asso-

ciation.

CHAPTER III

RESULTS OF THE STUDY

A. As stated earlier the total universe was 54. It was found that of this 5n
total, 39 were male and 15 female. Sixteen clients were in the age classification
of old and the young category consisted of 38 individuals.
B. Age and Recidivism

It was found that of the two age grouping classifications, young and old,
both equaled out to 5% rate of recidivism when figured on the total universe
and as separate entities. The reader must observe here that the above figures
were tabulated on the total universe and compared to each separate group alone.

When figuring the rate of recidivism in the two separate areas, young and
old, in themselves, somewhat of a different picture emerges. Figured in the
old classification, the rate of recidivism, tabulated on those undergoing
treatment between 13 and 16 years of age, was found to be 18.7%. Somewhat of
a statistical difference is shown when compared to the young grouping, between
ages of 8 and 12 years when undergoing treatment, in that the rate of recidivism
‘was tabulated at 7.8%. Further, when both groups were combined and compared to
the total universe, the rate of combined recidivism.was 11.1%. The rate of re-
cidivism, therefore, showed no real significance of association between the two
age groupings.1
C. Crime Range and Prison Records Recidivism

The total number of felonies committed by the group was six. Of this six_
were included: four breaking and entering; one carrying of concealed weapons;
leaving the scene of an accident death. not one of the individuals involved
in the above crimes served over two years in prison. All who were sentenced
to more were released on probation within two years.

The following list of findings showed the results of the project. The

 

1Turnto Page 8i.Discussion of Findings

 

-7.

original purpose of this study was to demonstrate a possible significance of
association. However, since two cells failed to incorporate over 10 subjects,
no significance of association or chi square was used.1 The following data was
speculated upon for possible trends but no statistical significance was attemp-

ted.

 

labs Table 1 on Page 12

CHAPTER IV

DISCUSSION OF FINDINGS

From the preceding chapter on the results of the study, it appears that
there were no characteristics between the age grouping of those who received
treatment and felonies that were committed in the adult years. Since none of
the variables measured in this study were significantly associated, this chap-
ter will merely attempt to.8peculate and point out the possible trends and
factors demonstrated by the presented data. 3

Perhaps the most glaring inadequacy demonstrated at the completion of this
study was the gross inadequacy of the records used forthat clinical year. Some
folders contained only the face sheet and in many instances such face sheet ma-
terial was not even recorded. Further studies, therefore, could focus in on more
up to date records and investigate the adequacy of these records.

Further investigation revealed that the state had realized some of these
,past inconsistencies in record recording and had taken steps to improve such
recordings. Dorothy Navizedah1 Bay City Child Guidance Clinic, stated that
presently the state does require closing information on all clients and this
information must be recorded and sent to the State Department.

As stated earlier, the information that was collected demonstrated no
real associations. Speculating on the percentages, it was easily observed that
in the grouping classification of young and old, each showed a recidivism of
5%fi of their two categories in reapect to the total universe. Carried further,
however, it was seen that if recidivism was measured, each within its own
classification of young and old, the results demonstrated a changed focus. The
recidivism now became 8%% in the young age grouping, compared to 18.7% recidivism

containment in the older age grouping.

 

1Interview'with Dorothy Navizedah, Chief Psychiatric Social worker, Bay City
Child Guidance Clinic, April, 196u

Realizing the absence of any statistical association one can possibly see
a trend toward less recidivism when earlier treatment was incorporated. Re-
searchers of the future should observe this area 6f study carefully.

Since no hypothesis was being confirmed in the study and the nature was
primarily an emploratory one, the study would be incomplete unless a further
final focus on recidivism was made. As stated earlier, 11.1% of the total
universe treated at the clinic were convicted of a felony persay in later adult
years. Such a figure does not demonstrate anything real significant. It does
show that of the total universe treated in 1949, 11.1% got into trouble with
the law. Hopefully, future studies can measure certain variables mentioned
throughout this study and make an analogy to the results secured here. Such
results, it is hoped, will demonstrate the future need for researchers to be-
come aware of the many variables involved, in recidivism following treatment
years earlier. Further, it is heped that this study demonstrated that even if
statistics prove or disprove the hypothesis, one must not become involved in
a singular variable as being the total causative factorjof any single social
phenomena, but view such a variable as a significant part contributing to the

end result and unseperable from other variables at times.

CHAPTER V

CONCLUSION

In the previous section, an attempt was made to demonstrate that this study
showed trends perhaps, but that any statistical significant association was not
present. The major point being that only a small portion of children treated
for emotional problems at the clinic during the year 1949-1950 were classified
in the category of recidivism. It was felt that this low percentage connection
between those committing felonies and those not should be made. This finding,
in itself, offers suggestive leads in other areas of followeup research in the
future. Although this has been only one specific measured variable for a single
year at a single agency, it is hoped that this, in itself, will offer suggestive

leads for further research in areas of any type followbup studies.

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APPENDIX A

CHANGES IN SCOPE & METHODS

The focus of this study remained generally the same throughout. The most
significant areas of change occurred in sampling technique and the analysis of
data.

Changes proved necessary when it was discovered that the total number of
individuals treated for the Specified year at the clinic only numbered 54.
This differed from the original sampling procedure that was designed to draw a
sample from cases for one fiscal year. The sampling procedure, therefore, was
unnecessary and a total universe was used of those treated.

In a direct correlation to the above, the original statistical method for
testing significance was eliminated. The chi square was not used as initially
planned since certain cells lacked the minimum 10 subjects. The study, there-
fore, remained exploratory in nature and attempted merely to speculate on cer-

tain trends and characteristics.

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Young

01d

APPENDHB

 

 

 

 

 

 

TABLE
Table I
. Felony No felorw
3 35
3 13
6 1+8
I2 = 1.338
d! 8 l
P > .20

$.12:

38

16

BOOKS

Healy and Brenner. Delinguents and Criminals, Their’Making and Unmaking.
Judge Baker Publication, No. 3

Glueck, Sheldon and Eleanor. Later Criminal Careers. New'York, The Common-
Wealth.

PERIODICALS & ARTICLES

Brommer, A. F., "Treatment and What Ha pened Afterward,” American Journal
of Orthogsychiatgz, XIV (1940), 28-36.

Andrew, G. "Investigations of Methods for Follow-up of Child Guidance Clinic
Cases." Social Service Review, 31: (March, 1957) 7fi-80.

Glueck, E. T. "Evaluative Research in Social work." Columbia University
Press (NeIe), 19360

Levitt, Eugene E., Beiser, Helen R. and Robertson, Raymond E. "A Follow-up
Evaluation of Cases Treated at a Community Child Guidance Clinic.”
American Journal of Orthopsychiatrygr (April, 1959), 337-3h9.

Robbins, Lee N., O'Neal, Patricia, ”Mortality, Mobility and Crime: Problem
Children Thirty Years Later." American Sociological Review. (Albany,
New York) Vbl. 23, 163-165.

Stein, Herman, ”Socioculture Factors In Psychiatric Clinics for Children,"
The Social Service Review, (March, 1956) 10-17.

Shirley, M., et al. ”Outgoing Childhood Problems: A Follow-up Study of

Child Guidance Patients." Smith College Studies in Social Work,
XI (1940).

O'Neal, P. and Robbins, L. ”The Relation of Childhood Behavior Problems to
Adult Psychiatric Status.” American Journal of Ps chiat , July,
1958 - July 1959.

Barbour, R. F. and Beedell, C. J. "The Follow-up of a Child Guidance Clinic
POpulation.' Journal of Mental Science, 1955, 101, 790-809.

Margaret, Ann. "Generalization in Successful Psychotherapy.” Journal of
Consulting Psychology, XIV (1951), 602-659.

Pearl, R. E. and Simon, A. J. ”Criteria of Success and Failure in Child
Guidance.” American Journalof Orthopsyehiatry, III (1902), 6&2-659.

Thorn, D. A. and Johnston, F. S. "Time as a Factor in the Solution of De-
linquency: A study of Results in a Child Guidance Clinic.” Mental

Hygiene 25: (April) 19in, 269-287.

‘Wallace, R. "A Study of the Relationship Between Emotional Tons of the Home
and Adjustment Status in Cases Referred to a Traveling Child Guidance

Clinic." Juvenile Research, 19: (1935) 205-220.

PERIODICALS AND ARTICLES (continued)

Knox, E. E. ”Follow of 103 Whittier State School Boys 10 years After Ad-
mission." Juvenile Delinguency. 12: pp 261-269.

UNPUBLISHED MATERIAL

Brown, Dennis. "Cases ReOpened In a Child Guidance Clinic." Unpublished
Master's dessertation, Department of Social Work, University of
Michigan, 19550

OTHER SOURCES

Flint Adult Mental Health Clinic. Personal interviews with the Director and
Psychiatric Workers of the Clinic. Jan. 196%.

Two brief interviews with Joe Heffernan, Political Science, Michigan State
University.

-11.-