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_mpo

A DESCRIPTIVE STUDY OF THE
FAMILY CARE PROGRAM AT THE
VETERANS ADMINISTRATION HOSPITAL

BATTLE CREEK, MICHIGAN

OLIVER ROBERT WILLIAMS

 

. _ I II 3. x . .
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- v awn: .3. 1

A DESCRIPTIVE STUDY OF THE FAMILY CARE PROGRAM
AT THE VETERANS ADVINISTHATION HOSPITAL,
BATTLE CREEK, MICHIGAN
I; If

Oliver Robert Williams

Submitted to the School of Social Work
Michigan State University
in Partial Fulfillment of the
Requirements for the Degree
of

LASTER OF SOCIAL WORK

May 1956

 
     

ADVPOVBd:
Chairma esearch Comm ttee

i
3.thwfi%M\WSESFP¥7S‘T‘ITQ>\J

I _Director of School

v ‘—~—— v-v-v “my

LIBRAR 1‘ f“ .
Michigan State
Univemity

     
     

THESIS

ACKNOII’ LEDGE‘-" EN TS

Particular acknowledgement is expressed to the
members of the Research Project Committe, Dr. Gordon
Aldridge, Chairman, Dr. Lucille Barber and Mr. Vanfred
Lilliefors, under whose ineoiration and guidance this
study was compiled. The author is also grateful to the
other merbers of the School of Social Work of Michigan
State University for their helpful suspestions and
assistance.

The author extends sincere thanks to the members
of the Social Service Department at the Veterans Admini-
stration Hospital, Battle Creek, and to Mr. Clarence Cole,
Mrs. Dorothea Hunter and Dr. Eugene Plewka in particular
for their help in gathering the material for this study.
Grateful acknowledgement is due to Mr. Willian Brewer for
the sufiyestions and support that he gave to the author.

The author wishes to express sincere appreciation
to his wife, Helen, for her endless encouragement during

this study and for its typing.

ii

I. THEORETICAL BASIS OF THE STUDY .

II. DEFINITIOVS, HISTORY, AND DESCRIPTION OF

THE SETTING

III. “ETHODOLOGY .

IV. SELECTION AFD PREPARATION OF PATIENTS FOR

FAMILY CARE

V. SELECTION OF FA“ILY CARE HOVES

VI. SUPERVISION OF PATIENTS

VII. SUYNARY . . .
APPEEDICES . . . . .

LIST OF REFEREKCFS .

TABLE OF COETENTS

111

IN

FAflILY CARE HOMES

Page

15

18
36
‘13
LIB
53
59

CHAPTER I
THEORETICAL BASIS OF THE STUDY

This study is based on the Drenise that the place-
ment of certain selected patients from a neuropsychiatric
hoeoital in homes other than their own can be a valuable
tool in rehabilitation of these netients. It is also as-
sumed that in order to choose carefully not only those
patients who can benefit from the rroprnn but those homes
and families that can be of the greatest benefit, certain
social work skills and techniques must be emnloyed in order
for the nropram to be of the greatest theraneutic value
to the natient.

This study will be chiefly concerned with the
role of the social worker in the total planning and exe-
cution of the fanily care rrogrem.in the hospital. The
social worker acts as a member of a teen conDrising the
ward doctor, nurses, administrative and other hospital
person el in order to use this plan effectively.

This tonic was chosen for study for these reasons:
(1) there is a scarcity of information on this topic in
the field of social work; therefore, it is the aim of this
study to nresent a penerel picture of a program as it is

used in one Veterans Administration Fosoital at this time

in an effort to be of some benefit to others who are
dealing with this problem. (2) The family care workers
of the Social Service Department of this Veterans Admini-
stration Hospital are attenpting to draw together the
details of the family care program in order to publish
a manual to be used by the hospital; it is hoped that
this study will be of some assistance in this. (3) The
author gained a personal interest in this pronram when
faced with the question of what plans were in effect to
care for those patients who have sufficiently recovered
from their illness but for one reason or another could
not return to their own homes.

The movement of the patient through the various
stages of treatment from admission to dischsree, is the
focus of the services offered by the hospital. Family
care is one phase or step of the total movement of the
patient through the treatment process. Family care is
treatnent on a community level as compared to the other
steps of the treatment which are on the institutional
level. For some patients family care is the last step
in their treatment, while for others it may serve as a
period to determine whether or not they can satisfactorily
function in the community. If it is found that they cannot
adequately adjust to community life they will be returned
to the hospital for further treatment. For the majority

of the patients this step in the treatment process is

never reached. Either they do not recover sufficiently
from their illness to be considered for placement, they
leave the hospital against medical advice or they are
discharged directly to the community after a trial visit
period. Family care serves as a bridge between the pro-
tective atnosphere of the hospital and the competitive
community in which the patient must live after leaving
the hospital. This program enables the patient to make
the transition fron the hospital to the community slowly,
and thus be more able to function effectively in the com-
munity after he is discharged from the hospital.

Although it is recognized that other benefits
are derived from family care in addition to the rehabili-
tative benefits it holds for the patient, this study is
prinarily concerned with the use of this program as a
step in the total treatment of the patient. Some of the
other benefits deserve mention here. Among the reasons
for using family care is that it makes beds available
on the hospital wards for patients who can profit from
the intensive treatment progran. In family care the
patient uses his own funds to meet the cost of his care
while still receiving hospital benefits and supervision.
This releases funds to be used for the treatment of other
patients. Another benefit of the family care program
is that it shows the patient unable to return to his own

home that there are provisions existing that will enable

him to go from the hospital to the community after he
receives the full measure of treatment in the hospital.
This knowledpe mipht help him engage himself more fully
in the treatment program. The prospect of leaving the
hospital in the future under supervision may help keep
the patient's morale up while he is recovering from his
illness. These reasons for the use of family care are
cited to illustrate that the program can have an effect
upon the entire hospital population that goes beyond the
rehabilitation of those Qualified to receive this care.
Actually, these are secondary benefits but do have an
indirect effect on the total treatment services in the
hospital.

This study will be concerned first with defi—
nitions of family care taken from the literature in this
field. This will be followed with a brief history of the
family care movement in Europe, in the United States,
in the Veterans Administrationl and, finally, in the VA
Hospital at Battle Creek. The setting in which this work
is being carried on will be described briefly. A chapter
will be devoted to the "ethod used in making this study.

The main concern of the study will be an account

of how patients are selected for family care, the moti—

 

1The Veterans Administration will be referred to
hereafter as VA.

vation of the patient to consider this treatment procedure
and the preparation of the patient for placement in a
family care home. The area of home finding and preparation
of the family care therapist? and other members of the
family to receive and work with the patient will be con-
sidered. The supervision of the patient in the family
care home and of the family care therapist by the hospital
social worker, will be included. The final part of the
study will include a sunmary and a statement of conclusions.
The material for this project will be drawn from
the literature on the subject, docuuents and other material
made available at the hospital by the Social Service
Depart ant, and from interviews and personal observations
made by the author in dealing with patients being pre-
pared for family care and those already in the prosran.
Statistical data will not be used as a primary source

of information.

 

2The term, family care therapist, refers to the
person in the family care home who assumes the responsi-
bility for the care of the patient. The possible reasoning
behind the use of the word therapist is to help that person
feel that he is part of the hospital's treatment team.

CHAPTER II

pgplylmlgyg’ HISTCRY, AND DESCRIPTION

0” THE SFTTIWG

The literature on family care uses various terms
to describe this program. Sometimes it is termed foster
family care, foster home care, boarding home care, home
care, or trial visit in a home other than his own. In
this study, however, the term family care will be used.

Hester B. Crutcher defined family care as:

Foster family care as used here is the placing
of the mentally ill or defective with families other
than their own for care....They have responded to
institutional treatment and training to such an ex-
tent that it is felt that they can adjust to living
under close supervision in a home and profit from
the individual attention which comes with family
life. However, faeily care is also used for some
natients who have resnonded so well to the intensive
hosnital treatment that they are placed in homes as
a theraneutic measure with the purnose of hastening
their recovery and rehabilitation.1

Horatio M. Pollock defined family care as follows:

...if a natient no lonrer needs active institutional
treatment but needs psychiatric halo and guidance in—
definitely and is placed in the custody of a family
not his own, he may be rewarded as being in 'family
care.‘ with this broad internretntion of the tern
the family care Froun would include convalescent
patients as well as the chronic type in which little

 

1Hester B. Crutcher, Foster More Cars For Pentsl
Patients, New York, The Conwonwealth Fund, IQHh, P. 2.

or no improvement can be expected.2
The Michigan State Department of Vental Health

defines fanily care as follows:

Family care in Michiran connotes the placewent
of special types of mental patients including the
defective individual with fanilies other than their
own. Generally sneaking, the broad classification
of patients selected covers two groups, the type
of patient who is classified by the hospital as
being a continuous treatment case...(and) patients
selected primarily for therapeutic reasons.3

The VA defines family care in still another way:

An important voal of the hospital treatment is
to enable the patient to re—establish himself in
the community under the most satisfactory conditions.
The placement of patients on trial visit provides
an intermediary step for those patients who are
believed able to live outside the hospital but are
not ready for complete discharre. Those patients
who do not have a supportive family situation to
which they can return may be helped to find guitable
homes other than their own in the community.

In an article on family care in the Veterans
Adninistration's Program Guide family care is defined

like this:

VA foster home care is defined as placement
of psychotic patients on trial visits in homes other

than their own, where responsible persons are receiving

payment from the patient for giving him care and

 

2Horatio M. Pollock, Ph. D., (96.), Family Care
of Mental Patients, Utica, n. Y., State Hospital Press,
T636 ) I). 71"”.

3FaMily Care "annal, State Department of Rental
Health, Lansing, Fichigan, 1951, pp. 1—2. '

 

”Veterans Administration Technical Bulletin,
TB lOA-27¢,'Washington, D. C., Veterans Administration,
1951, p. l.

guidance in direct collaboration with the Veterans
Adninistration.5

At the VA Hospital in Battle Creek the purpose
of family care is defined as follows:

Family care is designed to provide hoses for im-
proved patients who for one reason or another may not
be sent out on trial visit to their own homes or to
their relatives. Family care is extended hospital
treatment need by many hosnitals for the rehabili-
tation of their patients. Frequently, following
family care, patients are able to return to their
own hones and communities.

The above definitions agree that family care may
be used for the plaosnent of patients in the co munity
who are not able to return to their own hones for any
number of reasons. It allows the patient to live in the
community and still have contact with hospital personnel
for supervision and assistance in making the transition
from the hospital to the con~unity. The definitions point
out that two types of patients are nlaced in family care,
that is, the continuous treatment cases placed in family
care for custodial purposes and those who can use family

care as a therapeutic device to assist them in recovering

from their illness. Although some definitions include

 

5Roaer Cumming and Irene Grant, ”Foster Home Care
for Psychiatric Patients in the Veterans Administration:
Developments in 1953.” Program Guide, Psychiatry and
Neurology Service, G-l, h-Z, Part X, Washington, D. 0.,
Veterans Administration, March 1955. D. 15.

580 e Facts About Family Care, Battle Creek,
Michiran, Veterans Administration Hospital, (no date), p. l.

 

the mentally defective with the mentally ill, in this study
only family care of the mentally ill will be considered.
Although family care has not been used to any
great extent in this country, it has been more popular
in Europe as a means of caring for the mentally ill.
This t-ne of treatment had its origin in Europe during
the ”iddle Ares. Gheel, Pelgiun seems to be the place
where the family care plan originated. Pilnrims from
all over Europe came to Gheel to worship at the shrine of
Dymphne, the daughter of an Irish king who fled to Gheel
to escape the incestuous advances of her father. Soldiers
of the king sought out and killed Dymphne and her com-
panion, a priest, at Gheel. Her tomb became a shrine to
those afflicted with mental illness because it was be—
lieved that by worshiping there they could be cured of
their illness. Because this shrine became so well known
in Europe, great numbers of mentally ill came there and
the town became so crowded that its meager facilities
could not accommodate them. As a result, the townspeople
began to take the pilgrims into their hoses. It was ob-
served that the attention given to the mentally ill in the
homes helped them recover from their illness. Later, a
small hospital was built at Gheel which was to become the
center of a state colony for the mentally ill. Since that

time, it has been the tradition of the people of Gheel to

10

provide care for the mentally ill in their homes. In 1852
the plan was taken over by the state. Patients would be
admitted to the hospital and, within a short time, to a
home that it was felt could help then recover. Doctors
and other hospital personnel would then go out from the
hospital to visit the patients in the homes on a regular
basis. This program is still being carried out.

In 1857, Scotland initiated a plan whereby one or
two patients were placed in various hoses. The homes
under the Scottish plan were widely separated so the
patients were not able to pet supervision and attention
from the hospital physicians and staff as di'1 those
patients placed under the Gheel plan. In the Scottish
plan the guardians who cared for the patients were selected
by the Inspectors of the Poor instead of the hospital.

Other European countries began to use the family
care plan including France in 1992, Switzerland in 1909,
and Germany in 1911.

The family care progran has been more widely used
in European countries than in the United States to care
for the mentally ill. As a whole, the Gheel or colony
plan for family care has been more popular in both Europe

and the United States than has the Scottish plan.7

 

7For further history of family care in Europe Bee:
Pollock, on. cit., pp. 115-135 and 161-175; also Hnysie
T. Osborn, “The Use of Family Care as a Treatment Procedure
with the Mentally Ill,” Mental Hygiene, XXVII, (July 19h3),
u12-u23.

11

The first family care of rental patients in the
United States was started in Vaseachusetts in 1885, with
two hen chiefly resronsible; Frank B. Sanborn and Dr. Samuel
G. Howe, both of when served on the State Forrd of Charities.
They seemed to be outstanding in their understanding of and
interest in the mentally ill and retarded. The State hoard
of Charities stressed the imnortance of the family care
Drorrem and in l?85 the State Board of Health, Lunacy. and
Charities was authorized to place Patients in family homes
and to visit or supervise then after rlacetent. In 1¢lS
the Board discontinued tie placement of patients and this
responsibility was tr‘en over by the state hoeoitels.8

Since Massachusetts sterted this program in 1985
it hzs had a slow developaent in the United States. It
was introduced in Pennsylvania in 1932; New'York in 1933;
Nebraska in 1°3h; California in 1°39; Rhode Island in
lgho; Illinois in lle; Yaryland in lohl; and Michiran
in 1es9.9 I

In the VA, the family care program grew out of
a need to plan fcr those patients for wnom maximum hosrital

benefit had been achieved. In 1936 a family care program

 

8For further history of family care in the United

States see: Pollock, on. cit., on. 21—37; also Leo Maletz,
".D., "Family Care-~A Method of Rehabilitation,“ Mental

Hygiene, XXVI (October 19h2), Séh-éns.

9Crutcher, on. c‘t., no. lal-lQh.

12

was started on a small scale. By 19h9 the program had
expanded so as to affect more patients and a larger number
of peoole within the community. In 1951, the VA fully
adopted the family care program as a means of planning for
the placesent of patients in homes outside the hospital.

The family care program had its beginning in the
VA Hospital at Battle Creek, in 19b9. One patient was
placed in a family care home as an experinent. By July,
1950 only one home was in use but three others were being
studied as possible foster homes. By October, 1950 an
additional placement had been made. In 1951 the Chief of
Professional Services requested that serious consideration
be given to the enlargement of the program, and at the same
time it was recognized that adequate social planning was
needed in considering a patient for family care placement.

In July 1952 one social service staff member was
assigned to be the Supervisor of Home Care. This laid
the around work for expanding the program. There was
communication between the Supervisor of Home Care and other
VA hospitals, state hospitals, the State Department of
Mental Health, and the State Department of Social Welfare,
in an attempt to gather information on which to set stan—
dards for this program.

The program continued to grow, and in 1953 twenty

patients were in family care. It became obvious that the

13

plan involved more work than one person could handle effect-
ively. Therefore, in 1953, the forner Supervisor of Family
Care becaee the Family Care Home Finder. Two additional
staff members of the Social Service Departaent were assigned
to family care work with one becoming the new Supervisor of
Family Care.10

In July 195h, the first family care meeting was held
with 18 family care therapists attending. The therapists
were given an opportunity to discuss with the social workers
and doctors the problems facing them in their work with
patients, discuss the dynamics of mental illness with two
psychiatrists and to Join in the planning of the program.
The members of this group agreed that regular quarterly
meetings would be helpful in their efforts in dealing with
the patients and their care.

Cn December 31, 1955, there were uh patients in
family care. Thirty of these patients were placed during
this year. The total number of patients in foster homes
since the inception of this program is 72.11 At this time

there were #5 homes approved for use in the fa ily care program.

 

loseni-Annnel herrative Peport On Social Services,
Fattle Creek, VA hospital. Unpublished reports prepared by
the Social Service Deoart“ent for use by the VA Central
Office, June 1950 to March 1956.

llReport of Placement of Patients on Trial Visit in
Homes Other Than Their Own During Calendar Year lCfij, VA

Form 10~2h9h (NR).

lb

A brief description of the setting in which the
fatily care progrnn and this study are being carried out,
is essential. The VA hospital at Pattle Creek is a 2,000
bed neuropsychiatric institution located six miles outside
the city of Battle Creek on the Fort Custer Military Reser—
vation. There are approximately 1,000 employees to serve
the patients. he ennloyees include doctors, social workers,
nurses, psychologists, clergyman, occupational therapists,
educational therapists, hospital aide, administrative per-
sonnel, and others. The resources of the Hospital are
created for the patients in an attempt to rehabilitate
those that can be rehabilitated, and so arranged that the
patient can live wholly within the setting.

The patient population is largely psychotic and
ranges fron those patients who are repressed to the infan-
tile level to those who are sufficiently recovered to re-
enter the larger coppunity outside the hospital. The latter
group are the patients with whom the fanily care program is
primarily concerned. It is felt that not only the social
service and medical staffs should share in the promotion of
family care, but all personnel dealing directly with the
patients. All personnel need to be aware of the program
and its benefits for those patients that can qualify and
help in the preparation of the patients for fanily Care.
This program is not a social service and/or medical program

alone, but involves the total hospital personnel.

CHAPTER III

The method used to carry out this study was that
of groupinn deta g thered by four means: interviewing people
dealinr with patients involved in the family care Program;
observation of workers deelinr with patients; personal
experience; and a review of the literature on the topic.
St"tisticel data were not used because the purpose of
the etndy was to describe the ferily core plan, not to
evoluate it or any of its cosponent ports.

Interviews were conducted with nenbers of the social
service steff enreged in the fanily care plan. Members of
the redicel staff were also contacted concerning their role
in the total progran. The interviews were not carried out
on a structured basis. A great derl of material cane by
casual conversation with social workers, doctors, and
psycholorists at tines when they would meet end telk about
the prorrem inforrnlly.

Current thinking about fanily core was obtained
not only from those derlinn with the program on a full-
tine basis but fron all social workers connected with_the
prorran to any degree. A schedule of specific questions

was not used in the interviews because different infor—

15

l6

mation was sought fron the various workers depending on
their role in the program.

Observation played a significant part in this study.
The author had opportunities to accompany family care workers
on field trips to fanily care homes in which there were
patients residing. The author was able to talk to both
patients and family care therapists about their feelings
concerning the program, along with the problees which arose
as a result of the patient being in the hone. The visits
provided an opvortunity to observe the family care workers
in their dealings with both patients and therapists, as well
as a first hand account of some of the actual applications
of social work skills in the family care program.

A portion of the material used in this study came
as a result of the author's personal exnerience. The author
is now worhing with three patients, preparing thee to enter
family care. Jith others, the author is attenpting to in-
troduce them to the plan and motivate them to consider it.
In preparing the petients to leave the hospital for family
care, the author has worked with other hospital denartments
and has had contact with the VA Regional Office. Interviews
were held with the relatives of patients to explain the
procran and the reasons for placing the patient in family
care, to try to gain their consent to place the patient and

to enlist their help in planning for the patient's care.

17

The study of docuaents accounted for a large por—
tion of the material used in this study. Docunents were
not only important as a major source of information but
served to clarify questions tha arose free the other
sources of data. Reports and other written meterials con-
cerning fanily care were supelied by the Social Service
Departnent at the hospital.

Documents used included office me orande, papers
prepared to describe duties of the workers in dealing with
patients to prepare and motivate them for family care,
reports to other VA offices, retorts of meetings dealing
with family care, and special VA forms used in the family
care progran. In addition, other material from the VA was
used such as the Technical Bulletins and the Progran Guides
which spell out the policy for the entire VA system to
follow in this program.

The author has attespted to harshsl the facts
gathered from each of the four sources. The data have
been gathered from a wide variety of sources and focused
toward one goal, that of describing the farily care program

in one VA hospital.

CHAPTER IV

SELECTION AID 'HSPRKfiTIC? o? PATIV $8

FOR FA ILY CARE

Patients selected for family care are usually
those who have successfully noved through their trestrent
proyrss in the hosritsl and are ready to try to live in
the coununity under supervision. The patients may be free
from the sytptons of their illness such as delusions or
hallucinstions, or have then under control to the extent
that they will not be objectionable in a community. A pa-
tient must be able to care for his own physical needs
before beinr considered for family care. Patients who are
honicidnl or suicide , those showing alcoholic tendencies,
or those shoving sinus of sexual deviation are not con-
sidered for fanily care. Patients that are noisy, dis-
turbing, or overly agreesive way not be considered because
of the upsetting effect that they “irht have on the home
and coenunity inzflich they would be living.1 The VA hospital
selects the patients who will derive the sreatest amount of

heraneutic value from the nrogrnn.

Fasily care is a type of trial visit under VA regu-

 

lCrutcher, on. cit., chap. h.

18

l9

lations, thus only patients with psychotic diagnosis are
eligible for the progran. Trial visit is explicitly arranged
for psychotics only, with non-psychotic patients receiving
another kind of release from the hospital.

Patients vho heve made a food hosnitsl adjustment
and have resnonded to treat ent well but cannot return to
their homes, are often placed in family care. The reasons
for not being able to return home fall into one of a nu ber
of categories. Some patients are placed in family care
because they have no families to whom they may return or
that are able to care for then. Others cannot return to
their homes because their fanilies do not want them; they
may be afraid of the patient because they do not understand
the illness. Still others are unable to return to their
homes because their former family life had within it factors
which helped to hrecipitate the patient's illness. To place
the patient within the sane environment might only serve
to lessen or negate the benefits the patient received at
the hospital. In the latter cases, the family sometimes
wishes to have the patient return to the hose. In such
cases, interpretation of the family care prorram and its
benefits for the patient is given to the fanily. They may
fail to recognize that there are disturbing influences in
their family relationships, upsetting to the patient. The

worker may try to help then understand why the patient is

20

being placed in a fanily care home instead of returning
hin to his own home.

As patients move through their treatment program,
the various menbers of the hosgitcl staff are in a position
to be on the lockout for possible family care candidates.
hospital staff menbers such as teacher, nurses, attendents,
and social Workers usually deal with patients more closely
than the doctors do. This fact enables them to identify
those patients that may be potential family care candidates.
Staff members may bring to the attention of the ward
physician those ratients whom they feel would benefit
from family care. They have an opportunity to observe
the patients in their day to day life within the hostital
and are able to give valuable information concerning the
patients' adjustment to he hospital. The final decision
concerninc the selection of yetients for fanily care rests
with the ward physician. he compiles a list of potential
family care candidates and submits it to the various
hospital departnents concerned with the preparation of can-
dioates for placeuent.

Patients tho have resyonded well to hosoital treat-
ment and are ready to leave the hospital are selected for
this program. Because they cannot return to their own
homes, they are given an on ortunity to live in the com-

munity in homes selected by the hospital. The patients may

~""

21

have made a fair adj strent to the restitel but improve
even more outside, under hosoitsl suoervisioz. Thus they
are ylecefl in tNis profirrn because they can be ease” into

a
. 1..

"Mn .,.,....,~z+. .—‘~ r ! -, .. .. .. u . " !
tat co; UALUJ iu;te:J uf beLn; f reed uto ~aning s crostic

CHFHCE free the shelterei hcsfital ervironwent to the cow-
petitive CO'mUflity life.

The social service derertment assumes a large share
of the resoonsibility for the ectuel oreparetion of the
patients chosen to leave the hosritel. One of the early
stens in this process is to conplete a form entitled,
"Reccnwenfletion for Trial Visit of Patient in Home Cther
Than His Own."2 This fore must be conrletei by the ward
physician one registrar as well as the social worker. In
most cases the social worker totes the initiative in this
matter. The social worler is celled on not only to complete
his portion of the fore but at ti so to assist the word
physician and the registrar with their sections of the form.

The doctor states why the patient is being referred
for family care, the petient's diagnosis, his legal status,
and the psychiatric or wefiice stervision needefl. The
registrar is askefl to flisclose facts about the rstient's
source of income and gnsrflionshin. Social service spells

out the patient's hoopitelizetion history, his readiness

 

28ee Acnenoix A for a copy of VA Fern lO-RhOE,
”Recowmendetion for Trial Visit of Patient in Poms Other
Than His Own."

Tx)

(‘3

to live outside the hoaritel, onfl th kin3 of hose son

(I)

family which would op ear to best meet his needs. This
form is then included in the rotient's case record to be
used as a source of infornntion to help in planning for
place‘cnt.

Soon after the floctor sUKFents th:t a nrtisnt be
considered for fsnily care, the social we her may ssh the
psychology fierort‘ent to test the patient. T?" test results

eter ins wiether or not there rre oersonnlity choreo-

5
H
‘5
;

teristics which rust be considered before and after place—
. An aflJition 1 reason for referring e fistient for
testiny is that th psycholory derert ent is carrying on a
research project to deterfiine if there ore certain person—
ality characteristics which ray be necessrry for a good
family care cijuettent.

The social worker helps the patient trerere to
leave the hJGTltal by attempting to notivate his to eccept
this change. Although this may begin at admission end run
throughout the treatment process, it is intensified after
the netient has been svrfested fer fa ily care. The w=oti--
vetion of the patient may inclufie a fletoiled exnlsnation
of the program and on so ertnnity for the notient to ask
questions about it. Th; worker clnrifies with the patient
that he needs a nininnn of TUOO in his estate before he can

be considered for this rrogfr”n {on all pay ents for his

23

care must be rain from his own money. Hotefully) this has
been exnleined to the pstients before the floctor recommends
then for fewily core.

hu>n©rkerimgim elmiéafilsln'tni;the WV} finals
ceareé to those “itients tbrt keve shown a good adjustment
to the hes itol and have P8?”6H€GR well to their prescribed
treatwent. For those who have no feoily ties or are unable
to return to tneir families, the vor”er Wlfht explain the
this orcrran is a way in which the recovering retient may
leave the hospital on a trial Vin t. This “eons that he
will receive sneervision fron the hoenital staff and other
hosnital benefits such as access to the denttl enfl neflicsl
facilities. If the rotient feels unsure about being able
to live on the outsifle, the feet thvt this nrorrni gives

his

l" Q

‘n oerortunity to leave the hosvitsl and yet be under
the supervision of both .he fa ily care therenist end
hospitel oursonnel ray be a large factor in motivating him
to leave. The stairles of other netients who have used
the flee to their benefit may be a 5094 wry of showing

the notient thot this is a clan which way holfl some value

The patient is helrei to feel thrt he has a voice
in all this planninr. One may of sccowrlishing this is
to heve the patient re with the fenily care worker into

be com unity to visit knees which hrve been eprroved by

pt

1. b

the home finder. Ruring the yrocers of ;rep ring a fatient

for forily cere en inforeal meeting is held to determine

‘1
’3
(D
L!)
{.1
m

the tyfie of home which right best first the yetient'-
from thoee aVsileble. This pron , called the Failly Cere
Board, is made no of the surervieor of fcvily care, use

home finicr, the fa ilv care social ”0PK6P and the inglent'e
social worker. Fy reviewing what the patient needs in a
rose and those homes available, a aecieion is mzfie ttet a
patiefit Tlfht fit into one of two or three hores. Following
this meeting, the patient is taxed by the fs-ily care worker
into the ho'e to visit. He has an orrortnnity to see the
hose, "eet the therapist so? other fswily sewbere, ant then
flecifie which of the homes he would rrefer. If the thera-
pist agrees that the fietient will fit into the haee, a big
step in the preperstion of the petient hes been made. This
also fills”? the 1airf-zur to hrve e wore realistic picture of
what the raffle-"1t KIC'WtS $.an DEE-.38 in the c<:“e1tuz’1.‘..t3,' eta“. ‘rmy

hoefital.

(h

rive to e signs of his Willirceese to leave t:
Tiis ifiporflrtion will be evallehle when the tetiert is pre-
sented icr the Trial Visit Beard, as a rule.

The social worker way help the patient rrepare
to leave the hcebitnl in still other ways. The VA re—
quires that the betfient have a rhyeicel xzrinetion in—
cluding a chest X—rry, a dcntel eve instiOfi, and cow?

pletion of ery reeflea dertcl T"or? before the “otient Key

25

be placed. The social worker may be required to e phasize
the need of these exarinetions eon encourage the patient
to keen all an ointwents in an effort to hasten the ful-
fillment of this reqairerent.

Cne important area to 1e c ver ed in the :repar-

ation of a fisti ent for for ly care is thet of finnncfifi l

‘)

arrrnsetents. The ertient's funds vsy'b. handled by his

l

ganrfiiux or oy the hoe ital tenafer. T36 VA has an estab-
lished policy concerning the fins~cial arrangements for

fenily care.3 For those petiente who no not have a guardian,
the ona,er of the hoorwit l cares for the patient's funds
which are in an account at the hospital. Inesnnch as the

p meets for fo:ily care meet come fron the patient's funds,

"J
a:

he should have sufficient savinns, compensation or pension
payments, incone, or other estate to defray the cost of the
progrex. If the hoshitel menefier is responsible for the
handling of the patient's funds, he sends a check for the
cost of the patient's room, board, and laundry to the family
care therapist. At the same tine he will send a check to
the patient for a monthly sllotsent to cover his incidental
exoenses. If it is in the hest interest of the eatient,

the funis for all exoensee will be sent directly to his,
thus riving him the responsibility of making the actual pay-

ments to the therapist. One of the therapeutic aims of

 

3Veterans Adninistretion Technical Pnlletin, op. c‘t.,

p. 3.

26

this program is to help the patient learn how to handle his
funds himself.

In those cases in which a guardian has been appointed,
all arrangements for family care are made with the guardian's
consent. It is the guardian's responsibility to make all
financial arrangenents for the patient, subject to court
approval. The guardian is to be advised by the hospital if
the payments are to be made directly to the family care
therapist, with a separate check to the patient for inci—
dental costs, or if the total amount is to be sent to the
patient. The VA regulations governing payments for family
cars do not allow the guardian or manarer to rake payments
to the family care therapist, which include the patient's
allotnent for incidental costs. This gives the patient the
freedom of having some funds for himself regardless of the
arrangenents made for the cost of maint dance. It is
essential that the guardian understand that all payments
must be made promptly and regularly. The hospital requests
the services of the Chief Attorney of the VA Regional Office
in making financial arranfienents with guardians. The Chief
Attorney may also be called upon to work with guardians as
other matters may arise.

Payments for family care are f25 per week or 9108
per month. Inasmuch as the paynents are made in advance,

the first month's payment must cone from the veteran's

27

funds at the hospital. The guardian or the manager will
be notified as to the date on which the payments are due.
If a guardian is handling a patient's funds the hospital
will turn over What funds remain in the hospital account
to the guardian when the patient goes into fanily care.
It is customary for the social worker to write to
the Chief Attorney in cases where a conritted patient is
to so into family care, stating that the patient has been
reconnended for fanily care by a me‘ber of the medical staff.
The purpose of this contact is to determine the extent of
the veteran's estate and sources of income. The Chief
Attorney's office may also be requested to notify the
patient's guardian of the plan for possible placenent and
ask his 000“eration in matters pertaining to the placenent
and continuance of the patient in the family care program.
When it has been determined that the patient is
ready to be placed in family care, the doctor who recom-
mended him will schedule the case for presentation before
the Trial Visit Board. Notification is given to the hospital
denartcents concerned, including social service, two weeks
before the case is presented so the departnents may prepare
whatever material they may have to present to this Board.”

The Trial Visit Board is made up of the Chief of

bSuggested Procedure for Presenting Patients for
Trial Visit, Battle Creek, Michigan. VA Hospital, 1Q55.

 

28

Intensive Service or the Chief of Continuous Service, the
patient's doctor and one additional doctor, the social
worker, a psychologist, a representative from the registrar's
office and the nurse and attendant fror the patient's ward.
Each of the above mentioned personnel is asked to rive
inforretion about the patient which would be helpful to

the Board in carryinp out its function. Personnel from

the Physical "edicine Rehabilitation Service including
manual erts therapist, occupation therapists, educational
therapists, and others of this service who have dealt with
the patient eubnit written menorandn to the Board concerning
their contacts with the patient. At times, these repre-
sentatives may be asked to attend the meeting of the Board
in order to present their information. In addition to

those mentioned, a stenographer is present to record the
discussion and recommendations.

The social worker is asked to evaluate the patient's
home situation, his relationship with his family, and the
family's attitude toward the patient leaving the hosDital.
It is necessary for the social worker to obtain information
from the family either by personal interview or by corres-
pondence. The social worker oupht to be prepared to tell
the Board if consent has been given by the family for the
placement. The social worker is also asked to evaluate the

economic status and/or needs of the patient and his fanily.

29

Local community social agencies that are available to suver-
vise and give support to the patient and family are evaluated,
and the infor ation obtained presented to the Board to help
them make their evaluation. In his recomuendations the
social worker may state that in the lirht of the above facts
about the patient and his family, it is advisable that the
patient be placed in a family care home.
The physician presenting the patient is called upon
to Five a brief history of the events leading up to the
admission of the natient to the hospital, his diagnosis,
the treatnent urescribed, the adjustment to the hospital,
and the doctor's recomnendation which, in the case of a
patient being preoared for family care, would be to place
the patient in one of the hospital‘s family care bones.
The repistrar will wake the patient's clinical record
available to the Board and will have information concerning
the patient's legal status and financial situation. Repre-
sentatives of the other hosrital services may be called on
to ado infor“etion about the patient not covered by the
renorts riven by the doctor, social worker or registrar,
and which might have a bearing on the patient's adjusteent
outside the hosnital. The patient is then interviewed
before the Board by the physician preeehtinp the case.

he interview will be focused on bringinp out the natient's

contact with reality, the hresence or absence of delusions,

30

his hostile attitudes, and the patient's thinking which
might indicate whether or not he is suicidal or homicidal.
The physician helps the patient express his understanding
of the meaning of the placement, his plans while in family
care, and his attitudes toward returning to the hospital if
the placement is not successful. Following the interview
with the patient the Board determines if he should be placed
in a family care home or if he requires a loneer period of
hospitalization.

As soon as possible after a patient has been approved
for family care by the Trial Visit Board, arrangerents are
made to place the patient in the home selected. Usually
by the tine the patient is presented to the Trial Visit
Board he will have had his physical examination, his dental
work will have been completed, and he will have his clothing
and valuables available so he can move into his new home as
soon as possible. Final arrangements are made by notifying
the family care therapist that the patient will soon be
coming to the home. At the time the patient is placed, the
family care therapist signs an "Agreement to Provide Home Care
for Patient" and the patient eirns ”Patient's Agreement with
Hospital in Relation to a Home Other Than His Own.”5

 

5See Appendix B for a copy of VA Form lO—ZHOQ,
”Patient's Apreement With Hospital in Relation to a Home
Other Than His Own," and Appendix C for a copy of VA Form
lO-Zth, “Agreement to Provide Home Care For Patients.”

31

The role of the social worner in the preparation
of e patient for family care is cliefly that of motivating
him and sivinp support, so that he will be able to go

hrough with placement plannins. The worker also contacts

outside resourres for assistance in this planning. The
family care preproo and the reasons for placing a patient
in family care are interpreted to the patient and his
family. The social worker acts as a meebrr of a tram which
is preparing the patient to leave the L "nital. Usually
the team relationship is quite informal. The social worzer
may be called upon at times to help the doctor, registrar,
or others concerned with preparing the patient for leaving
the hospital. 0n the more structured level, the team
relationship is seen in the Trial Visit Board in which the
representatives of the various departments must present
their material and reach a definite conclusion.

Some of the social work skills involved are inter-
viewing, recording,'interpretation of policy and plans,
and motivation of the patient toward leaving the hospital.
In the interview the worker may hrlp the patient bring
out his thinking and attitudes, both favorable and un-
favorable, toward the proposed plsr. In the interview
situation, the worker may be able to help the patient explore
the adjust ents that he may have to make in the covnunity.

Recording is importrnt to the worker inasmuch as it shows

32

the direction that the contact with the patient has been
taking over a period of tire. It is also valuable if the
patient's social worker transfers the case to n fanily care
worker, by showing the new worker the progress that has
been maie in groparing the patient for family care and the
direction that the contact with the patient has taken.

A careful internretation of the family care progren and
the reasons for placerent is given to the patient, his
family anfl/or guardian and other interf"ted people in-
cluding those Ge ling with the patient in the hospital.
This is done to elicit full cooperation fron all concerned
with the placeeent. Yotivetion of the patient often re-
quires thet the worker be patient smi understanding in his
efforts to help the veteran accept the plan as one which
is believed to have value for his. The worker must accept
the patient where he is in his thinking about the possible
placement, allowing him to set the pace in the planning
for family care. The worker needs to allow the patient
the freeflom of questioning any part of the program or the
preparatory work involves, anfl to be willing to answer all
questions promptly and truthfully. This helps to show the
patient that the worker respects ”in as a person, and gives
him a sense of participation in the planning.

It is up to the worker to prepare the patient if

his case is to be transferred to another worker. Some re-

33

gression in the patient's progress might appear because
of the breaking of one patient-worker relationship and the
necessity to establish another.

The patient should also be prepared to leave the
sheltered entironsent of the hospital for the more com—
petitive life in the community. Even in a family care home
in which the patient is under the supervision of the
hospital and the family care therapist, he will face more
comnunity conpetition and denands than mere required of him
in the hospital. It is up to the social worker to help the
patient face this reality.

At times it may be necessary to man pulate the
patient's hospital environment, in an effort to stimulate
his willinpness to enter into family care. It is sometimes
necessary to move a patient into a ward in which the ward
personnel are more inclined to work with patients in pre—
paring then for family care and in pointing out the values
of this progrsn. It may be wise at tines to place a patient
who does not show a greet deal of motivation to leave the
hospital in a ward where there are other patients who are
being prepared to go into family care and who show an en—
thusiasm for this plan. At the present time a special ward
has.been set up for patients being prepared for family care.
The doctor in charge of the ward is active in helping

patients enter into family care. he ward personnel are

31;

selected for their interest in the program and given training
concernin: family care. The need for a family care ward
was underlined by the shortage of socirl workers to deal
with this prograa, the diversification of tlought towards

q

the plan and secause of a need to fictivete the patients by

group nethods.£

At tiers it may be necessary to change a patient's
work assign ent or assign hir a job at the hospital, as well
as change the ward on which he lives. it re also be neces-
sary to take a patient free one work sseinnrcnt ans place
his on another. If a pet ent is a good vcrker on his Job
and the person fer whom he is working is nore interested
in the Job than in the rehabilitation of the patient, it
would be Justifiable to change the patient's work assign-
weht.

In he social worner's role as a member of the
hoseital team, he needs to cope with the rstirst's feelings,
attitufies, fears and questions about the placerent. Fe also
aesls with the feelings of fssily members and other
interes e4 persons, trying to point out the rehabilitative
values of the program. Finally, the yorker uses whatever
cou'un.ty resources are neePed to a~”e the gatieet's adjust-

ment in the community as successful as possible. The worker

 

6Semi—Annunl Narrative Report On Socisl Services,
October lL 1955 to Terch 311 1956, Battle Creel, iicnigan,
VA Hospital, 1956, pp. 5-7.

attemats to interp'et the progrs; to the community at every
opyortunltyg in an effort t3 help the community accept and
better understanl the aatlents who are being placed in
their midst. Careful selection of patients for farily care
is essential at tlls early stage in the use of the program
in this country. Mhile the coemunlty is learning to accept
these patients the social worker, along with other hospital
person el, neels to be particularly careful in choosing
catlente wlo, by tlelr ability to afljuet ta he co gunlty,
will help establleh tLls prograw as a velueble tart of the

treatwent of e otlonally ill persons.

CHAPTER V
SELLC'IICLEQ CF FAE IL‘I Chi-1E HOTELS

The selection of patients for family care is a co-
ooerative effort in which a number of hospital personnel
work tonether. The selection of homes to be uses in the
family care program, however3 is the resuonsibility of the
social service department.1

The ground work for the selection of homes is done
some time before the home is actually needed. This requires
that the community be shown the value of the proprsn. The
propram is interpreted to influential inflividnals and groups
within the coemunity in order to elicit their suooort.
Prejufiices and resistance toward mental illness need to be
overcome before the nrorram can become successful. Successful
rlscesent of patients helss to enucate the community as to
the veins of the family care propram.

Fethods of obtaininp aoolicntions from crossective
family care therapists can be placed into three groups:

conferences and meetinps, publications, and personal contacts.2

lVeterans Adfinistretion Technicol Bulletin, op. cit.,

T“ o 2 o
2Dorothea K. Hunter, hone Pinning. Unpublished

report prebsred for use by Social Service Desertient, VA
Hospital, Battle Creek, hichipan, no date.

36

3?

Conferences and weetings include oeetings with child and
adult olacins agencies; meetings with hosnital doctors,

..
1+6;

E
*3
C)
-’ )
0
’3

;y:en, attendants, volunteers and others; and
t

co «unity wee ings with veterans' service EPOOPS: church

prouns, Faiily Service Agencies, PTA groups, and Bureaus of
Social Aid. To these groups, representatives point out the
anily care proyruo and the needs for homes to carry out
the progra. successfully.

Publications, as a means of soliciting possible
ho es, include blind newsraper advertieeoetts requesting
ho es for ratients, personal advertiseaents and 1nquiries
made by patients, feature stories about faoily care in the
nearby city newspapers, and newspaper reports of meetings
such as the quarterly family care therapists' sections.

Pers nal contacts eade by family care therapists
with their friends and acquaintances, is a third method of
obtain as prospective fanily care homes.

It has been found that the requests for homes made
through newspaper advertisements have resulted in a large
number of apolications. However, many of these appli—
cations had to be turred down if the standards of the pro-
gram were to be maintained. As a result, this aspect of
the progro: has been discontinued. The rost successful
means of finding possible family care homes hos been through

personal contact wade by fatily care theranists. The other

methofl citeu has been wildly success1ul, accounting for a
snail “12113“? of the homes nor; ave. .16.}. .

nicn a ijneon sflc'xtzmi interesi:.in trovi.€iij care

in his hose for e Entient, he is as efi to fill out an 3‘311-
cation for t gn‘ rubs t it ts the hone finfier in the Social

Service Derart4ent. The fort, "Aprlicetion For Consideration

of Yove in the Trial Visit Progra-,"3 safe for a description

of tie hone, an outline of tie me here of the household,

and a listing of the florestic enl otnei Tired heir on the

prenises. 80‘s sp€01fic Curstio's i Ween the ”prlttl
status of the houseLclfler and fa ily tembers; church atten-

dence; dis names 01 tile lOWG from the hoszit; 1; whether or

not the fa ily has ever cared for a mental patient anfi, if

so, the oatient's relationship with the family; the willing—

o

'

ness of the family members to have a patient in the home;
and reasons for trking a patient into tie he s.

Tie VA he s listed so e of the factors to be con-
sidered by the hose finder in eve luatic on tne anrlicstio
for consideration as a family care home: he understen’iis,
ielp anfi interest tm. t tee family can provise for the
patient; the effects of tLe 1stient on family we bers,

sepecially .tall chilirex; the reasons for wanting the

 

——

3866 Appendix D for a copy of VA Form 10-2h07,
"Anglication For Co.sineration of IWove in t}. Trial Visit
Prograa."

 

patient in the home; the adequacy of the family inco:e, so
that it is not dependent on th: Jontbly psynents received
for care of a patient; the cultural background of the family;
tne social ens recreational activities available; ph*sical
standards of the tote and the physical conditions of the
family nethers.
The Lore finder reviews the epiliCetions received

and, if any are disap”roved, the applicants are notified

wi h an ez-zplsnstion for the disagganovel. I’Leieining; appli-

c nts are visited by the home finder for further evaluation.
The home finder uses on "Outline For Obtaining Information

as to the Suitability of Homes Other Than Patient's (.‘:*....':'1,"lL

to aid in reaching a decision as to the value of the
potential home in light of the over-all program. Three
factors must be considered: the personalities of the fonily
members, the resources of the comnunity, and the physical
setting of the home. The form lists questions to be answered
concerning the physics attributes of the home and its
positive and negative aspects concerning the care of patients,
the home finder's sun ery of interviews with references
given by he apolicant, the staniing of the applicant and

fanily in the comnunity, the favorable and unfavorable inter-

personal reletioneqips in the fa ily, and the general type

 

”See Anpendix E for s cony of VA Fore lO-ZMOS,
“Outline For Obtaininr Information as to the Suitability
of Home Other Than Patient's Own."

 

 

no

of pot-ent who could use the lone to best advantage.

The infor‘xtion obtained frow tnc visit to the home
is revie ed and t}~ose not resting the stundurds of the pro-
grot are re iccts"h The bones eiproved are kept on file
to be used as ”It outs are rloced in fsaily care howes.
Rejected ojrlicsnts receive an sxylsnstion in which the
uprier points out why tieir Lone would not fit into the
progrez. T is is on area which cells for skill in public
relations on the tart of the social "J-ker. Tn(se homes

‘

re chosen because the favorubie yoints in the;

m
’1
o
<
m
p.
(‘2)

out'cirl th; unfevoro .ble points. Whether or not a bone is
used eftcr sp rove 1 depends on the needs and desires of
the iniiviiual pat: nts be ing con msi oer red for £8 wily care.

bones are selected to mes , es fully as possible,
the various needs of tie patient. This requires both rural
and urban bones, hoses with and without children, a large
range of ages of therapists and family members, various
reli5ious faiths, a vice range of nationality and racial
b"0"Po lus, and V2rious social, educational, and 92p loy-
ment levels.

The hose finder's activities so fer beyond the
were selection of Loves. While a 322t1-ert is being pre-
To red for fs‘ily care, the home finder meets with other

social service Vernon'el 003gris in5 the F3 nily Care Iosrd,

to help select a home for the patient. The hone finder

 

L1

is able, by virtue of her Knowleflge of the home, to taint
out the vrluee of the available hoses. 0? boss available

the Fefiily Crre Terri narrows the nunbrr to a few hoses

in’er or snotbcr f""iiy care worker then takes the patient
to visit tIe be e; and observes hlf with the Ye ily wembsrs.
The F02? fin’er or ctir soci l "orker r:e y be able to help
the rztiert choose the bore i" which he would like to live

are at the e~“e ti e Peter iue if the fe.ily .e here feel

cf
4
5
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wor‘er ray be csllefl on to exilein the fetizrt

lie 2refls, eri possible to-

h
’2‘
.a
1-
’
I
V
P
.D

rerbere of the f: ily vith whi,2 going to live. The

retiert "2" worker Lurk toret closely to clear up

Onrttioie tfst tYe srtient way have about the family, the
co enmity, "list is expected of him in the hose, 3&9 othcr

questions thzt ray {rise reinii t22e 2ove from tbe Losyital.

;e hoes fisfler carries a s '11 c"sel<:-ed of

patients being TPEELTPi for fa 'ly core, eke also yerforns
the ss2e duties as other social worfiers in precering
*etiert: for fa*ily care.

pwd
.

In hows fisainr, t'e ociel wcrler must be siilled

ED

is inter retisq tIis plan to isdiviouels poi Frouos in the

co”.uuity to stitulste com unit? interest in the rroerem.

In the selsctiun of homes stzrhnaig to jufige the values of a
TM) a cwxicljsf so :- Sextieignl ca 11;: ":uie Ifixe

rgjact it Vb? ‘33 also be cal-

..‘ ‘ + ...‘ .‘- Q . I r ' rs
“u tact,” yhb 9 tn 19 th’lr *c ~s.
1"“ '1- ,— ‘N‘P- . ,,._. J‘ ‘ "1
Lbs 4;? ; \r u t _095:Ls u.¢ s e E 1115 :.u
4. -3 ,_ ~ \ ,‘ 9 v. \ _ a _. V.‘ .‘_
DOC. lQhLS uqeu u; t*: 5 CL 1 4uT_tP9 HE‘lixL wit“ tug ,re-

paraticn c? patiezts, in afiiltlpn to the a :9i skill“ of
being able t7 vurk in t1& ce-xunity. TLe h0“e flnuer must
not only be Sgillei as a caSE“cr¥9r but aLsn as a co -unity

..,.,:_ ‘ ,. 4,. ‘1, .~..';..°.-:..... 1.. -. ~. . -
(.’1"2.;;‘.J._.CI', 5.0 5:.“ la": be 5.0...0 t1) T‘-kJ;J.L.L.L-.p;‘ Tut-’3 I‘T’i-UUI‘LS’S Of

tES cor unity to Yelp test the needs of a s ec;al group

CHAPTEW VI

OYT'TT““**T-‘1I""' ('1 's «.mTY-vrnn TT
L4.~.L..le,J.-.. \' _. JJ'"..L._,'_-1 I..] , ‘.

F IT}? cm” vor- m1

Il'bx n. .. J -'h-'

The place ent of a patient in a family care home
does not mean thst social service contacts with him are at
an end. Supervision of both the patient end fsnily care
therapist must continue until the patient leaves the home.
Supervision of the patient to help his adjust adequately
to the com unity is of equal inportsoce to the selection
and preneration of the patient for placement.

Supervision of a patient in a family care home
nipht be thought of as help given to the rstient and fasily
witl which he is living, to mete the adjustment that is
involved as a result of the placement. This supervision
may be given by the supervisor of family care, the home
finflcr, the family care social worker or, in some cases,
by a member of the general social service staff. In super-
vising a patient in a home the social worker works largely

independent of direct supervision end without the support

 

5

1The rreetest part of the data in tnis shooter was
rathered from the United States Civil Service ConnieSion
Position Descriwticn, for Social Worker (Tsychietric)—
Fa ily Cure, fehrnsry 10, 1?56 and Snrervisory Social
horier (Psychiatric) February 10, 1956.

 

h}

AI .1 1.. -:..__,1 - - ..,., p1 V a L -...w -i.‘,.._.
oi ibve Losii--ut FuVlPO'lxxlt. sit'wthil tn: SmCl i. uni t?

he? 0412113 in 1“crefilletrlets 'id cnuervieorc clicrr.in5
woss‘lle ens of P ‘livt t“ n‘tieytx .n. F' ily Ctr?

t3 3 “i'cs, $1??? a.‘ ocr,siyn‘ h'ck crll for the wanker's
i‘flra en”£2it j: "5: g<7t. i‘r;31le.s (a no emz.'cj the juitiervt's
rij:st‘efit or these vhich we. prise between the patiett and
the fewily and/or comznnity Hey reqaire i restate action

by tie worker in the Hell. The social trorlfer oust be able

to set li its for the outiest ezi try to Mal; the fa ily

' _J
- b
H
H
<
1)
.~ 4
3:.»
c1-
,3
S"
,;
l
J
m
('
C
0

$55 Com'unity accept er-
In lirect safervision of the patient, th= worker

confers with him concerning his feelings and behavior during

his *Jjnet'ent to the home and the com unity. The worker

Fey try to help the patient transfer his depenfiency from

the hce;itnl to the family care therapist, and eventually

ae atterets

to help the Fetient to reflirect lie energy toward incepenflent

activities such rs greater use of recreational facilities,

tertici,;tion in concunity effeirs and, later, torsrfi eoyloy-

Trot. Full-tine e gloy‘ent is uswslly not encouraged at

“3
(1'

the outset; r: her, it is felt that it is to the patient's

c?

sflvcntsre to c ert with 9 gart—tiee Job and work toward
full-ti'e e ‘rloy :‘ent.
The social worker may confer with psychiatrists

about the nvtient's prorresr, the neefl to transfer a retient

 

“-5

from one home to another, and the final disposition of the
case. Independent thinkinr is necessary, however, on the
part of the social worker in making decisions in these
matters. He may also wish to confer with the psychiatrist
about awarding the patient an extension of his trial visit,
or to discharge him from the hospital. The social worker
is the key person in these matters because he is the one
with the opportunity to observe the patient in the home and
coniunity. When the patient is first placed in the fanily
care hone the social worker visits him on a weekly basis.
As the patient makes the adjustment to the home and com-
runity in a satisfactory manner the visits are reduced to
one a month. If the patient is transferred from one home
to another the visits would be on a weekly basis until he
makes a satisfactory adjustment to the new home.

The social worker must deal directly with the family
care therapist as well as with the patient. This is to
evaluate the effects of family life on the patient and also
to help the family develop ways of meeting the patient's
needs. To help the family do this, the social worker may
be called upon to give the therapist and other family members
support and encouragement by suggesting ways of dealing with
the patient and by interpreting his illness. At times it
may be necessary for the social worker to deal with the

problems of the therapist so that the therapist may be able

 

as

to work with the patient more effectively.

If the home is one in which the patient is not able
to adjust, it may be necessary to terminate its use for
that particular patient. In such cases, the worker would
interoret the reasons for the action to the family care
theracist. The factors in the family care hone which are
not conducive to the best interests of the patient are
pointed out so the theraoist will understand the reasons
for the action.

The family care theranists are helned to understand
their duties and resnonsibilities to the ratient by
attending the quarterly family care theranist meetinrs at
the hosnital. In these meetinps, they are elven an opoor-
tunity to talk to doctors and social workers, as well as
to other fanily care theraoists in order to gain more know-
ledge of mental illness and how to work with patients
suffering from “ental illness. In addition, the therapists
are helped to feel that they are a part of the total treat—
ment plan for the patients and to identify with the hospital.

In addition to supervising the patient and the
family care therapist, the worker is active with the
patient's family and ruardian. The guardian is informed
of the original financial agreement and of any changes in
the patient's family care home or in the financial require-

ments. If a catient is changed from one home to another or

 

13. 7

returned to the hospital, the guardian is,notified to stop
pay'ents being made to the fanily care therapist or to
change to the new therapist. The sane procedure holds for
those patients without guardians whose funds are being
handled by the hospital manager.

The social worker deals with the natient's family
concerning its feelings about the patient and his placement.
Although it may not be to the patient's advantage to return
to his own hone, the family mieht not understand this and
might feel some resent“ent toward the patient for wanting
to live in a strrnre hone. The worker may be called upon
to evaluate the patient's nroyress for the fanily and, if
it is necessary to change hoses, the need for this must
also be explained. The social worker may try to enlist the
aid of the fanily in makinc plans for the patient, both
while he is in the hosoital and while he is in fanily care.

The fa ily care worker who supervises the patient
in the family care hove is occasionally required to work
with patients who must return to the hosrital. The worker
may be able to help the patient return to the hoebital

through the casework relationship that was established

while the patient was in family care.

CHAPTER VII
SUMVARY

This study has atte pted to show how a family care
progran is carried out in one VA hospital, focusing on the
role of the social worker. If the family care program is
to function successfully, then the work of the social
service departnent in the hospital is essential.

The social worker assuwes an i~portant position in
the hospital team. A larFe share of the work of making a
successful placenent centers around helping the patient to
accept a placerent as being in his best interest, to help
his wake an adequate adjustvent in the home and conmunity,
obtaining suitable homes, and interpretations of the program
to the connunity. hany of the obstacles that must be over-
cowe are social work rather than medical problems. These
problens range froa the patient's unwillingness to accept
placetent, to the attitudes of the patient's family and
conmunity toward the patient leaving the hospital.

If family care is to be of value as a step in the
total plan to rehabilitate the individual patient, much of
the success of the placefient will depend upon how adequately
the patient was prepared for placement and how well he is

supervised in the home. He needs not only to be treated

h8

“9

by the medical staff so as to be on his way toward recovery,
but to have been motivated and prepared to leave the hospital.
The social worker is responsible for a great amount of the
work involved in preparing a patient for family care, yet
the need for a team relationship remains strong. Family
care thus is visualized as a program involving many of the
hospital services, and requiring effective working relation-
ships. The social worker may be called on at times to
initiate action which may involve other hospital services,
or to coordinate the activities of the various services.
Despite the social worker's apparent large responsibility

in this plan, the use of other services and of the teat
relationships are basic.

In order for the fanily care progran to be successful,
the patient and his needs must be the primary objective of
consideration. There needs to be a respect for the person's
desires and wishes and a recognition that he is entitled to
have a voice in the planning for his future care. The worker
begins with the patient at his level of understanding of
the family care program and his willingness to try this
type of treatment. The social worker then attempts, in
the main, to motivate the patient to accept this plan as
something which is felt to have value for him.

It would seem that if these two basic social work

principles were overlooked the placevent might not be

50

successful. A placement made against the patient's will or
without his full understanding could set him back in his
recovery, perhaps requiring a further period of hospital
trestwent.

In the family care progran the social worker must
use not only the resources of the hospital to help pre-
pare the patient, but also those of the community. The
nature of this program demands the support of the indi-
viduals and families in the coenunity as well as that of
the social agencies and social groups. Without their support,
this program could not survive. The comeunity may need to
be educated about mental illness and how it may aid in the
treatment of the mentally ill by providing care for patients
in their hoses. This conmunity education is necessary if
families are to be willing to open their homes to patients.

The family care social workers have a responsi-
bility to assist in the planning for a patient from the
tine he is recommended for family care by a member of the
nedical staff until final termination of the case. The
representatives of the other hospital services such as
doctors, nurses and psychologists, are chiefly concerned
with the treatwent and preparation of the patient to enter
family care. The social worker is not only concerned with
this treatwent and preparation but is responsible for the

additional task of finding homes in which the patients may

51

receive help in makinr an adequate comnunity adjustment,
and for the supervision of the patient in the home and
community. The homes need to be chosen with a great deal
of care, to be of the greatest possible therapeutic value
to the patient. The social worker must be capable of
riving skilled supervision to both the patient and the
family care therapist in an effort to help the patient a-
chieve a state of recovery from his illness which will en-
able him to be discharged from the hospital and to re—
establish himself as a useful and productive nether of

society.

 

APP E111) IC ES

 

 

RECOMMENDATION FOR TRIAL VISIT OF PATIENT
IN HOME OTHER THAN HIS OWN

(Summary of Psychiatric, Medical, and Social Data)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. NAME OF VA STATION 2. ADDRESS 3. DATE
4. VETERAN’S LAST NAME . FIRST NAME . MIDDLE INITIAL 5. DATE OF BIRTH 6. REGISTER NO. 7. CLAIM NO. 8. WARD NO.
C-
9. VETERAN'S HOME ADDRESS 10. RELIGION
PART I (To be completed by ward physician)
11. REASON FOR REFERRAL (Composition and attitude of family, and reason for not placing patient with them)
’9
12. DIAGNOSIS (Psychiatric and medical)
13. DESCRIPTION OF PATIENT (Physical appearance, personality, behavior, moods, etc.)
14. IS PATIENT MEDICALLY CONSIDERED 15. LEGAL STATUS
ABLE TO HANDLE OWN FUNDS?
[:1 [:J [:1 GUARDIANSHIP PRO-
YES NO COMPETENT D INCOMPETENT CEEDINGS UNDERWAY D COMMITTED
16. WHAT PSYCHIATRIC OR MEDICAL SUPERVISION IS REQUIRED?
17. WHAT MEDICATION IS NEEDED?
18. WHAT DIET IS RECOMMENDED?
I9. SIGNATURE OF PHYSICIAN 20. DATE
PART II (To be completed by the Registrar)
21. NAME OF GUARDIAN 22. ADDRESS
23. NAME OF NEAREST RELATIVE 24. ADDRESS 25. RELATIONSHIP
PATIENT'S SOURCE OF INCOME
26. VA COMPENSATION 27. PENSION 28. MILITARY RETIREMENT 29. INSURANCE 30. OTHER
3 S 3 3 $
31. HAS AID AND ATTENDANCE 32. NMOUNT OF INSTITUTIONAL AWARD 33. AMOUNT OF ESTATE HELD AT HOSPITAL 34. AMOUNT HELD ELSEWHERE
BEEN AWARDED?
I:I YES [I NO 15 3 3

 

 

Xpé 13‘2”; 10-2 406

VA DC 160504

 

 

 

 

MILITARY SERVICE

 

 

 

 

 

 

 

 

 

 

AND DURING MILITARY SERVICE

 

DISCHARGE FROM MILITARY SERVICE

 

35. BRANCH OF SERVICE 36. LENGTH OF SERVICE 37. HIGHEST RANK OR GRADE 1%. DATE OF LAST DISCHARGE 39. COMBAT ACTION
1:] YES [:1 .0
PART III (To be completed by social worker)
HOSPITAL AND EMPLOYMENT HISTORY
40. LENGTH OF HOSPITALIZATION PRIOR TO 41. LENGTH OF HOSPITALIZATION SINCE 42. TYPE OF HOSPITALIZATION OTHER THAN VA

D PRIVATE I:I STATE D NONE

 

43.BRIEF HISTORY OF EMPLOYMENT PRIOR TO AND AFTER DISCHARGE FROM MILITARY SERVICE

 

PATIENT'S READINESS FOR PLACEMENT

 

 

 

 

 

 

 

 

 

 

 

 

44. PATIENT'S AND RELATIVES' ATTITUDE TOWARD HIS PLACEMENT

45. PATIENT‘S WORK ASSIGNMENTS. HOBBIES. AND OTHER REHABILITATION ACTIVITIES

46. ABILITY OF PATIENT TO ASSIST WITH HOUSEHOLD TASKS

47. CLUB MEMBERSHIPS AND OTHER ASSOCIATIONS

48. PRESENT AND PAST CHURCH ACTIVITIES

49. NAMES OF PERSONAL FRIENDS INTERESTED IN THE PATIENT 50. ADDRESSES
51 PATIENT'S SPECIAL NEEDS. CAPACITIES, PROBLEMS. ETC.

52.TYPE OF HOME AND COMMUNITY DESIRED

 

 

 

 

I]

RURAL AREA

[:] URBAN AREA

[:l YES

 

[:1 NO

53. KIND OF SUPERVISION AND PERSONAL ATTENTION REQUIRED BY PATIENT IN THE HOME

54. DESIRABLE QUALITIES IN THE PERSON ASSUMING RESPONSIBILITY FOR THE PATIENT 55 PRE.
FERRED
AGE
RANGE

56. RECOMMEND PLACEMENT OF VETERAN IN 57. SHOULD EMPLOYMENT IN THE NEIGHBORHOOD BE ENCOURAGED?

 

 

58. SIGNATURE OF SOCIAL WORKER

59. DATE

 

 

 

 

APPEZIDIX B

 

932 on S, OOVNJOF mum. «ex

 

uh<o .m— «unusual» mume! 4<_UOM no mmDH(ZQ_m .V.

 

uh<o .m—

 

Z<¢wPM) no mm3b<20_m .N—

 

.ucoEueumm was: 9..
mucosa has 335 H 9.0qu “gone pesos coo—.33 aeauow 05 53 pi euhem 2: 5; acoaoouwe n13 mo 09500 of waffle
near; yoga ea 3 Eeocou go .539: ace anaemic cu vogue caste H 63:03 he 3 83:3: pee Supp—EH .295
.500.— qu m .02 so: 5. pose: cemen— ocu cu n .02 En: cm $0332? ucsoca ecu mar—aces men 3 ooewe H "gag.

 

mmmei 4<_UOm no w1(z ._—

 

 

 

 

 

 

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n .0
>4Ih20!
><m Oh wwx0< .h .02 I_<4U .w .02 zwhm_wmm .m z<¢uhu> no u1<2 .1
.Oz wzoxmwgmh .n mmu¢00< .N ZO_k<hm <> no w1(z .—

 

230 2: 2(1... uthO _
mEO: < O... 202.138 2. a<._._._mOI It; thzmm¢O< m.._.2w_.—<._

 

 

 

 

Sb

III):[:( C:

h.

APP}:

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OHVNIOH mm”. 3

 

wh<o .np mmwmoo< .m.

 

 

kz<U_Jam< mo mm3h<26_m .—.

 

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oer uoc meow 0; HH .oEHu ace «a Heumamos ecu Cu :uzuou
n.ucomuea ecu «weaves Cu uLMHu ecu e>e£ H gene poEuoHcH
coon o>e£ H .tHOLomno; HE Ho henEoE a moeooen cemuoa
gusto has um cc powceco nH amour—ye be: .Heumawo; 2.: «a
ceHanzca no hequsHeHUOme hthELouoocue uoLuuSH H
.uconcou so empoHBocx he usosums 05H» mo voHuoa zce pom
0E0; he Seem “HomEHL mucomne uceHuea use am so .Heucoe
so HeoHu>£a sesame .coHqucou m.ucomuea ecu CH omuoB
use new emcecu Ace nH euozu um coco um .e>oce woumHH

.oz ocoxaoHou pco oEac.—eumamo; o;« as uoxcca HaHUOm

use so ceHonzsa n.ucomuea o£u kumuoc Cu oouweH
4338; 9: .8: team,

eom>uom Hemoow oca Ho Lessee e an nHe>uoucH ueHawou um

peuHmH> on HHHB pce 020: SE cH mean mHL wcHunp maueun.

«Hmm> Hsmuu :0 ob HHHB «ceHuen oLu ueLu tCeumuopcs H
.oeeHHeB HaCOmuea «H; Loewe zooH pee
.ooH>uom chcsan .Uueon .EOOu LuHB acoHuea o£u opH>oha
HHH3 H .m .02 EeuH CH c30£m cues mHLucos ego as 0H .02
Eon—H CH poueoflccH oust 2t :0 05979: cucH acoHuea Baa:
o>one use uaoooe ou oouwe.vecwmmuopc: oLu.H ”Hzmzmmmu<

 

wIOI >2 OHI— hzw_h<m wIP hmmUU< 44.! mh<o .0,

no uh<m >JIHZOI th H< h2m_h<m m1» «Om wm<u Oh wum0< .0

 

mwmeB 4(_UOm no u2<z

.w

Z<_U_m>Im m.h2m_h<m no m2<z .h

 

K)
RH,

.02 1_<JU .w .02 mmhm_0wm .m kzm_»<m no w2(z .v

 

 

.02 uzoxmwauh .n mmwmoo< .N zo.b<hm <> no w2<z .—

h2m_.—<._ 80“. w¢<u mEOI un=>Oum Oh h2m2mm¢0<

 

 

 

 

 

 

Pom Approved
Budget Bureau No. 76-R354

 

VETERANS ADMINISTRATION
APPLICATION FOR CONSIDERATION OF HOME IN THE TRIAL VISIT PROGRAM

 

1. NAME OF VA STATION

2 . ADDRESS

 

DESCRIPTION OF

HOME OFFERED

 

3. NAME OF PERSON TO BE RESPONSIBLE FOR PATIENT'S CARE

0

 

4. DATE OF BIRTH 5. RACE 6. OCCUPATION

 

 

7. ADDRESS (Number, street, city or tom, and State)

HOW LONG HAVE YOU LIVED 11‘:

THIS COMMUNITY?

8 .

 

 

9. MARITAL STATUS (Check)

D MARRIED D WIDOWED

D NEVER MARRIED

[j DIVORCED D SEPARATED

 

10. DO YOU LIVE IN (Check)

E] OWN HOME D APARTMENT

D RENTED HOME

11. HOW MANY ROOMS HAVE YOU?

D OTHER

 

12. HAVE YOU A TELEPHONE? 13. IF ITEM NO.
TO YOU?

(If “ Yea,"

 

12

(If to yes."

IS " NO. " IS THERE ONE AVAILABLE 14. HOW FAR IS TELEPHONE FROM

YOUR HOME?

 

 

 

 

 

D YES D NO

CI ‘1" I: D ‘1"
YES D NO number) YES NO number)
15. IF ITEM NO. 13 IS "YES. " GIVE NAME OF SUBSCRIBER 16. ADDRESS
P‘.‘ '
17. DO YOU ATTEND CHURCH? 18. ADDRESS
(If “ Yea. "

D D name of

YES NO church)
19. ARE YOU A MEMBER OF THAT CHURCH? 20. WHAT IS YOUR RELIGION? 21. CAN YOU ARRANGE FOR PATIENT TO ATTEND CHURCH REGULARLY?

D YES DNO

 

22. NAME OF NEAREST RAILROAD STATION TO YOUR HOME

 

23. NAME OF NEAREST BUS STOP

 

24. GIVE DISTANCE AND DIRECTIONS FOR REACHING YOUR HOME BY AUTOMOBILE FROM VA STATION LISTED

IN ITEM NO. I

 

25. NAME OF SPOUSE

26. DATE OF BIRTH 27. RACE 28. RELIGION

 

29. MEMBERS OF HOUSEHOLD (Family and others)

 

A. NAME

B.AGE C. SEX D. RIlATIONSHIP E. OCCUPATION

 

 

 

 

 

 

30. IS ANY MEMBER OF YOUR HOUSEHOLD AN

D YES E] N0

INVALID OR UNDER MEDICAL CARE?

(If " Yes," what in the
nature of the illness)

 

 

 

V A FORM
APR 1953

10-2407

VA DC 160092

 

 

3|. DOM

ESTIC AND OTHER HIRED HELP ON THE PREMISES

 

A. SEX B. RACE C. AGE

D. DUTIES

 

 

 

 

HOME AND EAT WITH THE FAMILY?

D YES D N0 D YES

 

32. DO ANY OF THE HELP LIVE IN YOUR 33-IX>Y0U HAVE BOARDERS 34. ARE ALL MEMBERS OF YOUR HOUSEHOLD WILLING 35.
OR LODGERS?

TO HAVE A PATIENT LIVE IN YOUR HWE?

D YES I:] NO

 

DNO

 

IS APPROX I MATE AGE

AND SEX 0F PATIENT DESIRED?

 

36. HAVE YOU EVER CARED FOR A MENTAL PATIENT IN
[:3 (If ~ Yea,“
YES

NO give name).

YOUR HOME BEFORE? 37. WHAT WAS THE PATIENTS RELATIONSHIP TO YOU?

 

 

38. REFERENCES (Give name and address of two persons not related to you. Also, name of your Doctor and Minister)

 

A. NAME

B. ADDRESS

 

 

 

39. WATER SUPPLY SOURCE AND PLUMBING FACILITIES

CITY WATER D PRIVATE WATER
SUPPLY SUPPLY

D INSIDE TOILET

D TUB BATH

D OUTSIDE TOILET

D SHOWER BATH

 

40. LIGHTING AND HEATING EQUIPMENT

D D FURNACE-PIPED
ELECTRIC LIGHTS STEAM OR HOT WATER

D FURNACE-WARM
AIR

STOVES OR
ROOM HEATERS

 

41. HEATING FUEL
D WOOD

D COAL

DLIQUID FUEL

D UTILITY GAS D BOTTLED GAS

D ELECTRICITY

 

42. DOMESTIC ANIMALS AND FOWLS

D HORSES D COWS

D POULTRY

D PIGS DDOGS

CI cm

 

43. AMUSEMENTS AND ENTERTAINMENT ITEMS

D RADIO

D AUTOMOBILE

D PHON OGRAPH

D DA I LY PAPER

D TELEVISION

[j MAGAZINES

 

44. OTHER FACILITIES FOR CARE, ENTERTAINMENT. AND INTEREST OF PATIENT

 

45. WHAT RECREATIONAL OPPORTUNITIES ARE AVAILAB

LE IN THE CCMMUNITY?

 

46. WHAT IS YOUR REASON FOR WISHING TO TAKE ONE

OF OUR PATIENTS INTO YOUR HOME?

 

 

 

47. DATE 48. SIGNATURE OF APPLICANT

 

 

APP 1T'Z‘IDDC D

 

 

«LugeHCHI has Louuon Each

 

HDO> Oh L_Imzo_h(4u¢ wha—

 

Haum_wuo thZRL no xwm .
u0< mh<2_xomam< m. h

 

 

 

 

 

mmmmf

 

m £5.09... 55 H4

 

vcnmlfib .02 Bdwunfl uiuvam

veto.— an< Eon

..

I .

_ uEO: m

23.:me .8—

 

 

 

 

 

 

 

 

 

meaon «9. 20:52.2 ;

 

  
               

56

APP EC‘LDIX E

 

 

 

 

_

 
      

m—ZOI LO >._._.G

inn-Ah .6- I10.-

 

          

“Hr—.2!

_m< 2n.

2°35..—

 

 

 

QmmwmommHZ. MI.— mm_mummo .

 

 

  

 

u,— OZ_2_<.—mO mOu wz.._._.:O

 

LIST OF REFEREI‘IC ES

FCOFS

Crutchér, Hester B. Poster Home Care for Mental Patients.
New York: The Comconwealth.Press, l?hu.

 

Deutsch, Albert. The Pentally Ill In America. New York:
Columbia University Press, lChQ.

 

Faeily Care Fennel. Lansing, Nichiran: State Department of
Fental Health, 1951.

 

 

Grimes, John Maurice, M.D. Institutional Care of Vental
Patients In The United States. Chicago: Privately
rrinted, 133b.

 

The Nantrl Health Prorrnrs of the Forty—Eight Statgg.
Chicago: The Council of State Governrents, 1950-

 

Pollock, Horatio M. (ed.). Family Care of I”ental Patients.
Utica, New York: State Hoeuital Press, IPBKT

ARTICLES

Cunning, Roger and Grant, Irene. "Poster Hone Care For
Psychotic Patients In The Veterans Administration:
Develonnents In 1C53," Proprae Guifie, G-l, F-2, Part X
("arch 1955): 15-24.

 

DeWitt, Henrietta B. “Casework Procedure In A Family Care
Froaram,” Illinois Psychiatric Journal, II (”arch, ISDZ),

Kent, Georpe. "Hones Instead of Hospitals," Survey Graphic,
XXXVII (June, isu8), 315-317, 327-328.

Valetz, Leo, W.D. ”Family Care - A Vethod of Rehabilitation,”
Vental Hygiene, XXVI (October, 1°h2), SSH-605-

Osborne, Yaysie T. "The Use of Family Cars A8 A Treatment
Proceaure With The Nentally Ill," "ental Pygiene, XXVII
(July 19b3), hlz-FZB.

6O

Planter, Ferraret, et al. “Family Care hanual For Social
Service Workers,“ Illinois Psychiatric Journal, III
(December, 19u3), 3D-50.

Pollock, Foratio N. "Requisites For The Future Development
of Family Care of Mental Patients,“ American Journal of
Vental Deficiency, L (October, 1Pb5), BZOHBZP.

Stern, Edith F. "Family Care For The Rentally Ill," Survey
Granhic, XXXI (January, lCLZ), 31-32, b2—Db.

Stuber. Katharina, ”.D. and DeWitt, Henrietta B. "Family Care
Place ent of State hospital Patients,“ Psychiatric
_ggerterly, XVI (January, lCDZ), IAN-155.

 

REPORTS

Hollier, Kellie u. and Farrison, Robert E. A Home Care Program
In The Cornunity. Palo Alto, California. Veterans Addini—
stration Hospital, 1955.

 

Hunter, Dorothea K. Family Care Program. Battle Creek, Michigan.
Veterans Administration Hospital, no date.

. Home Finding. rattle Creek, Michigan. Veterans
Adninistration Hospital, no date.

._:gtivation of Patients by A Social Worker. Battle
Creek, Jichipan. Veterans Adiinistration hosnital, no date.

Report of Placerent of Patients on Trial Visit in Pomes Other
Than Their Own During Calendar Year, 1955. VA Form lO—2h9h

Tan).

Veterans Administration Nosnital. Criteria for the Selection
of Patients for Family Care. Prepared by the Social
Service Depart ent. hattlETCreek, Fichhgan. Veterans
Administration Hospital, no date.

 

. Fanily Care of Patients. Preoared by the Social
Service Derart ent. rattle Creek, Michigan. Veterans
Administration Hospital, no date.

. Bani—Annual Narrative Report of Social Services.
Preoared by the Social Service Department. Battle Creek,
Michigan. Veterans Administration hospittl, June 1950-
“arch 1956.

e].

. Sore Facts About Family_Care. Prepared by the
Social Service Deoertment. Battle Creek, Michigan.
Veterans Administration Hospital, no date.

. Suggested Procedure for Presenting Prtients for
Trial Visit. Prepared by the Chief, Continuous Treat-
ment Service. Battle Creek, Vichigen. Veterans Adelai-
stretion Hosoital, 1955.

Veterans Adsinistretion. Veterans Administration Technical
hulletin, ‘8 103—279. Washington, D.C. Veterans Adnini-
stration, 1951.

 

UflPUDLISHED ”ATERIAL

Holden, Edith. "The Social Worker As A Com unity Fobilizer
In A Neuropsychiatric Hosrital.“ Unpublished Fasters
thesis, School of Social Bork, Smith Collere, 195h.

White, Irene. ”The Trial Visit Procedure." Unpublished
Vasters thesis, School of Social Work, University of
Fichigan, 1955.

OTHER SOURCES

United States Civil Service Commission, Position Description,
Vor Social worker (Psychiatric) Family Care, February 10,
1°56, and Supervisory Social Worker (Psychiatric),
February 10, 1356.

MICHIGAN STATE UNIVERSITY LIBRARIES

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