\H

l

  

M:

H

(

\ll ‘

H

4

  

1 N ‘

H

I.
W

H

!

‘t
l

w

A 1’31“ CY CT? CCF'IF.’UT~IITY—CIINIC

2::A“*”N3NII A: 222723229 BY
'3"‘T\' V'3"‘,f T ( Fm,» T f. 1‘.*( 7 r773 "VYVT ' ')
1.1? pr L'v iJ‘LL'Jk..L.¥ J 11;.

A

" ‘FT'.' n

“"Ija . c: 319, AymaI
7 1 ;

~7—1 .".
.1

'TH' '3 ITS I T

'd K A“ L‘J,

v, “n ~ TW" d)- v
“.11 \J Illv'LH [It '

‘\
5—4 ‘

 

gnaw

If-€§.3?Tii§mk35 A: . - .

7’ -
“ .
. ¢ ‘ ‘
I l' 3 ‘. 9|
; a" J o .
. . .a V ,
__ . , J H ,
,.
:. ' v‘ D ‘ _.. ‘:
~ ». 'o 1'“ $' fi'--‘=—- _ J

p
tit-muffin - -~'W invit-

f

 

 

 

A STUDY OF COILUHITY-CLINIC RELaTICEEHIPS AS REFLECTED
BY 93 ERRALS T3 LANSING CHIID uUIDAHCE CLINIC,

APRIL THROUGH JUNE 1955

by

M. Marianne Karin

A FYOJECT REPORT

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

~nr\'

v." (“ff‘fTT‘ .n r- “r, v ., v3
iniflréinii C; DOClALI nix/11F:

June 1956

Approved: WPMA Elias/LO

Chei fién"§es 1rch Committee
9

C) _ .
Z _ jinn '14,}h’3/Sk Cl- ,” ‘,.__...),.._:_. .1." .

’ Director offechool

3’“.
r". a" ,. ".9
J

ACKNOWLEDGMENTS

The writer wishes to express appreciation to all
those who made the completion of this project report pos-
sible.

Especially, she wishes to thank Miss margery Ross,
chairman of her committee, for her valuable suggestions and
her encouraging support. The other members of her research
committee, Dr. Gordon Aldridge and mr. Manfred Lilliefors,
also offered many helpful suggestions.

Further, the staff of the Lansing Child Guidance
Clinic granted permission to undertake the study and were
helpful throughout.

Finally, the writer wishes to express appreciation
for the interest and encouragement of family and friends
while in the process of making the study and preparing the

report.

P3
3?
L—i
l 'J
( 1
“j
( )

d‘TTrw: TmC
J 4JL'3.LQ

CHAPTER
I. IBTTRODTJCTIOZq O O O O O O O O O O C O
The Problem and Its Selection . .

The Setti mg 0 o o o o o I o o o 0

II. RELA ED LITERATURE A37 C‘HZTJT CPIHICN

Related Studies . . . . . . . . .
Other Related Studies . . . . . .
Related Areas . . . . . . . . . .
Current Opinion . . . . . . . . .
III. hqufiDOu GY AND I17373J§3P . . . . .
Objectivity and Validity . . . . .

IV. 1533? T2 ICU AND A"£:fuT° OF DATA .

Description of Children R ferred but

Characteristics of Children Seen at

Characteristics of

Characteristics of Clinic Plan . .
V. CUTS“ -.’:A‘?Y AID CCHCL'EICZIS . . . . . .

Summary . . . . . . . . . . . . .

Conclusions and Recommendations .

f
O

PAGE

15
15
17
19
2O
25
55
56

BIB'I.I:1G:3LJ&FHY O o o o 0

APPENDICES . . . . .

A.
B.

Schedule . . . .

List of Diagnoses

iv
PAGE
70
75
75
75

TAB L

1.

LIST OF TABLES

Cases Referred to the Lansing Child Guidance
Clinic in 1951, 1955, and in the Study
Sample by Source of Referral . . . . . . .

Problems Stated at Time of Referral as Chief
Reasons for Referring to the Clinic . . .

Problems Stated at Time of Referral as Chief

Reasons for Referring to
and Sex . . . . . . . .
Iroblems Stated at Time of
Reasons for Referring to
Crdinal Position . . . .
Help Expected as Stated at

of Referral . . . . . .

the Clinic by Age
Referral as Chief
the Clinic by
Intake by Source

Worker's Impression of “arents‘ Attitude

toward Coming to the Clinic by Source of

Referral . . . . . . . .

Time Lapse in Weeks between Referral and In-

take Interview by Problems Stated at Time

of Referral . . . . . .

Time Lapse in Weeks between Referral and In-

take Interview by Source

of Referral . . .

C.)
a:

27

45

47

51

57

57

TABLE
9.

Problems Stated at Time of Referral as Chief
Reasons for Referring to the Clinic by

Source of Referral . . . . . . . . . . . .

58

CHAPTER I
INTRODUCTION

The effectiveness of agency or clinic service is de-
pendent on the relationships of the community resources as
they work together with mutual health and welfare goals. A
clinic, such as the Lansing Child Guidance Clinic with
which this study deals, cannot stand alone in a community
but must be integrated with the various social agencies and
other community resources which make use of the clinic, and
which provide the various types of services beyond the.
function of the clinic. This allocation of referrals re-
quires that agencies understand one another and utilize fa—
cilities appropriately.

This understanding is gained largely through inter-
pretation of services and functions. The importance of in-
terpretation in its broad sense, and not in the special
meaning which it has developed through its use in social
work, cannot be underestimated. Some common, almost trite
ideas regarding it prevail. For instance, an agency cannot
live long without interpretation. There is an inevitable
interdependence between interest and understanding as the
resulting convictions lead to support and acceptance of the

pregram. Indifference or expressed hostility on the part

of the public or other agencies may in part be the result
offaulty or insufficient interpretation. Further, the best
interpretation is good service, promptly and considerately
rendered.l

In a democratic society social services are not im~
posed by the will of the state upon those presumed to need
them, nor are they established in response to a demand from
those who are to be the recipients alone, but from a much
broader cross section of the community. This includes
those who wish to see such services made available so that
the community as a whole might be a better place for its
members. These persons must be sufficiently convinced of
the soundness of the program to be willing to see it main-
tained. In the case of a clinic, which receives its sup-
port from both state and local sources, there is a neces-
sity of convincing the legislative body that it is a sound
program so that adequate apprOpriations might be forthcom-
ing. Further, it seems apparent that the standards of pro-
fessional performance which can be achieved ultimately de-
pend upon the degree to which they are understood and appre-

ciated by those who furnish the support, as well as those

 

lAnita J. Faetz, "Intertéetation in the Public Agen-
cy," National Conference 22 Social Work Proceedings, fitlan—
tic Citv, 1241 (New York: Columbia University Press), p.

 

 

who receive the benefits.2

Public understanding results
essentially from policy, carefully formulated and followed.
Basically, it is the concepts of interpretation and

understanding, and practice, with which this study.deals.

The Problem and Its Selection

 

Several factors have raised interest currently in
the clinic function, its service, and the understanding of
the program. First, the increased use of the clinic in the
last few years has made it impossible to meet the demands
for service on a current basis and a waiting list has been
established. Clinic records show an average per month of
twenty-eight referrals in 1954, thirty-one referrals in
1955, and forty referrals in the first three months of
1956, a quarter usually with fewer referrals. The waiting
list in itself raises questions regarding relationships be-
tween the clinic and those referring cases to it. Is the
clinic better understood or is it being used more without
understanding? Are schools, courts, social agencies, physi-
cians and parents using the clinic appropriately or has it
become a catchall for all types of problems? Because of
the increase in caseloads, is an increased emphasis on the

selection of caseload or limitation of intake a possibil-

 

2Mary Clarke Burnett, "The Social Worker in Agency-
Community Relationships," ibid., pp. 671-84.

C ity? Should treatment, diagnosis or consultation be the
main focus?

Further, from the writer's limited experience, there
seemed to be a general lack of understanding regarding the
clinic from parents coming to the clinic. Their conception
generally seemed to be either very broad, e.g., "help," or
limited, e.g., "advice." It seemed also that the general
public, based again on the writer's observations, had little
idea of the clinic and what it did, other than the fact
that it helped parents with problem children. In this re-
gard a survey or poll of the community's understanding in
general was considered, but it would be a larger project
than one might feasibly undertake in a few months' time.

It seemed probable that this study might give a partial pic—
ture of the community's understanding of the clinic and the
services provided.

Finally, interest was stimulated because of a recent
survey of family and children's services in Lansing.5 This
survey, conducted by the Community Research Associates, In—
corporated, included some evaluation of the clinic and its
service to the community. The need for evaluation and re-
evaluation is essential to progress and better service. It

is the writer's opinion that this study, although limited

 

3The survey was begun in the spring of 1955. Frank
T. Greving, of Community Research Associates, Incorporated,
124 East Fortieth Street, New York, New York, directed the

survey.

5
in scepe, may supplement the survey by giving a more exten-
sive and focused picture of the clinic's service. This
opinion is based on the use of a larger sample and-the con-
sideration of all cases referred, not only a study of cases
accepted for treatment. The survey, only briefly mentioned
here, will be discussed more completely in the next chap-
ter.

The problem considered in this study can'be briefly
stated as follows: there may be divergence between the re-
ferral source's understanding of clinic function and the
clinic's interpretation of clinic function. Also, there
may be divergence between clinic theory and practice. If
this is true, it would tend to decrease or limit the under-
standing of clinic function by those who use it.

For the purpose of study the following questions,
which contain the essence of the problem, were formulated:

1. What is the relationship between the clinic's

stated function and the type of cases referred
from the referral sources which are given serv-
ice at the clinic? Stated otherwise, is there
divergence between the practice of the clinic
and the theoretically stated function of the
clinic?

2. That is the relationship between the‘clinic and

the referral sources in their understanding of

6
clinic function? Stated otherwise, is there di-
vergence between the clinic and the referral
sources in their understanding of clinic func-
tion?

3. What are the characteristics of those children
who have been referred to the clinic and who
have been served by the clinic?

Because of the writer's role as a student social
worker in the lensing Child Guidance Clinic from November
7, 1955, to June 10, 1956, data were obtained, with the
clinic's permission, to attempt to answer these questions.
Originally, the study was to be based solely on cases re-
ferred from social agencies during a year's period to_de-
termine clinic-agency relationships. After discovering
that the number of referrals from this source, social agen-
cies, was small and scattered among the many agencies,
which would make any general conclusions virtually meaning—
less, the writer decided to study the more general picture
of relationships between the clinic and all who were using
it.

Data were collected by use<xfaschedule with case
records as well as by contacts within the clinic. These
data, which will be presented and discussed in a later
chapter, pertained to three broad areas, namely, the child,

the referral, and the clinic's plan. Sources of data in-

cluded: l) the case record, specifically the face sheet,
intake and interpretive interviews with parents, psycholo—
gist‘s report, psychiatric evaluation, and report of the
staff conference; 2) contacts with clinic staff; and

5) published statements of clinic program and policy. Only
cases of Lansing children referred to the clinic in the
second quarter of 1955 were used in the study because of
the necessity of obtaining a workable sample in terms of
size.

In attempting to determine the relationships between
the clinic and referral sources, some working assumptions
were necessary. First, referral is a meaningful index of
understanding, i.e., the type of case referred indicates to
a great extent the understanding of the clinic by the re—
ferral sources. Second, statements regarding the clinic
and expectation of help made at the intake interview are
another index of the extent to which the clinic is under-
stood. Third, decisions and recommendations of the staff,
namely, the clinic's plan, are an index of the practice of

the clinic.

The Setting

 

As mentioned previously, the study was undertaken in
the Lansing Child Guidance Clinic. The clinic, located at

420 West Ottawa Street, is a former house and office build-

ing, which was adapted to clinic use. Each staff member
has office and play space of his (her) own with a general
waiting room, large play space in the basement, and a li—
brary for use by staff members. At the present time the
professional staff consists of a full-time psychiatrist, a
chief psychologist, a chief social worker, a psycholOgist,
two social workers, and four student social workers com-
pleting their second year of professional training. In ad-
dition, there are an administrative secretary and a recep~
tionist-typist, on a full—time basis. Because of lack of
funds, volunteer workers are engaged to do some of the typ-
ing.

The Lansing Child Guidance Clinic is a clinic where
families may go for help when their children have emotional
problems. It provides psychiatric and psychological serv-
ice as needed. In general, it tries to improve and protect
the mental health of the children in the community by pro-
viding services and educating the community to understand
the factors promoting healthy emotional deveIOpment and to
recognize signs of emotional disturbance. This has been
attempted by talks to various groups with a system of rota—
tion used to determine which staff member will speak. Al-
so, the staff conferences are used to interpret the func-

tion of the clinic in an effort to assist other agencies in

9

understanding its function.4 Annual meetings, reports, and
participation on community committees are also a part of
its interpretive program.

The clinic, formerly known as Lansing Children's
Center, Inc., was Opened in 1938 by the Ingham County Coun-
cil of Social Welfare and became part of the state mental
health program. This step followed a survey by the Nation-
al Probation Association in connection with the prevention
of delinquency, a pattern characteristic of the beginning
of the child guidance movement in general. Its function
was that of diagnosis and treatment of behavior and person-
ality disorders of children, as well as prevention and edu-
cation.

At the present time, the clinic is a Joint state and
local project supported by the State Department of Mental
Health and local agencies, such as community chests, school
boards,.and boards of supervisors. The clinic has an ad-
visory board composed of citizens of the area served, which
acts as a liaison between the community and professional

staff. The board also assumes responsibility for the rais-

 

4During the time period considered in the study,
nine speeches were given to various community groups. One
television prOgram was devoted to the clinic. In thirty~
nine of the fifty-six cases staffed during this time, fifty-
nine people from other community agencies attended staff
conferences. The majority of those attending came from the
school.

lO
ing of local funds. Fees are not charged for service giv-
en, although gifts to the clinic by those served are ac-
cepted.

. The area which the clinic serves includes Ingham,
Eaton, Clinton, and Livingston counties. Lansing, the
largest city in the area, has a population of approximately
100,000 people. There are nearly twenty agencies which are
related to children's services in the community. The total
case load of the clinic in 1953, according to its statis-
tical report, was 441 children. Of this number, 277 were
new applications.

The age range of children served is from birth to
sixteen or until graduation from high school.

The team-approach, characteristic of child guidance,
is used in the service of the professional staff, with the
chief psychiatric social worker in charge of intake. Re-
ferrals received from the various sources-~i.e., parents,
school, doctors, courts and social agencies--are cleared
through her, and only a problem which seems to indicate the
child may have acne emotional difficulty is considered a
referral. Other calls and requests are considered to be
inquiries, and for the most part are not recorded. Besides
performing the functions characteristic of their discipline,
each staff member carries approximately fifteen treatment

cases; about one-half of their time is spent on treatment.

11
This increased emphasis on treatment is a relatively new
trend in the Lansing Clinic and is due to an administrative
decision to reduce the waiting list of those children wait-
ing for treatment, which means an increase in the number of
children who have been referred waiting for diagnostic
studies. The average time lapse between referral and first
contact in the latter case is now three months.

The usual procedure of the clinic after a referral
has been made is to arrange an appointment for parent and
child when time is available. It is standard practice to
see the parent and have then make the referral if possible,
regardless of the actual source of referral. For the most
part, referrals do come directly from the parent at the
suggestion or advice of another person or agency, because
parents are encouraged to involve themselves in the study
and planning for their child. Once appointments have been
arranged, a social worker discusses the problem and the
child with the parents. The child is seen for testing by a
psychologist and for psychiatric evaluation by the psychia-
trist. This is followed by a staff conference by the three
members of the team, and may also include workers from
other agencies, the court, or the school if this is indi-
cated from the study and if permission to contact these
sources is granted by the parents. At this conference, a

diagnosis andrecommendation are formulated on the basis of

the information received. An interpretive interview is.

then arranged with the parent and also with the child if he

is old enough to make his own decision regarding treatment.
A summary of clinic function and practice as found

in the Lansing Clinic will be presented in Chapter V.

CHAPTER II

;ELATED LITEiATURE AND CURREE‘ GPINIQN

Belated Studies

 

Community child guidance clinics have only recently

recognizel their responsibility for research. For the most
part, the few stuiies which have been published were done

by state mental health departments or in clinics which were
affiliated with universities. In the latter type of clin-

ic the research interest has for the most part taken the‘
9 .t’

H

form of basic research into child behavior. Research, as
it exists in public clinics, is largely at a descriptive
level and does not include applied research or program
evaluation.

Although there is much written about the child guid—
ance movement and about therapy with children, the writer
was unable to discover much literature or many studies

which considered specifically the problem of this study.2

 

1An excellent exception is Gartland's survey of the
services of the Child Guidance Clinic affiliated with the
University of Chicago. She attempted to determine the
value of psychiatric social service in a hospital setting.
Ruth Gartland, Psychiatric Social Service in a Children's
Hospital (Chicago: University of Chicago firess, 19377.

2hajor sources of possible information considered
were Social Casework, Journal pf orthopsychiatry, hental

14
However, the Cast study, as well as the study by the Michi-
gan Department of Mental Health, considers some of the
trends in services of the Lansing Child Guidance Clinic.

Cast, a graduate student in social work at Michigan
State College, made an exploratory attempt to discover what
the role of the child guidance clinic was in the community.3
Questions in her study related to the type of service most
frequently sought, the problems the clinic endeavored to
treat, and its success in dealing with these problems. Its
purpose was to provide a background of knowledge on which
to build a community interpretation program.

She considered 148 cases of children seen in the
first six months of 1946. She found that social agencies
and schools referred approximately three~fourths of the
children. Types of service given were diagnosis and treat-
ment, each accounting for forty percent of the total serv-
ice given, and consultation, accounting for twenty percent.
Seventy—eight percent of all children referred were boys.
Behavior and personality problems accounted for forty per-
cent of the problems. Contacts, in the form of confer-

ences, were made in one-third of the cases.

 

Hygiene, Smith College Studies ip Social Work, and Journal
gf Psychiatric Social Work.

3Marcella Gast, "A Child Guidance Clinic as a Social
Resource in a Small hetrOpolitan Community (unpublished
Master's Project Report, Department of Social Service,
Michigan State College, 1947).

15

Cast concluded that:

services offered by a child guidance clinic in a com-
munity cannot be duplicated easily in the c mmunity.
Its concentration of purpose to help children and‘
their problems meets a special need. COOperation
with other resources in the community through refer-
rals and consultation is essential.4

A study of the utilization of the facilities of the
Lansing Child Guidance clinic was made in 1955 by the Mich-
igan Department of fiental Health.5 The study was based on
an examination of the rates of utilization for the five-
year period, 1948—1952.

The hypothesis tested was that rates of utilization
are a function of the distribution and composition of the
pOpulation in the areas served. The primary assumption on
which the study was based was that there are social corre-
lates of behavior and these are related to the demographic,
economic, and social characteristics of the pOpulation.
Methods used included plotting addresses of the children of
all cases closed during this period and relating these to

census tract information, particularly in the metrOpolitan

area. Also race, age, and sex of the cases in the sample

 

4Ibid., p. 14.

“

5Michigan Department of Mental Health, Differential
Utilization pf the Facilities of a hichigan Child'Guidance
Clinic, Research Report No. l7.TLansina: hichiganwDepart-
ment of Mental Health, 1955).

 

 

16
were related to the characteristics of the general pepula-
tion.

Findings disproved the hypothesis tiat rates of uti-
lization are a function of pepulation distribution and com;
position, although they may be factors. Accessibility to
the facilities of the clinic and socio~economic status were
suggested as additional factors in determining clinic uti-
lization. This was based on the findings that rates of
utilization varied directly with aCCessibility and that the
composition of those census tracts with the lowest and
highest rates of utilization were related to socio-economic
status of the area. This was indicated by occupation,
schooling, and housing characteristics of the areas served.

Another study relating to the types of children re~
ferred to the Lansing Child Guidance Clinic is being made
by Wright.6 She is attempting to discover whether the
school tended to refer more aggressive or more withdrawn
children. Findings to this point have indicated that there

was no distinct difference.

 

6Jean Wright, "A Study of School Referrals to a
Child Guidance Clinic for the Year 1954" (unpublished
Project Report, School of Social Work, Michigan State Uni-
versity, in process).

17

Other Related Studies

 

Mass, in collaboration with others in a study of
socio-culturel factors in clinic services for children, at-
tempted to learn about the families using existing clinics,
how they use them and what they expect from them, as well

7 Specifically, they at—

as the outcome of services given.
tempted to determine if there are socio-cultural factors
contributing to the differential use families make of chil-
dren's psychiatric clinics.

A study was made in six clinics in Hetropolitan New
York and three clinics in the San Francisco area with a .
total sample of 654 cases. Findings indicated that fifty-
four percent of the children seen were of elementary school
age, with one-third being older. The ratio of boys to
girls was two to one. The presenting complaint was aggres-
sive reactions in one-fourth of the cases, difficulties in
social adaptation in twelve percent, and a school learning
problem in ten percent. Occupational status of the fami-
lies showed the families were either of high or low status

with fewest from the lower—middle group. Other determi-

nants of statues-namely, education, mobility, type of

 

7Henry Hess and Others, "Socio-Cultural Factors in
Isychiatric Clinic and Services for Children: A Collabora-
tive Study in the New York and San Francisco Areas," Smith
College Studies ip Cocial dork (Vol. XXV, February, 1§§§77

18
housing--were described. Parents and medical resources re-
ferred the child in one-half of the cases, with school and
social agencies each referring approximately one-fifth of
the total number of cases. Over one—half of the parents
expected the role of the clinician to be authoritative.

The authors concluded that socio-cultural factors do
contribute to the type of families using the clinic and to
the way_they use it. However, the study also pointed to
the fact that these factors were not emphasized in clinics
and to the fact that this information was not utilized.

In the Lansing area, a survey of family and chil-
dren’s services is in process. The study, undertaken by
the Community Research Associates, Incorporated, in coop-
eration with the Community Services' Council of Ingham
County, was co-sponsored by the United Community Chest and
the Board of Supervisors of Ingham County. It is an at-
tempt to evaluate the services to families and children in
this area.

Preliminary recommendations relating to the Child
Guidance Clinic indicated that a merger with the Adult Men-
tal Health Center into a Community Health Clinic may be ad-
visable. It further emphasized the need for a clinic of
this type to be a part of an integrated network of services
in the community. It would have responsibilities to pro—

vide direct treatment service to cases which are reasonably

19
productive, consultation service, and carefully planned ed-
ucational activities. An Open intake policy should be
maintained, with applicants seen on a brief interview basis
to determine whether the cases might be referred to appro-
priate community resources. Consultative service should be
given to the major agencies concerned with adjustment prob—

lems.8

 

There have been some attempts to determine under-
standing of various social services by community members.9
Much has been written regarding referral to and from social
agencies. Attempts have been made to clarify when referral
is necessary and, through channels of interpretation and

education, to increase understanding of the function and

purpose of child guidance clinics.lo Perhaps the fact that

 

8Report of the survey committee to the combined ,
boards of the mental Health Center and Child Guidance Clin-
ic, Earch 2, 1956. In a telephone conversation with a
representative of the Community Services’ Council on May 7,
1956, it was learned that the final report would be re-
leased on May 17, 1956.

9See Viola Paradise, Toward Public Understanding g;
Casework (New York: Russell Sage Foundation, 1948). An
example is found in Myrtle Reul, "A Study of the Lay Opin-
ion on the Family service and Other Social Work Agencies in
the Jackson Area" (unpublished Master's Project Report, De-
partment of Social Work, Xichigan State College, 1954).

10One example is Harold A. Greenberg, Child Psychia-
try in the Community, A Primer for Teachers, Nurses, and

 

 

 

23
interest in these areas exists is a step toward good work-
ing relationships between community resources. When agen-
cies become concerned with the act that other resources
and those whose support they need, understand their func-

tion, more effective service can be given to a community.
Current Opinion

Relationships between mental health clinics and fam-
ily agencies in particular have been discussed frequently.
Because overlapping of areas seems to exist, there has been
much effort to distinguish between the two areas, to deter-.
mine similarities and differences.11 This is perhaps a
part of the existing confusion between social casework and
psychotherapy. Some social workers consider their reaponsi-
bility to be psychotherapeutic treatment. Other profes-
sional clinicians question the validity of this practice.
The most common opinion, however, seems to be that both are

needed and can provide a different service. The family

field and the mental health field must each find its re-

 

Others Who Care for Children (Few York: G. P. Putnam's
Sons, 1950).

11See Lucille N. Austin, "Relationships between Fam-
ily Agencies and Manta Health Clinics," gpcial Casework
(Vol. XXXVI, February, 1955), pp. 51-59, and Mary Reeve and
Lorna C. Brangwin, "Family Service Agencies and Mental Hy-
giene Clinics," Social Casework (Vol. XXIII, May, 1952),

21
Spective place in the total community effort. They must
work closely together if the community is to receive maxi-
mum service from either field.

The relationship of school and clinic is also empha-
sized, because the school is in a position to recognize
problems. Children spend much of their day in school.
There are several trends. Cne trend is to establish the
school clinic. It is considered rewarding that psychologi-
cal and psychiatric services can be offered to parents as
part of the educational experience of their children. An-
other advantage includes the exposure of the clinic team to
the teacher's problems and the difficulties the child pre-
sents in the school room. All of the disciplines in the
school setting become aware of the value of weighing the
situation, of seeing the child as a totality because of
clinic influence. Further, cultural factors, so evident in
the school system, become a routine part of the clinic's
consideration. The teaching of mental hygiene to both stu-
dent and staff is facilitated.12

Another trend is closer working relationships be-
tween the school social worker and the outpatient clinic in

the community. With this system, the school social worker

 

12Rose Goldman, "Some Aspects of the Integration of
School Social Work into the Clinic Team of a School System"
(Journal of Psychiatric Social Work, Vol. XXIII, January,

 

 

22
often acts as liaison between clinic and school in helping
a child with his problem. She assists in preparing both
child and parent for referral if it is needed.15

Another Opinion regarding the clinic's role in rela-
tion to the school has been proposed. The clinic team
should provide consultative service to the school. This is
because of the lack of clinics to meet the needs of all
communities and the cost of maintaining such clinics. This
consultation would not necessarily be through a school so-
cial work program, but would be an effort toward educating
the staff of the school system to deal with maladjustments
of children.14

Because the clinics are not able to meet needs im-
mediately, long waiting lists are common. Suggestions have
been made to deal with this problem. The Guidance Center
of Buffalo has attempted a differential approach to intake
and the waiting list.15 They have found that this type of

approach results in the emergence of three groupings for

potential treatment: 1) parent consultation, 2) continued

13Philippa Eggleston, "The Role of the Clinic Social
Worker in Relation to the School Child," Ibid” pp. 86-90.

14Keith J. Perkins, "Consultation ServiCe to Public
Schools by a Mental-Health Team," Hental Hygiene (Vol.
XXXVII, October, 1955), pp. 585-9C.

15David Hallowitz and Albert V. Cutter, M.D., "Intake
and the Waiting List: A Differential Approach," Social
Casework (Vol. XXIV, December, 1954), pp. 439-45.

23
work with parents only, 5) full treatment of parents and
child. As a rule only those cases in the third group are
placed on a waiting list. In 1955, this latter group com~
prised fifty-four percent of the cases which were seen for
intake. Approximately one~third were placed in the first
group, where service was characterized by periodic inter-
view and follow-up contacts, and where the child's problem
seemed to be readtive behavior to parents or the family
situation. The second group, intensive work with parents
only, presents deeper conflict in the parental relationship
or in the parent-child relationship, but the child's probe
lem had not acquired enough depth to require treatment and
would seem to disappear in time if the parents could re-
solve their problems. The characteristics of the third
group requiring full treatment are internalization of the
child’s problem and less emotional health and strength on
the part of the parents.

Other suggestions regarding selection of cases for
continued treatment exist, most of them stressing the need
for skill in selectivity.

Another area of divergence between child guidance
clinics seems to be related to function. Although theory
in general has been relatively constant since the beginning
of the chill guidance movement, different clinics at dif-

ferent times have had different philosophies and policies.

24
Some clinics are diagnostically oriented, while others con-

hemselves treatment-oriented. Still others feel

('1'

l ,
sider

r ain responsibility is to offer consultative service

0*"
B

('1'

he
to the various community resources. Because the orienta-
tion of any one clinic seems to be largely determined by
its administration, one may expect that function would be
changing. It can only be hoped that the total community is
considered in determining the orientation of the clinic.
This need again points to more effective service to the

community, toward understanding and sound relationships be-

tween clinic and community.

CIAPTE? III

ESTHODCLOGY AZD IROCEDURES

The statement of the problem and reasons for its
selection, as presented in the introductory chapter, sug-
gest the basic methodology and procedures used in the
study. The steps taken to complete the project can be out-
lined as follows: a

1. Reading, informal contact, and observation-

2. Selection of problem and sample

5. Construction of a schedule

4. Collection of data

5. Classification, tabulation, and analysis

6. Organization and writing
Readingl Informal Contact, and Observation

Before and during the course of the study reading
pertaining to child guidance and to related studies was
done. Also informal contacts, i.e., an interview with the
chief psychiatric social worker and regular contact with
the clinic staff throughout the school year, helped the
writer in understanding the practice and function of the
Lansing Clinic.

Selection of Problem and Sample
Soon after joining the clinic staff, the writer be-

came interested in the problem of clinic understanding and

26
practice. In selecting the specific problem interest was
focused directly on clinic-agency relations hips. The study
was limited to children with a Lansing address in order to
limit the group to those of ildren wh icnt be referred
from or to Lansing agencies. The number of children was
established on the basis of the clinic's cards containing

ba‘ic information and a record of diagnostic interviews on

0“

In order to have a sample with which the writer
could work in the limited period available for research,
the se co ond quarter of 1955, April throua 3h June, was select-
ed. According to the chief psychiatric social worker, this
period was typical. Also it was more certain that these
children, rather than those referred at a later date, had
been seen for diagnostic studies at the clinic. At first
it s emed that referrals in this time period may be influ-
enced by the fact that it was the end of the school year,
which may have meant many school referrals to determine
promotion. Although it was one of the qua rters which gen-
erally has the largest number of referrals (with only the
last quarter havixmg more in 1955), it seemed to be fairly
representative of the entire year and previous year in
terms of source of referral of cases Opened for service.
This fact is illustrated in the following table, which

shows that the sample may be slightly higher in school re-

27
ferrals as expected, but is least representative in the so-

cial agency and court referrals.

TABLE 1

 

 

 

 

 

CASES :7FEQRED T3 THE TAHSIWG CHIL. GUIWANCE CEINIC
IN 1954, 1955. AND IS TH: STUWY sanrit
BY £03103 0? REFEQRAL
1954‘ 1955 SampleH
Source of
Referral Num- Per Num- Per Num- Per
ber cent ber cent ber cent
Total 291 100.0 277 100.0 47 100
Parents 107 56.8 121 45.8 18 58
School 65 22.5 62 22.6 12 25
Physicians 44 15.2 54 12.4 6 15
Social agencies 45 14.8 25 9.5 7 1
Court 52 10.9 55 11.9 4 9

 

 

’1954 totals include statistics of Jackson branch of
clinic also.

*‘Since sample is less than 100, percent may be in-
conclusive.

After it seemed possible to use this sample, a list

of cases was made. Case records were pulled from the memo

file. This is the file containing records of children who

have not been seen because of unkept
cause consultation was offered. The
the list of names of the children in

through the active file, those cases

appointments or be-
writer, again using
the sample, went

Open at the present

time, to determine which records were located there. The

 

 

28
remaining cases in the sample were then known to be in the
closed file, those cases which have been seen at the clinic
but which were not active at the time of the study.
Echeiule

After the cases were located, a schedule was con-
structed and consistel of three main areas: 1) Identifying
information, 2) Referral, and 5) Clinic Plan (see Appendix
A).

The identifying'information was essential to give a
description of the children referred to the clinic and also
was essential in relation to the sources of referral. This
gave an idea of the type of child referred in general by
each source of referral. This area included the following
factors:

Age, sex, race, school grade, intelligence quotient,

number of siblings, position, marital status of par-

ents, address of chili, parents' occupation, and
parents' age.

Content relating to referral was selected to give an
idea of what was referred and who referred and also what
the parent and/or the referral source may know about and
expect of the clinic. This was based on the assumptions
that the type of case referred and the statements made at

intake indicate the extent of understanding of clinic func-

tion by the referral source. Such questions as source,

29
stated problems, precipitation factors which affected re-
ferral, help expected, and indication of preparation of
child or parent for coming to the clinic and knowledge of
the clinic by their statement, were used. After testing
the schedule, some of the information was difficult to find
in the record or was not ascertainable. However, these
questions were considered important to the problem as well
as helpful information to be in the record, and so were not
omitted from the study. It was felt that the lack of this
information might be significant. '

Content included in the third area, Clinic Plan, was
determined primarily by the working assumption that decisions
and recommendations of the staff aresmiindex of the practice
of the clinic. This area included the worker's subjective im-
pression of attitude toward comingtx>the clinic, the problem
as seen by staff, accepted or not accepted for treatment,
reason for non—acceptance, ani recommendations made. Also
some idea of the use of other resources by the clinic was
attempted by the recording of contacts made during the diag—
nostic study. It was felt that data in this area would be
significantiiicomparing clinic practice and clinic theory.

Collecting of Data

 

Data were collected by reviewing each case record in
the sample in relation to the information needed in the
study. Because it was known that only some basic informa-

tion, mainly identifying information, would be foundixithe

50
files of children who had been referred but not seen, the
writer first collected and tabulated this information so
that this group of children could be described. Some dif-
ficulty in collecting the main body of data, relating to
referral, made it necessary for the writer to make a judg—
ment in answer to some questions not specifically asked in
the interview, but in which answers were indicated in other
content of the study. Where this was not possible or if it
was questionable, the data were considered "not ascertain-
able." An example of the former would be the impossibility
of determining from the intake interview whether the child
was prepared for coming to the clinic. By reading the psy—
chological report and the psychiatric evaluation, the
writer was able to determine the possible answer from the
contact with the child and thus able to judge what the
preparation might have been. An illustration of the latter
is the worker's impression of the parent's attitude toward
coming to the clinic that they were "uncomfortable." Since
it is assumed most people are uncomfortable in seeking help
with a problem, "uncomfortable" could not be considered
significant and the data were considered non-ascertainable.
Sources of data included the diagnostic study for collec-
tion of data required on the schedule, informal contacts,

observation, and annual reports for data relating to clinic

51
practice and functions, and wr tten statements on program

i
and policy of the clinic and clinic theory.

 

C assification, Tabulation, and Analysis
Because of the variety of responses, an open-end

questionnaire was used in the schedule. lhis made classi-
fication following the collection of data necessary. ihe
answers in each case were listed and then classified ac-
cording to common elements and completeness of classes.
The classifications made were, for the most par , the
writer's except for the "type of problem."1 Difficulty in
classifying the problem as seen by the clinic was experi—
enced because the clinic does not have a system of classi-
fication and most diagnoses are descr ptive and complex.
The Lansing Clinic agrees with the proponents of the phil—
OSOphy that psychiatric diagnosis is a synthetic procedure
and a neat "label" cannot be given; one word cannot do it
justice. It is a reformulation of the complaint on the
basis of all available data.2 Therefore, these diagnoses
were described for purposes of analyses and were listed in

Appendix B.

 

1Classifications found in Ruth Gartland's study,
Psychiatric Social Service ip a Children's Hospital (Chi-
cago: University of Chicago Press, 1957), were used.

2Leo Kanner, Child Psychiatry (Springfield, Illinois:
Charles C. Thomas, 19575, pp. 115—16.

 

32

Further, there was some difficulty in classification
because of the size of the sample. Broad classification
would mean little and would tend to obscure the data.- Too
many classifications for the size of the sample likewise
would tend only to point out the lack of common character-
istics or diversity of data when one can assume it would
not exist in a larger sample. In some instances it seemed
that more description than classification was of value.

In tabulating the data, the hand—sorting method was
used for the most part. First each of the questions was
tabulated, followed by cross~tabulation of those factors of
significance to the study.

Analyses of the data followed its tabulation. This
was analyzed in relation to the three questions with which
this study is concerned as stated in the introductory chap-
ter and restated here:

1. What is the relationship between the clinic's

stated function and the type of cases referred

from the referral sources which are given serv—

.o.’

ice at tre clinic? Stated otherwise, is there
divergence between the practice of the clinic
and the theoretically stated function of the
clinic?

2. What is the relationship between the clinic and

the referral sources in their understanding of

clinic function? Stated otherwise, is there di-
vergence between the clinic and the referral
sources in their understanding of clinic func-

tion?

have been served by the clinic?
The first question was answered by comparison of
clinic practice and clinic theory and statement of func-

d question was de-

:3

tion. The method of answerins the seco

\a

r“
O
J)
0
F4)
?
1:5
(1.:
'1
H
:0
H

scription and comparison of the characterist.
and the theoretically stated function of the clinic. rl‘he
third question was answered by a description of all child~
ren referred curin t
and analysis of date is ftund in the chapter followins.
Organization and Writin
Organization in preparation for the writing of this
project report and the writing itself was the last step

toward completion of the report.
Objectivity and Validity

hush has been written regarding both the potential
value of the use of case records in research and their lim-

itations. Three areas of concern are adequacy, validity,

34
and representativeness.3 The records used in this study

were analyzed in these terms. The material needed was not

*‘3

always included in the ‘ecord or perhaps was not asked. In
this regard a pilot study, where one had a schedule to use
during the int rview to assure getting; the information de-
sired, might have been a better method to conduct such a
study. Also, because of the lack of standardization in the
recording, it is not known whether material had been gained
in an interview and was not recorded or whether it was
gained at all. A further complication was the fact that
several different workers recorded the information. Work-'
are, all with different degrees of experience and skill,
cannot avoid affectins the type of material obtailed and
recorded, although basically their frame of reference is
the same. The necessity of condensation of records into a
meaningful report for purposes of convenience in handling
and economy may, depending on the skill of the caseworker
in being observant and selective, lose the essence of what
did happen or what was said in the interview.

Limitations of the study itself must also be enumer-
ated. The assumption that the statements made at intake

indicate the extent of understanding of clinic function by

 

3Hilde Landenberger Hochwald, "The Use of Case Rec-

ords in Research," Social Casework (Vol. XXKIII, February,
1952). pp. 71-76.

 

 

 

55
the referring source may be questioned because, regardless
of the source of referral, the parent is seen at intake.
However, it seems possible that a school, doctor, court or
social agency advising the parents to come to the clinic
would also tell them something of it. Therefore, one would
indirectly have the understanding of the clinic by the
source of referral. Also it must be remembered that the
study was based on first contacts recognizing that informa-
tion pertaining to help wanted or the problem stated may
not be the true problem.

The size of the sample used, though the sample it-
self is fairly representative, places another limitation on
the study. It is a study of a specific situation and gen—
eralization is difficult. The inclusion of items from the
schedule on which there was limited data may be interpreted
as subjective.

Further, it was discovered during the course of the
study that all telephone calls requesting service are not
recorded. If it seems possible that it is a problem with
which the clinic does not deal, another agency is suggest-
ed, and no record made; it is considered an inquiry. These
would be significant in determining understanding of the
clinic, it seems, as undertaken in this study. They might
be considered to be inappropriate requests for service.

They usually come from a child's parents.

PRESENTATION AND AKALYSIS OF DATA

For purposes of presentation and analysis the data
have been divided into the following sections:

1. Description of children referred but not seen

2. Characteristics of children seen

3. Characteristics of referrals made

4. Characteristics of the clinic plan

Description of Children Roferred but Not Seen

 

A total of fifty—nine children was referred to the
Lansing Child Guidance Clinic in the period, April through
June, 1955. Of these fifty-nine, twelve children were not
seen at the clinic. Reasons were not known in nine of the
cases since appointments were neither cancelled nor kept.
Of the remaining three cases, one was referred by the
court, which decided to do its own planning after making
the referral; one was referred by the mother on the advice
of the school, and although only a week elapsed between the
time of referral and the time an appointment_was offered,
the mother reported "things had gone too far“; and one was
referred by the Catholic Social Service agency, and consul~

tative service was given without accepting the case. In

37
one other case, this agency was seeking help in planning
also, but the parents did not keep their appointment.

Because this group of twelve cases was not included
in the sample which was studied, a description is presented
here. Data are necessarily limited because only informa-
tion received in the initial referral is included. There
was no Opportunity to get the additional information usual-
ly received in the intake interview.

Seven of the twelve children were boys, five were
girls. Ages ranged from four to fifteen years, with only
two children younger than eight years of age and five chil—
dren over twelve years of age. The most common type of
problems stated at the time of referral were truancy and
stealing. Other problems included "child won‘t mind," a
psychogenic disorder, school learning problems, difficulty
in social adjustment, day dreaming, enuresis, and tics.
There was one suicidal attempt and one exclusion from
school. Sources of referral included four cases from par-
ents, two from schools, three from social agencies, and one
each from physician, court, and lawyer. The average time
lapse between the time of referral and the intake interview
was eight weeks.

In three instances, recommendations were made by the
clinic without the usual diagnostic study. Foster home

placement was indicated for two children who were not able

38
to function adequately in the home environment. One family,
referred by the lawyer, stated they could afford a private
psychiatrist if the child could not be seen immediately.

Those cases referred by social agencies, the court,
and the lawyer indicated the type of help expected from the
clinic while those from parents, schools, and the physician
did not. Social agencies requested help in planning, as
did the court. The lawyer wished to determine if the via-
its of one child's mother were sufficiently upsetting to
the child to ask the court to remove her visiting privileges.

From this description, it seems possible that where
parents did not initiate the referral there was less inter-

est and motivation toward coming in for clinic service.
Characteristics of Children Seen at the Clinic

Forty-seven children were referred to the clinic and
seen for diagnostic evaluation in the time period consid-
ered. Seven of the forty-seven cases were reopened, that
is, the children were previously seen at the clinic. of
the forty-seven children, thirty-three were boys and four—
teen were girls. This prOportion is comparable to that
found in most clinics of this type. Ages ranged from three
to seventeen. By age group, the six and seven year olds,
the ten and eleven year olds, and thirteen and fourteen

year olds were nearly evenly represented with ten, ten, and

59

eleven children respectively. However, by school age
group, which is the classification used in the presentation
and analysis of data, the elementary school age group, six
through eleven years of age, having twenty-four of the
forty-seven children, outnumbered the preschool group by
seventeen, and the junior high school and high.3chool age
group, twelve through seventeen years of age, by eight

children. This can more clearly be shown as follows:

Age Number

 

Total . . . . . . . . . . . . 47

0-5 0 o c o o o o o o o a 7
6-11 o~o o o o o o o o o o o 24
12‘17 o o o o o o o o o o o o 16

Thirty-three of the children came from families
where the parents were married and living together. In ten
cases the child was living with one own~parent and one
step-parent. In only four instances was a child living
with one parent only, a relative or foster parents. In
these findings one can see the refutation of the common be-
lief that it is the child from the broken home that has
difficulties. It seems possible that children from appar-
ently stable families are as susceptible to emotional dis-
turbances as children from broken homes. Information re-

garding the status of the marital relationship in the stable

 

40
families would be necessary to form conclusions on the ef—
fect of this factor on the mental health of children.

An attempt was made to determine WLe ther many chil-
dren came from any one part of the city from the audresses
of the children, although on the basis f the size of the
sample this could not aiequately be determined. These
forty—seven children in the sample did, however, come from
a scattered area. Further, it seemed the occupation of the
parent might lend significance in understanding the econom—
ic class of people.served by the clinic. ‘In over three-
fourths of the families, the father was a drop forge or
factory worker or other type of laborer. In nine cases the
father or mother held'whitecollarflpositions, or positions
which involved work with peeple. From the records them—
selves, which usually give some indication of economic
status, there was no evidence of poverty or economic hard-
shin. Whether this would tend to corroborate the fact that
child guidance clinics are thought to serve the upper
middle or upper class families may be questioned.

ins is one character-

«
kg!

('9

The child ren' s intell i,e no

t
istic of the child t? at is import nt to the clinic, both in

)0

planning and in treatment. The distribution of these rat-
ings, which are general because a variety of tests were

used, was as follo we:

41

Rati ng Number

 

 

Total . . . . . . . . . . . . . . 47

 

Below average (to 89) . . . . . . . . .

Average (90-109) . . . . . . . . . . . 1
Above average (110 and above} . . . . . 1
Not tested . . . . . . . . . . . . . . 1

that retardation was not present, since testin

U’

can done ‘0 determine its .Wtent if it Was suspected.
This would be an essential determinant in planning for a
child of this kind It seemed from the findings that there
was not, on the Whole, a tendenc
ed child to the clir nic, but rather it seemed possible re-
ferral sources wished to nee it in it.s preventive and treat-
ment aspects.

Ordinal position of the chiliren we considered to
be another significant Characteristic of describing tne
children seen at the clinic. The following firures indi-

cate the number of children in eacn position:

Position Number

 

TOta-l o o o o o o o o o o o “"‘"‘47

Oldest . . . . . . . . . . . 21
”iddle . . . . . . . . . . . 7
Youngest . . . . . . . . . . . 11
Only . . . . . . . . . 6
Not ascertainable . . . . . . . 2

42

Characteristics of Referrals Made

The problems of the child as stated at the time of
referral can be found in Table 2. When reading this table,
it is necessary to remember that any given child may have
been referred for one or more problems so that the total
number exceeds the number of children referred. Also, it
should be remembered that further study of the child may
have revealed problems more significant than those given as
the reasons for the child having been referred. The types
of problems included in the classification1 are as follows:

1. Projective behavior--temper, disobedience,

stealing, quarreling, sex play, fighting, lying,
running away

2. Introjective behavior—-nervousness, restlessness,

timidity, seclusiveness, day dreams, depression,
slowness .

3. School failure—~lack of interest in school, poor
srades, specific disabilities, slow learner
4. Habit disturbance-~speech, enuresis, masturba-

tion, soiling, thumbsucking
5. Psychogenic illness (illness without physical
cause)--pains, tics, allergies, stomach disor-

ders, kidney disturbance, and nosebleeds

 

lGartland, 220 Cite, pp. 9-100

43

 

 

 

 

TABLE 2
PROBLEE3 STATED AT TIVE OF RE' FERRAL AS CHIEF
REaS HS I‘ll 2 FZFEQxI T‘G TO THE LINIC
Problem Iumber Percent
Total 90 100
Projective behavior 29 32
Introjective behavior 22 25
School failure 21 23
Habit disturbances 9 10
Illness without physical cause 9 10

 

From the table it can be seen that projective behav-
ior accounted for almost one-third of the total number of '
problems and was the most common problem seen in the chil-
dren referred. This is perhaps due to the fact that this
iseniobvious problem and most objectionable. The relative-
ly high incidence of introjective behavior considered a
problem in one-fourth of the cases referred might indicate
that there is a growing awareness of the importance of this
type of behavior, and more appreciation for prevention of
more serious illness or symptomatology by early treatment.
The high incidence of school failure may be due to the fact
that the child with difficulty spends much time in school
and is also apt to display difficulty there. It also may
be considered a safer, less involving way for a parent to

state a problem.

44

The relation of the stated problem to the age and
sex of the children referred is of significance in knowing
the type of children referred. This is shown in Table 3.
In the pre-school group, habit disturbances had the highest
incidence, followed by illness without cause, and an equal
number of introjective and projective behavior problems.

In the elementary school age group, projective behavior and
school failure were found in an equal number of cases,
thirteen, and were followed by introjective behavior found
in nine cases. Cf the twelve to seventeen year age group,
projective and introjective behavior were the most common _
problems, stated in nearly three-fourths of the cases. In
this latter group, there was no evidence of habit disturb-
ance and only one psychbgenic physical complaint.

From this study it appears that the young child is
apt to display a habit disturbance frequently while the
oldest child with emotional difficulties tends to act out
his problems. This is consistent with most psychological
theory in relation to children's behavior patterns.2

From Table 5 it can be noted that problems stated in
the cases of girls were almost evenly divided between the
five categories, with slightly more referred for introjec-

tive behavior. Projective behavior, accounting for nearly

 

2Gordon Hamilton, Psychotherapy 33 Child Guidance
(New York: Columbia University Press, 1949}, pp. 24-54.

45

.hpwnmao mo mmompum map pom mews mum .mpflmSHocoosfi gadonpam .memmuqmonmm.

 

 

 

 

 

 

es s m m m H OH e em a o magma Heoamssa guesses mmeeHHH
Hm m m e o 0 0H s mm m m meoempnspmae panes
Hm m em ma mm w on ma 0 0 am oneaame Hooeom
mm m em as an as mm o om m mm poapenop m>apoomoppeH
ma e mm mm as ma om mH om m om poapunep mpapomhopa
00H em ooH we 00H mm 00H m: 00H ma om Hepoa
Pflwo .Hmo. @900 #09 pamo .Hmn. Pdmo .HmD .PCGO .HmD

them I952 Ipmw I852 09mm tadz them I852 them IESZ

mapfiuw. whom : eHsmH Hans mum fleece seasons
Nmmw Omaha

 

 

HMO.W

an .7< hos Mm OH? :HHO Em OH GVHMWUmiw
.Hw mzfiumomh

mzou<mm bmHzU ad Q¢.V .HLHM ho mfiHB B¢ fine

_;m mamas

46
forty percent of all problems listed for boys, was the most
common problem stated for the boys. Introjective behavior
and school failure were.listed the same number of times,
each accounting for nearly one—fourth of the total number
of problems. habit disturbances and psychogenic illness
were found in only nine instances out of the sixty-six
symptoms stated for boys. These findin 3s su p rt the fact
that boys seem to be and are expected to be more aggressive
than girls in our society.

Regarding the relationship of ordinal position to
the problem stated, projective behavior or school failure.
accounted for two-thirds of all problems stated at the time
of referral. The middle child tended to display introjec-
tive behavior and the youngest child was projective, fol-
lowed by introjective behavior and illness vithout physical
cause. The only child displayed introj Mo ive behavior and
school failure equally, and twice as often as projective
behavior. This can be more clearly seen in Table 4.

The children were referred from five sources:

 

Source Number
T0t8.1 . C O O O O I I O O O O 47
Parent . . . . . . . . . . 18

O O O 0 O O O 12

7

School . . 5
Social Aaencies
Thysicians . .
Court (or police)

0 O O I O O O 6
O O O O O O O 4

O
O
O
O
O

BSocial agencies include Visiting Teacher program,

47
TABLE

PRCBLEIS STATED AT TIME OF REFERRAI AS CH IEF REASONS
FO:l REFIIRI 3 T1 THE CLINIC BY CEDIJJQL I SITION

 

 

Ordinal Position

 

 

 

8 tom Total NOt
ymp Oldest fiiddle Young- Only Ascer-
6” tainable
Total 90 4O 16 20 ll 3
Projective be-
havior 29 17 4 6 2 O
Introjective
behavior 22 6 7 4 4 1
School failure 21 9 5 5 4 2
Habit disturb-
ances 9 5 l 5 O 0
Illness without
physical cause 9 3 l 4 l O

 

In approximately one-third of the cases, it was sug-
gested that the parents m wee a referral to the clinic. How—
ever, if the referral was made by the parent but at the ad~
vice or suggestion of someone else, the latter was consid-
ered to be the actual source of referral.

All but three of the referrals were made by tele-
phone, with two persons referring in person. One referral,

from another city, was made by letter.4

 

Catholic Social Service, Michigan State University Psycho-
logical Clinic, and Adult Mental Health Center.

4Under clinic policy, referrals made by telephone
call, letter, or conference are accepted.

48

Precipitating factors affecting referral, help ex~
pected by parent and/or referral source, preparation of the
child for coming to the clinic, and the amount of knowledge
referring adults had about the clinic as indicated in the
statements made at the time of the intake interview, were
difficult to ascertain in many of the cases. These items
were included, however, as mentioned earlier, because of
the writer's belief that they are essential to good social
work practice. Gordon Hamilton also states the importance
of information of this nature in helping the client.

0n the one hand, we focus by means of understanding
and restating the chief complaint; on the other, we
focus through the request—-what the client wants to do
and what he wants us to do about it. This, in a spe»
cial way, makes the relationship a dynamic one because
we meet the client at the point of greatest interest.
We try to find out what was the client's expectation
in coming. What brings him to us? Why today? Did
someone suggest it? that crystallized his decision to
make the move? . . . The expectation is thus related
to what the worker, representing the agency, can do
about it, and it introduces the client to the agency
service in a realistic way.5

Further,

If the case has been referred by another agency, the
client may not be sure why he has been sent, so it is
imports nt to find out from him what he has in mind.

. . It may be presumed that since he has come here he
did have some idea in his mind. Especially, knowing
the functions of the other agency or worker, one must
guard against making assumptions that one therefore
knows all about referral and how the client feels about

 

5Gordon Hamilton, Theory and Practice of Social Case-
work (New York: Columbia University Press, IEBIS, p. l§§.

 

49
it. . . . When clients have been ill informed or have
had fantasies about the agency and its services, their
expectations may be out of prOportion to what can be
done for them either in general or by this agency in
particular.6

Of the forty-seven cases, sixteen were referred fol-
lowing specific incidents such as the child stoned on the
way from school, threatening suicide, stealing a gun, or
sexually assaulted. Twelve referrals followed a talk with
teacher, friend, or agency worker, five resulted from a
visit to the doctor and five were referred because of fear
on the part of the mother. Examples of this latter group
are: "mother is afrabithecflflld.will get in trouble,“
"teacher said the child may fail; mother upset," “mother
worried the child won't finish school." Nine were not
ascertainable. Because the average time lapse between re-
ferral and first contact was from six to eight weeks, a
discrepancy between what was said and what happened may ex-
ist.

The responses to the "help expected by parent and/or
referral source" in the study were classified as follows:

Plannins, evaluation and treatment

Advice ?”how to handle," "advice," "how to stOp bed-

wetting") .

Understanding of child and problem ("help him be hap-

pier," "am I doing something?")

Change in the child ("get to the bottom of this so

Tommy won't have this attitude," "help straighten

him out or place him in foster home," "stop de~
linquent behavior") ’

 

61bid., p. 161.

SO

.7.

a th school problem
flone, don't know
Other ("relieve physical distress," "relieve mother"s
nerves," "help parents eliminate friction," "make
home life happier")
There were seventeen requests out of fifty-nine for plan-
ning, evaluation and treatment, nine for advice, and seven
for understanding; there were seven requests for a change
in the child, and six for help with the school problem.

«ascribed above in the

m
11'!
D
$ \

There were four "other" request ,

r

listing and definition of the classification. dix indicat-
ed they wanted no help or did not know what help they ex—
pected and in three instances this was not ascertainable.

Social agencies, physicians and courts expected
planning, evaluation, and treatment, while parents who re-
ferred on the advice of the school had the largest prepor-
tion in the "none, don't know" classification. In fact,
five of the six statements in this category came from
school referrals. Iarents' expectations were more evenly
distributed with nearly two-thirds expecti.g planning,
evaluation, treatment, advice, and understanding of the
problem. The largest number and percentage of expectations
of change in the child also came from the referrals by par-
ents (Table 5).

In seventeen cases, it was impossible to ascertain
whether there had been any preparation of the chili for

coming to the clinic. In two instances, there was none.

TPD AT Yrfivv

~' .hokanoo;

HELP EXFEC so As
BY sooner

 

 

Source of Referral

 

Help

 

 

' ected Total ~c Social Ph si-
EXP Parents school Agencies cigns Court
Total 59 25 14 9 7 4
Planning,
evaluation
& treatment 17 5 5 4 5 2
Advice 9 6 O l 2 O
Understandé
ing 7 4 O 2 O 1
Change in
child 7 4 2 l O 0
With school -
problem 6 5 5 O O 0
Bone, don't
know 6 O 5 l O O
ther 4 5 O O l 0
Not ascer-
tainable 5 O l O l l

 

 

In ten instances, one could infer from the child's attitude
or statement that the child had been prepared. These are
listed because of the impossibility of classifying then:

hild resentful (5)

"Physical condition"

”No problem"

Punishment because of "badness"

Guilty, as though reminded of school difficulty
"Bad boy"

"Crazy”

"Ask questions and I'm not crazy"

What was said in those cases Where it is known there

Was preparation will also be listed for descriptive purposes:

"See a doctor again"

Doctor told child-~"a talk"

"Like coming to another kind of kindergarten"

"Get help in understanding him"

"Place where peOple like kids, want to help them and
see them play"

"Discuss problems"

"Talk over things"

"Place where they help you to learn better in school"

"Get understanding as to how you think"

"Because of school"

" Talk H

"Because of the way you treat sister" (twins)

"Place where people are trained to understand and
find out why we have this problem"

"Because of reading difficulty"

It was impossible to ascertain what knowledge the
parent and/or referral source had about the clinic in
twenty-nine cases; five others had been at the clinic preé
viously. Three said they knew nothing or little. Other
indications of knowledge were:

Asked about price and was surprised that mother
would be seen in treatment

Read about it in the newspaper

Game with a list of things do discuss—-bad things
only ’

Knew clinic could give diagnosis so the child could
be admitted to Starr Commonwealth

Knew clinic could determine if child is retarded

Testing

Thought of coming here about another daughter who is
failing in school

Expect treatment immediately

Thought she would remain with child during testing
as one does in a doctor's office

Because of the limited information one cannot base
any conclusions on these items in the study. They are of
value, however, in describing and picturing what some

peOple think of the clinic.

53

Characteristics of the Clinic Plan

 

The worker's impression of parent's attitude toward
coming to the clinic was felt to be of value in judging the
client's understanding of the clinic. The responses were
divided into three groups: I) "wanted to," meaning they
were interested in help to the_point where they indicated
willingness to involve themselves; 2) "indifferent," mean-
ing they came for advice or testing only, with no indica-
tion of willingness to involve themselves further; and
3) "did not want to or fearful," meaning they came from a
sense of duty rather than a sincere desire for help. The
workers felt that in eighteen cases parents came but did
not want to, thirteen wanted to, and in eleven they were
indifferent. In four cases this was not ascertainable.

Table 6 indicates that in cases referred by the
schools and the court, parents seemed to be most resistant
or fearful, while in those referred by social agencies, the
parents wanted to come in nearly three-fourths of the
cases. Nearly half of the parents vho referred their chil-
dren seemed to display an attitude of indifference toward
coming to the clinic. These findings seem to indicate that
social agencies which do use the clinic prepare parents for
coming to the clinic, while parents see the court and‘

school as representing authority and feel they must come in.

54
Parents themselves seem to be ambivalent as might be ex-
pected, since many parents, although desiring help for
their child, seem to feel this is an admission of failure

on their part.

TABLE 6

WORKER'S IMPRESSIOH OF PARENTS' ATTITUUE TOWARD
COJING TO THE CLINIC BY 30 ROE OF REFERRAL

 

 

-; J
t w.- WI.“—

Source of Referral

 

.’
I

 

 

 

Worker's
Impression Total c .
g, C , coolal Physi-
of Attitude iarents school Agencies cians Court
Total 47 18 12 7 6 4
Wanted to 13 n 3 5 O 1
Indifferent ll 8 O O 2 1
Did not want
to, fearful 18 4 9 l 2 2
Not ascere
tainable 5 2 O l 2 O

 

 

Of the forty-seven cases, thirty were accepted for
treatment. The problem as seen by the clinic was in most
cases a synthesis with the symptoms given as the method of
handling the problem. As mentioned in Chapter III, in the
paragraph on psychiatric diagnoses, it was difficult to
classify this data. It seems significant, however, that
the problems mentioned at the time of referral are consid-
ered the symptoms in the clinic diagnosis. A complete list

of diagnoses can be found in Appendix B. From the data it

55

seems the anxious, insecure child with a lack of satisfying
relationships who cannot function socially, intellectually
or emotionally and who would possibly move toward a more
severe disturbance, seems to be the type of child the clin-
ic will accept for treatment. The more seriously disturbed
children are more succinctly diagnosed--for example, "ex-
tremely disorganized," "psychotic state"--perhaps because
of the fact that the problem is clearer. These children
seem for the most part not to be accepted for clinic treat-
ment, but residential treatment is recommended. Children
diagnosed as mentally deficient or of low mentality cannot,
as a rule, profit by treatment and were, therefore, not ac-
cepted for continued treatment. In the cases the clinic
did not accept, suggestions or recommendations were made to
the parents and/or the referral source. One case in the
study was accepted primarily so that the parents could be
given help in understanding children in general and their
child, specifically.

Contacts by phone, letter or in person with other
community resources were made in eighteen of the forty-
seven cases according to the records, making a total of
twenty—two contacts. These contacts included those peOple
called in for the staff conference. The schools are fre-
quently contacted on this basis. Since a majority of the

diagnostic studies in the cases used were done during the

56
summer months, it is possible the schools were not contact-
ed for staffing of cases. Therefore, the number of con-
tacts made on the cases in the sample may not be represent-
ative. The following figures show the number and type of

contacts made during the diagnostic study.

 

 

 

Contact Number

Total . . . . . . . . . . . . . . . . 22
School . . . . . . . . . . . . . . . . 9
Police and Court . . . . . . . . . . . . Q
Social Service Exchange . . . . . . . . . 2
Physicians . . . . . . . . . . . . . . . 2
Visiting Teacher . . . . . . . . . . . . 2
Neuropsychiatric Institute . . . . . . . 1
Youth Haven . . . . . . . . . . . . . . . l
Kalamazoo State Hospital . . . . . . . . 1

Time lapse between referral and the intake interview
was considered to be an important indication of clinic
practice, particularly in relation to the type of problem
stated and the source of referral (Tables 7 and 8). From
Table 7 we note that of all children displaying projective
and introjective svmptoms, nearly one—third were seen with-
in two weeks. The average time lapse for all types of
problems was six to eight weeks. On the whole, children
displaying projective behavior seemed to be seen sooner
than any other type of problem, possibly because of its ob-
jectional features. Children with the less obvious habit

disorders were not seen as soon after referral, with nearl

57

 

 

 

 

 

 

TABLE
T133 ;-83 IN ENS BETJEZN 22873318 AND IVT‘VT INTE“VIEH
BY F 31338 STATED AT TISIE OF REFERRAL
Problem
. . Illness
”a k ~ 8 ' .e - x ‘ * ' '
"‘8 s TOt 1 Prggv: Infiifigec School habit Without
Bdrudo“ Behavior Failure Disorders Physical
“ C ‘ ““ Cause
Total 90 29 22 21 9 9
0-2 21 10 u 0 1 2
3-5 16 5 2 5 l 3
6-8 28 8 5 10 5 4
9-11 11 4 3 4 O 0
12-14 14 2 6 2 4 0
TABLE 8
TI": LAFCE I3 T.SSKS 7T 3TH RJFZtLan AID INTAKE
ITTTTJT“ 81 SQUZCE O? 27"'2LAL

 

 

Weeks

Source of Referral

 

Total

 

 

Parents School Aighiiés Physicians Court
Total 47 18 12 7 6 4
0-2 11 2 l 3 2 5
5-5 9 3 3 o 2 1
6-8 12 7 1 4 O 0
9-11 8 2 6 O O 0
12-14 7 4 1 O 2 O

58
one—half waiting from twelve to fourteen weeks. About one-
half of those displaying introjective behavior and one-
third of those with school failure waited for nine or more
weeks.

Children referred by social agencies and the court

were seen sooner than children referred by other sources.

H.

This can be exp ained n part by the fact that these

sources tend to refer children displaying projective behav-
ior (T able 9). Cases referred by the school were not seen
as readily, wit h seven of the welve waiting nine weeks or

more b tween referral and the intake interview. Although-

(D

children referred by parents seemed to be distributed
equally, on the whole, more seemed to wait at least the av-

erage number of weeks for all children.

 

 

 

 

 

TAB: -E
I? CBLT“E CT :- JAT TI‘.’D OF RTITJRAL AS CZIIEF Qfipwujo
FOR RLTLTIIQC T3 THU CLI JC BY SOURCE OF 127 ‘lRaL
Source of Referral
Symptom Total 0 Social Physi-
Iarents school Agencies cians Court
Total 90 41 20 14 9 6
Projective be-
havior 29 10 8 6 2 3
Introjective
behavior 22 11 4 5 2 2
School failure 21 9 7 4 1 0
Ho abit disturb-
ances 9 7 l O 1 O
Illness without
9 4 O l 3 1

physical cause

V‘—

CHAPTER V

SUEMARY AHD CONCLUSIONS

Summer

   

I. What is the relationship between the clinic's stated
function and the type of cases referred from the refer-
ral sources which are given service at the clinic?
Stated otherwise, is there divergence between the prac-
tice of the clinic and the theoretically stated func-

tion of the clinic?

This question can be answered best by comparison of
the two factors involved. Consideration of functions or
stated practice of the clinic will best set the pattern for
answering this question.

1. It is a clinic that tries to protect and improve
the mental health of the children in the community. From
the study, one sees that all children referred are given
diagnostic service. There is no restriction on sex, and
children from birth through seventeen are served.

From the data presented one can note service was
given to children of both sexes, although a larger number
of boys were served. Also children ranging from three to

seventeen were served by the clinic and, although there

60
were no referrals of children younger than three, it can be
assumed that the clinic may have accepted them for evalua-
tion of their develorment. Other characteristics of the
children seen, such as marital status of parents, and par-
ent's occupation, are of little significance in answering
.this question other than to indicate that children of all
types of families are served.

An interesting question arising here is the number
of children seen in prOportion to the number of children in
the Lansing area. This question of use of the clinic may
warrant study.

2. The clinic prefers that the parent refer the
child to the clinic, or that it is done with the parents'
permission.

In approxim tely one—fourth of the cases, cases re—
ferred from sources other than the parent were accepted.

In approximately one-third of the cases, it was suggested
that parents make a referral to the clinic but nearly half
of the referrals came directly from parents. In all of
these cases, parent or child was seen at intake, making it
possible to infer that permission was given for direct re—
ferral.

5. The clinic, although unable to treat mentally re-
tardei children, does not restrict by intelligence for di-

agnostic service.

61

Data presented supported this function in that an
almost equal number of children were found to be below av~
erage, and above average. Even those in which slowness or
retardation was suspected were given diagnostic service.
Five out of nine children below average were not accepted
for treatment, and only one out of eleven children with
above average intelligence was not accepted. Therefore, it
seems that the clinic is not restricting its intake by in-
telligence for diagnostic service, although they do not ac-
ceptnmmmally retarded children for treatment.

4. The clinic serves children with evidence of all
types of emotional problems.

From the data presented, one may note that there is
no limitation on the types of emotional problems or symp-
toms for which children may be referred.

S. The clinic tries to educate the community to un-
derstand the factors promoting healthy emotional develOp-
ment and recognizing signs of emotional disturbance. Fur-
ther, it tries to educate them in regard to the function of
the clinic, what it can do and what it cannot.

The clinic gives talks to various community groups
regarding both emotional health and clinic function. Staff
conferences are another method of interpreting function of

the clinic.

62

6. The clinic takes full advantage of all resources
in the community in dealing with every child referred.

In eighteen of the forty-seven cases referred, it
was recorded that contact was made with other resources in
the community during the course of the diagnostic study.
Whether other contacts were made but not recorded cannot be
determined. Host of these contacts were in the form of
staff conferences. Three were requests for written re-
ports. Two physicians were contacted and two cases were
cleared and registered with the Social Service Exchange.

It seems possible that there may be some divergence
between clinic function and practice based on the use of

community resources.

II. that is the relationship between the clinic and the re-
fe ral source in their understanding of clinic func-
tion? Stated otherwise, is there divergence_between
the clinic and the referral sources in their under-

standing of clinic function?

Because of limited information available, it was
difficult to attempt to answer this question. Descriptive
information given earlier in the presentation of material
relating to preparation, and knowledge of the clinic, al-
though inconclusive, showed the possibility that only a

broad, but accurate, understanding of function exists.

63

Help expected as indicated at the time of referral
might be indicative of understanding. Request for a change
in the child, with the school problem, none or don't know,
and the "other" classification accounted for twenty-three
of the fifty-nine requests, :hile planning evaluation and
treatment, advice and understandinz accounted for thirty-
three requests (Table 5, p.51). The latter types of re-
quests could be considered appropriate, although the giving
of advice may have a different meaning for parent and clin-
ic. The clinic does give advice in the broad sense of the
word, in terms of educating. However, it does not give
specific advice to parents regarding a child. It believes
in the parent's right to make his own decisions, in client
involvement in change if results are to be possible. It
does not include the ready—made prescription some parents
expect.

Help with a school problem implies a kind of change
in the child. The clinic does not see its function as
changing a child but rather evaluating the situation and
possibly giving psychiatric treatment. The latter may pro—
duce a change in the child but not in the "miracle cure"
way and only with involvement on the part of family mel—
bers.

Six parents stated they expected no help, or did not

out of these six were school

a

know what they expected. Five

64
referrals. In five other of the twelve school referrals,
help expected was a change in the child and with the school
problem. The other sources of referral seemed to be more
appropriate in terms of help expected.

The problem stated and the problem found seemed to
be directly related in all cases. The problems stated were
seen by the clinic in its diagnosis as the symptom or way
in which a child was handling his problem. Cn five cases,
the problem stated did not indicate the severity of dis-
turbance the clinic found. However, it seemed that the
types of problems did show an extent of understanding of
the clinic.

The clinic assumes that all parents referring chil-
dren to the clinic do want help. Yet, from the data, it
seemed that only thirteen of the forty-seven wanted to come
to the clinic to the extent that they were willing to in-
volve themselves. Five of these came from social agencies
and four from parents. The majority of those referred from
the school and from the courts seemed to be resisting serv-

ice or were fearful (Table 6, p. 54).

III. What are the characteristics of children seen and

served at the clinic?

From the presentation of the data, one sees that the

children are from three to seventeen, with the majority be-

65
ing of grade school age. Approximately twice as many boys
as girls are referred. The children tend to come from
whole families, are the oldest children, and are of average
intelligence.

The children display a variety of problems, projec-
tive behavior being most prominent in general and closely
followed by introjective behavior and school failure. Boys
and oldest children tend to display projective behavior and
school failure most frequently. Girls displayed habit and
psychogenic disorders. Introjective behavior was found
equally by sex, but was most characteristic of the middle.
and only child. Children displaying projective behavior
were referred most frequently by schools, social agencies,
and the court, while parents seemed to refer children with
introjective behavior most frequently. Schools also had
the largest percentage of school problems. Social agencies,
interestingly enough, referred no child because of habit
disorders when it seems possible they may have been in a
position to know about them.

The average time lapse was six weeks before contact.
There were exceptions, for emergencies. Cases referred by
social agencies and the court were seen soon after refer-
ral. Cases referred by the schools seemed to wait the
longest before being seen. Children referred for projec-

tive behavior were seen more quickly While those displaying

66
introjective behavior and habit disorders were seen after
the longest time.

Of the forty-seven cases, hirty were accepted for
treatment. Those not accepted for the most part displayed
a more severe disturbance which required hospitalization or
institutionalization. Those accepted tended to have an
emotional problem which hindered social, intellectual or
emotional functioning of the child, which could become more
severe. Recommendations were made for those who could not

be treated at the clinic.

Conclusions and Recommendations

 

The problem considered in this study was stated as
follows: there may be divergence between referral sources'
understanding of clinic function and the clinic's interpre-
tation of clinic function. Also there may be divergence be-
tween clinic theory and practice. If this is true it would
tend to decrease or limit the understanding of clinic func—
tion by those who use it.

On the basis of the study's findings, it is diffi-
cult to draw a conclusion whether clinic function is or is
not understood by the referral sources. The data available
from the case records were so limited as to make answers to

proof of lack of

L3
0

this question inconclusive. There is

understanding, however.

67

The clinic theory and practice seem to be directly
related except in the area of use of community resources.
This fact might raise the question of need to redefine
function inasmuch as many of the children seen and accepted
have waiting periods both preceding intake and treatment.
Although this is a question which could partially be solved
by additional staff, it seems possible that it is something
more than that. When it is coupled with the fact that the
clinic is used to a limited extent by community resources
which one would expect to make referrals to the clinic, one
may question whether these referral sources really under-.
stand and feel free to use the clinic. Is the waiting list
something that agencies understand about the clinic, and
are they discouraged by the waiting period? Do they find
it easier to make their own plan without clinic help?
Would it be more effective to serve more children who need
help by consultation and/or brief service than the limited
number the clinic can serve under the present policies? Or
is it important and necessary that there be an agency as a
child guidance clinic that can see emotionally disturbed
children for treatment, even though such treatment may be
available to a limited number? In short, is the clinic
fulfilling its function of service to the emotionally dis-

turbed children in the community?

68

Further, one can conclude on the basis of the find-
ings that the children whom the clinic does serve, although
limited in number, are children who need psychiatric or
psychological service.

Recommendations which may be made from the study are
limited. The writer suggests that:

I. An indication of the client's understanding of
the clinic become a standard part of the intake interview
and recorded, so that in working with a client, the worker
can more adequately begin where the client is. Further,
this would be helpful to the clinic in its program of in—.
terpretation and education.

2. All phone calls considered to be inquiries be re-
corded to help the clinic in interpretation and education.

5. The clinic itself objectively evaluate its pro-
gram and policy periodically to see if it is providing the
best service possible to the community; specifically, that
it attempt to solve the problem of long waiting lists.

4. School children with problems be cleared through
the Visiting Teacher program before referral is made.

This study suggests several tepics for further
study:

1. Ehy is there limited use of the clinic when the

potential needs of children seem to be so great?

. 69
2, Do the agencies in the community recognize the

symptoms of children with emotional problems?

,4.
m

3. If this apparent understanding ex ts, does it
extend to the outlying areas served by the clinic?

ce be

H.

4. Would more effective and extensive serv
available if procedures of referral from community agencies

were reformulated?

5. Are there Special areas which require more empha-
sis in the clinic's program of in erpretation and educa-

tion?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIBLIOGRAIHY
Books
Gartland, Ruth M. Psychiatric Social Service in a Chil—
dren’s Hospital. Chicago: University 0 Chicag
Press, 1757.
Greenberg, Harold A., K.D. Child Esychiatry ;n the Com—
munitv. A Primer for Lurses Teachers and Those Eho
Care for Children. .New York: 3. I. Iutnast Sons,
1753.
Hamilton, Gordon. Isycbotherory in a Chili unidence Clinic.
flew Yor‘: Columbia Lniversi ty Tress, 1747.
. o y and Practice of Social Case Work. New
York: Col in;bia Univer si y Iress, 1k51.
Harms, Ernest (ed. 3. fiendbook of Child Guidance. New York:
Child Care Publications, 1747. Ip. 225-551.
Ka er, Leo, M.D. Child Psychiatry. ringfield, IllinoiS°
Charles C. Thonas,1757, pp. 115-16.
Paradise, Viola. Toward Public Understanding 3_ Case Work.
new York: ru. e11 Cage roundation, 1748.
Iitmer, Helen Leland. Isychiatric Clinics for Children.
New York: The Commonwealth Fund 1740.
. Articles
Austin, Lucille N.

'Rela tionships between Family Agenc1es
and lental Health Clinics s," Social Casework,
X1211 (I eoruary, 1955), 51- 53.

 

 

 

Vol.

Burnett wary Cla rk. "mhe coc1al Worker in Agency-

Comwunitv i.elationships, national Conference of

Social for l Proceedings 17' +1. New York: Columbia

Uni've ‘38in 13888, pp. 671“(}[+o
Eggleston, Ihilippa. "The \ole of the Clir 'ic Social

in Relation to the School Child,"

atric Social I.ork, Vol.

 

Worker
Journal of IS'
XXIII (Tannery, 1751),

‘1‘

  

71

Faatz, Anita J. "Interpretation in the Public Agency,"
National Conference oi Social Iork Iroceeiinis,
1741. New iork: Columbia University Press, pp.
685-75.

Farmer, Hess, and Rossman, William B., M.D. "Helpin3
Teachers A33reciate E oticnal Iroolems in Childr en,"
American Journal of Isychiatry, Vol. 108, It. 1
kfiovemoer, 17517, 5% ~80.

 

 

 

Goldman, Rose. "Some Aspects of the Integration of School
Social Work into the Clinic I'eam of a School Sys-
tem, " Jo rnal of Isle iatric Soc mi Iork, Vol. XXIII

 

(January, 1.;5471‘ 82‘86.

Hallowitz, David, and Cutter, Albert V., M.D. "Intake and
the Waiting List: A Differential Anproach," Social
Casework, Vol. xxxv (December, 19543, 439-45."“"”'“

Hochwald, Hilie Landenberger. "The Use of Case Recoris in
Research," Social Casework, Vol. XiXIII (February,,
1952), 71-7bo

Janvier, Carmelita. "Problematic Areas in the Integration
of the Echool Social Worker ani the Clinic Team
Journal of Isychie trio Social fiork, Vol. XXIII (Jan-

uary, 132+). 71’15

LaMar, Helen. "The Intake Process in a Growing Community,"
Social ”as work, Vol. XXXIV (Aoril, fiB), 107- 75.

Levy, David M., “ .0. "Critical Evaluation of the Present
State of Child Isychiatry " American Journal of I51-
chiatrz, Vol. 108, It. January, 175:),4E1-74.

Perkins, Keith J. "Consultation Service to Iublic Schools
by a Ienta -Health Team, " Lental Hy3iene, Vol. XXXVII
\3ctober, 1755), 584-‘74.

 

Reeve, Mary, ani Brangwin, Lorna C. "Family Cervice Agen-
cies and Mental Hy iene Clinics, " E‘ocia l Casexork,
Vol. XXxIII (X ay, 1752), 175-77.

Wilson, Eunice W., ani Bartlett, Harriet M. "Referrals from
‘ Hospitals to Social Agencies " Social Casework, Vol.
XXXVI (December, 1755), 457-65.

72
Studies ar d Reports

Mass, Henry 8., and Others. "Socio-Cultural Factors in
Psychiatric Clinic Se1 vices for Children: A Collab-
orative Study in the New Yorl and San Irancisco
Areas, Smith CollegeS tudies in Social Work, XIV
(Iebraary, 1555).

 

Lansing Child Guidance Clinic. Sintecnth Annual Report,

1954.

. Seventeenth annual Renort, 1955.

 

Zichigan Child Guidance Clinics. Progra m and Iolicy Stat

ment. Lansing: Kichigan Lepartmen of Lenoa
>alth, September, 1952.

 

Michigm nDep'rtment of Mental Health, Differential Utiliza-
tion of th acilities of a Pichigan 3:11d Guiicnce
Clin:_, We ea ron Report-'-w no. 17. Lansing: Kichigan

Department of Zental Health, 1955.

 

Unpublished Material

marcella Jean. "A Child Guidance Clinic as a Social
Resource in a Small Metropolitan Community." Unpub-
lished AZ aster' sResearch Project Report, Department
Of Social Service, Kichigan State College, 1947.

C)
93
0’]
C1"
0

Reul, ryrtle R. "A Study of the Lay Opinion on the Family
Service and Other Social We rk Agencies in the Jack-
son Area." Unpublished Haster' s Research Project
Report, Department of Social L'or‘, Richigan State
College, 1954.

o aChild Guidance
g A~ency." Ia er
M1 School of Social

Large ry. "Criteria of Referral t
Clinic for a Iublic Child Ila
re
or

id
O
U.
'9
co

cin
n par ei for course work, hew Yo
k, l”5l. (Typewritten.)

YIY

wright, Jean. "A Study of School Referrals to a Child
Guidance Clinic for the Year 1954." Unpublished
Has ster’s Research Iroject Report School of Social
Work, Richigan State University. (In process.)

73
APIEKDIX A

SCHEDULE

I. Child
Age Sex Race School grade
Number of siblings Ordinal position

Marital status of parents

 

Address of child

 

Parent's occupationCs)

 

II. Referral
New ReOpened Means w Confirmationi‘~
Source Advised by

Problems stated at time of referral

 

 

what precipitated referral

 

Length of time between referral and intake

 

-Help expected by parent and/or referral source

 

Was child prepared for coming” By whom

What was he told

 

What did referring adults knot about the clinic (by

 

their statement)

 

III.

Clinic

Who came for intake

 

Worker‘

{0

impression of parents' attitude toward

coming to clinic

74

 

 

Problem as seen by staff

 

 

Accepted Not accepted

Other recommendations

 

 

Reason for plan

Other contacts during diagnostic study

 

Cu
Tr.

a
n.

4.1.

75
APIEKDIX B

Psychoneurotic; dependency and feelings of inadequacy be-
cause of overprotection, becomi g withdrawn

Feelings of anxiety, dependency, low self-esteem and ag-
gression which he is handling by ovcrconformity and
arrest of psychosexual develOpments

Limited intellectual capacity; castration and aggression
anxiety

Essentially healthy child; parents need an understanding of
children

Child too restricted, handling by behavior problem

Child insecure; feels affection is based on fulfilling his
many responsibilities

Neglected with chronic anxiety reaction, depression, and
acting out

Rejected, insecure with feelings of badness
Depressed, withdrawn, insecure

Insecure, negativistic with combination of psychopathic and
paranoid tendencies

Anxious, hostile, unable to express feelings
Angry at parents so is not conforming; speech difficulty

Character neurosis; hostility a cover—up for deep-seated
fears

mental deficiency

Tense, anxious, and hostile, showing signs of withdrawing
from his environment

Kisunderstaniing on part of parent regarding school inter-
pretation of child‘s mental ability

 

 

76
Rental deficiency

Situational reaction causing aprrs hension and anxiety with
feelinss of se if- deprec1arion

Anxious, impulsive, extremely emotionally responsive with
objective of self-gratification

Anxious, lacking confidence and overcautious

Ire -schizophrenia; below average mental ability with sexual
preoccupation and lack of superego development

Extremely disorganized; psychoneurotic

Possible organic involvement; hearing loss; feelings of
insecurity and inadequate

unwilling to express

Hostile, especially toward mother,
lationships with danger of
4-.
La

self, poor interpersonal e
becoming sexually delinquen

Insecure, over—controlled by parents

Ins secure, feelings of not being accepted, with sexual con-
fusion

Anxious and insecure, which makes thinking and learning
difficult

Sit national reaction hostile, pre occupa ition with family
disunity

Situational personality disorde with poor capacity to re—
late and la c‘li of inner resources

Anxious, hostile, possible sex problem and indications of
manic-depressive behavior

Insecurity due to family friction and per wnalityr roblems
of parents

Lack of satisfying relations hips with anyone, and need for
acceptance to prevent more serious disturbance

Situational personality disorder; acting out hostility in
passive negative way

77
Lack of stimulation, little interest in anything
No positive relationships and possible sex problem
Depressel and constricted

Constricted, depressed, and anxious, lacking feeling‘ of
acceptance

Psychotic state
Neurotic, near psychopathic personality

Hostile, overcontrolled, with possible break with reality
surgested

Severely disturbed and disorganized

SchiZOphrenic; paranoid tendency

Hostile child with need for parents to understtnd and
handle these feelings and their relation to other com—
plaints

Insecure and rejected with tendency toward more psychomatic
complaints and possible psychosis

Withdrawn and overconforming, with bedwetting
Anxious, overdependent, with no positive relationships

Anxious, depressed, and insecure because of pressures with
need for mother to exert less pressure