Europe's children are hungry-yes, very hungry-and this winter there -promises to be even less for them than

in other years.

Hunger, though, is not all that is the matter. Some insight into the problem comes from a report brought to the Children's Bureau by Helen Groot, a social worker from the Netherlands, a country traditionally a symbol of stability and order. The story is repeated over and over again with little change.

The emotional insecurity in which the children have spent their lives has left its mark. Miss Groot speaks of 4and 5-year-olds having "nervous breakdowns," one way of describing their going to pieces in the face of threats to their security which they cannot understand. The security children need is not to be had.

Family relationships, for one thing, are very much mixed up, with many elements that bear hard upon the children. The able-bobied men were taken from their families for work in Germany, and, over the course of years, sometimes family ties weakened. The men came home or they did not come

home-and it was difficult to take up the old ties again.

So they have done what other people would do under the circumstances; that is, make the best arrangement possible. Not all the children in the same family unit have the same mother; or, the other way around, not all have the same. father. Sometimes they are not even of the same nationality or race. Some of the children have no kinship ties with those who are looking after them. For a good section of the population the neat little family unit is gone. What has taken its place is often an unstable assemblage of adults and children.

one thing, with the problem of getting and keeping the children in school, wit getting food and housing for them, an such immediate matters. It lacks th money, the personnel, and the facilitie to do more than make a gesture in sup plying badly needed social services.

This break-down of social responsi bility, as far as children and youn people are concerned, has long-rang implications for all of us. The young ones will pull through, for peop somehow live, but what kind of men an women will they be? We ask th question repeatedly concerning our ow children and youth, but we must e tend that concern to these others, to Common humanity should lead us give food and money so that somethin can be done to meet the immediate nee

enlightened self-interest should lead to do more to strengthen such inte national channels as we now hav

Families live under conditions that would be hard enough even if all else. were right. Food is hard to come by. So is housing. Under such conditions, with all that the deprivation and the crowding mean in terms of people getcrowding mean in terms of people get whereby help may be brought to the ting on one another's nerves, the children often have little chance for any security. And, at a time when the community most needs to gather up its resources to bolster the home, the community is helpless. It struggles, for

children.

Katharine 7. Leurook

KATHARINE F. LENROOT
Chief, U. S. Children's Bureau

64

U. S. GOVERNMENT PRINTING OFFICE: 1947

THE CHILD VOL. 12 NO.

Study and

Treatment Homes

MARTIN GULA, Director,

Evanston Receiving Home of the
Illinois Children's Home and Aid Society

S

TUDY and treatment homes for troubled children are a new tool in the child welfare and mental hygiene fields. Like other new tools the use to be made of them is not always clear. To some they are looked upon as a means of bringing about a "quick cure" in the child's behavior. Others would use the study home as a substitute for some other service which is inadequate, or lacking, in the community. In still other instances, the name, not the tool itself, is appropriated for an existing institution or one being planned. In reality, the study and treatment home is a supplementary tool, but an increasingly important one, in a comprehensive program of services for children.

To describe a study home, briefly, it is a place where a carefully selected group of disturbed children are brought together in a home atmosphere under the care of adults with special qualifications. The purpose of their stay is to provide an opportunity for a diagnosis of their difficulty on which treatment can be based, and plans can be made for permanent care.

The study home is not by any means for all children who are showing difficult behavior problems. Good basic case work, as we know, calls for early detection of the emotional problem and treatment within the home setting. However, study and treatment in the

child's own home is not always possible. Parents are frequently inflexible. Sometimes the symptoms persist in spite of case work. What then needs to be determined is whether the young person's behavior is predominantly reaction to a provocative family, school, or neighborhood situation or whether it is a reaction to disturbing conflict within the young person himself. The need is to arrive at this differentiated awareness before too many changes of environment are tried.

Although there are exceptions, and each situation demands its own analysis, disturbed behavior that is due chiefly to environmental factors shows itself usually in response to a specific person, or setting, and in an isolated form. On the other hand, behavior that is due to internal conflicts appears in more than one form and in response to several persons or settings. A child, for instance, who steals at home because of

the lack of maternal affection and the hostility of a punitive father, may very well be treated in a foster home if it can satisfy the needs that were not met in his own home. But, if in that foster home the foster father is punitive like the child's own father, then the affection of the foster mother may not serve as a "corrective."

Condensed from paper given at the National Conference of Social Work, held April 13-19, 1947, at San Francisco.

PƆSITED BY THE

UNITED STATES OF AMERICA

had children who, seemingly without provocation, would break forth in se

vere tantrums or rages in which they would break windows and tear clothes. Others practiced sexual delinquency of a direct nature. Some had night terrors. Some set fires. Many had involved stealing patterns. One girl compulsively combed her hair 20 times before going to school. These symptoms, and a host of others that cannot be tolerated in the ordinary setting, make it necessary to provide some special form of care and treatment.

(3) The child whose symptom patterns need "professional" observation and treatment. Included in this category are those with symptom patterns such as: (a) compulsion neuroses that need careful, controlled observation of precipitating factors; (b) pseudodefective behavior with elements of disturbance and mental defectiveness that cannot be differentiated or tested in the community; (c) emotional behavior such as unexplained mood swingschanges that may have a physical basis; and (d) physical behavior that has an emotional basis, such as asthmatic attacks. Careful observation is needed, the kind of observation that can be carried on only in a controlled setting by people with special skills.

(4) The child who cannot relate to the foster family, community, school, or neighborhood. This group includes, for example, a girl so worried and afraid that she cannot leave her home to attend school; a boy, approaching adolescence, who is intensifying his aggression against parent persons; and a girl who is withdrawing from foster parents, school and neighborhood groups to such an extent that foster parents are not satisfied with her.

Parenthetically, it assumed that certain groups of disturbed children such as the feeble-minded, the physically crippled, and the emotionally disturbed on an organic base, the advanced delinquent, and the psychotic can usually be diagnosed in the community setting and through community resources, and that treatment services directed to their specific needs can be used. They are not among those for whom a study and treatment home is generally considered.

NOVEMBER 1947

In selecting those for whom such residence seems indicated, the case worker works under certain conditions. First, she tries to get the picture behind the symptoms in relation to past and present factors in the child's physical, mental, familial, and social development. Second, the diagnosis and the treatment plan are tentative until tested in the child's home, or until a "therapeutic test" is made in the foster home, or later in the treatment center. Finally, specific reasons for using the treatment center must be arrived at.

The study home

Operation of a study and treatment home varies in emphasis in relation to its sponsorship and to the community

need.

Our residence, the Evanston Receiving Home, is utilized as a diagnostic and treatment center for exceptional emotional deviations of children, in a planned residential group. It is under psychiatric direction and uses specific personnel in a specific program. It is a supplementary and integrated tool in the total program of the Illinois Children's Home and Aid Society.

This Society is a private, State-wide, nonsectarian child-placing agency that has under its care some 1,800 dependent children. It uses foster homes primarily, and, in addition, institutions other than its own residence, the need of particular children determining the placement. Case workers assume responsibility for the child as long as he is with the agency.

At any point of the youngster's stay with the society, Dr. Margaret Gerard, the psychiatric consultant, is available for conference. At intake a diagnosis is made, and during the child's stay in a foster home or an institution, consultation is given. Consultation also takes place when the child is considered for the study and treatment residence.

The psychiatric consultant leads seminar discussions at which case presentations by the society's social workers are used for a review of psychiatric concepts underlying their work with the youngsters.

That, then, is the framework in which the study and treatment home is operated.

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Diagnosis and treatment in the study home Diagnosis and treatment in the study home 36

Some study and treatment residences are primarily for diagnostic study within a brief period. Others combine diagnostic and treatment services. In both, the group residence is used to provide experience in living with others

under controlled conditions.

The setting quickly loses its artificiality. The child soon uses the staff as parents and the other children as siblings. He usually directs toward them. the fundamental emotions he directed toward his own parents and other significant persons in his earlier experi

ence.

In some homes a "repressive" atmosphere is sometimes developed and conformity is demanded from the child. Some homes, on the other hand, have an "indulgent" atmosphere that demands little conformance. Still others provide a flexible "expressive" atmosphere in order to bring out the best in the child.

Our approach is one of treatment, and in it, what is done and the attitude taken is related to the boy's or girl's individual emotional needs at a given time. Within this approach some selfindulging children are helped to impose limits on themselves. Those who have imposed upon themselves severe conformity are encouraged to relax. In

other words children with different needs are given different treatment.

The practice at the Evanston Receiving Home is to observe as many areas of the child's daily living as will help evaluate his personality, recognizing that the dynamic trends are more important than the static picture. Staff members, the residence personnel, the recreational workers and others in contact with the children make their observations of the child's behavior in relation to the initial reasons for his referral and acceptance. They inform the director as soon as possible after the behavior occurs, and he, in turn, notes their observations in a "log." This recording provides a basis for summarizing behavior trends. Case workers refer to this log prior to each interview with the child.

After a month's time the psychiatrist, case worker, case-work supervisor, director of the residence, and the house staff usually confer. This meeting is

67

for the purpose of arriving at a causal base for the youngster's disturbance in order to establish a relationship between his inner needs and the symptom picture, and to formulate a treatment plan to meet those needs.

The case worker reviews the child's history giving her tentative diagnostic formulation. Her report covers her interviews with him and brings out their content, trend, and significance.

The director summarizes the trends in the child's behavior in the group, school, and neighborhood, basing it upon the observations of the residence staff. Such significant information as the following is reported: the child's interests; his physical mobilization, eating habits, and use of time, sleep, and money; his emotional fluctuations and reaction from frustrations; his attitude toward boys and girls; his feelings about the case worker, and his verbalized feelings about his parents and their visits. Detailed information is also brought in about his response to school, work, and material possessions.

The psychiatric consultant, who presides over the conference, then helps the group formulate their diagnostic and treatment plans.

Following such a conference, the child's stay in the home may be terminated if it is felt that some other service can better meet his needs. If, how ever, diagnosis indicates that his problems are due to inner conflicts and that residence can be a constructive experi

A boy needs a place of his very own for "tinkering."

The case worker is given specific suggestions for handling her interviews. Likewise the resident staff is advised as to how to handle the child in the residence, and how to deal with problems that arise in the school and neighborhood. Every 6 or 8 weeks the case is reviewed and treatment progress evaluated. Throughout these periods the case worker interviews the child weekly

ence, then a treatment plan is carefully view is conducted is provided with a elaborated. glass panel in order to forestall interruptions. Play equipment-art materials, dolls, soldiers, music, construction sets, and other media-is at hand for the workers to draw upon as part of therapy. On one wall is a handpainted circus mural which subtly introduces father persons, mother persons, children of various ages, and dogs, all busy riding a merry-go-round, or watching it. The youngster being interviewed will express feelings toward different figures in the mural in the same indirect way in which the child uses play symbols.

and interprets developments in his be

havior to the house staff.

As treatment in the home is being concluded, a transition is planned and executed in accord with the child's need. That may be a return to his own family, a move to a foster family or institution, or in the case of the older ones, jobs may need to be found so that they can become self-supporting. The setting and the type of persons that will best serve the child's needs are determined on the basis of the study and treatment of the child while in residence. That information gives the worker a sounder basis for predicting behavior than could be obtained in the community setting.

Role of the case worker

Throughout her work with the child, the case worker not only refers to the "log" for recent observation of the resident staff prior to her interviews, but she also records the content of the interviews for their effect on the child's behavior. The room in which the inter

Case workers see each child at least weekly, the disturbed children more frequently. Some case workers have more than one child under care at the same time. As part of their individual treatment program, such workers learn to handle the sibling feelings arising in each child.

The case worker carries total responsibility for the child as a staff member of a child-placing agency. She obtains the initial and subsequent history of the child in his family setting, maintains a relationship with other agencies and resources, clears with and interprets to the houseparents the treatment movement for a particular child. and at the same time actively treats the child through interviews, manipulation of resources and play therapy. All de