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Intake priorities and criteria in a Family Service agency : a survey of waiting list cases and administrative… Porter, Eva Mildred 1960

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INTAKE PRIORITIES AND CRITERIA IN.A FAMILY SERVICE AGENCY: A SURVEY OF WAITING LIST CASES AND ADMINISTRATIVE IMPLICATIONS by EVA MILDRED PORTER T h e s i s Submitted, i n P a r t i a l F u l f i l m e n t of the Requirements f o r the Degree of MASTER OF SOCIAL WORK i n the S c h o o l of S o c i a l Work A c c e p t e d as c o n f o r m i n g t o the s t a n d a r d r e q u i r e d f o r the degree of M a s t e r of S o c i a l Work S c h o o l o f S o c i a l Work I960 The U n i v e r s i t y of B r i t i s h Columbia In presenting t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree that permission f o r extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e . I t i s understood tha t copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n permission. Department of ^ .A*~*Jl<^ J!J-<^JL Ttf^iJ: The U n i v e r s i t y of B r i t i s h Columbia, Vancouver 8, Canada. Date (p^lc-jS-e^^~^\J &3,  \ - .11 -TABLE OF CONTENTS •Chapter 1. Family Service and the Waiting L i s t Page Present and Future Dilemmas of the Family Service Agency4 The Vancouver Agency: (a) C e n t r a l -i z e d Intake and C o n t r o l l e d Assignment, (b) The Waiting-L i s t , '(c) The Issue of P r i o r i t i e s . Methods of Present Study. . i , .1., Chapter 2 . A p p l i c a n t s to the Family Agency: A Sample  Group B r i e f and Continued S e r v i c e * Who Were the Ap p l i c a n t s ? C r i t e r i a f o r P r i o r i t y . 18. Chapter 3 . Services Provided t o B r i e f Cases and the E f f e c t s of. the Waiting P e r i o d C l o s i n g E v a l u a t i o n . Main Presenting Problems -Case Examples. M o t i v a t i o n and the Doubtful A p p l i c a n t s . E f f e c t s of the Waiting P e r i o d and the "Lost" Cases. .. 5 8 . Chapter 4. Continued Service Cases T o t a l Items of S e r v i c e . Short-Term Cases. Medium-Term Cases... Long-Term Cases. 8 l . . Chapter 5 . The Challenge of P r i o r i t y Determination: A New Look at Family Service C l i e n t e l e Who Are the C l i e n t e l e ? Services Requested and Provided.. I m p l i c a t i o n s f o r P r i o r i t y Determina-t i o n . .. . 145. Appendix: B i b l i o g r a p h y . TABLES IN THE TEXT Table 1. Age, Sex and M a r i t a l Status of the I n i t i a l A p p l i c a n t 2 6 . Table. 2 . Number of C h i l d r e n i n the Home at. the Time of A p p l i c a t i o n . ^  2 8 . - i i i -Page Table 3 . Country of B i r t h of Adult C l i e n t s 3 0 . Table 4 . . Occupational Groups [Male Only) .............. 3 2 . Table 5 . . Occupation and M a r i t a l Status of Employed Women ................ .. ... 3 4 . Table 6 . D i s t r i b u t i o n of Main Presenting Problems Pound i n 9 5 Cases .............................,.... 41... Table 7 . P r i o r i t y and the W a i t i n g - L i s t . (Waiting P e r i o d f o r B r i e f S e r v i c e and Continued Table 8 . P r i o r i t y . a n d Length of Service ( B r i e f Service .and Continued Service Cases.)................ 4 9 . Table 9 . P r i o r i t y and Opening Status ( B r i e f Service and Continued Service Cases,)....,.........,.. 51. Table 1 0 . Main Pres e n t i n g Problems i n B r i e f Service Cases ......................................... 54.. Table 1 1 . . Pr e s e n t i n g Problems Given P r i o r i t y 5 4 . Table 1 2 . C l o s i n g Status and Caseworker's E v a l u a t i o n at C l o s i n g , B r i e f Service Cases .............. 5 8 . Table 1 3 . Items of Se r v i c e , T o t a l Continued Service Cases ... . i . . . . 8 3 . Table 1 4 . C l o s i n g Status and Caseworker's E v a l u a t i o n at .Closing, Continued Service Cases ........... 8,6, Table 15a.. Items of Se r v i c e , Short-Term Cases ............. 8 8 . Table 1 5 b , Items of Se r v i c e , Medium-Term Cases ........... 1 0 6 . Table 1 5 c . Items of Se r v i c e , Long-Term Cases 1 2 6 . - i v -INTAKE PRIORITIES AND CRITERIA IN A FAMILY .SERVICE AGENCY: A SURVEY OF WAITING LIST CASES AND ADMINISTRATIVE-, IMPLICATIONS, VANCOUVER 1958, by Eva M i l d r e d P o r t e r . ABSTRACT: P r e s e n t t r e n d s and s t r e s s e s i n f a m i l y s e r v i c e agen-c i e s are r e l a t e d t o e x t e r n a l and i n t e r n a l demands f o r more e f f e c t i v e s e r v i c e f o r an i n c r e a s i n g l y d i v e r s i f i e d c l i e n t e l e . I n the f a c e o f t h e s e demands, the d e v i c e of t h e " w a i t i n g -l i s t " has become w i d e l y p r e v a l e n t i n f a m i l y s e r v i c e a g e n c i e s t h r o u g h o u t N o r t h A m e r i c a . T h i s r e p r e s e n t s a b a c k l o g of a c c e p t e d a p p l i c a n t s who cannot be g i v e n immediate- s e r v i c e , and i t i n e v i t a b l y n e c e s s i t a t e s g i v i n g some a p p l i c a n t s p r i o r -i t y over o t h e r s , on the b a s i s of r e l a t i v e u r g e n c y . The w a i t i n g s l i s t d e v e l o p e d as a . r e s u l t of e f f o r t s t o p r o t e c t the q u a l i t y o f casework s e r v i c e t o f a m i l i e s , . b u t i t does pose some s e r i o u s q u e s t i o n s about the q u a l i t y as w e l l " as t h e quan-t i t y of s e r v i c e t o the community. What i s urgency? What happens t o t h o s e who w a i t f o r s e r v i c e ? What i s the r e l a t i o n -s h i p of the w a i t i n g - l i s t and p r i o r i t y d e c i s i o n s a t i n t a k e t o the c h a n g i n g c o n s t i t u e n c y of t h e f a m i l y s e r v i c e a g e n c i e s ? T h i s s t u d y examines some of the q u e s t i o n s t h a t a r i s e when t h e r e i s a w a i t i n g l i s t I n a f a m i l y agency, by f o c u s i n g - on c e r t a i n a s p e c t s of the w a i t i n g - . l i s t of one agency. T h i s i s an e x p l o r a t o r y s u r v e y of t h e w a i t i n g - l i s t of one agency (The F a m i l y S e r v i c e Agency of G r e a t e r V a n c o u v e r ) , as i t i s r e f l e c t e d i n a b l o c k of 95 cases a c c e p t e d f o r s e r v i c e d u r i n g a two month p e r i o d -of 1 9 5 8 . I t i n c l u d e s a s t a t i s t i -c a l s u r v e y of the a p p l i c a n t s and t h e i r f a m i l i e s and the main problems t h e y p r e s e n t e d a t the time t h e y approached the agency. The sample i s then d i v i d e d i n t o two main groups - . b r i e f s e r v i c e and c o n t i n u e d s e r v i c e cases ( a c c o r d i n g t o the F a m i l y S e r v i c e A s s o c i a t i o n of A m e r i c a - d e f i n i t i o n ) . S t a t i s t i c a l i n f o r m a t i o n about the l e n g t h of t h e w a i t i n g p e r i o d , opening s t a t u s , l e n g t h of s e r v i c e , and main p r e s e n t i n g problems i s r e l a t e d t o each of t h e s e groups, and a l s o t o c ases w h i c h r e c e i v e d p r i o r i t y s e r v i c e and t h o s e w h i c h d i d not get t h i s c o n s i d e r a t i o n . Case s t u d y of b r i e f s e r v i c e cases i s f o c u s e d on e v a l u a t i o n of s e r v i c e s t h e y r e c e i v e d , and p a r t i c u l a r l y on the e f f e c t s of the w a i t i n g p e r i o d and p r i o r i t y d e c i s i o n s . . Study of c o n t i n u e d s e r v i c e c ases i n c l u d e s s t a t i s t i c a l i n f o r m -a t i o n about the t o t a l i t e m s of s e r v i c e p r o v i d e d t o t h i s group, and t h e f a m i l y members who r e c e i v e d d i r e c t s e r v i c e . F o r the purpose of case s t u d y the c o n t i n u e d s e r v i c e cases are d i v i d e d i n t o t h r e e gro.ups a c c o r d i n g t o the l e n g t h o f s e r v i c e t h e y r e c e i v e d , and d e s c r i b e d as s h o r t - t e r m , medium-term and l o n g -t e r m c a s e s . Case examples g i v e a p i c t u r e o f the. range of t h e c l i e n t e l e and s e r v i c e s p r o v i d e d t o t h e s e t h r e e g r o u p s . - V -A l t h o u g h t h r e e - q u a r t e r s o f . t h e i n i t i a l . a p p l i c a n t s were women, i n c o n t i n u e d s e r v i c e s cases th e male m a r i t a l p a r t n e r was u s u a l l y i n v o l v e d and men r e c e i v e d a s u b s t a n t i a l amount of d i r e c t s e r v i c e . The employment of the male bread--w i n n e r s i n the sample was m a i n l y l o w e r m i d d l e c l a s s and upper w o r k i n g c l a s s i n s t a t u s , but t h e r e was r e p r e s e n t a t i o n f r om groups of h i g h e r and l o w e r s t a t u s . H o w e v e r , . i n f o r m a t i o n . a b o u t the a p p l i c a n t s * f a m i l y g r o u p i n g s , i n t e r p r e t e d i n the l i g h t of c u r r e n t l i t e r a t u r e , s u g g ests t h a t most of them are i d e n t i f i e d w i t h the s o - c a l l e d "middle c l a s s v a l u e s " of f a m i l y l i f e , and t h i s I s s u p p o r t e d by e x a m i n a t i o n of case m a t e r i a l . Among a d u l t c l i e n t s , p a r t i c u l a r l y those who r e c e i v e d s e r v i c e o v er l o n g p e r i o d s , t h e r e appears t o be a h i g h i n c i d e n c e of p e r -s o n a l i t y d i s o r d e r s . O t hers, p a r t i c u l a r l y among the new a p p l i c a n t s , a r e p e r s o n s e a s i e r t o h e l p by casework methods. The s t u d y p o i n t s up t h e i mportance of new . a p p l i -c a n t s , and the need f o r g i v i n g them g r e a t e r c o n s i d e r a t i o n a t i n t a k e i f new c l i e n t e l e are t o be r e a c h e d i n any numbers. The most p o s i t i v e f a c t r e v e a l e d by the s t u d y i s t h a t " l o s s " of cases i n t h e p r o c e s s of i n t a k e i s a lmost e n t i r e l y a p r o b -lem of "engaging", th e new a p p l i c a n t . I t i s s u g g ested t h a t , when t h e r e i s a w a i t i n g - l i s t , p e r s o n a l i n t a k e i n t e r v i e w s s h o u l d be o f f e r e d t o a l l who a r e making a f i r s t a p p l i c a t i o n . A p a r t from the need f o r more c o n s i d e r a t i o n f o r new a p p l i -c a n t s , . e x t e n s i o n o f e f f e c t i v e s e r v i c e appears t o be r e l a t e d t o the q u a l i t y of. i n t a k e s e r v i c e , r a t h e r than t o any c o n c r e t e r u l e s f o r p r i o r i t y d e t e r m i n a t i o n . - - v i -ACKNOWLEDGMENTS The w r i t e r w i s h e s t o acknowledge the v a l u a b l e c o n t r i b u t i o n o f Dr. Leo n a r d C. Marsh, w i t h o u t whose s k i l l e d and p a t i e n t d i r e c t i o n t h i s t h e s i s would not have been p o s s i b l e . S i n c e r e a p p r e c i a t i o n i s extended t o Mr. Der y c k Thomson, E x e c u t i v e D i r e c t o r of the F a m i l y S e r v i c e Agency f o r h i s c o - o p e r a t i o n and encouragement. The w r i t e r a l s o w i s h e s t o expres,s t h a n k s t o Mrs. I v y B u t t , R e g i s t r a r of the F a m i l y S e r v i c e Agency, f o r h e r p a t i e n c e and p r a c t i c a l h e l p . INTAKE PRIORITIES AND CRITERIA IN A FAMILY SERVICE AGENCY; A SURVEY OF WAITING LIST CASES AND ADMINISTRATIVE IMPLICATIONS CHAPTER I FAMILY SERVICE AND THE WAITING L I S T F a m i l y s e r v i c e a g e n c i e s a p p e a r t o be r a p i d l y a p p r o a c h i n g a n o t h e r m a i n c r o s s r o a d s i n t h e i r d e v e l o p m e n t . The l a s t m a j o r change i n d i r e c t i o n o c c u r r e d a s a r e s u l t o f two i n f l u e n c e s whose g r e a t e s t f o r c e was f e l t a t a b o u t t h e same t i m e . The f i r s t . o f t h e s e was t h e i m p a c t o f d y n a m i c p s y c h -i a t r y on t h e t h e o r y a n d p r a c t i c e o f c a s e w o r k . The s e c o n d was t h e a s s u m p t i o n o f ' r e s p o n s i b i l i t y f o r r e l i e f o f e c o n o m i c d i s -t r e s s .by p u b l i c , t a x - s u p p o r t e d a g e n c i e s , n e c e s s i t a t e d b y t h e d e p r e s s i o n o f t h e t h i r t i e s . The l a s t d e c a d e o r s o h a s s e e n t h e c o n s t r u c t i o n o f a s y s t e m o f s o c i a l i n s u r a n c e m e a s u r e s , b u t a l s o a b a s i c i m p r o v e m e n t i n p u b l i c s o c i a l a s s i s t a n c e . T h ese two e v e n t s h a v e h a d g r e a t s i g n i f i c a n c e f o r t h e S o c i a l Work p r o f e s s i o n a s a. w h o l e . F a m i l y s e r v i c e a g e n c i e s , r e l i e v e d o f r e s p o n s i b i l i t y f o r p r o v i s i o n o f f i n a n c i a l a s s i s t a n c e t o d e s t i t u t e p e o p l e , have b e e n a b l e t o c o n c e n t r a t e on t h e f a m i l y c o u n s e l l i n g , o r c a s e w o r k , a s p e c t s o f t h e i r s e r v i c e . The g r e a t i n t e r e s t i n rtew t h e o r i e s o f p e r s o n a l i t y d e v e l o p m e n t i m p e l l e d t hem i n t h e same d i r e c t i o n . The F a m i l y S e r v i c e A s s o c i a t i o n o f A m e r i c a h a s l o n g b e e n t h e v a n g u a r d a n d c o - o r d i n a t o r o f f a m i l y a g e n c i e s i n N o r t h A m e r i c a . One .of i t s c o m m i t t e e s , t h e C o m m i t t e e on M e t h o d s and S c o p e , u n d e r t o o k t h e s p e c i a l t a s k o f r e v i e w i n g t h e s p h e r e o f o p e r a t i o n s o f f a m i l y s e r v i c e a g e n c i e s . A r e p o r t o f t h i s - 2 T c o m m i t t e e s e t o u t i n 1 9 5 3 one o f t h e most d e f i n i t i v e s t a t e m e n t s o f t h e w o r k o f t h e f a m i l y s e r v i c e a g e n c y . I t r e c o g n i z e s f i v e f u n c t i o n s , a s f o l l o w s : ( l ) p r o v i d i n g c a s e w o r k s e r v i c e s ; ( 2 ) p a r t i c i p a t i o n i n c o m m u n i t y p l a n n i n g ; ( 3 ) c o n d u c t i n g g r o u p e d u c a t i o n a l a c t i v i t i e s ; ( 4 ) c o n t r i b u t i n g t o p r o f e s s i o n a l e d u c a t i o n j ;.and ( 5 ) e n g a g i n g i n r e s e a r c h . The f i r s t two a r e t h e m a j o r f u n c t i o n s ; t h e o t h e r t h r e e a r e s e c o n d a r y r e l a t e d f u n c t i o n s ; b u t a b o v e a l l t h e C o m m i t t e e s t r e s s e d " t h e ' i m p o r t a n c e o f k e e p i n g t h e d i r e c t c a s e w o r k p r o g r a m c l e a r l y i n t h e p i v o t a l p o s i t i o n i n t h e a g e n c y ' s p r o g r a m " . S i n c e t h e ^ d e p r e s s i o n , a n d p a r t i c u l a r l y s i n c e W o r l d War I I t h e f a m i l y a g e n c i e s h a v e c o n -c e n t r a t e d t h e i r e f f o r t ' s on i m p r o v i n g t h e q u a l i t y o f c a s e w o r k s e r v i c e s , a n d t h i s h a s s p e c i f i c a l l y meant h e l p w i t h p r o b l e m s o f i n t e r p e r s o n a l r e l a t i o n s h i p s , w h e t h e r f o r f a m i l i e s o r i n d i v i d u a l s . I n a r e c e n t a r t i c l e s t r e s s on i m p r o v i n g t h e q u a l i t y o f . c a s e w o r k s e r v i c e h a s b e e n d e s c r i b e d b y D r . C h a r l o t t e G, B a b c o c k a s " d e e p e n i n g " . " D e e p e n i n g has b r o u g h t u s ' a n i n c r e a s e I n p r o f i c i e n c y b e c a u s e i t h a s i n c r e a s e d o u r k n o w l e d g e and o u r I n s i g h t s , " F a m i l y a g e n c i e s h a v e a c h i e v e d s u c c e s s i n .improv-i n g t h e i r . c a s e w o r k s e r v i c e s t o t r o u b l e d f a m i l i e s and i n d i v i -d u a l s , p a r t i c u l a r l y t h o s e who have g o o d m o t i v a t i o n , i . e . a r e 1 S c o p e a n d M e t h o d s o f t h e F a m i l y S e r v i c e A g e n c y , R e p o r t o f The C o m m i t t e e on M e t h o d s and S c o p e , F a m i l y S e r v i c e A s s o c i a t i o n o f A m e r i c a , New Y o r k , 1 9 5 3 . 2 B a b c o c k , C h a r l o t t e G., M.D., "The C o n t r i b u t i o n o f t h e F a m i l y A g e n c y i n M e e t i n g Community P r o b l e m s " , The S o c i a l  S e r v i c e R e v i e w , S e p t e m b e r , 1 9 5 8 . - 3 -c o n s c i o u s l y w i l l i n g t o i n v o l v e t h e m s e l v e s - i n c a s e w o r k t r e a t -m ent. I n . h e l p i n g s u c h f a m i l i e s , c a s e w o r k e r s i n t h e s e and o t h e r ' a g e n c i e s ' a r e a t l e a s t on t h e t h r e s h o l d o f s u r e n e s s and p r e c i s i o n , a n d c o n t r i b u t i o n s f r o m t h e s o c i a l , s c i e n c e s s u c h a s s o c i o l o g y a n d a n t h r o p o l o g y p r o m i s e g r e a t e r u n d e r s t a n d i n g o f t h e i n d i v i d u a l i n s o c i e t y a n d f u r t h e r a d v a n c e s i n methods a n d t e c h n i q u e s o f f a m i l y c a s e w o r k . However, w i t h o t h e r f a m i -l i e s , n o t a b l y t h o s e l a c k i n g d e s i r e o r a b i l i t y t o u s e s u c h h e l p , t h e r e h a s b e e n l i t t l e s u c c e s s . T h i s i s p a r t i c u l a r l y t r u e o f t h e most u n d e r - p r i v i l e g e d , t r o u b l e d ( a n d s o m e t i m e s t r o u b l e s o m e ) f a m i l i e s , t h e " m u l t i - p r o b l e m " f a m i l i e s a n d t h e " h a r d - t o - r e a c h " , . a b o u t whom t h e c o m m u n i t y h a s g r e a t e s t c o n -c e r n . R e c e n t e x p e r i m e n t s h a v e shown t h a t t h e s e p e o p l e can. be " r e a c h e d " - t h r o u g h a l l - o u t e f f o r t s , c o - o r d i n a t i o n o f s e r -v i c e s , a n d i m a g i n a t i v e a d a p t a t i o n , o f c a s e w o r k m e t h o d s . T h i s i s a n o t h e r i n d i c a t i o n o f t h e c u r r e n t i n t e r e s t i n " b r o a d e n i n g " t h e b a s e o f c l i e n t e l e r e a c h e d b y c a s e w o r k , d i s c u s s e d by D r . B a b c o c k . D i l e m m a s o f t h e F a m i l y S e r v i c e A g e n c y F a m i l y a g e n c i e s s t r o n g l y d e s i r e t o m a i n t a i n t h e i r h a r d - w o n g a i n s i n q u a l i t y o f s e r v i c e , a nd a l s o t o i m p r o v e s e r v i c e g i v e n t o t h o s e who r e q u e s t i t . H owever, t h e y a r e f a c e d w i t h i n c r e a s i n g demands f o r q u a n t i t y a s w e l l a s q u a l i t y o f s e r v i c e now. A symptom o f o v e r d e m a n d f o r s e r v i c e i s t h e " w a i t i n g - l i s t " . T h i s r e p r e s e n t s a b a c k l o g o f a c c e p t e d a p p l i -c a n t s who c a n n o t be g i v e n i m m e d i a t e a t t e n t i o n , s o m e t h i n g - 4 -w h i c h i s w i d e s p r e a d t o t h e p o i n t o f b e i n g a l m o s t u n i v e r s a l i n . f a m i l y a g e n c i e s t h r o u g h o u t N o r t h A m e r i c a . The w a i t i n g - l i s t o r i g i n a t e d a s a d e v i c e t o p r o t e c t t h e q u a l i t y o f s e r v i c e -r a t h e r t h a n t a k i n g on c l i e n t s who c a n n o t be s e r v e d , t h e y a r e a s k e d t o . w a i t . B u t how many must w a i t , a n d what h a p p e n s t o them i f t h e y do? The w a i t i n g - l i s t r a i s e s some s e r i o u s q u e s -t i o n s a b o u t t h e q u a l i t y a s w e l l a s t h e q u a n t i t y o f s e r v i c e t o t h e c o m m u n i t y ; i n d e e d , i n many a g e n c i e s , i t i s i n d a n g e r o f b e c o m i n g a. F r a n k e n s t e i n w h i c h c o u l d d e s t r o y I t s m a k e r . E x c e s s i v e demand f o r s e r v i c e i n r e l a t i o n t o c a s e w o r k t i m e a v a i l a b l e i s t h e r e s u l t o f s e v e r a l r e l a t e d f a c t o r s . T h e r e i s i n c r e a s e d a p p r e c i a t i o n o f t h e t i m e a n d s k i l l r e q u i r e d t o r e a l l y h e l p f a m i l i e s who a r e s e r i o u s l y t r o u b l e d - i n t h e l o n g r u n , more e f f e c t i v e and e c o n o m i c a l t h a n s p r e a d i n g s e r v i c e t o o t h i n . B u t t h e r e i s a l s o a s e r i o u s s h o r t a g e o f f u l l y q u a l i f i e d a n d e x p e r i e n c e d c a s e w o r k e r s , and o f f u n d s t o h i r e them i f t h e y w e r e a v a i l a b l e . R a p i d l y I n c r e a s i n g p o p u l a t i o n s i n c i t i e s a n d m e t r o p o l i t a n a r e a s s e r v e d b y f a m i l y a g e n c i e s h a v e c r e a t e d more s o c i a l p r o b l e m s , . a n d more c l i e n t s f o r s o c i a l a g e n c i e s . F u r -thermore,., "as o u r c u l t u r e i n c r e a s i n g l y e m p h a s i z e s a n d p u b l i c i z e s p s y c h o l o g i c a l s o l u t i o n s t o p r o b l e m s , e v e r l a r g e r n umbers o f p e o p l e t u r n t o w a r d t h e h e l p i n g p r o f e s s i o n s f o r a s s i s t a n c e " . " 1 " E x t e r n a l and i n t e r n a l p r e s s u r e s f o r q u a l i t y a n d q u a n t i t y o f s e r v i c e a r e t h e m a i n i n g r e d i e n t s o f t h e i m m e d i a t e 1 C o o p e r , S h i r l e y , " E m e r g e n c i e s i n a P s y c h i a t r i c C l i n i c " , S o c i a l C a s e w o r k , M a r c h , i 9 6 0 . - 5 -d i l e m m a f a c i n g t h e f a m i l y s e r v i c e a g e n c y . A r e l a t e d b u t g r e a t e r d i l e m m a w i t h f a r - r e a c h i n g i m p l i c a t i o n s i s r a p i d l y a p p r o a c h i n g . Compared w i t h t h e p r e s e n t c l i e n t e l e , t h e p o t e n t i a l c l i e n t e l e o f t h e f a m i l y s e r v i c e a g e n c y i s s o v a s t a s t o be a l m o s t u n l i m i t e d . F u r t h e r m o r e , i n t h i s t i m e o f o v e r d e m a n d f o r s e r v i c e , s h o r t a g e s o f s t a f f a n d w a i t i n g - l i s t s , t h e a g e n c i e s ca n see e x c i t i n g new o p p o r t u n i t i e s t o s e r v e new a n d f a r more d i v e r s i f i e d c l i e n t e l e . I n d e e d , many a g e n c i e s a r e a l r e a d y g r o p i n g f o r some s o l u t i o n t o new p r o b l e m s o f d i r e c t i o n a n d s e r v i c e p r i o r i t i e s . What does i t mean t o " b r o a d e n " t h e r a n g e o f c l i e n t e l e m a k i n g e f f e c t i v e u s e o f f a m i l y c a s e w o r k s e r v i c e s ? The f o l l o w -i n g e x c e r p t s f r o m t h e a r t i c l e b y D r . B a b c o c k , p r e v i o u s l y q u o t e d , a r e p e r t i n e n t . "... what o f t h e b r o a d e n i n g ? Where i s t h e n e e d ? I t i s f r e q u e n t l y s a i d t h a t t h e d i l e m m a o f t h e f a m i l y f i e l d i s t h a t e v e r y o n e w a n t s t h e f i e l d t o do more, b u t t h a t t h e f a m i l y f i e l d w a n t s t o do w h a t i t d o e s b e t t e r . I t c o r r e c t l y w a n t s , t h i s a u t h o r t h i n k s t o be a p p r e c i a t e d f o r t h e k i n d s o f p r o b -l e m s t h a t i t i s w i l l i n g t o t a k e on a n d f o r t h e t i m e t h a t i s t h e n r e q u i r e d f o r h e a l t h y s o l u t i o n s o f t h o s e p r o b l e m s . L i k e t h e r e s t o f t h e p r o f e s s i o n a l w o r l d , s o c i a l w o r k h a s b e e n p l a g u e d b e t w e e n t h e mass o f n e e d a n d t h e t i m e t h a t i t t a k e s t o r e p a i r ; i t r e c o g n i z e s t h e p o t e n t i a l s I f one h a d t h e t i m e f o r b o t h c u r e a n d p r e v e n t i o n , and i t s t r u g g l e s w i t h t h e c o n s t a n t f e a r t h a t t h e mass w i l l o v e r w h e l m b e f o r e t h e f r a g i l e b e g i n n i n g s o f an i n t e r p e r s o n a l r e l a t i o n s h i p , c a n be n o u r i s h e d i n t o a s t u r d y s e l f - s u p p o r t i n g p l a n t . " "The r e a l i t i e s o f t h e c u r r e n t w o r l d c a n n o t be i g n o r e d e i t h e r . " "• - f a m i l y c a s e w o r k must a d a p t i t s m e t h o d s t o u s e i t s k n o w l e d g e a n d s k i l l s w h e n e v e r . t h e r e Is. n e e d . " " I t i s a t i m e - t e s t e d ' a n d p r o v e n p s y c h i a t r i c p r i n -c i p l e t h a t t h e p a t i e n t must h a v e h i s own m o t i v a t i o n f o r t r e a t m e n t ; b u t t h i s s h o u l d n o t be t a k e n s o l i t e r a l l y o r d e f e n s i v e l y t h a t t h e w o r k e r can - e x c u s e h i m s e l f f r o m r e s p o n -- 6 -s i b i l i t y f o r the c l i e n t by s a y i n g t h a t the c l i e n t i s t o o unmotivated, f o r casework a t t e n t i o n . " The i n d i c a t i o n i s t h a t apparent l a c k of m o t i v a t i o n on the p a r t o f some a p p l i c a n t s and p o t e n t i a l c l i e n t s may mask a. r e a l c r y f o r h e l p , w h i c h the s u f f e r i n g p e r s o n cannot a r t i -c u l a t e i n a f orm e x p e c t e d or u n d e r s t o o d by s o c i a l w o r k e r s -t h a t t h e r e a l d i f f i c u l t y i s o f communication.. "The r e s p o n -s i b i l i t y t o l e a r n how t o communicate i n such an i n s t a n c e i s ours.. T h i s t y p e of m o d i f i c a t i o n of casework s e r v i c e s means l a g r e a t e r g o i n g - o u t t o the c l i e n t i n an e f f o r t t o h e l p him overcome th e s t r o n g r e s i s t a n c e he f e e l s toward a c c e p t i n g s e r v i c e - ' b e f o r e the emergency becomes an i r r e p a r a b l e d i s a s t e r o r d i s e a s e . " "Our t a s k i s t o f i n d the cues and d e v i s e new ways t o meet problems of t h i s n a t u r e , r e g a r d l e s s of the s o c i a l and economic s t r a t u m of s o c i e t y i n w h i c h t h e y o c c u r . " I n o t h e r words, t o f u l f i l l i t s t r a d i t i o n a l r o l e i n the p r e v e n t i o n of. f a m i l y and p e r s o n a l breakdown., f a m i l y casework must n o t o n l y m a i n t a i n and Improve th e q u a l i t y of s e r v i c e , i t must r e a c h new c l i e n t e l e , and I t must r e a c h them e a r l i e r . W i l e n s k y and Lebeaux, i n a v e r y i n t e r e s t i n g c h a p t e r o f t h e i r i m p o r t a n t b o o k , • I n d u s t r i a l S o c i e t y and S o c i a l W e l f a r e , p o i n t up "new dilemmas" f o r f a m i l y s e r v i c e a g e n c i e s In a s o c i e t y of a d v a n c i n g i n d u s t r i a l i z a t i o n , w i t h p a r t i c u l a r r e f e r e n c e t o the "new c l i e n t e l e " f o r s o c i a l agencies."'" They 1 W i l e n s k y , H a r o l d L., and C h a r l e s N. Lebeaux, I n d u s t r i a l  S o c i e t y and S o c i a l W e l f a r e , R u s s e l l Sage F o u n d a t i o n , New York, 1958, Chapter V i l l i s u g g e s t t h a t " t h e s o c i a l change most d i r e c t l y a f f e c t i n g t h e n a t u r e o f f a m i l y a g e n c y c l i e n t e l e i s t h e e m ergence o f a mas-s i v e m i d d l e c l a s s " . " A l t h o u g h s o c i a l w o r k i s s e e n l e s s and l e s s a s an e m e r g e n c y s e r v i c e f o r t h e d e s t i t u t e , t h e v i e w p o i n t p e r s i s t s t h a t most o f i t s c l i e n t e l e s t i l l comes f r o m u n d e r -p r i v i l e g e d p e o p l e . W i t h t h e d e c l i n e i n p o v e r t y and t h e s w e l l -i n g o f t h e m i d d l e c l a s s , , t h e t r e n d t o w a r d a more d i v e r s i f i e d c l i e n t e l e w i l l s p e e d u p . A c l o s e r l o o k a t t h e g r o u p s t h e a g e n c i e s s e r v e w i l l show t h e e x t e n t t o w h i c h t h i s s h i f t h a s a l r e a d y b e g u n . " " F a m i l y and c h i l d r e n ' s s e r v i c e s . i n some s e t t i n g s h ave a l r e a d y s h i f t e d q u i t e f a r t o w a r d a m i d d l e -c l a s s c l i e n t e l e , a n d w i t h f u r t h e r s h i f t s i n s t r a t i f i c a t i o n , t h i s t r e n d may be e x p e c t e d t o c o n t i n u e . " One r e a s o n f o r t h e "new l o o k " o f f a m i l y a g e n c y c l i e n t e l e i s s u g g e s t e d by W i l e n s k y and L e b e a u x . M i d d l e - c l a s s p e o p l e , a n d t h o s e o f n e w l y - w o n m i d d l e - c l a s s s t a t u s ( o r s t r i v -i n g s ) a r e t h e p e o p l e who a r e r e a c h e d by t h e i n c r e a s e d e m p h a s i s and p u b l i c i t y b e i n g g i v e n t o p s y c h o l o g i c a l s o l u t i o n s t o p r o b l e m s . I n d e e d , a s s u g g e s t e d by W a l t e r B. M i l l e r , i t may be t h a t c l i e n t s o f v o l u n t a r y c o u n s e l l i n g a g e n c i e s h a v e a l w a y s come l a r g e l y f r o m t h e " s t a t u s - s e e k e r s " , t h o s e on t h e way up f r o m " t h e u r b a n l o w e r c l a s s " . ^ ' R e l a t e d t r e n d s i n t h i s d e v e l o p m e n t a r e c h a n g i n g p a t t e r n s o f f a m i l y l i f e , a n d t h e g r e a t p o p u l a t i o n s h i f t t o 1 M i l l e r , W a l t e r B., " I m p l i c a t i o n s o f U r b a n L o w e r - C l a s s C u l t u r e f o r S o c i a l Work", The S o c i a l S e r v i c e R e v i e w , S e p t e m b e r , 1959 > Vol. . x x x i i i , No. 3-t h e s u b u r b s , a s " t h e c e n t r a l c i t y h a s p r a c t i c a l l y e x p l o d e d a n d s c a t t e r e d i t s e l f o v e r t h e c o u n t r y s i d e " . W i l e n s k y a n d L e b e a u x t o u c h b r i e f l y on some q u e s t i o n s a n d p r o b l e m s f o r v o l u n t a r y f a m i l y a g e n c i e s p o s e d b y t h e s e t r e n d s , as " w o r k i n g p e o p l e on t h e i r way t o t h e s u b u r b s d i s c a r d o l d ' w a y s i n f a v o u r o f m i d d l e c l a s s s t a n d a r d s and v a l u e s " . W i t h r e g a r d t o c a s e -w o r k s e r v i c e t o t h e new m i d d l e c l a s s , t h e y s u g g e s t t h a t t h e most s e r i o u s q u e s t i o n i s w h e t h e r a g e n c y p e r s o n n e l "have s u f -f i c i e n t k n o w l e d g e o f t h e new f a m i l y l i f e p a t t e r n s i n s u b u r b i a t o h a n d l e c o m p e t e n t l y t h e t e n s i o n s t h e y p r o d u c e " . O t h e r q u e s -t i o n s c o n c e r n t h e o r g a n i z a t i o n , d i s t r i b u t i o n a n d f i n a n c i n g o f s e r v i c e s t o w i d e a nd s c a t t e r e d m e t r o p o l i t a n a r e a s . " S o c i a l w o r k h a s t r a d i t i o n a l l y b e e n an u r b a n phenomenon. S u b u r b a n i -z a t i o n i s p r o c e e d i n g t o s p r e a d t h e c l i e n t e l e o v e r b r o a d m e t r o p o l i t a n a r e a s c o v e r i n g many c i t i e s , t o w n s , a nd s c a t t e r e d c o u n t r y homes; how w i l l s e r v i c e s f o r a p o p u l a t i o n so d i s p e r s e d be d i s t r i b u t e d ? " A n o t h e r p r o b l e m n o t m e n t i o n e d b y W i l e n s k y a n d L e b e a u x c o n c e r n s t h e I m p o r t a n c e a n d f o c u s o f p u b l i c r e l a t i o n s , when many e c o n o m i c a l l y s e c u r e c l i e n t s a r e p a y i n g f e e s f o r s e r v i c e . W h i l e v o l u n t a r y f a m i l y a n d c h i l d r e n ' s s e r v i c e s a r e a p p a r e n t l y s e r v i n g c l i e n t s o f i n c r e a s i n g l y h i g h e r s o c i a l s t a t u s , W i l e n s k y a n d L e b e a u x n o t e an o p p o s i t e t r e n d among a g e n c i e s g i v i n g f i n a n c i a l a s s i s t a n c e . : " I n t h e y e a r s s i n c e t h e w a r ; c o n t i n u i n g i n d u s t r i a l i z a t i o n , c o u p l e d w i t h a v a r i e t y o f s o c i a l i n s u r a n c e a n d o t h e r i n c o m e - e q u a l i z i n g l a w s , h a s r e d u c e d - 9 -p o v e r t y and l e f t on g e n e r a l r e l i e f o n l y America's most s o c i a l l y and p h y s i c a l l y handicapped p e o p l e . " "These most d i s a d v a n t a g e d and d e m o r a l i z e d f a m i l i e s " a r e not e x a c t l y a "new c l i e n t e l e " f o r s o c i a l w e l f a r e - t h e y have always r e c e i v e d a l a r g e p o r t i o n o f the w e l f a r e d o l l a r i n the form o f e n v i r o n m e n t a l s e r v i c e s such as r e l i e f , m e d i c a l s e r v i c e s and c h i l d c a r e . "But t h e y have not been c l e a r l y seen as subjects- f o r p o s i t i v e r e h a b i l i -t a t i v e ' t r e a t m e n t ' i n the f a m i l y a g e n c i e s . They are d i f f i c u l t t o approach, do not come of t h e i r own v o l i t i o n f o r h e l p , and f o r the most p a r t are l o s t f r om s i g h t i n the l a r g e r ocean of the 'independent p o o r ' . Only now as l a r g e numbers of the independent poor r i d e the economic wave upward and. outward t o • t h e suburbs i s the d i s o r g a n i z e d bottom l a y e r l e f t i n t h e c e n t r a l c i t y coming f u l l y i n t o v i e w , brought d r a m a t i c a l l y t o t h e a t t e n t i o n of f a m i l y a g e n c i e s as a new c l i e n t e l e — t h e 'hard t o r e a c h 1 " . "Thus, i n t e r e s t i n g l y , a c h a n g i n g s o c i a l o r d e r i s b r i n g i n g groups from o p p o s i t e ends of the s o c i a l p y r a m i d i n t o a s o c i a l w e l f a r e p r e v i e w . What do t h e s e t r e n d s presage f o r f a m i l y s e r v i c e ? " W i l e n s k y and Lebeaux suggest t h a t a more d i v e r s i -f i e d c l i e n t e l e p a y i n g f e e s f o r s e r v i c e may t e n d t o r a i s e the s t a t u s of s o c i a l a g e n c i e s , but ask, " w i l l the poor man, and. t h o s e most n e e d i n g s e r v i c e but l e a s t a b l e t o pay, be l o s t f r o m s i g h t ? " Perhaps the r e a l q u e s t i o n does not concern payment of f e e s , o r whether s e r v i c e s w i l l be a v a i l a b l e t o p o o r p e o p l e who r e q u e s t them. As t h e y say, the most - 10 -d i s o r g a n i z e d , ; " m u l t i - p r o b l e m f a m i l i e s " v e r y s e l d o m a s k f o r o r w a n t c a s e w o r k s e r v i c e , ( a l t h o u g h t h e y do come t o t h e a t t e n -t i o n o f s o c i a l a g e n c i e s ) , a n d t h e y a r e e x c e e d i n g l y d i f f i c u l t t o a p p r o a c h . N o t a l l o f t h e m a r e c h r o n i c a l l y d e p e n d e n t e c o n o m i -c a l l y , a l t h o u g h many o f them a r e . I t h a s been shown t h a t many o f t h e m c a n be h e l p e d - t h e e x p e r i m e n t s o f t h e New Y o r k C i t y Y o u t h B o a r d a n d t h e S t . P a u l F a m i l y - F o c u s e d P r o j e c t a r e n o t a b l e . However, e f f e c t i v e l y h e l p i n g s u c h f a m i l i e . s i s an e x c e e d i n g l y e x p e n s i v e , t i m e - c o n s u m i n g b u s i n e s s , r e q u i r i n g t h e g r e a t e s t s k i l l , p a t i e n c e and i m a g i n a t i o n . I n f a c t , a s t h e s e p e o p l e t y p i c a l l y s u f f e r f r o m d e e p - r o o t e d s u s p i c i o n a n d d i s t r u s t o f a u t h o r i t y and t h e w o r l d a t l a r g e , c e r t a i n l y n o t e x c e p t i n g s o c i a l w o r k e r s , t h e most d i f f i c u l t p a r t o f t h e p r o -c e s s may be f o r t h e s o c i a l w o r k e r t o g e t h i s f o o t i n t h e i r d o o r i n t h e f i r s t p l a c e . The e v i d e n c e t h a t t h e y c a n be h e l p e d p r e s e n t s an e x c i t i n g p r o s p e c t t o s o c i a l w o r k e r s . So d o e s t h e p r o s p e c t o f o f f e r i n g e f f e c t i v e p r e v e n t i v e s e r v i c e t o t h e b e t t e r - m o t i v a t e d and u s u a l l y more e a s i l y t r e a t a b l e a p p l i c a n t s who a r e k n o c k i n g on t h e d o o r s o f f a m i l y a g e n c i e s i n i n c r e a s -i n g n u m b e r s , and i n c r e a s i n g l y , f r o m a l l w a l k s o f l i f e . Y e t i t a p p e a r s i m p o s s i b l e f o r m o s t f a m i l y s e r v i c e a g e n c i e s t o meet e v e n p r e s e n t demands f o r s e r v i c e w i t h p r e s e n t s t a f f c o m p l e -m e n t s , much l e s s t o a d v a n c e v e r y f a r i n t h e d i r e c t i o n o f open-i n g up new a r e a s o f s e r v i c e . The q u e s t i o n i s - w h i c h r o a d t o f o l l o w , . w h e n t o c h o o s e e i t h e r d i r e c t i o n a nd f o r s a k e t h e o t h e r a p p e a r s t o be an i n t o l e r a b l e d e c i s i o n ? - 11 -The present study i s focused on c e r t a i n s p e c i a l aspects of the. w a i t i n g - l i s t of a s i n g l e agency. However, the l a r g e r dilemma of the f a m i l y s e r v i c e agency as o u t l i n e d b r i e f l y here i s the e s s e n t i a l background against which t h i s study should be seen. The Vancouver Agency The Family Service Agency of Greater Vancouver was e s t a b l i s h e d i n 1927 as a r e s u l t of a survey of welfare resources and needs i n the c i t y of Vancouver, B r i t i s h Columbia. Now over t h i r t y years o l d , i t i s an agency of medium s i z e . I t serves an urban and suburban p o p u l a t i o n of over 500,000 i n the Greater Vancouver area, and Is a member agency of Family Ser-v i c e A s s o c i a t i o n of America. Besides the main o f f i c e , there i s one small d i s t r i c t o f f i c e on the North Shore. During 1958 there were fourteen caseworkers i n the main o f f i c e . The inauguration of a w a i t i n g - l i s t dates from 1957- I t can be described best i n two phases - the r e - o r g a n i z a t i o n of i n t a k e , and the growth of the w a i t i n g - l i s t p e r s e . This a l s o r a i s e s a t h i r d , i ssue - what of p r i o r i t i e s ? (a) C e n t r a l i z e d Intake and C o n t r o l l e d Assignment For s e v e r a l years p r i o r t o 1957 caseworkers i n the main o f f i c e of the Family Service Agency of Greater Vancouver were " d i s -t r i c t e d " i n r e s p o n s i b i l i t y , and assignment of cases was made acc o r d i n g l y * Although there might be s e v e r a l workers cover-i n g one d i s t r i c t , .except as i t could be worked out w i t h i n the - 12 -d i s t r i c t , t h e r e was no c o n t r o l on the s i z e of c a s e l o a d s . A p p l i c a t i o n s f o r s e r v i c e from one d i s t r i c t were a c c e p t e d i f w i t h i n agency f u n c t i o n , presumably f o r immediate s e r v i c e , and had t o be absorbed i n the c a s e l o a d s of w o r kers i n the d i s t r i c t . There was e v i d e n c e , i n agency s t a t i s t i c s , and In o t h e r ways ( s u c h as " b l a c k l o g s " of r e c o r d i n g ) , t h a t some workers were s e r i o u s l y o v e r l o a d e d . Under the c i r c u m s t a n c e s the s i t u a t i o n was e x c e e d i n g l y d i f f i c u l t t o e v a l u a t e or ' c o n t r o l . To meet t h i s problem, an a d m i n i s t r a t i v e s t r u c t u r e was s e t up In 1957, i n v o l v i n g i n p a r t t h e e s t a b l i s h m e n t of a c e n t r a l i z e d i n t a k e department w i t h i n the agency. A n o t h e r o b j e c t i v e was t o improve the q u a l i t y and u n i f o r m i t y o f the i n t a k e s e r v i c e t o the com-mu n i t y i As an i n e v i t a b l e c o r o l l a r y of t h i s p l a n , d i s t r i c t i n g o f caseworkers was e v e n t u a l l y l a r g e l y abandoned. The i n t a k e department was composed of f o u r p e r s o n s , of whom one, the i n t a k e s u p e r v i s o r , became r e s p o n s i b l e f o r the assignment of a l l c a s e s . T h i s was done on the b a s i s o f w e e k l y r e p o r t s from caseworkers g i v i n g the number of casework i n t e r v i e w i n g hours used the p r e v i o u s week, e s t i m a t e d time needed f o r the p r e s e n t c a s e l o a d i n the coming week, and time a v a i l a b l e f o r new cases i n r e l a t i o n t o t h i s and t o o t h e r agency demands. By t h i s means, c a s e l o a d s were g r a d u a l l y " s t a b i l i z e d " on a more r e a l i s -t i c b a s i s i n - a c c o r d a n c e w i t h the needs of c l i e n t s r e c e i v i n g s e r v i c e and the i n d i v i d u a l a b i l i t i e s o f caseworkers."'" 1 W r i g h t , Gordon R., " S t a b i l i z a t i o n o f C a s e l o a d s i n a Medium-sized F a m i l y Agency", The S o c i a l Worker, June, i 9 6 0 . - 13 -At the time th e above s t r u c t u r e was i n i t i a t e d a " w a i t i n g - l i s t " was e s t a b l i s h e d . As a d e v i c e t o h o l d cases a w a i t i n g assignment, t h i s was a n e c e s s a r y p a r t of the whole p l a n . I n t h e b e g i n n i n g t h i s d i d not mean t h a t a p p l i c a n t s w a i t e d more t h a n a few days f o r s e r v i c e , nor was t h i s the o r i g i n a l i n t e n t i o n . However, as s u s p e c t e d , i t g r a d u a l l y became apparent t h a t o t h e r " w a i t i n g - l i s t s " had been c o n c e a l e d i n w o r k e r s * c a s e l o a d s , w i t h workers g i v i n g p r i o r i t y t o some cas e s a c c o r d i n g t o t h e i r own.judgement as t o r e l a t i v e u rgency. As w o r kers found time t o g i v e an optimum amount of a t t e n t i o n t o a l l p r e s e n t l y a c t i v e c a s e s , l e s s time was a v a i l a b l e f o r new a p p l i c a t i o n s . As r e q u e s t s f o r s e r v i c e c o n t i n u e d h i g h , a r e a l w a i t i n g - l i s t was b u i l t up, and i t soon became i m p o s s i b l e t o g i v e immediate s e r v i c e t o a l l a p p l i c a n t s . I t s h o u l d be mentioned t h a t f o r s e v e r a l y e a r s p r i o r t o the e s t a b l i s h m e n t of t h e c e n t r a l i n t a k e department i t had been agency p o l i c y t o r e s t r i c t i n t a k e r e s p o n s i b i l i t y as much as p o s s i b l e t o c a r e f u l t e l e p h o n e assessment. T h i s d i d n o t , o f c o u r s e , c o v e r the f u l l i n t a k e p r o c e s s ; the main r e s p o n -s i b i l i t y of t h e worker 'on d u t y was t o determine whether the a p p l i c a n t ' s r e q u e s t f o r s e r v i c e was w i t h i n agency f u n c t i o n , t o . o u t l i n e t h i s t o the a p p l i c a n t , and t o o f f e r s e r v i c e i f i n d i c a t e d . I n c l u d e d , o f c o u r s e , were o t h e r " s e r v i c e s t o the community such as e x p l a n a t i o n of r e s o u r c e s , a p p r o p r i a t e r e f e r r a l , and emergency s e r v i c e t o " d r o p - i n s " and o t h e r a p p l i c a n t s . An i n t a k e o r assessment i n t e r v i e w would be o f f e r e d - 14 i f n e c e s s a r y , i . e . t o d e t e r m i n e t h e most a p p r o p r i a t e r e s o u r c e f o r t h e a p p l i c a n t . W i t h t h e e s t a b l i s h m e n t o f t h e c e n t r a l i n t a k e d e p a r t m e n t t h e same p o l i c y was c o n t i n u e d . . P u l l i n t a k e a n d t r e a t m e n t a r e i n t e r r e l a t e d f r o m t h e f i r s t c o n t a c t , a n d i t was b e l i e v e d t h a t i d e a l l y t h e w h o l e p r o c e s s s h o u l d be c a r r i e d t h r o u g h b y one c a s e w o r k e r , t o a v o i d a b r e a k i n t h e d e v e l o p i n g , c a s e w o r k r e l a t i o n s h i p , a n d a l s o t o a v o i d t h e l o s s o f d i a g n o s t i c c l u e s a n d c o n t i n u i t y . ( b ) The W a i t i n g - L i s t . B y 1958 t h e m a i n o f f i c e o f t h e F a m i l y S e r v i c e A g e n c y o f G r e a t e r V a n c o u v e r f o u n d i t s e l f i n p o s s e s s i o n o f what one w r i t e r h a s c a l l e d " t h e m i l l s t o n e t h a t h a n g s a r o u n d o u r n e c k - - t h e d r e a d w a i t i n g l i s t " . ' ' ' I n t e r e s t i n g l y , a n o t h e r f a m i l y a g e n c y a s f a r away a s M i a m i , F l o r i d a h a d a t t h e same t i m e an a l m o s t i d e n t i c a l i n t a k e s t r u c t u r e , w i t h v e r y s i m i l a r p o l i c y a n d p r a c t i c e i n r e g a r d t o t h e management o f a • w a i t i n g s l i s t , a l t h o u g h t h i s a g e n c y h a d 2 t r a v e l l e d a somewhat d i f f e r e n t r o a d t o t h e same p o i n t . As r e p o r t e d b y C a t h e r i n e M. B i t t e r m a n n , t h e w a i t i n g - l i s t o f t h e M i a m i a g e n c y o r i g i n a t e d i n 1 9 5 3 , a n d p r e c e d e d t h e e s t a b l i s h -ment o f c e n t r a l i n t a k e a n d a s s i g n m e n t o f c a s e s . "We h a v e ... d i s c o v e r e d t h a t a s t h e n e e d t o e s t a b l i s h p r i o r i t i e s a n d t o c o n s i d e r o f f e r i n g ' e m e r g e n c y 1 a p p o i n t m e n t s h a s a r i s e n , i t h a s b e e n h e l p f u l t o h a v e one s t a f f member w i t h k n o w l e d g e o f t h e . 1 C o p p e r , S h i r l e y , " E m e r g e n c i e s i n a P s y c h i a t r i c C l i n i c " , S o c i a l C a s e w o r k , M a r c h , i 9 6 0 . 2 B i t t e r m a n n , C a t h e r i n e M., " S e r v i n g A p p l i c a n t s When T h e r e i s a W a i t i n g L i s t " , S o c i a l C a s e w o r k , J u n e , 1 9 5 8 . - 15 -t o t a l a p p l i c a t i o n l o a d who c a n t h u s e v a l u a t e t h e r e l a t i v e u r g e n c y o f s p e c i f i c r e q u e s t s " . The m a i n f e a t u r e s o f t h e s t r u c t u r e i n b o t h a g e n c i e s . w e r e : c e n t r a l i n t a k e a n d a s s i g n m e n t w i t h one p e r s o n b e i n g r e s p o n s i b l e f o r a d m i n i s t r a t i o n o f t h e w a i t i n g - l i s t ; r e s t r i c t i o n o f i n t a k e r e s p o n s i b i l i t y t o t e l e p h o n e a s s e s s m e n t a s much as p o s s i b l e ; and r e c o g n i t i o n o f t h e need, t o o f f e r p r i o r i t y s e r v i c e i n c e r t a i n s i t u a t i o n s on an e v a l u a t i o n o f r e l a t i v e u r g e n c y . ( c ) The I s s u e o f P r i o r i t i e s . I n e v i t a b l y , t h e e x i s -t e n c e o f a w a i t i n g - l i s t and a w a i t i n g p e r i o d b e f o r e s e r v i c e c a n be g i v e n n e c e s s i t a t e s g i v i n g some a p p l i c a n t s p r i o r i t y o v e r o t h e r s . A l t h o u g h none s h o u l d be a s k e d t o w a i t , t h e r e a r e e m e r g e n c i e s , a n d some a p p l i c a n t s c a n n o t be a s k e d t o w a i t t h e i r t u r n . S e t t i n g up a s y s t e m o f p r i o r i t i e s i s d i s t a s t e f u l t o s o c i a l w o r k e r s , whose p r o f e s s i o n a l p h i l o s o p h y and e t h i c s have been b u i l t on d e m o c r a t i c f o u n d a t i o n s . " I t i s h a r d t o d e p a r t f r o m so d e m o c r a t i c a n o t i o n as ' f i r s t come, f i r s t s e r v e d ' " , s a y s S h i r l e y C o o p e r on t h i s p o i n t . " 1 " However, " w i t h p l e n t y o f r e s o u r c e s , one c a n a f f o r d t o be d e m o c r a t i c . When t h e p i n c h i s o n, t h e need, f o r s e l e c t i n g c a s e s f o r an i m m e d i a t e a p p o i n t -ment becomes a c u t e . " I t becomes i m m e d i a t e l y e v i d e n t t h a t i t i s n o t a s i m p l e m a t t e r t o d e c i d e w h i c h s i t u a t i o n s r e q u i r e p r i o r i t y 1 C o o p e r , S h i r l e y , " E m e r g e n c i e s i n a P s y c h i a t r i c C l i n i c " , S o c i a l C a s e w o r k , M a r c h , i 9 6 0 . - 16 -s e r v i c e a n d w h i c h do n o t . T h i s i s t r u e i n t h e p a r t i c u l a r . c a s e , a n d i n s e t t i n g up g e n e r a l g u i d e s f o r o f f e r i n g p r i o r i t y s e r v i c e . I f t h e c r i t e r i o n i s r e l a t i v e u r g e n c y , what l s _ " u r g e n c y " a n d how c a n t h i s be r e l a t e d t o o t h e r r e q u e s t s f o r s e r v i c e ? C o n s i d e r i n g o n l y t h a t t h e s t a t e o f t h e w a i t i n g -l i s t w i l l , v a r y f r o m week t o week, i t c a n be s e e n t h a t t h i s i s a v e r y c o m p l e x question... F u r t h e r m o r e , what i s " p r i o r i t y " . P r i o r i t y i s a v e r y s u b t l e t h i n g , w i t h i m p l i c a t i o n s f o r e a c h s i n g l e a p p l i c a t i o n , a s w e l l a s f o r t h e f u t u r e o f t h e a g e n c y an d f o r f a m i l y s e r v i c e . What i s t h e r e l a t i o n s h i p o f t h e w a i t i n g - l i s t a n d p r i o r i t y t o t h e c h a n g i n g c o n s t i t u e n c y and c l i e n t e l e o f f a m i l y s e r v i c e a g e n c i e s ? M e t h o d s o f P r e s e n t S t u d y P r e s e n t t r e n d s .and s t r e s s e s i n f a m i l y s e r v i c e a g e n c i e s , i t h a s been i n d i c a t e d , a r e r e l a t e d t o e x t e r n a l and i n t e r n a l demands f o r ' " d e e p e n i n g " t h e q u a l i t y o f s e r v i c e f o r 'an i n c r e a s i n g l y d i v e r s i f i e d c l i e n t e l e a n d a b r o a d s o c i a l r a n g e . I n t h e f a c e o f t h e s e demands f o r more e f f e c t i v e s e r -v i c e I n q u a n t i t y a n d q u a l i t y , t h e d e v i c e o f t h e " w a i t i n g - l i s t " h a s become w i d e l y p r e v a l e n t i n f a m i l y s e r v i c e A g e n c i e s t h r o u g h -o u t N o r t h A m e r i c a . A d m i t t e d l y , t h i s i s a s t o p g ap, and more c o n s t r u c t i v e a n s w e r s a r e n e e d e d . The p r e s e n t s t u d y t h e r e -f o r e e x a m i n e s t h e q u e s t i o n s t h a t a r i s e i n s u c h a s i t u a t i o n , w h e r e e f f o r t s t o p r o t e c t t h e q u a l i t y o f c a s e w o r k s e r v i c e t o f a m i l i e s h a v e h a d , a s one r e s u l t , t h e d e v e l o p m e n t o f a w a i t i n g p e r i o d b e f o r e o n - g o i n g s e r v i c e I s o f f e r e d . T h i s c a n . b e done - 17 -b y p u r s u i n g t h r e e l i n e s o f e n q u i r y . F i r s t , who a r e t h e c l i e n t e l e , a n d what s e r v i c e s do t h e y r e q u e s t ? S e c o n d l y , .what a r e t h e k i n d s a n d e x t e n t o f s e r v i c e t h e y r e c e i v e a n d u s e ? F i n a l l y , w hat a r e t h e i m p l i c a t i o n s f o r " " p r i o r i t y " d e t e r -m i n a t i o n ? " P r i o r i t y " i s i t s e l f a m a t t e r r e q u i r i n g d e f i n i t i o n : b u t a s t a r t c a n be made b y f a c i n g t h e f a c t t h a t some a p p l i c a n t s a r e o f f e r e d i m m e d i a t e s e r v i c e on t h e b a s i s o f some j u d g m e n t a s t o u r g e n c y , w h i l e o t h e r s a r e a s k e d t o w a i t . An e x a m i n a t i o n o f a r e p r e s e n t a t i v e s e t o f c a s e s drawn f r o m t h e r e c e n t p a s t ' w i l l b r i n g t h i s u n d e r r e a l i s t i c s c r u t i n y ; . - b u t i t i s h o p e d a l s o t h a t t h i s may s e r v e a s a b a s e f o r t h e c o n s i d e r a t i o n o f w i d e r • i m p l i c a t i o n s c o n c e r n i n g c r i t e r i a f o r p r i o r i t y , i . e . t h o s e a p p l y i n g t o a much b r o a d e r l e v e l o f p l a n n i n g f u t u r e s e r v i c e s , a l t h o u g h t h i s may be l i m i t e d b y t h e m a t e r i a l .of t h e p r e s e n t s t u d y . CHAPTER I I APPLICANTS TO THE .FAMILY AGENCY: A SAMPLE GROUP I t i s h a r d l y f e a s i b l e t o r e v i e w t h e w h o l e c a s e l o a d o f e v e n a m e d i u m r s i z e d f a m i l y s e r v i c e a g e n c y . However, t h e i n t e n t i o n i s t o t h r o w l i g h t p a r t i c u l a r l y on c u r r e n t demands f o r s e r v i c e b y t h e c o m m u n i t y , i . e . " i n t a k e " i n t h e f o r m o f new a n d r e - o p e n e d cases-. A c c o r d i n g l y , i t was d e c i d e d t o u s e a s a - m a n a g e a b l e s a m p l e a p a r t i c u l a r b l o c k o f c a s e s a c c e p t e d f o r s e r v i c e b y one a g e n c y ( t h e F a m i l y S e r v i c e A g e n c y o f G r e a t e r V a n c o u v e r ) , d u r i n g a two-month p e r i o d o f 1 9 5 8 . S e p t e m b e r a n d O c t o b e r o f 1 9 5 8 , t h e two months c h o s e n f o r t h e s t u d y , a r e f a r b a c k e n o u g h t o p e r m i t a p i c t u r e o f t h e e x t e n t o f s e r v i c e g i v e n t o t h e a p p l i c a n t s , y e t c l o s e e n o u g h t o t h e p r e s e n t t o i n d i c a t e c u r r e n t r e q u e s t s f o r s e r v i c e . T h i s i s a l s o a p e r i o d o f t h e y e a r when i n t a k e i s n o r m a l l y f a i r l y h i g h j most o f t h e c a s e w o r k s t a f f h a v e r e t u r n e d f r o m v a c a t i o n ! a n d i t h a p p e n e d t h a t t h e r e was v e r y l i t t l e t u r n o v e r 'of s t a f f d u r i n g t h e e n s u i n g e i g h t o r n i n e m o n t h s . I n f a c t , t o t a l i n t a k e d u r i n g t h e two months was a t a h i g h e r l e v e l t h a n t h e a v e r a g e f o r t h e y e a r . The t o t a l number o f c a s e s o p e n e d , r e - o p e n e d o r r e c u r r e n t d u r i n g 1 9 5 8 was ( i n r o u n d f i g u r e s ) 1 , 3 5 0 ( i n c l u d i n g t h e d i s t r i c t o f f i c e ) , o r an a v e r a g e o f s l i g h t l y o v e r one h u n d r e d c a s e s e a c h m onth. D u r i n g S e p t e m b e r a n d O c t o b e r , o v e r two h u n d r e d c a s e s w e re o p e n e d o r r e - o p e n e d i n t h e m a i n o f f i c e a l o n e . Of t h e s e two h u n d r e d " c a s e s made", - 19 -i . e . t hose i n w h i c h some casework s e r v i c e was g i v e n , n i n e t y -f i v e were a c c e p t e d as a p p l i c a t i o n s f o r c o n t i n u i n g s e r v i c e and were p l a c e d on the w a i t i n g - l i s t f o r assignment t o case-w o r k e r s . I t i s the s e w a i t i n g - l i s t cases w i t h w h i c h t h e p r e s e n t s t u d y i s m a i n l y concerned. I n r e f e r r i n g t o a p p l i c a t i o n s a c c e p t e d f o r - s e r v i c e , t h e term " i n t a k e " w i l l he used h e r e a f t e r i n a l i m i t e d sense.. I t w i l l not r e f e r t o the a d m i n i s t r a t i v e s t r u c t u r e of t h e i n t a k e department i n t h e agency, n o r w i l l i t r e f e r t o i n t a k e as an i n t e g r a l p a r t of t h e casework p r o c e s s . F u r t h e r m o r e , i t w i l l n o t be t a k e n t o mean the whole amount of i n t a k e s e r -v i c e t o the community, o r even t o a l l o f . t h e "cases made". E x c l u d e d a re cases c l o s e d a t i n t a k e , i n w h i c h the a p p l i c a n t s d e c i d e d n o t t o c o n t i n u e , were r e f e r r e d e lsewhere f o r more a p p r o p r i a t e s e r v i c e , . o r where s e r v i c e was completed by t h e i n t a k e w orker, even though some of the s e r e c e i v e d " c o n t i n u e d s e r v i c e " , o r more than one i n - p e r s o n i n t e r v i e w . These c a s e s , over h a l f o f the "cases made" d u r i n g t h e two-month p e r i o d , r e p r e s e n t a c o n s i d e r a b l e i n v e s t m e n t of casework time and s e r v i c e by t h e i n t a k e department and r a i s e many q u e s t i o n s , some o f w h i c h have b e a r i n g on the major q u e s t i o n s o f t h i s s t u d y . N e v e r t h e l e s s , i t was d e c i d e d t o c o n c e n t r a t e on the " c o r e " o f cases t a k e n i n t o t h e a g e n c y — " i n t a k e " i n the sense o f (a) a p p l i c a t i o n s f o r s e r v i c e w h i c h were a c c e p t e d as coming p r o p e r l y w i t h i n the f u n c t i o n of the agency, (b) where a p p l i -c a n t s e x p r e s s e d a d e s i r e f o r o n g o i n g s e r v i c e , and (c) e i t h e r a g reed t o w a i t f o r t h i s , o r were o f f e r e d p r i o r i t y s e r v i c e . - 20 -" I n t a k e " i n t h i s r e s t r i c t e d sense t h u s means cases "taken i n " t o t h e on-going s t r e a m of the agency's c a s e l o a d , or 'admitted t o i t s major casework and o t h e r complementary serv i c e s . " 1 ' B r i e f and C o n t i n u e d S e r v i c e Of the n i n e t y - f i v e a c c e p t e d a p p l i c a t i o n s , t h i r t y -t h r e e c l o s e d l a t e r as " b r i e f s e r v i c e " cases ( f o l l o w i n g the F a m i l y S e r v i c e A s s o c i a t i o n of America d e f i n i t i o n ) . That i s , t h e r e was not more than one i n - p e r s o n i n t e r v i e w w i t h a c l i e n t , r e g a r d l e s s of the number of t e l e p h o n e c a l l s or. o t h e r s e r v i c e r e n d e r e d . S i x t y - t w o of the a c c e p t e d a p p l i c a t i o n s ( o r 31 p e r cent of t h e two hundred cases opened d u r i n g t h e p e r i o d ) , became " c o n t i n u e d s e r v i c e " c a s e s , r e c e i v i n g a t l e a s t two p e r s o n a l i n t e r v i e w s . However, as mentioned p r e v i o u s l y , a few c o n t i n u e d s e r v i c e cases were e x c l u d e d f r o m the sample as cases r e c e i v i n g s e r v i c e f rom i n t a k e workers o n l y and c l o s e d a t t h a t p o i n t , w h i c h made t h e p e r c e n t a g e of cases opened dur-i n g t h e p e r i o d w h i c h became c o n t i n u e d s e r v i c e cases s l i g h t l y h i g h e r than 3 1 . The above f i g u r e s appear t o be t y p i c a l o f p r o p o r -t i o n s o f b r i e f s e r v i c e and c o n t i n u e d s e r v i c e c ases i n f a m i l y a g e n c i e s , j u d g i n g from the s t a t i s t i c s r e p o r t e d o v e r a number o f y e a r s by member a g e n c i e s of the F a m i l y S e r v i c e A s s o c i a t i o n o f America,, i n d i c a t i n g t h a t a p p r o x i m a t e l y two t h i r d s of a l l 1 Scope and Methods o f the F a m i l y S e r v i c e Agency: Report of The Committee on Methods and Scope, F a m i l y S e r v i c e A s s o c i a t i o n o f A m e r i c a , New York, 1 9 5 3 . - 2 1 -cases c l o s e d i n any one y e a r r e c e i v e " b r i e f service".''" They a l s o appear r e p r e s e n t a t i v e of the Vancouver agency's s t a t i s t i c s f o r the y e a r , w h i c h show t h a t a l m o s t e x a c t l y two-t h i r d s o f a l l cases opened and re-opened d u r i n g t h e y e a r were c l o s e d as b r i e f s e r v i c e . However, i f a p p l i c a t i o n s a c c e p t e d  f o r s e r v i c e o n l y a re c o n s i d e r e d , the p r o p o r t i o n s a r e r e v e r s e d . A p p r o x i m a t e l y o n e - t h i r d of t h e s e c l o s e d as b r i e f s e r v i c e , and t w o - t h i r d s became c o n t i n u e d s e r v i c e c a s e s . T h i s would a l s o appear t o be i n a c c o r d w i t h e x p e r i e n c e e l s e w h e r e . J u d g i n g f r o m a s t u d y conducted i n 1 9 5 3 in. two Chicago f a m i l y agen-c i e s , i n w h i c h the sample used i n c l u d e d o n l y cases where "at the end of the f i r s t i n - p e r s o n i n t e r v i e w i t was. a n t i c i -p a t e d t h e r e would be f u r t h e r contact"., L i l i a n R i p p l e n o t e d t h a t a p p r o x i m a t e l y t w o - t h i r d s o f the c l i e n t s e x p e c t e d t o 2 r e t u r n f o r a second i n t e r v i e w d i d r e t u r n . The method o f s a m p l i n g used i s not i d e n t i c a l w i t h the one used i n t h i s s t u d y , but i t I s r o u g h l y comparable, and i t shows the same p r o p o r t i o n o f a c c e p t e d a p p l i c a t i o n s d r o p p i n g out a f t e r one i n t e r v i e w . •1 Shyne, Ann W.,- "What R e s e a r c h T e l l s Us About Short-Term Cases i n F a m i l y A g e n c i e s " , S o c i a l Casework, May, 1 9 5 7 j see a l s o Kogan, Leonard S.,. "The Short-Term Case i n a F a m i l y Agency, P a r t I , The Study P l a n " , S o c i a l Casework, May, 1 9 5 7 . 2 R i p p l e , L i l i a n , " M o t i v a t i o n , C a p a c i t y and O p p o r t u n i t y as R e l a t e d t o t h e Use of Casework S e r v i c e : T h e o r e t i c a l Base and P l a n of Study", S o c i a l S e r v i c e Review, June, 1 9 5 5 , V o l . x x l x , • No.. 2 . . . . - 22 -A v a i l a b l e I n f o r m a t i o n I n f o r m a t i o n about each o f the n i n e t y - f i v e cases i n c l u d e d i n the main sample was f i r s t of a l l o b t a i n e d f r o m case c a r d s used f o r r e p o r t i n g t o F a m i l y S e r v i c e A s s o c i a t i o n of America and f o r o t h e r purposes i n the agency. M a t e r i a l s e l e c t e d f o r the s t u d y was t r a n s f e r r e d t o c a r d s s e t up f o r t h i s p u r p o s e . T h i s - i n c l u d e d i d e n t i f y i n g i n f o r m a t i o n , the m a r i t a l s t a t u s , b i r t h p l a c e and o c c u p a t i o n of t h e a p p l i c a n t s and t h e i r spouses, and the number of c h i l d r e n i n t h e home a t the time o f a p p l i -c a t i o n . Other i n f o r m a t i o n o b t a i n e d i n c l u d e d t h e manner of r e f e r r a l , whether t h e case was new or re-opened, whether p r i o r -i t y was g i v e n , and whether i t c l o s e d as b r i e f s e r v i c e . C l o s i n g i n f o r m a t i o n where a v a i l a b l e i n c l u d e d whether f i n a n c i a l a s s i s -t a n c e was g i v e n or a f e e was p a i d f o r s e r v i c e , the r e a s o n f o r . c l o s i n g ; and f i n a l l y , the caseworker's e v a l u a t i o n a t c l o s i n g as t o whether t h e s e r v i c e h e l p e d the i n d i v i d u a l o r f a m i l y t o a b e t t e r s o c i a l a d j u s t m e n t . I n f o r m a t i o n o b t a i n e d i n t h i s way was checked, added t o , and r e f i n e d by s c a n n i n g t h e case r e c o r d s , w i t h p a r t i c u l a r emphasis on the e a r l y i n t e r v i e w s and c l o s i n g summaries. The o b j e c t i v e was t o o b t a i n Information w h i c h would be as i n f o r m -a t i v e as p o s s i b l e about t h e a p p l i c a n t s and t h e i r f a m i l i e s a t the time when t h e y f i r s t came t o the agency. I t s h o u l d be mentioned t h a t "problems" as n o t e d a t I n t a k e and t i c k e d on the s t a t i s t i c a l c a r d s are not used as t h e m a t e r i a l f o r t a b u l a t i o n * , t h e s e i n c l u d e problems judged t o e x i s t by t h e caseworker, as w e l l as perhaps minor m a t t e r s mentioned by the c l i e n t about w h i c h - 23 -immediate a d v i c e may be given-. " P r e s e n t i n g p roblems", f o r t h e purpose of t h i s s t u d y , a r e i d e n t i f i e d as the main problems t h e a p p l i c a n t d e s c r i b e d and f o r w h i c h h e l p was s p e c i f i c a l l y r e q u e s t e d i n t he f i r s t i n t a k e i n t e r v i e w ' , u s u a l l y i n t h e f i r s t few se n t e n c e s over the t e l e p h o n e . T h i s p r o c e d u r e i s used i n o r d e r t o make c l e a r (a) the main p r o b l e m as seen by t h e c l i e n t and (b) the s e r v i c e r e q u e s t e d o f the agency. Other i n f o r m a t i o n o b t a i n e d m a i n l y f rom p e r u s a l o f case r e c o r d s i n c l u d e s the l e n g t h of time t h e a p p l i c a n t w a i t e d f o r s e r v i c e , t h e d u r a t i o n of s e r v i c e g i v e n t o c l o s e d c a s e s , the f a m i l y member who f i r s t made c o n t a c t w i t h the agency whether o r not t h e y were r e f e r r e d by someone e l s e , and such i n f o r m a t i o n about f a m i l y income and h o u s i n g as was a v a i l a b l e . The t o t a l sample was the n d i v i d e d i n t o two main groups, t h e t h i r t y - t h r e e b r i e f s e r v i c e cases and s i x t y - t w o w h i c h r e c e i v e d c o n t i n u e d s e r v i c e . I n o r d e r t o keep the f i l e s down t o manageable p r o p o r t i o n s I t was n e c e s s a r y t o t a k e o n l y h a l f o f the c o n t i n u e d s e r v i c e c a s e s : a c c o r d i n g l y , t h i s group was s u b - d i v i d e d , the ca r d s a r r a n g e d a l p h a b e t i c a l l y and e v e r y second one s e l e c t e d . The case m a t e r i a l was then s t u d i e d i n d e t a i l f o r t h e two s e l e c t e d samples ( t h i r t y - t h r e e b r i e f s e r v i c e cases and t h i r t y - o n e c o n t i n u e d s e r v i c e c a s e s ) . Data was t r a n s -f e r r e d i n summary t o i n d i v i d u a l s c h e d u l e s under t h e f o l l o w i n g main h e a d i n g s : (a) the a p p l i c a n t s * p r e s e n t a t i o n of t h e prob-lem, (b) r e a s o n s f o r p r i o r i t y (where a p p l i c a b l e ) , (c) apparent m o t i v a t i o n a t i n t a k e , (d) o u t l i n e o f the f a m i l y s i t u a t i o n and problems g i v e n a t t e n t i o n by t h e caseworker, (e) the k i n d o f - 24 -casework and o t h e r s e r v i c e g i v e n , ( f ) measurements or i n d i c a t i o n s of d u r a t i o n and i n t e n s i t y of s e r v i c e , (g) e v a l u a t i o n a t c l o s i n g , and (h) p r i o r o r subsequent s e r v i c e . I n f o r m a t i o n o b t a i n e d i n t h i s way w i l l be used f o r case s t u d i e s of b r i e f s e r v i c e cases and c o n t i n u e d s e r v i c e c a s e s . Who Were the A p p l i c a n t s ? I t i s f i r s t n e c e s s a r y t o ask, as a g e n e r a l background, who a r e t h e s e a p p l i c a n t s - t a k e n as a t o t a l group - who came t o the agency d u r i n g t h e s e two months? " A p p l i c a n t " i n t h i s c o n t e x t r e f e r s t o t h e c l i e n t , the husband or w i f e or s i n g l e p e r s o n , who f i r s t approached the agency t o r e q u e s t h e l p w i t h .a p e r s o n a l or f a m i l y p roblem. No attempt w i l l be 'made t o c o n s i d e r s o u r c e s of r e f e r r a l , o r how the c l i e n t h e a r d about the agency i n the f i r s t place." 1" However, i t i s of i n t e r e s t t o note t h a t e i g h t y - f i v e of the n i n e t y - f i v e a p p l i c a n t s made the i n i t i a l c o n t a c t w i t h the agency on t h e i r own b e h a l f . Of t h e s e , t h i r t y - t w o mentioned t h a t t h e y had been a d v i s e d by someone e l s e -. a f r i e n d , , a r e l a t i v e , a. s o c i a l worker from a n o t h e r agency or a n o t h e r p r o f e s s i o n a l p e r s o n - t o seek the s e r v i c e of the agency. I n o n l y t e n cases d i d someone o t h e r than t h e c l i e n t make the o r i g i n a l r e q u e s t f o r s e r v i c e . The i n i t i a l a p p l i c a n t i s d e f i n e d as t h e c l i e n t who makes the f i r s t c o n t a c t w i t h the- agency. I n some cases a husband 1 T h i s i s the s u b j e c t of a s e p a r a t e t h e s i s , a l s o b e i n g con-d u c t e d d u r i n g 1 959 -60 . or w i f e may have mentioned t h a t t h e i r m a r r i a g e p a r t n e r a l s o wanted s e r v i c e , o r the o t h e r spouse may have f o l l o w e d s h o r t l y w i t h a r e q u e s t on h i s own b e h a l f . However, such s i t u a t i o n s have been i g n o r e d f o r the sake of s i m p l i c i t y a t t h i s p o i n t . W i t h t h e s e q u a l i f i c a t i o n s i n mind, the f a c t i s t h a t over t h r e e -q u a r t e r s of the i n i t i a l a p p l i c a n t s were women. ( T a b l e l ) Over h a l f of tho s e who r e q u e s t e d s e r v i c e were m a r r i e d women w i t h c h i l d r e n ; and h a l f of t h e s e (26) were between the ages of t h i r t y and f o r t y . . I t c a n be s a i d t h e r e f o r e t h a t the most t y p i c a l a p p l i c a n t was a m a r r i e d woman, - between t h i r t y and f o r t y , and w i t h c h i l d r e n , . a s t h i s group i s t w i c e as numerous as any o t h e r group i n the t a b l e , and between them comprise o v e r . o n e - q u a r t e r •of the t o t a l sample. T h i s p i c t u r e o f a preponderance of female a p p l i c a n t s may appear d i s c o n c e r t i n g i n view of the d e s i r e of t h i s and o t h e r f a m i l y a g e n c i e s t o r e a c h more of the male m a r r i a g e p a r t n e r s , and the s t r o n g i m p r e s s i o n of the s o c i a l w o r k ers of the agency t h a t more men a r e u s i n g c o n t i n u i n g casework s e r v i c e . However, the f i g u r e s quoted prove o n l y t h a t d u r i n g t h i s p a r t i c u l a r p e r i o d more women than men made the i n i t i a l a p p l i c a t i o n . Perhaps I t Is more c o n v e n i e n t f o r a housewife t o t e l e p h o n e the agency and d i s c u s s i n t i m a t e p e r s o n a l p roblems, and i n some cases t h i s may '., be t h e r e s u l t of a mutual d e c i s i o n . There i s a s t r o n g i n d i c a t i o n , however, t h a t more women tha n men r e a c h e d a p o i n t o f d e s p e r a t i o n , • m o t i v a t i o n or d e c i s i o n s u f f i c i e n t ..to t a k e a c t i o n about t h e i r p r o blems, and saw the F a m i l y S e r v i c e Agency as a s u i t a b l e r e s o u r c e . (The a c t u a l use of casework s e r v i c e by v a r i o u s f a m i l y - 2 6 -Table 1. Age, Sex, and M a r i t a l S t a t u s  o f the I n i t i a l A p p l i c a n t M a r i t a l ' S t a t u s Age of I n i t i a l A p p l i c a n t T o t a l and Sex Under 2 0 2 0 - 3 0 3 0 - 4 0 4 0 - 5 0 5 0 - 6 o Over .60 M a r r i e d w i t h C h i l d r e n ( W i f e ) 0 7 26 13 4 0 50 M a r r i e d w i t h C h i l d r e n (Husband) 0 2 8 (c) 3 1 0 14 M a r r i e d , •. no C h i l d r e n ( W ife) (a) 1 0 5 0 2 2 10 S e p a r a t e d Wife, w i t h C h i l d r e n (b) 0 3 3 3 0 0 9 S e p a r a t e d . Husband w i t h C h i l d r e n 0 0 3 1 0 0 4 Widow w i t h C h i l d r e n 0 0 0 2 0 0 2 S i n g l e Man 0 2~" 0 0 0 0 2 S i n g l e Woman 1 0 2 0 0 1 T o t a l 2 14 4 7 2 2 7 3 9 5 (a) No dependent c h i l d r e n i n t h e home. (b) I n c l u d e s . D e s e r t e d and D i v o r c e d . ( c ) I n c l u d e s one case where t h e r e was no c h i l d a t the time o f i n t a k e (one was i m m i n e n t l y e x p e c t e d ) . - 27 -members, w h i c h i s e x p l o r e d l a t e r , p r e s e n t s a somewhat d i f f e r e n t p i c t u r e . . ) The g r e a t m a j o r i t y of t h e a p p l i c a n t s (7^ out of 95) were m a r r i e d . T h i s i s t o be e x p e c t e d : but two s m a l l though s i g n i f i c a n t groups a l s o asked f o r s e r v i c e - f i f t e e n u n a t t a c h e d p a r e n t s w i t h c h i l d r e n , and s i x s i n g l e p e r s o n s . The age of the a p p l i c a n t s r e v e a l s a. c o n c e n t r a t i o n i n the y e a r s of g r e a t e s t f a m i l y r e s p o n s i b i l i t y , w i t h t a p e r i n g t o b o t h ends of the a d u l t r a n g e . There i s an i n d i c a t i o n t h a t v e r y l i t t l e s e r v i c e i s extended t o aged p e r s o n s , o r r e q u e s t e d by them, w h i c h doubt-l e s s r e f l e c t s t he t r u e s i t u a t i o n . An e x c e p t i o n , however, i s t h a t two o f thos e l i s t e d as over s i x t y i n the Table were i n f a c t o v er s e v e n t y y e a r s of age. Indeed, one of thes e a p p l i -c a n t s was a r e c e n t b r i d e , aged over s e v e n t y , who r e q u e s t e d h e l p w i t h a m a r i t a l p r o b l e m l Only t h o s e a p p l i c a n t s who had dependent c h i l d r e n l i v i n g a t home a r e l i s t e d as h a v i n g c h i l d r e n . Grown c h i l d r e n l i v i n g away from home ,;are not i n c l u d e d , n or a r e c h i l d r e n of a p r e v i o u s .marriage l i v i n g w i t h t h e o t h e r p a r e n t . The sample I n c l u d e s s e v e n t y - n i n e f a m i l y groups w i t h minor c h i l d r e n , s i x t y - f o u r two-parent f a m i l i e s and f i f t e e n one-parent f a m i l i e s . ( T a b l e 2) The f i f t e e n one-parent f a m i l i e s comprise about 19 p e r c e n t of the t o t a l number of f a m i l i e s w i t h c h i l d r e n , and s e v e r a l cases of r e - m a r r i a g e a r e i n d i c a t e d by the n i n e c h i l d -r e n who had s t e p - p a r e n t s . A l t h o u g h a s i g n i f i c a n t number of f a m i l i e s had been "broken" by s e p a r a t i o n , d i v o r c e or d e a t h , - 2 8 -Table 2 . Number of C h i l d r e n i n t h e Home  at t h e Time of A p p l i c a t i o n M a r i t a l S t a t u s of P a r e n t s Number i n o f C h i l d r e n t h e Home T o t a l s 1 2 3 4 5 7 F a m i l i e s C h i l d r e n M a r r i e d Couple 1 7 1 9 9 10 8 1 64 1 6 9 (--a) S e p a r a t e d Mother 3 4 1 1 0 0 9 1 8 S e p a r a t e d F a t h e r 1 3 0 0 0 0 4 7 Widow 2 0 0 0 0 0 2 .2 T o t a l Number of F a m i l i e s 2 3 2 6 10 1 1 8 1 79 ' -T o t a l Number of C h i l d r e n 2 3 52 30 44 40 7 . 1 9 6 (a) 9 s t e p - c h i l d r e n . - 29 -t h e m a j o r i t y were s t i l l i n t a c t . Whatever e l s e the s t a t i s t i c s i n d i c a t e ( T a b l e 2 ) , the e v i d e n c e o f o n l y two months 1 a p p l i c a t i o n s i s t h a t almost two hundred c h i l d r e n l i v i n g i n the s e homes were a f f e c t e d t o some degree by p a r e n t a l s t r i f e or o t h e r f a m i l y p r o b l e m s , "^  Success o r f a i l u r e of s e r v i c e t o t h e s e f a m i l i e s , a c c o r d i n g l y , c o u l d have f a r - r e a c h i n g consequences. The g r e a t m a j o r i t y o f the c h i l d r e n were l i v i n g i n two-parent homes, and one hundred and. s i x t y , n e a r l y 82 p e r c e n t , were l i v i n g w i t h t h e i r two n a t u r a l p a r e n t s . Twenty-seven c h i l d r e n were l i v i n g i n o'ne-.parent o r "broken" homes, and n i n e o t h e r c h i l d r e n had a s t e p - p a r e n t . C o u n t r y of b i r t h of a p p l i c a n t s and. t h e i r m a r r i a g e p a r t n e r s was a v a i l a b l e i n o n l y e i g h t y - t w o cases.. ( T a b l e 3) Prom the i n f o r m a t i o n a v a i l a b l e , one hundred and twenty-two a d u l t s were born i n Canada; twenty i n B r i t a i n o r o t h e r Com-monwealth c o u n t r y ; and f i f t e e n , or s l i g h t l y l e s s t h a n 10 p e r cent were b o r n i n o t h e r c o u n t r i e s . . Thus the g r e a t m a j o r i t y were Canadian-born, w h i c h i s h a r d l y s u r p r i s i n g . However, i n t w e n t y - f i v e cases a t l e a s t one a d u l t was not born i n Canada, and i n t e n cases b o t h m a r i t a l p a r t n e r s were b o r n e l s e w h e r e . The B r i t i s h , w i v e s were w a r - b r i d e s , and most o f the "mixed" m a r r i a g e s i n c l u d e one Canadian-born and one B r i t i s h - b o r n p a r t n e r . A few im m i g r a n t s , o t h e r than B r i t i s h , a p p l i e d f o r 1 S i z e of f a m i l i e s as i n d i c a t e d by Table 2 i s not o f p a r t i -c u l a r s i g n i f i c a n c e . The a c t u a l s i z e of f a m i l i e s i s not shown, as c h i l d r e n away f r o m home are not i n c l u d e d , . n o r , . o f c o u r s e , a r e c h i l d r e n as y e t unborn. - 30 -Table 3 . C o u n t r y of B i r t h of A d u l t C l i e n t s C o u n t r y of B i r t h F a m i l y Members Number of Number of B o t h P a r t n e r s Husband Only Wife Only Cases Persons Canada 53 ( 7 ) (7) 53 1 1 8 B r i t a i n 4 5 6 1 5 19 U.S.A, 0 0 1 1 1 Germany 3 0 0 3 6 I c e l a n d 1 0 0 1 2 Roumania. 1 . 0 0 1 2 U k r a i n e 1 1 0 2 3 I t a l y 0 1 0 1 1 T o t a l F o r e i g n Born 10 7 7 . 2 4 3 4 Note i 4 s i n g l e p e r s o n s born i n Canada, 1 i n B r i t a i n . - 31 -s e r v i c e , and of these t h e l a r g e s t s i n g l e group i s represented. by t h r e e German c o u p l e s * From what s o c i a l c l a s s e s do the c l i e n t s come? The f o l l o w i n g q u o t a t i o n f r o m W i l e n s k y and Lebeaux i s h e l p f u l as a b a s i s f o r d i s c u s s i n g t h i s : "The s o c i a l background of c l i e n t s of f a m i l y a g e n c i e s w h i c h emphasize c o u n s e l i n g on m a r i t a l and c h i l d - p a r e n t problems v a r i e s w i t h t h e c l a s s c o m p o s i t i o n o f the community served.. The e v i d e n c e s u g g e s t s , however, t h a t t h e a g e n c i e s do not draw from a s o c i a l c r o s s - s e c t i o n , but f r o m a band r u n n i n g downward from the m i d d l e of t h e community. One s t u d y of a n o n s e c t a r i a n agency i n D e t r o i t , a h e a v i l y i n d u s t r i a l c i t y , r e v e a l e d a case-l o a d composed almost e n t i r e l y o f upper w o r k i n g c l a s s and l o w e r m i d d l e c l a s s , w i t h the f o r m e r p r e d o m i n a t i n g . But i n a r e s i -d e n t i a l suburb of D e t r o i t , p e o p l e d h e a v i l y by a u t o m o b i l e company e x e c u t i v e s and s u b e x e c u t i v e s , c l i e n t s o f h i g h e r s t a t u s predominate i n t h e l o c a l f a m i l y s e r v i c e c a s e l o a d — o n l y two of a sample of 96 who sought s e r v i c e c o u l d be c l a s s i f i e d as low as ' t r a d e s p e o p l e 1 " . ! The o c c u p a t i o n a l , s t a t u s a t l e a s t of the- male c l i e n t s can be judged from t h e i r o c c u p a t i o n a l d e s c r i p t i o n , and t h i s i s summarized i n Table 4. I t appears t h a t t h e sample of the c l i e n t e l e of the main o f f i c e of the F a m i l y Agency of G r e a t e r Vancouver i s r o u g h l y comparable t o the c a s e l o a d of the urban D e t r o i t agency, w i t h r e g a r d t o employment of the men, w h i c h i s s u b s t a n t i a l l y "upper w o r k i n g c l a s s and l o w e r m i d d l e c l a s s " . There i s r e p r e s e n t a t i o n b o t h above and below th e s e l e v e l s , . however. A t l e a s t some of the o c c u p a t i o n s l i s t e d under "White C o l l a r " i n the t a b l e would be c o n s i d e r e d above "lo w e r m i d d l e c l a s s " i n s t a t u s , and the " U n s k i l l e d " o c c u p a t i o n s a r e below "upper w o r k i n g c l a s s " i n s t a t u s . The d i s t r i c t o f f i c e 1 W i l e n s k y , ' H a r o l d L,, and C h a r l e s N. Lebeaux, I n d u s t r i a l  S o c i e t y and S o c i a l W e l f a r e , R u s s e l l Sage F o u n d a t i o n , New York, 1958, Chapter V I I I , p. 1 ? 0 . - .32 -Table 4.. O c c u p a t i o n a l Groups (Male o n l y ) ' Group Number Pe r c e n t a g e I White C o l l a r . 2 2 29 P r o f e s s i o n a l . 2 B u s i n e s s E x e c u t i v e 2 Own B u s i n e s s . ... 2 S t o r e Manager ................ 2 S a l e s 6 C l e r i c a l , C i v i l S e r v a n t , e t c . . 8 I I S k i l l e d 20 26.25 Foreman . . . i . . . . . . . . . . . . . . . . . . 3 E n g i n e e r (non p r o f e s s i o n a l ) . . 2 Mechanics ( e . g . a u t o , m a c h i n i s t ) ....... 5 B u i l d i n g t r a d e s ... 5 ( c a r p e n t e r , b r i c k l a y e r , plumber) Others ( e . g . r a i l w a y f i r e m a n ) . 5 I I I S e m i - S k i l l e d 23 30.25 Bus d r i v e r 2 D r i v e r ( t r a n s p o r t ; , t r u c k , e t c . ) 8 Cook 2 M i l l w o r k e r * 4 Others ( e . g . g r a i n l i n e r , s h i p p e r ) 7 I V . U n s k i l l e d 11 14.5 Deckhand, f i s h e r m a n , e t c . ... 3 J a n i t o r 4 L a b o u r e r 3 Longshoreman 1 T o t a l 76 100.0 - .33 -of t he agency s e r v i c e s two mi d d l e c l a s s suburban a r e a s , but the main o f f i c e a l s o o f f e r s s e r v i c e t o two suburban a r e a s as w e l l as t h e c i t y p r o p e r . One of thes e suburbs i s composed l a r g e l y o f l o w e r - m i d d l e - c l a s s homes; the o t h e r i s a r e s i d e n -t i a l .area o f e x p e n s i v e homes. R e s i d e n t s of the main c i t y p r o b a b l y c o v e r almost t h e t o t a l range of v a r i a t i o n i n w e a l t h , • s o c i a l s t a t u s and o c c u p a t i o n of t h e c o u n t r y as a whole-. The c l i e n t e l e of the main o f f i c e of the F a m i l y S e r v i c e Agency can perhaps be seen as r e p r e s e n t i n g a "band r u n n i n g downr-ward f r o m t h e m i d d l e of the community". There i s c o n s i d e r a b l e o v e r l a p p i n g w i t h r e g a r d t o income between " w h i t e - c o l l a r " and " b l u e - c o l l a r " o c c u p a t i o n s . Income o f the a p p l i c a n t s was not a v a i l a b l e i n a l l c a s e s , but e a r n i n g s of the men appeared t o v a r y between $ 2 0 0 and $ 7 0 0 a month.. Some of 'the h i g h e s t wages were earned by men i n the " S k i l l e d " group, e s p e c i a l l y foremen. From t h e i n f o r m a t i o n a v a i l a b l e i t appears t h a t most of the male br e a d w i n n e r s earned between $ 3 0 0 and $ 4 5 0 a month, whereas tho s e I n the " U n s k i l l e d " group earned between $ 2 0 0 and $ 3 0 0 . Only one male f a m i l y head was e a r n i n g l e s s t h a n $ 2 0 0 a month. F a m i l y incomes a r e n a t u r a l l y h i g h e r when b o t h m a r i t a l p a r t n e r s a r e w o r k i n g , and l o w e r f o r f a m i l i e s where a s e p a r a t e d mother i s the main b r e a d w i n n e r . Employment of women ( T a b l e 5) shows a somewhat g r e a t e r p r o p o r t i o n o f " w h i t e - e o l l a r " o c c u p a t i o n s than t h a t of the men, but some of thes e may be lowers-grade c l e r i c a l and s a l e s jobs... A s u b s t a n t i a l number o f the f a m i l i e s were - 34 -Table 5- O c c u p a t i o n and M a r i t a l S t a t u s  o f Employed Women Type of Employment M a r i t a l S t a t u s T o t a l M a r r i e d , U n a t t a c h e d , w i t h C h i l d r e n w i t h C h i l d r e n M a r r i e d , no C h i l d r e n Business, o r P r o f e s s i o n a l 3 1 1 5 • . C l e r i c a l and S a l e s s t a f f 5 2 (a) 4 11 S e m i - s k i l l e d o r U n s k i l l e d , Domestic 2 2 1 5 T o t a l 10 5 6 21 ' j (a) I n c l u d e s 1 unemployed a t time of a p p l i c a t i o n . Note; Of'the 4 s i n g l e women, 2 were i n c l e r i c a l work, 1 a d o m e s t i c , and one r e t i r e d . - 35 -i n v o l v e d in.mortgage payments on homes. U n f o r t u n a t e l y , i n f o r m a t i o n about e d u c a t i o n a l a t t a i n m e n t s of the a d u l t s was not r e a d i l y a v a i l a b l e i n most c a s e s . In s e v e r a l i n s t a n c e s c h i l d r e n of some of the p o o r e s t f a m i l i e s were r e p o r t e d as a t t e n d i n g u n i v e r s i t y . Employment of the b readwinner i s o n l y one i n d i - ^ c a t i o n of s o c i a l c l a s s s t a n d i n g . Income has r i s e n f o r many manual .workers i n t h e l a s t decade, and m i d d l e c l a s s a s p i r -a t i o n s a r e more common. There i s r e a s o n t o b e l i e v e t h a t a p p l i -c a n t s o f p r i v a t e f a m i l y a g e n c i e s , where the emphasis i s on c o u n s e l l i n g s e r v i c e (whereas the r e s p o n s i b i l i t y f o r r e l i e f of b a s i c economic need r e s t s w i t h a p u b l i c agency) a r e , almost by d e f i n i t i o n , o r i e n t e d t o m i d d l e c l a s s v a l u e s , whatever t h e i r o c c u p a t i o n a l or s o c i a l - s t a t u s . W i l e n s k y and Lebeaux suggest t h a t " I t i s .just the m i d d l e - c l a s s r a t i o n a l m e n t a l i t y w h i c h t a k e s most r e a d i l y t o the n o t i o n t h a t f a m i l i e s and p e r s o n a l i t i e s can .be s t u d i e d and r e p a i r e d l i k e b o d i e s or 'automobiles.. Such.an o u t l o o k i s not found i n the premodern mind, or t o .any e x t e n t i n urban l o w e r - c l a s s groups."" 1" I t i s not p o s s i b l e i n t h i s c o n t e x t t o examine i n a d e f i n i t i v e way the s o c i a l c l a s s a c c e p t a n c e or c u l t u r a l background of t h e a p p l i c a n t s . However, the i n f o r m a t i o n w h i c h has been p r e s e n t e d p r o v i d e s a few c l u e s w h i c h can be 1 W i l e n s k y , H a r o l d L., and C h a r l e s N. Lebeaux, I n d u s t r i a l  S o c i e t y and S o c i a l W e l f a r e , R u s s e l l 1 S a g e F o u n d a t i o n , New York, 1 9 5 8 , Chapter V I I I , p. 174. - 36 -considered, i n r e l a t i o n t o some q u o t a t i o n s from c u r r e n t l i t e r -a t u r e . V a r i o u s s t u d i e s have shown t h a t p s y c h i a t r i c and c h i l d guidance c l i n i c s seem t o be s e r v i n g a l a r g e l y m i d d l e -c l a s s c l i e n t e l e . Some of the r e a s o n s suggested f o r t h i s a r e : the g r e a t e r f a m i l i a r i t y of m i d d l e - c l a s s p e o p l e w i t h such f a c i l i t i e s , t h e i r g r e a t e r r e c e p t i v e n e s s t o the "mental-hygiene message" (see page 3 6 a ) , the c h i l d - o r i e n t e d n a t u r e of the m i d d l e - c l a s s f a m i l y , and the p o s s e s s i o n o f c o m p a r a t i v e economic s t a b i l i t y and l e i s u r e w h i c h a l l o w s time f o r problems and f o r d o i n g something about them."1" I t has been n o t e d t h a t few o f the a p p l i c a n t s i n the sample were f o r m a l l y r e f e r r e d . S i m i l a r f a c t o r s may o p e r a t e t o some degree i n the s e l f -s e l e c t i o n o f a p p l i c a n t s f o r f a m i l y s e r v i c e a g e n c i e s , and I n d e t e r m i n i n g w h i c h a p p l i c a n t s use casework s e r v i c e s on a con-t i n u i n g b a s i s . One r e c e n t a r t i c l e s u g g e s t s a c u l t u r a l approach t o d e f i n i n g s o c i a l c l a s s , w i t h p a r t i c u l a r r e f e r e n c e t o the urban 2 l o w e r - c l a s s , s t r u c t u r e . T h i s approach i s . concerned w i t h customary b e h a v i o u r , w i t h p a r t i c u l a r f o c u s on "those methods 1 G u r s s l i n , O r v l l l e , - Raymond G, Hunt and J a c k L. Roach, " S o c i a l C l a s s , M e n t a l Hygiene, and P s y c h i a t r i c P r a c t i c e " , The S o c i a l S e r v i c e Review, September, 1 9 5 9 , V o l . x x x i i i , No. 3 . 2 M i l l e r , W a l t e r B., " I m p l i c a t i o n s of Urban L o w e r - C l a s s C u l t u r e f o r S o c i a l Work", The S o c i a l S e r v i c e Review, September, 1 9 5 9 , V o l . x x x i i i , No. 3 . - 36.a -M e n t a l H e a l t h P r o p o s i t i o n s and C o - o r d i n a t e M i d d l e - C l a s s and L o w e r - C l a s s V a l u e O r i e n t a t i o n s M e n t a l - H e a l t h ' Statement 1.. P l a n f o r . tomorrow, but don't w o r r y about i t . M i d d l e - and L o w e r - C l a s s O r i e n t a t i o n s M i d d l e - c l a s s f u t u r e o r i e n t -a t i o n v s . l o w e r - c l a s s p r e s e n t o r i e n t a t i o n . 2. Everybody needs l o v e , espec-i a l l y c h i l d r e n . C h i l d - , and a f f e c t i o n - c e n t e r e d f a m i l y of m i d d l e - c l a s s v s . l a i s s e z - f a i r e and p a r e n t -c e n t e r e d l o w e r - c l a s s system. 3 . Face up t o your r e s p o n s i b i -l i t i e s . M i d d l e - r c l a s s p e r s o n a l r e s p o n -s i b i l i t y emphasis v s . depend-ency on f r i e n d , r e l a t i v e , or ' s o c i a l agency among the lo w e r c l a s s . 4. S et g o a l s you can r e a c h . 5. C o n t r o l y o u r emotions, don't l e t them r u n you. 6 . Do something about your t r o u b l e s , don't engage i n . s e l f - p i t y . G oal o r i e n t a t i o n ( s ee l ) and importance o f s t r i v i n g ( but " w i t h i n a t t a i n a b l e l i m i t s " i s a p p a r e n t l y a me n t a l -hygiene m o d i f i c a t i o n , as a g a i n s t the o l d e t h i c of " r e a c h f o r the sky") v s . " i f . y o u s e t g o a l s you.'11 o n l y be d i s a p p o i n t e d " o r i e n -t a t i o n of l o w e r . c l a s s . M i d d l e - c l a s s r e s t r a i n t v s . l o w e r - c l a s s f r e e r d i s p l a y of g r i e f , anger, l o v e , e t c . M i d d l e - c l a s s emphasis on i n i t i a t i v e and a c t i v e p r o b l e m - s o l v i n g v s . l o w e r -c l a s s s t r e s s on l u c k and f a t e ; f e e l i n g of f u t i l i t y and f e a r of t a k i n g chances. P a r a p h r a s e d from M e n t a l H e a l t h I s f o r E v e r y Day, A l b a n y : New Yor k S t a t e Department of M e n t a l Hygiene, 1953, as quoted i n " S o c i a l C l a s s , • M e n t a l Hygiene, and P s y c h i a t r i c P r a c t i c e " , by G u r s s l i n , O r v i l l e , Raymond G. Hunt and J a c k L. Roach, The S o c i a l S e r v i c e Review, September, 1959 . - 37 -o f a d a p t i n g t o common human p r o b l e m s s u c h a s m a t i n g , c h i l d -r e a r i n g , a n d g a i n i n g s u b s i s t e n c e w h i c h t a k e d i f f e r e n t f o r m s among d i f f e r e n t g r o u p s " . R a t h e r t h a n r a n k i n g s o c i a l c l a s s e s b y u s i n g s u c h c r i t e r i a a s e d u c a t i o n , o c c u p a t i o n a nd e t h n i c o r i g i n , i t i s s u g g e s t e d t h a t an i n d i v i d u a l o r g r o u p c a n be b e t t e r d e s c r i b e d a s b e l o n g i n g t o t h e " l o w e r c l a s s " " a c c o r d i n g t o t h e e x t e n t t o w h i c h o b s e r v e d b e h a v i o u r p a t t e r n s r e f l e c t d e s i g n a t e d f e a t u r e s o f l o w e r - c l a s s c u l t u r e " . The f o l l o w i n g p a t t e r n s , w h i c h c o n t r a s t s t r o n g l y w i t h p r e v a i l i n g m i d d l e -c l a s s c u l t u r e , a r e s u g g e s t e d : 1. I n v o l v e m e n t i n " u n s k i l l e d " o c c u p a t i o n s . 2 . "Female b a s e d " h o u s e h o l d . 3. S e r i a l m a t i n g . 4. Use o f n o n - s c h o o l . g r a m m a t i c a l s y s t e m . 5. F r e q u e n c y o f i n v o l v e m e n t i n c e r t a i n f o r m s o f i l l e g a l a c t i v i t y . 6 . C u s t o m a r y t e r m i n a t i o n o f f o r m a l s c h o o l i n g a t age 16 o r e a r l i e r . 7 . P e e r . g r o u p s u p e r s e d i n g t h e f a m i l y a s t h e p r i m a r y r e f e r e n c e g r o u p . A l t h o u g h A m e r i c a n l o w e r - c l a s s u r b a n c u l t u r e i s n o t homogeneous, one s u b - t y p e s e e n a s c h a r a c t e r i s t i c o f t h e u r b a n . l o w e r - c l a s s c o m m u n i t y i s t h e f e m a l e - b a s e d h o u s e h o l d . The a r t i c l e s t a t e s t h a t - t h i s i s "a w i d e l y p r e v a l e n t a nd p e r s i s t i n g s t r u c t u r a l f o r m , w h i c h c a n n o t be c o n s i d e r e d s i m p l y a. 'broken.' v a r i a n t o f t h e m i d d l e - c l a s s f a m i l y t y p e . • 'Broken- 1 I m p l i e s a m a l e p a r e n t a s an e x p e c t e d member o f t h e h o u s e h o l d , w h e r e a s f o r 'most f e m a l e - b a s e d u n i t s t h e r e i s l i t t l e a c t u a l e x p e c t a t i o n ( a l t h o u g h f r e q u e n t l y much e x p r e s s e d hope) t h a t t h e m a l e p a r e n t w i l l r e m a i n . E v i d e n c e i n d i c a t e s t h a t t h i s - 38 -type of u n i t i s f u n c t i o n a l l y r e l a t e d t o t h e demands o f the l o w e r - c l a s s o c c u p a t i o n a l system and thus appears h i g h l y r e s i s t a n t t o c h a n g e — " . Often a s s o c i a t e d w i t h the femal e -based h o u s e h o l d i s the p a t t e r n of " s e r i a l m a t i n g " , t h a t i s , women o f c h i l d - b e a r i n g age engage from time t o time i n s e x u a l a l l i a n c e s w i t h d i f f e r e n t p a r t n e r s , and o f r e l a t i v e l y b r i e f d u r a t i o n . F o r men and women as w e l l as a d o l e s c e n t s the peer.group i s of p r i m a r y i m p o r t a n c e , r a t h e r t h a n the f a m i l y . I n c o n t r a s t , "For the m i d d l e - c l a s s i n d i v i d u a l , t h e • 1 f a m i l y composed of a l e g a l l y m a r r i e d a d u l t man and woman l i v i n g w i t h t h e i r immature o f f s p r i n g i n a d w e l l i n g u n i t w h i c h g e n e r a l l y c o n t a i n s n e i t h e r o t h e r f a m i l i e s n or c o l l a t e r a l k i n — c o n s t i -t u t e s a u n i t of major p s y c h i c and s t r u c t u r a l i m p o r t a n c e . " I n p r e s e n t day c i t i e s , e x i s t e n c e of a. r e l a t i v e l y s t a b l e and growing urban l o w e r c l a s s i s i n d i c a t e d , and t h e r e a r e i m p o r t a n t i m p l i c a t i o n s f o r s o c i a l work p r a c t i c e a r i s i n g f r o m t h i s f a c t . I t appears e v i d e n t t h a t the a p p l i c a n t s of t h e F a m i l y S e r v i c e Agency of G r e a t e r Vancouver as r e p r e s e n t e d by the sample do not b e l o n g m a i n l y t o such an ' , lurban l o w e r c l a s s " ; and even when t h e y do- have some a t t r i b u t e s i n com-mon w i t h I t , t h e y o v e r w h e l m i n g l y s u b s c r i b e o r a s p i r e t o the m i d d l e - c l a s s f a m i l y p a t t e r n . . I n the p r e s e n t sample, o n l y 1 4 . 5 p e r cent of the male b r e a d w i n n e r s were engaged i n " u n s k i l l e d " o c c u p a t i o n s ( T a b l e 4 ) . The m a j o r i t y of the m a r r i a g e s and p r i m a r y f a m i l y u n i t s a re i n t a c t , and i t i s p r o b a b l e t h a t most of the one-parent f a m i l i e s c o u l d be -- . 3 9 -d e s c r i b e d as "a ' b r o k e n 1 v a r i a n t of the m i d d l e c l a s s f a m i l y t y p e " . There i s p r a c t i c a l l y no e v i d e n c e of the " s e r i a l m a t i n g " p a t t e r n . Q u i t e a number of the a p p l i c a n t s are sep-a r a t e d o r d i v o r c e d , but e i g h t y - n i n e of the i n i t i a l a p p l i c a n t s were,.or had been, m a r r i e d , . and a l l but one of t h e s e u n i o n s were l e g a l m a r r i a g e s . There i s one common-law u n i o n ( T a b l e l ) . The g r e a t m a j o r i t y of the c h i l d r e n o f the a p p l i c a n t s are l i v -i n g w i t h b o t h of t h e i r n a t u r a l p a r e n t s ( T a b l e 2 ) . Above a l l , the a p p l i c a n t s - 1 i d e n t i f i c a t i o n w i t h " m i d d l e - c l a s s " f a m i l y values, can be seen, i n the v e r y f a c t t h a t i n t h e v a s t m a j o r i t y of c ases t h e y a p p l i e d s p e c i f i c a l l y f o r h e l p w i t h f a m i l y r e l a t i o n s h i p or p e r s o n a l i t y problems ( T a b l e 6) .. A l l . of t h e s e t h i n g s are t o be e x p e c t e d from the f a c t t h a t t h e s e were a c c e p t e d a p p l i c a n t s , i n t h e sense t h a t t h e y had a c c e p t e d the agency's o f f e r of s e r v i c e as o u t l i n e d t o them by t h e i n t a k e w o r k e r s , as w e l l as i n the sense t h a t t h e i r r e q u e s t f o r s e r v i c e had been a c c e p t e d as w i t h i n , t h e agency's f u n c t i o n , . w h i c h i s p r i m a r i l y t h e s t r e n g t h e n i n g of f a m i l y l i f e . They had i n d i c a t e d t h a t t h i s was t h e k i n d o f h e l p t h e y wanted, and i n most cases t h e y had agreed t o w a i t f o r • i t . As p r e v i o u s l y e x p l a i n e d , an attempt was made t o d e f i n e the p r e s e n t i n g p r o blem as the major p r o b l e m w i t h w h i c h the a p p l i c a n t s p e c i f i c a l l y r e q u e s t e d help.. However, s i n c e a few of the a p p l i c a n t s p r e s e n t e d more than one, - 4o -t h e r e i s some o v e r l a p p i n g of pr o b l e m s . Table 6 a c c o r d i n g l y l i s t s more problems than t h e r e were p e o p l e . The f a c t s a r e f a i r l y c l e a r , however. W e l l over o n e - h a l f r e q u e s t e d s e r v i c e because of m a r i t a l d i f f i c u l t y . - Other f a m i l y problems were a main concern o f s i x t e e n a p p l i c a n t s . Seventeen a p p l i c a n t s d e s c r i b e d a pr o b l e m of p e r s o n a l i t y a d j u s t m e n t . I n o n l y seventeen cases was the major r e q u e s t f o r h e l p of a . " p r a c t i -c a l " n a t u r e , and most of t h e s e were a p p l i c a t i o n s f o r home-maker s e r v i c e . I n s e v e n t y - e i g h t of the n i n e t y - f i v e cases the major s e r v i c e r e q u e s t e d was h e l p of a p e r s o n a l o r i n t a n -g i b l e k i n d , t h a t i s , casework o r c o u n s e l l i n g h e l p . There were t h i r t e e n a p p l i c a t i o n s f o r homemaker s e r v i c e . Under p r e v a i l i n g c o n d i t i o n s o f urban f a m i l y l i f e an a p p l i c a t i o n f o r f i n a n c i a l and e n v i r o n m e n t a l a s s i s t a n c e i n t h i s f o rm does not i m p l y " l o w e r - c l a s s " s t a t u s . A p a r t from a p p l i c a t i o n s f o r homemaker s e r v i c e , i n o n l y f o u r cases c o u l d the r e q u e s t f o r s e r v i c e be d e f i n e d as f o c u s e d on e n v i r o n m e n t a l d i f f i c u l t i e s . In. a c t u a l f a c t , a l l o f t h e l a t t e r r e q u e s t e d h e l p w i t h employment o r v o c a t i o n a l a d j u s t -ment, and i n o n l y one case was the a p p l i c a n t ' s main concern c e n t r e d on f i n a n c i a l d e p r i v a t i o n . The one a p p l i c a n t whose p r i m a r y concern was economic d e p r i v a t i o n was t h e o n l y male breadwinner who was e a r n i n g l e s s than $200 a month.. He was. a l s o the - o n l y a p p l i c a n t who was l i v i n g i n commonrlaw union.. T h i s a p p l i c a n t was a w h i t e man l i v i n g w i t h a Chinese woman who had been - 41 -T a b l e 6 . D i s t r i b u t i o n of Main P r e s e n t i n g Problems  Found i n 9 5 Cases Problem • S e r v i c e B r i e f C o n t i n u e d Number o f T o t a l Problems M a r i t a l D i f f i c u l t y M a r i t a l . a l o n e M a r i t a l and o t h e r Sub T o t a l 21 2 7 3 2 24 29 48 5 53 53 Other F a m i l y Problems P a r e n t - c h i l d a l o n e P a r e n t - c h i l d and o t h e r Other F a m i l y R e l a t i o n s h i p Sub T o t a l 2 10 1 2 0 1 3 11 12 3 1 16 16 I n d i v i d u a l P e r s o n a l i t y Adjustment. A d o l e s c e n t s and c h i l d r e n A d u l t s M e n t a l I l l n e s s Sub T o t a l 3 3 3 5 0 3 £ 1 1 6 (a) 8 3 1 1 1 1 Homemaker A p p l i c a t i o n Care of C h i l d r e n . I l l n e s s o f Old Per s o n Sub T o t a l 3 9 0 1 3 ip_ 12 1 1 1 1 1 E n v i r o n m e n t a l ( o t h e r ) 2 2 4 4 T o t a l 36 67 1 0 3 1 0 3 (a) I n c l u d e s 4 a d o l e s c e n t s and 2 c h i l d r e n under 1 3 . - 42 -p r e v i o u s l y m a r r i e d and was hot l e g a l l y f r e e t o r e - m a r r y . There were s e v e r a l c h i l d r e n of the u n i o n , . w h i c h appeared t o be a r e l a t i v e l y s t a b l e one. The "husband" r e q u e s t e d h e l p i n f i n d i n g more r e m u n e r a t i v e employment and b e t t e r h o u s i n g , because he was g r e a t l y w o r r i e d about the e f f e c t upon h i s c h i l d -r e n and h i s w i f e of l i v i n g i n a slum a r e a . B o t h o f the p a r t -n e r s of t h i s u n i o n can be seen as d e v i a n t s from t h e i r c u l t u r a l backgrounds, but b o t h had c e r t a i n " m i d d l e - c l a s s " s t r i v i n g s and a s p i r a t i o n s f o r t h e i r c h i l d r e n . C r i t e r i a f o r P r i o r i t y The growth of the w a i t i n g l i s t of the F a m i l y S e r v i c e Agency o f G r e a t e r Vancouver d u r i n g 1958 has a l r e a d y been e x p l a i n e d . The p r o c e d u r e agreed on i s t h a t a p p l i c a t i o n s p l a c e d on the g e n e r a l w a i t i n g - l i s t a re a s s i g n e d t h e i r t u r n a c c o r d i n g t o the l e n g t h of time t h e y have w a i t e d . Those o f f e r e d s e r v i c e on a p r i o r i t y b a s i s , however, do not have t o w a i t t h e i r t u r n , but a r e g i v e n more or l e s s immediate s e r v i c e , . b e c a u s e i t i s judged t h e i r problems a r e u r g e n t or t h e i r s i t u a t i o n s p r e -c a r i o u s . I n o t h e r words, the most o p e r a t i v e c r i t e r i o n f o r p r i o r i t y i s u r g e n c y . "Urgency" may a r i s e f r om the a p p l i c a n t ' s p r o b l e m or s i t u a t i o n ; i n w h i c h case i t must s t i l l be a m a t t e r of judgment, or i t may be u r g e n t because, the a p p l i c a n t i s s e e m i n g l y u n a b l e t o t o l e r a t e w a i t i n g . A c t u a l l y c r i t e r i a were worked out f o r agency use when the need f o r p r i o r i t y assignment became a p p a r e n t ; and f i v e main c a t e g o r i e s were - 43 -d e c i d e d on; 1. S i t u a t i o n s . l i k e l y t o worsen markedly or r a p i d l y i f s e r v i c e i s d e l a y e d . 2. Cases of C l i e n t s now seeming r e a d y t o seek h e l p who have not been r e a d y t o do so e a r l i e r . 3 . Cases i n w h i c h a s e r i o u s p r o blem c e n t r e s around a c h i l d o r i s a f f e c t i n g a c h i l d o r c h i l d r e n . 4 . Cases of v e r y young, i n e x p e r i e n c e d p e r s o n s i n need of s u p p o r t . 5. Cases i n w h i c h t h e r e i s a time l i m i t i n the s i t u a t i o n i t s e l f , or i n r e l a t i o n t o an i m p o r t a n t f i g u r e i n the c a s e . D u r i n g the p e r i o d under s t u d y , t h i r t y - t h r e e of the n i n e t y - f i v e a p p l i c a n t s on the w a i t i n g - l i s t were o f f e r e d s e r -v i c e on a p r i o r i t y basis.- The d e c i s i o n t o g r a n t p r i o r i t y i s , of c o u r s e , a casework d e c i s i o n made i n each case on judgment of the i n d i v i d u a l a p p l i c a n t l s need ( r e l a t e d t o o t h e r u r g e n t s i t u a t i o n s a w a i t i n g a t t e n t i o n ) , and i t does not depend on h i s f i t t i n g i n t o a p a r t i c u l a r s l o t o r c a t e g o r y . However, r e v i e w of the r e a s o n s f o r o f f e r i n g p r i o r i t y t o t h e s e a p p l i c a n t s , as s t a t e d i n the case r e c o r d s , shows t h a t the g r e a t m a j o r i t y f a l l i n one ( o r o f t e n s e v e r a l ) of the c a t e g o r i e s l i s t e d above.' Ten a p p l i c a n t s were o f f e r e d p r i o r i t y because i t seemed t h a t the f a m i l y s i t u a t i o n was l i k e l y t o d e t e r i o r a t e m arkedly or r a p i d l y . These i n c l u d e d f o u r p e r s o n s whose m a r r i a g e s were a t a p o i n t of break-up or t h r e a t e n e d by s e r i o u s c r i s i s , t h r e e a p p l i c a n t s w i t h f a m i l y c r i s e s because of. t h e m e n t a l i l l n e s s of a m a r i t a l p a r t n e r , and one a p p l i c a n t whose e a r l y - a d o l e s c e n t daughter was a p p a r e n t l y "beyond the p a r e n t s 1 c o n t r o l and moving t o d e l i n q u e n c y " . Pour a p p l i c a n t s were g i v e n p r i o r i t y because th e e x p r e s s e d m o t i v a t i o n was t e n t a t i v e on t h e i r - 44 -p a r t o r t h a t o f t h e i r spouses, and i t seemed t h e r e might be a p r e s e n t o p p o r t u n i t y f o r s e r v i c e w h i c h would be d i s s i p a t e d by d e l a y - the s e f i t t e d i n t o c a t e g o r y 2 above. I n s e v e r a l c a s e s , such as the one a l r e a d y mentioned, the p r o b l e m c e n t r e d around a c h i l d , ( c a t e g o r y 3 ) . A l l of th e s e c o u l d a l s o be seen as u r g e n t under one o f the o t h e r c a t e g o r i e s as w e l l . . I n f a c t , i n the m a j o r i t y of cases o f f e r e d p r i o r i t y , c h i l d r e n were b e i n g d i r e c t l y a f f e c t e d by s e r i o u s f a m i l y p r o b l e m s . One a p p l i c a n t was o f f e r e d p r i o r i t y as "a. v e r y young, i n e x p e r i e n c e d p e r s o n . i n need of s u p p o r t " , ( c a t e -g o r y 4 ) . . T h i s was a n i n e t e e n - y e a r - o l d g i r l i n c o n f l i c t w i t h h e r p a r e n t s , who had a l r e a d y l e f t home. - I t I s c l e a r t h a t t h i s a p p l i c a t i o n was a l s o u r g e n t under c a t e g o r y 1 , as w e l l . E l e v e n a p p l i c a t i o n s f o r homemaker s e r v i c e were g i v e n p r i o r i t y because of t h e time l i m i t i n the s i t u a t i o n , f o r example, because a mother was i n h o s p i t a l and c h i l d r e n i n immediate need of care.. One a p p l i c a n t was o f f e r e d p r i o r i t y s e r v i c e not on the b a s i s o f p a r t i c u l a r u r g e n c y i n h e r s i t u a t i o n , as her problems were c h r o n i c , but because she had made two p r e v i o u s r e q u e s t s f o r s e r v i c e w i t h i n the y e a r , which.had been r e f u s e d on a p o l i c y b a s i s because a n o t h e r s o c i a l agency was a c t i v e a t the t i m e . T h i s a p p l i c a n t was g i v e n immediate s e r v i c e because I n f a c t she had a l r e a d y w a i t e d a l o n g time f o r the s e r v i c e she wanted. The s i t u a t i o n s d e s c r i b e d above account f o r twenty-s i x of t h e a p p l i c a t i o n s g i v e n p r i o r i t y . . Seven o t h e r - 4 5 r a p p l i c a t i o n s were from c l i e n t s who had r e c e n t l y r e c e i v e d s e r v i c e , and who c a l l e d t h e i r f o r m e r . w o r k e r s i n o r d e r t o r e q u e s t f u r t h e r s e r v i c e ; t h i s was o f f e r e d on p r i o r i t y b a s i s by the same caseworker, e i t h e r because t h i s seemed, the most e f f i c i e n t way of p r o v i d i n g a s e r v i c e w h i c h would, p r o b a b l y be b r i e f , o r because the need f o r s e r v i c e was seen as u r g e n t and b e t t e r g i v e n by a worker a l r e a d y f a m i l i a r w i t h the cas e . T h i r t y - t w o of the t h i r t y - t h r e e c ases a s s i g n e d t o caseworkers on p r i o r i t y b a s i s r e c e i v e d s e r v i c e w i t h i n two weeks of the time of a p p l i c a t i o n , ( t w e n t y - f o u r w i t h i n the week). ( T a b l e 7) The one a p p l i c a n t g i v e n p r i o r i t y who w a i t e d l o n g e r t h a n two weeks had a p p l i e d f o r homemaker s e r -v i c e d u r i n g h er confinement e x p e c t e d i n about s i x weeks t i m e ; i n o t h e r words, the ur g e n c y was not immediate, a l t h o u g h i t was n e c e s s a r y t o g i v e p r i o r i t y t o a l l o w time f o r a s s e s s -ment and p l a n n i n g . The w a i t i n g p e r i o d f o r a p p l i c a t i o n s on the g e n e r a l w a i t i n g - l i s t shows c o n s i d e r a b l e v a r i a t i o n d u r i n g t h e two months ( T a b l e 7 ) . There i s some apparent o v e r l a p p i n g w i t h p r i o r i t y a s s i g n m e n t s . However, t h i s i s e x p l a i n e d by the f a c t t h a t the t h r e e cases a s s i g n e d f rom the g e n e r a l w a i t i n g -l i s t w h i c h r e c e i v e d s e r v i c e i n l e s s than two weeks were cases, a s s i g n e d t o s t u d e n t s f r o m the S c h o o l o f S o c i a l Work whose f i e l d placement a t t h e agency began d u r i n g t h i s p e r i o d . The w a i t i n g time i n t h e s e cases was a f f e c t e d by s t u d e n t s 1 r e a d i -ness f o r cases r a t h e r than by a n y t h i n g i n the a p p l i c a n t s - 46 -s i t u a t i o n . The one case w h i c h w a i t e d l o n g e r than s i x weeks had a l s o been chosen as s u i t a b l e f o r a s t u d e n t , and was h e l d a w a i t i n g the s t u d e n t s 1 a r r i v a l . A c t u a l l y , the w a i t i n g p e r i o d v a r i e d f r om between f i v e and s i x weeks a t the b e g i n n i n g of September, 1958, and two t o t h r e e weeks a t the end o f October. There are s e v e r a l e x p l a n a t i o n s f o r t h i s . D u r i n g the summer two caseworkers had l e f t the agency; t h e i r cases s t i l l need-i n g s e r v i c e were i n the w a i t i n g - l i s t f o r r e - a s s i g n m e n t a t t h e b e g i n n i n g of the p e r i o d under s t u d y . (These cases are not i n c l u d e d i n the p r e s e n t sample, but d i d a f f e c t the s i t u a t i o n f o r a t i m e . ) A l s o , assignment of cases t o caseworkers had slowed down d u r i n g summer v a c a t i o n t i m e , and speeded up when a l l s t a f f members had r e t u r n e d from v a c a t i o n , and w i t h the a d d i t i o n of two new caseworkers t o t h e s t a f f . These f a c t o r s r e s u l t e d i n a c o n s i d e r a b l e r e d u c t i o n of b o t h w a i t i n g -l i s t and w a i t i n g p e r i o d by the end o f October. There does not seem t o be any v e r y s i g n i f i c a n t c o r -r e l a t i o n between the a c t u a l l e n g t h of time a p p l i c a n t s w a i t e d f o r s e r v i c e and the p e r c e n t a g e d r o p p i n g out, o r . c l o s i n g as b r i e f s e r v i c e ( T a b l e 7). The p e r c e n t a g e of drop-out i s some-what g r e a t e r among a p p l i c a n t s who w a i t e d over f i v e weeks; s i x out of t h i r t e e n i n t h i s c a t e g o r y r e c e i v e d o n l y b r i e f s e r -v i c e . C o n s i d e r i n g the o v e r a l l f i g u r e s , however, i t i s n o t a b l e t h a t n e a r l y 39 p e r cent of t h e cases a s s i g n e d from the g e n e r a l w a i t i n g - l i s t c l o s e d as b r i e f s e r v i c e c a s e s , ( t w e n t y - f o u r out of s i x t y - t w o ) ; , whereas o n l y n i n e out of t h i r t y - t h r e e cases / - 4 7 -Table 7. P r i o r i t y and the W a i t i n g L i s t . ( W a i t i n g P e r i o d f o r B r i e f S e r v i c e and. Gontinued S e r v i c e Cases) W a i t i n g P e r i o d B r i e f S e r v i c e C o n t i n u e d S e r v i c e T o t a l P r i o r i t y G e n e r a l P r i o r i t y G e n e r a l L e s s than 1 Week 5 0 19 1 25 1 t o 2 Weeks 4 •0 4 2 10 2 t o 3 Weeks - 4 1 6 11 3 t o 4 Weeks - 6 — 10 16 4 t o 5 Weeks - 8 - 12 20 5 Weeks or more - 6 7 ! 3 T o t a l 9 2 4 2 4 . 3 8 9 5 - 48 -r e c e i v i n g p r i o r i t y , o r 2.7 p e r c e n t , did, not c o n t i n u e beyond one i n t e r v i e w . T h i s may not be as s i m p l e as i t appears -g r e a t e r c o n t i n u a n c e among p r i o r i t y cases could, perhaps be e x p l a i n e d i n p a r t by g r e a t e r u r g e n c y o f the c l i e n t ' s need -but t h e r e i s n e v e r t h e l e s s i n d i c a t i o n of l o s s of cases because of the w a i t i n g p e r i o d . W i t h r e g a r d t o l e n g t h of s e r v i c e g i v e n t o th e s e a p p l i c a n t s , t h a t i s , the p e r i o d o f time t h e i r eases remained a c t i v e w i t h t h e agency, ( T a b l e 8), the n i n e t y - f i v e cases can be d i v i d e d i n t o t h r e e d e s c r i p t i v e c a t e g o r i e s . Cases c l o s e d w i t h i n f o u r months of the time of a p p l i c a t i o n can be des-c r i b e d as " s h o r t - t e r m " cases (54)j th o s e open between f o u r and t w e l v e months can be seen as "medium-term" cases (27); and t h o s e open l o n g e r than t w e l v e months (l4) a r e " l o n g -term" c a s e s . The f i f t y - f o u r . c a s e s c l o s e d w i t h i n f o u r months of the opening date i n c l u d e t h i r t y o f the t h i r t y - t h r e e b r i e f s e r v i c e c a s e s , as w e l l as t w e n t y - f o u r w h i c h r e c e i v e d con-t i n u e d s e r v i c e . . Pour months a f t e r opening date would seem t o be, i n g e n e r a l , w e l l beyond the c r i t i c a l d rop-out p e r i o d . E i g h t y - o n e of the t o t a l n i n e t y - f i v e cases i n t h e sample were c l o s e d t w e l v e months a f t e r the date of a p p l i c a t i o n ; and beyond e l e v e n months t h e r e i s a sharp decrease i n the r a t e o f c l o s i n g s , w i t h none of the r e m a i n i n g f o u r t e e n cases c l o s i n g between t w e l v e months of the opening date and the end of 1959 ( a t l e a s t f o u r t e e n months a f t e r o p e n i n g ) . F o u r t e e n of the o r i g i n a l n i n e t y - f i v e cases were s t i l l a c t i v e w i t h t h e - 49 -Table 8 . P r i o r i t y and L e n g t h o f S e r v i c e ( B r i e f S e r v i c e and C o n t i n u e d S e r v i c e Cases) L e n g t h • o f S e r v i c e P r i o r i t y Assignment G e n e r a l W a i t i n g L i s t T o t a l B.S. (a.) C.S.(b) ^ Sub T o t a l B.S.. C.S. • Sub T o t a l • Under 2'Months 6 4 10 14 3 17 27 2 t o 4 Months 2 7 9 8 10 18 2 7 4 t o 6 Months 1 2 3 1 5 6 9 6 t o 8 Months 0 4 4 1 6 7 11 8 t o 10 Months 0 3 3 0 3 3 6 10 t o 12 Months 0 0 0 0 • 1 1 1 Open J a n . l I 9 6 0 , 0 4 4 0 10 10 14 T o t a l 9 2 4 33 2 4 3 8 62 9 5 (a) B r i e f S e r v i c e . (fe) C o n t i n u e d S e r v i c e . - 50 -agency i n J a n u a r y , i 9 6 0 . ( A l l cases not d e f i n i t e l y r e q u i r -i n g f u r t h e r s e r v i c e a r e c l o s e d a t the end of the y e a r ; ) Some i n t e r e s t i n g , q u e s t i o n s . a r i s e as t o the n a t u r e of the cases i n the s e t h r e e c a t e g o r i e s , . p a r t i c u l a r l y t h o s e w h i c h became l o n g - t e r m c a s e s . I t i s a l s o i n t e r e s t i n g t o s p e c u l a t e about whether s t u d y of a n o t h e r p e r i o d o f i n t a k e would show the same p r o p o r t i o n of l o n g - t e r m c a s e s . Opening s t a t u s of a p p l i c a t i o n s i s d e s c r i b e d under t h r e e h e a d i n g s : cases new t o the agency, re-opened cases p r e v i o u s l y c l o s e d d u r i n g the same c a l e n d a r y e a r , and r e -opened cases w h i c h have been c l o s e d i n a p r i o r y e a r . F i f t y -one of t h e t o t a l sample were new a p p l i c a t i o n s , ( T a b l e 9 ) i f o r t y - f o u r were re-opened c a s e s , and of the l a t t e r s i x t e e n had been c l o s e d d u r i n g 1958, and t w e n t y - e i g h t had been c l o s e d i n a p r i o r y e a r . L o o k i n g a t opening s t a t u s i n r e l a t i o n t o p r i o r i t y assignment and c l o s i n g s t a t u s as b r i e f o r c o n t i n u e d s e r v i c e , the f i g u r e s i n Ta b l e 9 a r e q u i t e s i g n i f i c a n t , i f not a l a r m i n g . I t i s t o be e x p e c t e d , p e r h a p s , t h a t d r o p - o u t s w i l l be g r e a t e r among new a p p l i c a n t s , as m o t i v a t i o n i n many cases w i l l t e n d t o be more t e n t a t i v e where t h e r e i s l e s s under-s t a n d i n g , and p r o b a b l y l e s s r e a l i s t i c e x p e c t a t i o n , o f t h e agency's s e r v i c e . However, the p r o p o r t i o n o f cases c l o s i n g as b r i e f s e r v i c e was much g r e a t e r among new a p p l i c a t i o n s . T w e n t y - f i v e of t h e s e , or almost '50 p e r c e n t , c l o s e d as b r i e f s e r v i c e . Four of the cases re-opened w i t h i n the y e a r (about - 51 -Table 9 . P r i o r i t y and Opening S t a t u s ( B r i e f S e r v i c e and C o n t i n u e d S e r v i c e Cases) O p e n i n g S t a t u s P r i o r i t y A s s i g n m e n t G e n e r a l W a i t i n g L i s t T o t a l B , S . ( a ) C . S . ( b ) S u b T o t a l B,i S . C « S . - S u b T o t a l New C a s e -4 7 1 1 21 19 40 R e - o p e n e d w i t h i n y e a r 2 8 10 2 4 6 16 R e - o p e n e d , p r i o r y e a r 3 9 . 1 2 1 15 16 28 T o t a l 9 2 4 33 2 4 3 8 62 9 5 ( a ) B r i e f S e r v i c e . (-b) C o n t i n u e d S e r v i c e . - 52 -2 5 p e r c e n t ) c l o s e d as b r i e f s e r v i c e , and i t i s probable' t h a t o n l y b r i e f s e r v i c e was needed i n some of t h e s e c a s e s . Only 14 p e r cent of cases re-opened from a p r i o r y e a r -closed as b r i e f s e r v i c e , . To p u t i t a n o t h e r way, t w e n t y - f i v e of t h e t h i r t y - t h r e e b r i e f s e r v i c e cases were new a p p l i c a t i o n s ( n e a r l y J6 p e r c e n t ) ; whereas new a p p l i c a t i o n s were l e s s t h a n 54 p e r cent of the t o t a l number of a p p l i c a t i o n s . I t i s e v i d e n t t h a t t h e cases " l o s t " were, i n t h e main, the new c a s e s . U s u a l l y t h e s e were not the a p p l i c a t i o n s w h i c h r e c e i v e d s e r v i c e on a p r i o r i t y b a s i s . Only e l e v e n of the new a p p l i c a n t s , or l e s s than 22 p e r c e n t , were g i v e n immediate s e r v i c e . On the o t h e r hand, . 6 2 p e r cent of the a p p l i c a n t s p r e v i o u s l y seen d u r i n g t h e y e a r , and n e a r l y 43 p e r cent of t h o s e known t o the agency In a p r i o r y e a r r e c e i v e d s e r v i c e on p r i o r i t y b a s i s . I f the danger of "drop-out" i s g r e a t e r w i t h new a p p l i c a t i o n s , as seems more th a n l i k e l y , perhaps t h i s s h o u l d be c o n s i d e r e d i n g r a n t i n g p r i o r i t y s e r -v i c e where t h e r e i s a w a i t i n g - l i s t . Q u i t e e v i d e n t l y i t was not c o n s i d e r e d d u r i n g the p e r i o d under s t u d y . Some of the i m p l i c a t i o n s of the f a c t s o u t l i n e d above - t h a t " l o s s " of cases was g r e a t e s t among new a p p l i -c a t i o n s , and t h a t new a p p l i c a n t s were g r a n t e d p r i o r i t y s e r -v i c e i n p r o p o r t i o n a t e l y fewer cases - w i l l be l e f t f o r l a t e r c o n s i d e r a t i o n . However, a s t a r t can be made a t t h i s p o i n t by e x a m i n i n g the s e r v i c e r e q u e s t e d i n cases c l o s e d as b r i e f s e r v i c e , and p a r t i c u l a r l y what r e q u e s t s f o r s e r v i c e a r e - 53 -r e p r e s e n t e d by the twenty-one new cases not g r a n t e d p r i o r i t y , w h i c h closed, as b r i e f s e r v i c e cases ( T a b l e 9 ) • As t h e r e was v e r y l i t t l e o v e r l a p p i n g of problems i n the b r i e f s e r v i c e c a s e s , f o r the sake of s i m p l i c i t y the main s e r v i c e r e q u e s t e d i s l i s t e d I n Table 1 0 , S i x t e e n of the twenty-one new a p p l i c a n t s not r e c e i v i n g p r i o r i t y s e r v i c e , and not c o n t i n u i n g beyond one i n t e r v i e w , r e q u e s t e d h e l p w i t h a. m a r i t a l problem, two r e q u e s t e d h e l p w i t h a p r o b l e m i n p a r e n t - c h i l d r e l a t i o n s h i p s , and t h r e e were m a i n l y concerned w i t h a p r o b l e m of i n d i v i d u a l p e r s o n a l i t y a d j u s t m e n t . A l l of th e s e a p p l i c a n t s wanted s e r v i c e of a p e r s o n a l o r i n t a n g i b l e k i n d . T h i s , of c o u r s e , was the k i n d of h e l p r e q u e s t e d by the m a j o r i t y of the a p p l i c a n t s (see Ta b l e 6 ) ; i t was found i n one st u d y t h a t m o t i v a t i o n tends t o be more tenuous,.and "drop-o u t s " g r e a t e r , when the s e r v i c e r e q u e s t e d i s o f t h i s n a t u r e . 1 However, i f the f i g u r e s of Ta b l e 10 are compared w i t h Table 6 , i t can be seen t h a t i n a l l f i f t y - t h r e e a p p l i c a n t s r e q u e s t e d h e l p w i t h a m a r i t a l problem, and t w e n t y - f o u r of t h e s e , r o u g h l y 46 p e r c e n t , t e r m i n a t e d b e f o r e two i n - p e r s o n i n t e r -v i e w s , ( i n f a c t , t h i r t y - r o n e of the a p p l i c a t i o n s f o r m a r i t a l c o u n s e l l i n g were new r e q u e s t s f o r . s e r v i c e , of w h i c h e i g h t e e n , or n e a r l y 59 p e r c e n t , c l o s e d as b r i e f s e r v i c e . ) On the o t h e r hand, the t h r e e a p p l i c a n t s r e q u e s t i n g h e l p w i t h o t h e r 1 R i p p l e , • L i l i a n and E r n e s t i n a A l e x a n d e r , " M o t i v a t i o n , C a p a c i t y , and O p p o r t u n i t y as R e l a t e d t o the Use o f Casework S e r v i c e : Nature o f C l i e n t ' s Problem", S o c i a l S e r v i c e Review, March, 1 9 5 6 . - 54 -Table 1 0 . Main P r e s e n t i n g Problems In B r i e f S e r v i c e Cases P r e s e n t i n g Problems P r i o r i t y Assignment G e n e r a l W a i t i n g - L i s t T o t a l New Re-opened Sub T o t a l New Re^ - Opened Sub T o t a l M a r i t a l D i f f i c u l t y 2 4 6 16 2 18 2 4 P a r e n t - c h i l d R e l a t i o n s h i p 1 0 1 2 0 2 3 P e r s o n a l i t y A djustment 0 0 0 3 0 3 3 Homemaker A p p l i c a t i o n 1 1 2 0 0 0 2 Other 0 0 ' 0 0 1 1 1 T o t a l 4 ,5 9 . 21 3 2 4 33 Table 1 1 . . P r e s e n t i n g Problems Given P r i o r i t y P r e s e n t i n g Problems Opening S t a t u s T o t a l Number of P r e s e n t i n g Problems i n Per c e n t a g e R e c e i v i n g P r i o r i t y New Re- opened T o t a l Sample M a r i t a l D i f f i c u l t y 5 7 12 53 '• 23 Other F a m i l y R e l a t i o n s h i p s 1 4 5 16 31 P e r s o n a l i t y A djustment 3 3 6 17 •35 Homemaker A p p l i c a t i o n 3 8 11 13 84 . 5 Other 0 1 1 4 2 5 . T o t a l Number 12 23 3 5 103 34 - 55 -f a m i l y r e l a t i o n s h i p problems who d i d not c o n t i n u e beyond one i n t e r v i e w r e p r e s e n t o n l y 19 p e r cent of the s i x t e e n who r e q u e s t e d such s e r v i c e . I t would seem t h a t t h e danger of " l o s s " of cases i s g r e a t e s t among a p p l i c a t i o n s f o r m a r i t a l c o u n s e l l i n g , and i n p a r t i c u l a r among new r e q u e s t s f o r such s e r v i c e . New c l i e n t s d i d not r e c e i v e immediate or p r i o r i t y s e r v i c e as o f t e n as c l i e n t s p r e v i o u s l y known t o t h e agency. On the b a s i s , of opening s t a t u s , what problems were g i v e n p r i o r i t y ? - I t i s e v i d e n t t h a t r e q u e s t s f o r homemaker s e r v i c e ( u s u a l l y i n v o l v i n g a time l i m i t i n the s i t u a t i o n i t s e l f ) were g i v e n p r i o r i t y i n the g r e a t m a j o r i t y of c a s e s . ( T a b l e 11) The o t h e r f i g u r e s a r e not so s t r i k i n g , but r e q u e s t s f o r h e l p w i t h a m a r i t a l p r o blem r e c e i v e d p r i o r i t y somewhat l e s s o f t e n than r e q u e s t s f o r h e l p w i t h o t h e r p r o b l e m s . As p r e v i o u s l y mentioned, th e sample i n c l u d e d t h i r t y - o n e new a p p l i c a t i o n s f o r h e l p w i t h m a r r i a g e p r o b l e m s . Only f i v e of t h e s e , about 16 p e r c e n t , were g i v e n p r i o r i t y . I n a l l , t w e l v e r e q u e s t s f o r h e l p w i t h a m a r r i a g e p r o b l e m r e c e i v e d p r i o r i t y , and even of t h e s e 50 p e r cent c l o s e d as b r i e f s e r v i c e cases ( T a b l e 1 0 ) ; but as e x p l a i n e d e a r l i e r p r i o r i t y i s g i v e n on the b a s i s of .urgency, and a t l e a s t f o u r a p p l i c a n t s were g r a n t e d p r i o r i t y because t h e i r m a r r i a g e s were a t a. p o i n t of breakup of s e r i o u s c r i s i s , not the most h o p e f u l s i t u a t i o n f o r e f f e c t i v e m a r i t a l c o u n s e l l i n g . - 56 -I t i s w e l l known t o caseworkers i n f a m i l y a g e n c i e s t h a t a p p l i c a n t s f o r m a r i t a l c o u n s e l l i n g t e n d t o be h i g h l y a m b i v a l e n t i n comparison w i t h o t h e r p o t e n t i a l c l i e n t s , i n p a r t no doubt because u s i n g casework h e l p i n such a p r o b l e m i n v o l v e s l o o k i n g a t o n e s e l f i n r e l a t i o n t o t h e most i n t i m a t e o f p e r s o n a l r e l a t i o n s h i p s . . A nother r e a s o n i s t h a t r e a l l y e f f e c t i v e s e r v i c e o f t e n r e q u i r e s the i n v o l v e m e n t o f the two m a r i t a l p a r t n e r s , one of whom may be r e l u c t a n t t o p a r t i c i p a t e , or even v i o l e n t l y opposed t o t h e i d e a . The f i r s t approach t o an agency f o r help- w i t h such an i n t i m a t e p r o b l e m would t e n d t o be p a r t i c u l a r l y t e n t a t i v e . However, when t h e r e i s a w a i t i n g - l i s t and when urg e n c y o f the problem i s the c r i t e r i o n f o r p r i o r i t y , a p p a r e n t l y few of t h e s e a p p l i c a n t s t e n d t o r e c e i v e p r i o r i t y c o n s i d e r a t i o n . CHAPTER I I I SERVICES PROVIDED TO BRIEF CASES AND THE EFFECTS OF"THE WAITING PERIOD T h i r t y - t h r e e a p p l i c a n t s d i d not c o n t i n u e beyond one i n - p e r s o n i n t e r v i e w . How many o f t h e s e c l i e n t s o r p o t e n t i a l c l i e n t s r e c e i v e d s e r v i c e w h i c h was h e l p f u l t o them? How many of them were " d r o p - o u t s " , and how many r e c e i v e d a f u l l , though b r i e f s e r v i c e ? Why d i d the s e a c c e p t e d a p p l i c a n t s not use c o n t i n u i n g s e r v i c e ? What were the e f f e c t s of the w a i t i n g p e r i o d ? E x a m i n a t i o n of the c l o s i n g s t a t u s of t h e s e c a s e s , t o g e t h e r w i t h c a s e w o r k e r s 1 e v a l u a t i o n of the s e r v i c e g i v e n , p r o v i d e s a background f o r d i s c u s s i n g t h e s e q u e s t i o n s ; i t i s hoped t h a t d e t a i l e d e x p l o r a t i o n of case m a t e r i a l under the h e adings of the main problems p r e s e n t e d by the a p p l i -c a n t s w i l l p r o v i d e some answers. I n t e n c a s e s , the c l o s i n g s t a t u s d e s i g n a t e d by the caseworker was e i t h e r " s e r v i c e completed", o r " r e f e r r e d e l s e -where", the l a t t e r a l s o i n d i c a t i n g a completed s e r v i c e . ( T a b l e 12) Twenty-three cases r e c e i v e d i n c o m p l e t e s e r v i c e , e i t h e r because the c l i e n t was u n w i l l i n g t o c o n t i n u e , or d i d not c o n t i n u e i n s p i t e of u n d e r t a k i n g t o do so. F o r e l e v e n f a m i l i e s , the caseworker's e v a l u a t i o n a t c l o s i n g was t h a t t h e s e r v i c e had h e l p e d the f a m i l y o r one of i t s members t o some degree. F i v e of t h e s e were a l s o judged t o have r e c e i v e d a completed s e r v i c e ; t h e s e cases appear t o have had a f u l l y - 58 -Table 1 2 . C l o s i n g S t a t u s and C a s e w o r k e r s  E v a l u a t i o n a t C l o s i n g , B r i e f  S e r v i c e Cases C l o s i n g S t a t u s P r i o r i t y Assignment . G e n e r a l W a i t i n g L i s t T o t a l Yes Unable t o No E v a l u a t e Yes No Unable t o E v a l u a t e S e r v i c e Complete ( a) 2 0 2 3 0 3 10 S e r v i c e Incomplete 2 1 2 4 4 10 23 T o t a l 4 1 4 •7 4 13 33 (a) S e r v i c e completed, or r e f e r r e d e l s e w h e r e . (b) C l i e n t u n w i l l i n g t o c o n t i n u e , d i d not c o n t i n u e d e s p i t e plan., e t c . - 59 -s u c c e s s f u l outcome. I n f i v e cases t h e worker judged t h a t the s e r v i c e d i d not h e l p - t h e s e were a p p a r e n t l y c l e a r l y u n s u c c e s s -f u l . The outcome i n t w e n t y - t h r e e i n s t a n c e s was d o u b t f u l , a l t h o u g h s i x of the a p p l i c a n t s were judged t o have been h e l p e d by t h e s e r v i c e , and f i v e o t h e r s r e c e i v e d a completed s e r v i c e . . I n seventeen cases e v a l u a t i o n o f the s e r v i c e was not c o n s i d e r e d p o s s i b l e by the caseworker, because of the s c a n t y i n f o r m a t i o n a v a i l a b l e . 1. M a r i t a l Problems Help w i t h m a r r i a g e problems was by f a r the l a r g e s t group of r e q u e s t s . S i x t e e n among t h e s e b r i e f s e r v i c e r e c i -p i e n t s (24 i n a l l ) were new c l i e n t s , and e i g h t had been p r e -v i o u s l y known t o t h e agency. ( T a b l e 1 0 ). Only s i x were o f f e r e d p r i o r i t y , and the s e comprised t h r e e former c l i e n t s and t h r e e new a p p l i c a n t s . A l l who were g i v e n p r i o r i t y appeared t o be f a c i n g a c r i s i s of some s o r t : i n a t l e a s t f o u r eases, t h e need of a. d e c i s i o n about c o n t i n u i n g o r t e r m i n a t i n g t h e m a r r i a g e . The "marriage problem" group o f c a s e s , w h i c h were g i v e n p r i o r i t y , can be i l l u s t r a t e d by the t h r e e new c a s e s . ( l ) The Adams. Mrs. Adam, a b u s i n e s s woman of n e a r l y f o r t y , w i s h e d t o d i s c u s s "problems around a p o s s i b l e s e p a r a t i o n or d i v o r c e " . Her husband had c o n f e s s e d t o h e r a s e r i o u s i n v o l v e m e n t w i t h a n o t h e r woman. The,;couple had been m a r r i e d f o r y e a r s , and were c h i l d l e s s . Mrs. Adam t e l e p h o n e d t h r e e t i m e s w i t h i n a week, i n d i c a t i n g t h a t t h e s i t u a t i o n was d e t e r i o r a t i n g and e x p r e s s i n g mounting concern about h er hus-band, who- was "a nervous wreck" and f e a r f u l o f l o s i n g h i s j o b , a r e s p o n s i b l e one. P r i o r i t y was g r a n t e d as " s i t u a t i o n i n c r i s i s " . Mrs. Adam came t o the o f f i c e f o r o n l y one i n t e r v i e w , but she d i d c o n t i n u e t o use s u p p o r t i v e h e l p over a p e r i o d of - 6 0 -s e v e r a l months, t e l e p h o n i n g as she f e l t t he need. She was a p e r s o n of some s t r e n g t h ; and, knowing she had somewhere t o t u r n i f t h i n g s became t o o d i f f i c u l t , she was a b l e t o g i v e h er husband u n d e r s t a n d i n g d u r i n g a t r y i n g p e r i o d . I t was .c l e a r t h a t b o t h w i s h e d t o p r e s e r v e the m a r r i a g e . Mr. Adam was o f f e r e d s e r v i c e , . b u t d i d not keep h i s appointment, p r o b a b l y because of h i s g u i l t f e e l i n g s . When t h e case was c l o s e d , Mrs. Adam r e p o r t e d t h a t e v e r y t h i n g was " f i n e " , and t h a t t h e i r m a r r i a g e was on a sounder b a s i s than f o r many y e a r s . The c a s e w o r k e r 1 s e v a l u a t i o n was t h a t the s e r v i c e had h e l p e d Mrs. Adam, w h i c h seems c l e a r . The c l o s i n g s t a t u s was d e s i g n a t e d as " c l i e n t u n w i l l i n g t o c o n t i n u e " ; t h i s i s perhaps open t o q u e s t i o n . I t appears t h a t the c l i e n t was g i v e n a l l t h e h e l p she needed and wanted, and t h a t t h i s was i n f a c t a completed case, a l t h o u g h t h e r e was o n l y one p e r s o n a l I n t e r v i e w . . (2) The B r u c e s . Mrs. Bruce t e l e p h o n e d t o r e q u e s t i n f o r m a t i o n about t h e l e g a l a s p e c t s of s e p a r a t i o n , and when o f f e r e d casework s e r v i c e , d e c i d e d she would come i n t o t a l k about i t . She.was o f f e r e d p r i o r i t y because, i n two t e l e p h o n e i n t e r v i e w s , h e r d e s c r i p t i o n of her husband's b e h a v i o u r i n d i -c a t e d t h a t he was p r o b a b l y m e n t a l l y i l l . A l s o , Mrs. Bruce was a m b i v a l e n t about i n v o l v i n g h e r s e l f i n s e r v i c e , had p r e -v i o u s l y d e c l i n e d t o a c c e p t the w a i t i n g p e r i o d , and appeared most r e l u c t a n t t o t a k e any a c t i o n i n a s e r i o u s s i t u a t i o n , . i n v o l v i n g two s m a l l c h i l d r e n . . I t had been c l e a r l y e x p l a i n e d t o Mrs. Bruce t h a t t h e ageney c o u l d not f o r c e h er husband t o seek p s y c h i a t r i c t r e a t m e n t which, he d i d not Want ( e s p e c i a l l y as she would not t e l l him of t h e c o n t a c t ) . She had been g i v e n c o n c r e t e s u g g e s t i o n s i n t h i s r e g a r d . When Mrs. Bruce was i n t e r v i e w e d by t h e caseworker, she had not f o l l o w e d any of the s u g g e s t i o n s of the i n t a k e w o r k e r ; she appeared t o be i m m o b i l i z e d by f e a r and a n x i e t y . , ' S h e had d i f f i c u l t y a c c e p t i n g t h e i d e a t h a t the s e r v i c e she wanted was not w i t h i n the agency f u n c t i o n , n or i n d e e d w i t h i n the bounds o f p o s s i b i l i t y . She was t o l d of s t e p s she c o u l d t a k e s h o u l d she f e e l t h a t h e r husband's b e h a v i o u r was beyond h i s c o n t r o l and she and the c h i l d r e n i n need o f p r o t e c t i o n . The p l a n was t o c o n t i n u e the • c o n t a c t , but Mrs. Bruce d e c l i n e d l a t e r a p pointments, s a y i n g h e r husband's b e h a v i o u r had improved and she w i s h e d t o t e s t t h i s b e f o r e i n v o l v i n g h e r s e l f f u r t h e r . The caseworker t e l e p h o n e d Mrs. Bruce s e v e r a l t i m e s , . h o p i n g t o encourage h e r t o c o n t i n u e , : w i t h o u t s u c c e s s . - 61 -The above case was c l o s e d as " c l i e n t u n w i l l i n g t o c o n t i n u e " . The caseworker was u n a b le t o e v a l u a t e whether the s e r v i c e had been h e l p f u l , w h i c h seems a r e a s o n a b l e judgment. (3) The C a l e b s . Mr.. Caleb r e q u e s t e d h e l p w i t h m a r i t a l d i f f i c u l t i e s . . I n h i s f i r s t c a l l he s a i d t h a t he and h i s w i f e had been s e p a r a t e d but had r e c e n t l y gone back together.. D i f f i c u l t i e s c o n t i n u e d , however, as he " c o u l d not get her t r u s t " . . L a t e r he c a l l e d a g a i n , v e r y a n x i o u s , s a y i n g h i s w i f e had a g a i n l e f t him, t a k i n g t h e i r c h i l d . P r i o r i t y was g i v e n because of "severe m a r i t a l d i f f i c u l t y a t p o i n t o f c r i s i s i n a young couple".. A l s o , t h e r e was an u n s u b s t a n t i a t e d i m p r e s s i o n t h a t Mr. C a l e b might be s e r i o u s l y d i s t u r b e d . He appeared t o have s t r o n g m o t i v a t i o n f o r s e r v i c e and spoke knowledgeably of the k i n d of h e l p he was w a n t i n g ; However, when he was o f f e r e d an e a r l y appointment he seemed s u r p r i s e d , and d i d not keep h i s appointment. He d i d not c a l l a g a i n . A c o l l a t e r a l t e l e p h o n e c a l l some months l a t e r c o n f i r m e d the I n t a k e w o rker's i m p r e s s i o n t h a t Mr.. Caleb might be m e n t a l l y 111. The Caleb case was c l o s e d as " c l i e n t d i d n o t c o n t i n u e d e s p i t e p l a n " , and t h e w o rker's e v a l u a t i o n was "unable t o e v a l u -a t e " . E v i d e n t l y , the c l i e n t was not h e l p e d , a l t h o u g h he was o f f e r e d a lmost immediate s e r v i c e . In t h e c o n t e x t of o t h e r p r e s s i n g r e q u e s t s , o f f e r i n g p r i o r i t y t o t h e Adam case might be q u e s t i o n e d ; the f a m i l y i n c l u d e d two mature a d u l t s ; t h e r e were no c h i l d r e n , b o t h spouses seemed i n t e l l i g e n t and competent, and a t l e a s t one was a p e r s o n of c o n s i d e r a b l e s t r e n g t h . However, s e r v i c e was g i v e n when i t was most needed; and, c o n s i d e r i n g t h e p o s i t i v e r e s u l t s , i t was a v e r y e c o n o m i c a l s e r v i c e i n casework time s p e n t . I n the o t h e r two c a s e s , p r i o r i t y was c e r t a i n l y j u s t i -f i e d by the s e r i o u s n e s s of t h e s i t u a t i o n , a l t h o u g h t h e r e was e v i d e n t l y l i t t l e hope of i n v o l v i n g e i t h e r of t h e a p p l i c a n t s i n casework s e r v i c e . I n such s i t u a t i o n s , i t might be b e t t e r t o o f f e r an i n t a k e appointment b e f o r e a c c e p t i n g the a p p l i c a t i o n , - 62 -f o r t h e purpose o f " s c r e e n i n g " , as w e l l as g i v i n g an immediate s e r v i c e i n a s e r i o u s s i t u a t i o n , where m o t i v a t i o n i s d o u b t f u l . . Mr. C a l e b , however, had e x p r e s s e d a p p a r e n t l y s t r o n g m o t i v a t i o n f o r s e r v i c e ; and t r a n s f e r t o a n o t h e r . w o r k e r f o l l o w i n g an i n t a k e i n t e r v i e w might have l e s s e n e d t h e a l r e a d y dim changes of Mrs. Bruce c o n t i n u i n g the c o n t a c t . T u r n i n g now t o c o n s i d e r a t i o n of one of the " o l d " m a r i t a l c a s e s , . w h i c h was g i v e n s e r v i c e on a p r i o r i t y b a s i s by the f o r m e r worker, t h i s s u g g e s t s t h a t " b r i e f s e r v i c e " may sometimes be of c o n s i d e r a b l y more v a l u e t o t h e c l i e n t t h a n i s apparent t o t h e caseworker a t t h e t i m e . (4) The D e r r i c k s . Mrs.. D e r r i c k ' s , husband was an advanced a l c o h o l i c , and c o n t i n u i n g the m a r r i a g e seemed t o o f f e r l i t t l e hope f o r h er son's f u t u r e o r h e r own. Twice d u r i n g the p r e c e d i n g two y e a r s , she had asked f o r h e l p w i t h h e r m a r i t a l problem, each time coming i n f o r o n l y one i n t e r v i e w . On b o t h o c c a s i o n s , the caseworker was p e s s i m i s t i c about t h e p o s s i b i -l i t y o f h e l p i n g h e r . Mrs. D e r r i c k appeared c o m p l e t e l y con-f l i c t e d , u n r e a l i s t i c , and u n a b l e t o see t h a t she p l a y e d any p a r t i n h e r t r o u b l e s . As i s o f t e n t h e case w i t h a l c o h o l i c s ' wives.,' she seemed t o be t i e d i n t h e s i t u a t i o n and un a b l e t o make any d e c i s i o n . Her statement t h a t she remained w i t h h e r husband p u r e l y f o r h e r son's sake was q u e s t i o n e d , and an e f f o r t was made t o h e l p h er a s s e s s h er s i t u a t i o n and p o s s i b l e a l t e r -n a t i v e s . She c a n c e l l e d h er n e x t a p p o i n t m e n t , . s a y i n g she wanted no f u r t h e r c o n t a c t . The case was t h e r e f o r e c l o s e d , - 63 -w i t h the e v a l u a t i o n "No"; t h e s e r v i c e was judged n ot t o have h e l p e d the c l i e n t . Mrs. D e r r i c k now c a l l e d t h e worker she had p r e v i o u s l y seen,.wanting t o d i s c u s s 1 h e r d e c i s i o n to s e p a r a t e f r o m h er husband. She was o f f e r e d o f f i c e i n t e r v i e w s , w h i c h she d e c l i n e d , . b u t she d i d r e q u e s t h e l p over the t e l e p h o n e and used t h i s as she worked out her p l a n s . She had made f i r m and r e a l i s t i c p l a n s , but was w a n t i n g t o c l a r i f y t h e s e i n d i s c u s s i o n w i t h the worker, as w e l l as n e e d i n g e m o t i o n a l s u p p o r t and e a s i n g of h e r g u i l t , i . e . , t h a t she " c o u l d not h e l p h er husband - as t h e d o c t o r s a i d " . Mrs.. D e r r i c k c a r r i e d out h e r p l a n t o go t o a n o t h e r c i t y where h e r p a r e n t s were l i v i n g ; t h e y were w i l l i n g and a b l e t o h e l p h e r c a r e f o r h e r son, and s u i t -a b l e employment was a v a i l a b l e . . The case was c l o s e d , - e v a l u a t i o n — " Y e s " . The f o l l o w i n g q u o t a t i o n f r om a r e c e n t i s s u e of F a m i l y S e r v i c e H i g h l i g h t s devoted t o d i s c u s s i o n of problems r e l a t e d t o overdemand f o r s e r v i c e and w a i t i n g l i s t s I n f a m i l y s e r v i c e a g e n c i e s , . e x p r e s s e s e s p e c i a l l y w e l l some of t h e c o n s i d e r a t i o n s w h i c h h e l p t o e x p l a i n t h e a p p l i c a t i o n s w h i c h d i d not become c o n t i n u i n g c a s e s : "These f a c t s c l e a r l y I n d i c a t e t h a t w a i t i n g l i s t s a r e d i s c o u r a g i n g and f r u s t r a t i n g t o the p e o p l e on them. Yet -as the F a m i l y S e r v i c e a g e n c i e s know - t h e r e a r e v a r i o u s r e a s o n s why p e o p l e drop out. Some, who come i n as t h e r e s u l t of s p e c i f i c " p r e c i p i t a t i n g i n c i d e n t s " , d e r i v e such r e l i e f out of l e t t i n g o f f steam i n t h e i r i n i t i a l i n t e r v i e w s t h a t t h e y s u b s e q u e n t l y d e c i d e t h e y need no f u r t h e r a s s i s t a n c e . O t h e r s , i n t h e a c t of g o i n g f o r h e l p , e x p e r i e n c e a r e s u r g e n c e of s t r e n g t h t o h e l p t h e m s e l v e s w h i l e t h e y a r e w a i t i n g and o f t e n - 6 4 -manage t o work out t h e i r own s o l u t i o n s . S t i l l o t h e r s , a f t e r an i n i t i a l e x p r e s s i o n of d e s i r e f o r h e l p , become d e e p l y appre-h e n s i v e a t the thought of cha n g i n g t h e i r l i v e s i n any way and. beat an a n x i o u s r e t r e a t . . " 1 Of the e i g h t e e n b r i e f s e r v i c e r e c i p i e n t s who r e q u e s t e d h e l p w i t h m a r r i a g e problems but had t h e i r a p p l i -c a t i o n s placed, on t h e g e n e r a l w a i t i n g l i s t ( T a b l e 1 0 ) ; f i v e were judged t o have r e c e i v e d some b e n e f i t from the c o n t a c t , a l t h o u g h t h e y d i d n o t c o n t i n u e . Two of th e s e w i l l ..serve t o I l l u s t r a t e t h i s group. (1) The Edwards. Mrs. Edward, a mother of f o u r young c h i l d r e n , t e l e p h o n e d t o r e q u e s t m a r i t a l c o u n s e l l i n g because, she s a i d , t he c o n t i n u e d t e n s i o n i n t h e home was a f f e c t i n g h e r n e r v e s t o a s e r i o u s e x t e n t . Her husband worked h a r d and p r o v i d e d w e l l f o r t h e f a m i l y , but was t a c i -t u r n and i r r i t a b l e w i t h h e r and the c h i l d r e n . Mrs... Edward, appeared i n t e l l i g e n t , and she showed p o s i t i v e f e e l i n g f o r her husband and u n d e r s t a n d i n g t h a t h i s p e r s o n a l i t y d i f f i -c u l t i e s were r e l a t e d t o h i s d i f f i c u l t c h i l d h o o d , as w e l l as t o p r e s e n t s t r e s s e s . She t a l k e d e a s i l y over t h e t e l e p h o n e t o t he i n t a k e worker, but a d m i t t e d when a.sked t h a t she had ne v e r d i s c u s s e d h er d i s s a t i s f a c t i o n w i t h h er husband -e v i d e n t l y because she was t r y i n g t o l i v e up t o the example of a r e l a t i v e whose m a r r i a g e s u p p o s e d l y always r a n smoothly. I t was su g g e s t e d t o her t h a t t h i s was a d i f f e r e n t m a r r i a g e . I n the t e l e p h o n e i n t e r v i e w Mrs. Edward's m o t i v a t i o n f o r s e r -v i c e appeared s t r o n g , and h e r e x p e c t a t i o n s r e a l i s t i c . When an appointment was o f f e r e d , however, she s a i d t h a t . f o l l o w i n g h e r i n i t i a l t e l e p h o n e c o n v e r s a t i o n she had been a b l e t o have s e v e r a l d i s c u s . s i o n s w i t h h e r husband, and t o t e l l him how she f e l t , as she had ne v e r done b e f o r e . C o n s e q u e n t l y , she f e l t much b e t t e r , and h e r husband was b e i n g more c o n s i d e r a t e . She f e l t no need of f u r t h e r s e r v i c e . (2) The F r a n c i s e s . Mrs. F r a n c i s r e q u e s t e d h e l p w i t h m a r r i a g e p r o b l e m s , and came i n f o r one i n t e r v i e w . She was a s u c c e s s f u l b u s i n e s s woman, who appeared as a d o m i n a t i n g , a g g r e s s i v e , r a t h e r c o m p u l s i v e p e r s o n . She had two c h i l d r e n o f a p r e v i o u s m a r r i a g e , w h i c h had ended i n d i v o r c e . Her husband was younger than .she, and below h e r i n employment 1 F a m i l y S e r v i c e H i g h l i g h t s , F e b r u a r y , i 9 6 0 , p u b l i s h e d by F a m i l y S e r v i c e A s s o c i a t i o n of A m e r i c a , New York. - 65 -s t a t u s and i n e a r n i n g a b i l i t y . . Prom h e r d e s c r i p t i o n he was a p a s s i v e , r a t h e r I r r e s p o n s i b l e man, who drank h e a v i l y . Mrs. F r a n c i s showed a degree of s e l f - a w a r e n e s s and some d e s i r e f o r c l a r i f i c a t i o n . - "why do I. marry men l i k e t h i s ? " She was f e a r -f u l of b r e a k i n g a n o t h e r m a r r i a g e . L a t e r she t e l e p h o n e d t o say she d i d not want t o c o n t i n u e now - perhaps l a t e r . The caseworker thought she had d e c i d e d t o s t a y i n a s i t u a t i o n w h i c h had many v a l u e s f o r her and f i t t e d h e r needs. I t appears t h a t Mrs. Edward e x p e r i e n c e d a r e l e a s e of s t r e n g t h f o l l o w i n g t h e i n t a k e i n t e r v i e w , . w h i c h e n a b l e d h e r t o work out h e r own s o l u t i o n t o her problems. P r o b a b l y h er problems were not s e r i o u s , but r e s u l t e d f rom an impasse caused by poor communication between the p a r t n e r s , who had a b a s i c a l l y sound r e l a t i o n s h i p . . Mrs* P r a n c i s showed some d e s i r e f o r h e l p w i t h p e r s o n a l i t y p roblems, but s h i e d away f r o m the thought of changing h e r l i f e i n any way. Q u i t e a few of the " d r o p - o u t s " appeared t o have c a l l e d as a. r e s u l t of " p r e c i p i t a t i n g i n c i d e n t s " , such as a q u a r r e l the n i g h t before.. One woman who I n i t i a l l y r e q u e s t e d i n f o r m a t i o n about t h e l e g a l a s p e c t s of s e p a r a t i o n , a t f i r s t r e f u s i n g t o g i v e h er name, l a t e r d e c i d e d she would l i k e an . appointment t o d i s c u s s h e r m a r r i a g e problem. T h i s a p p l i c a n t appeared most r e l i e v e d when i t was suggested t o h e r t h a t she ta k e no d r a s t i c a c t i o n u n t i l she had seen her wor k e r . She even appeared r e l i e v e d t o hear about the w a i t i n g p e r i o d . F i n a l l y she d i s c l o s e d t h a t she had j u s t had a q u a r r e l w i t h h e r husband. When o f f e r e d an a p p o i n t m e n t t h e a p p l i c a n t s a i d t h i n g s had s t r a i g h t e n e d o u t - s i n c e she "blew u p " j t h e r e f o r e she saw no p o i n t i n coming i n . - 66 -The c h a r a c t e r i s t i c a t t i t u d e s of c l i e n t s who t e n d t o t e r m i n a t e e a r l y , . d e s p i t e a seeming need f o r casework s e r v i c e , have been i d e n t i f i e d i n a number of s t u d i e s o f b r i e f s e r v i c e cases." 1" One of t h e s e p a t t e r n s , i s the tendency t o p r o j e c t r e s p o n s i b i l i t y f o r the problem o r t o p h r a s e t h e r e q u e s t f o r s e r v i c e i n terms of the need of a n o t h e r p e r s o n . Another i s l a c k of r e a l i z a t i o n of the need t o p a r t i c i p a t e p e r s o n a l l y i n the s o l u t i o n of the problem.. A t h i r d i s u n r e a l i s t i c e x p e c t -a t i o n s of t h e s e r v i c e - i . e . s e e i n g the worker as a g i v e r of t a n g i b l e s e r v i c e r a t h e r than as-, a c o u n s e l l o r . Low m o t i -v a t i o n i n s e e k i n g f o r s o l u t i o n o f the problem, and r e s i s t a n c e t o e x p l o r a t i o n by the caseworker, are a l s o common. Many o f t h e s e c h a r a c t e r i s t i c s show up i n a s i z a b l e group of our a p p l i c a n t s who f a i l to- • c o n t i n u e . The p r o b a b i l i t y i s t h a t most of the a p p l i c a n t s showing t h e s e c h a r a c t e r i s t i c s i n marked degree would n ot have c o n t i n u e d beyond one or two i n t e r v i e w s , even i f t h e y had not had t o w a i t f o r s e r v i c e . Wives of a l c o h o l i c s o r p r o b l e m d r i n k e r s can o f t e n be seen i n t h i s c a t e g o r y , t h e r e a re f o u r i n t h e sample under r e v i e w , as w e l l as a number of o t h e r a p p l i c a n t s who appeared t o have s l i g h t m o t i v a t i o n t o change t h e i r s i t u a t i o n s , much l e s s t h e i r own a t t i t u d e s . I n o u t l i n i n g a s t u d y concerned, i n p a r t , w i t h m o t i -v a t i o n as r e l a t e d t o the use o f casework s e r v i c e , L i l i a n 1 Shyne, Ann W., "What R e s e a r c h T e l l s Us About Short-Term Cases i n F a m i l y A g e n c i e s " , S o c i a l Casework, May, 1957. - 67 -R i p p l e s t a t e s t h a t " m o t i v a t i o n has been ta k e n t o comprise what the c l i e n t wants and how much he wants t h i s ; t h a t i s , h i s g o a l s and immediate o b j e c t i v e s and t h e amount- of p r e s s u r e he has toward t h e s e g o a l s ' 1 . ^ An i m p o r t a n t c o n s i d e r a t i o n was whether what t h e c l i e n t sought from the agency was a p p r o p r i a t e , b o t h .as a means of s o l v i n g t h e p r e s e n t i n g problem, and i n r e l a t i o n t o h i s g o a l s i n h i s t o t a l l i f e s i t u a t i o n . L i l i a n R i p p l e r e f e r s t o Dr.. Thomas Fren c h e s f o r m u l a t i o n s r e g a r d i n g the "push" of d i s c o m f o r t and the " p u l l " of hope, b o t h seen as f a c t o r s of " m o t i v a t i n g p r e s s u r e " . D i s c o m f o r t was c o n s i d e r e d i n r e l a t i o n t o the pr o b l e m t h e c l i e n t brought t o t h e agency, and i n r e l a t i o n t o h i s t o t a l l i f e • s i t u a t i o n . . I t was.assumed t h a t a degree of d i s c o m f o r t r e l a t e d t o the pr o b l e m was neces-s a r y t o c r e a t e a d e s i r e t o s o l v e i t ; but t h a t extreme discom-f o r t i n the t o t a l l i f e s i t u a t i o n would t e n d t o be i m m o b i l i z i n g . These assumptions were borne out i n the s t u d y . F a c t o r s found t o f a v o u r c o n t i n u a n c e i n casework s e r v i c e were h i g h hope and s t r o n g m o t i v a t i o n t o s o l v e the problem, f o s t e r e d by an encourag-i n g a t t i t u d e on the p a r t of the caseworker. Where t h e prob-lem was l a r g e l y p s y c h o l o g i c a l r a t h e r t h a n e n v i r o n m e n t a l , i t was a l s o i m p o r t a n t t h a t key p e r s o n s i n the c l i e n t ' s s o c i a l environment s h o u l d be s u p p o r t i n g r a t h e r t h a n impeding s o l u t i o n o f the problem. 1 R i p p l e , L i l i a n , " M o t i v a t i o n , • C a p a c i t y and O p p o r t u n i t y as R e l a t e d t o t h e Use of Casework S e r v i c e : T h e o r e t i c a l Base and P l a n of Study", The S o c i a l S e r v i c e Review,"June, - 1 9 5 5 . - 68 -M o t i v a t i o n f o r the use of v o l u n t a r y casework s e r -v i c e s appears t o be composed' o f t h r e e e lements: r e a l discom-f o r t r e l a t e d t o the p r e s e n t i n g p r o b l e m o r problems; d e s i r e t o s o l v e the problem; and. hope t h a t s o l u t i o n i s p o s s i b l e and t h a t i t w i l l be f a c i l i t a t e d by use of t h e s e r v i c e . S l i g h t m o t i -v a t i o n can be i l l u s t r a t e d by t h e f o l l o w i n g examples. ( 1 ) The Georges. Mrs. George r e q u e s t e d a n . e a r l y appointment because o f m a r i t a l t r o u b l e s ; h er husband was not w o r k i n g s t e a d i l y and drank h e a v i l y . She was t e a r f u l ! and u p s e t when she c a l l e d -; her husband h a d . l o c k e d h er out the n i g h t b e f o r e . There were f o u r c h i l d r e n and many d e b t s , but Mrs.. George s a i d she " c o u l d s t a n d , b e i n g p o o r, as f a r as t h a t went". She j u s t wanted "some peac.e". She s t r e s s e d t h a t she t o i l e d n i g h t and day f o r h e r c h i l d r e n , and had t o go out some-t i m e s . Mrs. George s a i d she i n t e n d e d t o t e l l h e r husband she had c a l l e d t h e agency, i n d i c a t i n g t h a t she would do so i n a p u n i t i v e manner. When she was o f f e r e d an appointment she s a i d her husband was not d r i n k i n g now, as the n e i g h b o u r s had g i v e n him a " t a l k i n g - t o " , t h e r e f o r e she d i d not want t o con-t i n u e . She was i n v i t e d t o c a l l a g a i n s h o u l d she f e e l t he need of s e r v i c e . (2) The H a r o l d s . Mrs. H a r o l d d e s c r i b e d the t r o u b l e as " j u s t the u s u a l t h i n g " - t o o much d r i n k i n g , and t r o u b l e s around i t , i n c l u d i n g h er husband's a b u s i v e language t o her-s e l f and t h e i r d a u g h t e r . When asked i f h e r husband was p h y s i c a l l y a b u s i v e , Mrs. H a r o l d s a i d she was sure he f e l t l i k e I t but he d i d n ' t dare - she had t o l d him t h a t was j u s t what she was w a i t i n g f o r i - I n a l a t e r c a l l Mrs. H a r o l d e x p r e s s e d a n x i e t y about her " n e r v e s " . However, she d i d not respond t o a l e t t e r o f f e r i n g s e r v i c e , . a n d was not heard f r o m a g a i n . P r o j e c t i o n of r e s p o n s i b i l i t y f o r the pr o b l e m can be c l e a r l y seen i n t h e a t t i t u d e s o f t h e s e women. I t i s u n c e r t a i n whether low m o t i v a t i o n i n Mrs. George's case was caused by i m m o b i l i z a t i o n because of the d i f f i c u l t y of her l i f e s i t u a t i o n , or whether she- r e a l l y had l i t t l e d e s i r e t o change the s i t u a -t i o n . Her l o n g - s u f f e r i n g a i r and b i d f o r sympathy, as w e l l as h er p u n i t i v e a t t i t u d e toward h er husband, would suggest - 6 9 -t h a t t h e second p o s s i b i l i t y i s more p r o b a b l e . Mrs. George had c a l l e d as t h e r e s u l t of a " p r e c i p i t a t i n g i n c i d e n t " , w h i c h t e m p o r a r i l y i n c r e a s e d her d i s c o m f o r t . U n r e a l i s t i c e x p e c t -a t i o n s of the s e r v i c e a r e seen i n b o t h of t h e s e c a s e s ; b o t h -of the a p p l i c a n t s saw the agency as an i n s t r u m e n t t o use a g a i n s t t h e i r husbands, or t o keep t h e i r husbands i n l i n e , as the n e i g h b o u r s d i d f o r Mrs. George. B o t h of t h e s e women may have used the t e l e p h o n e c a l l t o the agency i n t h i s way. N e i t h e r showed awareness of t h e need t o p a r t i c i p a t e p e r s o n -a l l y i n t h e s o l u t i o n of t h e problem, n o r much d e s i r e t h a t the p r o b l e m s h o u l d be s o l v e d , e x c e p t i n a s u p e r f i c i a l way, and by a change i n someone e l s e ' s b e h a v i o u r . ( 3 ) The I r v i n g s . Mr; I r v i n g t e l e p h o n e d t o r e q u e s t h e l p w i t h " f a m i l y t r o u b l e " , . b y w h i c h he meant m a r i t a l d i f f i -c u l t y . . When he c a l l e d he was angry w i t h h i s w i f e , because he s a i d she was n e g l e c t i n g h e r health.. Mr. I r v i n g ' s u n d e r s t a n d -i n g of the s e r v i c e was poor, and h i s m o t i v a t i o n f o r p e r s o n a l i n v o l v e m e n t appeared s l i g h t , - a l t h o u g h he s a i d t h e y had r e c e i v e d h e l p from a f a m i l y agency i n a n o t h e r c i t y . , He d i d not respond t o a l e t t e r ' o f f e r i n g an appointment. The case was re-opened s e v e r a l months l a t e r when Mrs. I r v i n g r e q u e s t e d .homemaker s e r v i c e d u r i n g h e r h o s p i t a l i z a t i o n f o r a minor oper-a t i o n . Homemaker s e r v i c e was p r o v i d e d and was u n e v e n t f u l . There was some I n d i c a t i o n of m a r i t a l d i f f i c u l t y , but Mrs. I r v i n g d i s c l a i m e d t h i s . Casework s e r v i c e was o f f e r e d , but the I r v i n g s d i d not want o t h e r t h a n p r a c t i c a l h e l p . (4) The Johns. Mrs. John was r e f e r r e d ' b y the s o c i a l s e r v i c e department of a h o s p i t a l . . She had a r t h r i t i s , - h e a r t t r o u b l e , and "a v e r y unhappy m a r r i a g e " . L a t e r 'she c a l l e d her-s e l f , c o m p l a i n i n g t h a t m a r i t a l , d i f f i c u l t i e s were a f f e c t i n g h e r h e a l t h . She a l s o e x p r e s s e d concern t h a t h e r seventeen y e a r o l d daughter, on whom she was v e r y dependent, would l e a v e home because of p a r e n t a l s t r i v e . A l t h o u g h i t became e v i d e n t t h a t Mrs. John had r e a l l y no d e s i r e f o r casework s e r v i c e , numerous e f f o r t s were made t o I n v o l v e h e r , over a p e r i o d o f seven months, because of t h e s e r i o u s n e s s o f the s i t u a t i o n . Mrs. John never d i d keep an.appointment and was seen o n l y once, (whem she came I n w i t h o u t an a p p o i n t m e n t ) . She t e l e -- 70 -p h o n e d f r o m t i m e t o t i m e t o c o m p l a i n a b o u t t h e b e h a v i o u r o f h e r husband, .or .'daughter, M r s , J o h n d i d n o t see h e r s e l f a s h a y i n g a n y r e s p o n s i b i l i t y I n t h e s i t u a t i o n ; :she was s i m p l y w a n t i n g t h e a g e n c y t o t a k e an a u t h o r i t a t i v e r o l e .on h e r b e h a l f w i t h h e r h u s b a n d a nd d a u g h t e r . The h u s b a n d c o u l d n o t be reached.. M r s . J o h n was one o f t h e v e r y f e w a p p l i c a n t s i n t h e s a m p l e o f n i n e t y - f i v e who was f o r m a l l y r e f e r r e d t o t h e a g e n c y . She d i d n o t want c a s e w o r k s e r v i c e . . P o s s i b l y t w e l v e o r t h i r t e e n o f t h e a p p l i c a n t s f o r m a r i -t a l c o u n s e l l i n g c a n be i d e n t i f i e d a s p e r s o n s u n l i k e l y t o h a v e . c o n t i n u e d , r e g a r d l e s s o f t h e w a i t i n g p e r i o d . Some may r e t u r n l a t e r , p o s s i b l y a t a p o i n t when t h e y h a v e g r e a t e r m o t i v a t i o n t o s o l v e t h e i r p r o b l e m s . A f e w , o f c o u r s e , m i g h t have b e e n drawn i n t o s e r v i c e h a d an i m m e d i a t e a p p o i n t m e n t b e e n o f f e r e d . F o r e x a m p l e , one woman whose p r o b l e m s s o u n d e d s i m i l a r t o t h o s e o f M r s . G e o r g e a nd M r s . H a r o l d , n e v e r t h e l e s . s s o u n d e d more h o p e f u l . She was l e s s p r o j e c t i n g a n d l e s s p u n i t i v e t o w a r d h e r h u s b a n d , a n d she d i d s a y t h a t he was a l s o w i l l i n g t o come t o t h e a g e n c y f o r h e l p . E a r l i e r s e r v i c e m i g h t h a v e . p r e v e n t e d l o s s o f t h i s c a s e . I t i s a l s o p o s s i b l e t h a t i f i m m e d i a t e s e r v i c e c o u l d h a v e b e e n o f f e r e d , more o f t h e s e a p p l i c a n t s w o u l d have come i n f o r one o r two i n t e r v i e w s . T h i s m i g h t have b e e n o f some h e l p t o them d i r e c t l y ; b u t p a r t i c u l a r l y i t m i g h t h a v e i n c r e a s e d t h e l i k e l i h o o d o f t h e i r r e t u r n i n g a t a t i m e .when t h e y w o u l d be more a c c e s s i b l e t o t r e a t m e n t . - 71 -A p a r t from the c l i e n t s who a c t u a l l y , r e c e i v e d a com-p l e t e d s e r v i c e w h i c h e n a b l e d them t o s o l v e t h e i r problems, and a p a r t from t h o s e who were u n l i k e l y t o c o n t i n u e i n any c a s e , t h e r e remain s i x or seven m a r i t a l p r o b l e m cases where i t seems t h a t more Immediate s e r v i c e s h o u l d have been given,. T h i s was because t h e r e was a c r i s i s s i t u a t i o n , because i t was a t e n t a t i v e r e q u e s t f o r s e r v i c e by a new a p p l i c a n t , . o r f o r b o t h r e a s o n s . A c t u a l l y , t h e y were a l l new a p p l i c a n t s ' . The need f o r p r i o r i t y c o n s i d e r a t i o n i n some of t h e s e cases i s , of course,.more e a s i l y seen i n r e t r o s p e c t . Four examples i l l u s -t r a t e t h e s e s i t u a t i o n s . ( 1 ) The Kenneths. Mrs. „Kenneth, .a young women m a r r i e d about a y e a r , and w i t h . n o . c h i l d r e n , t e l e p h o n e d t o .say she and her husband w i s h e d t o have m a r r i a g e c o u n s e l l i n g on--"a v e r y p e r s o n a l p r o b l e m " . Her m o t i v a t i o n appeared u n c e r t a i n - she spoke of h a v i n g wanted t o see someone p r i o r t o m a r r i a g e - but d i d n ' t . She had been t o h e r d o c t o r , ,who gave her " " p i l l s " . When the caseworker t e l e p h o n e d f i v e weeks l a t e r t o o f f e r an appointment t h e c o u p l e were s a i d t o have moved, l e a v i n g no f o r -w a r d i n g a d d r e s s . A l e t t e r was s e n t , . b u t no r e p l y r e c e i v e d . (2) The L l o y d s . The L l o y d s were a l s o c h i l d l e s s , but b o t h around f o r t y , and m a r r i e d f o r y e a r s . Mrs. L l o y d t e l e -phoned f o l l o w i n g a v i o l e n t q u a r r e l w i t h her husband. T h i s was .not, .>apparently, ,a common .event. Mrs. L l o y d a d m i t t e d she was a l s o g u i l t y i n t h e f i g h t . She s a i d they, d i d not want t o s p l i t up, and b o t h were w a n t i n g h e l p . M r s . . L l o y d was concerned about her husband who was unhappy In h i s work and t h r e a t e n i n g t o g i v e up h i s job and move t o the p l a c e where h i s p a r e n t s l i v e d . She was d o u b t f u l about the wisdom of t h i s , . a s she f e l t h e r husband was t o o dependent on h i s p a r e n t s . She a c c e p t e d the w a i t i n g p.erlod. S i x weeks l a t e r t h e caseworker found t h a t the t e l e p h o n e was d i s c o n n e c t e d ; a l e t t e r o f f e r i n g s e r v i c e was returned.. B o t h . o f t h e above a p p l i c a n t s a c c e p t e d the w a i t i n g p e r -i o d w i t h o u t demur. I n t h e Kenneth case i t seems e v i d e n t t h a t the a p p l i c a n t had g r e a t d i f f i c u l t y g a t h e r i n g h e r courage t o - 72 -make her r e q u e s t f o r h e l p . R e a c h i n g out t o h e r a t t h a t p o i n t t h e r e f o r e might have c a p i t a l i z e d on an o p p o r t u n i t y f o r p r e v e n t -i v e s e r v i c e , p a r t i c u l a r l y as she s a i d her husband was a l s o w a n t i n g h e l p . A l t h o u g h i t was not e n t i r e l y c l e a r .at the time of i n t a k e , i t seems l i k e l y t h a t Mrs. L l o y d was f a c i n g a c r i s i s i n h e r m a r r i a g e . I t als.o appears t h a t h er husband was i n need, of h e l p , and a t t h a t time he might have been a w i l l i n g p a r t i -c i p a n t . (3) The Marvins;. Mr. M a r v i n t e l e p h o n e d t o ask f o r h e l p , as he s a i d h i s .wife had been g o i n g out - a l l summer w i t h a n o t h e r man, and she was w a n t i n g a divorce.. There were t h r e e c h i l d r e n in . the home. Mrs. M a r v i n had been p r e v i o u s l y . m a r r i e d and widowed. She had one c h i l d of her f i r s t m a r r i a g e , and t h e r e were two c h i l d r e n o f the p r e s e n t m a r r i a g e . Mr. Marvin' 1 s m o t i v a t i o n f o r casework h e l p was v e r y d o u b t f u l - he had c a l l e d o n l y under p r e s s u r e of c r i s i s . He was i r a t e and p r o j e c t i n g a l l blame f o r t h e problem. He .was a l s o u n r e a l i s t i c and u n c e r t a i n about what h e l p he was w a n t i n g , except t h a t he wanted someone t o " t a l k t o " h i s w i f e . When s e r v i c e was o f f e r e d s i x weeks l a t e r (by l e t t e r ) , t h e r e was no response from Mr. Marvin.. Mrs. M a r v i n t e l e p h o n e d t o r e p o r t t h a t h er husband had d e s e r t e d , t a k i n g w i t h him the two c h i l d r e n of the m a r r i a g e . She asked about the p o s s i b i l i t y of g e t t i n g s u p p o r t f o r h e r s e l f and the r e m a i n i n g c h i l d , and was r e f e r r e d elsewhere f o r h e l p w i t h t h i s p roblem. I t i s , of c o u r s e , d o u b t f u l t h a t the agency c o u l d have been of much h e l p t o t h i s f a m i l y , even i f Immediate, s e r -v i c e had been o f f e r e d . C e r t a i n l y i t i s u n l i k e l y t h a t the breakup .of the m a r r i a g e c o u l d have been p r e v e n t e d . I t does seem, however, t h a t p r i o r i t y assignment o r an i n t a k e i n t e r v i e w was i n d i c a t e d . . The f a m i l y , was a t t h e p o i n t of breaking.. I t i s p o s s i b l e t h a t the p a r e n t s might have been.helped t o p l a n more r e a s o n a b l y f o r t h e i r c h i l d r e n , so t h a t damaging e f f e c t s o f t r a u m a t i c e v e n t s -could have been m i t i g a t e d . - 73 -(4) The N o r b e r t s . Mrs. N o r b e r t telephoned, t o r e q u e s t s e r v i c e f o r h e r s e l f and., h er husband, r- t o h e l p them d e c i d e .whether t h e i r p r e s e n t s e p a r a t i o n s h o u l d be c o n t i n u e d . The Norbe r t s . were a v e r y young couple-, (25 and 22), w i t h one c h i l d . Mrs. N o r b e r t was l i v i n g w i t h h er p a r e n t s i n a n o t h e r p a r t of the p r o v i n c e , but a t the t i m e .of her c a l l p l a n n e d t o remain i n the c i t y f o r a week b e f o r e r e t u r n i n g t o her p a r e n t s ' home. Mr. N o r b e r t was w o r k i n g i n Vancouver. Mrs. N o r b e r t was a d v i s e d t o c o n t a c t the l o c a l w e l f a r e -agency f o r casework s e r -v i c e when she r e t u r n e d home,.and i t was agreed t h a t the F a m i l y S e r v i c e Agency would i n t e r v i e w Mr. N o r b e r t i n due c o u r s e , . ( f o l l o w i n g the w a i t i n g p e r i o d ) . Three weeks l a t e r Mr. N o r b e r t t e l e p h o n e d , w a n t i n g t o d i s c u s s a l e t t e r he had r e c e i v e d from h i s w i f e . He was the n seen i m m e d i a t e l y . The p i c t u r e t h a t emerged was t h a t b o t h p a r t n e r s were immature and o v e r l y dependent on t h e i r . r e s p e c t i v e p a r e n t s . They had been unwise In h a n d l i n g f i n a n c e s , and d i f f i c u l t i e s had been a g g r a v a t e d by Mr. N o r b e r t ' s i n d e c i s i o n about employment. On top .of a l l t h e s e p r e s s u r e s , Mrs. N o r b e r t ' s r e c e n t l o s s of an unborn c h i l d had r e s u l t e d i n near breakdown on h e r p a r t . The caseworker thought t h a t t h e r e was a good chance o f t h e m a r r i a g e b e i n g resumed when Mrs. N o r b e r t r e c o v e r e d e m o t i o n a l s t a b i l i t y , . a n d when her husband had made more adequate p l a n s f o r employment. F o l l o w -i n g the i n t e r v i e w , Mr.'Norbert p l a n n e d t o v i s i t h i s w i f e and d i s c u s s w i t h h er the p o s s i b i l i t y . t h a t she might r e t u r n t o Vancouver, so t h a t t h e y c o u l d b o t h use t h e agency's s e r v i c e s f o r a p e r i o d of p l a n n i n g . N o t h i n g f u r t h e r was heard from the Norberts.. The .caseworker''s e v a l u a t i o n was t h a t s e r v i c e g i v e n t o Mr-. N o r b e r t was of some h e l p t o him. However, had b o t h of the m a r i t a l p a r t n e r s been i n t e r v i e w e d a t the t i m e .of Mrs. N o r b e r t ' s c a l l , when she was i n the c i t y , i t appears t h a t the agency c o u l d have been c o n s i d e r a b l y more h e l p f u l t o t h i s c o u p l e . 2. P a r e n t - c h i l d R e l a t i o n s h i p s Three a p p l i c a n t s who r e q u e s t e d h e l p w i t h p a r e n t -c h i l d r e l a t i o n s h i p s r e c e i v e d .only b r i e f s e r v i c e . A l l of t h e s e r e q u e s t s f o r s e r v i c e concerned problems of.teenage g i r l s . A l l of the g i r l s were f a t h e r l e s s , a l t h o u g h two of them had - 74 -s t e p - r f a t h e r s . A l l t h r e e were o n l y c h i l d r e n . One a p p l i c a n t :was o f f e r e d p r i o r i t y , because h i s f o u r t e e n y e a r o l d s t e p - d a u g h t e r seemed t o be moving r a p i d l y beyond the p a r e n t s ' c o n t r o l and h e a d i n g toward d e l i n q u e n c y . When an appointment was o f f e r e d w i t h i n the week the J u v e n i l e Court was a l r e a d y a c t i v e , a charge of t r u a n c y h a v i n g been l a i d . The s t e p - f a t h e r wanted the s u p p o r t of an a u t h o r i t a t i v e agency, and r e a d i l y a c c e p t e d the w o r k e r ' s e x p l a n a t i o n t h a t the F a m i l y S e r v i c e Agency would not become i n v o l v e d under the c i r c u m s t a n c e s . C o n s i d e r i n g the o t h e r two c a s e s , b r i e f s e r v i c e was p o s s i b l y of some h e l p t o one p a r e n t . The o t h e r f a m i l y was not helped.. ( l ) The Owens. Mrs. Owen r e q u e s t e d h e l p i n knowing how t o manage her daughter, aged f i f t e e n , who was r e b e l l i n g a g a i n s t her mother and s t e p - f a t h e r and t h r e a t e n i n g t o l e a v e home t o l i v e w ith, her grandmother. Mrs. Owen's p o s i t i o n was d i f f i c u l t , as h e r husband h e s i t a t e d t o be a u t h o r i t a t i v e , and the grandmother was e n c o u r a g i n g the g i r l ' s r e b e l l i o u s a t t i -t u d e . At the time of i n t a k e Mrs. Owen r e q u e s t e d and r e c e i v e d h e l p i n c l a r i f y i n g h er l e g a l r i g h t s and r e s p o n s i b i l i t i e s , as w e l l as s u g g e s t i o n s , about h a n d l i n g the s i t u a t i o n . When an i n t e r v i e w was o f f e r e d t h r e e and a h a l f weeks l a t e r , she s a i d t h e p r o b l e m had been r e s o l v e d ; .her daughter was no l o n g e r m a n i p u l a t i n g the p a r e n t s and grandmother. Mrs. Owen f e l t t h i s was due t o t h e i r t e l l i n g the g i r l she c o u l d v i s i t h er grand-mother'; and a l s o due t o t h e i r h a v i n g spoken s t e r n l y t o the grandmother about I n t e r f e r i n g . She d i d not w i s h f u r t h e r s e r -v i c e . The above case was c l o s e d as " c l i e n t u n w i l l i n g t o continue"-, and the worker was "unable t o e v a l u a t e " whether the s e r v i c e had been h e l p f u l . Perhaps t h i s e v a l u a t i o n was somewhat t o o modest. - 75 -('2) The P e t e r s . Mrs. P e t e r , a widow, r e q u e s t e d h e l p w i t h her r e l a t i o n s h i p w i t h h e r teenage daughter, ( h e r .only c h i l d ) . Mrs. P e t e r d e s c r i b e d r a t h e r severe a c t i n g - o u t b e h a v i o u r on her d a u g h t e r ' s p a r t . She a l s o i n d i c a t e d t h a t the g i r l had had problems i n . r e l a t i o n s h i p w i t h b o t h p a r e n t s oyer a number 'Of y e a r s , . a n d t h a t t h e s e problems were r e l a t e d t o m a r i t a l d i f f i c u l t i e s and a l o n g s e p a r a t i o n of the p a r e n t s p r i o r t o the f a t h e r ' s d e a t h . Mrs. P e t e r appeared t o have s l i g h t m o t i v a t i o n f o r s e r v i c e - she s a i d the . s i t u a t i o n . w a s I m p r o v ing and she seemed d o u b t f u l about whether she wanted h e l p . She was unhappy about the w a i t i n g p e r i o d , but appar-e n t l y a c c e p t e d t h i s . She d i d not respond t o the o f f e r o f . a n appointment t h r e e weeks l a t e r . P r o b a b l y e a r l i e r . s e r v i c e s h o u l d have been o f f e r e d t o Mrs. P e t e r . Her d a u g h t e r ' s b e h a v i o u r as she d e s c r i b e d . i t I n d i c a t e d q u i t e severe d i s t u r b a n c e , but Mrs. P e t e r d i d not seem t o be r e a l l y aware of t h i s . The g i r l had had a d i f f i c u l t c h i l d h o o d , and the agency might have had an o p p o r t u n i t y t o h e l p her a t a c r u c i a l p o i n t i n her l i f e . A l l of t h e s e were new a p p l i c a t i o n s f o r the s e r v i c e r e q u e s t e d . However, Mrs. P e t e r had r e c e i v e d b r i e f s e r v i c e from th e agency as a s i n g l e woman, d u r i n g the d e p r e s s i o n , when she was out of work and s t r a n d e d away from home. 3. I n d i v i d u a l P e r s o n a l i t y Adjustment Two of the b r i e f s e r v i c e r e c i p i e n t s who r e q u e s t e d h e l p w i t h p e r s o n a l i t y d i f f i c u l t i e s were u n a t t a c h e d men. I n b o t h cases i t appears t h a t e a r l i e r s e r v i c e might have been more h e l p f u l t o the a p p l i c a n t s . ( l ) Mr. Q u e n t i n . Mr. Q u e n t i n , a s i n g l e man., aged twenty, had r e c e n t l y l e f t h i s p a r e n t s ' home i n a n o t h e r p r o v i n c e t o seek employment i n Vancouver. He was d i s s a t i s -f i e d w i t h the j o b .he had o b t a i n e d , .and u n c e r t a i n about f u t u r e p l a n s . Mr. Q u e n t i n r e q u e s t e d c o u n s e l l i n g , t o "know more about m y s e l f " , and " t o l e a r n what I'm capable o f d o i n g " . He -. 76 -was r e f e r r e d elsewhere f o r p s y c h o l o g i c a l t e s t i n g and v o c a t -i o n a l g u i d a n c e , and p l a c e d on the w a i t i n g l i s t f o r casework s e r v i c e . When t h e a s s i g n e d worker t e l e p h o n e d t o o f f e r 'service f o u r and a h a l f weeks l a t e r , i t was l e a r n e d t h a t Mr. Q u e n t i n had l e f t t he c i t y t o r e t u r n t o h i s p a r e n t s 1 home. -I t appears t h a t p r i o r i t y s e r v i c e might have been c o n s i d e r e d f o r Mr. Q u e n t i n . T h i s was a c r i s i s i n the l i f e of a v e r y young man. (2) Mr.. R o b e r t . Mr. Robert r e q u e s t e d h e l p w i t h p e r -s o n a l and f a m i l y p r o b l e m s . He had been s e p a r a t e d from h i s w i f e f o r a number of y e a r s . A teenage daughter was i n the ca r e of a s o c i a l agency i n E a s t e r n Canada.. Mr. Robert had r e c e n t l y a r r i v e d i n t h e c i t y f r om the E a s t , where he had r e c e i v e d case-work s e r v i c e f rom a f a m i l y agency. He f e l t t he need o f a s i m i l a r ..'contact h e r e . He was g u i l t y about, h i s d a ughter, and concerned about h e r welfare.. When an i n t e r v i e w was o f f e r e d about f o u r weeks l a t e r - , i t was l e a r n e d t h a t Mr. Robert had i n the meantime r e q u e s t e d p s y c h i a t r i c t r e a t m e n t t h r o u g h the o u t p a t i e n t s department of a h o s p i t a l , , a n d was r e c e i v i n g t h i s . The s o c i a l s e r v i c e department of the h o s p i t a l was a l s o a c t i v e , and Mr. : Robert was r e f e r r e d t h e r e f o r the h e l p he was now w a n t i n g , w h i c h i n v o l v e d correspondence w i t h an agency i n E a s t e r n Canada. There were s e v e r a l t e l e p h o n e i n t e r v i e w s w i t h two . s o c i a l a g e n c i e s t o c l a r i f y a p p r o p r i a t e r e s o u r c e s f o r Mr. R o b e r t . I t seems, i n r e t r o s p e c t , t h a t an i n t a k e i n t e r v i e w would have been h e l p f u l i n t h i s c a s e . The a p p r o p r i a t e s e r v i c e f o r the a p p l i c a n t might have been determined e a r l i e r , ..and w i t h more s e c u r i t y f o r him. I t was f o r t u n a t e t h a t he had s u f f i -c i e n t m o t i v a t i o n , a n x i e t y and s t r e n g t h , t o f i n d a p p r o p r i a t e h e l p on h i s own. The t h i r d . c a s e under t h i s c a t e g o r y might be p r o p e r l y c o n s i d e r e d under "'"parent-child r e l a t i o n s h i p s " . However, the s e r v i c e r e q u e s t e d , as s t a t e d by the a p p l i c a n t , was h e l p w i t h a p e r s o n a l i t y adjustment problem, s p e c i f i c a l l y temper tantrums . i n a two y e a r o l d c h i l d . - 77 --( 3 ) The S t e p h e n s . M r s . S t e p h e n , a g e d t w e n t y , a s k e d i f t h e a g e n c y c o u l d g i v e h e l p w i t h " t h e p r o b l e m s .of a v e r y y o u n g c h i l d " . H e r l i t t l e b o y wa.s b e i n g v e r y d i f f i c u l t a n d c o n t r a r y , a n d h a v i n g many t e m p e r t a n t r u m s . U n t i l t h e s e p o s s i -b i l i t i e s w e r e p o i n t e d o u t t o h e r , i t h a d n o t o c c u r r e d t o M r s . . S t e p h e n t h a t h e r s o n ' s d i f f i c u l t i e s m i g h t be r e l a t e d t o t h e f a c t t h a t he h a d a new b a b y b r o t h e r , a n d a l s o t o t h e f a c t t h a t h i s f a t h e r w a s a w a y f r o m h o m e , w o r k i n g o u t o f t o w n . She .was g i v e n some i n t e r p r e t a t i o n o f t h e n o r m a l b e h a v i o u r . o f t w o y e a r o l d c h i l d r e n . M r s . S t e p h e n ' s d e s i r e f o r ' s e r v i c e s e e m e d t e n t a t i v e . She a c c e p t e d t h e w a i t i n g l i s t a n d c o m m e n t e d t h a t s h e w o u l d . c a n c e l h e r a p p l i c a t i o n i f t h e s i t u a t i o n i m p r o v e d . . When a n i n t e r v i e w w a s o f f e r e d , M r s . S t e p h e n s a i d h e r l i t t l e b o y ' s b e h a v i o u r h a d i m p r o v e d , s i n c e . h i s f a t h e r h a d r e t u r n e d h o m e . T h e r e f o r e s h e f e l t n o n e e d o f h e l p . She.-was i n v i t e d t o c a l l a g a i n i f f u r t h e r p r o b l e m s a r o s e , a n d s a i d s h e w o u l d d o t h i s . The c a s e w o r k e r ' s e v a l u a t i o n . h e r e w a s t h a t t h e a p p l i -c a n t w a s - h e l p e d b y t h e s e r v i c e g i v e n . E v i d e n t l y t h i s y o u n g m o t h e r , .as w e l l a s h e r e o n , f e l t i n s e c u r e d u r i n g h e r h u s b a n d ' s a b s e n c e , a n d t h i s I n s e c u r i t y w a s r e l i e v e d w h e n . h e r e t u r n e d . D o u b t l e s s p e r s o n a l i n t e r v i e w s c o u l d h a v e p r o v i d e d m o r e s u p p o r t t o M r s . S t e p h e n . H o w e v e r , i t seems t h a t t h e s e r v i c e g i v e n w a s h e l p f u l , a n d I t i s p r o b a b l e , t h a t M r s . S t e p h e n w i l l r e t u r n f o r f u r t h e r s e r v i c e i f t h e n e e d a r i s e s . 4.. H o m e m a k e r S e r v i c e Two a p p l i c a t i o n s f o r h o m e m a k e r - s e r v i c e a c c e p t e d f o r e x p l o r a t i o n w e r e c l o s e d a s b r i e f s e r v i c e . I n o n e c a s e , . w h e n t h e . c a s e w o r k e r - c o n t a c t e d t h e f a m i l y , t h e y h a d made a n o t h e r p l a n f o r . t h e c a r e o f t h e i r / c h i l d r e n . The o t h e r c a s e m a y . b e a n ^example o f t o o m u c h p r i o r i t y . A f r i e n d o f t h e f a m i l y t e l e -p h o n e d , u r g e n t l y r e q u e s t i n g h o m e m a k e r s e r v i c e o n t h e m o t h e r ' s b e h a l f , a s t h e m o t h e r w a s i m m i n e n t l y e x p e c t i n g t h e b i r t h o f - 78 -h e r ' s i x t h c h i l d . Because of t h e apparent emergency a case-worker v i s i t e d t he home almost i m m e d i a t e l y . The mother was then i n h o s p i t a l , and a homemaker was p l a c e d i n t h e home. The f a t h e r was seen a t t h e t i m e , but a c t u a l l y n e i t h e r p a r e n t had made a d i r e c t r e q u e s t f o r the s e r v i c e . Under the c i r c u m -s t a n c e s , placement of a homemaker was c o n t r a r y t o agency p o l i c y , w h i c h r e q u i r e s . a p p l i c a n t s t o make a r e q u e s t on t h e i r own b e h a l f b e f o r e the agency w i l l o f f e r casework' o r o t h e r s e r v i c e . Sub-sequent e v e n t s i l l u s t r a t e t he soundness of t h i s p o l i c y . The homemaker was withdrawn a f t e r two days because o f e x c e e d i n g l y low s t a n d a r d s i n t h e home, and the f a t h e r ' s complete r e f u s a l t o c o - o p e r a t e i n c o n t r o l l i n g the c h i l d r e n or i n any way, w h i c h made the homemaker'1 s s i t u a t i o n u n t e n a b l e . The f a t h e r t hen d e c i d e d he could, manage on h i s own, w i t h some h e l p f r om r e l a t i v e s . Summary E l e v e n b r i e f s e r v i c e r e c i p i e n t s r e c e i v e d an approp-r i a t e s e r v i c e w h i c h was o f some b e n e f i t t o them. P o s s i b l y t w e l v e o r t h i r t e e n had l i t t l e d e s i r e f o r casework s e r v i c e , and were u n l i k e l y t o have c o n t i n u e d i n any e v e n t . I n a t l e a s t n i n e c a s e s , however, t h e w a i t i n g p e r i o d had t h e e f f e c t o f d e s t r o y i n g an o p p o r t u n i t y t o h e l p a . t r o u b l e d p e r s o n who showed a t l e a s t some d e s i r e f o r a s e r v i c e w h i c h was c l e a r l y w i t h i n . t h e f u n c t i o n of the agency t o p r o v i d e . W i t h one t e c h -n i c a l e x c e p t i o n , (Mrs. P e t e r ) , t h e y were a l l new a p p l i c a n t s . - 79 -S i x had r e q u e s t e d h e l p w i t h m a r i t a l p roblems; one was con-cerned about h e r r e l a t i o n s h i p w i t h h e r daughter'; and two had asked f o r h e l p w i t h problems of p e r s o n a l .adjustment. These might w e l l be c a l l e d the " l o s t " c a s e s . A l l of t h e a p p l i c a n t s who needed e a r l i e r a t t e n t i o n t h a n t h e y r e c e i v e d had a s e r i o u s f a m i l y o r p e r s o n a l problem. In most -cases t h e r e was u r g e n c y under 'one o f the c a t e g o r i e s o u t l i n e d e a r l i e r . I n t h e M a r v i n case, t h e s i t u a t i o n .did d e t e r i o r a t e d u r i n g the w a i t i n g , p e r i o d . There I s e v i d e n c e t h a t t h i s happened i n . s e v e r a l o t h e r c a s e s . Mrs. Kenneth was t e n t -a t i v e l y r e a c h i n g out f o r h e l p , h a v i n g been p r e v i o u s l y u n a b le t o b r i n g h e r s e l f t o t h i s p o i n t . I n the P e t e r -case t h e r e was a s e r i o u s problem a f f e c t i n g a young a d o l e s c e n t . Mr. Q u e n t i n was a young, I n e x p e r i e n c e d p e r s o n i n need of s u p p o r t . At t h e time of a p p l i c a t i o n t h e r e was a time l i m i t I n r e l a t i o n t o an i m p o r t a n t p e r s o n i n the N o r b e r t f a m i l y - the a p p l i -c ant h e r s e l f . To b a l a n c e the p i c t u r e , i t must be remembered t h a t d u r i n g t h e two month p e r i o d t h i r t y - t h r e e a p p l i c a n t s d i d r e c e i v e p r i o r i t y s e r v i c e , and, as e x e m p l i f i e d by the Bruce and Caleb .cases, p r o b a b l y most of t h o s e who r e c e i v e d p r i o r i t y had e x t r e m e l y s e r i o u s problems.. Among the a p p l i c a n t s who d i d not r e c e i v e p r i o r i t y a l t h o u g h t h e y a p p a r e n t l y needed I t , two . c h i l d l e s s c o u p l e s and two u n a t t a c h e d men would be u n l i k e l y t o r e c e i v e : c o n s i d e r a t l o n over f a m i l i e s where c h i l d r e n were b e i n g s e r i o u s l y ' a f f e c t e d by f a m i l y p r o b l e m s . W e l l over a hundred - 80 -new and re-opened .cases were a s s i g n e d t o .caseworkers d u r i n g the p e r i o d under s t u d y , ,and some a p p l i c a n t s w a i t e d over s i x weeks f o r s e r v i c e . The need f o r p r i o r i t y c o n s i d e r a t i o n i n an i n d i v i d u a l case must always be b a l a n c e d a g a i n s t the need f o r s e r v i c e of the o l d e s t a p p l i c a t i o n i n the w a i t i n g l i s t , as w e l l as a g a i n s t o t h e r u r g e n t r e q u e s t s n e e d i n g p r i o r i t y . Some common c h a r a c t e r i s t i c s o f . a p p l i c a n t s who d i d not r e c e i v e e a r l y . s e r v i c e , ..although. t h e y needed i t , can perhaps be i d e n t i f i e d . I n the p r e s e n t sample, a l l were new a p p l i c a n t s . They had a l l r e q u e s t e d h e l p of a p u r e l y p s y c h o l o g i c a l : o r i n t a n -. g i b l e n a t u r e , t h a t i s , casework h e l p . In a l l cases the need was r e a l and s e r i o u s . Most of t h e s e a p p l i c a n t s showed some u n d e r s t a n d i n g o f t h e i r need f o r h e l p , but m o t i v a t i o n " w a s t e n t a t i v e . W i t h one or two e x c e p t i o n s , t h e y a c c e p t e d ' t h e w a i t -i n g p e r i o d w i t h o u t c o m p l a i n t . U n l i k e Mrs. Adam, t h e y d i d not have s t r e n g t h of purpose w h i c h e n a b l e d them t o demonstrate and e x p l a i n t h e i r need f o r immediate s e r v i c e . . Two g e n e r a l c o n c l u s i o n s can be drawn a t t h i s p o i n t . F i r s t , more c o n s i d e r a t i o n s h o u l d be g i v e n . t o new a p p l i c a n t s , p a r t i c u l a r l y t h o s e who show some d e s i r e f o r h e l p w i t h s e r i o u s p e r s o n a l ..and f a m i l y problems, but g i v e e v i d e n c e of w a v e r i n g m o t i v a t i o n . S e c o n d l y , when t h e r e i s a w a i t i n g l i s t , t h e r e i s a g r e a t e r need f o r p e r s o n a l i n t a k e I n t e r v i e w s t o d e t e r m i n e , i n d o u b t f u l s i t u a t i o n s , whether th e a p p l i c a n t :can or s h o u l d be kept w a i t i n g . The number of cases where t h i s I s a d v i s a b l e p r o b a b l y i n c r e a s e s w i t h t h e l e n g t h o f the w a i t i n g p e r i o d . CHAPTER IV CONTINUED SERVICE CASES "Continued s e r v i c e " ea.ses are d i s t i n g u i s h e d from " b r i e f s e r v i c e " cases n ot so much by the n a t u r e of the prob-lems bu t . b y h a v i n g r e c e i v e d a t l e a s t two p e r s o n a l - i n t e r -v i e w s w i t h a c l i e n t o r c l i e n t s f o l l o w i n g the l a s t o p e ning of the c a s e . The e x t e n t of s e r v i c e o f course v a r i e s a good d e a l . Twenty-four 'of the c o n t i n u e d s e r v i c e cases i n the p r e -sent sample were c l o s e d w i t h i n f o u r months of the- time of a p p l i c a t i o n j a n o t h e r t w e n t y - f o u r c l o s e d between f o u r and t w e l v e months a f t e r a p p l i c a t i o n j w h i l e f o u r t e e n cases were s t i l l a c t i v e .in J a n u a r y , - i 9 6 0 , f o u r t e e n t o s i x t e e n months from t h e time of a p p l i c a t i o n f o r s e r v i c e . To c o n t i n u e t h i s p a r t of the s u r v e y the continued- s e r v i c e -cases are t h e r e f o r e d i v i d e d i n t o t h r e e c a t e g o r i e s a c c o r d i n g t o l e n g t h of s e r v i c e and d e s c r i b e d as s h o r t - t e r m , medium-term, and l o n g - t e r m c a s e s . To b e g i n .with, an o v e r a l l • i n d i c a t i o n of the amount of s e r v i c e p r o v i d e d by the agency can be o b t a i n e d by l i s t i n g t o t a l " items o f s e r v i c e " p r i o r t o January 1, ,19.60. ( T a b l e 1 3 ) . L a t e r s e r v i c e g i v e n t o t h e f o u r t e e n cases s t i l l a c t i v e a t t h a t time i s not i n c l u d e d ; n or i s f u r t h e r s e r v i c e t o cases w h i c h , .though c l o s e d w i t h i n the sample p e r i o d , .were s u b s e q u e n t l y r e -opened. Items o f casework s e r v i c e ( l i s t e d i n the f i r s t t h r e e columns) i n c l u d e i n - p e r s o n i n t e r v i e w s w i t h . . c l i e n t s , t e l e p h o n e -.82 -i n t e r v i e w s w i t h c l i e n t s , and c o l l a t e r a l i n t e r v i e w s . The •count o f i n - p e r s o n i n t e r v i e w s w i t h c l i e n t s can be q u i t e a c c u r a t e l y done. However, t h e number o f t e l e p h o n e i n t e r v i e w s and c o l l a t e r a l i n t e r v i e w s must be e s t i m a t e d , as i n the l o n g e r •cases i t i s not p o s s i b l e t o count t h e s e i t e m s p r e c i s e l y from summary recording.. The e s t i m a t e s have been kept on the c o n s e r v a t i v e side.. Casework i n t e r v i e w s o n l y a r e l i s t e d as t e l e p h o n e i n t e r v i e w s * ; c o n v e r s a t i o n s t o "arrange a p p o i n t m e n t s , f o r i n s t a n c e , b e i n g e x c l u d e d . C o l l a t e r a l i n t e r v i e w s i n c l u d e b o t h p e r s o n a l and t e l e p h o n e i n t e r v i e w s , and i n some cases c o r r e s p o n d e n c e . These are i n t e r v i e w s w i t h s o c i a l w orkers of o t h e r a g e n c i e s , w i t h p r o f e s s i o n a l p e r s o n s , r e p r e s e n t a t i v e s of o t h e r community r e s o u r c e s , . i n t e r e s t e d p e r s o n s and r e l a t i v e s o u t s i d e t h e immediate f a m i l y , and so :on. The f a m i l y i s the u n i t of s e r v i c e , and u s u a l l y i n c l u d e s o n l y the p r i m a r y f a m i l y and r e l a t e d p e r s o n s l i v i n g i n the same h o u s e h o l d . Members of the f a m i l y a re c l i e n t s ; c o l l a t e r a l i n t e r v i e w s a re a l l i n t e r v i e w s w i t h o t h e r p e r s o n s , e x c e p t those w i t h super-v i s e d homemaker's o r .other agency s t a f f members. A p a r t from casework s e r v i c e , homemaker s e r v i c e was p r o v i d e d f o r s i x f a m i l i e s , and o t h e r f i n a n c i a l a s s i s t a n c e was g i v e n i n seven c a s e s . The f i g u r e s i n t h e s e columns i n d i c a t e o n l y the number •of cases where such s e r v i c e was g i v e n . I n a l l f o r t y - s e v e n complete f a m i l i e s , , t e n broken f a m i l i e s , and f i v e s i n g l e p e r s o n s r e c e i v e d c o n t i n u e d s e r v i c e . Table 1 3 . Items of S e r v i c e , T o t a l C o n t i n u e d S e r v i c e Cases Groups Number: S e r v i c e s Rendered T o t a l ( F a m i l i e s ) and Persons P e r s o n a l I n t e r v i e w s Telephone Interviews C o l l a t e r a l I n t e r v i e w s Homemaker S e r v i c e F i n a n c i a l A s s i s t a n c e Items o f S e r v i c e Complete F a m i l i e s . ( i i ) 653 3 6 5 2 2 1 . 5 5 1 , 2 4 9 Husband 36 202 Wife 46 '403- * * * •* * C h i l d 6 48 Broken F a m i l i e s . ( 10 ) 1 2 5 64 31 1 1 222 Man 6 34 Woman 8 83 * * * * C h i l d 1 . 8 S i n g l e P e r s o n s . (5 ) 102 21 18 - 1 142 Man Woman 1 4 3 5 67 # •X- * * T o t a l [•62) 1 0 8(a) 880 4 5 0 2 7 0 6 7 1 , 6 1 3 Not s e p a r a t e d . (a) 1 0 8 i n d i v i d u a l c l i e n t s seen, from 62 f a m i l i e s . - 84 -P e r s o n a l I n t e r v i e w s w i t h t h e s e c l i e n t s t o t a l l e d 8 8 0 , an av e r -age of over f o u r t e e n f o r 'each .case. One hundred and e i g h t I n d i v i d u a l c l i e n t s were i n t e r v i e w e d i n p e r s o n - f o r t y - t h r e e men, f i f t y - e i g h t , women,.and seven c h i l d r e n . A l t h o u g h over t h r e e - q u a r t e r ' s of the i n i t i a l a p p l i c a n t s were women ( T a b l e I , Chapter I I ) , • i n over t h r e e - q u a r t e r s of the complete f a m i l y cases the .husband was seen. S u r p r i s i n g l y , the male m a r r i a g e p a r t n e r !of 60 p e r -cent o f the broken f a m i l i e s was a l s o i n t e r -v i e wed. Men. r e c e i v e d 271 i n t e r v i e w s , w h i c h i s an average of 6 . 3 i n t e r v i e w s f o r each a d u l t male c l i e n t g i v e n d i r e c t s e r v i c e - . More women r e c e i v e d d i r e c t s e r v i c e , and t h e r e were about t w i c e as many p e r s o n a l i n t e r v i e w s w i t h women. Women c l i e n t s a l s o r e c e i v e d a somewhat g r e a t e r number 'of i n t e r v i e w s on t h e av e r -age, 'about . 9 . 5 . I n o n l y t h r e e cases was no a d u l t female c l i e n t i n v o l v e d . Seven c h i l d r e n g i v e n d i r e c t casework t r e a t -ment r e c e i v e d a t o t a l of 56 i n t e r v i e w s . F o u r t e e n cases r e c e i v e d o n l y two I n - p e r s o n i n t e r -v i e w s . One of the I n i t i a l a p p l i c a t i o n s l a t e r r e s u l t e d i n s e v e n t y - s i x p e r s o n a l i n t e r v i e w s w i t h members of one f a m i l y . T h i s , however, .was a s p e c i a l s i t u a t i o n , where the teenage da u g h t e r of a f a m i l y was g i v e n h er own caseworker,.and when she l a t e r l e f t t he home t h e case was s p l i t and became two c a s e s . S e r v i c e t o t h i s g i r l has been i n c l u d e d ' i n the t o t a l , as i t came about as a r e s u l t o f t h e o r i g i n a l a p p l i c a t i o n . O t h e r w i s e , the l a r g e s t 'number of p e r s o n a l i n t e r v i e w s g i v e n t o one f a m i l y was f i f t y - t h r e e . - 85 -• I t i s of i n t e r e s t t o compare the f a m i l y groups r e p r e s e n t e d by t h e s i x t y - t w o -continued s e r v i c e cases w i t h the m a r i t a l .status of t h e I n i t i a l . a p p l i c a n t s , . ( T a b l e 1, Chapter I I ) . The o r i g i n a l sample i n c l u d e d s e v e n t y - f o u r m a r r i e d p e r s o n s (complete f a m i l i e s ) , f i f t e e n u n a t t a c h e d p a r e n t s w i t h c h i l d r e n ( b r o k e n f a m i l i e s ) , and s i x s i n g l e persons.. A s l i g h t l y g r e a t e r p e r c e n t a g e of "complete f a m i l y " cases c l o s e d as b r i e f s e r v i c e , but the p r o p o r t i o n s i n each c a t e g o r y were not g r e a t l y a l t e r e d . C o n s i d e r i n g the a b s o l u t e number, how-e v e r , the f i g u r e s appear t o be s i g n i f i c a n t . Cases " l o s t " as b r i e f s e r v i c e i n c l u d e d one s i n g l e p e r s o n , f i v e broken fami-r l i e s , and twenty-seven unbroken f a m i l i e s . T h i s was t h e e f f e c t of the g r e a t "drop-r.out" of a p p l i c a t i o n s f o r m a r i t a l c o u n s e l l i n g p r e v i o u s l y d i s c u s s e d . From t h e s t a n d p o i n t of t h e p r e v e n t i o n o f . f a m i l y breakdown and damage t o c h i l d r e n l i k e l y t o be c a r -r i e d over t o the nex t g e n e r a t i o n , t h i s i s not a v e r y happy s t a t e of a f f a i r s . On the more p o s i t i v e s i d e , .caseworkers' e v a l u a t i o n s a t c l o s i n g i n d i c a t e t h a t s e r v i c e g i v e n t o those who c o n t i n u e d beyond b r i e f s e r v i c e was c o n s i d e r e d t o be h e l p f u l t o c l i e n t s and t h e i r . f a m i l i e s i n the g r e a t m a j o r i t y o f c a s e s . ( T a b l e 1.4) F o u r t e e n cases r e c e i v e d o n l y two p e r s o n a l i n t e r v i e w s ; p o s -s i b l y many of t h e s e were " d r o p - o u t s " , and t h i s may be r e f l e c t e d In t h e somewhat g r e a t e r number of " s h o r t - t e r m " cases c l o s e d as an i n c o m p l e t e s e r v i c e . However, i n o n l y two " s h o r t - t e r m " cases d i d the caseworker c o n s i d e r t h a t s e r v i c e - 86 -Table 1.4. C l o s i n g S t a t u s and Caseworker's  E v a l u a t i o n a t C l o s i n g , C o n t i n u e d S e r v i c e Cas.es C l o s i n g P r i o r i t y - Assignment G e n e r a l W a i t i n g L i s t T o t a l S t a t u s Yes No Unable t o E v a l u a b l e Yes No Unable t o E v a l u a t e ( l ) S h o r t - T e r m S e r v i c e Complete (a) 9 0 0 7 0 0 1.6 S e r v i c e I n c o m p l e t e ( b ) 1 1 0 2 1 .3 8 Sub T o t a l 1 2 . 1_ 0 9 1 . 3 24 (2)Medium-Tern S e r v i c e Complete 7 ,0 0 11 0 0 18 S e r v i c e I ncomplete 1 0 1 3 •1 0 6 •Sub T o t a l . 8 0 JL 14 1 p_ • 24 . (3) Long-Term Open Jan.. 1, I 9 6 0 • 4 0 0 10 0 0 14 T o t a l 22 1 1 33 2 3 62 (a) S e r v i c e completed o r r e f e r r e d e l s e w h e r e . (b) C l i e n t u n w i l l i n g t o c o n t i n u e , d i d not c o n t i n u e d e s p i t e p l a n , e t c . - 87 -g i v e n d i d not h e l p the i n d i v i d u a l .or f a m i l y , and i n o n l y t h r e e i n s t a n c e s d i d caseworkers r e p o r t i n a b i l i t y t o e v a l u a t e the s e r v i c e . ' Of the f o r t y - e i g h t cases c l o s e d p r i o r t o J a n u a r y 1, i 9 6 0 , t h i r t y - f o u r were c l o s e d as a completed s e r v i c e , ..and w i t h a p o s i t i v e e v a l u a t i o n . Seven o t h e r s were c o n s i d e r e d t o have been h e l p e d , a l t h o u g h caseworkers c o n s i d e r e d t h a t c l i e n t s w i t hdrew from s e r v i c e p r e m a t u r e l y . Cases s t i l l open as of J a n u a r y 1, i 9 6 0 , have been l i s t e d as h a v i n g been h e l p e d by the s e r v i c e , on the assumption t h a t the c l i e n t s a t l e a s t must f e e l t h a t t h e y are d e r i v i n g some b e n e f i t , i f t h e y have not w ithdrawn from a. v o l u n t a r y s e r v i c e b e f o r e a minimum of f o u r -t e e n months. (a) S h o r t - t e r m Cases F a m i l y groups and i n d i v i d u a l c l i e n t s who r e c e i v e d c o n t i n u e d s e r v i c e of l e s s than f o u r months d u r a t i o n comprise n i n e t e e n complete f a m i l i e s , t h r e e broken f a m i l i e s , . a n d two s i n g l e women. ( T a b l e 15a) T o t a l items of s e r v i c e as l i s t e d i n the t a b l e i n d i c a t e t h a t t h e s e cases used o n l y o n e - e i g h t h o f " c o n t i n u e d s e r v i c e " p r o v i d e d t o the whole sample. T h i r -t e e n o f the cases i n t h i s c a t e g o r y r e c e i v e d o n l y two p e r s o n a l i n t e r v i e w s . The number of p e r s o n a l i n t e r v i e w s p e r case ranged between two and n i n e , w i t h an average of 3.4 a p p r o x i m a t e l y . T h i r t y - s e v e n i n d i v i d u a l c l i e n t s r e c e i v e d a t o t a l of e i g h t y -two i n - p e r s o n i n t e r v i e w s . One f a m i l y r e c e i v e d f i n a n c i a l a s s i s t a n c e , and homemaker s e r v i c e was g i v e n t o t h r e e f a m i l i e s . Table 1.5a. Items of S e r v i c e , Short-Term Cases Groups - ( F a m i l i e s and Persons) S e r v i c e s Rendered T o t a l P e r s o n a l I n t e r v i e w s Telephone I n t e r v i e w s C o l l a t e r a l I n t e r v i e w s Homemaker S e r v i c e F i n a n c i a l A s s i s t a n c e Items of S e r v i c e Complete F a m i l i e s ( 1 9 ) 69 73 18 2_ 1_ 1 6 3 Husband 13 2 4 * •* * * * Wife 18 43 C h i l d 1 2 Broken F a m i l i e s ( 3 ) 9 7 8 - 2 5 . Man 1 2 * •* * * * Woman 2 7 S i n g l e Woman (2) 4 6 5 — — 15 T o t a l (24-) 3 7 (a) 82 86 31 3 "1 2 0 3 Not s e p a r a t e d (a) 3 7 i n d i v i d u a l c l i e n t s seen from 24 f a m i l i e s . - .89 Main p r e s e n t i n g problems i n s h o r t - t e r m cases were as f o l l o w s : M a r i t a l d i f f i c u l t y 8 Other f a m i l y r e l a t i o n s h i p problems 1 Problems o f p e r s o n a l i t y adjustment ......... 1 Requests f o r homemaker s e r v i c e 5 Others ('economic, e n v i r o n m e n t a l ) ............ 3 E l e v e n cases r e c e i v e d p r i o r i t y assignment; i n c l u d i n g one a p p l i c a t i o n f o r h e l p w i t h a m a r i t a l problem, t h r e e r e q u e s t s f o r s e r v i c e around o t h e r f a m i l y problems, f i v e a p p l i c a t i o n s f o r homemaker s e r v i c e , and two " o t h e r s " . A p a r t from two of the r e q u e s t s f o r homemaker s e r v i c e , t h e s e were a l l re-opened cases.. Requests f o r m a r i t a l c o u n s e l l i n g i n t h i s group i n c l u d e d f o u r new a p p l i c a t i o n s and f o u r . r e - o p e n e d c a s e s . Case-w o r k e r s ' c l o s i n g e v a l u a t i o n s were somewhat more p o s i t i v e f o r the re-opened m a r i t a l cases - t h r e e of these c l o s e d as com-p l e t e d s e r v i c e w i t h a p o s i t i v e e v a l u a t i o n . One re-opened case, however, was c l o s e d w i t h a v e r y n e g a t i v e e v a l u a t i o n by the worker, because the c l i e n t s were " u n w i l l i n g t o c o n t i n u e " , " m o d i f i c a t i o n u n l i k e l y " , and the e v a l u a t i o n was "No". None of the new cases c l o s e d as a completed s e r v i c e , but two were judged t o have been h e l p e d by the s e r v i c e g i v e n . The one a p p l i c a t i o n f o r h e l p w i t h a m a r r i a g e prob-lem w h i c h r e c e i v e d p r i o r i t y s e r v i c e was a r e c u r r e n t case, ('previously c l o s e d w i t h i n the c a l e n d a r y e a r ) . T h i s case had been c l o s e d w i t h a p o s i t i v e e v a l u a t i o n when the forme r 'case-worker l e f t the agency, as .the c l i e n t s d i d not w i s h t o c o n t i n u e a t t h a t time.. The caseworker noted t h a t the woman- might w i s h - 90 -t o r e t u r n a t p o i n t s of d i f f i c u l t y , and recommended t h a t i n such an event she s h o u l d be seen, as she would p r o b a b l y o n l y need one o r two i n t e r v i e w s . T h i s p r o v e d t o be the case, and. s e r -v i c e g i v e n i n two i n t e r v i e w s was e f f e c t i v e and e c o n o m i c a l . However, one might q u e s t i o n the v a l i d i t y o f g i v i n g t h i s a p p l i c a t i o n p r i o r i t y o v e r new r e q u e s t s f o r s e r v i c e . The f o l l o w i n g i l l u s t r a t i o n i s an example of r e -a p p l i c a t i o n f o r help, w i t h a m a r r i a g e p r o b l e m . The a p p l i -c a n t had t w i c e p r e v i o u s l y made a t e n t a t i v e r e q u e s t f o r 'ser-v i c e , but had c a n c e l l e d .appointments o f f e r e d and had not r e c e i v e d a p e r s o n a l i n t e r v i e w . ( l ) The A r t h u r s . Mrs. A r t h u r , a mother of f o u r c h i l d r e n , was a woman i n her e a r l y . t h i r t i e s . Her husband was employed i n . a c l e r i c a l p o s i t i o n . I n 1957 she had t e l e p h o n e d on the a d v i c e . o f h er p a s t o r , t o r e q u e s t h e l p w i t h m a r i t a l problems r e l a t e d t o her' husband' s heavy d r i n k i n g , . She can-c e l l e d h e r appointment l a t e r , s a y i n g she would c a l l a g a i n , but d i d not do so. E a r l y , i n 1958 Mrs. A r t h u r a g a i n r e q u e s t e d h e l p . T h i s time she s a i d she was t h i n k i n g o f l e a v i n g h er husband, and she asked about h er l e g a l p o s i t i o n i n t h i s event.. When an appointment was o f f e r e d about s i x weeks l a t e r , Mrs,. A r t h u r s a i d the p r o blem was s o l v e d - she had p l a c e d h e r .confidence i n h e r r e l i g i o n , and needed no o t h e r help.. On t h i s o c c a s i o n Mrs. A r t h u r 'again r e q u e s t e d a d v i c e about h e r l e g a l p o s i t i o n s h o u l d she l e a v e h e r husband, but i n the t e l e p h o n e i n t e r v i e w she r e v e a l e d much ambivalence about s e p a r a t i o n . The. i n t a k e worker agreed t h a t i t was a v e r y d i f f i - r c u l t d e c i s i o n . Mrs. A r t h u r r e q u e s t e d an appointment, s a y i n g she would n ot want t o s e p a r a t e b e f o r e t a k i n g t h i s s t e p . She a c c e p t e d the e x p l a n a t i o n t h a t casework s e r v i c e o f f e r e d would be f o r h e r s e l f . Her m o t i v a t i o n now appeared t o be f a i r l y good. She a c c e p t e d the w a i t i n g p e r i o d , and was g i v e n an appointment t h r e e weeks l a t e r . Mrs. A r t h u r came t o the agency f o r t h r e e i n t e r v i e w s . I n the b e g i n n i n g she s t r e s s e d t h a t a l l of h e r t r o u b l e s were caused by her husband's d r i n k i n g . The caseworker'- 1 s impres-s i o n was t h a t Mrs. A r t h u r : h a d p e r s o n a l i t y problems w h i c h con-t r i b u t e d t o the m a r i t a l c o n f l i c t t o a c o n s i d e r a b l e degree. She appeared t o be a p e r s o n w i t h " g r e a t h o s t i l e and a g g r e s s i v e d r i v e s w h i c h she was r e p r e s s i n g w i t h d i f f i c u l t y " , and she seemed - 91 -t o be u s i n g " r e l i g i o n " . as a defence t o keep th e s e i n n e r f o r c e s i n check, >and a l s o as a weapon t o c o n t r o l her husband. The caseworker was not v e r y o p t i m i s t i c about the p r o s p e c t s ,of h e l p i n g her w i t h t h e s e p r o b l e m s . N e v e r t h e l e s s , i n t h e two l a t e r i n t e r v i e w s Mrs. A r t h u r showed t h a t she had a t l e a s t some a b i l i t y t o see her own p a r t i n f a m i l y d i f f i c u l t i e s , and t o change her b e h a v i o u r . She s a i d t h a t she had come t o see t h a t her c o n t r o l l i n g b e h a v i o u r and c r i t i c a l a t t i t u d e had caused her t o have d i f f i c u l t i e s , ..not o n l y w i t h her husband, but a l s o w i t h h e r c h i l d r e n . W i t h c o n v i c t i o n and s a t i s f a c t i o n she r e p o r t e d t h a t h e r e f f o r t s t o be more r e l a x e d had been more e f f e c t i v e t h a n her p r e v i o u s b e h a v i o u r , and i n t h i s she r e c e i v e d the encouragement and s u pport of the c a s e w o r k e r . However, as t e n s i o n s i n the home eased, Mrs. A r t h u r d i d not want t o con-t i n u e the c o n t a c t . A p p a r e n t l y she had had a l l the h e l p she wanted and c o u l d use a t t h i s time.. She d i d a s k f o r a s s u r a n c e t h a t the door.was open f o r her t o r e t u r n l a t e r i f she w i s h e d . The above case was c l o s e d as a completed s e r v i c e , and w i t h a p o s i t i v e e v a l u a t i o n . A l t h o u g h the c l i e n t wanted o n l y a minimum s e r v i c e , she d i d use t h i s w e l l . A l s o , she had a p o s i t i v e e x p e r i e n c e of casework h e l p w h i c h s h o u l d e n a ble her t o r e t u r n w i t h c o n f i d e n c e i f she needs and d e s i r e s f u r t h e r s e r v i c e . I n c l u d i n g the r e c u r r e n t case w h i c h was mentioned b r i e f l y . t w o o t h e r r e - a p p l i c a t i o n s f o r m a r i t a l c o u n s e l l i n g r e c e i v e d s e r v i c e w h i c h was complete and h e l p f u l t o the f a m i l y . The one case w h i c h was c l o s e d w i t h a v e r y . n e g a t i v e e v a l u a t i o n i n v o l v e d a most d i f f i c u l t m a r i t a l p r o b l e m . The m a r r i a g e r e l a t i o n s h i p d i d not improve - i n f a c t the w i f e l e f t h e r husband. T h i s c ouple seemed t o be e x c e e d i n g l y incortir p a t i b l e , and t h e husband's p e r s o n a l i t y problems were such as t o make a. s a t i s f a c t o r y m a r i t a l adjustment q u i t e u n l i k e l y . B o t h husband and w i f e were seen f o u r t i m e s , f o r a t o t a l of - 92 -e i g h t i n t e r v i e w s . None o f the above cases appear t o have been"""drop^ o u t s " . . I n . f a c t , e x a m i n a t i o n o f the t h i r t e e n t w o - i n t e r v i e w cases i n t h e " s h o r t - t e r m " group i n d i c a t e s t h a t o n l y f o u r o f ^ them can be seen i n t h i s l i g h t , i n c l u d i n g two new a p p l i c a t i o n s f o r m a r i t a l c o u n s e l l i n g . The f o u r new m a r i t a l p r o b l e m cases I n t h i s group had a l e s s s u c c e s s f u l outcome t h a n the re-opened cases.. A l l . o f them were c l o s e d as an imcomplete s e r v i c e and a l l of them can be d e s c r i b e d as " d r o p - o u t s " , a l t h o u g h two d i d c o n t i n u e beyond two i n t e r v i e w s . The f o l l o w i n g i s an i l l u s t r a t i o n o f one new a p p l i -c a n t , whom t h e worker judged t o have .been h e l p e d by the s e r v i c e . There i s , however, a s t r i k i n g s i m i l a r i t y between t h i s s i t u a t i o n and two o t h e r s where t h e caseworkers were "unable t o e v a l u a t e " whether the s e r v i c e had been h e l p f u l . (2)'The B r i a n s . T h i s c ouple were b o t h i n t h e i r t w e n t i e s , - and had two c h i l d r e n . The husband was employed as a s k i l l e d w o r k e r . Mrs. B r i a n r e q u e s t e d h e l p w i t h . m a r i t a l problems a s s o c i a t e d w i t h h e r . h u s b a n d 1 s heavy d r i n k i n g . She was i n t e r v i e w e d once .by the i n t a k e worker when she dropped i n a t a p o i n t of p a n i c ( h e r husband had h i t h e r ) , . and t h r e e t i m e s by the caseworker t o whom she was a s s i g n e d . An e f f o r t was made t o i n v o l v e Mr. B r i a n , but t h i s was u n s u c c e s s f u l . Mrs. B r i a n r e v e a l e d t h a t the ma r r i a g e had been on a shaky base from the b e g i n n i n g . T h e . e l d e r c h i l d was born p r i o r •to the. m a r r i a g e , and Mr. B r i a n had been persuaded t o marry h e r o n l y under p r e s s u r e f r o m h i s f a t h e r . A c c o r d i n g t o h i s w i f e L h e r e j e c t e d the e l d e r c h i l d , and had l i t t l e time f o r e i t h e r . o f the c h i l d r e n . He worked s t e a d i l y , but su p p o r t e d the f a m i l y i n o n l y m i n i m a l f a s h i o n . However, Mrs.. B r i a n ' s main c o m p l a i n t s c e n t r e d around her. husband's d r i n k i n g and h i s abuse o f h e r s e l f and the c h i l d r e n when under the i n f l u e n c e of l i q u o r . She s a i d she now had l i t t l e f e e l i n g f o r her husband. N e v e r t h e l e s s , she d e c i d e d she.would remain w i t h him, m a i n l y because she c o n s i d e r e d the a l t e r n a t i v e s t o be even l e s s - 93 -a t t r a c t i v e . Mrs. B r i a n c o u l d see no re a s o n f o r h er husband's b e h a v i o u r , o t h e r t h a n h i s f e e l i n g about the o l d e r c h i l d . Her r i g h t s as a w i f e were e x p l a i n e d t o h e r , and p o s s i b l e a l t e r -n a t i v e s were d i s c u s s e d . Mrs,. B r i a n d i d n ot want f u r t h e r s e r v i c e . I t i s p o s s i b l e t h a t t h i s woman d i d r e c e i v e more h e l p t han i s i n d i c a t e d i n t h i s summary o r i n the case r e c o r d i n g , and t h a t she may r e t u r n l a t e r f o r f u r t h e r s e r v i c e . How-e v e r , from the i n f o r m a t i o n p r e s e n t l y a v a i l a b l e i t would appear t h a t she r e c e i v e d and used a minimum of casework h e l p , and t h a t h e r s i t u a t i o n remained the same. She-was g i v e n some h e l p i n c l a r i f y i n g h e r problems, and i n the form of p r a c t i c a l a d v i c e . Among " s h o r t - t e r m " cases t h e r e were seven r e q u e s t s f o r h e l p w i t h f a m i l y r e l a t i o n s h i p problems, o t h e r t h a n m a r i t a l d i f f i c u l t y . F i v e were a p p l i c a t i o n s from former • c l i e n t s of the agency, and two were from n e w . a p p l i c a n t s . F i v e cases c l o s e d as a completed s e r v i c e , and w i t h a p o s i -t i v e e v a l u a t i o n ; one f a m i l y was judged t o have been h e l p e d , though s e r v i c e was i n c o m p l e t e ; and i n one case the a p p l i c a n t w i t h d r e w p r e m a t u r e l y and t h e f a m i l y was not h e l p e d . B o t h of the new cases c l o s e d as a s u c c e s s f u l s e r v i c e . Three a p p l i c a t i o n s f o r h e l p w i t h f a m i l y r e l a t i o n -s h i p problems r e c e i v e d p r i o r i t y c o n s i d e r a t i o n ; ; . a l l were re-opened c a s e s , i n c l u d i n g t h e one case w h i c h c l o s e d w i t h a n e g a t i v e e v a l u a t i o n , and w h i c h w i l l be d e s c r i b e d l a t e r . Two o t h e r a p p l i c a t i o n s g i v e n p r i o r i t y b o t h i n v o l v e d a "time l i m i t I n the s i t u a t i o n i t s e l f " . . I n one case t h e r e was an - 94 -u r g e n t n e c e s s i t y t o w r i t e t o a s o c i a l agency i n E a s t e r n Canada. The o t h e r s i t u a t i o n , . w h i c h "was r e c u r r e n t , r e q u i r e d an e a r l y , i n t e r v i e w w i t h former " c l i e n t s b e f o r e r e p l y i n g t o correspondence from a s o c i a l agency i n B r i t a i n . . I n s i x of the seven " f a m i l y r e l a t i o n s h i p " c a s e s , the main p r e s e n t i n g r e q u e s t concerned a p r o b l e m i n " p a r e n t -c h i l d " r e l a t i o n s h i p . However, i n o n l y t h r e e f a m i l i e s d i d t h i s r e f e r t o 'a pr o b l e m i n r e l a t i o n s h i p between p a r e n t s and minor c h i l d r e n . I n t h r e e o t h e r s i t u a t i o n s the d i f f i c u l t y , was between young a d u l t s and t h e i r p a r e n t s ; a l t h o u g h i n two cases c h i l d r e n were i n d i r e c t l y a f f e c t e d , i n one s i t u a t i o n the prob-lem had n o t h i n g whatever t o do w i t h a c h i l d . One case p r e -s e n t e d a d i f f e r e n t p r o b l e m i n f a m i l y , r e l a t i o n s h i p s ; an.'., e l d e r l y c o u p l e i n "Vancouver were b e i n g hounded by. r e l a t i v e s i n : B r i t a i n t o send money t h e y c o u l d i l l a f f o r d t o s p a r e . The .cases where r e l a t i o n s h i p s between a d u l t s and t h e i r p a r e n t s were a main focus' of concern are a l l .quite d i f f e r e n t and i n t e r e s t i n g . Time and space ,-do not p e r m i t a f u l l d e s c r i p t i o n of t h e s e s i t u a t i o n s , but two may be men-t i o n e d b r i e f l y . One f a m i l y had been known t o the.agency many y e a r s b e f o r e , when t h e y were h a v i n g f i n a n c i a l t r o u b l e s d u r i n g the d e p r e s s i o n . Now the middle-aged p a r e n t s asked the agency t o w r i t e t o a s o c i a l agency i n an E a s t e r n Canadian c i t y on t h e i r b e h a l f . The co u p l e .were e x t r e m e l y w o r r i e d about t h e i r d aughter and . g r a n d c h i l d , who appeared t o be i n s e r i o u s t r o u b l e - 95 -i n t h a t c i t y . They wanted a s s u r a n c e t h a t casework c o u n s e l l i n g would he made a v a i l a b l e t o t h e i r daughter, t h a t the c h i l d would be p r o t e c t e d from a b r u t a l s t e p - f a t h e r , and t h a t t r a i n -f a r e t h e y had s e n t so t h a t t h e daughter and g r a n d c h i l d c o u l d r e t u r n t o Vancouver would not be used e x c e p t f o r t h i s p u r -p o s e . Through.the f u l l c o - o p e r a t i o n of an E a s t e r n f a m i l y agency, a l l of t h e s e t h i n g s were a c h i e v e d . .The case might w e l l have been c l o s e d as a completed s e r v i c e . However, casework h e l p was o f f e r e d t o the daughter a f t e r she r e t u r n e d t o Van-couver, and she " d i d not c o n t i n u e d e s p i t e p l a n " . In the .other s i t u a t i o n s i n v o l v i n g young a d u l t s and t h e i r p a r e n t s , problems i n . r e l a t i o n s h i p were more d i r e c t l y the f o c u s of s e r v i c e r e q u e s t e d . One young c o u p l e , b o t h u n i v e r s i t y g r a d u a t e s , r e q u e s t e d and r e c e i v e d p r a c t i c a l a d v i c e about arrangements f o r the w i f e ' s mother t o l i v e e l sewhere than i n t h e i r home. The w i f e a l s o r e c e i v e d emot-i o n a l s u p p o r t i n the s t e p she was t a k i n g . From a p r e v i o u s l e n g t h y c o n t a c t when she was a teenage g i r l , i t was known t h a t t h i s woman had had a v e r y d i f f i c u l t time i n emanlc^-p a t i n g h e r s e l f f r om her mother. Two s i t u a t i o n s where the r e q u e s t f o r s e r v i c e . w a s c e n t r e d around the p r o b l e m of a c h i l d w i l l be p r e s e n t e d i n more d e t a i l . ( l ) The C a l v l n s . Mrs. C a l v i n r e q u e s t e d h e l p i n d i s c u s s i n g h e r r e l a t i o n s h i p w i t h her daughter, aged f i f t e e n . The g i r l had been l i v i n g w i t h a p a t e r n a l aunt and u n c l e f o r a -> 96 -y e a r , and was n o w . r e f u s i n g even t o v i s i t h e r p a r e n t s . Mrs. C a l v i n f e a r e d she was l o s i n g her daughter, and wanted t o e x p l o r e why the g i r l was d e n y i n g h e r f a m i l y i n t h i s way. The f a m i l y had been known t o the agency d u r i n g the war, when Mr. C a l v i n was ov e r s e a s i n the army, and t h e r e was a d i f f i c u l t y about Mrs. C a l v i n r e c e i v i n g dependent's a l l o w a n c e . She was g i v e n a s s i s t a n c e i n s t r a i g h t e n i n g out t h i s d i f f i c u l t y , and some f i n a n c i a l • a s s i s t a n c e i n the meantime. The couple were thought t o be s t a b l e p a r e n t s , who had the w e l f a r e of t h e i r c h i l d r e n a t h e a r t . Mrs. C a l v i n , however, appeared t o handle money b a d l y , w h i c h compounded f i n a n c i a l d i f f i c u l t i e s , but she d i d not want h e l p . w i t h t h i s p r o b l e m . Now b o t h p a r e n t s were w o r k i n g - the f a t h e r i n u n s k i l l e d employment the mother i n a f a c t o r y . Casework s e r v i c e g i v e n t o t h i s f a m i l y i n c l u d e d n i n e p e r s o n a l i n t e r v i e w s ; f i v e w i t h the mother,.two w i t h the f a t h e r , and two w i t h the da u g h t e r . I t a l s o i n c l u d e d s e v e r a l . i n t e r -v i ews w i t h the aunt and u n c l e , • ( w h i c h have been counted as c o l l a t e r a l i n t e r v i e w s ) . E x p l o r a t i o n o f the problem r e v e a l e d a t a n g l e d s k e i n o f i n t e r - f a m i l y r e l a t i o n s h i p s . The g i r l i n ques-t i o n was t h e youngest of s i x c h i l d r e n . She was born d u r i n g the war when Mr. C a l v i n was o v e r s e a s , and he was n o t her n a t u r a l f a t h e r . ' N e v e r t h e l e s s , , she appeared t o have been a c c e p t e d by both, p a r e n t s . The aunt, a d o m i n a t i n g and c o n t r o l l i n g woman, had wanted t o adopt the c h i l d a t b i r t h , and had been much i n v o l v e d w i t h her ever s i n c e . She was i n b e t t e r f i n a n c i a l c i r c u m s t a n c e s than the p a r e n t s , and had g i v e n the f a m i l y a good d e a l i n 'a m a t e r i a l way. As Mrs. C a l v i n , as w e l l as her daughter, l o o k e d up t o the .aunt as a "mother-person", she had been v e r y • h e s i t a n t t o s t a n d o n her l e g a l r i g h t s as a p a r e n t , or t o ta k e any a c t i o n f o r some t i m e . -Mrs. C a l v i n was an e a s y - g o i n g woman, w i t h r e l a x e d s t a n d a r d s of housekeeping, c h i l d c a r e and d i s c i p l i n e . A l s o , she worked o u t s i d e the home. The aunt was most c r i t i c a l , b e r a t e d the mother f o r her '"ne g l e c t " , and c l e a r l y wanted the daug h t e r f o r h e r own. The g i r l h e r s e l f was young f o r h e r 'age, had f e l t u n p r o t e c t e d and u n c h e r i s h e d i n the "happy-go-lucky" home atmosphere, and had succumbed t o the au n t ' s b r a n d i s h m e n t s . S u p p o r t i v e casework w i t h the v a r i o u s f a m i l y members, p a r t i c u l a r l y the mother, daughter and aunt, h e l p e d - a l l t o r e l a x so t h a t t h e y c o u l d see each o t h e r ' s v i e w p o i n t s and u n d e r s t a n d each o t h e r ' s f e e l i n g s t o some degree. Mother and daughter were h e l p e d t o r e c o g n i z e t h a t each d i d care f o r and have need o f t h e . o t h e r . When t e n s i o n s were r e l a x e d the f a m i l y were a b l e t o work out a m u t u a l l y a g r e e a b l e p l a n whereby the g i r l c o u l d go on l i v i n g i n her aunt's home i f she w i s h e d , but she would v i s i t h e r f a m i l y r e g u l a r l y and keep her r e l -a t i o n s h i p w i t h p a r e n t s . a n d s i b l i n g s . - 97 -The dynamics of v a r i o u s p e r s o n a l i t i e s i n v o l v e d i n the G a l v i n case c o u l d he d i s c u s s e d a t length.. However, i t has m e r e l y been p r e s e n t e d as an example of a completed " s h o r t -•'"term" s e r v i c e w h i c h was h e l p f u l t o the f a m i l y . (2) The D e l b e r t s . Mr* D e l b e r t r e q u e s t e d h e l p w i t h problems i n d i s c i p l i n i n g h i s s t e p - d a u g h t e r , aged f o u r t e e n . He s a i d she was s t a y i n g out v e r y l a t e a t n i g h t w i t h boys of whom he d i d not approve, r e f u s i n g t o account f o r where she went, and g e n e r a l l y d e f y i n g him. A c c o r d i n g t o Mr. D e l b e r t , h e r mother s u p p o r t e d the g i r l i n t h i s behaviour.. Because of the danger of a c t i n g - o u t b e h a v i o u r on the g i r l * s p a r t , p r i o r i t y was g i v e n t o t h i s a p p l i c a t i o n . A l s o , i t was e v i d e n t t h a t Mr, D e l b e r t ' s m o t i v a t i o n f o r s e r v i c e was d o u b t f u l . He- had made a p r e v i o u s r e q u e s t f o r h e l p w i t h the same problem,•had been d i s t u r b e d about t h e w a i t i n g p e r i o d , and had h o t a c c e p t e d an.appointment when o f f e r e d , as he then s a i d t h i n g s were i m p r o v i n g . Now he s a i d the s i t u a t i o n was d e s p e r a t e . Mr. D e l b e r t , who was about t h i r t y y e a r s of age, was employed i n a s e m i - s k i l l e d occupation.. H i s w i f e was n i n e y e a r s o l d e r , and a l s o worked. -The couple had l i v e d i n common-law p r i o r t o t h e i r m a r r i a g e and b e f o r e Mrs, Delbert-'s d i v o r c e f rom h e r f i r s t husband. There were two c h i l d r e n of Mrs. D e l b e r t * s f i r s t m a r r i a g e , . a n d one much younger c h i l d o f the p r e s e n t union.. Now i t seemed the mother was unable-t o p l a c e any c o n t r o l s on the b e h a v i o u r o f h e r a d o l e s c e n t d a u g h t e r , and Mr. D e l b e r t s a i d she t o l d him he had no r i g h t t o d i s c i p l i n e h e r c h i l d , . Mr. D e l b e r t was i n t e r v i e w e d t w i c e b e f o r e w i t h -d r a wing f r o m c o n t a c t w i t h the agency. H i s w i f e and daughter were v i o l e n t l y opposed t o h i s g o i n g t o " o u t s i d e r s " w i t h f a m i l y t r o u b l e s , .and r e f u s e d t o be involved.. D u r i n g t h i s t i m e t h e r e was a c l i m a x i n the f a m i l y s t r u g g l e , w h i c h r e s u l t e d i n Mr. D e l b e r t b a c k i n g down c o m p l e t e l y . He r a t i o n a l i z e d t h a t a f t e r , a l l t h e g i r l was not h i s r e s p o n -s i b i l i t y . . When he d e c i d e d n o t t o concern h i m s e l f w i t h h i s s t e p - d a u g h t e r and ceased h i s e f f o r t s t o d i s c i p l i n e h e r t h e r e .was a l e s s e n i n g o f c o n f l i c t i n the home. Mr. D e l b e r t t h e r e -f o r e d e c i d e d n o t t o c o n t i n u e u s i n g the a g e n c y l s s e r v i c e . The above case was clos.ed as c l i e n t " u n w i l l i n g t o c o n t i n u e " , the e v a l u a t i o n : b e i n g t h a t t h e f a m i l y had not been h e l p e d . The caseworker n o t e d t h a t the p r o g n o s i s f o r the f a m i l y and the g i r l i n q u e s t i o n appeared t o be p o o r . - 98 -The one a p p l i c a n t i n t h i s group who r e q u e s t e d h e l p w i t h a pr o b l e m of " p e r s o n a l i t y a d j u s t m e n t " was the s i n g l e woman. She was a woman of about t h i r t y , who had not been a b l e t o f a c e employment f o r s e v e r a l y e a r s , s i n c e she had had a breakdown. T h i s g i r l was d e c i d e d l y s c h i z o p h r e n i c , and r e a l l y w i s h e d t o a v o i d a l l human c o n t a c t s . She had r e q u e s t e d h e l p o n l y on h e r s i s t e r ' s i n s i s t e n c e , and i t was not p o s s i b l e t o I n v o l v e h er i n s e r v i c e , a l t h o u g h s t r e n u o u s e f f o r t s were made i n t h i s r e g a r d . She was not o f f e r e d p r i o r i t y , but w a i t e d o n l y t h r e e weeks f o r s e r v i c e , and t h e r e was ;a r e a s o n f o r t h i s w h i c h she u n d e r s t o o d . I t was agreed t h a t i n t h e meantime she would see the p s y c h i a t r i s t who had t r e a t e d h e r , and t h a t c l e a r a n c e from him about the a d v i s a b i l i t y o f o f f e r i n g casework s e r v i c e would be r e q u i r e d . The d e l a y i n o f f e r i n g s e r v i c e does not appear t o have been a s i g n i f i c a n t f a c t o r i n the l o s s of t h i s c a s e . The f i v e a p p l i c a t i o n s f o r homemaker s e r v i c e a l l r e c e i v e d p r i o r i t y a t t e n t i o n . I n two cases homemaker.service was not g i v e n . One e l d e r l y woman had been r e f e r r e d by the s o c i a l s e r v i c e department o f a h o s p i t a l , as n e e d i n g h e l p a t home f o r a s h o r t time d u r i n g c o n v a l e s c e n c e f rom an i l l n e s s . She was - o f f e r e d homemaker s e r v i c e , but e x p l a i n e d t o the case-worker t h a t she much p r e f e r r e d t o be by h e r s e l f and was q u i t e sure she c o u l d manage. The caseworker v i s i t e d h e r a t home and was s a t i s f i e d t h a t t h i s was p r o b a b l y t r u e , but she was g i v e n a s s u r a n c e t h a t h e l p was a v a i l a b l e s h o u l d she need i t . - 99 -One f a m i l y , w e l l known from p r e v i o u s .contacts, were encouraged t o make t h e i r own arrangements, and f o r t u n a t e l y were a b l e t o do t h i s . T h i s f a m i l y had r e c e i v e d homemaker.service s e v e r a l t i m e s i n the p a s t , and t h i s seemed t o he the b e s t p l a n f o r a l l concerned, e s p e c i a l l y f o r the homemaker who might be I n v o l v e d 1 . Three f a m i l i e s r e c e i v e d homemaker s e r v i c e . The .one i l l u s t r a t i o n w h i c h w i l l be p r e s e n t e d i n d e t a i l i s not a t y p i c a l homemaker -case. I t i s b e i n g p r e s e n t e d , however, as a c l e a r -c u t example of a s i t u a t i o n . w h i c h o f t e n a r i s e s , and a p p a r e n t l y w i l l c o n t i n u e t o a r i s e f o r some time i n t h e f u t u r e . •The E d g a r s . Mrs. Edgar, a mother of f o u r c h i l d r e n , t e l e p h o n e d t o e n q u i r e about the p o s s i b i l i t y of r e c e i v i n g home-maker s e r v i c e d u r i n g her confinement, e x p e c t e d i n about s i x weeks t i m e . She had not been p r e v i o u s l y known t o the agency, no r a p p a r e n t l y t o any o t h e r s o c i a l agency. As her husband was employed as a l a b o u r e r . a n d h i s wages were low i n r e l a t i o n t o the s i z e o f the f a m i l y , i t was e v i d e n t t h a t the f a m i l y c o u l d not a f f o r d t o h i r e a housekeeper. There were no f r i e n d s o r r e l a t i v e s who were f r e e and a b l e t o c a r e f o r the f o u r c h i l d r e n . Her a p p l i c a t i o n was a c c e p t e d f o r e x p l o r a t i o n , and l a t e r home-maker s e r v i c e was p r o v i d e d f o r about t e n days i n a l l . A l t h o u g h t h e i r income was low, i t was e v i d e n t t h a t the Edgars managed t h e i r money v e r y w e l l i n d e e d . They had no d e b t s of any s i z e . • The home, a l a r g e o l d house, was v e r y c l e a n , c o m f o r t a b l e and homey, and equipped w i t h the most neces-s a r y l a b o u r - s a v i n g d e v i c e s . Throughout the c o n t a c t the case-worker .and two homemakers i n v o l v e d were f a v o u r a b l y impressed by Mrs. Edgar, who was p a r t i c u l a r l y c o - o p e r a t i v e and . . p o s i t i v e i n her a t t i t u d e and i n her use of the s e r v i c e . Mr. Edgar appeared t o be a p e r s o n of more l i m i t e d u n d e r s t a n d i n g than h i s w i f e , but he t o o c o - o p e r a t e d t o the b e s t o f h i s a b i l i t y . F a m i l y r e l a t i o n s h i p s seemed t o he good, the c h i l d r e n happy, and the m a r i t a l p a r t n e r s w e l l - a d j u s t e d t o one. a n o t h e r . Mrs. Edgar was most a p p r e c i a t i v e of the s e r v i c e , and the b i l l f o r t h e p o r t i o n of the c o s t w h i c h the Edgars had agreed t o pay was p a i d p r o m p t l y . E v i d e n t l y i t was a most a g r e e a b l e e x p e r i e n c e f o r a l l concerned I What i s wrong w i t h t h i s p i c t u r e ? F i r s t of a l l , - 100 -t h i s f a m i l y d i d not need casework t r e a t m e n t - an i n t e g r a l p a r t of the s u p e r v i s e d homemaker.service. S e c o n d l y , the s i t u a t i o n d i d not r e a l l y w a r r a n t the s p e c i a l a b i l i t i e s and. t a l e n t s of a homemaker. F u r t h e r m o r e , a l t h o u g h Mrs. Edgar was a w e l l - o r g a n i z e d p e r s o n and t e l e p h o n e d w e l l ahead of her need f o r the s e r v i c e , h e r a p p l i c a t i o n s t i l l p r e s e n t e d a time . l i m i t and i t r e c e i v e d p r i o r i t y o v er s i t u a t i o n s where t h e r e were s e r i o u s f a m i l y p r o b l e m s . Homemakers a r e s t a f f members of the Family- S e r v i c e • Agency, s e l e c t e d because of p e r s o n a l q u a l i t i e s of f l e x i b i l i t y and u n d e r s t a n d i n g w h i c h e n a b l e them t o a c c e p t and h e l p c h i l d -r e n and a d u l t s who have o f t e n been u p s e t by t r a u m a t i c f a m i l y e x p e r i e n c e s and may be most d i f f i c u l t t o l i k e . . These p e r -s o n a l q u a l i t i e s are f u r t h e r d e v e l o p e d by t r a i n i n g and by e x p e r i e n c e i n w o r k i n g c l o s e l y , w i t h caseworkers on each c a s e . Homemakers are equipped t o r e c o g n i z e the e m o t i o n a l needs of c h i l d r e n and t h e i r p a r e n t s , t o b r i n g o r d e r t o t r o u b l e d homes, .and t o h e l p c h i l d r e n r e g a i n a f e e l i n g of s e c u r i t y . a n d f a i t h i n . a d u l t s . I n c a r r y i n g out h e r d i f f i c u l t j o b , the homemaker i s always s u p p o r t e d and s u p e r v i s e d by a caseworker; t h e y work t o g e t h e r as a h e l p i n g team. T h i s i s n e c e s s a r i l y an e x p e n s i v e s e r v i c e . A l t h o u g h i t was i n i t i a t e d as an a u x i l i a r y s e r v i c e t o f a m i l i e s r e c e i v i n g casework t r e a t m e n t from the agency, i t i s now. a v a i l a b l e t o f a m i l i e s s e r v e d by. o t h e r agen-r c i e s , and a l s o t o f a m i l i e s i n the G r e a t e r Vancouver a r e a who - 1.01 -may a p p l y on t h e i r own. To meet the needs .of a community of o v er h a l f a m i l l i o n p e o p l e , budget l i m i t a t i o n s e n a b l e d the .agency t o employ o n l y e i g h t homemakers d u r i n g 1 9 5 8 . The agency's p o l i c y i s t o g i v e p r i o r i t y t o s i t u a t i o n s w h i c h r e a l l y r e q u i r e the f u l l , use o f such :an e x p e n s i v e and s p e c i a l i z e d s e r -v i c e , . and. where i t s p r o v i s i o n w i l l h e l p t r o u b l e d , f a m i l i e s t o r e g a i n s t a b i l i t y . However, t h e r e was not i n 1 9 5 8 , and t h e r e . s t i l l i s no o t h e r community r e s o u r c e , such as a s u b s i d i z e d housekeeper s e r v i c e , t o meet the needs of f a m i l i e s l i k e the E d g a r s . Under p r e s e n t c o n d i t i o n s of urban l i f e , t h e r e are many f a m i l i e s who do not have the r e s o u r c e s t o meet such f a m i l y c r i s e s , but whose needs would be f u l l y met by the p r o v i s i o n .of. a r e l i a b l e , k i n d l y housekeeper, p r e f e r a b l y w i t h casework s c r e e n i n g t o ensure t h a t t h i s was the a p p r o p r i a t e p l a n . As t h e r e i s no such s e r v i c e , the agency has a c c e p t e d t h e s e a p p l i -c a t i o n s , and has g i v e n s e r v i c e i f a homemaker i s a v a i l a b l e . T h i s i s i n k e e p i n g w i t h the agency's c e n t r a l purpose - the s t r e n g t h e n i n g o f f a m i l y l i f e . I n the p r e s e n t sample, about 8 5 p e r c e n t of the a p p l i c a t i o n s f o r homemaker.service r e c e i v e d p r i o r i t y c o n s i d e r -a t i o n ; whereas o n l y about 16 p e r cent o f the new a p p l i c a n t s r e q u e s t i n g h e l p w i t h m a r i t a l problems were g i v e n p r i o r i t y . ( T a b l e 1 1 , Chapter I I ) . The a p p l i c a n t w i t h a m a r i t a l p r o b l e m w i l l p r o b a b l y s t i l l have i t i n s i x weeks or two months t i m e , ( a l t h o u g h the agency may n o t have the a p p l i c a n t ) . A p p l i c a t i o n s - 102 -f o r homemaker s e r v i c e a lmost always p r e s e n t .a time l i m i t i f any s e r v i c e i s t o be g i v e n , and o f t e n . r e q u i r e immediate a t t e n t i o n . When an a p p l i c a t i o n f o r homemaker s e r v i c e has been a c c e p t e d a t i n t a k e f o r casework e x p l o r a t i o n , the n e x t s t e p i s the assignment of a caseworker,.who has the'main r e s p o n s i -b i l i t y f o r d e t e r m i n i n g whether placement of a homemaker i s i n d i c a t e d . The caseworker must v i s i t t h e home, i n t e r v i e w b o t h p a r e n t s and e x p l a i n homemaker s e r v i c e t o them, l e a r n as much -as p o s s i b l e about f a m i l y r e l a t i o n s h i p s and the p e r s o n a l i t i e s i n v o l v e d i n o r d e r t o be o f h e l p t o the homemaker, o b t a i n i n f o r m -a t i o n about the f a m i l y budget, and come t o an agreement w i t h the p a r e n t s about the c o n t r i b u t i o n t h e y can a f f o r d t o make • toward the c o s t of the s e r v i c e . When t h e r e i s a w a i t i n g l i s t , t h i s o b v i o u s l y means t h a t some o t h e r r e q u e s t f o r s e r v i c e a w a i t i n g a t t e n t i o n cannot r e c e i v e i t d u r i n g the same week. Homemaker s e r v i c e g i v e n t o two o t h e r f a m i l i e s i n t h i s group was more a p p r o p r i a t e and t y p i c a l . One f a m i l y w i t h f i v e c h i l d r e n was i n many ways s i m i l a r t o the E d g a r s . The f a m i l y income was about the same, and the p a r e n t s were a l s o r e l a t i v e l y w e l l - a d j u s t e d p e o p l e . However, the mother had s u f f e r e d a s e r i o u s and l e n g t h y i l l n e s s , and p r i o r t o the a p p l i c a t i o n f o r homemaker s e r v i c e the p a r e n t s had e xhausted t h e i r p e r s o n a l and f i n a n c i a l r e s o u r c e s and were h e a v i l y i n d e b t . S e v e r a l of the c h i l d r e n were' showing symptoms of e m o t i o n a l d i s t u r b a n c e as a r e s u l t o f the m a k e s h i f t arrangements f o r t h e i r care w h i c h were the b e s t the p a r e n t s had been a b l e • - 103 -t o a r r a n g e on t h e i r own. Homemaker s e r v i c e was c l e a r l y i n d i -c a t e d , and .was p r o v i d e d f o r - a p e r i o d of almost f o u r months. The o t h e r f a m i l y c o n s i s t e d of a s e p a r a t e d mother •and two . c h i l d r e n . The mother had a s e r i o u s h e a r t c o n d i t i o n , and homemaker s e r v i c e was g i v e n f o r about t h r e e weeks d u r i n g her c o n v a l e s c e n c e f rom an i l l n e s s , when a r e l a t i v e who had. been h e l p i n g the f a m i l y had t o r e t u r n home. A f f e c t i o n a l t i e s between t h i s mother /and h e r c h i l d r e n were s t r o n g , and i t was i m p o r t a n t t h a t t h e y remain t o g e t h e r . However, the mother d i d have p e r s o n a l and e m o t i o n a l problems w h i c h s e r i o u s l y a f f e c t e d h e r h e a l t h , and. s e n s i t i v e -casework t r e a t m e n t was an i m p o r t a n t p a r t of t h e ' s e r v i c e g i v e n . I n c i d e n t a l l y , t h i s f amily,now needs permanent h e l p i n the home i n o r d e r t o remain t o g e t h e r , and f o l l o w i n g a l a t e r r e - o p e n i n g the case was r e f e r r e d t o the p u b l i c - a s s i s t a n c e .agency, w h i c h has r e c e n t l y begun t o p r o v i d e payment of a housekeeper's wages f o r c e r t a i n f a m i l i e s on m a r g i n a l incomes who have a l o n g - t e r m p r o b l e m of t h i s n a t u r e . The t h r e e f a m i l i e s who r e q u e s t e d h e l p w i t h " o t h e r " problems w i l l be mentioned v e r y b r i e f l y , as t h e s e were the. o n l y c o n t i n u e d s e r v i c e cases where the p r e s e n t i n g p r o b l e m c o u l d not be c l a s s i f i e d under one of the headings p r e v i o u s l y d i s c u s s e d . A l l were c l o s e d as a completed a n d . s u c c e s s f u l s e r v i c e . One f a m i l y r e c e i v e d f i n a n c i a l a s s i s t a n c e - the f a m i l y mentioned i n Chapter T I . One a p p l i c a n t was a s e p a r a t e d f a t h e r who r e q u e s t e d h e l p i n p l a n n i n g f o r t h e c a r e o f h i s c h i l d r e n ; he was a s s i s t e d t o use a n o t h e r r e s o u r c e w h i c h was a v a i l a b l e t o him, - 104 -as a veteran.. A n o t h e r former c l i e n t , an immature woman., was h e l p e d t o i r o n out d i f f i c u l t i e s w h i c h had a r i s e n i n the course of v o c a t i o n a l t r a i n i n g , and was a l s o g i v e n some h e l p around employment problems. I n summary, the m a j o r i t y of the f a m i l i e s and i n d i -v i d u a l , c l i e n t s i n t h i s group r e c e i v e d a completed s e r v i c e w h i c h h e l p e d them t o a b e t t e r a d j u s t m e n t . E i g h t cases were c l o s e d by the caseworker as an i n c o m p l e t e s e r v i c e ; but j u s t s i x can be d e s c r i b e d as " d r o p - o u t s " . These i n c l u d e d a l l f o u r of the new a p p l i c a t i o n s f o r m a r i t a l c o u n s e l l i n g , the one . a p p l i c a t i o n f o r h e l p w i t h . a p r oblem of i n d i v i d u a l p e r s o n a l i t y a d j u s t m e n t , and one of the seven r e q u e s t s f o r s e r v i c e around problems of p a r e n t - c h i l d r e l a t i o n s h i p s or o t h e r f a m i l y r e l a t i o n s h i p prob-lems . Only one o f the " d r o p - o u t s " was t e c h n i c a l l y , a re-opened case, ( the D e l b e r t s ) , but a c t u a l l y the a p p l i c a n t i n . t h i s case had n o t p r e v i o u s l y been i n v o l v e d i n casework s e r v i c e . . Mr. •Delbert was o f f e r e d p r i o r i t y ; the o t h e r s were not g i v e n p r i o r i t y c o n s i d e r a t i o n . I n a l l of the s e cases the a p p l i c a n t s can be seen as p e r s o n s who might have been u n l i k e l y t o con-t i n u e i n any event',., There i s a good p o s s i b i l i t y , however, t h a t s e r v i c e o f f e r e d a t the p o i n t when a n x i e t y i m p e l l e d t h e s e a p p l i c a n t s t o c a l l f o r . h e l p would have been more e f f e c t i v e , and some might have been drawn i n t o casework t r e a t m e n t . - 1 0 5 -(b) Medium-Term Cases C o n t i n u e d s e r v i c e f o r p e r i o d s of between f o u r months and one y e a r was g i v e n t o t w e n t y - f o u r c a s e s , i n c l u d i n g twenty complete f a m i l i e s , t h r e e broken f a m i l i e s , and .one s i n g l e woman.. ( T a b l e 1 5 b ) Items of s e r v i c e provided, t o t h i s group t o t a l l e d 4 9 2 , about one t h i r d of the t o t a l " c o n t i n u e d s e r v i c e " . (See T a b l e 1 3 ) . F o r t y - t h r e e i n d i v i d u a l c l i e n t s r e c e i v e d a t o t a l of 2 7 6 p e r s o n a l i n t e r v i e w s . One case r e c e i v e d o n l y two p e r s o n a l i n t e r v i e w s ; one r e c e i v e d t h r e e p e r s o n a l i n t e r v i e w s ; and the others r e c e i v e d from f i v e t o t w e n t y - s i x i n t e r v i e w s p e r .case. The average .was about e l e v e n i n - p e r s o n i n t e r v i e w s . No homemaker s e r v i c e was p r o v i d e d t o any f a m i l y i n t h i s group. Other f i n a n c i a l a s s i s t a n c e was g i v e n i n f o u r c a s e s . Main problems p r e s e n t e d a t i n t a k e by the a p p l i c a n t s i n t h i s group were.as f o l l o w s : M a r i t a l d i f f i c u l t y 14 • M a r i t a l d i f f i c u l t y and p a r e n t s - c h i l d r e l a t i o n s h i p s 2 P a r e n t - c h i l d r e l a t i o n s h i p s 2 I n d i v i d u a l p e r s o n a l i t y adjustment 5 Homemaker a p p l i c a t i o n 1 Four fo r m e r c l i e n t s ' and f o u r new a p p l i c a n t s r e c e i v e d p r i o r i t y s e r v i c e . The a p p l i c a t i o n s g i v e n p r i o r i t y a t t e n t i o n i n c l u d e d t h r e e new r e q u e s t s f o r m a r i t a l c o u n s e l l i n g , two r e - a p p l i c a t i o n s f o r h e l p w i t h m a r i t a l problems, one r e q u e s t f o r h e l p w i t h p e r s o n a l i t y problems of a young p e r s o n , and two o t h e r cases i n v o l v i n g p e r s o n a l i t y adjustment (mental i l l n e s s i n each c a s e ) . Table 1 5 b . Items o f S e r v i c e , Medium-Term Cases Groups Number ( F a m i l i e s S e r v i c e s Rendered T o t a l Items and Persons) P e r s o n a l I n t e r v i e w s Telephone I n t e r v i e w s C o l l a t e r a l Homemaker F i n a n c i a l I n t e r v i e w s S e r v i c e A s s i s t a n c e of S e r v i c e Complete F a m i l i e s (20.) 2 2 5 110 •43 - 2 3 8 0 Husband 16 72 * * * * * . Wife 20 152 C h i l d 1 1 Broken F a m i l i e s (3) 36 26 8 - .1 71 Man 3 23 * * * * * Woman 2 13 S i n g l e Woman (I) 15 15 1 0 - 1 41 T o t a l ( 2 4 ) 43 (a) 2 7 6 : 151 6 1 . - 4 4 9 2 * Not s e p a r a t e d . (a) .43 i n d i v i d u a l c l i e n t s seen from 24 f a m i l i e s . - 107 -I n c l u d i n g the two a p p l i c a t i o n s where p a r e n t - c h i l d r e l a t i o n s h i p s were a l s o a main p r e s e n t i n g problem, t h e r e were s i x t e e n r e q u e s t s f o r h e l p w i t h m a r r i a g e problems i n t h i s group, and these w i l l be d i s c u s s e d t o g e t h e r . Seven f o r m e r c l i e n t s and .nine new a p p l i c a n t s asked f o r help, w i t h m a r i t a l d i f f i c u l t i e s . S i x re-opened cases c l o s e d as a completed and s u c c e s s f u l s e r -v i c e ; .one c l o s e d as i n c o m p l e t e s e r v i c e and w i t h a n e g a t i v e e v a l u a t i o n . . F i v e of the new cases were c l o s e d as a complete s e r v i c e and w i t h a p o s i t i v e e v a l u a t i o n ; t h r e e o t h e r s were judged t o have been h e l p e d though c l i e n t s withdrew b e f o r e s e r v i c e was c o n s i d e r e d complete by the caseworker; in.one case s e r v i c e was i n c o m p l e t e and the e v a l u a t i o n d o u b t f u l . A l l but two of the s i x t e e n c o u p l e s were judged t o have been h e l p e d by casework s e r v i c e . The cases which, r e c e i v e d p r i o r i t y a t t e n t i o n seem t o have been t h e ones w h i c h had the l e a s t s u c c e s s f u l outcome. T h i s was p a r t i c u l a r l y t r u e o f the new c a s e s . F o u r • o f the f i v e c o u p l e s r e c e i v i n g p r i o r i t y were judged t o have been h e l p e d , but two new.cases c l o s e d as an i n c o m p l e t e s e r v i c e , and I n one new case e v a l u a t i o n was not c o n s i d e r e d p o s s i b l e . T h i s might be e x p l a i n e d by t h e f a c t t h a t , w i t h one e x c e p t i o n , . a l l of the c o u p l e s who were g i v e n p r i o r i t y had r e a c h e d a p o i n t o f ' c r i s i s o r were on verge of s e p a r a t i o n b e f o r e s e r v i c e was r e q u e s t e d . I n a l l but t h r e e of the s i x t e e n m a r i t a l cases b o t h husband and w i f e were i n t e r v i e w e d . One former c l i e n t r e c e i v e d seven p e r s o n a l i n t e r v i e w s , t h o u g h . h i s w i f e was not i n v o l v e d i n - 108 >, s e r v i c e d u r i n g t h i s c o n t a c t . One new a p p l i c a n t , an e l d e r l y woman and r e c e n t b r i d e , was i n t e r v i e w e d t w i c e and then r e f e r r e d e l s e w h e r e f o r the s e r v i c e she needed when she d e c i d e d t o l e a v e h e r second husband. One o t h e r husband was n o t seen, and i n t h r e e cases the husband came i n f o r o n l y one i n t e r v i e w . I n t h e o t h e r t e n cases b o t h m a r i t a l p a r t n e r s were i n v o l v e d i n casework s e r v i c e . To i l l u s t r a t e t h e wide v a r i e t y of c l i e n t s and m a r i -t a l problems p r e s e n t e d , t h r e e cases w h i c h r e c e i v e d p r i o r i t y and t h r e e w h i c h d i d not g e t p r i o r i t y a t t e n t i o n w i l l be o u t l i n e d . ( l ) The F r e d e r i c k s . Mrs. F r e d e r i c k r e q u e s t e d an appointment t o t a l k over problems between me and my husband". She was g i v e n p r i o r i t y because she had r e q u e s t e d h e l p w i t h . t h e same pr o b l e m s i x months e a r l i e r , but had been r e f u s e d s e r v i c e a t t h a t time on a p o l i c y b a s i s because of the a c t i v i t y of a n o t h e r s o c i a l agency. Mrs. F r e d e r i c k ' s m o t i v a t i o n f o r s e r v i c e appeared t o be. good, •she had w a i t e d a l o n g time f o r the h e l p she wanted, and had r e - a p p l i e d when the s i t u a t i o n changed so t h a t h e r a p p l i c a t i o n c o u l d be a c c e p t e d . L a t e r i t was l e a r n e d t h a t she had r e c e i v e d casework h e l p f r o m a n o t h e r agency i n 1951 , and she had had a good p r e v i o u s e x p e r i e n c e w i t h s o c i a l w o r k e r s . The F r e d e r i c k s were b o t h about f o r t y . There were f i v e c h i l d r e n , most of them t e e n a g e r s . One o f the teenage boys had been i n d i f f i c u l t y . Mrs. F r e d e r i c k was q u i t e c e r t a i n t h a t the m a r i t a l d i f f i c u l t i e s were a f f e c t i n g h e r c h i l d r e n a d v e r s e l y , and t h a t t h i s was the main problem. She was p r o b a b l y r i g h t i n . t h i n k i n g t h i s . Mr. F r e d e r i c k was a mechanic, and had h i s own s m a l l b u s i n e s s . U n f o r t u n a t e l y , "the o t h e r woman" was a f i n a n c i a l p a r t n e r i n h i s b u s i n e s s . Mr. F r e d e r i c k had never been a s a t i s -f a c t o r y m a r r i a g e p a r t n e r , and t h i s was not the f i r s t time he had been i n v o l v e d i n e x t r a - m a r i t a l a f f a i r s . At t h i s t i me he had r e a l l y moved out of the m a r r i a g e , d i d not eat at home, and was not s u p p o r t i n g a d e q u a t e l y . However, Mrs. F r e d e r i c k was r e l u c t a n t t o s e p a r a t e from h er husband, and hoped the a f f a i r w i t h the o t h e r woman would "blow o v e r " . She d i d want t o r e c e i v e more adequate s u p p o r t , and hoped h er husband c o u l d be persuaded t o g i v e . h i s c h i l d r e n , more c o n s i d e r a t i o n . S e r v i c e g i v e n t o t h i s f a m i l y i n c l u d e d s i x p e r s o n a l i n t e r v i e w s w i t h Mrs. F r e d e r i c k and two w i t h h er husband. - 1 0 9 -Mr. F r e d e r i c k when seen made i t c l e a r t h a t as f a r 'as he was concerned the m a r r i a g e was f i n i s h e d . He s a i d he wanted a d i v o r c e , and c o u l d o n l y see the agency was h e l p i n g him by f a c i -l i t a t i n g t h i s . He d i d agree t o support t h e f a m i l y b e t t e r . Mrs. F r e d e r i c k was g i v e n s u p p o r t i v e h e l p i n coming t o a d e c i -s i o n about h e r m a r r i a g e , and i n meeting p r a c t i c a l p r o b l e m s . She was an i n t e l l i g e n t woman, though p o o r l y e d u c a t e d . She had hung on t o o l o n g t o a shaky m a r r i a g e t o an inadequate man, but the caseworker saw her as a p e r s o n w i t h c o n s i d e r a b l e ego s t r e n g t h . She r e l a t e d w e l l .and .used casework h e l p e f f e c t i v e l y . Mrs. F r e d e r i c k e v e n t u a l l y d e c i d e d t o l e a v e h er husband and move w i t h h e r f i v e c h i l d r e n t o a town In t h e i n t e r i o r where h e r p a r -e n t s would be a v a i l a b l e t o h e l p h e r . T h i s she- d i d , and from s e v e r a l l e t t e r s she wrote t o t h e worker she appeared t o be s a t i s f i e d w i t h h er d e c i s i o n - .she s a i d she and the c h i l d r e n were much h a p p i e r . The above case was c l o s e d as a complete and s u c c e s s -f u l s e r v i c e . I t might be n o t e d t h a t a l t h o u g h t h i s was t e c h n i c a l l y a re-opened c a s e , a c t u a l l y Mrs. F r e d e r i c k had not p r e v i o u s l y r e c e i v e d s e r v i c e f r om the agency.. (2) The G a v i n s . Mrs. G a v i n , a forme r c l i e n t , came t o t h e o f f i c e w i t h o u t appointment, h o p i n g t o see her former caseworker. She s a i d she was on the p o i n t of l e a v i n g her hus-band. She was g i v e n p r i o r i t y because of t h e c r i s i s s i t u a t i o n . , and because she seemed t o be i n d e s p e r a t e need o f a d v i c e and e m o t i o n a l s u p p o r t . Mrs. G a v i n ' s m o t i v a t i o n f o r casework s e r v i c e might be c o n s i d e r e d " f a i r " , . a p a r t from the c r i s i s s i t u a t i o n . There had been t h r e e p r e v i o u s c o n t a c t s . In. 1 9 5 0 and a g a i n i n 1 9 5 1 Mrs. Gavin had made a t e n t a t i v e approach t o the agency, t h e second time t o ask f o r a d v i c e about o b t a i n i n g s u p p o r t as her husband had l e f t h e r . There had a l s o been a c o n t a c t c o v e r i n g about s i x months i n 1 9 5 7 when b o t h p a r t n e r s were i n v o l v e d and m a r i t a l c o u n s e l l i n g was g i v e n . The Gavins were now i n t h e i r mid t h i r t i e s , and had f o u r c h i l d r e n . Mr: Gavin when employed d i d u n s k i l l e d o r semi-s k i l l e d work; he was unemployed a t the time of t h i s a p p l i c a t i o n . He changed j o b s f r e q u e n t l y , was o f t e n out of work, and the f a m i l y d i d not r e c e i v e adequate s u p p o r t . When Mrs. Gavin a p p l i e d f o r h e l p t h e y were f a c i n g e v i c t i o n because of a r r e a r s of r e n t . She f e l t she c o u l d no l o n g e r t o l e r a t e the f i n a n c i a l i n s e c u r i t y , and d e c i d e d t o l i v e a p a r t from her husband. She wanted t o know about h er l e g a l p o s i t i o n and p r o s p e c t s of sup-p o r t , and whether she might be c o n s i d e r e d as n e g l e c t i n g her • c h i l d r e n i f she t o o k employment h e r s e l f . - 110 -Casework s e r v i c e t o t h i s c o u p l e c o v e r e d a p e r i o d of seven months and i n c l u d e d t h r e e p e r s o n a l i n t e r v i e w s w i t h Mrs. G a v i n , e l e v e n p e r s o n a l i n t e r v i e w s w i t h Mr. G a v i n , and about twenty-two t e l e p h o n e i n t e r v i e w s . -Mr. Gavin was v e r y a n x i o u s f o r r e c o n c i l i a t i o n w i t h h i s w i f e , and i n v o l v e d h i m s e l f i n casework t r e a t m e n t as he had not done p r e v i o u s l y . I n the b e g i n n i n g Mrs. Gavin was l e s s i n t e r e s t e d i n t r y i n g a g a i n t o make a go .of the m a r r i a g e . Casework t r e a t m e n t was m a i n l y s u p p o r t i v e , w i t h some c l a r i f i c a t i o n w i t h each m a r i t a l p a r t n e r around r e a c t i o n s of the o t h e r , and the . c h i l d r e n . 1 Problems d i s c u s s e d w i t h b o t h i n c l u d e d p a s t and p r e s e n t d i f f i c u l t i e s i n the m a r i t a l r e l a t i o n -s h i p and p r o s p e c t s o f a b e t t e r adjustment i n the f u t u r e , employ-ment p r o s p e c t s f o r b o t h of them, the e f f e c t on the c h i l d r e n of the s e p a r a t i o n , and Mrs. Gavin's nervousness and f a t i g u e and h e r need f o r m e d i c a l e x a m i n a t i o n . There was a l s o e x p l o r a t i o n of h o u s i n g and employment r e s o u r c e s . In the course of the c o n t a c t Mrs. Gavin came c l o s e r t o r e a l i s t i c t h i n k i n g about t h e d i f f i c u l t i e s of l i v i n g sep-a r a t e l y . . Mr.y „Gavin, whose tendency had been t o deny r e s p o n -s i b i l i t y , p r o g r e s s e d i n s e e i n g t h a t he had c o n t r i b u t e d t o m a r i -t a l d i f f i c u l t i e s , . a n d i n r e c o g n i z i n g the e f f e c t h i s b e h a v i o u r and t h e f i n a n c i a l v i s c i s s i t u d e s had had on h i s w i f e . A l s o , he became more aware of how much h i s home and f a m i l y meant t o him. He was a b l e t o d i s c u s s w i t h t h e worker h i s d e s i r e t o behave i m p u l s i v e l y , but t o see t h a t he had a b i l i t y t o c o n t r o l t h i s . W i t h much encouragement, he s e c u r e d employment. T h i s f a c t , and the worker's commendation of h i s good q u a l i t i e s as a f a t h e r , h e l p e d him t o g a i n more c o n f i d e n c e i n h i s w o r t h as a p e r s o n . At t e r m i n a t i o n of the case the Gavins had agreed t o t r y l i v i n g t o g e t h e r a g a i n . Mr. Gavin was w o r k i n g , and Mrs. G a v i n had d e c i d e d the c h i l d r e n ' s needs were more i m p o r t a n t t h a n f o r her t o work. The caseworker judged t h a t t h e f a m i l y had been h e l p e d by the s e r v i c e g i v e n , w h i c h seems c l e a r . (2) The Harmons. The Harmons were r e f e r r e d by the F a m i l y Court.. Mrs.Harmon had l e f t the home w i t h t h e c h i l d r e n f o l l o w i n g a s e v ere q u a r r e l , when Mr. Harmon t h r e a t e n e d t o k i l l h e r . B o t h s a i d t h e y were w a n t i n g m a r r i a g e c o u n s e l l i n g . Mrs. Harmon t e l e p h o n e d the agency t o r e q u e s t an Immediate a p p o i n t -ment, as she s a i d she d i d not know whether t o r e t u r n home. Mr. Harmon was on t h e t e l e p h o n e a t the same t i m e , a l s o r e q u e s t -i n g s e r v i c e , and e x p r e s s i n g g r e a t remorse. P r i o r i t y was o f f e r e d because of the tenuous m a r i t a l s i t u a t i o n . A l s o , . b o t h were th e n 1 Terms used as i n Scope and Methods of the F a m i l y S e r v i c e Agency: Report of The Committee on Methods and Scope, The F a m i l y S e r v i c e A s s o c i a t i o n of A m e r i c a , New York, 1 9 5 3 . - I l l -r e q u e s t i n g s e r v i c e but m o t i v a t i o n appeared d o u b t f u l , and i t seemed n e c e s s a r y t o move q u i c k l y i f t h e y were t o be h e l p e d . T h i s c o u p l e had been m a r r i e d d u r i n g the war, and both.were now over f o r t y . They had two c h i l d r e n , aged t e n and t w e l v e . Mr. Harmon was a f a i r l y w e l l educated man., h i s employ-ment was of a s e m i - p r o f e s s i o n a l n a t u r e , and the f a m i l y income was good. Though t h e i r backgrounds were s i m i l a r i n many ways, Mrs. Harmon was l e s s w e l l educated, and l e s s i n t e l l i g e n t . . There was a m a r i t a l p r o b l e m of l o n g s t a n d i n g . Mr. Harmon was a s e l f - c e n t r e d man,.with l i t t l e a b i l i t y i n p e r s o n a l r e l a t i o n -s h i p s . He had a wide range of i n t e r e s t s and h o b b i e s of a s e l f - i m p r o v e m e n t n a t u r e on w h i c h he spent most of h i s t i m e . H i s w i f e had no i n t e r e s t I n the s e p u r s u i t s . He complained t h a t she was "immature", u n a b l e t o share h i s i n t e r e s t s , and t h a t she pampered the c h i l d r e n . Mrs. Harmon complained of h i s temper, t h a t he was j e a l o u s of the c h i l d r e n , and t h a t he t r e a t e d h e r as a s e r v a n t r a t h e r than as a w i f e . B o t h had been d e p r i v e d i n c h i l d h o o d , i n d i f f e r e n t ways, and b o t h appeared t o be v e r y dependent p e o p l e . Mr. Harmon's f a t h e r had p r o v i d e d him w i t h a d i s t o r t e d male i d e n t i f i c a t i o n . He d i s t r u s t e d women, had a marked i n a b i l i t y t o share i n p e r s o n a l r e l a t i o n s h i p s , and was j e a l o u s o f h i s w i f e ' s a b i l i t y t o make f r i e n d s . He had l i t t l e t o do w i t h . h i s c h i l d r e n . .Because of her own t r o u b l e d c h i l d h o o d , Mrs. Harmon had a g r e a t need f o r a p p r o v a l , but she was r e c e i v -i n g v e r y l i t t l e support' from her husband. She was showing h e r need f o r a t t e n t i o n and her l i m i t e d f e e l i n g s , of s e l f - w o r t h by m a s o c h i s t i c b e h a v i o u r i n a n t a g o n i z i n g her.husband and r e c e i v -i n g abuse from him.. She had t u r n e d t o h e r c h i l d r e n f o r s a t i s -f a c t i o n and was o v e r - p r o t e c t i v e of them. S e r v i c e t o t h i s c o u p l e c o n s i s t e d of e i g h t p e r s o n a l i n t e r v i e w s and about the same number of t e l e p h o n e i n t e r v i e w s . Mr. Harmon came i n f o r o n l y two i n t e r v i e w s , and was not r e a l l y engaged i n casework t r e a t m e n t a t t h i s t i m e . Casework h e l p t o . Mrs. Harmon was l a r g e l y s u p p o r t i v e i n n a t u r e . E f f o r t s were made t o improve h e r f e e l i n g s o f s e l f - w o r t h , t o h e l p her r e l a x h er o v e r - p r o t e c t i v e ' a t t i t u d e t o her c h i l d r e n , and t o a c c e p t the f a c t t h a t h er husband was u n a b l e t o share i n the m a r r i a g e r e l a t i o n s h i p e x c e p t on a s u p e r f i c i a l l e v e l , and w i t h s u p p o r t from h e r . Mrs.lHarmon appeared t o p r o g r e s s a l o n g t h e s e l i n e s . She d e c i d e d t o remain i n t h e m a r r i a g e because she was f e a r f u l o f t h e a l t e r n a t i v e s . She managed t o l e s s e n h e r a f f e c t i o n a l demands on her husband, and t o do more e n t e r t a i n i n g and i n t e r e s t h e r s e l f i n group a c t i v i t i e s w h i c h gave her s a t i s -f a c t i o n i n an a r e a where, she c o u l d s h i n e . As the m a r r i a g e was i n a r e l a t i v e l y s t a b l e p e r i o d and Mrs. Harmon f e l t more a b l e t o cope w i t h h er problems, she d e c i d e d t o withdraw from the con-t a c t , s a y i n g she would r e t u r n I f n e c e s s a r y . When the case was c l o s e d the caseworker•commented'that the m a r i t a l adjustment s t i l l d i d not appear t o be good. N e v e r t h e l e s s i t was judged t h a t the f a m i l y had been h e l p e d by the s e r v i c e g i v e n . - .112 -The above case was re-opened about f i v e months a f t e r c l o s i n g , as Mr. Harmon requested, h e l p because of "severe m a r i -t a l p roblems". He c l a i m e d h i s w i f e ' s b e h a v i o u r had changed and she was no l o n g e r i n t e r e s t e d i n the home. He was v e r y u p s e t j s a y i n g he f e a r e d breakup of t h e m a r r i a g e . P r o s p e c t s f o r h e l p i n g the c o u p l e seemed b r i g h t e r when i t was p o s s i b l e t o engage b o t h of them i n casework t r e a t m e n t . However, i t appears t h a t t h i s i s a very, d i f f i c u l t c a s e , an i n t r a c t a b l e m a r i t a l p r o b l e m o f the s o r t .which w i l l be mentioned l a t e r , where a c o u p l e seem q u i t e . u n a b l e t o meet one a n o t h e r ' s needs. The p r e s e n t o u t l o o k i s t h a t the Harmons w i l l be w i t h the agency f o r some t i m e . I t i s now e v i d e n t t h a t b o t h o f the Harmons have p e r s o n a l i t y d i s o r d e r s w h i c h make i t v e r y d i f f i c u l t f o r them t o m o d i f y t h e i r b e h a v i o u r . However, t h e y have been m a r r i e d almost twenty y e a r s and a r e l i k e l y t o remain t o g e t h e r , as w i t n e s s Mr. Harmon's p a n i c a t the thought of separation,. The e f f e c t of m a r i t a l s t r i f e and p a r e n t a l p e r s o n a l i t y d i f f i c u l t y on t h e c h i l d r e n i n t h i s home i s o b v i o u s . The f o l l o w i n g t h r e e cases d i d not r e c e i v e p r i o r i t y attention... (4) The I r w i n s . Mr. I r w i n , a new a p p l i c a n t , sought c o u n s e l l i n g f o r h i m s e l f and h i s w i f e because of m a r i t a l f r i c t i o n a r i s i n g out of "nervous t e n s i o n " , caused, he s a i d , because h i s w i f e c o u l d not " s t a n d up t o t h e r e s p o n s i b i l i t y of c a r i n g f o r the c h i l d r e n " . W i t h r e g a r d t o m o t i v a t i o n , Mr. I r w i n d e f i n i t e l y wanted h i s w i f e t o have h e l p , but In the b e g i n n i n g had l e s s awareness of h i s own p a r t i n d i f f i c u l t i e s and need t o p a r t i -c i p a t e . Mrs. I r w i n seemed t o have some f e e l i n g t h a t she .needed h e l p , but was v e r y a m b i v a l e n t and h e s i t a n t . She s a i d she was w i l l i n g t o come i n because her husband f e l t she needed i t -not t h a t she wanted i t . They w a i t e d about t h r e e weeks f o r s e r v i c e . - 113 --M r s . I r w i n was t w e n t y - f i v e , her husband, about t h i r t y , and t h e y had., two s m a l l c h i l d r e n . Mr. I r w i n was a s k i l l e d worker,. w i t h a j o b w h i c h o f f e r e d c o n s i d e r a b l e s e c u r i t y of t e n u r e and moderate r e m u n e r a t i o n . B e s i d e s t h i s , he d i d o t h e r work as a s i d e l i n e . B o t h were q u i t e i n t e l l i g e n t . Mr. I r w i n found h i s work s a t i s f y i n g , , but not h i s r o l e as a husband and f a t h e r . Mrs. I r w i n was most d i s s a t i s f i e d i n her r o l e as w i f e and mother, f e l t r e s e n t f u l , and s u f f e r e d f r o m p s y c h o s o m a t i c symptoms and an i n a b i l i t y t o c o n t r o l her 'emotions. As the e l d e s t i n her own f a m i l y she had been g i v e n e x c e s s i v e r e s p o n s i b i l i t y f o r younger s i b l i n g s f r om an e a r l y age, had r e s e n t e d t h i s , and f e l t h e r mother had d i s c r i m i n a t e d a g a i n s t her i n f a v o u r of a s i s t e r . Mr. I r w i n a l s o f e l t he was t h e l e a s t f a v o u r e d c h i l d i n h i s f a m i l y . Each had had a f a n t a s y o f m a r r i a g e and was d i s a p p o i n t e d i n the r e a l i t y . The m a r r i a g e was s u f f e r i n g f r om l a c k o f com-m u n i c a t i o n and mutual s u p p o r t between the p a r t n e r s . • S e r v i c e t o t h i s c o u p l e i n c l u d e d e i g h t e e n I n t e r v i e w s over•a p e r i o d of s i x months. Mr. I r w i n came i n f o r t e n i n t e r -v i e w s ; .his w i f e was seen e i g h t t i m e s . B o t h were a b l e t o r e l a t e w e l l t o the caseworker and used casework h e l p e f f e c t -i v e l y a t d i f f e r e n t t i m e s ; but p r o g r e s s i n t h i s case had r a t h e r a r o c k y r o a d , as the I r w i n s were c o m p e t i t i v e w i t h r e g a r d t o the w o r k e r . When one seemed t o be making p r o g r e s s t h e o t h e r would be i n c l i n e d t o . w i t h d r a w . Because of t h e i r uneven p r o g r e s s , improvement and r e l a p s e i n t h e i r r e l a t i o n s h i p brought p e r i o d i c •disappointment. However, t h e y d i d p r o g r e s s i n t h e i r under-s t a n d i n g o f one a n o t h e r , and I n t h e i r a b i l i t y t o f u l f i l l t h e i r r o l e s i n m a r r i a g e and p a r e n t h o o d . I n i t i a l l y Mr. I r w i n saw c o u n s e l l i n g s e r v i c e as h e l p i n g h i s w i f e ; he a c c e p t e d h i s p e r -s o n a l r e s p o n s i b i l i t y f o r t h e r e l a t i o n s h i p i n t e l l e c t u a l l y , but not e m o t i o n a l l y , b u t made p r o g r e s s i n t h i s r e g a r d . Each was h e l p e d t o d i s c u s s t h e i r e x p e c t a t i o n s o f m a r r i a g e , t h e i r own r o l e s and t h a t of t h e i r p a r t n e r , . a n d t h e i r r e l a t i o n s h i p s w i t h p e e r s . Treatment was l a r g e l y s u p p o r t i v e , w i t h some c l a r i f i c a t i o n . When t h e case was c l o s e d Mrs. I r w i n s a i d " t h i n g s are g o i n g v e r y w e l l f o r u s " . (5) The James. Mrs. James r e q u e s t e d h e l p w i t h mar-r i a g e p r o b l e m s . She had been m a r r i e d j u s t seven months. She e x p l a i n e d t h a t t h e t r o u b l e was h e r husband had no r e s p e c t f o r h e r , due,.she t h o u g h t , t o the f a c t t h a t he had had a v e r y d i f f i c u l t c h i l d h o o d . T h i s had a f f e c t e d her n e r v e s t o the p o i n t where her d o c t o r had a d v i s e d h e r t o stop work f o r t h r e e months. S e r v i c e was g i v e n i n t h r e e weeks t i m e . Mrs. James 1 m o t i v a t i o n , f o r s e r v i c e was good; her husband was r e l u c t a n t t o p a r t i c i p a t e . The James were a v e r y young co u p l e - Mrs.James was j u s t n i n e t e e n . Mr. James was employed i n s k i l l e d work, and - .114 -Mrs. James had a c l e r i c a l j o b . When b o t h were w o r k i n g t h e i r combined income was $500 a month.. Mr. James had had a very-d i f f i c u l t c h i l d h o o d . H i s f a m i l y background was c o m p l i c a t e d , and t h i s had l e f t him a c o n f u s e d young man. Mrs. James had been more f o r t u n a t e . She was s t i l l Immature and somewhat t i e d t o her mother. She was " l i k e a good l i t t l e g i r l - always a n x i o u s t o do the r i g h t t h i n g " . A d m i t t e d l y , Mrs. James had m a r r i e d w i t h the i d e a of h e l p i n g her husband t o overcome h i s unhappy background, but was q u i t e u nprepared f o r r e l a t i o n s h i p problems w h i c h f o l l o w e d . S e r v i c e t o t h i s c o uple i n c l u d e d two i n t e r v i e w s w i t h the husband and s i x w i t h the w i f e . Mr. James f o u n d i t v e r y d i f f i c u l t t o come i n , and was t o o u n c o m f o r t a b l e t o .continue p a s t the second i n t e r v i e w . The caseworker had the i m p r e s s i o n t h a t he would l i k e t o gain.some u n d e r s t a n d i n g of h i s c o n f u s e d f e e l i n g s about h i s f a m i l y , but found i t t o o d i s t u r b i n g a t t h i s time,. Mrs, James, though a n x i o u s t o have a "mother" t o guide he r , a l s o showed a s t r o n g d e s i r e t o grow up. She wanted t o l e a r n t o be a good w i f e . Though i n c l i n e d t o be dependent on the worker t o t e l l h e r what t o do, she was a b l e t o l o o k a t h e r b e h a v i o u r i n a . r e a l i s t i c way. B o t h the James seemed t o g a i n a c l e a r e r p i c t u r e of t h e i r . r e s p e c t i v e r o l e s i n m a r r i a g e . They p r o g r e s s e d i n t h e i r a b i l i t y t o communicate w i t h one a n o t h e r and t o d i s c u s s d i f f i c u l t i e s t h a t a r o s e . Mr. James r e a l i z e d f o r the f i r s t time how u p s e t t i n g h i s s e l f - c e n t r e d b e h a v i o u r had been t o h i s w i f e . Mrs. James f i n a l l y d i s c o n t i n u e d the c o n t a c t , as her husband d i d not w i s h h e r t o c o n t i n u e . She was back a t work, and f e e l i n g l e s s nervous and more h o p e f u l about her m a r r i a g e . The I r w i n case and the James case b o t h i l l u s t r a t e m a r r i a g e c o u n s e l l i n g w i t h young p e o p l e whose m a r i t a l problems had not r e a c h e d a c h r o n i c s t a g e . I n each c a s e , t h e y were new a p p l i c a n t s . The f o l l o w i n g i l l u s t r a t i o n i s an example of s u c c e s s f u l s e r v i c e t o a middle-aged c o u p l e , who had had m a r i t a l and o t h e r f a m i l y t r o u b l e s f o r many y e a r s , and who had p r e v i o u s l y r e c e i v e d e x t e n s i v e s e r v i c e around these same problems. (6) The K e l v i n s . Mrs. K e l v i n r e q u e s t e d an appointment t o d i s c u s s m a r i t a l d i f f i c u l t i e s and f a m i l y problems - her husband's " s u l k l n e s s " and h o s t i l i t y toward a son and daughter i n t h e i r l a t e t e e n s who were b o t h unemployed and i n the home at t h i s t i m e . Mr. K e l v i n was v e r y r e s e n t f u l about t h i s . - 115 -The agency had had a l o n g and I n t e n s i v e c o n t a c t w i t h the f a m i l y d u r i n g 1953 and 195^. B o t h p a r t n e r s were seen r e g u l a r l y a t t h a t t i m e , and casework s e r v i c e was a l s o g i v e n t o one o f the d a u g h t e r s . The o l d e r - c h i l d r e n i n the home had been drawn i n t o t h e m a r i t a l c o n f l i c t , and the second daughter, then i n h e r e a r l y t e e n s , was a r e b e l l i o u s g i r l i n open c o n f l i c t w i t h her f a t h e r . Mr. K e l v i n , a r i g i d and r e s t r i c t e d p e r s o n , had been much d e p r e c i a t e d by h i s w i f e , who had e n l i s t e d t h e c h i l d r e n - o n h e r s i d e i n the m a r i t a l s t r u g g l e , i s o l a t i n g h e r husband from f a m i l y l i f e . Mrs-. K e l v i n . w a s a p a s s i v e , dependent p e r s o n , who had s u f f e r e d extreme d e p r i v a t i o n . i n c h i l d h o o d . She was i n c l i n e d t o e x p r e s s h er h o s t i l i t y t o her husband by poor housekeeping, i n f u r i a t i n g t o a man of h i s temperament. As each was u n a b l e t o meet the o t h e r ' s needs, .they had i n t e n -s i f i e d each o t h e r ' s p r o b l e m s . The p a r e n t s had s e p a r a t e d f o r a month d u r i n g t h e c o n t a c t , but d e c i d e d t o go back t o g e t h e r . As economic problems and r i v a l r y between the two o l d e r g i r l s had eased, t h e case was c l o s e d . Now Mrs. K e l v i n was i n her l a t e f o r t i e s , and h e r husband was over f i f t y . Of t h e i r f i v e c h i l d r e n , the e i g h t e e n y e a r o l d son and two s m a l l c h i l d r e n under ten' were s t i l l i n the home. Mr. K e l v i n was now i n i n d i f f e r e n t h e a l t h . . He had t r a i n i n g o n l y f o r s e m i - s k i l l e d work, w h i c h was t o o h a r d f o r him p h y s i c a l l y , but he worked h a r d and had a good employment r e c o r d . S e r v i c e d u r i n g t h i s c o n t a c t c o v e r e d e i g h t months and i n c l u d e d twenty-.six i n - p e r s o n i n t e r v i e w s , e i g h t w i t h Mr. K e l v i n and e i g h t e e n w i t h h i s w i f e . Help g i v e n t o Mr. K e l v i n was' s u p p o r t i v e , .The caseworker d i d not t h i n k he c o u l d change h i s a t t i t u d e s a t t h i s p o i n t , but hoped he might respond i f h i s w i f e c o u l d g i v e him more c o n s i d e r a t i o n . I n view of h i s p e r s o n a l i t y and h i s p h y s i c a l . c o n d i t i o n he appeared t o be d o i n g h i s b e s t , and he was g i v e n r e c o g n i t i o n f o r t h i s by the wor k e r . The worker was much more d i r e c t w i t h Mrs. K e l v i n . Much time was spent i n h e l p i n g h e r t o see t h a t h e r c h i l d r e n needed t o be more independent, and t h a t she s h o u l d g i v e h e r husband more time and a t t e n t i o n . n o w . When she was a b l e t o do t h i s , he r e a c t e d p o s i t i v e l y , and t h e s i t u a t i o n eased. When t h e worker l e f t t he agency Mrs. K e l v i n f e l t no need t o c o n t i n u e , e s p e c i a l l y as her husband was u n c o m f o r t a b l e about the c o n t a c t . I n two cases the main p r e s e n t i n g p r o blem was one of p a r e n t - c h i l d r e l a t i o n s h i p s . B o t h f a m i l i e s r e c e i v e d a completed s e r v i c e w h i c h was c o n s i d e r e d t o have been h e l p f u l t o them. These cases w i l l n o t be p r e s e n t e d i n any d e t a i l . However, comparison of the problems as d e s c r i b e d by the a p p l i c a n t s a t - 116-i n t a k e does r a i s e some q u e s t i o n about the v a l i d i t y of p r i o r i t y assignment of the r e c u r r e n t c a s e ; -whereas the n e w . a p p l i c a n t d i d not r e c e i v e t h i s c o n s i d e r a t i o n , a l t h o u g h p r e s e n t i n g a prob-lem w h i c h was much more s e r i o u s . In one i n s t a n c e a former c l i e n t who had r e c e n t l y r e c e i v e d e x t e n s i v e and v e r y s u c c e s s f u l casework s e r v i c e , a l o n g w i t h h er husband and teen-age son, t e l e p h o n e d t h e i r f o r m e r w o r k e r . t o r e q u e s t f o l l o w - u p I n t e r -views t o d i s c u s s e d u c a t i o n a l p l a n s f o r t h e boy. A l t h o u g h the a p p l i c a n t s a i d t h e r e was no urgency, she was g i v e n an a p p o i n t -ment a week l a t e r . The new a p p l i c a n t e x p r e s s e d grave doubts about the r e l a t i o n s h i p between her husband and t h e i r t w e l v e y e a r 'old daughter-, s a y i n g t h a t the f a t h e r t o o k an "improper i n t e r e s t " i n the c h i l d . . T h i s a p p l i c a n t w a i t e d f i v e weeks f o r • s e r v i c e . When s e r v i c e was g i v e n and b o t h p a r e n t s and t h e daughter were i n t e r v i e w e d the caseworker was s a t i s f i e d t h a t t h e r e was no b a s i s f o r the mother's s u s p i c i o n s , w h i c h r e s u l t e d from her own p r e c a r i o u s m ental b a l a n c e . However, the s i t u a t i o n was s e r i o u s enough, and t h i s had been e v i d e n t a t i n t a k e . I t i s v e r y d i f f i c u l t t o j u s t i f y t h e f a c t t h a t p r i o r i t y s e r v i c e was not o f f e r e d t o the new a p p l i c a n t . W i t h r e g a r d t o t h e form e r c l i e n t , perhaps the d i s c r e p a n c y can be e x p l a i n e d i n p a r t by s u g g e s t i n g t h a t caseworkers n a t u r a l l y t e n d t o have s t r o n g i d e n t i f i c a t i o n w i t h f a m i l i e s t h e y have h e l p e d . T h i s may be p a r t i c u l a r l y t r u e i f c h i l d r e n have been d i r e c t s e r v i c e . On the o t h e r hand, u n l e s s caseworkers are a l s o i n v o l v e d i n i n t a k e , the p l i g h t o f i n d i v i d u a l a p p l i c a n t s on the - 1 1 7 -w a i t i n g l i s t does not have the same meaning f o r them. F i v e a p p l i c a n t s i n t h i s group p r e s e n t e d a pr o b l e m of I n d i v i d u a l p e r s o n a l i t y adjustment of a f a m i l y member. I n a l l of t h e s e cases the c a s e w o r k e r s ' c l o s i n g e v a l u a t i o n s i n d i c a t e d t h a t the i n d i v i d u a l s or t h e i r f a m i l i e s had been h e l p e d by the s e r v i c e g i v e n , and f o u r c l o s e d as a completed s e r v i c e . Two were new cases and t h r e e were re-opened. One new a p p l i c a n t and two former c l i e n t s r e c e i v e d p r i o r i t y s e r -v i c e . The new a p p l i c a n t was a v e r y young p e r s o n , a g i r l o f n i n e t e e n ; i n the re-opened cases r e c e i v i n g p r i o r i t y mental i l l n e s s of a f a m i l y member had p r e c i p i t a t e d the r e q u e s t f o r s e r v i c e . F a m i l y members whose problems were the r e a s o n f o r the a p p l i c a t i o n were: an e i g h t y e a r o l d boy,•a g i r l o f n i n e t e e n , a woman of about t h i r t y , and two men who were m e n t a l l y 111 (one young and one m i d d l e - a g e d ) . The case w h i c h c l o s e d as an i n c o m p l e t e s e r v i c e was t h e one where t h e p r e s e n t i n g p r o b l e m was the adjustment of a n , e i g h t y e a r o l d boy, who was h a v i n g d i f f i c u l t y a t t e n d i n g s c h o o l . H i s p a r e n t s were h e l p e d w i t h ...their r e l a t i o n s h i p w i t h him, w h i c h eased h i s p roblems. How-ev e r , t h e r e was o b v i o u s l y a m a r i t a l d i f f i c u l t y , w i t h w h i c h t h e y d i d n o t want he l p . . T h i s was a re-opened c a s e , the f a m i l y hav-i n g r e c e i v e d homemaker s e r v i c e some y e a r s b e f o r e . However, t h e y had not p r e v i o u s l y been i n v o l v e d i n casework s e r v i c e t o any e x t e n t , and i n f a c t d i d not remember t h a t they,had had a p r e v i o u s c o n t a c t w i t h the agency. - 118 -The two i l l u s t r a t i o n s w h i c h a re b e i n g p r e s e n t e d cannot be c o n s i d e r e d as r e p r e s e n t a t i v e of the wide v a r i e t y of f a m i l y s i t u a t i o n s and problems p r e s e n t e d by the s e a p p l i c a n t s . However, t h e y do g i v e some i n d i c a t i o n of the range .of problems, and of s e r v i c e p r o v i d e d . ( l ) The L e s t e r s . Mrs. L e s t e r a r r i v e d .at the o f f i c e w i t h o u t an appointment, s e e k i n g a d v i c e and h e l p i n a desper-a t e f a m i l y c r i s i s caused by her husband's mental i l l n e s s . She s a i d she was now a f r a i d of h e r husband, and f r o m h er d e s c r i p t i o n of h i s v i o l e n t :and b i z a r r e b e h a v i o u r i t c e r t a i n l y appeared t h a t she had r e a s o n t o be f r i g h t e n e d . Her two t e e n -age c h i l d r e n were a l s o much u p s e t . Mrs. L e s t e r was a n x i o u s t o move out of the home, but she had no funds whatever. She wanted t o a r r a n g e f o r her husband's committment t o mental h o s p i t a l f o r t r e a t m e n t , but d i d not know how t o go about t h i s . Mrs. L e s t e r was g i v e n immediate f i n a n c i a l a s s i s t a n c e by t h e i n t a k e worker so t h a t she and the c h i l d r e n c o u l d s t a y away from, the home t e m p o r a r i l y . She was a l s o g i v e n a d v i c e and supp o r t w h i c h e n a b l e d h er t o a r r a n g e f o r her husband's h o s p i -t a l i z a t i o n , i n the f a c e o f c o n s i d e r a b l e d i f f i c u l t y . The case was then a s s i g n e d on a p r i o r i t y b a s i s . Mrs. L e s t e r had a s t r o n g d e s i r e f o r h e l p i n the d e s p e r a t e s i t u a t i o n , but from a p r e v i o u s c o n t a c t w i t h h er as an a l c o h o l i c ' s w i f e i t was doubt-f u l how much m o t i v a t i o n she would have t o i n v o l v e h e r s e l f i n ongoing casework t r e a t m e n t . However, she was v e r y concerned about p r e s s i n g f i n a n c i a l problems, v e r y poor h o u s i n g i n -a slum a r e a , and e m o t i o n a l d i f f i c u l t i e s of her c h i l d r e n r e s u l t i n g f r o m t r a u m a t i c e v e n t s i n the f a m i l y l i f e . Mrs. L e s t e r was over f i f t y . She was employed i n a c l e r i c a l p o s i t i o n a t a s m a l l s a l a r y , . a n d was the s o l e f a m i l y b readwinner a t t h i s t i m e . She was e v i d e n t l y a p e r s o n of c o n s i d e r a b l e s t r e n g t h and competence i n p r a c t i c a l m a t t e r s . Her husband had had s e v e r a l h o s p i t a l i z a t i o n s f o r a l c o h o l i s m , and one p r e v i o u s h o s p i t a l i z a t i o n f o r me n t a l i l l n e s s . He had not worked s t e a d i l y f o r y e a r s , and had not su p p o r t e d the f a m i l y w e l l when he d i d work. At one time he had h e l d r e s p o n -s i b l e p o s i t i o n s , and t h e r e were.many i n d i c a t i o n s t h a t the f a m i l y had come down i n the w o r l d . B e s i d e s the p a r e n t s , the f a m i l y I n c l u d e d ' a son..attending u n i v e r s i t y and a daughter i n h i g h s c h o o l . B o t h of the c h i l d r e n were v e r y b r i g h t . S e r v i c e t o t h i s f a m i l y c o v e r e d e i g h t months and i n c l u d e d t e n i n - p e r s o n i n t e r v i e w s and numerous t e l e p h o n e I n t e r v i e w s w i t h Mrs. L e s t e r , one i n t e r v i e w w i t h her daughter, and q u i t e a number o f c o l l a t e r a l c o n t a c t s . The h e l p g i v e n was of a s u p p o r t i v e and e n v i r o n m e n t a l n a t u r e . Mrs. L e s t e r was - 119 -g i v e n e m o t i o n a l s u p p o r t i n a l l a y i n g h e r g u i l t f e e l i n g s over h e r f i n a l r e f u s a l t o a c c e p t her husband back i n the home a f t e r h i s d i s c h a r g e from h o s p i t a l . She was a v e r y r e t i c e n t p e r s o n , and a p a r t from t h i s she d i d not want casework s e r v i c e w i t h h er own p e r s o n a l p r o b l e m s . She was h e l p e d t o o b t a i n b e t t e r hous-i n g . F i n a n c i a l a s s i s t a n c e was g i v e n a t v a r i o u s p o i n t s , of d i f f i c u l t y d u r i n g the w i n t e r months, and Mrs. L e s t e r was a l s o g i v e n a s m a l l g r a n t w h i c h e n a b l e d h e r t o complete a n i g h t s c h o o l course and o b t a i n a b e t t e r p a y i n g j o b . The son, who had a g r e a t f e a r of mental i l l n e s s , o b t a i n e d p s y c h i a t r i c t r e a t m e n t on h i s own. The daughter seemed q u i t e w i t h d r a w n . Her one d e s i r e was t o go t o l i v e w i t h r e l a t i v e s i n a c i t y where the f a m i l y had once l i v e d , as she had never been happy i n Vancouver. The r e l a t i v e s had s e v e r a l c h i l d r e n around h e r age, ,and were a n x i o u s t o have the g i r l . Mrs. L e s t e r d e c i d e d t o consent t o t h i s p l a n .on a temporary b a s i s . As t h e r e were then . ..no p r e s s i n g p roblems, the case was c l o s e d . I t can .be seen t h a t t h e p r e c i p i t a t i n g problem, the husband's m e n t a l i l l n e s s , was not a p r o b l e m w h i c h r e c e i v e d d i r e c t a t t e n t i o n f r o m the F a m i l y S e r v i c e Agency. The agency's s e r v i c e was f o c u s e d r a t h e r on h e l p i n g the f a m i l y t o " p i c k up the p i e c e s " of t h e i r l i v e s and make a r e - a d j u s t m e n t . . Casework s e r v i c e g i v e n t o the L e s t e r f a m i l y was w h o l l y . s u p p o r t i v e i n n a t u r e and i n c l u d e d c o n s i d e r a b l e e n v i r o n m e n t a l " m a n i p u l a t i o n " . Casework s e r v i c e g i v e n t o the couple i n the• f o l l o w i n g i l l u s t r a t i o n was of q u i t e a d i f f e r e n t k i n d . (2) The.Marks. Mrs. Mark, a new a p p l i c a n t , t e l e p h o n e d t o r e q u e s t h e l p w i t h h er own p e r s o n a l problems,. w h i c h she s a i d were a f f e c t i n g h e r m a r r i a g e . She s a i d she had been m a r r i e d two y e a r s , had "a t e r r i b l e i n f e r i o r i t y c o m p l e x " a n d " i t i s not d o i n g my husband any good a t a l l " . S e r v i c e was g i v e n f o u r weeks l a t e r . The Marks were b o t h about t h i r t y , and had no c h i l d -r e n of the m a r r i a g e . At t h i s time Mr. Mark was employed as a s k i l l e d workman. H i s income was o n l y moderate, and he was c o n t r i b u t i n g toward the sup p o r t of two c h i l d r e n of a y o u t h f u l m a r r i a g e w h i c h had ended i n d i v o r c e . The cou p l e were b o t h i n t e l l i g e n t , . a n d t h e i r e d u c a t i o n , i n t e r e s t s and s o c i a l p o s i t i o n were h i g h e r than might be suggested by Mr. Mark's employment a t the ti m e of. a p p l i c a t i o n . L a t e r i t became e v i d e n t t h a t Mr. Mark would advance i n employment as w e l l . - 120 -Mrs. Mark was In g r e a t c o n f l i c t because o f h e r f e e l i n g s toward Mr. Mark's c h i l d r e n , and h e r j e a l o u s y of h i s r e l a t i o n s h i p t o them.. She was a pe r s o n who s t r o n g l y d e s i r e d t o do the r i g h t t h i n g , and .she f e l t most g u i l t y about h er resentment and her f e e l i n g t h a t the e x i s t e n c e of t h e s e c h i l d -r e n s t o o d i n the way o f h e r h a v i n g c h i l d r e n o f her own. Her c o n f l i c t was t o g r e a t t h a t she was f e a r f u l of h e r mental h e a l t h . Because o f e m o t i o n a l d e p r i v a t i o n i n c h i l d h o o d , she had v e r y l i m i t e d f e e l i n g s of s e l f - w o r t h . T h i s made i t d i f -f i c u l t f o r h e r . t o t r u s t h e r husband's r e a l warmth and affection.-, t o i n v o l v e h e r s e l f i n the e m o t i o n a l r e l a t i o n s h i p of m a r r i a g e f u l l y , ' . o r t o e x p r e s s h e r - f e e l i n g s i n any a r e a . At the same t i m e , as she r e c e i v e d a f f e c t i o n f r om h er husband, she wanted a l l h i s l o v e . Mrs. Mark had many s t r e n g t h s , how-e v e r . She d i d not run from problems and she i n v o l v e d h e r s e l f f u l l y i n a casework r e l a t i o n s h i p w h i c h i n c l u d e d c l a r i f i c a t i o n o f her f e e l i n g s , . h o w e v e r p a i n f u l t h i s was f o r h e r . S e r v i c e t o t h i s c o u p l e c o v e r e d e l e v e n months, and i n c l u d e d t w e n t y - f o u r p e r s o n a l i n t e r v i e w s - s i x w i t h Mr. Mark, and e i g h t e e n w i t h Mrs. Mark. S u p p o r t i v e casework and c l a r i -f i c a t i o n were geared t o h e l p i n g Mrs. Mark b e l i e v e i n h e r s e l f , a c c e p t h e r own f e e l i n g s , and e x p r e s s n e g a t i v e as w e l l as p o s i t i v e f e e l i n g s . She a l s o used h e l p i n h a n d l i n g h e r p r e s e n t r e l a t i o n s h i p w i t h h e r m o t h e r l a n d s o c i a l l y i n r e l a t i o n s h i p s w i t h f r i e n d s . Mr. Mark a l s o i n v o l v e d h i m s e l f f u l l y i n u n d e r s t a n d i n g h i s w i f e and s u p p o r t i n g h e r e f f o r t s t o change. He t o o was a p e r s o n w i t h a s t r o n g super-ego, and he was a n x i o u s t o do the r i g h t t h i n g w i t h r e g a r d t o h i s c h i l d r e n . He was h e l p e d t o c o n s i d e r p l a n s f o r h i s c h i l d r e n . f r o m the p o i n t o f view of t h e i r w e l f a r e . H i s former w i f e had r e m a r r i e d , and h er husband was a n x i o u s t o adopt the c h i l d r e n . Mr." Mark's d e c i s i o n t o .allow t h i s was a p o i n t of s i g n i f i c a n c e i n the case; b o t h of the Marks were s u p p o r t e d i n r e a c h i n g t h i s d e c i -s i o n i n many i n t e r v i e w s . W i t h t h e s e m o d i f i c a t i o n s t h e r e was c o n s i d e r a b l e cementing of the m a r r i a g e r e l a t i o n s h i p . When the case was c l o s e d a l l was g o i n g w e l l f o r t h i s c o u p l e , and the p r o g n o s i s was c o n s i d e r e d t o be good. Mrs.. Mark mentioned concern about h e r m a r r i a g e as a r e a s o n f o r r e q u e s t i n g s e r v i c e , but she c l e a r l y p r e s e n t e d the main problem as h e r own p e r s o n a l i t y d i f f i c u l t i e s , and her p e r s o n a l problems were a major f o c u s of casework t r e a t m e n t . However, a l t h o u g h t h i s c o u p l e d i d not have a f u l l - b l o w n m a r i t a l problem, m a r i t a l c o u n s e l l i n g was a l s o p a r t of the - 12.1 -s e r v i c e g i v e n . Help was a l s o g i v e n w i t h problems of p a r e n t -c h i l d r e l a t i o n s h i p . I n f a c t , the g r e a t m a j o r i t y of f a m i l y cases r e c e i v i n g c o n t i n u e d s e r v i c e o f over f o u r months dur-a t i o n r e c e i v e d casework h e l p w i t h . p r o b l e m s i n a l l t h r e e of thes e a r e a s , and i n many i n s t a n c e s o t h e r problems a f f e c t i n g f a m i l y l i f e a l s o r e c e i v e d a t t e n t i o n . Indeed, i t i s d i f f i c u l t t o imagine a m a r i t a l p r o blem case w h i c h does not r e q u i r e casework c o n s i d e r a t i o n of p e r s o n a l i t y adjustment problems i n a d u l t s . 1 I t may be of some s i g n i f i c a n c e t h a t the Marks case i s one o f t h e b e s t examples of s u c c e s s f u l m a r i t a l c o u n s e l l i n g i n t he sample, and w h i l e i t was c e r t a i n l y not a simple, case, the p r o g r e s s of t r e a t m e n t d i d have a smoother co u r s e than i s o f t e n .the c a s e . T h i s may be e x p l a i n e d i n p a r t by the whole-h e a r t e d i n v o l v e m e n t of b o t h m a r i t a l p a r t n e r s ; i n p a r t by the .fact- t h a t t h e i r m a r i t a l problems were not as y e t severe and the r e l a t i o n s h i p had s u f f e r e d l i t t l e damage, so t h a t s e r v i c e g i v e n was t r u l y p r e v e n t i v e . There a r e u n d o u b t e d l y o t h e r r e a -.sons. One c l u e was p r o v i d e d by Mrs. Mark i n .her f i r s t sen-t e n c e spoken t o the i n t a k e w o r k e r . She was, n o t p r o j e c t i n g r e s p o n s i b i l i t y f o r d i f f i c u l t i e s i n t h e m a r r i a g e . One case i n . t h i s group was opened when the a p p l i c a n t , a mother e x p e c t i n g her f i f t h c h i l d , r e q u e s t e d homemaker s e r -v i c e on the s u g g e s t i o n of the F a m i l y C o u r t . Her husband had l e f t h e r and i t d i d appear t h a t she would need h e l p i n 1 H o l l i s , F l o r e n c e , Women In M a r i t a l C o n f l i c t , F a m i l y S e r v i c e A s s o c i a t i o n of America, New York, 19^9. - 122 -p l a n n i n g f o r the c a r e of her ' c h i l d r e n d u r i n g her c o n f i n e -ment. However, the f a m i l y was known t o the agency from f i v e p r e v i o u s s h o r t - t e r m c o n t a c t s , .and i t was f a i r l y c l e a r from the b e g i n n i n g t h a t homemaker s e r v i c e was not the answer. Mrs. N e v i l l e was a v e r y i r r e s p o n s i b l e p e r s o n whose care o f h e r , c h i l d r e n l e f t much t o be d e s i r e d and b o r d e r e d on n e g l e c t . Housing was v e r y poor 'and housekeeping s t a n d a r d s e x c e e d i n g l y low. The case- was not a c c e p t e d f o r s e r v i c e u n t i l t h r e e weeks a f t e r Mrs. N e v i l l e ' s a p p l i c a t i o n . I n the meantime t h e r e were c o l l a t e r a l .contacts w i t h . s e v e r a l s o c i a l a g e n c i e s , and f i n a l l y a c o n f e r e n c e was h e l d t o determine w h i c h agency c o u l d o f f e r the most a p p r o p r i a t e s e r v i c e f o r t h i s f a m i l y . As a r e s u l t , the F a m i l y S e r v i c e Agency d e c i d e d t o make one more attempt t o .help the N e v i l l e s , by a f u l l e x t e n s i o n of s u p p o r t i v e t r e a t m e n t and " a g g r e s s i v e " casework. The N e v i l l e s had m a r r i e d v e r y young, and had s e r i o u s m a r i t a l problems from the b e g i n n i n g . T h i s was about the t e n t h time t h e y had s e p a r a t e d . P r e v i o u s s e p a r a t i o n s had v a r i e d i n l e n g t h from a few days t o almost a y e a r , and had u s u a l l y been i n i t i a t e d by Mrs. N e v i l l e , who had a p a t t e r n of d e s e r t i n g h e r husband and c h i l d r e n . There was s t r o n g e v i d e n c e t h a t she had been promiscuous on s e v e r a l o c c a s i o n s . Mr. N e v i l l e appeared somewhat more s t a b l e , but he t o o had been i m p u l s i v e and e r r a t i c . At the time of t h i s s i x t h a p p l i c a t i o n f o r s e r v i c e t h e r e were t h r e e c h i l d r e n i n t h e home,, a l l boys. Mr. N e v i l l e - 123 -d i d n o t acknowledge the f o u r t h c h i l d as h i s own, and t h i s c h i l d was i n the home of the m a t e r n a l g r a n d p a r e n t s . Mr. N e v i l l e moved back i n t o the home t o c a r e f o r h i s sons d u r i n g h i s w i f e ' s c onfinement, and was a b l e t o manage w i t h the h e l p o f n e i g h b o u r s . B o t h of the N e v i l l e s d i s c u s s e d pos-s i b i l i t i e s of r e c o n c i l i a t i o n w i t h the caseworker, but s h o r t l y a f t e r the b i r t h of the f i f t h c h i l d t h e y came t o a d e c i s i o n t o s e p a r a t e p e r m a n e n t l y . They agreed t h a t Mrs. N e v i l l e would have c u s t o d y o f t h e f o u r t h c h i l d and the new baby, and t h a t Mr. N e v i l l e would remain i n the home and have c u s t o d y o f the t h r e e o l d e s t c h i l d r e n . On Mr. N e v i l l e ' s p a r t t h i s appeared t o be a d e f i n i t e and f i n a l d e c i s i o n . Over the n e x t s i x months Mr. N e v i l l e was o f f e r e d , and used, much s u p p o r t i v e casework h e l p . Mrs. N e v i l l e was a l s o o f f e r e d s e r v i c e , but came i n o n l y s p o r a d i c a l l y , d i d not r e a l l y engage h e r s e l f i n casework t r e a t m e n t , and f i n a l l y w i thdrew from the c o n t a c t . H aving r e s o l v e d the l o n g u n c e r t a i n t y about h i s m a r r i a g e , Mr. N e v i l l e r e v e a l e d u nexpected s t r e n g t h s . . W i t h s u p p o r t f r o m t h e caseworker, he showed t h a t he had c a p a c i t y t o s h o u l d e r r e s p o n s i b i l i t y i n c a r i n g f o r h i s sons, who r e s -ponded t o the more s t a b l e home environment. He was a l s o , a b l e t o come t o g r i p s w i t h s e r i o u s f i n a n c i a l d i f f i c u l t i e s i n s p i t e of heavy debts and a' s m a l l income. S e r v i c e g i v e n t o Mr. N e v i l l e and h i s sons i n c l u d e d a s m a l l amount of f i n a n -c i a l a s s i s t a n c e , and a l a r g e and v a r i e d number of c o l l a t e r a l - 124 -c o n t a c t s . There were numerous v i s i t s t o the home t o i n t e r -view housekeepers and see the c h i l d r e n . Other c o l l a t e r a l c o n t a c t s were w i t h the s c h o o l , neighbourhood house, a d o c t o r and a l a w y e r , and w i t h s e v e r a l s o c i a l a g e n c i e s . F i n a l l y Mr.' N e v i l l e moved out o f the c i t y , as he i n h e r i t e d h i s f a m i l y home. R e l a t i v e s were nearby t o h e l p him w i t h h i s boys, and he a c c e p t e d r e f e r r a l t o ano t h e r s o c i a l agency f o r c o n t i n u i n g s u p p o r t i v e h e l p . The p r o g n o s i s f o r 'Mr. N e v i l l e and the t h r e e o l d e s t c h i l d r e n appeared t o be f a i r when the case c l o s e d . P r o s p e c t s f o r two c h i l d r e n i n the mother's c a r e appeared q u i t e g r i m , but a p r o t e c t i v e agency was then a c t i v e w i t h t h i s p a r t of the f a m i l y . I n summary, the m a j o r i t y of the f a m i l i e s and i n d i v i d u a l c l i e n t s i n the sample who r e c e i v e d c o n t i n u e d s e r v i c e of "medium-term" d u r a t i o n were c o n s i d e r e d t o have completed t r e a t m e n t , and i n a l l but two cases t h e y appear t o have been h e l p e d by t h e s e r v i c e g i v e n . The e x c e p t i o n s were b o t h cases w h i c h opened w i t h a r e q u e s t f o r m a r i t a l c o u n s e l l i n g , but t h i s may be of no s i g n i f i c a n c e i n view of the preponder-ance o f such r e q u e s t s i n t h i s group. There a re i n d i c a t i o n s t h a t a p p l i c a t i o n s f o r m a r r i a g e c o u n s e l l i n g p r e s e n t e d case-workers w i t h the most d i f f i c u l t problems i n t r e a t m e n t . When c l i e n t s continue beyond four months, there appears to be no d i f f e r e n c e between new and re-opened cases as to'Success o f t r e a t m e n t . The e f f e c t of the. w a i t i n g l i s t i s no l o n g e r so e v i d e n t ; i n f a c t cases w h i c h r e c e i v e d p r i o r i t y assignment - 1 2 5 -because of a c u t e problems tended t o be somewhat l e s s s u c c e s s f u l i n outcome. New a p p l i c a n t s , i n g e n e r a l , appeared t o be of higher- s o c i a l s t a t u s than former c l i e n t s , e s p e c i a l l y former c l i e n t s who had been known t o the agency some y e a r s p r e v i o u s l y . Some of the new a p p l i c a n t s were young c o u p l e s whose problems were not y e t c h r o n i c ; s e r v i c e g i v e n i n t h e s e cases can be seen as t r u l y p r e v e n t i v e . Other new a p p l i c a n t s , l i k e t h e Harmons, had had s e r i o u s problems f o r many y e a r s , and these were much more d i f f i c u l t t o t r e a t . The Harmons d i d r e t u r n l a t e r , and t h e r e are a number of examples among r e -opened cases of f a m i l i e s known t o the agency i n the p a s t because of severe and m u l t i p l e f a m i l y problems, whom the agency was f i n a l l y a b l e t o h e l p a c h i e v e a b e t t e r a d j u s t m e n t . (c) Long-Term Cases F o u r t e e n c a s e s , f r o m the o r i g i n a l sample of n i n e t y -f i v e a c c e p t e d a p p l i c a t i o n s , r e c e i v e d c o n t i n u i n g s e r v i c e o f o v e r f o u r t e e n months d u r a t i o n . Long-term c o n t i n u e d s e r -v i c e was p r o v i d e d t o e i g h t complete f a m i l i e s , f o u r broken f a m i l i e s , and two s i n g l e p e r s o n s . ( T a b l e 1 5 c ) A p a r t from one case w h i c h was e x c e p t i o n a l and r e c e i v e d o n l y f o u r p e r s o n a l i n t e r v i e w s , t h i r t e e n f a m i l i e s and i n d i v i d u a l . c l i e n t s consumed w e l l o v er h a l f of t h e t o t a l i t e m s of s e r v i c e p r o -v i d e d f o r the 1; e n t i r e sample. Nor i s t h i s the whole s t o r y , Items of s e r v i c e p r o v i d e d a f t e r December 3 1 s t , 1 9 5 9 have not been counted, and a l l of t h e s e cases r e c e i v e d s e r v i c e Table 1 5 c , Items of S e r v i c e , Long-Term Gases Groups Number S e r v i c e s Rendered T o t a l ( F a m i l i e s and Persons.) P e r s o n a l I n t e r v i e w s Telephone I n t e r v i e w s C o l l a t e r a l Homemaker I n t e r v i e w s S e r v i c e F i n a n c i a l A s s i s t a n c e Items of S e r v i c e Complete F a m i l i e s (I) 3 5 9 182 160 3 2 706 Husband Wife 7 8 106 2 0 8 #• * * * * C h i l d 4 45 Broken F a m i l i e s (i) 80 • 31 - 1 2 6 Man 2 9 * * * * * Woman 4 63 C h i l d 1 8 S i n g l e P e r s o n (2 ) 83 - 3 - 86 Man 1 35 * * * * * Woman 1 4 8 T o t a l ( 1 4 ) 2 8 (a) 522 2 1 3 1 7 8 3 2 . 9 1 8 Not s e p a r a t e d (a) 28 i n d i v i d u a l c l i e n t s seen, from 14 f a m i l i e s . - 127 -e x t e n d i n g beyond t h a t t i m e . A p a r t from the one c l i e n t who r e c e i v e d o n l y f o u r p e r s o n a l i n t e r v i e w s , and the one f a m i l y w h i c h r e c e i v e d s e v e n t y - s i x , the range i n p e r s o n a l i n t e r v i e w s p e r case was between s i x t e e n and f i f t y - t h r e e . Long-term cases r e c e i v e d an average o f t h i r t y - s e v e n i n - p e r s o n i n t e r -v i ews p r i o r t o J a n u a r y 1 s t , i 9 6 0 . Twenty-eight i n d i v i d u a l c l i e n t s , ( t e n men, t h i r t e e n women, and f i v e c h i l d r e n ) , r e c e i v e d a t o t a l o f 522 i n - p e r s o n i n t e r v i e w s . Three f a m i l i e s r e c e i v e d homemaker s e r v i c e , and o t h e r f i n a n c i a l a s s i s t a n c e was p r o v i d e d i n two c a s e s . P r e s e n t i n g problems of l o n g - t e r m cases were as f o l l o w s : M a r i t a l d i f f i c u l t y 5 P a r e n t s c h i l d r e l a t i o n s h i p problems ... 2 I n d i v i d u a l p e r s o n a l i t y adjustment .... 4 Homemaker a p p l i c a t i o n 3 Only f o u r of these' cases opened as new a p p l i c a t i o n s f o r s e r v i c e . New a p p l i c a t i o n s i n c l u d e d two r e q u e s t s f o r m a r i t a l c o u n s e l l i n g , and two r e q u e s t s f o r h e l p w i t h problems of i n d i v i d u a l p e r s o n a l i t y a d j u s t m e n t . Pour a p p l i c a t i o n s r e c e i v e d p r i o r i t y assignment - the t h r e e homemaker a p p l i -c a t i o n s and one of the new r e q u e s t s f o r h e l p w i t h problems of p e r s o n a l i t y a d j u s t m e n t . What k i n d of cases were so time-consuming and e x p e n s i v e ? What f a m i l i e s and i n d i v i d u a l c l i e n t s remained w i t h the agency f o r such l o n g , unbroken p e r i o d s of t i m e , and were so d i f f i c u l t t o t r e a t ? A c u r s o r y e x a m i n a t i o n s of t h e s e - 128 -cases would i n d i c a t e t h a t t h e s e are not the s o r t of p e o p l e who were the agency's l o n g - t e r m c l i e n t s t e n , or even f i v e y e a r s ago. These c l i e n t s .are not e c o n o m i c a l l y dependent p e o p l e , and t h e y do not p r e s e n t a m u l t i t u d e of s o c i a l p r o b l e m s v i s i b l e t o the community a t l a r g e . A l l of them are o u t w a r d l y r e s p e c t -a b l e , .hard-working p e o p l e . I n e v e r y case the employment of the breadwinner was e i t h e r " w h i t e - c o l l a r " and m i d d l e - c l a s s i n s t a t u s , o r of the upper workings c l a s s s k i l l e d group. They are p e o p l e who s u p p o r t t h e i r f a m i l i e s t o the b e s t o f t h e i r a b i l i t y , and who t r y t o assume t h e i r s o c i a l r e s p o n s i b i l i t i e s . A l l of the f a m i l i e s and i n d i v i d u a l c l i e n t s i n t h i s " l o n g - t e r m " group were e i t h e r . o f m i d d l e - c l a s s s t a t u s , o r were c l o s e t o i t . H elen W. H a l l i n a n d e s c r i b e s the " h a r d - t o - r e a c h " or " m u l t i p r o b l e m " f a m i l y as f o l l o w s : " I n g e n e r a l , the m u l t i p r o b l e m f a m i l y can be d e s c r i b e d as h a v i n g more than i t s share of p h y s i c a l and e m o t i o n a l problems, a l o n g h i s t o r y of f i n a n c i a l dependency, poor h o u s i n g , a f r e q u e n t l y c h a n g i n g f a m i l y u n i t , heavy i n c i d e n c e o f . m e n t a l I l l n e s s and r e t a r d a t i o n , and a p a t t e r n of b e h a v i o u r t h a t i s o f t e n v i o l e n t and i n c o n f l i c t w i t h a c c e p t e d s o c i a l s t a n d a r d s . " " T h i s i s the f a m i l y b e s e t by so many problems i t seems un a b l e or u n w i l l i n g t o h andle t h a t i t has become a m a t t e r of grave concern t o the community, a t large.""'' C l e a r l y , the " l o n g - t e r m " f a m i l i e s and c l i e n t s i n t h i s sample were not " h a r d - t o - r e a c h " o r " m u l t i p r o b l e m " f a m i -l i e s as t h e s e terms are u s u a l l y u n d e r s t o o d . They were not 1 H a l l l n a n , Helen W., " C o - o r d i n a t i n g Agency E f f o r t s i n B e h a l f o f the Hard-to-Reach F a m i l y " , S o c i a l Casework, J a n u a r y , 1 9 5 9 . - 129 -" h a r d - t o - r e a c h " i n the sense t h a t the agency had t o seek them out, nor was t h e r e any d i f f i c u l t y whatever i n r e t a i n i n g them as c l i e n t s over l o n g p e r i o d s , of t i m e . I t w i l l he seen, how-e v e r , t h a t t h e y were " h a r d - t o - r e a c h " i n a n o t h e r s e n s e ; t h e y were v e r y d i f f i c u l t i n d e e d t o t r e a t by casework methods. F u r t h e r m o r e , many, but not a l l , had a m u l t i t u d e o f f a m i l y p roblems. Roughly, t h e s e cases can be d i v i d e d i n t o t h r e e g r o u p s : (a) c o u p l e s w i t h i n t r a c t a b l e m a r i t a l problems, and s e e m i n g l y , no o t h e r s e r i o u s d i f f i c u l t i e s ; (b) f a m i l i e s w i t h a. m u l t i t u d e of p h y s i c a l and e m o t i o n a l problems; and (c) s i n g l e p e o p l e w i t h v e r y s e r i o u s problems of p e r s o n a l i t y a d j u s t m e n t . There were f i v e c a ses i n t h i s group where m a r i t a l d i f f i c u l t y was the main p r e s e n t i n g problem. One of t h e s e cases d i d n o t r e c e i v e i n t e n s i v e t r e a t m e n t , a l t h o u g h i t was open f o r a l o n g t i m e . The a p p l i c a n t i n t h i s case was a woman who had made an a p p a l l i n g l y f o o l i s h m a r r i a g e , w h i c h ended almost as soon as i t began. The f o u r o t h e r c o u p l e s had m a r i t a l problems w h i c h p r o v e d h i g h l y r e s i s t a n t t o casework t r e a t m e n t . I n one of t h e s e cases t h e r e were a l s o s e r i o u s problems of p a r e n t -c h i l d r e l a t i o n s h i p ; i n t h i s case the f a m i l y d i d have a number of p r oblems. However, even i n c l u d i n g t h i s c ase, i t i s i n t e r e s t -i n g t o note the almost complete absence of the s o r t o f problems p o p u l a r l y c o n s i d e r e d t o be s e r i o u s impediments t o adjustment i n m a r r i a g e . None of t h e s e c o u p l e s had problems due t o d r i n k i n g o r a l c o h o l i s m . None of them had any p a r t i c u l a r f i n a n c i a l problems,.and t h e r e was no s u g g e s t i o n of n o n - s u p p o r t . - 1 3 0 -The p a r t n e r s I n each case were of v e r y s i m i l a r s o c i a l and. e t h -n i c backgrounds. None of the p a r t n e r s were m e n t a l l y i l l , and. t h e y had no s e r i o u s p h y s i c a l i l l n e s s . I n o n l y one case was t h e r e any s u g g e s t i o n of i n f i d e l i t y . . W i t h one p o s s i b l e e x c e p t i o n , t h e y were, or t r i e d t o be, good p a r e n t s . The one i l l u s t r a t i o n w h i c h w i l l be p r e s e n t e d i s p r o b a b l y t h e s i m p l e s t ' and most c l e a r - c u t example.. The Oswalds.. Mr.. Oswald r e q u e s t e d h e l p w i t h m a r i t a l problems w h i c h he s a i d had reached, a " c l i m a x " on h i s p a r t . T e c h n i c a l l y , t h i s was a re-opened ca s e , as Mr. Oswald had made a p r e v i o u s e n q u i r y about s e r v i c e when h i s w i f e was out o f town, but t h e Oswalds had not p r e v i o u s l y r e c e i v e d casework s e r v i c e . Mr. Oswald seemed a n x i o u s f o r h e l p . H i s w i f e was v e r y d o u b t f u l ; s a i d she c o u l d not see how i t would h e l p them, and she thought t h e y s h o u l d s o l v e t h e i r own pro b l e m s . The Oswalds were a young couple w i t h two s m a l l c h i l d r e n . Mr. Oswald was employed as a s k i l l e d w o r k e r , and t h e r e were no p r e s s i n g f i n a n c i a l p roblems. They p a i d a f e e f o r s e r v i c e . B o t h were i n t e l l i g e n t , and each had come from a f a m i l y w h i c h had some s o c i a l s t a t u s . They were b o t h concerned about t h e i r c h i l d r e n ' s w e l f a r e , and t r i e d t o be good p a r e n t s . N e v e r t h e l e s s , t h e y were e x p e r i e n c i n g g r e a t . d i f f i c u l t y i n making a happy, o r even t o l e r a b l e adjustment i n m a r r i a g e . I t became e v i d e n t t h a t n e i t h e r had r e c e i v e d an adequate p r e p a r a t i o n f o r t h e i r m a r i t a l r o l e s i n t h e i r c h i l d h o o d - they'had no p a t t e r n s t o f o l l o w . T h i s was p a r t i c u l a r l y t r u e of Mrs. Oswald. Her p a r e n t s had been d i v o r c e d when she was a v e r y s m a l l c h i l d , and she was brought up by her g r a n d p a r e n t s . D u r i n g her l o n e l y c h i l d h o o d she had deve l o p e d a r i g i d p a t t e r n of r e a c t i n g t o l i f e ' s problems by w i t h d r a w a l and d e n i a l . She had no c o n c e p t i o n of how she was f a i l i n g t o s a t i s f y h e r husband's needs f o r com-p a n i o n s h i p and e m o t i o n a l s u p p o r t , and was t h o r o u g h l y a g g r i e v e d by h i s c o m p l a i n t s . Mr. Oswald had s u f f e r e d from a p o v e r t y o f companionship and i d e n t i f i c a t i o n w i t h h i s i n v a l i d f a t h e r i n c h i l d h o o d . L a t e r , as a t e e n a g e r and the youngest c h i l d a t home he had had an o v e r l y c l o s e r e l a t i o n s h i p w i t h h i s widowed mother. He had emancipated h i m s e l f w i t h d i f f i c u l t y , was s t i l l q u i t e t i e d t o h i s mother, and had an u n d e r l y i n g resentment of t h i s t i e of w h i c h he was not f u l l y aware. H i s w i f e ' s f r u s -t r a t i o n of h i s e m o t i o n a l and s e x u a l needs f u r t h e r undermined h i s m a s c u l i n i t y t o the p o i n t where he saw s e p a r a t i o n as the o n l y s o l u t i o n . - 131 -T h i s proved, t o be an e x c e e d i n g l y d i f f i c u l t m a r i t a l p r o b lem t o t r e a t . Mr. Oswald, came i n f o r r e g u l a r i n t e r v i e w s , and appeared t o use s u p p o r t i v e casework and c l a r i f i c a t i o n and t o p r o g r e s s i n s e l f - u n d e r s t a n d i n g . H i s w i f e a c c e p t e d a p p o i n t -ments o n l y i r r e g u l a r l y , and f o r a v e r y l o n g time c o n t i n u e d t o e x p r e s s doubts about t h e p o s s i b i l i t y of the agency's s e r v i c e b e i n g h e l p f u l , s e e i n g the worker as an a l l y o f her husband. Her doubts r e l a x e d f o r a time due t o her husband's i n c r e a s e d c o n s i d e r a t i o n f o r h e r . However, t h e m a r i t a l r e l a t i o n s h i p improved v e r y s l o w l y , i f a t a l l . When the f i r s t caseworker l e f t the agency t r a n s f e r t o a n o t h e r worker was e f f e c t e d , w i t h the Oswalds c o n t i n u i n g on the same b a s i s . Mr. Oswald con-t i n u e d t o be v e r y d i s s a t i s f i e d w i t h h i s marriage.. He used i n t e r v i e w s f o r i n c r e a s e d s e l f - u n d e r s t a n d i n g , and t o some e x t e n t t o meet h i s needs f o r e m o t i o n a l support and e x p r e s s i o n of f e e l i n g w h i c h were not b e i n g met i n h i s m a r r i a g e He d i d not make much p r o g r e s s i n u n d e r s t a n d i n g h i s w i f e o r . m e e t i n g h e r needs. Mrs. Oswald's i n v o l v e m e n t c o n t i n u e d t o be s p o r a d i c , but she began t o w r i t e voluminous l e t t e r s t o t h e caseworker, and a p p a r e n t l y was a b l e t o use t h i s method of o b t a i n i n g e x p r e s -s i o n and r e l e a s e of f e e l i n g s . Mr. Oswald f i n a l l y d e c i d e d t o t r y a t r i a l s e p a r a t i o n . H i s w i f e was u t t e r l y shocked, r e s e n t -f u l and b i t t e r a t t h i s development. The co u p l e were r e -u n i t e d a f t e r s e v e r a l months, but d i f f i c u l t i e s .continued w i t h l i t t l e a m e l i o r a t i o n . The Oswalds a r e c o n t i n u i n g t o r e c e i v e s e r v i c e , and i t c e r t a i n l y appears t h a t much casework time and p a t i e n c e a r e s t i l l n e c e s s a r y i f t h e y a r e t o be r e a l l y h e l p e d . They have v e r y l i m i t e d a b i l i t y , o r w i l l i n g n e s s , t o make the n e c e s s a r y compromises and a d j u s t m e n t s of m a r r i a g e . I t i s as i f each i s p r e p a r e d t o go o n l y about f o r t y p e r cent of t h e way, and t h i s l e a v e s a g a p i n g h o l e I n the r e l a t i o n s h i p . Two a p p l i c a n t s i n t h i s group p r e s e n t e d t h e i r main p r o b l e m as one of p a r e n t - c h i l d r e l a t i o n s h i p . One f a m i l y s u f f e r e d f r o m a m u l t i t u d e of pro b l e m s , and as t h i s was a v e r y c o m p l i c a t e d s i t u a t i o n i n d e e d , t h e o t h e r example w i l l be p r e -s e n t e d . - 132 -The P h i l l i p s . Mrs. P h i l l i p , a widowed mother, t e l e -phoned t o r e q u e s t h e l p w i t h her r e l a t i o n s h i p t o h e r e l e v e n y e a r o l d son, whose b e h a v i o u r ( l y i n g and s t e a l i n g ) , was a g a i n caus-i n g h er c o n c e r n . She seemed v e r y a n x i o u s f o r s e r v i c e , and was angry about the w a i t i n g p e r i o d , but agreed t o w a i t . There had been two p r e v i o u s c o n t a c t s w i t h Mrs. P h i l l i p . I n - 1 9 ^ 5 she had been r e f e r r e d by a f r i e n d f o r h e l p w i t h a m a r i t a l d i f f i c u l t y . Her husband was r e q u e s t i n g d i v o r c e . Mrs. P h i l l i p t r i e d , but found i t v e r y d i f f i c u l t t o use c a s e r workj m a i n l y she wanted a p p r o v a l f o r h e r own p o s i t i o n . Her husband d i d l e a v e the home f o r a t i m e , but r e t u r n e d when t h e i r d aughter became i l l . Mrs. P h i l l i p was then c o n t e n t , and d i d not want f u r t h e r s e r v i c e . She had not t o l d h e r husband of t h e c o n t a c t . I n 1 9 5 ^ " M r s . P h i l l i p was a g a i n r e f e r r e d , t h i s t i m e by a n o t h e r agency. I n the meantime h e r husband had d i e d . She was concerned about her son, then seven y e a r s o l d , whom she had p l a c e d i n a f o s t e r home w h i l e she t o o k a t r a i n i n g c o u r s e t o p r e p a r e f o r employment. Her son was s t e a l i n g i n the f o s t e r home. Mrs. P h i l l i p was a l s o h a v i n g some d i f f i c u l t i e s i n h e r r e l a t i o n s h i p w i t h h e r teenage daughter. She used s e r v i c e t o t a l k about her d i f f i c u l t i e s , but was q u i t e u n a b l e t o u n d e r s t a n d h e r son's problems, o r t o a c c e p t any i n t e r p r e t a t i o n of h i s b e h a v i o u r . S e r v i c e t e r m i n a t e d a t her r e q u e s t when she o b t a i n e d employment and f e l t more a b l e t o cope w i t h her p roblems. Now Mrs. P h i l i p was i n her l a t e f o r t i e s . Of her two c h i l d r e n , o n l y t h e son was a t home.' Her daughter was m a r r i e d . Mrs. P h i l l i p had a c o m f o r t a b l e home. P r i o r t o h i s d e a t h Mr. P h i l l i p ' s employment had been i n " w h i t e - c o l l a r " j o b s . Mrs. P h i l l i p , however, had s u f f e r e d e x t r e m e ' d e p r i v a t i o n i n c h i l d h o o d , h a v i n g been brought up i n an orphanage. She was a r i g i d p e r -son, h o s t i l e and p u n i t i v e i n r e l a t i o n s h i p s w i t h men.. However, she now i d e a l i z e d her husband, and a c t u a l l y blamed the boy f o r h i s f a t h e r ' s d e a t h . I t appeared t h a t she t h o r o u g h l y r e -j e c t e d her s o n . She had t w i c e p l a c e d him i n f o s t e r homes, and w h i l e t h e r e had been some r e a l i t y b a s i s f o r t h i s , Mrs. P h i l l i p had done i t v e r y r e a d i l y and w i t h no u n d e r s t a n d i n g of i t s meaning f o r the c h i l d . She was g u i l t y and a m b i v a l e n t , but f e l t q u i t e u n a b l e t o h a n d l e h e r son, and i n many ways wanted t o be f r e e o f him. S e r v i c e p r o v i d e d over the e n s u i n g f i f t e e n months i n c l u d e d n e a r l y f i f t y p e r s o n a l i n t e r v i e w s , t h i r t y - e i g h t w i t h Mrs. P h i l l i p , and about t e n w i t h h e r son., Three caseworkers were i n v o l v e d i n t h i s case. Mrs. P h i l l i p was t r a n s f e r r e d t o a n o t h e r worker when the f i r s t worker l e f t the agency, and t h e boy had h i s own worker f o r a t i m e . I n s p i t e of c o n t i n u i n g and s t r e n u o u s e f f o r t s by t h e c a s e w o r k e r s , s u p p o r t i v e casework was of l i m i t e d h e l p t o Mrs. P h i l l i p . When she was h e l p e d t o meet h e r own needs she c o u l d t e m p o r a r i l y r e l a x h e r p r e s s u r e s on the - 133 -boy, but she seemed q u i t e u n a b l e and u n w i l l i n g t o change h er b a s i c a l l y p u n i t i v e a t t i t u d e . F i n a l l y she v e r b a l i z e d t h i s , r e q u e s t i n g h e l p t o arr a n g e f o s t e r home o r b o a r d i n g ' s c h o o l p lacement. The boy's problems and h i s mother's r e j e c t i o n . w e r e i n t e n s i f i e d by t h e f a c t t h a t he was not an apt p u p i l and had d i f f i c u l t y w i t h s c h o o l work.. When i n t e r v i e w e d he e x p r e s s e d f e e l i n g s of l o n e l i n e s s and d e s e r t i o n . . P s y c h i a t r i c e x a m i n a t i o n and c o n s u l t a t i o n were a r r a n g e d i n the f a l l of 1959- The boy was found t o be e m o t i o n a l l y d i s t u r b e d , and placement i n a t h e r a p e u t i c s e t t i n g was recommended. - U n f o r t u n a t e l y t h i s was d i f f i c u l t t o a r r a n g e , and Mrs. P h i l l i p had the n d e c i d e d t o r e -marry and f e l t t h i s would s o l v e a l l p roblems, so she changed he r mind about placement. The case was s t i l l open a t the end of 1959. Mrs. P h i l l i p had m a r r i e d a man w i t h . s e v e r a l c h i l d r e n , and i t appeared t h a t h e r f a m i l y problems and her son^s t r o u b l e s had o n l y begun. The n e x t example, t h e R i c h a r d s , shows the s i g n i f i -cance o f d i f f e r e n t i a t i n g between p r e s e n t i n g p r o b l e m and l a t e r knowledge. The p r e s e n t i n g p r o b l e m was l i s t e d as " i n d i v i d u a l p e r s o n a l i t y a d j u s t m e n t " , as the a p p l i c a n t o r i g i n a l l y r e q u e s t e d s e r v i c e f o r h e r son's adjustment d i f f i c u l t i e s . However, t h e boy's t r o u b l e s stemmed from u n h e a l t h y r e l a t i o n s h i p s w i t h h i s p a r e n t s , p a r t i c u l a r l y h i s mother, and t h i s d i f f i c u l t y was c o n t i n u i n g and becoming more s e v e r e . The f a m i l y ' s t r o u b l e s had begun over t h i r t y y e a r s e a r l i e r , w i t h the b i r t h o f a d e f e c t i v e c h i l d . At t h e time of a p p l i c a t i o n and thro u g h o u t t h e con-t a c t the mother's own e m o t i o n a l d i s t u r b a n c e was p r o b a b l y t h e major s o u r c e o f f a m i l y c o n f l i c t . O b v i o u s l y , h e r husband had a m a r i t a l problem. N e v e r t h e l e s s , t r e a t m e n t g i v e n t o t h i s f a m i l y was e f f e c t i v e ; and a l t h o u g h i n t e n s i v e s e r v i c e t o t h e f a m i l y i n c l u d e d over f i f t y p e r s o n a l i n t e r v i e w s , i n vi e w of the r e s u l t s i t was r e l a t i v e l y -economical when compared w i t h s e r v i c e g i v e n t o some of the f a m i l i e s i n t h i s group. - 1 3 4 -The R i c h a r d s . Mrs. R i c h a r d , a new a p p l i c a n t , sought c o u n s e l l i n g r e g a r d i n g t h e problems of h e r son, aged s i x t e e n . The p a r e n t s were concerned about th e amount of d e f i a n c e he was showing.,. .his i n a b i l i t y t o t a k e r e s p o n s i b i l i t y , and h i s d e l i n -quent b e h a v i o u r i n r e g a r d t o s c h o o l and j o b s . B o t h p a r e n t s were w a n t i n g h e l p and came i n t o g e t h e r f o r the f i r s t i n t e r v i e w . M o t i v a t i o n appeared t o be good i n terms of s e r v i c e . Mrs. R i c h a r d a c c e p t e d t h e w a i t i n g l i s t , but was v e r y a n x i o u s and t e l e p h o n e d s e v e r a l t i m e s b e f o r e t h e ease was a s s i g n e d s i x weeks l a t e r . The f a m i l y i n c l u d e d the p a r e n t s , b o t h i n t h e i r mid f i f t i e s , a d aughter of over t h i r t y who was p h y s i c a l l y d e f e c t i v e and m e n t a l l y v e r y r e t a r d e d , and two teenage c h i l d r e n . The f a t h e r was foreman and p a r t n e r i n h i s b u s i n e s s , and h i s income was good. The f a m i l y had a c o m f o r t a b l e home. The youngest c h i l d , a g i r l , d i d not p r e s e n t problems a t home o r a t s c h o o l . Mrs. R i c h a r d had been u p s e t and u n r e c o n c i l e d over many y e a r s because of the h a n d i c a p s of her o l d e s t c h i l d . F i n a l l y , a t f o r t y , she r i s k e d h a v i n g more c h i l d r e n . The r e t a r d e d g i r l had been i n the home a l l h e r l i f e , though her p r e s e n c e was so u p s e t t i n g t o a l l f a m i l y members t h a t none of them c o u l d be encouraged t o speak of h e r . Now problems i n h e r r e l a t i o n s h i p w i t h her son had u p s e t Mrs. R i c h a r d t o the p o i n t where her s t a t e of mental h e a l t h was p r e c a r i o u s . She was v e r y c r i t i c a l and p u n i t i v e i n her t r e a t m e n t o f the boy, a t the same time n e e d i n g t o c o n t r o l him and b i n d him t o h e r . The s t r e s s e s she had s u f f e r e d over many y e a r s had l e f t h er u n p r e p a r e d t o f a c e h e r son's a d o l e s c e n c e . Mrs. R i c h a r d was e m o t i o n a l l y q u i t e u n c o n t r o l l e d a t t i m e s . Mr. R i c h a r d had more u n d e r s t a n d -i n g and warmth f o r h i s c h i l d r e n . However, i n h i s e f f o r t s t o keep peace w i t h h i s w i f e he had adopted a p a s s i v e a t t i t u d e i n f a m i l y q u a r r e l s . At the same t i m e , i n sympathy w i t h h i s son's p r e d i c a m e n t , he was u n d e r m i n i n g h i s w i f e ' s a u t h o r i t y w i t h the boy and was h i m s e l f t o o p e r m i s s i v e and u n a b l e t o s e t l i m i t s . He was s u b t l y e n c o u r a g i n g h i s son's r e b e l l i o n . Between them, the p a r e n t s were d r i v i n g the boy t o d e l i n q u e n c y . S e r v i c e g i v e n t o t h i s f a m i l y p r i o r t o J a n u a r y 1 s t , i 9 6 0 i n c l u d e d f i f t y - t h r e e i n - p e r s o n i n t e r v i e w s , a number of t e l e p h o n e i n t e r v i e w s > s e v e r a l c o n t a c t s w i t h o t h e r a g e n c i e s , and p s y c h i a t r i c c o n s u l t a t i o n . Two w o r kers were a c t i v e on the case c o n c u r r e n t l y , as the boy"was g i v e n a s e p a r a t e caseworker. There were twenty-two p e r s o n a l i n t e r v i e w s w i t h Mr. R i c h a r d , twenty w i t h h i s w i f e , and e l e v e n w i t h the son, Mr. R i c h a r d was more a c c e p t i n g of casework h e l p and s e l f - i n v o l v e m e n t than h i s - w i f e , who was h i g h l y , defended and r e s i s t a n t . B o t h p a r e n t s were seen on a w e e k l y b a s i s u n t i l t h e m i d d l e of 1 9 5 9 , when Mrs. R i c h a r d began p s y c h i a t r i c t r e a t m e n t . Mr.. R i c h a r d c o n t i n u e d w i t h the -caseworker f o r a t i m e , and l a t e r i t was l e f t t h a t he s h o u l d t e l e p h o n e i f he needed f u r t h e r h e l p , .which he d i d - 135 -on . s e v e r a l . o c c a s i o n s . He was e n c o u r a g e d t o t a k e a more a c t i v e r o l e i n t h e f a m i l y , p a r t i c u l a r l y w i t h r e g a r d , t o h i s s o n , and was a b l e t o do t h i s . . The boy.'s p r o b l e m s seemed t o be q u i t e d i f f i c u l t t o t r e a t . . He was s e e n b y h i s own w o r k e r u n t i l he d i d g e t i n t o t r o u b l e and was p l a c e d on p r o b a t i o n . . T h e r e -a f t e r t h e r e was c o n s u l t a t i o n a n d c l o s e w o r k i n g t o g e t h e r w i t h t h e p r o b a t i o n o f f i c e r . The c a s e was c l o s e d i n J a n u a r y , i 9 6 0 . M r s . R i c h a r d ' s h y s t e r i c a l b e h a v i o u r .had c e a s e d f o l l o w i n g p s y c h i a t r i c t r e a t m e n t . The r e t a r d e d d a u g h t e r was a w a i t i n g a d m i t t a n c e t o W o o d l a n d s S c h o o l , a s h a d b e e n s t r o n g l y recommended b y t h e p s y c h i a t r i s t . Mr. R i c h a r d r e p o r t e d t h a t h i s .son was w o r k i n g s t e a d i l y i n h i s b u s i n e s s , p a y i n g b o a r d a t home, a n d d o i n g f a i r l y w e l l . Two s i n g l e p e r s o n s r e c e i v e d e x t e n s i v e a n d i n t e n s i v e c a s e w o r k s e r v i c e . B o t h o f t h e s e c l i e n t s r e q u e s t e d and r e c e i v e d h e l p w i t h v e r y d i f f i c u l t p r o b l e m s o f p e r s o n a l i t y a d j u s t m e n t . One was a y o u n g woman, t h e d a u g h t e r o f a p r o s p e r o u s f a m i l y . She h a d a u n i v e r s i t y e d u c a t i o n a n d some p r o f e s s i o n a l t r a i n i n g . H e r p e r s o n a l p r o b l e m s w ere o f a v e r y s e r i o u s n a t u r e , a n d she p r o v e d t o be a most d i f f i c u l t a n d d e m a n d i n g c l i e n t . . T h i s was t h e one c a s e i n t h i s s a m p l e w h e r e i t was n e c e s s a r y t o t r a n s f e r t o a d i f f e r e n t w o r k e r f o r c a s e w o r k a n d d i a g n o s t i c r e a s o n s . P r i o r t o t h e e n d o f 1 9 5 9 t h i s y o u n g woman h a d r e c e i v e d ' n e a r l y f i f t y p e r s o n a l i n t e r v i e w s . E v e n t u a l l y , i t was p o s s i b l e t o r e f e r h e r f o r p s y c h i a t r i c t r e a t m e n t , w h i c h was c e r t a i n l y t h e t r e a t m e n t o f c h o i c e , b u t w h i c h she h a d r e s i s t e d f o r a v e r y l o n g t i m e . The o t h e r s i n g l e p e r s o n was a y o u n g man. A l t h o u g h h i s p r o b l e m s w e r e a s o u r c e o f g r e a t d i s c o m f o r t a n d u n h a p p i n e s s t o h i m s e l f , t h e y w e r e much more s i m p l e and more e a s i l y t r e a t -a b l e b y c a s e w o r k m e t h o d s . T h i s s e c o n d c a s e i s b r i e f l y o u t -l i n e d b e l o w . - 136 -Mr. S t a n l e y . Mr. S t a n l e y , a s i n g l e man, t e l e p h o n e d on the s u g g e s t i o n of h i s company's nurse t o r e q u e s t "coun-s e l l i n g on a p s y c h o l o g i c a l problem". He appeared v e r y a n x i o u s f o r s e r v i c e , - w h i c h was o f f e r e d s i x weeks l a t e r . Mr. S t a n l e y was t w e n t y - f i v e y e a r s o l d . He was employed i n a c l e r i c a l p o s i t i o n a t a s m a l l s a l a r y , and was s t i l l l i v i n g a t home w i t h h i s p a r e n t s and s i b l i n g s . Mr. S t a n l e y was unhappy a t home" and a t work. He was v e r y s h o r t of s t a t u r e , and s u f f e r e d f rom poor e y e s i g h t . I n f a c t , he was q u i t e an u n p r e p o s s e s s i n g young man. He was d i s s a t i s f i e d because h i s employment o f f e r e d l i t t l e hope of advancement, and a l s o exposed him t o comparison w i t h more s u c c e s s f u l young men, w h i c h a c c e n t u a t e d h i s marked f e e l i n g s of I n f e r i o r i t y . A l s o , he f e l t i g n o r e d a t home, and s o c i a l l y . H i s r e l a t i o n s h i p s w i t h h i s p a r e n t s and h i s s o c i a l development i n d i c a t e d t h a t he was s t i l l i n an a d o l e s c e n t s t a g e . T h i s was r e f l e c t e d i n h i s b e g i n n i n g c o n t a c t w i t h the caseworker - f o r some time he posed as a g r e a t s u c c e s s w i t h the o p p o s i t e s e x . He r e a c t e d t o h i s f e e l i n g s o f I n f e r i o r i t y by d e f e n s i v e and i n a p p r o p r i a t e aggres-s i v e n e s s s o c i a l l y , but a t work was u n a b l e t o a s s e r t h i m s e l f r e a s o n a b l y , w i t h t h e r e s u l t t h a t he was v i c t i m i z e d . Mr. S t a n l e y was m a s o c h i s t i c and p r o v o k e d r e j e c t i o n i n many s i t u a -t i o n s . D u r i n g the e n s u i n g f i f t e e n months t h i s young man r e c e i v e d t h i r t y - f i v e p e r s o n a l i n t e r v i e w s w i t h a male caseworker. Casework s e r v i c e i n c l u d e d s u p p o r t and c l a r i f i c a t i o n . Mr. S t a n l e y had n o t g i v e n up, wanted t o grow up, and had many s t r e n g t h s . Over a l o n g p e r i o d he was h e l p e d t o be h i m s e l f , and t o s t a n d up f o r h i s r i g h t s i n a more r e a l i s t i c way. H i s f e e l i n g s of s e l f - w o r t h were s u p p o r t e d and s t r e n g t h e n e d , and he was h e l p e d t o c l a r i f y h i s r o l e i n l i f e , h i s r e l a t i o n s h i p w i t h h i s p a r e n t s , and w i t h the o p p o s i t e sex.. He made con-s i d e r a b l e p r o g r e s s a l o n g t h e s e l i n e s . A l t h o u g h t h e s e two s i n g l e p e r s o n s t o g e t h e r r e c e i v e d a v e r y l a r g e number of i n - p e r s o n i n t e r v i e w s , casework s e r v i c e was c o n f i n e d almost t o t a l l y t o o f f i c e i n t e r v i e w s . These cases were n o t , t h e r e f o r e , as r e l a t i v e l y c o s t l y i n terms of casework time as some of the f a m i l y cases w h i c h r e c e i v e d fewer i n t e r -v i e w s but where t h e r e were a l a r g e number of c o l l a t e r a l con-t a c t s and o t h e r s e r v i c e . The f o l l o w i n g example, one of the t h r e e where the I n i t i a l r e q u e s t was f o r homemaker s e r v i c e , w i l l s e r v e t o u n d e r l i n e t h i s p o i n t . - 137 -The Thomases. T h i s case was re-opened, ( a f t e r 'a very-r e c e n t c l o s i n g ) , when Mr. Thomas r e q u e s t e d homemaker s e r v i c e . T h e i r own p l a n s f o r the care o f t h e i r c h i l d r e n had broken down because of Mrs. Thomas,' f a i l u r e t o r e c o v e r f r o m a s e r i o u s i l l n e s s from w h i c h she had n e a r l y d i e d . Assignment was made on a p r i o r i t y b a s i s . The Thomas f a m i l y had r e c e i v e d casework s e r v i c e f rom the agency f o r over a y e a r d u r i n g 1957 and 1 9 5 8 . The p r e s e n t - • i n g p r o b lem had been m a r i t a l d i f f i c u l t y , c e n t r e d on c o n f l i c t over Mr. Thomas' teenage son of a p r e v i o u s m a r r i a g e , who had a v e r y poor r e l a t i o n s h i p w i t h h i s step-mother. T h i s boy was g i v e n d i r e c t t r e a t m e n t by h i s own caseworker.' He was encouraged t o l e a v e home, and d i d s o - i n 1 9 5 8 . A v e r y few i n t e r v i e w s w i t h Mrs. Thomas had i n d i c a t e d t o h e r . c a s e w o r k e r t h a t she needed p s y c h i a t r i c t r e a t m e n t . P s y c h i a t r i c c o n s u l t a t i o n was o b t a i n e d , and the p s y c h i a t r i s t s t a t e d t h a t i n h i s o p i n i o n Mrs. Thomas was i n danger of a p s y c h o t i c break, o r even s u i c i d e . However, b o t h Mr. and Mrs. Thomas r e s i s t e d t h e i d e a of i n v o l v e m e n t i n p s y c h i a t r i c t r e a t m e n t . ' S h o r t l y a f t e r her s t e p - s o n l e f t home, Mrs. Thomas became i l l w i t h a long-drawn-out and d e b i l i t a t i n g a i l m e n t . However, w i t h t h e s t e p - s o n out of the home, t h e Thomases wanted no f u r t h e r s e r v i c e . They r e f u s e d an o f f e r of homemaker s e r v i c e , and made t h e i r own p l a n s f o r r e l a t i v e s t o h e l p i n t h e home. At the time o f the second a p p l i c a t i o n the f a m i l y a t home i n c l u d e d t h e p a r e n t s and f o u r c h i l d r e n of. the m a r r i a g e . The c h i l d r e n were f r o m two t o . t w e l v e y e a r s o f age. . Mr. Thomas was a c i v i l s e r v a n t , employed i n a c l e r i c a l p o s i t i o n . H i s income was s m a l l i n . r e l a t i o n t o the s i z e of the f a m i l y . The f a m i l y l i v e d i n a l o w - c o s t h o u s i n g development. From the p r e v i o u s c o n t a c t , Mr. Thomas seemed t o be a p a s s i v e , dependent man. He appeared more s t a b l e than h i s w i f e , but had e v i d e n t l y withdrawn f r o m f a m i l y r e s p o n s i b i l i t y under p r e s s u r e of h i s w i f e ' s demands and her many p h y s i c a l and e m o t i o n a l u p s e t s . Mrs. Thomas had b o t h b u s i n e s s and p r o f e s s i o n a l t r a i n i n g , . a n d p r i o r t o her m a r r i a g e she had h e l d r e s p o n s i b l e p o s i t i o n s . D u r i n g h er m a r r i a g e she had a g r e a t number of i l l n e s s e s and •. h e a l t h d i f f i c u l t i e s ' . I t was s u s p e c t e d a t t h i s t i m e , and l a t e r c o n f i r m e d , t h a t some of her a i l m e n t s had been i n the n a t u r e o f c o n v e r s i o n , h y s t e r i a . There had been many problems w i t h h e r s t e p - c h i l d r e n , . h e r own c h i l d r e n , and g e n e r a l d i s -harmony. A l l o f t h e c h i l d r e n were now showing symptoms of e m o t i o n a l d i s t u r b a n c e . The o l d e s t boy was d e f i a n t and a g g r e s s i v e , . t h e second son roamed the neighbourhood and s e l -dom came home, and t h e s m a l l e r c h i l d r e n were e n u r e t i c and unhappy. The home was. i n a d e p l o r a b l e s t a t e o f f i l t h , the f a m i l y a l l unkempt, and t h e c h i l d r e n u n d i s c i p l i n e d . The p a r e n t s seemed c o m p l e t e l y i n e f f e c t u a l and t h e boys were r u n n i n g the h o u s e h o l d . O b v i o u s l y , homemaker s e r v i c e t o t h i s f a m i l y would prove t o be an e x c e e d i n g l y d i f f i c u l t and hazardous v e n t u r e , - 138 -e s p e c i a l l y as i t was s u s p e c t e d t h a t Mrs. Thomas' unmet depend-ency needs were as a " b o t t o m l e s s p i t " . There was, however, no o t h e r c h o i c e , o t h e r t h a n breakup of the f a m i l y and placement of a l l of the c h i l d r e n . S e r v i c e p r o v i d e d t o t h i s f a m i l y over the n e x t f i f t e e n months i n c l u d e d p r o v i s i o n of a homemaker f o r over a y e a r , w h i c h , w i t h a s m a l l amount of money spent t o pay f o r a b a b y - s i t t e r t o r e l i e v e t h e homemaker, c o s t the agency over t h r e e thousand  d o l l a r s , and a c c o u n t e d f o r one n i n t h o f the homemaker s e r v i c e a v a i l a b l e t o the whole community of over h a l f a m i l l i o n p e o p l e ! • T h i s c o s t does not i n c l u d e , of c o u r s e , c o u n t l e s s hours of casework t i m e . The p a r e n t s r e c e i v e d about f i f t y p e r - , s o n a l i n t e r v i e w s and about the same number o f t e l e p h o n e i n t e r -v i e w s . Besides,.many hours were spent i n a g r e a t number and v a r i e t y o f c o l l a t e r a l c o n t a c t s . S i x d o c t o r s , t h r e e h o s p i t a l s , and s e v e r a l o t h e r h e a l t h .and s o c i a l a g e n c i e s were i n v o l v e d . A l t h o u g h the Thomases had a s t r o n g d e s i r e f o r p r a c t i -c a l s e r v i c e , i t was. known t h a t i t would be v e r y d i f f i c u l t t o i n v o l v e them in..casework t r e a t m e n t , and so i t p r o v e d . I n the b e g i n n i n g Mr. Thomas gave the homemaker l i t t l e c o - o p e r a t i o n , and Mrs. Thomas made i m p o s s i b l e heavy demands. They d i d not use casework h e l p and were v e r y slow Indeed t o respond t o p r a c t i c a l h e l p . Mrs. Thomas d i d not r e c o v e r i n h e a l t h ; i n .fact seemed t o be g e t t i n g worse, and had a l a r m i n g p h y s i c a l symptoms. I t p r o v e d t o be i m p o s s i b l e f o r the caseworker t o o b t a i n any c l e a r m e d i c a l or p s y c h i a t r i c d i a g n o s i s or p r o g n o s i s - .such r e p o r t s as were o b t a i n a b l e were h i g h l y c o n f l i c t i n g . F i n a l l y , I n J u l y , 1959, Mrs. Thomas was a d m i t t e d t o a g e n e r a l h o s p i t a l f o r complete m e d i c a l and p s y c h i a t r i c assessment, and l a t e r was t r a n s f e r r e d t o a mental h o s p i t a l . I n t h e meantime the homemakers p l a c e d i n t h i s home had a c h i e v e d most a d m i r a b l e r e s u l t s w i t h the c h i l d r e n , w o r k i n g under almost I m p o s s i b l e c o n d i t i o n s . The c h i l d r e n , who were c o m p l e t e l y u n d i s c i p l i n e d and q u i t e u n a t t r a c t i v e i n the b e g i n -n i n g , f i n a l l y responded' t o f i r m , . k i n d l y d i s c i p l i n e and began t o "blossom" and t o behave more l i k e n o r mal, l i k e a b l e c h i l d r e n . D u r i n g h i s w i f e * s h o s p i t a l i z a t i o n , the caseworker.was f i n a l l y a b l e t o e s t a b l i s h a w o r k i n g r e l a t i o n s h i p w i t h Mr. Thomas, who t h e n showed t h a t . h e d i d have some s t r e n g t h s . Mrs. Thomas was found t o be n o n - p s y c h o t i c , and p h y s i c a l l y q u i t e w e l l . The d i a g n o s i s was " c h a r a c t e r d i s o r d e r " . Mrs. Thomas, an i n t e l l i g e n t woman, was e x t r e m e l y n a r c i s s i s t i c and h i g h l y r e s e n t f u l of h e r husband and s t e p - c h i l d r e n , whom she f e l t , t o be i n f e r i o r t o h e r s e l f . I t was b e l i e v e d t h a t she had mani-p u l a t e d her husband t o an extreme degree, and t h a t he had done h i s b e s t i n a v e r y d i f f i c u l t s i t u a t i o n . I t was s u g g e s t e d t h a t Mr. Thomas s h o u l d be encouraged t o m a i n t a i n a more p o s i t i v e r o l e i n the f a m i l y , and t h a t t h e homemaker be removed from, t h e home on Mrs. Thomas'- d i s c h a r g e f rom h o s p i t a l . - 139 -The homemaker was removed as suggested i n November, 1959, and t h e r e a f t e r t h e r e was no f u r t h e r c o n t a c t w i t h Mrs. Thomas.and the c h i l d r e n . At h i s r e q u e s t - M r . Thomas m a i n t a i n e d h i s c o n t a c t w i t h the caseworker, by t e l e p h o n e . (He d i d not want h i s w i f e t o know of the c o n t a c t , and t h i s appeared t o be sound from a casework v i e w p o i n t . ) Mr. Thomas used s u p p o r t i v e casework h e l p t o e x p r e s s h i s f e a r s and h i s f e e l i n g s , t o a c h i e v e , e f f e c t i v e a c t i o n , i n d i s c i p l i n i n g h i s c h i l d r e n , and t o . m a i n t a i n g a i n s on h i s w i f e ' s r e t u r n home. He was encouraged t o ta k e a f i r m e r s t a n d w i t h h i s w i f e so t h a t a h e a l t h i e r m a r i t a l b a l a n c e c o u l d be a c h i e v e d . Mrs. Thomas g r a d u a l l y assumed ho u s e h o l d tasks.. She made some b i d s f o r sympathy,which her husband d i d not encourage. At about t h i s time Mr. Thomas was. l e f t a sum of money.. At h i s own'request "he p a i d the f u l l .cost of home-maker s e r v i c e f o r the l a s t few weeks, and used the r e s t of t h e money t o make a down payment on a home. The move t o a new. neighbourhood had a s a l u t a r y e f f e c t oh the whole f a m i l y . The c h i l d r e n had -not been p o p u l a r i n the o l d neighbourhood, but now began t o f i n d f r i e n d s . A l t h o u g h p r e v i o u s h o u s i n g had been q u i t e good, -Mrs. Thomas had not been a b l e t o t o l e r a t e the l o s s of s o c i a l s t a t u s i m p l i e d by l i v i n g i n s u b s i d i z e d h o u s i n g . Now she began t o t a k e an i n t e r e s t i n neighbourhood a c t i v i t i e s . Mr. Thomas was more h o p e f u l f o r the f u t u r e . The Thomas f a m i l y was h e l p e d - a t a d r e a d f u l c o s t . I n r e t r o s p e c t , i t may be t h a t the homemaker s e r v i c e p r o v i d e d was i n exce s s of what was req u i r e d . . I n f a c t , Mrs. Thomas* r e c o v e r y may have been impeded. What of her c h i l d r e n , how-ever ? C o u l d t h e y have been g i v e n a chance f o r normal d e v e l o p -ment u n l e s s t h e y had a r e l a t i o n s h i p w i t h a warm and s t a b l e mother s u b s t i t u t e over a v e r y l o n g t i m e ? C o u l d t h e i r f a t h e r •have been a s s i s t e d , as he was, t o assume a more e f f e c t i v e r o l e , i n the f a m i l y ? I f the n a t u r e o f Mrs. Thomas-* • p e r s o n a l i t y -d i s o r d e r had been c l e a r l y u n d e r s t o o d from t h e b e g i n n i n g , d o u b t l e s s the case c o u l d have been h a n d l e d more e f f e c t i v e l y . - I t i s h a r d l y s u r p r i s i n g t h a t t h i s was not- p o s s i b l e . I n the f i r s t p l a c e , i t was an extreme m i s f o r t u n e f o r a l l concerned -t h a t t h i s p a r t i c u l a r woman d i d have an i n f e c t i o u s d i s e a s e - l4o -w h i c h d o e s s o m e t i m e s l e a v e p e o p l e i n i m p a i r e d h e a l t h , a n d o c c a s i o n a l l y c a u s e s o r g a n damage w h i c h c a n p r o v e f a t a l . F u r t h e r m o r e , i t i s e v i d e n t t h a t M r s , T h o m a s * p h y s i c a l a n d e m o t i o n a l c o n d i t i o n was n o t e a s i l y u n d e r s t o o d - m e d i c a l a n d p s y c h i a t r i c d i a g n o s e s r a n t h e g a m u t . The p i c t u r e w a s v e r y c o n f u s i n g . The f i n a l d i a g n o s i s w a s a c t u a l l y ' " c h a r a c t e r d i s -o r d e r w i t h h y s t e r i c a l f e a t u r e s " , w h i c h a p p e a r s t o b e a c o n -t r a d i c t i o n i n t e r m s - b u t t h a t i s M r s . T h o m a s . Two o t h e r l o n g - t e r m c a s e s b e g a n w i t h a r e q u e s t f o r h o m e m a k e r s e r v i c e . I n o n e c a s e , w h e r e t h e m o t h e r w a s m e n -t a l l y i l l , h o m e m a k e r s e r v i c e was a l s o g i v e n o v e r a l o n g p e r i o d , a t a c o s t o f o v e r o n e t h o u s a n d d o l l a r s . T h e s e v e r y l o n g - t e r m a n d e x p e n s i v e h o m e m a k e r c a s e s a r e e x c e p t i o n a l ; i t i s p r o b a b l y n o t t y p i c a l f o r t w o s u c h s i t u a t i o n s t o o r i g i n a t e i n o n e p e r i o d o f i n t a k e c o v e r i n g o n l y t w o m o n t h s . I n t h e o t h e r c a s e , h o m e m a k e r s e r v i c e p r o v i d e d w a s n o t e x c e s s i v e , b u t t h e m o t h e r h a d m a r i t a l a n d o t h e r p r o b l e m s , a n d s h e r e q u e s t e d a n d u s e d e x t e n s i v e c a s e w o r k h e l p . M r s . Thomas i s a n e x a m p l e o f " c h a r a c t e r d i s o r d e r " o r " p e r s o n a l i t y t r a i t d i s t u r b a n c e " i n a p e r s o n . o f m i d d l e -c l a s s b a c k g r o u n d . S u c h p e r s o n a l i t y d i f f i c u l t i e s , ^a.s d e s c r i b e d b y N o y e s a n d K o l b , a r e I n c l u d e d u n d e r t h e g e n e r a l h e a d i n g o f " p e r s o n a l i t y d i s o r d e r s " . ^ A c c o r d i n g t o t h e S t a n d a r d N o m e n -c l a t u r e o f t h e A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n , p e r s o n a l i t y 1 N o y e s , A r t h u r P . , M . D . , a n d L a w r e n c e C . K o l b , M . D . , M o d e r n C l i n i c a l P s y c h i a t r y , W . B . S a u n d e r s C o m p a n y , P h i l a -d e l p h i a .and L o n d o n , 1958, C h a p t e r X X X I , p p . 541-544. - 141 -d i s o r d e r s i n c l u d e "those cases i n w h i c h the p e r s o n a l i t y , i n s t e a d of u t i l i z i n g symptoms e x p r e s s e d i n m e n t a l , s o m a t i c o r e m o t i o n a l terms i n i t s e f f o r t s t o secure a djustment, makes use of p a t t e r n s of a c t i o n or b e h a v i o r " . "The p e r s o n a l i t y d i s o r d e r s are c h a r a c t e r i z e d by d e f e c t s i n the development of the p e r s o n -a l i t y o r by p a t h o l o g i c a l t r e n d s i n i t s s t r u c t u r e . " They can be d i v i d e d i n t o t h r e e groups: d i s t u r b a n c e s of p e r s o n a l i t y p a t t e r n , i . e . i n a d e q u a t e , s c h i z o i d and p a r a n o i d p e r s o n a l i t i e s ; s o c i o -p a t h i c p e r s o n a l i t y d i s t u r b a n c e s - w h i c h i n c l u d e d i s o r d e r s f o r m e r l y d e s i g n a t e d as " p s y c h o p a t h i c p e r s o n a l i t y " ; and d i s t u r b -ances of p e r s o n a l i t y t r a i t . I n g e n e r a l , p e r s o n s d e s c r i b e d as h a v i n g d i s t u r b a n c e s of p e r s o n a l i t y t r a i t are c h a r a c t e r i z e d by an i n a b i l i t y t o m a i n t a i n e m o t i o n a l e q u i l i b r i u m and independ-ence. Prominent i n t h i s group are the s o - c a l l e d " c h a r a c t e r d i s o r d e r s " , a t e rm w h i c h c o v e r s p e r s o n s d e s c r i b e d i n t h i s con-t e x t as h a v i n g " p a s s i v e - a g g r e s s i v e p e r s o n a l i t y " . . T h i s i s b a s i c a l l y an i m m a t u r i t y r e a c t i o n , i n w h i c h deep dependence and h o s t i l i t y may be m a n i f e s t e d e i t h e r o v e r t l y o r i n v e i l e d form. Often one of t h e s e c h a r a c t e r i s t i c s s e r v e s as a r e a c t i o n form-a t i o n t o h i d e the o t h e r from c o n s c i o u s n e s s . F o r i n s t a n c e , p e r s o n s of the " a g g r e s s i v e " type are h o s t i l e , p r o v o c a t i v e , . a n t a g o n i s t i c , c o m p e t i t i v e and a m b i t i o u s , but "below the s u r f a c e a deep dependency can be d i s c o v e r e d " . On the o t h e r hand, " p a s s i v e - d e p e n d e n t " p e r s o n s are p a s s i v e , t i m i d and f e a r f u l ; " t h e r e i s f r a n k e x p r e s s i o n of an absence of mature s e l f - c o n f i d e n c e and s e l f - r e l i a n c e " , and "an u n d e r l y i n g - 142 -h o s t i l i t y , c o v e r e d by a r i g i d s h e l l of t i m i d i t y and p a s s i v i t y , i s . e n t i r e l y u n c o n s c i o u s " . .Mr. Thomas p r o v e d t o have more s t r e n g t h than was i n d i c a t e d i n the b e g i n n i n g , when he was d e s c r i b e d as a p a s s i v e , dependent p e r s o n . However, i t may w e l l be t h a t he t o o had a p e r s o n a l i t y t r a i t d i s t u r b a n c e , of the "p a s s i v e - d e p e n d e n t " type i n h i s c a s e . I n m a r i t a l p a r t n e r s , t h i s c o m b i n a t i o n I s o f t e n f o u n d i n p a i r s . Among t h e i l l u s t r a t i o n s of cases i n the " l o n g - t e r m " group, t h e r e are a t l e a s t t h r e e examples of a d u l t c l i e n t s s u f f e r i n g f r o m such d i s t u r b a n c e s o r " c h a r a c t e r d i s -o r d e r s " : Mrs. Oswald, Mrs. P h i l l i p , and Mrs, Thomas.. A l s o , the s i n g l e woman who r e c e i v e d e x t e n s i v e and i n t e n s i v e s e r v i c e was s u f f e r i n g f r om a d i s t u r b a n c e i n e m o t i o n a l development w h i c h c e r t a i n l y comes under the g e n e r a l h e a d i n g o f " p e r s o n a l i t y d i s o r d e r s " . There are e x c e p t i o n s , however, ( n o t a b l y the R i c h a r d s ) , and the few i l l u s t r a t i o n s w h i c h c o u l d be given- do not g i v e a t r u e p i c t u r e . o f the v e r y h i g h i n c i d e n c e of p e r s o n a l i t y d i s o r d e r s , p a r t i c u l a r l y p e r s o n a l i t y t r a i t d i s t u r b -ance, i n t h e t o t a l group of f o u r t e e n c a s e s . T h i s i s e s p e c i a l l y t r u e of t h e m a r i t a l p r o b l e m cases i n t h i s group. Pour m a r i t a l p r o b l e m cases were not d e s c r i b e d , and i n a t l e a s t two cases b o t h m a r i t a l p a r t n e r s had p e r s o n a l i t y d i s t u r b a n c e s of t h i s t y p e ; i t appears t h a t i n t h e o t h e r two cases a l s o , one or b o t h m a r i t a l p a r t n e r s were ' s u f f e r i n g from such a p e r s o n a l i t y d i s o r d e r . - 143 -I f the p r e s e n t sample i s i n d i c a t i v e , a m a j o r i t y of l o n g - t e r m c l i e n t s are m i d d l e - c l a s s or upper w o r k i n g - c l a s s p e o p l e w i t h " c h a r a c t e r d i s o r d e r s " . T h e i r problems a r e not a f t e r a l l so d i f f e r e n t from th o s e of the l o n g - t e r m c l i e n t s f a m i l y agen-c i e s have always had. Prom a s o c i a l , c u l t u r a l and economic v i e w p o i n t t h e y are d i f f e r e n t ; but d i a g n o s t i c a l l y t h e y are " s i s t e r s under the ski n " . . T h i s a p p l i e s t o the new, or r e l a t i v e l y new a p p l i c a n t s - a l l but two of the a p p l i c a n t s i n t h e sample who r e c e i v e d " l o n g - t e r m " s e r v i c e . The two excep-t i o n s , and a number of f a m i l i e s i n the "medium-term" group, were the same p e o p l e . As the i l l u s t r a t i o n s show, case-workers are f i n a l l y l e a r n i n g how t o h e l p t h e s e p e o p l e . Beyond q u e s t i o n , p e r s o n s s u f f e r i n g f r o m p e r s o n a l i t y d i s o r d e r s are e x c e e d i n g l y d i f f i c u l t t o t r e a t , by any method.. T h e i r d i s t u r b a n c e s have been " b u i l t - i n " , and are imbedded i n the v e r y p e r s o n a l i t y or c h a r a c t e r s t r u c t u r e d u r i n g the course of e a r l y development; t h e y t h e r e f o r e permeate the i n d i v i -d u a l ' s t o t a l , manner of b e h a v i n g , f e e l i n g , and r e a c t i n g t o o t h e r s . A major i n g r e d i e n t of s u c c e s s f u l t r e a t m e n t i s time and p a t i e n c e on t h e p a r t of the caseworker or p s y c h i a t r i s t , as what i s r e q u i r e d i s r e - r t r a i n i n g i n new and more d e s i r a b l e ways of a c t i n g and f e e l i n g . But a s e r i o u s q u e s t i o n i s - how many such cases can a f a m i l y agency a f f o r d t o c a r r y a t any one t i m e , b e a r i n g In mind t h a t more " t r e a t a b l e " p r o s p e c t i v e c l i e n t s a r e a p p l y i n g f o r s e r v i c e i n g r e a t e r numbers t h a n e v e r b e f o r e , and many of t h e s e are b e i n g " l o s t " i n the w a i t i n g p e r i o d ? - 144 -Some a u t h o r i t i e s b e l i e v e t h a t the i n c i d e n c e o f p e r s o n a l i t y d i s o r d e r i s i n c r e a s i n g In the g e n e r a l p o p u l a t i o n . A l t h o u g h the i n c i d e n c e of p e r s o n a l i t y d i s t u r b a n c e appears t o be h i g h e s t among c l i e n t s i n the " l o n g - t e r m " group ( j u d g i n g f r om the p r e s e n t sample), i l l u s t r a t i o n s are not l a c k i n g in. t h e o t h e r groups, e.g., Mr. Gavin ( i f not h i s w i f e ) , the Harmons, the K e l v i n s , and the N e v i l l e s . I n the o t h e r groups, a l m o s t a l l of the c l i e n t s w i t h " c h a r a c t e r d i s o r d e r s " had p r e v i o u s l y . r e c e i v e d e x t e n s i v e s e r v i c e f r om the agency. The Harmons were an.excep-t i o n , but as p r e v i o u s l y e x p l a i n e d t h e y d i d r e t u r n and are now l o n g - t e r m c l i e n t s . The m a j o r i t y of new a p p l i c a n t s who r e c e i v e d s e r v i c e of l e s s t h a n t w e l v e months d u r a t i o n w h i c h was complete and h e l p f u l t o them appear t o be n e u r o t i c or r e l a t i v e l y "nor-mal" p e r s o n s f a c i n g d i f f i c u l t f a m i l y or e n v i r o n m e n t a l c r i s e s , o r young p e o p l e e x p e r i e n c i n g d i f f i c u l t y i n a d j u s t i n g t o a d u l t l i f e . Mrs: F r e d e r i c k , the I r w i n s , the James, and the Marks are examples. There are a l s o examples i n the l o n g - t e r m group, f o r i n s t a n c e t h e R i c h a r d s and Mr. S t a n l e y . I n g e n e r a l , these c l i e n t s are f a r more e a s i l y and e c o n o m i c a l l y h e l p e d by case-work, and the e x p e r i e n c e i s much more r e w a r d i n g f o r c l i e n t and caseworker a l i k e . T h i s i s not t o say t h a t s u c c e s s f u l t r e a t m e n t i n some of t h e s e cases may not r e q u i r e i n t e n s i v e and e x t e n s i v e casework s e r v i c e , but the r e s u l t s a r e more s t r i k i n g , *and t h e y may be more c l e a r l y p r e v e n t i v e . CHAPTER V THE CHALLENGE OF PRIORITY DETERMINATION: A NEW LOOK AT FAMILY SERVICE CLIENTELE T h i s s t u d y was u n d e r t a k e n i n the hope of u n c o v e r i n g some f a c t s about th e s i g n i f i c a n c e of i n t a k e p o l i c y and p r a c t i c e , I n c l u d i n g p r i o r i t y d e c i s i o n s , when t h e r e i s a w a i t i n g s - l i s t i n a f a m i l y s e r v i c e agency. In.view o f the w i d e s p r e a d b e l i e f t h a t the n a t u r e of the f a m i l y s e r v i c e c l i e n t e l e o r c o n s t i t u e n c y i s c h a n g i n g , i t was a l s o hoped t h a t e x a m i n a t i o n of a b l o c k of a c c e p t e d a p p l i c a t i o n s might throw l i g h t on t h e .present c l i e n t -e l e of one agency, t r e n d s w i t h r e g a r d t o the c h a n g i n g c o n s t i -t u e n c y , and whether i n t a k e p o l i c y has any r e l a t i o n s h i p w i t h t h e s e t r e n d s . The s u r v e y t o o k the w a i t i n g - l i s t as a s p e c i f i c p o i n t of time w i t h r e g a r d t o r e q u e s t s f o r s e r v i c e and i n t a k e p o l i c y . As the p r e c e d i n g pages i n d i c a t e , the importance of new a p p l i c a n t s , and the problems concerned w i t h them have c l e a r l y shown up. F o r t u n a t e l y , a companion s t u d y , .adding the q u a l i t a t i v e approach t o f a c t o r s of m o t i v a t i o n and communicaV t i o n a t t h e p o i n t of i n t a k e from the v i e w p o i n t of the new a p p l i c a n t , was u n d e r t a k e n a t the same time." 1" The two s t u d i e s s u p p o r t and complement one a n o t h e r , h i g h l i g h t i n g d i f f e r e n t .aspects of the same problem. 1 B e l a n g e r , K a t h l e e n , The P o t e n t i a l " C o n s t i t u e n c y " of a  F a m i l y S e r v i c e Agency: An I n t e r v i e w - S u r v e y of A p p l i c a n t s  Who D i d Not Become C l i e n t s . Master of S o c i a l Work t h e s i s , U n i v e r s i t y of B r i t i s h Columbia, i 9 6 0 . - 146 -One f a c t shown by t h i s s t u d y , and r e v e a l e d i n s h a r p e r r e l i e f by the companion s t u d y , i s t h a t t h e r e i s a g r e a t d i f f e r -ence between an " a p p l i c a n t " and a " c l i e n t " . The s t a t i s t i c a l d i s t i n c t i o n between " b r i e f " and " c o n t i n u e d " s e r v i c e cases w h i c h has become a s t a n d a r d use from F a m i l y S e r v i c e A s s o c i a -t i o n of America p r a c t i c e i s , i n t h i s r e g a r d , an a r t i f i c i a l d i s t i n c t i o n . The r e a l l y s i g n i f i c a n t d i s t i n c t i o n s are between, a p p l i c a n t s and c l i e n t s ; between those who r e a l l y use the agency' 1 s s e r v i c e t o h e l p them s o l v e t h e i r problems and those • who "drop out" - the l a t t e r may be r e g a r d e d as p o t e n t i a l c l i e n t s , , o r even as " l o s t c l i e n t s " . Who are the C l i e n t e l e ? V e r y few of the o r i g i n a l a p p l i c a n t s i n the p r e s e n t s u r v e y were f o r m a l l y r e f e r r e d t o the agency; e i g h t y - f i v e (out of n i n e t y - f i v e ) r e q u e s t e d s e r v i c e on t h e i r own b e h a l f . I t might be assumed from t h i s t h a t t h e a p p l i c a n t s were " w e l l -m o t i v a t e d " ; n e v e r t h e l e s s over o n e - t h i r d of them d i d not con-t i n u e beyond one i n - p e r s o n i n t e r v i e w . E l e v e n o f those r e c e i v i n g o n l y " b r i e f s e r v i c e " d i d i n f a c t r e c e i v e a completed and a p p r o p r i a t e s e r v i c e - but s i x a p p l i c a n t s who c o n t i n u e d beyond one p e r s o n a l i n t e r v i e w were i d e n t i f i e d as " d r o p - o u t s " . However, because th e d i s t i n c t i o n between b r i e f and c o n t i n u e d s e r v i c e c ases was made i n s e p a r a t i n g the cases i n the sample f o r s t u d y , .and o n l y s i x of the a p p l i c a n t s r e c e i v i n g " c o n t i n u e d " s e r v i c e were i d e n t i f i e d as " d r o p - o u t s " , f o r the purpose of p r e s e n t . s t a t i s t i c a l comparisons f a m i l y members r e c e i v i n g d i r e c t - 147 -s e r v i c e I n the s i x t y - t w o c o n t i n u e d s e r v i c e cases a re r e f e r r e d t o as the " c l i e n t s " . The g r e a t m a j o r i t y of the a p p l i c a n t s were m a r r i e d , and most had c h i l d r e n . The same was b r o a d l y t r u e o f the c l i e n t s , b u t , because o f the p r o p o r t i o n a t e l y g r e a t l o s s o f a p p l i c a t i o n s f o r m a r i t a l c o u n s e l l i n g , t o a l e s s e r degree. T h r e e - q u a r t e r s of the o r i g i n a l a p p l i c a n t s were women. However, the s u r v e y o f c o n t i n u e d s e r v i c e cases showed t h a t d i r e c t s e r v i c e was g i v e n t o 108 i n d i v i d u a l c l i e n t s i n t h i s group -43 men, 58 women, and J " c h i l d r e n " . Women c l i e n t s r e c e i v e d more s e r v i c e on the average, and t w i c e as many p e r s o n a l i n t e r -v i ews as men i n t h e a g g r e g a t e . Men c l i e n t s , however, d i d r e c e i v e a s u b s t a n t i a l .amount of casework time and a t t e n t i o n on t h e average, and i t i s c l e a r t h a t men a r e c l i e n t s of the agency i n numbers a p p r o a c h i n g the number of women c l i e n t s . C h i l d r e n of c l i e n t s ' r e c e i v e d d i r e c t casework t r e a t m e n t i n seven c a s e s . Most of t h e s e " c h i l d r e n " were t e e n a g e r s - v e r y -l i t t l e d i r e c t s e r v i c e was g i v e n t o c h i l d r e n under t h i r t e e n . I n c i d e n t a l l y , t e e n a g e r s u s u a l l y had t h e i r own caseworker, and these were the o n l y " s p l i t " cases i n the sample. I n no -case d i d a husband and w i f e have s e p a r a t e c a s e w o r k e r s . F i f t y - o n e of the a p p l i c a n t s had ne v e r b e f o r e had any c o n t a c t w i t h the agency. F o r t y - f o u r were re-opened o r r e c u r -r e n t c a s e s : i t might be assumed from t h i s t h a t . f o r t y - f o u r of the a p p l i c a n t s had p r e v i o u s l y used c o n t i n u i n g s e r v i c e , but case - 148 -m a t e r i a l r e v e a l e d t h a t q u i t e a number of these were not a c t -u a l l y f o r m e r c l i e n t s i n t h i s s ense. However, o n l y twenty-s i x of the new a p p l i c a n t s c o n t i n u e d beyond one p e r s o n a l i n t e r -v i e w , .compared w i t h t h i r t y - s i x o f the a p p l i c a n t s p r e v i o u s l y known t o the agency, however b r i e f l y . An attempt was made t o o b t a i n some i n d i c a t i o n .of the s o c i a l c l a s s o r s t a t u s of the a p p l i c a n t s f rom the s t a t i s t i c a l i n f o r m a t i o n a v a i l a b l e . The employment of t h e male bread-w i n n e r s i n the sample was found t o be m a i n l y l o w e r m i d d l e c l a s s and upper w o r k i n g c l a s s i n s t a t u s . However, t h e r e was r e p r e s e n t a t i o n f rom the group above - m i d d l e c l a s s , . b u s i n e s s and p r o f e s s i o n a l , and some f r o m the u n s k i l l e d worker group. I n f o r m a t i o n about the a p p l i c a n t s ' f a m i l y g r o u p i n g s and the s e r v i c e s t h e y r e q u e s t e d , i n t e r p r e t e d i n the l i g h t o f c u r r e n t l i t e r a t u r e , s u g g e s t s t h a t the m a j o r i t y o f t h e a p p l i c a n t s are i d e n t i f i e d w i t h the s o - c a l l e d "middle c l a s s v a l u e s " of f a m i l y l i f e , whatever t h e i r s o c i a l o r o c c u p a t i o n a l s t a t u s . T h i s was s u p p o r t e d by e x a m i n a t i o n of case m a t e r i a l . W i t h few excep-t i o n s , the c l i e n t s were h a r d - w o r k i n g , a p p a r e n t l y r e s p e c t a b l e p e o p l e , who s u p p o r t e d t h e i r f a m i l i e s and c a r e d f o r t h e i r c h i l d -r e n t o the b e s t of t h e i r a b i l i t y . They d i d not u s u a l l y p r e -sent problems t o the community a t l a r g e . The " c l i e n t e l e " i n t h i s sample r e p r e s e n t e d r e c e n t r e q u e s t s f o r s e r v i c e and s h o u l d not be t a k e n . a s n e c e s s a r i l y r e p r e s e n t a t i v e o f the f u l l c a s e l o a d of the .agency a t the t i m e . However, among the a c c e p t e d a p p l i c a n t s who became c l i e n t s t h e r e - 149 -were p r a c t i c a l l y no examples of the c l a s s i c a l , " h a r d - c o r e " or " m u l t i - p r o b l e m " f a m i l i e s . There were some b o r d e r l i n e c a s e s , and. some..families w h i c h c o u l d become, or produce, such prob-lems. Among the a d u l t ' c l i e n t s , p a r t i c u l a r l y those who r e c e i v e d s e r v i c e over a l o n g p e r i o d , t h e r e appeared t o be a h i g h i n c i d -ence o f p e r s o n a l i t y d i s o r d e r s - u s u a l l y p e r s o n a l i t y t r a i t d i s t u r b a n c e s of the p a s s i v e - a g g r e s s i v e t y p e . O t h e r s , p a r t i -c u l a r l y among the new a p p l i c a n t s , ' w e r e n e u r o t i c , o r i n some cases r e l a t i v e l y "normal" p e r s o n s , f a c e d w i t h s t r e s s f u l s i t u a -t i o n s o r d i f f i c u l t p e r i o d s of l i f e a d j u s t m e n t . " S e r v i c e s Requested and P r o v i d e d I n almost h a l f of t h e t o t a l cases a r e q u e s t f o r ma r r i a g e c o u n s e l l i n g was the p r i m a r y r e a s o n f o r the a p p l i c a t i o n ; i n 5 6 p e r cent of the cases m a r i t a l d i f f i c u l t y was one of the main problems p r e s e n t e d a t i n t a k e . Of t h e s i x t e e n a p p l i c a n t s who p r e s e n t e d o t h e r f a m i l y problems, a l l but one were concerned about a problem i n p a r e n t - c h i l d r e l a t i o n s h i p s , but the s e d i d not always a f f e c t ' m i n o r c h i l d r e n . I n s e v e r a l cases the p r e -s e n t i n g p r o b l e m was d i f f i c u l t y i n r e l a t i o n s h i p between a d u l t c h i l d r e n and t h e i r p a r e n t s . Seventeen a p p l i c a n t s wanted h e l p w i t h a p r o b l e m o f i n d i v i d u a l p e r s o n a l i t y adjustment - t h e i r own or t h a t of a f a m i l y member. I n s e v e n t y - e i g h t cases the o n l y h e l p r e q u e s t e d a t i n t a k e was casework or c o u n s e l l i n g h e l p . Seventeen a p p l i c a n t s r e q u e s t e d s e r v i c e o f a " t a n g i b l e " k i n d ; •of these., t h i r t e e n a p p l i e d f o r homemaker s e r v i c e . Pour a p p l i c a n t s wanted h e l p w i t h e n v i r o n m e n t a l problems o t h e r t h a n - 150 -•the need f o r homemaker s e r v i c e . I n cases w h i c h c o n t i n u e d beyond the i n t a k e s t a g e , • . s e r v i c e s r e c e i v e d by c l i e n t s and 'problems g i v e n casework a t t e n t i o n were u s u a l l y much more numerous and v a r i e d than the s e r v i c e r e q u e s t e d a t i n t a k e . Only seventeen a p p l i c a n t s s p e c i -f i c a l l y r e q u e s t e d h e l p w i t h problems of p e r s o n a l i t y a d j u s t m e n t ; but i t I s h a r d l y s u r p r i s i n g t h a t problems i n t h i s a r e a were found and g i v e n casework a t t e n t i o n i n almost a l l .of the con-t i n u e d s e r v i c e c a s e s , e x c e p t a v e r y few where the o n l y h e l p r e q u e s t e d ( p r needed) was of an e n v i r o n m e n t a l n a t u r e . U s u a l l y , p e r s o n a l i t y problems of one or b o t h m a r i t a l p a r t n e r s a re a t the r o o t of problems In the m a r r i a g e r e l a t i o n s h i p , and i n the t y p i c a l f a m i l y - s e r v i c e case p e r s o n a l i t y d i f f i c u l t i e s of p a r e n t s have caused them t o have some t r o u b l e In t h e i r r e l a t i o n s h i p w i t h t h e i r c h i l d r e n . A l s o , i n many cases where e n v i r o n m e n t a l problems were not a p r e c i p i t a t i n g f a c t o r i n the r e q u e s t f o r s e r v i c e , problems of t h i s n a t u r e a f f e c t i n g f a m i l y l i f e were g i v e n casework a t t e n t i o n . There was a wide v a r i a -t i o n i n the ite m s o f casework s e r v i c e p r o v i d e d f o r i n d i v i d u a l cases - f o r i n s t a n c e , f o r the whole sample casework i n t e r -v i e w i n g ranged from one t e l e p h o n e i n t e r v i e w t o s e v e n t y - s i x p e r s o n a l i n t e r v i e w s w i t h members o f one f a m i l y . I n some cases casework s e r v i c e was p r o v i d e d almost w h o l l y In o f f i c e i n t e r -v i e w s ; In o t h e r cases many home v i s i t s . w e r e made and s e r v i c e g i v e n i n c l u d e d e n v i r o n m e n t a l . h e l p such as homemaker s e r v i c e , and numerous c o l l a t e r a l . c o n t a c t s . S e v e r a l f a m i l i e s i n the - 151 -sample r e c e i v e d l a r g e amounts o f f i n a n c i a l a s s i s t a n c e i n t h e form of homemaker s e r v i c e , but no f a m i l y r e c e i v e d d i r e c t f i n a n -c i a l a s s i s t a n c e i n any amount. The k i n d o f casew.ork t r e a t m e n t was a l s o v a r i e d ; i n some cases t h e r e was c o n s i d e r a b l e c l a r i f i -c a t i o n , but w i t h o t h e r s t r e a t m e n t was p u r e l y s u p p o r t i v e . C o n t i n u e d s e r v i c e i n the sample d i v i d e d c l e a r l y i n t o t h r e e groups judged by l e n g t h of s e r v i c e , and t h e r e a l s o appeared t o be s i g n i f i c a n t d i f f e r e n c e s i n t h e k i n d s of cases i n the d i f f e r e n t g roups. Those c l o s e d w i t h i n f o u r months of i n t a k e i n c l u d e d a number where the a p p l i c a n t s "dropped .out" and d i d not r e a l l y become c l i e n t s , , and q u i t e a number where o n l y s h o r t - t e r m c o u n s e l l i n g , o r e n v i r o n m e n t a l h e l p was wanted or needed. The "medium-term" group, c l o s e d w i t h i n a y e a r , appeared t o i n c l u d e the h i g h e s t p r o p o r t i o n .of cases where casework t r e a t m e n t was s u c c e s s f u l i n h e l p i n g c l i e n t s a c h i e v e . b e t t e r f a m i l y . r e l a t i o n s h i p s and p e r s o n a l adjustment w i t h o u t v a s t e x p e n d i t u r e s o f time and money. There were a number o f new c l i e n t s i n t h i s group who were n e u r o t i c p e r s o n s , w i t h some ego s t r e n g t h and m o t i v a t i o n s t r o n g enough t o engage themselves i n t r e a t m e n t . There were a l s o a number of former c l i e n t s i n t h i s group whom caseworkers were f i n a l l y a b l e t o h e l p t o a b e t t e r a d j u s t m e n t . There appears t o be a f a i r l y sharp d i v i s i o n between the "medium-term" and " l o n g - t e r m " c a s e s : t h i r t e e n of the l a t t e r r e c e i v e d over h a l f o f the s e r v i c e p r o v i d e d t o the whole sample, and a l l o f th e s e were e x c e e d i n g l y d i f f i c u l t and e x p e n s i v e t o t r e a t . - 152 -I m p l i c a t i o n s f o r P r i o r i t y D e t e r m i n a t i o n The c l e a r e s t and. most p o s i t i v e f a c t r e v e a l e d by t h i s s t u d y i s t h a t l o s s of cases i n the process- of i n t a k e i s a lmost e n t i r e l y a p r o blem of "engaging" the new a p p l i c a n t . New a p p l i c a n t s , p a r t i c u l a r l y those who p r e s e n t a r e q u e s t f o r m a r r i a g e c o u n s e l l i n g , drop out i n l a r g e numbers. I f t h i s sample i s i n d i c a t i v e , t h e r e i s l i t t l e danger t h a t f o r m e r c l i e n t s w i l l make an a p p l i c a t i o n f o r s e r v i c e u n l e s s t h e y s e r i o u s l y i n t e n d t o use i t . Only e i g h t out of f o r t y - f o u r a p p l i c a n t s who had had some p r i o r c o n t a c t w i t h the agency d i d not c o n t i n u e as c l i e n t s , and e x a m i n a t i o n of case m a t e r i a l showed t h a t most of the " d r o p - o u t s " i n t h i s group were-not a c t u a l l y f o r m e r c l i e n t s - t h e y were i n e f f e c t " r e - a p p l i c a n t s " . H a l f o f the a p p l i c a n t s not p r e v i o u s l y known t o the agency d i d not use c o n t i n u i n g s e r v i c e . N e v e r t h e l e s s , new a p p l i c a n t s i n the sample r e c e i v e d p r i o r i t y s e r v i c e l e s s o f t e n than t h o s e p r e v i o u s l y known.to the agency. Seven r e c u r r e n t cases and e l e v e n a p p l i c a t i o n s f o r homemaker s e r v i c e were g i v e n p r i o r i t y ; a p a r t from t h e s e cases o n l y f i f t e e n a p p l i c a n t s were o f f e r e d immediate or e a r l y s e r -v i c e , and of t h e l a t t e r n i n e were new a p p l i c a n t s . I n the c o n t e x t of o t h e r u r g e n t r e q u e s t s , t h e r e i s some i n d i c a t i o n t h a t a few former c l i e n t s r e c e i v e d p r i o r i t y r a t i n g of doubt-f u l v a l i d i t y by a p p e a l i n g t o t h e i r former w o r k e r s . A p a r t from t h e s e e x c e p t i o n s , most of the a p p l i c a n t s who were g i v e n - 153 -p r i o r i t y p r e s e n t e d problems w h i c h were u r g e n t , or c e r t a i n l y appeared t o be so a t i n t a k e . However, the c o n c e p t s of "urgency" and " p r e v e n t i o n " seem i n some ways t o be m u t u a l l y i n c o m p a t i b l e j when urg e n c y i s the c r i t e r i o n of p r i o r i t y , what happens t o the . f a m i l y agency's p r e v e n t i v e f o c u s ? Of the t w e n t y - e i g h t a p p l i c a n t s who d i d not become c l i e n t s , e i g h t e e n . o r n i n e t e e n were i d e n t i f i e d i n t h i s s t u d y as p e r s o n s u n l i k e l y t o have c o n t i n u e d i n any e v e n t , r e g a r d l e s s of the w a i t i n g - l i s t . However, i t i s u s u a l l y not p o s s i b l e t o be sure of t h i s . Because of the p o l i c y of r e s t r i c t i n g I n t a k e s e r v i c e t o t e l e p h o n e i n t e r v i e w s , most of t h e s e a p p l i c a n t s had not been seen i n p e r s o n by the i n t a k e w o r k e r . They were a c c e p t e d a p p l i c a n t s who had i n d i c a t e d t h a t t h e y wanted con-t i n u i n g s e r v i c e . Most of them had agreed t o w a i t , y e t t h e y d i d not c o n t i n u e when s e r v i c e was o f f e r e d . O t h e r s , who were a s s i g n e d t o caseworkers' on a p r i o r i t y b a s i s , d i d not c o n t i n u e e i t h e r . E v i d e n t l y t h e r e are b a r r i e r s of communication between new a p p l i c a n t s and i n t a k e workers w h i c h , i n many c a s e s , are not e a s i l y r e s o l v e d i n b r i e f c o n t a c t s over .the t e l e p h o n e between s t r a n g e r s . There i s v i v i d e v i d e n c e of t h i s i n the companion s t u d y by K a t h l e e n B e l a n g e r a l r e a d y r e f e r r e d t o . - I n t e r v i e w s w i t h new a p p l i c a n t s who d i d not become c l i e n t s show i n many ways t h e i r l a c k of u n d e r s t a n d i n g of the agency and o f case-work s e r v i c e . F o r t h e s e d o u b t f u l a p p l i c a n t s a p e r s o n a l i n t e r v i e w c o u l d h e l p t o c l a r i f y , f o r the agency and the a p p l i c a n t , - 154 * whether a • s e r v i c e can be o f f e r e d w h i c h t h e y a re w i l l i n g and a b l e t o use t o h e l p them s o l v e t h e i r p r o b l e m s . Many of the " d r o p - o u t s " i n t h i s sample c o u l d be q u i t e e a s i l y i d e n t i f i e d by e x p e r i e n c e d i n t a k e w o r k e r s , even from t e l e p h o n e i n t e r v i e w s , as p e r s o n s u n l i k e l y t o use c o n t i n u i n g s e r v i c e . N e v e r t h e l e s s , because t h e y s a i d t h e y wanted c o n t i n u i n g s e r v i c e and the s e r -v i c e t h e y r e q u e s t e d or seemed t o need was w i t h i n the agency's f u n c t i o n , t h e i r a p p l i c a t i o n s were p l a c e d on the w a i t i n g - l i s t . The o f f e r of an i n t a k e dr assessment i n t e r v i e w would elimr-i n a t e the need t o p l a c e many of the s e a p p l i c a t i o n s on the w a i t i n g - l i s t . Some of these a p p l i c a n t s , p r o b a b l y , would n ot have kept an i n t a k e i n t e r v i e w . Many c o u l d be g i v e n some h e l p i n one i n t e r v i e w ; and, more Important, perhaps c l e a r e r under-s t a n d i n g of the s e r v i c e a v a i l a b l e would enhance the l i k e l i -hood of t h e i r r e t u r n i n g l a t e r . At l e a s t a few, w i t h a b e t t e r o p p o r t u n i t y f o r mutual assessment and u n d e r s t a n d i n g , might become s e r i o u s a p p l i c a n t s . O f f e r i n g i n - p e r s o n i n t e r v i e w s t o the " u n l i k e l y " a p p l i c a n t s c o u l d , t h e r e f o r e , .give a more r e a l -i s t i c p i c t u r e of the r e a l . w a i t i n g - l i s t and h e l p the agency t o o f f e r e a r l i e r s e r v i c e t o o t h e r a p p l i c a n t s . The w a i t i n g p e r i o d can c e r t a i n l y be a s i g n i f i c a n t f a c t o r i n the " l o s s " of o p p o r t u n i t i e s t o h e l p i n d i v i d u a l s and f a m i l i e s who might o t h e r w i s e make good use .of casework s e r -v i c e . At l e a s t n i n e of the a p p l i c a n t s i n the sample were a p p a r e n t l y d i s c o u r a g e d and d i d not c o n t i n u e because t h e y were asked t o w a i t . These a p p l i c a n t s were i d e n t i f i e d - 155 -(Chapter I I I ) as those who s h o u l d have been g i v e n p r i o r i t y but d i d not r e c e i v e t h i s c o n s i d e r a t i o n . None of them were p r e v i o u s c l i e n t s ; and none were o f f e r e d p e r s o n a l i n t a k e i n t e r v i e w s when t h e y f i r s t approached the agency. However, even from the s l i g h t i n f o r m a t i o n a v a i l a b l e , i t was e v i d e n t t h a t t h e s e a p p l i c a n t s were i n s e r i o u s t r o u b l e and most of them showed some d e s i r e f o r h e l p w i t h t h e i r r e a l p r o b l e m s . A l t h o u g h e v i d e n t l y t h e y could, not w a i t f o r s e r v i c e , t h e y d i d not com-p l a i n about the w a i t i n g p e r i o d . D i s c o m f o r t i m p e l l e d them t o r e a c h . o u t f o r h e l p - but t h e y d i d not have much.hope. Yet many of t h e s e a p p l i c a n t s can.be seen as p e r s o n s who might have used casework s e r v i c e e f f e c t i v e l y and even been r e l a t i v e l y easy t o h e l p - I.e. i n s e v e r a l i n s t a n c e s t h e r e was a n o t a b l e absence of p r o j e c t i o n o f r e s p o n s i b i l i t y f o r the problem. Some might have been v e r y d i f f i c u l t t o engage i n s e r v i c e : but t h e r e was a c r y i n g need, and the o p p o r t u n i t y was l o s t . Perhaps t h e s e " l o s t " a p p l i c a n t s needed r e c o g n i t i o n , encouragement and an o p p o r t u n i t y f o r mutual u n d e r s t a n d i n g more than t h e y needed p r i o r i t y a s s i g n m e n t . In f a c e - t o - f a c e i n t e r v i e w s t h e r e would be a b e t t e r o p p o r t u n i t y t o " r e a c h out" t o t h e s e needy but u n c e r t a i n a p p l i c a n t s , t o r e a s s u r e them t h a t t h e i r r e q u e s t i s a p p r o p r i a t e and h e l p i s a v a i l a b l e , and t o h e l p them a r t i c u l a t e t h e i r need so t h a t r e a l u r g e n c y i f p r e s e n t can be r e c o g n i z e d and a c c e p t e d . I n b o t h the b r i e f s e r v i c e and the c o n t i n u e d s e r v i c e cases i n t h e sample t h e r e was e v i d e n c e t h a t a few a p p l i c a n t s - 156 -were o f f e r e d c o n t i n u i n g s e r v i c e on a p r i o r i t y b a s i s , when an i n t a k e o r assessment i n t e r v i e w might have shown t h a t t h i s was u n n e c e s s a r y . I n c l u d e d among those seen as u n l i k e l y t o have c o n t i n u e d i n any event were s e v e r a l a p p l i c a n t s who were .of f e r e d p r i o r i t y assignment because o f acute and s e r i o u s prob-lems j n e v e r t h e l e s s t h e y d i d not continue-, and a p p a r e n t l y d i d not want any s e r v i c e the agency c o u l d o f f e r them.. Others who p r e s s e d f o r s p e c i a l c o n s i d e r a t i o n were g i v e n t h i s because of an apparent f a m i l y c r i s i s ; . l a t e r c o n t a c t r e v e a l e d t h a t t h e y were the s o r t of p e o p l e who " l i v e on c r i s i s " - the urg e n c y was more apparent than r e a l . I t i s c o n s i d e r a b l y e a s i e r . t o r e c o g -n i z e and e v a l u a t e t h e s e s i t u a t i o n s i n a p e r s o n a l i n t e r v i e w ; i n f a c t one would n ot dare t o make such assumptions on the b a s i s o f t e l e p h o n e c o n t a c t a l o n e . H a l f o f the new a p p l i c a n t s i n the sample group d i d become c l i e n t s i n s p i t e of the w a i t i n g s l i s t , and u s u a l l y w i t h o u t r e c e i v i n g a p e r s o n a l i n t e r v i e w a t i n t a k e . I t must be . remembered, however, t h a t the w a i t i n g p e r i o d d i d not exceed s i x weeks. When . w a i t i n g p e r i o d s a re longer,- t h e r e i s a s i g -n i f i c a n t and p r o g r e s s i v e i n c r e a s e i n the number.of a p p l i c a n t s f a i l i n g t o c o n t i n u e . "As might be e x p e c t e d , the drop-out r a t e i s c l o s e l y r e l a t e d t o the l e n g t h of t h e w a i t i n g p e r i o d and t o the type of p r o b l e m involved."" 1" F u r t h e r m o r e , i n t e l e p h o n e 1 F a m i l y S e r v i c e H i g h l i g h t s , F e b r u a r y , i 9 6 0 , p u b l i s h e d by F a m i l y S e r v i c e A s s o c i a t i o n o f Am e r i c a , New Y o r k . - 157 -i n t e r v i e w s w i t h new a p p l i c a n t s i t i s of course exceedingly-d i f f i c u l t t o a s s e s s whether m o t i v a t i o n i s f i r m o r w a v e r i n g ; whether t h e r e are m i s a p p r e h e n s i o n s w h i c h c o u l d be- c l e a r e d ; and whether the a p p l i c a n t has an u r g e n t need f o r s e r v i c e w h i c h he i s t o o u n c e r t a i n t o e x p l a i n o r t o o p o l i t e t o p r e s s . A p p l i -c a n t s v a r y i n t h e i r a b i l i t y t o 'express themselves over the t e l e p h o n e . Some can make good use of t e l e p h o n e i n t e r v i e w s , e s p e c i a l l y i f the i n t a k e worker can use t h i s medium t o p r o j e c t h i s c oncern and t h a t of the agency. F u r t h e r m o r e , much can be d.one t o improve t h e q u a l i t y of t e l e p h o n e i n t a k e . Neverthe-l e s s , i f the w a i t i n g p e r i o d i s l o n g e r than about t h r e e weeks, and i f t h e r e i s a s e r i o u s d e s i r e t o r e a c h new c l i e n t e l e by h e l p i n g new a p p l i c a n t s t o become c l i e n t s , i t seems a d v i s a b l e t o o f f e r p e r s o n a l i n t a k e i n t e r v i e w s t o a l l who a r e making a f i r s t a p p l i c a t i o n f o r s e r v i c e . On the o t h e r hand, the f i n d i n g s of t h i s s t u d y i n d i -c a t e t h a t f o r m e r c l i e n t s , do not u s u a l l y need p e r s o n a l i n t a k e i n t e r v i e w s o r p r i o r i t y a s s i g n m e n t . Undoubtedly t h e r e a re e x c e p t i o n s , but t h e s e are u n l i k e l y t o be o v e r l o o k e d . Because of the c o n s i d e r a b l y r e d u c e d a r e a of p o s s i b l e m i s u n d e r s t a n d i n g on b o t h s i d e s , t h e r e appears t o be . l i t t l e danger t h a t t h e y w i l l r e q u e s t c o n t i n u i n g s e r v i c e o r b e . o f f e r e d i t u n l e s s t h i s i s c l e a r l y a p p r o p r i a t e , o r t h a t t h e y w i l l ' " d r o p o u t " a f t e r t h e i r a p p l i c a t i o n s are a c c e p t e d . O c c a s i o n a l l y an:'intake i n t e r v i e w might be g i v e n t o o f f e r a b r i e f s e r v i c e , but u s u a l l y f ormer c l i e n t s c o u l d be q u i t e e a s i l y h e l p e d and " h e l d " on the - 158 -t e l e p h o n e w h i l e a w a i t i n g a s s i g n m e n t . I f p e r s o n a l i n t a k e i n t e r v i e w s c o u l d be o f f e r e d t o a l l new a p p l i c a n t s , t h i s s h o u l d a s s i s t the agency i n making e f f e c t -i v e use of casework time a v a i l a b l e f o r c o n t i n u e d s e r v i c e c a s e s , and l e s s e n t o some e x t e n t the u n f o r t u n a t e consequences of h a v i n g a w a i t i n g - l i s t . I t i s e v i d e n t t h a t such a p o l i c y would b r i n g i t s own pr o b l e m s . The f u l l i n t a k e p r o c e s s c o v e r s the e s t -a b l i s h m e n t of a w o r k i n g r e l a t i o n s h i p and the f o r m u l a t i o n of t e n t a t i v e d i a g n o s i s and t r e a t m e n t p l a n s , and i t o v e r l a p s w i t h t r e a t m e n t . P r e v i o u s agency e x p e r i e n c e i n d i c a t e s t h a t t h e r e can be l o s s e s and dangers i f t h i s p r o c e s s i s s p l i t between two ca s e w o r k e r s . F u r t h e r m o r e , t h e r e would o b v i o u s l y be heavy demands on the time o f i n t a k e workers w h i c h would e n c r o a c h on t o t a l casework time a v a i l a b l e f o r cases u s i n g on-going s e r v i c e , n e g a t i n g t o some e x t e n t s a v i n g s w h i c h might be e f f e c t e d by more c a r e f u l s c r e e n i n g a t i n t a k e . N e v e r t h e l e s s , i n f a i r n e s s t o a l l a p p l i c a n t s , and i n the i n t e r e s t of p r o v i d i n g the b e s t p o s s i b l e s e r v i c e t o the community, i t I s v i t a l l y Important t h a t i n d i v i d u a l p r i o r i t y d e c i s i o n s s h o u l d be based on c a r e f u l e v a l u a t i o n . When t h e r e i s a w a i t i n g l i s t , the i m p l i c a t i o n s o f i n t a k e p o l i c y and p r a c t i c e have g r e a t e r s i g n i f i c a n c e , and the c r u c i a l p o i n t of i n t a k e i s U n d e r l i n e d . When urg e n c y i s the c r i t e r i o n o f p r i o r i t y a t i n t a k e , the f a m i l y agency's f o c u s on p r e v e n t i v e s e r v i c e i s l i k e l y t o s u f f e r f r om a p r o c e s s of a t t r i t i o n . I f p r i o r i t y i s g i v e n t o the meeting o f emergencies, o p p o r t u n i t i e s f o r p r e v e n t i v e - 159 -s e r v i c e are l i k e l y t o be l o s t - the d i s c r e p a n c y between the p r i o r i t y a t t e n t i o n g i v e n t o a p p l i c a t i o n s f o r homemaker s e r v i c e i n c o n t r a s t w i t h a p p l i c a t i o n s f o r m a r i t a l c o u n s e l l i n g i n the sample group i s n o t a b l e . R e a l u r g e n c y cannot be ignored., and a l s o has p r e v e n t i v e a s p e c t s . However, i f p r i o r - ' i t y assignment i s t o be g i v e n on t h i s b a s i s , w h i c h cannot be a v o i d e d , i t i s _ n e c e s s a r y t o be sure t h a t the u r g e n c y i s r e a l and t h a t t h i s i s the b e s t way t o meet i t . A p a r t f rom s t r o n g l y s u g g e s t i n g t h a t renewed s t u d y and a t t e n t i o n s h o u l d be g i v e n t o new r e q u e s t s f o r s e r v i c e , t h i s s t u d y has l i t t l e t o c o n t r i b u t e w i t h r e g a r d t o s p e c i f i c c r i t e r i a f o r p r i o r i t y assignment of i n d i v i d u a l a p p l i c a t i o n s . E x t e n s i o n of e f f e c t i v e s e r v i c e appears t o be r e l a t e d t o the q u a l i t y of i n t a k e s e r v i c e , r a t h e r than t o any c o n c r e t e r u l e s f o r p r i o r i t y d e t e r m i n a t i o n a t i n t a k e . . I n t a k e p o l i c y and p r a c t i c e do a f f e c t the c l i e n t e l e of the agency, and are f a c t o r s i n d e t e r m i n i n g whether i t i s p o s s i b l e t o r e a c h out t o new c l i e n t e l e when t h e r e i s a w a i t i n g - l i s t . The l a r g e r ques-t i o n s about d i r e c t i o n s t o be f o l l o w e d i n opening new a r e a s f o r s e r v i c e w h i c h were r a i s e d i n Chapter I remain unanswered; but t h e r e are i m p l i c a t i o n s f o r p r i o r i t y d e t e r m i n a t i o n on the b r o a d e r l e v e l o f p l a n n i n g f u t u r e s e r v i c e s . BIBLIOGRAPHY Babcock, C h a r l o t t e G., M.D., "The C o n t r i b u t i o n of t h e F a m i l y Agency i n M e e t i n g Community Problems", The S o c i a l S e r v i c e •Review, September, 1958: . B e l a n g e r , K a t h l e e n , The P o t e n t i a l " C o n s t i t u e n c y " of a F a m i l y  S e r v i c e Agency: An I n t e r v i e w - S u r v e y of A p p l i c a n t s Who  D i d Not Become C l i e n t s . Master of S o c i a l Work t h e s i s , • U n i v e r s i t y of B r i t i s h Columbia, i 9 6 0 . B i t t e r m a n n , C a t h e r i n e M.> " S e r v i n g A p p l i c a n t s When There i s a W a i t i n g L i s t " , S o c i a l Casework,"June, - 1 9 5 8 . Cooper, S h i r l e y , "Emergencies i n a P s y c h i a t r i c C l i n i c " , - S o c i a l Casework, March, i 9 6 0 . F a m i l y S e r v i c e H i g h l i g h t s , F e b r u a r y , i 9 6 0 , p u b l i s h e d by F a m i l y S e r v i c e A s s o c i a t i o n of A m e r i c a , New Y o r k . G u r s s l l n , O r v i l l e , Raymond G. Hunt and J a c k L... Roach, " S o c i a l C l a s s , M e n t a l Hygiene, ..and P s y c h i a t r i c P r a c t i c e " , The S o c i a l S e r v i c e Review, September, 1 9 5 9 . H a l l i n a n , H e l e n W., " C o - o r d i n a t i n g Agency E f f o r t s i n B e h a l f of t h e Hard-to-Reach F a m i l y " , S o c i a l Casework, J a n u a r y , 1 9 5 9 . H o l l i s , F l o r e n c e , Women I n M a r i t a l C o n f l i c t , F a m i l y S e r v i c e A s s o c i a t i o n of A m e r i c a , New York, . 1949.. Kogan,- L e o n a r d S., "The Short-Term Case i n a F a m i l y Agency, . P a r t I , The Study Plan"., S o c i a l Casework, May, 1 9 5 7 . M i l l e r , . W a l t e r B., " I m p l i c a t i o n s of Urban L o w e r - C l a s s C u l -ture- f o r - S o c i a l . Work", TJne_J3^^ S e p t e m b e r , . 1 9 5 9 . Noyes, A r t h u r P., M.D., and Lawrence C. K o l b , M.D., .Modern  C l i n i c a l P s y c h i a t r y , W.B. Saunders Company, P h i l a d e l p h i a .and London, 1 9 5 8 . R i p p l e , L i l i a n , - " M o t i v a t i o n , C a p a c i t y , and O p p o r t u n i t y as R e l a t e d t o the Use of Casework S e r v i c e : T h e o r e t i c a l Base and P l a n ,of Study", The S o c i a l S e r v i c e Review, June, 1 9 5 5 . R i p p l e , L i l i a n and A l e x a n d e r , E r n e s t i n a , " M o t i v a t i o n , C a p a c i t y and O p p o r t u n i t y as R e l a t e d t o the Use of Casework S e r v i c e : N ature of . C l i e n t ' s Problem", The S o c i a l S e r v i c e Review, V o l . xxx, No. 1 , ( 1 9 5 6 ) , pp. 3 8 - 5 4 . R i p p l e , L i l i a n , " F a c t o r s A s s o c i a t e d w i t h Continuance i n Casework S e r v i c e " , S o c i a l Work, V o l . 11 , No. 1, (1957) pp. 8 7 - 9 4 . Scope and Methods of the F a m i l y S e r v i c e Agency, R e p o r t of The Committee on Methods and Scope, F a m i l y S e r v i c e A s s o c i a t i o n of America,"New York, 1 9 5 3 . Shyne, Ann W.,'"What R e s e a r c h T e l l s Us About Short-Term Cases i n F a m i l y A g e n c i e s " , S o c i a l Casework, May, 1957* W i l e n s k y , H a r o l d L. and C h a r l e s N.•Lebeaux, I n d u s t r i a l  S o c i e t y and S o c i a l W e l f a r e , R u s s e l l Sage F o u n d a t i o n , New York, 1958. W r i g h t , Gordon R.., " S t a b i l i z a t i o n of Case l o a d s i n a Medium-s i z e d F a m i l y Agency, The S o c i a l Worker, June, i 9 6 0 . 

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