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The place of casework services in the rehabilitation of the blind : a reconnaissance survey of social… Webb, Gerald Keith 1955

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THE PLACE OF CASEWORK SERVICES IN THE REHABILITATION OF THE BLHD A Reconnaissance Survey of Social Work Services Offered to a Group of Young Mult Males Registered with the Canadian National Institute for the Blind, (Western Division, Vancouver, B.C.). 1950-54. by GERALD KTETH WEBB Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the School of Social Work Accepted as conforming to the standard required for the degree of Master of Social Work School of Social Work The University of British Columbia 1955 - iv -ABSTRACT The Western Division of the Canadian National Institute for the Blind offers a varied program of services to their clients, includ-ing casework, home teaching, vocational counselling, job training, cer-tain kinds of employment and residential care. The present study under-takes to describe and make a preliminary evaluation of only part of these services, namely casework services, and only one important section of its clientele, namely, adult males whose numbers in the past few years have increased considerably. The study covers the registration of the blind client, the services of the Social Welfare Department, and the role of the social worker in offering casework services and co-ordinating the services of other departments. Casework services have been discussed under three classifications; (1) short-term, (2) long-term, and (3), intensive services, the division being made on the basis of the number and focus of interviews. Intensive services were offered to clients whose in-it i a l reaction to blindness was extreme, requiring more than supportive casework to assist them in their adjustment. Discussing the importance of employment in rehabilitation, problems that hinder the blind client vocationally have been identified, also the manner in which social work services aid in their solution. Areas of which the social worker has to be aware are: (a) the feelings of the client about his blindness, (b) the relationship between health and handicaps and adjustment to blindness, (c) family relationships and the acceptance of the client by his family, (d) social isolation, and (e) community attitudes toward blindness. Severe limitations of recording are discussed, and recommend-ations made for improving this aspect of casework services. A proposed registration inventory is submitted as a means to obtaining essential diagnostic information. While the study is of localized relevance i t does point up the need for a more intensive study of casework services for the young blind adult male and for research in the areas of psycho-logical, social, economic, and physical needs of the blind, for the establishment of future rehabilitation programs. - i i -TABLE OF CONTENTS CHAPTER PAGE I. THE DEVELOPMENT OF SERVICES FOR THE BLIND 1 The purpose of the study. Definition of blindness and re-habilitation. Blindness as a handicap. The effect of blindness on personality. The areas of rehabilitation. The team approach. Prevailing theories of rehabilitation of the blind. Financial assistance. The C. N. I. B.; its development and structure. The services of the C. N. I. B. Methods used in this study II. CASEWORK SERVICES OFFERED TO THE BLMD, (BRITISH COLUMBIA) 20 The registration of the blind. The intake interview. The services offered. The services of other departments. The soc-ial worker as co-ordinator. The group studied. Basic inform-ation. Classification of services offered. The Social Welfare Department. Casework services. Blind Personnel and Public Re-lations Department. Commercial and Industrial Operations Depart-ment. Recreation Department I l l MEETING THE PROBLEMS OF THE ADULT BLIND MALE 48 Some specific problems. Feelings about blindness. Health and handicaps. Family relationships. Social Isolation. Com-munity Attitudes. Employment and training. How these problems were met IV CASEWORK SERVICES AND THE FUTURE 67 Prior considerations. The limitations of recording. How recording might be improved. Casework services. Some problems facing the young adult blind. The role of the social worker. Areas for further research - i i i -LIST OF TABLES TABLE PAGE I Casework Services Offered to Blind Males 21-45 Years of Age, Registered Since 1950, C. N. I. B., Western Division, Vancouver, B. C 37 II Home Teaching Services Given to Blind Males 21-45 Years of Age, Registered Since 1950, C. N. I. B., Western Division, Vancouver, B. C 43 III Concessions and General Services Given Blind Males 21-45 Years of Age, Registered Since 1950, C. N. I. B., Western Division, Vancouver, B. C. . 44 IV Vocational Counselling and Job Placement Services Offered Blind Males 21-45 Years of Age, by the Blind Personnel and Public Relations Department, C. N. I* B., Western Division, Vancouver, B. C., 1950-54 46 THE PLACE OF CASEWOIK SERVICES IN THE REHABILITATION OF THE BLIND -1 -CHAPTER I THE DEVELOPMENT OF SERVICES FOR THE BLIND The Purpose of the Study: During 1he past few years the Western Division of the Canadian National Institute for the Blind has shown concern over the effectiveness of the rehabilitation services i t offers the adult male client. Since there has been a gradual increase in the number of young adult males registered in the last ten years, the need to assess the services becomes imperative i f this client group is to be served effectively. Being a multi-service agency, the Canadian National Institute is able to offer varied rehabilita-tion services. These range from instruction in basic adjustment tech-niques required for living as a blind person; e.g., travel and orientation techniques, self-care, learning Braille and other embossed types; to home teaching in crafts and other skills; casework services, vocational counsell-ing and job placement, employment in sheltered workshops and concession stands, and residential care. It was at the Annual Conference of Divisional Staff held in Van-couver in December 1954 that a committee was set up to enquire into the extent and effectiveness of these rehabilitation services and was instructed to prepare a program for further work in this area. The number of difficul-ties facing the committee were many and the lack of any previous research in the area of measurement of services offered by the Western Division of C. N. I. B. further complicated the problem. The present study was suggest-ed as a possible topic for a Master of Social Work thesis undertaken by a student taking his second year field work placement at the Vancouver office of the C. N. I. B. It is not within the scope of this study to evaluate the complete program of rehabilitation services but it is thought that a descriptive study of a part of these services, namely casework services, may make some contribution to the study of the services offered the young adult male client. The first chapter discusses the problems of blindness and the de-velopment of services to meet the needs of blind persons together with some considerations of the administrative framework of the C. N. I. B. In the second chapter, the registration process and casework services are described and located within the administrative structure of the Department of Social Welfare. Specific reference is made to casework services to young adult males between the ages of twenty-one and forty-five registered since 1950. The third chapter discussed some of the problems confronting these clients in their rehabilitation. The fourth chapter discusses the findings of this study and makes recommendations for improved service to this group of clients and delineates areas for further study. Definitions of Blindness and Rehabilitation t Blindness may be total or partial. Blindness does not always de-note the lack of sight but rather varying degrees of sight below a generally accepted level. In this sense, the C. N. I. B. defines blindness as eyesight equal to, or less than, 6/60 metric, or 20/200 feet (Snellen Chart), vision in one or both eyes after correction. This universally accepted definition constitutes legal blindness and includes al l who are for practical purposes industrially blind; i.e., those not having sufficient sight to perform work for which sight is essential. Any study dealing with the rehabilitation of the blind must begin not only with a definition of blindness but also one of rehabilitation. The following definition is considered by the writer to be an adequate and straightforward statement and is the one used by the National Conference on Rehabilitation held in Toronto in 1951; "Rehabilitation is to develop and restore the disabled individual to the fullest physical, mental, emotional, social, vocational and economic usefulness of which he is capable within the ni restrictions inherent in his environment. It should be recognized that the term rehabilitation is being used in its broadest meaning and not in the vo-cational sense only. For many years rehabilitation programs in agencies for the blind have been heavily slanted to the vocational. It is only within the past fifteen years that a more integrated concept of rehabilitation has developed and applied to programs helping the blind toward a more satis-factory adjustment to life without sight. In the field of rehabilitation of the blind this definition takes on particular significance since i t not only covers the restorative aspects of rehabilitation but i t also points out the limitations and the potentials that might be found within the client, his family, and the community in which he lives. Mental and other handicaps will affect the degree to which the blind person may be rehabilitated, the family attitudes toward blind-ness will carry otter limiting effects, vhile socially conditioned stereo-1 Proceedings of the National Conference on Rehabilitation. Canadian National Institute for the Blind, Toronto, 1951. p. 5. - 4 -types or concepts of blindness found in the community will again limit the blind person's total rehabilitation. Blindness as a Handicap; Throughout the literature of blindness and rehabilitation, the terms"disability" and "handicap" are often found incorrectly interpreted as having the same meaning. The following definitions will clarify this distinction. "A "disability" is a condition of impairment, physical, or mental having an objective aspect that can usually be des-cribed by a physician. It is essentially a medical thing." "A "handicap" is the cumulative result of the obstacles which disability interposes between the individual and his maximum functional level. It is an individual thing, com-posed of barriers which the handicapped person must sur-mount in order to attain the 'fullest possible physical, mental, social, vocational, and economic usefulness of which he is capable'." 1 It is the handicap, and not the disability, that becomes the de-ciding factor in affecting the individual's rehabilitation. However, the disability must be taken into account. Disabilities are usually found to 2 fal l into three main types: the organic, the sensory, and the structural. Each will have a resultant restriction upon the behavior of the individual. In the case of blindness Lowenfield states that the individual is restrict-ed in three basic ways: in the range and variety of experiences, in mobil-1 Hamilton, K. W., Counselling the Handicapped in the Rehabilitation  Process, Ronald Press Co., New York, 1950, p. 17. 2 Himes, J. S. Jr., "Some Concepts of Blindness in American Culture.", Social feasework, Vol. XXXI, No. 10, 1950, p. 410. ity, and in control of his environment and of himself in relation to i t . In this sense the disability limits the individual's visual perception in such a way that for one bom blind, the conceptual process is not fully developed while for one blinded at a later stage of development, i t is affected to a decreasing degree. Nevertheless, whatever the age of onset, areas of aquiring knowledge, of comprehending the environment, of commun-ication, are seriously affected and add to the implicit dependency upon others that is characteristic of blindness. The restriction of mobility implies a two-fold handicap in that i t limits the blind person in his locomotive ability, making him dependent upon others, thereby affecting his social relationships and attitudes. In the case of control of environ-ment the blind person is unable to measure distances, to note differences in spatial relationships. This limitation of visual experience permits a contact with only a fractionalized portion of the environment. Failing fuller experience of the environment the blind person must depend upon an auditory and tactile perception of i t . It is the degree to which these factors operate upon the blind person that the disability becomes a handi-cap. The Effect of Blindness upon the Personality: Lovrenfeld lists four factors that influence the adjustment of o the blind person to the visual handicap. These are: the degree of sight retained, the cause of blindness, the age at onset of blindness, and the 1 tiowenfeld, B., "Blindness, A Psychological Approach", Proceedings  of the American Association of Workers for the Blind, New York, 1948, p. 110 2 Ibid, p. 112. - 6 -kind of onset of blindness. These subjective variables condition, gener-ally, the individual's reaction to blindness. Cholden adds to this picture by stating that: "We might say that besides experiencing the loss of an organ, the newly blinded person experiences the loss of his accus-tomed inner picture of his physical and his psychological self. This loss of inner concept of self and the change to a different internal structure is what constitutes the essen-tial fact of reorganization or rehabilitation of the dis-ability. The awareness of this need for intrapsychic change is basic to an acceptance of himself as a handicapped person."! This statement can be taken to mean that the blind male's picture of him-self in the masculine role has been damaged; that he feels a loss of status in the family and the community; that he is handicapped in making a living; that he becomes physically dependent upon others, and that some degree of disorganization of personality results. It is important to recognize these factors in the many that affect the blind person's acceptance of his 2 blindness. Cholden lists five other internal and external factors that limit the acceptance of the disability. These are: (a) the inertia, or resistance to change in the human personality; (b) the stereotypes he has built up about the blind as a group for he will see himself in terms of this stereotype; (c) his irrational feelings concerning blindness including sexual meanings, and the historical connotations of blindness as punishment for sins; (d) the minority group aspect of blindness with its emotional meanings in terms for inferior status and personal devaluation; and (e) the 1 Cholden, L., "Some Psychiatric Problems in the Rehabilitation of the Blind," Proceedings, American Association of Workers for the Blind, New York, 1953, p. 23. 2 Ibid., p. 24. necessary dependencies which accompany this handicap. These factors combine to create a traumatic, disruptive ex-perience that brings about a state of inertia, or shock, followedvby a state of depression, or mourning, which must be undergone before the per-son can accept the reality of his blindness. This is followed by a state of dependency and finally, by a stage of completely tactile relationship with the environment.* The implications of this statement are important in any rehabil-itation program for the blind. Recognition of these stages and their im-pact upon the personality will be required before any effective work can be done in helping the blind in uieir adjustment to a sighted world. Fail-ure to recognize these stages could prevent growth toward integration of personality; e.g., depression can be termed 'unmanly' and disallowed by family and society, thereby forming a barrier to the blind person's accept-ance of the reality of his blindness and creating further complications in his rehabilitation. If we acknowledge the traumatic and disruptive impace of blind-ness upon the personality we acknowledge the fact of disorganization and the resultant effect upon the basic personality patterns of the blind person. Feelings of frustration, anger, loss of personal and economic worth, of de-pendency, will be stimulated to result in aggression or withdrawal. The effect of these feelings will be felt not only by the blind person, but also by those about him. The whole area of intrapersonal relationships will be 1 Cholden, Some Psychiatric Problems, Proceedings, p. 24 - 8 -disturbed. The implications for family and community understanding of this aspect of blindness are essential to rehabilitation and bring to notice areas not always considered in the definition of rehabilitation. The Areas of Rehabilitation: The definition of rehabilitation used in this study outlines its component areas. These are: physical, mental, emotional, social, vocation-al and economic. These areas are generally accepted and are found in most definitions of rehabilitation. However, the community is included in the definition upon which this study is based and is an area not always consid-ered. In the case of the rehabilitation of the blind i t is an important one since socially conditioned attitudes regarding the blind tend to limit i the extent to which they can be re-integrated into the community. In each particular area there are elaborations that can be made but generally these areas can be said to perform the following functions: (a) physical: in which the blind person is restored to as good a degree of health as possible, and sight corrected or restored i f possible; (b) emotional: in which adjust-ment is made to the condition of blindness; (c) social: in which the blind person learns to function in society as a blind person; (d) vocational: in which the blind person learns new skills and trains for the vocation of his choice, this training being based on his abilities and disabilities and (e) community: in which the community learns the falsity of its attitudes and stereotypes about the blind and seeks to readjust them. However, to 1 tenBroek, j . , "Concepts in Itehabilitation and Placement of the Blind," New Outlook for the Blind, American Foundation for the Blind, New York, Vol. XLV, No. 10, 1951, p. 288. - 9 -picture the rehabilitation process more fully, these areas can be expanded to include related aspects; e.g., emotional can be expanded to include fam-ily; social can include recreational; while vocational can include educa-tional, although educational aspects underly the total rehabilitative pro-cess. It is only when a l l areas of rehabilitation are integrated into one on-going process that rehabilitation in its fullest sense can take place. The Team Approach: The definition of rehabilitation discussed earlier implies an integration of the areas of rehabilitation before there can be an effective return of the blind person to society. It would seem logical that inte-gration should come at the level of services offered to the handicapped person. This definition brings into consideration the reorganizational aspect of adjustment to blindness, the learning of special skills needed by the blind person, and the reeducation of society required before a better understanding and acceptance of the blind can come about. Taken together these areas constitute a unified approach to the problems of rehabilitat-ing the blind. If the maximum function of the individual is to be attained each of these areas must be defined and the services specific to them related to each other to form a total approach, one in which no one area is empha-sized or neglected, in which al l areas contribute to each other and to the entire process. Thus the concept of "teamwork" develops. From each area specialists bring their skills and special knowledge, their insights and their services to bear upon the problems faced by the blind person through-out the entire rehabilitative process. By establishing a common focus the integrated rehabilitation program is developed. A particularly clear state-- 10 -ment on teamwork is seen in the following: "Teamwork in rehabilitation is created through the mutual understanding generated by two or more persons offering different, though related services to the individual with physical impairment. This understanding stems from two sources: one, recognition of a particular area of com-petence for which training and experience has prepared the given expert to offer a specific rehabilitation service; and two, knowledge, understanding and appreciation of the value that services by other experts may have for the individual in terms of his total restoration. It can be enriched through patterns of working together, such as regular conferences, but i t cannot be produced by virtue of the fact that various experts are housed under the same roof." 1 Perhaps the best examples of teamwork in the rehabilitation of the blind are to be found in the programs of the various rehabilitation centers developed by the American Armed Services during World War II. The programs at Avon Old Farms Convalescent Hospital and valley Forge General Hospital were such as to serve as models for many residential adjustment training centers throughout the United States as well as to provide a wide liter-ature on the subject of teamwork in the rehabilitation of the blind. In the particular instance of the C. N. I. B., Western Division, teamwork in the rehabilitation process is under the direction of the Super-visor of Social Welfare who brings to the particular needs of the individ-ual client the special skills of the social worker, the home teacher, the placement officer, the services of the salesroom, the training available in the Industrial Department and resources within the community; e.g., other social, health, recreational agencies, building them into a unified approach 1 Ellidge, C., The Rehabilitation of the Patient, Social Casework in  Medicine, J. P. Lippincott Co., Philadelphia, 1948, p. 85. - 11 -to his problem of readjustment. Prevailing Theories of Rehabilitation of the Blind; For many years the rehabilitation of the blind has been limited by a philosophy which tended to keep the blind dependent upon the agencies offering them services. This situation has been seen in the historical development of services for the blind in America and may be found in some i agencies today. The Reverend Thomas J. Carroll relates this situation to the particular agency's attitudes toward blindness as a handicap. He argues that there exist two main schools of thought, one treating blindness as a minor handicap and blind people as being normal in every respect save in the loss of sight. This type of agency sets up services making for the? segrega-tion of the blind into special social and vocational groups as well as creat-ing further dependency upon the agency. The other school of thought treats blindness as a severe, frustrating, and traumatic experience, and a major handicap, treating the problem realistically with the emphasis upon the re-organization of the blind to become independent and contributing members of a competitive society. Father Carroll states that the success of the former program is measured in terms of the number s t i l l receiving services vhile the success of the latter is measured in terms of the number independent of the agency, or no longer requiring services. This state of affairs is attest-2 3 ed to by other writers ' and may be found in the existence of many agencies 1 "Developing Public Understanding about the Blind", Proceedings, Business Association of Workers for the Blind, New York, 1954, p. 54. 2 Chevigny, H., and Braverman, S., The Adjustment of the Blind, Yale University Press, New Haven, 1950. 3 tenBroek, Concepts in Rehabilitation, The New Outlook for the Blind pp. 287-300. 12 ~ for the blind offering services to segregated groups of blind clients. Another aspect of rehabilitation of the blind has been the heavy vocational slant i t has been given. This emphasis upon vocational rehabil-itation has been an outcome of an unintegrated approach to rehabilitation and operated upon the assumption that a l l the blind person needed to effect his readjustment to society was a job. However, with the experience of World War II and the gradually developing concept of teamwork, rehabilita-tion work for the blind has reached a point in development where some objec-tivity in analysis is possible. There is some indication that Father Carroll's latter classification may become the accepted philosophy. While no written statement of its philosophy of rehabilitation is available, the C. N. I. B. has tended toward helping the blind become inde-pendent and contributing members of society. However, i t s t i l l operates sheltered workshops and segregated recreational and social programs. This situation has been realistically explained on the basis of recognition of the fact that there will always be a dependent group within the blind population. In the Western Division the avowed, i f unwritten, philosophy of rehabilita-tion is the reorganization of the blind person to become an independent, community-related, person. Financial Assistance; Since a blind person is rarely able to return to his former employ-ment the need for financial assistance is great. Realizing the need for some form of financial assistance for the blind person the C. N. I. B. for ten years prior to 1937 made representations to the Federal Government. Hitherto - 13 -blind persons were given assistance only i f they came within the provisions of the Old Age Pensions Act. In 1937 the Federal Government granted the first allowances to the blind under an amendment to the Old Age Pensions Act. This allowance was for the sum of twenty dollars a month, subject to a means test, and was made available to a l l blind persons over forty who had been resident in Canada for twenty years prior to application. In 1947 subse-quent amendment to the Old Age Pensions Act brought about an increase in the amount of permissible income ($480) but the influence of the Act s t i l l held to the philosophy of a subsistence allowance even though the allowance was raised to thirty dollars a month and the age requirements lowered to twenty-one years. The Blind Person's Act of 1951, which superseded former legisla-tion, provides blindness allowances up to forty dollars a month for the needy blind of Canada. A means test is s t i l l the basis of award although residence requirements have been reduced to ten years prior to application. Each province by agreement with the Federal Government administers the Act locally and pays the allowance. Later the Federal Government reimburses the provinces for 75 per cent of the cost of allowances paid. The eye reports which determine an applicant's statutory blindness are furnished by the Blind-ness Control Division to certified occulists at the request of the provincial authority. These eye reports are reviewed by the Blindness Control Division at Ottawa and the approved blindness certificates are sent back to the pro-vincial authority so that the allowance may be paid. There is no provision in the Blind Person's Act for preventive or remedial treatment of blindness. - 14 -Other forms of financial assistance are available for blind males through the Department of Veteran's Affairs, the Workmen1s Compensation Board, the Unemployment Insurance Commission, the Provincial Social Welfare Branch and municipal or local Social Service Offices. These various forms of assistance are: Wari Veteran's Allowance: Commonly called the Burnt-Cut Pension. Any man who has served in an active theatre of war is usually eligible subject to income restrictions at the age of sixty, and prior to this i f he is unemployed due to physical disability not connected with military service. The rate for a single veteran is $50.00 a month, and for a married veteran, $90.00 a month. Medical and hospital care for the veteran but not for the wife, are available. Military Disability Pension: Granted for loss of sight directly attributed to war service. However, where the ex-serviceman has a disability pension of any amount for a disability other than eyes and then loses his sight (not due to war service) he is eligible for an attendant's allowance. Workmen's Compensation: Loss of sight is considered a total disability and the amount of compensation is 70 per cent of the last year's income, with $210.00 a month the maximum amount paid. Blindness must be the direct result of industrial accident. Unemployment Insurance Benefits: Available to all who have contributed to the Unemployment Insurance fund during their working period. Claims must have a maximum number of 180 working days within the last year worked before benefits are paid. After benefits have expired further benefits may be applied for and benefits of a reduced rate received fCr a limited number of days. Social Assistance: Administered by either Provincial or Municipal Social Service Offices. Rates of $40.00 for a single person; $60.00 for two persons and $69.50 for three persons. The applicant may own his home, but may not have assets beyond approximately $150.00 for a single person and $300.00 for two persons. Medical care and hospitalization are provided. « 15 -The C. N. I. B.: Its Development and Structure: The Canadian National Institute for the Blind is a private, multi-service, national agency. The dual aims of the organization are the "amel-ioration of the condition of blindness" and ihe "prevention of blindness". The Letters Patent of Incorporation granted in 1918, are broad and compre-hensive giving the agency the right and power to provide for the develop-ment of a complete service program to the blind. It covered provision for employment, education, training, selling and distribution of products, etc., as well as "giving advice, counsel, and assistance of every kind to the blind and to those charged with or concerned with their education, training, employ-ment or well being." During 1918 the National Office and the Ontario Division were established in Toronto. Workshops for men and women were opened; a course for sightless home teachers was established; and the registration of all blind persons in the first Division was actually undertaken. In 1919 the Maritime Division, serving the provinces of Nova Scotia, Prince Edward Island and New Brunswick; the Central Western Division, serving the provinces of Alberta and British Columbia, were established. In each of these divisions active registration work, factory employment, heme teaching, and other ser-vices were undertaken. Also during 1919 the Canadian Free Library for the Blind was amalgamated and became the Library and Publishing Department of the Institute. In 1930 the Quebec Division was finally established in order to complete the registration for the Dominion and to provide home teaching, library, placement, prevention of blindness and other services not already given by the existing local organizations. In 1933 the Newfoundland Division - 16 -was established. It has been the policy of the Institute to amalgamate local service organizations only upon request and where it can be shown that greater unity of services ensures broader benefits for the blind. The Charter provided for a Board or National Council to be the governing body of the organization. The Constitution, as finalized in 1922, provides that National Council shall consist of from ten to thirty persons, representing, as far as possible, al l provinces of Canada, one-third of the membership being blind persons. The Council meets once a year in Toronto. The Executive Committee is empowered to meet at the call of the President and has the powers of the Council when i t is not in session. The National Council delegates responsibility to six Divisional Boards covering Newfoundland, the Maritimes, Quebec, Ontario, Central West-ern (Manitoba and Saskatchewan), and Western (Alberta and British Columbia). Each Divisional Board is empowered in its Creating Resolution, passed by National Council, to carry on the work of the C. N. I. B. in its Division, "providing that any work which is not of a local character shall not be in-cluded in the work of the Division". Each Division has the right to three representatives on the National Council. National Council appoints a paid Managing Director and General Manager to be functionally responsible for the operation of the agency. They also appoint Divisional Superintendents who are paid by National Council, but are responsible to the Divisional Board for the carrying out of the work of the agency within the Division. The Divisional Boards, since 1943, have been permitted to establish 17 -District Boards responsible for carrying out the agency program within the District. In the Western Division there are three Districts: British Columbia, Northern Alberta, and Southern Alberta. In actual practice the Divisional Board and the B.C. District Board are one and the same. The District affairs are managed by a paid executive called the Executive Officer. A recent extension of the board idea has been the development by the District Boards of C. N. I. B. Branches (duly constituted by minutes of the District Board) in small towns. These volunteers are responsible for raising funds in their particular area, for the referral of cases, for the development and use of community resources for the blind of the area under the direction of the staff person concerned ( a Field Secretary) and for public relations. The District Boards are entitled to representation on the Divisional Board and each Branch is entitled to send a representative to the annual meeting of the District Board. The administration of the C. N. I. B. in the Western Division is departmentalized. These departments are Social Welfare, Commercial and Industrial Operations, Blind Personnel and Public Relations, and Recreation. The degree to which these departments co-operate in the administration of services should be an index to the quality and effectiveness of teamwork in the rehabilitation of the blind. The Services of the C. N. I. B.: The services the C. N. I. B. offer in carrying out its two-fold purpose of the amelioration of the condition of blindness and the prevention of blindness, begin with the registration of the blind client. This is con-- 18 -sidered a basic necessity for the following reasons: (a) to determine whether operative or other treatment may restore useful vision; (b) to determine ser-vices needed and hence plan a service program; (c) to permit analysis of the cause of blindness and to determine conservation of vision and prevention of blindness programs; and (d) through analysis of registration and employment records to determine eligibility for assistance. Once a blind person is reg-istered he is eligible for a l l services offered by the C. N. I. B. The Fed-eral Government uses registration figures as the basis for national statis-tics on the blind. At present the Western Division offers the following services: Social Welfare: Casework Services: Short and long term and intensive contacts, supportive and environmental help, referral to other agencies and resources, etc. Heme Teaching: Instruction in travel techniques, orientation, craft skills, typing, Braille and other embossed types. Pre-school Blind Children and their Parents: Placement of the school child in sighted playschools and kindergartens, instruc-tion of parents in the development of the blind child, his needs, etc. Residence for the Blind: Available residential quarters for seventy-five persons at a reasonable monthly cost. Residence also used to house persons brought to Vancouver for treatment or adjustment training. Prevention of Blindness Services: Through publication of pam-phlets, movies, etc., talks to school children and P. T. A. groups by Field Secretaries and other personnel. Concessions: White<canes, bus passes, reduced transportation concessions, talking book services, Braille book service, re-duced purchasing privileges. Commercial and Industrial Operations: Offers employment training and employment in sheltered workshops, canteens, concession stands, - 19 -as well as placement in outside industry. Vocational counsel-ling. Piecework and home piecework. Salesroom service in-cludes sale of blindcraft products and offers reduced rates for the purchase of craft goods and raw materials. Recreation: Offers leisure-time activities to a large number of blind persons. A wide range of activities such as swimming, bowling, fishing, dancing, chess, discussion groups, drama groups, choir and service clubs. Most of these activities are of the mass activity or public recreation type. Methods to be used in the Study: The area chosen for study is that of Casework Services offered to the blind of British Columbia, and in particular, those casework services offered to blind male adults between the ages of twenty-one and forty. It has been the experience of the staff of the C. N. I. B., Western Division, that this group poses peculiar difficulties in the rehabilitation field since i t is often difficult to teach them new trades and employers are reluctant to offer them work. Since this group includes males with other persons de-pendent upon them i t is a matter of particular concern that their rehabil-itation should be as complete as possible. The files of the Vancouver office have been studied for a l l adult males between the ages twenty-one and forty-five, registered with the C. N. I. B., Western Division, during 1950 - 1954. An attempt has been made to tabulate some of the basic data available and to provide case illustrations of the problems requiring casework services. Since very little work has been done in this field the amount of material available is largely restricted to the casework file but any other information available has been included where possible. - 20 -CHAPTER II CASEWORK SERVICES OFFERED TO THE BLIND OF BRITISH COLUMBIA The Registration of the Blind: The Western Division of the C. N. I. B. estimates that approx-imately ninety-eight per cent of all blind persons in British Columbia are registered with the Vancouver Divisional Office. This high degree of reg-istration has come about through many years of impressing upon opthalmol-ogists the need for early referral of cases. When an eye examination is made by an opthalmologist and the degree of vision is equal to, or is below the legal limit of blindness or there is indication that sight may fal l be-low this limit referral is made and the eye report is mailed to the Vancouver office of the C. N. I. B. The registration of clients in Vancouver differs from that of clients living in rural areas. In Vancouver, the opthalmologist either mails or sends with the client an eye report indicating the degree of vision which determines eligibility for the services of the agency. If an enquiry is made in person or by 'phone, the need for an eye report is explained and arrangements made for an examination i f the client has no private opthal-mologist. In the case of reports mailed into the Vancouver office, each is checked with the files by the Registrar to find out i f the case is a new one and then referred to the social worker if it is in the Vancouver area. The name is noted and the folder is made out and filed in the "Suspense" drawer with only the eye report or letter of enquiry. It remains here t i l l - 21 -the registration questionnaire, face sheet, and first history are added after the initial interview has taken place. Upon receipt of the face sheet information the Registrar sets up the file in the "Pending" drawer. Once each month original eye reports and copies of the registration questionnaires are sent to the National Office where master files are kept and the case number is assigned. Notice of registration is sent to the Registrar who then numbers the file folder, the case then being entered in the "Registered" drawer. Index, geographical, age, and statistical files are made and filed when the registration number is received. Cases not eligible for registration are filed in the "Unregis-tered" drawer. This drawer is always checked when new reports come in. Upon receipt of the registration number from National Office, the case is registered with the Social Service Index. Cases are not always cleared with this office before the initial interview is held, but other agencies are contacted later i f the Social Service Index slip shows them active. In the case of the client living in an area covered by a Field Secretary, the eye report is sent from the Registrar to the Supervisor of Social Welfare, who then notifies the Field Secretary in that particular area. The latter then makes the initial interview and gathers the necessary information for the registration questionnaire which is sent to Vancouver and entered in the fil e . The registration procedure is essentially the same, foUowing the same pattern. The Field Secretary is the person with whom the client will most likely have the greatest number of contacts. He is trained in basic interviewing skills, is able to instruct in crafts, Braille, typing and is the administrative link between the client and the District Office. - 22 -The Intake Interview: Since 1951 the first, or intake, interview has been carried out by the social worker either in the client's home or in the office. Formerly, many of the registrants never had a contact with the Social Welfare Depart-ment, passing directly to other departments. Casework contact was not then a part of the registration process. Since lit t l e or no recording was done by other departments, and since there were not sufficiently trained and skilled counsellors in these departments aware of the problems faced by the newly blinded, many of the problems of clients were overlooked and no refer-ral made to the Social Welfare Department. However, the present procedure overcomes the difficulty and the initial contact is with the Social Welfare Department. At present al l Vancouver clients are contacted by the social worker. If the eye report indicates the client is not eligible for ser-vices the social worker explains why and offers to make referral elsewhere if she thinks he can use the help of other agencies. When an eye report indicates that the client is eligible for services the social worker will obtain face sheet information and explain services available. The intake interview is specifically designed to gather informa-tion about the client; his age, his birth place, marital status, length of residence in Canada and the province, his education, work and employment history, military service, financial position, date of onset of blindness and medical history. This information is entered upon the registration questionnaire and may be used for some of the face sheet information. How-ever, the social worker will gain as much information about the client as is «• 23 — necessary for her to make an assessment of his needs for services and his potentials for rehabilitation. She will also assess whether or not the client needs and can use casework services. Since sixty per cent of the clients of the Western Division, C. N. I. B. are over sixty and most have lost their vision gradually, they are often well adjusted to their dimin-ished vision and are only interested in a white cane, bus pass, talking book, learning Braille or some other similar service. If the client is younger and has lost his sight suddenly it will be necessary for the social worker to have a series of interviews with him. The initial interview is dictated as soon as possible. In areas covered by the Field Secretary the initial interview is essentially the same. Since none of the Field Secretaries have professional social work training, most having had some in-service training in interview-ing skills, the quality of casework services offered to the clients is limit-ed. The registration questionnaire is filled out and the initial interview recorded and mailed to the Vancouver office where i t is entered in the file. If the Field Secretary considers a client requires more intensive casework services than he can offer, a referral is made to the nearest social worker at the local Provincial Social Welfare Branch office. The Services Offered by the Social Welfare Department: In Chapter I the services of the C. N. I. B., Western Division, offered to the blind were discussed in summary form. Since this study focuses upon casework services to the young adult male client, the services of the Social Welfare Department, the services of other departments and the way in which they are brought to the client by the social worker will be - 24 -discussed in order to develop a better working perspective. Information in this discussion i s drawn from an unpublished monograph entitled, "Admin-istration of the C. N. I. B., Western Division.", by Miss Eileen Scott, Supervisor of Social Welfare, Western Division, Vancouver, B. C. The Department of Social Welfare is administered by the Supervisor of Social Welfare, a trained social worker who is responsible for the exten-sion of social welfare services to the blind of the Division. These ser-vices include casework services, home teaching, prevention of blindness services, operation of the residence for the blind, pre-school children services, concessions and other general services, e.g. white canes, bus passes, library services, etc. She acts as co-ordinator and liaison between departments to ensure that the welfare of the client i s paramount. It i s in this role that she logically heads up the team of social worker, home teacher, employment officer, placement officer, and Commercial and Indus-t r i a l Operations representative. Because of her administrative position liaison between departments i s direct and she i s able to request services of other departments without having to clear through other administrative channels. The work of the department i s carried on with the help of one sighted social worker, three Field Secretaries, four home teachers; three of whom are blind and had special in-service training courses of nine months' duration. The other home teacher has recently come to the department after twenty years training and work with the blind in England. The social work-er i s responsible for intake and a l l casework services to the adult blind in Vancouver. The home teachers, one in Victoria, one in New Westminster « 25 and two in Vancouver, are responsible for teaching Braille, Moontype, typ-ing, travel techniques and orientation methods, and making annual visits in assigned geographical areas and only on referral by the Supervisor. They are able to carry on some casework services under supervision. They teach either in the office or the client's home. The Field Secretaries are responsible for extending a generalized service program to the clients of their districts. The extent to which this is done varies with the facilities within their districts, the capabilities of the Field Secretary and the needs of the client involved. For instance, the Field Secretary in Victoria has a service center, including workshop and recreational facilities, while the Field Secretary in the Okanagan-Kootenays is on the road most of the time. The Field Secretaries, excluding the one in Victoria, are limited in the amount of casework services they can render because of the great distances between clients. This is partially remedied by the close working relationship between the Field Secretaries and the local offices of the Provincial Social Welfare Branch. The Field Secretary promotes the use of camimjnity resources to provide financial help, work and recreational facilities for the clients. For this part of their work they are responsible to the Supervisor of Social Welfare. The social worker, having gathered the required information for registration and made her assessment of the client's needs for service, will outline and offer the services of the C. N. I. B., suggesting and noting those services the client might find most useful. Requests for services other than casework, for concessions and general services, are approved and implemented by a memorandum i f the expenditure of money is required, e.g., - 26 -for talking books, admission to residence, and provision of hearing aids. The social worker discusses requests for home teaching with the Supervisor, who then notifies the home teacher and makes arrangements for these ser-vices to be given. Casework help is given by the social worker or by the Supervisor and will vary in intensity and focus with the needs of the clients. Casework services are usually required by those who have suddenly lost their sight and who are s t i l l relatively young and active. The trau-matic effects of blindness upon the personality, discussed in Chapter I, are often such as to require the skill and understanding of a trained social worker if the client is to make the most of his adjustment to his handicap. "When the social worker thinks the client is ready for participa-tion in recreational activities she discusses his case with the Director of Recreation and makes arrangements for him to meet the client and invite him to those groups and activities that might interest him. If the client is ready for employment she arranges for him to meet the employment officer and discuss his problems. When employment plans are being made for the client the employment officer, the social worker, and the Supervisor usually discuss the case before placement is made so that the Placement Officer has sufficient information about the client to be able to make a successful placement. In some cases the client is not considered ready for placement in outside industry and a request is made to the Supervisor of Commercial and Industrial Operations for a training period in either the sheltered work-shop or concession stands and canteens, depending upon the abilities of the client. After the training period the Supervisor of Commercial and Indus-trial Operations and his assistants decide whether or not the client will be - 27 -taken on their staff. They submit a history on the assessment of the client's progress at the end of the training period and the disposition of tiie client. The social worker, the employment officer and the Super-visor of Social Welfare do not continue contact with stand operators and workshop employees unless they request interviews for specific purposes. If the Placement Officer feels the client is ready for placement in out-side industry and a suitable job is available, the placement is made and follow-up visits are made by the Placement Officer who submits reports to both the employment officer and the Supervisor of Social Welfare. The Prevention of Blindness services consist of issuing orders for glasses to patients referred by the Vancouver General Hospital and opthalmologistSjWho have a progressive eye condition or very low vision. This is carried out by a clerk. Arrangements to bring out-of-town cases in to medical centers for treatment, the purchasing of transportation, and making arrangements for accommodation, are instituted and approved by the Supervisor but are carried out by the Registrar. The services to parents of blind pre-school children consist of casework services, instruction in the needs of the blind child and its devel-opment, and placement of the pre-school child in sighted playschools and kindergartens. These services are carried out by the Supervisor and a train-ed nursery or kindergarten teacher. This is an area of C. N. I. B. service currently being evaluated. ^  1 Scott, E., The Pre-school Blind Child and his. Parents, A Study of the Development of a Special Program by the C. N. I. B. in British Columbia to meet the needs of Pre-school Blind Children and their Parents. Unpublish-ed Master of Social Work Thesis, University of British Columbia, Vancouver, B* C., 1955. «* 28 — The residence for the blind, Queen Elizabeth Hall, offers res-idential care for seventy-five blind clients and is administered by the Supervisor through delegation of authority and responsibility to the Matron. The Supervisor is responsible for decisions for the admission and discharge of clients in the residence. The personal problems of clients are handled by the social worker. The residence is used to accommodate not only per-manent residents but also clients brought into the city for medical treat-ment, operations, or to participate in adjustment training courses. Concessions and other general services are handled by the social worker and are generally routine matters. The Services of Other Departments t The services of the Blind Personnel and Public Relations Depart-ment consist mainly of vocational counselling and job placement. Counsel-ling is handled by the employment officer who discusses plans for employment with the clients, advises on financial matters, handles the purchasing of articles at reduced rates and does some job finding and placement. Job find-ing in the industrial field is handled by a Placement Officer who interviews employers in outside industry and places blind workers in whatever openings are available. He carries out follow-up visits and reports to his super-visor on placements. He is in charge of piece and contract work, and home employment which provides part-time employment for a limited number of clients. The Commercial and Industrial Operations Department handle the training of blind clients for employment in concessions stands and the shel-tered basketry, workshop. Training for the concession stands takes place in - 29 -the stand while the training for the sheltered workshop i s usually under the supervision of the Placement Officer and takes place in the workshop. The Social Worker as Co-ordinator; From the foregoing discussion we see the pattern of work in the Social Welfare Department and the way in which services are brought to the client. Throughout the process the social worker acts in the role of co-ordinator of services, bringing to the client those services that can best meet his particular needs. This co-ordinating role in the total service program i s effective because the social worker holds the welfare of the client as paramount and sees the rehabilitation program as a dynamic pro-cess shifting to accommodate the individual needs of the specific client. The value of the aditiinistrative position of the Department of Social Welfare in the rehabilitation process wil l be seen in the discussion of the casework services given to young adult blind male, clients who form the basis of this study and upon whom the focus of discussion wil l now be placed. The Group Studied: A group of blind males between the ages of twenty-one and forty-five, married and single, registered with the Vancouver office of the C. N. I. B. since 1950, form the basis of this study. Information was gathered from a study of sixty-two case f i l e s , the total number of young blind males, twenty-one to forty-five years of age, registered during this period, and the information tabulated in two forms: the Basic Information Table and the Classification of Services Offered (Appendices A and B). In many cases the recorded material was scanty indeed and additional information had to be gathered through interviews with the social worker, Supervisor, or other - 30 -department heads who had contacts with the individual client. Field Sec-retaries were noted to have varying degrees of recording skill with the result that recording about services was difficult to assess. Related to this lack in recording skill is the lack in diagnostic ability, the two lacks combining in some cases to make for recorded material of little value to this study. The records of five of the six Indians registered in this group contain nothing more than the incomplete registration form and the following curt notice: "The Indian Affairs Branch states that owing to the excess-ive work which has been entailed for their field staff by the Blind Pension requirements they do not feel it advis-able at this time to submit further forms for completion, and consequently there are certain details lacking." 1 No other information than the date of birth, marital status and religion of the client is recorded. It is unfortunate 1hat a government office charged with the welfare of the native Indian should, through the excuse of excessive work, deprive the Indian blind of the services of the C. N. I. B. to which they have every right. The need on the field staff level, for gathering essential infor-mation in some systematic manner is conspicuous. Information about the client gathered in the Vancouver office pointed out the greater skill of the social worker in the matter of recording but there s t i l l existed gaps in the basic information required for this study. It is because of this lack of in-formation that only a preliminary and partial study of the casework services offered to this group of young adult blind males can be made here. For a 1 Quotation from correspondence filed in Case Numbers 31, 45, 56, 57, 58. 31 -more detailed analysis, or for any further research in other areas of ser-vice, much more fully recorded case files would be required. The Basic Information Table; The Basic Information Table (Appendix A) was devised to cover the areas of information that were considered essential for this study. These areas are: date of birth, marital status, degree of useful vision, age at onset of blindness, date of first contact, other handicaps, educational background, employment prior to onset of blindness, work record, placement, and present employment as a blind person. Under headings some of the in-teresting points that have come to light will be discussed. Marital Status: In the group of sixty-two clients studied there were twenty-nine single males while thirty-three were married. Degree of Useful Vision: Of this group there were eighteen with no vision whatever, seventeen had a slight degree of vision, thirteen had fair guiding vision and nine had a good guiding vision. The degree of vision of five cases was unknown. Visual acuity was measured by the following scale: Good: 20/200 - 20/300 Fair: 20/320 - 20/400 Slight: 20/450 - 20/700 None: 20/700 and below All measurements are Snellen Chart Figures Age at Onset of Blindness: Blindness was found to have attacked ten of the clients in the group studied during the first ten years of lif e , eight during the next ten years, twenty-two between the ages of twenty-one and thirty, and nineteen between the ages thirty-one and forty-five. The - 32 -age of onset for three clients was unknown. Other Handicaps; Of the sixty-two males studied, twenty-five had additional handicaps of various types. Five clients were afflicted with multiple sclerosis and eight were found to have diabetes, blindness being a concomitant of both these diseases. Four of the group studied were men-tally retarded while there were four alcoholics, one of whom was a half-breed Indian. In this case, the client's feelings about his parentage produced a further limitation upon his rehabilitation. Two of the group suffered from arthritis while one client's blindness was the result of syphilis with the resulting brain damage causing personality changes. One client was handicapped by the partial loss of his right hand. Of the to-tal group, three were limited by double handicaps. It would appear that the existence of multiple handicaps severely limits or prevents the client's rehabilitation. In such cases the social worker can only attempt to make the client more comfortable with his handicaps. Educational Background; The educational level of the clients studied appeared to be balanced between elementary and high school levels; twenty-two having elementary school education while twenty-nine had high school education. Four clients had received college or university educations while seven of the clients' educational backgrounds were unknown. Employment Prior to Blindness; Owing to the limitations of recording, noted previously in this study, the information in this column (XII) is drawn not only from the case file but also from C. N. I. B. personnel who have had contacts with specific clients. The client's employment prior to - 33 -blindness has been roughly classified in seven categories on the basis of this information. In the category of unskilled labour were placed such occupations as farming, mining, janitorial work, construction labourer, mill hand, and warehouseman; while semi-skilled labour included the occu-pations of electrician's helper, lino-layer, mechanic's apprentice, car-pet sewer, and millwright. Skilled labour covered the occupations of cab-inet maker, electrician, telegrapher, carpenter, linotype operator, lith-ographer and X-ray technician. Clerical work included the occupations of accountant, store keeper, bookkeeper, and office clerk. There was one professor and four students in the group. Seventeen clients were found to have engaged in unskilled labour, while eleven classified as skilled labour-ers. Nine were found to have done clerical work while seven had been em-ployed as salesmen. The employment of five clients was unknown. Employment as a Blind Person: Apart from listing the employment of clients in the group of young adult males studied, this column also attempts to give some indication of the type of adjustment to employment clients have made. This information is based solely upon the opinion of staff personnel who have had contacts with particular clients. Because of the limitations of recorded information i t is not within the scope of this study to make any accurate evaluation of adjustment to employment and the following information is included as adding to points of interest brought out in this study, as well as indicating possible areas for further re-search. Based upon staff evaluation of adjustment to employment, four cate-gories have been set up: none, undetermined, poor, fair and good. No adjustment has been used only in those cases where the client has been bed-ridden or has made no attempt to enter employment. Undetermined adjustment - 34 -referred to those cases where little or nothing was known of the client 1 s present occupation or his adjustment to i t . In some cases the client was unemployed and living on Blind Pension and had little contact with the agency. In other cases the client was bed-ridden or confined to an insti-tution, e.g. woodlands School for the Mentally Defective or Marpole Infirm-ary for the Chronically 111. Poor adjustment to employment was considered to be sporadic attendance at a job, or negative attitudes toward employ-ment. Fair adjustment to employment was considered to include a limited ability to perform set tasks without much adaptability being shown in mov-ing from one operation to another. Good adjustment was considered to be that in which the client had achieved a positive attitude to his work, had skills that equalled the requirements of the job, and attendance was steady. These evaluations of adjustment cannot be taken as being conclusive since there are many variables that enter into the real evaluation of this area and which are not available to this study. However, the following fig-ures can be noted as being points of interest. Twenty-nine of those studied were evaluated by staff members as having made good adjustments to employment and eight were considered to have made fair adjustments, while only two were considered to have made poor adjustments. Sixteen had no regular employment and for this reason no information was available. Work habits appeared to be repeated in present work since there was a pattern of work habits before blindness being re-peated in present employment. Again,this conclusion can be noted as a matter of interest only. - 35 -Classification of Services Offered: The classification of services offered to the group of blind males studied was made on the basis of departments offering services. These were Social Welfare, Blind Personnel and Public Relations, and Commercial and Industrial Operations. The classification of services offered (Appendix B) gives tabular representation of all services offered to this group of blind adult males. Social Welfare services were broken down into casework services, home teaching, residential care, and concessions and general services. Blind Personnel and Public Halations Department services were divided into vocational counselling and job placement, while vocational training was placed under the Department of Commercial and Industrial Operations. The Social Welfare Department. Casework Services: Casework records are recorded in summary form and in many cases the press of administrative work upon the Supervisor of Social Welfare precludes the more detailed recording of interviews. In the cases of some clients known to have received intensive casework services there is no re-corded information other than that elicited in the initial or intake inter-view available. In order to gather more detailed information in this area discussions with staff members of the Social Welfare Department revealed a rough division of casework services on the basis of number and focus of inter views. These divisions were classed as short-term, long-term, and intensive casework services. Short-term services were those where contacts were be-- 36 -tween one and five i n number, while "those numbering more than five were con-sidered long-term services. Intensive services were offered to the c l i e n t whose i n i t i a l reaction to blindness was extreme and whose need for more than supportive services was great. While these services were found to be either short or long-term i n duration, long-term intensive services were found to have been given fourteen of the nineteen c l i e n t s receiving intensive ser-vices. Of the sixty-two c l i e n t s studied i n t h i s age group, thirty-nine received casework services. Of these thirty-nine cases, twenty received short-term services, nineteen received long-term services, while nineteen received intensive services. These thirty-nine c l i e n t s were either l i v i n g i n or v i s i t i n g Vancouver during the time they received these services. The following examples of casework services w i l l be given to i l l u s t r a t e short and long-term and intensive services. Mr. P . , (Case No. 10) i s a single man, forty-one and diabetic. He has been employed as a bond salesman throughout his business career. His diabetic condition began to affect his sight when he was t h i r t y -five and i t has progressively diminished u n t i l the present time when only a s l i g h t degree of guiding v i s i o n remains. Throughout this period he made no attempt to r e g i s t e r with the C. N. I . B. and did not speak to others of his handicap. He remained i n the employ of his family 's bond house u n t i l i t changed ownership when he f e l t the need to do something about h i s diminished v i s i o n i n order to remain employable. By this time he was becoming unable to travel about with any degree of sureness and the need f o r sight i n his work produced a c r i t i c a l s i tuation. Through a friend who knew the extent of h i s handicap he came to the C. N. I . B, and was r e g i s -tered. H i s interview with the Supervisor of Social Welfare was the beginning of a short term contact of three interviews. In t h i s interview he b e l i t t l e d h i s handicap and refused a white cane or other services of the agency. He d i d , however, accept the r e a l i t y of h i s blindness s u f f i c i e n t l y to request an interview with the Employment Officer to discuss plans for a change of employment. This was arranged and during the interview h i s employment future TABLE I Casework Services Offered to Blind Males 21-45 Years of Age  Registered Since 1950, C.N.I.B., Western Division, Vancouver, B. C. No. Short-term Long-term Intensive 1 X X 2 X 4 X X 7 X 8 X X 10 X 11 X 13 X 14 X 15 X 16 X X 17 X X 19 X 21 X 22 X X 24 X X 25 X X 26 X 27 X 28 X X 30 X X 33 X X 35 X 36 X X 37 X X 39 X X 40 X X 41 X 43 X 44 X 47 X 48 X X 49 X X 51 X 52 X X 54 X 55 X X 59 X 60 X Total 39 20 19 19 - 38 -was discussed although no arrangements were made or decisions arrived at. Another interview with the Supervisor helped him accept his feeling about being blind and the limitations i t placed upon his business and social life. A third interview, some time later, showed him as gradually accepting his blindness and consid-ering realistically the ways in which he could cope with business and social limitations. No further casework services have been requested by Mr. F. although he has discussed employment problems with the Employment Officer. He is s t i l l employed as a bond salesman. Short-term contacts were often the only casework services clients received, the reasons for the limited contact being that the need was met and help given in the solution of the client's particular problem or that they were unable to use casework help. On the other hand, long-term services were used for the most part by those who were able to make use of casework help and whose problems were related to their total rehabilita-tion. The following example illustrates this point well. Jim (Case No. 55) was a young married man of twenty-four with two children, living in the Okanagan Valley town where he owned his home and was employed by the railway. He was a member of the local baseball club and was a well known and popular man about the town where his family had lived for same time. With the onset of Bale's Disease he gradually lost his sight and was forced to change his occupation to become a gardener at a nearby government institution. When his vision dropped to a lower level he was forced to give this position up and make application for Social Assistance. When he became legally blind he was referred to the C. N. I. B. by his doctor, and the local service club made referral to Ihe Field Sec-retary of that area. The Field Secretary got to know Jim fairly well and recognized in him the strength and independence that would contribute to his rehabilitation. Jim, who had made a reasonably good adjustment to his blindness, its gradual onset having reduced some of the traumatic effects, was interested in finding seme means of making a living; some job or occupation that would give him sufficient income to keep his home and provide for his family, rather than having to accept the restrictive limitations of the Blind Pen-sion. After seme thought ihe Field Secretary recommended that Jim be sent to Vancouver to take part in a rehabilitation course that was being given for six recently blinded men. Arrangements were made for him to travel to Vancouver and stay at Queen Elizabeth Hall while he took part in the course. In Vancouver Jim met the social worker and was introduced into the various classes in crafts, typing and Braille taught by the home teacher. He learned travel techniques and methods of orientation and before long was travelling back and forth from the Hall to the C. N. I. B. offices without a guide. On his first visit to the agency Jim discussed the re-habilitation course with the social worker and explored the ideas he had about future work. He wanted to find out what kind of a vocation he could turn to now his sight was gone. He showed a real interest in doing something for himself and had several suggestions to offer which he talked over with the social worker noting those he thought might be possible within the somewhat limited financial position in which he found himself. Apart from owning his own heme he had little put aside and the assistance allowance he received through the Social Welfare Branch was barely sufficient to live on. Talking these problems over he gave some indication that he had considerably deep and unexpressed feelings about being blind. As the relationship developed these feelings became the caseworker's focus as she helped him express them and gradually accept the re-alities of his blindness. As he progressed with his studies in Braille, crafts and typing and became more comfortable in his feel-ings about being blind, Jim was better able to discuss his plans for the future and in order to give him a better picture of the possibil-ities open to him the Employment Officer was brought in and several meetings were held during which Jim arrived at the decision to look into the poultry business as a likely occupation. The social worker arranged a visit to the Poultry Department of the University of British Columbia where Jim discussed his problems of poultry raising, what would be required to stock a poultry farm, what stock were best and many other problems he wished to have answered. Several later visits to the University were arranged after Jim had decided that poultry farming was what he wanted to do. Discussing this decision with the social worker he expressed his fears of not being able to achieve this goal because of the limited financial backing. In order to ensure that some degree of security would be available to him dur-ing the time he was setting up his poultry business the social worker contacted the Social Welfare Branch and discussed with them the pos-sibilities of keeping Jim on Social Assistance until he became settled in his business. Out of this discussion came the decision on the part of the Social Welfare Branch officials to let Jim keep the proceeds from the sale of his heme and turn them into his new endeavor without having to give up the Social Assistance. Jim's fears about the future were considerably lessened with this understanding and interest on the part of the Social Welfare Branch. In further discussions with the social worker he indicated an interest in recreation activities and he was introduced to the Director of Recreation who discussed bowling and swimming with him and brought him into these activities. On com-pletion of the six weeks' course Jim returned to his home keeping in touch with the social worker by letter, advising her of his progress with his new home and poultry buildings. He is presently beginning to develop his laying flocks, now that the basic buildings have been - 40 -completed with the help of the local service club who volunteered labour gangs and who have given constant support and volunteer help to help Jim in his enterprise. From the above example of a long-term casework service i t can be seen that the social worker in the rehabilitation setting has the client's total problem as her focus; she must be aware of his total life situation i f she is to be of use in helping him effect a readjustment to his handicap, to his family and to his community. With the time available during the six weeks course the social worker was able to have at least two interviews weekly with Jim. In these interviews she helped him accept his feelings about being blind and supported him in his pursuit of an occupation and brought various resources to the solving of this problem. Constant support was given through the many letters that were sent to Jim in reply to ques-tions and requests, indicating that in an agency where many of the clients are spread over large rural areas the casework relationship can be main-tained and used on a supportive level through the use of correspondence. Contrasting the above long-term casework service illustration with that of the following example of an intensive casework service, we will be able to distinguish the essential characteristics of this service. Mr. R. (Case No. 30) was considerably disturbed when he came to the Vancouver office on referral from the Southern Alberta District Office. He had been blind for over a year and had reacted to his handicap with depression and a hostile behavior. He had married and had three children but had divorced his wife and upon coming to Vancouver had entered into a common-law relationship with a woman who was now supporting him. He came to the office requesting em-ployment and during his interview with the social worker expressed his hostility at being blind. It was suggested that he begin in-struction in crafts and typing which he took up but could not work on for anything more than a severely limited period of time. After the first few interviews with Mr. R. the social worker found - 41 -she was not able to move further in offering services. Mr. R. de-cided he had had sufficient help from the agency and disappeared for a few weeks only to show up and demand an interview with the social worker during which he gave indication that he was ready to accept casework help. The social worker scheduled a meeting for the next day and for some days following Mr. R. met with her and gradually began to relax to a point where he was able to accept some of the limitations his blindness imposed upon him. Throughout, Mr. R. expressed a great amount of hostility while making clear his great need for dependency. The social worker recognized these com-ponents of the traumatic effect of blindness upon the personality and allowed the expression of hostility and supported the dependency to the extent that i t was necessary for Mr. R's handling of his situation.. One of his most characteristic expressions and one which indicated the extent of his disturbance was the statement that, "When I was blinded I resigned from the human race". Casework interviews continued for a short time before 1hey were broken off by Mr. R. only to be begun again when he felt he could demand the attention of the worker. These services continued over a period of three months and a re s t i l l continuing. This illustration of intensive casework services points out their distinctive characteristics. In most cases the degree of disorganization resulting from the traumatic onset of blindness is the most important factor that conditions the intensity of casework given. In Mr. R's. case, his disorganization was such as to require skillful handling of the expressions of hostility and his need for dependency if he was to move out of the angry and depressed state he was in. The relationship between dependency, blind-ness and hostility might be discussed in relation to 1his case. Dependency has special meaning for the blind male because there are certain objective dependencies that are specific to them. Economic and physical dependency are obvious examples. The conflict that arises between the cultural expect-ancies of the masculine role and the implicit limitations blindness places upon it are sufficient to make for a tendency toward dependency while activ-ating basic feelings of hostility. This conflict results in the development of aggression directed toward the objective source of dependency, previous - 42 -personality resources and patterns of behavior conditioning its expression. In Mr. fi's. case, his feelings of ambivalence toward his ccmmon-law wife and his rejection of the social worker are seen as expressions of depen-dency and aggression. Implicit in this behavior is the relationship be-tween blindness and castration fears, fear of losing the masculine role and the masculine identification. It is on this depth of understanding of de-pendency and hostility that intensive casework services must be based i f effective adjustment is to be the outcome. Other services of the Social welfare Department were home teach-ing, concessions and residential care. The following tables will show the number of clients in the group of blind males studied who made use of them. Home teaching services are shown in Table II. Home teaching services were used by twenty-four of the clients registered in the group studied, twenty learning crafts, while seventeen learned to read and write Braille. Twenty-one learned to type and of the total number receiving home teaching services fifteen received instruction in a l l three subjects. Concessions and general services covering a wide range were given as the following table (Table III) illustrates. Prom Table III i t will be seen that a total of forty clients in the group of blind adult males studied were in receipt of concessions and general services during the period 1950-1954. Of this number, eighteen re-ceived white canes while nineteen received and used bus passes in the city of Vancouver. Fifteen clients made use of the reduced fare privileges and - 43 -TABLE II Home Teaching Services Given to Blind Males 21-45 Years of Age, Registered Since 1950 C.N.I.B., Western Division, Vancouver, B. C. No. Crafts Braille Typing 1 X X 2 X X X 3 X 6 X X 7 . X X X 13 X 14 X 15 X X X 19 X 22 X 24 X X X 30 X X X 33 X X X 36 X X X 37 X X X 39 X X X 41 X X 43 X X X 44 X X 46 X X X 47 X X X 48 X X X 51 X X X 55 X X X Totals 20 17 21 - 44 -TABLE III Concessions and General Services Given Blind Males 21-45 Years of Age Registered Since 1950 C. N. I. B., Western Division, Vancouver, B.C. Reduced Transpor-Reduced Purchase Talking tation Library Other No. Cane Pass Fare Price Book Passes Service Services 1 X X 2 X i 3 X X 4 X 6 X 7 X X X X 8 X X 10 X X X 12 X X 13 X X X X 15 X 16 X X X 17 X X X X X 18 X 19 X X X X 22 X X 23 X 24, X X X X X 26 X X X 27 X X 28 X X X X X X 29 X X 32 X 33 X X 35 X X X 36 X X 38 X 39 X X X X X 42 X X X 43 X 44 X X 46 X X X 48 X X X 51 X X X X 52 x 53 X 55 X X X X X •X 59 X X 61 X X 62 X o Total 40 18 19 15 9 10 3 9 18 45 -eight made use of the reduced purchasing privileges. Ten clients applied for and received talking books while nine received other library services. Three clients made use of transportation passes elsewhere than in Vancouver City. Eighteen clients received a wide variety of other services. These ranged from letters of introduction, recommendations, etc., to the loan of special equipment, e.g. radios, gramophones and hearing aids. Blind Personnel and Public Relations Department: The Blind Personnel and Public Relations Department offered its services to thirty-six members of the group studied. The following table (Table IV) illustrates the services offered them. These services were in many cases brought to the client through referral by the social worker to the Employment Officer. Thirty-six clients in this group were given vocational counsel-ling by the Blind Personnel and Public Relations Department while four of this group were placed in outside employment and nine were placed in the sheltered workshop or in concession stand employment. Commercial and Industrial Operations Department: Of the sixty-two clients registered since 1950, six have been given training for concession stand employment by the Commercial and Indus-trial Operations Department. Recreation Department: Nineteen of the sixty-two members of this group of men partici-pated in recreational activities. Since no attendance records are kept in this department i t is impossible to provide more descriptive figures. TABLE IV Vocational Counselling and Job Placement Services Offered to Blind Males 21-45 years of Age, by the Blind Personnel and Public Relations Department, C. N. I. B., Western Division, Vancouver, B. C., 1950-1954 Vocational Job Pj acement No. Counselling Outside Sheltered 2 X 4 X 7 x 8 X 10 X 11 X 12 X 13 X 14 x 15 X X X 16 X 17 X 19 X 20 X 23 X 24 X 26 X X 28 X 30 X 33 X 34 X 35 X 36 X X 37 X X X 39 X 40 X 41 X 42 X 43 X 46 X X 47 X 48 X 51 X X 55 X 59 X 60 X X Total 36 32 4 9 - 47 -In the next chapter a discussion of some of the problems that beset the young blind adult male in the process of his rehabilitation will be dis-cussed in relation to the manner in which casework services helped in their solution. As indicated in the three illustrations of casework services given earlier in this chapter, these problems affect many aspects of the client's life experience and in many cases will require the skilled ser-vices of the trained social worker. - 48 -CHAPTER III CASEWORK SERVICES AND SPECIFIC PROBLEMS OF YOUNG ADULT BLIND MALES From the foregoing chapters the Social Welfare Department is seen within the ariministrative structure of the C. N. I. B., Western Division and its services have been discussed with the view to providing a fuller perspective of its role in the rehabilitation of the young adult blind male. The role of the social worker has been described and casework ser-vices have been discussed as falling into three categories; short term, long term, and intensive. It is now the purpose of this chapter to shift the focus from these considerations to a consideration of the specific pro-blems that affect the young adult blind male client in his rehabilitation. As employment is a major factor in the lives of young men in this age group, particular emphasis will be laid on spelling out the problems that hinder or prevent the blind client from achieving employment. Attention will be given to the problems not directly associated with blindness but which in combin-ation with the handicap of blindness produce complications in tne client's rehabilitation. These problems will be discussed in relation to the case-work services offered by the Social Welfare Department to this specific group of young adult blind males. It is unfortunate that one or two fully recorded cases cannot be used to illustrate these problems but lacking this resource selected case illustrations will be used where possible. Some Specific Problems: 1. Feelings about Blindness: With the onset of blindness there are 49 -precipitated certain feelings of anger, frustration, or hostility that have a noticeable effect upon the blind person and his initial adjustment to his handicap. These feelings are of great importance in the rehabilitation of the young adult blind male since in many cases they are directly related to his concept of himself as an independent and employable male. Natur-ally not a l l persons blinded at this age react in the same manner but these feelings are one of the first and most important areas with which the so-cial worker deals. Feelings of being dependent, not only physically and economically but also emotionally, are related to the degree to which the client was functioning as an independent person prior to blindness. The realization that what skills he had formerly can no longer be of any use to the client is sufficient to produce considerable dependency upon his family and other persons about him, at least until such time as he might be able to learn other skills with which to cope with his problem, or else become adjusted to his dependent position. This feeling of dependency can be the means of arousing other feelings, a l l tending to make for the client's greater immobility and increased frustration. The case of Mr. D. (Case No. 40) illustrates this point well. Mr. D. was a young Danish immigrant who had been employed as an accountant with a large firm when he was suddenly blinded in an accident. With the sudden loss of his sight he found he now had no means of support for himself and his family and was dependent upon others for help. As a result he became greatly frustrated and hostile, resenting his dependency. While he had a fair degree of vision remaining he attempted to carry on with some accounting work but his inability to perform at his former level of skill and accuracy only furthered his frustrations. As a result his re-lations with his wife and children became disturbed to the point where quarrelling was a usual outcome of any family discussion. 1 Chevigny, H., and Braverman, S., The Adjustment of the Blind, Yale University Press, New Haven, 1950, p. 189. Mr. D. with the sudden onset of blindness found his special skills and knowledge of no use in making a living. Ha, a formerly highly independent person, was now dependent upon his wife and others and felt his role as head of the family and wage earner had been lost. Blindness had made him, in his opinion, less of a man and his reaction to the loss of his masculine role was extreme. He was not able to move out of this frustrated, angry, and dependent state until he was able to express his feelings about being blind and realistically to seek other employment. On the other hand, these same feelings of frustration, hostility, and an-ger can be repressed by the client and a state of dependency maintained since it is less threatening to him to remain dependent than to overcome the resistance to dependency and achieve an adjustment as an independent person. The response to the traumatic onset of blindness will reflect the quality of personality resources and previous life experiences of the client. The problem is then to determine the extent to which the client wished to remain dependent and to ascertain what means of employment or financial help are available to him. The case of Mr. T. (Case No. 26) is a case in point. Mr. T. was a single man of thirty-four when his sight failed him. He had been born with a defective right eye and through the years vision in his left eye had steadily weakened. With only a slight degree of remaining vision he was now forced to give up his employ-ment as an unskilled labourer in a lumbering manufacturing plant. His reaction to blindness was such that he denied the opthalmol-ogist s reports and blamed the work he was doing for the steady de-crease of his vision and made application for Workmen's Compen-sation. Upon refusal of his application he retired to his family home and lived on his Unemployment Insurance Benefits making applic-ation, when they expired, for Blind Pension. He has not sought other than part-time work about his home since. In this case reduced vision had made for a degree of dependency that, with the onset of a greater degree of blindness, became sufficient to - 51 -block any attempt to move into a more independent role. Related to this problem is that of the diabetic blind client who has developed certain strong dependencies because of his diabetic condition. (Case No. 39) Tom was thirty when he suddenly lost his sight. He was a single man living with and supporting his mother, had few friends and was dependent upon them to drive him where he wished. EVen though he had been given instruction in travel methods he had never ventured out of the house without either his mother or a friend to guide him. He was receiving Unemployment Insurance Benefits and while interested in finding some employment never followed any suggestion offered him. He was given home-piece-work and was content to make a few dollars with this kind of work but would not travel to the workshop where he would have better facilities in which to work. Sid, (Case No. 24), a slim, almost mousy chap, was another dia-betic, had been a typographer before his sight failed him. He was married with two children and owned his own home. His adjustment to blindness was considered easy since he tended to repress his feelings about being blind and gave the appearance of having accepted his condition. He was content to remain at home making a few dollars from the sale of crafts. He had rented roams in his home and was in receipt of Unemployment Insurance and, like Tarn, he requested employment but never followed through on his request and found or took eimoloyment. From these illustrations we can see that with the diabetic blind the amount of dependency is increased with the onset of blindness and this factor must be taken into account when helping plan for the clientls rehab' ilitation. 2. Health and Handicaps: Another problem faced by the group of blind males studied is that of the clients health in relation to his blindness and also in relation to employment ability. In this category can be placed those clients with handicaps that limit them physically. From the illus-trations used above i t will be seen how a diabetic condition will affect the client's dependency needs and his attitude toward employment. In a - 52 -somewhat similar manner the client's health problems will condition his ability to take employment as well as to adjust to i t . It is possible that blindness, in itself, makes for a greater proneness to illness both for objective and psycho-somatic reasons. Other handicaps will further hinder the rehabilitation of the client as is seen in the case of Miles. Miles (Case No. 37) was the twenty-two year old son of an English father and an Indian mother. He had been blinded as a result of injuries sustained in World War II and had reacted to his demob-ilization and the beginning of the rehabilitation course with an alcoholic bender of some days' duration. Over a period of time i t became noticeable that this was a pattern for Miles to follow when he found the pressures too much for him or when he felt partic-ularly disturbed over his mixed parentage. Within a short period he had developed a chronic stomach condition and by the time he had completed his rehabilitation course he had been many times absent from the concession stand where he had been in training. Further attempts to place him in jobs both in sheltered and out-side industries proved to be failures because of his erratic be-havior and poor attendance. From this illustration several points can be made. First, that with the client having a health problem, or physical or psychological handicap, rehabilitation is seriously hindered and since employment for this group of blind males is closely related to their total rehabilitation i t is necessary to consider the kinds of employment available for and use-ful to ihem. With such limitations, employment in sheltered workshops would seem to be a workable solution. The second point to be made is that before any degree of rehabilitation can be considered effective, the health pro-blem must be treated. Had Miles' stomach condition been treated as soon as it became noticeable i t is possible that some of the pressures effect-ing his poor performance could have been removed and he might have been made to feel more comfortable with his handicaps. A third point to be made is that with the greater number of handicaps, the less chance there is of success-- 53 -ful rehabilitation. With four handicaps; blindness, a stomach condition, alcoholism and feelings about his parentage, Miles had very little chance of gaining sufficient strength to overcome any of them. A man with the handicap of blindness is a definite problem on the employment market but a man with more than one handicap will hardly be considered by the employer. 3. Family Relationships: In discussing the next problem facing the young adult blind client, that of family relationships, the case of Mr. D. (Case No. 40), referred to above, see page 49, will serve as an illustra-tion. With the growing frustration and anger aroused by his blindness, Mr. D. became quarrelsome and family relationships were strained. It was only when other employment was found and later with the return of a great-er degree of vision, that these relationships were restored to their normal tone. Until then they had exerted a negative effect upon not only Mr. D. but the whole family constellation, limiting his adjustment to the realities of limited vision, and furthering his frustration over his employment problem. Family relationships can effect rehabilitation and employment in other ways, too. Mr. R. (Case No. 30), discussed in Chapter II, see page 40, had entered into a common-law relationship with a woman whom'.he could not entirely accept as a mate. His reaction to blindness had been intense and he had become alcoholic, leaving his wife and getting drunk for days on end. His previous employment history had been of a clerical and adminis-trative nature and he felt it beneath him to enter his former places of em-ployment and ask for work. At the same time his feelings about the common-law relationship were so ambivalent that until these were resolved he could do nothing but remain alternately dependent upon, and independent of, this woman. To date he is s t i l l unemployed. Another illustration of this problem is that of a young married man of twenty-eight who lost his sight and entered hospital to have a cor-neal transplant. Dick, (Case No. 49), was a chubby fellow with a very affable man-ner who had been an accountant and a car salesman prior to becom-ing blind. With the onset of his eye condition Dick had stopped work and remained at home, his wife having to go to work to sup-port him and their small daughter. Dick's widowed mother had never let him grow up and had over-protected him during his child-hood from any crisis or difficulty. She constantly kept him de-pendent upon her by giving ham money and by easing the financial burden, paying his doctor's bills and taking care of the child. Dick entered hospital and had his operation, unrealistically deny-ing that the operation might not be successful. The operation was not successful and upon release from hospital Dick returned home and has remained there since, stating that he is sure his sight will improve and that i t is impossible to think of employ-ment until i t does. Not until Dick's mother and wife stop supporting him will he have to make any move in the direction of employment. His mother's over-pro-tectiveness has conditioned him to dependency, his blindness has reinforced it and has provided him with a rationalization for unemployment that is socially acceptable. 4. Social Isolation: A further problem met in the study of this group of young adult blind males is that of social isolation. This problem is usually found among single blind males who have no family contacts and rel-atively few social ones. Blindness tends to isolate them more than other handicaps since there are so few means of caranunication and few opportunities for social intercourse. While there is a recreational program offered by - 55 the C. N. I. B., Western Division, i t caters to large group activities and is designed to meet the needs of larger groups of the clientele. Since the more specific needs of this particular group of single males cannot be met within the scope of the recreation program they are left very much to their own devices and become more remote in their isolation and less approachable. Miles (Case No. 3 7 ) , is a good example of such social i s-olation. As his other problems increased he moved further away from the associations he had made at the workshop and moved into a single room some distance away. His alcoholism increased and what few friends he had grad-ually left him. As a result there is now very little chance that Miles will ever be employable and that he will ever lead even a reasonably happy life. 5 . Community Attitude Toward Blindness: One problem that a l l blind persons face, but which has particular meaning for young adult blind males, is that of the community attitudes toward blindness. With an employment market well stocked with young sighted males there is a strong reluctance on the part of employers to hire or train young blind males. These atti-tudes are very difficult to change and can only be changed as the community grows to know more about the abilities of the blind and is able to under-stand some of the feelings and associations that are generally associated with the blind. In this case only a long-range program of community edu-cation can solve the problem. However, there are indications that show some gradual change in attitudes within the local community. A great deal of the interpretation of this problem lies with the blind themselves since they must show the ccoimunity that they can make an economic contribution to the community within limited circumstances. The difficulty of showing an - 56 -employer what a blind person can accomplish requires skill in presenta-tion and evidence to back up any statement. In some cases the inappro-priate placement of a blind person in a particular job has meant that just one more employer moved farther away from appreciating the poten-tialities of the blind worker. The placement of Miles, (Case No. 37), to use an example of a poor placement, in a coal heaving job, without due consideration of his erratic performance on other jobs, was the means by whieh one source of employment was lost to this group of blind workers. In regard to this problem of employer's attitudes toward blind persons in industry, it is interesting to note the English legislation, passed in 1944, requiring al l employers employing staffs of more than twenty workers to employ a standard quote* of handicapped persons.* At present this standard percentage is three per cent of the total number of workers employed. Employers are required to consider handicapped persons for vacancies before hiring able-bodied workers. If similar legislation could be enacted in Canada the available vocational opportunities for handi-capped groups would be tremendously increased, rehabilitation programs would become more realistic, and, in the case of the blind, the factor of community attitudes could be effectively overcome. 6. Employment and Training: One of the greatest problems facing this group of blind males is that of employment training. Several factors con-dition the need for training and the kind of training needed. The degree of useful vision is a major factor while the type of employment followed 1 The Disabled Persons (Employment) Act, 1944, H.8, Geo. 6, CIO, Sec. 9. - 57 -prior to the onset of blindness is another. Both will condition the kind of employment the blind worker will be able to follow. From an analysis of the kind of employment prior to the onset of blindness and the degree of useful vision it will be relatively easy to distinguish three main factors that will condition the need for employment training. In the first place, there are those young blind males that have been blind since childhood or who were blinded while s t i l l students who had not had any em-ployment experience. These clients will require training that will estab-lish a whole constellation of attitudes to employment as blind persons as well as providing them with specific and usable skills. In the second place, there are those young blind adult males who have had employment ex-perience but who, with the onset of blindness, have had to give up their former employment. In this case there might be skills that have been de-veloped in the former employment that can be utilized in associated or re-lated fields of employment. In the third place, there are those whose specific skills from former employment are not usable and who will have to learn new ones. However, clients in this class will have had employment experience and will have a fund of knowledge to build upon. The degree of sight possessed by the client will determine to what extent each of these factors are operative. By way of illustration, Sam (Case No. 60), is an example of the first type of factor determining the need for employment training. Sam had reduced vision from early childhood and left school at the age of seventeen. He came to the C. N. I. B. and requested train-ing for employment. As he had a fair degree of vision he was suit-able material for concession stand training and was given this training and placed in a stand. His lack of previous experience and skills did not hamper his employment in this type of work since - 58 -he learned the necessary skills on the job. However, the number of occupations available to him is extremely limited. The case of Mr. 0. (Case No. 28), is a good example of the sec-ond category having been an accountant at the onset of blindness, a job which he followed for a year and a half prior to moving to become an insur-ance salesman and notary public. In this case the skills and knowledge were established prior to onset as were habits of work. With diminished vision the shift to related fields of work was advisable and quite possible. In the third category, that where specific skills are not usable and the learn-ing of new skills becomes imperative, the problem reaches its greatest in-tensity. For the young blind adult male who has had employment experience but whose skills are not usable,the need to learn new skills is paramount to his rehabilitation. Again the problem of limited fields of employment faces this client and he is required to accept what is available within the limits of the C. N. I. B. Placement Services and the community. If he is resourceful he might be able to find jobs on his own for which he can devel-op specific skills. The case of B i l l , (Case No. 33), will serve as an ex-cellent example of how an independent client was able to find employment that differed from his previous training and employment and for which he had to develop special skills and knowledge. Bi l l had formerly been a lithographer and with the onset of blindness found himself with only a limited amount of ready cash and a family to support. Not being content to remain idle he developed the idea of starting an over-charge freight auditing business and went about making contacts with large firms shipping a lot of freight. He pro-cured the help of two auditors to do the actual auditing while he handled the contact visiting aspects of the job. - 59 -In other cases this is not as easy as i t appears since there are relatively few clients with the education, independence and aggressiveness able to move from one area of competency to another where a knowledge of new skills is required. In many cases young adult male clients have to be restricted to the resources available. The results are that there are large numbers of clients in this age group who are severely limited In the type of work they can do. In order to meet this situation to some degree the C. N. I. B. in Vancouver offers training and employment in basketry and concession stands and canteens as well as employment for a limited number of men in the subsidized broom factory. Other employment available is piece-work to be done either at the workshop or in the client's home. Again, this employment is available for only a limited number of clients. Some of the problems affecting the young adult blind male in his rehabilitation have been discussed with a view to relating these problems to that of finding employment as a blind person. This has been done through the use of illustrations of cases drawn from the group of blind adult males studied. In a similar fashion the manner in which these problems have been met will be discussed in the following pages. How These Problems Were Met: While not a l l the problems illustrated above were resolved through direct casework services, the role of the social worker in helping to bring about their solution was of great importance and has implications for the role of social work in the total rehabilitation program. 1. Feelings about Blindness: In the case of Mr. D., (Case No. 40) see - 60 -page 49, short-term intensive casework services were given, helping him to express his feelings about his blindness, about his lost skills, about the limitations that blindness imposed upon him, and about the growing sense of frustration and anger that was damaging the family relationships. As stated previously, the need to express these feelings about blindness is paramount to the client's acceptance of himself as a blind person. The caseworker's knowledge of human behavior and the impact blind-ness has upon the personality was required before she could help Mr. D. with his problems. Her skill in using the resources of the agency and of the community were of great assistance in helping Mr. D. find a temporary job as bookkeeper of a small store where he was not under pressure to carry on his work at any high level of performance. With increased vision he was able to return to his previous employer and take up his former position of accountant, but with a better acceptance of the limitations his reduced vision imposed upon him. Mr. T., (Case No. 26), see page 50, retreated into dependency with the onset of a greater degree of blindness and the services offered him were short-term casework services which helped him make application for Workmen's Compensation and when this was not granted, for Blind Pension. He was refer-red by the social worker to the Employment Officer for vocational counselling but never made further use of this resource other than taking a few days em-ployment in an outside factory. Tom, (Case No. 39), see page 51, whose diabetes created a basic dependency has made many uses of agency services but with little change in the degree of his dependency. Long-term and intensive casework services have - 61 -been given; he has learned crafts, Braille and typing and has been employed on home piecework. He has attended recreational activities and intensive efforts have been made by the social worker to bring him closer to employ-ment most suited to his particular double handicap. However, he is con-tent to remain dependent and the social worker's focus shifted to making him as comfortable as possible within his dependent condition. Sid, (Case No. 24), see page 51, has been given similar services although he brought more strengths and skills to bear upon his problem than did Tom. His problem has yet to be solved since diabetes is again a barrier to employment. However, the social worker has been able to make him more comfortable with his handicaps and has brought the skills of the home tea-cher into his rehabilitation in order to provide him with a means of com-munication and of making craft products far sale. Through referral to the Employment Officer Sid was able to discuss his financial affairs and event-ually refrain from making a poor investment of what money he had. The social worker called upon the Caranercial and Industrial Operations Department for concession stand training and when an opening in this department becomes available Sid will have some means of limited employment. 2. Health and Handicaps: Miles, (Case No. 37), see page 52, was a blind war veteran and as such received many services including intensive casework services. However, his feelings about his mixed parentage were such as to preclude any degree of success while his other handicaps further complicated and made his chances for rehabilitation more distant. He was made to feel as comfortable as possible with his handicaps yet the damage had been done before skilled casework could be offered. In bringing him in - 62 -touch with the services of the C. N. I. B., the social worker arranged a contact with the Employment Officer who discussed his employment problems, his financial problems and tried to nelp him with his difficult adjust-ment to blindness. The Employment Officer made several job placements in outside industry and when these failed placed Mies in the sheltered work-shop where he was able to function reasonably well for only a short time before "going on a bender." Miles had been taught crafts, Braille and typing by the home teacher and when he was considered to have sufficient manual skill he was referred by the social worker to the Commercial and Industrial Operations Department for concession stand training. This train-ing covered three months but Miles was "too nervous and erratic" to con-tinue with i t . Several handicaps had combined to produce too great a bar-rier for Miles to surmount: the services of the C. N. I. B. were insuf-ficient to help him further. 3. Family Relationships: In Mr. R's case, (Case No. 30), see page 40, the social worker is s t i l l continuing intensive casework services in the hope that he will be able gradually to accept seme of the feelings he has about blindness as well as resolving the ambivalence he has toward his common-law wife. Until he has solved these problems he will not be able to seek employment. These services will have to proceed at his own rate of speed until he can accept help to the point where he can effectively plan for continuing services. The social worker has on one occasion helped Mr. R. to make arrangements to move to the residence for the blind where he stayed for a short period. -However, since he would not face the realities of paying for his board he was asked to make a decision about either pay-ing or leaving the residence. He chose to leave and returned to his common-- 63 -law wife who continues to support him. This case resembles Ihe following in that one of the basic problems is a disturbed family relationship act-ing as a barrier to rehabilitation. Dick, (Case No. 49), see page 54, never really accepted the fact that he had a problem and four months' of intensive casework were dismissed by him in a reference to the social worker as "a friend who dropped in every week". Casework services were supportive prior to his entry into hos-pital when he was prepared for the operation and during his stay there. Following his release from the hospital, casework services were s t i l l sup-portive but because of his refusal to see any problem connected with his blindness such services could be little more than supportive. The social worker tried to work with the mother, trying to effect some modification of her overprotective attitude toward her son. However, the patterns of years could be changed little and Dick was left to his denial of reality, since through i t he could remain the dependent child he wished to be. 4. Employment Training: a. The need to develop skills. In Sam's case (Case No. 60), see page 57, his problem of acquiring new skills in employment as well as employ-ment was handled by the social worker through referrals to the Employment Officer and the Commercial and Industrial Operations Department where train-ing in consession stand work was given. Prior to this Sam had received in-struction in crafts, Braille and typing where he learned the necessary skills required by the blind person in his adjustment to blindness. Casework ser-vices helped Sam express his feelings about blindness and supported him through the long training and waiting period. As his adjustment to blind-- 64 -ness had been gradual there was no need for intensive services. By bring-ing him in contact with the Recreation Department the social worker made available to him the means for enlarging his social contacts, b. The need to redirect skills. In Mr. O's case, (Case No. 28), see page 58, the need for a change in employment brought about by decreas-ing vision required the support of the social worker as well as suggest-ions from her as to what kind of employment would be possible and avail-able. With her support he made the shift to the related fields of insur-ance sales and notary public. This took place over an extended period of time and the chief means of communication with Mr. 0. was through corres-pondence. When he needed support Mr. 0. would write to the social worker and discuss his problems in letter form to which she would reply giving advice and support. A service was rendered to Mr. 0. by the social worker referring his request for a letter of acknowledgement to the Bmployment Officer. Mr. 0. needed his driver's licence in order to carry on his bus-iness and was able to drive with the restricted field of vision he possess-ed but had been refused bis licence. In writing the letter, comment was made that i f restrictions as to the time of day and speed were imposed upon Mr. O's. licence i t would s t i l l be possible for him to conduct his business satisfactorily. The licence was granted on these restrictions and Mr. 0. has been able to continue developing his business. c. The need to learn new skills. In a similar manner, the help in finding employment given B i l l , (Case No. 33), see page 58, was support-ive and made use of the resources both within the C. N. I. B. and within the camiiunity. Casework services of a long term and intensive nature helped this intelligent and "aggressive" client accept the limitations of blind-ness, understand the effect his blindness was having upon his family re-lationships and make him aware of the limiting types of employment avail-able to the blind. In supporting his initiative the social worker gave effective help in turning this client to look for employment on his own. By discussing with him the pros and cons of each suggested employment he was able to receive objective and knowledgeable help in deciding which jobs would be best suited to his particular skills and knowledge. How-ever, in Bill's case his own experience, independence and aggressive in-telligence constituted good resources upon which to develop his own employ-ment. Again, the social worker's role, apart from offering casework ser-vices, was that of co-ordinator or liaison between the client, the agency, and the entire community. It is this co-ordinating role that can be seen through the entire process of rehabilitation of the blind adult male client. This role is of particular importance since the social worker brings special knowledge, skills and understanding to bear upon the client's total rehabil-itation. It is imperative that she be in a position where there i s direct administrative liaison with other departments and services. Her placement in the Social Welfare Department is logical and sound since it is here that the client's welfare is of paramount importance and where initial contact with the client takes place. Further discussion of this role will be given in the following chapter. From the foregoing discussion i t can be seen that there are sev-eral specific problems that affect the young adult male's adjustment to blindness and condition his rehabilitation. These problems can be stated - 66 -as follows: 1. Feelings about blindness 2 . Health and handicaps 3. Family relationships 4. Social isolation 5. Community attitudes toward blindness 6. Employment and training a. no employment experience; need to learn new skills, attitudes and knowledge. b. employment experience but former skills of no use although possible to redirect them to associated or related employment areas. c. employment experience but skills of no use and need to develop new skills and knowledge. The above problems have been discussed in relation to employ-ment since employment is a major factor in the rehabilitation of this group of young adult males. It is important that the social worker, be aware of these problems i f the client is to receive services that best effect his rehabilitation. In Chapter IV specific recommendations for the improvement of these services will be made. Suggestions will also be made of those areas in which research would be helpful in providing rehabilita-tion services of better quality. - 67 -CHAPTER IV CASEWORK SERVICES AND THE FUTURE The services and practices of the C. N.:.I. B., Western Division have reached a stage in their development where intensive study of them is needed in order to analyse their quality and effectiveness. In the present study, the casework services offered a group of young adult males between t the ages twenty-one and forty-five registered with the C. N. I. B. since 1950, a lack of recorded information has confined research to a purely descriptive study of these services and no attempt at evaluating could be made. As a result, this study has become a reconnaissance study locating and describing casework services, identifying seme of the problems faced by this group of blind males, and outlining areas for further research. Discussion in the foregoing chapters has dealt with some of the problems of blindness, the development of services to meet the needs of the* blind, some considerations of the administrative structureof the C. N. I. B. and the program of services currently offered to the blind of British Columbia. Casework services offered through the Department of Social Welfare to young adult males of the age group selected for study have been discussed in detail and some of the problems affecting this group1s rehabil- ; itation have been stated and illustrations given. While there have been serious limitations imposed upon this study precluding any intensive anal-ysis of the casework services, i t is hoped that some of the findings will be of use in classifying these services, indicating problems of which the social worker must be aware in her work with this group of clients, defining the - 68 -role of the social worker in the rehabilitation process and making suggest-ions for gathering important information during the registration process. One of the chief purposes of this study wil l be to outline areas for fur-ther and much needed research. The TfTmutations of Recording The major difficulty met with in this study has been that of the paucity of recorded case information. While i t is recognized that untrain-ed field staff do not necessarily have the skills in recording required for keeping detailed and informative casework f i l e s i t i s recommended that some basic system of recording essential information about the client be devel-oped and put into use. The recording of the social worker was noted to be of better quality and gave more descriptive information. However, few fi l e s gave diagnostic information and most were lacking an adequate social history. In many cases there was l i t t l e useful recorded information but the social worker, when questioned, was in possession of important data that should have been entered in the f i l e . The need to record such information cannot be overemphasized. If the C. N. I. B., Western Division wishes to improve its services to the adult blind male i t is necessary to have on f i l e as clear and definitive a body of information about the services that have been offered this group as i s possible within the limitations of the agency and its staff, both trained and untrained. Without some uniform system of recording basic information about the client that i s within the competence of both the trained social workers and the untrained field secretaries l i t t l e further research can be undertaken. Trained social workers will recognize that recording is an essential part of the social work method and that with-- 69 -out i t serious limitations are imposed upon the quality of the casework services offered the client. Since casework services are the primary focus of this study this statement i s central. Discussing casework record-ing, Maurice F. Connery comments on the need to record essential infor-mation before there i s any consideration given to descriptive accounts of the social worker's activity in the many areas of helping clients with routine matters. He states: "These may be important activities, but we can assume that a professional person has the competence to carry them out. What i s more important is that our recording include the facts that lead to the decisions that these activities were appropriate, as well as material relevant to the effect of our activities on the individual, his family, and his camaunity. 1 He goes on to make the point that i f recording is to become a meaningful part of the casework process i t must be shown to advance the ultimate goal of social casework — service to the individual and the community. i How Recording Might be Improved. While the summary form of recording used by the Department of Social Welfare has value in limiting the amount of inessential information as well as the amount of time spent in recording by the social worker and stenographer, i t s value i s impaired by the lack of organization of the re-corded material and the fi e l d secretaries' conception of what i s essential information. In order to cope with this situation the following recommend-ations are made. 1 "The Measure of Effective Recording", Social Casework, December, 1954, Vol. XXXV, No. 10, Family Service Association of America, New York. - 70 -1. That scone system of reconiing basic information be de-veloped. This might take the form of a revised regis-tration form or basic social history in which the areas of information required are outlined to be f i l l e d in during the registration process. 2. That more time be spent by the social workers in dic-tating important information for casework f i l e s and in recorxiing each casework contact with the client. 3. That more diagnostic information and statements be entered in the casework f i l e s , by both social workers and field staff. 4. That summary recording be standardized as much as possible, particularly in regard to annual statements of the clients' residence', health, financial status, adjustment to blindness, family relations, and employ-ment. Because of the great differences between the casework services that can be offered to the client by the Field Secretary on the local level and the social worker on the District level i t i s suggested that some form of determining the needs of, and the potentials of, the client for casework services be developed. This information should supplement the basic regis-tration form and should request information on the clientis reaction to the onset of blindness, his family's acceptance of him as a blind person, his former employment and what skills he had prior to the onset of blindness, his financial condition and the Field Secretary's evaluation of his need for services at the local or District level. In this manner, diagnostic infor-mation wil l be gathered and the client will have a better chance of receiv-ing casework services that adequately meet his needs. It is therefore recom-mended that such a system of obtaining essential information be developed and i t i s in this regard that the Proposed Registration Inventory (Appendix C) is submitted. It is suggested that the Inventory be f i l l e d in by the - 71 -Field Secretary at the time of registration and that a l l questions be answered since i t is essential that as much diagnostic information as pos-sible be available. It is also suggested that the final decision as to whether or not the client should receive casework services on a local or District level should be made by the social worker who is equipped with the diagnostic skills required to make this decision. Casework Services It was found that casework services were offered to the group of young adult males studied by the Supervisor of Social Welfare and the social worker, both professionally trained social workers, while casework services of a highly limited nature were offered by home teachers and field secretaries who had received in-service training in interviewing techniques. From information gathered from the records, the Supervisor of Social Welfare and the social worker, it was found that casework services could be roughly classified in three groups: 1. Short-term Services: These contacts between one and five in number, these services meeting a particular need, e.g. registration, request for concessions, referral to other departments, limited casework services meeting an immediate need. 2. Long-term Services: Those contacts over five in number, these services meeting long-range needs of the client during his rehabilitation, e.g. adjustment to blindness, learning new skills, family problems, financial and employment problems. 3. Intensive Services: Either short or long-term services, the focus being essentially determined by the circum-stances surrounding the case, or the particular need of the client, e.g., the client's reaction to blindness and his adjustment to i t , disturbed family relationships. - 72 -Additional information and better recorxiing would have provided a closer analysis of these services and it is recommended that: 1. A system of classifying the kind of casework services offered each client be established. 2. Records of such classification be kept on an annual basis. 3. When sufficient statistical information is available, these services should be examined with a view to establishing their effectiveness in meeting the client's needs. 4. Recommendations made above regarding recording should be followed in order to facilitate these latter recommendations. Some Problems of Young Mult Blind Males Some of the problems affecting the adult male client in his re-habilitation have been identified and illustrated. 1. Feelings about blindness 2. Health and handicaps 3. Family relationships 4. Social isolation 5. Community attitudes toward blindness 6. Employment and training From a discussion of the employment and training of this group of blind males, three areas of adjustment of which the social worker must be aware when working with this age group of clients were identified. 1. No employment experience; need to learn skills, attitudes, and knowledge. - 7 3 2. Employment experience but former skills of no use although possible to redirect them to associated cr related employment fields. 3. Employment experience but former skills of no use; need to develop new skills and knowledge. The Role of the Social Worker This study has produced a well defined picture of the trained social worker and her role in the rehabilitation process. Not only is she the trained caseworker offering skilled help to the client but also the co-ordinator of services bringing to the client those services that best meet his needs during his rehabilitation. If the client's rehabilitation is to be held of paramount importance, the social worker would appear best equip-ped to head the team of departments offering services for two reasons. Firstly, because she is professionally trained in the skills and methods of helping, having highly developed skills of diagnosis and a knowledge of the methods by which she can help the blind person, and secondly, because she is primarily concerned with the client's over-all rehabilitation rather than offering a specific service. Her perspective is long-range and takes in a comprehensive view of the client, his problems, his family, and the community in which he lives. In the interest of increased services to this group of clients i t is recommended that this role be firmly established and given administrative authority so that services may be effectively and efficiently brought to the client as he needs them. Areas for Further Research For the past thirty-six years the C. N. I. B. has been offering services to the blind in Canada. It has pioneered in the field of the - 74 -"amelioration of the condition of blindness" and the "prevention of blind-ness" and has made tremendous strides in the direction of offering as com-plete a program of services to the blind as can be found today. In British Columbia the program of the C. N. I. B. has reached a stage in its devel-opment where it is now time to engage in research in order to determine new areas of service and assess the need to expand others. While the limits of this study are narrow i t is possible to delineate several areas for further research, areas which will profit from study by the increase in the quality of services offered to clients. The need for research is great since there is a paucity of the kind of material available upon which any definite assessment of services can be made. However, before this can be done, the statistical and recorded information must be available and i t is suggested that the recommendations on recording previously made be the basis of re-search in this area. Following this i t is suggested that a field study or survey of al l services offered clients of the C. N. I. B., Western Division, be undertaken in order to elicit information about the composition of the clientele, causes of blindness, the economic circumstances of clients, the services offered clients by both the C. N. I. B. and other agencies, the type of employment clients engage in, the financial assistance "they have received, and other information that will lead to a fuller picture of the situation of the blind in British Columbia. Further research should be carried out in the Social Welfare Department. Closer analysis of casework services, their nature, and their unique importance in the rehabilitation of the blind are a l l areas for fur-ther and necessary research. The whole area of -the psychological, social, economic and physical needs of the blind is as yet unexplored. Any research - 75 -into these fields will be of utmost importance in establishing a future program of services. Closer definition of the role of the social worker in the rehabil-itation of the blind and the degree to which the services of other depart-ments are used in the rehabilitation process is another area for study, as is that of the employment needs of the young blind adult male. While this study is of localized relevance it does have some implications for the employability of young blind adult males. Employment is a major factor in the rehabilitation of this group of clients who are not only handicapped by the loss of sight but also by the community attitudes toward blind persons in industry. Further complicating this problem of em-ployment is the seasonal nature of some of the major industries of British Columbia and the effect this has upon marginally employable groups. As noted in Chapter III the Disabled Persons (Employment) Act of 1944 decrees that a l l English employers having "substantial" staffs employ a quota of handicapped persons. This legislation has been an effective measure in assisting handicapped groups to achieve a higher level of rehabilitation than that possible in British Columbia. It is to be hoped that similar legislation may be enacted within the not too distant future. If this were carried out the services of the C. N. I. B., Jfestern Division would be real-istically focused on rehabilitation, "to develop and restore the disabled individual to the fullest physical, mental, emotional, social, vocational and economic usefulness of which he is capable within the restrictions in-herent in his environment". - 76 -GENERAL BIBLIOGRAPHY Cutsforth, T. C., The Blind in School and Society, Appleton-Century, Inc., New York, 1934. Zahl, P., Blindness: New Approaches to the Unseen Environment, Princeton University Press, Princeton, New Jersey, 1950. SPECIFIC BIBLIOGRAPHY Carroll, Rev. T. J., "Developing Public Understanding about the Blind", Proceedings of the American Association of Workers for the Blind, New York, 1954. Chevigny, H., and Braverraan, S., The Adjustment of the Blind, Yale University Press, New Haven, 1950. Cholden, L., "Some Psychiatric Problems in the Rehabilitation of the Blind", Proceedings of the American Association of Workers for the Blind, New York, 1953. Connery, M., "The Measure of Effective Recording", Social Casework, December 1954, Vol. XXXV, No. 10, Family Association of America, New York. ELlidge, C., The Rehabilitation of the Patient, Social Casework in Medicine, J. & P. Lippincott Co., Philadelphia, 1948. Hamilton, K., Counselling the Handicapped in the Rehabilitation Process, Ronald Press, New York, 1950. Himes, J. S., "Some Concepts of Blindness in American Culture", Social  Casework, December 1950, Vol. XXXE, No. 10, Family Service Assoc-iation of America, New York. Lowenfeld, B., "Blindness; A psychological Approach", Proceedings of the  American Association of Workers for the Blind, New York, 1948. tenBroek, J., "Concepts in Rehabilitation and Placement of the Blind", The New Outlook for the Blind, December 1951, Vol. XLV, No. 10, American Foundation for the Blind, New York. Proceedings of the National Conference of Rehabilitation, Canadian National Institute for the Blind, Unpublished mimeographed pamphlet, Toronto, 1951. - 77 -A P P E N D I X APPENDIX A; Tabulation of Basic Information on Young Adult Blind Males 21-45 - 78 -Years of Age, Registered Since 1950, C.N.I.B., Western Division, j Vancouver, B.C. Prom casework and statistical files. I II III IV V VI VII VIII IX X XI XII Date of Age at Date of Degree of Other Educational Employment Prior Placement Present Employment Case No. Marital Status Birth Onset Contact Useful Vision Handicaps Background To Blindness Work Record by as a Blind Person 1 married 1910 42 1953 fair none Gr. II skilled good none undet. unemployed 2 married 1910 44 1954 fair none Gr. I semi-skilled good none undet. unemployed 3 married 1910 43 1950 fair none Gr. II sales good self fair unemployed 4 married 1910 38 1951 good none Gr. I skilled good self good grave digger 5 married 1910 30 1950 fair arthritic Gr. I unskilled good self good farmer 6 married 1911 14 1950 slight none Gr. i n clerical good self good bookstore 7 single 1911 13 1950 good M.S. Gr. i i skilled good CNIB good shltd. wrkshop 8 single 1912 40 1952 fair syphilis Gr. i semi-skilled good none undet. unemployed 9 single 1913 6 1951 none alcoholic unskilled Indian 10 single 1914 35 1952 slight diabetic Gr. I I sales good self good bond salesman 11 married 1914 38 1952 none none Gr. I I semi-skilled good self good machine oper. 12 married 1914 36 1951 good M.S. Gr. n sales good CNLB good concession st. 13 married 1914 34 1953 good none Gr. i semi-skilled good self fair unemployed 14 married 1914 26 1952 good none Gr. n sales good self good salesman 15 married 1915 25 1952 fair none Gr. i i skilled good CNLB good shltd wrkshop 16 married 1915 6 1951 slight none Gr. I I skilled good self good mnftr'r 17 married 1915 35 1952 fair none Gr. I I clerical good self good ins. salesman 18 single 1916 2 1952 none M.D. Gr. i undet. Woodlands Sch. 19 married 1916 36 1950 none none Gr. i unskilled fair CNIB fair concession st. 20 single 1917 32 1953 slight M.D. Gr. I I unskilled good self good const, lbr'r 21 single 1917 12 1952 none M.S. Gr. n Clerical poor self poor unemployed 22 married 1917 33 1951 slight diabetic Gr. i n professional good self good professor 23 married 1917 25 1954 fair none Gr. n clerical good self good X-ray tech. 24 married 1917 36 1953 none diabetic Gr. n skilled good none none unemployed 25 married 1917 35 1954 none arth.deaf Gr. i skilled good none none bedridden 26 single 1919 1 1953 slight none Gr. i semi-skilled fair self fair const, lbr'r 27 single 1919 31 1951 slight diabetic Gr. i unskilled fair self fair unemployed 28 married 1919 13 1950 good none Gr. H clerical good self good resort owner 29 married 1919 35 1950 slight none Gr. i unskilled good none undet. unemployed 30 married 1919 31 1954 none alcoholic Gr. i n clerical good none none unemployed 31 single 1920 1953 Indian 32 married 1920 31 1952 none diabetic Gr. I I skilled good none none unemployed 33 married 1920 32 1952 slight none Gr. i n skilled good self good CNIB staff 34 married 1920 27 1953 good none Gr. i unskilled good self good wrehseman 35 single 1921 10 1951 none diabetic Gr. I I unskilled poor none none unemployed 36 married 1922 28 1951 slight none Gr. i unskilled good self good own cone st. 37 single 1923 22 1951 slight M.D. Gr. i unskilled poor none none unemployed 38 single 1923 1 1953 fair none Gr. i . none none none none bedridden 39 single 1923 30 1953 none diabetic Gr. i unskilled good CNIB good CNIB pcewrk 40 married 1924 31 1954 fair none Gr. n clerical good self good accountant 41 married 1924 27 1951 good none Gr. I I unskilled good self good farm lbr'r 42 married 1925 26 1951 fair none Gr. n semi-skilled good self good const lbr'r 43 married 1926 4 1954 slight none Gr. i unskilled good CNIB good concession st. 44 single 1927 20 1951 none M.S.&M.D. Gr. I I student none none none bedridden 45 single 1927 1953 Indian APPENDIX A (Con't) -79-I II III IV V VI VH VIII LX X XI XEI Date of Age at Date of Degree of Other Educational Employment Prior Placement Present Employment Case No. Marital Status Birth Onset Contact Useful Vision Handicaps Background To Blindness Work Record by as a Blind Person 46 single 1927 2 1951 none none Gr. I skilled good CNIB fair shltd wrkshop 47 single 1927 21 1950 good M.S. Gr. H sales good self good concession st. 48 married 1927 24 1953 slight diabetic Gr. II clerical good self good storekeeper 49 married 1927 28 1954 slight none Gr. II sales good none none unemployed 50 married 1927 26 1953 slight none none semi-skilled fair none none unemployed 51 married 1927 23 1951 fair none Gr. II clerical good CNIB good shltd wrkshop 52 single 1928 22 1951 none r.h. para Gr. I unskilled fair none none unemployed 53 single 1928 20 1950 fair M.D. Gr. I unskilled poor self fair resort handiman 54 single 1928 4 1954 slight none Gr. II unskilled good none none unemployed 55 married 1928 24 1952 none none Gr. II skilled good self good chicken farm 56 single 1929 1953 Indian 57 single 1930 1952 Indian 58 single 1930 23 1952 Indian 59 single 1931 20 1951 slight none Gr. II student good none good unemployed 60 single 1932 2 1953 none none Gr. II sales good CNIB good concession st. 61 single 1933 12 1953 none none Gr. I student poor none none unemployed 62 single 1933 20 1953 none none Gr. I student fair none undet. unemployed APPENDIX B: Tabulation of Services offered Blind Males 21-45 Years of Age. - 80 -Registered since 1950, C.N.I.B., Western Division, Vancouver, B.C.  From Casework and statistical files. Case No. Departmen t of Social Welfare i Blind Personn el Department Commercial Department Recreation Casework Services Home Teaching Concession IS Residential Job Plcment Voc. Training Department s.t. l.t. int. crfts Braille typg c. p« r.f. r.p. t.b. t.p. 1. oth. Care Voc. Cnslng. out shltd. 1 X X X X X X 2 X X X X X X X 3 X X X 4 X X X 5 6 X X 7 X X X X X X X X : X X X 8 X X X X X X X 9 10 X X X X X 11 X X 12 X X X X 13 X X X X X X X 14 X X X 15 X X X X X X X X X X 16 X X X X X X X 17 X X X X ; x X X 18 X 19 X X X X X X X X 20 X 21 X 22 X X X X X X 23 X X 24 X X X X X X X X X X 25 X X 26 X X X i X X X 27 X X 1 x X 28 X X X X X X X 29 X X 30 X X X X X X X X 31 32 33 X X X X X A. X X X 34 X X X X 35 X X X X X X X X X 36 X X X X X X 1 X X X X 37 X X X X X X ! X X X X X X 38 1 39 X X X X X X X '< X X X X 40 X X 1 X X 41 X X X X 42 X X X 43 X X X X X X X 44 X X X X X 45 APPENDIX B: (Con't) 81 -Departmen t of Social Welfare Blind Personnel Department Commercial Department Recreation Casework Service } Home Teaching Concessions Residential Job F lament 'Department Case No s.t. l.t. int. crfts Braille typg c. P. r.f. r.p. t.b. t.p. 1. oth. Care Voc. Cnslng. out shltd Voc. Training 46 X X X X X X X 47 X X X X X X X X X X 48 X X X X X X X X X X 49 X X 50 51 X X X X X X X X X X X X 52 X X X X 53 X 54 X 55 X X X X X X X X X X X X X X 56 57 58 59 X X X X 60 X X X X 61 X X 62 X Totals 62 20 19 19 20 17 21 18 19 15 9 10 3 9 18 4 32 4 9 6 19 Abbreviations: 1. s.t. - short term 2. l.t. - long term 3. int. - intensive 4. crfts. - crafts 5. typ. - typing 6. c. - cane 7. p. - pass 8. r.f. - reduced fare 9. r.p. - reduced purchase 10. t.b. - talking book 11. l.p. - transportation pass 12. 1. - library service 13. oth. - other services 14. voc. cnsllg. - vocational ccnmselling 15. shltd. - sheltered workshop 16. voc. training - vocational training APPENDIX C PROPOSED REGISTRATION INVENTORY Client Blindness: a. Total .. b. Partial c. If partial, how does he use it? d. Is he under treatment for eye condition? Appearance: a. Height b. Weight c. Grooming d. Stature: i . erect .. i i . slouched Health: a. Good b. Fair /. c. Poor d. If poor, describe condition and treatment i f any Handicaps: (Other than Blindness) describe: Reaction to Blindness: check one; a. Shock b. Depression ...... c. Dependency d. Independency Attitudes toward Blindness: Check: a. Anger b. Resentment c. Apathy d. Discouragement ... e. Denial f. Guilt g. Challenge m 83 "" 7. Attitudes toward Family: a. Demanding b. Quarrelsome c. Accepts blindness and takes responsibilities d. Rejects responsibilities e. Wants to assume responsibility but family overprotectLve 8. Usual Disposition: a. Easy going and cheerful b. Placid c. Easily depressed d. Worries e. Average 9. Personal Characteristics: a. Likes people g. b. Rglaxed h. c. Out going i . d. Shy j . e. Reserved k. f. Apathetic 1. Aggressive .. Antagonistic Suspicious .. Many friends Few friends . No friends .. 10. Former Interests: a. Athletics (describe) .. b. Games; ^ A c t ± v e  i i . Quiet c. Hobbies (list) d. Reading: Kind i . Reads a lot i i . Some I i i . Little ..... e. Clubs and organizations 11. Present Activity: a. Indoors i . Helps about house i i . Does nothing b. Outdoors i . Works about the house and garden i i . Other activity (specify) c. e^mmunity: (describe) - 84 -12. Ability to Plan for Future: a. Has definite plans. If so what? (describe) b. Is able to ask for and wants help in planning c. Unable to ask for help in planning d. Satisfied with present conditions 13. Relationship with Worker: a. Denies problems exist b. Can accept blindness and discuss i t : i . To limited extent i i . Freely c. Suspicious of worker d. Accepts worker B: Home Environment 14. Home: a. Number in family b. Other persons living in home c. Standard of living d. Attitudes toward blindness of persons in home C: Coomnunity 15. Community: a. Population b. Predominant nationality c. Possibilities for employment of blind client in this community d. C. N. I. B. Branch D: Worker's Recommendations 16. Recommendations for Services: a. In the home b. Training course c. None required 


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