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Child neglect situations : a comparative case analysis of two neglect cases, from Vancouver agencies,… Matison, Sonja Constance 1955

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CHILD NEGLECT SITUATIONS A Comparative Case Analysis of Two Neglect Cases, from Vancouver Agencies, 1955 by SONJA CONSTANCE MATISON Thesis Submitted i n Partial Fulfilment of the Requirements for the Degree of MASTER OP 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 1955 The University of British Columbia Abstract CHILD NEGLECT SITUATIONS A Comparative Case Analysis of Two Neglect Cases. From Vancouver Agencies, 1955 Casework with neglectful parents has particular problems, influenced by the special responsibility and function of the protection agency. A l l casework i s concerned with'bringing the client's personality into adjustment with his environment; i n the neglect situation the agency has the added responsibility of making the decision regarding a child's removal from his home. Superficially, these two responsibilities may seem incompatible: on one hand, the worker uses acceptance and understanding to treat the client; on the other hand he may have to use authority to render the necessary services. Workers have d i f f i c u l t y i n fusing the two responsibilities into a meaningful casework pro-cess. Two cases were used i n this study; one i s an example of emotional rejection, the other an il l u s t r a t i o n of both emotional and physical neglect. The cases were presented to emphasise the worker's use of diagnostic information in giving casework help to the clients. The work done was compared with some concepts of social work that are usually considered essential for productive casework. The elements of social work philosophy and practice generally recognized as indispensible to effective casework were often absent i n both cases. There was l i t t l e practical use of the concepts that each individual has worth, potential and a b i l i t y to change. Moreover, the use of relationship as a helping tool was hindered because of the misuse of authority; i t was either over-used or under-used, and i n either case was not helpful to the client. V i t a l l y important to any casework progress, but seldom apparent i n either case, was a sound treatment plan. Many of the casework d i f f i c u l t i e s were centred i n the fact that the workers were not sure of their function, of the use of authority, and perhaps of their a b i l i t y to help. It would appear that i f the worker has a genuine belief in the basic principles of casework (which must be carried out i n relationship with the client), a sound knowledge of human behaviour, and a belief i n his own a b i l i t y to help, many of the foregoing case-work d i f f i c u l t i e s could be remedied. ACKNOWLEDGEMENTS I wish to thank the people who contri-buted to the preparation of this study. The workers and supervisors of the Vancouver Child-ren's Aid Society and the Vancouver Family Wel-fare Bureau supplied a number of cases for reading. Special thanks are given to Miss Finlayson and Mrs. Finlay of the Family Welfare Bureau and Miss Tuckey of the Children's Aid Society who assisted me so generously. Special appreciation i s extended to the School of Social Work staff members—Mrs. Helen Exner, Dr. Leonard Marsh, and Mr. Adrian Marriage for their encouragement and suggestions which were invaluable. Without their continued sup-port, this study could not have been completed. . Chapter I TABLE OP CONTENTS Changing Philosophy on Child Neglect Definition of "child neglect"; Evolution of family .responsibility; Historical changes i n neglect work; Components of casework in the neglect case; Use of authority; Assertive casework; Legal framework of child protection work; Scope of this study; selec-tion of cases; The casework and the two agencies; Method of study. Chapter II Case Primarily Illustrating Emotional  Neglect Phase one with emphasis on "relief-giving": After the third referral - Mr. S. returns home; Mrs. S's pre-hospitalization period; psycho-social diagnosis; Joan's placements; Mrs. S's release from hospital; Return to husband and subsequent separation; Joan's removal from foster home and close of case. Phase two with rejection becoming apparent: Three interviews that bring out mother's feelings of rejec-tion; Emergency removal; Post-placement events; Natu-r a l father located; Joan's adjustment; Mother's par-ticipation; Brief summing up. Chapter III Case Illustrating Physical and Emotional  Neglect First referral; Second complaint; First apprehension; Children committed as C.A.S. wards; Return of child-ren; Case closed; Reopening of case; Second appre-hension; Helen's return; Summary. Chapter IV Implications of the Study Method and scope of study; Illustrations of gaps i n theory and practice; Some casework implications; Implications beyond the direct casework inferences; Essentials for successful work. Bibliography Chapter I Changing Philosophy on Child Neglect Definition of "child neglect"; Evolution of family responsibility; Historical changes i n neglect work; Components of casework i n the neglect case; Use of authority; Assertive casework; Legal framework of child protection work; Scope of this study; Selection of cases; The casework and the two agencies; Method of study. CHAPTER I CHANGING PHILOSOPHY ON CHILD NEGLECT Definition of Neglect Work What i s meant by neglect work i n the child welfare pro-tection field? The 1930 White House Conference on Child Health and Protection stated that protection work i s ...a specialized service in the f i e l d of child welfare i n the behalf of children suffering from cruelty or abuse, or whose physical, mental or moral welfare i s endangered through the neglect of their parents or custodians, or whose rights or welfare are violated or threatened.^ Another definition of neglect work emphasises the fact that i n a neglect case, the agency's service i s based on law and the parents cannot refuse i t . When the lives of children are being affected to such an extent that the community takes action to change the damaging situation, the agency has a responsibility to render the necessary services. In a bona fide neglect case, there i s the possibility that the inter-family relationships are so weak that the casework within that 2 unit w i l l be unsuccessful. 1 "Correction and Prevention of Neglect of Children", White House Conference on Child Health and Protection, Dependent and Neglected Children, IV, C-l, Appleton-Century, New York, N.Y., 1933, p. 354. 2 Child Protection i n Canada. Canadian Welfare Council, Ottawa, 1954, pp. 8-9. 3 Evolution of Family Responsibility We s t i l l have many things to learn regarding the causes of parental neglect. Coir expectancy of a family i s often based on pre-conceived standards of what the "ideal" family should be, without looking into the varied causative factors that made the husband the man he i s and the wife the woman she i s . We tend to label the parents "mother" and "father" instead of examining the situations of two individuals, each with his peculiar need to give and receive. The inter-relationship i n a family pro-duces a pattern uniquely different from a l l other families, both in the immediate environment and i n the total culture. In North American c i v i l i z a t i o n , the pattern of the family has altered radically during the last one hundred years. This culture has changed from a pioneering frontier status to a highly technological level and has experienced corresponding changes i n the type of family i t has produced. The pioneer family, often miles from neighbours, was forced to become self-reliant, inde-pendent and the arbiter of i t s own behaviour. As the land became more populated and small towns and villages spread across the country, the individual family was less isolated but s t i l l main-tained i t s insularity. In addition to i t s own inner strengths, the family was reinforced by the community attitudes and c r i t i -cisms. As urbanization increased, family ties were weakened. The responsibility of holding the family together i n a manner acceptable to community standards was placed more exclusively on the mother and father, strong or weak as they might be. Margaret Mead says this of the modern family and society's expectancy of 4 i t : ...we s t i l l expect the family, the inexperienced young wife and the inexperienced young husband, to manage i t s own finances, to handle the children's edu-cation and health, to tend the s i c k , to care for the mildly insane and the defective, and to meet major emergencies. ...we now expect a family to achieve alone what no society has ever expected an i n d i v i d u a l family to accomplish unaided. In e f f e c t , we c a l l upon the i n d i v i -dual family to do what a whole clan used to do. We put a l l those demands on the i n d i v i d u a l family and we make the members of that family f e e l inadequate i f they are unable to discharge those duties. As we r e a l i z e the f r a g i l i t y of t h i s small, inex-perienced, unsupported, iso l a t e d family l i v i n g i n an unfamiliar environment, amid temporary friends and associates, our big problem i s to bring i n community services to provide the assistance that the larger family used to extend. We can do t h i s much f a s t e r i f we r e a l i z e that the family has not suddenly l o s t i t s moral f i b e r , as a l o t of people think..... H i s t o r i c a l Changes i n Neglect Work The protection services on the North American continent, l i k e many other welfare programmes, originated i n p r a c t i c a l necessity. Children who were found suffering because of parental neglect had to be cared f o r immediately. Protection agencies were established by private c i t i z e n s to f u l f i l a need that the government did not cover. The almost c l a s s i c a l example of establishment of-the f i r s t society f o r prevention of cruelty to children i s t o l d i n the story of Mary-Ellen. In 1874, a complaint was lodged with the New York C i t y Police that a twelve-year-old g i r l was being c r u e l l y mistreated by her f o s t e r parents. Because there was no law to protect children, the case was taken to the New York Society f o r 1 Mead, Margaret, "What i s Happening to the American Family?" Journal of S o c i a l Casework. Nov., 1947, p. 326. 5 the Prevention of Cruelty to Animals. The President of the Society accepted the case saying that the child should have, at least, the justice of the dog on the streets. Mary-Ellen's case was taken to court and she was subsequently placed i n a foster home; her foster mother was imprisoned for a year. Prom that time on, the Society was besieged by complaints of children being neglected. One year after Mary-Ellen's case was tried i n court, the New York Society for the Prevention of Cruelty to Children was formed.1 The President of the N.Y.S.P.C.C. defined societies for the prevention of cruelty to children as being ...the hand of the law, attached to the arm of the law plucking unfortunate children from the atmospheres of poverty and crime...and preventing the depraved and bru-t a l from' wreaking their vengeance on those who but for our action...would be...at their mercy.2 This quotation perhaps exemplifies the philosophy of the original workers in the neglect f i e l d . The f i r s t step i n neglect work set the stages for the next eighty years of work. To gain a better understanding of to-day's work, i t i s important to ex-amine the successive transformations of philosophy and casework practice i n the neglect f i e l d . The following paragraphs outline the five major trends and eras of social work practice and philo-sophy in neglect work from i t s origination i n 1875 u n t i l the 1 Hubbard* Ray, Crusading for Children: 1878-1945. The Massachusetts Society for the Prevention of Cruelty for Children, Boston, 1943, pp. 11-12. 2 Lundberg, 0., Unto the Least of These, on p. 105, quoted McCrea, "The Humane Movement—A Descriptive Survey", pre-pared for the Henry Bergh Foundation for the Promotion of Humane Education, Columbia University Press, N.Y., 1910, p. 142. present time. Stage I Police Action; Punishment of Parents and Institutionalization of Children The era commencing with the Mary-Ellen case and lasting approximately twenty-five years was l i t e r a l l y concerned with res-cue work. It was rough and ready "treatment", generally on an emergency basis, I.e., when the child had to be removed from the home for his own safety. The work of child protection during this time rested on the theory that i f the child were i n a deplor-able home situation, any "home" would be better than his own. Almost a l l the children removed i n those early years were i n s t i t u -tionalized. A statement regarding the children placed by the New York Society i n 1900 shows that i n that year, 2407 children were committed to institutions and six were placed i n homes or "situations" Action with the parents i n this f i r s t era was on a puni-tive level. According to records available from the late 1800's, punishment of the parents was almost inevitable after the child was removed from the home. The punitive action taken was on the basis of retaliation and deterrence rather than rehabilitation of the parents. This pioneer era can be characterized by lack of diag-nosis and planning except on an extremely subjective, moralistic level. 1 .Eelksy Homer. The Care of Destitute. Neglected and  Delinquent Children. Macmillan, New York, N.Y., 1902, p. 176. 7 Stage II Firs t Knowledge of the Importance of Inter-Family Relationships People who began to realize the importance of family l i f e to children were concerned with the unplanned removal that charac-terized the f i r s t stage of development. In approximately 1907, the Massachusetts Society for the Prevention of Cruelty to Child-ren became one of the f i r s t agencies to be aware that i t was not enough merely to take a child out of one "bad" situation to put him into a "good" situation. Furthermore, they realized that institutional l i v i n g , wholesome as i t might be, was not the answer for every child who was removed from his home. Poor physical conditions and parental mistreatment did not necessarily affect the child's love for his parents, and excellent physical quarters did not necessarily erase the child's memory or love of his par-ents. The theory that a child may be "loyal" to parents regard-less of misery and mistreatment was an important working hypo-thesis in our understanding of work with neglectful families. In most cases, the man and woman the child knows as "mommy and daddy" are the only adults that the child equates with the hope of love and security. Only with extremely rejecting parents does the child receive no hope of security. To take the child from poor (as defined by the-social agency) parents and place him in a "good" home does not mean an automatic cutting of the emotional ties and a l l they mean to the child. Together with an incipient understanding of the basic elements and importance of inter-family relationships, the Massa-chusetts Society set the groundwork for a new phase of thinking i n the protection f i e l d , namely, the importance of keeping the 8 family together. The second phase can be characterized by the awareness of family ties, and i f removal i s necessary, the need of the child to have something l i k e a family setting (foster home) rather than institutionalization. Stage III Keeping the Family Together The third phase coincided with the development and growth of family agencies, and reflected the swing of treatment from "remove the children and the parents be damned" to "keep the children and parents together and the family be damned". This, of course, i s an extreme statement, but workers, i n their g l o r i -fication of the family, often tried to keep families together where the children were actually being harmed. While the impor-tance of the positive emotional ties of the parent=-child relation-ship was kept i n the forefront of social work thinking, the nega-tive results of keeping some families together were overlooked. In cases where the close family ties do not exist, emotional separation has often occurred before the agency causes physical separation. Some parents say ( i f the caseworker listens), "We do not want the responsibility of caring for our children." Likewise some children realize their parents' feelings towards them, and the child may ask for a home "where I ' l l be wanted." In more complex situations where strong ties of sado-masochistic needs and guilt exist i n both parents and children, or where parental ambivalence i s strong, "keeping the family together" f i t s some clients' expressed wishes. Furthermore, i t insulates the caseworker from entrance into painful and d i f f i c u l t areas of casework. 9 Stage IV "Do-nothing" Plan Agencies and workers may be aware of the p i t f a l l s men-tioned, i.e., being punitive, removing child without diagnosis or plan, holding the family together because of an idealized con-ception of "the family", but being aware of these dangers does not eliminate the agency's indecisiveness i n planning and acting on that plan. Why does this happen? Too often workers do not understand what they are doing when they have a case involving neglecting parents. Coupled with the intellectual quandary i s the emotional element of anxiety which further confuses the - worker i n a neglect case. These ambiguities i n thinking and feeling i s hesitant, ill-planned casework. "Doing nothing" can mean making one c a l l to "warn" the parents or i t can mean a number of desultory calls "to see how everything i s " . The worker who i s caught i n the mesh of emo-tional and intellectual indecision cannot take a firm stand as a helping authority figure with neglecting parents. Without a clear-cut diagnosis there can be no planning, and without plan-ning for the future, the social worker cannot mobilize his own actions nor can he help the family mobilize theirs, either for separation or for strengthening the family. Stage V Diagnosis and Planning The last phase of development i n the neglect work i n -volves the objective diagnosis of the total family i n i t s en-vironment. How often good diagnostic work and a competent execution of plans exists i s open to question. Perhaps i t 10 occurs only relatively rarely, but we believe that the profession as a whole i s becoming aware that to do competent work, diagnosis and objectivity are needed. Like many of the other professions, our knowledge about what to do i n neglect work i s farther advanced than our a b i l i t y to act on that knowledge. Components of Casework in. Neglect Cases Casework with neglecting parents, more than other areas of casework requires a confident, knowledgeable social worker. However, many workers forget, when confronted with a neglect case, that the social work needed i n this particular area does not involve strange or magical techniques, unused by and unknown to other casework areas. Casework i n the neglect f i e l d uses the same sound principles of practice as used i n the casework process with any problem. The comer-stone of sound casework involves the elements of study, diagnosing, planning and action. Casework i n the neglect f i e l d requires these techniques too. Diagnosis, i n the neglect situation is. to evaluate the home ...to determine what exists i n the child's home that con-tributes soundly and basically to his total growth, physically, emotionally, intellectually and socially, and especially to discover the positive ties that have deep and lasting values for the child. 1 Why i s i t , that too often we see recording and work that echoes subjectivity, punitiveness and/or any of the other previously 1 Welsch, M.D., "Sustaining the Child i n His Impaired Home", Child Welfare. July, 1953, p. 3. 11 mentioned p i t f a l l s ? Casework with a neglect family, though having common elements with other areas, has two particular affect-ing conditions that cause the most concern for caseworkers. These are (l) the caseworker's feelings that "I am not wanted", and (2) the caseworker's feelings about using authority. Regarding the f i r s t feeling that the worker has when he* goes into a situation where, r e a l i s t i c a l l y , he may not be wanted, the worker must recognize these feelings i n himself. Most per-sons, caseworkers or not, are anxious-when they find that they are not accepted by another individual. Since these feelings of ap-prehension i n a worker may affect the relationship and the ensuing progress with the client, the caseworker must face and, where possible, resolve these feelings. At the least, he must be aware of them i n order that he can counteract any adverse attitudes resulting from his feelings of being rejected. If diagnosis i s the corner-stone of casework, a strong positive relationship between the worker and client i s the foundation of casework. Therefore, i t i s extremely important that the worker "clear the decks" regarding his own emotions which might affect the formation and continuance of a positive relationship between himself and clients. Because of the emotional turmoil which can be generated i n both clients and workers i n a neglect case, the worker must also be sure that he i s meeting the neglecting parents i n an ob-jective, non-judgemental way. The non-judgmental attitude i s a quality of the case *The social worker w i l l be referred to i n the masculine. 12 work relationship; i t i s based on a conviction that the casework function precludes assigning guilt or innocence.•.but does include making evaluative judg-ments about the attitudes, standards or actions of the client; the attitude, which involves both thought and feeling elements, i s transmitted to the client... Use of Authority Social workers do hot l i k e to think that they "use autho-r i t y " and since most agency involvement i n neglect cases does carry with i t the onus of authority, there i s apprehension on the worker's part when he enters such a case. What most workers forget i s that they are authority-figures i n almost any portion of the casework f i e l d i n which they work. The very fact that a worker i s a representative of a community-sanctioned agency makes him a kind of authority. However, the neglect situation, which gives the agency legal authority and responsibility, definitely establishes i n the worker's mind that he i s acting i n an authori-tarian setting. In a few specialized areas such as probation, parole and prison work, caseworkers have proved that they are 2 able to use authority i n a constructive way. Because social work' i n the prison setting has certain parallels i n neglect work, we should consider their suggestions. Authority i s a positive 1 Biestek, Felix P., "The Non-judgmental Attitude", Social Casework. June, 1953. p. 235. 2 Perhaps the origins of social work pre-destined modern social workers to resist the use of direct authority. The tool of the "friendly visitor" was kindness and understanding, and we often seem to think that one cannot be kind and authoritarian at the same time. In our North American democracies, we fear "too much authority". "Authoritarian" has come to mean dictatorial, unrelenting, and force without reason. The use of authority can have this meaning, but i t can also mean the kindly, firm direction of a loving parent. This i s the meaning we often forget. 13 part of a l l casework technique, and i t can be used as a thera-peutic tool. In dealing with law-offenders, where the use of authority has been proven a necessary tool, one of the reasons for i t s success i s related to the fact that many of the offenders have had poor relationships with their parents. Three kinds of poor relationships have been described: (l) lack of understand-ing and love from the parent(s), (2) absence of constructive adult behaviour, and (3) l i t t l e experience with predictable and reasonable boundaries set for behaviour. 1 I f the client can identify with a "good" authority-figure, he w i l l be able to use authority to re-focus his behaviour into a more socially-accept-able pattern. Some neglecting parents act anti-socially because no one has put limits on their ac t i v i t i e s and they have not developed inner standards of their own. They are often frightened by their own wishes and ensuing actions; they are helped by limits being set for them. Then, relationship with a caseworker often enables them to internalize the limits and make them their own. Neglectful parents are often helped by a kindly, interested authority-person who sets some real limits for them and at the same time, helps them change their self-damaging actions. Fre-quently, i n working with clients "who don't want help", a firm stand must be used as the wedge with which to reach casework-shy clients. When using authority, and at the same time building a relationship, the worker must give the client the feeling that 1 Sherriffs, Alex, "Authority i n the Client-Worker Re-lationship: Asset or Li a b i l i t y ? " Federal Probation. June, 1953, pp. 22-25. 14 authority can he positive; the worker does this by showing res-pect, interest and firmness which leads to the client's respect for the worker, who i s authority. Similar to law-breakers, the neglecting parents have often had previous unhappy experiences with authority, whether i t be police, school, or their own parents. When the social worker enters the scene, often as the proverbial straw that broke the camel's back, the parents have developed a great residue of hos-t i l i t y , and whether or not i t i s verbally expressed the worker must expect i t to be there. The worker can help the client talk of feelings about authority. Some workers avoid talking about the ho s t i l i t y with the mistaken idea that i t w i l l be "safer" i f i t i s l e f t undis-cussed. In talking with the client about the feelings of hos-t i l i t y , the worker w i l l be accomplishing two things: the client w i l l accept and respect the worker for understanding but not con-demning the hostility; the client may be able to review the per-tinence of his feelings and sometimes see the source of his hos-t i l i t y . Assertive Casework This special kind of casework i s sometimes called aggres-sive or assertive casework; perhaps the latt e r phrase i s more indicative of the real meaning because i t implies an assurance within the worker ...that, by virtue of his professional a b i l i t y , he has something to offer, and wholeheartedly wishes to make i t known to those who do not yet know about, believe in or want i t . This healthy' self-assurance must 15 ^ derive also from the assurance that the community sanc-tions and supports our reaching out.^ Here again, the social worker may have feelings of push-ing himself on the client; this has an analogy i n the situation - where some would-be patients are afraid to get medical aid. The agency and workers must help the parents to accept the aid that they so very badly need. When the lives of children and parents are being adversely affected, our profession cannot follow the (sometimes) typical attitude of passivity. It i s our moral responsibility, as a profession concerned with human welfare, to take an active, positive role. Legal Framework of Child Protection Work Particularly i n the neglect situation, the agency reflects the community's expectation of parental duties to their children. The protection agency works from a base of laws that are designed to protect the child. In Canada, child protection legislation comes under pro-vinc i a l government legislation, and nine of the ten provinces' 2 laws have been developed along similar lines. In British Columbia, the "Protection of Children Act" defines children i n need of protection; any child under 18 years of age who f a l l s 1 Regensburg, Jeanett, "Reaching Children Before the Crisis Comes", Social Casework. March, 1954, p. 106. 2 The tenth province, Quebec, has a Touth Protection Act, which has some similarities to the other provinces' acts, but differs i n that the Act i s concerned with children between the ages of six and 18 years, and, i t has one general clause which states a child can be placed under the care of a youth school or agency. 16 into one or more of 15 classes, ranging from street-begging, i n -c o r r i g i b i l i t y to habitual school truancy, can be considered a child who needs protection. In practice, however, children are usually apprehended under Section K, which states that apprehen-sion may occur i f the home i s , "by reason of neglect, cruelty, or depravity...an unfit place for the child...or ( i f the child) has no parent capable of exercising proper parental control." 1 Apprehension of the child means the physical removal of the child from his home by an agency, and i t implies the subse-quent placement i n an agency foster home. While the child i s under care, he can be under any of three kinds of guardianship. They are: permanent wardship, semi-permanent wardship, and tem-porary wardship. Permanent wardship i s , as the words imply, agency custody of the child u n t i l the child becomes an adult. When the court gives this kind of custody, i t generally does so on the basis that the parents w i l l never be able to assume care of their children. Semi-permanent wardship indicates that guardianship has been given to the agency, and the parents can reapply for a rescinding of the order i f they give evidence that they w i l l provide a suitable home. Temporary wardship gives the agency guardianship for a certain length of time; the limit of time allows the agency and parents to work together i n order to 2 make a more suitable home. 1 "Protection of Children Act", Provincial Statutes of  British Columbia. Chapt. 47, 1943, C, 5, S 1, Victoria, B. C , Queen's Printer. 2 Child Protection i n Canada. Canadian Welfare Council, Ottawa, June, 1954, pp. 25-29. 17 Scope of this Study The case study method has been used i n analysing two cases. The casework was compared with some concepts of social work that 1 are usually considered essential to effective treatment. The basic tenet of our democratic society and of the social work profession i s the belief i n the personal worth of the individual and his right to achieve his maximum development and capacity i n his own way. Social workers believe i n the client's right to be different, and they recognize that each individual i s a unique and special person. From belief i n this concept, the social worker realizes the importance of understanding himself in order that he can help the client better. Secondly, social workers believe that every individual has the potential for growing and changing and that behaviour i s purposeful and meaningful to the client. These two beliefs are closely-linked and from them has evolved the concept, that i n order to help the client change, we must know what i s causing his behaviour and what value that behaviour has to him. The fourth premise is closely linked to the f i r s t ; we believe that each individual has a right to personal freedom and  growth. Social work provides the enabling stimulus to allow the person to operate at the maximum of his a b i l i t y . The individual inter-relates i n society and social work 1 The following six philosophies of social work and their concepts are adapted from a thesis, Seeking Placement Per- manency for Foster Childrent An Analysis of a Portion of a Tear's Cases i n Non-Metropolitan B r i t i s h Columbia, 1948-1953, by Nettie Proven; thesis submitted in partial fulfilment of the require-ments for the degree of Master of Social Work, University of Brit i s h Columbia, 1954. 18 sees this as responsibility the individual has to society and the responsibility society has to the individual* Lastly, the family i s the primary and most dynamic unit of  society; this is particularly important when working with family situations that involve the possible separation of the family mem-bers. Relating particularly to point three, the basic methods of the casework process involve diagnosis and planning. In any casework situation, there are certain basic steps that must occur i f the client i s to be helped. They are: (l) study; (2) diag-nosis; (3) treatment plan; (4) action on plan; (5) evaluation and possible repeat of foregoing four steps. The above basis of philosophy and method was used to study the two neglect cases. Selection of Cases Approximately two dozen neglect cases were examined for the purpose of selecting two for this study. The cases were ob-tained by suggestions from the supervisors and workers from the Vancouver Children's Aid Society and the Vancouver Family Welfare Bureau.* While there was no specific c r i t e r i a set for choosing the cases, the request was for a "typical" neglect case, one i n which the client had i n i t i a l feelings of h o s t i l i t y and resistance towards the worker, and i n which the rejection or neglect of the children was obvious. Some of the cases read were eliminated because they did not f u l f i l the above criterion of obvious ne-glect, but the more prevalent reason for not using a case was the * To be referred to i n this study as "C.A.S."-and "F.W.B." 19 workers' lack of diagnosis and subsequent planning: to be more exact, there was not sufficient recording to indicate either diagnosis, planning or movement. Too often the cases followed the patterns of either removal of the children with l i t t l e plan-ning, or leaving the children i n the home, s t i l l without a sound casework plan. In the former cases, one could almost read between the lines that "these parents can never change", or i n the latter cases, "these parents aren't so bad". There seemed to be a lack of looking at the entire picture or evaluating each family individual, f i r s t , as a separate person and secondly, as a member of a group affecting and being affected by the whole group. I f the parents were labelled "inadequate", too often, i f they had any positives, these seemed to be ignored by the worker. What the parent meant to the child or the child meant to the parent was not evaluated. The cases were judged on the basis of "should we remove the children or should they remain in their home?" This, of course, must be decided somewhere i n the course of working with the family; however, i t should not be the end i n i t s e l f . The end, i f there i s any such thing (because i t i s always changing as the people and situation changes), should be diagnosis of the total situation i n order that the maximum ad-justment can be achieved. The agency has a responsibility to see that the children have an adequate home l i f e that w i l l allow them to become happy, well adjusted adults. The Oases Used and the Two Agencies The two cases are chosen from the C.A.S. and P.W.B. The former agency i s ostensibly a private agency, but i n child protec-20 tion work, many of i t s responsibilities are those of a public ageney. It has legal authority and responsibility to investigat neglect cases within the Vancouver City limits. Though i t i s a private agency, considerably more than half of i t s financial sup-port i s from the government. The P.W.B. too i s a private agency but does not have governmental responsibility or authority. Its clients seek agen cy services voluntarily, and though the psychological components of resistance may be present (as part of the skein of dynamic casework), the patent ho s t i l i t y i s less frequently observable than i n C.A.S. records. Since P.W.B. does not have the legal authority to give counsel to neglecting parents, i f such a case i s detected by P.W.B., i t i s referred to C.A.S., who has the responsibility and authority to give the family help. One case chosen for this study started i n the P.W.B., was closed and reopened with that agency. The second time i t was re opened, the mother's emotional rejection was severe and definite; the ease was referred to C.A.S. who removed the child and did the subsequent casework with the child and family. The second case i s one i n which C.A.S. was active the entire time. It i s a "classical" example of neglecting parents who vacillate from time to time i n their interest i n the children i t i s also an example of the caseworker being unsure and indefi-nite i n the planning and working. Method of Study The method of case study was used i n examining the two 21 cases. They were summarized with an attempt to show two things: diagnostic information and the worker's role i n the casework sit u -ation. The casework was studied, keeping i n mind, some elements of social work concepts with which to compare the actual work. The case study method i s almost wholly dependent on the worker's recorded account. The concern of this study-is with the quality of casework done. There may be many reasons -e.g., administration problems, training of worker, case-load pressures - that affect the work, but these are not within the scope of this study. Chapter II Case Primarily Illustrating Emotional Neglect Phase one with emphasis on "relief-giving": After the third referral - Mr. S. returns home; Mrs. S's prehospitalization period; psycho-social diagnosis; Joan's placements; Mrs. S's release from hospital; Return to husband and subsequent separation; Joan's removal from foster home and close of case. Phase two with rejection becoming apparent: Three interviews that bring out mother's feelings of rejection; Emergency removal; Post-placement events; Natural father located; Joan's adjust-ment; Mother's participation; Brief summing up. CHAPTER II CASE PRIMARILY ILLUSTRATING EMOTIONAL NEGLECT The f i r s t case i s an example of direct emotional neglect and i t illustrates a case which was active with P.W.B. for a num-ber of years but, because no diagnosis was made, the clients were not helped with their real problems; seven years after the case was closed, the mother returned to the agency and asked for her daughter's removal from the home. Family members : Father Richard Simpson born 1920. Mother Mary (Abby) " " 1921. Children Joan " » 1938. Mother remarried to Emil Gunderson. First Referral Mrs. S. came to .the office i n late 1939 to ask for tem-porary r e l i e f . He was a short, gangling youth, whose clothing, while clean, was i l l f i t t i n g and creased. He had a pleasant manner, but did not appear too bright. A few months previously, their f i r s t child, a daughter, was born, after which Mrs. S. became seriously i l l and remained hospitalized for some time. Collateral contact with the Victorian Order of Nurses (hereafter, V.O.N.) revealed that Mr. S. had never been steadily employed; before going on r e l i e f , he had been selling doughnuts. 24 In the home v i s i t s , the social worker described Mrs. S. as being a "pretty l i t t l e thing" despite the fact that she had a birth-mark on her face, a speech impediment, and club feet; Mrs. S. told the worker that, as a child, she had been very sensi-tive to the children's teasing her about her appearance. Her husband, whom she knew "several years" before their marriage, had helped to "snap her out" of her extreme sensitivity by teaching her to play the banjo; she also sang and got much satisfaction from this. Mrs. S. finished the eight grade and was married when she was 16 years old; her family made no objection to the early marriage. When she was i n the hospital., a nurse asked her i f "she wasn't sorry she got married when she was so young, and she replied that she was glad (because) she knew Mr. S. so well and he suited her exactly." Neither Mr. nor Mrs. S. could ...understand how they have go so far behind, and appear to think i t was in the general confusion of Mrs. S. coming home, and a l l the new expenses. They feel they w i l l be able to manage after this, and Mr. S. assured v i s i t o r earnestly, l i k e a small boy, "that this would not happen again." In the f i r s t agency v i s i t s , clues point to the S's as being dependent people; both are barely out of their adolescent years, and in addition, they seem to be dependent i n a childish manner. We do not know how dependent Mrs. S. is on her husband (nor how strong he i s ) . Neither do we know how close the relationship i s between Mrs. S. and her family. We do know that even though she was very young, her parents did not object to her marriage. 2 5 In the f i r s t opening period, the S's were seen three times and the case was handled as a straight 'relief case". Though the S's did give indications of personality d i f f i c u l t i e s , there was no attempt to treat the problem on this basis. Second Referral About a year and a half later, the case was reopened, again because the S's needed emergency r e l i e f . Mr. S. had been employed as a motorcycle delivery man and was involved i n an ac^ cident i n which both legs were broken. From the V.O.N, referral, i t was learned that the S's had recently returned from the mountains where Mr. S. had been employed. He had quit his job there because i t had been "too hard" and also, his wife "could not stand the high altitude". Mrs. S. had not been well and would have to have another operation on her uterus. The referring nurse believed that Mrs. S. had been sterilized Immediately after the birth of Joan as a peculiar deformity of (her feet) and her marred face appears to be inherited....Joan has the same condition, only with improvement. V.O.N, requested that the agency talk to Mrs. S. to reassure her that financial aid would be available to her and Joan while Mr. S. was hospitalized. Mrs. S. planned to l i v e with her mother u n t i l her husband was discharged from the hospital. The worker visited Mrs. S.; the discussion revolved around money matters and Mr. S's hospitalization. Mrs. S. didn't think she could stay at her mother's home very long because her mother 26 . . . s t i l l had a young family and very l i t t l e money.... The worker continues to be impressed by Mrs. S's girlishness and neat ways. Mrs. S. i s a nice young girl....She has a peculiar defor-mity... and her child has the same characteristic. Mrs. S. was neatly dressed as was the child. Mrs. S's dis-a b i l i t y does not appear to hinder her....She explained she could work quite well though no one would believe that she could. She said. "Oh well, such i s l i f e . I guess." She seems to regard Mrs. S. as a g i r l with few problems, despite the obvious body-disfigurements. When Mrs. S. began to talk about her disability, an opening was made for the worker to dis-cuss withrMrs. S. what her feelings about herself were, but i t was not followed up. In the following five months, un t i l the case was closed, Mr. S. was visited four times i n the hospital, and Mrs. S. four times at home. The v i s i t s consisted mainly of discussions with the S's about their financial problems and Mr. S's application for compensation. The worker's opinion of Mrs. S. began to change, and she commented that Mrs. S. had no immediate plans and appeared to be waiting for someone to solve her problem. She was lethargic about attacking her own problems and was somewhat demanding i n her attitude. The case was closed when Mr. S. was released from the hospital and he began to collect compensation. In this second opening, the agency service was focussed on giving financial r e l i e f . There are few comments on the personalities or relation-27 ships within the family. The worker mentions Joan whom she observed i n one home c a l l : Joan...was eating her lunch. She ate up well and liked her lunch. In the recording thus far. these clients seem to present a f a i r l y typical picture of two immature young people faced with the responsibilities of marriage and family l i f e . Coupled with their individual dependencies are Mrs. S's feelings of inade-quacies about her deformed face and feet. The S's return from the mining camp may be an indication of their immature reaction. We do not know how r e a l i s t i c or wise the move was. but i t i s possible that the S's, were escaping from a trying situation. Since the worker was handling the case on an environmental level, she could have explored with Mr. S. his vocational interests. Rehabilitation at this point might have prevented future family breakdown. In the recording, i t i s interesting to note the worker's opinion of the S's, and Mrs. S. i n particular, change from one of "what a sweet young thing" to an opinion which shows Mrs. S. to be lethargic and "somewhat demanding". The worker's observation of the relationship between Joan and her parents i s , i n the f i r s t pages, restricted to com-ments on how Joan looked and ate. The agency casework is kept on the environmental level. I f the personality patterns of the clients or the dynamics of their particular situation i s examined, i t i s done so only on a superficial level and rather as an after-thought. Third Referral 28 One year later the case was reopened for the third time during the S's marriage. Again, the reason for agency service was to give emergency r e l i e f . Mr. S. had enlisted i n the navy, and Mrs. S. and Joan were i n temporary need of funds. When the worker f i r s t saw Mrs. S., she noted that Mrs. S. "looked most attractive" and though she was not feeling well, she seemed considerably more self-reliant than when she was seen before. The S' s owed much money on a new home they had purchased shortly before M. S. had enlisted. In order to pay some of the b i l l s , Mrs. S. worked(part-time i n a grocery store. She hired an eighteen-year-old g i r l , L i l l i a n , to care for Joan. Mrs. S. t considered L i l l i a n f a i r l y reliable to care for the house and Joan; her only complaint about L i l l i a n was that she did not handle money carefully. (Later i t was found that L i l l i a n had been a C.A.S. ward. She had been considered dull, and when i n various foster homes, she had "run wild".) For the f i r s t three months of the agency aid, the main emphasis was, as i t had been, on helping Mrs. S. with financial matters, and i n particular, i n helping her spend her money more wisely. If Mrs. 3 . expressed other needs directly or indirectly, they were overlooked by the worker. Onset of Mrs. S's Illness Three months after the beginning of agency help, Mrs. S. called to say that she was i l l and would be staying at the home of a friend. The worker visited Mrs. S. later that day. Mrs. 29 S. was lying down and looked pale and i n pain. She decided not to go home for a few days u n t i l her husband, who was stationed a few miles out of Vancouver, would be home. In the meantime, Mrs. S. was sure that L i l l i a n could take care of the home and Joan. Mrs. S. was very upset over the unpaid b i l l s . At the end of the interview, Mrs. S. appeared to become unconscious and jerked violent-l y from head to foot a number of times. She remained i n this state u n t i l v i s i t o r l e f t sometime later. This i s the f i r s t indication that Mrs. S. may have had a personality or physical disturbance. Whether her illness and subsequent seizure i s psychological i n cause i s not yet known. One wonders i f the worker or friend called a doctor at this time. No follow-up v i s i t or inquiry as to termination of the seizure and medical diagnosis i s recorded. There are indications that Mrs. S. has strong dependency needs, and sometimes i s unrealistic i n her expectations and plan-ning. Mr. and Mrs. S. seem to have made an unwise purchase of a new house. Mrs. S. does show in i t i a t i v e i n trying to solve the financial problem by working. This might have been motivated from a real urge to help pay the b i l l s , and part of the motivation may have been due to her urge to leave the house and her child, which may even have i n part motivated the unwise spending which resulted i n the need to work. Apparent also i s Mrs. S's indifference to the.welfare of her three-year-old daughter who was being cared for by a g i r l whom Mrs. S. did not consider too reliable. 30 Mr:.. 3. Returns Home: Mrs. S's Pre-Hosnitalization Period Four days later, Mr. S. returned home. His wife was s t i l l staying at her friend's home because she was "quite sick". She would enter the hospital as soon as room was available. (There i s s t i l l no notation as to the nature or seriousness of Mrs. S's illness.) At the same time Mr. S. gave this information, he asked for money to buy food and fuel. The worker made a home c a l l to the S's house, where she found Mr. S., L i l l i a n and Joan. The home was slightly neater than previous v i s i t s . J. looked clean and attractive....Mr. S. i s a youthful looking man, appeared somewhat lacking i n i n i t i a t i v e , overwhelm-ingly grateful for v i s . assistance and suggestions. He expressed concern for Mrs. S. but felt she would feel better when she could get home. Two days later, the worker brought Mrs. S. home (Mr. S. had no money for taxi fare). Mrs. S. was feeling unwell but "looked fine". She was taking many prescribed medicines, but the agency had not yet talked to the doctor to discuss the nature of Mrs. S's ill n e s s . Mrs. S. again complained about L i l l i a n ' s incompetent and dishonest handling of the money but she seemed to think that she could get along with L i l l i a n ' s help at home. There was no re-corded discussion of the effect of Mrs. S's illness and absence on Joan, nor was there any comment on the family reunion when Mrs. S. came home. Three days after her home-coming, Mrs. S. called the worker because she had just received her husband's service cheque and she wanted the worker "to t e l l her what to do with the money." 31 Mrs. S. was calling from her friend's home and the subsequent v i s i t was made there. Mrs. S. appeared completely overwhelmed by her financial' position...and v i s i t o r agreed, because of Mrs. S's obvious-l y upset state...that P.W.B. would help for food for a short period. Visitor explained that the aid could not be continued after one month but i t would give Mrs. S. a chance to work out a plan to meet her debts. Mrs. S's dependency on the worker i s obvious as indicated by her request for the worker to " t e l l her what to do with the money." At this point, what might the worker have done to help this client deal i n a more satisfying way with her problems? Undoubtedly, the immediate, practical help was needed, but help-ing Mrs. S. gain a confidence and/or understanding of herself would have been the more meaningful and lasting kind of help. The worker's handling of this particular problem reflects the tone of casework through the case. The help was almost always given on the superficial, limited environmental level. While the worker states throughout the record that these two people seem immature and do have personality problems, the causa-tive factors are not related to each other to make a meaningful plan. Perhaps Mrs. S's personality deviations were too complex for the social worker to treat; however, some of the d i f f i c u l t i e s might have been eased had they been dealt with earlier. Por ex-ample, Mrs. S's feelings about herself and her physical disfigure-ments should be known; the relationships between the three family members i s not explored; what Mrs. S. means to Mr. S. (and vice versa) i s not considered; neither Mr. S's vocational ' 32 a b i l i t i e s nor his strengths for growth are known. At this point, dealing with the financial problems only, deals with the symptoms and not the causes of Mrs. S's d i f f i c u l -ties. This i s rather clearly borne out in the next interview when Mrs. S. says that she really isn't upset because of money matters. Mrs. S. asked for more financial aid and the worker "sug-gested that Mrs. S. would have to keep closer account of her money." The financial problem did not worry Mrs. S. to any great degree, but was obviously the only one she had found which would bring a response from the worker. She did want to talk to the worker about " L i l l i a n who has been spreading gossip about the S's." According to Mrs. S., L i l l i a n had told Mr. S. "wild stories" about Mrs. S's behaviour, which were untrue, but s t i l l her husband believed them. Mrs. S. told the worker that she intended to divorce her husband as soon as possible "...not because of L i l l i a n but because she herself is in love with another man. Dick...is anxious to marry her." Mrs. S. had told her husband about this and he had "been very nice about the whole matter." According to Mrs. S., she had told him about Dick before he had met L i l l i a n . Mrs. S. didn't care i f L i l l i a n married Mr. S.; she didn't hold anything against L i l l i a n except that she talked too much. The marriage conflict i s revealed to the worker, evidently for the f i r s t time, although i t has been developing for some months. Mrs. S. thought she would stay with her husband u n t i l surgical care could be obtained for Joan through Army financial aid. Since Joan had not been seen in the c l i n i c for some months, 33 the worker suggested that Mrs. S. take Joan now. Mrs. S. said her mother was horrified that she was going to get a divorce and-that she (Mrs. S.) had too disapproved of divorce u n t i l she was i n a situation where she realized that divorce was the only answer. "She expressed expressed determina-tion no matter what other plans were made, to keep Joan with her, since she understood the child's disability and the troubles she would probably have as a result." Flans for divorce and re-marriage and for Joan are accep-ted as stated. The discrepancy between Mrs. S's stated interests and goals and her actions (leaving Joan with Lillian~, neglecting medical dare) i s ignored by the worker; the implications of these discrepancies which indicate deep emotional conflict are not considered. Mrs. S's Hospitalization Four days after this interview, Mrs. S. was hospitalized with epileptic-like seizures that were diagnosed as being hysteri-cal i n nature. The foregoing interview gave specific clues that Mrs. S's ego-defences had become weak. She used defences of isolation to repress her resentments and fear. In this way she could s t i l l present acceptable feelings to self, family and com-munity. She could thus retain an acceptable picture of self and hide shameful and guilty feelings. One of Mrs. S's reasons for-staying with her husband was that Joan would receive medical treatment through Mr. S's service connections. Whether this was out of a l t r u i s t i c purpose or whether i t was from a desperate effort to deny the rejection we do not know. 3 4 The worker visited Mrs. S. i n the hospital where Mrs. S. displayed considerable guilt because she had not taken Joan to the hospital before she. herself, was hospitalized. Visitor attempted to soothe her by saying that she must look to her own health f i r s t and that Joan's condition would probably not be harmed by waiting for a few days. Mrs. S. told worker that after she l e f t the hospital following Joan's birth she developed an aversion to sexual inter-course with her husband; she so hated i t that on two occasions she got drunk i n the hope that this would help. It had not, so she told her husband about her feeling. How she wonders i f , when she marries Dick, she w i l l have the same trouble. She feels she may have the same aversion to him....She remarked rather pointedly that she has never tried to find out. However, whatever her decision, she wished to be apart from her husband and to devote herself to looking after Joan. At this point Mrs. S. lapsed into another seizure and v i s i t o r l e f t . Psyeho-social Diagnosis of Mrs. S's Personality Structure Mrs. S. had many dependency needs and at the same time she had a real need to be accepted. These ever increasing demands put more pressure on the super-ego, which resulted, eventually, in the seizures and later, amnesia. Some of the pressures exerted were: the financial stress; absence of husband; possibly the marriage (we do not know what the marriage meant to her or how threatening i t might have been); the birth of a similarly deformed child; responsibility of meeting that child's need when her own needs required meeting at a similar level; the rivalry a small child offers for attention, affection and praise. 35 These pressures increased Mrs. S's unacceptable feelings (those feelings about being a responsible and loving mother, of "weakness", feelings about being dependent, etc.). Super-ego pressure caused repression of the unacceptable feelings, using reaction formation, denial, isolation, an attempt at a l t r u i s t i c surrender, and f i n a l l y , the i l l n e s s . The latter method of defence serves as a punishment for her "bad" feelings; i t i s a way of having her dependency needs met, and i t i s a way of tem-porarily escaping the above-named pressures. The convulsions and amnesia which follow represent an even stronger attempt at repression, this time of the whole con-f l i c t , including the super-ego forces. This, and the payment (punishment) she offers through the illness, open the way to (l) an acceptance of her own dependent needs (she i s i l l ) ; (2) an acceptance of re-marriage to a father-person (family standards and the previous marriage become rationalized as "the old l i f e " , now discarded); (3) an acceptance of illness and drink as an escape (note her drinking to escape sexual intercourse); (4) projection that Mr. S. and particularly Joan have "made" her sick; therefore acting out her rejection on them i s acceptable because they, not she, are "bad". The physical manifestations are "safer" for Mrs. S. because they are more socially acceptable and secondly, the trend towards a f u l l psychosis i s interrupted. She can probably remain inte-grated with a father-person and no child. I f Joan remains with her mother, i t w i l l be dangerous for her because Mrs. S's hate for her i s freed. The pertinent questions concerning treatment of Mrs. S. ^ 36 are whether or not skilled casework help could have lessened any of the destructive pressures. Could Mrs. S. have accepted plans for Joan, as a "good mother" would have done? These plans might have involved temporary or permanent placement of the g i r l or i t might have meant helping Mrs. S. to be a "less-destructive mother" to Joan. Joan's Placements When Mrs. S. was hospitalized, Joan was placed with her maternal grandparents but they could not keep her very long because a l l the family members worked. The worker visited the grandmother and learned that she was very c r i t i c a l of Mr. S., and thought that divorce would be a good thing as Mr. and Mrs. S. had "nothing in common". After a few days at her grandmother's home, Joan was placed i n a friend's home where Mrs. S. thought she would receive good care. While Mrs. S. was hospitalized, she became irrational and amnesia developed. A conference was had with the doctor (the record does not indicate whether or not he was a psychiatrist). He said that Mrs. S. had "marked hysterical symptoms", and her amnesia would pass. In fact, when Mrs. S. talked to the doctor, she indicated that she was well aware of the situation between herself, husband and boy friend. The doctor had given Mrs. S. , advice on dealing with her marital d i f f i c u l t i e s and (he) obviously expected the couple to continue i n their l i f e together....He appeared hopeful of adjustment although he was "not impressed" with either Mr. or Mrs. S. 37 He f e l t that Mrs. S. should definitely be expected to resume responsibility for Joan's care and he f e l t she was capable of looking after the child quite adequately. The doctor's advice i s necessary and valuable, but i n view of what happens later, i t appears that the social worker was in complete agreement with him regarding Mrs. S's being expected to resume, and being capable of resuming, care of Joan. The social worker should have had much to add i n the planning area, especially since the plan concerned the client's social adjustment. The doctor's diagnosis and plan for the patient in the area of mental or physical illness i s v i t a l to the social plan that w i l l be made, but the area of social planning i s primarily, i f not solely, i n the social worker's area of competency and responsibi-l i t y . Particularly i n thise case, where the social worker ob-served and presumably knew the S's for years, and the doctor had seen Mrs. S. for only a few weeks, we might expect the social worker to have had a plan to implement the medical diagnosis. The social worker evidently had not made a diagnosis, or, i f she had, she did not have the confidence to carry through on i t . Perhaps she was impressed by the knowledge and prestige of the medical profession, but i f this were true, she forgot that the profession of social work, too, has i t s own particular knowledge and s k i l l s in helping people. Mrs. S's Release from Hospital: Return to Husband and  Subsequent Separation After three weeks of hospitalization, Mrs. S. was dis-charged, with the amnesia symptoms s t i l l prevalent. She had no rememberance of marital d i f f i c u l t i e s nor, i n fact, any memory of 38 the last three years. Joan was s t i l l a small baby and any thought of divorce vanished. Both Mr. and Mrs. S. seemed very happy, li v i n g together as "newly-weds". Mrs. S. asked the worker for books on child psychology as she f e l t unequipped to handle the problems of a "new" child. How-ever, after Joan was home for about two weeks, Mrs. S. again placed her with another friend because she (Mrs. S.) was having periods of unconsciousness, and "she i s afraid that she i s not looking after the child properly." The amnesia symptoms reflected the strength of the defences needed to repress the "bad" feelings. The last three years, which were so stressing to Mrs. S., were "erased" from her mind. How-ever, even amnesia was not a completely strong enough-defence, and her feelings partially broke through which resulted i n Joan's removal. After about three weeks of li v i n g with her husband, Mrs. S. said she was again corresponding with Dick and intended to marry him. Worker pointed out that because Mrs. S. might have traces of amnesia, she should wait before she decided to get a divorce, but Mrs. S. thought this unnecessary since Dick could help her remember the "forgotten" portion of her l i f e , and she thought she could be "perfectly happy" with him. While the worker tried to "point out" the disadvantages of another marriage, she was unsuccessful. It is not surprising that, even after the number of times the worker had seen Mrs. S., there was s t i l l not a relationship which the worker could use i n a helpful way. The v i s i t s were made on a "friendly v i s i t o r " basis, with neither diagnosis nor plan. Mrs. S. was not given 39 help in understanding her feelings towards Joan and, more elementary of course, there was no attempt to understand Mrs. S. as an i n d i -vidual with her own special needs and strengths. The worker did nothing discernible towards relaxing pres-sures or strengthening that which can be strengthened i n Mrs. S.'s personality. It appears that the worker was "drifting along" with the clients. Perhaps the worker believed that neither Mr. nor Mrs. S. could use the kind of help she was able to offer but i f she had arrived at this conclusion, one would expect either (l) the caseworker to withdraw her services, or (2) ro refer the family or individual family members to a resource that could help. One might compare the responsibility of the medical and social work professions. If a doctor cannot make a diagnosis or give proper treatment, we expect him to refer us to another doctor or to a specialist. Similarly, though the client does not pay 1 for the services, we should expect' that the social work profession would have the same ethical responsibility. We realize that the two positions are not precisely analogous because often, among other things, there are no community resources to which the agency can refer a client. However, we do think that this case illustrates a lack of evaluation as to the nature of the social maladjustment and how the agency was helping or i f i t could offer more pertinent help. The Separation Mrs. S. l e f t her husband and divorce action was started. 1 Fee payments for casework services are being intro-duced into some of the private agencies but, i n the profession as a whole, are not common. 40 Mrs. S. was receiving some financial help from the agency. A l l during this time. Joan was l i v i n g i n a home, which the S's found by a newspaper advertisement. The home was, i n fact, a house-boat; C.A.S. knew Mrs. B., the foster mother, and considered her home an unsuitable home for a child. That agency had received complaints that Mrs. B-. had been cruel to a mentally deficient child whom she had boarded. A C.A.S. worker advised that they did not think Mrs. B. "would receive a C.A.S. v i s i t o r and i t i s doubtful i f they could refuse on actual condition." Later a C.A.S. worker did make a home c a l l , and while they would not give the home a licence, they thought i t might be advisable to keep Joan i n the home unt i l the divorce was granted. The foregoing account i s somewhat confusing, particularly as i t relates to agency responsibility. C.A.S. does have the legal responsibility and authority to examine a situation which might be harmful to a child. Since they had received complaints previously which indicated the possibility of Mrs. B.'s ina b i l i t y to give a child proper care, there i s a question as to the mean-ing of "actual condition". Mr. S.. was worried'about the care Joan was receiving i n the B. home, and he talked to the worker a number of times about this. He also wondered i f he should ask for the custody of Joan since he fe l t that' his wife had not shown any interest i n Joan since her illness and he doubts very much i f this interest w i l l come back. He states he would l i k e to see operative work done for Joan....Visitor urged Mr. S. to take Joan back to the doctor or to the c l i n i c . He said he would do this eventually.... 41 Again the lack of focus is noticeable in the interviews with both Mr. and Mrs. S. While the worker recognizes Mr. S's inadequacies, mainly a dependency and inability to make a decision, she does not recognize that these indicate a need for help, for • example, support of healthy impulses i n his decision-making. She does not identify his strengths and build on them. Prom the record, i t appears that Mr. S. i s more stable and better adjusted than his wife. He understands that his wife does not want Joan, yet the worker gives him no support i n making plans for Joan. If an evaluation of the strengths and weaknesses of both Mr. and Mrs. S. had been made, i t would have been seen that the casework activity that was concerned with Joan should have been focussed on Mrs. S., in terms of relinquishing the responsibility that was too hard for her, and on Mr. S., i n terms of assuming responsibility for the care of Joan. Joan's Removal from Poster Home and Mrs. S's Office Call Mrs. S. called the agency saying that the foster mother would no longer care for Joan so she (Mrs. S.) was going to take Joan. Mrs. S. was "excitable, nervous and dirty". She insisted that she would never let Joan l i v e away from her again; she asked the agency for help i n finding a room for herself and Joan. How-ever she would consider temporary C.A.S. foster home placement, and * after she talked to her husband, she would consent to placement, but would "insist" on C.A.S. placement only, where Joan would have good care and would be "as much mine as his" unt i l matters are more settled. 42 It was l e f t that Mrs. S. would c a l l the worker after she talked to her husband. However she did not c a l l u n t i l a month later to t e l l the worker the divorce was completed and she had obtained cus-tody of Joan. Had the worker been more assertive i n Mrs. S's plans to talk to her husband, the boarding home plans might have been carried through. However, without any real support, Mrs. S. could not carry through on plans to relinquish Joan. Shortly after the divorce, Mrs. S. called the agency for financial aid u n t i l she received her f i r s t city r e l i e f cheque. The agency offered a small amount, but Mrs. S. "thought she could manage for a few days" and with this Last c a l l , the case was closed. Sporadic Neglect Complaints Received by C.A.S. In the next three years following the case's close, the C.A.S. received two complaints that Joan was being l e f t alone for long periods of time while the mother was spending her time i n beer parlours. The f i r s t complaint could not be checked because the worker could not find the correct address. The second com-plaint was followed up; Mrs. S. was now married to a Mr. Gunder-son. She denied haying neglected Joan and blamed malicious neighbours for the complaint. Two months later, the worker attempted to make another v i s i t , but the family had moved again, and their address was un-known. The G's were not heard of again u n t i l early 1950, when Mrs. G. called P.W.B. to get help with Joan's behaviour problems. 43 Second Phase: Referral because of Emotional Problems Joan had been to the Children's Hospital and they had re-ferred her and Mrs. G. to P.W.B. The hospital social worker believed that Mrs. G. needed help badly, "partly with helping the child but mostly with her own problems." When Mrs. G. called to make.an appointment, she said, "We are having some d i f f i c u l t y with Joan—she i s developing some kind of complex." Because Mrs. G. had a broken foot, the f i r s t inter-view was held at home. Mrs. G. impressed the worker as being a "well-spoken woman...who used many pseudo-psychological terms when referring to her daughter." Mrs. G. was not well; she had epileptic seizures which she said were the result of a f a l l which occurred last year. During the seizures, she was helpless, and afterwards was so weak she could do nothing. "Joan was utterly useless to her mother during these attacks. She would not even bring her a glass of water." In these f i r s t few comments by the client, we get the hint of. an upset personality. Mrs. G. stated that she had epileptic seizures which started just one year ago, but according to agency records, these attacks had begun at least seven years ago. Mrs. G., i n her complaints that Joan was "utterly useless", showed her dependency, and her 12-year-old daughter was unable to take on the role of being a mother to Mrs. G. At the same time Mrs. G. accused her daughter of not caring for her; she also , accused her of precipitating the attacks; the mother blamed Joan 44 for causing the attacks and then, during the attacks, doing nothing to help her. This appears to be a projection of Mrs. G's rejec-tion of her daughter. Mrs. G. went on to l i s t the things that were wrong with Joan. Not only was the child (physically maimed) but something was developing that could easily lead to a serious mental disability. Mrs. G. was at a loss to explain how this situation came about. She thought that Joan had now reached maturity (Joan was 12 at this time) but s t i l l she didn't act grown up. She was'filthy"; Mrs. G. had to examine her ears and neck to see that they were clean. She wouldn't clean her room unless her mother made such a scene that Joan would pick up a few things. Then there was the problem of bed-wetting that Mrs. G. f i n a l l y discovered when she found that Joan was turning over the chesterfield cushions every morning. (This was i n X-City where they had lived before moving here; Joan's bed had been on the living-room sofa.) Mrs. G. had tried to solve the bed-wetting problem by scolding but this had not helped. The bed-wetting had been going on for almost a year and Mrs. G. didn't think she could stand i t much longer. We can speculate on how r e a l i s t i c are Mrs. G's demands on her daughter. The fact that she thought Joan was an adult at age 12 may be an expression of Mrs. G's unrealistic expectations of l i f e , and i n particular, as i t involved her daughter. Further-more (as the worker tries to point out later with disastrous re-sults), some of Joan's so-called failings are those which are 45 f a i r l y common i n youngsters of Joan's age group. However, to the mother, pushed near to breaking point, a l l of these normal failings had become magnified to an intolerable state. Again, regarding Mrs. G's discovery of the bed-wetting, one wonders about the length of time before Mrs. G. discovered i t . Was she "purposely" avoiding finding out an unpleasant fact? If this were true, i t would add to the supposition that she does not want to see l i f e as i t really i s . Incidentally, one might ask about the g i r l ' s sleeping on the chesterfield. We do not know what f a c i l i t i e s were in this home, but one might think that a more desirable sleeping accom-modation might have been obtained. Another of Joan's dreadful habits was (lying)...to her mother. When Mrs. G. asked her i n the morning i f she had wet the bed, the child.usually answered i n the negative, which was a l i e . Mrs. G. now f e l t she could believe nothing Joan said. She f e l t very guilty about this because after a l l this was a child of her own flesh and blood and she knew she should try to believe a l l that was told h e r — i t was apparent she could no longer do so. Another problem was Joan's great appetite. For example, the G's had bought a two-pound can of marmalade three days ago; i t was used just two mornings by Mr. G. and now i t was nearly empty. "Joan had been helping herself1 She ate everything i n the house with no consideration of what her mother or step-father would want." During this f i r s t interview, the mother poured out her complaints. She f e l t guilty because of Joan's lying. "A child of her own flesh and blood" lying—doing something bad I 46 Again we see f a i r l y obvious clues that Mrs. G. was rejecting her daughter. Joan's behaviour was symptomatic of her feelings of rejec-tion. Her over-eating probably reflected a psychological rather -than a physiological need. Her other "faults", too, reflected the rejecting action she f e l t from her mother. Mrs. G's complaints seemed to be based on the fact that Joan did not give to and for her mother, which was a basic re-quirement for Mrs. G's peace of mind. Mrs. G. said she just did not know what to do. She had turned to us because she wanted definite psychological preferably psychiatric treatment for the child. Inciden-t a l l y , she denied that she had ever been to our agency before—she just happened to remember the name. During some of the previous conversation, I could see Joan standing in the kitchen...well within hearing distance. Her mother had also apparently seen her but i t was not u n t i l most of Mrs. G's statements had been made that she told her daughter to go out and play. Mrs. G. said that her present husband was very kind to her throughout their l i f e together. He was quite a bit older than she "but he was a perfect husband". He too was concerned over Joan. Mrs. G. did not think the Children's Hospital was doing Joan any good. They did not realize what a serious prob-lem she was. Mrs. G. reflected the child-like dependency and need to be cared for. Her "problem child" was beyond her realm of understanding; she was more or less washing her hands of the wearing situation and wanted an expert's help to rid her of the problem. One may question the worker's allowing this conversation 47 to occur in the child's presence; however, one can assume that, this was not the f i r s t time Joan had heard her mother's condemna-tion of her. This interview points to one of the d i f f i c u l t i e s of a home interview; i t i s usually true that i n an interview occurring i n the home there are more variables which tend to detract from the focal point of the interview. (The hospital) thought that Joan could be admitted for further surgery, yet, said Mrs. G., she could not allow the g i r l to go to the hospital while she was s t i l l wet-ting the bed at night... .Mrs. Gr. asked or, rather, demanded that I write to the X-City Children's Hospital to get Joan's medical and social history. I suggested to her that the Vancouver Children's Hospital would l i k e l y be writing for the medical history, but Mrs. Gr. thought I should write too. I did not argue the point further....Mrs. G. (said) she did not care what happened as long as something was done. She' f e l t having to cope with Joan was too much on top of a l l her other problems. Life had treated her very harshly. She loved Joan but she did not think Joan loved her. Just before the worker l e f t , Mr. G. came home from work. Mrs. G. wanted the worker to talk to him so that he could confirm a l l her statements. Mrs. G. reviewed the complaints while her husband sat "almost silent, only occasionally agreeing i n a few words....Since there did not seem to be much chance to get Mr. G's point of view, I l e f t . " Another clue adding to the idea that Mrs. G. was a basically dependent type of person i s her choice of man for a husband. This husband was much older than she; he said very l i t t l e except to agree with her. Mrs. G's punitiveness towards Joan was seen i n her refusal to allow Joan to go to the hospital, giving as an excuse Joan's bed-wetting. One might point out here that the social 48 worker should have had closer communication with the hospital so she could have evaluated how r e a l i s t i c this excuse was and; i n any event, interpreted to Mrs. Gf. some of the hospital regulations. For some reason, the worker f e l l into the error of arguing with the client about whether or not she should write to X-City Hospital for the social and medical history. Mrs. Gf. called twice in the next two-week period, and each time she asked what was being done.- to get Joan off her hands and into the hospital. Mrs. Gf. said that F.W.B. "was as bad as the hospital, putting her off without helping her...the child was becoming too much of a t r i a l and her own health would not stand more." Mrs. G's frustration tolerance was very low. This and her extreme narcissistic tendencies are reflected in the next interview: Mrs. G. was i n a semi-stuporous state, which the worker discovered was actually an alcoholic hang-over. She repeated her complaints of Joan, and said that Joan's behaviour was causing Dick to threaten to leave home. "Joan i s breaking up my marriage just as she has always broken upmy l i f e , " sobbed Mrs. G. She became increas-ingly upset, crying and talking i n an irrelevant manner. She f i n a l l y asked for Mrs. Fern, an elderly woman who lived i n the basement suite. Mrs. Fern came upstairs and calmed Mrs. G., who seemed to trust her. Mrs. G. thought that any plan that would "get Joan off her hands, even for a short while" would be preferrable to Joan's remaining at home. Mrs. G. became very upset and demanded that the worker take Joan away. 49 "She (Joan) hates me—she must hate me, but I have done a l l I could for her and now she treats me l i k e t h i s — i t would be best i f I never saw her again." This was said well within hearing distance of Joan, and Mrs. Gf. would not lower her voice even though I told her Joan could hear. She replied that i t didn't make any difference—she had already told Joan what she thought of her. Joan was lying curled up on the sofa outside her mother's bedroom, trembling badly and crying. Mrs. Fern comforted her and assured her she would not l e t anything happen to her. She asked the child i f she would not be happier somewhere else. Joan quickly agreed, then turned to me and said, "Do you think I could be sent some-where where they would love me?" I promised her I would do the best I could. Mrs. Gf. i n this interview, gave indications that her re-jection of Joan had become overt and extreme—"get Joan off her hands for even a short while". Furthermore, Joan was, according to her mother, breaking up the marriage, "just as she has always broken up my l i f e " . Mrs. Gf's feelings that her daughter has been a detriment seems to have gone back many years, and i f the f i r s t agency records are indicative, the mother's rejection of Joan was probably present since the child's birth. Mrs. Gf's drinking habits were indicative of her total personality pattern that leans towards dependency, unrealistic expectations and demands, and a tendency towards escapism. Mrs. Gf. forsook a l l attempts to present a front of the concerned mother; she admitted that Joan hated her--"she must hate me". Mrs. Gf. was also able to say that i t would be best i f she never saw Joan again. Evidently, the drink had served as a super-ego dissolver i n this particular time; Mrs. Gf. told the worker her true feelings i n an extremely direct way. She had been t e l l i n g the worker before that she "wanted something done", but was saying so i n such a way that the worker probably 50 concluded that this would be a treatment job with the child re-maining i n the home. This interview brought out the actual physi-cal rejection of the child and the consequential changes i n plans for the child's removal to boarding home. Later that day, the worker called C.A.S. to advise them of the possibility that this child would be removed from' her home. C.A.S. would take the case but "could not give a foster home for some time."' Two days after the previous home c a l l , the worker visited and took Joan for a walk through the park.; Joan seemed very relaxed throughout this hour. She began by chatting of super-f i c i a l things, but suddenly began to t e l l the worker about her relationship with her mother and about her l i f e at home. She spoke so intensely that the worker attempted to get her away from the subject, but Joan would always voluntarily return to this topic. She t.old me that her mother hated her. She knew i t because her mother told her so over and over again. She could not understand why....She said her mother begrudged her anything i n the way of clothes or play-things that she might want.... Considering the short time the worker knew Joan, Joan's ab i l i t y to relate her intensive feelings is important diagnos-t i c a l l y . It could mean a number of things: the feelings are very close to the surface and a small amount of stimulation i s needed to e l i c i t them; the client relates extremely quickly; there i s not as much real feeling behind this as would be ex-pected because of the content of what has been related (e.g., the client i s intellectualizing). 51 She was used to her mother slapping her when she did not do things correctly, hut she f e l t that she could never get used to her mother calling her "a l i t t l e ..." (here Joan paused and said, "I don't know whether you know this word or not," blushed slightly and blurted "bitch"). Furthermore her mother called her this name in front of her friends. There were other words too that her mother called her, but Joan was too shy to repeat them. I told her I could use my imagination and did not want to know the exact words anyway. Mrs. G's derogatory comments,would have been d i f f i c u l t for an adult to accept, but for a child, and especially for a daughter, to accept or understand must have been very d i f f i c u l t . The child who has had a f a i r l y satisfying childhood usually has some di f f i c u l t y i n adjusting as he enters into the adolescent period. This i s because the ego i s not f u l l y developed and the super-ego i s s t i l l a simple reflection of his parents' attitudes and has not yet been modified by the social environment. Particularly for Joan, who seems to have received l i t t l e i n the way of security or love, this kind of an attack would be devastating. Joan described the kind of foster home she would l i k e ; she wanted a small home where there would be younger children. She liked small children because they were more l i k e l y to accept her appearance. Joan thought that ...I w i l l be able to stop wetting my bed when I am i n a place where I am loved....I guess i t really does not matter (what kind of a home I go to) but I would like to go somewhere where grown-ups love me. Joan's a b i l i t y to verbalize her feelings and thinking about the problems i s amazing. In her solution for bed-wetting, one wonders whether she has unusual insight or whether she has been informed either through reading or from talking to someone. 52 The worker asked Joan what she thought of her step-father. Joan's answer was non-committal, saying he was " a l l right" and that he was never unkind to her; the non-committal reply might be a clue that the worker has hit on an area that i s either dan-gerous or painful for Joan to discuss. .Within the next week, Mrs. G. called the worker twice, "demanding" that Joan be removed. The worker replied that they would have to wait un t i l C.A.S. found a foster home. In the next home c a l l the worker attempted to interpret to Mr. and Mrs. G. what teen-aged behaviour meant. She said that Joan's "messiness" was a f a i r l y normal teen-aged pattern. I asked Mrs. G. i f she had never been untidy when she was Joan's age...and Mrs. G. denied that she had ever acted i n such a manner. I said that in that case she was probably unusually well behaved...but I well remem-bered, when I had been Joan's age that I certainly had to be forced to wash...and clean my room. I explained that I did not think I was very abnormal.... ...Mr. G. was nodding his head throughout my talk-ing and said after I had finished, "That Is what I keep t e l l i n g her, but she won't believe me." Mrs. G. then said to me, "So you are against me too." I denied that I was, saying that I was merely trying to help her, and pointing out that some of Joan's behaviour was not very unusual.... The-worker again crosses swords with Mrs. G. Mrs. G. i s right: everyone is against her. At least no one i s with her, attempting to understand her needs and why and how she thinks and acts. The G's moved to a new apartment where the worker visited. Mrs. G. had hoped the move would stop Joan's bed-wetting but i t s t i l l continued. Mrs. G. continued to ask the worker when she would take Joan away, but the worker could not 53 give her any answer because C.A.S. had not yet found a foster home. A case conference was held with both agency workers present. Though C.A.S. did not have a home, i t was planned that i n the next v i s i t , the C.A.S. worker would accompany the P.W.B. and that P.W.B. would gradually withdraw from the situation. Since the next v i s i t resulted i n the immediate placement of Joan, both the P.W.B. worker and Miss D. of C.A.S. visited. Mrs. G-. was in bed and the smell of alcohol was heavy. Joan welcomed us and i t was apparent that the child was fighting back tears. Mrs. Gf. was obviously very drunk although' she talked f a i r l y rationally.... She was so nervous that she jumped whenever anyone spoke, and she tossed in the bed u n t i l we were afraid she was going to f a l l out. She ordered us to take Joan away. The child was the cause of a l l her troubles and i t was for Joan's own good as well as hers, that she was asking us to find another home for the child. To make matters worse, Dick had l e f t the previous night and had not yet returned....She wanted us to find him. We told her that we had no way of doing so, and Mrs. Gf. began to cry and then shriek i n an almost hyste-r i c a l manner, sobbing that i f only Joan were gone, her l i f e would be much easier. Whether we took Joan or not, she was not going to stay any longer; as soon as she was able she would go but she had to be alone. Dick didn't love her any more and she was so sick and burdened by other people's troubles as well as her own. Miss D. said she would take Joan with her to the office to try to find temporary accommodation for the child. As she and Joan l e f t , the youngster clutched a totem pole that her mother said she might have. When the child turned back to say good-bye to her mother, Mrs. Gf. turned away, shrieking, "Don't come near me, just get out!" I said that I would be going too as Miss D. would be making a l l future plans. Mrs. Gf. yelled at me that i f I went she would jump out of the window. I said... I would stay for a few minutes. (Miss D. told me she would return as soon as she could t e l l me what arrange-ments had been made....) I sat i n the corner of the room while Mrs. Gf. 54 talked spasmodically and mostly irrationally. If I made any attempt to move she began to shriek again and once got out of bed and grabbed me so firmly that I could do nothing except forcibly push her back into bed again. Mrs. G. calmed down after a time and eventually Mr. G. arrived. She told him she was going to leave. He replied that i f that was what she wanted, she should go. Mrs. G. began to.cry hysterically, saying that I now had proof that no one loved her, not even her husband. Mr. G., very quietly, replied that that was not the case; he just could not put up with anyone who was so upset day after day. Miss D. returned to collect some of Joan's clothes. The two workers told Mr. G. they hoped that Joan could spend the week-end with Mrs. G's relative and when a permanent home was found, the G's would be notified. Mr. G. said i n a whisper, as we stood i n the ha l l , that he was sure his wife would not be leaving, as she was too drunk to do so; he would l e t us know i f there was any change of plans and would, i n any case, wait for a phone message from Miss D. The P.W.B. worker did not make any other calls on the G's, and with this last home c a l l , the case was closed. (The worker and the C.A.S. worker sent a birthday g i f t to Joan a few weeks later.) One might question the rapidity with which the agency's service ended. Obviously, Mrs. G. had many problems and some of them might have been helped with skilled casework. This might have been an instance where the two agencies could have cooperated i n making a plan to help the family and the in d i v i -duals. Post-Placement Events Joan told the C.A.S. worker that she never wanted to 5 5 return home because she knew her mother hated her and she thought i t would be better for both her mother and herself for her to be away. Despite Joan's verbalization of her r e l i e f at being sepa-rated from her mother, when she was admitted to the hospital two weeks later (for plastic surgery), she tried to c a l l her mother and was very upset to learn that Mrs. G. had gone to X-City with-out t e l l i n g her. This was a reflection of the natural swing of ambivalence of I-love-you-I-hate-you feelings. Mrs. &., too, expressed some feelings opposite to the rejections she had shown. Four days after Joan's removal, Mrs. G. told the worker she would never give Joan up permanently, but she had broken down her health, and had nearly lost her her husband and was completely beyond her management. Mrs. G. gave the worker Joan's birthday present and some clothes that had been forgotten.... Later, Mrs. G. had quite a need to justify the request for placement, saying that she and Joan clashed i n personality and that Joan had become unmanageable. She did not want Joan to think that her mother hated her. Worker remarked that i t seemed at times when Joan had misbehaved and Mrs. G. had become upset, she had f e l t this way. Mrs. G. was unable to accept this. Worker tried to point out some of the positive things Mrs.G. had done for Joan, particularly the help she had given Joan in learning to walk and talk. Mrs. G. reacted quite favourably to this slight praise and then agreed that at times Joan had bogged her down to the point where she did not feel she could stand her any more. This i s one of the few instances where the worker has given Mrs. G. any recognition for the positive things she has done; more-56 over, this i s focussing on Mrs. Gf. what appears to be the f i r s t step i n establishing a relationship. However, this f i r s t positive approach could not be followed because Mrs. Gf. broke most of the appointments. About two months after Joan was placed, Mrs. G. called the worker saying that she and her husband were moving to X-City where Mr. Gf. had been offered a job. Mrs. Gf. thought Joan should stay where she was because ,when she saw Joan recently, she had embarrassed both the G's by "her mannerisms and general attitude". Natural Father Located Four months after Joan's placement, Mr. S. was located by newspaper advertisement. He came to the office for an interview. He i s a small man who appears mild and unassuming. He was surprised at being contacted because he thought he had lost a l l legal claim to Joan.... Mr. S. asked many questions about Joan and seemed sincerely interested i n her. He said that i t would be impossible for him to help her financially at present, as he recently suffered severe business reverses and had medical b i l l s as his wife had a baby a few months ago.... Worker f e l t that although Mr. S. has not seen Joan since she was 4 years old that he had considerable under-standing of some of the d i f f i c u l t i e s she has had and that he i s sincerely interested i n her. Mr. S. began v i s i t i n g Joan and showed increasing interest i n her. Through support and interpretation given to Mr. S., he f e l t more secure and confident i n his relationship with Joan. He saw the worker regularly and she said though he " i s a quiet-appearing man, he can express himself well and i s accepting of assistance." 57 Joan's Adjustment ) Joan's progress towards maturity was characterized by uneven swings. Intellectually, she seemed able to understand many of the causes and effects of her own situation. Emotional-ly, however, she was very immature, and showed l i t t l e movement towards an emotional maturity. She was inclined to be "cheeky, argumentative and lazy". Her main problems were enuresis and masturbation. The enuresis and Joan's reluctance to keep herself clean was a special problem to the boarding mother. In addition, Joan put many emotional demands on the foster parents that they were unable to meet. In two years, Joan was moved to three foster homes, and in each home she repeated behaviour indicating that these basic needs were not being met. While she was i n the second home, Joan told the foster mother that her step-father had been intimate with her since she was 10 years old. The foster mother became upset and without consulting the agency, she wrote a letter to Mrs. G. giving her this information. This, of course, upset Mrs. G. and she ac-cused Joan of lying. In the next v i s i t to Vancouver, Mrs. G. demanded to see Joan. An interview with Joan, Mrs. G. and the worker took place, and Joan calmly repeated her charges. Mrs. G. wept, but as the worker noted, seemed more upset by her daughter's calmness than by any implications of the charge. About the same time, Joan told the worker that her foster father was making improper suggestions to her, and while this was not discussed direct with the foster parents, Joan was re-58 moved from the home. Both parents had become increasingly annoyed and hostile towards Joan, and the record implies that neither foster parent was mature or stable enough to meet Joan's demands. They said that Joan often said and did things i n a highly suggesr-tible manner. The worker talked to Joan about her sexual experiences with Mr. Gf.; Joan discussed this on a very intellectual.level with l i t t l e emotional expression. For example, she was very interested why an older man would be interested i n having sexual intercourse with a child rather than an adult woman; she supposed that her own mother didn't satisfy Mr. Gf. Joan did not (at least i n the recording) give much expression about her feelings. Joan was examined at the Child Guidance Clinic about a year after she was taken into custody; she was 14 years old at the time. She ranked i n the upper range of normal intelligence and the tester believed a valid rating would have placed her score i n a superior group. For example, her vocabulary was equivalent to that of a university graduate. However, she was hampered by her feelings of anxiety, unhappiness and general personality dis-turbance. Later i n the year, she was again examined and the Clinic believed that she showed less signs of disturbance, a re-duction in anxiety, and seemed happier. The foster mother re-marked that there was a decrease i n the frequency of the enuresis and masturbation, and that she showed definite progress i n social adjustment: she belonged to various clubs and had a number of g i r l friends and seemed to have the normal teen-aged interests i n clothes and boys. Though her adjustment was improving she s t i l l had many . 5 9 behaviour and personality idiosyncracies which were impossible for the foster parents to accept. In the third home, both foster parents and Joan were unhappy and Joan asked to be removed. Though the c l i n i c had recommended that "a good foster home" would be preferable to an institution, the agency believed that a more permanent home-setting, such as the Girls' Receiving Home, would be preferable to temporary foster homes. In making this deci-sion, the agency also recognized the real demands Joan made on -foster parents, and they realized the improbability of finding foster parents to meet this qualification. Also involved i n the decision was (presumably) the extent of Joan's personality upset and the limitations of treating i t i n order to make her a better adjusted person. Joan i s at present in the Receiving Home where she has adjusted f a i r l y well to the routine though i t i s doubtful that improvement i s being made towards a more satisfying personality adjustment. It would not- seem l i k e l y that group l i v i n g i s meeting the emotional needs which were unmet i n Joan's early childhood. It appears that she needs a warm, accepting woman from whom she can receive the emotional support and satisfactions she needs i n order to grow to maturity. (It i s doubtful that she could adjust i n a home where both parents are, because of her past experiences with men; Perhaps, after she has a satisfying relationship with a woman, she w i l l be able to move to normal relationships with the opposite sex.) Joan's present worker i s an older, extremely warm, accepting "mother-figure", and i t i s interesting that Joan has told her that she would like to have 60 "two interviews a week". Joan has shown this need for close attachment to other women, i.e.. a foster mother and a teacher. Summary of Mother's Participation and of Work Done Mrs. Gf's v i s i t s to Joan have gradually been decreasing. When she did come to Vancouver, she was uncooperative i n planning with the worker for v i s i t s with Joan. Frequently, she visited Joan when she was extremely intoxicated, though lately she has been interested i n an organization to help paraplegics and seems to be devoting much (sober) time and energy to this cause. Mrs. Gf. has been extremely hostile to C.A.S. and has threatened to take Joan to the X-City C.A.S. where "they would do something with Joan." These seem to be idle threats and Mrs. Gf. has never given real indication that she plans or wants Joan with her. The worker noted that when Mrs. Gf. became angry, she would have what would amount to a temper tantrum, and within a few minutes of this, she could be very pleasant and friendly. In the last summary of Mrs. Gf., the worker says: Although severely limited emotionally, Mrs. Gf. i s an intelligent woman with a r t i s t i c talents. The biggest thing she has ever done for Joan was to give Joan up, and to teach her how to do everything for herself.... In reviewing this entire case, one might consider how much better for a l l concerned i t would have been i f a clear diagnosis and plan had been made earlier, before so much damage had been done to Joan and indeed to her parents. Chapter III Case Illustrating Physical and Emotional Neglect Fir s t referral; Second complaint; First appre-hension; Children committed as C.A.S. wards; Return of children; Case closed; Reopening of case; Second apprehension; Helen's return; Summary. CHAPTER III CASE ILLUSTRATING PHYSICAL AND EMOTIONAL NEGLECT Reardon Case This case i s presented as a classical example of what happens i n a neglect situation where the parents vacillate from week to week in their interest i n the children, and where the social worker's evaluation and plan vacillate with the manifest action of the parents. The case i s typical too, i n that, un-fortunately, every child-caring agency on the continent has neglect cases like the Reardon case - give or take a few drinking sessions. The case opened five years ago and i s s t i l l active i n the Vancouver C.A.S. First Referral The f i r s t referral was made i n the summer of 1950 when the police department called the agency. A C.A.S. case worker made an immediate home c a l l where she talked to both Mr. and Mrs. R. Mrs. R. denied that their two children, aged two months and 16 months, had been l e f t alone. She did say that she and her husband went drinking occasionally, but when they did, they had a teen-aged baby-sitter to care for the children. Mrs. R. thought her mother was trying to cause her trouble as her mother had become a religious fanatic and was determined to cause 63 trouble and separate her from her husband. The worker did not follow this further nor establish a basis of interest i n the R's. Evidently Mr. R. was not too active i n this interview; the worker comments that he was lying on a " f a i r l y clean bed", playing with the 16-months child. The worker thought the house looked " f a i r l y clean and adequate". As she was leaving, "Worker advised Mr. and Mrs. R. that they should try not to give cause for...complaints as i t was our work to see that children were properly cared for." The parents promised to be good and the worker told them about agency help, but she did not explain what the agency help would be. If what she had demonstrated i n the f i r s t interview was help, i t would be unlikely that Mr. and Mrs. R. would want more. This approach of "carry a big stick and walk softly" does not set the stage for the quality of relationship needed for treatment in the casework setting. To the inexperienced or unsure worker, te l l i n g the client what to do might seem l i k e the most expedient technique. It might work as a deterrent with some clients, but in the great majority of cases i t does nothing but temporarily inhibit the undesirable behaviour. And, as pointed out, i t has the definite negative aspect of starting the worker-client relationship out on a poor footing. Exactly two weeks later, the police called again saying that Mrs. P. (Mrs. R's mother) had called saying the R's were neglecting the children. The worker made a home c a l l next day where she was met by Mrs. P. i n front of the house. The R's were i n the process of moving because, according to Mrs. P., they were being evicted because of drinking parties. Mr. R.- was 64 present but he and Mrs. P. weren't speaking. Mrs. R. was ab-sent and Mr. R. said she was at the new house; (however when the worker went there later, she could not find Mrs. R.) Instead of saying that this was a poor time to v i s i t and suggesting a new appointment time, as a token of .courtesy and respect, the worker asked Mr. R. i f she could see the youngest child. The worker observed that there were no marks on his body; he seemed to be healthy and active. The elder child, Helen, seemed very fond of her father; she ran to meet him and he took her i n his arms. In her closing recording the worker noted that Mr. R. looked like a "half-breed"; and his wife was Scottish though her mother looked"quite Indian" too. The worker said, "This case would seem to warrant close attention and worker w i l l try to v i s i t early next week." This worker i s certainly to be commended on her prompt-ness at answering the complaint, and her evaluation that the case w i l l c a l l for close attention i s quite correct. Again, we get the attitude of the worker supervising, i n the narrow sense of the word. We can appreciate the d i f f i c u l t i e s of trying to interview when the family i s moving, and suggest that the worker might also have been sensitive to them for the family. Particularly i n casework with a neglectful family, i t i s essen-t i a l to the casework relationship that appointments be made i n advance. Eleven days later, after two home calls with no one home, the worker visited Mrs. P's home. Mr. R. had been jailed for drunkenness, and Mrs. R. went to work, leaving the 6 5 children in her mother's care. Mr. and Mrs. R. were eating their evening meals at Mrs. P's home. "The house was clean and the children looked well cared for." Both Mr. and Mrs. R. told the worker they intended to "go straight" from now on. The case was transferred to another worker, and the next v i s i t was made a l i t t l e over two weeks later. ^ The.worker talked to Mrs. P. f i r s t ; she was no longer caring for Jimmy and Helen, but she complained of the R's drinking and leaving the children alone. Just last week-end, Mrs. R. had been drunk and Mrs. P. was sure she had been with the putative father of Helen. (Mrs. P. said that Mrs. R. had been pregnant by some other man when Mr. R. married her; he knew this and married her "because he f e l t sorry for her.") Mrs. P's idea of solving the. problem was to take the children away from the R's, to "give them a scare l i k e the wel-fare did to the other daughter." Her other daughter had now settled down, according to Mrs. P. After seeing the grandmother, the worker went to. Mrs. R's home; i t was very dirty and there were many f l i e s . The children were "grubby" and Helen was very f r e t f u l . Mrs. R. gave her milk and syrup - the only way she would take milk, said Mrs. R. When Helen demanded more milk, Mrs. R. took the bottle away; Helen cried and wet the floor. Mrs. R. made no attempt to wipe this; she just stood there and said "oh". We get the worker's concern with the household detail and Mrs. R's a b i l i t y as a mother so far as keeping things order-l y i s concerned. Whether or not the worker recognizes, i n the 66 mother's actions, the kind of relationship between her and the children, i s nor recorded. The worker discussed Mrs. R's absence from the home the previous week-end. Mrs. R. "seemed dull and i l l at ease"; she maintained that she had been v i s i t i n g a g i r l friend, and she tried to brush off the incident by saying that her husband got upset easily. Worker l e f t : I said i t was pretty serious when police became interes-ted and advised that she should not give them concern again, especially where children were involved....1 would be v i s i t i n g again. Just where does this worker's concern l i e ? She seemed most concerned that the police (and consequently the agency) should not be bothered again. The second interest i s the child-ren, and then Mr. and Mrs. R. seemed to be of interest only as they caused the police and agency more work. The client would tend to see the worker as an extension of the police department because the worker's approach smacks of ordering and warning/ One can only surmise how Mrs. R. was affected by the "I would be visi t i n g again" phrase; she could hardly look forward to the worker's comingr. Second Complaint Two weeks later, Mrs. P. called, complaining about the care the R. children were receiving; the worker made a home c a l l to the R's i n the early evening. Mr. and Mrs. R. and Mrs. R's brother were there, a l l drunk. Mr. R. was silent while the brother was most talkative, trying to prove to the worker 67 that he was a good provider. The R's were i n a great state of confusion as they were again moving. The worker had a d i f f i c u l t time trying to talk to the parents because the brother kept interrupting. Mrs. R. was very unconcerned about the complaints saying that the child-ren "always cry l i k e that and...besides she was home now to look after them." (She had evidently quit her job to stay home.) The father wanted to know who had complained and the worker said "several people". This was Mr. R's only contribu-tion to the interview and the worker might have picked this up, sensing his concern with, i f nothing else, the possible effects of community censure. Certainly an interview conducted with inebriated clients i s d i f f i c u l t and i f the interview must be continued, the worker can probably do l i t t l e more than observe the clients' reactions. Again the worker i s given an indication of Mrs. R's casual a t t i -tude toward care of the children. If a number of these clues occur, i t i s a f a i r l y adequate indication that the mother either lacks, or has repressed, concern for the basic needs of her children. First Apprehension Two days later, on a Saturday night, both of the R. children were taken from their home by the police and placed i n a C.A.S. foster home. The children had been l e f t at home alone and neighbours complained. On Monday morning Mrs. R. called, saying that she was 68 not home on Saturday night because her husband was knifed i n a brawl and was taken to the hospital. Later, both Mr. and Mrs. R. were i n the office to have court procedure explained. Neither seemed upset or angry that the children Were removed, but they did express a wish to v i s i t them. In the courtroom, Mrs. R. did not show any emotion when the children were brought in, though later she picked up Helen and became quite emotional. No mention i s made of Mr. R's or Jimmy's reactions. One significant observation i s the parents' outward acceptance of the children's apprehension. It does not seem to be the reaction of concerned parents; the only sign of emotion was i n the courtroom when Mrs. R. f i n a l l y showed attention to Helen. Are the parents actually as devoid of emotion as they appear? If so, why? And i f they are repressing emotion, what i s i t ? In particular, what does Helen mean to her mother? These questions point up the fact that there i s nothing to indicate diagnosis or evaluation of Mr. or Mrs. R. With such apparent apathy, there i s a possibility that mental deficiency, severe personality disorder, or emotional immaturity was affecting one or both parents' functioning. Two days after the court hearing, the worker visited Mrs. P. who said that she was "washing her hands" of the whole situation. She had not raised her daughter "to be this way". The .worker did not use this opportunity to get a picture of Mrs. R.'s early l i f e ; this information would be v i t a l to the total diagnosis and plan. 69 The R's moved again, and the worker visited. She. dis-cussed with Mrs. R. how the children could be returned. The worker said the R's would have to present a suitable plan to the court. Mrs. R. "guessed she'd better stop drinking." Before talking to the mother about plans to return the children, some effort should be made to know the parents' real needs and wishes, and the best way of meeting them. Certainly, the parents should know the legal procedure, but more should be involved than having a suitable plan for the judge. Again we see the mechanical assumption that (l) a l l parents want their children a l l the time, and (2) that improved care w i l l result from threats, or i f not from threats, from punishment by separa-tion (which is based on assumption number ( l ) ) . Children Committed as C.A.S. Wards Both parents were present at the court committal, and neither showed any observable emotion. Next week, Mr. R. called the worker and asked i f the children could be returned home. The worker asked i f he did not understand what committal meant; he said he did but his wife "was most upset, and he was afraid of what was going to happen to her." The recording does not cl a r i f y this comment, but in the previous week, Mrs. R. had called saying that she was staying with her mother, because Mr. R. had beaten her while he was drunk. The worker advised Mr. R. that his wife should go to her mother's more often "because i t seemed to calm her." The worker also talked to him about his drinking, and he told her he had stopped; the worker commen-70 ted that he had stopped before only to start again. The "classical" pattern of this neglect case was not ob-served by the worker. The pattern as characterized by the mother's swings from "good" behaviour to "bad" behaviour were primarily reflections of Mrs. R's actions. She was emotionally tied to her mother; when her mother's demanding pressures became too great, she attempted to escape by becoming drunk. The re-sults' of this action caused her to become fearful, which neces-sitated a return to her mother. In view of Mrs. R's desperate attempt to escape from her mother's control, i t i s rather i r o n i -cal that the worker should suggest that Mrs. R. should go to her mother's more often. The worker's principal attempt to help the clients i s i n her use of "advising" them what to do. Prom the recording, there appeared to be no bolstering up of the R's positive ac-tions. Por example, when Mr. R. said he had stopped drinking, the worker evidently gave him no support i n this, but rather reminded him that "he had stopped before." Mr. and Mrs. R. occasionally visited their two children, and they became increasingly c r i t i c a l of C.A.S. and the care the children were receiving., Both Mrs. R. and Mrs. P. pleaded for the return of the children, and Mrs. P. was particularly vocal i n asking for Helen's return. Mrs. P. swore that both Mr. and Mrs. R. were now "saved" and that Mr. R. had never had so much fun as now when he went to the Pour-Square Gospel meetings. According to Mrs. P., her daughter never drank before her marriage, and afterwards did so just to drink with her husband. The worker 71 asked why Mr. R. drank; Mrs. P. didn't know, and the worker tried to point out that this time might only he temporary-too. This comment have have reinforced Mrs. P's negative feelings about Mr. R. Whenever Mrs. P. and Mrs. R. were seen together, Mrs. P. dominated the conversation while her daughter said l i t t l e or nothing. It was Mrs. P. who pleaded for the children's return; i t was Mrs. P. who said the R's had reformed. A casework re-lationship i s basically a primary one-to-one relationship and when the third person plays such a dominant role, i t i s extreme-l y d i f f i c u l t to know what the "primary clients" (Mr. and Mrs. R.) are really thinking and what their real wishes are. It i s d i f f i c u l t to see the causes of their problems and to see, with them, what constructive plans can be made. Furthermore, i t i s d i f f i c u l t to develop any helping relationship on which such a plan could be based. The R's reactions were related to Mrs. P's domination, which when i t became unbearable, led to revolts, and consequent returns to the grandmother. In any case where a third person complicates both the problem and the actual treatment, the worker must be aware of the importance of this person to the primary clients and how i t can affect the treatment plan. The worker must, i f she wants to help the clients, make arrangements to eliminate a l l pos-sible negative influences. Here individual office v i s i t s would appear both possible and essential. Mrs. R. "was s t i l l hostile, unaccepting and not under-standing of what had gone on." She thought that either the city 72 or O.A.S. was lining their pockets with money received for the children's care. She complained that at the previous court hearings she could not say anything but the worker could do what she wanted. She asked i f she could have a lawyer and worker said she could. The R's hired a lawyer who was very sympathetic to their cause. The lawyer believed that the main, i f not only, reason the children were removed was because of the dirty home conditions. The lawyer (a woman) thought that "just because the children were dirty was no reason they should be removed." The worker agreed and though she explained the other factors involved, the lawyer was adamant (as we can expect and appreciate i f she wishes to "win" the case for her clients). About eight months after the children were taken from the home, the R. and P. family came to the agency to talk to the wor-ker. The worker asked to see Mr. R. alone f i r s t , but Mrs. R. insisted on coming into the room, each time taking-C.A.S. to task for the kind of care they were giving. Finally, Mrs. R., after her husband requested her, banged out of office, slamming the door behind her. It was no sooner closed than i t opened again and Mrs. R. went through an almost identical performance, this time accusing worker of being sly and not planning to t e l l her anything. Worker told her that she had spoken to lawyer and the R's would be contacted. Mrs. R. then bounded out...again...asking her husband to come home, and, when he continued to s i t , told him he could just stay there then. Mrs. R. l e f t and entered the room twice more, accusing O.A.S. of wanting to have the children adopted so they could make some money. Once when she l e f t the office, she said to husband and worker, "O.K., go ahead and elope!" • 73 Once alone, Mr. R. repeated his wife's wish that the children he returned because home was the only proper place for them when they were i l l . (The children had been having a variety of sicknesses—colds, fevers.) Evidently the worker never did see Mrs. R. alone this time and the last entry for the "interview" states: A l l the time Mrs. R. had been stamping in and out of the office, Mrs. P. had been outside and i t i s l i k e l y that she... encouraged Mrs. R. i n her attempts to break up the interview. The whole family stamped down the hall...to the waiting room to ask for the children's worker...who was out for the morning so the family went home. Certainly this interview or attempt at an interview pro-duced negative feelings i n both worker and clients. Interviews with more than one client are often d i f f i c u l t ones, .and especial-l y so when the worker can expect antagonism from one or both clients. Mrs. R. i n this interview reflects an extreme amount of insecurity, anxiety and resultant ho s t i l i t y . Mrs. R's defences are heightened by the worker^ insistence on seeing Mr. R. f i r s t and alone. Mrs. R. f i n a l l y says what is bothering her when she accuses the worker working solely with Mr. R., and t e l l i n g the worker and her husband, "O.K., go ahead and elopeI" The worker has put herself into the position of being a r i v a l for Mr. R's attention, and to Mrs. R., attention means affection. Mrs. R's behaviour during the interview was heightened because previously she had been pushed i n the background because of her mother's domination; i n this situation, Mrs. R. was the 74 centre of attraction and, i n addition, had her mother's attention and approval. Mrs. R. was an unemancipated adult, seeking the approbation and attention she never had from her mother, except as she gave her mother control of herself and her children. Because Mrs. R. had never had the satisfaction of being loved by her mother, she was unable to love her husband and children, which i n turn prevented her from receiving their love. Perhaps Mr. R. drank because he could not reach his wife, and drink was an escape for him. Mrs. R. needed help as a person i n her own right; an expression of her feelings should have been obtained. She needed help to grow up and to accept her real wishes. What did motherhood mean to her? It appeared that her children were useful to her i n that they held Mrs. P's attention and won sym-pathy for Mrs. R. In particular, what did the f i r s t child, Helen, mean to Mrs. R.? Was Helen needed to get her mother's attention, and also, was It an attempt to make Mrs. R. more acceptable or at least more interesting to her mother? Young discusses these possibilities as one of the reasons some g i r l s become unmarried mothers.1 (Recall that Mrs. R. was illegitimate-l y pregnant with Helen when Mr. R. married her.) Mr. R., too, needs help as a person with his own needs and wishes. Why did he marry Mrs. R.? The record states that"he was sorry for her". His own drinking may have been an 1 Young, Leontine, Out of Wedlock, McGraw-Hill Book Co., New York, N.Y., 1947. 75 escape for him because he did not receive love from his wife. What did parenthood mean to him? It would be important to know what his expectations of marriage were. Hovering over this tenuous family, l i k e a wavering black cloud, i s Mrs. P. She too needs attention for herself, and she should be considered as much part of the problem to be dealt with as the R's themselves. When she does turn to the agency for help with her erring off-spring, the worker should explore with her her understanding of the R's problems and of the children's needs. Particularly i n the neglect case, the diagnostic and relationship bases must begin early with attention to each by interest and acceptance. The worker supports and builds i n the positive end of the ambivalent swings and holds i n the negative end to the minimum. Crises are used i n opening new areas, giving increased support, acceptance and firmness. Return of the Children: Case Closed The parents petitioned for their children's return, and their petition was approved by the judge though he gave them a "good, sound warning". We do not get the f u l l details of the judge's decision; while he knew the R's past history, he also, presumably, believed that they had reformed. The social worker had made many observations, but had no diagnosis or plan to offer the court. The case was transferred to another worker, and within the next nine-month period, 11 home calls were made. The R's 76 lived with Mrs. P. She was very domineering but the worker believed that Mrs. R. needed "a certain amount of direction' 1 and would not rebel "unless Mrs. P. became too controlling." The R's had given up drinking and smoking and were ardent supporters of the "Youth for Christ" movement. The worker believed that the home standards were higher and since the over-all improve-ment seemed satisfactory, the case was closed i n November, 1951. Superficially, the R's behaviour appears to have improved, but their behaviour seems to be directly affected by Mrs. P's controlling personality. As the worker noted, Mrs. R. "needed" her mother's domination. However, this "need" for controls was a part of the cycle that seemed unbreakable: Mrs. P. over-con-trolled Mrs. R. u n t i l she rebelled; when this break with the mother occurred, Mrs. R. became fearful because of her breaking away. Because of the lack of inner controls, Mrs. R. drank. The consequences of the drinking caused her to panic, which i n turn caused the fl i g h t back to the rigid controls of her mother. Mr. R. was swept along by his wife's swings of dependency. Moreover, he was probably a partial cause for Mrs. R's attempt to break away from control, because to her, he was another con-tr o l l i n g person from whom she had to escape. Reopening of Case Two months after the close, Mr. R. called, complaining that his wife was running around with other men. While he seemed more worried about her running around, he implied that Jimmy was not receiving proper care. The worker suggested that the R's 77 should li v e by themselves, but Mr. R. was afraid that i f they lived alone, his wife would take the children and leave him. The previous worker had suggested that Mrs. R. could be helped i f she lived with her mother. That was tried without success, and this alternative suggestion i s given. In retro-spect, i t appears to be a trial-error method, or at best, an attempt to manipulate the environment without examining the personality motivation. The worker visited and "suggested" the R's try to "iron out" their d i f f i c u l t i e s for "the children's sakes". As might be expected this was not too helpful to the R's. In the next two-week, period, Mrs. R. began to drink and stay away from home; Mrs. P. took the children. Mrs. P. swung from blaming her daughter and accepting Mr. R. to accusing Mr. R. of being too stubborn and asking the agen-cy to take the children, because she could not longer keep them. Mrs. R. was i n and out of her mother's home during this period; at one time she came to Mrs. P's house twice i n one night, banged furniture around and tore a l l her husband's good clothing. The police had to be called on this occasion. Mrs. P. said she had had trouble with Mrs. R. ever since she was 14 years old—she was "stubborn and got into rages i f she couldn't get her way." Mrs. R's uncontrolled actions appear to have started i n her childhood. She over-repressed her hostile feelings towards her mother. The mother's neurotic pattern of over-controlling did not allow her daughter to develop her own strengths and stan-dards. However, Mrs. R., as a child, tried to break from her mother's controls by being stubborn and going into rages. She 78 repeats similar actions as an adult, e.g., stamping i n and out of the office, cutting her husband's clothes. This diagnostic information should have been obtained early i n the casework relationship i n order that a diagnosis could have been made to indicate sound planning. Second Apprehension i Mr. R. came i n and asked for non-ward care as Mrs. P. refused to care for the children any longer. The agency refused his request because they f e l t that Mr. and Mrs. R. would ask for the children's return shortly after placement. Five days after Mr. R's request, the three children, aged 3, 2 and 1 were apprehended. Mrs. P. requested this because she said she could not afford to keep them, and she also indicated she had given up hope that her daughter would ever settle down. The next day, the R's were in, "breathing hatred for Mrs. P." According to them, Mrs. P. said that C.A.S. had insisted on placement. The apprehension occurred i n February of 1952; there was l i t t l e direct contact with the family after this. The R's rented a house from Mrs. P. and lived close to her. Mrs. P. asked for the children's return, and the parents applied for the return of Helen. (In the spring of 1952, the fourth child was born to the R's.) Helen's Return The judge allowed Helen's return to her home, but he did so reluctantly, believing the R's would "have their hands f u l l " 79 with two children. The reason for the return of even one child i s not clear, especially since the agency opposed return of any of the children. It i s unfortunate that social agencies, with their special knowledge of human behaviour and child development, do not carry more weight i n the legal decision when i t regards the future welfare of a child. Helen's change, from a "plump, well-cared for child" (when she returned to her home) to a "brat-tish", insecure child, after a half-year l i v i n g with her parents, causes speculation about the wiseness of the court's decision. The social worker's observations were borne out by an examination at the Child Guidance Clinic; Helen scored i n the low average of intelligence, but did not perform to the best of her a b i l i t y . She was unhappy, seemed restless and insecure; there was no close mother-daughter relationship. Chapter IV Implications of the Study Method and scope of study; Illustrations of gaps i n theory and practice; Some casework implications; Implications beyond the direct casework inferences; Essentials for successful work. CHAPTER IV IMPLICATIONS OP THE STUDY I. Method and Scope of Study This study was undertaken with the premise that the same basic social work principles are used' i n a l l phases of casework, including work with neglecting parents. The assumption we l i k e to make, that these principles consistently inform our practice, was certainly not borne out i n a survey of cases preliminary to the selection of those used for study. Approximately two dozen cases were read to find illustrations of this integral relation-ship of theory and practice, but i t was discovered that the principles were a l l too seldom realised i n the actual casework process. Therefore thia thesis i s concerned with the inconsis-tencies between what we might assume are the professional i n -tentions of caseworkers and what i s actually being practised. The case study method was used to analyse two cases. They were chosen with the help and suggestions of the staff of the Vancouver Children's Aid Society and the Vancouver Family Welfare Bureau on the basis of their having sufficient detail i n recording to indicate the significant points of worker-client interaction and relationship. The value of this kind of study l i e s i n the fact that i t illustrates the specifics of the thesis that a l l i s not well in casework practice, and, characteristically, i t points up how 82 the casework process and clients' lives go awry when fundamental casework principles are not an essential part of the worker and his work. II. Illustrations of Gaps i n Theory and Practice The basic philosophy of social casework revolves around the belief i n the worth of every individual, and in the belief that he can change, according to his potential, to find his most satisfying social adjustment. The six axiomata stated i n Chap-ter I 1 w i l l be reviewed to illustr a t e from the two cases where the practice did not follow theory. (It might be added that where practice did reflect theory, i t w i l l also be cited.) A. Belief i n the Personal Worth of the Indivi-dual and the Right to Change in His Own Way This principle implies that the social worker w i l l make every effort to understand and respect the client as a person, with his personal and individual beliefs and feelings. The need for individualizing the client and his needs i s essential i f effective help i s to be given. In the Gunderson case, the worker made l i t t l e attempt to know Mr. or Mrs. G. as individuals with their own unique feelings and ideas. When Mrs. G. indicated that she had some feelings about appearance, the worker ignored the opportunity to find out what she thought about herself. The worker, throughout the record, referred to the G's as being "immature", but there was no attempt to go beyond this definition to see the G's as people. In the Reardon case, too, the worker ignored the clients' worth and the fact that they were situated i n a unique "reality". 1 See Chap. I, p. 17. 83 The workers attempted to change the R's hy advising them "not to give cause for...complaints". Throughout the record this "advis-ing" i s recorded as the "casework help" the worker used, presumably under the impression that she was working with intractable child-ren, when i n reality, they had never been treated by the worker (or Mrs. P.) as anything but children. B. Belief in the Individual's Potential for Growth and Change This concept i s closely a l l i e d to the concept of the belief in and respect for the worth of each person. However, i t goes beyond the f i r s t concept i n that i t indicates the possibility for each individual to change. The cases reveal, more implicitly than explicitly, the workers' attitudes that their clients could not change. When Mrs. G. asked for help with.Joan, the worker evidently discarded any possibility of helping Mrs. G.change, and instead focussed the planning on Joan. (This may have been the wisest course i f Mrs. G. was too disturbed to be helped by casework, but i f this was a fact, i t i s not recorded.) In the Reardon case, the lack of faith i n this concept is repeatedly demonstrated by the worker's methods of attempting to change the clients by "direct appeal and suggestion. It i s as i f the clients, could be moulded by the worker without any inner change i n themselves. C. Behaviour i s Purposeful and Meaningful Unless causes of behaviour are known, the f i r s t two con-cepts used in practice are seldom very helpful. The concept that 84 "behaviour i s purposeful and meaningful provides the basic tool of casework help—diagnosis and planning. In a neglect case, with-out an understanding of why the person acts as he does, the best intentioned of social workers cannot help the parents with their conflicts. In the Reardon case, a diagnostic assessment of Mrs. R's actions i s completely missing. The worker vaguely saw that Mrs. R's actions were bound to her mother's controlling influences, but there was no attempt to relate the dynamic cause-effect relation-ships into a meaningful plan. In the Gunderson case, diagnosing i s done to a greater degree (probably because the neglect i s quite clear-cut and drama-t i c ) ; however, the planning appeared to be concerned with Joan alone i n mind. There was no attempt to meet Mrs. G's needs. When the C.A.S. and F.W.B. workers met, they decided that G.A.S. would try to find a home for Joan, and that F.W.B. would withdraw "gradually". However, the day that Joan was safely out of the house was the last day that the F.W.B. worker saw Mrs. G. Certainly Mrs. G. needed a special kind of help, and whether or not a social agency could have given i t , depended partly on the diagnostic evaluation of the severity of her per-sonality disturbance. Whether two agencies should be counselling in one family depends on the individual situation, and perhaps i t was wiser for C.A.S. to assume the entire responsibility. How-ever, in this case, one does question the rapidity with which F.W.B. relinquished their casework responsibility. D. Each Individual has a Right to Personal Freedom and Growth This i s a right which i s linked to the f i r s t concept, 85 which affirms the belief i n personal worth and the right of each individual to grow, according to his own choosing. The right to growth and freedom implies the possibility of natural development of an individual from that of a helpless infant to that of a mature, self-sufficient adult. Implicit i n the statement i s that when the natural development of growth has been halted, the individual has the right to find a way to grow to maturity. As i t concerns the functioning of social work, i t implies that the social worker has a responsibility to help the client grow out of immaturity. Both Mrs. G. and Mrs. R. had not grown to a personal freedom: Mrs. R. was emotionally tied to her mother, and Mrs. G. was bound to her infantile needs which had never been satisfied. (She too was bound to her mother but less directly observably so than Mrs. R.) Mrs. R's bid for freedom was reflected i n her excessive drinking and temper tantrums. Mrs. G., too, drank to excess and moreover, tried to force Joan into giving her what she had missed in her own childhood. Both of the women failed i n their neuro-t i c attempts to gain satisfaction, and in addition, entrained other people with them on their "searches". In both instances, the caseworkers did not see the women's need for growth and freedom, but instead focussed on their actions, which often included rejection or neglect of the children. Had the workers seen the actions as a struggle for emancipation, and treated i t as such, both Mrs. R. and Mrs. G. might have been helped, and consequently their families would have been aided. 86 B. Each Individual Inter-Relates i n Society This concept implies two things: cause-effect relation-ships and interaction of one individual or group to another. This includes the community's responsibility to the individual and vice versa; the social worker i s concerned because he has a responsibility to help the client to become a constructive part of his society. Applied to the casework process, the concept means that the individual affects and i s affected by his own family, his immediate neighbourhood, and the larger community and nation. While this might appear to be a truism and one which would be underwritten i n any social diagnosis, i n both cases, i t seems to have been forgotten. For example, Mrs. P., because she was not in the immediate R. family, was overlooked as a direct cause for Mrs. R's escapes into drunkenness; i f her effect was noticed, there was no attempt, to counteract the damaging results on the R's lives and on the casework relationship. F. The Family i s the Primary and Most Dynamic Unit of Society Social workers believe that the family (as long as i t i s a true family) i s the best place for the child to be, unless the parental neglect, either physical or emotional, i s so severe.that i t i s preventing the child from achieving a normal development. Caseworkers, i n order to evaluate family strength, must understand the dynamics of personality delveopment and of inter-personal relationships. . In a neglect case, where the possibi-l i t y of family separation may exist, the worker must be particu-87 l a r l y aware of the affect of the damage being done to the child, and he must also be aware of the affectional bonds between the family members. Only when the parental neglect i s causing more damage than removal would, and when i t i s obvious that the parents cannot change, should the children be removed. The G-underson case presented a clear-cut example of the parent directly requesting the child to be removed, and also of the child herself requesting removal. The R. case was less clear-cut because the parents were not consistent in their wish to keep the children. Too often, i t appeared that the worker accepted, at face value, the parents' (and Mrs. P's) actions and talk as their real wishes. III. Some Casework Implications The philosophic concepts underlying social work are indeed ide a l i s t i c , but they are more than that: they are working tools necessary to the day-to-day work, and i f one of them i s negated, the entire casework process i s weakened. In the two cases studied, gaps between practice and theory did exist, and in fact, appeared to be the rule rather than the exception. There i s an assumption of this study that misuse or no-use of the basic concepts was a determinate influence in the quality of the work done. A. Lack of Meaningful Casework Relation-ships; Some Causes and Implications A good relationship, which i s the essential basis for any successful casework, was absent with both the R's and Mrs. G. No meaningful relationship was made with the R's because the 88 worker did not see them as people, but rather as "neglecting parents". As she regarded them i n a stereotyped manner, so did her v i s i t s to them reflect her lack of interest i n , or respect for, them as people with inherent worth. Certainly, part of the d i f f i c u l t y i n forming a meaningful relationship revolves around thinking i n terms of labels and over-rigid categories, rather than i n terms of individual personalities. Labels and categories have an'important usage i n treatment plan-ning, but when the label, rather than the person, i s treated the concept of personal worth i s negated and the entire purpose of agency service i s lost. B. Use of Authority Another contributing influence which complicated the development of a good relationship appeared to be the workers' misuse of authority. A social agency has certain responsibilities to the community and to the client. Responsibility implies autho-r i t y , both as part of the legal framework i n which the agency operates, and also i n the active use of i t to carry out agency functions. This does not mean the super-imposing of authority, but authority as part of the case work process. The worker must understand the implications of having inherent or direct authority, because until he understands and feels comfortable i n the use of authority, he w i l l mis-handle i t . The authoritarian attitude of workers in the Reardon case hindered the formation of a positive relationship, and moreover, i t had a negative affect on the attempt to help the R's find a satisfac-tory solution to their problems. 89 Why does this confusion i n the usage of authority exist? The profession of social work, being relatively young, may be reacting to the pioneer social work philosophy which emphasised the authoritarian approach. Some workers w i l l s t i l l use this method of "pointing out", "directing", and "t e l l i n g " the client (witness, particularly, the Reardon case). Another characteristic reaction, more typical i n the Gfunderson case i n i t s second phase, i s to avoid any use of authority. The worker i s a kindly, friendly v i s i t o r who makes desultory calls i n the complacent hope that the mere presence of a social worker w i l l generate a beneficial influence. The proper uses of authority present a real problem, both in the philosophy and practice of social casework. The over-use of authority can negate the client's rights to personal freedoms; in neglect cases some parental rights may be abrogated when the children's welfare i s endangered. In the Reardon case, i t may have seemed "easier" to do nothing than to take action; however, the choice of "nothing" resulted i n poor work. These gaps between knowledge, theory and practice pose c r i t i c a l questions for the profession. This study considers only two cases, but how i s authority generally used? What i s the place of authority in casework? It has been used successfully; with other social problems, e.g., i n probation, with adolescents and i n treatment centres. Can some of the lessons of that work be applied to neglect situations? Do the special casework techniques needed i n neglect work c a l l for a specially trained, or specially oriented social worker, i n particular a person who can use authority i n a helping way? 90 Up to now, the profession has taken no definite stand on this issue, and u n t i l the various questions are examined and resolved, casework services to clients w i l l he inferior and con-fused. C. Lack of Treatment Plan If a good worker-client relationship i s the basis for treatment, the treatment plan i s the corner-stone of casework help. The five steps of the treatment plan study, diagnosis, plan, acting and re-evaluating are absolutely essential i n help-ing the client. Both cases revealed an abundance of dlagnostlcally Impor-tant information but neither case (especially the f i r s t phase of the Gunderson case) went beyond the f i r s t study, and consequently l i t t l e help was given. While the worker's attitudes and beliefs, largely deter-mine the quality of the relationship, planning depends on the worker's knowledge, both of human behaviour and of the casework process. Since diagnosis and planning were so obviously missing in both cases, one wonders i f the workers were- ignorant of i t s uses. Or were they aware of i t s value, but believed i t inap-plicable to a neglect case? Whatever the answers, the facts point to a need for a greater emphasis on the importance of diagnosis and planning as v i t a l processes i n casework dealing with a l l types of problems. IV. Implications Beyond the Direct Casework Area Though this is a study concerned primarily with the 91 actual casework process, i t contains inferences applicable to social work as a whole. While casework's immediate responsibility i s with the direct rehabilitation of the client, i t s secondary (and more far-reaching) concern i s with the social and physical environ-ments that produce debilitating effects. A. Treatment Resources: Those Closely Allied with Direct Casework Treatment The casework process deals with people who need social rehabilitation, and the resources directly used and implemented by the casework process are treatment aids. The two cases i l l u s -trated the use of some of these aids, and also indicated where additional services could help the casework process. 1. Interaction between the social work profession and other profes-sions The cases illustrated interaction, and sometimes lack of understanding, with the medical and legal professions. In the f i r s t phase of the Gunderson case, the worker slavishly accepted the doctor's' recommendation as law, to be followed without ques-tion. In the Reardon case, there i s an allusion to the legal profession's lack of understanding of human behaviour and develop-ment, especially as i t applies to the decision for return of a child to his home. We would not expect the judge to have that knowledge, but we could reasonably expect that he would use and rely upon the knowledge of someone else who does know, and who, in this case, i s the social worker. 2. Inter-agency cooperation Inter-agency cooperation i s best illustrated in the . 92 referral from F.W.B. to C.A.S. i n the Gunderson case. This i s a clear-cut example of the functional use of transfer of case res-ponsibility from an agency without child-placing authority to an agency which has both legal function and f a c i l i t i e s for placement. 3. Foster-home f a c i l i t i e s In the case of the emergency removal of Joan, there was no available foster home so she was temporarily placed with relations. Joan's case illustrates the need for a receiving home which would provide temporary care for children, while the parents and agency made long-term plans. If permanent placement was the plan decided upon, less haphazard "permanent" placements would result because the worker would be under less stress to find a home immediately. A treatment centre, with psychiatric f a c i l i t i e s , i s neces-sary for any child-placing agency. While some children under agency care have had many of their normal needs met before place-ment, many others have had disturbing negative experience before placement. Children with a background similar to Joan's deprived years present behaviour problems that are too severe for most foster parents to accept. If the ultimate aim of a children's agency i s to provide an environment for the child in which he can develop into a mature adult, i t appears most unrealistic to expect untrained, underpaid foster parents to assume the day-to-day responsibility of rearing a disturbed child. A treatment centre i s essential to treat the severely emotionally damaged child so he w i l l be able to li v e i n an ordinary foster home. 93 B. Preventive Resources Social work has a responsibility beyond that of giving direct services to the client; this responsibility involves the attempt to provide community services and resources which, i f present, would aid i n the individual's growth and would help to prevent personal and family breakdown. Perfection in, and com-plete access to, casework s k i l l s as such would only alleviate some problems which are, at least, partially caused by the ab-sence of certain resources. Moreover, i t i s unrealistic to expect a caseworker to treat an individual or family when the means for minimum mental and physical growth are absent. Adequate housing i s one of the essential means that pro-vides a foundation for sound family l i f e . An income (whether i t i s a pay cheque or government allowance), on which the family can maintain acceptable standards i s another essential. Some other imperative requirements to which the individual i s entitled, are medical and dental f a c i l i t i e s , suitable outlets for leisure-time activities. The philosophy of social welfare asserts that each in d i -vidual has the right to a minimum standard of l i v i n g which w i l l lay the groundwork for the best possible physical, mental and emotional growth. In believing this, the social worker has an ethical responsibility to be aware of lacks i n community resources, and most important, to engage himself i n action appropriate to having these resources supplied. V. Essentials for Successful Work in the Neglect Situation This study of two cases has illustrated that there are 94 large gaps between the casework philosophy and the casework. This- discrepancy appeared to be a contributory cause i n the poor quality of the casework, and consequently, to a lack of progress i n client adjustment. Casework relationships were poor, and this too, seemed to be due to the lack of the worker's feeling that the client had worth as a person. Another contributing cause to the poor rela-. tionship (and to the quality of the casework) was the worker's unsure feelings about the use of authority. The essential steps of diagnosis and planning were not used, which further qualified . the worker's help to the client. Therefore, i t appears that i f casework i s to be effective with neglect cases, i t i s essential that the worker must believe and practice the basic concepts relating to the belief i n each individual's worth. The worker must be comfortable and sure in his use of authority; furthermore, he must use diagnosis and planning as an essential part of the casework treatment. BIBLIOGRAPHY Specific References Books Dependent and Neglected Children. White House Conference on Child Health and Protection, 17, C-l, Appleton-Century, New York, N.Y., 1933. Polks, H., The Care of Destitute and Delinquent Children. Macmil-lan, New York, N.Y., 1902. Hubbard, R., Crusading for Children. The Massachusetts Society for the Prevention of Cruelty to Children, Boston, 1943. Lundberg, E., Unto the Least of These, Appleton-Century Co., Inc., New York, N.Y., 1947. Young, L., Out of,Wedlock. McGraw-Hill Book Co., New York, N.Y., 1954. Articles Biestek, P., "The Non-Judgemental Attitude", Social Casework, June, 1953-Mead, M., "What i s Happening to the American Family?" Social Case-work, November, 1947. Regensburg, J., "Reaching Children Before the Crisis Comes", Social . Casework, March, 1954. Sherriffs, A., "Authority in the Client-Worker Relationship: Asset or Liability?" Federal"Probation. June, 1953. Welsch, E., "Sustaining the Child i n His Impaired Home", Child  Welfare. July, 1953. Pamphlets and Studies Child Protection in Canada. Canadian Welfare Council, Ottawa, 1954. 96 Proven, N., "Seeking Placement Permanency for Poster Children", University of British Columbia, unpublished thesis, 1953. General References Brumbaugh, 0., "Protective Service—Whose Responsibility?" Child  Welfare, April, 1953. De Schweinitz, E. and K., "The Place of Authority i n the Protec-tive Function of the Public Welfare Agency", Bulletin of the  Child Welfare League of America, September, 1946. Gordon, H., "Protective Services for Children", Bulletin of the  Child Welfare League of America, May, 1946. Hutchinson, D., "The Parent-Child Relationship as a Factor i n Child Placement", The Family. April, 1946. Lane, L., "'Aggressive1 Approach in Preventive Child Welfare Case-work with Children's Problems", Social Casework. February, 1952. Overton, A., "Serving Families Who 'Don't Want Help'", Social Case- Work. July, 1953. Page, N., Protective Service. A Case Illustrating Casework With Parents. Child Welfare League of America, Inc., New York, N.Y., 1947. Wisgerhof, H., "Casework i n Non-Voluntary Referrals", Social Case- work, November, 1947. 

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