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Development of the Social Service Department at the Woodlands School : a review and assessment of developments… Sampson, Leonard Stanley 1954

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DEVELOPMENT OF THE SOCIAL SERVICE DEPARTMENT AT THE WOODLANDS SCHOOL A review and assessment of developments i n The Woodlands School, New Westminster, B. C, (1931 - 1953) by LEONARD STANLEY SAMPSON Thesis Submitted i n P a r t i a l Fulfilment of the Requirements f o r the Degree of MASTER OF SOCIAL WORK in the School of Soc i a l Work Accepted as conforming to the standard required f o r the degree of Master of So c i a l Work School of Social worK 1954 The University of B r i t i s h Columbia i i i ABSTRACT This study makes an examination of a t r a i n i n g pro-gramme i n an i n s t i t u t i o n f o r the mentally handicapped. It outlines the hist o r y of t h i s i n s t i t u t i o n and traces the development of the t r a i n i n g programme through i t s various stages, with s p e c i a l reference to the contribution which s o c i a l work has made to the r e h a b i l i t a t i v e programme. The study makes an appraisal of t h i s i n s t i t u t i o n ' s e x i s t i n g programme i n l i g h t of accepted p r i n c i p l e s and stan-dards of pr a c t i c e , derived from an examination of relevant professional medical and s o c i a l material i n the f i e l d . Mat-e r i a l studied included reports of the medical d i r e c t o r of The Woodlands School, reports of the P r o v i n c i a l Supervisor of Psychiatric S o c i a l Work, and a r t i c l e s written i n pro-fe s s i o n a l p e r i o d i c a l s and books on the subject. Other' material was obtained by personal observation of The Wood-lands School's programme and by personal interviews with various s t a f f members. The case material was obtained from the case records of the Soc i a l Service Department of The Woodlands School. These records cover a two-year period, 1951 through 1953. The conclusions of t h i s study indicate that the services f o r the t r a i n i n g and education of the mentally handicapped are seriou s l y l a c k i n g i n B r i t i s h Columbia with p a r t i c u l a r reference to s o c i a l services. I t i s recom-mended that both lay and professional groups i n B r i t i s h Columbia reassess t h e i r current programmes f o r the men-t a l l y handicapped i n l i g h t of e x i s t i n g standards so that a more adequate understanding of needs i n t h i s area may be at t h e i r disposal. The need f o r greater expan-sion of r e h a b i l i t a t i o n services f o r the mentally handi-capped i s stressed. * * » i v ACKNOWLEDGEMENTS I wish to acknowledge indebtedness to the s t a f f i n the various departments at The Woodlands School f o r t h e i r i n t e r e s t and co-operation i n the preparation of t h i s thesis. Acknowledgement i s also made of the d i r e c t i o n of Miss A. C a r r o l l , P r o v i n c i a l Supervisor of Psychi a t r i c S o c i a l Work, Dr. Leonard C. Marsh, Miss Muriel C u n l i f f e and Mr. William Dixon of the School of So c i a l Work without whose help t h i s thesis would not have been completed. * * # i i TABLE OF CONTENTS Page Chapter 1. The Problem of Mental Retardation. Mental deficiency and mental retardation. Stan-dards f o r I n s t i t u t i o n s f o r the mentally retarded. Adaptation of S o c i a l Work to the f i e l d of mental retardation. Contribution of S o c i a l Work to the f i e l d of mental retardation. Method of the present study 1 Chapter 2. The Development of the I n s t i t u t i o n a l Programme f o r the Mentally Retarded i n  B r i t i s h ColnmbiaT ! Public concern f o r the mentally retarded. Admission Procedure. The Woodlands School Today. Formal Academic Programme of The Woodlands School. Psychology Department. Nursing Department. Occu-pational Therapy Department. Linen and Clothing Department. Other F a c i l i t i e s 22 Chapter 3. The Movement of S o c i a l Service into The  Woodlands School. Beginnings and development of the S o c i a l Ser-vice Department. Present organization of S o c i a l Ser-vice Department. Functions of the So c i a l Service Department. Intake and Reception. Continuing Ser-v i c e . Rehabilitation and Community Interpretation 43 Chapter 4. Conclusions. Introduction. S k i l l s of the s o c i a l worker. The Treatment Team Approach. Contributions of the S o c i a l Service Department. The need f o r research. Physical f a c i l i t i e s . S t a f f t r a i n i n g . Administrative procedure. PUblic int e r p r e t a t i o n . Other considera-tions. 5 8 Appendix: A. Bibliography. * * * V DEVELOPMENT OF THE SOCIAL SERVICE DEPARTMENT AT THE WOODLANDS SCHOOL A Review and Assessment of Developments i n The Woodlands School, New Westminster, B.C. (1931 - 1953) CHAPTER I MENTAL RETARDATION IH GENERAL The f i e l d of training, education and rehabilitation of the mentally retarded has been receiving an increasing amount of attention in recent years. With the rapid expan-sion of mental health services has come an ever-Increasing concern for the mentally retarded child. Professional s k i l l s in the areas of medicine, psychiatry, psychology, education, social work and sociology have contributed much to the rise of this present day concern about programmes for the men-tal l y retarded. In order to study effectively present day programmes for the mentally retarded, i t w i l l be necessary to clear up some of the prevalent confused thinking on this subject. What i s mental retardation? Is i t comparable to mental i l l -ness? Are there any hopes for the mentally retarded person? If there are - what are they? Unfortunately, there i s no clear-cut universally acceptable definition of "Mental Retardation.1* However, the definitions which have been formulated on the subject give one many clues so that an intelligent understanding of the d i f f i c u l t i e s encountered in defining such a complex subject may be obtained. England's Mental Deficiency Act of 1927 states that "mental defectiveness means a condition of arrested or in« complete development of mind e x i s t i n g before the age of eigh-teen years, whether a r i s i n g from inherent causes or induced by disease or i n j u r y . " 1 Or. George A. J e r v i s , writing on the medical aspects of mental deficiency, states that "Mental deficiency may be defined, from a medical point of view, as a condition of arrested or incomplete mental development induced by disease 2 or i n j u r y before adolescence, or a r i s i n g from genetic causes." I t i s necessary to note at t h i s point that "mental retardation" and "mental def i c i e n c y " are not, and should not be, synonymous terms. The former suggests slowness of devel-opment, whereas the l a t t e r suggests a condition produced by a con s t i t u t i o n a l or organic d e f i c i t . "The s o c i a l implications of •mental retardation' are p r i m a r i l y educational and may extend to the vocational adjustment i n adulthood. The term 'mental d e f i c i e n c y , ' on the other hand, should be r e s t r i c t e d f o r a condition of men-t a l arrest r e s u l t i n g i n s o c i a l inadequacy which i s not amen-able to fundamental improvement through education and exper-3 ience and any known treatment." - - - ; : , ; e Tredgold, A.P., Mental Deficiency. B a i l l u r e , London, Eng-land, 1952, p. 3. 2 DiMichael, G. Salvatore, Vocational Reha b i l i t a t i o n of the Mentally Retarded. Washington, D.C, U.S. Government, p. 1. 3 Myers, C. Rogers, Toward Mental Health i n School. U. of Toronto Press, 1947, p. 38. - 3 ~ Both the concept and diagnosis of mental deficiency were well developed before the advent of i n t e l l i g e n c e and other psychological t e s t s . However, the concept and diagnosis of mental retardation were not developed u n t i l a f t e r the v a l i -dation of i n t e l l i g e n c e t e s t s . Therefore, i n order to describe mental retardation adequately, i t i s necessary to have the scores of mental and educational tests which the mentally retarded person has completed. Tet d i f f i c u l t y i s encoun-tered i n t h i s area because test scores do not show the under-l y i n g modes of i n t e l l e c t u a l functioning. There can be no un i v e r s a l l y v a l i d s i n g l e concept of mental retardation, according to Dr. T h o r l e i f G. Hegge, 1 because such a concept must contain a l l the suitable educa-t i o n a l , psychological, vocational and s o c i a l c r i t e r i a neces-sary i n such a concept. Dr. Hegge goes on to state that the actual formulation of the concept w i l l vary somewhat with the circumstances and with the purposes which i t must serve. Consequently, d e f i n i t i o n of mental retardation would vary f o r the purposes of education, medicine, s o c i a l work, psychology and vocational r e h a b i l i t a t i o n . Is mental retardation comparable to mental i l l n e s s ? The answer to t h i s question i s , d e f i n i t e l y not. The mentally i l l are not necessarily mentally retarded, and the mentally retarded are not nece s s a r i l y mentally i l l . In many cases the 1 Hegge, T h o r l e i f , Psychological Aspects of Mental Retar-dation, Vocational Rehabilitation of the Mentally Retarded. U. S. Government, 1950, p. i s . - 4 = mentally retarded are p e r f e c t l y healthy, both p h y s i c a l l y and mentally. They are simply below the average i n mental stature, and they make up only a small percentage of the patients i n our mental h o s p i t a l s . I t must be remembered, however, that a l l mentally retarded persons do not show the same degree of mental retardation. Feebleminded persons do not constitute a d i s -t i n c t group, and they do not represent a d i f f e r e n t kind or type of human being. Mentally retarded persons range a l l the way from the almost completely h e l p l e s s . i d i o t to the high-grade moron who may have p e r f e c t l y normal appearance and, who may be able to carry on as a normal Individual and be a use-f u l c i t i z e n . The d i s t i n c t i o n between the mentally retarded and the mentally d e f i c i e n t i s an important one, f o r the mentally retarded person i s amenable to the educational and t r a i n i n g programme whereas the mentally d e f i c i e n t person has not the mental capacity to p r o f i t from such programmes. For the purpose of t h i s study the terms "mentally retarded" w i l l r e f e r to those persons who may benefit from an adequate educational and t r a i n i n g programme. The term "mentally handi-capped" w i l l be used as a general term covering both the "men-t a l l y retarded" and the "mentally d e f i c i e n t " but not includ i n g the "mentally i l l . " the mentally handicapped may be divided roughly into three groups. F i r s t there are the mentally handicapped persons of very low-grade i n t e l l i g e n c e who are almost e n t i r e l y dependent upon others for physical care and well being. Secondly there are those who require only social protection rather than physical care from parents and the community. Lastly, there are those who under ordinary circumstances and appropriate education, can lead f a i r l y independent lives in the community. A large number of the f i r s t group may have to be given permanent custodial care, whereas many i n the other two groups may profit by a combination of institutional training and supervision of their lives i n the community. Others, pos» sibly a very large proportion, may l i v e happy and usefully normal lives within their own family spheres or in the com-munity. Are there any hopes for the mentally retarded per-son? One would only have to look around to see the number of institutions which are based on hope for helping the men* t a l l y retarded. The modern approach to the problem of mental retardation consists of special education and community super-vision. It i s now known that there i s definite hope and i t must never be thought that the specific training of the men-t a l l y retarded i s a hopeless or worthless procedure. "The feebleminded, no matter how defective, are never ineducable."'1' The success of present day programs for the mentally retarded proves conclusively that they can and are being made both happy and more useful to society through special training. 1 Kvers. C. Rogers, op. c i t . . p. 39. The implications of mental retardation pose a pro-blem to the community. Estimates at the present time place one per cent of the population i n the mentally retarded range. 1 Another thirteen per cent of the population are estimated to have an " i n t e l l e c t u a l equipment that i s so mar-ginal that unusual s o c i a l pressure or temperamental i n s t a b i -l i t y i s l i k e l y to p r e c i p i t a t e the i n d i v i d u a l i n t o i n s u f f i -2 eiency.* With so large a group f a l l i n g i n t o the mentally retarded range, and i n view of the former outlays of public expenditures f o r i n s t i t u t i o n a l i z a t i o n with l i t t l e or no worth-while return, i t i s l i t t l e wonder that public concern has been aroused i n the area of education, t r a i n i n g and r e h a b i l i -t a t i o n of the mentally retarded. Consequently, with the dev-elopment of greater s k i l l s i n diagnosing cases of mental retardation has come a sharp r i s e i n the admission rates to various schools f o r the mentally handicapped. The t r a i n i n g and educational functions of the schools f o r the mentally handicapped are almost a s t o r y i n themselves. A c t i v i t i e s c a r r i e d on by these schools range from the simplest of occupational therapy to the undertaking of preliminary t r a i n i n g f o r industry. I t i s now recognized that no philosophy i s v a l i d f o r the education of the mentally 1 Gibson, Robert, Mental Deficiency as a Basic D i s c i p l i n e i n the Training of a P s y c h i a t r i s t , Mental Health. National Association of Mental Health, Summer, 1952, p. 272. 2 Mental Hygiene, S o c i a l Work Tear Book. 1945, p. 272. - 7 = retarded which i s not b e n e f i c i a l to the retarded themselves. Such a philosophy would n a t u r a l l y have to be based on a r e a l -i s t i c assessment of the strengths and weaknesses of the retarded as well as on the place they may eventually occupy i n society. " I t i s now believed that the retarded have a potential contribution to make to the world i n which they l i v e , and that i t i s a primary function of s p e c i a l education to help the retarded to r e a l i z e such p o t e n t i a l i t i e s . * 1 As ea r l y as 1931 the White House Conference stated: Serious consideration must be given to the curriculum best suited to the needs of subnormal (retarded) c h i l d r e n . Tbe aim i s to develop the c h i l d ' s mental capacities and the control of b i s emotions to the point of adequate s o c i a l adjustment and the curriculum must necessarily be determined i n part by adult r e q u i s i t e s . Tbe f i r s t point to consider i s what work these sub-normals (retarded) w i l l eventually be able to do. 2 Dr. E l s i e Martens, Chief, Exceptional Children and Youth, a department i n tbe United States O f f i c e of Education, has stated: Education f o r the mentally retarded i s not d i f f e r e n t i a i t s aim from education f o r any group of ch i l d r e n . This aim i s to teach the i n d i v i d u a l how to l i v e better; to teach him to use a l l of h i s capacities; to teach him to become a useful and a contented member of the s o c i a l group. Whether be i s i n a day school or i n a r e s i d e n t i a l school, the general purpose i s the same. The s o c i a l group of which he i s a member may be the community at large or i t may involve tbe more circumscribed l i f e of the i n s t i -t u t i o n . Tet the aim i s always to make him a better and more e f f i c i e n t member of the group i n which he l i v e s . This i s the philosophy underlying every curriculum ad-justment . 3 Hungerford, R.H., C. De Prospo, L. Rosenzwig, Education of the Mentally Handicapped i n Childhood and Adolescence, Vocational Rehabilitation of the Mentally Retarded. U. S. Government, 1950, p. 54. Loc. c i t . 3 Loc. c i t . - 8 -Dr. Charles Scott Barry, writing i n a b u l l e t i n of the Michigan State Department of Education, states: There has been much time, money, and e f f o r t wasted i n the education of subnormal (retarded) childr e n through f a i l u r e to recognize c l e a r l y the proper aim of education i n the case of t h i s type of c h i l d . Since about 20 per cent of the adult population are engaged i n u n s k i l l e d labor the f o l l y of attempting to prepare childr e n of the most I n f e r i o r i n t e l l i g e n c e f o r s k i l l e d labor or f o r e l e c -t r i c a l work i s self-evident. The aim of the teacher, a f t e r a thorough t r i a l i n the s p e c i a l c l a s s had demon-strated the i m p o s s i b i l i t y of the pupils ever success-f u l l y doing regular grade work, should be to prepare him to become a law-abiding, self-supporting c i t i z e n , i n the simplest occupations.1 Thus, many educators have come to the conclusion that i f the retarded are to r e a l i z e f u l l y t h e i r p o t e n t i a l i t i e s they must be given a d i f f e r e n t developmental programme rather than a remedial or impractical adaptation of a normal programme. In order to meet succe s s f u l l y the needs of the retarded such a programme should give to each c h i l d competency i n the follow-ing: (1) The technique of measuring and knowing oneself. (2) A basic understanding of the job f a m i l i e s and s o c i a l requirements which one i s suited to meet. (3) The technique of meshing a b i l i t i e s with vocational and s o c i a l requirements. (4) The "drive" or desire f o r s o c i a l contribution. Therefore, the entire program f o r the education of the mentally retarded must be constructed around achievement i n the areas of vocational and s o c i a l competency, f o r i n these Hungerford, R.H., Loc. c i t . areas, i f i n no others, the retarded w i l l most nearly reach normalcy. In Hew York C i t y t h i s d i f f e r e n t developmental pro-gram i s c a l l e d •Occupational Education.* 1 This program i n -cludes the following f i v e major areas: (1) Occupational information-giving the p u p i l Information concerning the work available to him: how t h i s work i s done (job a n a l y s i s ) ; and what i t s importance i s to the world. (2) Vocational guidance-guiding tbe p u p i l to measure h i s own a b i l i t i e s against the requirements of the job i n which he i s interested; showing other jobs i n the same work area. (3) Vocational t r a i n i n g - g i v i n g the pup i l t r a i n i n g i n the manual s k i l l s found i n tbe work area (25 per cent); t r a i n i n g i n the nonmanual s k i l l s necessary i n the work area (25 per cent); t r a i n i n g i n general habits, a t -titudes, and s k i l l s common to a l l good i n d i v i d u a l i t y , workmanship, and c i t i z e n s h i p (50 per cent). (4) Vocational placement-providing the i n d i v i d u a l with actual job placement i n cooperation with other agen-c i e s . (5) S o c i a l placement-adjusting the adult on the job and i n tbe freedom of h i s f i r s t independence f o r as long a period as may be necessary, again i n cooperation with other agencies. 1 Hungerford, R.H., C. De Prospo, L. Rosenzwig, Education of the Mentally Handicapped i n Childhood and Adolescence, p.55. - 10 -Occupational Education i s an inclusive programme Which prepares the retarded child for many possible l i f e situations. This programme seeks to give the retarded child sufficient freedom to enable him to develop his capabilities for self-support and yet sufficient protection from rigorous competition to keep him from being too hopelessly discouraged to u t i l i z e these capabilities. It provides a number of occu-pational-social s k i l l s leading toward a social maturity that includes occupational adjustment as a part of total adjust-ment. As such i t provides a good example of present day trends i n tbe education and training of the retarded. It must be kept i n mind, however, that there i s no known method of changing the degree of a person's native intelligence. Such intelligence i s fixed at birth and remains constant throughout l i f e . Therefore mentally retarded persons cannot be made more intelligent by present educational methods. They can, however, through training and education, develop greater potentialities and a more efficient approach to their l i f e situation. Standards of Practice The American Association on Mental Deficiency be-lieves that the underlying objective of every institution for the mentally retarded i s : To provide sheltering protection for the retarded individual, to provide opportunity for him to grow phy-s i c a l l y , mentally, emotionally, and socially to bis f u l l limits of growth, to restore and rehabilitate him both within his limitations and the limitations of the - 11 -knowledge and culture of h i s times, and to t r a i n and educate him i n s o f a r as h i s capacities permit, with the goal i n mind of permitting him to l i v e h i s l i f e , whether i n the i n s t i t u t i o n or returned to the commun-i t y , with as much di g n i t y , happiness and usefulness as may he inherent to him.l The following p r i n c i p l e s were evolved by t h i s Asso-c i a t i o n : (1) A modern physical plant, free from hazards and pro-p e r l y equipped f o r the comfort and s c i e n t i f i c care of the pat-ient . . (2) A competent, well trained executive o f f i c e r or admini-s t r a t o r with authority and r e s p o n s i b i l i t y to carry out the p o l i c i e s of the i n s t i t u t i o n as authorized by the governing l e g i s l a t i o n concerning mental deficiency i n the state i n which the i n s t i t u t i o n operates and without hazard of p o l i t i c a l i n -terference or r e t r i b u t i o n . (3) An adequate number of e f f i c i e n t personnel, competent i n t h e i r respective duties and conforming to proper ph y s i c a l , mental, educational and character standards f o r the duties they perform, and under competent supervision, (4) An adequate medical s t a f f of e t h i c a l , Competent phy-si c i a n s f o r the e f f i c i e n t care of the patients and f o r carry-i n g out the professional p o l i c i e s of the i n s t i t u t i o n i n keep-ing with the accepted minimum therapeutic standards as est-ablished by the American Medical Association and competent, well trained s t a f f i n the f i e l d s of psychology, education, d i e t e t i c s , and s o c i a l service to assure adequate diagnosis, study, t r a i n i n g , supervision and r e h a b i l i t a t i o n of the pat-ient by contemporary standards i n these various d i s c i p l i n e s . (5) A systematic program of preparing patients f o r return to the community when advisable, or supervising them i n the community, and of collaboration with community services i n connection therewith. (6) Accurate diagnosis and therapeutic f a c i l i t i e s with e f f i c i e n t technical service under competent medical supervision. (7) Accurate and complete records promptly f i l e d i n an accessible manner so as to be a v a i l a b l e f o r study, reference, follow-up and research. American Association on Mental Deficiency Standards Brochure, American Association on Mental Deficiency, 1952, p. 1. - 12 -(8) An organized formal in-service t r a i n i n g program f o r i n s t i t u t i o n a l personnel adequate to insure tbe maintenance of a high standard of patient care, t r a i n i n g , supervision and opportunity. (9) Group conferences of the administrative and profess-io n a l s t a f f s to review r e g u l a r l y and thoroughly t h e i r respec-t i v e a c t i v i t i e s i n order to keep the service and the s c i e n t i -f i c work i n the highest plane of e f f i c i e n c y . (10) A humanitarian s p i r i t i n which the best care of the patient i s always the primary consideration. (11) The a v a i l a b i l i t y of professional s k i l l s i n the I n s t i -t u t ion f o r out-patient service and other problems. I t i s important that each service of the i n s t i t u t i o n , within the l i m i t s of i t s need and the demand of tbe l o c a l conditions, have ce r t a i n features i n common as follows: (1) Administration and Supervision Competent trained head with s u f f i c i e n t executive a b i l i t y and an adequate number of assistants and other personnel to carry on the work of the service e f f i c i e n t l y . (2) Coordination The coordination of e f f o r t among members of each service with the other personnel of the i n s t i t u t i o n to promote desirable teamwork and a highly e f f i c i e n t service of the i n s t i -tution as a whole. (3) Location Each department or service should have adequate space and located i n that area of the i n s t i t u t i o n which w i l l most conveniently permit e f f i c i e n t service. (4) Equipment The equipment should be s u f f i c i e n t and adequate to per-mit s a t i s f a c t o r y performance of the usual scope of work with-out undue hardship. (5) Protection and Safety , Proper protection of the worker and patient against the usual hazard of the operation. (6) Records A complete system of accurate records on c a r e f u l l y developed forms to permit day by day e f f i c i e n t operation and to provide means of tabulation and evaluation at a l a t e r date. (7) Training Opportunity f o r repeated attendance at conferences and i n consultation to insure continued professional growth of tbe personnel and technical advancement. 13 -Therefore, the quality of the training f a c i l i t i e s w i l l largely determine to what degree the potentialities of the mentally retarded are effectively developed. Present day schools for the mentally retarded are now making more pro-vision for such training of the mentally retarded, and society i s beginning to see such training as an inalienable right of each retarded child. The Adaptation of Social Work to the Field of Mental Retardation when the f i r s t school for the mentally handicapped was established over 100 years ago, the best s k i l l s from both the educational and medical professions were brought into play to help provide custody for these deprived children. With the gradual change in focus of these schools for the mentally handicapped from custody to training and rehabilitation, came an Invitation from educators and physicians to the social work profession to join i n the administration of these institutions. The profession of social work found f e r t i l e s o i l for growth in the mentally retarded f i e l d , for social work's two major objectives of well being (or a healthy and decent standard of l i v i n g ) , and satisfying social relationships for a l l human beings, applied meaningfully to the situation i n which the mentally retarded person found himself. The social worker's effective use of social casework enabled him to under-stand the many social implications of mental retardation and how such implications affected the child and his family. Such - 14 -understanding by the worker could be carefully interpreted to the other disciplines so that the many forces acting on the retarded were able to be clearly seen. Before the contributions of the social worker in the f i e l d of mental retardation are discussed, i t w i l l be necessary to outline b r i e f l y what social casework i s . The following definition of social work and social casework was evolved in 1953 by second year social work stu-dents completing f i e l d work at the Provincial Mental Hospi-t a l , Essondale, B.C. This definition was evolved after the group f e l t a general dissatisfaction with current and past definitions of social casework. Soeial work i s an enabling process of helping the individual, the group, and the community to cope with the stresses which prevent their best possible adjust-ment to society. Its philosophy i s rooted in democratic principles and i n the social worker's beliefsand con-viction in man's dignity, worth, and self-determining rights, i n i t s specific professional sense, social casework embodies an integrated, dynamic understanding of the inter-relating factors (social, economic, de-velopmental and psychological, cultural and religious). Simultaneously, the easework method employs a d i s c i -plined, integrated use of the client-worker relation-ship, the agency services, and community resources. Thus, the client i s enabled to mobilize his internal strengths and external resources so that he can reach his optimum adjustment. Casework has been defined by many social workers i n i t s relatively short history. However, there i s a definite lack of definite concepts and precise terminology i n social casework and this may again be attributed to social case-work's relatively short history. In spite of the lack of concise terminology, there 15 -are principles upon which social casework i s founded and which may he adequately applied to any setting for the mentally retarded. The caseworker believes that a l l behaviour i s pur-poseful and that i t i s Important to understand the manner i n which an individual attempts to adjust to his situation. What may appear to be a bizarre, extreme, unsocial adjustment of behaviour i n light of existing standards and soeial norms, may really be a struggle for equilibrium on the individual's part. His manner of adjustment, even i f alien to others, may be the only adjustment he i s able to make, with the capacities he has at his disposal. In the f i e l d of mental retardation, the social worker must ask himself what i s the retarded person's response to his l i f e situation, and what i s the meaning of his limitations to him, and what he has done or what does he want to do about his situation. Secondly, the worker must carefully assess the extent of the mentally retarded person's a b i l i t y to enter successfully into a casework relationship. Therefore, know-ledge of the retarded person's past behaviour and relation-ships would be a necessity before the worker could understand f u l l y the retarded person's reactions to his present situation. In order to help the mentally retarded client ade-quately, the social caseworker must use three basic social casework tenets: (1) That there i s a cause-and-effect relationship i n human behaviour; (2) That behaviour i s emotionally determined; (3) That behaviour may be consciously or unconsciously determined. - 16 -Mary Richmond points ont in her book, What i s Social Casework, that: Human beings are not dependent and domestic animals. This fact of man's difference from other animals est-ablishes the need of his participation in making and carrying out plans for his welfare. Individuals have wills and purposes of their own and are not f i t t e d to play a passive part in the world; they deteriorate when they do.l This quotation would seem to apply most aptly to tbe f i e l d of mental retardation. Such a short discussion of social work and more specifically social casework leaves untouched much of the tremendous s k i l l contained under the orbit of social work. Social work i s a professional body of knowledge which i s con-stantly undergoing growth and change. Its horizon of know-ledge and s k i l l s i s being continually broadened by the newest developments in the sciences with which i t i s intimately associated, namely, psychiatry, psychology, education, socio-logy, and cultural anthropology. As social work has as i t s basic purpose the helping of people in need, i t must constantly adjust i t s s k i l l s to meet tbe ever-changing social and economic problems of the world. This a b i l i t y to adjust has greatly helped social work's widespread acceptance in many diversi-fied settings. The Contribution of Social Work to the Field of Mental  Retardation The contribution which the social worker i s able to Richmond, Mary E., What Is Social Case Work. Russell Sage Foundation, Hew York, 1922, p. 258. - 17 make in any programme for the mentally retarded i s immense. The Soeial Service Department performs a valuable function as a link between the institution and the pat-ient, the family and the community. It interprets the institution and i t s program to the family and seeks to maintain continuity of responsibility of family and community for the patient. It assists the family with problems arising from admission and discharge of the patient to and from the institution. It can i n certain situations assist the patient in his inter-personal relationships with the institutional staff and his fellow patient. The f i e l d of opportunity for the social service department may include the spheres of the psychiatric social worker, medical social worker and the group social worker. With his understanding of the dynamics of human behaviour, knowledge of family, cultural group and community interrelationships the worker i s able to pool his s k i l l s with those of the other helping professions, i n order that a more adequate understanding of the mentally retarded person in the residential school-setting may be reached. Helping the parents or relatives to consider possible placement of the mentally retarded child i s another s k i l l which the social worker brings to any programme for the mentally retarded. This requires patient and s k i l l f u l meeting of parents* feelings about hav-ing a defective child and through the medium of a carefully planned orientation to the sehool-setting, the parents or relatives are able to prepare properly the child for the essen-t i a l separation from the family sphere. Feelings of guilt and rejection which the parents or relatives may have can thus be worked through with the supporting, helping relationship which American Association on Mental Deficiency Standards Brochure, op. c i t . . p. 12. - 18 -the worker i s able to offer. Once these feelings are worked through the parents or relatives are able to participate more f o l l y daring the residents' educational period and later dur-ing the important stage of his rehabilitation. Work with the child during this educational period i s another important contribution which the social worker i s able to make. The child must learn to adapt himself to an entirely new experience. He must adjust to the group situa-tion and this requires the acquisition of new responsibilities regarding himself and others. Tbe social worker must stand behind him as he makes each new step in the institutional pro-gram, be i t backward or forward. Frequent interviews bet-ween the worker and the child are therefore necessary i f such a relationship i s to grow. Interpretation to the parents of tbe resident's pro-gress in the School i s another contribution which the social worker i s able to make. Thus the parents' interest in the child's education and training i s kept keen and alive. Through tbe medium of a close relationship with the social worker the parents are able to accept many decisions of the School which may be to the best interests of the resident but which may be misunderstood by the parents. Thus many d i f f i c u l t i e s which might arise through such misinterpretations are avoided. Working cooperatively with tbe other disciplines in order that more effective help may be given to the resident i s another function which the social worker i s qualified to carry out. The social worker, through his study of the r e s i -- 19 dent as an individual, and of the resident's home, community and parents, i s able to share this valuable information with the other disciplines. This sharing of knowledge adds greatly to the understanding which each discipline should have of the resident. Rehabilitation i s an area to which the social worker brings his greatest s k i l l s . The social worker should be res-ponsible for intensive casework services in this f i e l d . He must assess the community situation, the readiness of the par-ents, and the readiness of the resident to move into the re-habilitation process. This involves proper preparation of the resident, the parents, and various community resources for the resident's return to the community. Often employment opportunities must be uncovered by the social worker who acts in close cooperation with the national Employment Service. The resident i s i n need of much support both before and during the rehabilitation process. Through the close understanding relationship which i s established between the worker and the resident this support i s able to be effectively used in help-ing the resident in his adjustment. The social worker must also use his s k i l l i n inter-preting to the community what the School i s doing and planning. What the School i s able to accomplish in i t s educational pro-gram w i l l largely depend on the support i t receives from the community. If there i s a well-integrated program for the men-ta l l y retarded in the community, the benefits received by the resident during the training period w i l l have lasting effects - 20 -and w i l l continue to grow. A greater i n t e r e s t i n and under-standing of the problems created by mental retardation i s needed by the community. Professional and l a y groups should have t h e i r i n t e r e s t s awakened so that they too w i l l see the need f o r an adequate community programme f o r the mentally retarded. Miss A.K. C a r r o l l , writing on the functions of the s o c i a l worker i n the School setting, states: The important contribution of s o c i a l workers i n a programme geared to the understanding, education, t r a i n -ing and r e h a b i l i t a t i o n of the mentally retarded i s that of forming a l i n k between the i n s t i t u t i o n a l School, the pupil-patient, the family and the community. This l i n k i s forged by purposeful helping and i n t e r p r e t a t i o n under-taken by the s o c i a l workers. Such help and i n t e r p r e t a -tion i s directed toward the development, maintenance and furtherance of the r e s p o n s i b i l i t y of family and community i n the provision of services geared to the continuing s o c i a l adjustment of the mentally retarded both within the School and the community. 1 The foregoing material points out the general problem and complexity of mental retardation and mental deficiency. This material also i l l u s t r a t e s the gradual extention of the r i g h t s of children to include the mentally handicapped and the increasing study and emphasis which i s being devoted to t h i s problem by professional groups and the general public. A set of professional r e h a b i l i t a t i v e standards f o r the administration and actual programming i n present day i n s t i t u t i o n s f o r the mentally handicapped i s used as c r i t e r i a against which a s p e c i f i c i n s t i t u t i o n a l programme of the kind The Woodlands School S o c i a l Service Department, Annual Report (1952-53), p. 1. 21 -is evaluated. The method of the study i s to examine in detail the actual inner workings of The Woodlands School with par-ticular reference to the role which the social service worker is able to play. An examination i s made of the extent to which a total rehabilitative programme has been instituted in The Woodlands School and an assessment made of i t s present operation. The method of assessment used includes the review of institutional records and reports, the study of numerous Social service f i l e s , interviews with the Medical Director, the Provincial Supervisor of Psychiatric Social Work, the supervisor of the Social Service Department and with the beads of Departments, and by conversations and discussions with other members of staff, supplemented by personal obser-vation of the programme in operation. Background material includes various a r t i c l e s , studies and reviews appearing i n the current literature in this f i e l d , a l l of which are enumerated in the bibliography. Finally, an assessment i s made of the adequacy of the existing services in meeting the social and emotional needs of the residents and their families. CHAPTER 2 THE DEVELOPMENT OP THE INSTITUTIONAL PROGRAMME FOR THE MENTALLY HANDICAPPED IN BRITISH COLUMBIA The history of public concern for the mentally retarded began over 100 years ago with the development of special institutions for their care. Changes had to be made in the punitive legislation relating to the insane and the mentally retarded, both in penal law and in laws deal =• ing with training and custodial care, for such laws were outmoded by modern treatment methods. Within recent de-cades, the concept of standards of intelligence and their bearing on educational and occupational planning became recognized as having practical significance. The decade of the World War I, and the decade following th i s , saw the use of intelligence tests by schools, colleges, armed ser-vices and vocational training. Research on pathological and abnormal phenomena threw much light on normal and sup-erior intelligence. Studies on such problems as feeblemindedness led to the use of intelligence tests in planning for children and adults of normal intelligence. Psychometric methods improved and psychometric concepts flowed into the other fields of behaviour, such as personality, temperament, emo-- 23 -tional maturity, and intellectual and social aspects of ab i l i t y and behaviour. As time passed, various studies showed beyond doubt that the earlier emphasis upon identifying and labelling men-tal- retardation, upon setting up r i g i d classifications, upon isolating and institutionalizing persons so cla s s i f i e d , was being pushed beyond limits that were s c i e n t i f i c a l l y sound or socially useful. They saw the mentally handicapped not as a score on a populative test but as people belonging to fami-l i e s and society. Soon i t became apparent that some persons suffered from mental limitations rather than mental deficiency, and that suitable employment and appropriate education was fre-quently the treatment for such persons. In British Columbia, concern for the mentally retarded has been mainly centered around developments in the Provincial Government institution located at the corner of Columbia Street and McBride Boulevard in the cit y of New West-minster. This institution, formerly called the Provincial Hospital for the Insane and later the Provincial Mental Hos-pit a l (New Westminster), had i t s name changed in recent years to The Woodlands School. Such changes in name il l u s t r a t e society's various approaches to the subjects of mental def i -ciency and mental retardation. To begin with, society asso-ciated the mentally handicapped with, the criminal tendencies of the "insane." With the scrapping of this punitive approach came the medical emphasis in which the mentally handicapped - 24 -were seen as "mental cases" which required medical treatment. This approach to the mentally handicapped was replaced by the modern day programmes which emphasize t r a i n i n g and education geared to the p a r t i c u l a r a b i l i t i e s of the mentally handicapped person. Ea r l y History The P r o v i n c i a l Mental Hospital, Hew Westminster, (The Woodlands School), had a small beginning. A bui l d i n g consisting of twenty-eight small rooms i n units of seven, intended f o r mentally i l l persons, was constructed and opened i n 1878. As the years passed, more buildings were constructed and remodelling of a l l buildings took place. From 1930-45 t h i s remodelling programme continued, so that at the present time a l l older buildings are s a t i s f a c t o r y and up to date. In 1945 the Administrative building was ready f o r occupation, a f t e r an extensive remodelling programme. Also during t h i s year a new school building was completed and occupied. Provision f o r female nursing s t a f f residences on the i n s t i t u t i o n a l grounds was also made. The year 1920 saw the completion of a Nurses' Home f o r 32 nurses. In 1948 a second Nurses* Home was completed f o r 51 nurses. More recently, i n January 1953, a t h i r d Nurses* Home was ready f o r 100 nurses to occupy. In February 1950, The Woodlands School, was f i t t e d with the addition of a f i r e p r o o f , reinforced s t e e l , concrete bu i l d i n g (Cedar Cottage) f o r the residents. This b u i l d i n g - 25 -contains no s t a i r s or ramps and has capacity f o r 112 cr i b s and 65 adult beds. Playrooms are located i n t h i s new building as well as dormitories, kitchens, sunporches and a combination room fo r medical examinations and minor surgery. At the present time three other buildings s i m i l a r to Cedar Cottage have been completed and occupied. These were named Pine, Beech and Willow Cottages, respectively. These three cottages contain a t o t a l of 404 c r i b s with a p o t e n t i a l -i t y of 60 more beds. Plans are being l a i d f o r a new dispen-sary i n the Pine building as well as a modern laboratory and autopsy room. Admission Procedures The gradual change from admitting the mentally i l l person to tbe admitting of the mentally retarded c h i l d i s an i n t e r e s t i n g phase i n the development of The P r o v i n c i a l Mental Hospital, New Westminster, (The Woodlands School). Admis-sions of tbe mentally i l l took place i n the P r o v i n c i a l Mental Hospital, New Westminster, from 1878 u n t i l 1925, when the Admitting Building at Essondale was completed. From 1925 a l l admissions took place at the P r o v i n c i a l Mental Hospital, Essondale, f o r both the mentally i l l and the mentally retarded person, with transfers from Essondale to New Westminster or vice versa. Transfer of psychotics from New Westminster con-tinued, generally speaking, u n t i l the spring of 1931. For several years p r i o r to 1951 a small unit of approximately 85 pupils (smaller retarded boys and g i r l s ) were domiciled at - 26 -Essondale i n a two-storied wooden frame structure. This group was transferred to the P r o v i n c i a l Mental Hospital, New Westminster, (The Woodlands School) and a num-ber of mentally i l l male and female patients were transferred from New Westminster to Essondale. These transfers i n both directions are s t i l l i n process, and today The Woodlands School i s almost exclusively f o r the mentally retarded. Training Programme Development In the summer of 1931, Dr. L.C. Sauriol began or-ganizing the t r a i n i n g school which i s found at The Woodlands School today. At t h i s time there were no modern f a c i l i t i e s f o r the carrying on of the school classes. With the vacancy of a physician's o f f i c e , a nucleus f o r school classes was formed. In 1936 the f i r s t q u a l i f i e d school teacher assumed her duties at the i n s t i t u t i o n . Soon a f t e r t h i s , two teachers were engaged and Manual Arts i n s t r u c t i o n , c a r r i e d on previously by i n d i v i d u a l attendants from the s t a f f , (now named Psychia-t r i c Nurses), received a q u a l i f i e d i n s t r u c t o r . A Domestic Science class was begun, and i n the year 1945, with the open-ing of the new school building, f i v e school teachers were ap-pointed. Later a q u a l i f i e d Manual Arts i n s t r u c t o r and a Recreational i n s t r u c t o r were added to the school s t a f f . In the f a l l of 1950 the school had eight q u a l i f i e d academic school teachers on i t s s t a f f , one of whom was a school p r i n c i p a l . The Women's Occupational Therapy department, which had been a function of the hospital f o r many years, was l a t e r - 27 -reorganized under the direction of a qualified Occupational Therapist. The month of September, 1950, saw the addition of a modern classroom in the new Cedar Cottage building. Since this time there has been a steady rise in both the number of staff and in better qualified staff. The Woodlands School Today Today The Woodlands School i s a residential training school for the mentally retarded. Making up the population of this School are residents of the lower, the medium and the higher level of intellectual accomplishment. In this sett-ing special teaching and other f a c i l i t i e s such as nursing care and medical attention, are given during twelve months of the year, so that the resident's numerous needs find satisfaction. The psychiatrist, psychologist, social worker, academic teacher, dietician, manual arts instructor, recreational instructor, women's occupational therapist and the staff of the industrial departments have tried to keep one goal in mind-that of helping each resident to reach his best possible adjust-ment to l i f e with the capacities which he has at his disposal. Formal Academic Programme of The Woodlands School The schoolroom i s one of the most important educa-tional training areas in this residential school for the men-ta l l y retarded person. As many as possible of the residents attend the school classes. If some are unable to attend classes, provision i s made for lessons to be conducted i n the - 28 -various cottages. Thus the physically handicapped are able to enjoy the attention given to them; they are able to feel that they are learning as the others do, and not being neg-lected. Most educators now feel that the majority of men-t a l l y retarded children do have a contribution to make to the world in which they l i v e , and that i t i s a primary respon-s i b i l i t y of special education to help them attain such respon-s i b i l i t i e s . The aim of Education should be to meet the needs of a l l mentally retarded children in the areas of self-realization, social relationships, c i v i c responsibility and economic efficiency* The need ofor favourable recognition, social approval and prestige gives the mentally retarded child a feeling of belonging and a sense of personal worth, both of which are so important to their personality adjustment. They must be given a chance to succeed in an educational programme based on real i t y and not upon fantasy. Throughout the training process the mentally retarded child benefits from the affection of friends, companions and loved ones, as well as from understanding and sympathetic guid-ance from a l l of those who come in contact with them. This philosophy seems to have been adequately incorporated into the Formal Academic Programme of The Woodlands School. Consequently, owing to the fact that the mentally retarded person has limited powers of concentration, only two hours a day in the schoolroom are allotted for academic 29 -work. The student spends the rest of the day doing some, var-iety of occupational work such as manual arts, cooking, hand-work or physical training. Pupils are placed in a classroom according to their mental age and social adequacy. Informa-tion from both the Psychology and Social Service Departments provide the basis for the decision as to what class a child w i l l be placed i n . A typical mentally retarded child of six years of age would undergo the following procedure as he moved into the school and gradually progressed through i t . He would start in a Pre-School Class, which i s conducted in either Pine or Cedar cottages. Such a class would accommodate approxim-ately sixty children. In this class the child learns to share toys and obey simple commands, and the beginnings of sense training and other training necessary for classroom behaviour are instituted. In the group situation he learns to give and take. To begin with, he may not be able to adjust to others, but i n time he learns to become more sociable. After finishing with the pre-school classes, the child would come to the school building where he would enter one of the three Kindergarten Classes of approximately thirty-six children each. Here the child would continue with the training instituted in the pre-school classes with the teacher expecting better results. Word recognition, counting and rhythm games are also introduced to him. Much patience i s needed by teacher, for she must repeat many things to the - 30 -mentally retarded child Which would be almost automatic to children of average intelligence. The child would next move into one of the two P r i -mary Academic Classes which cover grades one and two. Here rhythm games and exercises are conducted, using the piano. Development of sand table projects i s encouraged and a toy store has been constructed in the classroom which i s used by a l l academic classes. Both older and younger children are combined, and while the younger children w i l l l i k e l y move on to higher academic classes, the older children w i l l reach their level in this class. If he completes this class, the child would enter the Junior Academic Class covering grades one to four. This class covers the regular academic work of these grades with the exception of history, science and geography. In many cases the boys at this grade level are able to start attend-ing manual arts classes and the g i r l s w i l l be able to attend cooking classes. From the Junior Academic Class the pupil would at-tend the Senior Academic Class which covers grades four to eight. The Senior Academic Class covers a l l academic work. However, because of the limited time, history and science are not stressed as much as the other subjects. If a pupil has attained his academic optimum before attending a l l available classes he i s encouraged to f i t into some other department of the training school. Consequently, - 31 -he may or may not attend school for some type of occupational work. However, i f he has reached the age l i m i t , which may be eighteen or twenty-one, and he i s i n need of academic train-ing, he would f i t into one of the three Opportunity Classes and continue his training i n some other department for the rest of the day. For those students confined to wheelchairs, for one reason or another, there i s a teacher who v i s i t s the wards every morning. Daring these v i s i t s , classes are held ranging from the pre-school to the grade seven period. In Beech Cot-tage, a qualified teacher also conducts l i p reading classes for the deaf residents every morning. Each year a Christmas concert i s put on by the stu-dents attending the academic classes. Acting, singing and rhythm band numbers are presented to both the residents and the parents who are invited to attend these performances. Through the medium of educational films received each week from the Department of Visual education, tbe c h i l -dren are able to see l i f e outside of their limited environment. School broadcasts have also proved beneficial to the school's educational programme. Under the school's programme, occupational work includes cooking, manual arts, and a l l forms of handwork. Cooking classes are held each afternoon with seven Or eight g i r l s i n each class. Approximately one-third of these g i r l s are able to follow a recipe unsupervised, but the other g i r l s - 32 -need constant supervision. Each Friday afternoon, two or three of the g i r l s from each group prepare a complete meal and have one of the members of staff as guest. In these classes the teacher i s able to teach the g i r l s the correct way to set the table, to say grace, and to learn correct and acceptable behaviour at the table. The cooking classes are very popular and a great deal of benefit i s derived from them. Handwork classes are also held each afternoon. Four such classes are in operation and the g i r l s are assigned to each of the classes according to the g i r l s ' particular abi-l i t i e s . The g i r l s begin with sewing cards and a simple design. As their a b i l i t y grows they w i l l work up to more complicated designs. Knitting, shellwork and rugmaking are carried on by the more capable g i r l s . Once a year a sale of a l l handwork done by the students i s held. Manual Arts Classes are conducted i n the mornings for the older boys who work i n some other department i n the afternoon, and who do not attend the school. The school boys, however, attend the Manual Arts Classes in the after-noon. Classes are kept small because of the limited space and because of the need for constant supervision by the teacher. Recreational Classes are conducted from ten in the morning until eight-thirty i n the evening. Morning classes are intended mostly for the boys and g i r l s , who, because of their limited capacity, are not able to attend academic classes. - 33 -These children spend t h e i r time playing with whatever equip-sent they wish. One hour i s a l l o t t e d f o r each of the junior boys, the junior g i r l s and the t i n y t o t s . In the evening there i s recreation f o r adult residents with a weekly dance. A gymnastic display i s also put on each spring by the students. Such a display includes d r i l l s , games, f o l k dancing and square dancing. In Tbe Woodlands School i t i s well recognized that the teaching a b i l i t i e s of the school teacher must be above average. She must have knowledge of spe c i a l educational methods used i n the t r a i n i n g of the mentally retarded. This would naturally require a teacher who was emotionally stable and mature i n her outlook. In order to have such an outlook and such s t a b i l i t y , the teacher must not have too many problems of her own. She must learn that the mentally retarded person learns i n h i s own l i m i t e d way, and with h i s own p a r t i c u l a r speed. The mentally retarded person may also lack i n t e r e s t . Therefore, i t i s up to the teacher to make her teaching i n -teresting, so that the pupil's attention and in t e r e s t i s main-tained. In short, a sound i n s t i t u t i o n a l programme f o r the mentally retarded must have as i t s basis a good academic pro-gramme conducted by w e l l - q u a l i f i e d teachers. Psychology Department Like the profession of S o c i a l Work, the profession of Psychology has had to adapt i t s e l f to a r e l a t i v e l y new set t i n g , as i s found i n The Woodlands School. As an i n t e -g r a l member of the treatment team, the psychologist i n The Woodlands School has important functions to f u l f i l . Per-- 34 -haps the most notable function of the psychologist i s . t h e per-formance of psychological evaluations on various residents. Through the medium of various tests of personality, vocational and manual dexterity, an assessment i s made of the resident's strengths and l i m i t a t i o n s . Thus school c h i l d r e n can be graded before attending school and placed accordingly. Such assessments can be useful i n s e l e c t i n g those residents which w i l l p r o f i t from occupational therapy classes. Lately, the psychologist has i n s t i t u t e d play therapy interviews f o r the young c h i l d r e n . Preliminary assessment of pot e n t i a l r e h a b i l i t a t i o n cases, i n consultation with the S o c i a l Service Department, i s another function of the psychologist. Here, the focus i s upon lo c a t i n g and assessing those residents who would best seem to adapt themselves to community l i v i n g and a l l i t s pressures. The psychologist also interviews residents, with the object of helping them work out any problems which may a r i s e during any such adjustment. Up u n t i l May 6th, 1953, the psychologist had assessed 130 residents. To these 130 residents, 1550 tests were administered over a four or f i v e months' period. The psychologist has been recognized as an i n v a l -uable member of the treatment team and of The Woodlands School's s t a f f i n general. His assessments add greatly to the t o t a l understanding which the treatment team must have of the mentally retarded r e s i d e n t . 1 1 In July, 1953 t h i s department became temporarily vacated by the resignation of the Psychologist. - 35 -Nursing Department The profession of Psychiatric Nursing, i n the s e t t -ing of The Woodlands School, c a r r i e s out s p e c i f i c functions r e l a t e d to the profession. Being the closest of any of the d i s c i p l i n e s to the resident naturally involves many respon-s i b i l i t i e s . Through the process of person to person contact, the psychiatric nurses t r y to •socialize' 1 the pupils as much as they can. Help i s needed by the resident i n h i s adjust-ment to the group. Psychiatric nursing t r i e s to teach and help the c h i l d to l i v e with h i s l i m i t a t i o n s and to develop his c a p a b i l i t i e s as a mentally retarded person. Such an approach n a t u r a l l y involves much perser-verance on the part of the nursing s t a f f . However, t h i s perserverance pays o f f i n the long run, f o r such s t a f f time, which would normally go into helping one resident, could then be expended on behalf of another resident, who also required considerable attention, but who was not receiving i t owing to the lack of s t a f f time. As of October, 1951, a l l psychiatric nurses were trained at Essondale. At the present time the profession of psyc h i a t r i c nursing at The Woodlands School i s divided into two sections—Female and Male—each section being under a Chief PsychiatrictNurse. The Male section employs 84 psy c h i a t r i c nurses and 79 psychiatric aides. Six student nurses are also assigned to the School f o r a three month period under the Essondale plan. This t o t a l group i s responsible f o r giving 24 hour - 36 -nursing service care to approximately 525 men residents. The Women's section employs four registered nurses, 49 psychiatric graduates, 42 nurses-in*training, 16 student nurses and 96 aides. Female nurses provide nursing care to both women and men residents. However, as soon as a boy i s f e l t to be old enough to make his own way on the men's wards he may be transferred, a f t e r consultation between the nursing departments, to a men's ward. Whereas male nurses tend to look upon ps y c h i a t r i c nursing as a l i f e ' s profession, the majority of female nurses tend to regard i t as a short-term employment f i e l d . Thus there has been a large turnover beset by many d i f f i c u l t i e s i n the women's section, and a r e l a t i v e l y stable s t a f f with minute turnover i n the men's section. The majority of the male nur-ses and one-third of the female nurses l i v e outside the School. With the l i c e n s i n g of Psychiatric Nursing i n B.C. has come a recognition of the professionalism required i n t h i s type of work. Psych i a t r i c Nursing, i n such a s e t t i n g as The Woodlands School, must have high standards i f the t o t a l pro-gramme i s to be e f f e c t u a l . 1 Occupational Therapy Department S t i l l another very important t r a i n i n g area f o r the mentally retarded i s the Occupational Therapy Department. Under the d i r e c t i o n of an Occupational Therapist the residents Number of nurses quoted are approximate t o t a l s as of Angust 3, 1953. - 37 -are able to learn to use their spare time to the best of their a b i l i t y . To the disturbed person occupational therapy often has a soothing effect. Residents with behaviour pro-blems also seem to receive benefit from occupational therapy. Referrals to the occupational therapy department are made by the medical doctor. After such a referral i s made, a discussion i s held between the doctor and the psychologist and between the psychologist and the occupational therapist. Such discussions assess the number of hours of active occupa-tional therapy which would prove of the utmost benefit to the referred resident. Once a resident has been selected for occupational therapy he may receive such therapy for an inde-f i n i t e period of time. At the present time occupational therapy classes are held for f i f t y g i r l s . Thirty of these g i r l s come to the occu-pational therapy class on their own, whereas the remaining twenty receive occupational therapy instruction on the ward, owing to their i n a b i l i t y to come to the occupational therapy classroom on their own.1 The overall aim of occupational therapy i n this setting i s to help the residents receive emotional benefit from tbe work i t s e l f , and not solely from the finished product. However, once the product i s finished encouragement i s given to the resident's receiving pleasure from completing such a product. 1 Subject to periodic assessments of medical director, psychologist and occupational therapist. 38 -As i n the other departments, d i f f i c u l t i e s are encountered in handling the residents and i n maintaining their interest. Helping the residents to get along with each other i s one of the major d i f f i c u l t i e s . Other d i f f i -culties are encountered in the scaling of work which a r e s i -dent i s given. The resident must learn to move on to more d i f f i c u l t work gradually. If pressed too far beyond his or her a b i l i t i e s only frustration and confusion result. Occupational Therapy can therefore be seen as hav-ing a great deal to contribute to any programme designed for the training of the mentally retarded. It not only provides amusement and relaxation for the resident, but i t also pro-vides invaluable training for the resident 's future rehabi-l i t a t i o n . Linen and Clothing Department A Linen and Clothing Department i s responsible for the practical work which i s required by the various wards of the School. Towels, bags, nurses' uniforms are among the pro-ducts which this Department turns out. In addition to pro-ducing such items, this department also contains a mending annex which in turn i s responsible for the total mending requirements of the School. The staff of two, made up of one supervisor and her assistant, supervise a number of women residents, who are employed in what might be referred to as industrial training. Only six to eight g i r l s are engaged i n this industrial train-- 39 -ing, owing to the limited trained staff and space avail-able. Training the women for positions outside the School i s " a prime consideration of the staff, as several women residents have been successfully rehabilitated after having worked in this department. On the whole the women residents who are selected for this department are of the School's higher intelligence group. Patients must be able to recognize the front and back of uniforms i f they are to benefit from this department. If a woman i s unable to run one of the department's sewing mach-ines, she may be able to hand sew and consequently she may receive some emotional benefit from thus contributing to the work of the department. Unfortunately, however, the primary focus of this department i s definitely not therapeutic. This arrangement i s due to the number of emergency situations which this department has to meet. Referrals to this department are made by the doc-tor. Such a referral might be made when a woman resident ex-pressed an interest in working in the Linen and Clothing Department. Other F a c i l i t i e s The Public Works Department i s responsible for the total maintenance of the buildings making up The Woodlands School. Such ac t i v i t i e s as replacing windows, plumbing re-pairs, and repairing fixtures, are carried on by this depart-ment. On request by the Superintendent of Public Works at The - 40 -Woodlands School, several hoys are periodically recommended and ut i l i z e d by this department. Valuable training i s there-fore given to the boys so recommended and several within this rehabilitative training programme have returned to the com-munity and have secured employment in these lines. The Shoe Department i s responsible for the repair-ing of a l l shoes worn by the resident population of the Wood-lands School. In certain cases, special shoes, which may be required by a resident, are turned out in this f a i r l y well-equipped shoe repairing department. However, such work i s on a very minute scale owing to the pressures of other work. Several men residents are retained in this depart-ment and they have in many cases become quite ski l l e d in the area of shoe repairing. Host of the men have been in this department for years, and are in need of constant supervision because of their limited intelligence and in order that the heavy demands made upon the department, can be met. The carpentry and painting shops carry out the total carpentry and painting duties as are required in such a large setting as The Woodlands School. Each of these shops i s under i t s own foreman and each shop employs i t s own particular men. Hale residents are permanently u t i l i z e d within these shops. The gardening department under the supervision of an experienced gardener grows the flowers and shrubbery of which The Woodlands School i s so proud. Such flowers and shrub-- 41 -bery greatly add to the beauty of the grounds and add to the resident's comfort. Flowers and potted plants, while in sea-son, are delivered to the wards and are in turn changed every few days. The gardening department of The Woodlands School also grows the flowers and small shrubs for the Pro-vincial Mental Hospital grounds located at Essondale, B.C. As well as flowers and shrubs this department has the responsibility of growing the vegetable requirements con-sumed i n the summer months by the School's large population. Men residents are utilized extensively in this department. A l l of the laundry needs, with the exception of dry cleaning, for both The Woodlands School and The Provincial Mental Hospital are met through the Laundry department at the Woodlands School. Located in a very old brick building d i r -ectly behind the Administration building, the laundry uses mostly resident help to carry out i t s work. On the ground floor of the laundry building men r e s i -dents convey the soiled clothing and linen to the various laundry machines which wash and dry the articles. These articles are then sent upstairs, where women residents machine or hand iron the art i c l e s . This department provides an invaluable training ground for both men and women residents who are about to move into the rehabilitation process. Under close super-vision many residents are able to learn a great deal about the laundry trade. - 42 -PATIENTS EMPLOYED IH VARIOUS DEPARTMENTS AT TBE WOODLANDS SCHOOL1 Laundry . 23 Paint Shop 4 Carpenter Shop . . . . . . 2 Kitchen 10 Sewing Room 6 T a i l o r & Linen Shop . . . . 6 Vegetable) Greenhouse) - Garden . . . 10 Cemetery 6 Shoe Shop 7 2 Grass Gangs 20 School Chores 4 E l e c t r i c i a n 1 Stores . . . . . . . . . . 1 Centre Desk 3 messengers 9 Gangs - Bo i l e r room Outside Heavy 2 h a l l & s t a i r s ). . . 36 2 wax Food Office Nurses' Home Plus Ward Workers Each of the departments which we have described i n t h i s chapter contribute to the t o t a l t r a i n i n g programme which The Woodlands School offers to the mentally retarded resident. The residents may come into contact with any member of the School's s t a f f , whether he be a carpenter or the medical d i r -ector. Therefore, each s t a f f member i s encouraged to consider himself as a helping person. Numbers vary i n a l l departments from day to day. As workers are required they are assigned by Chief Male and Fe-male Nurses Office , No records maintained. Approximate num-bers as of August 3, 1953. CHAPTER 3 MOVEMENT OP SOCIAL SERVICE INTO THE WOODLANDS SCHOOL On September the 19th, 1951, the beginnings of a Soc i a l Service Department were started at The Woodlands School i n the appointment of two s o c i a l workers with one year t r a i n i n g each. These two workers became involved i n di r e c t work with the children, whereas formerly a very l i m i t e d information-giving service had been extended to the School by the S o c i a l Service Department of the Prov i n c i a l Mental Hos-p i t a l and Crease C l i n i c . Such a limi t e d service was not due to a f a i l u r e to recognize the contribution which a s o c i a l worker could make i n any programme f o r the mentally retarded but rather i t was due to a serious understaffing of workers at the Pr o v i n c i a l Mental Hospital and Crease C l i n i c and to a general lack of workers available f o r appointment. In truth there had never been an establishment set up f o r the appointment of s o c i a l workers i n The Woodlands School. "Social Service was faced immediately with the d i f -f i c u l t task of choosing an area i n which the li m i t e d case-work services which two s o c i a l workers would bring to the School*s already well-advanced i n s t i t u t i o n a l care programme could be used most e f f e c t i v e l y . 1 , 1 The quality of service 1 The Woodlands School S o c i a l Service Department, Annual Report (1951-52), p . l . - 44 -which could be given to both residents and to relatives was of paramount importance in considering this problem. After careful consideration, i t was f e l t that the Social Service Department should l i m i t i t s services to four main areas, the f i r s t of which would be casework services to children and relatives during the admission period. It was realized that this service would involve the process of intake and reception then developed. Such an area would also include social service during the reception of the child into the School. The second of these areas included continuing soc-i a l service to the child once he had become a resident of the School. Both of these services were to be on a selective basis, owing to the shortage of social service staff. Rehabilitation of the residents and the casework services involved i n such a process were f e l t to be the third area in which social service could be most effective. This too was to be on a selective basis. Lastly, social service was seen as being responsible for a programme of community education and interpretation. Such a programme was to include the responsibility of the community in helping the mentally retarded person adjust to the commun-i t y . In order to assess the extent to which the aforemen-tioned functions have been instituted, i t w i l l be necessary to examine in detail the workings of the Social Service Depart-ment at The Woodlands School. - 45 -Under the present plan of organization, the Social Service Department, made up of two trained social workers and a supervisor who has had many years of experience i n the psy-chiatric f i e l d , has one hundred per cent coverage of a l l admis-sion cases. This means that every child entering the School has an intake interview with the social worker. During the intake process the parents also participate. Social workers now realize that the parents often require the utmost s k i l l , patience and understanding which the worker i s able to give. Often such parents are torn between the bitterly conflicting opinions of relatives and friends. Often they are crushed by the immense pressure of their own neighbourhood's judg-ments. These external pressures coexist with pressures from within, such as feelings of fear, frustration and deep pain over having such a thing happen to them. Since both the intake and social history interviews are often the child's f i r s t direct contact with the School, the social worker has an early opportunity to lay the groundwork effectively for later services. The social history becomes not only a diagnostic tool but also an opportunity for the beginning of a relationship between the. worker, the child and the parents. The case of Susan Sadler, a five year old spastic mentally retarded child, illustrates how the social service worker helped a mother to come to a decision about placing her child in The Woodlands School. 46 -Susan was referr e d to the School by a community s o c i a l agency. Her father was reported as being a drug addict and at that time was serving a prison sentence. Susan had become, a problem i n the home because of her need f o r constant atten-t i o n . Her younger brother f e l t rejected by t h i s attention and he reacted by turning to a delinquent pattern of behaviour. The mother, who had just recently accepted the mental retardation of her c h i l d as a f a c t , wanted to see the School. The s o c i a l worker arranged to show the mother the School, and during t h i s v i s i t the mother was very much impressed by the children themselves, by t h e i r f r i e n d l i n e s s to one another, and by t h e i r o v e r a l l happiness. Interviews with the mother were arranged by the worker, and i n the course of these interviews, the mother was helped to bring out her f e e l i n g s about having a mentally retarded c h i l d . The mother*s o r i g i n a l hope f o r a miracle cure of the ch i l d ' s slowness was gradually replaced by a more r e a l i s t i c acceptance of the c h i l d ' s permanent l i m i t a t i o n s . Eventually the c h i l d was admitted to the Woodland's School on the decision of the mother. Considerable support was given by the worker during t h i s period of casework ser-vice. Thus through the s k i l f u l help of the trained s o c i a l worker, both the parent and c h i l d are able to work out many of t h e i r f e e l i n g s about mental retardation and r e s i d e n t i a l treatment. Through the k i n d l y counsel of the s o c i a l worker i n the reception process the parent and c h i l d are able to move at t h e i r own speed i n a s s i m i l a t i n g and v e r b a l i z i n g t h e i r i n i -t i a l and l a t e r reactions to the r e s i d e n t i a l school s e t t i n g . The worker helps the parent to see that her c h i l d w i l l be an i n d i v i d u a l of worth i n t h i s s e t t i n g and not merely an e n t i t y which soon becomes l o s t i n a cumbersome i n s t i t u t i o n a l arrangement. Right from the beginning, the parent and c h i l d have the worker to lean upon should they f e e l the need. The parent i s made to f e e l that she, as a parent, has something worthwhile to contribute to the School, which has as i t s basic - 47 -obligation the treatment of the c h i l d which she may wish to place therein. This parent i s helped to see that mental retardation i s not her problem alone. As i n the case of Susan S. the parent i s not pressed to make a decision, but i s l e f t to make up her own mind a f t e r the f a c t s have been outlined by tbe worker. I f the parent should decide to place her c h i l d i n the School, the process of intake enables the worker to f u r -ther explore the parental fee l i n g s about the c h i l d ' s l i m i t a -tions. I t i s i n the intake interview that the parent needs further support f o r the process of breaking the c h i l d away from the family unit, even i f only temporarily, may produce various parental reactions. It i s i n t h i s area that the worker must use h i s utmost s k i l l s , f o r with proper interpre-tation to the parents, the c h i l d may be adequately prepared f o r separation from h i s family and from h i s f a m i l i a r pattern of l i f e . The f e a s i b l e time to prepare the c h i l d f o r separa-t i o n would be between the reception and the intake processes, f o r i f the c h i l d i s properly prepared before h i s i n i t i a l move-ment into residence i n the School he w i l l be a much happier c h i l d , who w i l l be able to accept the School's programme with a minimum of d i f f i c u l t y . Once the c h i l d has been properly prepared f o r sep-aration from the home, both parents and c h i l d are free to di r e c t t h e i r energies into active p a r t i c i p a t i o n i n the School's programme and eventually into f i n a l r e h a b i l i t a t i o n . Careful screening of applicants f o r the School's services i s es s e n t i a l - 48 -so that commitments which may not be i n the best i n t e r e s t s of the family or c h i l d can be prevented. From January to March 1953. 30 children under the age of s i x , together with t h e i r parents and r e l a t i v e s were helped by the s o c i a l service s t a f f at the time of the child' s admission to the School. In addition to t h i s , some 103 i n t e r -views of a helping nature were given to parents. In a l l , during the f i s c a l year ( A p r i l , 1952 -March, 1953) the s o c i a l service s t a f f helped to receive into the School, some 205 residents as well as 560 helping i n t e r -views to residents and parents. In summary, 1004 interviews, aimed at helping the parent to express and r e l i e v e h i s f e e l -ings about the p o s s i b i l i t y of committing h i s mentally retarded c h i l d , were held by s o c i a l workers. During these interviews the worker had as his goal the s e t t i n g up of a r e l a t i o n s h i p with the parent which would enable the parent to see the School not as an i n s t i t u t i o n o f f e r i n g permanent custodial care f o r t h e i r c h i l d but as a treatment area with r e h a b i l i t a t i o n as i t s f i r s t goal. During the f i s c a l year ( A p r i l , 1952 - March, 1953) 132 families made enquiry about the service offered by the Woodland's School f o r the mentally retarded. A l l of these f a m i l i e s were seen and interviewed by various members of the So c i a l Service Department. Of these 132 f a m i l i e s , 60 were referred to other s o c i a l agencies f o r help with various inade-quacies, such as marital problems, which were f e l t to be the basis f o r the family's i n a b i l i t y to help i t s mentally retarded member. - 49 -The s o c i a l service s t a f f also provided d i r e c t ser-vice to 72 families who sought information about the School's services. To t h i s end, some 264 interviews were provided f o r t h i s group, together with 180 consultative conferences with s t a f f p s y c h i a t r i s t s . Pre-admissions interviews of a screening nature numbered 444. These 444 interviews helped 80 parents become orientated to the School's programme. Continuing casework services to the children already admitted to the School are on a highly s e l e c t i v e basis. Only cases which would seem to benefit mostly from continuing case-work services axe considered. Referrals are commonly made by members of the other d i s c i p l i n e s , but frequently the r e s i -dents themselves, request such help by sending a note to the worker or by c a l l i n g i n person at the s o c i a l worker's o f f i c e . Many times the worker herself i n her v i s i t s to the wards sees residents who could p r o f i t from casework services. In his adjustment to the School, the c h i l d meets many obstacles some of which he i s unable to suc c e s s f u l l y handle alone. With the help which he receives through the process of the casework r e l a t i o n s h i p he i s able i n many cases to meet such d i f f i c u l t i e s . Successful casework treatment on a continuing basis i s shown i n the following case i l l u s t r a t i o n : Bobby James was a 14 year o l d fo s t e r c h i l d who was referred to the School by the Chi l d Guidance C l i n i c . He came from a large family which contained several other retarded children. His mother was reported as being a promiscuous woman who neglected her children seriously. A f t e r being ad-mitted to the School through the wish of h i s f o s t e r mother he began to develop problems i n adjusting to the t r a i n i n g 50 -regime. A f t e r r e f e r r a l by b i s doctor, Bobby was seen on the ward by h i s s o c i a l worker. He was thus able to voice h i s feelings regarding h i s d i f f i c u l t i e s . Bobby's natural mother began v i s i t i n g the ho s p i t a l and she became very h o s t i l e to the se t t i n g . This h o s t i l e attitude of the mother greatly added to the disturbances which Bobby was facing. The s o c i a l worker was able by frequent interviews with both Bobby and h i s mother to r e l i e v e t h e i r f e e l i n g s about the School. As the r e l a t i o n s h i p developed both Bobby and the mother were able to accept the t r a i n i n g program and to take an interested part i n i t . I t i s the r e s p o n s i b i l i t y of the s o c i a l worker to di r e c t h i s s k i l l s to the newly arrived resident so that the best possible adjustment to the School's programme may be effected by the resident. The new arrivee finds himself i n a group s e t t i n g , a s e t t i n g which requires both give and take on h i s part. With the help of the s t a f f and the casework process as practised by the s o c i a l worker, the c h i l d i s made to f e e l important. This f e e l i n g of worth enables him to bridge the gap between family and i n s t i t u t i o n a l l i v i n g . In Bobby's case he was able to t a l k to the s o c i a l worker as a f r i e n d who was genuinely interested i n what hap-pened to Bobby. This i n t e r e s t on the worker's part gave Bobby f a i t h i n himself and he was able through c a r e f u l i n t e r -pretation to take a better part i n the School's programme. Without the worker's i n t e r e s t i n him, Bobby could e a s i l y have turned into a boy with many problems who would require much of the s t a f f ' s time to handle him. The worker's handling of Bobby's mother i l l u s t r a t e s a s i t u a t i o n i n which the worker through understanding and patience was able to r e l i e v e pot-e n t i a l tensions i n the mother's mind, thus f r e e i n g her to take part i n the School's programme. - 51 -Daring the f i s c a l year ( A p r i l , 1952 - March 1953) 251 residents were referred to the S o c i a l Service Department. To these residents some 1,244 interviews were extended. Hem-hers of the s o c i a l service s t a f f , together with members of other d i s c i p l i n e s , p a r t i c i p a t e d i n 242 c l i n i c a l study ses-sions which had as t h e i r objective the formulation of t r a i n -ing and r e h a b i l i t a t i o n goals f o r residents. Conferences with other s o c i a l agencies i n order to e f f e c t i v e l y plan f o r var-ious residents numbered 24. Rehabilitation i s perhaps the newest of the respon-s i b i l i t i e s which the s o c i a l worker has acquired i n t h i s s e t t -ing. P r i o r to the entrance of s o c i a l workers on the scene, r e h a b i l i t a t i o n was p r a c t i c a l l y non-existent. Today a rehab-i l i t a t i o n programme has been set up which i s f a i r l y adequate when one considers the l i m i t e d number of s o c i a l workers. Teamwork and cooperative planning are the basis f o r the many needs of the retarded, i n order to achieve the u l t i -mate objectives of good vocational and s o c i a l l i v i n g . In order f o r the retarded to hold a job successfully, he must acquire p o s i t i v e attitudes i n the following areas: (1) A sincere desire to acquire work. (2) A sense of r e s p o n s i b i l i t y once the job has been acquired. (3) Sound personal habits. (4) A b i l i t y to work with others. A thorough understanding of the r e h a b i l i t a t i o n prospect i s therefore necessary. The s o c i a l worker must know - 52 -about such areas as the resident's emotional and social matur-it y and also the degree of development of his manual dexter-, i t y . Knowledge must also be acquired about the resident's a b i l i t y to follow simple oral and written directions and to complete assigned tasks. In practically a l l cases the worker w i l l need to know about the resident's a b i l i t y and i n i t i a t i v e in handling machinery and handtools. Only by careful observa-tion and teamwork can the best rehabilitation prospects be located and util i z e d . In The Woodlands School, the prospective rehabilita-tion case i s referred through many mediums, such as the doc-tor, the nurse or the resident himself. A review of the pat-ient's f i l e i s made by the social worker, the doctor, and sometimes the psychologist. The psychologist i s then con-tacted in order that a psychological assessment of the resident may be made. Such an assessment adds greatly to the total information which wi l l eventually be compiled as a background for the rehabilitation decision. A report i s also received from the school. Such a report contains details as to whether or not his teacher thinks that this resident has reached his maximum in the academic programme. If the resident has not reached his maximum, then he may be allowed to continue with his aca-demic education until such a maximum i s reached. In addition to the report from the teacher, the resident receives a f u l l medical and dental checkup. Once a l l these details are attended to, the resident's relatives = 53 -are notified that he i s being considered for rehabilitation. It i s then the social worker's responsibility to assess the resident's home, his community, and his prospective employ-ment opportunities. After a careful assessment of a l l the facts facing the resident in rehabilitation, the social worker makes a recommendation, keeping i n mind the resident's abi-l i t i e s at a l l times. The f i n a l decision for or against the return of the resident to the community rests with the medi-cal superintendent. The complex area of rehabilitation i s brought out in the case of Margaret Bayer, who had come from a family whose parents had deserted her when she was a very young g i r l . Margaret, a 26 year old g i r l , had been a resident in the School for the past twelve years. During this time she had made frequent home v i s i t s to a cousin. Margaret was referred for possible rehabilitation to the psychologist. A mental assessment was made and Margaret, pre-viously tested as a moron, now tested as a borderline mentally retarded person. Social Service was then requested to v i s i t the cousin regarding possible rehabilitation for Margaret. During such v i s i t s the worker was able to help the cousin to bring out her feelings of anxiety and guilt. It soon became clear to the social worker that the cousin did not wish to have the r e s i -dent stay with her permanently. Social service also worked with the resident during this time. Margaret was able to voice her h o s t i l i t y and her f e e l -ings about leaving the School. From here Margaret was able to move on to a frank discussion of her limitations and strengths. Discussions were held between the Social Service Depart-ment and the National Employment Service in regards to employ-ment poss i b i l i t i e s for Margaret. A housekeeping position was secured in an understanding home and the resident was moved out into the community under the supervision of the social worker. - 54 -Margaret needed much support during t h i s time and grad-u a l l y the s o c i a l worker was able to p u l l away and leave Mar-garet i n the care of a community s o c i a l agency which would make periodic v i s i t s to Margaret. This resident i s now adjust-ing well to the community and she now f e e l s that she i s making her own p a r t i c u l a r contribution to community l i f e . Once a resident i s returned to the community, through the process of r e h a b i l i t a t i o n , he or she i s placed under pro-bation f o r s i x months. The S o c i a l Service Department has the r e s p o n s i b i l i t y f o r v i s i t i n g and assessing the resident's adjustment during t h i s time. There are two forms of care under which probation i s i n s t i t u t e d . These are family convalescent care and work-ing convalescent care. Under family convalescent care the r e l a t i v e s sign the probation terms and agree to supervise the resident when he leaves the School. V i s i t s are made to the home of the r e l a t i v e s once a month by the s o c i a l worker. After s i x months the case i s reviewed and the resident i s e i t h e r d i s -charged i n f u l l by the medical superintendent or the probation-ary period i s renewed f o r another s i x months, a f t e r which the case i s reviewed again. Working convalescent care i s much the same as family convalescent care with the exception that an employer i s contacted and should the resident be acceptable to him, he i s asked to sign the probationary forms. I f the resident i s placed outside the Greater Vancouver area or New West-minster, the branch s o c i a l welfare o f f i c e concerned i s asked to supervise the resident during the probationary period. During the f i s c a l year ( A p r i l 1952 - March 1953), f i v e residents were r e h a b i l i t a t e d , four i n t o working convales-- 55 -cent care and one into family convalescent care. Of these f i v e two were returned to the School before the expiration of the six-month probationary period. In the s i t u a t i o n of one long i n s t i t u t i o n a l i z e d resident, the employment selected was beyond his emotional maturity and he was therefore unable to adapt himself to the needs of the job. The other resident was returned to the School because he was not able to cope with h i s employer's demands. Lack of praise i n h i s work also tended to make him question his own a b i l i t y on the job. In preparing these f i v e residents f o r r e h a b i l i t a t i o n , the s o c i a l service s t a f f conducted 205 interviews aimed at preparing, supporting and supervising the resident. Confer-ences with employment and agencies o f f e r i n g f i n a n c i a l a s s i s -tance were made on 33 occasions. Before the residents were moved out into the community the ps y c h i a t r i s t s were consulted on 165 occasions, psychology on 86, occupational therapy on 19, recreation and i n d u s t r i a l on 45, education on 81 occa-sions and 15 study c l i n i c s were attended by s o c i a l workers. In order to assess possible working home resources some 45 v i s i t s were made by the workers. Contacts with other agencies requesting assessment of homes numbered 21. In addi-tion to thi s 68 follow-up v i s i t s were made to both residents and employers during the placement period. One f o r t y year old woman who had been deserted by both parents on placement i n an orphanage was committed to The Woodlands School about twenty-five years ago. While i n the School her progress had been remarkable from the medical, psy-chological and s o c i o l o g i c a l aspects. When f i r s t admitted to the School at the age of 15, she was described as imbecile given to h y s t e r i c a l attacks and f a i n t i n g . P r e - r e h a b i l i t a t i o n - 56 -study a f t e r her education and t r a i n i n g period revealed her to be of dull-normal i n t e l l i g e n c e . In A p r i l 1952, she approached the S o c i a l Service Department and a f t e r numerous interviews with the pupil and contact with a distant r e l a t i v e a programme fo r her i n i t i a l r e h a b i l i t a t i o n was i n i t i a t e d . There was, however, some doubt i n the p s y c h i a t r i s t s ' minds as to t h i s pupil's a b i l i t y to adjust to the outside community having regard to her long residence i n the School which had not pre-sented her with an opportunity f o r competition with i n d i v i d -uals her own age. S o c i a l Service, however, proceeded with the r e h a b i l i t a t i o n process working c l o s e l y with the pupil and i n i t i a t e d a programme geared to helping her to face the world with new confidence and reassurance. The r e s u l t was a f i n e l y integrated personality, assured signs of emotional and s o c i a l maturity and most important of a l l , the pupil's desire to return to the community. A f t e r four months, the National Employment Service was contacted and a f t e r c a r e f u l selection by N.E.S. and the School s o c i a l worker, a job on a chicken farm was investigated and selected with the cooperation of the pup i l and other School s t a f f . The employer was given a complete picture pupil's emo-t i o n a l l e v e l and i t was explained that she would need constant and close supervision and that she would need to be trained by s i m p l i f i e d methods i n order to learn. A v i s i t to the working home was planned f o r the pup i l and a s t a r t i n g wage of $50, monthly was offered. Since placement, an intensive follow-up programme has been c a r r i e d out. Employer and employee were both seen from time to time and on each occasion high s a t i s f a c t o r y reports were received. The pupil's enthusiasm and improvement i n both appearance and behaviour was such that when the s i x months' probationary period was about to expire the employers agreed very r e a d i l y to an extention of probation as everything was working out well. The pup i l has been given increasing respon-s i b i l i t i e s and has proved r e l i a b l e i n every respect to date. 1 A review of the part which S o c i a l Work has played i n the r e h a b i l i t a t i v e process w i l l indicate the long, detailed and s k i l l e d work involved. The S o c i a l Service Department has also assumed as one of i t s functions the education and t r a i n i n g of various pro-fe s s i o n a l and l a y groups which have v i s i t e d the School. Such The Woodlands School S o c i a l Service Department, Annual Report (1952-53), p. 6. work i s invaluable, f o r the School must r e l y on i n d i v i d u a l s and groups i n the community to make r e f e r r a l s and to help i n the important area of r e h a b i l i t a t i o n . During the f i s c a l year ( A p r i l 1952 - March 1953), the s o c i a l service s t a f f p a r t i c i p a ted i n a teaching c l i n i c f o r 60 f i r s t year students of the School of S o c i a l Work, Uni-v e r s i t y of B r i t i s h Columbia. Three second year students were also orientated over a three-day period. A s p e c i a l teaching c l i n i c was also set up f o r a number of in-service trained workers. In a l l , f i v e groups of public health nurses, post-graduate nurses and nursing a f f i l i a t e s received in t e r p r e t a -tion of both the School's programme and the part which the So c i a l Service Department plays i n the education and t r a i n i n g of the mentally regarded. One group of 35 teachers and another group of 30 kindergarten teachers studied education i n t h i s s e t t i n g and the party which s o c i a l service plays i n r e l a t i o n to education. The S o c i a l Service Department also played host to four representatives of r e h a b i l i t a t i o n and s o c i a l work agen-c i e s who spent time i n the Department. Members of three Ser-vice Clubs also v i s i t e d to study the School's programme. It has been shown i n t h i s chapter that the work of the S o c i a l Service Department contains many varied responsi-b i l i t i e s . Each of these r e s p o n s i b i l i t i e s has as i t s ultimate goal the enhancement and eventual well-being of the resident. From the moment he enters the School u n t i l h i s movement back to the community the s o c i a l worker stands ready to help him i n any way i t can. CHAPTER 4 CONCLUSIONS Introduction In the preceding three chapters there has been some discussion of the many complexities which must be considered i n the understanding, education and t r a i n i n g of the mentally retarded. The increasing amount of attention which the pro-blem of mental retardation has received from both l a y and pro-fessional groups has resulted i n a more detailed assessment of ways and means to combat the effects of the l i m i t a t i o n s brought on by mental retardation. S o c i a l work, i n spite of i t s youth as a profession, has long been interested i n the area of mental retardation. With the generic t r a i n i n g , which many s o c i a l workers received i n professional schools of s o c i a l work, came the r e a l i z a t i o n that s o c i a l work, and i t s two main components of s o c i a l case-work and s o c i a l groupwork, had something to o f f e r to the r e s i -dential t r a i n i n g programmes offered by many schools f o r the mentally retarded. Being a condition and not an i l l n e s s , mental r e t a r -dation i t s e l f cannot be treated. However, the s o c i a l implica-tions of mental retardation can be treated. Social workers are aware that t h e i r p a r t i c u l a r area of competence includes - 59 -case work and group work s k i l l s i n the alleviation of the impact of mental retardation. Social workers also understand that mental retarda-tion affects the whole community and not just the family of the mentally retarded person. Therefore, the community becomes a valuable partner in any planning which the school makes for the mentally retarded person. Any successful training pro-gramme for the mentally retarded has to have cooperation of the community from the moment of the mentally retarded child's admittance to the residential training school u n t i l the time of his eventual discharge back to the community. S k i l l s of the Social Worker It was also pointed out that in any residential training programme for the mentally retarded the social case-worker i s able to apply his s k i l l s in five major areas. The f i r s t of these areas i s the intake process, during which the worker helps both the child and relative to understand what the school has to offer the mentally retarded person. Through such understanding and the help of the worker, the relative i s able to move at her own pace and to arrive eventually at a decision regarding whether or not he wants his child to be a part of such a residential programme. Once a decision i s reached to enroll the child i n the School, the second of the social work functions comes into being, namely, reception of the prospective resident into the school. Because of the previous contact with the c h i l d , the worker i s able to help the c h i l d to break away from the parent and become a resident of the school. The worker then becomes the l i n k between the school and the parents. Another r e s p o n s i b i l i t y of the s o c i a l worker was seen to be i n the area of helping the resident to adjust to the school regime. In t h i s area the caseworker uses h i s s k i l l i n the understanding of the dynamics of i n d i v i d u a l and group be-haviour i n order to help the resident make the best possible adjustment to the school. Such work was seen to be needed on a continuing basis. The fourth r e s p o n s i b i l i t y of the worker l i e s i n the complex area of r e h a b i l i t a t i o n . Here the worker uses h i s s k i l l s to prepare the c h i l d , the r e l a t i v e s and the community f o r the c h i l d ' s return to supervised community l i f e . The l a s t function of the s o c i a l worker i s i n the f i e l d of s t a f f t r a i n i n g and community i n t e r p r e t a t i o n . Here the s o c i a l worker i s able to share his knowledge of s o c i a l behaviour and i t s many complexities with groups of s t a f f and with community groups. The use of the "case i l l u s t r a t i o n 0 helps these groups to understand the many s o c i a l stresses acting on the resident and h i s family before, during and a f t e r discharge from the School. Being a partner to the School, the community also has to be aware of the f a c t that not a l l mentally retarded residents are able to return to the community, owing to the extent of the retardation or to - 61 -oar limited resources and knowledge. The Treatment Team Approach This study has shown that some of the mentally retarded are educable and can be helped i f placed in the pro* per educational and training programme. Such a programme re-quires a team approach involving both group and individual cooperation between the professional and lay levels. In this regard the historical background of The Woodlands School shows a change of emphasis which has resulted in a gradual expansion and improvement in the services for Br i -tish Columbia's mentally handicapped children. Such services have grown in order to meet the ever-increasing needs of the many provincial communities which The Woodlands School serves. Operating as a residential training and educational school for British Columbia's mentally handicapped children, The Woodlands School contains the many f a c i l i t i e s necessary for such education and training, namely, academic education, nursing, medicine, occupational and industrial therapy, manual arts, recreation, psychology, and social service. Every staff member of The Woodlands School i s therefore a potential i n -structor, as a l l of the residents have various forms of con-tact with staff members. Selection and training of staff i s therefore very important as the quality of staff must be such as to enable the School to meet f u l l y i t s objectives of ade-quate education and training. - 62 -Contributions of the S o c i a l Service Department The S o c i a l Service Department, which was established on September 19, 1951, has made an important contribution to The Woodlands School's programme i n spite of many l i m i t a t i o n s . With a s t a f f of only one supervisor and two s o c i a l workers, the S o c i a l Service Department has been able to l a y the ground work fo r more intensive s o c i a l service contributions to the f i e l d of mental retardation i n B r i t i s h Columbia. This depart-ment now c a r r i e s out one hundred per cent coverage of residents entering the School. Such work covers intake and reception interviews with both the resident and h i s r e l a t i v e s . S o c i a l Service also c a r r i e s a s e l e c t i v e caseload of continuing cases. Many chi l d r e n , who have been unable to respond successfully to the School regime, have thus been re c e i v i n g help i n t h e i r ad-justment from the s o c i a l worker. The area of r e h a b i l i t a t i o n has also received some at-tention from the S o c i a l Service Department of The Woodlands School. Several residents, who possibly would have remained i n the School, have now been successfully r e h a b i l i t a t e d with the help received from the S o c i a l Service Department. Community int e r p r e t a t i o n of The Woodlands School's functions has been another function which members of the S o c i a l Service Depart-ment have c a r r i e d on. Through such mediums as group discus-sions to outside groups and personal representation i n pro-f e s s i o n a l groups, such as the Canadian Association of S o c i a l Workers, the S o c i a l Service Department has been able to i n t e r -pret i t s own unique functions i n The Woodlands School s e t t i n g . - 63 -Perhaps one of S o c i a l Services* greatest functions i n The Woodlands School s e t t i n g i s the e f f e c t t h i s department has had on the various s t a f f groups. S o c i a l Service has been able to show these s t a f f groups just what the objective of the t r a i n i n g programme i s , and, that i n personality makeup no two residents are the same. S t a f f members, therefore, f e e l that t h e i r contribution, be i t ever so minute, when combined with the o v e r a l l t r a i n i n g and educational programme, i s helping the resident to at l e a s t achieve some contentment. However, there i s s t i l l a lack of r e a l i z a t i o n i n some groups as to what they are t r y i n g to accomplish as a school. There exists instead a f e e l i n g of r i v a l r y between groups which impedes a r e a l teamwork approach. It i s hoped that the o f f i -c i a l s at The Woodlands School w i l l be able to overcome t h i s basic d i f f i c u l t y by formal s t a f f coferences which would give perspective on the present s i t u a t i o n . These conferences might then give way to departmental reports and eventually to the type of cooperation achieved when each team member knows and accepts the r o l e s of the others and uses them to the.best advantage. The Need f o r Research The phenomenal increase i n the populations of i n s t i -tutions f o r the mentally retarded has created many complex pro-blems i n the accommodation, feeding, education and t r a i n i n g of such persons. There i s therefore a great need f o r a vigorous programme of research i n the areas of determination and pre-vention of the causes of mental deficiency and mental retarda-- 64 « t i o n . Coincident with such research should he the working out of more adequate programmes f o r the r e h a b i l i t a t i o n of the men-t a l l y handicapped person. It i s recommended that The Woodlands School i n s t i -tute periodic surveys and studies of i t s services i n order to ascertain where such services may be improved and made more e f f i c i e n t . In any study the goals should be thoroughly under-stood. Terms should be defined and i f possible a small scale test should be i n s t i t u t e d before the study begins. Analysis of material should be planned i n advance of the study. Controls w i l l also be needed where the e f f e c t of any action i s to be measured. Above a l l , the cooperation of The Woodlands School s t a f f should be assured. To date there has been no large scale assessment of the mental c a p a b i l i t i e s of the residents at The Woodlands School. Several attempts have been made at such assessments, but each time these studies have been stopped i n the e a r l y stages owing to various members of the assessment team leaving The Wood-lands School f o r other positions. No e f f i c i e n t t r a i n i n g or educational programme f o r the mentally retarded can operate unless i t knows the approxi-mate c a p a b i l i t i e s of i t s members. As has been pointed out pre-viously, only the mentally retarded can p r o f i t from t r a i n i n g programme methods now i n use. If mentally d e f i c i e n t members are enrolled i n such a programme there i s a loss of much s t a f f time which could have been much more p r o f i t a b l y used by men-- 65 -t a l l y retarded residents who would respond much more to such t r a i n i n g . There should, therefore, be an immediate assessment made of the population at The Woodlands School so that those residents who would p r o f i t best from an educational and t r a i n -ing programme reach t h e i r right to such a programme as soon as possible. Physical F a c i l i t i e s Research should also decide whether the present phy-s i c a l setup of The Woodlands School i s too cumbersome fo r the administration of an e f f i c i e n t educational and t r a i n i n g pro-gramme. The f e a s i b i l i t y of s e t t i n g up small cottage-style t r a i n i n g units throughout B r i t i s h Columbia should be c a r e f u l l y studied. Thought also should be given to the p o s s i b i l i t y of a t r a i n i n g school s o l e l y f o r the mentally retarded population of B r i t i s h Columbia. S t a f f Training Adequate care f o r the mentally handicapped i n an i n s t i t u t i o n a l s e t t i n g requires well-trained s t a f f i n s u f f i -cient numbers, e f f i c i e n t administration practices, high stan* dards of service and sound and economical use of e x i s t i n g f a c i l i t i e s . Both professional and non-professional s t a f f must be c a r e f u l l y trained so as to enable them to serve the resident with understanding, knowledge and s k i l l . Each s t a f f member must be concerned with the resident's physical, emotional, - 66 -s p i r i t u a l , s o c i a l and economic needs. E f f i c i e n t use of per-sonnel i n turn depends upon adequate supervision and adminis-t r a t i o n and upon good personnel p o l i c i e s . Any programme f o r s t a f f development should give the in d i v i d u a l s t a f f member a f u l l e r appreciation of the importance of the team approach. Case demonstrations i l l u s t r a t i n g the team approach should therefore be an important part of s t a f f development t r a i n i n g . Personnel members should also a t t a i n a greater understanding of the sig n i f i c a n c e of the resident as a person and of the importance of the resident's s o c i a l environ-ment i n the control of his reactions to mental retardation and deficiency. The s o c i a l worker as a member of the treatment team should therefore assume a leading r o l e i n the t r a i n i n g of s t a f f members i n The Woodlands School. Administrative Proceedings In The Woodlands School, there i s a need fo r sound admission, discharge and r e f e r r a l p o l i c i e s and procedures. There i s also a d e f i n i t e need fo r an integration of f a c i l i t i e s so as to enable a free flowing of residents and pertinent data i n r e l a t i o n to the resident's needs. As an i n s t i t u t i o n a l pro-gramme must be dynamic and meet the resident's needs, i t i s recommended that The Woodlands School s t a f f p e r i o d i c a l l y r e -evaluate the resident's status and need f o r further services. This service has been d e f i n i t e l y lacking i n The Woodlands School programme. - 67 -Public Interpretation A sound public educational programme on mental retardation and deficiency i s almost non-existent i n B r i t i s h Columbia. The public must be made aware of the extent of men-t a l retardation and deficiency so that they w i l l l a t e r be able to see that second class service to the mentally handicapped i s uneconomical. Interpretative material should be d i s t r i b u t e d to the public and l o c a l surveys should be made of community needs and services. The development of private philanthropic funds f o r research i n t h i s f i e l d should also be encouraged. Good i n s t i t u t i o n a l care of the mentally handicapped i n B r i t i s h Columbia may be said to be a r e a l i t y only when each and every one of the following conditions have been success-f u l l y i n s t i t u t e d : -(1) When the public i s made aware and accepts the need f o r the best possible care of i t s mentally handicapped. (2) When there i s coordination of professional s k i l l s and f a c i l i t i e s . (3) When services and f a c i l i t i e s keep pace with the demand for care. (4) When a l l resources are used to the optimum. (5) When research uncovers the best methods of providing the utmost quality of care. (6) When services are available f o r every mentally handi-capped person. Thus f a r B r i t i s h Columbia i s lagging f a r behind i n any r e a l i z a t i o n of such goals. Impetus to reach these goals should come from both professional and lay groups with the - 68 -s o c i a l worker playing a major r o l e i n i n t e r p r e t a t i o n to the community at large. Other Considerations The S o c i a l Service Department at The Woodlands School i s s e r i o u s l y handicapped by lack of depth i n s t a f f . This nat-u r a l l y means a curtailment of casework services to the residents. However, casework services should be a natural r i g h t of the resident, a r i g h t which he has every opportunity to make use of. Increasing the S o c i a l Service Department at The Wood-lands School to a basic minimum of ten trained s o c i a l workers, including two senior casework supervisors, should be i n s t i t u t e d as soon as possible. This increase i n s o c i a l service s t a f f would then bring the r a t i o of s o c i a l workers to i n s t i t u t i o n a l population more i n l i n e with the recommended standards of one s o c i a l worker to one hundred residents f o r s i m i l a r i n s t i t u t i o n s . Closer cooperation between the S o c i a l Service Depart-ment and other departments should be maintained. There i s a d e f i n i t e need f o r a manual o u t l i n i n g d e f i n i t i o n s and p r i n c i p l e s used i n the care of the mentally handicapped. Such a manual should be compiled by a committee or group chosen from pro-fessi o n a l and non-professional representatives having know-ledge on the subject. The whole area of r e h a b i l i t a t i o n i n The Woodlands School should be reassessed. Reha b i l i t a t i o n should not be seen as being necessarily synonymous with discharge or as a separate segment from admission and i n s t i t u t i o n a l care. Rather, i t should be seen as a process which begins with the intake - 69 -interview and continues through the t r a i n i n g programme u n t i l f u l f i l l m e n t i s reached i n the i n s t i t u t i o n or i n the community. During the intake interview the s o c i a l worker should focus his attention on returning the c h i l d to the community provided that the c h i l d can p r o f i t s u f f i c i e n t l y from the School's educational and t r a i n i n g programme. If complete bed care f o r an imbecile c h i l d i s the only recourse, then t h i s should be seen as the f i n a l r e h a b i l i t a t i v e plan, pending periodic reas-sessments of the s i t u a t i o n , as the c h i l d w i l l have reached the l e v e l most suited to h i s c a p a b i l i t i e s at that time. Such an approach to r e h a b i l i t a t i o n would n a t u r a l l y take time to i n i t i a t e and would require c a r e f u l i n t e r p r e t a t i o n to s t a f f groups. However, once i t was incorporated, i t would open a whole new future f o r B r i t i s h Columbia's mentally retarded. A programme of community f o s t e r homes and boarding homes f o r the mentally retarded could be i n s t i t u t e d . This would extend even further "The Rights of Children 1 1 to the mentally retarded. L a s t l y , i n order to show the change i n emphasis from schooling to r e h a b i l i t a t i o n the name of The Woodlands School might be changed to 'The Woodlands School for R e h a b i l i t a t i o n . ' No programme f o r the education and t r a i n i n g of the mentally retarded can be completely successful without ade-quate material resources i n the programme i t s e l f . In The Woodlands School there i s a d e f i n i t e need f o r more equipment such as recreational equipment, toys, et cetera. Adequate reading material and l i b r a r y f a c i l i t i e s should also be provided f o r the residents. As was previously mentioned, the public must - 70 -be aware that second-class care i s not economical, in the long run. This study has pointed out the need for further expansion of services to the mentally handicapped in British Columbia. The necessity of expanding such services, after careful research has disclosed the actual needs in this area, must be carefully interpreted to the public so as to assure their f u l l support on both the community and institutional levels. The social worker must be prepared to assume a large proportion of the responsibility for keeping the ever-increasing needs of the mentally handicapped before the pub-l i c ' s eye, so that the best possible care may at some future time be available to every mentally handicapped person. •ss- # * - 71 -APPENDIX A BIBLIOGRAPHY SPECIFIC REFERENCES Books DiMlchael, G. Salvatore, Vocational Rehabilitation of the  Mentally Retarded. U.S. Govt. P r i n t i n g O f f i c e , Washington, D.C., 1950. Myers, C. Rogers, Toward Mental Health i n School. U. of Tor-onto Press, Toronto, 1947. A r t i c l e s . Reports and Other Studies American Association on Mental Deficiency Standards Brochure, American Association on Mental Deficiency, 1952. Dinsmore, Mayme, "Teaching Specialized Subjects to the Men-t a l l y Defective," American Journal of Mental D e f i - ciency. July 1952. Gibson, Robert, "Mental Deficiency as a Basic D i s c i p l i n e i n the Training of a P s y c h i a t r i s t , " Mental Health. National Association of Mental Health, Summer 1952. Heilman, Ann Elizabeth, "Parental Adjustment to the D u l l Handi-capped C h i l d , " American Journal of Mental Deficiency. July 1952. Meyer, Gladys A., "Twelve Years of Family Care at Belchertown State School," American Journal of Mental Deficiency, January 1951. Potts, Jane, "Vocational R e h a b i l i t a t i o n of the Mentally Retarded i n Michigan," American Journal of Mental Deficiency. October 1952. Richman, S o l , "The Public Rehabilitation Program and E f f e c -t i v e Relationships with Other Agencies," American Journal of Mental Deficiency. October 195V. Rogers, Jean, "Family Care School Program at Newark State School," American Journal of Mental Deficiency. October 1951. 72 -Sion, A l v i n , "Casework with An Adolescent Boy of Moron I n t e l -l i g e nce," A m e r i c a n J p u r n a l o f M ^ A p r i l 1953*1 '. The Woodlands School So c i a l Service Department Annual Report, (1951-1952). The Woodlands School So c i a l Service Department Annual Report, (1952-1953). Tizard, J . , "The Employability of High Grade Mental Defectives," American Journal of Mental Deficiency. A p r i l 1950. GENERAL REFERENCES Books Burt, C y r i l , The Backward C h i l d . University of London Press, London, England, 1937. Penrose, L.S., Biology of Mental_Defectives. Sidquick and Jack-son, London, England, 1950. Richmond, Mary E., What Is So c i a l Casework, Russell Sage Foun-dation, New York, 1922. Sarasen, S.B., The Psychology of Mental Deficiency. Harper, New York, 1949. Tredgold, A.F., Mental Deficiency. B a i l l u r e , London, England, 1952. A r t i c l e s , Reports and Other Studies Buck, Elizabeth W., "Developing the Community's Responsibility f o r the Adjustment of the Mentally Retarded," American Journal of Mental Deficiency, February 1952. Coleman, James C., "Group Therapy with Parents of Mentally Deficient Children," American Journal of Mental D e f i -ciency. A p r i l 1950. G i l i b e r t y , Frank R., "The Role of the So c i a l Worker,* American Journal of Mental Deficiency, January 1951. Haasarvd, Florence F., Moore, Sara W., "Vocational Rehabilita-tion and Education f o r the Mentally Retarded i n Minneapolis," American Journal of Mental Deficiency. October 1952. - 73 -Mental Hygiene. Social Work Year Book, 1945. Scholter, Bertha B . , "Social Training for Boys and G i r l s , " American Journal of Mental Deficiency. April 1950. # * * 

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