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The Health Centre for Children, 1948-1951 : a review of the development and current programme at the… Richards, Sonia Patricia 1952

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THE  HEALTH CENTRE FOR CHILDREN, 1948-1951  A Review o f t h e D e v e l o p m e n t and C u r r e n t Programme at the Vancouver. General H o s p i t a l  hy  Sonia P a t r i c i a Richards  Thesis Submitted i n P a r t i a l F u l f i l m e n t of t h e Requirements f o r t h e Degree o f "MASTER OF SOCIAL WORK i n t h e S c h o o l o f S o c i a l Work  A c c e p t e d a s c o n f o r m i n g t o the. standard r e q u i r e d f o r the degree o f .Master o f S o c i a l Work  S c h o o l o f S o c i a l Work 1952 The U n i v e r s i t y  of B r i t i s h  Columbia  TABLE OF  Chapter 1.  COMMITS  Beginnings of the H e a l t h Centre f o r C h i l d r e n  D e f i n i t i o n of h e a l t h c e n t r e . C h i l d r e n ' s s e r v i c e s i n the a d u l t O u t p a t i e n t s ' Department. The need f o r . separate f a c i l i t i e s f o r c h i l d r e n . E s t a b l i s h m e n t of the H e a l t h Centre f o r C h i l d r e n . Chapter 2.  P h y s i c a l S t r u c t u r e of the H e a l t h Centre f o r Children  Financing, of the H e a l t h Centre. F u n c t i o n s . O r i g i n a l s e r v i c e s and n e c e s s i t y f o r expansion. M e d i c a l staff. Increase i n attendances. D e s c r i p t i o n of m e d i c a l c l i n i c s . . V o l u n t e e r s . F u r t h e r needs. Chapter 3,  The S o c i a l Worker i n the H e a l t h Centre f o r Children  The s o c i a l worker i n a medical s e t t i n g . The s o c i a l worker i n a c h i l d r e n ' s o u t p a t i e n t s e t t i n g . The s o c i a l worker i n the Health.Centre f o r C h i l d r e n , Casework s e r v i c e r e f e r r a l s w i t h case i l l u s t r a t i o n s . Other casework s e r v i c e s . D i s t r i b u t i o n of workers' time. Improvement of s e r v i c e s . Chapter 4.  E v a l u a t i o n and C o n c l u s i o n s  M e d i c a l s t r u c t u r e and s e r v i c e s . E v a l u a t i o n of s p e c i f i c c l i n i c s . Heeded adjustments. Medical-social s t r u c t u r e and s e r v i c e s . E v a l u a t i o n of m e d i c a l - s o c i a l area.  ii  Appendices: A.  H e a l t h Centre 1948-1951.  B.  Bibliography.  TABLES AND  T a b l e 1.  Table  2.  Table  3.  Table  CHARTS IN THE TEXT  Attendances,  1  C o n s u l t a t i o n s w i t h A d u l t s and C h i l d r e n , Vancouver General H o s p i t a l O u t p a t i e n t s * D e p a r t m e n t , 1940-1946 i n c l u s i v e Numbers o f C o n s u l t a t i o n s , J a n u a r y 1947 and 1 9 4 8  5,  C h i l d r e n ' s Attendances, Vancouver General H o s p i t a l , J a n u a r y - M a y , 1947 - 1951 inclusive . . .  A d m i t t i n g and'Other I n t e r v i e w s , H e a l t h Centre f o r Children,.January-December, 1951  (b) 1  5  t o May,  4. • H e a l t h C e n t r e f o r C h i l d r e n : Attendance at S e p a r a t e C l i n i c s , June, 1948 December, 1951  Table  Fig.  f o r Children Clinic  13  23  24  79  Charts  Monthly Attendances, C h i l d r e n , 1948-1951  iii  H e a l t h Centre f o r 22  A B S  T R A C T  T h i s study r e v i e w s t h e g r o w t h and development o f t h e H e a l t h Centre f o r C h i l d r e n , Vancouver G e n e r a l H o s p i t a l , w h i c h has o f f e r e d , f o r t h e p a s t f o u r y e a r s , a d i a g n o s t i c and treatment s e r v i c e t o c h i l d r e n i n l o w income f a m i l i e s . The aim o f t h e p r o j e c t i s t o determine to what e x t e n t the.need i n t h e community f o r a s e r v i c e of t h i s k i n d i s b e i n g met. The main r e s e a r c h methods used t o o b t a i n t h e n e c e s s a r y . i n f o r m a t i o n have been i n t e r v i e w s and s t u d i e s o f m e d i c a l and s o c i a l case r e c o r d s . The m e d i c a l s t r u c t u r e i s d e s c r i b e d i n d e t a i l w i t h s u g g e s t i o n s f o r improvement o f s e r v i c e i n t h i s a r e a . The r o l e w h i c h t h e s o c i a l worker f u l f i l l s i s o u t l i n e d , and i s compared w i t h t h e r o l e w h i c h t h e s o c i a l worker would i d e a l l y assume i n a s e t t i n g o f t h i s t y p e . S u g g e s t i o n s f o r improvement o f s e r v i c e a r e made i n t h i s a r e a a l s o . P a r t i c u l a r emphasis i s p l a c e d upon t h e need f o r treatment o f t h e "whole" i n d i v i d u a l , a f a c t o r w h i c h , because o f c o n c e n t r a t i o n upon e x p a n s i o n o f m e d i c a l s e r v i c e s , appears t o have r e c e i v e d t o o l i t t l e a t t e n t i o n i n t h e H e a l t h Centre,. A l t h o u g h t h e r e i s ' s t i l l room f o r improvement i n t h e programme, t h e r e i s r e a s o n t o b e l i e v e t h a t t h e need i n t h e community f o r a s e r v i c e o f t h i s k i n d i s b e i n g met t o a g r e a t e x t e n t . The main i n d i c a t i o n o f t h i s i s the c o m p a r a t i v e l y l a r g e number o f p e o p l e who use t h e H e a l t h Centre f a c i l i t i e s , This i s p a r t i c u l a r l y evident when attendances f o r t h e f o u r - y e a r p e r i o d a r e compared w i t h t h e numbers who used t h e o n l y p u b l i c m e d i c a l s e r v i c e s formerly available. S i n c e t h e H e a l t h Centre w i l l ' b e moving i n t o new and more s p a c i o u s q u a r t e r s i n t h e course o f t h e n e x t few months and s i n c e , a t t h i s t i m e , many major and m i n o r changes w i l l be i n s t i t u t e d , t h i s study i s c o n s i d e r e d an i n t e r i m one. I t would be v a l u a b l e t o have a f u r t h e r study completed a f t e r f o u r o r f i v e y e a r s o f c o n t i n u e d operation.  / A C K N O W L E D G M E N T S I w i s h to p r e f a c e my acknowledgments w i t h an e x p r e s s i o n of thanks and a p p r e c i a t i o n t o M i s s M a r i e C r a i g , s e n i o r s o c i a l worker, H e a l t h Centre f o r C h i l d r e n , who p r o v i d e d a g r e a t d e a l o f f a c t u a l i n f o r m a t i o n f o r t h i s study, and who helped immeasurably by d i s c u s s i o n s r e l a t i v e t o theory and content, I would a l s o l i k e t o g i v e thanks t o D r . Donald Paterson, P a e d i a t r i c i a n - i n - C h a r g e of the H e a l t h Centre f o r the time he gave and t h e i n f o r m a t i o n he provided, p a r t i c u l a r l y i n reference to the e a r l y p a r t of the m e d i c a l programme; and t o Dr. J . P. McCreary, p r o f e s s o r and P a e d i a t r i c Department head, Vancouver General H o s p i t a l , f o r h i s . h e l p f u l suggestions r e l a t i v e to improvement of medical s t r u c t u r e . To Dr. L . C. Marsh, I w i s h t o express a p p r e c i a t i o n f o r h i s i n v a l u a b l e a s s i s t a n c e i n connection w i t h o r g a n i z a t i o n and p r e s e n t a t i o n of m a t e r i a l .  v  THE HEALTH CENTRE FOR CHILDREN, 1948-1951 A Review of the" Development and Current Programme at the Vancouver. General H o s p i t a l ,  CHAPTER 1  BEGINNINGS OP THE HEALTH CENTRE POR CHILD REM  The used.  term " h e a l t h centre" i s somewhat l o o s e l y  In f a c t , from examination o f s e v e r a l  establishments  c a l l e d h e a l t h c e n t r e s , the only u n i v e r s a l common denominator which appears to e x i s t  i s that a l l h e a l t h  centres c a r r y on s e r v i c e s r e l a t e d i n some way t o the h e a l t h and w e l f a r e stated region.  of a c e r t a i n group of people i n a  A s t r e s s on p r e v e n t i v e  care and treatment  i n the area of h e a l t h i s a f e a t u r e which i s u s u a l l y , but not u n i v e r s a l l y , found among h e a l t h c e n t r e s .  Beyond t h i s ,  there i s a vast v a r i a t i o n i n emphases and s t a t e d purposes. Administration,  f i n a n c i n g , e l i g i b i l i t y f o r treatment, o v e r a l l  programme and s e r v i c e s , a t t e n d i n g and permanent f a c i l i t i e s such as l a b o r a t o r i e s and t e a c h i n g all  staff,  programmes:  of these are arranged f o r i n v a r i o u s and widely  divergent  ways. The  H e a l t h Centre f o r C h i l d r e n o f the Vancouver  General H o s p i t a l i s a s p e c i a l i z e d e x t e n s i o n O u t p a t i e n t s " Department which has,  of the  s i n c e the e a r l y days  of i n c o r p o r a t i o n o f the H o s p i t a l , made medical treatment a v a i l a b l e to a d u l t s and c h i l d r e n unable to a f f o r d the  services  2 -  of p r i v a t e medical p r a c t i t i o n e r s .  advent,;:, o f B r i t i s h eligible  Columbia  individuals  Hospital  residing  Prior  Insurance  i n organized  to the  legislation,  territory  o u t s i d e V a n c o u v e r were r e q u i r e d t o o b t a i n a l e t t e r from t h e i r m u n i c i p a l i t y  stating  agree  o f $1.00 p e r v i s i t  to accept  charges  f o r l a b o r a t o r y work, X - r a y ,  A letter nurse,  of r e f e r r a l  or social  territory, backing and  charges  that  a g e n c y was a l s o  and a d d i t i o n a l  required.  agencies.  In unorganized  Since the Hospital effect,  i s s e r v e d on t h e l a t t e r b a s i s . eligible  f o r treatment  t h e whole  Included i n  a t t h e O u t p a t i e n t s *'  a r e t h o s e wage e a r n e r s and r e t i r e d  whose i n c o m e s have f a l l e n b e l o w a s t a t e d dependents o f such persons, Mothers'  services.  from p u b l i c h e a l t h d o c t o r s  I n s u r a n c e l e g i s l a t i o n h a s come i n t o  Department  and e x t r a  however, r e f e r r a l s were a c c e p t e d , w i t h o u t t h e  n u r s e s and s o c i a l  t h e group  would  from a p h y s i c i a n , p u b l i c h e a l t h  of the m u n i c i p a l i t y ,  province  the municipality  Allowance,  recipients  persons 1  amount, t h e  o f O l d Age P e n s i o n s ,  and c e r t a i n S o c i a l A s s i s t a n c e  1. E l i g i b i l i t y r e q u i r e m e n t s have c h a n g e d c o n s i d e r a b l y over the y e a r s . I n 1 9 3 8 p e r m i s s i b l e m o n t h l y income f o r a s i n g l e p e r s o n was.$60; f o r a m a r r i e d p e r s o n , $70; f o r a f a m i l y o f t h r e e , $80; and f o r e a c h a d d i t i o n a l p e r s o n a f t e r t h r e e , $15 e x t r a was a l l o w e d . The p r e s e n t r e q u i r e m e n t s are, f o r a s i n g l e p e r s o n , $100; f o r two p e r s o n s , $130; f o r t h r e e p e r s o n s , $150; and f o r e a c h a d d i t i o n a l p e r s o n a f t e r t h r e e $ 2 5 . i s a l l o w e d up t o a maximum o f $250 f o r a f a m i l y o f seven.  1 recipients. individual  Decisions basis  nave a l s o b e e n r e n d e r e d on a n  regarding  p e o p l e whose i n c o m e s may  have f a l l e n b e l o w t h e s t a t e d minimum b u t who, reasons, unable,  have s u f f e r e d f i n a n c i a l therefore,  hardship  not  f o r various  and have b e e n  to pay f o r the s e r v i c e s  of p r i v a t e  physicians. The Heed f o r S e p a r a t e F a c i l i t i e s The O u t p a t i e n t s '  Department has f i l l e d  1  o b v i o u s n e e d i n t h e community, considering  f o r Children  and has done  the l i m i t e d f a c i l i t i e s ,  w i t h w h i c h i t has h a d t o o p e r a t e . in  t h e way  that kind,  eventually  for  Children  done  i s every i n d i c a t i o n  be a s u p e r i o r  service of i t s  advance i n almost  establishment  i n J u n e , 1948 was  of t h e s e advances. included  The  staff  Much h a s y e t t o be  and one n o t e s some s i g n i f i c a n t  every Annual Report.  i t s job well  equipment, and  o f improvement, b u t t h e r e  this will  an  of the Health  Centre  one o f t h e more n o t e w o r t h y  P r i o r to t h i s ,  c h i l d r e n had been  i n t h e o v e r a l l o u t p a t i e n t s ' programme w h i c h , o f  n e c e s s i t y was  very  limited.  T h e r e were  constant  e f f o r t s to  1. S o c i a l A s s i s t a n c e r e c i p i e n t s were t r e a t e d a t t h e O u t p a t i e n t s ' D e p a r t m e n t u n t i l 1953 when t h e C i t y a r r a n g e d t o have p h y s i c i a n s r e i m b u r s e d , a t a r e d u c e d f e e , f o r t r e a t i n g them p r i v a t e l y . However, t h e s e p e o p l e continued t o be r e f e r r e d t o t h e O u t p a t i e n t s ' D e p a r t m e n t f o r c o n s u l t a t i o n s , X - r a y s , and l a b o r a t o r y work; and most p h y s i c i a n s now make a p r a c t i c e o f a u t o m a t i c r e f e r r a l t o t h e O u t p a t i e n t s ' D e p a r t m e n t , as t h e y f e e l t h a t t h e p a r t i a l f e e p a i d by t h e C i t y i s i n a d e q u a t e . I n some c a s e s , however, the p a t i e n t i s r e f e r r e d back t o the p h y s i c i a n f o r treatment when d i a g n o s i s has b e e n e s t a b l i s h e d .  rectify  this,  facilities  "but  were  the  a  "barrier  effective  measures.  treatment  of  That was a  the  The  children  to  small  i n the number The  of  O u t p a t i e n t s * Department  consultations  of  the  assume  with  service how  gives  many  children,  g r o u p s who  as  of  compared  meet which  as  to  years  i s no  compared these  eligible,  a much g r e a t e r number  this  to  years;  to the  \\ray o f adults, but,  that  attended in  number  1940  children  need  adults  of  1946 inadequacy knowing were  because  i t i s reasonable of  medical  revealed  the  of  of  obvious.  actually  indication There  for  " b r a c k e t s was  children  some  lack  any  community  d i d not  f o r the  during  were  and  consultations with  for children.  f o r treatment  that  of  children  (Table 1),  inclusive  eligible  number  time  figures  eligible  the  exactly  i n the  attendance  "by  formation  i n low-income  clinic.  this  the  need  the  of  imposed  O u t p a t i e n t s ' Department  reflected  very  limits  were  to eligible  1 than  actually  attended.  1. I t s h o u l d be n o t e d t h a t t h e M e t r o p o l i t a n H e a l t h Committee had a w e l l o r g a n i z e d p u b l i c h e a l t h programme d u r i n g t h e s e y e a r s , and t h a t , t h e r e f o r e , minor- i l l n e s s e s , f e e d i n g and b e h a v i o r p r o b l e m s and s i m i l a r difficulties were t a k e n care of here w h i c h might o t h e r w i s e have been r e f e r r e d to the O u t p a t i e n t s ' Department. However, t h e W e l l Baby C l i n i c s ( a l s o c a l l e d C h i l d H e a l t h Centres) served c h i l d r e n u p t o two y e a r s o f a g e o n l y , a n d t h e s c h o o l p r o g r a m m e d i d n o t r e a c h t h e c h i l d u n t i l h e was six. Thus, t h e r e v/as p r a c t i c a l l y no p r o v i s i o n f o r t h e t w o to s i x year-old. I t m u s t be k e p t i n m i n d , a l s o , t h a t c h i l d r e n who needed a c t u a l medical treatment r a t h e r than p r e v e n t i v e t r e a t m e n t o r a d v i c e , were r e f e r r e d , i f f i n a n c i a l l y eligible, t o t h e O u t p a t i e n t s ' D e p a r t m e n t by t h e M e t r o p o l i t a n H e a l t h Committee.  TABLE i :  Years {Jan-Dec)  5 -  C o n s u l t a t i o n s with, Adul t a _ a n d _ j ^ i l d r e n , VancouYer General H o s p i t a l O u t p a t i e n t s ' D e p a r t m e n t , 1940-1946 i n c l u s i v e .  Consultations with Adults  Consultations with Children  Total " Consultations  1940  54,394  1, 776  56,170  1941  45,963  1,496  47,459  1942  31,212  677  31, 889  1943  22,217  328  22,545  1944  20,957  289  21,246  1945  22 y 2<d 8  290  22,518  1946  28,237  424  28, 661  Source: Annual Reports, 1940-1946 i n c l u s i v e .  Vancouver General H o s p i t a l ,  1  What a s p e c t s  i n t h e programme  and p o l i c y  of  t h e O u t p a t i e n t s ' D e p a r t m e n t p o i n t e d up t h e p r e s s i n g n e e d for  special  children"s services,  to the establishment Early  o f the H e a l t h Centre  in'the history  Department, d a i l y  and l e d t h e way u l t i m a t e l y  clinics  f o r Children?  of the O u t p a t i e n t s '  f o r c o n s u l t a t i o n b e g a n t o be  1. The t o t a l f i g u r e o f t h e number o f c o n s u l t a t i o n s i n t h e O u t p a t i e n t s * D e p a r t m e n t f o r e a c h y e a r was o b t a i n e d f r o m t h e A n n u a l R e p o r t s o f t h e V a n c o u v e r G e n e r a l H o s p i t a l , 1.9401946 i n c l u s i v e . The f i g u r e o f t h e number o f c o n s u l t a t i o n s w i t h c h i l d r e n was o b t a i n e d f r o m u n p u b l i s h e d m a t e r i a l i n p o s s e s s i o n of the C h i e f C l e r k i n the O u t p a t i e n t s ' Department. T h u s , t h e number o f a d u l t c o n s u l t a t i o n s f o r e a c h y e a r was a r r i v e d a t by s u b t r a c t i n g t h e l a t t e r f r o m t h e f o r m e r .  conducted, physical  and  a  examination.  clinics  specific  -  each p a t i e n t  "be i n d i c a t e d , t h e weekly  6  was  I f continued  p a t i e n t was  day.  The  clinics,  s t u d e n t n u r s e s was  scheme.  The  programme was  Ear,  were t h i r t y  Cardiac,  the  Centre f o r C h i l d r e n  Seizure  C l i n i c was  a part  i n theory,  t o he  not an  he  s e e n hy  lack  p o s s i b l e to  and  on  eleven  o "clock.  out  the  of adequate f a c i l i t i e s  opening  and  Eye,  of  a Paediatric  a l l c h i l d r e n were,  Due  Saturday to p r e s s u r e  established,  treatment  in  Allergy,  E v e n when a c h i l d  the  the  Surgery,  however, t h e p r o c e d u r e  was  for  i n weekly  Medical,  Until  of  expanded u n t i l ,  i n J u n e , 1948  a diagnosis  carry  seen  programme  integral part  a p a e d i a t r i c i a n on  efficiently.  e x a m i n a t i o n and  not  Clinics.  of f a c i l i t i e s ,  followed  to  various  thereafter  a teaching  o f t h i s programme, and  mornings from nine to lack  was  found  of the  Throat, Orthopaedic, A r t h r i t i c , 1  and  t i m e and  one  different clinics  Endocrine, Health  an  enlarged  These i n c l u d e d  Nose and  and  and  and  operation.  t r e a t m e n t was  complete  s e r v i c e s of w e l l - q u a l i f i e d s p e c i a l i s t s  internes  there  t o have a  r e f e r r e d to  w h i c h were s e t up,  were d o n a t e d t o t h e s e  1950,  required  did  of  could receive  i t was  often  i n d i c a t e d because  e q u i p m e n t , and  of  crowded  1. Medical terminology i n t h i s paper i s i n conformity w i t h d e f i n i t i o n s i n New Gould M e d i c a l D i c t i o n a r y , F i r s t E d i t i o n , e d i t e d by H. ¥ . J o n e s , N. I». H o e r r , and A. O s o l , B l a k i s t o n Company, P h i l a d e l p h i a and. T o r o n t o , 1949.  - J? hospital  wards.  physiotherapy, disturbances; facilities  T h e r e was o n l y v e r y l i m i t e d p r o v i s i o n f o r dental  care,  f o r c h i l d r e n f o r treatment  diabetes,  were a l l meagre.. O f t e n , were n o n - e x i s t e n t ,  it  clinic  although  referral  disturbances,  purposes,  sometimes s u c h c a s e s adult  f o ra child  t h r e e months a f t e r refractionist.  and e n d o c r i n e  clinics.  to wait  from  were  frequent, but  s i x weeks t o  for his turn with the  T h e r e was a l w a y s a l o n g w a i t i n g - l i s t o f  c h i l d r e n who r e q u i r e d g l a s s e s .  The number o f b e d s  available  on t h e wards f o r h o s p i t a l i z a t i o n  attending  t h e O u t p a t i e n t s ' D e p a r t m e n t was g r o s s l y  and  t h e r e were few o p e r a t i o n s  such operations indicated place  except  of children  Special  When  were  c o n d i t i o n s , i t was a g a i n n e c e s s a r y t o  t h e c h i l d ' s name o n a l o n g w a i t i n g - l i s t , result  inadequate,  f o r emergency.  as t o n s i l l e c t o m y and herniotomy  for chronic  inevitable  they  Referrals to  f o r r e f r a c t i o n were f a i r l y  was n e c e s s a r y  The  of orthopaedic, ear,  for a l l practical  to the appropriate  adult  emotional  c a r d i a c , and n e u r o l o g i c a l c o n d i t i o n s  as w e l l a s a l l e r g i e s ,  the  of  and no p r o v i s i o n f o r s p e e c h t h e r a p y .  nose, t h r o a t , s k i n ,  referred  and treatment  that h i sgeneral  with the  health often suffered.  Care f o r C h i l d r e n i n t h e O u t - P a t i e n t s '  Department  C h i l d r e n d i d r e c e i v e some a t t e n t i o n i n t h e O u t p a t i e n t s ' Department and  the e f f o r t s  nurses',  apart  from the P a e d i a t r i c C l i n i c ,  o f t h e Women's A u x i l i a r y ,  and e v e n t u a l l y s o c i a l  "social-service  s e r v i c e workers a r e a l l worthy  of  note  i n this  8 -  regard.  The  work o f o u t s i d e a g e n c i e s  as t h e M e t r o p o l i t a n H e a l t h Committee, t h e Society,  and t h e D e p a r t m e n t  contributed,  Children's Aid  of S o c i a l Welfare  i n some m e a s u r e , t o t h e  service  c h i l d r e n i n the O u t p a t i e n t s ' Department. s e r v i c e was,  until 1  environmental, child  as an i n d i v i d u a l  c o g n i z a n c e was children's  illnesses  or to h i s emotional that  of parents.  organizations  and  individuals  were r e m i s s i n t h e i r It  was  the  T h i s i s not  duties,  at  social  time,  and  t h e k n o w l e d g e t h a t was In to  treatment  the H o s p i t a l devoted "social  mainly  of the r a i s i n g  Ho  as  rejecting the  services  child  as  efforts.an  r e c o g n i z e d anywhere v/as commensurate  with  available.  t h e y e a r s 1902 2  called  or the  f o r t h e y made g r e a t  t h a t v/as l i t t l e  the  behind  r e n d e r i n g such  i n d i v i d u a l person this  needs.  t o say t h a t  importance' o f c o n s i d e r i n g t h e  to  such  g i v e n to  f r e q u e n t l y l i e such problems  dependency, i g n o r a n c e , f e e b l e m i n d e d n e s s , attitudes  extended  almost p u r e l y  c o n s i d e r a t i o n was  t h e n taken of the f a c t  also  However,  comparatively recently,  and l i t t l e  such  service"  t o 1912,  t h e Women"s A u x i l i a r y  i t s major e f f o r t i n the H o s p i t a l .  of funds  t o what was This  to p r o v i d e the  then  consisted Hospital  1. That i s , the p r o v i s i o n o f m a t e r i a l needs o r the a d j u s t m e n t , by m a n i p u l a t i o n , o f an u n f a v o u r a b l e s o c i a l situation. 2. " H o s p i t a l " , unless otherwise f r o m h e r e on t o t h e V a n c o u v e r G e n e r a l  indicated, Hospital.  refers,  -  9 -  w i t h equipment,and p a t i e n t s w i t h a p p l i a n c e s and c o m f o r t s . I t may "be assumed t h a t extent, Social  t h o u g h no f a c t s  c h i l d r e n b e n e f i t e d from are available.  this  t o some  I n 1912, t h e  S e r v i c e D e p a r t m e n t was b e g u n i n t h e H o s p i t a l a n d  was f i n a n c e d by t h e Women's A u x i l i a r y . A s o c i a l n u r s e was engaged.  The d u t i e s o f t h i s  service  nurse i n c l u d e d  f o l l o w - u p work w i t h i n homes a f t e r p a t i e n t s ' d i s c h a r g e s , and to  attendance suppose t h a t  a t outdoor  clinics.  I n 1916, t h e S o c i a l  began t o t a k e r e s p o n s i b i l i t y  and  S e r v i c e Department  f o r arranging f o r the care  children of sick parents.  that  i t i s reasonable  c h i l d r e n r e c e i v e d some m e a s u r e o f  a t t e n t i o n here.  of  Again  I n 1918, i t was r e p o r t e d  " f i f t e e n b a b i e s have b e e n a d o p t e d i n t o g o o d homes 1 are doing w e l l " . A l s o , i n t h i s y e a r , " m i l k and o t h e r 1  nourishing needy  foods"  and warm c l o t h i n g were p r o v i d e d f o r  c h i l d r e n d i s c h a r g e d from  were made f o r t h e f i r s t Women's A u x i l i a r y )  time  t o send  Hospital.  Arrangements  i n this year  (through the  f i v e mothers and seventeen  c h i l d r e n t o a f r e s h a i r camp f o r two weeks. social  s e r v i c e n u r s e who h a d h a d a c o u r s e  s e r v i c e work was p l a c e d i n c h a r g e  Women's A u x i l i a r y  1.  found  that  Vancouver General  i n social  of the Social  Department, and t h e p r e v i o u s l y - m e n t i o n e d were c o n t i n u e d and expanded.  I n 1920, a  types  Service of services  On December 31, 1 9 2 6 t h e i t c o u l d no l o n g e r manage  H o s p i t a l Annual  R e p o r t , 1918.  - 10 financially* into  and  the S o c i a l  the H o s p i t a l .  still  carrying  children, and was  S e r v i c e D e p a r t m e n t was  I n 1930,  the O u t p a t i e n t s  the adoption of  c l o s e l y w i t h outside agencies  Children's Aid Society i n this  connection.  to  entirely  this  Department  on i t s work o f a r r a n g i n g f o r b o a r d i n g  i n f a n t s , m o t h e r s , and  working  1  absorbed  t i m e were s t i l l  almost  of  infants;  s u c h as  The  on an  was  the  services  up  environmental  level. 1 In  1934,  the  first  trained  s o c i a l w o r k e r v/as  employed i n t h e O u t p a t i e n t s ' D e p a r t m e n t . o v e r t h e work p r e v i o u s l y done by t h e and,  carried  of  social  service  marked t h e  on by t h e  this  Social  f u n c t i o n was  Neglected  advent  end  adoption service  S e r v i c e Department  carried  on by  the  o f t h e t r a i n e d w o r k e r was  individual  attention  c o u l d be  given.  workers i n the S o c i a l  D e p a r t m e n t , and  t h e y were, i n t h a t y e a r ,  clinics.  were n o t  p a e d i a t r i c wards and  The  but  individual  By  still  1941,  Service  assigned to v a r i o u s  enough w o r k e r s t o go  a l t h o u g h a few  Hospital,  t r e m e n d o u s and  social  however, and  i n the  Government.  t h e r e were n i n e  There  as  a g r e a t advance,  c o v e r e d was  The  Superintendent  C h i l d r e n of the P r o v i n c i a l  t h e volume o f work t o be little  of the  took  nurse,  i n addition,- s u p e r v i s e d the v o l u n t e e r groups.  y e a r 1935  and  T h i s worker  around,  children  on  i n the O u t p a t i e n t s ' Department  the could  1. A s o c i a l w o r k e r was, a t t h i s t i m e , c o n s i d e r e d t o be t r a i n e d a f t e r one y e a r o f p o s t - g r a d u a t e s t u d y i n s o c i a l work had b e e n s u c c e s s f u l l y c o m p l e t e d . ( P r e s e n t s t a n d a r d s s p e c i f y two y e a r s ) .  have t h e  specifically  c h i l d r e n ' s wards. considerable  other  things,  staff  duties  to  supervise  The  be  the  social  done i n t h e  p a e d i a t r i c i a n who  had  recently  permission  to  s i t i n at  observer.  At  this  averaged  P a t e r s o n was extended  d i d not  fill  the  done a b o u t t h e who,  he  was  for their  not  time,  children.  great,  who  of  personnel,  the  staff.  important, of  were what  He  had  Donald Paterson,  there  was  that  expressed the  as  an  and  Dr.  need f o r that  available  something  services  i n low-income  opposed to opinion  that  an  the  should  have a c c e s s t o m e d i c a l  a t t i t u d e was  asked  month.  a serious  the  a  Paediatric  i n Vancouver,  thought  otherwise the  Department  c h i l d r e n per  numbers o f p e o p l e  This  Children  at the  i n d i c a t i o n that  need.  large  was  Among  a r r i v e d from England,  attendance  of t h i s k i n d an  for  Outpatients'  c e r t a i n , d i d not  some p h y s i c i a n s was  the  convinced that  a t t e n d a n c e was  had  rearrange  a sma.ll p a r t  t h a t Dr.  about t h i r t y - f i v e  service  the  worker-patient r e l a t i o n s h i p .  I t \tfas i n J u l y , 1947  low  only  or  i n 1947.  use  s e r v i c e s , while undoubtedly as  worker  c h i l d welfare,  c a s e w o r k e r s on  recognized  no  had  duty of t h i s p e r s o n to  B e g i n n i n g s of Expanded S e r v i c e s  Clinic  of  e f f e c t a more e f f i c i e n t  coming t o be  could  field  who  S o c i a l S e r v i c e Department the  was  the P a e d i a t r i c C l i n i c  casework s u p e r v i s o r ,  i t was  Environmental now  A  to  worker, t h e r e  e x p e r i e n c e i n the  appointed to the  to  -  s e r v i c e s of a s o c i a l  appointed  and  11  be  brackets services  that the  of need  s e r v i c e w o u l d be more v / i d e l y  used. and  Dr.  Paterson 1  felt  moved t o  smugness" o f t h e g e n e r a l p u b l i c  in this  b e g a n , on O c t o b e r  1,  1947  after  only.  c h i l d r e n were, f r o m  Paterson.  The  gave t a l k s  i n the  from  s e r v i c e was  social  this  time  publicized  community.  come t o  b e e n done b e f o r e t o any  great  more t h a n d o u b l e d  through  of r e f e r r a l . extent,  in positions  c o n s u l t a t i o n which l a s t e d  by D r .  and  seen  by  Dr.  Paterson,  T h i s had  the  action  1947  and  January  to  i n d i c a t i o n of the bear  the  ( T a b l e 2}  increased attendances,  out D r . P a t e r s o n ' s I n an  1948  and  not  daily  June,  f o r C h i l d r e n opened.  t o May,  Comparison to  gives  an  would  seem t o  contention.  i n t e r v i e w w i t h the w r i t e r , Dr.  1. As s t a t e d by D r . P a t e r s o n writer.  i n an  of  referrals.  during t h i s p e r i o d of 1947  and  was  o f t h e number o f c o n s u l t a t i o n s i n t h e p e r i o d s J a n u a r y May,  who  the p o l i c y  t o make  from October,  when t h e H e a l t h C e n t r e  Saturdays  health personnel,  carried  source  r e c e i v e d by p e r s o n s  on,  the  F u r t h e r r e c o g n i t i o n was  agencies, p u b l i c  a r e p o r t to the  Attendances  i n the  i n t h e week i n s t e a d o f on  p h y s i c i a n s when D r . P a t e r s o n  1948  physicians  a p e r i o d of o b s e r v a t i o n ,  t o have c h i l d r e n  every  The  day  and,  Department  sending  local  obtained a small o f f i c e  O u t p a t i e n t s ' Department  gained  and  "complacency  connection. Dr. P a t e r s o n  well  c h a l l e n g e the  paterson  interview with  TABLE 2:  13  -  Numbers o f C o n s u l t a t i o n s , 1947 and 1948.  MONTH  stated he  spent  he  i n the  169  February  56  193  March  64  197  April  25  180  May  59  145  232  884  (5 m o n t h s )  Annual Report, H e a l t h  was  very  He  believed  t h e p r e s e n c e o f one been s u f f i c i e n t l y  that  quarters  to  the  greatest  needs,  the  indicate that  i t w o u l d be  that  services  there  was  Outpatients' even  willing physician,  c o m p r e h e n s i v e programme were s e t up fill  months  that  of the  Children,  the marked r e s p o n s e ,  i n t e r e s t e d and  great  the  Department, t h a t  f a r f r o m a d e q u a t e , and  room f o r e x p a n s i o n i n t h e  Department.  Centre f o r  much aware, d u r i n g  Outpatients'  o f f e r e d were s t i l l no  1948  28  Source: 1948.  that  1947  January  Total '  J a n u a r y t o May»  to  had  i f a more  which could w e l l used.  efficiently He  had  1, Monthly f i g u r e s of attendance at the P a e d i a t r i c C l i n i c a r e not a v a i l a b l e p r i o r t o 1947. Yearly figures show, however, t h a t t h e r e were o n l y 424 c o n s u l t a t i o n s i n t h e whole o f 1946 as compared w i t h 884 i n t h e f i r s t s i x months a l o n e o f 1948. The 1947 a t t e n d a n c e f i g u r e s were c o m p i l e d f r o m t h e u n p u b l i s h e d d a i l y r e c o r d s k e p t by t h e O u t p a t i e n t s ' Department. (The r e l a t i v e l y s m a l l number f o r May, 1948, i t may be n o t e d , i s a c c o u n t e d f o r by t h e f a c t t h a t D r . P a t e r s o n was a b s e n t f o r most o f t h i s month.}  -Unrealized  at t h e o u t s e t t h a t , i n o r d e r t o conduct  programme, i t w o u l d be n e c e s s a r y s e r v i c e s and e s t a b l i s h a u n i t staffed, role  administered,  i n promoting  His p e r s i s t e n t  to effect  a d i v i s i o n of  w h i c h w o u l d be s e p a r a t e l y  and e q u i p p e d .  this  He t o o k  square,  an a c t i v e  i d e a and d i d meet w i t h some  efforts  resulted  support.  i n h i s o b t a i n i n g an o l d  b u i l d i n g known a s L a u r e l House, two s t o r i e s feet  such a  h i g h and f o r t y  w h i c h had p r e v i o u s l y been a n u r s e s '  cafeteria.  T h i s b u i l d i n g was g i v e n o v e r by t h e H o s p i t a l f o r t h e purpose of e s t a b l i s h i n g Children. light,  the present  H e a l t h Centre f o r  The H o s p i t a l u n d e r t o o k t o l o o k a f t e r  and j a n i t o r i a l  services.  The R o t a r y  Club donated  $15,000 cheque f o r t h e p u r p o s e o f c o m p l e t e l y the b u i l d i n g ,  and f o r one y e a r  the heat,  the s a l a r i e s  renovating and o t h e r  e x p e n s e s o f t h e H e a l t h C e n t r e were p a i d by " d o n a t i o n s 1 some o f V a n c o u v e r ' s g r e a t h e a r t e d The Paterson  final  s t e p was t a k e n  a  from  citizens." June 4, 1948.  Dr.  had been a p p o i n t e d P a e d i a t r i c i a n - i n - C h a r g e o f  the H e a l t h Centre g i v e n over.  f o r C h i l d r e n at t h e time  Other  full-time  staff  the b u i l d i n g  initially  was  included a  s o c i a l w o r k e r and a s e c r e t a r y ( b o t h o f whom h a d h a d s e v e r a l years Aid  experience  i n work w i t h c h i l d r e n a t t h e - C h i l d r e n ' s  S o c i e t y ) , a n d a nurse.  1.  H e a l t h Centre  The f i r s t  services offered  f o r C h i l d r e n , Annual Report,  were  1948.  - 15 basic  ones.  Nose and  A Paediatric  T h r o a t , Eye,  operation.' from  the  The  staff The  marked t h e  1  C l i n i c was  and  Orthopaedic  opening  comprehensive  and  and  c h i l d r e n of people  British  Columbia. and  was  no  for Children  i n the a d u l t  the  doubt  first  t o make  establishments  t h e r e a r e few p r e c e d e n t s  welfare  service  i n low-income b r a c k e t s i n  It i s d i f f i c u l t similar  important  e v e n t u a l l y be  s u p e r i o r h e a l t h and  f o r the  between t h i s  donated.  for children  Department p r o p e r ,  Ear,  specialists  of the H e a l t h Centre  of treatment  and  C l i n i c s were i n w e e k l y  s e r v i c e s of w e l l - q u a l i f i e d  s t e p t o w a r d s p r o v i d i n g what w i l l a very  held daily  o f t h e H o s p i t a l were  end  Outpatients  -  comparisons  elsewhere,  i n the l i t e r a t u r e  since  regarding  the  operation of other h e a l t h centres f o r c h i l d r e n  i n North  America,  of  recent  most o f t h e s e  origin.  w h i c h was largest  child  ability  itself  treatment  and  to ready  and  i s the  Continent's,  centre, provides medical  o u t - p a t i e n t s i n one  to pay.  very  S i c k Children's H o s p i t a l i n Toronto,  e s t a b l i s h e d i n 1875,  in-patients to  The  specialized units being  care  establishment,  I t s programme does n o t ,  to  according  therefore, lend  comparison w i t h that of the H e a l t h Centre  in  Vancouver. Purpose  of P r e s e n t  Study  Three questions the H e a l t h Centre  concerning  come n a t u r a l l y  the p r e s e n t  to mind:  operation of  - 16  -  (1) I s i t now a d e q u a t e l y meeting the need f o r p r o v i d i n g complete m e d i c a l care f o r c h i l d r e n of low-income f a m i l i e s i n the community? ( 2 ) -What are p r e s e n t m e d i c a l f a c i l i t i e s and s e r v i c e s o f f e r e d , and how can t h e s e he improved? (3) I s the S o c i a l S e r v i c e b r a n c h i n the H e a l t h Centre meeting a need, i s i t p l a y i n g an a p p r o p r i a t e r o l e , and how can i t "be improved? Now  t h a t t h e H e a l t h Centre has been o p e r a t i n g f o r  f o u r y e a r s , i t i s r e a s o n a b l e t o assume t h a t t h e r e i s s u f f i c i e n t evidence on the b a s i s of w h i c h t h e s e q u e s t i o n s might be answered.  I t i s the purpose of t h i s study t o attempt  to  answer them; and. i n t e r v i e w s and case r e c o r d s have been u t i l i z e d as t h e main s o u r c e s of e v i d e n c e .  S i n c e t h e r e are  p l a n s t o move the H e a l t h Centre i n a few months, from i t s q u a r t e r s i n L a u r e l House t o a new l o c a t i o n i n the SemiP r i v a t e P a v i l i o n of the H o s p i t a l , the p r e s e n t time seems a p p r o p r i a t e f o r such an e v a l u a t i o n . Many major and m i n o r changes i n v a r i o u s a s p e c t s o f the programme are  scheduled  to t a k e p l a c e i m m e d i a t e l y a f t e r the move, and, because o f t h i s , the p r e s e n t study s h o u l d be c o n s i d e r e d i n t h e n a t u r e of an i n t e r i m one. study completed operation.  I t would be v a l u a b l e t o have a n o t h e r  a f t e r f o u r o r f i v e y e a r s of c o n t i n u e d  CHAPTER 11  PHYSICAL STRUCTURE OP THE HEALTH CENTRE FOR CHILDREN  I t was on June 4, 1948 t h a t s e r v i c e s f o r c h i l d r e n were t r a n s f e r r e d f r o m t h e a d u l t O u t p a t i e n t s ' 1 Department t o t h e p r e s e n t H e a l t h Centre f o r C h i l d r e n . A f t e r t h e f i r s t y e a r o f o p e r a t i o n , d u r i n g w h i c h time the H e a l t h Centre was f i n a n c e d hy d o n a t i o n s , i t s expenses began t o be i n c l u d e d i n t h e budget o f t h e > Vancouver General H o s p i t a l O u t p a t i e n t s ' Department. The  c o s t s o f a d d i t i o n a l s t a f f , equipment, and new  developments, however, must i n p a r t s t i l l be f i n a n c e d by Dominion Government H e a l t h Grants and i n p a r t by voluntary contributions. The f u n c t i o n s o f t h e H e a l t h C e n t r e , l a i d down 2 at t h e time o f i t s i n c e p t i o n , a r e f o u r - f o l d .  First, i t  a c t s as a d i a g n o s t i c c e n t r e f o r d i s e a s e s o f c h i l d r e n i n : : 1. C h i l d r e n up t o t h e age o f seventeen may a t t e n d t h e H e a l t h C e n t r e . The p o l i c y i n t h i s r e g a r d i s f l e x i b l e , however, and i n c e r t a i n c i r c u m s t a n c e s c h i l d r e n up t o eighteen are allowed to attend, 2, Mucji o f t h e m a t e r i a l on t h e work o f t h e H e a l t h Centre was o b t a i n e d from t h e F i r s t Annual Report o f the H e a l t h Centre f o r C h i l d r e n , 1948-49.  - 18 -  low-income f a m i l i e s f o r the P r o v i n c e of B r i t i s h Columbia. S i n c e emphasis i s p l a c e d upon the d e t e c t i o n o f d i s e a s e i n i t s e a r l i e s t s t a g e s , every c h i l d who  comes t o t h e  H e a l t h Centre i s g i v e n a t h o r o u g h e x a m i n a t i o n b e f o r e b e i n g treated or r e f e r r e d to a s p e c i a l i s t .  The  initial  examination i n c l u d e s t u b e r c u l i n e t e s t i n g , blood t e s t i n g , u r i n e e x a m i n a t i o n , w e i g h i n g , measuring, taking.  and  temperature-  To a i d i n t h i s e x a m i n a t i o n t h e r e i s , at t h e  H e a l t h C e n t r e , a b r a n c h of t h e main P a t h o l o g i c a l L a b o r a t o r y of t h e H o s p i t a l .  A t e c h n i c i a n i s i n attendance  every  morning t o c a r r y out the l a b o r a t o r y i n v e s t i g a t i o n s . Second, the H e a l t h Centre o f f e r s t r e a t m e n t on b o t h an i n - p a t i e n t and an o u t - p a t i e n t b a s i s .  I t has a c c e s s t o  beds on the f o u r p a e d i a t r i c wards of the H o s p i t a l ,  and  can u s u a l l y make arrangements f o r a d m i s s i o n of a c h i l d w i t h i n a few days.  There i s p r o v i s i o n , o f c o u r s e , f o r  immediate a d m i s s i o n i n emergent c a s e s .  By o f f e r i n g  service  on an o u t - p a t i e n t b a s i s , the H e a l t h Centre i s a s c r e e n i n g d e v i c e f o r h o s p i t a l a d m i s s i o n s and p r e v e n t s abuse i n the use of h o s p i t a l beds. Because of t h e p o l i c y of a t h o r o u g h  initial  e x a m i n a t i o n , and c o n s i d e r i n g the n a t u r e o f some o f t h e s e r v i c e s o f f e r e d , the H e a l t h Centre p l a y s a g r e a t p a r t i n p r e v e n t i o n of i l l n e s s i n the c h i l d r e n who  attend i t .  P a e d i a t r i c , I n f a n t F e e d i n g , and V e i l Baby c l i n i c s are most s i g n i f i c a n t i n t h i s regard.  There i s a l s o a c l o s e l i a i s o n  - 19  H  •between the M e t r o p o l i t a n H e a l t h Committee p u b l i c h e a l t h n u r s e s and the H e a l t h Centre which, makes t h i s p r e v e n t i v e f u n c t i o n more e f f e c t i v e . The f o u r t h f u n c t i o n of t h e H e a l t h Centre i s t o p a r t i c i p a t e a c t i v e l y i n the t e a c h i n g programme o f t h e Vancouver General H o s p i t a l .  I t p r o v i d e s an e x c e l l e n t  t r a i n i n g ground f o r i n t e r n e s , m e d i c a l s t u d e n t s , s t u d e n t n u r s e s , and s t u d e n t s o c i a l w o r k e r s , as w e l l as g i v i n g  an  opportunity f o r f u r t h e r l e a r n i n g to p r a c t i c i n g p h y s i c i a n s and p u b l i c h e a l t h n u r s e s .  I n t e r n e s and s t u d e n t  nurses  are a s s i g n e d to t h e H e a l t h Centre on a r o t a t i n g b a s i s , p a r t of t h e i r t r a i n i n g .  as  Student s o c i a l workers have, i n  the p a s t , been a s s i g n e d cases o r i g i n a t i n g i n t h e H e a l t h C e n t r e , and i n 1951  arrangements were made f o r a s t u d e n t  s o c i a l w o r k e r t o t a k e a f u l l - t i m e f i e l d work placement there. There i s much scope f o r r e s e a r c h i n the H e a l t h C e n t r e , and i t i s a n t i c i p a t e d t h a t t h i s may, be an a d d i t i o n a l f u n c t i o n .  i n the  future,  A l t h o u g h l i t t l e r e s e a r c h has  been u n d e r t a k e n t o d a t e , r e c o r d s are p r e p a r e d and v a r i o u s t y p e s of i n f o r m a t i o n are kept up-to-date  and f i l e d away f o r  f u t u r e p o s s i b l e r e s e a r c h use. Emerging Heeds I t soon became apparent t h a t t h e b a s i c c l i n i c s , P a e d i a t r i c , E a r , Hose and T h r o a t , Eye, and  Orthopaedic  were not s u f f i c i e n t t o meet t h e h e a l t h needs of t h e  - 20 c h i l d r e n a t t e n d i n g the H e a l t h Centre.  As the 'needs  became apparent, and as funds were s e c u r e d , new were s e t up.  clinics  S t a f f i n c r e a s e s were found t o he n e c e s s a r y ,  a l s o , and w i t h i n s i x months a nurse and a  stenographer  were added t o the o r i g i n a l f u l l - t i m e s t a f f o f a s o c i a l worker, a s e c r e t a r y , and a n u r s e .  Within eighteen 1  months a second p r o f e s s i o n a l s o c i a l worker t o the s t a f f and, l a t e r s t i l l ,  another  was  added  stenographer.  S o c i a l S e r v i c e i n the H e a l t h Centre i s a d m i n i s t e r e d "by t h e S o c i a l S e r v i c e Department o f the main Hospital.  I t has, from the o u t s e t , t a k e n an a c t i v e p a r t  i n the o p e r a t i o n of the H e a l t h Centre.  The r o l e , o f t h e  s o c i a l worker i n t h i s s e t t i n g i s d i s c u s s e d i n d e t a i l i n Chapter 111.  E a c h of t h e workers has a c a s e l o a d w h i c h  i n c l u d e s "both i n - p a t i e n t s and o u t - p a t i e n t s . I n 1950,  a  r e p r e s e n t a t i v e of the S c h o o l of S o c i a l Work, U n i v e r s i t y of B r i t i s h Columbia,  came t o t h e H e a l t h Centre t h r e e days  a \\reek f o r the purpose  of h e l p i n g t o c l a r i f y t h e r o l e o f  the s o c i a l worker i n t h a t s e t t i n g .  T h i s worker, a c t e d i n  an a d v i s o r y c a p a c i t y , and c a r r i e d a c a s e l o a d as w e l l . S o c i a l workers are w e l l a c c e p t e d i n t h e H e a l t h C e n t r e , a l t h o u g h t h e i r e n t i r e f u n c t i o n i s s t i l l not c l e a r l y  understood.  1 1. B o t h s o c i a l workers are f u l l y q u a l i f i e d , i . e . they have s u c c e s s f u l l y completed two y e a r s of post-graduate, s t u d y at a r e c o g n i z e d S c h o o l of S o c i a l Work.  The  medical  21 -  s t a f f men a t t h e H e a l t h  Centre  f r o m t h e b e g i n n i n g , b e e n members o f t h e a t t e n d i n g of t h e Vancouver General H o s p i t a l . p e r s o n n e l who d o n a t e t h e i r education,  varying resident Health  E a c h department  periods,  Centre,  is for  interne  supplies, f o r  and a  o r an a s s i s t a n t  of from three  senior of the the  resident  t o s i x months.  also p r o v i s i o n f o r the attendance of a j u n i o r  There interne  one-month p e r i o d s , Paterson*s  contention  need f o r a s e r v i c e o f t h i s available  kind,  that  but t h a t  attendance f i g u r e s o f the Health  attendance nearly once c l i n i c s continued reaching eleven  there  was a  great  the previously  s e r v i c e d i d n o t meet t h e n e e d , i s b o r n e o u t i n  those i n the Outpatients'  doubled during  fairly  i t s highest  times greater  C e n t r e a s compared t o  Department.  b e g a n t o be h e l d  to r i s e  (Figure l ) . but  i n the Hospital  The P a e d i a t r i c D e p a r t m e n t p r o v i d e s  f o r a period  Dr,  the  and t h e u s e o f H o s p i t a l  f o r t h e c o r r e s p o n d i n g department  services of a resident interne  They a r e v o l u n t a r y  one o r more p h y s i c i a n s  interne  staff  s e r v i c e s i n exchange f o r  h o s p i t a l experience,  facilities.  have,  that  t h e month o f June,.1948  t h r o u g h o u t 1 9 4 8 and 1949  i n M a r c h , 1950 when i t was  than i t had been p r i o r  The r i s e was n o t c o n f i n e d  v/as e v i d e n t  be s e e n  e v e r y day ( A p p e n d i x A ) , a n d  steadily  level  It will  about  t o t h e move  t o any one d e p a r t m e n t ,  i n each of the s e r v i c e s o f f e r e d .  I t should  be  Fig.. 1  Monthly Attendances, 1948-1951*  :ealth Centre f o r C h i l d r e n ,  noted,  i n this  referral by  have r e m a i n e d  therefore,  process. in  connection, that p o l i c i e s  the O u t p a t i e n t s  cannot,  23-  unchanged from those l a i d  D e p a r t m e n t , and  1  be  down  increased attendances  a t t r i b u t e d t o a more e l a s t i c  I t i s acknowledged t h a t  eligibility  governing  requirements,  t h e r e have b e e n  referral changes  b u t t h e s e have b e e n  commensurate w i t h t h e n a t i o n a l  rise  i n salaries  and  living,  costs. A registered 1951  striking  i n the - f i r s t  (Table 3).  January  growth i n the attendance  t o May,  It will 1947  f i v e months o f t h e y e a r s 1947 be  remembered t h a t  January  attendances  t o May,  1949  and  the  (See T a b l e 4 and A p p e n d i x A  The  attendance  and 1950  figures  in  f o r the  show what h a p p e n e d t o  concomitant for total  t h e move  extension of  1 services.  figures).  C h i l d r e n ' s Attendances, Vancouver General H o s p i t a l . J a n u a r y - M a v , 1947-1951 i n c l u s i v e  MONTH  1947  January February March April May Total  period  f o r t h e same p e r i o d s i n t h e y e a r s a f t e r  to the H e a l t h Centre  TABLE 3:  the  to  preceded Dr. P a t e r s o n ' s attendance  the O u t p a t i e n t s ' Department. periods  figures i s  (5 n o s )  28 56 64 25 59  232  1951  1948  1949  1950  169 193 197 180 145  711 673 1,012 902 1,026  877 1,302 1,511 1,188 1,450  1,313 1,264 1,119 1,335 1,412  4,324  6,328  6,443  884  '  1 Source:  Annual  1. The 1947 unpublished daily  Reports, H e a l t h Centre f o r C h i l d r e n ,  1948-51  a t t e n d a n c e f i g u r e s were c o m p i l e d f r o m t h e r e c o r d s k e p t by t h e O u t p a t i e n t s ' D e p a r t m e n t .  TABLE 4:  24 -  H e a l t h Centre f o r C h i l d r e n ; Attendance a t S e p a r a t e C l i n i c s , June, 1948 - December,  Average Monthly ! 19481194911 1950 1951  CLINIC  1948  >  Paediatric  (a)  E a r , Nose, & Throat (b) Eye (c) Refraction U) Hearing (e) Speech (f) Orthoptics (g) Skin Allergy Feeding Metabolic Cardiac Orthopaedic Surgery Diabetic Neurology Psychiatry Chest Genitourinary Total x Clinics  $  336  469  508  53 25  79 53 55 19 19 54  80 84 58 25 56 6.3  25 95 17  37 137: 181 17;  ' 14 49 8 2  15 48! 12 1 19  33 14 40  (k)  -  (m)  11 19 4  (n)  (o) (P)  (q) r) (B)  -  -  -8 4  -  507  78 i 63 i 51 12 57 ! 106 | 34 114 13 9  20 ... 57 - 11 2 19 8 7. :  -- j  :  -8  1951  T o t a l Annual 1949 1950  1951  2,349  5,624  6,099  6,088  369 176  953 632 444 114 94 644  958 802 692 300 677 758  931 761 615 149 ' 680 1,269  -  :  — —  134;  299 •83.! 277 1,142 168  -  -  11 133 18  -  164 588 95 19  -  75 17  -  444 406 1,647 1,364 220 154 149 . * 104 182 5 71 141 16; 187 90  -  241 680 135 25 225 92  -23  I  •  535  970 1,185 1,169  3,550 11,0 72, 13,933  Source: H e a l t h C e n t r e f o r C h i l d r e n Annual. 1948-1951 i n c l u s i v e .  13.942  Reports,  ( a ) Opened June, 1948 (b) Opened June, 1948 ( c ) Opened June, 1948 (d) Opened May,. 1949 ( e ) Opened J u l y , ,1949 (f) Opened A u g u s t , 1949 (g) Opened.September, 1948 (h) Opened J u l y , 1948 ( i ) Opened J u l y , 1948 ( j ) Opened March, 1949 ( k ) Opened Opened A p r i l , 1950 ( l ) . Opened December, 1948 (m) Opened June, 1948 (n) Opened S e p t e m b e r , 1948 (o) Opened J a n u a r y , 1949 (p) Opened"March, 1950 . (q) Opened A p r i l , 1949 ( r ) Opened F e b r u a r y , 1949 ( s ) Opened O c t o b e r , 1951. x S i n c e e a c h v i s i t i s r e c o r d e d s e p a r a t e l y , t h e s e figures"'-' r e p r e s e n t t h e number o f v i s i t s t o t h e H e a l t h C e n t r e , r a t h e r t h a n t h e number o f c h i l d r e n who a t t e n d e d .  -  The  Paediatric  to  programme. held  an  Paediatric he,  the  This  Clinic  basic  clinic  every morning  certified  and  resident  has  had  two  Health  Centre,  and  do  months  basis  clinics.  appointments unbroken  with  seen  taken  and,  care  of  there  examination  by  referred is  specialists have  as  interne.  The  to  scheme  the  the three  staff  to  i n most  accept  they  to  to  the  by  Clinic, upon  will  at  six of  the  indefinite stay  and  to  for  long,  Clinic  have  from  for  that  the  them  only  clinic  may of  w h i c h he  was  may  the  preliminary  the  that  children  clinic job  of  i f the  children  attend  condition referred.  who  A  specialty.  still any  thorough  of  those  their  are  required,  ensure  simplify  treatment for  to  one  Centre a  specialized  which l i e within  specialized  given  to  for  is  appropriate  Health  treatment  reason  r e f e r r i n g to  Paediatric apart  the  referred  The  indicated,  a  or  to  a paediatrician  conditions  referred  coming  depending  clinics.  referral  well  junior  a  they  that  Paediatric  specialized  are  attending  idea  children  i n the  examination, be  on  as  senior  periods. All  first  basic  Instead,  the  a  been  more  attendance,  and  rotate  OT  has  the  always  considered  specialized  of  beginning,  interne  the  part  and  the  are  do  central  in daily  not  initially,  from  paediatricians  as  was  and  has,  paediatricians  assistant  -  Clinic  The continued  25  child  the he  may  Other  Special The  weekly all  Clinics E a r , Hose,  operation  children  26 -  since  with  the Health  hearing  infected  ears  In  1949, however,  July,  were  referred  were  most  common  practice, medical is  dealt  specialized  increased basis,  many  The number  scheme many  was v e r y  this  great. given  reflected  than  i n the Vancouver The p r e v i o u s 100, and w h i c h  a year,  a dozen  periods  of only  General  out-patient  this  There  Health  Centre  and adenoidectomies, under  the former  I n 1951, as were  on H e a l t h  w h i c h was  Centre  usually  i t a waiting  t o a few dozen w i t h  a few weeks.  as t h e  i n t h e numbers o f  Hospital  carried with  school  The need f o r  on an  a year  list,  from  clinic  and adenoidectomies  waiting  has dwindled  and pa.ediatric  As w e l l  from  of tonsillectomies about  a r e amongst  Centre.  to the Hospital  a s 391 t o n s i l l e c t o m i e s  patients.  about  conditions,  f o r services  averaged  difficulties  are referred  i n the o l d O u t - p a t i e n t s ' Department.  performed  more  i n general  at the Health  service  or  clinic.  children  f o r these  throat  morning.  hearing  found  admitted  example,  Thursday  children with  one c a n s e e t h e demand  clinic.  every  Initially,  infected  conditions  attendance  in-patients  for  with  opened.  o f ear and throat  one o f t h e l a r g e s t  this  Centre  has been i n  infections  and s i n c e  services  Clinic  difficulties,  t o a separate  Since the  and Throat  period  of  waiting  i s provision,  too,  for  immediate  admission  were a c c o m p l i s h e d  27 -  i n c a s e s o f emergency.  i n spite  number b e i n g r e f e r r e d  increasingly be  Clinic, for  evident that  effectively but  treated  that  o f t h e immenseley g r e a t e r  for this  D u r i n g the f i r s t  and  other surgery.  y e a r o f o p e r a t i o n , i t became cases of deafness  need f o r s e p a r a t e  children with hearing d i f f i c u l t i e s .  The  deaf  a measure o f s p e c i a l  demand f o r t h e s e  services  speech t h e r a p i s t  s o o n b e g a n t o come i n two  later, In  established  it  J u l y , 1949  This c l i n i c  i s important  is  disturbing still  The  the  mornings,  Hearing  Clinic  and  a  i s held  influences  c o n f u s i o n be k e p t  Because at  a r e examined, o n l y f o u r  Hearing  apart from  Throat  on Monday m o r n i n g s .  t h a t n o i s e and children  was  difficulties  f r o m -the E a r , Hose, and  Clinic.  the P a e d i a t r i c are kept  i n w h i c h to c a r r y  out  The  a children  examining  examining  a t a minimum.  a g r e a t n e e d , however, f o r more  facilities  difficulties  q u i c k l y grew,- however, and  a Special  seen at each S p e c i a l  room i s l o c a t e d and  one  a t t e n t i o n here..  to which c h i l d r e n w i t h h e a r i n g  -minimum when d e a f are  of  t h r e e m o r n i n g s a week.  have s i n c e b e e n r e f e r r e d Clinic.  services  c h i l d r e n w i t h speech  began t o r e c e i v e  Throat  treatment  s p e e c h " t h e r a p i s t were o b t a i n e d f o r  m o r n i n g a week, and  little  c o u l d not  i n t h e g e n e r a l E a r , Hose, and  t h e r e was  a highly-trained  These t h i n g s  room,  There  sound-proof  examinations  of  deaf  - 28 children, There  and  i n which  i s provision  Centre  quarters  children Hearing staff on  a  of  the  doctor  important  was  were  children,  and  each  from  case  to  one  ,Por  the  Department  otologist least  the  remain  of  the  children,  apprehensive and  these  strange An  Special should  at  Hospital  children  than  they  are  doctor  at  every  done  to  make  of  Hose,  Throat  upon  Clinic  i s sometimes  attending services  changes on  the  the  changes  w e r e made  have  the  came  attending  can  of  at  follow time;  c o - o p e r a t i v e and  c o n f r o n t e d by  in  with  for a period  doctor  of  continuity  f o r a p e r i o d of  when  a  the  and less  different  visit. hearing  and the  as  to  one  become more  Clinic,  frequent  Centre  way,  the  effect  deaf  Special  their  establish  another  Health  assessment  gave  arrangements  this  i n turn,  Depending  therapy  the  when t h e  The  to  Health  i n dealing with  disturbing  to  the  In  hearing. and  a  new  p h y s i c i a n s on  basis.  reasons,  same  Hearing be  the  classes.  Pavilion.  treatment.  difficult  of  therapy  i n the  Department  doctor  s i x months.  progress  Ear  have  i t was  about. Ear  of  rotating  found  room  factor  s e t up,  Hospital  short-term,  a  speech  Semi-Private  i s continuity Clinic  hold  f o r such  i n the  Another  to  a  i s arrived  decision  i s made  best possible  the  case,  or,  by  as  the  to  what  use  of  residual  treatment  at  the  i s sometimes  advised,  at  as  indicated,  Ear,  speech  o f t e n happens,  a  combination  29  o f t h e s e two .types o f t r e a t m e n t  Speech therapy time b a s i s a f t e r and  was  August,  1949.  related  i n investigating  cause  T h e s e two  -While  anomalies  and  -Some c h i l d r e n who  Mental  help.  i n i t s own  the v a r i o u s causes  amongst t h e  of  fullClinic,  right  inter-  speech  t o be  a  common  children attending  and  certain  some o f t h e  cases o f t e n improve  physical  speech with  treatment.  a r e e m o t i o n a l l y d i s t u r b e d , a,nd who as  symptoms,  come t o t h e H e a l t h  i s a m i n o r one,  stutter  however, as  show Centre  children  o r stammer a r e g i v e n h e l p  i n the  s c h o o l s t h r o u g h t h e M e t r o p o l i t a n H e a l t h Committee o f Vancouver. group  A  s m a l l number o f p r e - s c h o o l c h i l d r e n  have b e e n h e l p e d by The  in  c a s e s a r e n o t t h e o n l y ones g i v e n  t o be b e h i n d  T h i s group  s c h o o l age who  Hearing  have b e e n c l o s e l y  deficiency  these  speech d i f f i c u l t i e s  of  clinics  these  are found  difficulties,  for  established  of speech d i f f i c u l t y  speech therapy.  of the S p e c i a l  d e a f n e s s has b e e n f o u n d  the H e a l t h Centre,  i s d e c i d e d upon.  s e r v i c e s were o b t a i n e d on a  the opening  the Speech C l i n i c  .difficulty.  -  speech  Greater  i n this  therapy at the H e a l t h Centre.  s p e e c h t h e r a p y programme a t t h e H e a l t h C e n t r e ,  under the d i r e c t i o n of a h i g h l y - t r a i n e d been very  successful.  were u s e d  to p r o v i d e the  speech t h e r a p i s t ,  Funds o b t a i n e d from t h e H o s p i t a l s p e e c h t h e r a p y room w i t h  equipment.  -Among o t h e r t h i n g s ,  audiometer,  a t a p e - r e c o r d e r , and  there are included  budget  special an  a special record-player  has  on w h i c h t h e volume degree large The  only  and  important  sound-proof  services  w h i c h has  been  Clinic  a r e seen by an  indicated,  refraction.  an  refractions  Before  a  o r be  of  a  extra  clinic  Health  Paediatric  i n the main  or  recently  treatment  the main  for orthoptic from  clinic  clinic  congenital treatments  the outset,  of the large  has  the  to attend  has,  Because  from  the  Depending upon  continue  clinic  specialized .  the time  specialist  referred  main  orthoptic  service  and  is i n daily  and  treat  the Health  or  been  attendance,  been  of, the  requiring  list,  followed  and  scheduled f o r  sub-service  operation,  eye  at the request  qxi&  refractions  a waiting  f  o  r  were  -Their period  of  the  Orthoptists  doctors  opened,  Department.  before  i s a  f o r squint  Centre  Outpatients*  waiting  months  eye  from  o f i n f e c t i o n s , wounds,  the d i r e c t i o n  children  adult  f o r children.  afternoons.  Clinic,  under  i s  i s lack  of the  referred  examination.  The  The  all  an  every morning.  Tuesday  appropriate itself  suitably  i s another offered  c h i l d r e n may  abnormalities,  however,  room  at present,  A l l children  eye  for'treatment  Eye  drawback,  Clinic  given  The  i s furnished  The E y e  opened.  held  patients.  to an  room.  Centre  and  -  c a n "be c o n t r o l l e d  f o r the various and "bright,  30  referred  names were of  do  of,  and  i n the main a time  three  t h e e x a m i n a t i o n was  main  clinic.  afterwards, to the placed  to s i x  carried  out.  on  Orthoptic existent  31  -  treatments f o r squint since  these require  were p r a c t i c a l l y  a great  deal  a t t e n t i o n and  a  and  extensive  work f o r s e v e r a l m o n t h s .  the  H e a l t h C e n t r e opened, i t was  w i t h the  Head o f t h e  engage t h e and  to  course of treatments  services  carry  out  Eye of  Department  an  orthoptic  American O r t h o p t i c  obtained and  put  opthalmic  d a i l y operation surgeon from the  Department.  The  of the  The  orthoptics  under the  v/ere p a i d  f o r by  about  a year's  a Federal  Hospital  s e t up  training  for orthoptists.  d i r e c t i o n of the the  kind  of  (certified  hy  an  Hospital  Eye  Outpatients' orthoptic  v/as begun.  salary  Government  structured  f o r the  The orthoptist  health grant  of  |5,000. I n O c t o b e r , 1950  at  services  intensive  treatments f o r c h i l d r e n w i t h squints equipment and  refractions  guidance of  of the  D e p a r t m e n t v/as worked t h r o u g h , and  to  i n C h i c a g o ) were  w a i t i n g - l i s t i n the  necessary  consultation  A programme was  staff  after  Hospital,  treatments.  shortly after this. In  in  do  Association  skilful!',  Shortly  o r t h o p t i s t to  a person q u a l i f i e d to p r a c t i c e the  of i n d i v i d u a l  involving  decided,  non-  at  the  senior  the  O p t h a l m i c s Department  H e a l t h Centre a one-year course This  staff  course, under  doctor of  Vancouver General H o s p i t a l ,  offered  i n Canada.  of  the  i s the  F o u r s t u d e n t s , who  Eye  only pay  the of  the Department one  of i t s  fees  to  -  the  32  -  H o s p i t a l . , were e n r o l l e d  i n O c t o b e r , 1950,  g i v e n a course of l e c t u r e s This  was  s u p p l e m e n t e d hy  o p t h a l m o l o g i s t s from the  Health Centre.  the Eye  examinations i n Chicago Association,  and  orthoptics.  A  i n October,  1951,  The initial one  are  now  to  facilities, fractures Children  the  for  after-care  r e m e d i e d when the executed.  a part  still  f o r these  move t o  services,  Clinic  follow-up. the  at  This  immediate  on  be  no bone casts.  the  adult  are  then  Health  Centre  situation will  part  and  s i x months ago,  that  of be  the  be  "basic  provision  for  c h i l d r e n w i t h bone  continuous  this  conditions  Semi-Private P a v i l i o n i s  will  •  acquired  plaster  and  the  so  casts  and  r e f e r r e d to  a p p l i c a t i o n of p l a s t e r  • About  other  s e t t i n g of  there w i l l  get  and  f o r X - r a y and  X-ray f a c i l i t i e s  can  i s held  There are  are  the  surgeons attend  and  splints  teach  enrolled  of  congenital  H e a l t h C e n t r e e q u i p m e n t , and  fractures  and  involvement.  Orthopaedic and  took  s t u d e n t s was  sprains,  from  Orthoptic  Health Centre,  a p p l i c a t i o n of  with fractures  to the  students  also  of  orthoptist  to p r a c t i c e  treat various  at p r e s e n t ,  and  the  Three orthopaedic  joint  O u t p a t i e n t Department returned  the  direction  American  of four  bone i n f e c t i o n s ,  w h i c h have bone o r  the  Clinic,  at  and  four  qualified  Orthopaedic  examine and  deformities,  hy  second group  b a s i c programme  Clinic  were  refraction.  under the  group of set  m o r n i n g e a c h week.  clinic  i n o p t h a l m i c s and  practice  This  and  attention,  a physiotherapist  from  - 33 the Department to  of P h y s i c a l M e d i c i n e  a t t e n d the weekly O r t h o p a e d i c  a t the H o s p i t a l began  Clinics.  This  acts i n a consultative capacity i n determining benefits,  in specific  physiotherapy  c a s e s , m i g h t be  treatments.  derived  person what  from  Where p h y s i o t h e r a p y  is  recommended, t h e p h y s i o t h e r a p i s t makes a r r a n g e m e n t s f o r the  child  to a t t e n d the Department  of P h y s i c a l Medicine.  T h e r e i s a gree.t n e e d f o r a gymnasium and equipment is  as an i n t e g r a l p a r t o f t h e H e a l t h C e n t r e .  anticipated  t h e new  that these  H e a l t h Centre The  one  Allergy  month a f t e r  of the l a r g e s t  of  Clinic  specialized  i n the  $200 was  and  has  set  of s k i n - t e s t i n g  apparatus  work o f t h i s  The  Clinic  has  continuous training  used  Clinic  on  and  an  at the an  The  sum  time  of -  excellent  w h i c h makes p o s s i b l e t h e  hay  referred  i n the A l l e r g y  one  s e r v i c e s of  to purchase  been l a r g e l y  asthma and  are u s u a l l y  procedure  It i s held  o f a l l t h e known a s p e c t s  manifestations, allergies  the  to the A l l e r g y T h i s was  in  Pavilion.  i s now  c o n d i t i o n s of c h i l d r e n . .  establishment.  investigation  be p r o v i d e d  opened, and  clinics.  its  It  began i t s o p e r a t i o n about  have s p e c i a l  allergic  donated  villi  q u a r t e r s i n the S e m i - P r i v a t e  p a e d i a t r i c i a n s who  interest  facilities  the H e a l t h Centre  Wednesday a f t e r n o o n s , two  physiotherapy  of a l l e r g y .  c o n f i n e d to  fever.  two  Children with  to the Dermatology  Clinic  The  i s to g i v e  skin  Clinic..  skin  tests  to  34 -  c h i l d r e n to determine  allergic,  and t h e n  t o what  to administer  substances  they a r e  desensitization  i n j e c t i o n s which a c t as a n t i d o t e s to these T  1948  h  e  Dermatology  a b o u t t h e same t i m e  specialist  Clinic  substances.  was s t a r t e d ' i n  as t h e A l l e r g y  Clinic.  July, A  i n Dermatology attends t h e H e a l t h Centre  T u e s d a y m o r n i n g and d e a l s w i t h c h i l d r e n who have and  other  every  allergic  skin conditions. A general Surgical  Clinic  has been i n weekly  o p e r a t i o n s i n c e September, 1 9 4 8 and.has t h e s e r v i c e s o f attending surgery for  s u r g e o n s who have a s p e c i a l k n o w l e d g e o f t h e  o f choldhood.  surgery  arranged,  of the heart,  as n e c e s s a r y ,  While  the Eye C l i n i c  their  surgery  all at  other  Special  Paediatrics  departments.  the H e a l t h Centre  of the S u r g i c a l  i s booked  Clinics,  Clinic  only  from  clinics.  surgeons decide whether s u r g e r y , i s i n d i c a t e d ,  There i s s t i l l  book  Children  directly  any o f t h e s p e c i a l i z e d  arrangements f o r - admission  Clinic  own d e p a r t m e n t s i n t h e H o s p i t a l ,  to the S u r g i c a l  or from  system a r e  w i t h the appropriate  their  surgery from  may be r e f e r r e d  c h e s t , and n e r v o u s  a n d E a r , Nose and, T h r o a t  through  the i n s t i g a t i o n  surgical consultations  The  and make  to h o s p i t a l .  a great l a c k i n the area of  s u r g e r y , however, and room f o r much f u r t h e r d e v e l o p m e n t a n d expansion. it  Generally, i n a children's out-patient  i s considered l i k e l y  that f i f t y  p e r cent  setting,  of the attending  children w i l l w i t h the of  there  and  orthopaedic  f i f t y per.cent 1  attention.  s h o u l d be  clinics  -  require surgical  remaining  medical  35  requiring  attention,  other  I n o r d e r t o f u n c t i o n on t h i s  about  three  surgical  i n weekly o p e r a t i o n .  The  and  present  Health  a l l o w s f o r o n l y one  the t o t a l  number o f c h i l d r e n a t t e n d i n g t h e H e a l t h  this  482  were a d m i t t e d  prior  particularly  from  are  either  suffering  to  expansion  and  the  that the  There i s reason  Centre While  surgery  Centre, and  service  is  still  t o b e l i e v e t h a t many  'require s u r g i c a l  f o r attendance from  Of  amount o f  of t h e H e a l t h  seen  at the  treatment,  Health  a l a c k of a t t e n t i o n ,  care f o r which t h e i r  Centre,  or  are  parents  pay.  A r r a n g e m e n t s a r e now and  clinic.  area of t o n s i l l e c t o m i e s  getting p r i v a t e medical are unable  advent  community who  are e l i g i b l e  Centre  to H o s p i t a l f o r s u r g e r y .  i t can be  adequate.  c h i l d r e n i n the and who  to the  i n the  adenoidectomies, far  such weekly  r e p r e s e n t s a g r e a t i n c r e a s e i n the  performed  basis,  orthopaedic  structure  i n 1951,  types  of the  changes w i l l  surgical be p u t  C e n t r e moves t o i t s new  proceeding and  into  quarters.  f o r improvement  orthopaedic f a c i l i t i e s ; effect  when t h e  Health  The.main f a c t o r  which  1. S t a t e m e n t by Dr, J . P. E t c C r e a r y , r e c e n t l y a p p o i n t e d p r o f e s s o r and h e a d o f t h e P a e d i a t r i c D e p a r t m e n t , V a n c o u v e r G e n e r a l H o s p i t a l , i n an i n t e r v i e w w i t h t h e w r i t e r .  36 -  has  made i t p o s s i b l e t o c o n s i d e r  surgical  and o r t h o p a e d i c  to the H o s p i t a l s t a f f  service i s the recent  of a professor  Department head from t h e S c h o o l of B r i t i s h Sick  Columbia.  a reorganization of the appointment  and P a e d i a t r i c  of Medicine,  University  This physician, formerly  with the  C h i l d r e n " s H o s p i t a l i n T o r o n t o , h a s an o f f i c e  Hospital,  and i s now d e v o t i n g  towards a p l a n  efficient  a t t e n t i o n i s being  orthopaedic  given  Rheumatism and C a r d i a c  paediatricians with  result  in a  specialized  t o t h e s u r g i c a l and  C e n t r e programme.  December, 1 9 4 8 h a s t h e c o n t i n u o u s  cardiology.  of effort  Paediatric structure.  needs of t h e H e a l t h  The  deal  of reorganization which w i l l  more i n t e g r a t e d , a n d Particular  a great  at the  Clinic,  opened i n  s e r v i c e s o f two  training  i npaediatric  C h i l d r e n s u f f e r i n g from rheumatism,  cardiac  disease,  and c o n g e n i t a l m a l f o r m a t i o n o f t h e h e a r t a r e  referred  to t h i s  used a great Health  deal  i n this  Clinic,  funds p r o v i d e d  a close l i a i s o n with.the  X - r a y Department,  time.  A  fluoroscope,  was d o n a t e d when t h e  There are,  by t h e b u d g e t .  this  Clinic  at present,  This  Clinic  Pathological Laboratory,  and t h e D e p a r t m e n t  Children often attend  the  f o r treatment.  C e n t r e opened, and an e l e c t r o c a r d i o g r a p h was  purchased with has  Clinic  of Physical  the  Medicine.  f o r long periods of  no a d e q u a t e a r r a n g e m e n t s f o r  l o n g - t e r m h o s p i t a l c a r e , w h i c h i s so f r e q u e n t l y  necessary and  i n the treatment  rheumatic The  o f c h i l d r e n who  diseases. next  clinic  t o open was  the D i a b e t i c C l i n i c ,  w h i c h began i t s o p e r a t i o n i n January, only  a s m a l l number, b u t  to g i v e d i a b e t i c  i t was  c h i l d r e n the  1949.  and  specialized  the p r o g r e s s of each p a t i e n t is recognized i n this H e a r i n g and A l l e r g y  important  services of  the  of  procedure  i n the D i a b e t i c  content,  t h e amount o f i n s u l i n r e q u i r e d f o r  The  p a t i e n t s and  as t o d i e t ,  a d m i n i s t r a t i o n of i n s u l i n  of u r i n e f o r sugar. most  and  Close follow-up  to  stabilization. to achieve,  are g i v e n  instruction  a t home, and i s necessary,  testing and  c h i l d r e n a t t e n d e v e r y week. The  1949  t h e i r parents  having  Special  A p e r i o d of h o s p i t a l i z a t i o n i s o f t e n necessary this.  children  same d o c t o r  as i t i s i n t h e The  a  concerning  importance  f o l l o w e d by  Clinic,  Clinics.  The  i s t o r e g u l a t e t h e body s u g a r  determine  serves  an a p p r e c i a t i o n o f t h e p r o b l e m s w h i c h  w i t h t h i s d i s e a s e might have.  Clinic  It  b e l i e v e d t o be  p a e d i a t r i c i a n w i t h p a r t i c u l a r knowledge diabetes,  have c a r d i a c  lasted  Chest  Clinic,  o n l y about  w h i c h was  f o u r months.  started The  e q u i p m e n t , an e s s e n t i a l p a r t o f a C h e s t available  at the H e a l t h C e n t r e ,  expedient  to r e f e r  Control f o r X-ray The  and  i n February,  necessary Clinic,  i t was  found  was to  X-ray not be  c h i l d r e n w i t h c h e s t c o n d i t i o n s t o T. and  follow-up.  Infant Feeding  Clinic,  started  i n March,  B.  1949,  has  are  staff-patients  Infant Feeding  progress  -  a c l o s e l i a i s o n w i t h the O b s t e t r i c s Department.  M o t h e r s who to the  38  Clinic  of t h e i r babies  s i x weeks o l d . obstetrical  The  are r e f e r r e d ,  n u r s e - s u p e r v i s o r i n charge attends  these  clinic,  too,  an  the p r o g r e s s Feeding  effort  of the  and  of t h i s  At  i s progressing normally, Veil  Baby C l i n i c  1948.  for  infant.  In  this  doctor follow  six-week p e r i o d .  r e g u l a t i o n of f e e d i n g s are  the  The end  importance  own  the  of b r e a s t -  o f s i x weeks, i f t h e to  baby  the  district,  Baby C l i n i c  was  e s t a b l i s h e d at  the  t h e M e t r o p o l i t a n H e a l t h Committee l a t e  i s used  teaching purposes  student  methods and weekly  and  to l e a r n  treatment. draws l a r g e  H o s p i t a l uses t h i s  i t provides  i n the p r e s e n t  nurses  The  as  The  The  one  of the  in  but  by t h e H.H.C. t o g i v e s e r v i c e t o  babies- i n the d i s t r i c t .  opportunities and  and  I t i s . n o t p a r t o f t h e H e a l t h C e n t r e programme,  the b u i l d i n g well  by  the  obstetrical  the mother i s r e f e r r e d  i n her  A model V e i l H e a l t h Centre  f o r the  Clinic.  i s stressed.  of the  i s made t o have one  infant  difficulties  major concern feeding  early history  of  clinics, ,;  the  the  the baby i s  b r i n g s w i t h h e r a knowledge o f the mother s and  confinement,  a t t h e H e a l t h C e n t r e where  i s followed u n t i l  babies' nursery  history  after  the Clinic  few  t e a c h i n g programme f o r i n t e r n e s something about p r e v e n t i v e Veil  Baby C l i n i c  operates  attendances.  Psychiatry Clinic,  w h i c h has  been h e l d b i -  monthly April,  on T h u r s d a y m o r n i n g s s i n c e 1949, i s a d i a g n o s t i c  medical problems w i t h who have p h y s i c a l be  39 -  discovered.  i t s inception i n 1  clinic  f o r c h i l d r e n who  have  r e l a t e d p s y c h o l o g i c a l problems, or  symptoms f o r w h i c h no o r g a n i c  The M e t r o p o l i t a n  Health  b a s i s can  Committee h a s  provided  t h e s e r v i c e s o f a p s y c h i a t r i s t and p s y c h o l o g i s t  for this  Clinic.  Recently,  also undertaken to give psychologist Clinic  forthis  the C h i l d Guidance C l i n i c has  t h e s e r v i c e s o f - a - p s y c h i a t r i s t and  Clinic..  Recently,  has a l s o u n d e r t a k e n t o g i v e  psychiatrist procedure,  and p s y c h o l o g i s t  after.a child  the Child  Guidance  the services of a  by s p e c i a l a p p o i n t m e n t .  i s referred to Psychiatry,  The  i s to  have t h e s o c i a l w o r k e r e x p l a i n t h e r e a s o n f o r r e f e r r a l t o the p a r e n t s , social  to e n l i s t  their  co-operation,  h i s t o r y which i s presented  to obtain  a  to the p s y c h i a t r i s t i n  advance of t h e C l i n i c ,  and t o a r r a n g e f o r a p s y c h i a t r i c  conference.  i s brought  The c h i l d  on t h e m o r n i n g o f t h e C l i n i c  day, and i s g i v e n  •of t e s t s by t h e p s y c h o l o g i s t , who the p s y c h i a t r i s t . and a  child  case  social  worker,  school  a battery  imparts h i s f i n d i n g s to  In the afternoon  o f t h e same d a y ,  i s h e l d between p s y c h i a t r i s t ,  psychologist,  and t h e p a e d i a t r i c i a n who h a s e x a m i n e d t h e  child physically. the  Centre  The p s y c h i a t r i s t t h e n s e e s t h e m o t h e r  separately.  conference  to the Health  teacher,  D e p e n d i n g upon i n d i v i d u a l the school p r i n c i p a l ,  circumstances,  and t h e p u b l i c  h e a l t h n u r s e may be i n v i t e d t o a t t e n d . As t h e s e c o n f e r e n c e s 1. D i a g n o s t i c i s u s e d h e r e t o mean d e t e r m i n a t i o n o f t h e p r o b l e m , i t s e t i o l o g y , and a p o s s i b l e t r e a t m e n t p l a n .  -  40  -  provide a valuable teaching experience, a r e sometimes i n c l u d e d , p a r t i c u l a r l y  one  i f the  b e e n known t o them a t t h e H e a l t h C e n t r e . aspects  of the  of treatment the  social  worker.  or r e f e r r e d I f the medical Health  The  has  various  i s done  be k e p t  at the H e a l t h  a p p r o p r i a t e agency i n the  i s to  reasons,  follow-up  a plan  Centre,  community.  continue to attend the H e a l t h Centre  for  casework s e r v i c e s are u s u a l l y g i v e n at  the  Centre. There i s a case  exclusively expanding  provided  f o r t h e use  f o r having  A  special  i n t h e new  a separate  room  of the P s y c h i a t r y C l i n i c ,  the t e a c h i n g f a c i l i t i e s  provides.  which t h i s  room f o r t h i s p u r p o s e H e a l t h Centre  and  Heurology  Clinic,  neurosurgeon,  C h i l d r e n who of having,  attended has  i s to  be  quarters,  any  a  a certified neurologist  been o p e r a t i n g at t h e H e a l t h  have e p i l e p s y o r who  have, or are  are  Clinic.  A Metabolic i s h e l d every  Centre.  suspected  n e u r o l o g i c a l disease or disturbance,  r e f e r r e d to t h i s  and  by  for  Clinic  .Each T h u r s d a y m o r n i n g s i n c e M a r c h , 1950  and  by  i s d e c i d e d t h a t casework s e r v i c e s  the' c a s e may  to the  child  If'it  Most  internes  child  c h i l d ' s p r o b l e m a r e d i s c u s s e d , and 1  i s d e c i d e d upon.  are necessary,  o r two  C l i n i c was  begun i n A p r i l ,  Friday afternoon.  I t works  1950  closely  1. Follow-up i n v o l v e s e i t h e r working w i t h the c h i l d h i s f a m i l y , o r m a k i n g a r e f e r r a l t o an a g e n c y e q u i p p e d t o handle the problem.  and  -  41 -  w i t h t h e D i e t e t i c s Department all  c h i l d r e n w i t h endocrine  this  Clinic,  function.  the treatment  of t h e H o s p i t a l .  disturbances  While  are r e f e r r e d to  of o b e s i t y i s i t s main  I t was e s t a b l i s h e d a s a r e s u l t  of a  survey  made b y t h e M e t r o p o l i t a n H e a l t h Committee w h i c h showed that  five  thousand  hundred and f i f t y  s c h o o l c h i l d r e n were t h i r t y p e r c e n t  overweight.  Since approximately  population l i v e eligible it  t e n p e r cent  to  the Metabolic  of  public  t h a t t e n p e r cent  Clinic  f o r obesity.  h e a l t h n u r s e s was e n l i s t e d  i n order t o see  overweight  to the Health Centre.  After this,  c h i l d r e n as p o s s i b l e  Attendances  however, a t t e n d a n c e s  below.  This i s partly  initial  group a t t e n d i n g , treatment  that medical  dropped t o 7 and that, ofthe  was c o m p l e t e d  the H e a l t h Centre,  treatment  varied  s i x months o f  e x p l a i n e d by t h e f a c t  p a t i e n t s were d i s c h a r g e d f r o m  for referral  The c o - o p e r a t i o n  b e t w e e n 12 and 23 i n 1950 and i n t h e f i r s t  by t h e f a c t  of the  of f i v e  c h i l d r e n w o u l d be e l i g i b l e 1  a s many o f t h e e l i g i b l e  1951.  o r more  at t h e O u t p a t i e n t s ' Department,  estimated  hundred and f i f t y  were r e f e r r e d  hundred.  on i n c o m e s l o w e n o u g h t o make them.  f o r treatment  was r o u g h l y  that  o f Vancouver's f i v e  given i n this  and t h e and p a r t l y Clinic i s  symptomatic. 1. Watt, F r a n c e s Met a, The Treatment" o f O b e s i t y i n T.ow-Income ' F a m i l i e s ; A Study of the S o c i a l Worker's Role i n a C l i n i c a l S e t t i n g ; M a s t e r o f S o c i a l Work T h e s i s , U n i v e r s i t y o f B r i t i s h Columbia, 1950.  - 42 The 1951, at  and  the  this  held  Clinic  see  on  have an  acts  Most  in a  Clinic.  child  must  O u t p a t i e n t s ' Department long  i s offered  school-age attending of  staff  and  c h i l d r e n has  to  be  dental  complete  service  a f t e r n o o n a week. s c h o o l - a g e and  for  Fsychiatry child  is  main  there  children,  are  and  for  some r e a s o n , of  work f o r  t i m e and  lack  school-age extractions.  dentist  has  to  H e a l t h Centre p a t i e n t s  As  many c h i l d r e n as p o s s i b l e , are  this  Complete d e n t a l •  mainly l i m i t e d to  pre-school-ages,  the  explain  the  work, and  service.  not,  examines  r e f e r r e d to the  R e c e n t l y , however, a p r a c t i c i n g l o c a l a  and  treatment.  Because of p r e s s u r e  -facilities, had  for  f o r pre-school-age are  to  attending  found, the  f o r dental  c h i l d r e n who school.  r e f e r r e d to  be  Clinic  organic basis^for  Clinic  still  waiting-lists for this  service  The  capacity,  bases are  the P a e d i a t r i c  Children  newest  p h y s i c a l ! r e a s o n to  i s usually  Where p h y s i c a l  returned to  problem.  t h e r e i s an  i s no  i s the  children referred  consultative  I f there  symptom, t h e  opened i n O c t o b e r ,  T  of the  enuretic  w h e t h e r o r not  enuresis.  m i n-j g  Saturday mornings,  Health Centre.  urologist to  Genito-Urinary  fitted  for  into  offered one both  of  this  schedule. Volunteers No  description  of  t h e work done a t  the  Health  Centre  43 -  w o u l d be c o m p l e t e w i t h o u t  g i v e n by t h e Women's A u x i l i a r y Hospital  t o t h e Vancouver  and t h e J u n i o r L e a g u e o f V a n c o u v e r .  g r o u p s have a s n a c k h a r i n d a i l y provides charge,  Health with  Centre  financial  and m i l k .  Hospital gives for  o f t h e work o f w e i g h i n g ,  c h i l d r e n f o r examination,  and p r o v i d i n g  u n d e r t a k e n by r e p r e s e n t a t i v e s o f t h e s e filing,  clinics.  A s many a s s i x t e e n d i f f e r e n t  The Centre one  groups,  considers that t h i s  helpers  i s truly  has a l l taken p l a c e  During  medical  staff,  i n the Health  i n the short  increased  number o f t w e n t y t o a p p r o x i m a t e l y and o t h e r  specialists  ;  from  fifty-five  (most o f whom s e r v e o n  I n a d d i t i o n , r e s i d e n t i n t e r n e s and  n u r s e s ' come t o t h e H e a l t h  ,;  and t h e a t t e n d i n g  drawn f r o m t h e H o s p i t a l , . h a s  a rotation basis).  basis.  given  t h i s t i m e t h e number o f  h a s grown f r o m f o u r to - s e v e n t e e n ,  paediatricians  have  r e m a r k a b l e when  clinics  student  i n the various  t r e m e n d o u s amount o f e x p a n s i o n  s e r v i c e s and f a c i l i t i e s  original  &s w e l l a s  e a c h week.  space o f f o u r y e a r s .  an  has been  and w r i t i n g f o r t h e d o c t o r s  some t i m e d u r i n g  appliances  measuring,  t r a n s p o r t a t i o n f o r p a t i e n t s when n e c e s s a r y ,  typing,  free of  In addition, the  t o t h e Vancouver General  Part  These  which  a i d t o p a t i e n t s , where n e c e s s a r y ,  car-fare.  preparing  operation  General  p a t i e n t s and t h e i r p a r e n t s ,  soup, c o o k i e s ,  Infants' Auxiliary  and  mention o f the help  Centre  on a r o t a t i o n  - 44 F u r t h e r Needs The  diagnostic  and  treatment  services  offered  t h e H e a l t h C e n t r e a r e f a i r l y • c o m p r e h e n s i v e , and improvements w h i c h m i g h t would  suggested  Apart  f o r the i n d i v i d u a l  A l t h o u g h one wide range  the g a l a x y of c l i n i c s  t h o s e who cannot  of i t s o r i g i n a l  out  there i s recognition  that  this  the  as  i n any  the  sprung  rapidly  i n low-income that  influence  course of medical  a t t e n t i o n d u r i n g the p e r i o d  of r a p i d  treatment  the  of  developed losing  families. social  i t appears  received  little  expansion.  have r e a c h e d  i n the p h y s i c a l ' area; but  of t h i s ,  seem t h a t  the p a t i e n t  and  physical  treatment,  specialized level i t would  by  e s t a b l i s h e d t o meet a l l  of the f a c t  can g r e a t l y  f o r medical  impressed  o f b a l a n c e , and  a s p e c t o f t h e programme has  facilities  situation.  objective.  the m e d i c a l needs of c h i l d r e n  c o n d i t i o n and  know t h e  and "the r a p i d i t y w i t h w h i c h  H e a l t h C e n t r e was  factors  a number o f o t h e r s  h e l p b u t be  b e i n g , t h e r e i s a danger,  emotional  sound  a t t h e H e a l t h C e n t r e have  programme, o f i t s g e t t i n g  While  are measures which  clinics,  of s e r v i c e s o f f e r e d  The  any  f r o m needed improvements a l r e a d y  have b e e n s u g g e s t e d by  sight  suggested  s e r v e t o enhance an a l r e a d y b a s i c a l l y  programme.  into  he  at  a  The highly  i n the  as a p e r s o n  course has  -  b e e n somewhat l o s t is  that  of.  The m a i n i n d i c a t i o n o f  expanding medical s e r v i c e s .  two s o c i a l w o r k e r s  the necessary structure. of  sight  -  t h e s o c i a l w o r k programme h a s n o t k e p t  w i t h the of  45  casework  While i t  services  a t t e n t i o n than others, will  it  be d i r e c t e d t o w a r d s  to  that  are l i k e l y  staff  render  i n this large,  i s understandable  a r a p i d l y expanding s e r v i c e  pace  The p r e s e n t  seems h a r d l y a d e q u a t e  specialized  some  aspects  to receive  i s t o be h o p e d t h a t  There  are  A more d e t a i l e d d i s c u s s i o n o f  will  these  n e e d s and some o f t h e p o s s i b i l i t i e s f o r m e e t i n g t h e m presented  i n Chapter  is  that  parents,  doctors,  and s t a f f  i n c o n v e n i e n c e d by o v e r c r o w d i n g . for  a larger  this  considerably  There i s a g r e a t  s e t t i n g of t h i s k i n d .  children  o r m e r e l y d i v e r t i v e way. a real place  I t w o u l d be d e s i r a b l e ,  to occupy p a r e n t s w h i l e t h e y  c h i l d r e n t o be e x a m i n e d .  A  in a also,  a p l e n t i f u l s u p p l y o f v a r i e d and u p - t o - d a t e  material  need Ideally,  s h o u l d be s u p p l e m e n t e d by f a c i l i t i e s t o k e e p  w e l l - e q u i p p e d p l a y r o o m w o u l d have  their  a r e now  space.  and more c o m f o r t a b l e w a i t i n g - r o o m .  occupied i n a constructive,  have  facilities  o f b o t h w a i t i n g - r o o m and e x a m i n i n g - r o o m  Patients,  is  111.  A g l a r i n g -lack i n the H e a l t h Centre  are w a i t i n g  to  reading for  The e x a m i n g - c u b i c l e s  •-  efforts and  i n d i c a t i o n s - t h a t much i m p r o v e m e n t i n t h i s d i r e c t i o n s o o n come a b o u t .  less  future  a c h i e v i n g more p e r s p e c t i v e  c o o r d i n a t i o n i n t h e o v e r a l l programme.  this  in  -  the present adequate,  quarters  overcrowding  he  will  larger,  and  the p r e s e n t  Even the  sufficient the  services  i n the  The  one  i n the  course  of t h e i r  due  The  to  cubicles  and  and  orthopaedic  quarters w i l l  economic  not  About -  slump. out-patient  department  impossible  i s that p a t i e n t s are  s e r v i c e o f one  physician  contact.  Apart  Allergy  Clinics  from the D i a b e t i c , i n the H e a l t h  same d o c t o r  Centre,  i s not p r o v i d e d ,  however, and  d o c t o r who  a t t e n t i o n d u r i n g the at the H e a l t h  not  throughout  it is  time-scheme f o r a t t e n d i n g d o c t o r s ,  into  be  as n e a r l y as p o s s i b l e .  of i t i s r e c o g n i z e d ,  attendance  brought  general  out-patient s e t t i n g which often  e a c h p a t i e n t t o one  patient's  will  needed f o r c h i l d r e n ' s o u t - p a t i e n t  contact w i t h the  the m e d i c a l  v / i l l be  surgical  s e r v i c e g i v e n i n an  continuous  by means o f a new  for  Semi-  of i n c r e a s e d attendances.  o f an  approximation  importance  assign  event  i n an  Hearing,  continuing The  will  i n the  difficulties  s p a c e i n t h e new  event  element  g i v e n the  Special  quarters  approximate p r i v a t e p r a c t i c e  makes t h i s  the  There  t h e r e v / i l l be more o f them, w h i c h  s p a c e w o u l d be  Medical should  size.  really  as w e l l as m a k i n g room f o r a more a d e q u a t e  service.  twice  t o he  somewhat a m e l i o r a t e d . -  make p o s s i b l e a more a d e q u a t e service  the  s p a c e i n t h e new and  be  s m a l l and,  about t w i c e  Private Pavilion,  will  -  are very  s h o u l d he  he g r e a t e r f l o o r  46  will course  Centre.  be of  responsible  This  scheme  o p e r a t i o n when t h e move t o t h e  new  - -  planned,  to  the  a  quarters i s executed. A staggered desirable. to  At the present  he p r e s e n t  two  appointment time,  i s most  a l l patients are required  a t t h e H e a l t h Centre  by 9 a.m.  hours o f t e n f o l l o w s before the doctors  clinics  arrive.  patients arrive  While  i t may s t i l l  by 9 a.m.,  in  to t h e time  w a i t i n g p e r i o d s cannot  appointment An  in-patient  H e a l t h Centre  time t o  c o u l d be a s k e d  will  begin.  t o come  Because o f  of doctors, i t i s recognized that be e n t i r e l y  be made i n t h e new l o c a t i o n ,  flexible  f o r the f i r s t  clinics  the c l i n i c  the u n c e r t a i n schedules  will  conducting the  i t w o u l d a p p e a r t h a t t h o s e who a r e  to attend s p e c i f i c  closer  A wait of  be n e c e s s a r y f o r  a t t e n d i n g t h e H e a l t h Centre  scheduled  of  schedule  avoided.  An  attempt  however, t o make more  arrangements.  o u t - p a t i e n t department services.  s h o u l d b e r u n a s a n arm  One g r e a t d r a w b a c k o f t h e p r e s e n t  i s t h a t i t i s l o c a t e d a l o n g way f r o m t h e  p a e d i a t r i c wards, making i n t e g r a t i o n t h e two f a c i l i t i e s  of the s e r v i c e s of  exceedingly d i f f i c u l t .  Plans  a r e now.  underway f o r c o n s t r u c t i o n o f p a e d i a t r i c w a r d s i n t h e SemiPrivate Pavilion,  and t h i s  drawback w i l l ,  therefore,  e v e n t u a l l y be overcome. Teaching  facilities  c o u l d be g r e a t l y  expanded.  P r e s e n t p l a n s f o r t h e f u t u r e i n c l u d e arrangements w h i c h will, provide f o rt h i s .  I t i s intended that f o u r t h year  -  medical will  students  eventually  short-term  48  from the  -  U n i v e r s i t y of B r i t i s h  be a s s i g n e d  to the v a r i o u s  is  a case f o r d e v e l o p i n g  better  relationships w i t h p u b l i c health nurses. M e t r o p o l i t a n H e a l t h Committee e a c h c h i l d who comes t o t h e attendance.  This  is  School Medical Services conceivable to  helpful  in  practice  Such an arrangment  of having a c h i l d r e t u r n to  of  course,  it  is possible  Committee  t h e M . H , C. ' s It  i n the  area  is  quite  a  further  of  would e l i m i n a t e  the  the H e a l t h Centre  for  into  by  a  operation,  o n l y by t h e M e t r o p o l i t a n H e a l t h C o m m i t t e e , that the H e a l t h Centre  towards  comprehensive whose f a m i l i e s  Centre  of  . T h i s i d e a c o u l d be p u t  the  i n s t i g a t i o n of  The H e a l t h C e n t r e  attention.  of  coordinating  w h i c h c o u l d w e l l be l o o k e d a f t e r  n u r s e i n t h e home.  the  reason  could render  some H e a l t h C e n t r e p a t i e n t s  routine matters  and t h e  and W e l l B a b y C l i n i c s .  that p u b l i c h e a l t h nurses  medical follow-up.  At present  H e a l t h Centre  i s very  working  n o t i f i e d by l e t t e r  t h e w o r k of- t h e H e a l t h C e n t r e w i t h t h a t  service  c l i n i c s on a  basis. There  for  Columbia  diagnostic cannot  Starting  for  c o u l d work w i t h  Children offers  to pay  f r o m modest  the  such a p l a n .  and t r e a t m e n t  afford  but  service  a to  for private  beginnings,  the  children  medical Health  (under the d i r e c t i o n of D r . Donald P a t e r s o n )  has  increased  i t s services  f u n d s became a v a i l a b l e . growing  attendance  i s meeting is the  still  An  figures  a g r e a t need  shortcomings  remedied,  became a p p a r e n t ,  examination of the indicates  that  i n t h e community.  room f o r improvement  participating be  as t h e need  i n t h e programme.  p l a n s have b e e n  draughted.  Although there services,  Many o f t h e f a u l t s  when t h e H e a l t h C e n t r e moves t o i t s new the  ever-  r e c o g n i z e d by  and many o f t h e d e f i c i e n c i e s  as-  the H e a l t h Centre  and e x p a n s i o n o f  a r e a c k n o w l e d g e d and  and  will  be  location  those will  overcome f o r which  CHAPTER 111  THE SOCIAL  WORKER  IN THE HEALTH CENTRE  FOR  CHILDREN "Social patients,  service,  physicians,  a professional, service to  hospital  community, h a s b e e n d e v e l o p e d sanatoria, personal and  to help p a t i e n t s  difficulties  preservation  i n the medical is  r e l a t e d to t h e i r i l l n e s s , 1  of health."  concepts and t h e o r y  integration  emotional  and  recovery,  The s o c i a l w o r k e r ' s  a w a r e n e s s and u n d e r s t a n d i n g  role as t h e r e  of these  of the contribution  i n medical  practice.  o f new p s y c h i a t r i c k n o w l e d g e w i t h m e d i c a l  t h e o r y has r e s u l t e d and  clinics,  w i t h e n v i r o n m e n t a l and  and a l s o w i t h t h e r e c o g n i t i o n  of p s y c h i a t r i c The  i n hospitals,  and t h e  s e t t i n g i s b e c o m i n g more p r o m i n e n t  an i n c r e a s i n g  services;  administration,  i n a growing a t t e n t i o n  factors  involved  to the s o c i a l  i n illness,  and an 2  increased valuable  recognition contribution  that  s o c i a l c a s e w o r k c a n make a  t o treatment  i n these  areas.  1. A S t a t e m e n t o f S t a n d a r d s t o be Met by S o c i a l S e r v i c e D e p a r t m e n t s i n H o s p i t a l s , C l i n i c s , and S a n a t o r i a , The A m e r i c a n A s s o c i a t i o n o f M e d i c a l S o c i a l W o r k e r s , 1834 K S t . , N. W., W a s h i n g t o n 6, D. C., T h i r d R e v i s i o n , 1949, p . 3. . - -•• 2. S o c i a l c a s e w o r k may be d e f i n e d a s t h e m u t u a l l y p l a n n e d u s e o f c o n s t r u c t i v e r e l a t i o n s h i p s and e x i s t i n g r e s o u r c e s i n e f f e c t i n g t h e r e l e a s e and g r o w t h o f i n d i v i d u a l c a p a c i t i e s f o r a more s a t i s f a c t o r y a d j u s t m e n t i n t h e e c o n o m i c , s o c i a l a n d p e r s o n a l l i f e of the i n d i v i d u a l .  - 51 More s p e c i f i c a l l y , social  caseworker  helping to free  is  milieu,  equipped to p e r f o r m i s  the p a t i e n t  medical diagnosis,  the f u n c t i o n w h i c h the m e d i c a l  from a n x i e t y  treatment,  and t o h e l p h i m t o  and h i s  i n the area  relative  to  c a r r y out m e d i c a l  recommendations  i n the p h y s i c a l a r e a .  i n v o l v e s h e l p i n g the d o c t o r ,  the p a t i e n t ' s . f a m i l y ,  to understand,  appropriate, also,  i n the  i s necessary  function.  for  It  the e f f e c t i v e  is elsewhere which  i s given .  c a r r y i n g out of  The p r i n c i p a l m e t h o d s u s e d a r e  where  involves,  of the p a t i e n t ,  should proceed concurrently w i t h the help that him,  and  i n e i t h e r the h o s p i t a l or  A thorough study  community,  needs.  s u c h e n v i r o n m e n t a l a i d as  from resources  This  the r e s p o n s i b i l i t y ,  f o r meeting the p a t i e n t ' s  the p r o v i s i o n of  necessary  a,nd t o t a k e  his  socio-economic  so t h a t he may make p r o g r e s s  others  this  interviews  with  t h e p a t i e n t a n d members o f h i s f a m i l y , a n d c o n f e r e n c e s h i s behalf w i t h other p r o f e s s i o n a l M e d i c a l . s o c i a l casework  Because  social  the primary purpose  on  persons. s h o u l d n o t be t h o u g h t  as a s p e c i a l t y w i t h i n the b r o a d f i e l d of s o c i a l but r a t h e r as g e n e r i c  casework  i n a medical  of a h o s p i t a l ,  clinic,  setting. or  and p r o v i d e m e d i c a l t r e a t m e n t  physical  illnesses,  are n e c e s s a r i l y  features  to the  setting. whose  social  casework w h i c h i s  Most p a r t i c u l a r l y , i t s focus  social  for  some u n i q u e c a r r i e d out i n  i s always  s i t u a t i o n i s r e l a t e d to h i s  of  work,  s a n a t o r i u m i s to d i a g n o s e there  of  s t a t e of  the  this  patient  health  - 52 i n s u c h a way a s t o  create a problem.  I t must be b o r n e  m i n d , when d e a l i n g w i t h s u c h p a t i e n t s , not asked f o r h e l p , to r e c o g n i z e ,  is  social  that  the  often they  do n o t r e c o g n i z e ,  t h a t t h e i r p r o b l e m has  implications. makes  and s o m e t i m e s  that  social  or  in have  or w i s h  emotional  Another of the important f e a t u r e s w h i c h casework  i n a medical setting  s o c i a l worker f u n c t i o n s ,  somewhat  unique  not i n d i v i d u a l l y , but  1  a s a member o f  a team o f w h i c h t h e p h y s i c i a n i s t h e  The p h y s i c i a n t a k e s t h e and  the f i n a l  which s o c i a l members,  r e s p o n s i b i l i t y for medical  diagnosis  f o r m u l a t i o n o f an o v e r a l l t r e a t m e n t p l a n , casework  s e r v i c e may be a p a r t .  i n c l u d i n g the s o c i a l  caseworker,  i n f o r m a t i o n a n d make s u g g e s t i o n s the d i a g n o s i s  for  but  these remains w i t h the  Other  may  which w i l l  and p l a n o f t r e a t m e n t ,  responsibility  the  i n any m e d i c a l s e t t i n g ,  of  team  give  influence  both  ultimate  doctor.  The S o c i a l W o r k e r i n a C h i l d r e n ' s O u t - P a t i e n t As  head.  Setting  the s o c i a l worker i n a  1, The t e a m a p p r o a c h i n v o l v e s t h e p o o l i n g o f k n o w l e d g e and t h e c o - o p e r a t i v e w o r k i n g t o g e t h e r o f a l l t h o s e c o n n e c t e d w i t h t h e p a t i e n t , i n o r d e r t o f o r m u l a t e and c a r r y out a t r e a t m e n t p l a n w n i c h w i l l meet a s many o f t h e p a t i e n t *s n e e d s a s p o s s i b l e , and w h i c h i s i n h i s b e s t i n t e r e s t s . The.patient i s always t h e f o c u s o f the t r e a t m e n t team, b u t team members, a p a r t f r o m t h e d o c t o r , may v a r y d e p e n d i n g u p o n i n d i v i d u a l circumstances. The t e a m i d e a i s a p r o d u c t o f t h e p r e s e n t era of intense s p e c i a l i z a t i o n . A s d o c t o r s h a v e become s p e c i a l i s t s i n v a r i o u s s e c t i o n s o f t h e human o r g a n i s m , i t h a s g r a d u a l l y come t o be r e c o g n i z e d t h a t t h e p a t i e n t a s a n i n t e g r a t e d s o c i a l a n d e m o t i o n a l b e i n g v/as g e t t i n g l o s t . M e d i c a l s o c i a l w o r k a n d t h e team a p p r o a c h h a v e done a g r e a t d e a l towards p r e s e r v i n g the i d e n t i t y of the i n d i v i d u a l .  -  children's  out-patient  the t r e a t m e n t casework. who  53 -  setting functions  a s a member o f  team f r o m t h e b a s e o f g e n e r i c  The f o c u s  here i s the c h i l d  social  o f a low-income  has come t o a c l i n i c p r i m a r i l y f o r t r e a t m e n t  m e d i c a l p r o b l e m , b u t i n whose  s i t u a t i o n there  or emotional f a c t o r s which w i l l medical  treatment The  c h i l d r e n who  worker as p a r t out-patient  i s t o be  require  family  of a  are social  attention i f  effective. should  of the o v e r a l l  be d e a l t w i t h  treatment p l a n  s e t t i n g c a n be c a t e g o r i z e d  by a  social  i n a children's  into four  types:  (1) C h i l d r e n whose m e d i c a l , p r o b l e m i s t o t a l l y o r i n p a r t ' c a u s e d o r a g g r a v a t e d by t h e s o c i a l o r ( a n d ) economic s i t u a t i o n . (2) C h i l d r e n who a r e n o t p r o g r e s s i n g u n d e r t r e a t m e n t , whose r e s p o n s e t o t r e a t m e n t i s s p a s m o d i c , o r who a r e r e s i s t i n g treatment, (3)  C h i l d r e n whose p a r e n t s  are r e s i s t i n g  treatment.  (4) C h i l d r e n f o r whom t h e u s e o f o u t s i d e resources i s r e q u i r e d , o r where o u t s i d e a g e n c i e s o r p e r s o n s a r e working w i t h the c l i n i c to help the p a t i e n t and h i s family. In p r a c t i c e , i t i s obvious t h a t  children referred  t o t h e s o c i a l w o r k e r do n o t u s u a l l y have p r o b l e m s t h a t c a n be  considered  t o be i n o n l y  e x c l u s i o n of the others. considered  unusual  difficulty  to require The  total  social  one o f t h e s e  In fact,  f o r a child with  categories  i t w o u l d n o t be a medical-social  some a t t e n t i o n i n a l l o f t h e s e  importance  to the  of considering  the c h i l d  areas.  and h i s  s i t u a t i o n i s p e r h a p s more r e a d i l y a p p a r e n t  to  54  s o c i a l workers i n t h i s  social  agencies.  The  -  s e t t i n g t h a n i n some  e f f e c t o f f a m i l y members u p o n  c h i l d ' s b e h a v i o r i s sometimes- so be  a, t e n d e n c y t o  parents. should that and  often  a n x i e t i e s , and  can  t h e m s e l v e s as  of  affecting  the  social  their  c h i l d r e n to  schools,  churches, the service  and  including  their  staff.  the p h y s i c i a n  the has  social  worker  a responsibility  agencies,  family,  however, t h e the  are to  social  the  clinic  courts,  o r members  advisability  c a s e w o r k s e r v i c e as p a r t  be  parents.  When someone o t h e r  as t o  can  However, r e f e r r a l s  welfare  fears  of  problems t h a t  patient's  physicia.n r e f e r s a c h i l d , consults  forgotten  l e g i t i m a t e l y come f r o m o t h e r  from h e a l t h  social  personal  treatment p l a n .  s o c i a l w o r k e r may personnel,  and  i t be  recognition  to  the  attitudes  Casework, i n s h o r t , as  may  work w i t h  expressing  comes f r o m t h e p h y s i c i a n who  to r e c o g n i z e  the  should  the  there  of p a r e n t a l  respond to  individuals.  referral  i n the  capable of  c h i l d r e n a.s w e l l The  usually  importance  be m i n i m i z e d , n e i t h e r  c h i l d r e n are  o f f e r e d to  obvious that  over^concentration  A l t h o u g h the  not  other,  than  of a  worker of  of the m e d i c a l  treatment  plan. The  success of  children's out-patient  social  clinic,  casework s e r v i c e s i n a as  i n a l l medical  depends upon " i n d i v i d u a l i z e d study o f the p a t i e n t  settings, so  that  -  his  medical  personal sharing  55 -  s i t u a t i o n and i t s i n t e r r e l a t i o n s h i p w i t h h i s 1  n e e d s and p r o b l e m s may he u n d e r s t o o d . " of information  worker i s b a s i c understanding  between t h e d o c t o r  and t h e s o c i a l  t o t h e team approach, and t o t h e i r i n d i v i d u a l  o f the p a t i e n t .  The p h y s i c i a n g i v e s t h e  s o c i a l worker a comprehensive p i c t u r e o f the physical  condition  of environmental,  condition.  goal.  emotional,  economic, and on t h e p a t i e n t ' s  W i t h t h i s mutual u n d e r s t a n d i n g , the  p h y s i c i a n p r o c e e d s w i t h t h e programme o f m e d i c a l while the s o c i a l worker helps to p a r t i c i p a t e i n a p l a n  the p a t i e n t  consistent  .recommendations, a n d w h i c h w i l l physical  the  t o see a l l p a t i e n t s  contribute  to h i s  t h e s o c i a l w o r k e r "s  admission. considerably  on a d m i s s i o n t o t h e c l i n i c f o r  of e l i g i b i l i t y requirements,  p a t i e n t s who s h o u l d  there  a r e some  be d e a l t w i t h by t h e - s o c i a l worker on  T h e s e w o u l d i n c l u d e p a t i e n t s who a r e upset  about  coming t o t h e c l i n i c  show r e s i s t a n c e t o c l i n i c  attendance,  who have b e e n r e f e r r e d t o t h e c l i n i c  !•  and h i s f a m i l y  progress.  checking  families  care,  w i t h the m e d i c a l  Although i t i snot w i t h i n province  The  i n t e r p r e t s to the p h y s i c i a n t h e  s o c i a l p r o b l e m s w h i c h m i g h t have a b e a r i n g physical  patient's  and an i d e a o f t h e t r e a t m e n t  s o c i a l worker, i n t u r n , significance  The  A Statement  o f Standards  by o t h e r  o r whose patients social  , A.A.M.S.W., p . 3.  - 56 agencies  and where t h e p r o b l e m s a r e  whose c a s e s t h e  t o be  financially  admission  s h o u l d be  leave the  clinic  to ensure  their getting  treatment  who  s e e n by  outside persons,  w i t h the  and  s o c i a l worker  social  worker b e f o r e contact w i l l  not  w o r k e r on a d m i s s i o n  can be made.  Where t h e y  interview  are  admitting- c l e r k w i l l s o c i a l worker  not  be  able  should  service  attending  are i n low-income b r a c k e t s . i s also  a p a r t o f the  f u n c t i o n when i t i s c a r r i e d casework r e l a t i o n s h i p ,  and  The  social  out w i t h i n t h e i s p a r t of  provision worker's  framework o f  worker should r o u t i n e l y handle and  whom s u c h r e q u e s t s casework s e r v i c e ,  similar  the  social  ordering of appliances,  requests.  a r e made, a r e n o t these  a  the'casework  However, t h i s d o e s n o t mean t h a t the  transportation,  see,  i s obviously often  i n an o u t - p a t i e n t s e t t i n g where a l l p e o p l e  treatment.  will  agencies  indicated  such s e r v i c e  of  a r r a n g e m e n t s f o r an i n t e r v i e w .  Environmental  of  they  Some o f t h e p a t i e n t s  contacts with other  which p a t i e n t s the  and make prompt  are  on  arrangements f o r i n i t i a l  known, however, a s e n s i t i v e to determine  social  elsewhere.  the  with  to explore the p o s s i b i l i t i e s  be known i n a d v a n c e t h r o u g h and  the  f o r treatment  that their  and  in  C h i l d r e n whose f a m i l i e s  ineligible  s e e n by  have b e e n d e s t r u c t i v e ,  s h o u l d be  children  s o c i a l w o r k e r p l a n s t o work c l o s e l y  an o u t s i d e a g e n c y o r p e r s o n . found  complex,  When p a t i e n t s f o r referred  d u t i e s can v e r y  for  adequately  be  -  57 -  p e r f o r m e d "by n o n - p r o f e s s i o n a l p e r s o n n e l .  When p a t i e n t s  have been r e f e r r e d t o - a s o c i a l w o r k e r f o r  casework .  service,  however,  responsibility the necessary resource,  it  i s then the  and p a r t  environmental assistance  or to help the p a t i e n t  help  clinic  s h o u l d be l a r g e  c a n be o f f e r e d  however,  to  worker's  of her f u n c t i o n e i t h e r to  The s o c i a l w o r k s t a f f patient  social  to  from the  secure  it  the r o l e o f the  for  e n o u g h so t h a t  himself.  out-  casework  Ideally,  s o c i a l worker should not  l i m i t e d to d i r e c t work w i t h p a t i e n t s T h e r e s h o u l d be s u f f i c i e n t t i m e c a n be a l l o w e d f o r  appropriate  i n a children"s  a l l v/ho r e q u i r e i t .  secure  and t h e i r  families.  s o c i a l work p e r s o n n e l  c a s e and i n t e r p r e t i v e  w i t h other p r o f e s s i o n a l people  be  so  that  conferences  i n and o u t o f the  clinic,  a n d f o r p a r t i c i p a t i o n i n community e d u c a t i o n a n d i n t e r p r e t a t i o n programmes. It  i s most d e s i r a b l e  that  s o c i a l workers  have  t i m e t o engage i n a g e n c y r e s e a r c h d i r e c t e d t o i m p r o v i n g the  c l i n i c programme.  The s o c i a l  to r e n d e r i n g e f f i c i e n t casework p r a c t i c e ,  is vital  and f o r  evaluation of  factual  data that  are  essential  performance,  service  social  and p o l i c i e s .  accurately-kept  and a r e  indispensable  and to m a i n t a i n i n g good  for effective  services  for objective  case r e c o r d ,  statistics  e v a l u a t i o n of  i n v a l u a b l e f o r use  research  Also,  the  provide,  social  workers*  i n programme  - 58 - . planning  and  study p r o j e c t s i n the  c o l l a b o r a t i o n with other reasons,  the  time  clerical  and  and  clinic  a s s i s t a n c e to to date.  c o m p l e t e and  I t i s important  t h a t they p a r t i c i p a t e  statistical  forms to ensure t h a t these w i l l  i n f o r m a t i o n w h i c h can be p u t  for  to  i n the  Social  S e r v i c e branch  C h i l d r e n i s a p a r t o f , and  Social  S e r v i c e Department  T h e r e i s an o p p o r t u n i t y  of  these  sufficient  keep  records  also,  in this  formulation  of  'contain  c o n s t r u c t i v e use.  S o c i a l Worker i n the H e a l t h Centre The  For  s h o u l d have  connection,  The  in  community a g e n c i e s .  s o c i a l workepersonnel  s t a t i s t i c s up  or  for Children  i n the H e a l t h  i s administered  Centre  by,  the  the V a n c o u v e r General- H o s p i t a l ,  f o r exchange o f i d e a s and t h i n k i n g  between s t a f f members i n t h e m a i n p a r t o f t h e H o s p i t a l those  i n the H e a l t h Centre  s t a f f meetings. for  the  a l s o p r o v i d e d by  one  the main S o c i a l  professionally-trained  a valuable  channel  service in  the  social  service  opened i n J u n e , 1948,  s o c i a l w o r k e r on t h e  This person  handled  the  a s w e l l as p e r f o r m i n g  staff  S e r v i c e Department,  '  clinics  Departmental  of s o c i a l  S u p e r v i s i o n of H e a l t h Centre  When t h e H e a l t h C e n t r e was  weekly  T h i s arrangement p r o v i d e s  advancement o f s t a n d a r d s  Hospital. is  through  and  - 1  staff,  .. .  a l l casework s e r v i c e s e m a n a t i n g clinic  there  admitting  from services,  1, Casework s e r v i c e i s u s e d h e r e i n a b r o a d e r s e n s e t h a n i n t h e e a r l y p a r t of t h i s c h a p t e r ( s e e f o o t n o t e 2, p. 50), and i n c l u d e s s u c h s e r v i c e s as p r e p a r a t i o n o f a, s o c i a l h i s t o r y , r e f e r r a l t o o t h e r a g e n c i e s , and f o l l o w - u p s e r v i c e s ( see f o o t n o t e 2, p . ). ,  -  arranging for  59  f o r some a s p e c t s  -  of hospital  admission,  the obtaining of glasses, orthopaedic  hearing  arranging  a p p l i a n c e s , and  a i d s f o r v a r i o u s p a t i e n t s , and a r r a n g i n g f o r  t r a n s p o r t a t i o n t o and f r o m t h e H e a l t h  Centre  f o r some- ,  patients.  I n October, 1948 t h i s worker began t o a c c e p t  referrals,  a l s o , f r o m t h e p a e d i a t r i c w a r d s of- t h e H o s p i t a l ,  and  v/as i n c l u d e d i n w a r d r o u n d s t h r e e  1950,  because o f p r e s s u r e  d a y s a week.  I n May,  o f work, i t was n e c e s s a r y  f o r the  \\/orker t o d i s c o n t i n u e h e r a t t e n d a n c e a t ward r o u n d s ,  however.  I n June, 1950 a s e c o n d p r o f e s s i o n a l l y - t r a i n e d social  w o r k e r was added t o t h e H e a l t h  worker has a c c e p t e d the  Health Centre,  admissions  casework r e f e r r a l s and h a s s h a r e d  s>nd o t h e r  has  continued  the  wards.  referrals  staff.  This  from the c l i n i c s a t  w i t h the other worker t h e  routine duties.  to accept  Centre  The o r i g i n a l  from both  worker  t h e c l i n i c s and  Casework S e r v i c e R e f e r r a l s Patients for  from the c l i n i c s  and wards 3,re r e f e r r e d  casework s e r v i c e s when t h e r e a r e s o c i a l and  emotional  f a c t o r s which the r e f e r r i n g p h y s i c i a n wishes to  have i n v e s t i g a t e d i n c o n n e c t i o n w i t h t h e i l l n e s s . sometimes i n v o l v e s o n l y t h e g a t h e r i n g social  This  of pertinent  i n f o r m a t i o n i n the form of a s o c i a l  history.  Sometimes, however, d e p e n d i n g u p o n t h e * i n d i v i d u a l p h y s i c i a n and on  the nature  o f t h e case,  either a continuing  contact  a casework b a s i s i s e s t a b l i s h e d , o r t h e p a t i e n t i s  0  -  referred  60  t o an a p p r o p r i a t e  -  agency.  whether or not the p a t i e n t v / i l l t h e "basis o f what h i s p r o b l e m attending  he  I f he  a referral carried  to  r e f e r r e d i s made  on  involves.  I f he  i s to  reasons  and  or e m o t i o n a l p r o b l e m . i s a cause  illness,  Centre.  d e c i s i o n as  the H e a l t h Centre f o r m e d i c a l  the -social his  he  The  i s offered i s t o be  or a p a r t  casework s e r v i c e s a t t h e  d i s c h a r g e d from the  t o an a g e n c y e q u i p p e d  to handle  be  Clinic,  of Health however,  the problem  is  out.  w o r k e r by  Patients  are r e f e r r e d d i r e c t l y  doctors,  internes,  and  other Hospital  f r o m b o t h t h e p a e d i a t r i c w a r d s and Health Centre,  The  patients  to the  the  clinics  r e f e r r e d from  social personnel i n the  the wards  1 .may  be  i n the H o s p i t a l All  patients  to the P s y c h i a t r y  on e i t h e r a p r i v a t e  r e f e r r e d from the P a e d i a t r i c  Clinic  go  first  to the  formulates a s o c i a l  and  t h e m o t h e r f o r p s y c h o m e t r i c t e s t i n g and The  h i s t o r y , and p r e p a r e s t h e  social  basis.  Clinic  s o c i a l v/orker,  who  the p s y c h i a t r i s t .  or a s t a f f  patient  interview  v/orker a r r a n g e s t h e  with  conference  1, P r i v a t e p a t i e n t s a r e t h o s e who p a y f o r t h e s e r v i c e s o f a p h y s i c i a n whom t h e y s e l e c t . S t a f f p a t i e n t s are t r e a t e d by s t a f f d o c t o r s f r e e o f c h a r g e . A l l H e a l t h Centre p a t i e n t s admitted to H o s p i t a l are s t a f f p a t i e n t s , 2, I f t h e m o t h e r " d o e s n o t accompany t h e c h i l d t o t h e H e a l t h C e n t r e , she i s c o n t a c t e d f o r t h i s p u r p o s e . I f the m o t h e r i s n o t l i v i n g , t h e c h i l d ' s g u a r d i a n assumes t h i s position.  time, to  and i n v i t e s  contribute  include  the attendance  the p s y c h i a t r i s t ,  referred  the psychologist  and t h e d o c t o r  who  i s attending  h e a l t h nurse.  treatment p l a n . 1  s o c i a l worker. psychiatric i s .not  school,  the school  t e a c h e r and  T h e - s o c i a l worker attends  dealt with  If  the conference to  formulate  i s c a r r i e d o u t by t h e  n e e d , i n many c a s e s , f o r the follow-up  period.  This  present.  sometimes happens t h a t  to t h e P s y c h i a t r y  Clinic  follow-up  There i s a great  a v a i l a b l e .at  screens  Host  consultation during  It  be  administers  o r i n t e r n e who  a l s o , ' p a r t i c i p a t e s i n t h e d i s c u s s i o n , and h e l p s the  These  t h e p a t i e n t , a n u r s e f r o m t h e ward o r c l i n i c , a n d ,  the child  public  o f p e o p l e who may he a b l e  t o , and b e n e f i t f r o m , the. c o n f e r e n c e .  the p s y c h o m e t r i c t e s t s ,  if  61 -  Clinic,  a doctor  or interne,refers  a p a t i e n t who c o u l d l e g i t i m a t e l y  by t h e s o c i a l w o r k e r .  The s o c i a l  worker  a l l t h e p a t i e n t s who a r e r e f e r r e d t o t h e P s y c h i a t r y t o see whether o r n o t such a r e f e r r a l  she f e e l s  handling  that  could  i s appropriate.  a p a t i e n t has a problem o f which t h e  fall  within her province,  she d i s c u s s e s t h e  s i t u a t i o n w i t h - t h e p h y s i c i a n who made t h e r e f e r r a l , what h e r p l a n w o u l d be w i t h  regard  explains  t o t h i s p a t i e n t , and  1. Follow-up i n v o l v e s e i t h e r working w i t h t h e p a t i e n t d i r e c t l y o r h e l p i n g h i m t o a c c e p t a r e f e r r a l t o an a p p r o p r i a t e a g e n c y , and t h e s e n d i n g o f r e p o r t s , where applicable, to i n t e r e s t e d people. F o r example, t h e f i n d i n g s of p s y c h i a t r i c conferences a r e r e l a y e d t o t h e M e t r o p o l i t a n H e a l t h Committee i f t h e c h i l d i n v o l v e d i s a t t e n d i n g s c h o o l i n Vancouver.  requests that physician  the o r i g i n a l  referral  i s usually willing  thinks that carried  62 -  the p s y c h i a t r i c  out i n accordance  to co-operate, referral  and an u n d e r s t a n d i n g  what t y p e s is  difficulties worker.  bring his  of the s o c i a l  t o suggest  There  i t is is a  worker's  role  on t h e p a r t o f d o c t o r s as t o  that  should handle.  It  a l l patients with psychological  s h o u l d he r e f e r r e d d i r e c t l y  Because o f her t r a i n i n g  emotional  should stand,  o f cases the s o c i a l worker  reasonable  The  h u t i f he  w i t h h i s wishes.  g r e a t need f o r c l a r i f i c a t i o n here  he w i t h d r a w n .  to the s o c i a l  i n the s o c i a l  and  a s p e c t s o f i l l n e s s , , she i s i n a p o s i t i o n t o  to the p h y s i c i a n i n f o r m a t i o n which would h e l p him i n  d e c i s i o n s as t o w h i c h p a t i e n t s r e q u i r e p s y c h i a t r i c  attention  and w h i c h c o u l d b e n e f i t  from  casework  services  I n t h e y e a r 1951, about  twenty p s y c h i a t r i c  a l o ne . case  c o n f e r e n c e s were h e l d a t t h e H e a l t h C e n t r e ,  although the  statistics  on t h i s  entirely  accurate.  There w i l l  a r e n o t c o n s i d e r e d t o be  since the diagnostic from t h e C h i l d  p r o b a b l y be c o n s i d e r a b l y more i n 1 9 5 2 , services  o f an a d d i t i o n a l  Guidance C l i n i c  have r e c e n t l y  psychiatrist  become  available. Apart  from  the Psychiatry C l i n i c , the c l i n i c s  which involves  an a u t o m a t i c  casework r e f e r r a l ,  vary  considerably  i n t h e number o f p a t i e n t s whom t h e y  refer for  _ 63 casework s e r v i c e . record  There i s , at present,  o f t h e numbers o f c h i l d r e n r e f e r r e d  clinics  specifically  Service  staff  statistical definite present  of the H o s p i t a l  of service  o f any k i n d  number d i s c h a r g e d f r o m s e r v i c e ,  i n v/hich i s i n c l u d e d  at p r e s e n t  attendance.  referred  Clinic  o f t h e number  since  Also,  Clinic.  Next t o P a e d i a t r i c s ,  the  greatest  and  after this  Clinic.  Clinic  instances  has t h e  where  patients  to the S u r g i c a l  (both of which o f f e r a  o n l y ) and a s o c i a l  f o r casework s e r v i c e  section  number o f c a s e w o r k  Clinic  Clinic  carried  are indicated.  the P a e d i a t r i c  i n those  t h e month,  and a n o t h e r  come f r o m t h e P a e d i a t r i c  from the P a e d i a t r i c  service  during  or emotional  p r o b l e m i s f o u n d t o be p r e s e n t , t h e r e f e r r a l patient  The  and t h e number  the greatest  o r t h e G-eni t o - U r i n a r y  consultative  given.  interviews,  interviews  appears t h a t  i s not s u r p r i s i n g  largest  a more  There i s a separate  admitting  s e c t i o n where a l l o t h e r  are  of getting  c a r r i e d f o r w a r d f r o m t h e p r e c e d i n g month, t h e  f o r w a r d t o t h e n e x t month.  This  The S o c i a l  f o r a statement  number a c c e p t e d f o r s e r v i c e s  referrals  from the  i s w o r k i n g o u t a new  form w i t h t h e object  f o r m p r o v i d e s .only  It  statistical  f o r casework s e r v i c e .  i n d i c a t i o n o f the type  of p a t i e n t s  the  no  of the  comes f r o m t h e P a e d i a t r i c the Metabolic  number o f c h i l d r e n f o r c a s e w o r k comes t h e A l l e r g y  Clinic.  Clinic  refers  services,  The E y e , D i a b e t i c ,  -  64 -  S p e e c h , and N e u r o l o g y and  referrals,  t h e s m a l l e s t numbers come f r o m t h e O r t h o p a e d i c ,  Cardiac,  Skin,  and E a r ,  Three I l l u s t r a t i v e An referral case for  C l i n i c s make o c c a s i o n a l  Nose, and T h r o a t  Clinics.  Cases  example o f t h e p r o c e d u r e f o l l o w e d  to the Psychiatry C l i n i c  o f B i l l y A.  Billy  a post-operative  attended  examination  B e c a u s e he v/as u n c o - o p e r a t i v e was u n d e r n o u r i s h e d ,  i s provided  in a i n the  the Paediatric C l i n i c f o l l o w i n g a mastoidectomy.  during the  examination,  and h a d b e e n a d i s c i p l i n a r y p r o b l e m on  t h e ward d u r i n g h i s p e r i o d o f h o s p i t a l i z a t i o n , conducting  the p h y s i c a l examination  Psychiatry  Clinic,  the  case,  times.  A student  I t was f o u n d  mother,  three  that B i l l y  c h i l d r e n o f a common-law  A. was a n e x t r e m e l y  neurotic person  c h i l d r e n , was l i v i n g  environmental Mr.  s o c i a l w o r k e r v/as a s s i g n e d  On t h e b a s i s o f t h e i n f o r m a t i o n o b t a i n e d ,  second o f t h r e e male  three  r e f e r r e d him t o t h e  and v i s i t e d M r s , A., B i l l y ' s  h i s t o r y was drawn u p .  Mrs,  the i n t e r n e  strain  under a  social  was t h e marriage,  who, w i t h h e r  demoralizing  i n an u n d e s i r a b l e  A., t h e f a t h e r o f t h e c h i l d r e n ,  a  industrial  area.  had been i n t h e e a s t  1 " f o r h e a l t h reasons"  f o r the past  tv/o y e a r s ,  a n d v/as  s e n d i n g M r s . A, #20 a week t o keep h e r s e l f and t h e t h r e e  1.  A s s t a t e d by M r s , A.  - 65 children. for  The two o l d e r  retarded  still  c h i l d r e n at school,  of pre-school Mrs,  the  w h i l e t h e y o u n g e s t was  age,  A. was c o - o p e r a t i v e  f o r this  involved,  and a g r e e d r e a d i l y t o  experience  by t e l l i n g  a n d what w o u l d he r e q u i r e d  psychiatric  c o n f e r e n c e was l a t e r  psychiatrist, psychologist,  referral,  Billy's  f o r the d i s t r i c t , of the problem, Billy was  school  teacher,  worker.  A l l were  was  s u f f e r i n g from the environmental pressure  little  t h a t M r s , A, was n e u r o t i c  of h i s  and a n x i o u s , a n d  that B i l l y  t o w h i c h she  could  gain  s e c u r i t y from h i s r e l a t i o n s h i p w i t h mother,  he wa,s made more i n s e c u r e i n t h e home.  by t h e f a c t  He c o n s i d e r e d  c o u l d n o t be r e a d i l y m o d i f i e d , given  and t h a t  the p s y c h i a t r i s t reached  conclusion  He t h o u g h t  the support  Billy  reported  On t h e b a s i s  the  subjected.  concerning  had found t h a t  a t h i s optimum l e v e l  w i t h M r s , A, a n d B i l l y ,  nurse aware  h i s knowledge,  i n t e l l i g e n c e , and t h e t e a c h e r  he was a b e h a v i o r p r o b l e m i n s c h o o l .  was b e i n g  The  the p u b l i c health  The p s y c h o l o g i s t  he was n o t p e r f o r m i n g  interviews  o f them.  t h e i n t e r n e who made t h e  and t h e s o c i a l  and h i s f a m i l y .  them t h e p r o c e d u r e  a r r a n g e d and i n c l u d e d  and e a c h c o n t r i b u t e d  of borderline  that  not  classes  p s y c h i a t r i c e x a m i n a t i o n , • The w o r k e r p r e p a r e d h e r a n d  Billy  the  c h i l d r e n were i n s p e c i a l  that  and t h a t  t h e f a t h e r was  t h a t M r s . A. "s p e r s o n a l i t y b u t recommended  that  she be  o f a s o c i a l w o r k e r and some e n v i r o n m e n t a l  assistance.  He  66  further  recommended t h a t B i l l y  supportive relationship t e a c h e r was Billy  -  w i t h a male  g i v e n some p r a c t i c a l  m i g h t he  handled  conducted  hi-monthly  him  over a five-month p e r i o d . v i s i t e d Mrs.  This  A.  A.  The  and p r o v i d e d c l o t h i n g  t o he  t e r m i n a t e d when i t  she had  undoubtedly otherwise the  T h i s unburdening prevented  had  s o c i a l work s t a f f have p r o f i t a b l y  l o n g e r p e r i o d of  time.  Cli-nic also  an  illustrative  i s that  Mrs.  someone whom  A.  Billy,  A.  at the  a g g r e s s i v e and  been a v a i l a b l e , been c a r r i e d  case r e f e r r e d  from  o f f i v e - y e a r - o l d H a r o l d R.  she  w h i c h would  d o i n g b e t t e r .work a t s c h o o l .  case w h i c h might  An  to  outbursts of h o s t i l i t y  c o n t a c t , v/as r e p o r t e d t o be l e s s  sufficient  was  on t h e p a r t o f Mors.  have o c c u r r e d i n t h e home,  t o manage, and was  and  a good d e a l from h a v i n g been a b l e  her t r o u b l e s p e r i o d i c a l l y  could t r u s t .  a  a n e e d f o r them.  felt  gained  had  c o n t i n u e d t o see h e r t w i c e  expressed  c a s e had  Billy,  s t u d e n t w o r k e r who  f o r the workers t o l e a v e the agency.  to r e l a t e  how  a s s i g n e d to  necessary that  The  supportive play interviews with  month on a s u p p o r t i v e b a s i s , as M r s .  worker.  s u g g e s t i o n s as t o  s o c i a l w o r k e r was  and  .other items  a  i n school.  A male s t u d e n t  originally  social  have  end  of  easier  However, this  is a  on f o r a  the  Neurology  T h i s case i s  example o f a s i t u a t i o n where a m e a s u r e o f  success  was  achieved through  where i t was  67  casework s e r v i c e s w i t h a p a r e n t ,  unnecessary  H a r o l d R.,  -  to deal d i r e c t l y w i t h the  after  examination  Clinic,  was  f o u n d t o have a b i l a t e r a l  atrophy  and  a bilateral  c o n d i t i o n was and  not  and  child,  at the  Neurology  secondary  optic  e x t e r n a l r e c t u s weakness.  This  considered r e s p o n s i b l e f o r the  headaches  eyeaches from which H a r o l d s u f f e r e d c o n s i d e r a b l y ,  however.  I t was  felt  by t h e  examining  d o c t o r t h a t Mrs.  H a r o l d ' s t w e n t y - f i v e y e a r o l d m o t h e r , was person,  and  symptoms.  that She  her a t t i t u d e  was  referred  worker f o r " c l a r i f i c a t i o n child",  Mrs,  R.  was  a tense,  c o n t r i b u t e d to the  anxious  child's  to the H e a l t h Centre  social  of her r e l a t i o n s h i p w i t h  g i v e n weekly  R,,  the  casework i n t e r v i e w s  over a seven-month p e r i o d .  t h a t Mrs. parents  During  the  R.  b e e n p l a c e d , a t an e a r l y  had  She  o r p h a n a g e and,  person", me".  the  d i d domestic  as she  o f W o r l d War  joining  df the  age,  11,  came o f m i l i t a r y she  as she  expressed  Because b o t h Mrs.  age  R,  R,  met  d i d not  it, and  Very  and m a r r i e d  "who  ever  the  showed any  not v e r y  a r e c u r r e n t p a t t e r n o f s e p a r a t i o n and  the  soon  "the  h e r h u s b a n d had was  found her  towards  j o i n e d t h e Army.  s e r v i c e , Mrs,  by  work a f t e r l e a v i n g  dependency needs, the m a r r i a g e and  c o n t a c t , i t was  i n an o r p h a n a g e f o r r e a s o n s w h i c h she  understand.  end  course  after  first love for  unmet  successful  reconciliation  -  r e s u l t e d u n t i l Mr, a year year  ago.  One  R,  t h e Army and went  H a r o l d , was  he p r o v e d  f r i c t i o n between Mr.  -  joined  child,  of marriage;  68  t o he  and M r s .  R.  emotionally  deprived people  that  the  child.'  When he was  his  h e a d , and became u n c o n s c i o u s .  horn  overseas  during  a constant  the'second  source  of  b e c a u s e b o t h were t h e y had  little  such  to  offer  s i x months o l d , H a r o l d f e l l He  was  admitted  on to  h o s p i t a l , where a d i a g n o s i s o f b r a i n h a e m o r r h a g e was and  he was  operated  on.  responsible f o r this guilt  feeling  herself. the  about  She  had  prevented  activity  considered had  same t i m e ,  herself  a great deal  i t , a c c o m p a n i e d by  p r o j e c t e d her marriage  a need to  because of her  from  indulging  i n spite  s h o u l d be  m i g h t have a n o t h e r  i n any  of assurance  encouraged,  normal  from the  because,  accident--and t h i s  on  to  guilt  She  childhood doctor  she  time  of  punish  difficulties  a great, n e e d t o o v e r p r o t e c t him.  him  activities,  R.  a c c i d e n t , and  c h i l d y e t , at the  feeling,  Mrs.  made,  said,  that "He  i t would  kill  him". During R,  course  v/as a b l e t o e x p r e s s  towards p a r e n t acceptance to  the  figures.  of the  casework c o n t a c t ,  some o f h e r d e e p - s e a t e d Through the  support  Mrs.  hostility  and  - •.  o f t h e w o r k e r , h e r d e p e n d e n c y n e e d s were  some e x t e n t .  She  expressed her  a n x i e t y about  her  met  marriage had  situation,  failed.  Only  and  a f t e r Mrs.  u n d e r l y i n g f a c t o r s was with Harold, helped had  to  and  g r a d u a l l y came t o r e a l i z e why  she  express  see why  her  she f e l t  t h e end  had worked t h r o u g h  a b l e to c o n s i d e r her hostility  about him  a need to o v e r p r o t e c t At  R.  she  of the  c o n t a c t , Mrs.  Mr.  their  difficulties  able,  also,  He  was  School  and M r s .  to allow Harold  she  Because t h i s o f t i m e was  appeared  children,  c a s e was  Mrs.  Mrs.  R.  was  freedom.  R.  felt  dreaded.  t o i t , a,nd i t was  work s t a f f  at the H e a l t h Centre to  returned  a t t e n d i n g Sunday  specially  successful conclusion.  as much t i m e  and  about  of h i s a t t e n d i n g school i n the  relatively  give  she  t o be d i s c u s s i n g  by m a i l .  had p r e v i o u s l y  devoted  why  resumed  when he  a g r e a t d e a l more  at the p r o s p e c t  autumn, a s i t u a t i o n  had  enthusiastic  u n a c c o m p a n i e d by h i s m o t h e r ,  comfortable  deal  R.  realistically  p l a y i n g with other  was  d i d and  R.  w o r k i n g t o w a r d s a more s u c c e s s f u l m a r r i a g e overseas.  She  him.  c o n t a c t w i t h h e r h u s b a n d , and was  from  these  relationship  t o him.  as  i t  clients  as  selected, a great carried  However, t h e  i s not  a  social  ordinarily  i s necessary  to  able  to  to produce  the d e s i r e d r e s u l t s . The attended of  case  o f J o h n I»», a n i n e - y e a r  the H e a l t h Centre  f o r over  a year  h i s o b e s i t y , i s an example o f t h e t y p e  o l d boy for  who  treatment  of r e f e r r a l  which  -  70 -  comes f r o m t h e M e t a b o l i c C l i n i c . beginning student  after the  o f h i s m e d i c a l t r e a t m e n t , he was r e f e r r e d  social  requested about  Shortly  worker.  The d o c t o r i n c h a r g e o f t h e c l i n i c  that t h e worker  o b t a i n background  contributing  t o John's  c o n d i t i o n was f o u n d t o be v e r y s i g n i f i c a n t , worker  continued to carry John's  from t h e p o i n t  took l i t t l e  o f view o f c o n t r i b u t i n g  interest  children.  unsatisfactory  to h i s healthy  i n h i s home, h i s w i f e ,  and a b o u t  p e r s o n who seemed t o d e r i v e a martyr-like  basis,  The f a t h e r 'was an a l c o h o l i c  The m o t h e r ,  h e r husband  the s o c i a l  t h e c a s e on a c a s e w o r k  home s i t u a t i o n was most  emotional development.  about  information  John t o a i d i n t h e f o r m u l a t i o n o f a treatment p l a n .  Since the emotional f a c t o r  six  to a  attitude,  overly  who  and t h e i r  c o n c e r n e d and a n x i o u s  J o h n , was a s u b m i s s i v e some s a t i s f a c t i o n  J o h n , who h a d b e e n  i n maintaining  overweight  s i n c e he was f i v e y e a r s o l d , was moody a n d unhappy a t home, v/as t o r m e n t e d by o t h e r c h i l d r e n and a t s c h o o l Mrs. During anxiety the  because  o f h i s weight,  H. a c c e p t e d t h e o f f e r  the f i r s t  neighborhood  a n d h a d no f r i e n d s . o f casework  help.  few weeks, she was u n a b l e t o e x p r e s s h e r  and, a s J o h n h a d l o s t  Clinic,  i n the  no w e i g h t  since  coming t o  i t v/as t h o u g h t by t h e d o c t o r and s o c i a l  t h a t p e r h a p s n e i t h e r m e d i c a l n o r casework However, M r s . H. e v e n t u a l l y  help  worker  c o u l d be u s e d .  r e a c h e d t h e p o i n t where s h e  was  71 -  able to t a l k w i t h the worker about her a n x i e t i e s .  expressed  She  a great deal of h o s t i l i t y towards her husband,  and r e l a t e d s e v e r a l t r a u m a t i c  f a m i l y i n c i d e n t s f o r which  she f e l t he had been r e s p o n s i b l e .  Mrs.  that she o v e r - f e d John to make up the home, as he was  the one who  from the disharmony.  She  encourage him  acknowledged  f o r the d i f f i c u l t i e s i n  seemed to s u f f e r most  r e c o g n i z e d w i t h the worker the  n e c e s s i t y f o r John's adhering d u r i n g the course  H.  to a d i e t , however,  of the next few months, was  in this.  and  able to •  John l o s t t w e n t y - f i v e pounds  during t h i s period. John reached a p o i n t , however, where he became very demanding about food, had exceedingly  difficult  temper tantrums, and  to handle.  I t was  decided,  was  at t h i s  time, t h a t weekly p l a y i n t e r v i e w s between John and.the worker might be a good medium, f o r h e l p i n g him to express h i s f e e l i n g s about the d i e t a r y r e s t r i c t i o n s which were p l a c e d on him.  Mrs.  of t h i s p l a n .  During  i t waa  H. was  agreeable  the course  found t h a t John had  of the p l a y i n t e r v i e w i n g ,  a great d e a l of a n x i e t y about  h i s home s i t u a t i o n , and that he was normal competition.  I t was  to the c a r r y i n g out  felt  unable to endure  that he equated a  withdrawal of food w i t h a withdrawal of a f f e c t i o n , that he was  i m p e l l e d to attempt to secure  and  affection i n  other ways, i . e . , by e x c e l l i n g i n some area.  John  able to express h i s f e e l i n g s to the worker, and  was  with  -  her  support,  situation contact  able  to maintain  h i s weight  the  time  the  worker  with  had  not  pressure  of  situation periodic  reached  The  time,  the  closely  telephone to  time  as Mr,  take  insulin.  H,  as  to  the  gained  weight,-  Mrs,  Clinic.  the  several of  weeks  As of  the M e t a b o l i c  treatment  would  .T h i s  he  was  she  wished  Health own  he  and  had  Clinic be  in a to  her  lost  no  helpful.  that As  Mrs.  to  John's gradually  conversation John's  s e v e r a l weeks reappeared  after  doctor  H.  same  husband's  weight  further  the  he  request,  the  to  began  and  However,  treatment,  decided  about  telephone  h i s mother's  still  admitted  discontinue  Centre,  were  no  hospital,  about  home  John's  f o r w h i c h he the  of  There  but  occurred  from  indicated  continued  not  H..,  the  and  f o l l o w the  upset  that  his  to  H,  worker,  the  because  became, s p o r a d i c ,  with  at  successfully  relationship.  diabetes,  was  attending  have wished.  until  the  workers,  was  Centre  c o n d i t i o n , and  at  low  discharge  diabetic  John,  unable  a. w o r k i n g  developed  with  he  her  casework  regular  although  would  that  the  continued  was  appendectomy,  Health  later,  she  discontinued  d i s c u s s i o n s w i t h Mrs.  After  visits  association  the  loss.  judged  John while  worker  relatively  f o r an  the  see  of  contact  develop  remained  hospital  One  f o r s e v e r a l months,  as  opportunity  to  i t was  a p o i n t where  closed.  Clinic,  uneventfully  student  Hospital,  undertook  Metabolic  weight  the  c o u l d he  therefore,  -  was  At association  72  in  charge  medical and  John  were  -  very upset about t h i s ,  73 -  i t was  arranged that the worker  would continue to see John, but that m e d i c a l would cease.  treatment  John continued to see the worker under  t h i s arrangement f o r about f o u r months, and, at the end of t h i s time, the s i t u a t i o n showed improvement. main advance was  The  that John began to p a r t i c i p a t e i n  c o n s t r u c t i v e a c t i v i t i e s and was making f r i e n d s . appeared to be much happier at home.  He  At the time of  w r i t i n g , John had begun d i e t i n g a g a i n , and took g r e a t p r i d e i n the f a c t that he and h i s f a t h e r c o u l d d i e t together, A c l o s e r contact w i t h the f a m i l y by; another worker d u r i n g the course of John's contact would have been the i d e a l arrangement i n t h i s case.  Because of time-  p r e s s u r e s and-lack of s t a f f , however, i t was  not p o s s i b l e  to c a r r y out home v i s i t s i n t h i s or other cases where i t would have been d e s i r a b l e , These t h r e e cases p r o v i d e i l l u s t r a t i o n s of what casework s e r v i c e can accomplish w i t h c h i l d r e n whose p h y s i c a l c o n d i t i o n i s c l o s e l y r e l a t e d to emotional environmental f a c t o r s .  and  Although t i m e - p r e s s u r e s p r e v e n t e d  the s o c i a l work s t a f f from r e n d e r i n g optimum s e r v i c e to these c h i l d r e n and t h e i r f a m i l i e s , they d i d r e c e i v e some s p e c i a l a t t e n t i o n and o b v i o u s l y p r o f i t e d from i t .  Many  more children.who a t t e n d the H e a l t h Centre could use  casexsrork to  74 -  help, t o g o o d a d v a n t a g e , h u t i t i s n o t y e t p o s s i b l e  extend t h e s e r v i c e beyond a r e l a t i v e l y  O t h e r Casework  small  group.  Services  Included  i n the broad d e f i n i t i o n  o f -casework  service  r e n d e r e d by t h e s o c i a l w o r k e r i n t h e H e a l t h  Centre,  i s the j o b of follow-up.  activity  being  public  instructions with  regard  c a r r i e d o u t , and o f c o n t a c t i n g  h e a l t h nurses to acquaint  which apply  i n the school  receiving  This  Clinic,  l e g i t i m a t e l y within the province except  to see t h a t to the c h i l d s c h o o l s and  s i t u a t i o n a n d . t o keep  comes m a i n l y f r o m t h e C a r d i a c  duties,  such  them w i t h i n s t r u c t i o n s  informed of the c h i l d ' s progress.  be  involves  as k e e p i n g i n t o u c h w i t h p a r e n t s  the p h y s i c i a n ' s are  This  them  type o f r e f e r r a l  and i s n o t f e l t t o  of the social  worker's  i n t h e f e w c a s e s where t h e p a t i e n t i s  casework  treatment.  R o u t i n e S e r v i c e s P e r f o r m e d by t h e S o c i a l W o r k e r As some r o u t i n e  was p r e v i o u s l y duties  can w e l l  province  o f the s o c i a l  carrying  out o f admissions  and part  worker.  o f t h e casework p l a n .  the performance o f  be c o n s i d e r e d  interviews  s e r v i c e s when t h i s i s  s e c t i o n , however, a r e a t p r e s e n t  regardless  the •  f o r certain patients,  The r o u t i n e  s o c i a l workers f o r p a t i e n t s  within the  These i n c l u d e  the p r o v i s i o n of environmental  in this the  stated,  duties  described  c a r r i e d o u t by  at the Health  Centre  o f w h e t h e r o r n o t c a s e w o r k s e r v i c e s axe b e i n g  -  75  -  given. The workers  d e v o t e most  registering  child  takes  patients  the  for  coverage,  explains  by  the  committee  depending required  to  decision  upon  for  date,  the  essential  as  pay  Hospital  be  of  the  family  and  reason that  for the  is  with If  and  sends  to  patient  but  covered,  be  the  i s not  a  be  later  the  social and  regard  family  a  to  pay which  hospital  date  If not  or,  may  not  the kept  provided, emergent.  be  family payments  postponed  hospitalized  i s  done.'  family  has  to  report  i t to  i s to a  the  i s unable  coverage.  admission  out.  parent,  completes  what  Insurance,  patient  carry  admitted,  hospitalization is usually the  interview  the  worker  insurance  about  of  circumstances,  for  information  P a e d i a t r i c Wards  the  to  establish  to  Insurance,  as  involves  the  i s postponed  the  to  play  Insurance,  social  morning,  in  consent  of  social  a part  i s to  signed  "both  admitting  also  the  circumstances,  for  to  such time that  to  Hospital  Sometimes payment  up  workers  status  the  every  twenty minutes  Columbia, H o s p i t a l  covered  which  i n order  Each  When a p a t i e n t  not  pay  to  of  the  time  to  statistical  family.  social  investigates  can  their  obtain  fifteen  obtains  British  to  his  service,  patients  The  Hospital, worker  and  and  about  admission  of  a l l new  eligibility, the  admissions  until  of If  course, i t is  immediately,  inability  76 -  to pay i s not a b a r r i e r When t h e p a t i e n t  social  to admission.  i s c o v e r e d by B.C.H.I. , t h e  worker determines w i t h t h e ' f a m i l y  can p a y c o - i n s u r a n c e . same p r o c e d u r e  I f they are unable  i s followed  c o v e r e d by H o s p i t a l  they  t o do s o ,  the  as f o r t h o s e who a r e n o t  Insurance.  C h i l d r e n who r e q u i r e appliances,  whether  and h e a r i n g  aids  glasses,  orthopaedic  are r e f e r r e d to the s o c i a l  w o r k e r who a r r a n g e s w i t h t h e p a r e n t s how t h e n e c e s s a r y funds w i l l  be o b t a i n e d .  When g l a s s e s  are prescribed, the  social, worker determines whether o r n o t t h e f a m i l y all  or a part  of the cost.  can pay  I f t h e y a r e u n a b l e t o do s o ,  a d e c i s i o n i s made, a s t o w h i c h fund, t h e money w i l l be obtained  from.  complete  cost  The M e t r o p o l i t a n of five pairs  money f o r g l a s s e s set  Health  of glasses  i s obtainable  Committee p a y s t h e p e r month.  from the donations  Further fund  up by t h e V a n c o u v e r P a r e n t - T e a c h e r s A s s o c i a t i o n .  child  i s f r o m o u t of. town, t h e s o c i a l  local  p u b l i c h e a l t h n u r s e t o see i f r e s o u r c e s  community  can pay f o r t h e g l a s s e s .  I f the  worker contacts t h e  I f .this  i n the  i s not p o s s i b l e ,  the p u b l i c h e a l t h nurse i s r e q u e s t e d t o approach t h e Junior  Red C r o s s f o r payment. When a c h i l d  again family  the social  requires  an o r t h o p a e d i c  appliance,  worker determines whether o r not t h e  can pay a l l o r a p a r t  of the cost.  I f they  are able  to  pay, they  supply If  house  Red  obtain  Cross  worker, to  from  undertake  or the Infants  aids  the Junior  provides  hearing-aids,  without  are unable  social for  glasses,  are required  the required  Cross,  Hospital  the  payment  charge,  social  i s able  i s made  organization to those  patients  to pay. orthopaedic  the social  item  approaches the  through  This  appliances  f o r c h i l d r e n whose  assistance,  or can  I f the family  of the cost,  Red  aids  agreement.  A u x i l i a r y to the  1  Cross.  to the Junior  Where  worker  are obtained,  Red  a l l or part  families  has an  funds.  directly  whose  a surgical  Centre  of i t , the social  hearing  by  to pay f o r the appliance,  the necessary All  rate  the Health  i s unable  pay f o r a part  Junior  a nominal  with which  the family  only  to  are given  77 -  worker  to the l o c a l  and  hearing-  families  are on  forwards  the  social  order  assistance  branch. The of  social  c h i l d r e n who  their  worker  are very  the Outpatients'  a taxi  i s called  the  i l l ,  homes t o t h e H e a l t h  either  charges  Centre,  under  o r who  Centre.  Department  f o r transportation cannot  For this  fund  funds  s e t up  has been  the care  walk,  from  of the social  or  else  Department  donations.  established  from  purpose,  car i s used  and t h e S o c i a l S e r v i c e  out-of  transportation  arranges  at the  worker,  pays  A Health  by t h e  Women's A u x i l i a r y provides for  who  Social  money  are  unable  Service  each month to  Hospital  to  street-car  A  to  an  with  also  and  Social  the  Health  This  Centre  i t themselves.  The  delegates  of  Service  of  other  assistance  a  sum  Department recipients  of  the  with  clinic.  idea  the  interviews  up  regarding  figures  and  includes  to  or  the  to  social can  be  showing  the  numbers  over  determine  financial and  casework  arrangements  financial to  interviews  people  concerning  This  category  a l l interviews for  Table  arrangements.  service.  J u l y , 1951  of  period  in  prior  clinic  collateral  obtained  the  Interviews"  interviews,  ward  workers*  duties  conducted  conducted  patients, parents,  includes,  various  regarding  referred for  how  "Admitting  f o r treatment,  a.dmission  of  interviews  1951.  Interviews"  parents  for  the  among t h e i r  examination  patients  pay  to  also  general  January-December,  "Other  visits  Hospital.  of Workers ' Time very  eligibility  General  Department  the  from  includes  to  fare  is divided  admitting  for  social  time  Hospital  Vancouver  provide  Distribution  5  the  street-oar fare  those  City  to  78 -  the  with  obtaining  of  appliances. It meaning casework obvious  i s evident  i s obviously service when  one  from  these  limited,  i s not  that  great.  considers  that  figures, although the  time  This  is  even  many  of  the  allo\^ed  their for  more interviews  - 79 recorded of  the  i n "Other  year  obtaining he  are  term,  parents  to  properly Health the  and  Centre  In  that the  and  this  out,  such  TABLE  5:  as  as  acting  as  a liaison  adhered  to a  as  they  i n order service  to  as  i t  here,  should is  follow-up  person  apply  for  to  a with  are'being betv/een to the  see  the  that  school  i n s u r e -that  the  possible,  A d m i t t i n g and O t h e r I n t e r v i e w s , H e a l t h C e n t r e f o r C h i l d r e n , January-December, 1951  Admitting Interviews  January FebruaryMar c h April May June July (a) August . September October November December  Source;  used  physician's instructions  complete  Months  Total  as  too,  Metropolitan Health personnel  being  i s getting  s i x months  arrangements  activities  physician's instructions, are  first  connection,  case\>/ork s e r v i c e ,  includes  carried  situation, child  that  see  f o r the  interviews regarding  appliances.  remembered  broad  Interviews"  214 174 187 239 268 213 181 172 167 182 196 154 1  2,347  Other - Interviews 195 127 119 255 228 181 51 164 110 163 171 109 1,873  M o n t h l y s t a t i s t i c a l r e p o r t s c o m p l e t e d by two s o c i a l w o r k e r s a t t h e H e a l t h C e n t r e .  (a) A f t e r June, 1951, i t was d e c i d e d b y one o f t h e workers that d i s c u s s i o n s with parents regarding a p p l i a n c e s w o u l d no l o n g e r b e r e c o r d e d . From the b e g i n n i n g o f 1952, n e i t h e r worker i n c l u d e d these interviews i n s t a t i s t i c a l reports.  the  Improvement  would  from  the  which might work  staff  service time but  because the  role  they  i n the  consumes  are  worker,  a great  capable,  and  the p o t e n t i a l  which in  performance deal  the  the  optimum  evident  of these  prevents  social  service  duties,  i s most  need  i n order the  setting.  to  clinic  Without  the  of which  some  to  If  changes  should  Along  be  in be  re-  with  this  and  understanding the  they  i s to  interpretation  team  worker  social  t o g e t h e r v/ith a  the  social  duties  programme  enhance as  assigned  worker's  casework  essential.  for further  Second,  been t r a i n e d .  that  l i t t l e  clearly  contribution  increase i n staff,  a professional  this  and  is  duties  social  from  Centre,  staff. the  casework  have,  there  initially  o f many  time,  i t seems  An  of  of  not  social  i s a great  t h e members  was  the  from  of  demonstration  i t seems t h a t  contribution  aspects  there  some o f  social  of  Health  regular  have  these  of  of  the  workers  supervision,  which  service  amount  the  they  realized,  assignment  at  factors  First,  the  for which  fully  considered.  out  the  nature  two  casework  Student  close  Centre  from making  social  cases  of  are  setting.  given.  assigned  routine  The  the  carry  the p a r t  Health  understood.  to  require  on  of the social  workers  been  of  there  in this  s h o u l d he  time  that  adequacy  offered  time,  of  appear  i s inadequate  because  saving  to  he  which  to  -  of Services  It detract  80  among  kinds  of  work  i s equipped  to  perform  such understanding- the  quality  - 81 o f t h e teamwork c a n n o t r e a c h a y e r y h i g h l e v e l . P r o b a b l y t h e most u r g e n t l y needed a d d i t i o n t o the  staff  at t h e p r e s e n t  time i s  p o s i t i o n would r e q u i r e the person,  but not n e c e s s a r i l y  The d u t i e s would  an a d m i t t i n g ' c l e r k .  services  of a s e n s i t i v e ,  This outgoing  one w i t h s o c i a l w o r k t r a i n i n g .  o f an a d m i t t i n g c l e r k i n t h e H e a l t h C e n t r e  be;  (1) The h a n d l i n g o f a l l a d m i n i s t r a t i v e m a t t e r s r e l a t e d to the d e t e r m i n a t i o n of e l i g i b i l i t y f o r H e a l t h C e n t r e c a r e , and t h e a d m i s s i o n o f c l i n i c p a t i e n t s to the H o s p i t a l , (2) The o r d e r i n g o f a p p l i a n c e s and t h e m a k i n g o f f i n a n c i a l arrangements f o r t h e s e on b e h a l f o f p a t i e n t s who a r e n o t r e c e i v i n g c a s e w o r k s e r v i c e s . (3) The o r d e r i n g o f t r a n s p o r t a t i o n f o r p a t i e n t s when n e c e s s a r y , and t h e d i s b u r s e m e n t o f s t r e e t - c a r f a r e where a p p l i c a b l e on b e h a l f o f p a t i e n t s who a r e not r e c e i v i n g casework s e r v i c e , (4) The r e f e r r a l casework.division.  of d i s t u r b e d p a t i e n t s  P r o v i s i o n has r e c e n t l y services  of an a d m i t t i n g c l e r k f o r  This person w i l l moves t o  b e e n made t o  i t s new  be t a k e n o n s t a f f  required.  the  obtain  the H e a l t h Centre, when t h e H e a l t h C e n t r e  of a f u l l - t i m e stenographer  d i v i s i o n of the H e a l t h Centre are  The two s t e n o g r a p h e r s  presently  employed,  i n matters p e r t a i n i n g to the v a r i o u s  A stenographer  attached to the  casework  for  the  urgently  a great deal of t h e i r time performing stenographic for doctors  the  quarters.  The s e r v i c e s Social Service  to  spend service  clinics,  d i v i s i o n c o u l d be  - 82 k e p t "busy i n t a k i n g d i c t a t i o n o f records, the  letters  full-time fill  to i n t e r e s t e d persons  community, the  workers'  social  s e t t i n g up o f  or agencies  social  service  and  While the  services  of an a d m i t t i n g c l e r k and a  a need,  the  filing.  s o c i a l workers  s e r v i c e programme.  It  i s hoped t h a t  a t t a c h e d to the P s y c h i a t r y C l i n i c , i n the near f u t u r e .  a n d w a r d s as t h e y do a t the  social service  casework  staff  there  from the  to. be  the will  clinics  of the H e a l t h Centre  i s l i t t l e doubt  service w i l l  Not o n l y w i l l  more t h o r o u g h a n d l e s s  social  present.  i s b r o u g h t up t o t h i s l e v e l , a more e f f e c t i v e  an  be added t o workers  to  would  a t h i r d worker,  will  referrals  for  complete the  The two p r e s e n t  continue to accept  If  there  i n the o p i n i o n of the w r i t e r ,  a d d i t i o n a l f u l l - t i m e s o c i a l worker to  operation,  files  caseloads,  would enable  and  in  of t h e i r  t h e i r a p p r o p r i a t e r o l e s more a d e q u a t e l y ,  probably  case  card f i l e s  stenographer  still'be  staff  service  be b r o u g h t  that into  t h e w o r k e r s h a v e t i m e t o do  selected  and t h e i r f a m i l i e s i n t h e  a  casework j o b w i t h p a t i e n t s  clinic,  but they w i l l  do home and s c h o o l v i s i t i n g where n e c e s s a r y ,  be a b l e  to  and f o r m  c l o s e r working r e l a t i o n s h i p s w i t h the M e t r o p o l i t a n H e a l t h Committee's School M e d i c a l S e r v i c e s p e r s o n n e l . be a b l e t o keep service;  will  adequate  records,  be more f r e e  a v i t a l part  They . w i l l of  to p a r t i c i p a t e i n the  casework social,  -  health, to  83  -  a n d e d u c a t i o n a l programmes  instigate  of the  r e s e a r c h and study p r o j e c t s  community; at the  and  Health  Centre. The p r o v i s i o n o f t h e r e q u i r e d s t a f f would c o n t r i b u t e  a great deal  second major d i f f i c u l t y at the H e a l t h Centre, s o c i a l vrorker i s not  i s probably  i n the  i.e.,  social  the f a c t  the  the  s o c i a l workers  While  a symptom o f  constant  that  programme  the  role of  The f a c t  the l a c k of  c a n come t o  s i t u a t i o n i s perhaps  It  is  performance  realize  the  sick  child.  as s u g g e s t e d , accepted area of  the  I f present  functions  actual  on t h e j o b  and  conditions are  treatment  adjusted  s o c i a l w o r k e r w o u l d be more l i k e l y  casework.  be  recognized.  outpatient  a s a member o f t h e h o s p i t a l social  to  and h e r  w o u l d come t o be more w i d e l y  team f r o m t h e base of g e n e r i c  that  contribution which  The s o c i a l w o r k e r i n a c h i l d r e n ' s setting  of  this  i n t h e r o l e f o r w h i c h she was t r a i n e d , competence  an  effect.  only through  s o c i a l w o r k e r c a n make i n t h e d i a g n o s i s  of the  that  until  some i n t e r p r e t a t i o n c a n be done v e r b a l l y ,  physicians  the  understanding,  i s b e g i n n i n g t o h a v e some  d e m o n s t r a t i o n and e f f i c i e n t  the  i n t e r p r e t a t i o n on t h e p a r t  method has a l i m i t e d v a l u e .  the  service  has not been r e c o g n i z e d  a n d t h e r e c e n t move t o remedy t h e i n d i c a t i o n that  overcoming  c l e a r l y understood.  t h e n e e d f o r more s t a f f lately,  towards  additions  treatment The  f o c u s o f casework i n t h i s s e t t i n g i s the a medical  c h i l d who  condition w i t h r e l a t e d s o c i a l or  emotional  d i f f i c u l t i e s which i n t e r f e r e w i t h the progress medical  treatment.  the p a r e n t s and  and  The  aim  o f casework h e r e  the p h y s i c i a n  to help to r e l i e v e the  contribution  from  i s greatly  a better  appreciation  i n further  i s . to a i d the  stressful situation. the  child,  There  potential  casework i n the H e a l t h C e n t r e f o r  Children  result  of  i n understanding  seem t o he g r o u n d s f o r b e l i e v i n g t h a t  has  l i m i t e d by of the  improvement  inadequate  staff,  s o c i a l worker's r o l e of the  Clinic's  and  that  could  services.  CHAPTER I V  EVALUATION AMD  CONCLUSIONS  Is the H e a l t h Centre f o r C h i l d r e n meeting need f o r complete families?  The  medical  to a very great extent, i t i s .  Donald Paterson's  conviction that  service  t h e n e e d was  f o r c h i l d r e n t h a n was  the a d u l t O u t p a t i e n t s ' Department, in  fact  by  extended  s e r v i c e v/as o f f e r e d .  out  once  that,  an  prior  c h i l d r e n i n low-income  treatment  are e l i g i b l e  attention  structure,  provides a  diagnostic  been d e v e l o p e d  I t i s true that and  facilities.  and  they  to  service f o r those  aware.  Such adjustments  funds  additional  staff  considers  i n the s h o r t space  existing  i n t h e programme  take time,  to i n s t i t u t e ,  of  gaps i n the  o f some o f t h e  these, the p a r t i c i p a t o r s  are q u i t e  pay.  remarkably  there are s t i l l  room f o r improvement  Of  afford  t o a t t e n d , e s p e c i a l l y v/hen one  t h e programme has  four years.  c o u l d not  H e a l t h C e n t r e now  comprehensive  and  in  o r e l s e were a t t e n d e d by p r i v a t e p h y s i c i a n s f o r  The  that  available  I t would appear  of the H e a l t h Centre,  whose s e r v i c e s t h e i r p a r e n t s  who  great f o r a  seems t o he b o r n e  e i t h e r d i d not get the m e d i c a l  required,  Dr,  the phenomenal i n c r e a s e i n a t t e n d a n c e s  to the advent families  i n low-income  evidence gathered gives a very strong  indication that,  more a d e q u a t e  care of c h i l d r e n  the  and  however.  require As  i t has  - 86 "become p o s s i b l e  to'do  s o , changes and e x p a n s i o n s  o c c u r r e d a l o n g t h e way.  Many more p r o p o s e d  r e a l i z e d when t h e H e a l t h C e n t r e moves i n t o i n the Semi-Private P a v i l i o n Hospital  evaluations  he  i t s new q u a r t e r s General  few m o n t h s .  The  and r e c o m m e n d a t i o n s made i n t h i s p a p e r a r e  t o he i n t e r p r e t e d , factors,  plans w i l l  o f the- V a n c o u v e r  i n t h e course o f t h e next  have  First,  the r e a l i s t i c  therefore,  i n the l i g h t  the ideas expressed take  limitations,  o f two  Important  cognizance of  and t h e s u g g e s t i o n s w h i c h a r e  made a r e p u t f o r t h a s p o s s i b l e ways f o r i m p r o v i n g a n already  basically  criticisms that and  g o o d programme r a t h e r  of the s t r u c t u r e  than being  as i t i s ; , S e c o n d ,  sharp  considering  t h e H e a l t h C e n t r e has been i n e x i s t e n c e f o r f o u r y e a r s , i s s o o n t o make some m a j o r changes i n c l u d i n g  in location,  this  e v a l u a t i o n i s a n i n t e r i m one.  be v a l u a b l e t o have a n o t h e r  such study  a change I t would  completed  after  four or f i v e years of continued operation. The provide  primary  a complete  aim o f the H e a l t h Centre  programme o f m e d i c a l  i n low-income f a m i l i e s . therefore, and  including  subsidiary The  medical  achievement  that  of social  care f o r c h i l d r e n services  service,  offered,  are a part o f ,  t o , t h i s main aim. r e c o m m e n d a t i o n s f o r improvement  structure  would r e s u l t  , A l l additional  i s to  and s e r v i c e s ,  the implementation  i n a closer realization of the primaxy  of the  of the  and s e c o n d a r y  of which  complete  aims,  may be  - a? divided  into  relative and  two  broad  categories:  t o improvement  second,  First,  suggestions  of services i n s p e c i f i c  suggestions r e l a t i v e  clinics,  t o improvement  of  service  as a w h o l e . E v a l u a t i o n of S p e c i f i c  Clinics  The P a e d i a t r i c s e c u r i n g the s e r v i c e s basis,  and  of g i v i n g  Centre a thorough referring  him  efficiently.  improvement  of p a e d i a t r i c i a n s each  The  Clinic,  w h i c h has  insofar  as t h o s e  Clinic  importance  relative  as a w h o l e  apply  Throat  b e e n a b l e t o make a d j u s t m e n t s  and  to the Dermatology,  Hearing  and  S u c h a room w i l l Hearing  or  Clinic  suggestions  t o t h e E a r , N o s e , and  and  be  Genito-Urinary  out  require  available  o f t h o s e w h i c h has  of c o n t i n u i t y  of treatment  s e e n by t h e  Infant  a  relatively  examinations  i n t h e new  by  has  Clinics.  i n which to h o l d speech therapy  i s one  p a t i e n t s w i l l be  Diabetic,  and S p e e c h C l i n i c s  room i n w h i c h t o c a r r y  children,  him  for this  service  F e e d i n g , N e u r o l o g y , M e t a b o l i c , and  deaf  health  i n i t s programme as t h e n e e d f o r d o i n g so  become a p p a r e n t ,  sound-proof  long-term  a t t e n d i n g the  changes are s u g g e s t e d  same a p p l i e s  The  on a  seems t o be o p e r a t i n g  of H e a l t h Centre  to i t .  modifications  child  to a s p e c i a l i s t No  v/ith i t s p o l i c i e s , of  examination before t r e a t i n g  at p r e s e n t , except to  Clinic,  quarters.  of classes. The  recognized the assuring that  same d o c t o r a t l e a s t  over  a  six-month p e r i o d . valuable  The  88  -  Speech C l i n i c  has  s p e e c h t h e r a p y programme, and  having the  services  The  Special  and  i n close  of  been o p e r a t i n g  i s fortunate  a  in  a h i g h l y - q u a l i f i e d speech t h e r a p i s t .  H e a r i n g and  S p e e c h C l i n i c s work  c o n n e c t i o n w i t h the  Ear,  cooperatively,  Nose and  Throat  Clinic. The successfully  Eye  except  overcrowded.  always l a r g e ,  f o r the  f a c t that  has  so  that  children  can  be  attached  there  the  Eye  operating  often  so- t h a t  T h e r e i s an  C l i n i c w h i c h has  as  of  squint  a r e s u l t of The  X - r a y and  recently  desirable. the  Orthopaedic.Clinic  This The  s e r v i c e s to  often  requires  attention  casts.  facilities At  for  present,  physiotherapist  needed f a c i l i t i e s  who  adult  will new  be  Outpatients  c h i l d r e n to  f o r remedial  location.  exercises. to  on  A  makes  attend  to g i v e p h y s i o t h e r a p y treatment  f  than i s  available  attends to t h i s C l i n i c  appointments f o r s p e c i f i c of P h y s i c a l M e d i c i n e  the  r e s u l t s i n more d e l a y  H e a l t h Centre p r e m i s e s i n the  possible  of  The  a r e " s u s p e c t e d o f h a v i n g bone f r a c t u r e s must  r e f e r r e d f o r these  Department,  deal  started  t h i s programme.  a p p l i c a t i o n of p l a s t e r  c h i l d r e n who be  i s r e c e i v i n g a great  more  orthoptics  a t r a i n i n g programme f o r s t u d e n t s i n o r t h o p t i c s . treatment  •  expanded i t s  i s l e s s c r o w d i n g and  taken care of.  to  been  i t was  R e c e n t l y , however, i t has  services  unit  Clinic,  the  Department  It i s  not  a l l children  - 89 who m i g h t b e n e f i t that  this will  from i t  at p r e s e n t ,  be r e m e d i e d  but  it  is  hoped  shortly.  There i s a g r e a t need f o r e x p a n s i o n o f Surgical  Clinic.  Surgical  C l i n i c s i n weekly  structure  Ideally,  there  considerable  extension of t h i s  as w e l l , as f o r  acceptance  s h o u l d be a t l e a s t  operation.  a l l o w s f o r o n l y one.  the  The  three  present  There i s p r o v i s i o n f o r Clinic  i n t h e new  o f more H e a l t h C e n t r e  quarters, surgical  c a s e s on t h e P a e d i a t r i c W a r d s , The A l l e r g y C l i n i c recognizes, the  operates  Clinic,  receive  There i s perhaps Allergy  and  a s do t h e S p e c i a l H e a r i n g a n d D i a b e t i c C l i n i c s  importance of having the p a t i e n t ,  to the  successfully  Clinic  the a t t e n t i o n of the  room f o r  i n that  e a c h t i m e he  it  same  expansion of  service  now c o n f i n e s  i t s e l f to  two a l l e r g i c m a n i f e s t a t i o n s ,  a.sthma a n d hay  comes  doctor.  i n the only  fever.  The t r e a t m e n t - g i v e n i n t h e R h e u m a t i s m a n d Cardiac C l i n i c arrangements  c o u l d o f t e n be much more e f f e c t i v e  c o u l d be more e a s i l y made f o r  h o s p i t a l i z a t i o n of  some  T. B.  Control f o r X-ray  Chest  Clinic discontinued i t s  c o n d i t i o n s a r e now  as T. B .  referred  and f o l l o w - u p as t h e H e a l t h C e n t r e operation after  T h i s seems t o be a l o g i c a l a n d  arrangement  long-term  patients.  C h i l d r e n w i t h chest  months.  if  about  three  satisfactory  C o n t r o l has s u p e r i o r equipment  and  90  -  -  specially trained staff,  and c a n t h e r e f o r e  t h o r o u g h and s p e c i a l i z e d  service  Health  g i v e a more  t h a n was p o s s i b l e  at  the  a n e e d f o r a s e p a r a t e room f o r t h e  use  Centre, There  is  of the P s y c h i a t r y and so t h a t  Clinic  so t h a t p r i v a c y  c a n he  assured,  t h e t e a c h i n g programme i n t h i s a r e a c a n he  expanded.  There  is provision for  quarters.  The P s y c h i a t r y  Clinic  s u c h a, room i n t h e now h a s t h e  new  services  of  c o n s u l t i n g p s y c h i a t r i s t s from the M e t r o p o l i t a n H e a l t h C o m m i t t e e and f r o m t h e there  is  still  C h i l d Guidance C l i n i c .  a need f o r d i r e c t p s y c h i a t r i c t r e a t m e n t  some c h i l d r e n , and f o r p s y c h i a t r i c the p s y c h i a t r i s t where  the  Hov/ever,  c o n s u l t a t i o n between  and s o c i a l w o r k e r i n o t h e r  s o c i a l worker i s g i v i n g casework The D e n t a l S e r v i c e  for  offered  is  specific  cases  service.  still  and c h i l d r e n m u s t be r e f e r r e d t o t h e a d u l t  quite  inadequate,  Outpatients  1  D e p a r t m e n t f o r d e n t a l wT&rk, Needed Adjustments  i n Medical Service  as  I n the o p i n i o n of the w r i t e r ,  a Whole the greatest  n e e d i n t h e H e a l t h C e n t r e programme i s f o r more between t h e m e d i c a l and s o c i a l work s t a f f . factors,  o n one h a n d , a n d t h e  f a c t o r s , o n the perspective,  it  essential  the  into  physical  proper  t h a t t h e p h y s i c i a n and  w o r k e r w o r k t o g e t h e r as t e a m members. p a r t i c u l a r l y w i t h the  coordination  e m o t i o n a l and e n v i r o n m e n t a l  o t h e r a r e t o be b r o u g h t is  If  overall  existence of  At  so many  social  present, specialized  - 91 clinics,  there  i s g r e a t danger t h a t  the  c h i l d as  integrated person i s being forgotten. that  It  a programme w h i c h h a s d e v e l o p e d  is  recognized  so r a p i d l y t o  p r o p o r t i o n s o f t h e one a t t h e H e a l t h C e n t r e i s to get  out o f b a l a n c e  the medical services adequacy, to the light  it  i n some a r e a . offered  However,  now  are b e g i n n i n g to  reason to b e l i e v e  that  this will  there  eventually  be  i s f o r more f l o o r  and l a r g e r and g i v e  cubicles  treatment,  s p a c e so t h a t  is  i n w h i c h to so t h a t  c a r r y out  some o f t h e  accomplished,  emergency  c a n be more  facilities a n d so- t h a t  admitting.  There  a l s o be c o n s i d e r a b l y more w a i t i n g - r o o m s p a c e ,  while waiting for examination or-treatment. i n the Semi-Private P a v i l i o n w i l l  there  should  supplemented  by f a c i l i t i e s t o k e e p c h i l d r e n a n d t h e i r p a r e n t s  quarters  at  examinations  m e n t i o n e d as l a c k i n g may be p r o v i d e d f o r , may be a f a c i l i t y f o r  the  every  be  there  given In  A v e r y g r e a t need i n the H e a l t h Centre present  that  approach  i n areas other than p h y s i c a l .  o f some o f t h e p r o p o s e d c h a n g e s ,  the  likely  i s h o p e d t h a t more a t t e n t i o n w i l l  individual  an  occupied  The new be  considerably  l a r g e r t h a n t h o s e w h i c h t h e H e a l t h C e n t r e now o c c u p i e s , will  still  be i n a d e q u a t e  i n the event of  but  increased  attendances. The i m p o r t a n c e o f t h e d o c t o r - p a t i e n t and  of e s t a b l i s h i n g c o n t i n u i t y i n treatment  for  patients  t o have t h e  continuing services  by of  relationship arranging the  same  . p h y s i c i a n throughout taken cognizance Diabetic  the  of  Clinics.  92  -  course  of treatment,  has  been  i n the A l l e r g y , S p e c i a l H e a r i n g , and It  i s most d e s i r a b l e  should p r e v a i l i n a l l the  Clinics,  possible to i n s t i t u t e i t generally,  that  but i t  this  system  has not  up t o t h e  been  present,  because of the d i f f i c u l t i e s i n v o l v e d i n a r r a n g i n g times of attendance establishment  of the m e d i c a l s t a f f .  With  for  the  of the P a e d i a t r i c Department i n the  G e n e r a l H o s p i t a l , and w i t h t h e advent  Vancouver  of the S c h o o l  Medicine, U n i v e r s i t y of B r i t i s h Columbia, i t v / i l l possible  t o make such- a r r a n g e m e n t s  moves t o t h e S e m i - P r i v a t e An appointment at the H e a l t h Centre. at  9 a.m.,  the  to take p a t i e n t s .  It  Pavilion, system i s  At p r e s e n t ,  Clinic is  be  when t h e H e a l t h C e n t r e  a much n e e d e d a l l patients  and a r e u s u a l l y r e q u i r e d t o w a i t  more h o u r s b e f o r e  of  f o r which they  recognized that  innovation come  in  one,  two,  or  came  begins  an a p p o i n t m e n t  system s i m i l a r to t h a t used i n p r i v a t e p r a c t i c e  c o u l d not  be i n s t i t u t e d b e c a u s e o f u n a v o i d a b l e d e l a y s w h i c h o f t e n occur i n the morning r o u t i n e of p h y s i c i a n s , seem t h a t  those  c l i n i c s , which never  time could arrange certain time,  come i n a t  still  9 a.m. to  attempt w i l l  it  before  some e x t e n t ,  be n e c e s s a r y  stagger  t o h a v e new  would  a  t h e i r appointments to begin at  and c o u l d , t o  Although i t v/ill  start  but  certain a  appointments. patients  c a r r y out a d m i s s i o n s p r o c e d u r e ,  be made t o make more f l e x i b l e  an  appointment  -  93 -  a r r a n g e m e n t s i n . t h e ne\i H e a l t h C e n t r e  location..  I n t e g r a t i o n o f o u t - and i n - p a t i e n t s e r v i c e s between t h e H e a l t h C e n t r e difficult  and t h e P a e d i a t r i c Wards i s made  under the p r e s e n t  set-up  by t h e d i s t a n c e o f a b o u t  two c i t y  b l o c k s w h i c h s e p a r a t e s t h e two p l a c e s .  expected  that  c o n s t r u c t i o n o f p a e d i a t r i c wards i n t h e  Semi-Private P a v i l i o n w i l l C e n t r e moves i n t o will  It i s  begin  soon a f t e r t h e H e a l t h  this building.  The o u t - p a t i e n t s e r v i c e s  t h e n be a n arm o f i n - p a t i e n t  services.  There i s o p p o r t u n i t y f o r the i n c o r p o r a t i o n i n t o the H e a l t h Centre than  exists  o f a much l a r g e r  at present.  as w e l l as t h e t r e a t m e n t excellent  t e a c h i n g programme  W i t h t h e e m p h a s i s on t h e p r e v e n t i v e aspects  of medicine,  t r a i n i n g ground f o r d o c t o r s , nurses,  i t i s an social  w o r k e r s , and o t h e r p r o f e s s i o n a l h o s p i t a l p e r s o n n e l . i s planned programme  to b r i n g medical  students  into  the teaching  i n two y e a r s , when t h e r e i s a f o u r t h - y e a r  i n Medicine  at the U n i v e r s i t y  of B r i t i s h  It  class  Columbia.  B e t t e r w o r k i n g r e l a t i o n s h i p s between H e a l t h personnel  and p u b l i c  h e a l t h n u r s e s w o u l d do a g r e a t  towards making t h e H e a l t h Centre  s e r v i c e more  Centre  deal  comprehensive.  T h e r e i s , a t p r e s e n t , no w e l l - d e f i n e d . p o l i c y f o r c a r r y i n g out m e d i c a l  follow-up  i n t h e home.  eliminate the n e c e s s i t y o f having H e a l t h Centre require  S u c h a scheme w o u l d a child  r e t u r n to the  f o r a t t e n t i o n to r o u t i n e matters  the s e r v i c e s of a p h y s i c i a n .  w h i c h do n o t  -  94  -  A n o t h e r way i n w h i c h t h e H e a l t h C e n t r e m i g h t f u r t h e r meet t h e n e e d f o r w h i c h i t i s t o make i t s  services  without reference areas.  exists  i n the  a v a i l a b l e to the general p u b l i c ,  to f i n a n c i a l e l i g i b i l i t y , i n c e r t a i n  These a r e a s w o u l d be: speech therapy o r t h o p t i c s treatment long-term physiotherapy l o n g - t e r m i l l n e s s e s s u c h as  (1) (2) 3| 4)  disease Skilled i n Vancouver,  and  diabetes  speech therapy  regardless  cardiac  i s not g e n e r a l l y  of a b i l i t y to pay,  obtained.  The p r o v i s i o n o f t h e s e s e r v i c e s  Centre would not, of p h y s i c i a n s .  therefore,  affect  available  certain extent, It  is felt,  public,  that  r e q u i r i n g frequent  to  cardiac  a  of p h y s i c i a n s .  from the p o i n t of view of the  such a s e r v i c e  in  treatment  s u c h as  course,  on the p r i v a t e p r a c t i c e s  however,  The H e a l t h  The g e n e r a l  would impinge, of  for  i n the gaps  at the H e a l t h Centre of l o n g - t e r m i l l n e s s e s and d i a b e t e s  practices  others.  C e n t r e m i g h t be a g o o d medium ' f o r f i l l i n g the a v a i l a b i l i t y of t h i s t r e a t m e n t .  c a n be  the p r i v a t e  but not f o r  are  by t h e H e a l t h  Physiotherapy is generally  some c h i l d r e n who n e e d i t ,  available  and t h e r e  v e r y few r e s o u r c e s where o r t h o p t i c s t r e a t m e n t s  disease  community  i s almost a n e c e s s i t y .  general Illnesses  v i s i t s to a doctor over a l o n g p e r i o d  of t i m e casue g r e a t f i n a n c i a l s t r a i n even t o p e o p l e h a v e what w o u l d n o r m a l l y be a c o m f o r t a b l e  income.  who The  -  number o f  c h i l d r e n drawn out o f p r i v a t e p r a c t i c e s ,  provision for general as t o  95 -  such treatment  p u b l i c at  was made a v a i l a b l e  the H e a l t h Centre,  if  to  the  w o u l d n o t be  so  c a u s e undue h a r d s h i p t o any one p r a c t i c i n g p h y s i c i a n . There  is  evidence  available  Centre might a p p r o p r i a t e l y direction, readily  namely,  available  theoretically  that  extend  its  that  the  Health  services  in  of making i t s f a c i l i t i e s  serves a l l the  another more  to the whole of the P r o v i n c e .  While  c h i l d r e n of low-income  i n B r i t i s h Columbia, i n a c t u a l i t y ,  very  few  which the t r i p conceivably  involves.  A travelling clinic,  u n i t e w i t h the  health travelling c l i n i c ,  is  visionary,  inconceivable.  development.  these  At present,  are  sufficiently  operating that  offered  further  could perhaps  present  Obviously, and  additional the  ideas  T h e r e may w e l l come a t i m e ,  services  and e f f i c i e n t l y service  c o n s i d e r i n g the  not to mention the  w h i c h w o u l d be i n v o l v e d .  the  s u c h as  s p a c e and a d d i t i o n a l f a c i l i t i e s  w o u l d be r e q u i r e d ,  the present  the  p u b l i c and t o t h e P r o v i n c e as a w h o l e  somewhat  of  in  consideration.  stage of the H e a l t h Centre's great deal  difficulties  which could  a p o s s i b i l i t y which,  The i d e a o f p r o v i d i n g s e r v i c e s  may a p p e a r  families  C h i l d Guidance C l i n i c ' s mental  could w e l l receive  to the general  it  come i n f r o m  d i s t a n t p o i n t s because of the f i n a n c i a l and o t h e r  future,  great  a  equipment staff  are  however,  quite when  highly-developed efforts  to  be d i r e c t e d t o  improve inclusion  a  - 96 of these  areas. The r e c e n t  appointment  P a e d i a t r i c Department University greater  of B r i t i s h Columbia w i l l undoubtedly  a t t e n t i o n t o t h e i n t e g r a t i o n and more  Vancouver  services  and  Social Service Health Centre, supplement  a subsidiary of which i s  the medical procedures  A l t h o u g h the  identifying  from treatment  social worker's  setting  generally  efficacy  the  to  service  on a p h y s i c a l  area of  in.the  enhance  i n order to  and  achieve  the  level.  competence  in as  the the  s o c i a l and e m o t i o n a l f a d e r s  of medical treatment,  i s much t o . b e  done i n t e r m s  it  effect  seems e v i d e n t  that  o f i n t e r p r e t a t i o n ajid  the r o l e  c a n be more f u l l y u n d e r s t o o d .  of the  social worker  The a c c e p t a n c e o f t h e  social  a t e a m member v a r i e s w i t h i n d i v i d u a l p h y s i c i a n s .  having witnessed  patients,  in  of d i a g n o s i s , a n d w h i c h have an  demonstration i n order that  Some,  effective  has been e s t a b l i s h e d  and h a n d l i n g o f  which are a p a r t  w o r k e r as  in  Services  is  the purpose  maximum b e n e f i t  there  as a whole  result  General H o s p i t a l ,  Medical-Social Structure  medical  and  head from t h e S c h o o l of M e d i c i n e ,  o p e r a t i o n of p a e d i a t r i c  on t h e  of a p r o f e s s o r  the b e n e f i t s  make r e f e r r a l s  O t h e r s have b e e n u n a b l e  of  appropriately to  casework  in their  and c o o p e r a t e  accept v e r b a l  readily.  interpretation,  and h a v e b e e n u n w i l l i n g t o be c o n v i n c e d b y d e m o n s t r a t i o n . i s recognized that,  because of the  i n t a n g i b l e nature  of  It  - 97 the work,  i t usually  takes a great deal  s o c i a l worker i n a s e t t i n g be f u l l y is  accepted  on t h e j o b t h a t services the  her r o l e  of the  connection,  major occur  of  agency  can  There  are  It  demonstration  comes t o be u n d e r s t o o d ,  s o c i a l workers  and h e r  indications  that  i n the H e a l t h Centre,  are b e g i n n i n g to have an e f f e c t , . a n d  changes i n t h e  casework  a  other d i s c i p l i n e s .  i n t e r p r e t a t i o n and  used a p p r o p r i a t e l y .  efforts  this  other than a s o c i a l  by p e r s o n n e l  only through constant  of time before  d i v i s i o n are  expected  in some  to  shortly.  E v a l u a t i o n of M e d i c a l - S o c i a l Area The a d m i n i s t r a t i v e Service  arrangement  Branch of the H e a l t h Centre  o v e r a l l S o c i a l S e r v i c e Department Hospital excellent  appears  of  t o be e f f e c t i v e .  supervision is  is  whereby  a part  of  of  to H e a l t h Centre  There are not,  Health Centre. very  a r e two m a i n r e a s o n s  at p r e s e n t ,  of which they  through weekly  are  able  capable,  The f i r s t  time-consuming,  number o f p a t i e n t s  w i t h i n the they  routine duties  t o whom t h e y  and t h e  ideas  meetings.  optimum c o n t r i b u t i o n structure are  of  assigned  which r e s t r i c t  can o f f e r  and w h i c h i s an i n d i c a t i o n o f t h e l a c k regarding t h e i r r o l e ,  staff  workers,  x^hy s o c i a l - w o r k e r s  t o make t h e  i s that  General  this,  and an o p p o r t u n i t y i s p r o v i d e d f o r t h e m t o e x c h a n g e w i t h other H o s p i t a l workers  Social  the  the Vancouver  Because  available  the  of  casework  the some the service,  understanding  second i s t h a t  the  social  - 98 work s t a f f  is  inadequate  i n number t o  c a r r y out  casework  s e r v i c e w h i c h s h o u l d be g i v e n ,  staff  inadequate  is  from t h e i r present There are rectify  this  at t h i s  experienced  necessarily procedure, well  First,  almost A  sensitive but  could handle  a need,  stenographer  also,  f o r the  of  casework  f o r the  casework  services  and l e t t e r s *  files,  filing,  and p r e p a r a t i o n o f  dictation social  card-index f i l e s  of  caseloads. staff,  there  be a n e e d f o r a p p o i n t m e n t o f a n a d d i t i o n a l  time s o c i a l worker i f adequate.  a  the  s e t t i n g up o f  Even w i t h these a d d i t i o n s to still  of  s e c t i o n of  of  case r e c o r d s  as  referrals.  S u c h a p e r s o n w o u l d be u s e d f o r  1  not  admissions  Health Centre,  workers  by  a p p l i a n c e and t r a n s p o r t a t i o n arrangements source  to  could  entirely  i n dealing with people,  s o c i a l work t r a i n e d ,  There i s  service  workers  the s o c i a l w o r k e r s  an a d m i t t i n g c l e r k .  as a c t i n g as a n o t h e r  full-time  social  time.  be r e l i e v e d o f t h e i r r o u t i n e d u t i e s  person,  clerical  s e v e r a l measures w h i c h would h e l p  situation.  the appointment of  and the  I n number t o r e l e a s e duties  the  casework  The s e r v i c e s  services  fullbe  o f t h e t h i r d w o r k e r c o u l d be  e x c l u s i v e l y by t h e P s y c h i a t r y C l i n i c , workers  c o n t i n u i n g to accept r e f e r r a l s  clinics  as t h e y h a v e done i n t h e These  were t o  would  additions to s t a f f  w i t h the  used  present  f r o m the wards  and  past. would free  the  workers  - 99 -. not  o n l y t o do a t h o r o u g h  casework j o b , h u t would  them t o do more home a n d s c h o o l v i s i t i n g , a d e q u a t e r e c o r d s , and t o p a r t i c i p a t e agency s o c i a l , I t would a l s o role  enable  t o keep more  i n community a n d  h e a l t h , e d u c a t i o n a l , a n d r e s e a r c h programme accomplish  a great deal i n c l a r i f y i n g  s i n c e t h e y w o u l d be a b l e , by a c t u a l  their  demonstration  r a t h e r t h a n by v e r b a l i n t e r p r e t a t i o n a l o n e , t o show what can be a c c o m p l i s h e d  through  t h e u s e o f casework  techniques  When t h e H e a l t h C e n t r e moves t o t h e S e m i - P r i v a t e Pavilion, taken for  i t i s expected  on t h e s t a f f .  t h e appointment  t h a t an a d m i t t i n g c l e r k w i l l b e  Long-term f u t u r e plans provide of a third  social  f o r work w i t h t h e P s y c h i a t r y C l i n i c , will  an  overcome.  effective  Centre,  These appointments .  social  c a s e w o r k programme  i n the Health  indications are that social  contribution w i l l  utilized.  w e l l o n t h e way t  The groundwork h a s a l r e a d y b e e n l a i d f o r  and p r e s e n t  potential and  worker t o t h e s t a f f  r e n d e r much o f t h e m a j o r d i f f i c u l t y  being  also  s o o n be more f u l l y  work's recognized  APPENDIX  A  H e a l t h Centre f o r C h i l d r e n C l i n i c Attendances  Year  Paediatrics  1948 June (a) JulyAugust September October November December Total  1948 2 %  January February March April May June July August September October November December  T o t a l 1949 January February March April May' June July August September October November December Total  O t h e r C h i l d r e n 's Clinics  Total  279 240 294 361 381 469 325  42 123 135 204 213 240 244  321 363 429 565 594 709 569  2.349  1.201  3.550  43 8 418 589 490 483 384 426 490 397 541 549 419  273 255 423 412 543 527 418 456 454 527 692 468  711 673 1,012 902 1,026 911 844 946 851 1,068 1,241 887  5,624  5,448  11,072  375 561 630 488 633 505 539 479 442 465 579 403  1950  1948-1951  6,0 88  502 741 881 700 817 722 464 433 580 682 755 ' 557 7.Q54  •  877 1,302 1,511 1,188 1,450 .1,227 1,003 912 1,022 1,147 1,334 960 13.942  (a) The H e a l t h C e n t r e opened i n J u n e , 1948. Attendances recorded at the P a e d i a t r i c C l i n i c . i n the Adult ( c o n t 'd) O u t p a t i e n t s ' Department a t the Vancouver G e n e r a l H o s p i t a l a v e r a g i3d 177 m o n t h l y f r o m J a n u a r y t o May, 1948. 3CE S e v e n  months - 100 -  APPENDIX A  Year 1951 January February March April May June July August' September October November December Total  1951  Paediatrics 577 555 546 508 539 504 487 543 435 487 504 403 6,088  (continued)  O'ther C h i l d r e n Clinics  736 709 5 73 827 873 733 534 584 528 616 618 523 7,854'  Source: H e a l t h Centre f o r C h i l d r e n , Annual 1951, i n c l u s i v e .  - 101 -  1  s Total 1,313 1,264 1,119 1,335 1,412 1,237 1,021 1,127 963 1,103 926 13.942  R e p o r t s , 1948-  B IBL 1.  10  G H A P H I  PERIODICALS 1.  Ball,  G> ," Case Work W i t h C r i p p l e d Children',' The F a m i l y . V o l . 20, No. 2, A p r i l , 1939.•  2.  Hoge, V.M., " H e a l t h C e n t r e s and t h e H o s p i t a l S u r v e y and C o n s t r u c t i o n Act',' A m e r i c a n J o u r n a l o f P u b l i c H e a l t h , V o l . 38, No. 12, December, 1948, p a g e s 1653-1656.  3.  Paterson,  4.  P i l l s b u r y , R., " C h i l d r e n Can be H e l p e d t o P a c e S u r g e r y " , R e p r i n t e d from.The C h i l d , F e d e r a l . S e c u r i t y Agency, S o c i a l S e c u r i t y and A d m i n i s t r a t i o n , C h i l d r e n ' s B u r e a u , W a s h i n g t o n , D. C., M a r c h , 1951..  D. , " C h i l d r e n ' s H e a l t h C e n t r e s and T h e i r Uses", Journal.of. the Canadian M e d i c a l A s s o c i a t i o n , V o l . 62, 1950, p a g e s 39-43.  11. BOOKS 1,  D a v i s , M.M., C l i n i c s , H o s p i t a l s , and H e a l t h C e n t e r s , H a r p e r and B r o t h e r s , New Y o r k and L o n d o n , 1927.  111. PAMPHLETS 1,  H i e t t , E . , Case-Work R e l a t i o n s h i p s W i t h i n a M e d i c a l S e t t i n g , p a m p h l e t p u b l i s h e d by t h e U n i t e d S t a t e s Department of L a b o u r , C h i l d r e n ' s B u r e a u , W a s h i n g t o n 25,, D. C., F e b r u a r y , 1945,  2.  The A m e r i c a n A s s o c i a t i o n o f M e d i c a l S o c i a l W o r k e r s , A S t a t e m e n t o f S t a n d a r d s t o be Met by S o c i a l S e r v i c e Departments i n H o s p i t a l s , C l i n i c s , and S a n a t o r i a , 1834 K. S t . , N.W. , W a s h i n g t o n 6 D. C., T h i r d R e v i s i o n , 1949.  - 102  -  IV.  THESES 1.  B o w k e t t , M. F. The S o c i a l W o r k e r i n t h e T r e a t m e n t Team. An E x a m i n a t i o n o f R e p r e s e n t a t i v e J. Lv-'^ J- wgv/iiua.Oi ¥ <w  T  Cases i n t h e Vancouver G e n e r a l H o s p i t a l Out P a t i e n t D e p a r t m e n t , M a s t e r o f S o c i a l Work T h e s i s , . U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1951 -  V.  2.  Collier,  3.  Watt,  E.A., The S o c i a l S e r v i c e D e p a r t m e n t o f The V a n c o u v e r G e n e r a l H o s p i t a l , I t s H i s t o r y and D e v e l o p m e n t , 190'2-1949, M a s t e r o f S o c i a l Work.Thesis, U n i v e r s i t y of B r i t i s h Columbia, 1950. . -  P.M., The T r e a t m e n t o f O b e s i t y f o r C h i l d r e n . f or,. C h i l d r e n i n Low-Income • F a m i l i e s , A S t u d y o f t h e S o c i a l Worker.'s R o l e ' - i n a C l i n i c a l S e t t i n g , M a s t e r o f S o c i a l Work T h e s i s , U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1951.  REPORTS 1.  Medical  H e a l t h Of f i b e r ' s R e p o r t , H e a l t h D e p a r t m e n t , C i t y o f V a n c o u v e r , B r i t i s h C o l u m b i a , 19191936.  2.  M e d i c a l H e a l t h O f f i c e r 's R e p o r t , f o r t h e C i t y o f V a n c o u v e r and G r e a t e r V a n c o u v e r M e t r o p o l i t a n H e a l t h D i s t r i c t , 1937-1951..  3.  H a m i l t o n R e p o r t , A H o s p i t a l P l a n and a P r o f e s s i o n a l E d u c a t i o n a l Programme f o r t h e P r o v i n c e o f B r i t i s h C o l u m b i a , Canada ( P a r t Two), by James A. H a m i l t o n and A s s o c i a t e s , H o s p i t a l C o n s u l t a n t s , M i n n e a p o l i s , M i n n e s o t a , June, 1949, Volume 1.  4.  A n n u a l R e p o r t s , H e a l t h C e n t r e f o r C h i l d r e n , The Vancouver General H o s p i t a l , Vancouver, J u n e , 194 8-Dec ember, 1951.  5.  Seventy-First  A n n u a l R e p o r t , The  Children,  A n n u a l R e p o r t s , The V a n c o u v e r  7.  Hospitals  Child  f o r Sick  67 C o l l e g e S t . , T o r o n t o , Canada,  6.  and  Hospital  General H o s p i t a l ,  H e a l t h , White  1907-1951,  House C o n f e r e n c e on  C h i l d H e a l t h and P r o t e c t i o n , Hew Y o r k , 1932,  - 103 -  1946.  The  Century  Co.,  

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