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Casework-groupwork referral; a study of co-operative relationships between agencies offering casework… Franklin, David St. George 1949

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CASEWO RK- GRO UPWO RK REFERRAL A Study of Co-operative Relationships between Agencies of f e r i n g Casework Services and Agencies providing Leisure-time Services. by DAY ID ST GEORGE FRANKLIN Thesis Submitted i n P a r t i a l Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the Department of So c i a l Work 1 9 4 9 The University of B r i t i s h Columbia V Abstract CASEWORK - GROUPWORK REFERRAL Investigation of r e f e r r a l practices between agencies offering casework services and agencies providing l e i s u r e -time services i s the essential subject of t h i s t h e s i s . To meet the c r i t e r i o n of success, which was established i n the study, a r e f e r r a l should be planned and carried through only when an individual's needs are thereby more adequately met. In the past, r e f e r r a l s often f e l l short of t h i s standard, but since roles of the workers, and the nature of the r e f e r r a l process i t s e l f were not c l e a r , factors promoting f a i l u r e were unidentified. To c l a r i f y these matters was an objective. An additional objective was an evaluation of experimental attempts to provide casework services i n leisure-time agencies. This fusion of casework and groupwork services and the needs hereby met are examined. In the study twenty-nine case and group records, c h i e f l y from Vancouver agencies, are used. Both adultsand i children are considered i n the cases, but children's prob-lems frequently stemmed from relationships with parent fig u r e s . Thus, helping the parent was an i n t e g r a l part of help for the c h i l d ' s d i f f i c u l t y . The findings deal with phases i n the r e f e r r a l pro-cess. The burden of the evidence shows the outcome of r e f e r r a l to be problematic i f workers t r y to deal with a c h i l d alone. I f a worker recognizes and deals with parents' resistances and problems, thereby e n l i s t i n g t h e i r co-operation, p r o b a b i l i t y of successful r e f e r r a l i s increased. Nevertheless, when workers have no clear idea of t h e i r respective responsi-b i l i t i e s , any a c t i v i t y Is of doubtful service to the i n d i v i -duals. The implication Is that a j o i n t casework-groupwork s t a f f conference offers the best framework with i n which to define r o l e s , to evaluate Information about a s i t u a t i o n and to form a s o c i a l plan. Later review of t h i s plan Is usually es s e n t i a l ; then workers may modify t h e i r approach or with-draw from the process. Lack of group records constitutes a s p e c i f i c weakness i n evaluation of the groupworker's r o l e ; moreover, i t was often d i f f i c u l t to l e arn from case records how the caseworker had functioned. This discloses the need for better recording. New insights into the nature of r e f e r r a l show i t to be a jo i n t casework-groupwork function requiring (a) careful attention to each case on an i n d i v i d u a l basis, (b) close collaboration between caseworker and groupworker, and (c) a capacity of parents to modify t h e i r attitudes to children needing r e f e r r a l . Additional c r i t e r i a f o r good r e f e r r a l are given. TABLE OF CONTENTS Chapter 1. The Basic Problem - Meeting the Individual's Need Aim of Referral; Approach of Caseworker and of Group-worker; Referral on an Individual Basis. Chapter 2. Aims and Methods i n the Present Study Preliminary Approach; Types of Relationship and Referrals between Agencies; The Material Used; Questionnaire Abandoned; C r i t e r i o n of Success of Referrals Stated. Chapter 3^  Referral from the Caseworker to the S o c i a l Group Readiness for Group P a r t i c i p a t i o n ; Parent and Family Attitudes; J o i n t - S t a f f Conference - to meet Clie n t ' s Needs, to Make Social Plan: Establishing the Referral; D i v i s i o n of Responsibility; Summary Chapter 4. Referral from a S o c i a l Group to Casework Treatment The Groupworker's Function and Limitations; Use of other Agencies; Problems Needing R e f e r r a l ; Gaining Infor-mation and Planning the Referral through Jo i n t - S t a f f Conference; Need for Parent's P a r t i c i p a t i o n ; Avenues of Approach to the Parent. Chapter 5. The Caseworker as Consultant to the Groupwork Staff Joint Casework-Groupwork Experiment; Program at Bronx House; Evaluation of the Trend; Functions Appropriate to the Groupworker; Conclusion. Chapter 6. Implications and Recommendations for Further Study Current Practice. Improvement In Four Areas; Gaining Parent Co-operation; D i v i s i o n of Responsibility; J o i n t -Staff Conference; Experimental Recording; Groupwork Consultation; C r i t e r i a for Improved Referral Practice Given. Appendices: A. Sample of Questionnaire B. Sample of Schedule for Recording Information C. Samples of Referral Forms D. Bibliography Schedules: 1. Parent Attitude to Referral p. 19 2. Children's Group Behaviour which Led to Ref e r r a l . . p. 56 3. Home Environment of Children Referred to Casework . p. 62 CASEWORK - GROUPWORK REFERRAL Study of Co-operative Relationships between Agencies offering Casework Services and Agencies providing Leisure-time Services. 1 Chapter One THE BASIC PROBLEM - MEETING THE INDIVIDUAL'S NEED The Aim of Referral Two d i s c i p l i n e s which are basic to s o c i a l work -casework and group work - t y p i f y d i f f e r i n g ways of working with people, but f i n d t h e i r roots i n the common aim of consciously helping people toward more complete and sat i s f y i n g personal and s o c i a l r e l a t i o n s h i p s . In both d i s c i p l i n e s the underlying objective Is to meet people's needs; inter-agency relationships and r e f e r r a l processes must promote t h i s objective. A l l too often, a clearly-defined, smoothly a r t i c u -l a t i n g r e f e r r a l process can become an end i n i t s e l f . Then the indi v i d u a l i n need of service f a l l s between two agencies because the d e f i n i t i o n of function and r e s p o n s i b i l i t y or the comple-mentary contribution of each agency remains unspecified. The much neglected area or relationship between casework and groupwork programs i s the s p e c i f i c focus of t h i s study. D i f f e r e n t i a l Approach of Caseworker and Groupworker Since relationships between two d i f f e r i n g types of programs and agencies are to be discussed, there i s need to define the methods of casework and groupwork so that t h e i r d i f f e r e n t i a l approach i s clear. Merely to assume, a r b i t r a r i l y , that caseworkers work with individuals and groupworkers work with groups w i l l lead to s t e r i l e controversy. It i s ess e n t i a l to understand the roles and functions of practitioners In both d i s c i p l i n e s . 2 a) The Caseworker The caseworker has always been Interested i n helping individuals to meet th e i r problems. Often he met the need by prescribing a service. "Over the years emphasis gradually shifted from an exclusive interest i n external problems toward in c l u s i o n of treatment of personality d i f f i c u l t i e s " . 1 Although perhaps a caseworker did not have the background of dynamic psychology required of today's worker, he nevertheless rea l i z e d that giving a service or deferring a c l i e n t to another resource was i n e f f e c t u a l while personality d i f f i c u l t i e s i n t e r f e r e d . Today "character diagnosis, patterns of s o c i a l and ego func-2 ti o n i n g . . . " are perhaps the special province of the caseworker. b) The Groupworker Groupwork i s also a way of helping i n d i v i d u a l s . "In the leisure-time agencies i t replaces super-imposed programs a r t f u l l y designed by adults for the building of character, especially i n the so-c a l l e d underprivileged, by self-governing groups and programs growing out of the interests of the members."3 But groupwork i s also undergoing a change, analogous, though not i d e n t i c a l to that In casework. Since these changes are sometimes obscure, they w i l l be examined i n some d e t a i l here. In the past, what groupwork offered was r e l a t i v e l y unknown. In f a c t , only recently have groupworkers c l a r i f i e d 1 Annette Garrett, " H i s t o r i c a l Survey of the Evolution of Casework", Journal of Social Casework, v o l . 3 0 , June 194-9, p.219 2 Gordon Hamilton, Psychotherapy i n Ch i l d Guidance. New York, Columbia University Press, 1947 , p. 36 3 Grace Coyle, "Social Work at the Turn of the Decade", Proceedings of the National Conference of Social Work. New York, 1940, p. 12 3 t h e i r objectives, methods and techniques. Caseworkers had doubts as to the contribution of t h i s new and growing d i s c i p l i n e , and l a t e r experience has made i t evident that these doubts were well founded on the basis of groupwork as i t i s often practised. In one c i t y the writer asked a group leader: "What do you do with the boys who cannot f i t into the program as you have defined i t ? " , and received the reply: "We have no such problem boys - they either stay i n l i n e with the r e s t , or they are out." In the same c i t y , a groupworker i n a Community House explained that the method used In her agency "to d i s c i p l i n e rowdy boys" was "to suspend the membership of a l l who are found to be ringleaders". Such remarks point up some of the least enlightened aspects of "groupwork" as i t was practised. It i s only f a i r to add that i n t h i s same c i t y there were also profes-sional groupworkers with sound attitudes and practices. Never-theless, t h i s "...wide divergence...had delayed both the accep-tance of standard regarding professional competence for group-workers"4" and the recognition that groupwork could provide a much needed resource. By rethinking of thei r goals and functions, groupworkers came to see more c l e a r l y than ever the p r i n c i p l e that i n d i v i d u a l needs must be met through the groupwork process. In 1944, Grace Coyle described t h i s aspect of groupwork when she said, groupwork i s " . . . i n part...the conscious use of group experience for the development of persons."5 4 Clara A. Kaiser, "Generic Aspects of Professional Training for Casework and Groupwork", Proceedings of the National  Conference of Social Work, New York, Columbia University Press, 1940, p. 607 5 "Not A l l Group A c t i v i t i e s Are Group Work", The Group, v o l . 1, Nov. 1944, p. 10 4 From the emphasis on "development of persons" i t was but a short step to a stress on "therapy for Individuals", and there has grown up an Incorrect and confusing tendency to refer to any intensive work with people i n groups as group therapy. T r a d i t i o n a l l y , the s o c i a l groupworker has r e a l i z e d that his role i s to work with groups to develop healthy inter-relationships between group members. More recently, he has seen, i n addition, that i n some settings his task i s "...intensive work with individuals i n the group and that (he) must have a knowledge of causative factors of behaviour..." In t h i s way he can help those individuals whose personality d i f f i c u l t i e s i n t erfere with t h e i r a b i l i t y to p r o f i t from group experience. But while It Is Important to see that therapy i s not recognized as a goal for a l l groups, i t i s well to understand that a l l groupwork has therapeutic "aspects". The following excerpt from the record of "Club 4 7 " , demonstrates how a tension-laden group s i t u a t i o n can be s k i l f u l l y handled so as to be valuable and constructive for the participants. A notable feature of t h i s group of adoles-cent g i r l s was t h e i r desire to t a l k of personal, home and family problems. Case 1 Toxy Anston, aged 14, frequently hinted at d i f f i c u l t i e s at home with her mother. Arriving l a t e at the group one evening, she was s t i l l carrying her school books and had not yet been home. She appeared humiliated yet defiant. The other two g i r l s present, 6 Gisela Konopka, "Knowledge and S k i l l of the Group Therapist", American Journal of Orthopsychiatry, v o l . 19, Jan. 1 9 4 9 , p. 56 5 knowing of her unhappy l i f e , immediately sensed something amiss. No one spoke, but suddenly and spontaneously, Roxy burst out with her story. "One night I woke up and heard mother screaming and h o l l e r i n g at my older s i s t e r , Les, who came home very l a t e . She t o l d her to quit going with her boy fr i e n d - right i n front of him, too." Les had refused and, i n a subsequent argument, Roxy had sided with her. The mother had t o l d both g i r l s to leave the house, not to return. Roxy was staying temporarily at her g i r l friend's house. In tears, she concluded: " I almost hate my mother, sometimes." The leader knew Mrs. Anston had recently sus-tained a serious burn and asked i f t h i s did not partly explain her i r r i t a b i l i t y . Roxy said i t didn't give her license to be mean and i n s u l t i n g . To t h i s the leader agreed, but added that at times, a l l parents seem unjust. Encouraged, Lois spoke up: "You think that's bad? You don't know anything t i l l you've heard my f o l k s scrap." Then, "My father's a seaman and comes home drunk. Mom hates i t - they're always f i g h t i n g and getting a divorce any time." This meeting gave an opportunity for v e r b a l i z a t i o n of feelings and release of h o s t i l i t y . Each g i r l ' s recognition that her experience was not unique, the support afforded through group discussion and the leader's attempt at c l a r i f i c a t i o n were s t a b i l i z i n g influences i n th e i r turbulent l i v e s . As groupwork practitioners refine th e i r methods and become increasingly adept i n their use of techniques, the needs of more seriously disturbed and unhappy individuals may be met through the groupwork process. Need for Referral on an Individual Basis < At present i n Vancouver's leisure-time agencies, instances of behaviour that cannot be handled i n the group setting are referred to other resources such as a Family Service Society, Child Guidance C l i n i c or Ch i l d Protection Agency. With greater s k i l l and more perfect programming techniques, the worker may be able to provide constructive outlets f o r d i f f i c u l t behaviour. However, when a c h i l d presents c e r t a i n rather severe troubles, which nevertheless 6 can be assimilated w i t h i n the group, there may s t i l l a rise the need to refer the parent for casework treatment. Such a process should be undertaken not only as a method of i n d i r e c t l y meeting the c h i l d ' s needs i n the home, but also as the considered task of d i r e c t l y handling the parent's needs. For example, c o n f l i c t between a child's and a parent's dependency needs may be expressed as the parent's r e j e c t i o n of the c h i l d . Then, from the c h i l d ' s point of view, the parent usually emerges v i c t o r -ious. Since the child-parent relationship requires adjustment, i t i s obvious that help given only to the c h i l d w i l l not reach the r e a l source of trouble. Upon examining the reverse s i t u a t i o n , where, for example, a c h i l d i s referred to a leisure-time agency, it w i l l be found that a r e j e c t i n g parent may view with deep suspicion his child's p a r t i c i p a t i o n i n a group. He may com-pl a i n the c h i l d does not receive " s t r i c t d i s c i p l i n e " or "has too much fun at the group" or i s "too f r i e n d l y with the group-worker". Such problems presented by parents are the r e a l attitudes to be dealt with i n the r e f e r r a l process. Not only the mechanical d e t a i l s of r e f e r r a l between casework and groupwork, but also t h e i r many ramifications are subjects of inquiry i n t h i s thesis. The agency i n t e r - r e l a t i o n -ships which came Into play were examined. The attitudes and actions of the children and adults who figured i n the r e f e r r a l s were studied. Various ways of dealing with the situations are suggested, and th e i r effects on the people involved are evaluated. 7 In some leisure-time agencies a casework service was offered. In the Young Women's C h r i s t i a n Association t h i s service takes the form of interviewing g i r l s regarding personal matters. The functions of the caseworker In t h i s s e t t i n g were b r i e f l y examined. In other leisure-time agencies the caseworker had functions which were mainly consultative. This worker's relationships to the groupwork s t a f f were appraised. A l l eases of r e f e r r a l were considered i n r e l a t i o n to the question: "Did the r e f e r r a l process enable either worker involved to a s s i s t the i n d i v i d u a l to meet his needs more f u l l y , either d i r e c t l y or i n d i r e c t l y ? " 8 Chapter Two ALMS AND METHODS IN THE PRESENT STUDY Preliminary Approach The casework-groupwork r e f e r r a l process was examined c h i e f l y as i t existed i n Vancouver and as i t had been used i n those agencies which kept records of inter-agency relationships. Under what conditions, when and where did these r e f e r r a l s occur? This was one of the f i r s t questions to be answered; others followed. How did they occur; what were the mechanics of the process? What happened to c l i e n t s or group members during the process? How did caseworkers and groupworkers implement the action? It was f e l t that the attitude of the worker In the process would be of paramount Importance, there-fore i t was also necessary to learn what attitudes did workers bring to the task of working with another s o c i a l work d i s c i p l i n e ? Was there antagonism and bitterness to be found or was there warmth and understanding shown as s t a f f s worked together? Even i n a general way, conclusive answers to these questions could not be found; s p e c i f i c understanding of the process as i t applied to the Vancouver s i t u a t i o n was s t i l l l e s s w e l l defined. Lack of previous experience and of d e f i n i t i v e knowledge excluded at the outset the p o s s i b i l i t y of sett i n g down any but the most tentative c r i t e r i a f o r good r e f e r r a l practices. To establish such became an objective of the study. C r i t e r i a had to be developed and become c r y s t a l i z e d as material was gathered and as general patterns became clea r . 9 Types of Relationship and Referrals between Agencies Si g n i f i c a n t for t h i s study were relationships between agencies off e r i n g casework service and agencies providing leisure-time service when these relationships resulted i n r e f e r r a l of an in d i v i d u a l to or from either agency. Thus, two forms of r e f e r r a l s were recognized: 1) a caseworker could i n i t i a t e the process for one of h i s c l i e n t s - c h i l d or adult. He would then contact a leisure-time agency and refer the c l i e n t to a currently operating group. This was c a l l e d Type X r e f e r r a l . 2) I f a groupworker found a member of one of the groups he l e d , i n need of casework help, he i n i t i a t e d the contact with the casework service and referred the member. This was cal l e d Type Y r e f e r r a l . In both Type X and Type Y r e f e r r a l two workers - a caseworker and a groupworker -and two agencies are involved. To provide casework service to g i r l s seeking t h i s help i s a function of the Personal Counselor i n some Young Women's C h r i s t i a n Associations. In consultation with a groupworker i n the agency's Program Department, the Counselor might sometimes decide that a ce r t a i n g i r l was ready f o r , and could p r o f i t from, groupwork a c t i v i t y . She would then refer the g i r l to the Program Department. The reverse s i t u a t i o n also occurred. Then a g i r l enrolled i n a group of the Program Department, showing a need f o r casework help, would be referred to the Counselor. 10 Such situations were analogous to the Type X and Type Y r e f e r r a l except that they occurred with i n the walls of one agency. In selected cases, however, there might be r e f e r r a l to, or from another agency. Cases 4 and 14 are such examples; they were received from the Winnipeg Y.W.C.A.-In some leisure-time agencies an experimental approach to co-operative casework-groupwork services was attempted. This procedure was adopted when groupworkers were faced with the need f o r increased insight into the meaning of the beha-viour exhibited by ce r t a i n group members, but also saw In th e i r own ranks a serious shortage of s k i l l e d groupworkers. The Joint Casework-Groupwork Project of the Welfare Federation of Cleveland i s b r i e f l y described as one of the e a r l i e s t recorded attempts to meet t h i s need. Certain trends are followed and evaluated. A decade l a t e r , a di f f e r e n t program, sponsored by Bronx House, New York, was designed to meet roughly: the same need. Func-tions of the caseworker, appropriate to his special s k i l l and approach, are evaluated as they appeared i n this experiment. No such experimental approach was found i n Vancouver agencies and a l l information was found i n the l i t e r a t u r e . What cases. What Agencies were U t i l i z e d ? From 29 cases on which the study i s based, 21 were selected for detailed description. Three of these i l l u s t r a t e groupwork process only; the rest display some facets of the r e f e r r a l process. Leisure-time agencies i d e n t i f i e d are Alexandra Neighbourhood House, Gordon House and the Young Women's Ch r i s t i a n Association. The Y.W.C.A. of Winnipeg, Manitoba and Bronx House, New York were used. Casework service 11 was provided by the following Vancouver agencies: Child Guidance C l i n i c , C i t y Social Service Department, Family Welfare Bureau, Social Service Departments of the P r o v i n c i a l Mental Hospital and of the Vancouver General Hospital and the Y.W.C.A. Personal Counselor. The Child Guidance C l i n i c of Winnipeg i s also i d e n t i f i e d . When case material had to be gathered from such a large group of agencies, to f i n d a s t a r t i n g point offered some d i f f i c u l t y . I t was therefore decided to review material pre-pared for the groupwork-casework I n s t i t u t e , held i n Vancouver, November 8, 1948. Unfortunately, only one case presented f o r discussion at that time was avail a b l e . The next avenue of approach was v i a the minutes of a s t a f f committee of Gordon House which had met to study casework-groupwork r e f e r r a l s . This record provided a summary of names of persons referred to Gordon House. To learn the process by which these people were referred made i t necessary to perform three steps: (1) reading the group record or the group to which the person was referred, (2) reading the case record, and (3) consulting with workers regarding d e t a i l s not e x p l i c i t i n either record. Owing to lack of group records, consulting with workers often was the only way to c l a r i f y the groupworker's rol e i n the process, since he would have first-hand knowledge of the s i t u a t i o n . However, when t h i s required a worker to r e c a l l d e t a i l s months or years old, the u n r e l i a b i l i t y of the procedure i s obvious. Since a f a i r proportion of the r e f e r r a l s studied were 12 known to the Family Welfare Bureau, case records often gave the only written material on the r e f e r r a l . Sometimes reports of telephone conversations with a groupworker would be incor-porated, but these gave l i t t l e evidence of the type of co-operative thinking which went into the r e f e r r a l . Consequently, the aspect of r e f e r r a l pertaining to the groupworker was often obscure. The workers at the Young Women's C h r i s t i a n Associa-t i o n i n Vancouver had real i z e d how a lack of casework-groupwork r e f e r r a l records prevented an evaluation of the process. They had thus made a start i n recording t h e i r work. Frequently, however, cases showed only a b r i e f period of co-operative casework-groupwork a c t i v i t y and they were inadequate for f a i r appraisal and were discarded. Some other cases represented r e f e r r a l s from other casework services and consequently did not f a l l w i thin the scope of th i s study. Three cases only could be construed as being casework-groupwork r e f e r r a l s ; two of these were received from the Winnipeg Y.W.C.A. One case was a r e f e r r a l from the P r o v i n c i a l Mental Hospital but since a l l d e t a i l s of the co-operative a c t i v i t y of the two workers involved had been recorded i n a f i l e at the leisure-time agency, the hospital case record was not consulted. Projected Questionnaire Abandoned As the study progressed, i t was found that the d i f f i -c u l t i e s encountered i n Type Y r e f e r r a l were greater than those i n Type X r e f e r r a l . Reasons for t h i s may have been the r e l a -t i v e l y greater d i f f i c u l t y i n obtaining background Information i n Type Y r e f e r r a l s . This primary d i f f i c u l t y of discovering 13 whether or not there was a chronie home s i t u a t i o n whieh adversely affected an individual's l i f e and behaviour led to the question: "What background data do workers want to know about persons referred between casework and groupwork?" Aside from i d e n t i -fying information what should be known about the individual'.s history? A questionnaire designed to f i n d answers to t h i s question was formulated. It i s reproduced i n Appendix A. In preliminary t r i a l , the questionnaire evoked vary-ing responses. The common element i n a l l was the thought that to emphasize some facts as more important than others, was meaningless when they were unrelated to a case. Theoretically, a l l information would be of equal Importance, no item of information would be more meaningful or useful. The question-naire was therefore abandoned and i s mentioned here only as a matter of record. A schedule used for abstracting information from records which were read during the course of the research Is reproduced i n Appendix B. Success of Referrals Sometimes i t was found that workers made r e f e r r a l s for reasons of the i r own anxieties about the Individual's behaviour, rather than from the f e l t need of the person. Such r e f e r r a l s were not r e a l l y helpful but I t became necessary to formulate a d e f i n i t i o n of a successful r e f e r r a l . I f a c h i l d , referred to a group, came only once or twice, but no more, obviously he was not helped. By the same token, a person urged to seek casework help who presented problems which could 14 not be reached through such treatment, or whose resistances caused him to terminate treatment after one or two appointments, was not helped. Such r e f e r r a l s were c a l l e d unsuccessful. Often a period of thorough and painstaking co-operating work would be required before a successful r e f e r r a l process could be concluded. For t h i s study, Type X r e f e r r a l was "successful" when a c h i l d or adult had become an accepted and established member of a group. Type Y r e f e r r a l was "successful" when the group member alone, or with his parent, could see the value of casework s k i l l i n solving the presenting problems and sought such help at the appropriate agency. Chapter Three 15 REFERRAL FROM THE CASEWORKER TO THE SOCIAL GROUP Development of good r e f e r r a l s from agencies off e r i n g casework services to those off e r i n g leisure-time a c t i v i t i e s has been a slow process. There have been many reasons why, i n the past, caseworkers did not r e a l i z e the value of group experience. The caseworker was occupied i n attending to fundamental need -food, housing, employment - and i n tre a t i n g widespread s o c i a l i l l s such as delinquency and family breakdown. Caseloads were heavy and often, though believing a c l i e n t suffered because of the Inadequacy of recreational f a c i l i t i e s and poor leader-ship, a caseworker was powerless to a l t e r the s i t u a t i o n . Later, he was bl i n d to the relationship between planned, informal leisure-time a c t i v i t i e s , under able leadership, and the long-term goals of emotional and physical well-being. Indeed, a f u l l pantry i s a more tangible necessity than improved recrea-t i o n a l f a c i l i t i e s . Nevertheless, as long as workers and agencies continue to deal with the " f r a c t i o n a l i z e d " c h i l d they cannot implement t h e i r avowed concept of tre a t i n g the whole person. For an ef f e c t i v e r e f e r r a l process i n t h i s Type X r e f e r r a l , workers need to consider two main areas: c l i e n t readiness for group p a r t i c i p a t i o n and the j o i n t - s t a f f conference as a method of optimum professional planning. !• Client Readiness for Group P a r t i c i p a t i o n Children were involved i n the majority of r e f e r r a l s studied, yet i t i s never possible to consider the c h i l d alone. Relationship of the c h i l d to his home and the parent attitude to him are usually c r i t i c a l components of his readiness for group experiencer 16 a) The Child's Readiness Regarding the child's readiness for the group, the caseworker should he f a m i l i a r with the purpose and function of the leisure-time agency to which r e f e r r a l Is proposed. He should know about the types and sizes of the groups found there. He must always ask himself the question: "Readiness for what group?" The matter of how individuals a f f i l i a t e with such groups i s also Important since, whereas a c h i l d might r e a d i l y j o i n an a c t i v i t y group, he might be unwelcome i n a friendship group (wherein friendship, or membership i n the "gang" i s a condition of j o i n i n g ) . 7 One writer speaking of the c h i l d ' s readiness for group experience, l i s t e d s i x th e o r e t i c a l stages, as follows: x 1 Children who appear healthy emotionally but who crave more companionship and directed a c t i v i t y then the neighbourhood provides. 2 Children, too shy to take i n i t i a t i v e i n seeking out f a c i l i t i e s who, i f they were informed about them by a caseworker and given help i n overcoming i n i t i a l fears, would carry on. 3 Children who may be able to use e x i s t i n g f a c i l i t i e s provided the group as w e l l as the agency i s care-f u l l y selected and the introduction c a r e f u l l y planned. 4 Children who require a "protected" group experience either because the nature of t h e i r d i f f i c u l t i e s makes i t hard to deal with them i n the usual com-munity groups or because they have unsuccessfully t r i e d such groups, without fi n d i n g s a t i s f a c t i o n through them. 7 Margaret Svendsen: "The Relationship between Casework and Groupwork i n the Interests of .the Individual", i n Connover, M.B.: "The Joint Use of^Groupwork and Casework Techniques", Journal of Social Case Work, v o l . 23, November, 1942, p. 26o~ J' c 17 5 Children who require i n d i v i d u a l work preliminary to placement i n even a protected group s i t u a t i o n because they are struggling primarily for accep-tance by an adult and have been unable to re l a t e themselves p o s i t i v e l y to other children. 6 Children for whom no group connection can be thought of for a considerable time u n t i l their i n d i v i d u a l problems have received intensive treatment. Ideally, to predict accurately a child's stage of readiness caseworkers might desire a complete s o c i a l h i s t o r y . To obtain t h i s i s usually impossible. Furthermore, i n thinking of those children who f a l l into stage one or two above, such a detailed report might prove i n t e r e s t i n g , but i s completely superfluous from the point of view of an e f f e c t i v e r e f e r r a l . For the r e f e r r a l needing careful planning, as i n stage three above, thorough knowledge of the child's background i s necessary to make a wise selec t i o n . In categories four and f i v e , i t Is evident that s k i l l e d handling of the s i t u a t i o n i s necessary. In a "protected" group, the worker must be able to,give Indi-vidualized attention on the basis of his dynamic understanding. Such attention presupposes intimate knowledge of the child ' s background and s k i l l on the part of the worker i n using such knowledge. Much w i l l be known about the problems facing children i n stage f i v e , and selected aspeetw of t h i s should be disclosed to the groupworker. With understanding of group dynamics i n i t s present phase, i t Is usually Impossible to state conclusively that a cert a i n c h i l d w i l l p r o f i t from group experience. There are s t i l l too many unknown factors. In a study of a therapeutic 18 8 groupwork project i t was found that children dropped out of special protected groups for a variety of reasons. In further comment on such children, the authors state: "In most cases they were too h o s t i l e or too f e a r f u l . The fact that these children did not belong, had not been apparent u n t i l they were 9 a c t u a l l y put i n the group s i t u a t i o n . " Further analysis might have revealed that conditions i n the home or i n the parent attitude to the r e f e r r a l was a factor i n the c h i l d ' s f a i l u r e to become established i n the group, b) Parent and Family Attitudes Parental attitudes to the c h i l d and to the proposal to refer him to a group are usually important i n the f i n a l outcome of the r e f e r r a l process. Margolis states that i n cases i n which there was "...a r e j e c t i n g or punitive parent" there was some response to a c t i v i t y group experience, i n contrast to the high proportion of f a i l u r e s among cases where the "mother was inconsistent, v a c i l l a t i n g between over-indulgence and punishment - the father a weak, submissive person or out of the home."10 It was also learned that the largest number of successes i n group treatment were found among children who were too f e a r f u l to relate to t h e i r caseworkers, and that "...the children who are g u i l t y , f e a r f u l and anxious are more amenable to a c t i v i t y group treatment than are those children who act without c o n f l i c t or are seriously d i s t u r b e d . " 1 1 8 Margaret Svendsen and Dorothy Spiker, e t . a l . : Integration of Casework and Groupwork Services for Children. State of I l l i n o i s . 9 O D . c i t . , p. 51 10 L i l l i a n Margolis: "Selection of Children for A c t i v i t y Group Therapy", Smith College Studies In Social Work, v o l . 17, September 1946, p. 44 11 _0p. c i t . , p. 47 1 9 While the number of cases here c i t e d i s too few, and the va r i e t y of situations which they represent too diverse to permit any analogous deductions, i t i s possible to show a relationship between parental attitude to the r e f e r r a l , and i t s outcome. In Schedule number One, the eighteen cases found to represent r e f e r r a l from casework to groupwork are c l a s s i f i e d according to the-parent's attitude to the proposed r e f e r r a l . Schedule 1 Parent Attitude to Referral class number of description of parent attitude cases found 1 5 Parent requested the r e f e r r a l to group-work and co-operated whole-heartedly with workers to achieve t h i s aim. 2 2 Parent agreed re l u c t a n t l y for c h i l d to participate i n a group. Casework help enabled parent to see the need f o r such p a r t i c i p a t i o n . 3 5 Parent rejected caseworker's suggestion of r e f e r r a l and either forbade c h i l d to participate or discouraged him. 4 3 Parent's attitude was not s p e c i f i c a l l y recorded or known. 5 3 Parents deceased or l i v i n g elsewhere. In class one, a l l f i v e cases presented no special problem i n selecting a suitable group for the children. In terms of Svendsen's readiness for group experience, these children would f a l l into stages one and two. Four out of f i v e r e f e r r a l s were established, and the children continued to attend th e i r groups. The f i f t h family moved out of the c i t y . In t h i s c l a s s , there was a high proportion of success i n r e f e r r a l s . 20 In class two, the children presented some special problems - one was of borderline i n t e l l i g e n c e , the other had a physical deformity - and a careful selection of group was imperative. The parents showed a proneness to reject t h e i r children and casework with the parents was an int e g r a l factor i n establishing the r e f e r r a l s successfully. Improvement i n the c h i l d rested upon the continued parent treatment and t h i s required a period of co-operation i n which both agencies played complementary roles. Two types of parent attitude are included i n class three. 1) Some parents d i r e c t l y opposed groupwork. Their opposition may have arisen from th e i r great h o s t i l i t i e s or from the fact that preliminary planning with the parent had not been thoroughly carried through. Perhaps the worker hurriedly and anxiously "referred" the c h i l d as a l a s t token e f f o r t . The re f e r r a l s were unsuccessful, as would be expected. In one case an 11-year old g i r l did show up at the Neighbourhood House, but was only seen t h i s once. In the other cases the groupworker saw no sign of the "referred" person and did not hear further from the caseworker. 2) Some parents did not openly oppose the r e f e r r a l and permitted t h e i r children to attend the groups of t h e i r choice. Nevertheless, th e i r attitudes n u l l i f i e d any b e n e f i c i a l e f f e c t . In casework treatment they were defensive and irr e g u l a r i n the i r appointments. When i t appeared the relationship had deteriorated the caseworker closed the case. Class four and Class f i v e cases cannot be used p r o f i t a b l y for analysis since the parent's a t t i t u d e was an unknown facto r . 2 1 One of the individuals i n class f i v e was an orphan; the other two were adults whose parents were not In the v i c i n i t y . In general i t may be stated that for c e r t a i n cases studied, the parental attitude to the proposed r e f e r r a l i s a c r u c i a l factor i n the chi l d ' s a b i l i t y to p r o f i t from and enjoy group experience. The second major area for consideration by workers of both agencies which co-operate i n a r e f e r r a l , i s the j o i n t -s t a f f conference. 2 . Need for Joint S t a f f Conference When the caseworker believes that group experience would be valuable for his c l i e n t or for a member of the c l i e n t ' s family, the f i r s t step should be to discuss the matter In a joi n t casework-groupwork s t a f f conference. Other workers who have had, or who expect to have contact with the i n d i v i d u a l , may be summoned to t h i s conference. Frequently, i n the cases examined, there were only b r i e f and inadequate plans for the r e f e r r a l . What purposes does such a conference serve? There are at least four. a) to c o l l e c t and exchange background information about the c l i e n t . b) to consider whether the needs of the c l i e n t (or family member) can be met through one of the groups currently operating at the agency o f f e r i n g groupwork services. c) to discuss the method of establishing the r e f e r r a l . This w i l l include consideration of the beat way to present the Idea of group p a r t i c i p a t i o n to the person, the method of introducing him to the group leader and 22 to the group i t s e l f , preparation ( i f any) of the group members for the a r r i v a l of the newcomer, d) to propose a d i v i s i o n of r e s p o n s i b i l i t y between the two workers who w i l l now have contact with the c l i e n t . This would vary with the type of case: for instance, the case wherein the caseworker continues to have an active relationship with the parent while the group-worker has the c h i l d i n a group might c a l l f o r the major r e s p o n s i b i l i t y to be carried by the caseworker. I f , however, the caseworker wished to taper off tr e a t -ment and to gradually decrease the frequency of i n t e r -views, the groupworker might assume major r e s p o n s i b i l i t y as the c h i l d became accepted i n the group as a regular member. a) C o l l e c t i o n and Exchange of relevant background information Consideration of t h i s question poses a number of further questions. What i d e n t i f y i n g data i s necessary i n each case? How i s such data obtained? What other types of informa-t i o n are needed and to what extent i s a detailed case hi s t o r y required? During the years 194-6 and 1947, the Gordon House Casework-Groupwork Referral Committee discussed r e f e r r a l s with a number of s o c i a l agencies i n Vancouver. In the findings, 12 the chairman states: "When i t was agreed that...a r e f e r r a l should be made, that i s , that the ind i v i d u a l was ready to p a r t i -cipate i n a group and would benefit from such a group 12 Casework-Groupwork Referral Committee Report, January 1948 23 experience, the caseworker agreed to present a written case summary to the groupworker. Such a summary would include i d e n t i f y i n g material such as name of c l i e n t , address, birthdate, status, r e l i g i o n , n a t i o n a l i t y , when case opened, school, health, behaviour, case h i s t o r y as deemed necessary, i n t e r e s t s , reason f o r r e f e r r a l , ten-t a t i v e s o c i a l plan for c l i e n t , preparation of c l i e n t f o r r e f e r r a l , present or past club a f f i l i a t i o n s and finances; thus o u t l i n i n g pertinent data regarding the past and present s i t u a t i o n . " This background data, obtained from the caseworker's record would be f i l e d at Gordon House, where a senior worker would be responsible for i t . In the spring of 1948, Gordon House again sponsored a committee to study r e f e r r a l procedure i n Vancouver agencies, with a view to establishing a procedure for i t s e l f . Among other d e t a i l s to be learned, the workers wanted to know: "How i s i d e n t i f y i n g material secured?" and "Is a form used?" 1^ Their findings are of i n t e r e s t : At Alexandra House, the caseworker was requested to come In person to discuss a prospective r e f e r r a l s i t u a t i o n . No r e f e r r a l was taken by telephone. The director or assistant director received a l l r e f e r r a l s and did not require any written forms. A l l records required by the agency were completed at the agency by the s t a f f ; Indeed, i n only very few instances was wri t t e n material submitted by the caseworker. The Young Women's C h r i s t i a n Association has a s t a f f caseworker (Personal Counsellor) who In face-to-face conference with the c l i e n t appraises her s u i t a b i l i t y for group experience, and obtains necessary information. The caseworker keeps wr i t t e n records of the interviews but does not u t i l i z e a form. At the Vancouver Boys' Club Association r e f e r r a l s are handled over the phone by the superintendents. Occasionally, a caseworker may v i s i t to discuss i n person some s i t u a t i o n . No form i s used. Lack of s t a f f l i m i t s the services offered. 13 For samples of such forms, see Appendix C. 24 On the basis of these findings and from t h e i r know-ledge of good practice, the committee made a tentative plan' for r e f e r r a l , as follows: 1 Both Junior House and Senior House are to have a trained worker, one of whose functions w i l l be handling r e f e r r a l s . 2 Before r e f e r r a l i s made, the groupworker i s to receive from the caseworker r e f e r r i n g the case, a typed summary of background information, follow-ing the l i n e s suggested by the previous year's Committee. 3 A joi n t caseworker-groupworker conference i s to be c a l l e d , to discuss the r e f e r r a l and plan steps. The leader of the proposed club could be c a l l e d i n at t h i s point, or; 4 The groupworker and club leader would d i s -cuss r e f e r r a l and placement of the c l i e n t i n the group; t h i s would include consideration of the optimum time to introduce the c l i e n t to the group, and preparation of members to receive him. 5 The caseworker should prepare the c l i e n t for the group, and continue follow-up treatment as long as both workers agree i t i s u s e f u l l and necessary. The closing of the caseworker's, contact should be j o i n t l y determined. 6 Periodic caseworker-groupworker contacts, by telephone or i n face-to-face situations should be continued to discuss the individual's progress i n the group and the evolution of the s o c i a l plan. As determined by the leisure-time agency, these discussions may be carried out between either the groupworker or the leader of the group and the caseworker. This plan covers more than background information about the c l i e n t and indicates how such data should form a basis for determining whether the c l i e n t ' s needs can be met and, i f so, how co-operation can e f f e c t i v e l y proceed. The type of background Information submitted would depend on the i n d i v i d u a l case "...with f u l l consideration of the functions of each agency concerned, the extent of previous 25 contacts with the c l i e n t , the attitude of the c l i e n t and his wishes, the complexity of the problem, the extent of the tre a t -14 ment and the emergency of the need." Thus i t w i l l vary from a complete s o c i a l history to a bare minimum of information, b) Can the c l i e n t ' s needs be met in an established group? The background information w i l l enable the workers to determine what are the major needs of the c l i e n t . In some cases these can be e a s i l y and simply met. Case Two depicts a man with no complicating personal d i f f i c u l t i e s which would interfere with his enjoyment of a c t i v i t i e s i n a s o c i a l s e t t i n g . Case 2 A caseworker i n a public agency phoned to the groupworker to request information about groups suitable for Mr. Davidson, an Old Age Pensioner. He enjoys checkers and i s musical. The groupworker Indicated a time when a group met which might meet his needs. On the specified day the caseworker accompanied her c l i e n t to the Neighbourhood House. When i n t r o -duced to some members In the games room. Mr. D. found an opponent i n checkers, enjoyed himself and l a t e r took out his membership i n the House. The worker sensed Mr. D.'s i n i t i a l reluctance to come to the agency, and as a resu l t decided to accompany him. In many instances t h i s would be a questionable procedure, since the c l i e n t might f e e l pushed into a s i t u a t i o n for which he was not ready. Case Three i l l u s t r a t e s t h i s . Case 3 A caseworker i n a medical set t i n g phoned the groupworker to request a schedule of a c t i v i t i e s for Mrs. Hurd, an older c l i e n t of hers who was 14 Elizabeth P. Rice: "Co-operative Casework", Journal of Soc i a l Casework, v o l . 18, July 1937, p. lo6 26 then In her o f f i c e . The groupworker gave the information. Next day the caseworker again phoned to explain more about the s i t u a t i o n . Mrs. Hurd i s nearly 70 years old, i s i n poor health and i s lonely. She has two daughters i n a distant Province. U n t i l recently she supported herself In an o f f i c e job, but now has to seek f i n a n c i a l aid which has upset her. The caseworker said she was interested i n leathercraft as a hobby, and would perhaps enjoy voluntary jobs i n the o f f i c e as she was a good t y p i s t . The groupworker co-operated by w r i t i n g a personal note to Mrs. Hurd i n v i t i n g her to c e r t a i n groups and explaining a l i t t l e about the Neighbourhood House. For s i x weeks no word was heard from the c l i e n t ; then she appeared at an evening meeting. She was introduced to the group's President and other mem-bers, she expressed a l i k i n g f o r the group and promised to return but f a i l e d to do so. Invitations to meetings and to a Christmas Dinner were sent but there was no response. Then two months l a t e r , she again attended and seemed more relaxed. She became a member of the club and payed her dues. She continues i n the. group, quiet and r e t i r i n g but much happier. This c l i e n t , used to "independence", required con-siderable time to prepare herself for regular attendance. Had the casework contact continued, i t i s possible that she could have been helped to overcome her reluctance sooner, though any attempt to push or urge the c l i e n t into the groupwork s i t u a t i o n probably would have marked the f a i l u r e of the r e f e r r a l . In addition to meeting her group needs, the group-worker had to see her as an i n d i v i d u a l . The background data contributed towards an understanding of her. In another type of s i t u a t i o n , nothing more than the b r i e f e s t mention of the family picture was necessary i n order for the groupworker to indicate suitable groups for the children. 27 Case 4 Mrs. Bryant spoke to her caseworker regarding her children's needs f o r recreation. She and her family are l i v i n g i n the center of town i n a h o t e l , awaiting the completion of t h e i r own house which Mr. Bryant i s working on. The caseworker made an appointment for her with the groupworker at a Neighbourhood House and at t h i s time she discussed the needs of the chi l d r e n , giving their ages, names, sexes and i n t e r e s t s . The groupworker s a t i s f i e d himself that there were no other problems outstanding, and said he would welcome the children on the stated days. The children came as planned and enjoyed t h e i r a c t i v i t i e s . There was no necessity for an elaborate s o c i a l h i s t o r i e s , or fo r background data. More complete planning and careful s e l e c t i o n of a group w i l l be necessary when the case offers other complexities. Yvonne Rougier was referred from the C h i l d Guidance C l i n i c to the Y.W.C.A. and a very complete s o c i a l history was a v a i l -able and necessary. Case 5 Yvonne i s a g i r l of 1 9 , second c h i l d of the family. She received b i r t h i n j u r i e s r e s u l t i n g i n her lack of f i n e r muscle co-ordination. Other stigmata observed were irr e g u l a r teeth, rather flattened features, some s l u r r i n g of speech and a rather spastic g a i t . Her s i b l i n g s are of normal development. She i s neat and accomplished i n s o c i a l amenities of meeting people, but since she was unable to adjust to school routines she had private t u i t i o n and reached grade 9 l e v e l . In addition she enjoys reading, i s Interested i n music and has developed into a strong swimmer at the family's lake camp. The caseworker thought that Yvonne could be helped to a more mature l e v e l of development through group a c t i v i t y ; hence the r e f e r r a l was made. She said that the family attitude to Yvonne showed an over-protective, c o n t r o l l i n g mother, while the father was more accepting and had a good rel a t i o n s h i p with her. Both the s i b l i n g s , p a r t i c u l a r l y the older son, had a good understanding of her condition. The family attempted to include her i n planning around the home. 28 Here the c l i n i c caseworker made the i n i t i a l request to the Personal Counsellor at the Y.W.C.A. Information was recorded on the Referral Form and submitted at the time the r e f e r r a l was accepted. Later the caseworker (Counsellor) at the Y.W.C.A. supplemented t h i s information through conference and also through separate interviews with Mr. and Mrs. Rougier. The groupworker of the Program Department and the Counsellor drew up a tentative s o c i a l plan and shared some of the informa-t i o n regarding background with the group leader, who would have Yvonne i n a group. C l e a r l y , the range of background information available varies from case to case. The information needed depends on the p a r t i c u l a r needs of the i n d i v i d u a l . Caseworkers have often been protective of the information they present to groupworkers, and r i g h t l y so, since i n the past, and to a less degree i n the present, a groupworker was often^ajiperson who would be unprepared to use such case history material. As they deal with professionally q u a l i f i e d and experienced group-workers t h e i r fears regarding misuse of confidential' material would be unfounded. However, i t must be stressed that often detailed case history material i s not required i n order to develop a good r e f e r r a l . The fact that a caseworker may f e e l he w i l l v i o l a t e the co n f i d e n t i a l nature of some of the informa-t i o n he possesses by submitting i t to an untrained group leader i s no excuse for not offe r i n g as much help,support and background information as he can to assure a successful r e f e r r a l . Caseworkers themselves have often been g u i l t y of drawing from 29 the c l i e n t much information which i s r e a l l y irrelevant to the c l i e n t ' s problem. There has been no focusing. The epoch i s over i n which the caseworker sat back and permitted the c l i e n t to ramble on about his l i f e h i s t o r y . Indeed, i t i s known that a c l i e n t may very well use Interesting h i s t o r i c a l / material i n the service of resistance. It would be a mistake to believe that the more background data which could be co l l e c t e d , the better the r e f e r r a l could be made. Knowing t h i s , some caseworkers have eschewed the use of forms on which to record c e r t a i n background data, believing they would lead to stereotyped, mechanical r e f e r r a l s . Yet i t i s not the presence or absence of the form which would deter-mine the qu a l i t y of the r e f e r r a l . True, some caseworkers or groupworkers might f i l l i n a form and believe they had therein f u l f i l l e d t h e i r function. This would be unfortunate. The use made of the form, and the desire by both workers to use informa-t i o n contained on i t to f u l l advantage for the c l i e n t are more s i g n i f i c a n t determinants of the qu a l i t y of r e f e r r a l s . Use of the A c t i v i t y Group to Meet Client's Needs In any group, the need f o r approval and the consequent fear of f a i l u r e or r e j e c t i o n come prominently into play. For those individuals whose s o c i a l relationships have been unsuc-c e s s f u l , or whose group p a r t i c i p a t i o n has been minimal,the a c t i v i t y group offers a form of group p a r t i c i p a t i o n not too threatening. The group member may work i n almost complete " i s o l a t i o n " or may attach himself to another (perhaps the leader) or may become, himself, the objective of another 30 member's f r i e n d l y overtures - a l l t h i s , i n accordance with his own readiness to enter such relat i o n s h i p s . Some " i n t e r e s t " groups have as th e i r sole aim, the perfection of a pa r t i c u l a r s k i l l - l e a t h e r c r a f t , w h i t t l i n g , puppetry - " . . . i n which case i t i s a matter of chance whether membership i n the group w i l l be h e l p f u l . . . " 1 ^ to the s o c i a l l y retarded or withdrawn person. The s k i l l e d groupworker should be able to arrange a c t i v i t i e s and situations so that not only i s the a c t i v i t y , per se, furthered, but also the s o c i a l s k i l l s of the members. Case 6 Olive's childhood has been extremely deprived. Much of the time she was l e f t alone, to provide f o r herself. At the insistence of a missionary she was placed i n a home, but made a poor adjust-ment. L i t t l e more of her childhood was known. Now, being picked up on a charge of vagrancy, she came to the attention of the Y.W.C.A. Personal Counsellor, since she was referred to the Agency Residence. It was suggested that she j o i n some group a c t i v i t y . The Counsellor agreed but i n view of her probable lack of group experience, and her poor personal adjustment an interest group was considered appropriate. The Counsellor took advantage of the g i r l ' s birthday to purchase some art supplies for Olive, and following t h i s the g i r l came d a i l y to the club room to work. The recreation leader became acquainted with Olive and some time l a t e r observed that she was experimenting with poster paints. U n t i l t h i s time, her only relationships were with the Counsellor and with the recreation worker. Later i n the spring, she made her f i r s t expression of a f f e c t , i n that she wanted to j o i n a leathercraft club which was forming. 15 Gertrude Wilson: Groupwork and Casework. New York, Family Welfare Association of America, 194-1, pp 6 7 - 6 8 . 31 During the summer and f a l l , she continued to see the Counselor on a f r i e n d l y basis and i t was noticed that she made several attempts to form friendships, i n residence, the f i r s t being with a lame g i r l , the next with an even more severely handicapped g i r l and the l a t e s t with a Negro g i r l . The groupworker believed that Olive's needs could be met w i t h i n the group set t i n g but doubted her readiness to progress from an A c t i v i t y group to a friendship group. Such a group demands a great deal from i t s members. A person with character disorders, such as Olive, would be unable to break through the strong inter-personal t i e s , or co-operate i n group plans and decisions which would be required of her by the members. Meanwhile she remained i n the leath e r c r a f t group. During a l l t h i s time the Counsellor "maintained f r i e n d l y relationship with Olive", and Olive c a l l e d i n occa-s i o n a l l y "to chat" with the Counsellor. There was l i t t l e recorded evidence to suggest that the Counsellor was able to form an Intensive r e l a t i o n s h i p with Olive. The record continues: Then i t was learned that a l l g i r l s In residence had been Invited to a club party. Olive was the only one who responded. She thoroughly enjoyed herself i n some of the games and spontaneously joined i n the dancing. The President of the club took an Interest i n her and planned to encourage her to j o i n . This case i s primarily of interest as an example of Olive's growth with i n the framework of an a c t i v i t y group 32 and how her changing needs were met. However, some general observations are pertinent. Since l i t t l e of Olive's background i s known i t i s necessary to accept at face value the c r i t e r i o n of "improvement" as i t was defined i n a statement In the record which says Olive learned to "lose herself In pre-occupation with s o c i a l a c t i v i t y " . Some changes were also brought about i n the g i r l ' s character; i n her personal appear-ance, her s o c i a l r e l a t i o n s h i p s , and i n the fact that she applied for, and kept a job. It i s pertinent to ask "how basic were these changes?" and was there "...a r e a l change or a pseudo-improvement i n the service of r e s i s t a n c e . . . " 1 ^ which may have only group-limited s i g n i f i c a n c e . Further d i f f e r e n t i a t i o n must be made to d i s t i n g u i s h "...changes i n attitudes toward the group as compared to changes i n attitudes through the group... h 1 7 . It seems that the Counsellor bent her e f f o r t s to consider the present s i t u a t i o n , e l e c t i n g to leave undisturbed the roots of the problem. I t i s not intimated that a very necessary function was not served i n t h i s course of action, since the actual problems of the moment were indeed r e a l . In some cases the necessary corrective emotional experience can be given almost exclusively i n the group s e t t i n g , or with a minimum of support i n face-to-face r e l a t i o n s h i p . Alexander states: "This new corrective experience may be supplied by 16 F r i t z Redl: "Problems of C l i n i c a l Groupwork with Children", Proceedings of the Second B r i e f Psychotherapy Council. Chicago, Jan. 1944, p. 35. 17 l o c . c i t . 33 the transference r e l a t i o n s h i p , by new experiences i n l i f e , or 18 by both." "By both" i s the c r i t i c a l phrase as applicable to the case of Olive, since i t i s doubtful that change could be expected from the use of group experience alone. However, i n the Y.W.C.A. set t i n g , the casework relationship i s subject to fewer of the necessary controls, since the caseworker i s located i n the informal framework of a leisure-time agency. In t h i s case, It i s probable that r e f e r r a l of the g i r l to another casework resource would be the plan of choice. However, d e f i n i t e answers to these unknowns l i e i n further study. To what degree can intensive casework treatment be carried by the Counsellor In the Y.W.C.A. setting? How do fundamental personality changes occur, to what depths do they extend and under what conditions are they f a c i l i t a t e d when treatment i s l i m i t e d to the group setting? It i s l i k e l y that through the experience of group p a r t i c i p a t i o n alone,some improvement i n s o c i a l adjustment would be seen, but the crys-t a l l i z e d symptoms would remain. Further investigation i s needed on t h i s point. Cl i e n t ' s previous Group Experience -a Factor i n Meeting His Needs In meeting a c l i e n t ' s needs the groupworker w i l l want to know about previous attempts and f a i l u r e s to adjust through group a c t i v i t y . He w i l l ask: How i s the c l i e n t l i k e l y to express himself i n the group? How secure has he been i n his 18 Ffanz Alexander and Thomas French: Psycho-analytlc Therapy. New York, The Ronald Press Co., 1946, p.22 3 * relationships otherwise? Is he l i k e l y to be aggressive or r e t i r i n g i n his behaviour i n the group? What would the caseworker suggest as a means of helping him to use h i s c a p a b i l i t i e s ? I f he i s at home, what has been the parents' attitude to his group participation? The case of Yvonne Rougier i s again i n t e r e s t i n g here since she was a g i r l with a physical deformity, who had f a i l e d to adjust to both public and private school s i t u a t i o n s , despite demonstrated academic a b i l i t y and whose mother was c o n t r o l l i n g and over-protective. Case 5 During the f i r s t weeks Yvonne attended a l l meetings of the club where she was w e l l accepted by the members, yet she has not made an adjustment to the group as a whole. She has, however, developed a very close friendship with another club member, Constance. The admiration and dependence i s r e c i p r o c a l . This Is the f i r s t i n d i c a t i o n that t h i s g i r l can relate meaningfully to another g i r l . The s o c i a l plan f o r Yvonne indicated that although she had had a deprived l i f e s o c i a l l y , she was to be i n t h i s Teen-Age Supper Club on a t r i a l basis, and i f t h i s proved successful she was to be helped to move on to more adult l e v e l s . She engaged i n other a c t i v i t i e s during the winter such as a swimming class and a dancing c l a s s . Yvonne took an increasingly active part i n group a c t i v i t i e s to the point where i t was necessary for the group-leader to exercise some control. Gra-dually she became more assured of herself i n the group, and though the others, while accepting her, realized her to be d i f f e r e n t and indulged In some kidding, Yvonne did not take t h i s as a threat and joined i n the laugh. 35 This period was characterized by the "crush" with Constance and by a type of hero-worship of the gym instructress who taught the dancing c l a s s . However, one day Yvonne revealed to the Counsellor that she did not see as much of Constance, since "she had three or four other friends now". Later s t i l l , she was able to screw up her courage to ask another g i r l I f she could eat lunch with her, following the swim cl a s s . Yvonne i s now better prepared for constructive and easy relationships i n a more mature group - the swimming c l a s s . She shows a development from the e a r l i e r , c l o s e r e l a t i o n s h i p with Constance when she was f e a r f u l of being hurt, rejected or discovered for what she believed she was. The groupworker believes Yvonne has the p o t e n t i a l i t i e s to develop further but thinks t h i s cannot be achieved i n a group s e t t i n g . In her report she stated: I do believe i t ean be done through i n d i v i d u a l contact coupled with other outside s a t i s f a c t i o n s such as recognition achieved through some a c t i v i t y or employment. r She thus indicates the need for further casework-groupwork co-operative work with an i n t e n s i f i c a t i o n of the casework treatment. Achievement of the tentative goals of the s o c i a l plan was through cl o s e l y co-ordinated team work i n which the Child Guidance C l i n i c caseworker continuously contacted the parents and interpreted to them the g i r l ' s need for greater independence. L i a i s o n was maintained between the C l i n i c caseworker and the Counsellor, and,of course,between Counsellor and groupworker. Through c a r e f u l l y graded steps t h i s g i r l , who had had l i t t l e group experience of a successful nature and through maternal 36 over-protection "has been under-functioning, even for her li m i t e d a b i l i t i e s " , was helped to accept her l i m i t a t i o n s , to par t i c i p a t e i n group a c t i v i t i e s , indeed to make a notable ad-justment to l i f e , through the group process. I f a group i s c a r e f u l l y selected for the c l i e n t to meet his c h a r a c t e r i s t i c type of group-behaviour, much can be accomplished. Close co-operation with the caseworker i s necessary. I f the caseworker merely absorbs some of the parental h o s t i l i t y , which would otherwise be vented on the c h i l d , he i s performing a very worthwhile job. c) Method of Establishing the Referral How i s the process of r e f e r r a l to a groupwork agency commenced? It i s not possible to generalize, since In some cases the worker may make the suggestion and i n Others the c l i e n t requests information. Many other variables must also be heeded. A number of situations w i l l be describedi Case 2 McPherson, a c l i e n t at the Family Agency, sought housekeeper service for his f i v e children. The caseworker's role was l a r g e l y one of working with the father and helping him to use resources to manage his home since his wife had died. The father was now looking toward the summer holidays when the children would be unsupervised much of the day. The worker suggested that the childr e n who ranged i n age between seven and twelve years might enjoy a Day Camp at one of the' Neighbourhood Houses. He gave a b r i e f explanation of the service and the regulations. Mr. McPherson said he was interested. Ten days l a t e r , Mr. McPherson stated that the children had made t h e i r own application to camp, and were enjoying i t . I t was not necessary for the caseworker to discuss the s i t u a t i o n i n d e t a i l with the groupworker since a l l camp groupings were made at time of intake. The caseworker continued to see the father, and at times discussed with him ways of handling the children i n r e l a t i o n to the camp s i t u a t i o n . 37 This ease i l l u s t r a t e s good c l i e n t capacity for I n i t i a t i n g the r e f e r r a l . Often the caseworker may under-estimate t h i s a b i l i t y i n t h e c l i e n t and may venture to control the s i t u a t i o n too r i g i d l y , as Is seen i n the next case. Case 8 The caseworker spoke to Mr. and Mrs. Blackston " about the f a c i l i t i e s of the Neighbourhood House i n th e i r d i s t r i c t . Although Mrs. B had heard of the agency, Mr. B was amazed that such a place existed and said he was interested. The worker promised to obtain a schedule of a c t i v i t i e s f o r them. Here the worker, despite the marked interest shown, wishes to guide t h i s s i t u a t i o n herself and l a t e r , when i n discussion with the groupworker, the l a t t e r suggested that a volunteer be sent to the Blackston family to t e l l them of the groupwork agency, the caseworker acquiesced. The caseworker made no other follow-up at t h i s time, but a month l a t e r , received a c a l l from the groupworker to report that the volunteer had v i s i t e d Mrs. B, had been appalled at their l i v i n g conditions, much concerned at Mrs. B's story of misery and had offered to help her with her medical expenses. Use of volunteers by the groupwork agency to Intro-duce to a prospective member the types of a c t i v i t i e s at the agency, should be attempted with discrimination. In t h i s case the relationship was not disturbed, but an unexpected response by the volunteer may unfavourably dispose the c l i e n t towards the agency, or may i n some way arouse anxiety. When a parent Is i n casework treatment, and the caseworker wished to refer the c h i l d , he must be guided i n timing the suggestion by considerations of the phase of 38 treatment. I f the parent i s needing to control and punish the c h i l d and the caseworker suggests r e f e r r a l to groupwork, success i s improbable, whereas i f the parent has shown some improvement i n her attitude to the c h i l d (a l a t e r phase i n treatment) the r e f e r r a l w i l l not be so d i f f i c u l t . On the other hand a worker should not make the mistake to see i n a parent's sudden willingness f o r the c h i l d to be referred to a group, a wholely praiseworthy at t i t u d e . Even a genuine request for help may not mean that the parent i s ready to accept i t . A parent may be " w i l l i n g to do anything" - except participate In t r e a t -ment himself. Further, for many parents the very need to resort to help i n bringing up one's c h i l d carries with i t a burden of g u i l t , and fear that the "cost" ( i n emotional invest-ment) may be too high. Case 2 Mrs. Stevens indicated to the school nurse that she required help i n rearing Roberta, aged eight. She admitted that perhaps she had "brought her up a l l wrong". The nurse t o l d her of casework help and the mother expressed willingness to apply at the desig-nated agency. In the f i r s t appointment with the caseworker, Mrs. S. said she did not know where to start and requested the worker to ask her questions. Later, the mother said that Roberta was "backward, unhappy, hard to d i s c i p l i n e and f r i e n d l e s s " , although at times she showed surprising insight into the child's behaviour. The mother stated she "was glad there was someone to help" and remarked that she would bring Roberta to the o f f i c e . The worker permitted t h i s . This was probably a s h i f t from the proper focus i n treatment since i t permitted the mother to project her g u i l t to the c h i l d , and implied that the caseworker agreed that the c h i l d was the one needing treatment. The mother's resistance to 39 treatment and re j e c t i o n of, (but need to control) the c h i l d was graphically demonstrated i n the next interview. The appointment was for 10:30 a.m. At eleven o'clock, Mrs. S. phoned asking what time her appoint-ment was f o r . She was t o l d , expressed deepest regret fo r the mistake and said she would come at once, bringing Roberta. The caseworker talked b r i e f l y with the mother, then saw Roberta, who expressed an interest i n a r t . Roberta also remarked that she had many friends (whose names and birthdates she enumerated) but that she never played with them. The worker saw that t h i s c h i l d could p r o f i t from a group experience and asked her i f she would l i k e to go to an art group at a Neighbourhood House i n her d i s t r i c t . Roberta was immediately interested and said some of her friends from school went. At the conclusion of the interview the worker again saw Mrs. S, who anxiously asked i f the child's v i s i t did not "bear out" what she had said about her. A number of interviews with the mother followed. Once the mother offered "to take Roberta to the group the f i r s t time". She then brought up the matter of the family's moving to another d i s t r i c t and spoke of terminating treatment. She l a t e r said that she had decided not to permit Roberta to attend the group, "since i t would be for only a short while before we move". The worker urged her to l e t the c h i l d go, even i f i t was only for a month. Mrs. S. did not return. Six months l a t e r , the caseworker learned that the family did not move, and he therefore made a home v i s i t . At th i s time, Mrs. Stevens claimed Roberta "had marvellously im-proved" and offered to fetch her so the worker could "see". She added furthermore that " s h e , s t i l l goes to the group occasionally and now finds i t much easier to make friends". On the contrary, the school reported she was continuously l a t e , performance J 40 unimproved and she was unable to j o i n i n group a c t i v i t i e s . The groupworker reported that on the few occasions when Roberta had attended she had always been on the fringe of the group. Sometimes her behaviour had been close to h y s t e r i c a l : on one occasion she had locked herself i n the washroom and had had a screaming tantrum. Here was an attempt at co-operative casework-groupwork treatment, with wrong emphasis. Apparently, the worker f a i l e d to see the resistances to Roberta's r e f e r r a l as evidences of the mother's own re j e c t i o n of treatment and the consequent need to work with the mother herself. In another case (Case 10), a neurotic father, who returned frequently to a Veteran's hospi t a l for medical tr e a t -ment, applied to a Family Agency for "l e g a l a i d " . Since his problem could not be solved at a s o c i a l agency, the father then said that he wanted his daughter to have a " l i t t l e s o c i a l l i f e " . The father was t o l d about the Neighbourhood House. The case-worker made a phone c a l l to the groupworker saying he had "referred" the adolescent g i r l to a group. He then closed the case. Needless to say, the c h i l d did not follow through. It could w e l l be on the basis of such s c a n t i l y planned " r e f e r r a l s " that groupwork agencies come under f i r e from caseworkers with such c r i t i c i s m s as "a c h i l d referred to groupwork, becomes l o s t i n the agency". It i s not always a matter of the c h i l d becoming l o s t ; It may be a question of the child's never a r r i v i n g at the agency, since there i s a none too clear d i v i s i o n of r e s p o n s i b i l i t y between workers. 41 d) D i v i s i o n of Besponsibilltv between co-operating workers The precise factors which ensure success i n r e f e r r a l s are not known. Sometimes the parent i s "untreatable" from the standpoint of casework and f a i l u r e arises at t h i s point. In an experimental program, some r e f e r r a l s f a i l e d despite c a r e f u l l y l a i d co-operative procedures. "The number of children who are referred and never appear, or who drop out after a few meet-ings, would suggest the need for some improvement of practice at t h i s p o i n t . " 1 9 An extreme case w i l l i l l u s t r a t e the point. It i s possible that Fred, aged 21, diagnosed schizophrenic, would never be able to be at ease i n a s o c i a l setting unless i t was through steps c a r e f u l l y graded i n complexity. He was on proba-t i o n from the P r o v i n c i a l Mental Hospital, and was referred to a Neighbourhood House. Case 11 The caseworker f e l t Fred should participate i n r a c t i v i t i e s with young people. Since he had shown interest i n music and dancing, i t was suggested that a casework-groupwork conference be arranged to plan the r e f e r r a l to a suitable group. At t h i s conference, the groupworker spoke of a dance group i n which a number of members of the planning committee could be r e l i e d upon to accept him as "a lonely young man". I f , after v o l u n t a r i l y coming to the dance Fred enjoyed i t , he could con-tinue. The caseworker would prepare him for the type of group i t was and would t e l l him his v i s i t was to see i f he l i k e d i t . The groupworker was to prepare ce r t a i n members for Fred's a r r i v a l . Fred arrived, enjoyed himself, helped around the dance f l o o r a l i t t l e , and continued to attend the group. He seemed to attach himself cl o s e l y to the groupworker and to need her support. She, of course, was unable to give him such attention as he demanded. 19 Margaret Svendsen and Dorothy Spiker: Integration of  Casework and Groupwork Services f o r Children. State of I l l i n o i s , p. 19 42 Contacts between caseworker and groupworker during the f i r s t two months were numerous and f r u i t f u l for both workers. The caseworker continued to work with Fred and his family. Then, for no apparent reason, he stopped coming to the group. It was subsequently learned that he severed his connection with the group coi n c i d e n t a l l y with the time the caseworker dropped his case "due to pressure of other cases" and because the family s i t u a -t i o n was "untreatable". With f u l l recognition of the pressures of the caseworker, f a i l u r e of t h i s r e f e r r a l was a function of discontinuing case-work treatment. Even i f the caseworker decided the family was not amenable to casework and the boy, Fred, occupied too much time, her withdrawal from the s i t u a t i o n should have been a joi n t casework-groupwork decision. In co-operative cases i t i s the r e s p o n s i b i l i t y of each worker to n o t i f y the other i f any J change or modification i n approach i s contemplated. Preparation of a c h i l d for a group i s the responsi-b i l i t y of, the caseworker. In one program, p a r t i c i p a t i o n i n a group was presented as a " p r i v i l e g e rather than as treatment for t h e i r problems". In another instance the group was "...an opportunity for following t h e i r interests and having 20 fun," and th i s interpretation stemmed from the g i r l ' s expres-sion of a desire f o r , but i n a b i l i t y to have normal s o c i a l contacts. In a t h i r d program, motivations for joi n i n g a group 21 were " s o c i a l hunger" and the group was presented as an opportunity to make friends and est a b l i s h s o c i a l relationships. 20 P.L. Axelrod, M.S. Cameron and J.C. Solomon: "An Experiment In Group Therapy with Shy Adolescent G i r l s " , American  Journal of Orthopsychiatry, v o l 14, October 1944, p. 617 21 Betty Gabriel: "Group Treatment f o r Adolescent G i r l s " , American Journal of Orthopsychiatry, vol 14, October 1944, p. 596 43 Once the c l i e n t i s established at the groupwork agency, the task of continuing the joint-agency relationship does not cease. At t h i s point, d i v i s i o n of r e s p o n s i b i l i t y for service to the c l i e n t i s of paramount importance. Confusion arises "...because workers lack c l a r i t y regarding their own responsi-22 b i l i t y and that of other workers..." In case 7, Mr. McPherson understood both the reason for r e f e r r a l and,that h i s casework relationship was a continuing one. It was very clear i n t h i s case since the agency provided the housekeeper. The caseworker on the other hand understood her r e s p o n s i b i l i t y for continuing treatment, and added to the problems of treatment was the one of the children's adjustment In the camp. The groupworker's report to the caseworker at the end of the camp period was used to interpret to the father some of the children's needs. In case 11 (Fred), the plan worked while the caseworker continued treatment. Following his withdrawal, the groupworker and other members attempted to contact Fred, without his being able to return. The supportive casework treatment was essential to the working of the s o c i a l plan. In the case of Mrs. Blackston (case 8)* casework and groupwork have continued t h e i r respective functions.oyer a two-year period. Mrs. B. and her younger son continued at the Agency, enjoying th e i r respective groups. When i t became evident that Mrs. B. would withdraw from her group because her marginal income did not permit payment of fees, the caseworker and the groupworker again co-operated to obtain payment. Despite the 22 Elizabeth P. Rice: "Co-operative Casework", Journal of  So c i a l Casework, vo l 18, July 1937, p. 166 44 i n i t i a l setback due to the involvement with the volunteer, t h i s case i l l u s t r a t e d the value of continued long-term co-operative planning. Maintaining the mother's interest had meant a more wholesome home. In another case a mother wished help with her young son who, upon examination, proved to be of borderline i n t e l l i gence. Case 12 Following the psy c h i a t r i s t ' s suggestion, Bobby was referred to the Nursery School of the Neighbour-hood House. Although he did not f i t into the group too w e l l , he l i k e d i t and seemed to improve. His speech habits were better, his former fussiness over food diminished. For a two-year period the caseworker continued to see the mother, who became more able to accept B's l i m i t a t i o n s . At the close of Nursery School at the end of the second year, she herself applied to enter him i n the Day Camp of the Neighbourhood House, and appeared less tense and anxious. She showed considerable a b i l i t y to plan. Careful co-operation produced marked improvement i n t h i s d i f f i c u l t case. Summary Type X r e f e r r a l was approached from two d i r e c t i o n s : c l i e n t readiness for group a c t i v i t y and worker's j o i n t functions In the process. Regarding the f i r s t , s i x theore t i c a l stages of a child ' s readiness were named and applied to the case material. In addition, a worker must view parental attitude to the refe r -r a l as a fact o r , c r u c i a l to the outcome. The parent has his-own needs (often opposed to the c h i l d ' s ) , and the caseworker must treat him separately, In his own rights with his own in d i v i d u a l problems. 45 The second focus was the j o i n t - s t a f f conference -a means of effecting I n i t i a l planning and periodical review and re-evaluation of the process. Four areas which were { \J considered were: 1) C o l l e c t i o n of background data: the type of case must dictate what data was c o l l e c t e d . It was stressed that a com-plete s o c i a l history i s not essential f o r a successful r e f e r r a l . 2) The needs of the Individual: These w i l l be disclosed i n the background data. When needs were complex, more informa-t i o n , planning and s k i l l were required; minimal planning was s u f f i c i e n t for an uninvolved case. 3) Establishing the r e f e r r a l : The function of workers co-operating i n the process was to discover and reduce any forces threatening the r e f e r r a l . The caseworker must work with the parent to ensure his willingness and continuing support. 4) D i v i s i o n of Responsibility: The team of workers i n a r e f e r r a l process must combine t h e i r a c t i v i t i e s w i t h i n the framework of a single service. I f one worker modifies or stops an a c t i v i t y without a l e r t i n g the other, he has f a i l e d to function co-operatively i n the process. r 46 Chapter Four REFERRAL FROM A SOCIAL GROUP TO CASEWORK TREATMENT Referrals of an indi v i d u a l from his group to the resource of casework have been few. Indeed, i t i s a curious phenomenon that "...caseworkers use the f a c i l i t i e s and services of groupwork to a far greater extent than groupworkers ask for aid from casework agencies. " 2 3 Aside from the greater complexi-t i e s i n Type Y r e f e r r a l process another h i s t o r i c a l factor i s important i n explaining t h i s condition. In the past, s o c i a l agencies offering leisure-time a c t i v i t i e s have been l a r g e l y concerned with program, and their s t a f f s (among whom there are s t i l l many p a r t i a l l y trained workers) were often unprepared to recognize problems of Individuals. Type Y r e f e r r a l process i s discussed here from the viewpoint of the functions of the groupworker and how they l i m i t the development of intensive relationships i n the group-work process; the use of c o l l a t e r a l agencies as resources; and the types of problems needing casework treatment. The necessity for joi n t casework-groupwork s t a f f conferences i s then set f o r t h . E n l i s t i n g the parent's co-operation and meet-ing his own needs i s discussed a s ^ i t relates to t h i s kind of r e f e r r a l . 1 Function of the Groupworker The groupworker today, on the basis of his knowledge of s o c i a l conditions and community r e l a t i o n s , "...contributes 23 Gertrude Wilson: Grouowork and Casework, op.cit., p. 84 47 to the group with which he works a s k i l l i n leadership which enables the members to use th e i r capacities to the f u l l and to create s o c i a l l y constructive group a c t i v i t i e s . " 2 4 His function is thus c l e a r l y defined as helping people towards personal development, by enabling them to experience s a t i s f y i n g group rel a t i o n s h i p s . Such relationships exist d i f f e r e n t i a l l y i n the groupwork process and may be found within the group, between groups i n the same agency and leading out into society. 2 Limits to Forming Intensive Relationships i n the S o c i a l Group The groupworker must face the problem of the nature of his r o le with the group, es p e c i a l l y as i t l i m i t s the formation y of intensive relationships with members i n d i v i d u a l l y . In case-work treatment, the worker accepts an Individual for treatment on the basis of a stated problem, helps him, through casework process and the resources of the agency, to meet the s i t u a t i o n i n a r e a l i s t i c manner. When some of the c o n f l i c t of the s i t u a -t i o n i s reduced, If and when s p e c i f i c goals In treatment have been attained, he terminates the process. Though i n the group-work process relationships between groupworker and i n d i v i d u a l member do develop, and i n some instances the groupworker w i l l " . . . f i n d himself engaged i n a treatment rel a t i o n s h i p with members,"25 he should remember that he i s giving help to a person as a, member of a group. The groupworker 1 s major function, and the purpose of the group should not be l o s t sight of. Show-ing an in d i v i d u a l interest i n group members i s "...separate and 24 " D e f i n i t i o n of Function of the Groupworker", a Statement of the American Association of Groupworkers, November 30 , 1948 25 Gertrude Wilson: Groupwork and Casework, op.cit., p. 54 48 d i s t i n c t from dealing with individual problems of therapy" as i n casework treatment. In the following s i t u a t i o n the groupworker i s able to meet the request f o r help as i t relates to a member's group functioning. Case 13 Maryanne, President of her club, made di d a c t i c and patronizing suggestions which were a l l rejected by the members. Following the meeting she and the groupworker were putting the room i n order when suddenly Maryanne exclaimed with obvious anxiety, "Miss Glsen, what's wrong with me? I can't seem to get anywhere with the g i r l s i n t h i s club." The groupworker recognized M's needs to dominate and control, but r e a l i z e d her intense desire to "make good" as President of the club and to have her suggestions accepted. She discussed these needs, r e l a t i n g them always to the s i t u a t i o n i n the group. In such discussions, a groupworker would not uncover deeper problems since i f he showed permissiveness i n allowing the c h i l d to t a l k of these matters the rela t i o n s h i p might l a t e r grow to proportions which could not be handled In the group process. When the group member shows need to discuss d e t a i l s of a problem which r e l a t e to his personal or family r e l a t i o n -ships, f o r instance, he should be t o l d of the resources where to obtain help. An intense groupworker-member rel a t i o n s h i p may encourage the member to become over-dependent on the worker, to be defiant towards him or unable to share him with other group members. Thus a s i t u a t i o n of intense r i v a l r y could be created wherein both the leader's and the member's status would be uncertain. The d i f f i c u l t i e s are not Insurmountable, however, 26 H.B. Moyle: "Some Psychiatric Comments on Groupwork", The Group, v o l . 8, January 1946, p. 1 49 and the groupworker needs to be aware of the forces with which he i s dealing. Case 14 i l l u s t r a t e s some of the p i t f a l l s to be avoided. Case 14 The leader of older g i r l s 1 club was c a l l e d l a t e one Sunday night by a member who anxiously said that Joyce, a fellow member, " i s upset and has been locked i n her room a l l day, crying". The purported reason was that Joyce's landlady had forbade her to play her v i o l i n . Joyce was almost b l i n d and t h i s her only recreation; thus a serious l i m i t a t i o n was imposed. When the groupworker was also informed that Joyce had threatened s u i c i d e , she offered to come to t a l k with her. The other member said t h i s was unnecessary, and the telephone conversation ended. Five minutes l a t e r , Joyce herself c a l l e d and seemed i n a rather indignant mood, but i n the course of conversation again threatened suicide to the groupworker " i f things didn't improve". She requested the groupworker to phone her again the next day. The worker agreed to do t h i s . During the phone conversation on Monday, Joyce said she would l i k e to t a l k to the leader " i n private" before the group met on Tuesday night. The worker agreed to be at the Neighbourhood House one hour e a r l i e r . On t h i s occasion, Joyce poured out many d e t a i l s of her l i f e - her d i f f i c u l t i e s with her eyes and with her ears, d e t a i l s of a money-raising drive for her benefit to send her to a s p e c i a l i s t i n Philadelphia, and how she had turned t h i s money "over to ch a r i t y " , the type of job she had, her family hi s t o r y . As i t was then approaching the time for the commence-ment of the meeting, the leader terminated the discussion, saying she would help Joyce to obtain a new room where she could practise. It was perhaps unfortunate that the worker offered to do t h i s , for thereafter Joyce put a l l her contacts with the leader on the basis of, "Did you f i n d an apartment for me?" That week Joyce c a l l e d the leader i n the evening on three 50 occasions. Once the leader encouraged her to enquire at a Rental Agency, but Joyce r e p l i e d that she was a f r a i d to go alone (she i s a woman of t h i r t y ) . In many other ways she indicated her extreme dependence, hidden h o s t i l i t y and i n a b i l i t y to carry through plans. The leader checked with the Social Service Exchange, and found no r e g i s t r a t i o n s . The record continued: The groupworker phoned Joyce t e l l i n g her she might use a room i n the Neighbourhood House to practise i n . Any day but Sunday she might have t h i s p r i v i l e g e ; however, Joyce said that Sunday was the very day she l i k e d to play. She thanked the worker for the o f f e r , but declined to make use of i t . She asked i f she might again t a l k to the leader before t h i s week's meeting. During t h i s conversation Joyce talked f or about f o r t y - f i v e minutes about her rooming arrangements. Then the other g i r l s started to arrive around eight o'clock and the discussion terminated. During the meeting following: Joyce shaded her eyes and put her hand to her forehead. The leader asked I f the l i g h t s were bothering her eyes to which Joyce r e p l i e d : "Don't bother about me, I'm a l r i g h t . " Later i n the evening some of the other g i r l s were planning to attend a concert together. Usually Joyce enjoyed going to such events with the others. Tonight she declined, making her eyes the excuse. On a number of occasions, the leader saw Joyce before the meeting and allowed her to t a l k In an uncontrolled, general fashion, about anything. On one of these talks Joyce mentioned the fact of her being "mentally t i r e d " and the leader picked t h i s out and said there were some people who made i t t h e i r business to understand such things. Joyce said she would l i k e 51 to go to such a person, "just once". Arrangements were made for her to v i s i t a p s y c h i a t r i s t . Following t h i s v i s i t , Joyce indignantly reported she "could not understand why he had asked her a l l about her family and whether she went on dates, since she wouldn't look at a broom i f i t had pants on - a l l they l i k e d to do was paw and mull around." She said she was perfectly happy as she was, i f only she could f i n d a place to stay. She then commented she had bumped into a man on the way to meeting that night, because she could not see him. This had s t a r t l e d both of them; i t had also made her nervous. The leader meanwhile contacted a casework agency and started making plans for a r e f e r r a l . This case i l l u s t r a t e d the method by which the group-worker formed a relationship with a member who was i n need of casework or psychiatric help. On the basis of t h i s r e l a t i o n -ship, the worker attempted to refer the woman to the appropriate agency. The d i f f i c u l t i e s inherent i n the process are cl e a r . In t h i s case, Joyce endeavoured to involve the worker i n her a f f a i r s ; she threatened the worker by hints of suicide and t r i e d to get a sympathetic l i s t e n e r . The worker may have been a l i t t l e anxious at the suicide threat (understandably so, since such threats should not be taken l i g h t l y ) and offered to perform c e r t a i n tasks for her. During the f i r s t few days, Joyce phoned the worker almost every day, and had two lengthy discussions with her. During t h i s period she developed a proprietory attitude towards the worker, expressed as she declines the members' i n v i t a t i o n to the concert. Rising hos-t i l i t y to the worker i s i m p l i c i t i n the reply to the worker's f r i e n d l y enquiry about Joyce's eyes. 52 It i s probable that the worker, not being sure how to control Joyce's free discussion of her personal a f f a i r s , permitted too much release of material. Joyce could thus obtain some g r a t i f i c a t i o n through t a l k s with the worker, her dependency needs were s a t i s f i e d p a r t i a l l y and c e r t a i n anxieties were drained away. It i s improbable that any damage was done, but i t i s also u n l i k e l y that the ta l k s were of much value. That Joyce i s "perfectly happy the way she i s " was a statement of her r e a l i t y ; she obtained many neurotic s a t i s f a c t i o n s and saw no need for change. It might have been more pro f i t a b l e for the worker to spend her time channeling Joyce's anxieties into a need for casework help. It i s obvious much s k i l l and experience are required here. 3 Use of C o l l a t e r a l Agencies as Resources for Information and Help In a worker's eagerness to help a disturbed c h i l d or adult through the group method, he may be imposing or asking for an impossible task. I f , for instance, a c h i l d has extreme fears (of children or adults) or i f he i s very insecure i n making relationships (despite how he reacts to his inse-c u r i t y , whether by dependency or defiance) he i s u n l i k e l y to p r o f i t from group experience. S u f f i c i e n t control of Impulses w i l l be lacking, and rather than integrate those inner impulses with r e a l i t y demands he w i l l suffer greater hardships. Group-workers, often baffled by a child's e r r a t i c and uninhibited behaviour, nevertheless t r y to toler a t e him i n a group, but to no a v a i l . Since they have taken to the practice of using the Social Service Exchange, they have been aware of other services which may already be helping the family, or with advantage might 53 be c a l l e d i n . When a c h i l d or parent may, at l e a s t , be offered some alternative service, the groupworker i s not faced with the intolerable task of having to prohibit a ch i l d ' s atten-dance i n a group. I f through r e g i s t r a t i o n at the Exchange, the leader can f i n d another agency previously or currently active with the family, there Is a bridge to valuable co-operation. A study i n Hartford, Connecticut, found that 52 percent of the members of two leisure-time agencies came from families registered at the Social Service Exchange; 38 percent 27 of the Boy Scouts came from families so registered. Here was a tremendous unrealized opportunity for co-operation and for economy i n the use of resources and s k i l l s . It i s not suggested that a l l members of a Neighbourhood House be registered indiscriminately at the S o c i a l Service Exchange, but when an indi v i d u a l problem does a r i s e , t h i s resource should be u t i l i z e d . It i s further suggested that one worker at the agency be made responsible for making a l l Exchange clearings. 4 Types of Problems Needing Casework Treatment The v a r i e t i e s of behaviour responses which.may require help from the groupworker with a view towards.referral to another resource are great. Although at ce r t a i n times groupworkers have been c a l l e d upon to work with individuals showing Insatiable drives for dominance, extreme p a s s i v i t y , 27 From a lecture delivered at the Y.W.C.A., Vancouver, B.C. by R. Osbourne, Soc i a l Service Secretary, 1941 marked dependency, negativism, excessive r i g i d i t y , and other 28 characterics, there are Instances wherein such behaviour cannot be absorbed i n the group or tolerated by the members. Behaviour symptoms exhibited by individuals i n groups must not be considered i n i s o l a t i o n , but as they effect the group -as they c a l l f o r t h group and Individual responses. Inv one group, c e r t a i n deviating behaviour may be tolerated, while i n a second i t leads to group tensions which tend to be destruc-t i v e of the group. Within t h i s r a p i d l y moving picture of group dynamics the groupworker's f e e l i n g s also play a part. An insecure worker may become s t a r t l e d and defensive i n his counter-reaction to the deviant behaviour or to the i n d i v i d u a l . He may see removal of the ind i v i d u a l as the only sol u t i o n to the mounting tensions and be b l i n d to ways i n which he can ass i s t the group to set controls or ways i n which he can aid the member to redirect his energy, and subject himself to group controls. Often the c h i l d who a c t i v e l y disturbs the group i s seen as the one who needs r e f e r r a l to a resource where his individual needs may be more adequately met. There are others who exhibit behaviour which, while not acutely disturbing to a group, nevertheless indicates the existence of a problem which i s not met or solved through the group. Neither can ce r t a i n problems of t h i s type be attacked by the groupworker without jeopardizing his position i n the group. Such a c h i l d may remain isolated and w i l l a f f e c t the group only insofar as 28 Harleigh B. Trecker: S o c i a l Group Work. P r i n c i p l e s and  Practices. New York, The Woman's Press, 1948, p. 95 55 the members notice him and think he i s funny, queer, curious or "never joins i n " . He operates on the fringe of the group, and his needs are unmet. The worker must have, or e s t a b l i s h , a f r i e n d l y relationship with such a c h i l d i n order that he can draw his attention to the fact that his needs are not met w i t h i n the group. Opportunities w i l l arise i n which the worker can suggest alternative resources and help the in d i v i d u a l to withdraw from the group ( i f t h i s i s necessary) and arrange an appointment with the caseworker i n the new agency. In Schedule 2, which follows, the kind of behaviour which led the groupworker to seek casework s k i l l i s l i s t e d i n order of decreasing need to refer from the standpoint of group pressures. Thus Gerald v i r t u a l l y halved his group through his t e r r i f y i n g behaviour, whereas Helen occasionally aroused members to make unkind remarks to her. In the f i r s t three cases, reports from the school indicate the child's behaviour i n t h i s setting and the method of handling i t there. 5 Need f o r Joint Casework-Groupwork Sta f f Conference As i n Type X r e f e r r a l , the j o i n t - s t a f f conference serves a number of purposes; but there would be a s h i f t i n emphasis. Workers should direct t h e i r thinking to at least three areas: a) C o l l e c t i o n and comparison of relevant background information. b) Discussion of the chil d ' s group behaviour i n r e l a t i o n to the collected background data. W i l l It be necessary to i n i t i a t e the d i f f i c u l t r e f e r r a l process or can group process meet the child's needs? 56 Schedule 2 Children's Group Behaviour which Led to Referral Name Age Behaviour Gerald 7 (Case 17) Alice 1 0 (Case 16 ) Jocelyn 9 (Case 15 ) Oliver 1 5 (Case 18) Helen 29 (Case 19) Abnormally aggressive and mean; ter r o r i z e s other children. Has caused membership In group to drop from 30 to 1 5 . Claims he fi g h t s i n " s e l f defence". At school i s "no trouble" since he receives "firm d i s c i p l i n e " . Noisy and aggressive. Cheats at games and does not react to group pressures. Other children are antagonistic but sometimes amused and claim " A l i c e always s p o i l s the fun". Demanding towards the leader; makes b e l i t t l i n g remarks of her such as "We have a stupid leader". School "handles her" with " s t r i c t d i s c i p l i n e " . Untidy and unclean personally leading to other g i r l s ' r e j e c t i o n of her; cheats and l i e s at games; repeats f a n t a s t i c tales about parents; l i v e s i n fantasy world; was found wandering on streets l a t e at night. School reports she i s "below average i n work performance and behaviour" and "troublesome on the playground". Formerly stole from agency; shows other unspeci-f i e d "attention getting" devices; l i e s and i s ringleader i n group "pranks". Looks nervous, pale and i l l - c a r e d f o r . D i f f i c u l t y i n making decisions, unhappy and antagonistic i n the group; sometimes she i s rude to members. c) Evaluation of the home environment as a factor c o n t r i -buting to the chil d ' s behaviour. Here the workers need to consider whether the parent, or parents, can be approached and how t h i s i s to be done. This i s a phase of the process re-quiring much s k i l l and s e n s i t i v i t y i n handling and i s discussed more f u l l y In the succeeding major section - e n l i s t i n g parent co-operation. a) C o l l e c t i o n and Comparison of Relevant Background Information Before any decision i s reached to refer an i n d i v i -dual to casework treatment, i t i s necessary to confer with the caseworker. It may seem banal to emphasize the obvious, yet i t was found that t h i s v i t a l point was often overlooked. When i t was observed, workers did not seem to be aware of the value that the conference could be. As much as Is known about the ind i v i d u a l should be brought up for discussion at this time. Identifying material w i l l of course be i n the hands of the groupworker. Impressions of other workers i n the agency and of workers i n other agencies who may have had contact with the person or family are also valuable. Some agencies are not able to reveal any information from a case record without previously obtaining the c l i e n t ' s consent to share the f a c t s . However, from his knowledge of a ease, the caseworker might be able to give his opinion of the proba b i l i t y of success i n casework treatment, should the group member be referred. Other information which the caseworker might be able to supply could become a framework Into which the isolated instances of behaviour, observed by the group-worker, would f i t and become understandable. In many instances, however, neither the c h i l d nor his family i s known to any other s o c i a l agency and a report from the school teacher may then be the only other source of observa-t i o n . In a l l cases the pooled thinking and s k i l l of a group of workers can form a sounder basis for making a treatment plan than the decision of one worker, who l a t e r t r i e s to press other workers to serve the person's needs. A rapid transfer 58 of a c l i e n t or of a group member to another agency cannot properly be cal l e d a r e f e r r a l ; i t i s when such d i f f i c u l t situations are hurriedly shifted to another agency that " r e f e r r a l s " f a i l . b) Discussion of the Member's Group Behaviour as an Indication of Need Acceptance or r e j e c t i o n of group associations, e x h i b i t i o n of aggressions or withdrawals under c e r t a i n group pressures and the fantasies and verbalizations which the group may stimulate i n a group member can be s t a r t l i n g indications of personal c o n f l i c t s . Case 1 5 , Jocelyn P., w i l l i l l u s t r a t e : Case 1,5 Aged nine, she comes d a i l y and three nights a week to the neighbourhood house. She talks to many of the adults on the s t a f f and one day spoke to the director about her "brother Donald" whom she says comes also to the house, yet no one seems to know him. A remark to the school teacher to the effect that Mrs. P. was "so bad" to her that her father took her away to l i v e i n his apartment seemed to make sense because the s t a f f at the Neighbourhood House also understood she had recently moved. Jocelyn also said that her father had "flown away to the East where he was i n a bad accident" and was now " i n a New York h o s p i t a l " . She was overheard t e l l i n g a member that she bought $ 5 . 0 0 for the l i b r a r y fund, whereas she brought 5 £ . Other workers supplied additional information. She had asked the c r a f t worker for additional materials to make g i f t s for her friends i n the United States. The worker gave these to her and asked her to request help should she need i t , but Jocelyn never did so. She t o l d the groupworker her mother used to be a movie star. The games worker reported that Jocelyn cheats, and she believes i t i s because J . needs to excel. It was obvious that J . sought Inordinately the approval of adults; she had been observed p o l i t e l y to ask adults i f they wished to occupy a seat, before she herself rushed to i t . The school nurse believed Jocelyn had moved to another school d i s t r i c t , but i t was l a t e r learned that t h i s was a l l part of Jocelyn's fantasy. 59 These observations were gathered over a number of months and It i s obvious that they came from many sources -namely - the workers who pooled t h e i r impressions at the j o i n t - s t a f f conference. A l i c e , aged 1 0 , presents d i f f e r i n g symptoms of unhappiness i n the group. P h y s i c a l l y unattractive, slovenly dressed and a continuous disruption to the group, she was ob-served by the personal counsellor, at the request of a group-worker i n the Y.W.C.A. Case 1 6 The f i r s t part of the club period, which was held at the school, was a play period during which A l i c e was noticeably noisy and attention-seeking, c a l l i n g to the leader, bossing the others, etc. The members' reactions varied from qu i e t l y ignoring her to demanding her to "shut up". The project for the afternoon was to make sl i p p e r s . Again A l i c e demanded attention whenever her low threshold of f r u s t r a t i o n was reached. When her work went wrong she ripped the whole thing up i n disgust, and required much encouragement i f she were going to f i n i s h at a l l . Sometimes she would tease the other g i r l s , and at one point grasped the scissors and banged them down on the table y e l l i n g , "How can I do anything when these kids are making so much noise?" Not two minutes l a t e r she was shrieking at the top of her voice. The Counsellor remarked on th i s and was met with a defiant, yet pleading glare. Later A l i c e mentioned q u i t t i n g the club, as she frequently does. The Counsellor remarked that she wondered i f A l i c e l i k e d the club very w e l l , to which came the reply: "Oh, sometimes I do and sometimes I don't - the other kids don't l i k e me and pick on me". At one time when l e t t e r w r i t i n g was mentioned, she complained that no one ever wrote her a l e t t e r and turning to the Counsellor s a i d : " W i l l you write me a l e t t e r ? " The counselor had observed a t y p i c a l session. She had taken an interest i n A l i c e , forming a relationship with her should she l a t e r need to have a f r i e n d l y basis upon which to refer her to casework treatment. 60 The counsellor thought that: ..s-to ask her to withdraw from the club without offering her alternative help at another agency... would be very threatening...as i t would represent one further r e j e c t i o n to a c h i l d whose only way to gain attention at home, at school and i n the com-munity was by unacceptable behaviour. In another case a boy was considered i n need of casework help: Case 17 He i s always on the defensive when playing, t e r -rorizes the other boys, twisting t h e i r arms and t r i p p i n g them while they are running. He f i g h t s to s e t t l e arguments, yet despite t h i s apparent boldness, c r i e s b i t t e r l y when reprimanded or ordered home. A study of r e f e r r a l s at one leisure-time agency i n d i -cated that "...groupworkers were more apt to recognize as behaviour problems those children who interfered with group 29 programs." 7 The more pressing problems of the "acting out" variety attract attention and sometimes overshadow less drama-t i c cases, such as Oliver and Helen, which follow: Case 18 Oliver had once stolen from the agency, but was now well-behaved, yet his mother v i s i t e d the agency occa-s i o n a l l y to say that hecontinued to make "mistakes" at home. She complained of his " g l i b tongue", that "things pass i n one ear and out the other". He roams the streets l a t e , and worships an older "undesirable" l a d . Both he and his brother (who also attends the agency) look nervous and not well-cared-for. Case 19 Helen, an older g i r l of twenty-nine, i s e p i l e p t i c ; ~" she i s handicapped by poor speech and movement co-ordination. In the group she i s "unhappy, antagonis t i c and compulsive", yet sought the companionship of 29 Saul Scheidlinger: "Patterns of Casework Services i n Group work Agencies", The Group, v o l . 8, November 1945, p. 3 61 the g i r l s . She has been rude to them at times. Casual conferences with the groupworker l e d to the formation of quite a friendship. Helen brought samples of her handiwork for the leader to see. At the end of the year the club sponsored a Bazaar and Helen assumed r e s p o n s i b i l i t y for a sales booth. She was proud and happy at the close of the evening and i n a burst of confidence i n the leader said she supposed she ought to t e l l the other g i r l s of her f i t s . That the club was s a t i s f y i n g to her was demonstrated, but i t was f e l t that she required help i n making her personal adjustments regarding her medical program and i n her r e l a t i o n to her over-protective mother. The groupworker watched for an opportunity to refer her to the Counsellor. The i s o l a t e d , f e a r f u l c h i l d who has been selected for casework study and treatment Is exemplified i n the f o l -lowing record: Case 20 He Is "...an 11-year-old boy, f r a i l , underweight and nervous, with unkempt black hair and vague eyes. His father has been i n the hospital and his mother had also been i l l and was unusually unhappy. She had suffered a series of heart attacks which, according to...reports, were emo-t i o n a l . Both the mother and c h i l d had been seen by a ps y c h i a t r i s t and our caseworker was asked to help the mother with her d i f f i c u l t i e s , p a r t i c u l a r l y to aid her i n planning for her children. The psy-c h i a t r i s t found t h i s small boy well started i n copying the patterns of unhappiness his mother was showing. He was moody and aloof and did not seem to get any fun out of l i f e . It was recommended that he see as l i t t l e of his mother as possible, that he should have group play and outside contacts, especially those of a non-competitive kind, and that he be encouraged i n all Qsuccesses. Any f a i l u r e s were to be minimized."-' H o s t i l i t y and aggression, r e b e l l i o n against authority of the leader and against that of the agency, inappropriate and exaggerated responses, fearfulness or extreme i s o l a t i o n a l l come withi n the range of problems requiring casework r e f e r r a l and treatment. 30 E l i s e Van Ness: "Reorganizing a Casework-Groupwork Program", Journal of Soc i a l Casework, vol .22, July 1941, p. 155 62 c) Evaluation of Home Environment That children w i l l show such symptoms of maladjustment is* often not surprising when the home background i s revealed. Learning d e t a i l s of broken homes among group members may often lead the a l e r t groupworker to recognize other symptoms and to commence thinking i n terms of a possible r e f e r r a l should (the need a r i s e . ? Schedule 3 Home Environment of Children Referred to Casework Name Siblings Gerald none (Case 17) A l i c e older (Case 16) brother Jocelyn two older (Case 15) step- ^ brothers Oliver younger (Case 18) brother Helen none (Case 19) M a r i t a l problem and parent attitude to the c h i l d Parents on verge of separation Both mother and grandmother (who i s i n home) indulge Gerald: father i s "con-cerned about problem" Parents separated Mother works out and favours the son, rejects A l i c e . Grandmother l i v e s i n same house, also rejects A l i c e . Parents l i v e separately, father with two older sons who are openly h o s t i l e to the stepmother. Father chronically i l l , does not support family. Mother a l t e r -natively h o s t i l e and over-protective to J. Father deserted some years previously. Mother favours younger brother, i s anta-gonistic to Oliver and rejects him, believing he i s "mentally i l l " M a r i t a l s i t u a t i o n not known Mother extremely over-protective of daughter Using the f i v e cases which are closely examined i n thi s chapter, i t was found that parental s t r i f e , or accomplished separation, occurred i n four, while indulgence and over-protection or outright r e j e c t i o n occurred i n a l l cases. These findings are summarized i n Schedule 3. 63 6 E n l i s t i n g Parent Co-operation and Meeting the Parent 1s Need Where the parent's attitude to the c h i l d and his treatment of him are punitive and r e j e c t i n g , the outlook for casework treatment of the parent i s poor. In the case of a young c h i l d , i t i s probable that casework treatment i s im-possible. Where an adolescent i s concerned, casework can be at least supportive. In any s i t u a t i o n , the way i n which the facts of the child's disturbing influence i n the group are presented to the parent Is all-important. No matter how care-f u l l y the approach i s made, nor by whom - caseworker or group-worker - i t can be stated generally that the parent w i l l react with some degree of g u i l t or h o s t i l i t y . Since t h i s i s a prime factor throughout the duration of treatment, i t must be stressed that i n offering treatment for a c h i l d alone« a worker Is not meeting the needs of the parent. Through the worker's v i s i t or phone c a l l , the parent i s , i n e f f e c t , dislodged somewhat from his position of authority In the family. The v i s i t subtly points to his inadequacy i n rearing his c h i l d . Yet to balance these forces m i l i t a t i n g against acceptance of the worker, In his favour are the parent's anxieties about the c h i l d and his undoubted need to j u s t i f y himself before the worker. During the home contact, the parent may bring up for discussion c e r t a i n areas having l i t t l e r e l a t i o n to the child's need, or his behaviour i n the group. The worker must be able to judge whether t h i s i s a defense or a request for help i n other areas. Yet the groupworker must also see that such problems require a different type of help than his function 64 permits him to give, and he must r e f r a i n from entering these. Depending upon the agency concerned and the require-ments of the case, an approach to the parent may be made by one of three workers: (1) the caseworker from the agency which w i l l give the casework service, (2) the groupworker from the leisure-time agency where the c h i l d i s a member, or (3) the Personal Counselor ( i n the Y.W.C.A. se t t i n g ) . These three approaches are discussed below. a) Approach to the Parent by the Caseworker The case of Mrs. P (Case 15) i l l u s t r a t e s how the caseworker made an i n i t i a l approach to the parent, who sub-sequently n u l l i f i e d any gains which the c h i l d might have made through the eff o r t s of either caseworker or groupworker. ^ Mrs. P. had experienced very l i t t l e constructive help from s o c i a l workers. She was the kind of person who rushed to an agency requesting, almost demanding, "something be done". She had l i t t l e a b i l i t y to p r o f i t from casework since she was incapable of carrying through any decisions or plans. On December 23, she had appeared at the Family Agency asking them to do something for Jocelyn's Christmas - to send her to a party. At t h i s time she had talked volubly about her marital problem which was beset with d i f f i c u l t i e s . The interview was short, with minimal emotional investment on the part of Mrs. P. 1 65 Case 15 In December also, the groupworker, learning through the Social Service Exchange of the Family agency con-t a c t , requested to t a l k to the caseworker. Certain information was exchanged and an early joint-conference was planned. It was decided then that the caseworker would v i s i t the father and the groupworker would con-tinue with J. i n the group. In the group Jocelyn was referred to as "Poor Jocelyn, she i s so unhappy, we should be kind to her" and although the young club president had shown some friendship towards her, she announced that she had "taken her i n , because we ought to". The caseworker also v i s i t e d Mrs. P. and established a relationship. Subsequently, Mrs.P. phoned, however, saying she did not see how the Family agency eould help unless they put Jocelyn i n a home or a school of some sort. This would indicate that Mrs. P. f e l t the caseworker was not helping i n the way she wished. The worker nevertheless continued her v i s i t s , since Mrs. P. did not consider coming to the agency. Later, the worker suggested that Jocelyn have an appointment with the school p s y c h i a t r i s t . Resisting at f i r s t , Mrs. P. f i n a l l y made and kept the appointment, only to refuse to allow the psychia t r i s t to see Jocelyn p r i v a t e l y . The p s y c h i a t r i s t ' s report indicated Jocelyn showed "marked signs of emotional deprivation", an "extreme sense of re j e c t i o n " which was compensated for through the creation of a "happier dream world for herself"; that the mother showed inconsistency, poor judgment and an unwillingness to have the child's d i f f i c u l t i e s analyzed. Since these findings were i n s u f f i c i e n t evidence upon which to lay a neglect charge, the school and groupwork agency were urged to continue to provide a l l the support they could. Subsequently, Mrs. P. expressed bitterness over the report as she had heard i t and referred to J. as "subnormal" and "abnormal" and "very d i f f i c u l t " . She saw a l l her d i f f i c u l t i e s as l y i n g beyond herself. The Family agency decided to withdraw but expressed willingness to re-enter as opportunity presented. Jocelyn was now seen less at the Neighbourhood House; when she came she behaved c o o l l y towards the group-workers. 66 Mrs. P. did enrol Jocelyn at a summer camp which l a t e r reported much the same d i f f i c u l t i e s which had been seen i n agency groups. Jocelyn kept close to the camp leaders as though yearning for their a f f e c t i o n and approval. She made no friends. The following f a l l the groupwork record indicated that:' Jocelyn continues i n regular attendance. She seems much happier i n her relationships with other c h i l -dren and her appearance i s improved. She has less need to seek response from the s t a f f ; with them she remains on a s u p e r f i c i a l l e v e l not discussing any-thing which savours of home. The worker wondered i f she had been t o l d "not to t e l l " . It i s d i f f i c u l t to assess the meaning of her changed attitude towards adults at the Neighbourhood House. The group-worker suggested a possible explanation. What damage may have been done w i l l not be known; but i t seemed that indeed she retained her need to seek attention from adults (as at camp) but now distrusted adults at the agency. It i s probable that where the parent's r e j e c t i o n of the c h i l d i s intense and very near the surface, the casework relationship should provide the mother c h i e f l y with an outlet for h o s t i l i t i e s which would otherwise be directed to the c h i l d . Casework should not be used as a means of levering the mother into a^ more accepting attitude of the c h i l d . The parent senses that the caseworker i s tr y i n g to get "a better deal" for the c h i l d and r e t a l i a t e s by punishing the c h i l d i n subtle ways, thus "hurting" the caseworker. In such a plan, the groupworker should co-operate by giving the c h i l d as much love and af f e c t i o n as i s possible i n the groupwork se t t i n g . The entire groupwork s t a f f could co-operate i n t h i s emphasis, 67 every adult showing acceptance and attention, thus con s t i t u t i n g a type of "milieu treatment". Velma Grove found that many unsuccessfully treated mothers were characterized by: "...aggression, domination and h o s t i l i t y cloaked i n anxiety, . . . d i v e r s i f i e d , s u p e r f i c i a l s o c i a l i n t e r -ests or none at a l l . (They were) d i s s a t i s f i e d r est-l e s s women, showed capacity to make plans but f a i l e d to carry them out... (They b u i l t ) . . .strong defenses by projecting blame for f a i l u r e on the environment..."-5 Mrs. P. showed many of the t r a i t s enumerated above -an attempt to dominate the s i t u a t i o n i n r e l a t i o n to the case-work interview regarding J's Christmas and again with the psy-c h i a t r i s t ; she projected her d i f f i c u l t i e s beyond herself; her attitude to J. v a c i l l a t e d between open h o s t i l i t y and over-protection. Thus, on the basis of formulated knowledge, the outcome of treatment could have been predicted f a i r l y accurately, b) Approach to the Parent by the Groupworker The decision regarding who s h a l l seek out the parent i s a major one. Where the groupworker i s known to the parent, and a p o s i t i v e , though s l i g h t , relationship? e x i s t s , the method of choice would be for the groupworker to strengthen h i s r e l a -tionship. This w i l l then form a sound basis upon which group-worker and supervisor can co-operate with the caseworker to plan technical d e t a i l s of the r e f e r r a l . How parents w i l l view t h i s request w i l l of course depend, i n part, upon t h e i r previous experiences with s o c i a l workers. I f i n the past they have been helped through the eff o r t s 31 Velma Grove: "Personality T r a i t s as C r i t e r i a for the Treata-b i l i t y of Mothers by a Child Guidance C l i n i c " , Smith College  Studies i n S o c i a l Work, v o l . 8, June 1 9 3 8 , p. 367 68 of workers, t h i s w i l l colour t h e i r present reactions: Case 18 Oliver's mother had, at times, come to discuss her troubles with the groupworker who knew her boys. The groupworker had often taken the lads on weekend camping t r i p s . Now the groupworker found i t quite natural to suggest to the mother that a caseworker could, perhaps, help.in the matter. The mother accepted the r e f e r r a l . When the parent has not resorted to the groupwork s t a f f person for guidance (as i n the majority of cases), the parent may be at a loss as to how to interpret the groupworker 1s v i s i t . In any event, intense, though perhaps unverbalized, feelings w i l l well up i n the parent. It w i l l be d i f f i c u l t f o r the groupworker, unaccustomed to interviewing, to so control the s i t u a t i o n , and at the same time be aware of his own f e e l -ings, that a flood of material i s not released. Should t h i s occur, the tone of the interview a l t e r s from that of " t e l l i n g of a resource" to that of a highly charged "intake process". The groupworker may indeed overstep his function. In some instances merely t e l l i n g the parent of the resource of case-work w i l l stimulate him to reveal many problem areas and some-times t h i s cannot be prevented. The problem l i e s i n the c l i e n t ' s discharge of feelings i n a sett i n g where the worker cannot control them. Following such a discharge the c l i e n t may f e e l he has abused a p r i v i l e g e , has been misunderstood, or i s not assured of the c o n f i d e n t i a l i t y he would desire. His mounting indecision as to the appropriate way to act may create a barrier both to his continued relationship with the groupworker and to the child's continuance at the group. 69 In some eases studied, groupworkers (and caseworkers, for that matter) f e l t easier i n suggesting to parents that the Family agency might help them, and t h e i r "problem c h i l d " with his vocational plans, or would test him through the f a c i l i t i e s of the Child Guidance C l i n i c . This approach may i n i t i a t e the casework relationship on a f a l s e basis, since i t does not recognize the child's r e a l d i f f i c u l t y , neither does i t attempt to meet the parent's problems. Both caseworkers and group-workers need to r e a l i z e that the parent's own personal problems must be met i f the casework relationship i s to be sustained subsequently. Only then w i l l i t be possible for the child's problems to be met. Many parents avow thei r Interest i n the child's problems, and claim to want nothing for themselves. However, t h i s i s a form of resistance to treatment of t h e i r own problems and to uncovering deeper problem areas. To focus on the r e a l problem at the r i s k of the parent's disfavour w i l l prove to be a sounder and more direct approach than the most adroit manoeuver, or a r t i f i c e . In the case of Ol i v e r : Case 18 The groupworker made an appointment for the case-worker, who arrived as arranged. The mother, Mrs. Z., hotly denounced him since sheunderstood her a f f a i r s had been discussed at meetings and " i t was nobody's a f f a i r , since i t was a problem she needed no help with and was capable of handling." The caseworker recognized her f e e l i n g s . Mrs. Z. then chastized her husband who had deserted, and complained that she alone had been blamed for Oliver's troubles. She then did admit her son was a problem - but beyond help. The caseworker then offered an appointment at the Child Guidance C l i n i c to es t a b l i s h "what kind of vocation Oliver would be suited f o r " . Mrs. Z. l i k e d t h i s idea, and brightened at the prospect, but thought that i n addition the C l i n i c could "diagnose Oliver and give him treatment" since he was "mentally i l l " . 70 The groupworker, having made a direct approach to the problem of Oliver who needed help and Mrs. Z's need for guidance, l e f t considerable resistance unresolved. This i s natural as i t i s the province of the caseworker to deal with i t . The caseworker, however, though recognizing i t to some degree, attempted immediately to offer consultation. In an intake interview of t h i s type i t i s not enough for the case-worker to promise that casework treatment can be help f u l i n the future; he must demonstrate the help i n the f i r s t interview. The sequel to the case of Oliver follows: Case 18 A number of interviews with the caseworker followed. Then during the summer the groupworker arranged for Oliver to work on a farm, and i n September the case-worker telephoned Mrs. Z. to say that the C l i n i c appointment was arranged. During the summer months there had been no continuous casework contact. Mrs. Z. replied that Oliver was so much improved since his summer work on the farm that she was now asking to cancel the appointment. She thanked the worker and promised to phone i f the problem recurred. The Family agency closed i t s case. F l e x i b i l i t y i n the caseworker's approach might have permitted him to see other areas for p r o f i t a b l e treatment than the one he concentrated upon, namely, the C l i n i c appointment. In the case of Gerald, the groupworker phoned the Family agency to enquire about r e f e r r a l procedures to the Child Guidance C l i n i c , since she believed t h i s was the appropriate agency to use as a resource for Gerald. She outlined the case to the worker, who thereupon recommended direct r e f e r r a l to the Family agency. I f , following the groupworker's o f f e r , the parent wished to co-operate i n casework treatment, the caseworker 71 would accept the case. Since case loads, professional s k i l l a v a i l a b l e , needs of the c l i e n t , and agency intake p o l i c y , a l l influence the framework within which the r e f e r r a l w i l l take place, the groupworker appropriately contacted the caseworker before making any approach to the mother. A further point wherein the groupworker demonstrated her s e n s i t i v i t y was i n phoning Mrs. Gordon, the mother, thus respecting her right to privacy. Where i t i s thought necessary to make a home v i s i t , a worker should at least precede his v i s i t with a l e t t e r or phone c a l l . Case 17 In course of conversation, the groupworker men-tioned some of the problems which Gerald presented, and offered to discuss these with the mother. She suggested the mother come down to the groupwork agency. The mother admitted her son was "a problem" and accepted the i n v i t a t i o n . A loud, uncontrolled voice and unmanageableness were the mother's chief complaints against Gerald. She revealed that when he learned she was coming to the agency he said: " I ' l l bet that's about me fi g h t i n g .'" The groupworker stressed the kind of help which was available at the Family agency, but i n addition, talked at some length of the resource -of the Child Guidance C l i n i c , since she f e l t t h i s was easier to accept. The mother seemed w i l l i n g to obtain help with her c h i l d , and suggested that the caseworker c a l l at a time when her husband would be home, since "he was also concerned about i t " . In the interview with the caseworker which ensued, both parents seemed anxious to t a l k and discuss Gerald's childhood. The mother said that he attended movies which were not selected by her, but could not control t h i s "since a l l the neighbour-hood children went". The caseworker remarked that she might explain to G. why he could not go, but that she was not responsible for a l l the other children. Later, she conceded that probably Gerald's behaviour arose from her way of handling him. It appeared that she was unable to set any prohibitions for him and was extremely indulgent of him. She then commenced to t a l k of herself, d i s c l o s i n g that as a c h i l d she was nervous, "but kept i t bottled up". 72 I t can be seen from the above how close to the surface were the mother's anxieties about herself; had the worker d i s -regarded her to discuss only Gerald, he would not have met the mother's needs. Now, f e e l i n g accepted as she was, the mother was encouraged to enter into a weekly appointment schedule. Mrs. Gordon had also mentioned that Gerald was a fussy eater. On her next appointment she ex-claimed that she had wrapped his lunches i n wax paper so that he could s i t out on the front porch to eat " l i k e workmen do". Gerald was quite taken with t h i s idea and no longer fussed over h i s food. The caseworker wanted Mrs. G. to see the reason why she was unable to set l i m i t s on Gerald's freedom and thus to become more firm i n the way she handled him. In the interviewing week, Gerald had become v i o l e n t l y angry, and had threatened the members of the group with knives. There was an immediate community response to th i s incident, and the mother wished to discuss i t . The caseworker had already been t o l d of the a f f a i r by the groupworker, and was now able to turn Mrs. Gordon's attention to s p e c i f i c phases of the trouble, helping her to see how she might deal with them. That the mother f e l t some support i n the casework relationship was evident i n that she brought further material to the interview and wished to discuss her part In handling the knife incident of the previous week. She also shows certain strength i n her resourcefulness i n handling Gerald's eating habits. Another noteworthy feature i s that the group-worker, although not playing an active r o l e i n the treatment, per se. nevertheless maintains contact with the caseworker. Since many workers believe that once the r e f e r r a l i s accom-plished, they may quietly withdraw, i t i s s i g n i f i c a n t that t h i s groupworker saw his role as important and an in t e g r a l part 73 i n the attainment of the treatment goal of which the r e f e r r a l i s but one part. Subsequently these two workers were able to redefine th e i r r e s p o n s i b i l i t i e s i n a j o i n t - s t a f f conference. Case 17 At t h i s meeting each worker explained h i s a n t i -pated goal. The groupworker presented further evidence of Gerald's continued h o s t i l i t y , and intimated that the boy was allowed pretty free reign at home. The caseworker substantiated t h i s but explained how he was working with the mother. The groupworker disclosed that Mrs. Gordon had v i s i t e d the agency, and had been concerned about G's habit of f i g h t i n g to s e t t l e a l l arguments. I t was suggested i n conference that the groupworker request G. to leave the group the moment he became annoying. The caseworker, i n his treatment periods, would interpret to the mother how she might handle Gerald upon his return home following such i n c i -dents. Regular interviews continued, each worker carrying out his segment of the plan. At one point, the caseworker brought up the matter of r e f e r r a l to Child Guidance C l i n i c , since t h i s had been mentioned i n the beginning. Interpreta-t i o n to Mrs. Gordon of agency function indicated that t h i s resource need not be used at t h i s time. Opportunity to e n r o l l Gerald i n an agency Day Camp during the summer was however offered. Mrs. Gordon expressed interest and l a t e r enrolled her son. As an indi c a t i o n of the success of casework treatment, an incident which occurred at the camp i s c i t e d : Some of the older boys at the camp were preparing an overnight t r i p . Gerald coaxed for permission to accompany them but his mother, f e e l i n g he was too young, was able to remain f i r m i n her denial. The caseworker praised t h i s stand. In the f a l l Gerald returned to his group at the agency where the worker maintained his f r i e n d l y but firm a t t i -tude of the preceding spring. He reported that Gerald was no trouble i n the group or to the s t a f f . This indicated the lessening of c o n f l i c t between the mother's and the chi l d ' s needs. c) Approach to the Parent by the Personal Counsellor The Y.W.C.A. Personal Counsellor i s i n a singular position i n that she may become a f a m i l i a r person to members meeting i n the agency, yet her role does not prohibit her from forming close relationships with i n d i v i d u a l s . What l i m i t a t i o n s to the formation of an intensive therapeutic r e l a t i o n s h i p t h i s type of agency se t t i n g may impose, i s not precisely known. This i s an area of needed research. How the Personal Counsellor approached A l i c e i s discussed here. Case 16 Following the Counsellor's observation of A l i c e i n her group, a s t a f f conference was convened and i t was decided to refer her to the C h i l d Guidance C l i n i c for treatment. The Counsellor contacted A l i c e at the next club meeting and took her back to an informal setting to discuss the problem. As A l i c e went with the Counsellor she asked: "Am I i n trouble?", to which the Counsellor replied "No, but you seemed to be having an unhappy time at the club and perhaps we could t a l k about t h i s " . Basing the discussion on Alice's unhappiness i n the group, the Counsellor said she thought i t better that A l i c e not go to the group any more. A l i c e responded that she was so "cross inside" at the group and elaborated, saying that her mother wondered why she went to the group when she always came home f e e l i n g so unhappy. Alice said that at school she could not act l i k e t h i s , or she got the strap. 75 The Counsellor then said that she would need to l e t Alice's family know about the club and wondered i f she should see the grandmother. Alice asked: "Do you have to see grandmother?" The counsellor questioned further and found that i t would be pre-ferable to see the mother. Al i c e was happy at t h i s prospect. Alice's statements about her "horrible grandmother" was accepted without attempt to c l a r i f y since the C l i n i c would be entering t h i s phase i n a more intensive treatment rel a t i o n s h i p . In t h i s contact the Counsellor learned more about the home s i t u a t i o n and obtained permission to contact the mother regarding Alice's withdrawal from the group. The Counsellor then telephoned the C l i n i c , t e l l i n g of her actions, and indicating she would be v i s i t i n g the mother shortly. It would have been preferable to contact the C l i n i c before making other plans with A l i c e . The record continues: The Counsellor Introduced herself to the mother, and explained the reason for Alice's withdrawal from the group. The mother was at f i r s t defensive, l a t e r becoming freer and admitting the problem. She remarked then how dif f e r e n t her two ch i l d r e n were - the boy, older, so pleasant, Industrious and helpful with work after school; the g i r l so Intractable. Using the mother's remark that she wished she knew what to do with A l i c e , the Counsellor broached the subject of the C l i n i c . The mother was imme-di a t e l y interested, but raised the problem of her working hours. The Counsellor said that perhaps the caseworker at the C l i n i c would work t h i s out with her and promised to have the caseworker c a l l i n a few days. In a few days the c l i n i c caseworker telephoned the Counsellor saying he had contacted the mother by phone, and she had been quite evasive, remarking she did not know when she eould come since she was working. The caseworker considered the mother needed more interpretation of the C l i n i c function and doubted i f she was ready to accept treatment. 76 It i s a p o s s i b i l i t y that the Counsellor stressed only the help available for M i c e , i f the mother went to the C l i n i c , to the exclusion of the mother's needs. Frequent abortive attempts to rapidly refer c l i e n t s to other agencies point to the fact that great s k i l l i s required i f the process is to be completed. The fewer transfers from worker to worker, the more l i k e l i h o o d of success, Is another axiomatic statement. Had the Counsellor been prepared to offer t r e a t -ment to the mother and had she commenced with recognition of the mother's problem i n t h i s case, something more positive would have resulted. I f t h i s was impossible owing to agency pol i c y , i t might have been advisable for the C l i n i c worker to make the i n i t i a l i n t erpretation of the C l i n i c function to the mother. In either case, the resistances developing i n r e f e r r a l s must In every instance be understood and treated. Frequently, a person w i l l accept r e f e r r a l (as occurs i n t h i s case), only l a t e r to unfold his resistances i n such profusion that he withdraws not only himself from treatment, but the c h i l d also. It i s d i f f i c u l t for a parent to see the ch i l d ' s need for help, when often the unconscious needs of the parent running counter to the child's needs are an important element i n the child's d i f f i c u l t y . It would be I r r a t i o n a l to expect the parent to accept help for the c h i l d while her own needs remain ignored or unmet. 77 Summary The r e f e r r a l process cannot be accomplished on the basis of routine technique. A relationship with the group member or with his parent i s the foundation upon which sound r e f e r r a l can be b u i l t . However, l i m i t a t i o n s inherent i n the groupwork process prevent the groupworker from developing too intensive a relationship with a member. Consequences of th i s practice are the member's increasing i n a b i l i t y to share the leader with the other group members and his mounting h o s t i l i t y . Through the use of the Soc i a l Service Exchange a groupworker may discover untapped resources and c o l l a t e r a l agencies which can help him understand a group member who pre-sents intolerable group behaviour or exhibits marked with-drawal tendencies. Recognition of problems requiring i n d i v i d u a l atten-t i o n sets as imperative upon the groupworker not to overlook the timid c h i l d i n favour of the aggressive one who attracts the worker's attention more re a d i l y . Sometimes such problems can be treated through the group, but a l l decisions r e l a t i n g to choice of treatment and d i v i s i o n of r e s p o n s i b i l i t y between workers In the co-operating agencies, i n i t i a l l y must be brought to a j o i n t - s t a f f conference, and redefined from time to time. The problems of e n l i s t i n g parent co-operation for the r e f e r r a l and the parents' accepting casework treatment for themselves are often those of recognizing and trea t i n g resistances. F a i l u r e i n r e f e r r a l resulted when parents' needs remain unrecognized and ignored. 78 Chapter Five THE CASEWORKER AS CONSULTANT TO THE GROUPWORK STAFF There are good reasons for the general p r i n c i p l e that one person cannot be a groupworker and a caseworker with the same i n d i v i d u a l . This i s based, i n part, on a difference i n s k i l l s required for these two d i s c i p l i n e s , but also i t resides In the differ e n t type of relationships which must develop i f these two processes - casework and groupwork - are to be f r u i t f u l . In some of the e a r l i e r experiments In casework-groupwork co-operation, described i n t h i s chapter, awareness of t h i s p r i n c i p l e i s not too evident. Later i t was seen that a caseworker could be more help f u l to a groupwork s t a f f when he devoted his time l a r g e l y to consultation with other s t a f f members. To avoid confusion, the t i t l e "consultation worker" was chosen to describe t h i s person. This d e f i n i t i o n i s clos e l y i n l i n e with that used to describe the a c t i v i t y of the consultant i n a Family Agency who i s d i f f e r e n t i a t e d from those s t a f f members who d i r e c t l y treat c l i e n t s . Moreover, t h i s t i t l e d i f -ferentiates t h i s person from both the groupworker and the groupwork supervisor. It i s pr o f i t a b l e to examine how the fusion of casework and groupwork practices occurred i n order to see how the func-tions of the consultation worker have emerged from an attempt to provide casework services i n an agency organized to offer 32 Ann W. Shyne: Operation S t a t i s t i c s of Family Service  Agencies. 1948, p. 12 79 leisure-time and informal educational a c t i v i t i e s . I n i t i a l l y , both caseworkers and groupworkers have observed the s i m i l a r i t y of problems found i n th e i r respective work loads. It was perhaps natural for each group of the s o c i a l work f i e l d to ask the other: "Can the a l t e r n a t i v e form of working with people be of help to me?" In consequence, caseworkers have formed groups, and groupworkers have t r i e d experimental use of casework methods. To s t i l l other workers, a j o i n t approach seemed wiser, and the next l o g i c a l step. It was undoubtedly true, as Mary Hester observed,3 3 that "the way we began these projeets...set the stage for thinking i n terms of treatment prematurely." Though the individual goals of such experimentation have been varied, a general aim of a l l is well expressed i n the St. Paul Experiment: "To study ways of discovering and getting treatment to children who were 34 showing behaviour d i f f i c u l t i e s . " - ^ The ferment of psychiatric knowledge and the new understanding of the dynamics of behaviour which pervaded the groupwork d i s c i p l i n e were both p a r t l y res-ponsible for the emphasis on the i n d i v i d u a l group member. Throughout a l l these experimental attempts the dominant theme has been the i n t e n s i f i c a t i o n of the groupwork process, with increasing a t t e n t i o n being paid to group i n t e r -33 Discussion of a r t i c l e : Conover, M e r r i l l B.: "The Joint Use of Groupwork and Casework Techniques", Journal of So c i a l  Casework, v o l . 2 3 , November 1942, p. 270 34 A.S. Stone, e t . a l . : Children In the Community, Children's Bureau Publication No. 317, foreword, p. i l l relationships i n d i s t i n c t i o n to content of program. Since the program now grew out of the needs and planning a b i l i t i e s of the group members, f l e x i b i l i t y of program and understanding of individual's needs was required of the groupworker. To practise adequately ca l l e d f or an understanding of the meaning of behaviour. From such developments has come much a c t i v i t y geared to the needs of individuals and small groups. Yet sometimes groups have t r i e d to assimilate problem behaviour with which they were unable to cope and t h i s has led to f a i l u r e and disappointment. The need to understand, i d e n t i f y and treat those children showing behaviour d i f f i c u l t i e s i n groups, has lead to the development of many projects. This feature distinguished the function of caseworkers working i n a group-work setting from the e a r l i e r h i s t o r i c functions of caseworkers on Settlement House s t a f f s . These l a t t e r persons interviewed c l i e n t s , gave family service, helped individuals obtain medical and other services, determined e l i g i b i l i t y for camp scholar-ships and simi l a r a c t i v i t i e s . Rarely did such a worker deal exclusively and consciously with behaviour d i f f i c u l t i e s as such. Joint Casework-Groupwork Experiment of Welfare Federation of Cleveland In the year 1937 a joint casework-groupwork project was commenced by the Welfare Federation of Cleveland. The project was designed to operate for a two-year period. During the f i r s t year four caseworkers were released one-half day a week from t h e i r agency r e s p o n s i b i l i t i e s i n order to work with four groupworkers, each pair working with a club. The purpose was "...to discover how needs of the ind i v i d u a l can be met i n the groupwork process, what l i m i t a t i o n s i t presents, and how these l i m i t a t i o n s may be overcome through supplementary ser-•55 vices of the casework process." J y In each s i t u a t i o n the group worker was requested to work as was his custom, and as much as possible as i f the caseworker were not there. The caseworker was asked to observe and record the behaviour of the I n d i v i -duals i n the group i n accordance with his usual manner of recording and to have in d i v i d u a l contacts with any members of the group who offered the opportunity. It i s in t e r e s t i n g to note that although i t was known that the caseworker was a v a i l -able for personal interviews at the agency on club meeting day no one took advantage of t h i s opportunity. The caseworker was a new person i n each group and, as f a r as the membership could comprehend, one without a r o l e . In each group the caseworker found i t necessary to make a place for himself, and his experience i n doing t h i s and the problems he encountered were unique. In group "A", children came from an i n s t i t u t i o n and a l l had pronounced be-haviour problems. Both the caseworker and the groupworker were s t a f f members and as such were known to a l l the children. The children, unaccustomed to having the caseworker attend the i r meetings, looked upon her as "an assistant leader". Her presence was a disrupting influence i n the group since she reminded them of the i r own problems. From her point of 35 Gertrude Wilson: "Interplay of Insights of Casework and Groupwork", Proceedings of the National Conference of  S o c i a l Work. 1 9 3 7 , p. 154 82 view, however, observation was a great advantage for "charac-t e r i s t i c s were revealed i n the informal group s i t u a t i o n which she had only suspected through her face-to-face r e l a t i o n s h i p s . " - ^ In group "B", ( g i r l s aged nineteen to twenty-nine years), the caseworker was forced to undergo the long process of moving from the position of being an unknown g i r l struggling for status amid a friendship group to that of being an accepted member. In group "C" (a young boys' group) the caseworker, a woman, never r e a l l y f e l t accepted. There was much aggressive behaviour and i t was r e a l l y d i f f i c u l t to determine how much of i t was related to her presence. In group "D", the caseworker and the groupworker early i n the project established a relationship which seemed more successful. Neither worker was previously known to the membership. The groupworker explained that the former leader could not come and from now on she would be the leader. The caseworker was Introduced as a person "who was going to be at Alta House for a while" and who "was interested i n children and would l i k e to v i s i t the c l u b . " j r The record of group "D" describes many situations i n which the children used the caseworker as f r e e l y as they did the groupworker4 though i t i s d i f f i c u l t to discriminate between the uses they made of each. However, since the case-worker was not In any sense a group leader, any questions or 36 Gertrude Wilson: Groupwork and Casework. New York, Family Welfare Association of America, 1941, p. 90 83 a c t i v i t i e s related to t h i s function were turned back to the groupworker i n order to keep the role c l e a r . Miss Hester states that the children did appeal to the caseworker to complain about things which occurred, and they were allowed to discharge th e i r feelings and ideas of what would improve the s i t u a t i o n . It would then be suggested that these ideas be taken back to the groupworker. In that sense, also., the caseworker supported the groupworker and did not enter into competition with her or side with the children i n th e i r com-plaints against her for whatever was going on. The children also "used" the groupworker to complain about the caseworker, questioning why she was there, and indicating t h e i r suspicion about her presence. The groupworker of course permitted th i s discharge. In a l l groups i t was found that the caseworkers were unable to use their s k i l l s to f u l l advantage, although some of the casual contacts were h e l p f u l . Group "D" was of special Interest because two c h i l -dren who displayed marked behaviour d i f f i c u l t i e s and the case-worker was able to work with them, on the fringe of the group, while the groupworker looked to the functioning of the group as a whole. Case 21 One of these children, Frances, was evidently i n c o n f l i c t with regard to her interest i n boys, desiring contact with them and yet f e e l i n g that It was bad. The caseworker saw Frances as "a c h i l d i n c o n f l i c t i n her relationship to her mother, attempting to resolve her discomfort by conforming 38 Letter to the w r i t e r , October 18, 1948 84 to the pattern of the good g i r l . She was unusually f e a r f u l i n r e l a t i o n to boys, but was ambivalent i n her f e e l i n g as she showed interest i n them, too. The end res u l t was a paralysis of action. " 3 9 The groupworker knew the c l i e n t e l e of the Settlement and had a knowledge of the c u l t u r a l and n a t i o n a l i t y background of t h i s g i r l . This Indicated Frances was less free than others, i n her s o c i a l adjustment, to break away from the old norms. To counteract t h i s the groupworker was able to provide the kind of setting which gave the g i r l opportunity to l i v e through an experience which helped to a l l a y her fears, by ac t u a l l y having some acquaintance with a young man and at the same time receiving adult approval. In attempted i n d i v i d u a l contacts, the worker found Frances f e a r f u l , unwilling to t a l k and eager to get away from a discussion of her feelings i n r e l a t i o n to these fears. The case-worker also c a l l e d on the g i r l ' s mother i n an attempt to evaluate the home s i t u a t i o n and the mother's attitude to her children. It was learned that the mother was interested i n having the g i r l make casual friendships with boys but not steady ones. She also spoke with more noticeable fondness of younger s i b l i n g s . It was indicated that the caseworker should continue to work with the mother i n order that she might modify her demands on the g i r l . This would i n turn free the l a t t e r for such a c t i v i t i e s as the groupworker might arrange. When indicated, the caseworker or the groupworker would t a l k go Frances. Here i s a case then In which both workers contributed to the therapeutic value of the group experience while, i n addition, the caseworker discussed the s i t u a t i o n with the parent. During the f i r s t year, the caseworker's roles were 40 summarized as follows: 1 Casual contacts with members leading to help; 2 Informal intake with members referred from agencies offering casework services; 39 Mary C. Hester and Dorothy G. Thomas: "Casework and Group-work Co-operation", Proceedings of the National Conference of S o c i a l Work, 1 9 3 9 , p. 337 40 Gertrude Wilson: Groupwork and Casework, op.cit., p. 89 3 Consultation with groupworkers over needs of p a r t i -cular individuals observed i n groups; 4 Casework service with members outside the groupwork s i t u a t i o n and outside the agency. This year provided a l l workers concerned with an understanding of the functions and l i m i t a t i o n s of another area of practice. It was also found that i t was well-nigh impossible, w i t h i n the rapid movement of the group process, to establ i s h any sustained type of relationship wherein the casework process might develop. Accordingly, i n the seeond year of the study the project was set up so that a larger number of groups were observed and so that there was more scope f o r experimenting with newer forms of co-operative service. The caseworker now assumed the role of "consultant" to the groupworker; he explained the meaning of behaviour of the group members, d i s -cussed ways of treatment w i t h i n the group and, i n general, helped the, groupworker understand his members. That i s , function number three of the f i r s t year was expanded, though other methods of helping were not e n t i r e l y dropped. This was perhaps a natural outcome since i t had been found that the caseworker's services, as counsellor or caseworker, were not used by members. In the group se t t i n g , the members had a prior relationship with the groupworker, and would look to him, I f to anyone, for help. For the same reason, i t was more natural for the groupworker to intervene when inter- r e l a t l o n s h i p s of the members required i t . To have the caseworker assume t h i s function, despite h i s s k i l l i n such matters and the sensitive 86 handling he might bring to such as task, would be an a r t i -f i c i a l and clumsy method. It i s evident that the caseworker had now become lar g e l y an "educational s u p e r v i s o r " 4 1 , and insofar as he duplicated the functions of the groupwork supervisor, an area of possible f r i c t i o n was created. Were he to confine his consultation to the meaning of behaviour, benefit to the membership would r e s u l t ; when he was drawn into direct planning for groups confusion would r e s u l t . Were the group-workers and group leaders responsible to the groupwork super-visor or to the consultation worker? What i s the d i s t i n c t i o n between the areas of function of these two workers? Does the groupwork supervisor never give supervision to a groupworker when i t relates to the behaviour of a member? Is t h i s area reserved for the consultation worker to supervise? If t h i s Is so, does the groupwork supervisor concentrate only on adminis-t r a t i v e d e t a i l s ? How are group members selected for study by the consultation worker? Program at Bronx House In a d i f f e r e n t project, sponsored at Bronx House, somewhat more extensive c r i t i c a l evaluation was carried on. Among other things, the roles of some of the workers were more c l e a r l y defined. For a number of years i n New York C i t y , Jewish agencies giving both casework and groupwork services have had close working relationships. At the start of the war period, agencies were alerted due to the increase i n delinquency, and 41 Gertrude Wilson: Groupwork and Casework, op.ejjt., p. 95 87 there was a pressing need for a place f o r children to congre-gate. Many children came to the agencies, and i t was observed that some were unable to adjust to groups, and became d i s -rupting influences. Six agencies requested the Jewish Board of Guardians to "help them study and understand the needs of 42 such children." Caseworkers were assigned on a purely experimental basis In response to t h i s request. There was constant analysis of t h e i r r o l e s , conferences were held regard-ing t h e i r increasing understanding, and ef f o r t s were made to determine the contribution of the group to healthy adjustment. Certain general conclusions were drawn. It was decided that the role of the caseworker was "to observe and study i n d i v i d u a l children who presented either personality problems or who were problems to groups, either at the caseworker's own i n i t i a t i v e , or at the s t a f f ' s suggestion." J Though th i s worker has some tasks which were performed i n d i v i d u a l l y , gradually more of her emphasis was given to conferring, and her function ap-proached that of the "consultation worker" described above. To describe i t b r i e f l y , the procedure of a r r i v i n g at a sound formulation of an individual's d i f f i c u l t y required that a s o c i a l history be obtained. This included interviewing parents, school principals and other interested persons whose organizations had some relationship to the c h i l d . The consul-t a t i o n worker then arrived at a diagnosis and interpreted the behaviour to the groupwork supervisor and the groupworker. 42 Miriam Cohen: Progress i n Casework-Groupwork - 3 5 t h Anniversary Report of Bronx House, 1947, p. 4 43 i b i d . , p. 5 A plan to help the c h i l d would then be formulated. Referral to another agency for assistance might be indicated, i n which event the consultation worker might aid i n t h i s process. In some instances the consultation worker was available for i n d i v i d u a l consultation with membership. The experience showed that t h i s was not as sat i s f a c t o r y as working i n consul-t a t i o n with the groupwork s t a f f . This tended to support the 44 conclusions reached i n the Cleveland experiment. Although both caseworkers and groupworkers attempt to help people to the most s a t i s f a c t o r y personal and s o c i a l adjustment, the l i m i t s w i t h i n which each d i s c i p l i n e operates impose c e r t a i n d i s t i n c t i o n s . Casework has the goal that the c l i e n t s h a l l be able to l i v e adequately and independently after the part i c u l a r c o n f l i c t for which he sought help i s resolved and the contact i s terminated. In short, the case-worker aims to work himself out of a job. He offers service over a l i m i t e d time and wi t h i n specified l i m i t s which the 44 It i s interesting to note that Samuel Levine and Mayer Schwarz, reporting on the Irene Kaufmann Settlement (Pittsburgh), state that t h i s agency had a caseworker, who as well as doing co-operative work with the group-work s t a f f , performs casework i n the groupwork s e t t i n g . The most important fact i s that the r e f e r r a l process was f a c i l i t a t e d and the caseworker was able to decide whether or not the indi v i d u a l could be aided by case-work. Most of th e i r fears regarding stigma, and consequent reluctance to keep appointments with the caseworker located i n the agency did not materialize. "What factors are operating and what t h e i r effects are i n the casework process" when the worker works i n t h i s setting " i s an area to which we have not addressed ourselves as yet", Groupwork-Casework Cooperation. Editor: Charles S. Bernheimer. 89 relationship demands. In groupwork, there i s a continuing service over a number of years, the controls are of a d i f f e r -ent type, and the r e l a t i o n s h i p , though i t may be intense, i s of a d i f f e r e n t q u a l i t y than what one expects i n a casework rel a t i o n s h i p . The danger of mobilizing anxiety i n the mind of an Individual i n the group, through confusing the roles and functions of the group leader and the caseworker who offers casework services w i t h i n the groupwork s e t t i n g , should never be minimized. In addition, the c o n f i d e n t i a l nature of the casework relationship must be preserved. This i s more re a d i l y disturbed i n a leisure-time agency where friends and acquain-tances of the potential c l i e n t are constantly coming and going i n the hallways of the agency. Thus i n Bronx House i t was not the role of the consultation worker to offer casework services w i t h i n the groupwork se t t i n g . In summary form, the procedure for the study of a 45 group was developed as follows: 1) The groupwork supervisor and the groupworker presented to the consultation worker a b r i e f picture of the group to be discussed. 2) A description of the personality d i f f i c u l t i e s of the c h i l d or children under consideration was given. 3) S o c i a l Service Exchange clearance was made. 4) Any c o l l a t e r a l reports thus obtained were used to highlight the c h i l d and his family i n situations other than that presented at the Community House. 45 M. Cohen, op.cit., p. 9 90 5) The chil d ' s schoolteacher was consulted to learn how he had adjusted i n the school s e t t i n g . 6) Any material on the c h i l d , his parents or his s i b l i n g s , which was already available at Bronx House was incorporated. 7) The groupwork supervisor arranged a parent conference to serve a dual purpose: (a) to discuss the child's d i f f i c u l -t i e s at Bronx House, and (b) to record the mother's attitude to the c h i l d , as she talked about him i n giving any history leading up to the present behaviour. 8) The group i n which the c h i l d , or children, were mem-bers was observed by the consultation worker, i f possible, several times. 9) Frequent conferences were arranged between the group-work supervisor, the consultation worker and, i f possible, the group leader. 10) When the t o t a l picture was assembled, a conference was c a l l e d of a l l those d i r e c t l y concerned with the handling of the c h i l d , or children, and treatment plans were evolved. As a result i t was possible to see whether the appro-priate action was to continue to handle the chil d ' s behaviour i n the group, to deal with i t i n the group but with a modi-f i e d approach, to change the c h i l d to another group, or to refer him to casework services i n another agency. As an i n d i c a t i o n of the type of changes which might occur w i t h i n the group setting when the groupworker used his knowledge of the children for therapeutic goals, the following i s an example: ° 46 M. Cohen, op_. c i t . , pp 6-14 91 Case 22 Junior, a Negro and small for his age, was a t t r a c t i v e looking and always clean and neatly dressed. Much of his d i f f i c u l t y centered around r i v a l r y with his older s i s t e r who had consider-able r e s p o n s i b i l i t y for him since the parents both worked. In Bronx House, Junior seemed to take advantage of the permissive atmosphere and dominated most of the meetings. When he was able to do t h i s he became a "sorehead" and projected his d i f f i c u l t i e s on to other boys. The group leader t r i e d various methods of d i l u t i n g the pressures of his stronger per-son a l i t y ; however, she observed that Junior invariably gained control. It was f e l t that his small stature and need to compensate through physical prowess, his r i v a l r y and c o n f l i c t with his s i s t e r were Influencing fa c t o r s . It was also evident that he reacted to the woman leader much as he would have l i k e d to treat his s i s t e r . At about t h i s juncture a man leader took the woman's place. He attempted to reinforce the new growing relationship with the boy by i n f o r -mal talks with him. Junior would not l i s t e n to the previous worker but would always accept the man, who became a father-person to him. Gra-dually, Junior no longer needed to assert his sup e r i o r i t y i n a t h l e t i c s , was able to participate i n other a c t i v i t i e s and to gain more from his group experiences. With the change i n leadership a new problem arose with Don, another member of the group, who was Junior's follower. Don was now unable to es t a b l i s h any relationship i n the group except on a f i g h t i n g basis. In Don's family, i t was learned, the mother i s protective and r i g i d and Don has a dependent relationship with her; whereas the father i s passive and r e t i r i n g and seems greatly disinterested i n his son. This fact Don seems to resent. Thus the male worker was unacceptable to Don. The groupworker attempted to see Don informally from time to time, i n order to gain his confidence and strengthen h i s relationship to an accepting man. Other d e t a i l s of the procedure at Bronx House r e l a t e to recording and the keeping of s t a t i s t i c s . At the outset, two types of records were kept: process records and memos of a l l conferences. The groupworker had r e s p o n s i b i l i t y for 92 the former while the consultation worker kept records of a l l areas i n which she participated, such as supervisory confer-ences, c o l l a t e r a l v i s i t s and phone c a l l s , parent conferences -i f these were held through her f a c i l i t a t i o n - and reports of her observations of the groups. Such recording became volu-minous and d i f f i c u l t to do i n the short time l i m i t permitted for the project, although i t could be valuable as teaching material. In discussing "Diagnostic Recording" one author makes the suggestion that "the record be done at the end of an ex-ploratory period, at which time the worker would take responsi-b i l i t y f o r s i f t i n g the material and presenting i t with a 4 diagnostic focus, eliminating t r i v i a , process and r e p e t i t i o n . " By t h i s method i t i s not proposed that the record should be stripped of a l l f e e l i n g tone and substantiating d e t a i l , but that i t be organized to bring into r e l i e f the central and c r u c i a l material. I f thought necessary, a statement of a t t i -tude expressed by the c l i e n t could be included by the consul-t a t i o n worker. In the Bronx House experiment some actual paring down and reorganizing of the record did occur, i n so far as a summary schedule for organizing the record was drawn up. This suggested that the f i n a l record as w r i t t e n by the consultation 48 worker should contain the following elements: 47 Ruby L i t t l e : Journal of S o c i a l Casework, v o l . 30, January 1949, p. 18 48 Ruth Slutsker: "Bronx House, New York"; In Bernhelmer, Ch.S.: Groupwork-Casework Cooperation. New York, Association Press, 1946, pp 31-32 93 1) plans for the individuals i n the group, and for the group. 2) the p a r t i c i p a t i o n and attitude of members of the group towards the program or the materials used i n the program. 3) the interpersonal relationships of the members of the group. 4) the relationships of the members of the group to the leader. 5) the a c t i v i t i e s of the members outside of agency-act i v i t i e s . 6) the records of in d i v i d u a l members of the group. These records were used at conferences to as s i s t the consulta-t i o n worker to further understand his function at the agency. During these conferences the groupwork supervisor made no attempt to supervise the consultation worker i n the casework aspects of his function. This was the job of the casework supervisor who supervised the consultation worker. Problems raised i n r e l a t i o n to the groupwork aspect of supervision were administrative procedures to be followed: nature of the groups to be v i s i t e d ; frequency of v i s i t s ; t e r -mination of group v i s i t s ; methods of r e f e r r a l ; intake policy of agencies; problems of recording; development of reports for meetings. In the casework aspect of the supervision such matters as the following were considered: Was enough known about the c h i l d or children to enable the consultation worker to under-stand the behaviour? Was the child ' s reaction a normal one to a s i t u a t i o n created for him? I f i t was abnormal, did i t indicate 94 an already forming personality disturbance? How should the c h i l d be handled i n either case? If additional help were needed, by what method should the c h i l d be referred to the appropriate source? I f there was reluctance to accept help, what were the reasons for i t , and how could they be overcome? Evaluation Several other studies might be considered besides the two discussed i n d e t a i l here. The aims of each, though d i f f e r i n g from agency to agency according to needs, might wel l be subsumed under the agreement of co-operation of the Joint Consultation Project of the Jewish Board of Guardians and the National Jewish Welfare Board, namely: to u t i l i z e a caseworker "...to a s s i s t the groupworker to effect a better 4 9 adjustment for i n d i v i d u a l children with special problems." In w r i t i n g of another project i n C a l i f o r n i a , Wanda Linderman states that the groupworkers " f e l t that t h e i r work had been v i t a l l y enriched by t h i s project and that a more fact u a l approach has been achieved by the diagnostic informa-50 t i o n from the case records."^ From these b r i e f statements i t i s evident that interest and enthusiasm for such experimentation are spreading over a wide area. It i s not to be denied that sound co-operative e f f o r t s between any two or more agencies to meet needs i s ad-mirable; nevertheless, i n t h i s p a r t i c u l a r type of cross-49 M. Elson: "New York Metropolitan Area"; i n Ch. S. Bern-heimer, op.cit., p. 22 50 "An Experiment i n Casework-Groupwork Cooperation", The Group, v o l . 8 , November 1 9 4 5 , p. 13 95 f e r t i l i z a t i o n i t i s necessary to enquire whether or not the fusion serves as an expedient or as a pattern for long-term development. I f the former i s true, i t would Indicate that groupwork i s seeking additional avenues to educate i t s s t a f f s i n order that groupworkers may do a more sensitive job. In the face of d i f f i c u l t i e s with which they are not prepared to cope, they are turning to casework for assistance and a l l par-t i c i p a n t s i n such enterprises t e s t i f y to the benefits. I f the l a t t e r alternative i s true, i t Is pertinent to question whether the consultation worker was performing the function for which he was best f i t t e d by t r a i n i n g and experience. Functions appropriate to the groupworker Some of the tasks performed by the consultation worker could be done less a r t i f i c i a l l y by an experienced groupworker -such tasks might be the following four: Interviews with parents, intake, observation of the group, and study of cases. 3, Parent interview What s i t u a t i o n i s more l i k e l y to arouse latent h o s t i l i -t i e s i n the parent than a v i s i t from the consultation worker? Often the v i s i t i n g worker has l i t t l e knowledge of the c l i e n t being interviewed, yet must plunge into a d i f f i c u l t area. Of course, an experienced worker i s required to deal i n a construc-t i v e manner with feelings which may be aroused. Yet there may be an easier way out of t h i s impasse. Bronx House evolved a plan whereby the groupworker requested the parent p e r i o d i c a l l y to v i s i t the House. At t h i s time the nature of the child's adjustment was explained. Should the child's behaviour become severe, there existed already a relationship from which the groupworker could launch h i s discussion of the child's need for casework. It i s nevertheless necessary to be aware of s i t u a -tions i n which a direct approach to the parent by the consul-t a t i o n worker may be the only way of contacting the parent. There are some instances, also, i n which the parents consciously search for help and where the r e f e r r a l i s welcomed. 2 Intake In some projects the caseworker or consultation worker handled a l l r e f e r r a l s . Although i t should be empha-sized that only a trained worker should perform t h i s function, the question arises should t h i s person be the consultation worker or a member of the groupwork s t a f f ? A further considera-t i o n arises when no groupworker on the s t a f f i s s u f f i c i e n t l y trained or experienced to handle intake on a select i v e basis. In view of the fact that the consultation worker may be only a part-time worker, i t would be sounder, i n some instances, for him to devote time to the i n s t r u c t i o n of a regular s t a f f person for t h i s function than to do i t himself. Moreover, had he assumed sole r e s p o n s i b i l i t y for t h i s function, the agency would be l e f t , at the conclusion of the consultation worker's services, without a s t a f f person able to conduct selec t i v e intake. The trained groupworker who conducts intake has the additional advantage i n that he i s i d e n t i f i e d with the agency, knows the program intimately and understands the groupwork process from first-hand experience. 97 3 Observation of a group Some question of the v a l i d i t y of t h i s procedure i s raised. At Bronx House observation by the consultation worker was stressed, but l a t e r abandoned, since time spent i n observation might be used to greater advantage i n other ways. Often an untrained volunteer may be trained through supervision to see implications of behaviour. 4 Case Study One role of the consultation worker was to assemble a l l pertinent data about an i n d i v i d u a l or group under study. Often, he i s not as f a m i l i a r as i s the groupworker with c u l t u r a l factors i n the l i f e of the i n d i v i d u a l s . The central reason for assigning t h i s r o l e to him i s because he has collected the various components of the case study. Conclusion The general pattern for the function of a consul-t a t i o n worker i s that he acts as consultant on the meaning of behaviour. Doubtless, i n s p e c i f i c settings, he w i l l have other r o l e s . Through his services, groupworkers may come to r e l y heavily on him to perform jobs which are r e a l l y within the i r own function and capacity. There may even be tendencies to place r e s p o n s i b i l i t y on him for planning the groupwork process i n certain cases. On the basis of the present experimentation i t appears that whatever help was given by the consultation worker should be understood as contributing i n an educational 98 way to the development of groupwork s t a f f s . In t h i s sense, use of the consultation worker i s an expedient during the present lack of trained groupworkers. It i s a poor substitute for guidance and leadership by experienced workers. No f i n a l answer can be given as to how the r o l e of the consultation worker w i l l develop. The lack of experienced groupworkers may continue and the consultation worker may f i n d a permanent and valuable r o l e to play i n leisure-time agencies. 99 Chapter Six IMPLICATIONS AND RECOMMENDATIONS FOR FURTHER STUDY In the e a r l i e s t stages of the study general questions were raised. What had been the current practice among s o c i a l agencies i n Vancouver? What were the workers' roles i n the process; how did they complement each other? Under what conditions was r e f e r r a l most successful? What d i v i s i o n of r e s p o n s i b i l i t y between the co-operating agencies was made? Current Practice Current practice varied i n qu a l i t y and, i n the l i g h t of the d e f i n i t i o n , a large proportion of r e f e r r a l s were "unsuccessful", since workers did not seem to r e a l i z e what was involved i n the process. Even i n Type X r e f e r r a l s , where few d i f f i c u l t i e s might hamper the process, i t was important to give care to planning. In Type Y r e f e r r a l , no instance was found without numerous complicating factors. In general the following constituents entered into any r e f e r r a l process: the in d i v i d u a l to be referred; h i s family ( i f he was a minor) and the needs of h i s parents; the policy of the agency which referred him (and the s k i l l s of the worker); the policy of the agency to which he was referred (and the s k i l l s of the worker there); and f i n a l l y , the group i n which he would become a member or i n which he was already a member. Thus the dynamics and nature of the r e f e r r a l were studied, not as an isolated e n t i t y , but as an in t e g r a l part of groupwork or casework process, helping s o c i a l workers to meet ind i v i d u a l s ' needs more completely. 100 Type X and type Y r e f e r r a l s were i d e n t i f i e d . Whether the i n i t i a l r e f e r r a l request came from casework or groupworkj provided the c r i t i c a l difference between these two forms; other differences were secondary. A t h i r d kind of r e f e r r a l involved the use of the Y.W.C.A. personal counsellor who served as l i a i s o n person between the Program Department (groupwork) and another casework service. Special advantages or disadvantages deriving from the use of t h i s person to f a c i l i t a t e r e f e r r a l were not immediately evident. However, insofar as the counsellor constituted another worker with whom the referred person had to become acquainted, and necessitated an additional step i n the r e f e r r a l , i t weakened the potential worker-client r e l a t i o n -ship and subjected i t to another stress. Parents Important When Child Referred The worker must consider the parents of those c h i l -dren who display d i f f i c u l t i e s i n t h e i r adjustment. In many cases, a groupworker or caseworker offered services related only to the child's apparent problems and f a i l e d to recognize, and work with, the needs and resistances of the parent. These cases were usually closed, neither the c h i l d nor the parent being helped. Agency Responsibility Agencies between which r e f e r r a l s take place must define t h e i r working relationships and agree on a d i v i s i o n of r e s p o n s i b i l i t y . This relationship should be reviewed from time to time and a re-evaluation of the o r i g i n a l s o c i a l plan made. In some cases i t was evident that workers did not see 1 0 1 the value of further contact after the f i r s t r e f e r r a l request, or after the o r i g i n a l s i t u a t i o n had been described. In selected cases, further contact would be superfluous, but both co-operating workers should agree on t h i s i n the i n i t i a l joint casework-groupwork conference. The matter should not be l e f t i n doubt, one worker expecting further discussion subsequently. If one worker f i n d s , for any reason, he must withdraw from the contract during the period agreed on for co-operative handling, he should n o t i f y the second worker. Joint Casework-Groupwork Conference Workers must be clear that the r e f e r r a l process i s subject to Individual variations as diverse as those found i n either the groupwork or casework processes. A jo i n t casework-groupwork conference was found to be the soundest basis for discussing these variations and for evolving a s o c i a l plan. It i s recommended that the conference should always precede mention of r e f e r r a l to the c l i e n t or group member. Certain f o c i for most profi t a b l e discussion of a s p e c i f i c case include the following: 1 The ind i v i d u a l and his personality trends and pattern of behaviour. Is he l i k e l y to be passive and r e t i r i n g , or aggressive and ho s t i l e ? 2 The Individual's health; i s i t a c r i t i c a l factor? What is his general appearance? Has he any nervous mannerisms? 3 What i s his school adjustment, both academic and social? What i s his employment record, i f any? 4 What group a c t i v i t i e s does he:: pursue? What s k i l l s and interests has he? How does he mix with children his own age - e a s i l y or tensely? How does he mix with adults? 102 5 How does the family s i t u a t i o n r e l a t e to the above prob-lems? What i s the parent attitude to the c h i l d and to his siblings ? Can the parent attitude to the agency and the worker be known? 6 Are there other pertinent factors entering the picture? Use of Referral Forms The use of a form on which to record information about an indi v i d u a l has been considered a way of expediting r e f e r r a l . However, the Welfare Federation of Cleveland spon-sored a Joint Committee of the Casework and Groupwork Councils which found that "...forms did not necessarily speed the 51 r e f e r r a l practices." Nevertheless, at the leisure-time agencies studied, recorded information about referred i n d i v i -duals was often non-existent. Sometimes i t lay i n the memories of groupworkers. In case records also, there was often only the b r i e f e s t mention of r e f e r r a l s . I f a serious approach to the improvement of the r e f e r r a l process i n Vancouver agencies i s to be made, a more detailed recording of that s p e c i f i c process must be made. A caseworker and a groupworker interested i n groupwork-casework r e f e r r a l s might, for the purposes of understanding the process, agree to record selected cases In d e t a i l . The use of a form would supply a record of at least preliminary information. Kurt Lewin emphasizes t h i s need for experimentation: "To gain the necessary insight one w i l l have to carry out also some work planned f o r the express pur-pose of gaining these insights; i n other words^ some groupwork w i l l have to be group experiments."-7 51 Letter to the wr i t e r , from Secretary of the Groupwork Council of the Welfare Federation, March 3> 194-9 52 "The Challenge Should be Met", The Group, v o l . 8, March 1946, p. 4 Groupwork Consultation Groupworkers, who were by lack of t r a i n i n g un-equipped to understand and help children presenting s p e c i f i c d i f f i c u l t i e s i n groups but who nevertheless desired help i n th i s task, employed caseworkers to have ce r t a i n functions i n leisure-time agencies i n these areas. E a r l i e r experiments stressed the caseworker's attempt to do casework with members of the groups, but i t was found he could not use his s k i l l s to f u l l advantage. Later experiments stressed the caseworker's function as consultative person who helped the groupworker understand the behaviour of the group members. A summary of procedures showed the t o t a l process as an Interaction of various workers co-operating to assemble data and to complete the study of a group or of an i n d i v i d u a l . However, many functions delegated to the consultation worker were r i g h t l y those of an experienced groupworker or supervisor. During the shortage of trained groupworkers, the employment of a consultation worker may be regarded as an expedient. With further experimentation, i t may be seen that a permanent place should be found for such workers on the staf f s of leisure-time agencies. Experimentation i n the Referral Process Lack of c r i t e r i a f o r good r e f e r r a l s hindered evalua-t i o n i n t h i s study, but some suggestions for good practice w i l l be given - (1) as a tentative outline for use by co-operating agencies, and (2) as a guide to evaluation of subse-quent r e f e r r a l practice. Throughout t h i s guide, the terms " f i r s t worker" and " f i r s t agency" w i l l mean that worker and 104 that agency to which the c l i e n t was f i r s t known; "second worker" and "second agency", the worker and the agency to which the individual was referred. The word " i n d i v i d u a l " w i l l mean either " c l i e n t " or "group member" for whom r e f e r r a l to the second agency i s proposed. C r i t e r i a for Casework-Groupwork Referral 1 The Joint Conference Did the f i r s t worker request and arrange a conference before suggesting r e f e r r a l to the individual? If not, when was the second agency notified? If no n o t i f i c a t i o n was given, why was this?, What was the s o c i a l plan evolved during the meeting? What d i v i s i o n of r e s p o n s i b i l i t y was agreed upon? What agency was to assume major r e s p o n s i b i l i t y ? Was the indi v i d u a l t o l d of this? What provision was made for review of the s o c i a l plan? Was the Social Service Exchange u t i l i z e d ? What reason for the r e f e r r a l was given by f i r s t worker? 2 Explanation to the Individual What reason was given to the ind i v i d u a l of the need to refer? What evidence suggests he understood the reason? If the individual himself requested r e f e r r a l , what were his reasons f o r doing this? What explanation and interpretation of the agencies' functions were given to the individual? 3 Individual's Reactions What were his reactions to the proposed r e f e r r a l ? Did he see the need for r e f e r r a l ? Was he reluctant? How did the worker help him accept the need? How was a c h i l d t o l d , I f the worker contacted his parent? 4 Contact between Indlvidual and Second Agency How did the workers assure that the indi v i d u a l would come to the second agency? Was the ind i v i d u a l given an appointment time, an i n v i t a t i o n to attend a club, or was another device used? > 105 5 Reaction of the Parents If the parent was to be contacted, which worker did this? How was the need for r e f e r r a l interpreted to the parent? Did he understand the interpretation? Was he confused? What evidence suggests this? 6 Establishment of Individual i n Casework What evidence suggests Individual's needs are being met? Was the parent able to permit c h i l d to keep appointments? Did the parent accept casework treatment for himself? 7 Establishment of Individual In the S o c i a l Group Did the ind i v i d u a l arrive as intended? I f not, what e f f o r t s were l a t e r made to contact him? In the group, what behaviour did he show? Was t h i s expected or unexpected? How did the groupworker handle the behaviour? How did the in d i v i d u a l accept agency and group l i m i t a t i o n s ? Did he continue to attend? I f not, why not? 8 Evidence that S o c i a l Plan was Working S a t i s f a c t o r i l y How was i t known that the c h i l d or adult was helped? Did the behaviour d i f f i c u l t i e s diminish? Did the parent gain better understanding of the situation? Did the ind i v i d u a l become a l i k e d and accepted member of the group? Were there other evidences of growth? 9 Conclusion of Referral Process Within what time period did the workers stop t h e i r co-operative a c t i v i t i e s ? Did both workers agree j o i n t l y to conclude a c t i v i t i e s ? I f one withdrew, for any reason, before the process was successfully concluded, what reason did he give for t h i s ? Appendix A BACKGROUND DATA REQUIRED FOR EFFECTIVE CASEWORK-GROUPWORK REFERRALS Name of Agency . . Are you a caseworker or groupworker? Please state under the following sections what kind of back-ground information seems most meaningful to you, or most useful, i n the l i g h t of your r e f e r r a l experiences. 1) Individual personality trends, patterns of behaviour, general emotional tone of the in d i v i d u a l to be referred. Is he l i k e l y to be passive or aggressive and acting out? 2) Health of referred person, any nervous mannerisms, general appearance, etc. 3) School adjustment, academic and s o c i a l . 4) What group a c t i v i t i e s does he pursue? What s k i l l s and interests does he have? How does he get on with children his own age, with adults? How does he participate i n games? 5) What i s the Individual's family s i t u a t i o n as i t relates to the above problems? What i s the parent attitude to the child? to his s i b l i n g s ? to the agency, to the workers there? 6) What other pertinent related factors enter the situation? ( i f necessary, use reverse side for extra space) Appendix B ' Sample of Schedule for C l a s s i f y i n g Record Information Case work Was there a record? Worker' s name? Group work Was there a record? Worker's name? Name of indi v i d u a l sex age marital school grade status empl1t Dates of - Contact between agencies and workers - means used none l e t t e r phone c a l l s j o i n t - s t a f f conference written material sent or only verbal? Worker's statement of reason for r e f e r r a l request C l a s s i f i c a t i o n of causes of the d i f f i c u l t y : -Personality d i f f i c u l t i e s Health reasons Family influences Intelligence factor Inadequacy i n education or t r a i n i n g ; u n s u i t a b i l i t y of schooling Economic influences - Including housing Community influences What service was offered to improve t h i s situation? Psych, treatment friendship group casework a c t i v i t y group education mass a c t i v i t y environmental change other Was any improvement i n behaviour noted? In the child? In f a c t o r s a f f e c t i n g his behaviour? Appendix C Samples of Referral Forms Referral to Special Play Group Date Name Birthdate Intelligence (I.Q. i f known, other, general statementjl . . . School Grade Placement . . . . Address Parents Phone Number Foster Parents Agency Caseworker D i s t r i c t . . Interests Physical Condition . . Referral to Recreational Agency Attendance at any Recreational Agency Camp Experience Where? When? Is there a report from camp? Has he been i n a Special Play Group before?. . .Specify. . . (use other side i f necessary) Problems: 1 Does t h i s c h i l d show any s p e c i f i c symptoms (nervous mannerisms, enuresis, etc.)? Specify: 2 Does he tend to i n t e r n a l i z e or act out his emotional d i f f i c u l t i e s ? Elaborate: 3 How does c h i l d r e l a t e himself to other children? Elaborate (as to age group and sex preference, etc.) 4 Special d i f f i c u l t i e s i n his relationship to members of the family: 5 Why are you r e f e r r i n g t h i s c h i l d to a playgroup? 6 Other pertinent comments about his problems? 1 Margaret Svendsen and Dorothy 3piker, e t . a l . , Integration  of Casework and Groupwork Services for Children, State of I l l i n o i s , p. 86 Appendix C YOUNG WOMENS' CHRISTIAN ASSOCIAT10N@ REFERRAL FORM 1 . Name Address 2 . Age Parents' name Ages of s i b l i n g s Is g i r l l i v i n g with both Parents? i f not, specify: 3. School and Grade :  4 . Employed? Type of Work _Wage Received Unemployed? Reason?_ Z _ I f unemployable, state why 5. L i v i n g arrangements town home, foster home, alone i n c i t y , etc.) 6. F i n a n c i a l circumstances 7. State i f family receiving casework service Does g i r l ' s problem indicate need f o r family casework? 8. W i l l r e f e r r i n g agency continue casework service? To family or to g i r l ? 9. Present supervision of g i r l . Staff Volunteer Not at a l l _ 1 0 . Problem g i r l presents: 1 1 . Y.W.C.A. service required: Accommodation casework group work _ $mark X i f unable to pay moderate sum for recreation) 1 2 . Name of r e f e r r i n g Agency Worker @ Counsellor's O f f i c e , Y.W.C.A., Winnipeg, Manitoba. Appendix D BIBLIOGRAPHY General References Coyle, Grace: "Not a l l Group A c t i v i t i e s are Group Work", The Group, v o l . 1, November 1944, p. 10 Elkes, Regina: "Group-Casework Experiment with Mothers of Children with Cerebral Palsy", Journal of S o c i a l Case Work, v o l . 28, March 1947, p. 95 Gabriel, Betty: "Group Treatment for Adolescent G i r l s " , American Journal of Orthopsychiatry, v o l . 14, October 1944, p. 5 9 3 " Garrett, Annette: " H i s t o r i c a l Survey of the Evolution of Casework", Journal of Soc i a l Case Work, v o l . 30, June 1949, p. 219 Kaiser, Clara: "Generic Aspects of Professional Training for Casework and Groupwork - from the Point of View of a Teacher of Groupwork", Proceedings of the National Conference of S o c i a l Work, 1940, Columbia University Press, 1940, p. 606 Margolis, L i l l i a n : "Selection of Children f or A c t i v i t y Group Therapy", Smith College Studies i n Soc i a l Work, v o l . 17, Sept. 1946, p. 44 Redl, F r i t z : "Problems of C l i n i c a l Groupwork with Children", Proceedings of the Second Br i e f Psychotherapy Council. Chicago, January 1944, p. 29 ~~ Rice, Elizabeth P.: "Co-operative Case Work", The Family. v o l . 18, July 1937, p. 165 Stone, A.S.: Children i n the Community, Children's Bureau Publication Number 317 Trecker, Harlelgh B.: Soc i a l Group Work, P r i n c i p l e s and Practices, New York, The Woman's Press, 1948 Wren, Jean: "Group Work i n a Casework Setting", The Group, v o l . 8, November 1945, p. 8 References on Casework-Groupwork Referral Baker, Elizabeth Hoyt: The Integration of Case Work and  Group Work at, Abraham Lincoln Centre, Chicago, pub-li s h e d by the Centre, 700 Oakwood Blvd., 1942 Bernheimer, Charles S. ( e d i t o r ) : Grouowork-Casework Co-operation, New York, Association Press, 1946 Cohen, Miriam: Progress i n Casework-Groupwork - ^5th  Anniversary Report of Bronx House. 1947 m Bibliography - continued Conover, M e r r i l l B.: "The Joint Use of Group Work and Case Work Techniques", The Family, v o l . 2 3 , November 1942, p. 264 Hester, Mary and Thomas, Dorothy G.: "Case-work and Group-work Co-operation", Proceedings of the National Conference of S o c i a l Work. 1939. New York, Columbia University Press, 1939 Linderman, Wanda: "An Experiment i n Casework-Groupwork Co-operation", The Group, v o l . 8, November 1945, p. 13 Moyle, H.B.: "Some Psychiatric Comments on Group Work", The Group, v o l . 8, January 1946, p. 1 Scheidlinger, Saul: "Patterns of Case Work Services i n Group Work Agencies", The Group, v o l . 8, November 1945, p. 1 Svendsen, Margaret and Spiker, Dorothy: An Experimental  Project i n the Integration of Casework and Groupwork  Services for Children. Chicago, The In s t i t u t e f o r Juvenile Research Van Ness, E l i s e : "Reorganizing a Casework-Groupwork Program", The Family, v o l . 2 2 , July 1941, p. 153 Wilson, Gertrude: Groupwork and Casework - Relationship  and Practice. New York, Family Welfare Association of America, 1941 Wilson, Gertrude: "Interplay of the Insights of Case Work and Group Work", Proceedings of the National Conference of Social Work, 1937. University of ^ Chicago Press, 1937, P. i5o~ 

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