Arts, Faculty of
Social Work, School of
DSpace
UBCV
Hooson, William Thomas
Master of Social Work - MSW
University of British Columbia
"Rehabilitation" is the term commonly and often loosely used in public welfare to connote the restoration of the physical functioning of the client. Restoration on a physical and economic level has, to a marked degree in the past, taken precedence over the casework treatment process. Although such restoration is vitally important, its lasting value to the client and his family is doubtful if not accompanied by a thorough effort on the part of the worker to mobilize the client's personal resources. This study examines a public assistance caseload of a small size coastal city with a population of approximately 60,000, as it existed during one particular month of the year, with the view to analyzing the rehabilitation possibilities of the clients. The initial classification distinguishes (a) the temporarily dependent person, that is, one who is receiving public assistance for reasons other than chronic physical or mental illness and likely to become self-supporting, and (b) the permanently dependent person, one who is unlikely to become self-supporting because of age, physical or mental illness, or disability. Within these classifications, sub-groupings of partial and total dependency were evolved. Factors promoting or retarding rehabilitation have then been analyzed in two groups, summarized as "extrinsic" and; "intrinsic". "Extrinsic" factors are physical and economic including; the reason for the granting of assistance, the length of time the grant has been in pay, and the degrees of skill and the work histories of the wage-earners. The "intrinsic" include personal and emotional factors conditioning the acceptance of assistance and the potentialities for improvement or readjustment. Two basic methods are employed: (1) statistical classification of the total sample group (Chapter II) and (2) case description of typical individuals (Chapter III). As a byproduct of the study, a rating scale of emotional maturity has been compiled (Appendix A) as an aid to future case recording, assistance in diagnosing rehabilitation problems, and setting or evaluating casework treatment goals for social assistance clients. It is evident that the rehabilitation plan for persons on public welfare rolls should include an assessment of the emotional factors of the client's personality development. Because these are vital in the individual's total adjustment pattern, it is recommended that such assessments should be made by qualified social workers during the intake process when the client first applies for assistance. While only a cursory review is made of medical and vocational rehabilitation facilities available for handicapped persons, a provincial coordinator of rehabilitation (including public and private resources) seems indicated to provide integrated and long-range planning for rehabilitation. Finally, it must be recognized that a large proportion of persons in receipt of current public aid are suffering from medical disabilities which are irremediable. For these, the goal of total rehabilitation is not realistic; but a proper function of the social worker is to help such clients accept their handicaps and achieve a limited adjustment.
THE REHABILITATION OF PUBLIC ASSISTANCE RECIPIENTS An Analysis of Reh a b i l i t a t i o n P o s s i b i l i t i e s Among Current S o c i a l Assistance Recipients, Based on the Caseload of the So c i a l Welfare Department, V i c t o r i a , June, 1952. by WILLIAM HOOSON Thesis Submitted i n P a r t i a l Fulfilment of the Requirements f o r the Degree of MASTER OF SOCIAL WORK i n the School of S o c i a l Work Accepted as conforming to the standard required f o r the degree of Master of gpcial. Work School of S o c i a l Work 1953 The University of B r i t i s h Columbia - i i -TABLE OF CONTENTS Chapter I Rehabi l i t a t i o n and Public Welfare Page "Rehabilitation" defined. Types and phases of r e h a b i l i t a t i o n . Casework i n r e h a b i l i t a t i o n programmes. Rehabil i t a t i o n i n the public welfare f i e l d . Casework i n public welfare. Development of public welfare programmes. Method of study. Definitions 1 Chapter II " E x t r i n s i c " Dependency; Physical and Economic Factors Economic and physical e l i g i b i l i t y requirements f o r assistance, and the measurement of i n d i v i d u a l needs. A sample public assistance caseload. D i s a b i l i t i e s of s o c i a l assistance cases. Temporary dependency - p a r t i a l and t o t a l . Permanent dependency - p a r t i a l and t o t a l . Special groups. Summary .. 1 6 Chapter III " I n t r i n s i c " Dependency: Personal and Emotional Factors The meaning of emotional dependency. The casework process and the role of the s o c i a l worker. Casework t r e a t -ment goals. Comparative case studies: temporary dependency — p a r t i a l and t o t a l ; permanent dependency - p a r t i a l and t o t a l . Summary 40 Chapter IV Essentials of Rehabi l i t a t i o n i n Public Assistance The comprehensive programme. The need for s o c i a l workers. Evaluation of the r e h a b i l i t a t i o n process. Measurement of c l i e n t movement. Factors a f f e c t i n g r e h a b i l i t a t i o n . R e h a b i l i t a t i o n f a c i l i t i e s . Subjects for further study. Conclusion 92 APPENDICES: A Scale of Emotional Maturity 1 3 0 B Bibliography 152 - i i i -TABLES, CHARTS, AND SCHEDULES IN THE TEXT (a) Tables Page Table 1 D i s a b i l i t i e s of S o c i a l Assistance Cases 18a Table 2 Composition of Case-load i n the Four Groups ... 20a a. Sex and Age Groups b. Family Status Table 3 Employment Status 22a a. S k i l l Groups b. General Work History (b) Charts F i g . 1 Duration of Assistance 21a a. P a r t i a l Temporary b. Total Temporary c. P a r t i a l Permanent d. Total Permanent (c) Schedules (Appendix A) Schedule A Emotional Maturity Scale-Sexual Adjustment.. 145 Schedule B Emotional Maturity Scale-Achievement 146 Schedule C Emotional Maturity Scale-Social Consciousness 148 Schedule D Emotional Maturity Scale-Self-Worth 150 Schedule E Evaluation Chart of Emotional Level of Client 151 - i v -ABSTRACT "Rehabilitation" i s the term commonly and often loose l y used i n public welfare to connote the restoration of the physical functioning of the c l i e n t . Restoration on a physical and economic l e v e l has, to a marked degree i n the past, taken precedence over the casework treatment process. Although such restoration i s v i t a l l y important, i t s l a s t i n g value to the c l i e n t and his family i s doubtful i f not accompanied by a thorough e f f o r t on the part of the worker to mobilize the c l i e n t ' s personal resources. This study examines a public assistance caseload of a small size coastal c i t y with a population of approximately 60,000, as i t existed during one p a r t i c u l a r month of the year, with the view to analyzing the r e h a b i l i t a t i o n p o s s i b i l i t i e s of the c l i e n t s . The i n i t i a l c l a s s i f i c a t i o n distinguishes (a) the temporarily dependent person, that i s , one who i s receiving public assistance for reasons other than chronic physical or mental i l l n e s s and l i k e l y to become self-supporting, and (b) the permanently dependent person, one who i s u n l i k e l y to become self-supporting because of age, physical or mental i l l n e s s , or d i s a b i l i t y . Within these c l a s s i f i c a t i o n s , sub-groupings of p a r t i a l and t o t a l dependency were evolved. Factors promoting or retarding r e h a b i l i t a t i o n have then been analyzed i n two groups, summarized as " e x t r i n s i c " and; " i n t r i n s i c " . " E x t r i n s i c " factors are physical and economic including;the reason f o r the granting of assistance, the length of time the grant has been i n pay, and the degrees of s k i l l and the work h i s t o r i e s of the wage-earners. The " i n t r i n s i c " include personal and emotional factors conditioning the acceptance of assistance and the poten-t i a l i t i e s for improvement or readjustment. Two basic methods are employed: (1) s t a t i s t i c a l c l a s s i f i -cation of the t o t a l sample group (Chapter II) and (2) case description of t y p i c a l individuals (Chapter I I I ) . As a by-product of the study, a rating scale of emotional maturity has been compiled (Appendix A) as an aid to future case recording, assistance i n diagnosing r e h a b i l i t a t i o n problems, and setting or evaluating casework treatment goals for s o c i a l assistance c l i e n t s . It i s evident that the r e h a b i l i t a t i o n plan for persons on public welfare r o l l s should include an assessment of the - V -emotional factors of the c l i e n t ' s personality development. Because these are v i t a l i n the indiv i d u a l ' s t o t a l adjustment pattern, i t i s recommended that such assessments should be made by q u a l i f i e d s o c i a l workers during the intake process when the c l i e n t f i r s t applies f o r assistance. While only a cursory review i s made of medical and vocational r e h a b i l i t a t i o n f a c i l i t i e s available f o r handicapped persons, a p r o v i n c i a l co-ordinator of r e h a b i l i t a t i o n (including public and private resources) seems indicated to provide integrated and long-range planning for r e h a b i l i t a t i o n . F i n a l l y , i t must be recognized that a large proportion of persons i n receipt of cufrent public aid are suffering from medical d i s a b i l i t i e s which are irremediable. For these, the goal of t o t a l r e h a b i l i t a t i o n i s not r e a l i s t i c ; but a proper function of the s o c i a l worker i s to help such c l i e n t s accept.their handicaps and achieve a limited adjustment. 9 - v i -Acknowl ed gement s I would l i k e to record my sincere indebtedness to those who have given generously of t h e i r time and thought i n helping me to develop t h i s study. I t i s only through t h e i r invaluable assistance and t h e i r pertinent suggestions that I have been able to present and evaluate i n t h i s t r e a t i s e the r e h a b i l i t a t i o n p o s s i b i l i t i e s among public assistance r e c i p i e n t s . To Miss Marjorie J . Smith and Dr. Leonard C. Marsh of the School of Soc i a l Work, University of B r i t i s h Columbia, and to Mrs. Edna Alexander, my f i e l d advisor, may I express my appreciation f o r t h e i r genuine in t e r e s t and consideration. THE REHABILITATION OF PUBLIC ASSISTANCE RECIPIENTS Chapter I REHABILITATION AND PUBLIC WELFARE Rehabil i t a t i o n i s not a new eoncept i n the f i e l d of public welfare. Stated i n one form or another, i t i s one of the basic tenets of public welfare p r a c t i c e . To carry out a programme of r e h a b i l i t a t i o n , however, constitutes the greatest single problem confronting any public assistance o f f i c i a l , be he the elected representative of the people, the administrator of an agency, the supervisor, or the public welfare worker. In spite of the significance of r e h a b i l i t a t i o n to public assistance r e c i p i e n t s , i t seems to be one area wherein the s p e c i f i c aspects have not been too c l e a r l y examined or defined. It i s proposed i n this study to discuss the various facets of r e h a b i l i t a t i o n and, then, to examine a s p e c i f i c public assistance caseload with the view to determining how e f f e c t i v e l y these facets may be applied and carried out. It i s important to appreciate that there i s more than one possible d e f i n i t i o n of the term " r e h a b i l i t a t i o n " . The d e f i n i t i o n proposed by the National Council on Rehabilitation, New York, i s that " r e h a b i l i t a t i o n i s the r e s t o r a t i o n of the handicapped to the f u l l e s t p h y s i c a l , mental, s o c i a l , vocational, and economic usefulness of which they are capable". Such a d e f i n i t i o n i s an admirable statement of philosophy, but without further q u a l i f i c a t i o n , i t immediately brings to mind only the - 2 -physical and vocational aspects of r e h a b i l i t a t i o n . Hence, a more detailed review of i n d i v i d u a l programmes must be made i before any p r i n c i p l e s can be evolved. An examination of the available l i t e r a t u r e reveals that there can be almost as many interpretations of r e h a b i l i t a -t i o n as there are special groups of p h y s i c a l l y and mentally handicapped persons and aberrations of human behaviour. There i s written material on the r e h a b i l i t a t i o n aspects of the following: general d e b i l i t y of the aged a l l e r g y and asthma a r t h r i t i s and rheumatism cancer blindness and p a r t i a l sight deafness and limited hearing speech d i s a b i l i t i e s dental defects disfigurement brain i n j u r i e s cerebral palsy encephalitis epilepsy polio m y e l i t i s multiple s c l e r o s i s n e u r i t i s hemi and paraplegia tuberculosis s i l i c o s i s chronic bronchitis and s i n u s i t i s heart conditions cardiovascular impairment g a s t r o - i n t e s t i n a l disturbances malnutrition pernicious anaemia glandular defects diabetes mellitus hypo and hyperthyroidism hernia severe disablement muscular atrophy orthopaedic conditions occupational diseases leprosy malaria undulant fever venereal diseases mental deficiency neurosis psychosis exceptional children delinquency alcoholism drug addiction There are programmes u t i l i z i n g the medical, s o c i a l , psycholog-i c a l , economic, educational, and vocational aspects of r e h a b i l i t a t i o n . These programmes are available to the handi-capped through the f a c i l i t i e s of c l i n i c s , community services, fo s t e r and do m i c i l i a r y homes, hospitals, r e h a b i l i t a t i o n centers, - 3 -schools, and sheltered workshops. I n i t i a l l y , the r e h a b i l i t a t i o n programmes are developed by i n d i v i d u a l p r a c t i t i o n e r s i n various professional f i e l d s and many are administered and financed by private, philanthropic s o c i e t i e s . Examples of such so c i e t i e s are the American Red Cross Society, the Canadian National I n s t i t u t e for the B l i n d , the B. C. Cancer Foundation, and the Western Society f o r Physical R e h a b i l i t a t i o n at Vancouver, B r i t i s h Columbia. As the s p e c i f i c programmes become-more widely recognized, govern-mental support i n the form of f i n a n c i a l grants, may be made avail a b l e . In some countries, such as i n Great B r i t a i n , New Zealand, and the United States, governmental programmes r e l a t i n g to medical treatment, vocational t r a i n i n g , and employ-ment placement of Individuals are set up on a national basis as a function of government. In Canada th i s movement has been slow to develop generally, but considerable i n t e r e s t i n r e h a b i l i t a t i o n i s e v i -dent at both the federal and p r o v i n c i a l l e v e l s of government. At the same time, a f a i r l y large number of private agencies are active i n the f i e l d , and some integration of public and private programmes i s attained through the c o l l e c t i o n and dissemination of information by such organizations as the Canadian Welfare Council, the National Council on Rehabilitation, and the Montreal 1 cf. Rivi e r e , Maya, Rehabi l i t a t i o n of the Handicapped, National Council on Reha b i l i t a t i o n , New York, 1949 > v o l . 1, p. x v i i et seq. - 4 -Reh a b i l i t a t i o n Survey Committee. The Canadian Welfare Council functions as a clearing-house f o r a l l matters r e l a t i n g to s o c i a l welfare i n Canada. Although many provinces are interested i n the f i e l d of r e h a b i l i t a t i o n , except i n r e l a t i o n to workmen's compensation, the only province at the date of writing which has developed a s p e c i f i c r e h a b i l i t a t i o n programme within i t s public assistance scheme i s Saskatchewan. B r i t i s h Columbia has enacted s o c i a l welfare l e g i s l a t i o n which permits the development of such a. pro-gramme. However, i n practice, public welfare o f f i c i a l s here tend to u t i l i z e e x i s t i n g private agency resources rather than to develop new f a c i l i t i e s to meet the needs of handicapped persons. Throughout Canada generally, workmen's compensation boards have been concerned with the medical and vocational aspects of rehab-i l i t a t i o n of the injured workman. Unfortunately, as i n most programmes, l i t t l e emphasis i s being placed on understanding i n d i v i d u a l emotional behaviour i n r e l a t i o n to r e h a b i l i t a t i o n . Phases of Re h a b i l i t a t i o n A l l r e h a b i l i t a t i o n programmes, whether private or govern-mental, have ce r t a i n similar elements. They generally provide for a medical examination of the handicapped person and make available medical, s u r g i c a l , dental, and other treatment i f nec-essary. Psychometric t e s t i n g , pre-vocational counselling, vocational t r a i n i n g , and employment placement are also common fact o r s . The actual programmes of r e h a b i l i t a t i o n appear to be divided into two d i s t i n c t phases, (a) the physical aspects, and involving medical and surgical treatment, and (b) the vocational - 5 -aspects, involving counselling, r e t r a i n i n g , and employment placement. However, one area which does not appear to be given s u f f i c i e n t consideration i s that involving the emotional attitudes of the handicapped person. A number of i n t r i n s i c factors are emotional i n character and v i t a l l y a f f e c t such a person's morale and his desire to parti c i p a t e i n the r e h a b i l i t a -t i o n process. It would seem, then, that the r e h a b i l i t a t i o n of the handicapped i s a complex process: i t could involve the combined s k i l l s , e f f o r t , and co-operation of the professions of den t i s t r y , d i e t e t i c s , medicine, nursing, occupational therapy, physical therapy, psychiatry, psychology, psychotherapy, s o c i a l work, teaching, and vocational counselling. ; Probably due to differences i n understanding amongst the professional groups, many existing r e h a b i l i t a t i o n programmes place l i t t l e emphasis on the way the patient or c l i e n t f e els about his s p e c i f i c handicap or i n j u r y . In general, an excellent job i s being done on the physical and vocational phases of rehab-i l i t a t i o n but, except i n those programmes u t i l i z i n g the medical or p s y c hiatric s o c i a l worker, l i t t l e attention has been given to the invaluable contribution that the s o c i a l caseworker can make to such programmes. Perhaps t h i s i s because much of the emphasis of these programmes has been on the re-education of the handi-capped at the physical and i n t e l l e c t u a l l e v e l s . Certainly, some considerable progress i n the r e h a b i l i t a -t i o n of certain individuals has been made, even with such a limited approach, f o r there are many persons with handicaps who are able to cope with t h e i r own emotional f e e l i n g s . However, - 6 -the experience of a l l programmes shows that no matter how good they may be, they never seem to reach some people. Since the actual treatment aspects are r e l a t i v e l y constant from one person to the next, depending upon the physical condition of the c l i e n t , the probable reason for the lack of success i n the attempted r e h a b i l i t a t i o n of some persons must l i e within the i n d i v i d u a l himself. It i s these i n d i v i d u a l variations that are the concern of the s o c i a l worker. The e f f e c t of the emotions on the well-being and function-ing of the body was known to the Ancient Greeks, but i t i s only i n recent years that the standard of general practice of medicine has taken into account the e f f e c t of the emotions on treatment. This same concept has yet to gain widespread acceptance by present day professional practitioners i n the f i e l d of r e h a b i l i t a t i o n . Speaking of the tuberculous patient, i t has been said that the medical diagnosis i s made, the su r g i c a l repair work i s done, the psychometric tests of aptitude and interests are carried out, and the vocational counselling related to s k i l l s and a v a i l a b i l i t y of employment i s embarked on - a l l without any adequate assessment of the emotional strengths and weaknesses of the client." 1' This would seem to be equally true of many other r e h a b i l i t a t i o n pro-grammes, regardless of the type of d i s a b i l i t y being, treated. Accepting the fact that the emotional attitudes of the i n d i v i d u a l a f f e c t his physical well-being and, more p a r t i c u l a r l y , 1 c f . Nitzberg, Harold, "Rehabilitation of the Tuberculous — A Casework Process", Social Casework, February, 1950, v o l . XXXI, no. 2 , pp. 61-64. - 7 -his a b i l i t y to u t i l i z e his capacities and his resources, i t seems f r u i t l e s s to attempt the physical and vocational steps of r e h a b i l i t a t i o n without the knowledge of whether or not the c l i e n t i s emotionally w i l l i n g to make use of these f a c i l i t i e s . Herein l i e s the s p e c i f i c . f u n c t i o n of the s o c i a l worker i n the r e h a b i l i t a t i o n process, and without his i n i t i a l psycho-social diagnostic help and casework treatment to r e l i e v e the anxiety and h o s t i l i t y that the c l i e n t relates to his handicap, any such programme i s l i k e l y to remain, at best, a t r i a l and error process. Rehab i l i t a t i o n i n Public Welfare In the f i e l d of public welfare as i n others, there i s considerable v a r i a t i o n i n the meaning of r e h a b i l i t a t i o n . T r a d i t i o n a l l y , the public welfare o f f i c i a l has been concerned with the cost of public assistance as well as with the problem of meeting the needs of c l i e n t s . In many instances, the money involved i n administering the programme became of paramount importance, and the r e a l needs of the recipients were r a r e l y considered. The e f f o r t s of the public welfare workers were focused primarily upon enforcing the e l i g i b i l i t y factors i n a r i g i d manner and i n removing c l i e n t s from s o c i a l assistance r o l l s as expediently as was possible. Hence, i t i s not surprising to find that current thinking on the part of public welfare o f f i c i a l s towards r e h a b i l i t a t i o n i s confused, and that almost i n e v i t a b l y the emphasis seems to be directed towards the problem of hastening the termination of the - 8 -payment of f i n a n c i a l a i d . In such instances, " r e h a b i l i t a t i o n " appears to be the current jargon for the old idea of reducing the cost of assistance, and casework, medical, and other services are only i n s t i t u t e d to f a c i l i t a t e the process. The s o c i a l worker i n the public assistance setting also i s concerned with the c l i e n t * s becoming self-supporting but his t o t a l scope i s much broader. In addition, his attention i s focused on understanding the behaviour of the c l i e n t , and on attempting to meet the c l i e n t ' s needs through the existing f a c i l i t i e s of the agency. As the c l i e n t gradually i s enabled to function on his own, he w i l l no longer require the f i n a n c i a l help of the public assistance pro-gramme. Casework i n Public Welfare It has been suggested that public welfare o f f i c i a l s should adopt a preventive rather than a p a l l i a t i v e approach towards meeting the needs of the c l i e n t s . In doing so, apart from the provision of f i n a n c i a l a i d , they would aim to prevent the breakdown i n functioning or would f a c i l i t a t e the promotion of more e f f e c t i v e functioning of an i n d i v i d u a l i n his r e l a t i o n -ships with his fellow men. Such an approach would necessitate the employment of q u a l i f i e d s o c i a l workers who would u t i l i z e the same s o c i a l services as are presently administered by public welfare s t a f f . These s o c i a l services include f i n a n c i a l a i d , care of neglected children, care of the aged, medical, h o s p i t a l , and convalescent f a c i l i t i e s , care of the mentally i l l , and the l i k e . The aim of the s o c i a l worker would be to help the c l i e n t - 9 -to use e f f e c t i v e l y a l l the resources available to him, such as his own i n t e l l e c t u a l and physical capacities, his family, his frie n d s , his work or school, and his church, as well as the ser-vices provided by the public welfare agency."1" Thus, the s o c i a l worker through his use of the casework treatment process not only would enable the c l i e n t to function more e f f e c t i v e l y , but also would render him less l i k e l y to remain on public assistance for an indeterminate period. However, the success of the s o c i a l worker should not be measured i n terms of the reduction of the costs of public assistance only, but rather, i n terms of the improvement i n the emotional adjustments of the c l i e n t s . Granted, some individuals w i l l become economically s e l f - s u f f i c i e n t as a result of casework treatment, but there are adverse factors a f f e c t i n g many c l i e n t s which preclude such an improvement. s Development of Public Welfare Programmes In B r i t i s h Columbia, as elsewhere, the development of the current public welfare programme has been slow. Public assistance i n i t s o r i g i n a l form i n England was commonly known as poor r e l i e f . I t was designed to meet the needs of those persons who were unable to provide for themselves. Such persons were considered as being less worthy than others i n the community-who were able to maintain themselves. Poverty was thought to be due to a personal defect within the i n d i v i d u a l . These concepts of the pauper and poor r e l i e f were transplanted to the Maritime Provinces 1 c f . Perlman, Helen H a r r i s , "Casework Services i n Public Welfare", Proceedings of the National Conference on Social Work, 1947, Columbia University Press, New York, pp. 261-269. - 10 -and to the New England States by the early s e t t l e r s from England, Scotland, and Wales. Similar i n s t i t u t i o n s to those i n the Old Country were b u i l t , and comparable schemes to deal with these problems of the poor and destitute gradually developed and slowly spread across Canada and the United States i n one form or another. •.; En time, the causes of dependency were recognized as being a part of the s o c i a l and economic structure of the community rather than an i n d i v i d u a l defect or inadequacy. At the same time, the needs of s p e c i f i c individuals as d i f f e r e n t i a t e d from others within the general grouping of paupers was noted, and categorical aid programmes for the aged, the b l i n d , and the dependent children were developed. Concurrently with these categorical aid programmes, the s o c i a l insurance schemes of unemployment insurance, workmen's compensation, sickness insurance, d i s a b i l i t y insurance, health insurance, and old age insurance also came into being. These programmes enabled the employed person to contribute sums of money during periods of f u l l employment into funds which would "insure" him against the v i c i s s i t u d e s of economic f l u c t u a t i o n . The i n d i v i d u a l employee thus established a ri g h t to such finan-c i a l grants and he was no longer dependent upon poor r e l i e f funds that the community determined were i t s duty to provide. A l l these f i n a n c i a l aid schemes succeeded i n removing many persons from the poor r e l i e f or general assistance category. Since many are not able to q u a l i f y f o r help elsewhere, poor r e l i e f i n the form of general assistance has been maintained to provide for the needs of these people. As may be expected, these people - 11 -are the aged, the s i c k , and the i n f i r m , who are l i k e l y to be permanently dependent i n one way or another during the balance of t h e i r l i v e s . P u b l i c Welfare i n B r i t i s h Columbia The r e c i p i e n t s of p u b l i c a s s i s t a n c e i n B r i t i s h Columbia are no exception to the above r a t h e r general statement. The s o c i a l insurances of old age s e c u r i t y , f a m i l y allowance, work-men's compensation, unemployment insurance a n d . h o s p i t a l insurance as w e l l as the c a t e g o r i c a l aid programmes of o l d age a s s i s t a n c e and mothers' allowance are a v a i l a b l e to s p e c i f i c groups of persons. However, these programmes by no means a s s i s t everyone who i s i n need of help and, consequently, the general a s s i s t a n c e programme has been maintained to provide f o r such i n d i g e n t per-sons who f a i l to q u a l i f y f o r other forms of p u b l i c a s s i s t a n c e and s o c i a l insurance. In B r i t i s h Columbia, the general a s s i s t -ance programme i s c a l l e d S o c i a l A s s i s t a n c e . The current s o c i a l a s s i s t a n c e programme i n B r i t i s h Columbia evolved from the p l a n of procedure which was set up i n the 1930's to meet the p r e s s i n g demands of unemployment r e l i e f . A change came i n 1946 when the Department of H e a l t h and Welfare was organized and the a d m i n i s t r a t i o n of a l l c a t e g o r i c a l a s s i s t a n c e programmes was placed under i t s j u r i s d i c t i o n . The passage of the S o c i a l A s s i s t a n c e Act i n the same year made l e g a l p r o v i s i o n f o r the granting of a i d "to (the) i n d i v i d u a l , whether a d u l t or minor, or to f a m i l i e s , who through mental or p h y s i c a l - i l l n e s s or other exigency are unable to provide i n whole or i n part by t h e i r own e f f o r t s , through other s e c u r i t y measures, or from income and - 12 -other resources, necessities essential to maintain or assist in maintaining a reasonable normal and healthy existence". 1 According to the same Act, social assistance is defined 2 as follows: (a) Financial assistance: (b) Assistance i n kind: (c) Institutional, nursing, boarding or foster home care: (d) Aid i n money or in kind to municipalities, boards, commissions, organizations, or persons providing aid, care, or health services, and in reimbursing expen-ditures made by them: (e) Counselling service: (f) Health services: (g) Occupational training, retraining, or therapy for indigent persons and mentally or physically handi-capped persons: (h) Generally any form of aid necessary to relieve destitution and suffering: Thus, by legislative definition, social assistance is very broad and could serve as an excellent base for a good physical and vocational rehabilitation programme. In practice, a comprehensive medical scheme including surgical treatment is available to a l l persons in receipt of public assistance, either from their private physicians or from qualified specialists. Trained social workers are employed by the department in so far as is possible, and generally, a high proportion of f i e l d personnel have at least some academic train-ing in social work. Nevertheless, these public welfare o f f i c i a l s have to rely on the f a c i l i t i e s of private organizations and local municipalities to provide the necessary occupational training, 1 Revised Statutes of B r i t i s h Columbia, 1948, Chapter 310, Section 3 (The Social Assistance Act). 2 Ibid., Section 2 . - 13 -r e t r a i n i n g and therapy that are e s s e n t i a l for the restoration of active p a r t i c i p a t i o n of r e c i p i e n t s , and no attempt has been made as yet to organize these necessary f a c i l i t i e s i n centers where they are lacking. Such f a c i l i t i e s are extremely limited i n the province and can meet the needs of l i t t l e more than a handful of persons requiring Individual service. The regulations of the S o c i a l Assistance Act make i t mandatory for the C i t y of V i c t o r i a to operate i t s own s o c i a l welfare department and to employ s o c i a l work s t a f f who meet the q u a l i f i c a t i o n s set by the p r o v i n c i a l Department of Health and Welfare. The p r o v i n c i a l department does supply an equivalent number of s o c i a l workers to the V i c t o r i a S o c i a l Welfare o f f i c e , and, i n addition, provides l i b e r a l means of aid f o r the reimburse-ment of a large proportion of the f i n a n c i a l assistance that i s granted to indigent persons residing within the c i t y . Method of Present Study For the purposes of t h i s thesis the t o t a l s o c i a l a s s i s t -ance caseload of the V i c t o r i a C i t y S o c i a l Welfare Department for the month of June, 1952 i s chosen for study. The c l i e n t s receiving aid at t h i s time constitute, so to speak, the "hard core" of the public assistance caseload. With the employment s i t u a t i o n much improved a f t e r the slack period of the winter months, there are very few persons i n receipt of f i n a n c i a l aid who are capable of taking employment. Hence, many of the c l i e n t s included i n t h i s study are the aged, the s i c k , the i n f i r m , and the women with dependent children. Each case i s reviewed, and the material documented i n - 14 -schedule form. Since age i s a major factor i n the process of physical and vocational r e h a b i l i t a t i o n , a preliminary c l a s s i f i -cation of the heads of the case units was made on the basis of the age ranges of 20 to 44 years, 45 to 59 years, 60 to 69 years, and 70 years and over. Further study of the material has resulted i n the f i n a l c l a s s i f i c a t i o n s of temporary and t o t a l dependency, with sub-groupings for each. Cases which are determined as being temporarily dependent are those i n which i t seems l i k e l y that the head of the family or the breadwinner might become economically self-supporting at some future date. The t o t a l l y dependent c l i e n t s are those who are suffering from degenerative or chronic ailments which preclude the l i k e l i h o o d of t h e i r ever maintaining themselves f i n a n c i a l l y . A comparative s t a t i s t i c a l analysis of t h i s material has been made and i s reviewed i n Chapter I I . Since the material i s drawn for the most part from the limited e l i g i b i l i t y studies which are so c h a r a c t e r i s t i c of public welfare recording, a detailed analysis of the records from the point of view of s o c i a l casework i s d i f f i c u l t , and v i r t u a l l y impossible i n many cases. This paucity of background information i s very evident i n the cases wherein the breadwinner applied f o r assistance l a t e i n his l i f e t i m e . Therefore an e f f o r t has been made to determine the p a r t i c u l a r contribution that the s o c i a l worker can make towards r e h a b i l i t a t i o n i n the public welfare s e t t i n g . This can best be i l l u s t r a t e d by the more detailed subjective study of selected case records. This material, stud-ied from the casework point of view, i s the substance of Chapter I I I . - 15 -The material discussed i n Chapter I? constitutes a review of the essentials of a comprehensive public assistance r e h a b i l i t a t i o n programme. • Of major importance i s the suggested plan of r e v i s i o n of public assistance caseloads and the s e l e c t i v e assignment of a l l new cases so that the diagnostic and treatment s k i l l s of the q u a l i f i e d s o c i a l worker can best be u t i l i z e d . D e finitions In the following discussion a number of terms i n common use i n public welfare practice are u t i l i z e d . However, the s p e c i f i c meanings of these are by no means uni v e r s a l l y accepted even amongst public welfare p r a c t i t i o n e r s . In the context of t h i s presentation these terms are used as follows: 1. Public welfare, public assistance, and categorical aid programmes are synonymous and refer to those programmes which are financed by general taxation and which require the use of a means test to prove the e l i g i b i l i t y of each i n d i v i d u a l applicant f o r f i n a n c i a l a i d . 2. S o c i a l insurance programmes ref e r to those schemes whereby f i n a n c i a l assistance i s granted on the basis of the right of the i n d i v i d u a l applicant being established by personal contributions i n one form or another. Such assistance i s paid without the i n d i v i d u a l a p p l i c a t i o n of a means t e s t . 3« The terms "public welfare o f f i c i a l s " and "public welfare workers" are interchangeable and refer to persons who may or may not have formal t r a i n i n g i n s o c i a l work. Generally, i t can be assumed that these persons have no t r a i n i n g . 4. The terms " s o c i a l worker" and " s o c i a l caseworker" are used to connote such persons as have special professional t r a i n i n g i n s o c i a l work and are graduates from a recognized school of s o c i a l work. Chapter II "EXTRINSIC" DEPENDENCY: PHYSICAL AND ECONOMIC FACTORS Economic dependency may be reasonably defined as the i n a b i l i t y or incapacity, by reason of phys i c a l , mental, or emotional defects, to earn a l i v i n g and to take one's r i g h t f u l place i n the work-a-day world. It i s the lack of a b i l i t y to maintain oneself and to be s e l f - s u f f i c i e n t from a f i n a n c i a l point of view. Individual economic dependence, as a l l public welfare workers know, i s a r e l a t i v e matter, and the economically dependent person of today cannot be re h a b i l i t a t e d without an understanding by the welfare worker of the meaning of dependency and i n s e c u r i t y i n r e l a t i o n to broader economic issues. The basic premise of any public assistance programme, regardless of i t s philosophy or of i t s methods of administration, i s that the programme w i l l meet, i n one way or another, the needs of those individuals i n the community who are unable to provide f o r them-selves the necessities of l i f e . Obviouslyj a clear d i s t i n c t i o n has to be formed between human needs and human desires. .Therefore, to enable such a programme to function, an attempt must be made by public welfare o f f i c i a l s to determine the personal factors common to each a p p l i -cant that w i l l permit him or her to be e l i g i b l e for assistance. Such e l i g i b i l i t y requirements constitute, i n essence, a scale of measurement which can be applied to a l l indiv i d u a l s who seek a i d . - 17 -The scale measures t h e i r needs i n r e l a t i o n to the needs that the programme i s designed to meet. With the p r a c t i c a l a p p l i c a t i o n of the programme involving the measurement of in d i v i d u a l needs, the physical and economic factors of dependency play a major r o l e . Such factors are r e l a t i v e l y easy to define, and can be determined with reasonable accuracy from one applicant to the next. The emotional factors of dependency, which vary greatly from i n d i v i d u a l to i n d i v i d u a l , are, to say the l e a s t , subjective. Although they can be defined, they can only be measured i n r e l a t i v e terms, which makes accurate and v a l i d comparisons from one i n d i v i d u a l to another somewhat d i f f i c u l t . Such measurement i s further complicated by the fact that the observations of the public welfare worker as related to these emotional factors of the i n d i v i d u a l may be coloured by his own personality development. The end resu l t i s that the assessment of the applicant's emotional factors may vary from worker to worker unless these workers have had extensive t r a i n i n g i n t h i s area of psycho-social development and behaviour as have profes-sional s o c i a l workers. As w i l l be indicated l a t e r , i t i s esse n t i a l for t h i s reason alone that some pro f e s s i o n a l l y trained s o c i a l workers be employed i n the public assistance programme. With the e l i g i b i l i t y study of the applicant emphasizing the physical and economic factors of the s i t u a t i o n , i t i s under-standable that public welfare workers tend to consider r e h a b i l i t a -t i o n almost exclusively i n terms of these e x t r i n s i c f a c tors. Hence, t h e i r emphasis i s related to e f f o r t s which w i l l enable - 18 -such persons as may be receiving assistance to become f i n a n c i a l l y and p h y s i c a l l y self-supporting again. During June, 1952, s o c i a l assistance was paid by the V i c t o r i a C i t y S o c i a l Welfare Department to 467 persons. These persons were single men, single women, and heads of families with and without dependent children. A c t u a l l y there were 698 i n d i v i d u a l men, women, and children i n receipt of assistance during the month. For the purposes of analysis the t o t a l case-load has been d i r e c t l y related to the number of cash grants that were disbursed. The recipient of such a grant i s designated as being a single case unit, regardless of the number of persons i n the family for which the assistance was paid. Hence, a case unit may refer to a single person, a married couple, or a family with dependent children. In B r i t i s h Columbia, public assistance i s usually granted only to those individuals who are unemployable and who are i n need. Temporary assistance may be given to needy employable persons for compassionate reasons. The applicant i s designated as being unemployable i f he suffers from a medically diagnosed physical or mental ailment. Therefore, the heads of case units receiving public assistance i n V i c t o r i a i n June, 1952, were suffering from chronic or degenerative physical conditions which precluded t h e i r ever becoming self-supporting (Table 1 . ) .^ On the other hand, there were also a number of case units wherein the family head was 1 A preliminary analysis of the health of the t o t a l group revealed that these individuals suffered from more than 48 d i f f e r e n t ailments or conditions. - 18a -Table 1. D i s a b i l i t i e s of Social Assistance Cases len and Women; V i c t o r i a Social Welfare Dept., June 1952) Type of Age Groups Male D i s a b i l i t y 20- 45- 60- 70& 20- 45- 60- 70& No. P.C. 44 59 69 up 44 59 69 up Heart Condition 3 4 15 9 2 6 20 8 67 14.5 Tuberculosis 28 6 6 - 14 - - 56 11.7 General D e b i l i t y - 8 14 - 2 11 14 49 10.6 Mental I l l n e s s 2 4 5 1- 8 7 9 3 39 8.5 Physical Injury - 4 10 2 - 1 9 4 30 6.4 Cerebral Hemorrhage - 1 2 4 - 1 4 16 28 6.1 Gastro-Intestinal 1 1 11 2 - 2 6 2 25 5.5 A r t e r i o s c l e r o s i s - - 3 10 - 1 10 24 5.2 A r t h r i t i s - 2 6 1 1 5 2 6 23 4.9 Blindness - - 4 5 - 1 1 1 12 2.6 Genito-Urinary - 1 2 3 - - 2 3 11 2.3 Paralysis 1 - 2 1 1 3 2 1 11 2.3 Asthma and Excema - - 8 - - 1 - 1 10 2.1 Cancer 1 - 2 - 9 1 1 - 7 1.5 Epilepsy 3 1 1 5 1.1 Alcoholism 1 1 2 1 - - - - 5 1.1 Multiple Sclerosis - 1 - - 2 1 - - 4 .8 Goitre and Thyroid 2 2 - 4 .8 Diabetes mm — 1 1 - - - 1 3 .6 Women with Dependent Childern - — - - 42 12 2 - 56 11.7 Total 40 25 87 54 72 45 73 71 467 100 Female Total - 19 - " employable (the women with dependent children), or was l i k e l y to be employable at some future date (some tuberculous c l i e n t s ) . These people were capable of becoming self-supporting since the factor which currently made them e l i g i b l e for assistance probably would eventually be resolved. Hence, i t may be assumed that there were some case units which were temporarily dependent and others which were permanently dependent. The c l a s s i f i c a t i o n of temporary and permanent dependency has been used as the basis f o r the analysis and f o r the comparison of the personal and environmental situations of a l l case units examined i n the study. In t h i s chapter, a "cross-section picture" of the t o t a l caseload i s presented from the point of view of the physical and economic factors a f f e c t i n g the heads of the i n d i v i d -ual family u n i t s . A. Temporary Dependency A number of case units, though, requiring f i n a n c i a l assistance for varying periods of time, were e s s e n t i a l l y capable of managing without the assistance i f i t were not f o r c e r t a i n factors i n t h e i r physical or environmental situations (Table I . ) . One group of case units were receiving aid for a temporary period, although the breadwinners were normally employable. A change i n the labour market had l e f t these persons without work and without s u f f i c i e n t funds to manage. Assistance had been granted primarily f o r compassionate reasons, as the case units were generally families with dependent children. Another group were tuberculous patients, women with dependent children, and families where the male wage-earner was temporarily incapacitated with an - 20 -acute i l l n e s s or i n j u r y . These persons would probably be on assistance for a considerable period of time, but both groups l i k e l y ! were to become self-supporting again at some future date. The former group might be considered as being one of p a r t i a l temporary dependency, and the l a t t e r , one of t o t a l temporary dependency. 1. P a r t i a l Temporary Dependency The p a r t i a l l y temporarily dependent case units were granted assistance on compassionate grounds. Because the bread-winner or head of the unit was employable, i t was not expected that the assistance would be continued f o r longer than a very minimal period. The number of case units f a l l i n g into t h i s category varies considerably from month to month depending upon the employment s i t u a t i o n . The number i s greatest during the winter months, and lowest or non-existent during the summer months. Generally, such units consisted of married couples with dependent children, or widowed, divorced or deserted women with dependent children. Occasionally, single persons were granted assistance, but they.were i n the age grouping of 45 years and over. The younger single persons were expected to make t h e i r own arrangements regarding maintenance during such periods of slack employment. Eleven case units of the p a r t i a l l y temporarily dependent type i n the V i c t o r i a C i t y S o c i a l Welfare Department caseload i n June, 1952 constituted 2 .3$ of the t o t a l case units receiving assistance during that month (Table 2a and b.). They were com-paratively few i n number since the employment market was f a i r l y - 20a -Table 2. Composition of the Caseload i n the Four Groups a. Sex and Age Groups 1. I I . I I I . IV. P a r t i a l Total P a r t i a l T otal Total Temporary Temporary Permanent Permanent Men 20"- 44 4 32 7 2 45 45 - 59 2 7 17 3 29 60 - 69 1 1 58 15 75 70 and over - - 5 50 55 Women 20 - 44 3 64 13 6 86 45 - 59 15 26 7 43 60 - 69 1 3 42 14 60 70 and over - - 5 64 69 Total 11 122 173 161 467 P.C. 2.3 26.1 37.1 34.5 100 b. Family Status Family Groups I. P a r t i a l Temporary I I . Total Temporary I I I . P a r t i a l Permanent IV. Total Permanent Total Men Family ITon-Family 6 1 6 34 4 83 50 16 168 Women Family Non-Family 4 57 25 3 83 64 64 172 Total P.C. - 11 2.3 122 26.1 173 37.1 161 34.5 467 100 - 21 -good at that time of the year. The s i t u a t i o n became more serious i n July and August, 1952, owing to the extensive s t r i k e s i n the lumbering industry and the building trades which developed during June, and lasted throughout the summer. Generally, however, December, January, and February of any year are the months when the labour market i s slackest, and when the number of applications f o r assistance might r i s e to 10% of the t o t a l caseload. The amendments to the federal Unemployment Insurance Act, passed i n March, 1950, which extended supplemental benefits to wage-earners whose unemployment insurance coverage had expired, has been a material factor i n keeping the applications f o r public assistance by the employable group at a minimum even during the winter months. Of the eleven case units i n t h i s category of p a r t i a l temporary dependency i n June 1952, only three breadwinners were suffering from physical i l l n e s s . These i l l n e s s e s were of a minor nature that incapacitated the family head fo r a period of only two to three weeks. Assistance i n the balance of the cases was granted f o r compassionate reasons. Eight of the case units received assistance for one month or l e s s , two for a period of two months, and one for a period of four months ( F i g . l a ) . The l a t t e r case had been o f f assistance f o r a short period during the four months. However, the lumbering industry s t r i k e l e f t the family head again without work. A s k i l l e d person has been defined as one who has learned a trade or profession by serving a period of special t r a i n i n g or apprenticeship, a semi-skilled person as one who has learned a trade by experience on the job, and an u n s k i l l e d person as one - 21a -F i g . 1. Duration of Assistance a. PARTIAL Temporary b. TOTAL Temporary S3 Z) 3 vrtOTe 4. 1 3 \ r 6 J I 1 1 1 1— than i V l < \ \ \ \ \ \ { \ \ \ \ W No, of cases (Time i n months) 1 5 to ^ V*a» s ijeo<-S O T o<r«i 10 -^o "^ O «»o - 4 I 1 I I I I I . No. of cases Men Women c, PARTIAL Permanent d. TOTAL Permanent 1 k V W W W U V W W S to ^ u«ar3 5 IO -JL«B T>© «V0 I I 1 • 1 1 4 ^ years 1 to t « SET TOW 5.0 yft.a.<f 0»- f*>or« No. of cases 10.— T-O "iO AO •mi i i — i • • • • No. of cases (Duration i n years, except F i g . 1 a.) - 22 -who has been employed at work requiring no t r a i n i n g . With 73>7% of the wage-earners f a l l i n g into the s k i l l e d or semi-s k i l l e d categories, i t would seem l i k e l y that such persons would be re-employed r e l a t i v e l y quickly with an improvement i n the labour market (Table 3 a ) . The r a p i d i t y of such a group's return to work might also be estimated from a review of the work h i s t o r y of the wage-earner. A steady work hist o r y i s defined as one wherein the head of the case unit has been employed at his p a r t i c u l a r job or type of work for more than one,year, a seasonal work hist o r y as one i n which the worker has been employed for some months on the same job or i n the same type of work during the year, and a casual work history as one wherein the wage-earner works on a day to day basis during the month for one or more than one employer. Gf the wage-earners of the group, 63 .6$ were st e a d i l y or seasonally employed before assistance was granted (Table 3 b ) . Again, i t might be expected that these units would be o f f assistance i n a r e l a t i v e l y short period of time. The work h i s t o r i e s , however, do suggest another point. Presumably, these wage-earners were not e l i g i b l e f o r unemployment insurance, or public assistance would not have been granted. Generally, a s t e a d i l y or seasonally employed worker i s e l i g i b l e for unemployment insurance sp e c i a l benefits i f he i s employed f o r a longer period than 60 days i n the immediately preceding 180 days, or 45 days i n the preceding 90 days. This would seem to indicate that the wage-earners i n the category of pax-tial temporary dependency were not employed i n work which necessitated - 22a -Table 3. Employment Status a. S k i l l Groups Degree of S k i l l I. P a r t i a l Temporary I I . Total Temporary I I I . P a r t i a l Permanent IV. Total Permanent Total Men - 15 S k i l l e d 2 5 . 4 4 Semi-skilled 2 11 10 10 33 Unskilled 3 10 56 4 2 111 Unknown - 14 17 14 45 Women Sk i l l e d - 4 3 5 12 Semi-skilled 3 9 7 6 25 Unskilled 1 59 73 43 176 Unknown - 10 3 37 50 Total 11 122 173 161 467 b. General Work History I. I I . I I I . IV. P a r t i a l Total P a r t i a l Total Total Temporary Temporary Permanent Permanent Men Steady 3 14 16 15 48 Seasonal - 6 7 3 16 Casual 4 6 47 38 95 Unknown - 14 17 14 45 Women Steady 4 16 8 6 34 Seasonal - 1 - 6 7 Casual - 13 17 10 40 Unknown - 10 3 37 50 None - 42 58'"*' 32 132 Total 11 122 173 161 467 - 23 -payment of contributions to the Unemployment Insurance Commission when they were working. The role of the public welfare worker, then, i s to a s s i s t these wage-earners i n finding work i n covered employment which w i l l enable them to become e l i g i b l e f o r unemployment insurance benefits. This i s preferable to the granting of assistance during periods of slack employment. This conclusion might not be v a l i d , however, as unemployment insurance special benefits cease to be paid a f t e r A p r i l 15th of any year. Considering the t o t a l group of case units i n t h i s cate-gory of p a r t i a l temporary dependency from the point of view of the physical and economic factors, the goal of r e h a b i l i t a t i o n towards economic self-support involved no major problems. The great majority of the wage-earners were under 60 years of age ( 6 3 . 6 $ were a c t u a l l y under 45 years), were s k i l l e d or semi-s k i l l e d tradesmen ( 7 0 . 7 $ ) • and had a steady or seasonal work histo r y ( 6 3 . 6 $ ) . An improvement i n the environmental situation, that i s , i n the demand for labour, would result i n a rapid reduction of t h i s portion of the t o t a l public assistance case-load through l i t t l e or no e f f o r t on the part of public welfare personnel. 2 . Total Temporary Dependency The families and single persons c l a s s i f i e d as being temporarily t o t a l l y dependent were those wherein the head of the family unit was suffering from an i l l n e s s requiring lengthy treatment, for instance, tuberculosis. Widowed, divorced, and deserted women with young dependent children were also included. Both th i s category and that of p a r t i a l temporary dependency - 24 -included those cases that might have been considered as being capable of becoming self-supporting. The d i f f e r e n t i a t i n g c h a r a c t e r i s t i c s of t o t a l temporary dependency were f i r s t , that the f i n a n c i a l assistance was of a more permanent nature rather than a "stop-gap" measure during slack employment periods, and second, that other agency services were required. These serv-ices included extensive medical treatment, prolonged h o s p i t a l i z a t i o n , i n t e r p r e t a t i o n of the needs of growing children, help i n mobilizing personal and community resources to meet the needs of the family, and general moral support and guidance. It i s probable that applications from persons c l a s s i f i e d i n t h i s category are f a i r l y constant throughout the course of the year, and from one year to the next, since the incidence of i l l n e s s , death, divorce, and desertion does not fluctuate as markedly as does employment demands. The t o t a l of 122 case units i n t h i s category constituted 26.1$ of the caseload f o r the month (Table 2a and b). A s s i s t -ance was granted for compassionate reasons i n 69 .5$ of the cases where women were heads of the family, and i n 2 .5$ where men were s t i l l i n the home. On the other hand, physical i l l n e s s was the determining factor i n the granting of assistance to 90$ of the families where the father assumed his customary r o l e , and 24.4$ where the mother was the family head. Mental i l l n e s s and physical handicap as reasons f o r granting aid occurred i n only 4.1$ and 2 .5$ respectively f o r the t o t a l group, regardless of the sex of the breadwinner. - 25 -Of the 122 case units, 99 or 81.1$ had been i n receipt of aid for a. period of less than f i v e years, and 50.8$ of the t o t a l had been, granted within one year (Fi g . l b ) . This probably indicated that the families and single persons i n the category of t o t a l temporary dependency were f a i r l y mobile, and were not prone to remaining on the public assistance r o l l i n d e f i n i t e l y . Certainly, there was no marked increase i n the t o t a l agency case-load over the period of three years from June, 194-9, to June, 1952. However, a more detailed analysis of the case records over several years i s necessary to determine the significance of the duration of assistance. With 56.6$ of the group f a l l i n g under the heading of unskilled wage-earners, obviously some considerable d i f f i c u l t y would have arisen i n returning t h i s group permanently to the labour market when the children ceased to be dependent, or when the health of the head of the family improved. (Table 3a) The degree of s k i l l i n almost 20$ of the wage-earners was unknown. However, i t might be assumed that many of these persons were un-s k i l l e d . Then, too, the high proportion of women (71.9$) who had no job s k i l l s presented a r e a l l y serious problem i f the plan of t h e i r eventually becoming permanently self-supporting was considered. The comparison of the work hist o r y of the breadwinners i n conjunction with the degree of s k i l l emphasized the point that some consideration of vocational t r a i n i n g would have to be made i f the persons i n t h i s group were to become economically rehabilitated (Table 3b). Those individuals having a casual - 26 -work history, or none at a l l , constituted 50.1$ of the t o t a l group, and 67.1$ of the women. These figu r e s , too, would l i k e l y have been increased i f more detailed information were available on those whose work hist o r y was unknown. Clearly, the group of t o t a l temporary dependency appears to be one i n which the r e h a b i l i t a t i o n service of a vocational t r a i n i n g nature could have been most p r o f i t a b l y u t i l i z e d , p a r t i c -u l a r l y as 77•9$ of the family heads were i n the age range of 20 to 44 years. The majority of these persons had no employment s k i l l s and a ne g l i g i b l e work hi s t o r y . There would have been no great demand for extensive medical and sur g i c a l care other than that which was being provided, f o r only 2.5$ of the group were suffering from physical handicaps. The need f o r , and the use of vocational t r a i n i n g for such a group requires much more extensive study than has been given i n thi s presentation. The issue to be determined i s whether or not the women with dependent children can p r o f i t a b l y use such training, and when they should be encouraged to embark on i t . Obviously, there i s no point i n tra i n i n g these persons years i n advance of when they w i l l be able to use the acquired s k i l l . Nor can they be expected to star t on a new learning experience without adequate in t e r p r e t a t i o n or help. However, casework treatment throughout the process and vocational t r a i n i n g at the appropriate time would give such women the necessary confidence to venture out from the meagre secu r i t y provided by the minimal public assistance grant. They would be placed i n a p o s i t i o n where they could com-pete successfully i n the open labour market and would become - 27 -contributing c i t i z e n s to the economy of the community. B. Permanent Dependency Some case units i n the V i c t o r i a S o c i a l Welfare Department caseload were c l a s s i f i e d as being permanently dependent because the physical and mental conditions of the wage-earners or heads of the units were such that these persons would never become economically self-supporting. There were, however, a number of these c l i e n t s who were able to manage as long as they had s u f f i c -ient funds to feed, to clothe, and to house themselves. They were ambulatory, shopped for t h e i r own groceries, prepared t h e i r own meals, and generally cared f o r themselves without outside help. These persons were designated as being p a r t i a l l y perman-ently dependent. The remainder were those persons who needed the physical care provided by the i n s t i t u t i o n a l setting, the medical care of the physician and nurse, as well as the f i n a n c i a l aid of the s o c i a l welfare department. Some of these c l i e n t s were ambula-tory to a degree, but many were t o t a l l y bedridden. But, as a general r u l e , they required help of more than just that of a f i n a n c i a l nature. They were cared for i n boarding and convales-cent homes, private hospitals, and other i n s t i t u t i o n s . These were the c l i e n t s who were t o t a l l y permanently dependent. With the public assistance programme being related to meeting the needs of residual cases, i t might be anticipated that the cate-gories of p a r t i a l permanent dependency and temporary permanent dependency would constitute the greater portion of the caseload. - 28 -1. P a r t i a l Permanent Dependency Persons who were si n g l e , that i s , those who were widowed, deserted, divorced, or who had never married, c o n s t i -tuted 95.9$ of the group. (Table 2a and b). It may, therefore, be expected that, as they grew older and required more care and attention, i n s t i t u t i o n a l care i n one form or another would have been required, and since these persons would be without family resources, they would become t o t a l l y permanently dependent on public assistance. Assistance was granted because of physical i l l n e s s i n 46.7$ of the cases, for compassionate reasons i n 23.3$? and due to mental i l l n e s s of the c l i e n t i n 1 6 . 3 $ . There were 13.7$ of the family heads who were p h y s i c a l l y handicapped. However, 91.6$ of these persons were over 45 years of age, and 58.3$ were over 60 years. Hence, even with intensive and prolonged medical treatment and vocational t r a i n i n g , there was probably l i t t l e hope of t h e i r ever becoming self-supporting. With reference to the length of time that assistance had been paid to these c l i e n t s , 64 .4$ of the grants had been made within the l a s t four years ( F i g . l c ) . There was, nevertheless, . a marked difference between male and female r e c i p i e n t s . 81.6$ of the men had applied for help within the past four years, whereas 79«4$ of the women had been on s o c i a l assistance f o r nine years or l e s s . The women not only became dependent at an e a r l i e r age than the men, but also they tended to remain i n t h i s category for a longer period. This possibly indicated that they did not deteriorate into t o t a l permanent dependency as quickly as - 29 -did the men. For the t o t a l group, 74.9$ were u n s k i l l e d , and 70.8$ had been only casually employed or had never worked for wages at' a l l . (Table 3a and b) Those who were s k i l l e d or semir-skilled and who had worked st e a d i l y or seasonally were a l l over 45 years of age. Of the s k i l l e d or semi-skilled i n d i v i d u a l s , 66 .7$ were over 60 years of age as were 80.7$ of those persons who had held steady or seasonal employment. With almost two-thirds of the wage-earners i n t h i s cate-gory of p a r t i a l permanent dependency being 60 years of age or older, and almost three-quarters of them with no s k i l l or steady work experience, i t seemed u n l i k e l y that any degree of success would have resulted from e f f o r t s to enable them to become econom-i c a l l y self-supporting. The role of the public welfare worker here then would be to complete periodic e l i g i b i l i t y studies and to a s s i s t the c l i e n t i n meeting other material needs as they arose. Such needs include housing, medical care, recreation, and so on. Generally, however, the c l i e n t would be l e f t on his own to manage for himself unless he s p e c i f i c a l l y requested further help. 2. Total Permanent Dependency The person who required i n s t i t u t i o n a l care as well as f i n a n c i a l aid to meet his physical needs was defined as being t o t a l l y permanently dependent. Of the t o t a l of l 6 l persons, a l l were single units and 88.7$ were over 60 years of age. This constituted 92.4$ of the men and 85.3$ of the women (Table 2a and b). - 30 -The c l i e n t s who were granted aid for compassionate reasons were a c t u a l l y suffering from general d e b i l i t y and were receiving some medical attention. Consequently, those persons who were granted assistance f o r compassionate reasons, and those who received aid because of physical i l l n e s s constituted 80.8$ of the t o t a l group. With almost nine%tenths of them over 60 years of age, the public welfare worker could have done l i t t l e except to make clearer to them the r e a l i t y factors of t h e i r i l l -nesses and limited capacities, and to help them to accept t h e i r environmental s i t u a t i o n , thus making t h i s group f e e l easier i n t h e i r minds and more resigned to t h e i r l o t . Of the t o t a l number of c l i e n t s , 64$ had been i n receipt of aid for less than f i v e years; 70.9$ of the women and 56.2$ of the men f e l l into this group (Fig. I d ) . S k i l l s and work histo r y were probably not s i g n i f i c a n t , but 15-5$ of the c l i e n t s were s k i l l e d or semiskilled, and 17.6$ had a steady or seasonal work hist o r y (Table 3a and b). It was pointless to have consid-ered any c l i e n t i n t h i s category i n terms of his or her becoming economically s e l f - s u f f i c i e n t . As noted previously, the best the public welfare worker can hope to accomplish i s to make the i n d i v i d u a l f e e l less tense about his personal and environmental s i t u a t i o n . It i s recognized generally that the permanently dependent and the aged need more than just economic support. Some consid-eration should be made, of course, for the provision of such forms of recreational a c t i v i t y as films, books, games, and hobbies, and also for the furnishing of f a c i l i t i e s for group - 31 -p a r t i c i p a t i o n and intere s t i n g s o c i a l contacts. Such an e f f o r t on (the part of the s o c i a l assistance agency and the community would give the t o t a l l y permanently dependent person a happier outlook on l i f e , and might;.prove of invaluable assistance i n the promotion of client-community i n t e r - r e l a t i o n s h i p s . The depend-ent himself would be encouraged to develop a degree of s e l f -respect and a feeling of belonging i f he i s made a genuine p a r t i c -ipant i n the l i f e of the community.. It seems l i k e l y that these recreational f a c i l i t i e s can help a great:deal i n enabling the c l i e n t to improve i n morale and i n physical conditionsso that he can more r e a d i l y move from one type of i n s t i t u t i o n to another as he requires more intensive or less specialized physical care. But, as t h i s study i s concerned with the broader aspects of r e h a b i l i t a t i o n , no attempt has been made to examine i n d e t a i l what can be done within the groupings of p a r t i a l and t o t a l perma-nent dependency. C. Special Groups In the t o t a l caseload of the V i c t o r i a S o c i a l Welfare Department, there were three s p e c i a l groups which were to be found i n both the temporary and the permanent dependency cate-gories, and which deserved some special consideration i n t h i s presentation. These were those persons suffering from tubercu-l o s i s , the c l i e n t s of Chinese r a c i a l o r i g i n , and the family units with dependent children. - 32 -1. Tuberculous Patients The c l i e n t suffering from tuberculosis, whether he i s i n or out of i n s t i t u t i o n a l care, should not be considered a part of the caseload from the point of view of r e h a b i l i t a t i o n . While the V i c t o r i a S o c i a l Welfare Department administers the f i n a n c i a l aid for accounting purposes, the p r o v i n c i a l government D i v i s i o n of T. B. Control employs the s o c i a l workers and r e h a b i l -i t a t i o n o f f i c e r s who are responsible for the s p e c i f i c r e h a b i l i t a -t i o n programme. In the month of June, 1952, 54 persons were i n receipt of assistance because of tuberculosis. None were i n the category of p a r t i a l temporary dependency. Re h a b i l i t a t i o n prospects seemed excellent i n 83.3$ of the cases. These cases were those ^Total P a r t i a l Total Temporary Permanent Permanent male 31 7 2 female 14 -i n the category of t o t a l temporary dependency. Of th i s group, 93.3$ were under 45 years of age. With adequate casework, and vocational t r a i n i n g f a c i l i t i e s , " c o u p l e d with specialized medical care, a high percentage of th i s group could have been r e h a b i l i -tated within a reasonably short period of time. Those patients i n the categories of p a r t i a l and t o t a l permanent dependency were over 60 years of age. With a l l but - 33 -one person, the tuberculous condition was quiescent, but i t seemed u n l i k e l y that these indiv i d u a l s would ever have been able to maintain themselves without some form of public assistance. 2. - Chinese Cl i e n t s Clients of Chinese r a c i a l o r i g i n constituted 12.6$ of the June 1952 caseload. P r i o r to January, 1952, when the changes- i n the federal governmental regulations regarding finan-c i a l assistance for aged persons became e f f e c t i v e , this group made up approximately one-quarter of the caseload. They were p a r t i c u l a r l y d i f f i c u l t to interview since they rarely"spoke English, and consequently, e l i g i b i l i t y i n the in d i v i d u a l case was hard to est a b l i s h accurately. The employment of a public welfare worker of the same r a c i a l o r i g i n was considered for a time. A l l of the eight women i n thi s group were i n the category of t o t a l t emporary dependency. Six were suffering from tuber-r . culosis and were being carried by the D i v i s i o n of T. B . Control for r e h a b i l i t a t i o n purposes. The other two were women with dependent children. None of the men were p a r t i a l l y temporarily dependent. Total P a r t i a l Total: Temporary Permanent Permanent male 5 18 33 female 8 Gf the male Chinese c l i e n t s i n the categories of permanent - 34 -dependency, 88.3$ were over 60 years of age, and a l l were over 45 years o l d . Hence, there would seem to be l i t t l e need for the inten-sive casework service that would merit the employment of a case-worker of Chinese r a c i a l o r i g i n to deal only with such a limited workable caseload. I f , however, the expansion of the present minimal service to thi s r a c i a l group i s considered, then such a caseworker would be invaluable. 3• Dependent Children There were 177 dependent children i n 74 families i n receipt of s o c i a l assistance i n June 1952 i n V i c t o r i a . 98$ of the children were i n the temporary dependency category, with 81 .9$ of them l i k e l y to have been on assistance f o r a lengthy period. 64.5$ of the breadwinners i n these families were under the age of 45 years, and 90$ were less than 60 years o l d . In only 14 .9$ of the families were both parents i n the home. 20 .4$ of the children were i n these f a m i l i e s . The number of children i n these families was as follows: Family P a r t i a l Total P a r t i a l Head Temporary Temporary Permanent male 24 12 -female 6 133 2 It i s not within the scope of thi s study to discuss the psycho-dynamic aspects of r a i s i n g children without the presence of both the father and the mother i n the home. Needless to say, - 35 -the d i f f i c u l t i e s encountered by children who do not have the father with whom to i d e n t i f y or from whom to seek a f f e c t i o n are further aggravated by f i n a n c i a l , housing, r e c r e a t i o n a l , and other problems. It requires the attention and s k i l l of well-q u a l i f i e d caseworkers to minimize the damage that can and does seriously handicap or hamper the emotional growth of such c h i l -dren and the mature adjustment of th e i r mothers. Summary In th i s chapter, some of the physical and economic factors contributing to e x t r i n s i c dependency i n a public a s s i s t -ance caseload have been examined. It i s noted that these factors can be f a i r l y accurately measured during the completion of the e l i g i b i l i t y study of each c l i e n t , and that they can generally be compared from one c l i e n t to the next. A much more detailed study of these aspects could be made than has been done here. In such a study, the discussion might include an evaluation of the community resources which would a s s i s t i n the r e h a b i l i t a t i o n of the public assistance c l i e n t and his family.. Nevertheless, several facts are revealed i n t h i s paper which have a d i r e c t bearing on the r e h a b i l i t a t i o n programme. Of primary importance to any scheme of r e h a b i l i t a t i o n i s the health and age of the c l i e n t . In the public assistance group studied, 88.3$ of the heads of the case units were suffer-ing from some medical d i s a b i l i t y , and i n 71.6$ of the cases, the - 36 -ailment was of a chronic or degenerative nature. 55*4-% of the cl i e n t s were over 60 years of age, and 71*9$ were 45 years or older. Therefore, i t would seem that, regardless of the adequacy of the medical and vocational phases of the r e h a b i l i t a -t i o n programme, more than two-thirds of the c l i e n t s were not able to benefit from such a scheme i f the goal of enabling them to become self-supporting i s to be contemplated. According to the c l a s s i f i c a t i o n used i n thi s study, 71.6$ of the heads of the case units were permanently dependent. S l i g h t l y more than one-half were women. 60.2$ of the t o t a l group i n thi s category had received help for les s than 5 years. However, the women appeared to apply f o r help e a r l i e r than the men since 79.4$ had been on assistance f o r less than 10 years, while.81.6$ of the men had received f i n a n c i a l aid for less than 5 years. It seems s i g n i f i c a n t that 98.5$ of the permanently dependent group were either single persons or were l i v i n g alone. It might be assumed that when these people became more dependent and required extra care, the public welfare agency would have to meet t h e i r needs. I f they were l i v i n g with immediate r e l a t i v e s , these r e l a t i v e s l i k e l y would have provided the extra care. In r e l a t i o n to employment status, 64.1$ of the heads of permanently dependent case units were u n s k i l l e d , and 60.5$ had casual or no work h i s t o r i e s . The s k i l l s and work h i s t o r i e s of 20.1$ were unknown, but i t was l i k e l y that many of these persons were uns k i l l e d , casual workers. 50.8$ of the women had never - 37 -been employed for wages. It appeared, therefore, that the t o t a l group would need f a i r l y extensive r e t r a i n i n g , and that they would not be: good prospects for vocational r e h a b i l i t a t i o n since 75.6$ of the individuals were over 60 years of age. The c l i e n t s f a l l i n g i n the category of temporary depend-ency constituted 28.4$ of the t o t a l caseload. 54.9$ of the group received help f o r less than one year, and 82.9$ f o r le s s than 5 years. There seemed to be no s i g n i f i c a n t difference between men and women i n r e l a t i o n to the length of time that they received assistance. 55$ of the group were married or had dependents. In r e l a t i o n to employment status, almost h a l f of the men i n the' temporary dependency category were s k i l l e d or semi-skilled, and had steady or seasonal work h i s t o r i e s . 69.9$ of the group were women and, i n contrast to the men, 69.8$ of them were uns k i l l e d , and 64$ had casual or no work h i s t o r i e s . With 8 .6$ of the women, the degree of s k i l l and the work h i s t o r y was un-known, but i t seemed l i k e l y that many of these were u n s k i l l e d , casual workers. Since 78.9$ of the c l i e n t s i n the temporary dependency group were under 45 years of age, r e h a b i l i t a t i o n prospects seem f a i r l y good, p a r t i c u l a r l y with regard to the men. However, the situations of the women need more intensive study than has been given here. Almost half of them had no previous work experience, and 65.1$ had dependent children. The ages of these children, no doubt, would have an effect on r e h a b i l i t a t i o n plans since the - 38 -mothers could not be enabled to take employment when they were needed to care f o r the young children. One point which t h i s study did not i l l u s t r a t e but which i s well-known to public welfare workers i s the fact that a number of women with dependent children never do go o f f public assistance, even afte r t h e i r children are no longer dependent. This t r a n s i -t i o n of c l i e n t s from temporary dependency to permanent dependency can possibly be prevented i n a great many cases. Herein l i e s one area where a r e h a b i l i t a t i o n programme u t i l i z i n g the services of qua l i f i e d s o c i a l workers could probably be successful. Consider-ing the t o t a l caseload, i t i s the c l i e n t s i n the temporarily dependent categories and not those i n the permanently dependent groups who are best able to benefit from the r e h a b i l i t a t i o n pro-gramme. In th i s chapter no attempt has been made to discuss the possible causes of physical and economic dependency of these c l i e n t s . In so many cases of d i s a b i l i t y and dependency, the underlying causes are due to emotional maladjustments which mani-fest themselves i n many ways. Such outward manifestations of emotional malfunctioning are desertion, non-support, i n a b i l i t y to apply oneself or hold a job, physical i l l n e s s , simulated i l l -ness or incapacities as i n some cases of blindnesaKor deafness, lack of judgement or concern over money matters, general i n a b i l i t y to cope with r e a l i t y , and so on. Such overt action on the part of an i n d i v i d u a l r e f l e c t s his basic emotional attitudes and f e e l i n g s . These attitudes and - 39 -feelings are v i t a l l y important for they have a d i r e c t bearing on the c l i e n t ' s a b i l i t y and desire to u t i l i z e the services of the s o c i a l worker and the community resources i n the r e h a b i l i t a -t i o n process. Therefore, the s o c i a l worker's aim i n the t r e a t -ment and r e h a b i l i t a t i o n of public assistance recipients i s not just that of taking care of t h e i r physical and economic needs or pure " r e l i e f - g i v i n g " , but rather that of'diagnosing t h e i r emotional needs and meeting these needs reasonably adequately i n so far as i s possible. The clients can thus be strengthened, and often an improvement can be made i n t h e i r s o c i a l and emotion-a l adjustments. I t i s only through the recognition of the more basic factors of human motivation that the caseworker i s able, to some degree, to as s i s t i n c l a r i f y i n g and modifying the in d i v i d u a l c l i e n t ' s current reactive pattern, and to t o t a l l y or p a r t i a l l y r e h a b i l i t a t e him from the dependency state. Chapter III "INTRINSIC" DEPENDENCY: PERSONAL AND EMOTIONAL FACTORS While physical and economic factors are generally more objective and reasonably easy to determine and measure, the emotional factors of dependency vary greatly from i n d i v i d u a l to in d i v i d u a l and are, for the most, e n t i r e l y subjective and r e l a t i v e . Emotional dependency may be defined as the i n a b i l i t y or incapacity to accept one's own s e l f , one's assets, and one's li m i t a t i o n s with an objective a t t i t u d e . This includes the a b i l i t y or i n a b i l i t y to relate to others i n one's environment i n a s o c i a l l y acceptable manner, to cope with most situations reasonably adequately, and, i n general, to make s a t i s f a c t o r y adjustments to environmental conditions. Such psychological aspects are always hard to define, and.are s t i l l more d i f f i c u l t to evaluate. Every human being w i l l react somewhat d i f f e r e n t l y to the same or si m i l a r external s t i m u l i and stresses. Each person i s influenced primarily by his early growth processes, as well as by his current environment, his s o c i a l contacts, and his previous experiences. Such growth processes and experiences r e s u l t i n the development of a general reaction pattern which i s commonly referred to as the individual's personality. The emotional factors within the i n d i v i d u a l are both positive and negative. The s o c i a l worker i s concerned d i r e c t l y with the - 41 mobilization of the positive emotional strengths of the client to enable him to utilize in the rehabilitation process his personal resources and those of the agency and the community. Dr. Irene M. Josselyn notes that " i t is in childhood that the gradual evolution of the personality should take place, culminating in emotional maturity coincident in time with physical and social maturity"."'" She further states that " i t is only through understanding the child that we can evaluate the adult. An emotionally healthy adult deals with reality as such, free from the crippling implications relative to past emotional experiences or to chronic emotional hungers, whereas 2 the disturbed individual does the reverse." Therefore, Dr. Josselyn argues that i t is essential that the significance of a particular situation be understood in terms of its meaning to the individual rather than solely in terms of the actual reality situation. To accomplish this, the worker must have some know-ledge of the past experiences and reactions of the adult when he was a child. The growth of personality or maturing process i s , of course, strictly relative, and people vary widely in their partic-ular adaptations to reality situations. However, there seems to be certain common factors amongst a l l individuals which can be "measured" in terms of the individual's relationships to his 1 Josselyn, Irene M., Psychosocial Development of Children, Family Service Association of America, New York, 1948, p. 19. 2 Ibid., p. 27-- 42 -parents, his siblings, his marital partner, his children, his friends, his other associates, and to his environment. The difficulty is to determine and to define normal and emotionally mature relationships. A. The Casework Process and the Role of the Social Worker In order to diagnose with reasonable accuracy the under-lying problems contributing to the client's difficulties, i t is imperative that the social worker study how the client has react-ed to people and to situations during the past. The worker cannot be content with one or two isolated instances of behaviour. He must strive to ascertain the client's usual reactive patterns, and to determine the reasons why the client has adopted his present behaviour patterns. Since a l l adults are greatly influenced by their experiences in childhood and adolescence, the worker will find i t helpful to know some of the things that happened to the individual early in l i f e , and to learn what these have meant to him. It has been pointed out that certain generalizations regarding human behaviour have emerged from observation and study. As reported by one writer who has given systematic attention to the subject, these generalizations are as follows: 1 1. Individuals tend to do that which is most satisfying, most comfortable and apparently most safe, and to avoid 1 cf. Orchard, Bernice, "The Casework Aspects of Rehab-ilitation", Proceedings of the Institute for County Welfare Directors and Social Case Workers, October, 1950* University of Wisconsin, Madison, Wisconsin, p. 33 et seq. - 43 -that which i s pa i n f u l and produces anxiety. This i s the well known pleasure-pain p r i n c i p l e . . . . 2. No matter how i l l o g i c a l i t seems, the way an i n d i v i d u a l behaves helps him to maintain a kind of equilibrium i n l i f e . . . . In other words, a l l behaviour i s purposive.... 3. People cannot be talked out of t h e i r disturbed f e e l -ings. In other words, t e l l i n g an i n d i v i d u a l that he i s s i l l y to f e e l as he does, that his fears have no r a t i o n a l foundation, does not help him to overcome them.... 4. Changes produce anxiety and, often, fear. Everyone r e s i s t s change to some extent.... 5. An i n d i v i d u a l often has opposite feelings about a given s i t u a t i o n . This i s the f a m i l i a r concept of ambivalence.... 6. People cannot always take r e s p o n s i b i l i t y for t h e i r feelings and actions. They blame something or someone else. This i s known as projection.... 7. When l i f e becomes extremely d i f f i c u l t people often regress to behaviour which brought s a t i s f a c t i o n e a r l i e r i n l i f e . . 8. People normally have strong impulses to grow and improve, to reach for something better. This i s the growth p r i n c i p l e on which the whole idea of r e h a b i l i t a -t i o n i s based.... By recognizing his own emotional feelings and by learning to d i s c i p l i n e himself, the trained s o c i a l worker can, on the basis of the above generalizations, gain a clearer insight into the underlying causes of his c l i e n t ' s behaviour. Once he has perceived these causes and t h e i r r elationship to the c l i e n t ' s current adaptive behaviour, he has, i n essence, diagnosed the problem and can e s t a b l i s h the treatment goal. Needless to say, such a. goal i s never s t a t i c , but i s always subject to modifica-t i o n or change depending upon the s k i l l of the s o c i a l worker and the movement of the c l i e n t . - 43a-The r o l e of the s o c i a l worker, regardless of the se t t i n g i n which he works, i s e s s e n t i a l l y that of a "helping" person. He never does more than help. It i s the c l i e n t who chooses, decides, achieves, and accomplishes. The s o c i a l worker can only help i n pointing the way; i n making obstacles and inade-quacies clearer, and i n aiding the c l i e n t to modify or sublimate them within and without himself; by r e l i e v i n g as much as possible the pressure of inner tensions and c o n f l i c t s ; and by a s s i s t i n g the c l i e n t to free himself for his own e f f o r t and l a s t i n g s a t i s f a c t i o n . The s o c i a l worker i s an understanding, sympathetic, non-c r i t i c a l , permissive person who helps the c l i e n t to express his feelings f r e e l y . Insso doing, the c l i e n t i s encouraged to learn why he f e e l s the way he does, for i t i s only as he under-stands his feelings that he can modify them. The s o c i a l worker helps the c l i e n t to face r e a l i t y and to accept r e s p o n s i b i l i t y f o r his own feelings and actions. The s o c i a l worker helps the c l i e n t to weigh the advantages and the disadvantages of his s i t u a t i o n by bringing to the c l i e n t ' s attention factors that he may never have considered. Thus, the i n d i v i d u a l i s enabled to make a better decision as to the course of action that he wishes to pursue. Casework Treatment Goals It seems obvious that casework treatment i s not going to meet with the same degree of success i n each i n d i v i d u a l case. - 44 -Whereas one c l i e n t w i l l be t o t a l l y r e h a b i l i t a t e d and become self-supporting, another whose physical condition i s not subject to improvement can only be p a r t i a l l y helped, and a t h i r d can only be assisted to accept the r e a l i t y factors of his present s i t u a t i o n and to f e e l easier with his l o t . It i s proposed i n t h i s study to separate three possible goals. With casework treatment, t o t a l r e h a b i l i t a t i o n may be said to r e s u l t from working with an i n d i v i d u a l towards a modifi-cation of his usual adjustment reactions, i n order that he can gain the most benefit from the r e h a b i l i t a t i o n programme and i s better able to assume r e s p o n s i b i l i t y and gain remunerative employ-ment i n a competitive s i t u a t i o n . It i s presumed, also, that he i s able to accept to some degree c l a r i f i c a t i o n by the worker of some of his less deep-seated emotional problems, and consequently^ that he i s able to modify, to some extent, the tension and anxiety that he experiences i n his i n t e r - r e l a t i o n s h i p s with those about him. While he does not require further f i n a n c i a l aid from public assistance funds, he may continue to use additional case-work help from time to time. The attainment of t h i s goal can be reached i n r e l a t i v e l y few cases, and only by s k i l l e d and exper-ienced s o c i a l workers. Generally, p a r t i a l r e h a b i l i t a t i o n may r e s u l t from supportive help on the part of the s o c i a l worker so that the c l i e n t can better use his present c a p a b i l i t i e s and personal re-sources. Such a c l i e n t i s able to accept work i n a sheltered setting which may or may not remove him from the public assistance - 45 -r o l e . I t i s not l i k e l y that the s o c i a l worker would attempt to c l a r i f y the c l i e n t ' s emotional problems because they are f o r the most part too deeply embedded i n his unconscious. To do so only serves to destroy the defenses that the c l i e n t has set up to cope with r e a l i t y . I f these defenses are destroyed, the c l i e n t w i l l regress In his behaviour patterns and w i l l become more dependent than ever. C l i e n t s with c e r t a i n types of chronic physical and mental conditions who are s t i l l able to function reasonably well, and the dependency cases who have been i n receipt of public assistance f o r several years may be able to respond to t h i s type of casework treatment. Much of the s o c i a l worker's time and e f f o r t w i l l be expended i n working towards the goal of p a r t i a l r e h a b i l i t a t i o n . The t h i r d goal of the s o c i a l worker i s simply the easing of tension and anxiety i n the i n d i v i d u a l c l i e n t . 1 Again, i t involves the use of supportive help, but the aim of the s o c i a l worker i s to encourage the c l i e n t to accept his l i m i t a t i o n s and his i n a b i l i t y to manage without public assistance rather than to encourage him to become more economically independent. This goal i s p a r t i c u l a r l y applicable to those aged and i n f i r m persons requiring i n s t i t u t i o n a l care who are, to a varying degree, quite helpless. The use of s k i l l e d s o c i a l workers may not be neces-sary to work with most of these c l i e n t s except with s p e c i f i c problems. It i s the warm, sympathetic understanding and the physical handling by a motherly type of person that i s so essen-t i a l . The r e a l objective, here, i s to help the c l i e n t become a happier and less disturbed i n d i v i d u a l . - 4 6 -The focus of th i s thesis i s on the contribution that the s o c i a l caseworker can make towards r e h a b i l i t a t i o n i n the public assistance f i e l d . I t would, therefore, appear to be relevant to examine the situations of some c l i e n t s i n r e c e i p t of public assistance as i s recorded i n the case f i l e s . Unfortunately, most public assistance case records are almost barren of subjective material describing the feelings and a t t i -tudes, of the c l i e n t s . In many instances, the f i l e s contain l i t t l e more than the repeated e l i g i b i l i t y studies which stress the f i n a n c i a l situations and the physical incapacities of the r e c i p i e n t s . For obvious reasons, i t i s impractical to attempt a detailed analysis of the emotional factors a f f e c t i n g the behav-iour of each one of the wage earners of the 467 case units that were reviewed i n Chapter I I . However, for purposes of compari-son, eight cases have been selected, two from each of the four categories suggested i n Chapter I I ; namely, those categories of p a r t i a l temporary dependency, t o t a l temporary dependency, p a r t i a l permanent dependency, and t o t a l permanent dependency. In each of the eight case h i s t o r i e s , a more intensive examination and a f u l l e r , more detailed discussion of the i n t r i n s i c factors contributing to the emotional dependency of these c l i e n t s i s presented. In each category, the two cases were chosen because of the apparent s i m i l a r i t i e s of the physical and economic factors contributing to the dependency of the two c l i e n t s . To a l l out-ward appearances, these two c l i e n t s , depending upon which - 47 -category they are both i n , should be p h y s i c a l l y and economically equal i n t h e i r capacities or Incapacities to accept and benefit from a r e h a b i l i t a t i o n programme. Having selected c l i e n t s with as si m i l a r e x t r i n s i c factors a f f e c t i n g them as i s possible i n two d i f f e r e n t i n d i v i d u a l s , a more detailed study i s made of these persons i n order to emphasize the v i t a l importance of also con-sidering the emotional factors contributing to t h e i r dependency. Further, i t i s s i g n i f i c a n t to note that i n each category, the one c l i e n t probably could be r e h a b i l i t a t e d successfully to a degree, whereas the other c l i e n t l i k e l y could not be. It i s the underlying reasons f o r emotional dependency that the s o c i a l worker must look for and understand that i s so necessary i n the casework and r e h a b i l i t a t i o n process. Thus, i n the following eight case h i s t o r i e s , i t i s hoped that a clearer picture of a l l factors influencing a c l i e n t ' s dependency are brought Into focus, and that a keener awareness of the c l i e n t as an Individual needing more than just physical or economic assistance i s pointed out to the worker. The i d e n t i f y -ing information i n a l l Cases i s disguised i n so f a r as i s possible i n order to conceal the i d e n t i t i e s of these c l i e n t s . The record-ing has not been taken verbatim from the f i l e s , but has been rearranged and expanded to f a c i l i t a t e the presenting of a clearer and more concise exposition wherever i t was possible to do so without changing the context. - 48 -B. Temporary Dependency 1» P a r t i a l Temporary Dependency The two cases of thi s category that were chosen for discussion are si m i l a r i n the following respects. Both were f a i r l y young men with f a m i l i e s , who had been granted assistance for compassionate reasons. Both had a reasonably steady, a l b e i t sporadic, work h i s t o r y previous to applying for assistance, and both were manual labourers with marginal incomes. However, the prospects of t o t a l r e h a b i l i t a t i o n with each of them were quite d i f f e r e n t . With one case, such prospects appeared to be poor, while with the other, they appeared to be quite good. Mr. Donald Jones; a. Background Information Mr. Donald Jones was a man 3 6 years of age, s l i g h t , t h i n , and growing bald. He was quiet, mild-mannered, and inoffensive. He appeared to be emotionally flattened, and of below average i n t e l l i g e n c e . He and his family had been on and off public assistance for years, as had his parents and his s i b l i n g s . He applied f o r assistance during A p r i l , 1 9 5 2 when he was unable to locate work. He had been s e l f -employed i n the capacity of a chimney-sweep and, i n addition, had some j a n i t o r i a l experience. Mr. Jones expresses no p a r t i c u l a r feelings on applying for public assistance. He has grown to accept such incidents as a part of his l i f e . As f a r as he i s concerned, providing he receives f i n a n c i a l help he can manage by himself f a i r l y w e l l . He i s not interested i n other services the agency has to o f f e r , except for medical care f o r his wife when she i s pregnant. Mr. Jones was born i n V i c t o r i a i n 1 9 1 6 . He was the youngest c h i l d i n a family of three g i r l s and one boy. His s i s t e r s were a l l considerably older than he was. His - 49 -parents would have been almost 80 years old had they been living. Little was known of the inter-personal relationships of the parents or of the other siblings, although they had a l l been in receipt of public assistance at one time or another. The one point that did stand out was that they were a very closely-knit family group. Each sup-ported the other in times of stress even though they did not have the actual financial means by which to assist each other to any marked degree. Mr. Jones was very dependent upon his wife, and i t was she who undertook to send him to the office when help was needed. He was married at an early age to a woman six years his senior. There were nine children of the union, ranging in age from 15 to l£ years. Mr. Jones is a very dependent person. He is unable to assume the customary masculine role, and he is quite content to leave a l l decisions and aggressive actions to his wife. When he applies for financial help on the insistence of his wife, he usually comes into the office and just sits down. It is very difficult for the worker to draw him out sufficiently to discuss his problems. The degree of Mr. Jones1 intelligence is not known. He left school before he completed Grade 5• Even without a psychometric examination, he did not appear to be very intelligent. After leaving school, he worked with his father in the capacity of a chimney-sweep. During the late spring, the summer, and the f a l l of each year they managed to earn enough money to maintain their families, but in the winter months they were without work and had to apply for social assistance. The business was never very successful as Mr. Jones Senior was not a very aggressive man. When he died in 1947, Mr. Jones inherited the chimney-sweep equipment. Because of Mr. Jones' general inadequacies, i t has been difficult to stimulate him to find employment and thus to become independent of public funds. On many occasions assistance has .merely been cancelled when work became more plentiful and he has - 50 -been l e f t to f i n d a job on his own. In 1949 • a worker helped Mr. Jones to locate employment i n one of the l o c a l hospitals and, for the f i r s t time i n his l i f e , he held steady employment which paid him a reasonable wage. He worked as a j a n i t o r and a general handyman, and here he was not under the pressure of excessive competition. He adjusted very quickly into his new job and was considered by the ho s p i t a l s t a f f to be a slow but a very constant and r e l i a b l e worker. The gaining of steady employment i s a. marked change f o r Mr. Jones. Heretofore, he had been quite dependent and generally functioned on a f a i r l y inadequate l e v e l as f a r as employment was concerned. Now he i s working regularly i n the sheltered s e t t i n g of the hospital and adjusting with unexpected ease to a new s i t u a t i o n . For almost a year nothing further was heard of the Jones' family. Once Mr. Jones gained steady work, the case was closed, and no a d d i t i o n a l service was offered by the public welfare agency. Then Mr. Jones suffered an accident at work and injured his knee. P r i o r to the establishment of his claim f o r workmen's compensation benefits, he applied for public assistance. At t h i s time the worker noted b r i e f -l y that Mrs. Jones seemed quite happy about the accident. Because of the limited information on the f i l e regarding the r e lationship between Mr. Jones and his wife, both before and a f t e r the accident, i t i s only possible to speculate as to the reasons for such an attitude on the part of Mrs. Jones. However, i t does seem apparent that Mr. Jones' new-found independence i n a work s i t u a t i o n i n some way upset the adjustment of the couple. Before he obtained regular work, he was known to be very dependent upon Mrs. Jones. Although she was the dominant member of the family, she was never consulted about the matter of his new job i n the h o s p i t a l . It may have been that with more adequate - 51 -functioning i n the employment s i t u a t i o n he t r i e d to assume a more dominant role i n the determination of family matters. This may have resulted i n considerable f r i c t i o n between the couple and, as a r e s u l t , may have culminated i n the accident. In any event, Mr. Jones has regressed to his former dependency rol e again, and i t appears l i k e l y that the move w i l l be more or less permanent. Mr. Jones re-applied f o r public assistance i n A p r i l , 1952. He had been c l a s s i f i e d by the Workmen's Compensa-t i o n Board as being p h y s i c a l l y f i t f o r work. F i n a n c i a l aid was granted to him for compassionate reasons u n t i l he could either return to his former profession of chimney-sweeping, or find other work i n a sheltered s e t t i n g . He expressed some bitterness over the decision of the Workmen's Compensation Board, and claimed that his knee was s t i l l too s t i f f f or him to take on employment. Although he did not say so, his attitude appeared to be one of ahject resignation. b. Diagnosis i . Physical and Economic Aspects. According to the medical reports, Mr. Jones had been p h y s i c a l l y employable for several months, and was capable of accepting employment when work was more f r e e l y a v a i l a b l e . Hence, he was c l a s s i f i e d i n t h i s study as being p a r t i a l l y temporarily dependent. Assistance had been granted f o r compassionate reasons because he had a family. Had he been single, i t was not l i k e l y that he would have been granted f i n a n c i a l help. The Workmen's Compensation Board had attempted to work out over a period of several months a vocational r e h a b i l i t a t i o n plan which would have involved counselling, r e t r a i n i n g , and employ-ment placement. However, Mr. Jones steadfastly refused to - 52 -consider the matter, and continued to claim that his knee i n j u r y s t i l l incapacitated him. Instead, he preferred to remain a t home and to be cared for by his wife. In view of th i s preference f o r dependency, the Board determined that he was not a l i k e l y prospect for r e h a b i l i t a t i o n , and thus termina-ted t h e i r contact with him i n A p r i l , 1952. Mr. Jones was l e f t to fend for himself and to manage as best he could. Here, i t i s s i g n i f i c a n t to note that i f only the physical aspects of the si t u a t i o n are considered, the public welfare worker might be tempted to do the same as the Workmen's Compensation Board had done. But, the s o c i a l worker should go one step further i n assessing the r e h a b i l i t a t i o n p o s s i b i l i t i e s of the c l i e n t ; he should also consider the emotional aspects r e l a t i v e to the si t u a t i o n . i i . Emotional Aspects. When the matter of Mr. Jones• emotional climate i s con-sidered, the p o s s i b i l i t i e s of t o t a l r e h a b i l i t a t i o n as defined e a r l i e r i n thi s chapter do not appear to be very good. Mr. Jones had always encountered d i f f i c u l t y i n asserting himself. Possibly because his father was a mild-mannered and passive per-son, he had no strong male figure with whom to i d e n t i f y . His mother, apparently, was a warm, motherly person who accepted without question the r e s p o n s i b i l i t y of running the home and of keeping the family together, i n spite of f a i r l y severe f i n a n c i a l d i f f i c u l t i e s . He married a woman who was very l i k e his mother and kho encouraged him to be dependent upon her. - 5 3 -Despite a possible i n t e l l e c t u a l handicap, Mr. Jones was helped by a female worker to move out of t h i s state of dependency into a sheltered employment s i t u a t i o n . The fact that he adjusted f a i r l y quickly into t h i s new p o s i t i o n and was able to function with reasonable adequacy on the job would seem to i n d i -cate that he had some desire to become more s e l f - s u f f i c i e n t , and that such a move was s a t i s f y i n g to him. Unfortunately, the worker withdrew her support too soon (as i s often the case i n the present public welfare agency). Nor was Mr. Jones' wife included i n the plan and helped to see the possible changes that would l i k e l y follow with Mr. Jones ' increasing opinion of his own self-worth. Indeed, i t was surprising that he managed to remain i n the work s i t u a t i o n as long as he d i d . In view of these emotional factors, and his past history, Mr. Jones appears to be p a r t i a l l y permanently dependent, c. Casework Treatment. Whether or not i t w i l l be possible to enable Mr. Jones to move out from his present dependency state seems questionable. His current behaviour of holding tenaciously to his knee i n j u r y i n spite of the r e a l i s t i c factors of competent medical advice, and of continually refusing to consider vocational r e h a b i l i t a t i o n plans, appears to indicate that he found the i n i t i a l independency s i t u a t i o n f a i r l y p a i n f u l . His i n j u r y has provided him with an acceptable excuse for remaining dependent, and his wife tends to encourage such dependency. The primary concern of the worker, then, should be to consider the t o t a l family picture, and to involve the wife i n - 54 -the treatment plan. Obviously, t h i s has not been done before. If a female s o c i a l worker can e s t a b l i s h a rel a t i o n s h i p with Mrs. Jones, so much the better, f o r the presence of a strong, but permissive female figure would l i k e l y be more h e l p f u l torMr. Jones than that of a male worker. Mrs. Jones would probably accept a female worker, p a r t i c u l a r l y as the four oldest children are boys, and she seems to be encountering some trouble with them. However, the developmental background of Mrs. Jones needs c l a r i f i c a t i o n before the e f f e c t of a female worker can be determined, d. Prognosis. Regardless of the s k i l l of the s o c i a l worker, the prog-nosis of a plan of t o t a l r e h a b i l i t a t i o n does not appear to be very favourable. Mr. Jones i s not a young man. He has enjoyed his dependency over a long period of time. His experience with independency has apparently been so p a i n f u l that he has retreated from i t . Hence, i t seems inevitable that the family w i l l contin-ue to require f i n a n c i a l help and other services, at l e a s t from time to time, i f not permanently. The best the s o c i a l worker can hope to do i s to provide supportive help to enable the couple to rais e t h e i r children as adequately as possible, and to a s s i s t Mr. and Mrs, Jones i n maintaining at best the n e c e s s i t i t e s of l i f e . Mr. Edward Townsley: a. Background Information Mr. Edward Townsley was a husky, w e l l - b u i l t , active man of 32 years of age. He was rough, somewhat uncouth, very demanding, and quite h o s t i l e when he applied for public assistance. This was his f i r s t a p p l i c a t i o n for f i n a n c i a l help and he seemed to resent b i t t e r l y having to apply f o r - 55 -such. He had been unable to claim unemployment insurance benefits which he had accrued,as he had been forced out of work by a general strike in the lumbering industry. Mr. Townsley's i n i t i a l reaction of aggressiveness and hostility towards the public welfare worker is not unusual. The loss of work and the means by which to provide for the main-tenance of his family arouses considerable anxiety and fear within him. The function of the social worker must be related to the relief of this anxiety before any progress can be made towards helping Mr. Townsley view realistically his total situation. In the public assistance setting, the social worker is in the fortunate position of being able to supplement the permissive atmosphere of the client-worker relationship with environmental help in the form of actual financial aid. Such help can aid materially in the establishment of a working relationship with the client. There was only meagre background information on the case f i l e regarding the Townsley family. Mr. and Mrs. Townsley had been married for ten years. There were five children of the union, ranging in ages from 9 to 2 years old. The family had moved to British Columbia from Alberta, settling in the Greater Victoria area in 1949. There"were no relatives living in British Columbia. According to the Unemployment Insurance Commission, Mr. Townsley's work history was excellent when employment was available. He was normally employed in the capacity of a truck driver for a lumber company and, except for slack periods, he had been employed by the same company for the previous three years. He had drawn unemployment insurance benefits during the later part of December, 1951> and for January, February, and March, 1952. Mr. Townsley returned to his former employer in the last week of March, and had worked during April, May, and part of June, 1952. When the loggers went out on strike, and other unions struck in sympathy in June 1952, Mr. Townsley was forced out of work, although he did not actually - 5 6 -belong to any union. He was unable to draw unemployment insurance benefits immediately because none of the claims from strike-bound workers were being adjudged by the l o c a l Unemployment Insurance O f f i c e . Since he had been dependent upon rather low unemploy-ment compensation benefits e a r l i e r i n the year, he had been u t i l i z i n g his credit to maintain himself and his family, He had budgeted his earnings during March, A p r i l , May, and June to pay o f f his debts, and he did not have any extra funds to meet his current expenses now that he was unemployed again. Obviously there are very r e a l i s t i c factors i n Mr. Townsley's environmental s i t u a t i o n which account, i n part, for his anxieties and fears. He has already been l i v i n g on a very stringent budget f o r several months, and aft e r he does regain work, i t terminates before he i s able to pay o f f his debts. He i s unable to draw unemployment benefits to which he has contribu-ted, and i n addition, he i s unfamiliar with public assistance provisions i n the province. The r e l a t i o n s h i p between Mr. and Mrs. Townsley seemed to be f a i r l y good, and Mr. Townsley appeared to enjoy his children. However, when his wife intimated that she should seek employment temporarily, Mr. Townsley was extremely upset and simply would not discuss the s i t u a t i o n with her or consider such a plan. Nor would he apply f o r temporary assistance from the l o c a l branch of the Order of Saint Vincent de Paul even though he and his family were active members of t h e i r church. Then, too, Mr. Townsley found i t d i f f i c u l t to accept public assistance f o r he con-sidered i t to be charity. I t was only a f t e r the worker suggested that the f i n a n c i a l grant could be considered a loan and could be repaid that Mr. Townsley f e l t free to take the cheque. He appeared very relieved to sign a promissory note to repay the money i n due course of time. Certainly, i t would seem l i k e l y that Mr. Townsley's fears and anxieties are more deeply rooted than merely concern over the means of meeting his family's immediate needs. The loss of employment and income apparently threatens his basic - 57 -adjustment towards masculinity, and any suggestion on the part of his wife that she be permitted to help out by going out to work herself r e s u l t s i n a marked reaction from him. However, Mr. Townsley's defenses are functioning f a i r l y w e l l , and except i n times of unusual stress, he i s making a f a i r l y s a t i s f a c t o r y adjustment towards r e a l i t y s i t u a t i o n s . Within a period of les s than two weeks, Mr. Townsley returned to the public welfare o f f i c e to make arrangements to repay his "loan". He had found temporary employment as a manual labourer with lower pay than his truck d r i v i n g job had formerly paid him, but he was glad to take anything he could find u n t i l he could return to his previous employ-ment. Although he wished to make some payment on the loan immediately, such a plan was not very r e a l i s t i c when he had his family to provide f o r , so he was persuaded to postpone such payments u n t i l a l a t e r date. He, subsequently, repaid the entire amount of the public assistance grant i n regular weekly installments over a period of two months. b. Diagnosis i . Physical and Economic Aspects P h y s i c a l l y , Mr. Townsley was employable. He was w i l l -ing to work, but due to environmental conditions he could find no employment. Assistance was granted to him for compassionate reasons u n t i l he could locate a job. Because of t h i s , he was c l a s s i f i e d i n Chapter II as being p a r t i a l l y temporarily depend-ent. i i . Emotional Aspects There was not a great deal of information regarding Mr. Townsley's emotional adjustment. There was some i n d i c a t i o n , however, that under undue stress his habitual adjustive patterns broke down and his basic adjustment to the masculine role was threatened. Nevertheless, with a minimum amount of support he - 58 -was able to continue to function quite adequately, and was able to cope with his problems. With almost no active casework treatment, he was able to seek out employment, to plan r e a l i s t i c -a l l y regarding the retirement of his debts, and to carry out his plans. Hence, the p o s s i b i l i t i e s of t o t a l r e h a b i l i t a t i o n seemed excellent. c. Casework Treatment The plan of casework treatment was related exclusively to supportive help and to the provision of f i n a n c i a l a i d . Mr. Townsley needed only a minimum amount of assistance and under-standing to maintain his current adjustive patterns and to function as adequately as he had done i n the past. There was some i n d i c a t i o n that he might have benefited from more intensive casework treatment, but he was not asking f o r i t nor, indeed, was he aware that he needed any further help. d. Prognosis. Because of Mr. Townsley's ego strengths, the prognosis of the plan of t o t a l r e h a b i l i t a t i o n seemed excellent. His current adjustment reactions were adequate, and he was capable of making his own decisions and following through on them. He had a d e f i n i t e sense of goal and achievement, and, under normal circumstances, he accepted his masculine role reasonably w e l l . He also retained a f a i r l y good opinion of his own self-worth throughout the period of resolving his d i f f i c u l t i e s . 2. Total Temporary Dependency The following case h i s t o r i e s were chosen f o r several - 59 -reasons. In many ways they were quite s i m i l a r . Both i n d i v i d -uals were single men of approximately the same age. They were both suffering from physical d i s a b i l i t i e s i n which the medical prognosis was f a i r l y good under ordinary circumstances. Both men had been i n receipt of public assistance i n t h e i r own r i g h t f o r some time (three years i n one case, and f i v e i n the other), so that there was some information available i n the records pertaining to each of them as i n d i v i d u a l s . Then, too, both men were from families who had received r e l i e f during the depression of the " T h i r t i e s " that had been administered through the V i c t o r i a S o c i a l Welfare Department. Although the informa-t i o n i n these f i l e s was extremely l i m i t e d , i t did help to f i l l i n with background information. Again, the primary reason f o r the selection of these two cases was that i t appeared l i k e l y that casework treatment might be p a r t i a l l y successful i n r e h a b i l i t a t -ing one man, and would probably be quite unsuccessful i n the restoration of the other. Mr. John Adamss a. Background Information. Mr. Adams was a t a l l , t h i n , sharp-featured, s i c k l y -looking, dark young man of 26 years of age. He was aggressive, out-spoken, c r i t i c a l , complaining, short-tempered, and very demanding.^ He had been i n receipt of public assistance from the So c i a l Welfare Department f o r varying periods since 194-9 when he was diagnosed as suffering from tuberculosis. When he was not receiving d i r e c t f i n a n c i a l a id, he was undergoing treatment i n hos p i t a l . Mr. Adams seems to be a person who i s apparently harbouring considerable anxiety and fear which he expresses - 60 -through aggressiveness and h o s t i l i t y . The anxiety may have been aroused when he f i r s t learned that he had tuberculosis, or i t may be much more deeply seated. However, Mr. Adams might e a s i l y be described by a public welfare worker who i s not trained to search deeper f o r the causes of behaviour as being uneo--operative and ungrateful and, thus, not worthy of help. Mr. Adams was born i n V i c t o r i a i n 1926. He was the youngest c h i l d i n a family of three g i r l s and two boys. His brother, who was 33 years of age, was the oldest. His three s i s t e r s were 31 > 29? and 27 years o l d . Had his mother been l i v i n g , she would have been about 50 years of age. His father was approximately the same age. Mr. Adams' father was reputed to have been an aggres-sive, domineering, rough, uncouth person. In the old Unemployment R e l i e f f i l e , he was noted as being a •Twastrel", who was abusive and p h y s i c a l l y b r u t a l towards his common-law wife and children. The couple were never married. The father made no attempt to support the family f i n a n c i a l l y , and deserted them on many occasions both before and a f t e r Mr. Adams' b i r t h . He f i n a l l y l e f t permanently i n 1939 when Mr. Adams was 13 years of age, and had not been heard from again. The mother and c h i l -dren were i n receipt of r e l i e f i n one form or another almost continuously throughout the depression period. Some of the reasons f o r Mr. Adams' behaviour are becom-ing clearer. His response to the threat of dependency, that i s , extended convalescence necessitated by his tuberculous condition, i s one of aggressiveness and h o s t i l i t y which compensates f o r anxiety and fear. He grew up i n an obviously deprived environ-ment with a punitive and castrating father, who was home one day and gone the next. It does not seem l i k e l y that such a financ-i a l l y and otherwise unstable environment could harbour many sa t i s f y i n g experiences f o r a growing boy. His fear of punish-ment from the father-figure might well be generalized to fear of - 61 -authority. The medical doctor likely represents to Mr. Adams an authoritative figure, and from past experience, he is afraid. Or again, his fear may he much more deeply rooted. Mr. Adams' mother was apparently a passive, patient, long-suffering, neurotic woman who never complained of her husband's short-comings or abusiveness. She was a sickly person, and the children were placed with relatives and in foster homes on several occasions when she required hospitalization. She died in 1941. The emotional deprivation of Mr. Adams' home is now even more apparent, and his difficulties are evidently more basic than i t was at first presumed. With his mother sick a great deal of the time, possibly due to her own emotional troubles, Mr. Adams and the rest of the children were moved from home to home and had no opportunity to experience the warm, friendly, consistent, secure, and satisfying relationship with a mother-figure. Such an experience is vital for the child's normal emotional growth and maturing processes. It is not surprising to find, there-fore, that Mr. Adams is encountering considerable difficulty in his relationships in areas other than those with respect to his feelings towards his physical illness. Mr. Adams had been on his own since he was 15 years old. With the exception of a close relationship between himself and his next oldest sister, Mr. Adams had no friends. He did not speak of his mother or of his other sisters. He bitterly hated his father and his only brother. Mr. Adams' childhood was most unstable. He was appar-ently in and out of his own home, the homes of relatives, and foster homes from the time that he was a very young child. He had a poor school record and did not complete Grade Six. Mr. Adams had a long history of petty thieveries and sexual delinquencies from an early age. He was considered neglected, and was running the streets before he was ten. - 62 -In 1939> Mr. Adams was committed to the Boys' Industrial School where he remained until 1941. His mother died xvhile he was in this institution. He was discharged to the home of a relative, but shortly after-wards he ran away and apparently wandered extensively a l l over Canada for the next few years. In 1946, he was apprehended by the police on a charge of .".breaking and entering", for which he served a prison term of almost two years. In the winter of 1949, Mr. Adams returned to Victoria and was granted temporary public assistance. The doctor who performed the routine medical examination suspected that he was suffering from tuberculosis. This diagnosis was confirmed by the provincial Division of T. B. Control, and shortly afterwards Mr. Adams entered hospital for treatment. He proved to be a most unco-operative and difficult patient, and after several months he left hospi-tal against medical advice. He was readmitted on two occasions to different tuberculosis hospitals, but was never able to accept treatment. Although the background information for Mr. Adams is far from complete, a fairly clear picture can be gained of how deeply rooted his emotional difficulties are, and what specific short-comings in his environment gave rise to them. To him, the world has always been a hostile, cruel, and unsatisfying place. From birth he has experienced l i t t l e love and affection, except perhaps from one of his sisters in latter years. Conse-quently, Mr. Adams feels most insecure, and this has made i t difficult for him to assume any responsibility for his actions or feelings. He exists only for day to day pleasures. He is extremely demanding and verbose, and is almost childlike in his wants and desires. He displays poor judgement in relation to finances, housing, medical care, and almost a complete disrespect for others in a l l his social relationships. He seems to be unable to profit from experience, and he is generally lacking in - 63 -honesty. He has no h e s i t a t i o n i n f i t t i n g the truth to meet his needs. He i s known to be o v e r t l y homosexual and, i n f a c t , tends to act out his primitive and c h i l d i s h impulses without r e s t r a i n t or remorse. In June, 1952, Mr. Adams was i n receipt of public assistance from the V i c t o r i a S o c i a l Welfare Department. Because of his i n a b i l i t y to budget his funds, he had been given f i n a n c i a l aid f o r some months i n the form of grocery orders. His r e n t a l was paid d i r e c t l y to the landlord. He was free to choose the type of food that he wished, and he received #5.00 i n cash f o r i n c i d e n t a l s . This arrangement, which was p a r t l y his own idea, had been worked out with him by the s o c i a l worker. He had been managing f a i r l y well, and, f o r the f i r s t time since receiving public assistance through the V i c t o r i a o f f i c e , he seemed f a i r l y s a t i s f i e d and was not continually com-plaining about the inadequacy of the grant. b. Diagnosis. i . Physical and Economic Aspects From the point of view of the e x t r i n s i c factor's discussed i n Chapter I I , Mr. Adams would appear, on the surface, to f i t into the c l a s s i f i c a t i o n of t o t a l temporary dependency. Physi-c a l l y , his tuberculous condition was arrested and he had a negative sputum. His condition was advanced and the medical s i t u a t i o n was such that he might e a s i l y have suffered a relapse. The s u r g i c a l collapse of the diseased lung was recommended, and i t was f e l t that i n due course of time his condition might have become quiescent. However, he refused to submit to the operation. Had he undergone the chest surgery, then psychometric and aptitude t e s t i n g , and vocational t r a i n i n g might have been of some help i n a s s i s t i n g him to locate suitable steady employment - 64 -f o r he was not uni n t e l l i g e n t i n spite of his obvious lack of schooling. Even without any special t r a i n i n g , i t was possible that he might have found f a i r l y steady work. Mr. Adams was usually fastidious i n his personal appearance, and when he so wished, he could be f r i e n d l y and l i k e a b l e . He displayed no he s t i t a t i o n i n meeting people and i n talking with strangers. With V i c t o r i a being a t o u r i s t center during a great part of each year, there was considerable employment for young men i n various aspects of the t o u r i s t business. Hence, with help, suitable work could have been found i f he had wanted to seek i t . However, i n view of the information regarding his poor emotional adjustments, i t seems evident that Mr. Adams should be c l a s s i -f i e d as being p a r t i a l l y permanently dependent from the economic and physical point of view, i i . Emotional Aspects Emotionally, Mr. Adams was extremely immature. Because his basic dependency needs were never met i n childhood, he was s t i l l fixated at a very i n f a n t i l e l e v e l . In f a c t , his t o t a l behaviour pattern seemed related to accomplishing only that which was pleasing to him. Certainly, he never had a warm, accepting mother-figure i n childhood. The i n s t i t u t i o n a l setting of the Boys' I n d u s t r i a l School may have s a t i s f i e d ; h i s needs to a limi t e d degree, but i n adolescence, when his e a r l i e r d i f f i c u l t i e s r e l a t i n g to depend-ency were reactivated, he spent much of his time wandering aimlessly around the various provinces. I t appeared as i f he - 6 5 -was searching f o r his idealized mother-figure. He did not seem to be able to accept the fact that his mother died while he was i n the i n d u s t r i a l school. When he was unsuccessful i n his search he returned to his older s i s t e r i n V i c t o r i a , and he continued to return to her afte r stays i n the p r o v i n c i a l j a i l and i n various tubercu-l o s i s s a n i t a r i a . Some of his experiences with t h i s woman must have s a t i s f i e d his basic needs to a limited degree, or perhaps he may have hoped to s a t i s f y them with a person who was as near to his r e a l mother as he could f i n d . Obviously, however, he was not able to work out his basic c o n f l i c t s , l i k e l y because his s i s t e r , too, had her own problems, and the one aggravated the other. F i n a l l y , Mr. Adams developed tuberculosis and was hospi-t a l i z e d , but he refused to undergo treatment f o r the condition. Here was the i n s t i t u t i o n a l setting that was Ideal l y suited to cater to his great dependency needs. But, at every turn, the 0 doctors, the nurses, and s o c i a l workers were attempting to re h a b i l i t a t e him. Such r e h a b i l i t a t i o n would re s u l t i n his not requiring i n s t i t u t i o n a l care and i n forcing him to become independent, i f only to a degree. It was not surprising, therefore, to f i n d that he was r e s i s t i v e of treatment. It appeared that i n the l i g h t of his marked emotional d i f f i c u l t i e s Mr. Adams should have been c l a s s i f i e d as being p a r t i a l l y , i f not t o t a l l y permanently dependent. In view of such a diagnosis, the worker then could do l i t t l e more than meet his physical and - 66 -and economic needs as adequately as possible from public assistance funds. c. Casework Treatment It seemed questionable whether or not Mr. Adams was capable of entering into a relat i o n s h i p with the s o c i a l worker. In spite of the fac t that there was some movement on his part towards the worker, the great deprivation that he suffered from the loss of his mother would l i k e l y i n t e r f e r e with treatment. Any permanent change could only r e s u l t from his growth through the various stages of psycho-social development. A female worker might take on Mr. Adams' great degree of emotional depend-ency that he would display towards an accepting mother person. This substitution f o r the mother-figure was shown repeatedly by his reaching out for his older s i s t e r . However, without close psychiatric supervision or consultation, such an intensive treatment plan seemed dangerous from the s o c i a l casework point of view. Hence, i n the casework treatment of Mr. Adams, the public welfare worker should be as sympathetic and as understand-ing as possible, and he should l i m i t himself towards helping Mr. Adams to accept the r e a l i t y factors of the f i n a n c i a l l i m i t a t i o n s of public assistance, and of his need for medical care to prevent further breakdown and regression. d. Prognosis The p o s s i b i l i t y of enabling Mr. Adams to modify his behaviour i n any respect was s l i g h t . Because of almost no - 67 -super-ego structure i n his personality, i t w i l l continually be necessary f o r the worker to a c t i v e l y set l i m i t s for him i n r e l a t i o n to the r e a l i t i e s of the s i t u a t i o n i n which they are working. Mr. Adams w i l l always require public assistance, of course, and keeping t h i s i n mind, the worker's primary function w i l l be to help him manage oh his assistance as best as possible. Mr. William Black: a. Background Information. Mr. Black was a t a l l , good-looking, clean-cut, f a i r -haired, husky, young chap of 28 years of age. He was rather shy, unassuming, s e l f - e f f a c i n g , and somewhat effeminate i n manner. He had been i n receipt of public assistance almost continuously since 194-7> owing to an e p i l e p t i c condition which prevented him from gaining regular, steady employment. Mr. Black i s l i k e the "good l i t t l e boy"1 who i s seen but i s never heard. He i s always grate f u l f o r any help that i s given to him, and he i s never complaining or troublesome. As long as he i s l e f t alone, he does not present any problem to the public welfare worker. Unfortunately, l i k e the "good l i t t l e boy", Mr. Black does have problems i f the worker i s trained to recognize them. Mr. Black was born i n 1924 i n Calgary, Alberta. He was the second oldest i n a family of three boys and one g i r l . His oldest brother was 32 years of age, while the youngest was 24 years. His s i s t e r was 21 years o l d . His mother and father were 54 and 67 years of age respectively. Mr. Black's father was reputed to have been a rather weak and passive person. He had a steady employment history as a labourer except during the depression period. The family moved to V i c t o r i a i n 1935* and they were on and o f f r e l i e f u n t i l 1940. The father then found work which he had retained to the time that t h i s study was made. - 68 -Mr. Black's mother was apparently a rather aggressive and domineering woman who was somewhat b i t t e r and d i s -i l l u s i o n e d . She was believed to nag at and to squabble with Mr. Black's father over the lack of money, poor housing, and t h e i r general economic and environmental s i t u a t i o n . Part of Mr. Black's d i f f i c u l t y would seem to be i n the area of c o n f l i c t over the concept of the masculine r o l e . Some cha r a c t e r i s t i c s of masculinity i n Anglo-Saxon culture are independence, s e l f - s u f f i c i e n c y , and aggressiveness. Yet Mr. Black grows up i n an environmental s i t u a t i o n where the masculine figure i s passive and dependent, and the feminine f i g u r e , which would normally be the more passive and dependent partner i n the family s e t t i n g , i s in c l i n e d to be aggressive and strong-willed. It i s l i t t l e wonder, then, that Mr.°Black i s himself somewhat effeminate. The r e l a t i o n s h i p between Mr. Black and his father was not known. His mother was somewhat over-protective of him, and she tended to deny that he had epilepsy. None of Mr. Black's s i b l i n g s were married, and a l l were l i v i n g at home with the parents. P a r t i c u l a r l y when drinking, the oldest brother was i n c l i n e d to be p h y s i c a l l y abusive towards Mr. Black, and the youngest brother occasionally was the same. Mr. Black's mother sided with him i n the arguments, but she had been unable to prevent the f i g h t i n g . A l l t h i s , of course, increased the frequency of his seizures. Accord-ing to Mr. Black, the arguments centered on the fact that he was not working and bringing money into the home. Apart from Mr. Black's d i f f i c u l t i e s regarding his mascu-l i n i t y , his i l l n e s s and the fact that he i s not employed and earning his own money, plus the differences between himself and his s i b l i n g s must serve to emphasize his low opinion of his e s s e n t i a l self-worth. He cannot help but f e e l that i n a l l res-pects he i s a very i n f e r i o r human being. - 69 -Little was known of Mr. Black's"childhood. He presumably started school at the age of six years, but, owing to the onset of his epileptic seizures, he left school at the age of 14 before completing Grade Nine. His work history was poor since he was never able to hold a steady job. Because of his presentable appearance, he had had for short periods such jobs as gas station attendant, helper on delivery vans, and clerk in a grocery store. He lost these jobs when he had seizures at work. He did not drink or smoke. He tended to associate with older men, but had never been in any difficulty with the law. The picture of an unfortunate young man, stricken with an incurable condition that is quite beyond his control, is clearly presented. However, the social worker knows that this is not necessarily true, for an individual's epileptic seizures can be controlled by medical treatment, and such a person is able to lead a reasonably normal and active l i f e . Hence, Mr. Black's real problems must l i e in the emotional area. Mr. Black first applied for public assistance in March, 1947. He had left home after a fight with his brother, and for a time had been able to. maintain himself. He lost his job after experiencing several seizures, and eventually he was admitted to hospital. For a while he responded well to treatment, but when his discharge from hospital was imminent, he suffered a relapse which, of course, prolonged his stay. On the recommendation of his doctor, he was transferred to Vancouver for a thorough examination by a prominent specialist. The findings of this physician confirmed those of his own doctor, and the routine treatment for epilepsy was prescribed, including maintenance drug therapy and temperance in a l l activities and habits. Since his home environment was apparently aggravating his condition, the local doctor also advised that other housing arrangements be made, and that Mr. Black be encouraged to engage in light employment. Certainly the treatment seems simple, clear-cut, and easy to initiate and carry out. Mr. Black's seizures can be controlled by drug therapy providing that the emotional upsets of the home environment can be eliminated. The answer to this - 70 -problem i s to locate other suitable accommodation f o r Mr. Black, and to a s s i s t him i n finding a job that i s f i t t e d to his physical l i m i t a t i o n s , thus helping him to keep his mind o f f his troubles. In addition, the fact that he i s working and making his own money obviously w i l l aid i n fostering a more posit i v e outlook on Mr. Black's part, w i l l improve his low opinion of himself, and w i l l encourage him towards independence and s e l f -r e l i a n c e . Arrangements were made f o r Mr. Black to board with an aunt i n Nanaimo, with his maintenance be'ing paid through the l o c a l s o c i a l welfare o f f i c e . Although he did not appear to p a r t i c i p a t e i n the plan to any degree, he offered no objections. Within a matter of a few weeks, however, he returned to V i c t o r i a and to his home where he remained to the date of the study., except for three r e l a t i v e l y short occasions. He continued to have a series of e p i l e p t i c seizures at i n t e r v a l s of two and three months. Obviously, having Mr. Black follow out the treatment plan i s not quite as -easy as i t o r i g i n a l l y looked. There i s , also, some i n d i c a t i o n that he does not remain on the drug therapy as regularly as the doctor has prescribed. On two occasions i n 1950, he moved away from home, more or less on his own i n i t i a t i v e . For approximately four months he l i v e d i n the servicemen's naval hostel i n V i c t o r i a , and while here his seizures did not recur. He also found part-time work during t h i s period. Unfortun-ately, the hostel closed, and he was forced to move. A, few weeks l a t e r he was helped to est a b l i s h himself i n a housekeeping room with a friend from the naval hostel, but t h i s arrangement f e l l through a f t e r a short time, and he returned home. In the spring of 1952, he was again hospitalized f o r a f a i r l y long period for he f e l l on the stove during a seizure and burned himself rather badly. He was very reluctant to leave h o s p i t a l , but f i n a l l y did so, and once more he returned home. The doctor f e l t that l i t t l e could be done f o r him other than routine treatment. However, i n practice, Mr. Black followed out the doctor's prescribed schedule only sporadically. - 71 -b. Diagnosis i . Physical and Economic Aspects Because of the fact that his seizure condition was subject to modification and control, and that he was capable of and w i l l i n g to accept employment at times, Mr. Black was c l a s s i -f i e d as being t o t a l l y temporarily dependent. He displayed a considerable i n t e r e s t i n the f i e l d of radio repair work, and had some aptitude i n th i s connection. The p o s s i b i l i t y of his taking formal t r a i n i n g i n radio work should be considered. However, this should not be undertaken u n t i l the employment s i t u a t i o n i s reviewed, and the matter of providing him with the necessary testing equipment i s s e t t l e d . i i . Emotional Aspects Because Mr. Black was able to function reasonably well when not under pressure, he probably had not been too badly damaged emotionally as a c h i l d . Certainly, his dependency needs had been met much more adequately than had Mr. Adams'. Hence Mr. Black would appear to be more amenable to casework treatment. Mr. Black did move to fi n d work f o r himself, and he was generally successful i n holding a job, i f only for a limited time. He tended to exhibit some dependency needs, and was usually lacking i n aggressiveness. He revealed some c o n f l i c t and in s e c u r i t y when facing new and strange s i t u a t i o n s , and, at times, he regressed somewhat to more c h i l d i s h forms of behaviour i n order to compensate for these f e e l i n g s . Gn the whole, however, Mr. Black would appear to be able - 72 -to u t i l i z e and benefit from casework treatment. He was C l a s s i -f i e d as being t o t a l l y temporarily dependent, and.it seemed l i k e l y that he could be helped, c. Casework Treatment The p o s s i b i l i t y of establishing a treatment relationship with Mr. Black seemed f a i r l y good. He was able to move towards the worker, and was apparently w i l l i n g to enter into planning. It would be e s s e n t i a l , then, that Mr. Black be permitted to decide himself on the actual adoption of the plan of treatment. This, of course, i s inherent i n good casework pr a c t i c e . Mr. Black had considerable ego strength. He was able to stand up to his brother to some degree, to move out of the home and es t a b l i s h himself i n the hostel, and to show some i n i t i a t i v e i n finding work f o r himself. However, there were danger signs too. The primary warning was his regression into dependency i n the hospital s e t t i n g . Another was his f a i l u r e to take his medication, which aggravated his e p i l e p t i c condition,' and again rendered him dependent. • The worker, i n his casework r o l e , gives continuous supportive help, gives f r e e l y of genuine encouragement, and assi s t s Mr. Black i n the matter of finding other accommodation and of obtaining the radio course. In fostering a desire i n Mr. Black to control his seizure condition, the worker can also interpret the v i t a l importance of his f a i t h f u l l y adhering to the prescribed drug therapy and a temperate way of l i f e . Each success w i l l serve to build Mr. Black's confidence i n his own - 73 -a b i l i t y , and he can be aided i n facing r e a l i t y and i n accepting r e s p o n s i b i l i t y f o r his own actions. Direct reassurance on the part of the worker would do much to help Mr. Black improve his opinion of his essential self-worth, d. Prognosis. With Mr. Black, the outlook for f a i r l y adequate r e h a b i l -i t a t i o n would seem to be reasonably good. He had many strengths, and with a p o s i t i v e approach on the part of the worker, Mr. Black might well have learned to modify his behaviour, f o r he had no great need to withdraw from r e a l i t y or to r a t i o n a l i z e his d i f f i c u l t i e s . With a clearer and more objective understand-ing of his condition, and i t s r e l a t i o n to his way of l i f e , he might be expected to adjust to most situations i n his environ-ment with, perhaps, the continued moral support of the worker. C. Permanent Dependency 1. P a r t i a l Permanent Dependency The two cases chosen as being representative of t h i s category are both older women who had been i n receipt of public assistance f o r some time. Because of t h e i r ages and other factors i t was not p r a c t i c a l to consider t o t a l r e h a b i l i t a t i o n as a r e a l i s t i c goal. However, there were personality v a r i a -tions which indicated that one could be helped to accept her misfortunes more e a s i l y than the other. - 74 -Mrs. Olivia Smythe: a. Background Information Mrs. Smythe was an aggressive, domineering,complaining woman of 63 years of age. She appeared to be hypochondri-acal and complained bitterly about the lack of attention she received from her doctor because she was a "welfare case". She and her husband had been in receipt of public financial aid since 1948. Mr. Smythe was over 70 years of age, but due to lack of sufficient residence in Canada, he was not eligible for old age pension. Mrs. Smythe is like a number of older persons on public assistance rolls. Because of her extreme hostility and bitter-r ness, she is difficult to work with. She complains that nothing in her l i f e is satisfying and states that she cannot manage on the financial grant, that their housing accommodation is degrad-ing, that she is a sick woman, and that no one will pay any attention to her. She continues to live in the past and constant-ly remarks how much better things were when she and her husband had money and were not "paupers". She blames everyone, particu-larly her husband, for her troubles and cannot see the part that she plays in them. Mrs. Smythe prided herself on being a f i f t h generation Canadian and a direct descendent of one of the prominent "Fathers of Confederation. There was l i t t l e information on f i l e regarding her childhood, with the exception of a notation that she was the eldest in a family of three girls. She had not been in touch with her sisters for several years and did not speak of them. It appeared that they married many years before she did and that both of them were quite wealthy and influential. Mrs. Smythe seems to have made a poor adjustment to femininity. Her great emphasis on family prestige, on the value of money, and on financial standing might indicate considerable - 75 -i n s e c u r i t y i n her childhood relationship with her mother. She l i k e l y harbours a great deal of repressed h o s t i l i t y towards her mother and s i s t e r s . Mrs. Smythe married when she was 4 5 years of age. Her husband was 1 5 years older than she. He was a member of a t i t l e d , but impoverished, English family. Although by profession he was a b a r r i s t e r , he was never admitted to the bar i n Canada and did not practise law here. P r i o r to World War I I , he occupied a high post i n the B r i t i s h Colonial Service In China, but he l o s t a l l his investments when the Japanese occupied Hong Kong i n 1941. He and Mrs. Smythe barely escaped being interned at the time. Mrs. Smythe appears to have rushed into marriage rather la t e i n l i f e , possibly during the menopausal period. It i s s i g n i f i c a n t that she chooses a man who i s considerably older than herself and one whom she l i k e l y i d e n t i f i e s with her father. With marriage she gains prestige and f i n a n c i a l status. She travels extensively, something which she had never done before. S t i l l , i t seems questionable that she could have been very happy as her needs are so great. For a time the couple t r a v e l l e d extensively i n Canada and England. They appeared to spend money f r e e l y and without concern as to where i t was coming from. F i n a l l y , they were stranded i n V i c t o r i a , and i n 1 9 4 8 had to apply for public assistance. Mrs. Smythe was unable to accept t h i s reversal of t h e i r fortunes and continued to l i v e beyond t h e i r means i n so f a r as housing accommodation was concerned. The couple moved frequently, either because they were evicted for non-payment of r e n t a l , or because of personal differences between Mrs. Smythe and the land-l a d i e s . Each move has made future adjustments more d i f f i c u l t f o r Mrs. Smythe. As the r e a l i t i e s of t h e i r f i n a n c i a l s i t u a t i o n have grown more apparent to her, she has tended to deny them more strongly than ever. While her husband has been almost - 76 -completely immobilized, she has become more aggressive and defensive. b. Diagnosis. i . Physical and Economic Aspects The physical and economic s i t u a t i o n of the Smythes was l i t t l e d i f f e r e n t from that of many other older persons on public ' assistance. They both were i n reasonably good health f o r t h e i r ages and were capable of managing t h e i r own a f f a i r s without help. Granted, they did have the problem of locating adequate housing but, as a general r u l e , they occupied better accommodation than most other persons i n t h i s group. They located t h i s accommoda-t i o n on t h e i r own and were very f a m i l i a r with housing resources i n the Greater V i c t o r i a area. Obviously, they were economically dependent and would so remain for the rest of t h e i r l i v e s . Mr. Smythe was 78 years of age and i t would not have been fe a s i b l e to attempt to e s t a b l i s h him i n the practice of law i n B r i t i s h Columbia. Even i f the $1500 fee were obtainable, i t was questionable i f he could pass the bar examinations. Hence, the couple were c l a s s i f i e d as being p a r t i a l l y permanently dependent i n Chapter I I . i i . Emotional Aspects While i t was true that there was l i t t l e s p e c i f i c i n f o r -mation on the f i l e to assess Mrs. Smythe's emotional l e v e l , the great degree of " f r e e - f l o a t i n g " h o s t i l i t y was very evident. Such h o s t i l i t y was directed e n t i r e l y towards her environment and never towards h e r s e l f . Her dependency needs were great but she - 77 -could only maintain her equilibrium by denying them. These needs were i n d i r e c t l y expressed i n her complaints of her poor state of health which, i n actual f a c t , was quite good. Her r e j e c t i o n of femininity and i d e n t i f i c a t i o n with the male figure was quite apparent. She spoke only of her father and of her grandfather, and was p a r t i c u l a r l y h o s t i l e towards women generally and e s p e c i a l l y towards landladies. She was extremely domineering of Mr. Smythe and she became almost hyster-i c a l i f he showed any signs of r e b e l l i o n or independence. Any display of masculinity on his part was too great a threat to her rather tenuous adjustment i n t h i s area. c. Casework Treatment The prospects of even easing the tension under which Mrs. Smythe existed seemed poor. Certainly, her emotional d i f f i c u l -t i e s were too deep-seated to attempt any c l a r i f i c a t i o n . Because of the length of time during which her defenses have been operating, i t appeared u n l i k e l y that she could be helped to modi-f y them. It was equally impossible for a s o c i a l worker to " r e l i e v e " Mrs. Smythe's h o s t i l i t y . Over a period of two or three hours she could u t i l i z e the permissive client-worker relationship to vent her feelings i f the worker allowed her to do so. At the end of such an interview she was s t i l l as b i t t e r and h o s t i l e as when i t began. d. Prognosis It seems obvious that l i t t l e can be done to help Mrs. Smythe. She has successfully projected a l l her personal - 78 -inadequacies on to her environment and she has no desire to a l t e r t h i s adjustment. Since she i s ab-le to function reason-ably well, i t would seem unwise to attempt to upset t h i s balance. Consequently, continued f i n a n c i a l assistance i s probably a l l that i s indicated here, accompanied by the patient understand-ing of the s o c i a l worker. Mrs. Olga Standing a. Background Information Mrs. Glga Standing, 59 years of age, was born and raised i n Holland. She was a s l i g h t , diminutive woman who seemed almost a f r a i d to speak. She was quiet, mild mannered, and very passive. At the age of 29 she married Mr. Standing, a man ten years her senior. He was the di s i n h e r i t e d son of a w e l l -to-do English family and had been sent to the Continent to l i v e . He was well-educated and considered himself a scholar. There was no i n d i c a t i o n on f i l e that he ever sought employment to maintain his family or himself. Mrs. Standing was a very refined woman and apparently also had a good education. She was a talented p i a n i s t and, on occasion, played at small concerts i n the community. However, she preferred to remain In the home and for many years had not practised her music. Mrs. Standing seems to be almost overly feminine. She married a man several years older than h e r s e l f because she l i k e l y i d e n t i f i e s him with her father. There i s no information regarding her reasons f o r the marriage, but she must have been aware of the r e a l i t y factors of the s i t u a t i o n and that Mr. Standing might not make a responsible husband. The element of self-punishment may have emtered into her decision, but again, there i s l i t t l e information to substantiate such a presumption. - 79 -The Standings emigrated to Canada i n $,925 and. se t t l e d i n V i c t o r i a . Their two sons were born here shortly a f t e r -wards. Mr. Standing apparently made no attempt to find work or to support his family. He was quite content to -remain at home and permit his wife to find what work she could. As well as care f o r the children, Mrs. Standing did domestic work and sold home-cooked foods from door to door. Her income from these sources was meagre and t h e i r standard of l i v i n g was very low i n comparison to what they had been used to as children. However, Mrs. Standing never complained although her husband was very b i t t e r about t h e i r s i t u a t i o n . She retained only a few of her personal a r t i c l e s of furniture, including her piano, which she had brought with her from Holland. The rest were sold to meet expenses. The p r o b a b i l i t y of self-punishment seems f a i r l y evident i n Mrs. Standing's adjustment to the r e a l i t y s i t u a t i o n . She" accepts her husband's attitude towards r e s p o n s i b i l i t y without : complaint and even s e l l s her personal belongings to maintain him. The reason for the self-punishment i s not so c l e a r . I t may be related to a basic r e j e c t i o n of femininity and envy of masculinity on her part. Although she i s d i s s a t i s f i e d with her femininity, she over-compensates to a degree by being very feminine and passive. At the same time, she has a male figure almost t o t a l l y dependent upon her. Thus, she maintains a balance between two c o n f l i c t i n g d r i v e s . Mrs. Standing applied f o r public assistance i n 1950 a f t e r considerable h e s i t a t i o n . In 1949 Mr. Standing was granted the old age pension. However, he refused to share any of t h i s income with her or to contribute to the expen-ses of the home. He bought food for himself but would give none to Mrs. Standing. Both the boys had l e f t home and did not communicate with t h e i r parents. Nor did they forward any money to either the mother or the father, although they were aware of the older couple's poor f i n a n c i a l circumstances. - 80 -Mrs. Standing continued to work as long as she could. However, i n 1950 her health began to break down and she had to remain at home. Since Mr. Standing would not contribute towards her maintenance, she applied for s o c i a l assistance. She found i t d i f f i c u l t to accept help and was extremely anxious l e s t the neighbours and her husband learn that she was i n receipt of assistance. In June 1952, she was s t i l l i n c lined to be secretive about her need f o r f i n a n c i a l a i d . Mrs. Standing finds i t d i f f i c u l t to accept the fact that she i s dependent. For several months she would not apply f o r help, and i t was only through the d i r e c t intervention of her doc-tor that the matter came to the attention of the public welfare worker. To a limited degree a relationship has been established with a female worker and Mrs. Standing i s able to t a l k about some of her troubles. b. Diagnosis 1. Physical and Economic Aspects The physical and economic aspects of the Standings presen-ted no p a r t i c u l a r problems. Both were i n f a i r health and were able to take care of th e i r own physical needs as long as they were assured of a minimal public assistance grant. They occu-pied t h e i r own cottage which, although not well kept, was habitable. Mrs. Standing was a f a i r l y good manager and they l i v e d reasonably well on t h e i r very limited income. When he f e l t l i k e i t , Mr. Standing did pay some of the b i l l s , but f o r the most.part they l i v e d on Mrs. Standing's s o c i a l allowance. In Chapter I I , Mrs. Standing was c l a s s i f i e d as being p a r t i a l l y permanently dependent. i i . Emotional Aspects ; In spite of the fact that Mrs. Standing has some deep* - 81 -seated personality d i f f i c u l t i e s , she was able to relate to the worker. She always functioned f a i r l y welln;even under consider-able stress. She had some ego strength and tended to face her problems,for the most part, i n a r e a l i s t i c manner. c. Casework Treatment As noted previously, Mrs. Standing has been able to rel a t e to some degree to a female worker. She has been able to t a l k about her troubles, but has not dwelt on them incessantly. She has renewed her inter e s t i n music and w i l l play occasionally for the worker. She has shown some int e r e s t also i n returning to her r e l i g i o u s f a i t h which she gave up when she married Mr. Standing. Throughout the contact the worker has been sympath-e t i c , permissive, and supportive. She has encouraged and reassured Mrs. Standing whenever i t has been possible to do so. d. Prognosis While no progress has been made towards even p a r t i a l r e h a b i l i t a t i o n , Mrs. Standing seems to be more outgoing and displays less need to be f u r t i v e and secretive. C e r t a i n l y , she s t i l l i s unable to rebel against Mr. Standing or even to express any overt h o s t i l i t y towards him. However, she does seem to f e e l easier about her s i t u a t i o n and i s seeking some small pleasures f o r h e r s e l f . 2. Total Permanent Dependency The following two cases were taken from the t o t a l permanent dependency grouping mainly because the p o s s i b i l i t i e s of r e h a b i l i t a t i o n were so s t r i k i n g l y d i f f e r e n t . The one woman - 82 -had been i l l f o r a number of years. She was under medical and i n s t i t u t i o n a l care and l i t t l e , p h y s i c a l l y , could be done to help her. The second woman suffered from a functional paralysis of her rig h t l e g , and because of t h i s , she was placed i n an i n s t i t u t i o n . Almost nothing had been done to as s i s t her i n spite of the obvious symptoms that she displayed. The degree that each of these women could be helped i s not known, but some action seems indicated. Mrs. Martha Hoy: a. Background Information Mrs. Hoy was a rather t a l l , slim woman of 65 years of age. She was always very tense and seemed unable to relax. Her husband died i n 1932 and she maintained her-s e l f from that date u n t i l she was admitted to hospital i n 1951 with a chronic heart ailment. She found i t very d i f f i c u l t to accept the fact that she needed help as she had been heretofore a very independent person. She rebelled against accepting public assistance and l e f t the hospital against medical advice. However, t h i s move aggravated her condition and she returned to hospital shortly afterwards. With so l i t t l e information i t i s d i f f i c u l t to perceive why Mrs. Hoy i s so upset by the threat of dependency embodied i n h o s p i t a l i z a t i o n . But, i n view of her rather serious medical condition, her overt reaction of leaving h o s p i t a l seems very u n r e a l i s t i c . Mrs. Hoy married a man who was very s i c k l y , and for a number of years she personally cared for him without help. P r i o r to his death he required a great deal of attention which she gave unstin t i n g l y . In spite of the fact that _she knew that he was dying, her husband's death came as a great shock, and for several months afterward she was quite seclusive. Eventually, Mrs. Hoy recovered and, to maintain her s e l f , - 83 -she sought employment as a p r a c t i c a l nurse. She was inclined to drive herself r e l e n t l e s s l y and tended to accept cases that she knew would terminate i n the death of the patient. The patients were generally men and t h e i r eventual deaths were upsetting to her. Mrs. Hoy seems to have a greater need to associate with death than i s usual. She apparently i s attempting to re-exper-ience a relationship to the father-figure that i s very p a i n f u l fo r her. Her periods of depression and her withdrawal from r e a l i t y following the death of the patients seems i n d i c a t i v e of considerable g u i l t . Again, the reasons for these feelings are not known. With the help of a male s o c i a l worker Mrs. Hoy was able to accept public assistance and was moved to a private h o s p i t a l . Almost immediately, her behaviour changed. She became extremely dependent and could do nothing f o r h e r s e l f . She wanted to be fed, washed and dressed. She complained that no one paid any attention " to her and that her doctor was neglecting her. At the same time, she protested that she did not need the care that she was receiving and that she would manage much better on her own. She refused to give up her house-keeping room but, as she was unable to pay the r e n t a l , the landlord moved her belongings to her s i s t e r ' s home. When she was told t h i s , she became very subdued and would not t a l k to anyone. It would appear that Mrs. Hoy's dependency needs are very great, and that she over-compensates by being extremely independent. Once she gives t h i s independency up, her basic needs assert themselves and she becomes very dependent. She s t i l l clings to the i l l u s i o n of independence though, as she wants to r e t a i n her housekeeping room. When t h i s i s gone^he regresses even further into c h i l d i s h behaviour. In June 1952, Mrs. Hoy was bedridden and almost t o t a l l y helpless. She apparently looked forward to the monthly - 84 -v i s i t s of the s o c i a l worker and t r i e d to prolong the interview as long as she could. It appears that Mrs. Hoy i s reaching out f o r the attention and the concern of others. Apparently her complete dependency i n the i n s t i t u t i o n a l setting brings her personal s a t i s f a c t i o n and aids i n some way to ease the tension of some of her inner c o n f l i c t s . b. Diagnosis i . Physical and Economic Aspects P h y s i c a l l y and economically, Mrs. Hoy i s t o t a l l y depend-ent. She i s receiving good medical and i n s t i t u t i o n a l care, and l i t t l e more can be done f o r her. In view of her medical condi-t i o n the p o s s i b i l i t y of t o t a l or even p a r t i a l r e h a b i l i t a t i o n i s remote. i i . Emotional Aspects Some emotional factors have been brought out i n the recording that require further study before an assessment can be made of Mrs. Hoy's t o t a l s i t u a t i o n . She seems to be capable of doing more f o r herself than just l y i n g i n bed and being waited on. Just what caused her to react i n thi s manner i s not known, but c e r t a i n l y there i s more to the s i t u a t i o n than might be expected with the average chronic heart case. c. Casework Treatment The p o s s i b i l i t y of stimulating Mrs. Hoy to do more f o r herself does not appear to be very good. She has found the answer to her c o n f l i c t s i n her present state of almost complete dependency and she l i k e l y w i l l be r e s i s t i v e of any e f f o r t to - 85 -improve her s i t u a t i o n . However, with the continued i n t e r e s t i n her re l a t i v e s and with sympathetic understanding from the private hospital s t a f f and the s o c i a l worker, some change may be brought about i n her attitude towards her s i t u a t i o n , d. Prognosis It would seem that the prognosis i s poor. Unfortunately^ the s t a f f of most private hospitals are not prepared to give Mrs. Hoy the continuous attention that she demands. Nor can they be expected to understand the basic reasons why she wants such care. Even her doctor i s somewhat of the opinion that she i s malingering. But, the more she i s rebuffed and denied attention, the greater w i l l be her need to gain i t . A private placement i n the home of a warm, motherly woman where she i s the only patient, plus the continued help of a s o c i a l worker may provide the solution to the problem. Without such help, i t seems l i k e l y that Mrs. Hoy w i l l become more and more dependent. Miss E l s i e Lane: a. Background Information Miss Lane was a comparatively young woman to be requir-ing i n s t i t u t i o n a l care. She was only 44 years of age. She was a very small, s l i g h t woman and was in c l i n e d to be shy and uncommunicative. She appeared to be r i t u a l i s t i c and compulsive with regard to her personal hygiene. In 1950 she was under medical care f o r a foot i n j u r y and was admitted to hosp i t a l f o r examination and treatment. She subsequently developed a functional p a r a l y s i s of the right leg which did not respond to treatment. Later she was discharged to private h o s p i t a l care. During the next two years, to June 1952, no action was taken by either her doctor or by the s o c i a l workers i n the public welfare agency. The above information sums up most of the f i l e on t h i s - 86 -woman. Nevertheless, even from t h i s limited knowledge, the deep-seated nature of her problems seems f a i r l y obvious. Her compulsive r i t u a l s , coupled with her marked withdrawal from the competitive world are undoubtedly i n some way related to the re - a c t i v a t i o n : during the menopausal period of her previous d i f f i c u l t i e s that she experienced i n her childhood and adoles-cence. P r i o r to her i l l n e s s , Miss Lane held a responsible p o s i t i o n as senior clerk-stenographer i n one of the pr o v i n c i a l governmental o f f i c e s i n V i c t o r i a . She was receiving a f a i r l y good salary and she shared an a t t r a c t -ive apartment with her younger s i s t e r who was also a successful career woman. While Miss Lane was shy, seclusive, and withdrawn, her s i s t e r was believed to be active and outgoing, and a person who had many friends. This i s the extent of the information that i s currently available on Miss Lane. The reasons for her need to withdraw from r e a l i t y and seek solace i n dependency are not known. How-ever, they do seem related to possible inner c o n f l i c t s centering around her s i s t e r ' s s o c i a l acceptance i n comparison to that of her own, and around her i d e n t i f i c a t i o n of the s i s t e r with the mother-figure. In addition, her personal feelings regarding her femininity and her ess e n t i a l self-worth may also contribute to her present state of emotional dependency. The p a r a l y t i c condition may be a form of self-punishment connected with sexual disfunction, b. Diagnosis i . Physical and Economic Aspects From the physical and economic point of view, Miss Lane i s t o t a l l y permanently dependent. She i s suffering from a pa r a l y t i c condition which has not responded to medical treatment over a period of two years. She i s a model patient and does a l l she can to help around the i n s t i t u t i o n . She i s without funds and i s unable to earn a l i v i n g since she cannot move about s u f f i c i e n t l y to l i v e outside the nursing home. She i s receiving adequate care and her physical needs are being met. i i . Emotional Aspects It seems apparent that some emotional d i f f i c u l t i e s are i n t e r f e r i n g with Miss Lane's adjustment to r e a l i t y s i t u a t i o n s . For a number of years, she was able to function f a i r l y well i n a competitive work s i t u a t i o n . She was capable of assuming considerable r e s p o n s i b i l i t y and held a senior p o s i t i o n i n a governmental department. Then, rather suddenly, she gave t h i s up and regressed into a state of dependency. Some of the possible reasons f o r t h i s behaviour have been suggested previous-l y . It would seem that an attempt should be made by a s o c i a l worker to reach t h i s woman before she finds her current adjust-ment too s a t i s f y i n g for any modification, c. Casework Treatment Miss Lane appears to be able to enter into a r e l a t i o n -ship with the worker. In the past, she has been amiable and f r i e n d l y towards the worker, but she has been reluctant to discuss her p a r a l y t i c d i f f i c u l t y . I t may be that she would re l a t e better to a male worker, but a more detailed assessment would have to be made before considering t h i s plan, or proposing the treatment methods and goals. - 88 -d. Prognosis It i s d i f f i c u l t to determine the prognosis at t h i s point. A great deal of intensive casework treatment w i l l have to be done with Miss Lane i f she i s to be stimulated to modify her current adjustive pattern. However, she has considerable ego strength on which to build i f she can gain some insight into her troubles. Very b r i e f l y , some of the s i g n i f i c a n t circumstances i n the l i v e s of these eight people have been outlined. The d i f f e r -ences i n t h e i r emotional development can be r e a d i l y perceived. In a l l cases, i t i s r e l a t i v e l y easy to look into the past and to find causes f o r t h e i r current behaviour. The d i f f i c u l t task l i e s i n predicting the p o s s i b i l i t i e s of change i n future behaviour and i n the ascertaining of the poten t i a l aspects of r e h a b i l i t a t i o n . Summary In th i s chapter some of the underlying factors have been i l l u s t r a t e d that af f e c t the adjustment of the c l i e n t to his environment. So c i a l casework emphasizes the fact that a l l persons must be considered as i n d i v i d u a l s . The determination of d i f f e r e n t i a l casework treatment, then, i s based on the psychosocial diagnosis. Thus, s o c i a l casework treatment can be integrated into the public assistance programme and can f a c i l i t a t e the r e h a b i l i t a t i o n process. The d i f f e r e n t i a l approach of the s o c i a l worker towards r e h a b i l i t a t i o n plans f o r - 89 -the c l i e n t i s i m p l i c i t i n his consideration of casework tr e a t -ment.' Human relationships are dynamic, not s t a t i c , and growth w i l l fluctuate with changing conditions, s t r a i n s , and s t i m u l i . Therefore, the s o c i a l worker must be continually evaluating and re-evaluating each c l i e n t . As the c l i e n t becomes more able to r e l a t e to the worker, the greater w i l l be the worker's knowledge of that person's background and the reasons f o r his present behaviour. With t h i s increased knowledge of the c l i e n t , the worker i s able to change his treatment goals and to determine how e f f e c t i v e casework treatment w i l l be. In some instances, intensive treatment i s not indicated at a l l , while i n others^there i s some p o s s i b i l i t y of success. However, i n most cases, the accurate p r e d i c t i o n of the degree of success of the r e h a b i l i t a t i o n plan can not be made without some understanding of the i n t r i n s i c emotional factors within the c l i e n t . I t i s these factors that the s o c i a l worker i s s p e c i f i c a l l y trained to seek out and to diagnose with the view to a s s i s t i n g the c l i e n t i n modifying his disruptive behaviour patterns. Currently, considerable d i f f i c u l t y i s encountered i n • evaluating the a b i l i t y of the c l i e n t to u t i l i z e the r e h a b i l i t a -t i o n programme and casework treatment. « It i s possible that, with further research, a method of measuring such subjective factors may be evolved. In a separate section of t h i s paper some of the l i t e r a t u r e r e l a t i n g to emotional maturity i s - 90 -reviewed, (Appendix A). An attempt has been made to develop a rating scale to point up the varying degrees of maturity and immaturity i n some areas of human behaviour so as to provide a basis from which the s o c i a l worker can i n i t i a t e casework t r e a t -ment, and from which he can measure c l i e n t movement. However, the discussion therein i s more or les s related to the descrip-t i o n of human behaviour rather than to the determination of the primary causes of such behaviour. The scale of assessment of emotional maturity i s , at best, only a t o o l to aid the s o c i a l worker i n understanding the c l i e n t . I t may, however, a s s i s t the worker i n graphically determining the c l i e n t ' s l e v e l of emotional maturity i n r e l a t i o n to the suggested l e v e l of normality. It may also help to define more c l e a r l y the focus of treatment i n the environmental s i t u a t i o n by pointing up appropriate and inappropriate treatment plans. I f the scale i s incorporated into the recording i n the c l i e n t ' s f i l e , or i s tabulated i n graphic form, the c l i e n t may be re-evaluated from time to time. Comparisons of these evaluations at regular i n t e r v a l s would serve to detect movement on the part of the i n d i v i d u a l . The p r i n c i p l e value of such a scale i s to enable the s o c i a l worker to screen his cases more objectively. In a r e l a t i v e l y short period of time, he should be able to determine whether or not the c l i e n t i s capable of accepting and u t i l i z i n g treatment. In addition, the worker i s enabled to assess how intensive the casework treatment should be, which areas the c l i e n t Is p a r t i c u l a r l y i n need of help, and - 91 -at what l e v e l t h i s treatment should be directed f i r s t . The scale may also help the worker to look at himself more objectively i n the client-worker r e l a t i o n s h i p , and to a s s i s t him i n evaluating his own c a p a b i l i t i e s , pointing up those areas i n which he himself i s not functioning at the l e v e l of his normal capacity. I t i s presumed, of course, that the s o c i a l worker i s an emotionally mature, professional person. Chapter IV THE ESSENTIALS OF REHABILITATION IN PUBLIC ASSISTANCE The aim of t h i s study has been to discuss the meanirig of r e h a b i l i t a t i o n i n a public assistance programme. An attempt has been made to outline current concepts of r e h a b i l i -t a t i o n as related to the economic and physical factors of the public assistance r e c i p i e n t , and to point up the l i m i t a t i o n s of these concepts. It has been suggested that i n order f o r the r e h a b i l i t a t i o n programme to be e f f e c t i v e , these current con-cepts must be broadened to include the emotional factors which govern the behaviour and the attitudes of the c l i e n t towards the goal of r e h a b i l i t a t i o n . While the contribution that casework can make to r e h a b i l i t a t i o n i s important, a comprehensive approach to the t o t a l problem obviously i s necessary i f the programme i s to be r e a l l y e f f e c t i v e . Hence, i n thi s chapter some material i s introduced which, although discussed previously > appears to be an esse n t i a l part of the broad scheme of r e h a b i l i -t a t i o n . A. The Need fo r S o c i a l Workers The need for u t i l i z i n g the services of q u a l i f i e d s o c i a l work personnel i n the r e h a b i l i t a t i o n programmes has been repeatedly emphasized. However, i t i s imperative that public welfare administrative o f f i c i a l s give serious thought to the question of how the s o c i a l worker can best be integrated into the t o t a l programme. There i s no point i n accepting b l i n d l y the p r i n c i p l e that trained s o c i a l workers are required to administer public assistance, and then to embark on the r e c r u i t -ment and placement of such personnel without f i r s t s p e c i f i c a l l y defining the job that the s o c i a l worker i s equipped to do. Quite apart from the appalling waste of money i n the payment of sal a r i e s to an unnecessary number of workers, the ,loss of poten-t i a l talent attracted by the higher wages from other f i e l d s u t i l i z i n g s o c i a l work s k i l l s , and the permanent damage i n f l i c t e d on young inexperienced s o c i a l workers by the pressure of work' unrelated to t h e i r t r a i n i n g i s hardly j u s t i f i a b l e . 1. S o c i a l Work Function A detailed job analysis of the t o t a l public assistance programme i s not required to show that many of the s p e c i f i c administrative functions are of a routine c l e r i c a l nature. In the generalized public welfare programme i n B r i t i s h Columbia, categorical aid schemes and general assistance are administered by the one public welfare worker within a spe c i f i e d d i s t r i c t . A great deal of his time i s , of necessity, spent completing and notorizing a p p l i c a t i o n forms, confirming residence, age, and d i s a b i l i t y , evaluating negotiable assets and r e a l property, and the l i k e . Many such workers are trained s o c i a l workers, yet much of the work can be reviewed just as e f f i c i e n t l y , accurately, - 94 -and rapi d l y by sympathetic and understanding c l e r i c a l s t a f f . The d i f f i c u l t y i n job d e f i n i t i o n l i e s i n segregating the purely s o c i a l work function from the c l e r i c a l e l i g i b i l i t y study. Herein i s to be found the solution to the dilemma of c l a s s i f i -cation. 2« Current Public Welfare Thought During the past two decades, public welfare o f f i c i a l s i n V i c t o r i a have tended to become "category-conscious" 1. They are inclined to think generally i n terms of old age pensioners, mothers' allowance r e c i p i e n t s , neglected children, and so on. In so doing, they seem to have p a r t i a l l y l o s t sight of the fact that these same old age pensioners, mothers' allowance recipients and neglected children are individual-human beings. Whether or not t h i s apparent oversight by the workers i s due to lack of t r a i n i n g or to pressure of work i s probably a matter of conjec-ture. Like many other persons i n the world, these c l i e n t s have personal as well as f i n a n c i a l problems. 3 . Assignment of C l i e n t s . The job of the public welfare worker should be to assess a l l c l i e n t s i n terms of whether or not they need and can u t i l i z e casework treatment, lather than just to consider these c l i e n t s i n the narrower terms of whether or not they need and can u t i l i z e f i n a n c i a l assistance as i s done at present. While the need for f i n a n c i a l aid may be very r e a l to the c l i e n t when he f i r s t applies for assistance, the s o c i a l worker i s primarily concerned with the diagnosis and casework treatment of the i n d i -vidual's underlying problems. I f the c l i e n t i s not a good - 95 -prospect for r e h a b i l i t a t i o n , that i s , i f he i s permanently-dependent, and he can function reasonably well without casework treatment, then he can be supervised by an experienced although untrained public welfare worker f o r routine maintenance. On the other hand, i f he i s only temporarily dependent and can u t i l i z e casework treatment, he should be assigned to a q u a l i -f i e d s o c i a l worker. In Chapter I I , the s t a t i s t i c s show that i n the V i c t o r i a C i t y Social Welfare Department caseload for the month of June, 1952, more than two-thirds of the case units were permanently dependent. While some of the wage-earners i n these units no doubt needed casework treatment, the greater majority of them functioned reasonably well without such intensive treatment. There seems no point i n u t i l i z i n g the talents of trained case-work personnel to perform the routine work of granting s o c i a l assistance to these persons, The remaining one-third of the caseload consisted of younger persons with and without dependent children. C e r t a i n l y , i t seems more l o g i c a l for the trained s o c i a l workers to concentrate t h e i r e f f o r t s on working with t h i s group although, again, some of these c l i e n t s did not need such specialized services. Obviously, the assignment of c l i e n t s should be made on the basis of the needs and problems of the i n d i v i d u a l c l i e n t as related to the c a p a b i l i t i e s of the public welfare worker. At the present time, assignment i s made on the basis of the category of assistance that the c l i e n t i s e l i g i b l e f o r , or on the residence of the c l i e n t within a - % -c e r t a i n area. Naturally, there are factors which w i l l necessitate modification of t h i s rule of selec t i v e assignment., but to some degree, the p r i n c i p l e can be adhered to i n most o f f i c e s . Some of the modifying factors are the topography and the population of the land area under the supervision of a s p e c i f i c o f f i c e , the d i f f i c u l t i e s of t r a v e l i n the area, the number of public welfare workers, and the degree of s o c i a l work tr a i n i n g that the s o c i a l workers have. 4. The Selection Process The screening of c l i e n t s f o r assignment to workers can best be done during the i n i t i a l contact when the i n d i v i d u a l f i r s t applies f o r assistance. This necessitates that highly s k i l l e d s o c i a l workers be u t i l i z e d to handle a l l intake i n t e r -views. The role of such an intake worker i n the public welfare agency should be d i f f e r e n t i a t e d from that of a reception-i s t . Currently, the practice appears to be one of assigning the majority of intake periods to the r e l a t i v e l y inexperienced or unskilled worker. Such workers are pri m a r i l y receptionists and are not equipped to diagnose the c l i e n t ' s underlying prob-lems. Therefore, they can not determine which worker i n the agency i s best q u a l i f i e d to carry out the s p e c i f i c treatment process. The assignment of the c l i e n t to a s p e c i f i c worker, then, i s determined by the intake supervisor on consultation with the q u a l i f i e d intake s o c i a l worker who makes the casework diagnosis. Hence, the intake supervisor must also be a trained s o c i a l worker. Ideally, the intake process should be handled by a - 97 -separate section of the s o c i a l welfare department and would require the employment of one or more s o c i a l workers as well as a supervisor. Such a section i s p a r t i c u l a r l y adaptable to larger s o c i a l welfare o f f i c e s i n metropolitan centers, but i s not p a r t i c u l a r l y feasible for small o f f i c e s i n a r u r a l setting employing only three or four workers. However, regardless of the size of the o f f i c e , there i s generally a supervisor i n charge, and such a person should be trained and be prepared to handle the assignment of cases on the same basis as outlined above i n so f a r as i t i s possible. 5 . Size of Caseloads The tendency i n recent years i n public assistance agencies i n Canada and the United States has been to develop generalized caseloads i n which the worker administers to c l i e n t s the categorical aid programmes and the child welfare services, as well as the general assistance programme. I t has been suggested 1 that the s o c i a l worker can deal with more aged per-sons than with families having dependent children since many of the aged persons do not require the intensive casework treatment that the families with children often do. Although there i s no u n i v e r s a l l y established optimum caseload, i t i s recognized that the workers should not carry a "mixed" caseload of more than 225 to 250 i n d i v i d u a l s . A "mixed" caseload i s one wherein there are c l i e n t s of d i f f e r e n t ages requiring d i f f e r e n t forms, of assistance and services. 1 White, R. Clyde, Administration of Public Welfare, American Book Co., New York, second e d i t i o n , 195©> pp. 149-151. - 98 -In the V i c t o r i a C i t y S o c i a l Welfare Department i n June, 1952, the average i n d i v i d u a l caseload consisted of approximately 400 c l i e n t s . Naturally, the greater percentage of these c l i e n t s were i n the older age groups but, even so, the number of persons needing help was too great to permit the worker to spend more than a very minimum amount of time with each person. Intensive casework was almost out of the question. With the assignment of caseloads as suggested above, i t i s v i s u a l i z e d that the s o c i a l worker i n th i s o f f i c e who i s to give intensive casework treatment w i l l carry only 30 to 50 such cases. The les s specialized worker who i s doing a much les s intensive job w i l l probably carry the same number as he did i n June, 1952, and more s t a f f w i l l be needed. However, a detailed review of the t o t a l agency caseload as related to the demands of the c l i e n t for services w i l l have to be completed before a more d e f i n i t e statement can be made as to the proposed size of the various i n d i v i d u a l caseloads i n t h i s p a r t i c u l a r o f f i c e . B. Evaluation of the Re h a b i l i t a t i o n Process Any programme, regardless of i t s focus, must at some time or other be subjected to review and evaluation i f i t i s to be successful i n reaching the objectives that i t was designed to meet. Because r e h a b i l i t a t i o n programmes are dealing with human l i v e s , i t i s essential that such evaluations be conducted continuously. Nor should public assistance programmes be exempted from such scrutiny, although i n actual practice, a l l - 99 -too l i t t l e review, research, and long-range planning is present-ly attempted. It would seem to be true that rehabilitation in the public assistance setting can only be as effective and as far-sighted as the personnel who are employed to do the work. Hence, i t is essential that a l l public welfare officials, from the chief administrative officer to the worker in the field who deals with the clients, have a deep conviction of the value of the programme*.. It has been suggested that there are four basic concepts which, in effect, constitute the philosophy of 1 an effective public assistance rehabilitation programme. These are f i r s t , that recognition be made of the essential worth and dignity of each individual applicant; second, that the client has within himself the potential ability to utilize these social services, with help i f necessary, and become an asset to the community; third, that everyone has the right to a satisfy-ing and effective existence; and fourth, that as a l l persons are not created equal, the community must provide equality of opportunity through the medium of social services to compensate for this variance in status. 1. The Role of the Supervisor While i t is necessary that the administrator be familiar with, and favourable to social casework practice, i t is the supervisor of the social workers who is the key person in the 1 cf. Perlman, Helen Harris, "Casework Services in Public Welfare", Proceedings of the National Conference on Social Work, 1947, Columbia University Press, New York, pp. 261-269. - 100 -r e h a b i l i t a t i o n programme. After consultation regarding the i n i t i a l i n d i v i d u a l diagnosis, the casework supervisor i s d i r e c t l y responsible for guiding and evaluating the casework treatment plan embarked on by the s o c i a l worker. At the same time, the supervisor i s evaluating the s k i l l of the worker and i s able to u t i l i z e the supervisor-worker relationship as a teaching s i t u a t i o n whereby the s o c i a l worker learns to function more e f f e c t i v e l y with the c l i e n t i n the treatment process. Hence, the p o s i t i o n of supervisor should be f i l l e d by a s k i l l e d s o c i a l worker who has the v i s i o n and foresight to be able to perceive the p r a c t i s i n g s o c i a l worker's short-comings and lack of self-awareness. Through the medium of d i r e c t i n t e r p r e t a t i o n , such a supervisor i s able to help the s o c i a l worker to correct these personal lacks. Naturally, i f the supervisor i s to function properly, he must be free from much of the weight of the routine administrative d e t a i l s of o f f i c e and programme management, unless he has only two or three work-ers to supervise. In practice i n B r i t i s h Columbia, the emphasis i s on the recruitment of persons for supervisors i n the public assistance programme with administrative as well as with casework capabil-i t i e s . The p o s i t i o n of supervisor i n d i s t r i c t o f f i c e s , of necessity, requires considerable attention to administrative d e t a i l . Consequently, these supervisors have l i t t l e time to concentrate on the purely casework aspects of the job, and t h i s lack i s reflected i n the mediocrity of casework practice by - 101 -many s o c i a l workers i n the f i e l d . There i s l i t t l e stimulus f o r growth i n the young, newly-trained s o c i a l workers who have poten t i a l casework a b i l i t i e s , but who are lacking i n experience to develop these a b i l i t i e s . Even i n the inexperienced i n -service trained public welfare workers, the experienced case-work supervisor and s o c i a l worker can i n s t i l l the basic ease-work p r i n c i p l e s which w i l l promote more adequate functioning by these workers. Hence, i t would seem that the degree of success i n the r e h a b i l i t a t i o n of the public assistance r e c i p -ient i s d i r e c t l y related to the s k i l l of the casework supervisor as well as to that of the s o c i a l worker. 2. Staff Development The importance of the e f f e c t of the s o c i a l worker's own attitudes and l e v e l of emotional maturity on the c l i e n t i n the diagnosis and treatment process i s a factor that cannot be overlooked. The role of the s o c i a l worker i n r e l a t i o n s h i p to the c l i e n t i n a programme of emotional r e h a b i l i t a t i o n i s of primary concern, and i s one which has been studied elsewhere. 1 I t i s imperative i n practice that the s o c i a l worker be aware of himself, and that he recognize the importance of c o n t r o l l i n g what he brings to the interview from his personal experiences and adjustments. He must continually s t r i v e to increase his self-awareness and s e l f - d i s c i p l i n e , and at the same time, to increase his knowledge of human behaviour, i f he i s to improve 1 Carscadden, L i l l i a n , An Evaluation of the C l i e n t -Worker Relationship, 1950, unpublished Master's of S o c i a l Work thesis, University of B r i t i s h Columbia. - 102 -i n his professional functioning. While the supervisor-social worker relationship i s basic to the promotion of good s o c i a l work pr a c t i c e , there are other methods of s t a f f development which can be u t i l i z e d i n a group s e t t i n g , and which are designed to help the worker to function better on the job. However, i t must be kept i n mind that, to be e f f e c t i v e , a good s t a f f t r a i n i n g programme requires detailed and continuous planning with a l l s p e c i f i c phases being integrated into the t o t a l scheme. Such a t r a i n i n g programme involves regular and planned s t a f f meetings i n which the s o c i a l workers are encouraged to discuss t h e i r problems i n r e l a t i o n to s p e c i f i c c l i e n t s , the resources available to help the c l i e n t , and the gaps i n the r e h a b i l i t a t i o n programme. In t h i s manner, s o c i a l workers are able to pa r t i c i p a t e i n agency policy-making which w i l l be d i r e c t l y related to the needs of the c l i e n t , f o r no one knows these needs as intimately as does the s o c i a l worker. The a v a i l a b i l i t y of books and current periodicals on s o c i a l work practice i n other f i e l d s as well as i n public welfare i s i n v a l -uable. Films, exhibits, pamphlets, prepared case records, and other forms of v i s u a l aids are also extremely hel p f u l i n promoting discussion and sel f - e v a l u a t i o n . The attendance of s o c i a l workers at conferences, i n s t i t u t e s , workshops, and the l i k e can be encouraged. Agency delegates, by attending such conferences, can report back to s t a f f meetings. Case conferences on the i n d i v i d u a l c l i e n t s can bring i n other professional groups such as doctors, nurses, - 103 -and teachers, who are also interested i n the i n d i v i d u a l c l i e n t . This can do much to broaden the v i s i o n of the s o c i a l worker by-making him aware of the scope and the l i m i t a t i o n s of his own and other professions. The employment of part-time profession-a l consultants i n psychiatry and s o c i a l work by the agency can do much to sharpen the s o c i a l worker's focus of the treatment of the c l i e n t . F i e l d v i s i t s by s o c i a l workers to other agencies dealing with related public welfare and r e h a b i l i t a t i o n programmes can serve to stimulate s t a f f thinking. Of paramount importance i n the development of s t a f f i s an adequate scheme of educational leave, with some provision f o r f i n a n c i a l assistance. Not only w i l l t h i s serve to bring academically trained s o c i a l workers into the public assistance f i e l d , but also i t can be used to stimulate the experienced worker who has been on the job for several years. Continuous s t a f f development and education i s one of the most important r e s p o n s i b i l i t i e s of public welfare adminis-t r a t i v e o f f i c i a l s . A l l the e f f o r t that, i s expended i n the task of continuous s t a f f development i s well repaid with the growth of an energetic, active, and s o c i a l l y conscious s t a f f ; a s t a f f that takes a personal pride i n doing the job well; a s t a f f v i t a l l y interested not just i n the job, but i n the wel-fare of the people with whom they are working; a s t a f f who are not just investigators, but who are professional s o c i a l workers with a professional job to do and a goal to aim fo r ; and l a s t l y , a s t a f f that i s conscious of i t s r e s p o n s i b i l i t i e s as an integrated unit serving the community. - 104 -3• Recording As a general r u l e , the recording i n the f i l e s of most public assistance c l i e n t s i s t o t a l l y inadequate i f casework treatment i s to be attempted. Certainly, there i s no need f o r a detailed s o c i a l history on a l l aplicants f o r assistance. In cases other than those that are selected f o r intensive treatment, such extensive recording would be a great waste of time since i t would never be used. However, i n s p e c i f i c cases, the s o c i a l worker w i l l f i n d i t necessary to record i n d e t a i l , not only the pertinent facts of his treatment progress with the c l i e n t , but also the developmental background informa-t i o n of the c l i e n t . Such recording i s useful i n making the diagnosis, i n planning treatment, and i n evaluating the c l i e n t ' s progress and the functioning of the s o c i a l worker. It i s not intended at t h i s point to present a tabulated outline of recording. However, diagnostic recording should give a clearer picture of the c l i e n t ' s usual adjustive behaviour pattern i n some of the areas where he i s encountering d i f f i -c u l t y , as well as point up some of the important events i n his childhood, and the meaning of these events to him. The record-ing should include such face sheet information as the names and ages of the husband, ( i f married), wife, and children, the date of marriage, the n a t i o n a l i t y , the r a c i a l background, and the r e l i g i o n of the family group. The d e t a i l s of the p a r t i c u l a r c r i s i s s i t u a t i o n which brought the c l i e n t i n f o r help are impor-tant. Some notation, with s p e c i f i c i l l u s t r a t i o n s , of the - io5 -chief d i f f i c u l t i e s , of the duration of the troubles, and when the troubles started, i s he l p f u l and pertinent i n f a c i l i t a t i n g the diagnostic procedure. With reference to the background of the c l i e n t , i t i s necessary to know his place i n the family, the attitudes of his parents to him and to the other children, and the attitudes of the s i b l i n g s and other persons toward the c l i e n t . Information regarding i l l n e s s of a serious or minor nature should be record-ed, and p a r t i c u l a r attention should be given to minor complaints which have existed over a long period of time. A review of educational background related to the work h i s t o r y , adjustment, and the current f i n a n c i a l status of the c l i e n t should also be made. The d e t a i l s of the couple's courtship and marriage, including periods of s t a b i l i t y and i n s t a b i l i t y , and the causes and durations of separations, are necessary. It i s also impor-tant to record the attitudes of the c l i e n t to the present and any previous marriage. The c l i e n t ' s sexual adjustment, and whether or not he finds i t s a t i s f y i n g should be noted, as well as any i n d i c a t i o n of pre-marital or extra-marital a f f a i r s . I t i s h e l p f u l to ascertain any marked changes i n the attitudes of the c l i e n t towards his environment and marital s i t u a t i o n on the b i r t h of his children or during the children's adolescence. Strong t i e s or antipathies between the c l i e n t and his children are s i g n i f i c a n t . In the case of the unmarried person, any unusual sexual practices should be recorded i f they are apparent, or i f they are divulged by the c l i e n t himself. - 1 0 6 -Of v i t a l importance are the c l i e n t ' s personal ideas of what his troubles are, the part that he plays i n the troubles, how he adjusted previously, what he wants to do now, and how he expects the s o c i a l worker to help him. A l l these ideas are affected by his c u l t u r a l c h a r a c t e r i s t i c s , his r e l i g i o u s b e l i e f s , his basic attitudes to l i f e , * and his strong l i k e s and d i s l i k e s . Hence, these d e t a i l s , too, need to be recorded i f the s o c i a l worker i s to see the c l i e n t i n true perspective. 4. S t a t i s t i c s and Research At the present time, s t a t i s t i c s for the V i c t o r i a C i t y S o c i a l Welfare Department are derived from forms developed and u t i l i z e d by the p r o v i n c i a l a u t h o r i t i e s . These s t a t i s t i c s are e s s e n t i a l l y the r e s u l t of a process of enumerating the monthly increase and decrease of case units i n the d i f f e r e n t categories of assistance. While they give a general picture of the monthly and annual fluctuations i n the numbers of case units i n receipt of assistance, and also the a c t i v i t y - o f the workers, much more detailed information i s needed to denote s p e c i f i c trends. Even the general c l a s s i f i c a t i o n s of temporary and permanent dependency used i n Chapter II could c l a r i f y the s i t u a -t i o n more than i s done now. What i s r e a l l y lacking i s the use of an adequate s t a f f of research s p e c i a l i s t s i n the p r o v i n c i a l S o c i a l Welfare Branch. I f such a s t a f f unit could be added to the present Department of Health and Welfare, and a s u f f i c i e n t number of q u a l i f i e d personnel employed, they could be u t i l i z e d to develop and co-ordinate s t a t i s t i c s and research i n both the health and the - 107 -welfare fields. With this material available, provincial and municipal departments could develop programmes designed to meet the needs of persons within their own jurisdictions. Overlap-ping of services could be prevented, and joint efforts could be bent towards developing services where they are needed and can be used most effectively. C. Measurement of Client Movement The accurate measurement of the growth or progress of clients during casework treatment has created a problem for social workers for a long period of time. It is suggested in Appendix A that the social worker may be enabled to judge the relative improvement in the individual client's adjustment by * plotting on a simple chart (see Schedule E) his estimate of the client's situation over regular intervals. However, since the material used in judging behaviour depends to a degree on the subjective interpretation of the worker, this method of measuring growth is difficult to validate statistically without extensive testing on many individuals by different workers and comparisons of the results. This problem has been studied by several authorities for some time, and two schemes1 have been developed which appear 1 Hunt, J.McV., and Kogan, Leonard S., Measuring Results in Social Casework: A Manual on Judging Movement, Family Service Association of America, New York, 1950• Hunt, J. MeV., Blenkrier, Margaret, and Kogan, Leonard S., Testing Results in Social Casework: A Field Test of the Movement Scale, Family Service Association of America, New York, 1950. Preston, Malcolm G., Mudd, Emily H., and Froscher, Hazel B., "Factors Affecting Movement in Casework", Social Casework, March, 1953» vol. XXXIV, no. 3 , PP- 103-111. - 108 -to measure movement on the part of c l i e n t s with a considerable degree of accuracy. The movement scale developed by Hunt and Kogan u t i l i z e s the records of "anchor" eases depicting varying degrees of movement against which the i n d i v i d u a l case to be measured i s compared. The scale plots movement i n the areas of the c l i e n t ' s adaptive e f f i c i e n c y , disabling habits and con-d i t i o n s , verbalized attitudes and understandings, and environ-mental circumstances. Preston, Mudd, and Froscher have developed the conference judgement method wherein two profession-a l l y trained persons (caseworkers, p s y c h i a t r i s t s , or psychologists) make independent analyses of the c l i e n t ' s case record, using a prescribed check l i s t of 31 items. The two s p e c i a l i s t s then meet i n conference and compare the r e s u l t s , item by item. Any disagreements are reconciled by reference to the case record. The f i n a l product i s the conference judge-ment of the c l i e n t ' s movement. The Hunt-Kogan movement scale would seem to be the most advantageous of these two methods since i t can be applied by one person with reasonable o b j e c t i v i t y i n a r e l a t i v e l y short period of time. D. Factors Aff e c t i n g R e h a b i l i t a t i o n There are a great many factors a f f e c t i n g the r e h a b i l i t a -t i o n of the c l i e n t . Some are personal, that i s , they are peculiar to the i n d i v i d u a l c l i e n t , and others are environmental or are a part of the community f a c i l i t i e s i n general. Some personal factors are as follows: - 109 -1. Innate Intelligence The primary requisite to be considered i n the r e h a b i l i -t a t i o n plan of the i n d i v i d u a l i s his innate i n t e l l i g e n c e and, to a degree, his aptitudes. Obviously, the physical content of the vocational training or re t r a i n i n g programme w i l l be d i f f e r e n t for the mental defective than that for the person of average or greater than average i n t e l l i g e n c e . Then, too, the degree of mental deficiency i s also important f o r , while a person with the i n t e l l e c t u a l capacity of a high grade moron may learn to complete simply r e p e t i t i v e tasks, the imbecile can h a r d l y l e a r n to meet even his most simple personal needs, and the idiot i s t o t a l l y dependent upon others. Aptitudes are factors which must be considered as well. Some people are mechanically i n c l i n e d while others are a r t i s t i c a l l y bent. Therefore, the interests and a b i l i t i e s of these persons does provide a rather general guide to the p a r t i c u l a r type of work or trade at which they are l i k e l y to be successful. 2. Age and Sex The age of the c l i e n t i s important i f the s o c i a l worker i s considering t o t a l r e h a b i l i t a t i o n as the goal of treatment. The older the i n d i v i d u a l , the les s l i k e l y he i s able to become economically s e l f - s u f f i c i e n t . He i s r e s t r i c t e d as to the type of work that he can perform and, generally, he has lower stamina and less resistance to i n f e c t i o n . The attitudes of employers also m i l i t a t e against the older person i n spite of the fact that, i n some instances, his productivity and steadi-ness on the job may be higher and his absenteeism lower than - 110 -those of younger persons. The sex of the c l i e n t has a bearing on employability. Apart from differences i n the physical capacities of men and women, discrimination against women i s s t i l l to be found i n many employers as i s evidenced by the difference i n salary paid for the same job, i n the types of positions that women can occupy, and i n the kind of work that they may undertake. While these employer prejudices are slowly being broken down by the numerical weight of the women In the labour market at the present time, there are s t i l l many women who unconsciously harbour the thought that these prejudices are v a l i d . I f such i s the case, i t w i l l a f f e c t the Individual's approach to retr a i n i n g i n cer t a i n areas of work, and the s o c i a l worker must be aware of these. 3 . I l l n e s s , Handicap, and D i s a b i l i t y The medical prognosis of the c l i e n t ' s condition i s important. I f the ailment i s degenerative or chronic, there i s less l i k e l i h o o d of the worker doing much more than easing the tension of the in d i v i d u a l as related to his condition. The area and degree of handicap are also important since these w i l l determine whether or not su r g i c a l repair should be attempt-ed. With acute i l l n e s s , the slowness or r a p i d i t y of recovery w i l l affect the worker's treatment plan. The medical t r e a t -ment of malnutrition, diabetes, anaemia, and the l i k e , and the future prevention or control of such conditions must also be considered as a part of the r e h a b i l i t a t i o n plan i f i t i s to be successful. - I l l -4. Emotional Attitudes The e f f e c t of the c l i e n t ' s emotional attitudes on his behaviour has been discussed i n Chapter I I I . Worthy of emphasis i s the c l i e n t ' s r e a l opinion of his es s e n t i a l s e l f -worth and his r e s u l t i n g acceptance of masculinity. The person with a low opinion of himself may overcompensate and become aggressively masculine, or he may become quite femininec and dependent. Whatever his adjustment may be, i t w i l l give r i s e to feelings of h o s t i l i t y , g u i l t , or anxiety, which w i l l i n t e r -fere with his e f f i c i e n t functioning. The degree of t h i s interference w i l l a f f e c t the c l i e n t ' s progress i n the r e h a b i l i -t a t i o n plan, and i t may well be that he can never p a r t i c i p a t e i n these plans u n t i l he learns to cope with t h i s anxiety, fear, tension, h o s t i l i t y , and g u i l t . The c l i e n t ' s attitude towards authority i s also important, and i t i s d i r e c t l y related to the sat i s f a c t i o n s that he received as a ch i l d from his parents. Unless he has learned by experience to cope with and, to a degree, to resolve his feelings and attitudes i n th i s area, he w i l l find i t d i f f i c u l t to enter into the r e h a b i l i t a t i o n programme. 5 . Educational Background The educational background of the c l i e n t i s h e l p f u l i n setting up the l i m i t s of the vocational t r a i n i n g aspects of the r e h a b i l i t a t i o n programme. Not only does the record of past educational achievements, including apprenticeship, vocational and specialized t r a i n i n g as well as formal schooling, give clues as to the type of t r a i n i n g that may be embarked on, but 112 -also, i t serves to indicate the duration of time that t h i s phase of the r e h a b i l i t a t i o n process may require. The amount of academic or vocational education that the i n d i v i d u a l has absorbed during his past education experiences ,1s,' of course, r e l a t i v e . But i t can, with some degree of accuracy, be determined through the medium of psychometric t e s t i n g . 6. Employment S k i l l s and Work History Past employment s k i l l s can be l o s t by the c l i e n t i n two ways: f i r s t , through accident or bodily i n j u r y to that part of the body u t i l i z e d to practise the s k i l l , and second, through disuse due to the time that the person has been out of employment i n which the s k i l l was used. In the case of accident or i n j u r y , i t may be possible f o r the c l i e n t to con-centrate on the learning of new s k i l l s which are related i n some way to the f i r s t , or may require t r a i n i n g i n an altogether new f i e l d . With the second, practice i n a sheltered work si t u a t i o n may be a l l that i s necessary to restore the c l i e n t ' s confidence and to revive the old s k i l l . The review of the work history of the c l i e n t can be h e l p f u l i n determining his s t a b i l i t y i n a competitive s i t u a t i o n , and, when related to employment s k i l l s , can serve to evaluate the c l i e n t ' s probable a b i l i t y to undertake a new learning s i t u a t i o n . 7. Race and Religion Racial o r i g i n of the c l i e n t can a f f e c t the i n d i v i d u a l r e h a b i l i t a t i o n plan. Employer and community prejudice against s p e c i f i c r a c i a l groups can negate the whole purpose of the - 113 -programme. Fortunately, such prejudices are not so widespread as they were i n the past, but they must s t i l l be taken into consideration. A language handicap wean also be a d i f f i c u l t b a r r i e r to overcome, and c u l t u r a l habits and patterns of some r a c i a l groups can i n t e r f e r e with treatment unless the worker makes, allowances f o r such c u l t u r a l v a r i a t i o n s . The r e l i g i o n of the c l i e n t i s another aspect which should be considered. Some r e l i g i o u s groups indulge i n v a s t l y d i f f e r e n t and often more r e s t r i c t i v e practices than do persons of more orthodox f a i t h s who may constitute the. majority of the population of the community. Again, i f the worker i s not aware of these differences and able to accept them as part of the c l i e n t ' s t o t a l personality, then he may commit serious blunders which may result i n the actual withdrawal of t h i s c l i e n t from the r e h a b i l i t a t i o n plan. 8. Morale Like the term " r e h a b i l i t a t i o n " , morale i s commonly, but often loosely, used i n current discourse. Generally, morale i s thought to be the mental attitude of the i n d i v i d u a l , i n d i c a t -ing the possession of or the lack of confidence, zeal, hope, and courage i n himself and i n his relat i o n s h i p s . Morale appears to be c l o s e l y related to self-worth, and good morale i s t y p i f i e d by the expression of a sense of belonging, of purpose, of objective recognition of capacities, achievements, and l i m i -tations on the part of the i n d i v i d u a l . The mental, physical, and emotional health of the i n d i -v i d u a l are probably the prime factors a f f e c t i n g his morale. - 114 -Environmental and e x t r i n s i c influences also play an important part i n the composite of his morale. The self-confidence of the i n d i v i d u a l i n himself and i n others accompanied by a r e a l -i s t i c adjustment to most situations or crises i s commensurate with good moralei The possession of an inner sense of security, personal prestige, and se l f - r e c o g n i t i o n by the i n d i v i d u a l promotes good morale. The assurance to him of income and adequate care during a period of i l l n e s s or d i s a b i l i t y insures his inner f e e l i n g of protection, and as a r e s u l t , promotes freedom from unnecessary worry and anxiety. Morale was not discussed i n r e l a t i o n to the emotional aspects of r e h a b i l i t a t i o n i n Chapter I I I . In Appendix A an attempt i s made to d i f f e r e n t i a t e between mature, self-centered, and self-deprecatory attitudes r e l a t i n g to i n d i v i d u a l s e l f -worth, but i t does not seem possible to apply such a s p e c i f i c c l a s s i f i c a t i o n to in d i v i d u a l morale. Morale seems to be either high or low. A poor or low morale depicts, e s s e n t i a l l y , self-deprecatory attitudes by the person towards his own s e l f -worth i n a l l or i n s p e c i f i c areas of human relationships and behaviour. There i s , of course, variance i n the i n t e n s i t y of these attitudes. On the other hand, a good or high morale connotes self-confidence and self-res p e c t , an objective view of his own a b i l i t i e s and p o t e n t i a l i t i e s , and a recognition and acceptance of his l i m i t a t i o n s . However, a self-centered person, whether to a limited degree or i n the excess, generally displays a high morale as - 115 -f a r as his opinion of his own self-worth i s concerned, but there i s l i t t l e or no acceptance of personal l i m i t a t i o n s or inadequa7 c i e s . There i s a lack of co-operation with and understanding of others, and as a r e s u l t , high morale i n the self-centered person i s c h i e f l y a s e l f - g l o r i f i c a t i o n process. Here, again, these exaggerated attitudes exist to a d i v e r s i f y i n g degree i n di f f e r e n t i n d i v i d u a l s . Naturally, an emotionally mature person also displays a high morale i n most instances, but he i s not necessarily s e l f -centred, either to a l l i m i t e d or to an excessive degree. Rather, he has good insight and an objective approach to most situations and rela t i o n s h i p s . He i s o p t i m i s t i c , but not unduly so. E s s e n t i a l l y , then, 'morale' i s a broader, more expansive view of self-worth as related to a l l phases or areas of human in t e r - r e l a t i o n s h i p s , of reactions to si t u a t i o n s , and of adjust-ment to ever changing environmental conditions. From the point of view of the worker i n the r e h a b i l i t a t i o n programme, good morale on the part of the c l i e n t i s indicated by his willingness to p a r t i c i p a t e i n and to devote his f u l l energies to the task of becoming independent. E. Rehab i l i t a t i o n F a c i l i t i e s Quite apart from the a b i l i t y of the c l i e n t to u t i l i z e the r e h a b i l i t a t i o n plan and the s k i l l of the s o c i a l worker i n diagnosis and casework treatment, there are many environmental factors which can f a c i l i t a t e the success of the programme. Some of these factors are as follows: - 116 -1. Mmi n i s t r a t i b n of the Programme As noted previously, there are many administrative d e t a i l s which v i t a l l y a ffect the t o t a l programme. Of major importance i s the philosophical b e l i e f of the s t a f f as a whole from the administrator to the s o c i a l worker, i n the inherent value of a r e h a b i l i t a t i o n programme. Far-sighted l e g i s l a t i o n can be drafted, a comprehensive programme can be formulated, and an e f f i c i e n t organizational structure can be established, but unless the personnel who are employed to put the thinking into practice have an empathy f o r the c l i e n t s who need the service, a r i g i d i n t e r p r e t a t i o n and app l i c a t i o n of p o l i c y may re s u l t which w i l l negate the o r i g i n a l i n t e n t i o n of the planners. The routine procedures of handling applications, issuing funds, and reviewing continued e l i g i b i l i t y w i l l r e f l e c t t h i s basic philosophy of the s t a f f , and w i l l permeate the whole pro-gramme. A niggardly, depreciatory approach to the c l i e n t s should be avoided i f any attempt at actual r e h a b i l i t a t i o n i s to be made. Then, too, the actual assistance grants paid to c l i e n t s must be s u f f i c i e n t to provide f o r minimal n u t r i t i o n a l and hous-ing standards, and must be related i n some way to increases or decreases i n the actual cost of l i v i n g . I t seems very short-sighted to embark on a r e h a b i l i t a t i o n programme, make provision fo r extensive medical care, and so on when the amount of the f i n a n c i a l aid i s so low that i t serves to create the very prob-lems i n c l i e n t s that the balance of the programme i s trying to overcome. - 1 1 7 -It goes without saying that the effectiveness of the r e h a b i l i t a t i o n programme i s d i r e c t l y related to the amount of money available f o r the programme, and the number of q u a l i f i e d personnel employed to administer i t . 2. Co-ordinator of Reh a b i l i t a t i o n This paper has not attempted to explore i n d e t a i l any s p e c i f i c gaps i n the current programme i n B r i t i s h Columbia. Nevertheless, a cursory review of the present s i t u a t i o n serves to point up considerable lack of co-ordination, not only among programmes operated under private auspices, but also among those within the p r o v i n c i a l governmental structure i t s e l f . C e r t a i n l y , a more intensive study of the actual scheme seems indicated. The development of equivalent r e h a b i l i t a t i o n f a c i l i t i e s i n the small towns throughout the province i s neither feas i b l e nor very p r a c t i c a l . The greater proportion of the population of the province i s located i n the v i c i n i t y of Greater Vancouver and Greater V i c t o r i a . Employment which i s suitable f o r handicapped persons i s also more r e a d i l y available i n these two areas. Since employment placement i n the urban areas l i k e l y i s necessary f o r those handicapped individuals residing i n r u r a l communities, the development of comprehensive r e h a b i l i t a t i v e f a c i l i t i e s i n Vancouver and V i c t o r i a would serve two purposes. F i r s t , the needs of those persons residing i n the neighbourhood of the c i t i e s would be met. Second, i n d i v i d -uals from r u r a l areas who move to the c i t y f o r t r a i n i n g would be enabled to become acclimatized to urban community l i v i n g , thus - 118 -making easier t h e i r t r a n s i t i o n from dependency to g a i n f u l employment. There are private agencies operating s p e c i f i c physical r e h a b i l i t a t i o n programmes for adults; for example, the B. C. "Cancer Foundation, the Canadian A r t h r i t i c and Rheumatism Society, the Canadian National I n s t i t u t e for the B l i n d , and the Western Society for Physical R e h a b i l i t a t i o n . The Children's Hospital and the Queen Alexander Solarium are two private i n s t i t u t i o n s with physical r e h a b i l i t a t i o n programmes related to meeting the needs of children. The p r o v i n c i a l government i s functioning i n the r e h a b i l i t a t i o n f i e l d through i t s D i v i s i o n of T. B. Control and V. D. Control as well as through the quasi-p r o v i n c i a l department of the Workmen's Compensation Board. This l a t t e r agency i s expanding i t s r e h a b i l i t a t i o n programme rap i d l y and i s presently constructing a new building to house i t s f a c i l i t i e s . The federal government has long been operating r e h a b i l i t a t i o n programmes f o r war veterans i n the Department of Veterans A f f a i r s ' m i l i t a r y h o s p i t a l s . Among a l l these agencies there i s l i t t l e or no co-ordination, with the exception of the Canadian A r t h r i t i c and Rheumatism Society and the Western Society for Physical R e h a b i l i t a t i o n which share the same physical f a c i l i t i e s . With reference to the vocational counselling, t r a i n i n g and employment placement aspects of r e h a b i l i t a t i o n , lack of co-ordination i s even more obvious. Apart from the p r o v i n c i a l Child Guidance C l i n i c and c e r t a i n s p e c i f i c agencies which have t h e i r own counsellors, the B r i t i s h Columbia Counselling Service - 119 -i n Vancouver i s the only vocational testing and counselling agency with f a c i l i t i e s available to the general public. In the vocational t r a i n i n g area, only the Vancouver Vocational Ins t i t u t e i s designed to meet the need, except for the p r i v a t e l y operated commercial schools f o r s p e c i f i c trades. Most of the employment placement of the handicapped i s dealt with by the federal National Employment Service. On the whole, the public assistance agencies i n the province make l i t t l e use of these services. The Greater Vancouver Community Chest and Council has a voluntary committee dealing with the problem of co-ordination of services, but elsewhere i n the province, no such integrated planning e x i s t s . It seems e s s e n t i a l , therefore, that the pr o v i n c i a l government should take immediate steps to develop a s t a f f d i v i s i o n within the structure of the Department of Health and Welfare to deal with t h i s problem. The d i r e c t o r of the d i v i s i o n might well be e n t i t l e d the Co-ordinator of Rehabilita-t i o n . He should be a person who i s well q u a l i f i e d and trained i n the vocational r e h a b i l i t a t i o n f i e l d , and should also have an appreciation of the function of the s o c i a l worker. The Co-ordinator of Reh a b i l i t a t i o n would be responsible for the development of three d i s t i n c t functions within his depart-ment. F i r s t , he would be responsible f o r integrating the vocational aspects of the r e h a b i l i t a t i o n programmes now operated by the Workmen's Compensation Board, the D i v i s i o n of T. B. Con-t r o l , and the Mental Health Services. In addition, he should i n s t i t u t e new services f o r the use of the S o c i a l Welfare Branch, - 120 -or expand the present services of the above departments so that t h i s Branch can u t i l i z e them. He also should a s s i s t with the development of the programme designed to meet the needs of adult and juvenile delinquents i n the i n s t i t u t i o n a l s e t t i n g . Second, he would be required to e s t a b l i s h a research and s t a t -i s t i c a l unit with adequately trained s t a f f . This unit would not only i n i t i a t e studies and surveys, and prepare s t a t i s t i c a l data, but would gather, publish, and c i r c u l a t e to a l l agencies engaged i n t h i s work i n the province!,- p a t e r i a l pertinent to the f i e l d of r e h a b i l i t a t i o n . Third, he would act as the l i a i s o n person between a l l agencies to promote co-ordination i n the f i e l d . His p o s i t i o n i n t h i s area would be greatly enhanced i f he i s permitted to disburse funds to these agencies to subsidize c e r t a i n aspects of current programmes and to estab-l i s h and develop new f a c i l i t i e s where gaps are found to e x i s t . It i s not intended to suggest that the p r o v i n c i a l government should r e l i e v e the private agencies of the f i n a n c i a l burden or of the r e s p o n s i b i l i t y f o r operating t h e i r s p e c i f i c programmes. Rather, i t i s hoped that the organization of an o v e r a l l planning agency would serve to integrate the present programmes, avoid duplication of services, and stimulate the development of long-range planning i n a l l aspects of the f i e l d of r e h a b i l i t a t i o n i n B r i t i s h Columbia. 3 . Family Resources The degree of success i n the r e h a b i l i t a t i o n of c l i e n t s can be increased by the use of the resources of the c l i e n t ' s - 121 -own family. Apart from the f i n a n c i a l aid that they may be able to give i n ce r t a i n areas, t h e i r attitudes to the c l i e n t and t h e i r emotional support and praise of his e f f o r t s to improve his s i t u a t i o n can be of great help. Such support improves the c l i e n t ' s morale and enables him to pa r t i c i p a t e more wholeheartedly i n the treatment plan. Then, too, these r e l a t i v e s may provide such extras as housing, transportation, physical care, s p e c i a l treatment, and so on. I f the worker i s aware of the fact that c l i e n t s are people who l i v e i n fa m i l i e s , and uses his s k i l l s to e n l i s t the support and sympathy of the c l i e n t ' s family towards the t r e a t -ment plan, he w i l l be well rewarded with the p o s i t i v e benefits that both he and the c l i e n t w i l l reap. There are so many l i t t l e things that families can provide that can not be budgeted for i n the public assistance grant. 4. Community Resources There are many community organizations which can supple-ment the resources of the family i f the s o c i a l worker gives the matter some thought. There are service clubs, f r a t e r n a l organ-i z a t i o n s , philanthropic s o c i e t i e s , and church groups who are w i l l i n g and anxious to meet some of the needs of public assistance r e c i p i e n t s . The organization, planning, and integration of such groups into the r e h a b i l i t a t i o n programme must be done care-f u l l y i f the in t e r e s t s of the i n d i v i d u a l participants are to be maintained and the group's help used e f f e c t i v e l y . There are recreational agencies and community centers whose services can be u t i l i z e d to draw i n interested public - 122 -assistance c l i e n t s . Through the f a c i l i t i e s of such agencies, special handicap groups can be formed, but there i s a danger i n segregating the public assistance recipient or the handi-capped person which cannot be minimized. This should be avoided i f i t i s at a l l possible. Such persons should be i n -tegrated into the normal programmes of the agency, and thus encouraged to r e t a i n contact with other members of the community rather than to withdraw from s o c i a l r e l a t i o n s h i p s . To stimulate the c l i e n t ' s i n t e r e s t i n the community, and to promote his s o c i a l r e l a t i o n s h i p s , the r e h a b i l i t a t i o n plan might well con-sider the importance of such personal factors as general appear-ance, dress, makeup and cosmetic aspects, the development of " s o c i a l graces", and the a c q u i s i t i o n of some s k i l l i n various a c t i v i t i e s (for example, dancing, cards, games, and so on). The effect of these factors on the c l i e n t ' s general morale, and on his success i n the o v e r a l l r e h a b i l i t a t i o n programme can not be overlooked. 5. Economic and Employment Conditions To a degree, the economic conditions of the community and the province have an e f f e c t on the r e h a b i l i t a t i o n plan f o r the i n d i v i d u a l c l i e n t . The demand fo r goods, the price of commodities, and the a v a i l a b i l i t y of markets i n which to s e l l i n d u s t r i a l l y produced a r t i c l e s are of p a r t i c u l a r i n t e r e s t to the employer. When these are favourable, the employer's business prospers, and he i s able to pay adequate wages and to provide f u l l time work for his employees rather than to f u r n i s h employment of merely a sporadic or seasonal nature. The employer tends to expand his business i n times of prosperity, and t h i s i n turn provides more job opportunities. Part of the objective of the r e h a b i l i t a t i o n programme i s to t r a i n i t s c l i e n t s i n s k i l l s which can be u t i l i z e d both i n times of expansion and i n times of recession. However, the job of placement of the c l i e n t i s made easier i n periods of f u l l employment and provides a wider range of trades from which he can choose for the purposes of vocational t r a i n i n g . Conditions of employment, such as the attitudes of employers towards handicapped persons, the conditions of indus-t r i a l plants, the work hazards, and the d i v e r s i f i c a t i o n of industry must be considered by the s o c i a l worker and by the vocational counsellor. The a c c e s s i b i l i t y of the plant, the nature of the work, and the factors of the s p e c i f i c job, such as the hours of work, days o f f , s i c k leave, and break periods are important to the i n d i v i d u a l c l i e n t . Sheltered workshops are h e l p f u l i n carrying the c l i e n t through the t r a n s i t i o n period from unemployment to steady work, and, i n addition, they provide a setting wherein the older or more handicapped person becomes an active contributor to his maintenance rather than just a passive recipient of assistance from others. 6. The Medical Care Programme A l l aspects of medical care are v i t a l to the r e h a b i l i t a -t i o n programme. The a v a i l a b i l i t y and calibre of the physicians and the medical s p e c i a l i s t s i n a l l f i e l d s d i r e c t l y a f f e c t the c l i e n t ' s a b i l i t y to u t i l i z e the treatment plan constructively. - 123a- v H o s p i t a l i z a t i o n , and diagnostic and treatment f a c i l i t i e s are important as well as the a v a i l a b i l i t y of convalescent and i n s t i t u t i o n a l care. Such a n c i l l a r y services as dental t r e a t -ment, medical treatment for cosmetic defects, provision of orthopaedic appliances, and optometrical accessories f a c i l i -tate, the c l i e n t ' s progress. Some provision must also be made for the re-examination of and the follow-up care f o r the c l i e n t as i t becomes necessary. 7. The Vocational Counselling and Training Programme Before vocational t r a i n i n g can be embarked on, some assessment of the c l i e n t ' s c a p a b i l i t i e s , aptitudes, and i n t e r -ests must be made. The tests are generally administered by a qu a l i f i e d psychologist who may also f i l l the role of the voca-t i o n a l counsellor. It i s a part of his function to interpret to the c l i e n t that person's p o t e n t i a l i t i e s i n the l i g h t of currently available employment and possible employment demands i n the various f i e l d s . Vocational training or re t r a i n i n g i s correlated with the psychologist's findings. When the course of study i s complete, the job placement i s made and the follow-up contacts are maintained with the c l i e n t to help him with his early adjustments i n the work s i t u a t i o n . It w i l l be noted that no attempt has been made to set up i d e a l or even minimum standards of the physical or vocational phases of r e h a b i l i t a t i o n . It seems obvious that the maximum of success for any programme of r e h a b i l i t a t i o n can be expected only when these f a c i l i t i e s are available to a reasonable degree. - 124 -I t i s essential that some provision be made f o r the medical, s u r g i c a l , and p s y c h i a t r i c care required to improve, i n so f a r ,.. as i s possible, a l l physical and mental handicaps. It i s important, also, that vocational counselling, t r a i n i n g , and employment placement be a v a i l a b l e . Without these f a c i l i t i e s , the job of the s o c i a l worker generally i s limited to the r e l i e f of tension, and the true meaning of r e h a b i l i t a t i o n i n the public assistance f i e l d can hardly be r e a l i z e d . F. Subjects f o r Further Study It i s apparent that much more time must be given to the study of a l l aspects of the r e h a b i l i t a t i o n programme before a concrete scheme can be developed i n B r i t i s h Columbia. P r i o r i t y should be given to the study of the various programmes that are presently operating i n the province i n order to assess more accurately the gaps that e x i s t , and to recommend how these gaps can best be overcome. Such a study would bring to the fore the d r a s t i c need fo r co-ordination, integration, and o v e r a l l plan-ning as has been suggested i n t h i s paper. The place of a vocational r e h a b i l i t a t i o n programme i n the public assistance agency merits further attention. The s t a t i s t i c a l material i n Chapter II indicated that there was a group of persons receiving f i n a n c i a l aid who might have been able to u t i l i z e vocational t e s t i n g , counselling, and t r a i n i n g f a c i l i t i e s . However, t h i s group should be reviewed over a longer period than was done here from the point of view of the emotional as well as the physical and economic factors a f f e c t i n g - 125 -t h e i r dependency. A study of t h i s nature i s presently being conducted by the Aid to Needy Children Bureau of the C a l i f o r n i a State Department of Public Welfare i n co-operation with the Bur-eau of Vocational R e h a b i l i t a t i o n of the C a l i f o r n i a State Depart-ment of Education. 1 The material derived from t h i s project might well provide a basis f o r further study i n B r i t i s h Columbia. With the majority of public assistance c l i e n t s being more or less permanently dependent, i t would also seem advisable to conduct additional research into the need for and the use of f a c i l i t i e s which would prevent t h e i r becoming t o t a l l y dependent. Certainly, i n the i n s t i t u t i o n a l setting alone much can be done to prevent the premature ageing of c l i e n t s . These a c t i v i t i e s can include the provision of books, f i l m s , games, and barbering and hairdressing services, with f a c i l i t i e s available for the formation of friendship, s o c i a l , i n t e r e s t , and hobby groups. Such programmes can do much to enable the c l i e n t to maintain contact with r e a l i t y and with the community about him, and such may even stimulate him to the point where he i s able to function on his own and leave the i n s t i t u t i o n a l s e t t i n g . The development of useful s t a t i s t i c s on a province-wide basis seems es s e n t i a l and needs further study. A d i f f e r e n -t i a t i o n should be made between s o c i a l s t a t i s t i c s and f i n a n c i a l s t a t i s t i c s , and t h i s should be more than just a matter of "counting noses". If adequate s t a t i s t i c s were developed, com-parisons could be made between the c l i e n t s of the various municipal and p r o v i n c i a l welfare o f f i c e s , and differences i n 1 Lepon, Leon, "Rehabilitating Public Assistance Recipients", Public Welfare, A p r i l , 1953, vol.11, no. 2, p.47. - 1 2 6 -the geographic areas i n the province would become apparent. In general, much more emphasis should be placed on research i n the public welfare f i e l d , at lea s t at the p r o v i n c i a l l e v e l of government i f not at the municipal l e v e l . Conclusion . A great deal of emphasis i n thi s study has been placed on the attempt to determine the emotional components of person-a l i t y development, and to i l l u s t r a t e the ef f e c t of these compo-nents on the individual's behaviour i n r e l a t i o n to his physical and economic s i t u a t i o n . The purpose here i s not to suggest that the r e h a b i l i t a t i o n of the c l i e n t can be attained only through growth towards emotional maturity. Rather, i t i s intended to bring out f o r c i b l y the fact that the c l i e n t ' s emo-t i o n a l feelings and reactions have a di r e c t e f f e c t on the success or f a i l u r e of the t o t a l r e h a b i l i t a t i o n plan. Knowledge of these emotional factors can serve as a guide to the s o c i a l worker, and can prevent him from wasting time pursuing i n e f f e c -t u a l goals. E s s e n t i a l l y , i t would 'seem that a l l behaviour on the part of the i n d i v i d u a l i s the r e s u l t of his attempts to s a t i s f y his basic needs. Such a person thrives on the love, a f f e c t i o n , and acceptance of himself by his fellowmen. Yet, i n the culture of Western C i v i l i z a t i o n , great emphasis i s placed on aggressiveness. Such aggressiveness tends to bring about the - 12? -denial ef love and a f f e c t i o n by others. It i s the attempt to s a t i s f y the need to be loved i n antipathy with the need to be aggressive that results i n human behaviour. Prom b i r t h , the i n d i v i d u a l i s confronted with the necessity of resolving these c o n f l i c t i n g needs. The methods or the behaviour by which he learns to accomplish t h i s i n childhood are retained as he matures chronologically, and they shape the adjustive patterns that he adopts towards the r e a l i t y situations i n his l i f e . Such c o n f l i c t s arouse anxiety and th i s i s d i r e c t l y related to the success of his adjustment methods. When the c l i e n t i s unsuccessful, the anxiety may become so great that he i s immobilized, and he w i l l then regress towards u t i l i z i n g inappropriate and i n f a n t i l e reactions which, at one time, were successful i n meeting his needs. In so doing, he hopes to s a t i s f y his needs and to disburse the anxiety. The task of the s o c i a l worker i s to support the normal function-ing of such a person i n so far as i t i s possible and to r e l i e v e his anxieties and tensions. He determines the c l i e n t ' s d i f f i c u l t i e s or areas of c o n f l i c t by observing the degree of anxiety that i s aroused i n the c l i e n t i n response to c o n f l i c t s i t u a t i o n s , and then the worker i s able to e s t a b l i s h the diagnosis and treatment goal accordingly. In the public assistance se t t i n g , tie s o c i a l worker has the resources of the f i n a n c i a l aid programmes to a s s i s t him i n meeting some of the material needs of the i n d i v i d u a l , and these can serve to mitigate some of the anxieties. This f i n a n c i a l - 128 -a i d , coupled with the worker's knowledge of the c l i e n t ' s d i f f i c u l t i e s , enables him to help the person to strengthen or to modify his adjustment patterns. Thus, the fundamental objective of the r e h a b i l i t a t i o n programme for the emotionally dependent i s more clos e l y reached, for the c l i e n t then i s better able to compete successfully with others, to resolve his inner c o n f l i c t s , and to s a t i s f y his own i n d i v i d u a l needs. The importance of the e f f e c t of the s o c i a l worker's own attitudes on the c l i e n t i n the diagnostic and treatment process cannot be overlooked. Unless the s o c i a l worker i s aware of his own attitudes and f e e l i n g s , and d i s c i p l i n e s him-s e l f accordingly, he can completely negate the r e h a b i l i t a t i v e aspects of the public assistance programme. Instead of helping the c l i e n t to build new adaptive patterns, he only succeeds i n r e i n f o r c i n g the unhealthy defense mechanisms that the c l i e n t has already set up. Instead of enabling the c l i e n t to become independent, he forces him further into a state of dependency. However, i t has not been the intention here to deal with the role of the caseworker and with casework treatment as such; neither i s i t within the boundaries of t h i s t r e a t i s e to attempt to interpret the caseworker's d i r e c t influence on the c l i e n t . Rather, the purpose has been to show that the emotion-a l factors contributing to the individual's personality do af f e c t the degree of success of the r e h a b i l i t a t i o n plan. It i s hoped that i n the future a broader and more comprehensive - 129 -view of a l l factors contributing to the r e h a b i l i t a t i o n p r o 4 gramme w i l l be considered by the public assistance agency. But i t must be remembered that although the s o c i a l worker can help to a great extent i n guiding persons to a more useful, independent, and s a t i s f y i n g way of l i f e , he i s l i m i t e d to working with the material at hand, and he i s bounded by the c l i e n t ' s own l e v e l of maturity, by the i n d i v i d u a l physical or mental handicap, and by the ex i s t i n g economic and environmen-t a l s i t u a t i o n . Thus, although the worker can do much, he cannot be expected to perform miracles i n the area of the t o t a l r e h a b i l i t a t i o n of the public assistance r e c i p i e n t . APPENDIX A A BATING SCALE OF EMOTIONAL MATURITY During the process of evaluating the emotional factors of dependency of the individuals outlined i n the case h i s t o r i e s i n Chapter I I I , some considerable d i f f i c u l t y was encountered when an^attempt was made to compare the l e v e l s of emotional development of these d i f f e r e n t persons and to determine the treatment goals applicable to each. Comparison was almost impossible as each worker had recorded the varied reactions of the c l i e n t s i n many d i f f e r e n t and often unrelated r e a l i t y s i t u a t i o n s . The solution to the problem appeared to l i e i n the determination of common areas i n which i n d i v i d u a l human behaviour could be observed and recorded as o b j e c t i v e l y as possible. It i s pertinent, then, to f i r s t consider a b r i e f discussion of normality, emotional maturity, and neurotic trends. A rating scale f o r assessing the c l i e n t ' s emotional maturity i s suggested as a possible guide to a s s i s t the s o c i a l worker i n r e f i n i n g his diagnosis of the c l i e n t ' s problems, and to determine more accurately from a subjective point of view a v a l i d and p r a c t i c a l treatment goal for the possible r e h a b i l i t a -t i o n of the c l i e n t . - 1 3 0 -- 131 -A. Aspects of Normality and Emotional Maturity It has been suggested that emotional maturity is but one aspect of normality and, while this paper is essentially interested in discussing emotional maturity as related to dependency, i t seems desirable to consider a l l the aspects of normality. Dr. Maurice Levine notes that normality1 can only be a relative approximation based on statistical averages of groups i f such averages are not contrary to individual health. It includes physical normality, that i s , the presence of good structure, function, and maturity, and the absence of physical disease; intellectual normality, with relative freedom from neurotic or psychotic symptoms; and emotional maturity. The same author continues with a discussion of some of 2 the essential points of emotional maturity. He suggests that emotional maturity in each individual may be determined by that individual's ability to be guided by reality rather than by wishes and fears, by his ability to live in terms of long-term values rather than short-term values, and by the display of a grown-up conscience instead of one of a childhood variety. Further evidences of emotional maturity are the ability to be independent, the capacity to love someone other than oneself, and the display of only moderate, reactions of fear and hatred. Finally, Dr. Levine states that the capacity to be;reasonably 1 Levine, Maurice, "Normality and Maturity", The Family, March, 1940, vol. XXI, no. 1, p. 18. 2 Ibid., pp. 18-25. - 132 -dependent on others, to use healthy defense mechanisms, to have a good sexual adjustment, and a good work adjustment are other aspects of emotional maturity. He further notes that there are other facets of maturity not mentioned here, such as depend-ability, the capacity to meet emergencies, the acceptance of individual differences, the capacity to learn by experience, the capacity to persevere and carry through, and the integration of contrary drives, but he proposes that these are fundamentally aspects of those factors already presented. B. Neurotic Trends Before attempting to draw up criteria by which to evaluate an individual's emotional level in relation to maturity, i t is worth while to consider some of the deviations from the normal. Dr. Karen Horney suggests that there are at least ten neurotic trends of behaviour.1 These trends are related to the need for affection and approval, the need to be dependent on someone else, the need to restrict one's l i f e within narrow borders, the need for power, and the need to exploit other persons. Other trends are those related to the need for social recognition or prestige, the need for personal admiration, the ambition for personal achievement, the heed for self-sufficiency and independence, and the need for perfection and unassailability. 1 Horney, Karen, Self-Analysis, W.W.Norton, New York, 1942, pp. 54-60. - 133 -The author points out by examples that i t i s the extremes of in d i v i d u a l behaviour i n these areas that are neurotic. She stresses that a l l persons tend towards one type of behaviour or another, and that several types of reactions may be present i n varying degrees i n the same person. However, while the objectives may be the same for the neurotic and the normal person, the basis and the meaning of the s t r i v i n g s are e n t i r e l y d i f f e r e n t . The neurotic goals are not what the person r e a l l y wants, but rather,they are what he i s driven to i n order to maintain an equilibrium between his inner drives and outer r e s t r a i n t s . While the above noted c r i t e r i a of Levine and Homey are he l p f u l to the s o c i a l worker i n the determination of emotional maturity and the recognition of neurotic behaviour, no directions of enquiry for each i n d i v i d u a l case are indicated. I f the worker wishes to compare the emotional development of d i f f e r e n t c l i e n t s , or of the same c l i e n t at d i f f e r e n t i n t e r v a l s , i t would seem to be es s e n t i a l that he consider the c l i e n t ' s p a r t i c u l a r behaviour i n ce r t a i n d i s t i n c t areas. C. Scale of Assessment of Emotional Maturity For comparative purposes, i t i s proposed that objective descriptions can be made of an indiv i d u a l ' s a t t i t u d e s , f e e l i n g s , or behaviour i n the four areas of sexual adjustment, achieve-ment, relationships with others i n his environment, and - 134 -1 evaluation of personal self-worth. For the sake of brevity, these areas will be referred to as sexual adjustment, achieve-ment, social consciousness, and self-worth in the balance of the text. A five point scale has been drawn up for each one of these areas (Schedules A, B, C, and D). In the following discussion, the pronoun "he" has been used throughout to signify both male and female persons, thus simplifying the task of writing. The context, therefore, must be altered where necessary when evaluating a female client. Attitudes and behaviour depicting excessive and limited self-centeredness are set at one end of the scale, while those typifying excessive and limited self-depreciation are placed at the other. Emotionally mature behaviour is interposed between the two extremes. 1. Sexual Adjustment In the area of sexual adjustment, i t is suggested that the emotionally mature person enjoys a heterosexual partner-ship, and has the capacity to give and to receive love and affection. He has a normal sex urge and a desire for love and 1 cf. Adler, Alfred, Social Interest: A Challenge to Mankind, Faber and Faber, London, 1938, P« 13» cited in Mullahy, Patrick, Oedipus Myth and Complex, Hermitage Press, New York, 1948, p. 123. Mullahy suggests that Adler Was of the opinion that there is only one single standard by which one can form an estimate of a human being and that is by his movement when confronted with the unavoidable problems of humanity. These problems are the att i -tude adopted toward love, one's vocation or professions, and fellow men. As outlined above, the writer has adapted Adler's classification to refer to attitudes relating to sexual adjust-ment, achievement, and social consciousness, and has added a fourth, the individual's evaluation of himself, or self-worth. - 135 -sexual s a t i s f a c t i o n . The co-operative relationship involves mutual understanding, and promotes the growth and development of shared sexual pleasures and s a t i s f a c t i o n s . The sexual act i t s e l f i s s a t i s f y i n g for the most part to both the i n d i v i d u a l and to his partner. He also has accepted the importance of his own sex r o l e , and has a mature appreciation of the fact that men and women each have t h e i r own assets and l i m i t a t i o n s . The sexual adjustment of the excessively self-centered i n d i v i d u a l i s related to the g r a t i f i c a t i o n of the s e l f only, with l i t t l e or no capacity to give love and a f f e c t i o n to others. He needs to be aggressive i n the sexual act and thus to dominate the partner completely. There, perhaps, i s considerable evidence of promiscuity on the part of t h i s person, and he l i k e l y i s i n c l i n e d to boast of the number of sexual conquests or orgasms he has per night. The i n d i v i d u a l also i s probably a c t i v e l y homosexual, generally being the aggressor i n the r e l a -tionship. Such a person usually practises frequent masturbar t i o n with the exclusion of hetero-sexual intercourse. Limited self-centeredness i n the area of sexual adjust-ment implies that the i n d i v i d u a l has p a r t i a l i n s ight into his partner's sexual needs, but that he i s predominantly concerned with s e l f - g r a t i f i c a t i o n . L i k e l y , he desires a quick r e p e t i t i o n of the sexual act, and may indulge i n occasional " a f f a i r s " . He may evidence some degree of masturbation accompanied by occasional sexual intercourse. At the other end of the scale i s the person who i s excessively self-depreciating i n his sexual adjustment. He - 136 -lacks the capacity to receive love and a f f e c t i o n , and i s unable to enter into a s a t i s f a c t o r y r e l a t i o n s h i p . He evidences severe inner tension and feelings of inadequacy which may result i n impotency. I f he indulges i n homosexual p r a c t i c e , he i s the passive partner. The i n d i v i d u a l whose role i s that of limited s e l f -depreciation i n the sexual adjustment area i s one who i s unsure of himself i n the sexual act. He probably has some feelings of g u i l t or anxiety due to repression of the sexual drive, with inner tension l i m i t i n g free expression. Such a person encounters d i f f i c u l t y i n relaxing i n the love r e l a t i o n s h i p and gains l i t t l e , i f any, r e a l s a t i s f a c t i o n from i t . 2. Achievement Emotional maturity i n the. area of achievement i s t y p i f i e d by the disp l a y of a good sense of goal with c l a r i t y of purpose on the part of the i n d i v i d u a l . He displays a desire f o r e f f i c -iency and an avoidance of waste. Money i s regarded by him as a means to an end and not the end i n i t s e l f . His judgement and sense of proportion i s good, and he has the capacity to evaluate r e a l i s t i c a l l y his assets and l i a b i l i t i e s . He apprec-iates his own a b i l i t i e s and s k i l l s , and shows a reasonable degree of self-confidence i n most s i t u a t i o n s . He harbours reasonably strong impulses to grow and to improve, and learns by experience to adapt his behaviour to outside s t i m u l i and s i t u a t i o n s . He i s able to maintain a steady and sustained e f f o r t over a reasonable period of time, aided by systematic organization of his work and by his a b i l i t y to plan and concentrate on the matter i n question. - 137 -He exhibits a sense of r e s p o n s i b i l i t y , and has a capacity f o r independent unsupervised a c t i v i t y . He i s dependable, adapt-able, f l e x i b l e , and resourceful i n meeting most emergencies as well as capable of admitting an error or mistake i n judgement. While he expresses some ambivalence, he i s able to weigh the r e a l i t y factors i n the s i t u a t i o n and arr i v e at a l o g i c a l d ecision. He i s able to accept f r u s t r a t i o n and postponement of plans most of the time. The grading of excessive self-centeredness i n the area of achievement i s indicated when the i n d i v i d u a l displays an excessive sense of goal f o r the purpose of s e l f - g l o r i f i c a t i o n . He expresses the b e l i e f that he i s i n f a l l i b l e or that he i s omnipotent and can do no wrong. Achievement becomes an obses-sion, and to a t t a i n t h i s goal, he drives himself r e l e n t l e s s l y , exhibiting destructive tendencies towards the plans, the ideas, and the success of his competitors. Behaviour i n d i c a t i v e of some sense of goal and achieve-ment on the part of the c l i e n t f a l l s i n the c l a s s i f i c a t i o n of limited self-centeredness. Such a person l i k e l y i s unduly op t i m i s t i c , and while he has a c e r t a i n drive towards achievement i t i s i r r e g u l a r and not sustained. He has some a b i l i t y to meet emergencies, but i s in c l i n e d to exercise snap-judgements, and hence, needs considerable supervision. While he i s adapt-able to a degree, he tends to be rather r i g i d and to r e s i s t change. His decision i s influenced by the possible gain for s e l f . - 138 -The person who i s excessively self-depreciating i s one who finds no personal s a t i s f a c t i o n s i n achievement. He has no sense of goal, and can assume no r e s p o n s i b i l i t y . Hence, he needs constant supervision i n the employment s i t u a t i o n . He always works i n jobs which are below his actual capacity, and occasionally, he over-works to compensate for his feelings of anxiety and inadequacy. He i s not dependable, and finds i t d i f f i c u l t to complete the p a r t i c u l a r task. F r u s t r a t i o n or postponement of plans results i n regression to c h i l d i s h a t t i -tudes and i r r e s p o n s i b i l i t y . He tends to seek dependency, and to r e s i s t any attempt to encourage his independence. The c l a s s i f i c a t i o n of limited self-depreciation i n f e r s the display of uneven a b i l i t y on the part of the c l i e n t to r e l a t e to p a r t i c u l a r s i t u a t i o n s . In other words, the c l i e n t lacks i n i t i a t i v e , i s unable to plan a job and to concentrate on a task, and i s unsystematic and disorganized most of the time. Gn occasion, he does show some degree of purpose, although i t i s very l i m i t e d . Usually he needs supervision i n the work s i t u a -t i o n . He i s unduly pessimistic, and b e l i t t l e s his own capabil-i t i e s and p o t e n t i a l i t i e s . He i s e a s i l y s a t i s f i e d and has a tendency to d r i f t along. 3. S o c i a l Consciousness The attitudes and feelings of the i n d i v i d u a l that a f f e c t his relationships with other persons i n h i s environment are c l a s s i f i e d as being i n the area of s o c i a l consciousness. The emotionally mature person expresses a sense of give and take i n his inter-personal r e l a t i o n s h i p s . He i s able to make friends - 139 -e a s i l y and get along with people of d i f f e r e n t economic, r e l i g i o u s , r a c i a l , and c u l t u r a l backgrounds. He generally i s lacking i n prejudice and can accept i n d i v i d u a l differences i n his fellow men. He displays a considerable degree of sympathy, understanding, honesty, and i n t e g r i t y . He can be attentive and imaginative, and has a good sense of humour. He has the capac-i t y to see the point of view of .others, and can show deference and humility when necessary. He can give praise when i t i s deserved, and i n turn, he can accept advice and c r i t i c i s m when i t i s pertinent and merited. He may display moderate reactions of anger and hatred, but he can red i r e c t them into p o s i t i v e channels. He i s reasonably s e l f - a s s e r t i v e i n his relationships with others, but he i s also w i l l i n g to compromise when i t i s discerning to do so. The excessively self-centered Individual has an i n f l a t e d image of himself i n r e l a t i o n to a l l others i n his environment. His interest i n s o c i a l intercourse i s limited to s e l f - g a i n . He fe e l s superior to others because, to his mind, he i s perfect. He i s generally i n c l i n e d to be very aggressive, and craves to dominate others i n his environment. His relat i o n s h i p with others i s characterized by attitudes on his part of antagonism, r e s t r i c t i o n , and d e n i a l . He commands and orders his subordinates without regard f o r them as i n d i v i d u a l s . Such a person exhibits frequent outbursts of temper, anger, and hatred," without r e a l j u s t i f i c a t i o n . Generally, he i s completely d i s r e s p e c t f u l of the rights of others. He expresses marked disapproval of the - 140 -actions and desires of those with whom he comes i n contact. He i s very prejudiced and biased, and i s not cognizant of i n d i v i d u a l d i f f e r e n c e s . He i s a c t i v e l y c r i t i c a l of others without just cause, but he can not accept c r i t i c i s m or advice himself. He i s s k e p t i c a l , s a r c a s t i c , jealous, and envious. He i s ' excessively formal and r i t u a l i s t i c since the difference and separateness of himself from others i s his one source of security. He values everyone and everything i n terms of how he can make use of them. He i s unco-operative, and reveals no a b i l i t y to "give and take". A person exhibiting limited self-centeredness i s suc-c e s s f u l i n some inter-personal r e l a t i o n s h i p s , but i s i n c l i n e d to show immature behaviour i n most si t u a t i o n s . He i s aggres-sive i n some areas, and finds i t d i f f i c u l t to accept c r i t i c i s m and advice. He i s ambivalent to a degree, and shows some envy and jealousy of others. He i s i n d i f f e r e n t to others a great deal of the time and daydreams considerably. He i s also rather distant and s u l l e n on occasion. He t r i e s to control others by f l a t t e r y and pretense when he f e e l s he has to compete with those about him i n s o c i a l r e l a t i o n s h i p s . The person displaying excessive s e l f - d e p r e c i a t i o n places t o t a l emphasis on the p o s i t i v e a b i l i t i e s of others i n contrast to his own. His evaluation of himself i s e n t i r e l y dependent upon his acceptance by others. He feels that any f r u s t r a t i o n i s i n d i c a t i v e of personal d i s l i k e or discrimination on the part of others. He. severely represses his own f e e l i n g s , and i s excessively submissive or excessively amiable and w i l l i n g to - 141 -give i n . He has no opinions of his own, and dreads making demands of others or of asserting himself. He i s extremely f e a r f u l of h o s t i l i t y , c r i t i c i s m , or reproach on the part of others i n his environment, and i s continually disparaging of himself and his e f f o r t s i n order to compete with others soc-i a l l y . With reference to lim i t e d s e l f - d e p r e c i a t i o n , an i n d i v i d u a l i n t h i s area has the tendency to be dependent, and to relate to others on an i n f a n t i l e l e v e l . He represses his feelings i n some areas of his s o c i a l consciousness and tends to be reserved. He lacks the a b i l i t y to be s e l f - a s s e r t i v e or aggressive. He prefers to remain inconspicuous, i s modest, and i s prone to b e l i t t l e his a b i l i t i e s i n r e l a t i o n to those of others. He i s lacking i n imagination, and accepts c r i t i c i s m too readi l y , usually without question. He finds i t hard to move out towards others and hence, he has d i f f i c u l t y i n making and hoId ing f r i end s. 4. Self-Worth The area of self-worth i s that area which involves the individual's feelings and attitudes towards his own value and po s i t i o n i n r e l a t i o n to his environment and to society and his fellow men. The emotionally mature person has a good opinion of himself as i s shown by his di s p l a y of self-esteem, s e l f -respect, and by his self-confidence i n his own a b i l i t i e s and p o t e n t i a l i t i e s . He has the emotional capacity f o r looking at himself o b j e c t i v e l y i n r e l a t i o n to others and to his environment. - 142 -He adopts a "common sense" viewpoint, possesses a grown-up conscience, and shows s t a b i l i t y i n balancing inner c o n f l i c t s with outer pressures. He has good i n s i g h t , and can admit most of his inner feelings and c o n f l i c t s even though i t may be pa i n f u l f o r him to do so. He u t i l i z e s only those defense mechanisms which are not harmful to his emotional growth. He can accept c r i t i c i s m , and does not conclude that he i s t o t a l l y unworthy because of censure. He shows a capacity f o r s e l f -assertion and s e l f - c r i t i c i s m , and, on the whole, can recognize his own capacities and l i m i t a t i o n s . B a s i c a l l y , he i s able to accept the masculine r o l e . The excessively self-centred person i s primarily n a r c i s s i s t i c . He has an exaggerated opinion of his self-worth, and i s absorbed i n worshipping his personal perfections. He i s dogmatic and bigoted regarding his opinions. He i s always s e l f -s u f f i c i e n t , never makes mistakes, and cannot accept c r i t i c i s m . He i s resistant to change, and i s often n e g a t i v i s t i c and rebel-l i o u s towards any intimated correction of inadequacies or sug-gested improvements i n the s i t u a t i o n . He reveals many defense mechanisms which he uses frequently. He projects his mistakes, failures,'and shortcomings onto others. He has no sense of humour and no insight into his inner feelings and c o n f l i c t s . He i s excessively masculine to compensate f o r his feelings of inadequacy regarding the masculine r o l e . I t might be noted here, that i n the female c l i e n t , exaggerated femininity may manifest i t s e l f , but, that i n many such excessively s e l f -centered persons, e s p e c i a l l y where there i s a r e j e c t i o n of the - 142 -feminine r o l e , a marked tendency towards c h a r a c t e r i s t i c mascu-l i n e behaviour sometimes occurs. The i n d i v i d u a l who indicates limited self-centeredness i n t h i s area i s self-confident i n some si t u a t i o n s , and defends his self-esteem to some degree. He has unwarranted attitudes of superiority at times, but he i s generally aware of his own feelings i n those situations where there i s no threat or pain to himself personally. He /employs harmful defense mechanisms to a limited degree. The excessively self-depreciating i n d i v i d u a l lacks self-esteem to a marked degree and i s overly s e l f - c r i t i c a l . He i s very insecure i n most s i t u a t i o n s , and may t r y to over-compensate f o r r e a l or supposed inadequacies. He i s in c l i n e d to be depressed and to indulge i n excessive self-punishment. He has intense feelings of i n f e r i o r i t y , and displays severe anxiety states and extreme tension. He represses, d i s t o r t s , and displaces his r e a l f e e l i n g s , having no ins i g h t into what his r e a l feelings are. He dreads the p o s s i b i l i t y of his being inadequate, of his being humiliated, or of his being a f a i l u r e . He i s af r a i d of the unknown and of new si t u a t i o n s . He may be excessively feminine as he cannot accept the masculine r o l e . On the other hand, the female c l i e n t who i s excessively s e l f -depreciating does not take on the masculine r o l e , but rather, also tends to emphasize the feminine and to simulate an exagger-ated attitude of submissiveness. Limited self-depreciation i n self-worth i s recognized - 143 -i n the person who shows some inner c o n f l i c t s and i n s e c u r i t y when facing new or previously d i f f i c u l t s i t u a t i o n s . He has some feelings of i n f e r i o r i t y and inadequacy. He lacks the capacity to integrate c o n f l i c t i n g drives, those drives that by the mature person are sublimated and redirected into p o s i -t i v e channels. He feels that personal l i m i t a t i o n s block self-expression and self-assertion. He expresses l i t t l e sense of humour. He has mixed feelings regarding masculinity and femininity, with the feminine aspects occasionally out-weighing the masculine. Conclusion B r i e f l y , t h i s study suggests that the emotional maturity of the i n d i v i d u a l may be rated with some degree of o b j e c t i v i t y i f the s o c i a l worker on intake notes the c l i e n t ' s s p e c i f i c behaviour, attitudes, and responses i n the general areas of sexual adjustment, achievement, s o c i a l consciousness, and self-worth. The c l a s s i f i c a t i o n s of excessive s e l f -eenteredness, limited self-centeredness, emotional maturity, limited self-depreciation, and excessive self-depreciation are proposed i n order to give a clearer picture of the c l i e n t ' s general reactive patterns i n the above areas (Schedules A, B, C, and D). Such a subjective d e s c r i p t i o n of the c l i e n t would enable the intake worker to diagnose more accurately the c l i e n t ' s underlying personal and emotional problems. The - 144 intake worker and the casework supervisor are then better able to determine with some degree of pr e c i s i o n desirable and appropriate treatment goals i n r e l a t i o n to the professional s k i l l s of the s o c i a l workers employed by the agency. In the intake process, the worker may f a c i l i t a t e the casework tr e a t -ment to be planned f o r the c l i e n t by summarizing on a chart the information as i t i s e l i c i t e d from him (Schedule E ) . Such a concise description of the c l i e n t would be an aid to the s o c i a l worker to whom the c l i e n t i s assigned. As i s noted on the chart, however, a complete and comprehensive appraisal of the c l i e n t ' s emotional l e v e l should be evaluated i n d e t a i l i n the recording of the c l i e n t ' s f i l e . Thus, i t i s hoped that with a deeper understanding of the c l i e n t i n a l l his relationships with others and his environment, the s o c i a l worker i s enabled to carry out e f f e c t i v e l y a broader, more intensive treatment programme i n the r e h a b i l i t a t i o n f i e l d . - 145 -Schedule A. Sexual Adjustment Excessive Self-centeredness: The i n d i v i d u a l displays 1. a marked lack of capacity to give love and a f f e c t i o n . 2. a concern with s e l f - g r a t i f i c a t i o n only i n the sexual re l a t i o n s h i p . 3 . aggressiveness and the need to dominate i n the sexual act. 4. a marked i n c l i n a t i o n to boast of orgasms and sexual conquests. 5. promiscuous behaviour. 6. active homosexual tendencies wherein he i s the aggressor. 7« excessive masturbatory tendencies to the exclusion of hetero-sexual intercourse. Limited Self-centeredness: The in d i v i d u a l displays 1. p a r t i a l insight into the needs of the sexual partner. 2. a tendency towards s e l f - g r a t i f i c a t i o n . 3 . a desire f o r frequent r e p e t i t i o n of the sex act. 4. a tendency towards masturbation with some hetero-sexual intercourse. 5. the need f o r occasional " a f f a i r s " . Mature Behaviour: The i n d i v i d u a l displays 1. the a b i l i t y to give and take i n the hetero-sexual r e l a t i o n s h i p . j 2. the capacity to give and receive love and a f f e c t i o n . 3 . a normal sex urge and a desire for love and sexual s a t i s f a c t i o n . 4. a co-operative attitude leading to understanding, growth, i and the development of shared sexual experiences. ! 5. s a t i s f a c t i o n i n the sexual act with concern for s a t i s -f a c t i o n of sexual partner. 6. the a b i l i t y to accept his own sex r o l e . 7. a mature appreciation of the fact that men and women each have t h e i r own assets and l i m i t a t i o n s . • — Limited Self-depreciation: The i n d i v i d u a l displays 1. i n s e c u r i t y i n sexual r e l a t i o n s h i p s . 2. some feelings of g u i l t or anxiety due to repressed urges. 3* some inner tension l i m i t i n g free expression. 4. d i f f i c u l t y i n relaxing i n the love r e l a t i o n s h i p . Excessive Self-depreciation: The i n d i v i d u a l displays 1. a marked i n a b i l i t y to receive love and a f f e c t i o n . 2. an i n a b i l i t y to enter into a s a t i s f a c t o r y relationship leading to f r u s t r a t i o n of s e l f and sexual partner. 3 . severe inner tension and feelings of inadequacy. 4. impotency. 5. active homosexual tendencies wherein he i s the passive partner. - 146 -Schedule B. Achievement Excessive Self-centeredness: The i n d i v i d u a l displays 1. excessive g l o r i f i c a t i o n of s e l f and achievements. 2. complete b e l i e f i n own i n f a l l i b i l i t y . 3 . emphasis on own magic power of w i l l . 4. an obsession with achievement regardless of means. 5. destructive tendencies to defeat a l l others. 6. a pride i n own exploitative s k i l l . ?• admiration for strength and power and contempt for weakness. 8. i n a b i l i t y to admit personal errors or mistakes. Limited Self-centeredness: The i n d i v i d u a l displays 1. some sense of goal and achievement. 2. undue optimism. 3 . i r r e g u l a r drive for achievement. 4. a tendency to act impulsively. 5. some adaptability, but i s generally r i g i d . 6. the need fo r supervision of work. 7. a tendency to l e t s e l f - b e n e f i t weight thinking. Mature Behaviour: The i n d i v i d u a l displays 1. a good sense of goal with c l a r i t y and self-confidence. 2 . a desire for e f f i c i e n c y and avoidance of waste. 3. a regard for money as a means to an end. 4. the a b i l i t y to enjoy work as such. 5 . good judgement and a b i l i t y to evaluate r e a l i s t i c a l l y . 6. an appreciation of own a b i l i t y and s k i l l s . 7. reasonably strong impulses to improve performance. 8. a capacity to learn by experience. 9. a capacity for sustained e f f o r t . 10 . a sense of r e s p o n s i b i l i t y without close supervision. 11. some ambivalence with a b i l i t y to weigh r e a l i t y f a c t o r s . 12. a willingness to accept change. 13 . an a b i l i t y to accept f r u s t r a t i o n . 14. an a b i l i t y to admit personal errors or mistakes. Limited Self-depreciation: The i n d i v i d u a l displays 1. an uneven a b i l i t y depending on the personal meaning of the s i t u a t i o n . 2 . an uneven sense of goal and achievement. 3 . a tendency to save rather than spend. 4. undue pessimism. 5. a tendency to be e a s i l y s a t i s f i e d and d r i f t along. 6. a tendency to b e l i t t l e own capacities or p o t e n t i a l i t i e s . 7. c a p a b i l i t i e s and capacities but cannot use them. continued - 147 -Schedule B. Achievement continued Excessive Self-depreciation; The individual displays 1. no personal satisfaction in achievement. 2. no sense of goal or responsibility. 3 . a marked inability to learn by experience. 4. a tendency to work in jobs beneath his capacity. 5« inability to complete tasks without supervision. 6. inability to be dependable 7. inability to accept frustration or postponement of plans. 8. a tendency to regress to childish behaviour. 9. a tendency to fight against the development of independ-ence. r 148 -Schedule C. S o c i a l Consciousness Excessive Self-centeredness: The i n d i v i d u a l displays 1." an intere s t i n s e l f - g a i n only. 2. marked aggressive tendencies and domination of others. 3 . complete disrespect f o r others. 4. excessive formality to maintain security. 5 . a tendency to evaluate a l l things i n terms of prestige. 6. a marked lack of co-operation. Limited Self-centeredness: The in d i v i d u a l displays 1. some immaturity i n relationships with others. 2. marked ambivalence with envy and jealousy. 3 . aggression i n some areas. 4. d i f f i c u l t y i n accepting c r i t i c i s m and advice. 5. i n d i f f e r e n t s u l l e n behaviour. 6. a tendency to disrupt and interrupt others. 7. a tendency to control by f l a t t e r y and pretense. Mature Behaviour: The i n d i v i d u a l displays 1. inter-dependence i n re l a t i o n s h i p s . 2. g r a t i f i c a t i o n from inter-personal r e l a t i o n s h i p s . 3 . an a b i l i t y to make friends e a s i l y . 4. an a b i l i t y to accept i n d i v i d u a l differences without prejudice. 5. a considerable degree of sympathy and understanding. 6. honesty and i n t e g r i t y i n relati o n s h i p s . 7. a sense of humour. 8. attentiveness and imagination. 9 . a capacity to see the point of view of others. 10. a desire for absence of r e s t r a i n t imposed by others. 11. moderate r e a l i s t i c reactions of anger and fear. 12. reasonable s e l f - a s s e r t i o n . Limited Self-depreciation: The i n d i v i d u a l displays 1. some need for dependency. 2. some repression i n c e r t a i n r e l a t i o n s h i p s . 3 . a lack of s e l f - a s s e r t i o n . 4. a preference for remaining inconspicuous. 5. a tendency to b e l i t t l e own s o c i a l c a p a c i t i e s . 6. a lack of attention. 7. a lack of imagination. 8. a tendency to accept c r i t i c i s m too r e a d i l y . 9. frequent untoward u n r e a l i s t i c responses. 10. d i f f i c u l t y i n making and holding f r i e n d s . continued - 149 -Schedule C. S o c i a l Consciousness continued Excessive Self-depreciation; The i n d i v i d u a l displays 1. a marked tendency to devaluate s e l f . 2. marked feelings that f r u s t r a t i o n indicates d i s l i k e by others. 3 . marked repression when r e l a t i n g to others. 4. marked fear of asserting s e l f . 5 . marked fear of h o s t i l i t y and c r i t i c i s m from others. 6. a marked lack of inter-personal r e l a t i o n s h i p s . 7. a marked tendency to continually disparage s e l f . - 150 -Schedule D. Self-Worth Excessive Self-Centeredness: The i n d i v i d u a l displays 1. an exaggerated opinion of his own self-worth 2. a tendency to be dogmatic and bigoted i n his opinion. 3. an appearance of being very s e l f - r e l i a n t . 4. the use of many r i g i d defense mechanisms. 5 . no insight into own feelings and c o n f l i c t s . 6. marked use of projection for f a i l u r e s and mistakes. Limited Self-depreciation: The i n d i v i d u a l displays 1. some confidence i n s e l f . 2. a tendency to defend self-esteem. 3.. some feelings of s u p e r i o r i t y i n some areas. 4. some awareness of inner feelings i n areas that are not pa i n f u l . 5 . the use of some defense mechanisms. Mature Behaviour: The i n d i v i d u a l displays 1. a good but not i n f l a t e d opinion of s e l f . 2. the capacity to look at s e l f o b j e c t i v e l y . 3. good insight into inner feelings and c o n f l i c t s . 4. the use of unharmful defense mechanisms. 5 . an a b i l i t y to accept c r i t i c i s m without tension. 6. a capacity for s e l f - c r i t i c i s m . 7 . a capacity for s e l f - a s s e r t i o n . 8. an a b i l i t y to recognize own capacities. 9. an a b i l i t y to recognize own l i m i t a t i o n s . 10. an a b i l i t y to accept own masculinity or femininity. Limited Self-depreciation: The i n d i v i d u a l displays 1. some tendency to depreciate s e l f . 2... some anxiety over f r u s t r a t i o n s and i n s e c u r i t y when facing new s i t u a t i o n s . 3. some feelings of i n f e r i o r i t y and anxiety. 4. a lack of capacity to integrate c o n f l i c t i n g d rives. 5. some blocking over s e l f - a s s e r t i o n and expression. Excessive Self-depreciation: The i n d i v i d u a l displays 1. a marked lack of self-esteem and i s very s e l f - c r i t i c a l . 2. marked i n s e c u r i t y i n most s i t u a t i o n s . 3. intense feelings of i n f e r i o r i t y . 4. severe anxiety states and marked tension. 5 . a tendency to displace and repress r e a l f e e l i n g s . 6. marked r e j e c t i o n of masculinity or femininity. 7 . a marked fear of inadequacy, f a i l u r e , the unknown or new s i t u a t i o n s . - 151 -Schedule E. Evaluation Chart of Emotional Level Sexual ad-justment Achieve-ment So c i a l Con-sciousness S e l f -Worth Excessive S e l f -Centeredness Limited S e l f -Centeredness Mature Behaviour Limited S e l f Depreciation Excessive S e l f -Depreciation 1. Note: It i s suggested that t h i s type of chart be used by the s o c i a l worker to summarize the c l i e n t ' s emotional responses as they are e l i c i t e d . Annotated descriptions of behaviour s i m i l a r to those outlined i n Schedules A, B, C, and D could be b r i e f l y consolidated on t h i s sheet. A complete and comprehensive appraisal of the c l i e n t ' s emotional l e v e l would be evaluated i n d e t a i l i n the recording. - 152 -APPENDIX B B I B L I O G R A P H Y Books Adler, Alfred, Social Interest: A Challenge to Mankind, Faber and Faber, London, 1938, cited in Mullahy, Patrick, Oedipus Mythe and Complex, Hermitage Press, New York, Elledge, Caroline H., The Rehabilitation of the Patient, J. B. Lippincott, Philadelphia, 1948. Family Welfare Association of America, Case Work in Public' Relief 1935-1939, Family Welfare Association of America, New York, 1939. Great Britain, Report of the Interdepartmental Committee oh the Rehabilitation and Resettlement of Disabled Persons, H. M. Stationery Office, London, 1943, Cmd. 6415^ Great Britain, Report of the Standing Committee on the Rehab-ilitation and Resettlement of Disabled Persons, H. M. Stationery Office, London, 1946. Hamilton, Kenneth W., Counselling the Handicapped in the Rehabilitation Process, Ronald Press, New York, 1950. Homey, Karen, Self-Analysis, W. W. Norton, New York, 1942". Hunt, J. MeV., Blenkner, Margaret, and Kogan, Leonard S., Testing Results in Social Casework: A Field Test of the Movement Scale, Family Service Association of America, New York, 1950. Hunt, J. MeV. and Kohan, Leonard S., Measuring Results in Social Casework: A Manual on Judging Movement. Family Service Association of America, New York, revised edition, 1952. Josselyn, Irene M., Psychosocial Development of Children, Family Service Association of America, New York, 1948 - 153 -Marsh, Leonard C , Employment Research, Oxford University Press, Toronto, 1935. ' ., Health and Unemployment, Oxford University Press, Toronto, 1938. Montreal R e h a b i l i t a t i o n Survey Committee, Report on Re-establishment of Disabled Persons, Montreal R e h a b i l i t a t i o n Survey Committee, Montreal, 194-8. Morton, N. W., Individual Diagnosis, A Manual for the Employment O f f i c e , McGill University, Montreal, 1937* Mosher, William E., Kingsley, J . Donald, and Stahl, O.Glenn, "Human Relations and Morale", Public Personnel Administra-t i o n , Harper and Brothers, New York, 1950, p. 285. Rivier e , Maya, Reh a b i l i t a t i o n of the Handicapped, National Council on Reha b i l i t a t i o n , New York, 194-9, v o l . 1 and v o l . 2. (Annotated Bibliography of Literature Published from 1942-194-6). Saskatchewan, Annual Report of the Department of S o c i a l Welfare and Rehabilitation, 1951-52, Queen's P r i n t e r , Regina, Saskatchewan, 1952. White, Clyde R., Administration of Public Welfare, American Book Company, New York, second edition, 1950. A r t i c l e s Bishop, M. K., "Employables on Public Assistance R o l l s " , The Family, A p r i l , 1945, Family Welfare Association of America, New York, p. 67. Bond, J . H., "Rehabilitation - American Style", Journal of Rehabilitation , 1950, v o l . 16, no. 3, PP. 17-19. Burnite, Alvena L., "A Program f o r the Handicapped", Public Welfare, December, 194-7, v o l . 5, PP. 274-276. Capwell, Dora F., "Vocational Counseling as a Community Service", Public Welfare, 1948, v o l . 6, p. 198. - 154 -Carscadden, L i l l i a n , An Evaluation of the Client-Worker Relationship, 1950, unpublished Master's of Social Work thesis, University of British Columbia. Cockerill, Eleanor, E., "Rehabilitation and Community Case-work Services", The Family, July, 1944. Dreifuss, Kurt, "A Public Assistance Agency Tries Vocational Rehabilitation", Public Welfare, 1949, vol. 7, p. 179-Fitzsimmons, Margaret, "Treatment of Problems of Dependency Related to Permanent Physical Handicap", The Family, January, 1943, p. 329. Furscott, Hazel E., "The Rehabilitation Centre of San Fran-cisco Inc. - A Community Project", Journal of Rehabilita-tion, 1950, vol. 16, no. 2 , pp. 8-12. Hamilton, Kenneth W., "A Sound Rehabilitation Program", Proceedings of Canadian Conference':: in Social Work, 1950. Hilliard, Raymond M., "Attacking Dependency at its Source", Public Welfare, 1948, vol. 6, p. 26 Lepson, Leon, "Rehabilitating Public Assistance Recipients", Public Welfare, April, 1953, vol. 11 , no. 2 , p. 4 7 . Levine, Maurice, "Normality and Maturity", The Family, March, 1940, vol. XXI, no. 1, p. 18. McGrath, Edward F., "Handicapped", Public Welfare, 1948, vol. 6 , p. 202. Maeder, LeRoy, "Diagnostic Criteria - The Concept of Normal and Abnormal", The Family, October, 1941, p. 171. Mannering, John W., "Wisconsin's Aid for Physically Disabled", Public Welfare, 1948, vol. 6 , p. 128. Masur, J. "Physical Restoration in the Vocational Rehabilita-tion Program", Public Welfare, August, 1944, vol. 2, pp. 200-203. Mugford, T. H., "California's Disability Insurance Program", Public Welfare, 1948, vol. 6 , p. 178. Nitzberg, Harold, "Rehabilitation of the Tuberculous - A Case-work Process", Social Casework, February, 1950, vol. XXXI, no. 2 . - 155 -Odgers, John G., "Rehabilitation Services for the Handicapped; A Community Responsibility", Journal of R e h a b i l i t a t i o n , 1948, v o l . 14, no. 6 , pp. 17-19. Orchard, Bernice, ^The Casework Aspects of R e h a b i l i t a t i o n " , Proceedings of the I n s t i t u t e f o r County Welfare Directors and S o c i a l Case Workers, October, 1950, University of Wisconsin, Madison, Wisconsin. Painter, W. L., "Constructive Aspects of Public Assistance for the Disabled", Public Welfare, December, 1951? v o l . 9 , PP. 233-235. Pearson, 0 . A., "Vocational Guidance and Counselling i n a C i t y Welfare Department", Public Welfare, December, 1944, v o l . 2, pp. 294-296. Perlman, Helen Ha r r i s , "Casework Services i n Public Welfare", Proceedings of the National Conference on S o c i a l Work, 1947, Columbia University Press, New York, p. 261. ~ Preston, Malcolm G., Mudd, Emily H., and Froscher, Hazel B., "Factors A f f e c t i n g Movement i n Casework". S o c i a l Casework, March, 1953, v o l . XXXIV, no. 3 , Family Service Association of America, New York, pp. 103-111. Scheffer, Ruth, "Casework and Vocational Counselling", Jewish Soc i a l Service Quarterly, 1947, v o l . 23 , pp. 314-315. Shimberg, Myra E., "The Employment Program of the New York C i t y •Department of Welfare", Public Welfare, October, 1951, v o l . 9 , P. 188. Shortley, Michael J., "The Vocational R e h a b i l i t a t i o n Program", Public Welfare, 1948, v o l . 6 , p. 3 8 . Smith, Marjorie J . , " S o c i a l Casework i n Public Assistance", Proceedings of National Conference of S o c i a l Work, 1944, Columbia University Press, New York, p. 319. ., "The Places of Services i n a Public A s s i s t -ance Program", Public Welfare, August, 1951, p. 161. - 15<? -Statutes Revised Statutes of British Columbia, 194-8, Chapter 3 1 0 ~ (The Social Assistance Act). " United States Public Law 113, 1943, 78th congress, Washington, D.C., (The Vocational Rehabilitation Act). o
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Social Work
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The rehabilitation of public assistance recipients : an analysis of rehabilitation possibilities among current social assistance recipients, based on the caseload of the Social Welfare Department, Victoria, June 1952
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