@prefix vivo: . @prefix edm: . @prefix ns0: . @prefix dcterms: . @prefix skos: . vivo:departmentOrSchool "Education, Faculty of"@en ; edm:dataProvider "DSpace"@en ; ns0:degreeCampus "UBCV"@en ; dcterms:creator "Bell, Kenneth Edward"@en ; dcterms:issued "2012-03-01T17:13:27Z"@en, "1951"@en ; vivo:relatedDegree "Master of Social Work - MSW"@en ; ns0:degreeGrantor "University of British Columbia"@en ; dcterms:description """The present study is an attempt, on a sample basis, to measure the ability of teachers to recognize and refer for help emotionally disturbed children in their classrooms; the incidence of children recognized as needing help; and the help at present being given children to overcome their maladjustment. The survey was limited to the first four grades because the sooner a child's disturbance is detected, the easier it is to help him overcome it. A basic questionnaire was used for securing information about emotionally disturbed children from teachers in the primary schools in the sample area (Burnaby). Forty-six teachers out of a possible eighty-four reported ninety out of approximately three-thousand children as emotionally disturbed—about three per cent of all the children in grades one to four. An average of two children per teacher were reported. There were seven boys for every two girls. The largest number of children were classified as withdrawn, with only half as many classified as aggressive. Less than one-fifth of the teachers made comments indicating that they were making special efforts to help the children overcome disturbance. As a follow-up, a more detailed study was made of the emotionally disturbed children reported from three schools. Additional information was secured from school progress and health records; from the school social worker, mental health counsellor, and school nurses; and from social agency records. Of the thirty-two children reported from three schools, seven children were in urgent need of casework help, nine of them needed more casework help than they were getting, and the needs for help of the remaining sixteen children were unknown, although they had definite emotional disturbance. Virtually the only casework help given was supplied, in other connections, by social workers from the Social Welfare Branch, the Children's Aid Society of Vancouver, and the Family Welfare Bureau. The teachers had secured special help for less than half of the children that they reported as emotionally disturbed. The school nurses had made some investigation into the problems of fourteen children, four of whom were also under the supervision of the mental health counsellor. None of the children had been called to the attention of the school social worker. Emotionally disturbed children in the three schools surveyed need much more help than they are presently getting. It is probable, that of the ninety children from twelve schools, more than half are in need of intensive casework help. A caseload of forty-five seriously disturbed children, plus forty-five children who need some help, would keep at least one trained caseworker busy all the time. When it is taken into consideration that only the first four grades were covered in the sample survey, and that of the eighty-four teachers in those grades, thirty-eight did not participate, the implication is that in the sample area, there are at least a hundred children needing intensive casework services, and an equal or greater number needing at least some investigation into their problems by the school social worker. Before help can be given disturbed children by the school social worker, the teachers must refer the children as needing help. And then, there must be active co-operation between social worker and teacher, the teacher giving help in the classroom, the social worker in the home. The mental health counsellor is not trained to do casework, but he performs a valuable function in helping teachers to recognize the gravity of various symptoms of emotional disturbance. Unfortunately, the school social worker and mental health counsellor work in different schools. If they were to work in the same schools they would complement one another's efforts and form a valuable team. School nurses are doing an effective job with physical health problems, but they do not appear to be giving emotionally disturbed children needed help, although in most instances they are the only ones asked to give such help. It seems likely that improved attention for children with serious emotional disturbance will come only if social workers are made available, and their services used by the school teachers for children needing help."""@en ; edm:aggregatedCHO "https://circle.library.ubc.ca/rest/handle/2429/41037?expand=metadata"@en ; skos:note "THE RECOGNITION AND TREATMENT OF EMOTIONALLY DISTURBED CHILDREN I N GRADES ONE TO FOUR OF A P U B L I C SCHOOL SYSTEM A Sample S u r v e y o f t h e C h i l d r e n f r o m T w e l v e B u r n a b y S c h o o l s R e p o r t e d b y T h e i r T e a c h e r s as M a l a d j u s t e d , w i t h F u r t h e r S t u d y o f t h e C h i l d r e n f r o m T h r e e S c h o o l s and t h e H e l p P r e s e n t l y G i v e n S u c h C h i l d r e n t o Overcome T h e i r E m o t i o n a l D i s t u r b a n c e b y KENNETH EDWARD B E L L T h e s i s S u b m i t t e d i n P a r t i a l F u l f i l m e n t o f t h e R e q u i r e m e n t s f o r t h e . D e g r e e o f MASTER OF SOCIAL WORK, i n t h e S c h o o l o f S o c i a l Work 1951 The U n i v e r s i t y o f B r i t i s h C o l u m b i a ABSTRACT The present study i s an attempt, on a sample basis, to measure the a b i l i t y of teachers to recognize and refer for help emotionally disturbed children in their classrooms; the incidence of children recognized as needing help; and the help at present being given children to overcome their maladjustment. The survey was limited to the f i r s t four grades because the sooner a child's dis-turbance i s detected, the easier i t is to help him overcome -it. A basic questionnaire was used for securing information -about emotionally disturbed children from teachers i n the primary schools i n the sample area (Burnaby). Forty-six teachers out of a possible eighty-four reported ninety out of approximately three-thousand children as emotionally disturbed—about three per cent of a l l the children i n grades one to four. An average of two children per teacher were reported. There were seven boys for every two g i r l s . The largest number of children were classified as withdrawn, with only half as many classified as aggressive. Less than one-fifth of the teachers made comments indicating that they were making special efforts to help the children : overcome disturbance. As a follow-up, a more detailed study was made of the emotionally disturbed children reported from three schools. Additional information was secured from school progress and health records; from the school social worker, mental health counsellor, and school nurses; and from social agency records. Of the thirty-two children reported from three schools, seven children were in urgent need of casework help, nine of them needed more casework help than they were getting, and the needs for help of the remaining sixteen children were unknown, although they had definite emotional disturbance. Virtually the only casework help given was supplied, in other connections, by social workers from the Social Welfare Branch, the Children's Aid Society of Vancouver, and the Family Welfare Bureau. The teachers had secured special help for less than half of the children that they reported as emotionally disturbed. The school nurses had made some investiga-tion into the problems of fourteen children, four of whom were also under the supervision of the mental health counsellor. None of the children had been called to ;the attention of the school social worker. Emotionally disturbed children in the three schools surveyed need much more help than they are presently getting. It i s probable, that of the ninety children from twelve schools, more than half are i n need of intensive casework help. A caseload of forty-five seriously disturbed children, plus forty-five children who need some help, would keep at least one trained caseworker busy a l l the time._. When i t is taken into consideration that only the f i r s t four grades were covered in the sample survey, and that of the eighty-four teachers in those grades, thirty-eight did not participate, the implication is that i n the sample area, there are at least a hundred children needing intensive casework services, and an equal or greater number needing at least some investigation into their problems by the school social worker. Before help can be given disturbed children by the school social worker, the teachers must refer the children as needing help. And then, there must be active co-operation between social worker and teacher, the teacher giving help in the classroom, the social worker in the home. The mental health counsellor i s not trained to do casework, but he performs a valuable function in helping teachers to recognize the gravity of various symptoms of emotional disturbance. Unfortunately, the school social worker and mental health counsellor work in different schools. If they were to work i n the same schools they would comple-ment one another's efforts and form a valuable team. School nurses are doing an effective job with physical health problems, but they do not appear to be giving emotionally disturbed children needed help, although in most instances they are the only ones asked to give such help. I t seems li k e l y that improved attention for children with serious emotional disturbance w i l l come only i f social workers are made available, and their services used by the school teachers for children needing help. ACKNOWLEDGEMENTS Grateful acknowledgement is made to Dr. Leonard C. Marsh, director of research, for his constant inspiration, penetrating analysis, and contagious enthusiasm; to Mrs. Ruth Ford for her critical review of the thesis, and to the many persons at the School of Social Work who ga\\e assistance at various times. Special, thanks are owing to Burnaby School Inspector C. Brown for expediting the study, and for numerous helpful comments; to the school principals, teachers, and nurses, who so generously supplied information and to Mr. McPherson, school social worker, and Mr. Findlay, mental health counsellor in the schools, who gave every possible assistance. Principal T. J. Sanderson of Kingsway West School displayed exceptional interest in helping emotionally disturbed children with their problems. Miss Amy Leigh, Assistant Director of Welfare, made available the resources of the Social Welfare Branch in securing information from case records about disturbed children, and prompt assistance was given by Miss Helen Sutherland of T. B. Social Service and Mr. E. Coughlin of the Burnaby Social Welfare office. Miss Dorthy Coombe of the Children's Aid Society of Vancouver and Miss Mary McPhedran of the Family Welfare Bureau made available al l needed information from their agency records. Dr. C. H. Gundry of the Metropolitan Health Committee of Greater Vancouver, Mental Hygiene Division, made comments of great value in focusing the study, and Mr. H. Itzkow, social worker attached to the Mental Hygiene Division Clinic, gave hours of his valuable time in similarly helpful,discussion. TABLE OF CONTENTS Chapter 1. Formulating the Survey Selection of grades and schools. Definition of emotionally disturbed children. The information sheet. Classification of symptoms of emotional disturbance. Chapter 2. The Children Reported From Twelve Schools Distribution by school and grade. Comparison of continuous and short-term symptoms. Classification of boys and g i r l s by symptoms. Classifica-tion of children by grade. Children with physical handicaps or serious i l l n e s s ; children from broken homes; over-age and under-age children; children from s p l i t shifts. Chapter 3. The Comments of Teachers on Emotionally Disturbed Children No explanation of disturbance; general or vague comment oh disturbance; specific descriptive comment; comments indicating special attempts to help the child. Chapter 4. Children Urgently Needing Casework Help; Three Schools Children receiving only token assistance. Children receiving no assistance. Help given by the school social worker, mental health counsellor and school nurses.. Use of the Social Service Index. Chapter 5. Children Needing Some Casework Help: Three Schools Children receiving considerable assistance. Children receiving minimum assistance. Help given by the school social worker, mental health counsellor and school nurses. The need for assistance from the school social worker. Chapter 6. Children with Unknown Needs for Help: Three Schools Children with some investigation- of circumstances. Children with no special attention given. Need for investigation by-the school social worker. The role of the mental health counsellor in orienting teachers towards the needs of emotionally disturbed children for help. Chapter 7. Some Proposals for Helping Emotionally Disturbed'Children The role of the teacher. The roles of the : school social worker, the mental health counsellor, and the school nurses. Use of the Social Service Index. The need for records. The school administrators point of view. TABLE OF CONTENTS (cont.) Appendices; A« Questionnaire; B. Statistical Tables. C. Bibliography. TABLES AND CHARTS IN THE TEXT (a) Tables Page Table 1. Classification of check-list symptoms. 13 Table 2. Comparison of continuous and short-term symptoms of emotional disturbance . . . . . . . . . 21 Table 3. Classification of children and teachers by teacher's comment 34 (b) Charts Fig. 1. Distribution of teachers, pupils and maladjusted pupils, grades one to four 16 Fig. 2. Distribution by grade, children in twelve schools . . . . 18 Fig. 3. Classification of maladjusted boys and girls in twelve schools, grades one to four 22 Fig. 4. Classification of maladjusted children by grade, continuous symptoms only 25 THE RECOGNITION AND TREATMENT OF EMOTIONALLY DISTURBED CHILDREN I N GRADES ONE TO FOUR OF A PUBLIC SCHOOL SYSTEM Chapter One FORMULATING THE SURVEY Strong professional interest in children is shared by educators, social workers, psychiatrists, and the members of allied disciplines. The work of these few people is the concern of everybody, for only i f prepared to do so will children be able to assume the duties and enjoy the privileges of adult l i f e in an adequate manner. Most children do not need exceptional help; in order to achieve emotional maturity. Some children, because of defective physical or mental endowment, need assistance in various ways. S t i l l other children, through harmful family relationships or poor material circumstances, have developed warped attitudes, and their capacity to live effectively is stifled or misdirected. Every possible provision must be made for these children who need exceptional help in growing up. Only by such provision will the later development of much unhappiness, poverty, disease, and crime, with their heavy cost to the individual and to the taxpayer, be kept at 2 a minimum. This survey of emotionally disturbed school children is made in the belief that present knowledge of treatment and preventive measures, i f used, is sufficient to enable every- reasonably endowed infant to grow up into a mature, contributing, and well adjusted member of his group. The survey is conducted in the schools because i t is there that the f i r s t real opportunity to study the general adjustment of children presents itself. It is already widely known that many children reflect maladjustment at school, and that in almost every instance the difficulties begin in the home. •\" There is general agreement amongeducational authorities that the child who does not learn, or who makes an inadequate social adjustment, is the proper concern of school teachers and principals, and school administra-tors. Agreement is less universal, however, as to what help is to be given such children. It is becoming recognized by educators that teachers cannot assume, f u l l responsibility for helping children who are problems to others or. to themselves. When the origin of a child's emotional disturbance lies i n the home, i t is illogical to expect the teacher to help that child overcome maladjustment during school hours, at least to any appreciable extent. On the other hand, the opinion is s t i l l considerably entertained that problem children and children with problems need only watchful supervision and firm discipline — such as can be given by the classroom teacher. This method, of supervision and discipline very often succeeds in keeping the child under control at school. It does not help the child with his basic emotional disturbance, and he may leave school at the earliest opportunityj a confirmed rebel against authority. 3 An interesting comparison has been drawn between school physical health programsand the* developing school mental health programs. There was a time when citizens—yes, schoolmen\" themselves— objected to placing this (physical health) burden on the schools whose job was to teach, not nurse, but the results have been so astounding that the wrath of a nation would descend on the heads of any board of education that dared even suggest the elimination of these services. Now another 'burden' is being placed upon the broad shoulders of our schools, a burden that gives promise of-paying: even greater dividends than did the assumption of a degree of responsibility for the physical health' of the child. Our teachers and administrators' are now expected to recognize early symptoms of mental illness (neuroses and psychoses) and social illness (delinquency and other behavior disorders). They are then expected to do some-thing about the treatment of these illnesses while they are s t i l l in their early stages and further, to set up programs of prevention. 1 The ways in which children may be helped have already been discovered, and in many places put into practice; Refinements and additions to present knowledge will undoubtedly follow in the years to come, but the major problem today is to extend the use of proven preventive and treat-ment methods. Before school efforts to help emotionally disturbed children can be co-ordinated within the school system, or combined with the efforts of other persons in the community, there must be research to discover needs, and the resources available to meet them. Such research is vital in the i n i t i a l stages of any program, but must be continued i f the most effective use of resources is to be made as the years go by. The present survey of emotionally disturbed children who are reported by school teachers, is an experimental attempt to assess the problems of such 1 Volz, H. S., ''Role of the School in the Prevention and Treatment of Delinquent and Other Abnormal Behavior\", School and Society, January, 1950, pp. 21-22. 4 children, and the use of :current treatment resources. There is no thought of fixing blame on school teachers and adminis-trators for behavior difficulties displayed by children at school. Certainly, in a few instances, a- teacher may in a more or less superficial sense be responsible for a child's unsettled behavior, but such instances are unquestionably the exception rather than the rule. No attempt is made to evaluate the general teaching process, or the subject matter taught. Attention is focused on the problems which children exhibit at school, on home circumstances, and on the help which various people are attempting, or should be attempting to give to children. Selection of Grades and Schools for Survey The survey was limited to children in the fi r s t four grades of school for three reasons. In the fi r s t place, i t is in the early grades when problems are f i r s t seen and before they become compounded that emotionally disturbed children can be most effectively helped. In the second place, children in grades one to four are for the most part in the latent phase of psychosocial development. Their ways of getting along with other people can be observed much as they will be in later adult l i f e , undistorted by sexual impulses which have such a large influence on the behavior of 2 children in higher grades. Finally, the survey had to be limited some-where, and four grades .provide a reasonably large sample. It was suggested at one point in the formulation of the survey that children from sectarian schools should be studied as well as children 2 English, 0. S., M.D., and Pearson, G. H. J., M.D., Emotional Problems of living, W. W. Norton & Company Inc., New York, 1945. The latent period is discussed pp. 132-144. 5 from public schools. It would certainly be of interest to know what proportion of children from private schools are reported by their teachers as emotionally disturbed. However, in the area selected for study, children in private or denominational schools are relatively few in number compared with those in non-demoninational or general public schools. Moreover, while teachers from private schools might report a lower or a higher proportion of emotionally disturbed children than teachers from public schools, there is absolutely no reason to suppose that they would report new forms of emotional disturbance. Private schools were accord-ingly excluded from the survey. A local system containing nineteen schools with classes in grades one to four was chosen for study. Four very small schools having one teacher each and a total of only one hundred and thirty-seven children in grades one to four\", were eliminated from the survey, leaving fifteen schools in which one hundred and seven teachers conduct classes with approximately thirty-seven hundred children. , It was very desirable to enlist the participation of the teachers in survey of emotionally disturbed children in their classes. There was no practicable alternative method of securing information, but more important, any actual program for helping children depends on the ability and willingness of the teachers to refer children needing help. It may be that the survey only inaccurately measures the actual number of emotionally disturbed children. However, i f i t does measure the number of children which the teachers recognize as maladjusted, and needing help, valuable information will have been gained. 6 Definition of Emotionally Disturbed Children After deciding upon the grades and schools in which to survey children, and after discussing the survey with the school authorities and receiving assurance of support and participation, i t was necessary next to define \"maladjustment\" as accurately as possible and devise methods and tools for the collection of information. It was from the f i r s t realized that neither exact degree of: emotional disturbance nor exact type could be ascertained from a simple survey. However, i t was believed that general trends of maladjustment could be discovered. Another major premise, and one which at f i r s t seemed to limit possible usefulness of survey findings, is that no general significance can be attached to any particular form of emotional disturbance. Thus, for example, although any number of children might be left out of play groups, there would probably be a different reason with each child. Similarly with a l l other behavior. This principle of limited symptom significance is of great importance when i t comes to treatment, for i t means that every child must be approached as an individual. General treatment program cannot be formulated on the basis of symptoms of 3 emotional disturbance. However i t is very valuable to be able to recognize symptoms, for until emotional disturbance is seen, nothing can be done to help the child overcome i t . Statistically defined, abnormal behavior \"...deviates to a marked degree from the average or general trend...\" 4 By this definition, for example, chewing fingernails is abnormal behavior, since most people do 3 This principle was ably expounded by Dr. Elda Lindenfeld in her 1951 class on the behavior problems of children, School of Social Work, University of British Columbia. 4 Tiegs, E. W., and Katz, B., Mental Hygiene in Education, The Ronald Press Company, New York, 1945, p. 68. 7 not chew their fingernails. Similarly, excessive timidity, truancy, and so on, are abnormal. Statistical measurement does not take into account emotional disturbance. It merely measures deviation from norm, and abnormal or deviating behavior is not always indicative of emotional disturbance, although i t often may be. An excellent criterion, although a general one, has been given us for evaluating adjustment to l i f e : ...mental health is a matter of living effectively with ourselves and others; and of constantly becoming more and more effective in these personal, human relationships, g An emotionally disturbed person, then, Is one not living effectively with himself or with others, and this is the definition used for the-purposes of this survey. Effectiveness, of course, is always relative. A l l the circumstances of each person must be examined before i t is possible to decide whether lack of effectiveness is caused by some handi-cap, or whether i t is caused by emotional inability to get along with other, people. A handicapped person, for example, might not be a very effective person in many ways, but he might be excellently adjusted to his handicap. The Information Sheet A check-list of symptoms of emotional disturbances, and questions on home circumstances, were devised in questionnaire form, and an adequate number of forms was supplied to each teacher, along with a covering letter. Teachers were asked to complete and return an information sheet for each child revealing definite symptoms of emotional maladjustment. ^ Teachers 5 Line, Dr. W., O.B.E., \"Mental Health and John Doe\", Proceedings, Canadian Conference on Social Work, 1950,p. 55. 6 See Appendix A for a sample of the information sheet. 8 were asked to describe symptoms as either continuous or short-term. Continuous symptoms were defined as those which \".. .may be evident from the fi r s t week at school, or begin at any time, and'persist: for example, habitual bullying, or temper tantrums.\" Short-term symptoms were defined as those \"...which appear at any time during the term, last for perhaps two to ten days, and then apparently disappear: for example, crying off and on or stuttering for two or three days in mid-term.\" Teachers were asked to distinguish between continuous and short-term symptoms as an elementary safeguard. It was recognized that in spite of instructions and definitions, there would be many symptoms which the teachers could not readily describe as definitely continuous, or definitely short-term; It must be clearly understood that the difference between a continuous and a short-term symptom is a relative rather than an absolute one. Yet, i t is permissable to make the distinction because i t is entirely probable that children who display symptoms of emotional dis-turbance at a l l times are more disturbed than children who display the same symptoms infrequently. Much thought was given to the check-list of symptoms. Any itemized description of human behavior has certain disadvantages. A check-list might permit a teacher to f a i l to notice unlisted important things that are right under his nose, because of the human tendency to see only what is being looked for. It is hoped that this disadvantage was largely over-come by making the l i s t of symptoms as complete as possible, and by leaving prominent space for the'teacher to write in comments. The other major disadvantage of a check-list' is that i t may encourage a tendency to look at a child as a problem, without seeing causes o f emotional disturb-ance i or good qualities. The information sheet partially overcomes this 9 defect by requesting additional information about the child—information intended to throw some light on the causes of maladjustment. Actual items on the check-list are discussed with the material on classification which comes after the discussion on \"additional information\", which follows. It was essential to know the child's age, sex, and grade in school, for purposes of analysis. The child's name and the name of the school were unimportant in the preliminary surveys but were vital for more detailed study of maladjustment. The school authorities deemed i t wise not to supply name of pupil, but to give initials, or some other identify-ing symbol. An agreement was made that information sheets would later be turned over to school social worker and mental health counsellor^ for use in helping the particular children reported on the Information sheets. Information was requested as to the number of boys and number of girls in the class, and whether there was a f u l l school day or a split shift. It was also asked whether the teacher f i l l i n g out the information sheet was a classroom teacher, a home room teacher, or a teacher in a depart-mental system, as there would be different opportunities, at least theoreti-cally, of knowing the children. Teachers were asked to name any serious physical handicap or deformity possessed by the child, and any known serious illness in the past which may have influenced behavior. It was asked whether the child were in his own home, living with relatives, or in a foster home. If he were in his own home, i t was asked if he had both or only one parent, and in the latter instance, which parent. 7 Further informati&n about these persons may be found in chapter four. 10 There was a question on living quarters, a question as to whether the home was over-indulgent, and another question concerning inadequacy or neglect. The words \"inadequacy or neglect\" and \"over-indulgent\" would of course be interpreted differently by each teacher, and the answers would have no scientific value. Nevertheless, they would provide clues as to whether the teacher thought there was something wrong with the way the child was treated at home. There was a question as to whether the teacher had met the parents or foster parents. The last question in the additional information section invited the opinion of the teacher as to the reason for the child's behavior. Olassification of Symptoms of Emotional Disturbance Twenty-one symptoms of emotional disturbance were selected for use on the check-list. It will be repeated that the cause of a child's emotional disturbance cannot be determined by observation of symptoms. Classifica-tion of symptoms therefore gives no insight into the origin of a child's difficulties, or, except in a very general way, the help that the child needs to overcome his emotional disturbance. Every child is different from every other child, and must be given individual casework\" or psychiat-ric help before disturbance can be diagnosed and casework or psychiatric treatment suggested and carried out. Symptoms are classified as a matter of interest, in order to secure some idea of the proportion of children that appear to have habit disorders, the proportion of apparently aggressive, and the proportion of apparently withdrawn children, and the proportion of children with general, mixed, or slight symptoms of emotional disturbance. Children are classified 10. according to the group in which the majority of their symptoms may be enumerated. Where there is not a clear majority of symptoms' in one classification, the child is described as having mixed symptoms of emotional disturbance. Where the symptoms do not clearly indicate aggressive or withdrawn behavior, or habit disorders, they are regarded as being merely general symptoms of disturbance. Symptoms i n the general disturbance group are regarded as reinforcing symptoms in other groups, except when the majority of symptoms are those of a general disturbance, in which instance the child is described as displaying general symptoms of emotional disturbance. Where only one or two symptoms of disturbance are reported by the teacher, and these symptoms f a l l in a group other than the general disturb-ance group, the background information and teacher*s comments are scrutinized to see whether supporting evidence can be found indicating that the child can be classified according to his symptoms. Where no supporting evidence is found, the child is classified in a slight disturbance group. Children with general, mixed, or slight symptoms of emotional disturbance are placed in a composite classification. Aggressive children, and aggressive children with habit disorders are classified together, as are withdrawn children and withdrawn children with habit disorders. Continuous and short-term symptoms of maladjustment are classified by the one method, since the only difference between them is duration of symptom manifestation. There may be difference of opinion as to which group a particular child should be classified in, especially children with symptoms of. withdrawal. A very poor sport, for example, might be classified under the aggressive group under some circumstances. On the whole, however, a 8 See the scheme of classification in Table 1. 12 poor sport withdraws from participation in play or work with others. If he also attempted to coerce others into his own planning, he would be acting in an aggressive manner. Protection against haphazard classifica-tion is provided by the variety of symptoms presented by most children. Gn the basis, of a l l symptoms presented, a reasonably valid distinction can be made between aggressive children, withdrawn children, children with habit disorders, and children with symptoms of general, mixed, or slight emotional disturbance. Emotionally disturbed children, no matter how their symptoms may be classified, need assistance to overcome their maladjustment. A l l emotionally disturbed children are in need of social casework services. Briefly, social workers do casework with the parents of emotionally dis-turbed children, with the children themselves, and also work closely with school teachers and other persons in a position to understand and help the child. Major casework services for children are in most instances conducted directly with the parents, although of course the social worker should by a l l means gain the confidence of the child, forming what is known in psychiatry and social work as helpful * relationship'. The social worker is alert to the limitations of social casework, and part of social casework, indeed, is referring to appropriate sources of assistance children or parents who need psychiatric, financial, or other services. At the same time i t is never a matter ox giving casework services or securing psychiatric services; of giving casework services or securing economic aid, and so on. To be most effective, and in many instances to be effective at a l l , psychiatric or other specialized services must be complemented by social casework. 13 TABLE 1. CLASSIFICATION OF CHECK-LIST SYMPTOMS Original Check-list Supplied by Teachers 1. 2. 3. 4. 5. General Symptoms of Disturbance Cries or is unhappy. Is restless or excitable. Lies or tells • t a l l tales'. Has a nervous 'twitch' . Has 'obsessive' behavior. 1. Is extremely untidy. 2. Talks to himself. 3. Is very tense and nervous. 4. Worries over incidents-. 5. Is impulsive. 6. Desires constant praise and attention. Sympt oms of Aggre s s ivene ss 1. Bullies or shows cruelty 1. Cannot work with others 2. Is a 'tattle tale'. without causing a disturbance. 3. Is a 'showoff'. 2. Is defiant. 4. Steals. 3. Has temper tantrums. 5. Truants. Symptoms of Withdrawal 1 . Is timid. 2. Is l e f t out of play groups. 3. Is bullied by playmates. 4. Works..tax. below capacity. 5. Unaccountably stubborn. 6. Very poor sport. 7. Daydreams far too much. 8. Sulks. 1 . Has played sick to miss school. 'Habit* Disorders 1 . Poor bladder or bowel control. 2. Chews fingernails. 3. Stutters. 1 . Poor muscular co-ordination 2. Sucks thumb Symptoms supplied by teachers were those written on the information sheet by teachers while making the survey. 14 Chapter Two THE CHILDREN REPORTED FROM ALL SCHOOLS Fifteen schools were canvassed in the survey. One or more children were reported as maladjusted from each of twelve schools. From ;the remaining three schools there was no reply. From the twelve schools, containing eightyrfour teachers and some twenty-nine hundred children, ninety-two children were reported by the teachers as displaying symptoms of maladjustment. One child was not included in the returns because the teacher reported that a l l his difficulties stemmed from a language barrier— in a l l probability a short term problem, and one which could be readily understood and dealt with by teachers and school principal* Work with this boy would consist largely of helping him to learn to speak English. A second child was eliminated from the returns because- only slight symptoms-of maladjustment were reported, and there was no background information given. The information sheets for the remaining ninety children were reliably completed. 15 Distribution by School. There was considerable variation among the proportion of children reported from each school. The teachers from some schools reported much larger percentages of children as emotionally disturbed than did the 9 teachers from other schools. School \"A\" for example, had 13.1 per cent of the teachers and 13.1 percent of the pupils in the group surveyed, but reported 28.9 per cent of the children reported from a l l schools with symptoms of emotional disturbance. At the other extreme, school \"I\" had 4.8 per cent of the teachers, 5.9 per cent of the pupils, but only one child—1.1 per cent of the total—reported as having symptoms of emotional disturbance. It appears that in schools where there is a high proportion of children to each teacher, the number of maladjusted children reported is relatively high. In schools where the proportion of children to each teacher is lower, a relatively low number of maladjusted children are reported by the teacher. It may be that where the teacher is able to give each student more attention fewer children display symptoms of emotional disturbance. Some explanation of the varying percentages of children returned by the teachers in different schools may be attempted. Presumably, in some schools the teachers have more encouragement to think about emotionally disturbed children than in other schools. It is not likely that the schools from which no returns were received have no emotionally disturbed children, in the fi r s t four grades. It is more probable, with such schools, to suppose that the school principals have not encouraged the greatest interest in helping emotionally disturbed children. There is a known explanation for some of the more extreme variations. 9 See Fig. 1. F i g . l . Distr ibution of Teachers, Pupils and Maladjusted Pupils Grade One to Four December, 1950 28.9 13.1 13.1 School 1 12.2 10.7 10.8 School S 4.8 6.9 T 6 1.1 School I 11.9 9.6 4.5 21 School B 10.4 9.5 10 j—I 1 8 2 Ml = 9 Q 9 mi — 9 111 School ¥ 11.1 • 4.8 4 14 a School J 11.9 11.2 1 3 5.6 0 2 1 rTTn 5 Mill = HIP School C 8.3 8.2 7 2 3.3 3 A pni — |3| School G 4.8 m 3.3 School K 12.5 13.3 10.7 School D 6.9 5.9 4.5 School H B El m School L A l l Teachers J A l l Pupi l s . a Maladjusted * Pupils 84 2870 90 Note: Percentages are at top of bars Absolute figures are inside bara * 0 f these 84, 41 returned questionnaires. 17, In school \"A\" the principal is a very alert, competent, and thorough educator. His enthusiasm for helping children with problems has no doubt carried over-to his teachers. At school \"I\" and school \"B\" the survey was interpreted by the principals and teachers as dealing only with children having extreme symptoms of maladjustment. It Is surmised that at school \"C\" and school \"6\" there was-\"-a similar searching out of extremely disturbed children. One principal suggested that some teachers did not report emotionally disturbed children because of thelr\\own insecurity; That i s , the teacher declined to call attention to maladjusted children in the class lest she at the same time call attention to herself. It is also possible that many teachers identify with emotionally disturbed children—that is, subconscious-ly feel like-them—and therefore do not recognize them as maladjusted. Similarly, for this reason, teachers may report most children with symptoms of maladjustment, but because of identification, may not be able to recognize children with particular symptoms as being disturbed. It is interesting to note that twenty-two teachers reported one child from their class as emotionally disturbed, eleven teachers reported two children, nine teachers reported three children, three teachers reported four children, and only one teacher reported more than four children. This last-mentioned teacher reported seven children. An average10 of two children were reported as emotionally disturbed by each teacher. Distribution of Emotionally Disturbed Children by Grade. There was a sharp and constant decrease in the number of children reported as maladjusted in grades one through four.1\"'' Grade one had only 10 Taken from the median. 11 See Fig. 2 . F i g . £. D i s t r i b u t i o n by Grade Children i n Twelve Schools December, 1950 IS Grade 1 Grade £ Grade 3 Grade 4 3£.£ £6.0 £6.9 £ 6 . 4 £4.7 B ££.£ TTTT1 ££.9 m 1 6 . 7 1 Rate of Maladjusted Children per 1 0 0 Pupils 3.7 3.3 £ . 8 £.£ A l l Children Maladjusted C . £976 90 Note: jfciolosed figures are absolute. Other figures are percentages. 19 26 per cent of the children in the survey, but 32,2 per cent of cthe mal-adjusted children were from grade one. In grades two, three, and four the grade population decreased slightly, but the number of maladjusted children reported decreased 3harply. Grade four had 22.9 per cent of the children in the survey but only 16.7 per cent of the maladjusted children. Taken as a proportion of a l l pupils in the survey sample, 3.7 per cent of the emotionally disturbed children were in grade one, 3.3 in grade two, 2.8 in grade three and 2.2 in grade four. Spontaneous recovery may account for the decreasing proportion of children having symptoms of emotional disturbance in grades one through four. Perhaps as they become familiar with school and more interested in their work, children actually become better adjusted. On the other hand, their symptoms may, through the pressure of necessary school dis-cipline, take leas recognizable forms. They may become internalized, and hence more readily unnoticed. It is also possible that as children pass into higher grades teachers are able to spend less time with each- child, and hence f a i l to notice many symptoms of maladjustment that might be noticed i f there were fewer children in the class. A great deal of research would have to be done before the reason for decline in maladjustment could be accurately established. Comparison of Continuous and. Short-term Symptoms The number of children having continuous symptoms in each classifi-cation was paralleled very closely by the number of children with short-12 term symptoms in the same classification. Twenty-six children were reported as having no short-term symptoms and four as having no continuous 12 See Table 2. 20 symptoms of emotional disturbance. With the remaining sixty children there was no significant variation among distribution of continuous and short-term symptoms among the several classifications. There was, however, very l i t t l e positive correlation between continuous and short-term symptoms. There were thirteen children whose continuous and short-term symptoms were both of withdrawal. The symptoms of children in other classifications showed l i t t l e correlation. Greatest significance must be attached to. continuous; symptoms. Short-term symptoms are of interest* but for most purposes of analysis may be disregarded. Distribution of Boys and Girls by Symptoms Sixty-nine boys were reported as maladjusted and only twenty-one 13 girls, or approximately seven boys for every two girls. In schools where large numbers of children were reported as maladjusted there were relatively more girls reported than in other schools. However, even in these schools the number of girls reported was s t i l l significantly lower. It is, of course, possible that there are very many more emotionally disturbed boys than girls. The only other probable explanation is that teachers report maladjusted boys more readily than they do maladjusted girls. Most i f not a l l of the teachers in grades one to four are women. They may have trouble in recognizing children of their own sex as,being emotionally disturbed. The proportion of boys to girls remained fairly constant in a l l classifications except that of withdrawal, in which the proportion of girls to boys increased noticeably. 13 See Fig. 3. 20. TABLE 2. COMPARISON OF CONTINUOUS AMD SHORT-TERM SYMPTOMS OF EMOTIONAL DISTURBANCE (Children from Twelve Schools, December 1950.) Short-term Symptoms Continuous Symptoms General Aggressive mixed, and A. with and slight habit disorders disorders Withdrawn and W. with habit disorders Habit dis- T orders and o H. D. with t general mixed a and slight 1 disorders. General mixed and slight disorders 16 Aggressive and A. with habit disorders 11 Withdrawn and W. with habit disorders 10 13 25 Habit dis-orders and H. D. with general, mixed, and slight dis-orders:. Total 21 26 60 No comparison is possible in thirty cases: twenty-six information sheets gave no short-term symptoms and four gave no continuous symptoms. t i g . 3 . C l a s s i f i c a t i o n of Maladjusted Boys and G i r l s In Twelve Schools, Grades One to Four December, 1950 Symptoms General, mixed, and s l i g h t . Aggressive and A. with habit disorders. Withdrawing and W. with habit disorders. Habit disorders and H.D. with general, mixed and s l i g h t symptoms. No symptoms re-ported. Boys i i i n i i i i i i i i i i i i i i i i i i i f T m i M i i n M T i G i r l s iiii6ii]iiiili Illinium 14 IIIIIIH Hill II IIIIIIIIIIIHIIIIIIIIII 12M Combined P.O. 26.7 24.4 17.8 11.1 38.9 28.9 12.2 6.7 4.4 28.9 100.0 Continuous symptoms. Short-term symptoms Aggressive Behavior Withdrawing Behavior Habit Disorders General Disturb-ed Behavior 1. B u l l i e s or shows cruelty. 2. Is a 'ta t t l e t a l e ' . 3. Is a 'show o f f . 4. Steals. 5. Truants. 6. Is d e f i a n t . 7. Has temper tantrums. 8. Cannot work with o t h e r B without caus-ing a di s -turbance. 1. Is timid. 2. Is l e f t out of play groupe 3. Is bu l l i e d by playmates. 4. Works f a r below oapacitj 5. Unaccounta-bly stubborn. 6. Tery poor sport. 7. Daydreams f a r too much. 8. Sulks. 9. Plays sick to miss s c h o o l , 1. Poor blad-der or bowel control. 2. Chews f i n g e r n a i l s . 3. Stutters. ,4. Sucks thumb. 5. Poor motor o o n t r o l . 1. Cries or i s unhappy. 2. Restless or excitable. 3. Lies or t e l l • t a l l t a l e s * . 4. Has a •nerv-ous t w i t c h ' . 5. 'Obsessive' behavior. 6. Untidy. 7. Talks to s e l f . 8. Tense and nervous. 9. Worries. 10. Impulsive. 11. Desires con-stant praise a n d a t t e n t i o n . 23 Approximately one-quarter of the children f e l l in the general, mixed, and slight classification of symptoms of emotional dis turbance. Almost eighteen per cent of the children f e l l in the aggressive classification of disturbance. This is a small number of children, since almost twice as many, or thirty-eight per cent of the children had symptoms of with-drawal. A very small number of children were classified in the habit dis-orders group—only twelve per cent. It is reasonable that one-quarter of the children f e l l in'the f i r s t group. Many of these children have only slight symptoms of maladjustment. It is interesting that there should be almost twice as many withdrawn as aggressive children. Perhaps aggressive behavior is not tolerated at home and at school and the children have gradually become withdrawn. Only twelve per cent of the children have habit disorders, not a very large per-centage. T h i 3 last finding is not an unexpected one, since most habit disorders are infantile methods of displaying maladjustment. Children going to school would be expected to show different symptoms of disturbance as progress is made from grade to grade. The basic maladjustment, however, would probably remain unchanged. Classification of Children by Grade The proportion of children classified as having general, mixed, and slight symptoms declines steadily in grades two and three as compared with grade one. In grade four there is a rise in the proportion of children reported, but this is insignificant considering that only four children are 14 involved. The higher percentage in grade four is occasioned by the 14 See Fig. 4. 24 smaller total number of children in grade four than in grade three. Generally, i t might be expected that children in this classification would adjust spontaneously to some extent, and this apparently is what happened. It is also possible that some of the children in this classi-fication develop more marked symptoms of disturbance each year, and are accordingly reported in other classifications of maladjustment. The proportion of children with aggressive symptoms of maladjustment reaches apeak in grade three and declines in grade four. Two school principals commented that they had noticed the same trend. One principal explained that until they reach grade four, children are treated very much like babies. In grade four, however, they find more outlets for their energies and aggression in sports and games. There is a steady decline in the number and proportion of children with symptoms of withdrawal in grades one to four. The number of children-involved is not very large—there are thirty-five In a l l four grades—but a definite trend is evident. Perhaps, with many children, maladjustment is only to the new school situation, and recovery may be spontaneous as the children adjust better to school. On the other hand, there may be just as many maladjusted children in the higher grades unnoticed or un-reported by the teachers. Withdrawal symptoms are indicative of fairly serious maladjustment. It ±3 to be hoped that the actual proportion of maladjusted children does become smaller from grade to grade. Further educational research would be valuable on this question. The number of children with habit disorders is very small, but remains fairly constant from grade to grade. Habit disorders- are indic-ative of fairly serious maladjustment, and spontaneous recovery would Fig.4. C l a s s i f i c a t i o n of Maladjusted Children, by Grade (Continuous Symptoms Only) December, 1960 Grade 1 Grade Z Grade 3 Grade 4 T m r (764) (736) (681! 1.2. General, mixed, and s l i g h t disorders. Aggressive and A. with habit disorders. Withdrawing and W. with habit disorders Habit Disorders and H.D. with general, mixad and slight disorders .8 .6 • 8 1.3 1 .9 1C 1 7 .3 .3 .6 .4 U .6 1 .5 f UJJi 6 111 n .7 m 6 Note: Percentages are at top of bars; absolute figures are inside bars. (Four of the ninety maladjusted children did not have continuous symptoms: eighty-six children are reported in this chart.) 26 probably not operate to any appreciable extent with children having them. At the same time, habit disorders are very noticeable, and i t would be harder to overlook a child with habit disorders than itr.would be to over-look a withdrawn child. This explanation may account for the decrease in number of children reported from grade to grade as being withdrawn while the number of children reported as having habit disorders remains relatively constant. Physically Handicapped or Seriously 111 Children Ten of the twenty-one physically handicapped or seriously i l l children were reported as having continuous symptoms of withdrawal. Four were classified as having general, mixed, and slight symptoms of disturbance, three as having aggressive symptoms, and four children had habit disorders.1 There were twelve different types of illness or physical handicap reported. Two children were reported as having a cleft palate, and seven as having speech defects. Two children had hearing difficulty, and two were thought to have poor general health. The remaining eight children had different afflictions, most of them of a relatively severe nature. It is impossible to draw any general conclusion as to the part played by physical handicap or illness in the emotional disturbance of the twenty-one children concerned. It is significant that these children comprise twenty-three per cent of the total number of children reported as having symptoms of maladjustment. It might have been expected that the largest group of handicapped or i l l children would be withdrawn, as the classifica-tion showed. It would seem a wise policy, in the light of this finding, 15 See Appendix B, Table 5. 27, for teachers to keep; a. very close watch on children known to have serious illness or physical handicap, and to call on the school social worker and school nurse at the f i r s t sign of emotional disturbance. Children from Broken Homes Twenty-three emotionally disturbed children had lost either one or 16\" i both parents. Ten children were living in foster homes, ten were being brought up only by their mothers, and three children were living with rela-tives. In the last instance i t is known that in two homes, one parent of the children also was living with the relatives at least part of the time. Children from broken homes were almost evenly distributed among three classifications. Eight children had continuous symptoms of general, mixed, and slight emotional disturbance, seven had continuous aggressive symptoms, and seven had continuous symptoms of withdrawal. Only one child had habit disorders. Children from broken homes comprise slightly more than one-quarter of a l l the children reported as having symptoms of emotional disturbance. Most of the children in foster homes are wards of the children's aid societies. Probably most of the children in homes with only the mother are supervised by Social Welfare Branch social workers in the course of administering financial aid. The school social worker should maintain liason with other social workers giving help to children from broken homes, or their families, and make needed home visits where casework services are not already being given. 16 See Appendix B, Table 6. 28 Over-age and Under-age Children Twenty-seven over-age children were reported, and only four under-17 age children. There was more or less even distribution of the over-age children from grade to grade. Three of the under-age children, however, were in grade one, and the fourth was in grade two. There were no under-age children reported as maladjusted in grades three and four. It may be assumed that the under-age children either f a i l in the f i r s t grades, or make a better adjustment to the school by the time they reach grade three and four. It may also be speculated that the under-age .children are largely in a transient group. Perhaps the parents place them in a school temporarily to get them off their hands, and soon move on to another loca-tion. If there were constant changes of residence and school, the children involved would be almost certain to fail- a later grade, even i f they passed the fi r s t year. One principal expressed great interest in the findings on over-age and under-age children. He said that one of the great problems facing educational authorities was the minimum\"age at which children should be permitted to start school. He commented that a comparison of the number of over-age and under-age children reported as emotionally disturbed, with the number of a l l over-age and under-age children in the same group, would prove very interesting. It was not possible to do any follow-up in the present survey, but the question is worthy of further attention. Children from Classes on \"Split-Shift\" Twenty-nine children, approximately one-third of the emotionally 17 See Appendix B, Table 7. starting age. Six years is the normal school 29 disturbed group, came from classes sharing the teacher's time with another 1 8 class. That is, the teacher handles one -class in the fir s t part of the day, and another class in the afternoon. A larger proportion of the children attending school on shortened hours had general, mixed, and slight symptoms of emotional disturbance than did a l l the ninety children. Proportionately, only half as many children on shortened hours displayed symptoms of aggressiveness as did a l l the ninety children. Similarly, there was a slightly larger proportion of withdrawn children, and a slightly smaller proportion of children with habit disorders among the children having a shortened school day. Because a shortened school day is- only a temporary educational necessity, not too much attention need be paid to the particular trends which emotional disturbance appears to take among children involved. Classi-fication of symptom does vary somewhat from classification of symptoms displayed by a l l ninety children, but there is no reason to suppose that a substantially higher proportion of children on a shortened school day dis-play symptoms of emotional disturbance than among children having the f u l l school day. 18 See Appendix B, Table 8. Chapter Three THE COMMENTS OF TEACHERS ON EMOTIONALLY DISTURBED CHILDREN When the survey was being formulated there was no thought of attempting to evaluate the attitude of teachers toward emotionally disturbed children in their classes. The last question on the information sheet, \"State, in your opinion, why this child behaves 19 the way he does:\", did not f u l f i l its intended function of pro-viding information useful in diagnosing disturbance. However, the answers did make i t very evident that different teachers take a variety of attitudes toward emotionally disturbed children. The attitude of the teacher towards the child is of great importance, for an understanding, and a positive attitude towards emotionally disturbed children is the greatest, and indeed the only contribution that the classroom teacher can make towards helping a child become better adjusted to school, and l i f e in general. 19 A 6°Py cf the \"information sheet\" may be found in Appendix A. 31 It must be understood that there is no thought of blaming teachers where attitude towards the student appears not to be the most helpful. It is up to the professional training schools to screen out applicants not suited to teaching, and to orient successful applicants towards the needs and problem behavior of children. Teachers who f a i l to give the most help to children, for the most part do so unconsciously. Their attitudes are not wilful, or conscious. They may f a i l to function most effectively either because of incomplete training, or because they are themselves suffering from some emotional upset. To a considerable extent a comment may not only indicate a teacher's attitude, but also reflect the amount of time the teacher was able to devote to the survey. It is recognized that teachers may have had the most desirable attitude towards children needing help, but for lack of time may have supplied l i t t l e information, or made a comment not indica-tive of their interest or understanding. Forty-six teachers participated in the survey and thirty-eight did not. The forty-six teachers, at the very least, were interested enough in their students to make a survey of the class and provide a very con-siderable amount of information about children with symptoms of malad-justment. It may be suggested that the thirty-eight teachers who could not discover at least one maladjusted boy or g i r l , may have a poor attitude. On the other hand, a l l the children in those thirty-eight classes may have been reasonably well adjusted, or the teachers too over-worked to participate in the survey. In the fi r s t classification are placed the children about whom the teachers made no explanation or comment whatever about the emotional disturbance. In the second classification are placed the children 32 about whom the teacher made only a general comment, giving a too-simpli-fied .-or \"blanket\" explanation of behavior, or placing a label upon the child. Children about whom the teachers made some specific descriptive comment or explanation as to disturbance are placed in the third classi-fication. In the last classification are placed those children about whom the teachers' descriptive comments include information about attitude taken toward child in the class, or some mention of the child's reaction to teachers attitude or treatment. Where there is a broken home or physical handicap, note of such fact is placed in brackets at the head of the teacher's comment. Where no comment was made, teachers may- have understood very well the signifi-cance of broken homes and physical handicaps or illness, in emotional disturbance, but children concerned are classified in the \"no comment\" group, since i t is impossible to guess at what a teacher may have been thinking.. The children in each classification by teachers' comment were cross-20 classified by continuous symptoms of maladjustment. Distribution was roughly similar to distribution of a l l children by continuous symptoms. In every classification the largest proportion of students was found in the withdrawing group. Similarly, the second largest group of students in the f i r s t , second, and fourth classifications by teachers' comments, was among the mixed, general, and slight symptoms of disturbance group. The exception was in the third classification, those children about whom the teacher made a specific comment or description of behavior, or causes of behavior; In this instance the second largest group falls among* those children with aggressive symptoms of maladjustment. The number of 20 See Appendix B, Table 9. 33 children involved is so small, however, that no special significance can be attached to this one variation. There were fifteen children—-sixteen per cent of the ninety—about 21 whom the teachers made no comment. Teachers made'general comments concerning almost one-quarter of the students.. Specific comments1 were made concerning forty-three childrenj almost half of the ninety children. With only ten children—eleven per cent—did the teachers' comments indi-cate that there was-conscious attempt to help the child-overcome his maladjustment. It will be seen later that one or two of these ten comments indicate that although intentions were good, possibly not the best help was given to the child. Thirteen per cent of the teachers made no comment about reason for emotional disturbance. Twenty-one per cent of the teachers made a general comment, giving only a \"blanket\" or label explanation or descrip-tion. Almost.half of the teachers made a specific comment, carefully describing behavior, or giving a definite reason for i t . Seventeen per cent of the teachers made a \"treatment\" comment-, giving relationship with child, or indicating that the child responds in a definite way to treatment. Where there were comments in more than one classification, the teacher was accredited according to the most advanced comment. It is a hopeful sigh that sixty-five per cent of the teachers made \"specific\" or \"treatment\" comments. Most of these thirty teachers are undoubtedly capable of maintaining a helpful relationship with the; child in the class, and they are probably doing an effective job at the present time. If interpretation of a child's.emotional disturbance or suggest-ions for treatment are needed, these thirty teachers will probably have 21 See Table 3. TABLE 3. CLASSIFICATION OF CHILDREN AND TEACHERS BY TEACHERS' COMMENTS (Twelve Schools, December 1950.) Teachers' Number of P. C. Number of P. C. Comments. children teachers No explana-tion or description 15 16.7 6 13.1 of child's maladjustment. General com-ments \"blanket\" or label ex- 22 22.4 10 21.7 planation or description. Specific com-ments behavior 43 47.8 22 47.8 or reason for, described. \"Treatment\" comments gives treatment, or 10 11.1 8 17.4 response of child to treat-ment in class. Total 90 100.0 46 100.0 ' Where a teacher had comments in more than one classification, the teacher was accredited according to the most advanced comment. 35 very l i t t l e difficulty in accepting interpretation, or carrying out suggestions. The sixteen teachers who gave no explanation, or made only a general comment about the reason for maladjustment, may benefit more from discussion of the child's behavior with psychiatrist, social worker, or mental health counsellor. In fact, with this group, comprising thirty-five per cent of the teachers, such discussion is probably essen-t i a l . The teachers who might benefit most, of course, are those who did not participate in the survey. No Explanation of Child's Emotional Disturbance Teachers-gave no explanation about the emotional disturbance of fifteen children, or 16.7 per cent of the ninety maladjusted pupils from a l l twelve schools. There were only six children about whom there was no information to suggest that home circumstances, or health problems, might play a part in maladjustment. In these instances the teachers may either have known nothing about home circumstances, or lacked the time to write information down. There was information about five children which suggested that perhaps reason for the child's disturbance lay in a certain direction: 1. There is evidence of'inadequacy or neglect. 2. Poor eyes. 3. • This foster child has a harelip and speech defect. 4. Speech defect. Evidence of neglect by parents. 5. This child is hard of hearing. He lives in a very poor, small home, and there is evidence of neglect. With these five children the teachers very likely saw the part that the child's circumstances or handicaps may have played in maladjustment, 36 but .did not pass comment. Teachers maintained an open mind concerning three children, stating that they did not know the cause of the child's behavior. 1. Haven't any idea. 2. Haven't any idea. 3. Don't know. (He has a cyst under his jaw, but i t is not supposed to affect him.) One teacher could see only the child's problems, and did not venture any possible reason for them. This child has been in this school about one'year, and the other two teachers he has had say he has presented the same problems.. Furthermore, reports from the pre-vious school he attended state the same kind of behavior. This comment may reflect an attempt to deflect possible censure from self and from school. More likely, the teacher has not been oriented towards the causes of maladjustment in children. This particu-lar information sheet was completed otherwise in a very satisfactory manner. General Comment on Child's Emotional Disturbance Teachers gave a \"blanket\" or label explanation or description about the maladjustment of twenty-two children, 24.4 per cent of the ninety maladjusted pupils. In many of these instances, comment indicates lack of insight into the child's difficulties. There may be failure to appreciate the fact that the child is not solely responsible for the way he acts, but that there is an interaction between child and environment. 37 One teacher used a label to describe a child, with a general qualifi-cation: I feel that this g i r l is a very * slow learner'. Many of her problems are due to her immaturity. There is no explanation of what is meant by immaturity. Another teacher wrote: This child may be treated too severely at home, or is just unusually sensitive. For six children j' there'was some-other information available on the information sheet. This information is given in brackets as part of the comment. 1. (Mother only.) X understand that this child)has not lived with his mother continually because-of his poor conduct. Apparently the father has been a very poor influence on the children which no doubt accounts for the boy*8 strange behavior. This comment contains the implication that the child and the father are solely to blame for the child's difficulties. In fact, further investi-gation would be almost certain to show that the mother shares partial responsibility. 2 . (Lives with relatives.) Did not get a good start; 3. (Speech defect.) This boy is the fourth child in a family of five children. I feel he has had too much help, and has been babied a good deal. 4. (Poor muscular co-ordination.) This l i t t l e g i r l is an only child. i 5. (Very poor eyesight.) Too immature to do grade one work successfully. 6. (Tonsilectomy two years previously.) This boy is an English war baby just two years out of England. Fourteen remaining general comments had no qualifying or additional information elsewhere on the information sheet. 1. He appeared to have behavior problems at the beginning of the term, but is adjusting nicely now. 2 . It is a bid for attention, I think. 3. I believe this child is given too much attention at home, and wants the same at school. This particular g i r l was not reported as having any continuous symptoms of maladjustment. At times, however—on a short-term basis-she chews her fingernails, has poor bowel or bladder control, works far below capacity, and is timid. The attention that a child with such symptoms would receive at home would not likely be consistently favour-able . 4. I believe home conditions may have an influence on this child. 5. I'm under the impression she is thinking she is missing out at home. Also, i t may be a neurotic condition. ; . 6. He has a younger brother in the class. 7. In my opinion this child is immature. 8 . This boy is very immature and seems to have been given l i t t l e responsibility at home. There is an older brother, and this may account for his extreme timidity, etc. This boy started school at age five, which may account for his immatur-ity. It is likely that along with his lack of \"responsibility\" at home, the boy also has not received anough affection. 9 . Overbearing father; mother very undecided and inconsistent. 10. This child lacks proper discipline in the home. 11. This g i r l shows definite signs of being spoiled at home. This g i r l was reported as continually chewing her fingernails and having 39 temper tantrums in class. Further investigation would be valuable in discovering how this child actually is treated at home. 12. This child, I believe, has been greatly spoiled. He has never had any responsibility, and l i t t l e discipline at home. Kindergarten seems to have had no effect in this case, as far as adjustment is concerned. 13. Child appears to be over-indulged by mother. 14. He hasn't had firm enough discipline at home and in his f i r s t grades at school. He doesn't know how to share things with other boys and girls. He wants every-thing for himself. Doesn't seem to realize that there are more children in the room beside himself. Probably spoiled at home. I think he will outgrow this, as he has already improved his behavior from that of the f i r s t of the term. The comment on this child is specific in many ways. However, i t generalizes that the child is \"spoiled at home\", and that \"firm discip-line\" is needed. Perhaps i t is needed, but on the other hand the child or the parents may have any number of problems to cope with. Disciplin-ing the child will not overcome emotional disturbance and may intensify i t . The general comments a l l have a more or less simple explanation or remedy for a child's maladjustment. Actually, there Is no simple explanation for any behavior problem, and no simple remedy. It is nec-essary to have specific information about the child's relations at home, and the meaning of his behavior to himself, before i t is possible to make diagnosis or suggest treatment. Specific Comment on Child's Emotional Disturbance Teachers made a specific comment about forty-three children, 47.8 per cent of the ninety pupils reported. It is encouraging that teachers were able to look with some objectivity at such a large proportion of disturbed students. Chronological immaturity was reported with four children. 1. He is too young to settle down-'to, school work. 2. (Over-indulgent home.) This child is under-age for grade one. I believe this is one cause for such a great deal of her restlessness. 3. Mother gave wrong date of birth to get the child in school. 4. (Hearing Difficulty.) Living in trailer so that he can attend school at five years six. months. Child is not ready for school. Being much younger than others in family, he is more like an only child. He is below average mentally, and poorly adjusted socially. Appar-ently he has not learned that one has ever to do anything he does not wish to. . I.feel that he would have been much better had he stayed out of school another year. It seems to me inevitable that he build up poor attitudes and work habits as he cannot read or print with others in his class and will not try—seems actually to resent indiv idual heIp. Six children were recognized as having physical handicaps or dis-abilities which played a part in -their maladjustment; Implicit in most comments is description of an attitude taken towards the children by their parents. 1. (Stutters.) This pupil was changed from left to right-hand writing by parents before attending school. We are changing him back to left hand now. 2. .This child has suffered from kidney trouble since childhood, and his mother has been afraid to discipline him. 3. (Cleft palate.) Continually acts listless and unin-terested. I believe his general health is not good. 4. This child has a continuous nasal discharge which causes her a great deal of embarrassment. Also, she does not talk clearly. 5. Because of his convulsions he has grown apart from any group of playmates. He experiences some difficulty in 'keeping up' with his age group in anything that requires use of hands or feet. He is 'spoiled' to some degree by his parents as a compensation for his disabilities. 6. This child had encephalitis, lost his speech entirely, and spent a great deal of time in children's hospital regaining i t . He s t i l l does not talk plainly, and has to touch other people to gain their attention. Nine children were living in foster homes, or with relatives. 1. (Evidence of neglect.) This is a broken home wherein the grandmother, the aunt, the uncle, and the father are a l l bringing the children up. I believe these boys are confused in regard to discipline. They both seem emotionally immature; 2. (Lives with relatives.) In a good home now. I think previous home environment is responsible for his behavior. s 3. (Foster child.) This child was ill-treated in his former home. 4. I understand this child has improved in this foster home. The mother and father are living, but seem incapable of looking after the children. 5. May feel that he cannot keep up standard set by older foster brother. 6. (Foster child.) Lack of affection and care in early childhood. 7. (Neglected.) Craves attention. Has been moved around to several foster homes in the past few years. 8. Treatment was supposed to have been poor before. Foster parents seem to be quite good with him. I've had him for grade one and now grade two, and he has shown a slight improvement. 9. This child seems to have a feeling of insecurity and when he has done wrong he becomes sulky, and stubborn. But he is not aware, as far as we know, that he is a foster child, so I am not quite certain as yet why he should feel insecure. His former teacher feels i t may be an inherited streak of stubbornness. He speaks softly when answering 42 questions or reading in class, but talks quite pleasantly and freely in an informal atmosphere. If he is told to stay after school he sometimes cries and runs from the room. If he is late, or is spoken to for not working, or for talking he seems to withdraw into himself, becomes sullen, and responds only by movements of his head. Three children were living in homes without their father. Only one comment concerns the absence of the father. The remaining two dwell on other aspects of the child's maladjustment; \\ 1. During last year the boy's father died and both children (sister) took i t very.hard. Since then he has been inclined to ..remain in a 'shell' or be an introvert. His behavior suggest that his father was over-indulgent to. him, and since his passing, he has not received the same kind of affection. The important thing is the recognition by the teacher that this child began to show symptoms of emotional disturbance after the father's death. This recognition is important, in the f i r s t place, because i t is possible to secure help once the reason for the child's difficulty is seen. In the second place, the teacher will likely have an understanding and sympa-thetic attitude towards the child. If she did not know the cause of his disturbance, she would be more apt to take a purely disciplinary attitude. 2. (Mother only.) This g i r l tries hard in most work,, but is.dreadfully slow in a l l that she does. For her ability, I suppose that she is doing the best she can. There is no evidence supplied by the teacher that this g i r l is mentally deficient. She may be, but on the other hand, there may be other emotion-al causes for her backwardness; 3. (Mother only.) Sister in grade four. When they were very young they were both badly spoiled by soldiers because they lived near an army base on the Alaska Highway. This g i r l is under control now, but she would do nothing but play and try to attract my attention in class. She would take an hour to print six letters. Now she will do about four sentences in an hour, although she is capable 43 of about ten sentences. N e a t n e B S is a very low standard. Father works out of town. Mother is headed for a nervous breakdown, and its 'no wonder', because the other sister is just the same as this g i r l . For eight children, the teachers did not attempt to give specific description or cause of general behavior. Comments were limited to equally valuable description of specific events, or characteristic actions. The fir s t two comments which follow label the child, but also provide specific information. 1. This g i r l is a 'bother'. She is forever bothering others, and is utterly unable to keep her hands or feet s t i l l . 2. This g i r l is a 'worrier'. She is a very clever child, but is always anticipating trouble. She appears tense and excited at a l l times. 3. I cannot reprimand this child without him having a temper tantrum. 4 . (Speech defect.) Although this child gets money from home, she seems unable to resist picking up and spending any left by another child on his desk. She then lies to get out of this. 5. (Evidence of neglect.) The boy seems to be affected by an older brother who shows even stronger characteristics of the bully. Both boys take boxing lessons, which seem to give them a feeling of physical superiority. This boy cannot take the punishment he likes to dish out. 6. (Bad speech defect.) Seems afraid others are going to take advantage of him. Always seems to be on the defensive. 7. He seems to be spoiled and used to having things his own way. He does not like to be scolded. If punished, he will repeat the same thing to defy. He was punished one day for climbing on a dirt pile after being told not to. He was extremely stubborn, and on the way home threw a rock and missed a boy by a fraction of an inch. About twelve boys and girls tried to bring him back to school, but he fought them off, and went home badly beaten. The teacher's comment on this child is valuable because of the detailed information i t contained. The boy is certainly having difficulty getting along with other people, and the school social worker should be asked to find out why. • 8. This child Is apparently not interested in school work or the things going on at school. He is very desirous of the other pupil's attention and recognition. His father is away from home for con-siderable periods of time in his work. The boy is not noisy and is not a discipline problem^ at home or at school. He is quite co-operative when asked to do anything. However, he daydreams^ a great deal, and as a result is not achieving the amount (of work) that he should. He quarrels with other pupils' his age, but not excessively for boys his age. He appears to lack attention or affection and appears to make up for i t by daydreaming. This problem has apparently been in existence for some time, and is not a development of the past year or two. The teacher's comment on this child is a very excellent one, being indicative of interest, objectivity, and helpful attitude. Thirteen comments contained specific reference to the home as a factor in the child's maladjustment. 1. (Mother only.) This child does not receive proper care at home. 2. (Evidence of neglect.) Because of home circum-stances. 3. (Mother only.) He does not receive adequate care and attention at home; 4. The people are busy running an auto court and leave their l i t t l e g i r l to herself a good deal. 5. (Evidence of neglect.) Father is not living. Mother is non-interested. A community problem-family. 6. (Some evidence of neglect.) The mother works swing shifts, and the father, works days when he works. 7. (Mother only.) The mother works, and the child is not paid enough attention. I don't think the rela-tives that this child is staying with are very keen on 45 having her; I think this is where the problem i s . 8. Two boys (grade 2,3.) get themselves off to school in the morning because both parents work. He gets his own lunch^ and up until last week he was frequently late. He is very bright, but does not work up to his ability. Loves to get attention by playing with things, and being slow and poky. 9. (Speech defect.) Parents are too strict and not consistent in handling the child. He is a middle child—has one brother three years older and one a year younger. This child does not get enough affection at home. 10. Has undergone treatment from Child Guidance Clinic, but -treatment was discontinued through lack of parental co-operation. This boy has not adjusted to school\"life. 11. Boy is under supervision of Mental Health Clinic. In doctor's opinion, this boy lacks affection from the mother. She is the type which one would expect could give love to no one. 12. Mother states that she has no love for her son, but pours affection on a younger g i r l . 13. He does not receive the necessary love and affec-tion to stabilize him outside the home. Lack of attention at home makes him revert to doing babyish things in order to get attention, as he is oldest in family of three — two babies. Comments Definitely Indicating Attempts to Help the Child For ten children, or 11.1 per cent of the ninety, the teachers' comments indicate that some deliberate method of dealing with maladjusted children is being used. These ten children comprise the smallest group of the ninety. -Comments made by two teachers seem to indicate that the attempts to help the child overcome emotional disturbance are negative. 46 1. He seems to be living in a world a l l of his own. Every few minutes he has to be told to get on with his work. I don't know what has caused him to adopt this dreamy attitude. After I have explained something to the class and then ask him what I've said he doesn't know. Then, when he has finally realized what to do, when I look at his work i t isn't done at a l l the way he's been told to do i t . The same thing happens every day with every lesson. He is a very bright boy and when he does his work i t is a l l done correctly. I don't know why he daydreams. It is evident that sometimes this boy does his work, and sometimes he gains attention by not doing his work. Perhaps he needs more praise for good work that he does, or perhaps he is worrying about so many troubles of his own that he cannot keep his mind on school. Cause of disturbance and help needed will remain unknown \"until the school social worker visits the parents. In the meantime, the teacher is forced to spend excessive amount of time with the child. 2. I think i t is hereditary to some extent. I don't think he knows he is a foster child. The people he lives with are very good to him. He is well fed, well dressed, and is given his own pocket money. He is very stubborn, moody and selfish. He wants to be given al l the attention and thinks of no-one but himself. He shows off a lot, which is another way he seeks attention. Corporal punishment or any other form of punish-ment has l i t t l e or no effect on him. He failed last year, and is quite big for his age. However, I have been informed that he had the same dis-position last year as he has now. I think he puts on a front and underneath i t a l l he would like to meet with the social approval of both myself and the class. This teacher has discovered that punishment will not help this child to give up his aggressive-behavior. The teacher is unable to give him a l l the attention that he desires. However, he is apparently getting attention anyway by making himself obnoxious. The implication of the 47 comment is that the teacher is taking an attitude of disapproval toward the child. The reason for the child's behavior would have to be investigated before i t could be discovered to what type of treatment he would respond best. Until such investigation is made, the teacher should endeavour to maintain an accepting attitude towards the child, at the same time making i t clear that his aggressive behavior is unwanted. This boy is a ward of a children's aid society* and the society could be asked to review the home situation. If the child was not a ward of any children's aid society then the school social worker would have to be called in i f any help is to be given the child at home. Without help at home, l i t t l e alleviation of the child's school symptoms of maladjustment can be looked for. 3. This child probably behaves the way she does because given too much attention at home—or the reverse, too l i t t l e attention. If told to do her work she will start to cry, lay her head on her desk, sulk, and do nothing. Why? Maybe she is just plain stubborn, or maybe she is embarrassed when the attention of the class is called to her. I just ignore her, and she does her work much better than i f I'm after her a l l the time. She has begun to take more interest in her work, and has consequently been much easier to handle. This teacher does not state what effect praise or a l i t t l e extra favourable attention has with this child, but is plainly trying to help the g i r l . Comments about five children indicate that teachers have found that praise and attention will help the child to adjust in the classroom. While a positive experience in school would not alter conditions at home which cause the child's emotional disturbance, the child may be enabled, through school experience, to make a somewhat better adjustment to l i f e . 48 Even where the child responds favourably to positive attention in the class-room, i t is s t i l l advisable to investigate the home situation to see i f any help can be given there. 1. Feels he needs a great deal of individual attention. Seems to sulk and daydream when he doesn't receive i t . Bigger and older than classmates. Resents sister in the same room who gets better marks. Enjoys only manual work. Dislikes mental work. 2. (Aching ears.) He is not stupid, but seems too young for his grade. He never attempts to do anything new on his own unless he received encouragement. He does everything very slowly, except eat, when he has to be scolded for not chewing his food properly. 3. From observation, I find that this child responds favourably to affection. 4. The boy's father is very nervous and is much annoyed by his son's noisy behavior. He suspects his boy of stealing, or of being up to some wrong. The father— according to the mother who seems a sort of go-between— seldom praises the boy. The child has a poor reputation at school. I find him very co-operative and responsive to recognition. As long as he gets attention for doing something worth-while, he does not seem to feel the need to misbehave. His work is fair, but is showing continuous improvement, and he will often do a page of work again without being told to do so, if I am displeased with i t . In class he is often annoying because he creates so many opportunities to interrupt other groups. I think that this is his way of being noticed. He would probably be a better member of his group at school i f he received more sympathetic attention from his father. 5. This child's father is at present in prison. A few years ago he used sometimes to come home and be pleasant, but at other times he came home drunk and would beat the children. They, not knowing what to expect, were in a very nervous state. This boy is anemic and needs his tonsils out. HiB mother is very concerned, and he is beginning to approach a normal child's behavior. He is s t i l l very pale. He does not work unless constantly reminded and praised. He wishes to show every piece of work he does for immediate praise. Two teachers gave a great deal of information about boys who were maladjusted. Comments are reproduced in f u l l , not because a l l statements 49 are necessarily true, or of tremendous significance, but because they show how much knowledge i t is possible for a teacher to acquire about a child and his family. 1. Father never had a fight in his l i f e and intends his son to get along similarly. Father never had friends until he met his wife. Father played with tinker toys until he entered university. Mother feels that her son's best friend is a bad influence on him, but I had the friend in my class last year and found him to be quite acceptable. On Halloween this boy was the only boy in the class who did not go house visiting. He reportedly tells his mother how he asserts himself and beats up on other boys, when the truth is that he allows himself to be bullied. This boy will go to extremes to avoid talking about a bright and forward younger sister. He is reported to have said that he wished he never had a sister. The mother describes herself as not being the affection-ate type. The boy is reported to have sobbed to his mother that he would like to hang himself. (She found him sobbing in bed.) He started to t e l l me once how one could easily k i l l a person. In my horror I directed his thoughts quickly elsewhere, with-out asking where he got that information. He doesn't know his mother by the word 'mother' but calls her by her Christian name. The mother says that both she and her husband are clever and smart, and can't see why their boy shouldn't be able to head his class. The boy is reported to have told his mother that he doesn't like school, but is unhesitantly affirmative to me. He takes a pride in making cookies. His mother is a social worker. I believe that the boy's main trouble is over-sensitive-ness, timidity, and lack of motherly love. I believe he has to go to extremes to get necessary attention. I feel the mother's concern is wrongly placed. This comment contains a great mass of information, which may be summarized as indicating that the father and mother have a very poor relationship with their boy, denying him affection, and discouraging or failing to encourage participation in activities normally enjoyed by children. It is desired to leave the impression that this teacher's interest in this boy is very commendable. There is evidently understanding and 50 appreciation of the child's difficulties and problems. However, i t must be pointed out that harm may be done the child i f the teacher herself attempts to gather too much information. The teacher's main task—and one that no one else can do—is to show the child understanding, encourage-ment, and praise in the classroom. Teachers should refer children with symptoms of emotional disturbance to the school social worker for casework help. 2. (Foster child.) I don't think he has any sense of security as he has been moved from one home to another. Also, the lack of affection is\" very evident. He feels that no one really cares for him. He has failed several times in school, which I know has given him an 'I don't care, I won't pass anyway* attitude. I think the reason for his failure is that he has never been long enough in one school to pass, but the sense of failure is continually with him. He bullies the younger children and has a mean, nasty disposition quite frequently. I feel that if something definite is hot done for him that he will turn into a juvenile delinquent. He has told me he was almost sent to a reform school. He also feels that he has been pun-ished a great many times without a just chance to explain the reason for his behavior. I have tried to be very understanding and patient with him. I have made i t very clear that I am his friend and helper, but at times he tries to take advantage of my attitude. I have used a l l the psychological devices that I studied at university and normal school. However, this is my f i r s t year teaching, and perhaps I have not had the experience which would enable me to help the boy. I do think that with the right kind of understanding and guidance he could become a normal, happy, well adjusted boy. The attitude of this teacher is sound, and her method of helping the child is excellent. Diagnosis as-to origin of the child's maladjustment is undoubtedly correct; However, the teacher very unfortunately has a sense of failure when her good attitudes and excellent practices f a i l to bring great changes in the boy's behavior. This teacher needs to discuss the boy's difficulties with the school social worker or mental health counsellor, 51 so that she will understand that she is approaching the child the right way, and should persevere. The reason for l i t t l e apparent accomplishment is that the child took a long time to become emotionally disturbed, and i t will take a long time for him to change his attitude to people and improve his behavior. The teacher should understand that even with the best of care at school, the boy's behavior is not necessarily going to improve at a l l . If the present foster home is a poor one, attention will have to be paid to the source of the trouble—the foster home. If the boy has had such poor l i f e experience that his attitudes are seriously warped, only psychiatric assistance will be of any great help to him. The teacher Bhould understand that she is already giving the boy the most valuable help that i t is possible to give in the classroom* and that she can only refer the child to the school social worker for casework help. In this instance, the school social worker would likely maintain very close liason with the boy's supervisor at the children's aid society. Summary It appears that those teachers who report specific information about emotionally disturbed children have the most helpful attitude towards them. While understanding and acceptance of children appears to go hand in hand with knowledge of what causes them to behave the way they do, teachers cannot be expected to investigate the home back-ground of disturbed children. The teachersshould refer such children to the school social worker for a social investigation into emotional disturbance and needed casework help. Teachers can then reasonably 52 expect to receive enough information to enable them to give disturbed children help in the classroom most effectively. Some teachers are evidently concerned with helping children over-come emotional disturbance, but their approach is mainly a disciplinary one. \"Other teachers use encouragement and praise with good results, but some teachers have found that a l l children do not at once respond to such treatment. These last teachers should continue good efforts in the knowledge that encouragement, praise, and of course discipline, are exactly what the child needs. More help than this cannot directly be given by the teacher, and she has done everything possible when she has asked the school social worker to give casework help. 53 Chapter Four CHILDREN URGENTLY NEEDING CASEWORK HELP: THREE SCHOOLS Further study was made of emotionally disturbed children from three schools in order to learn, in more detail, causes of disturbance, and the nature of any special assistance being given the children. One school was chosen because of the proportionately large number of emotion-ally disturbed children reported, a second school because of the average 22 number, and the third school because of the proportionately small number. The children from these three schools classified in substantially the same proportions, by continuous symptoms, as did a l l the children reported 23 from twelve schools. In the three schools in which further studies were made, seven children left the school between December when the preliminary survey was made and April, when final investigations were completed. No school or 22 These are schools \"A\", \"F\", and \"B\", respectively, Fig. 1. 23. See Appendix B, Table 10. health records were available for these seven children, and they were there-fore eliminated from the l i s t of children to be studied, leaving thirty-two. children. The seven children who left school comprised 17.9 per cent or almost one-fifth of the children reported as maladjusted from three schools. This is a fairly large percentage, and i t would be interesting to know whether there is a corresponding turnover of children not reported as showing symp-toms of maladjustment. That is, are children who move from one school to another more disturbed emotionally than children who remain in one school? The answer to this question would not alter the need for services to help children with symptoms of emotional disturbance, since any help that can be given, even i f the children later move away, will s t i l l be of benefit to the child, and to the teachers. The fact that so many children do move from one school to another is important in providing treatment. If the children leave behind a l l infor-mation that has been gathered about them, and a l l understanding that has been acquired about their behavior, a tremendous waste and duplication of effort is entailed. Good casework records are a prime necessity, and they should be sent on for use in the school next attended by the child. Information about emotionally disturbed children was secured directly 24 from the school social worker, mental health counsellor, and school nurse: 24 The school social worker is a qualified social worker, and possesses, in addition, a teaching certificate. The mental health counsellor is a qualified teacher, with additional training in mental hygiene. Both persons are employed by the Burnaby School Board, the former in South Burnaby schools, the latter in North Burnaby schools. The school social worker and mental health counsellor are expected to give as much casework assistance as possible to the children in their respective areas, and to orient teachers, through the basis of informal dis-cussion, to the personality development of a l l children. School nurses are employed by the Metropolitan Health Committee of Greater Vancouver, and in addition to their ordinary physical health duties, are expected to refer children in need of psychiatric help to the Clinic operated by the Mental Hygiene Division. 55 from school progress cards and health records, and from social agency case records. Information was very scattered, and gathering i t was a very difficult and time-consuming task. Summaries are extensively used, and in order to provide the best possible estimate of what was being done by different persons to help these emotionally disturbed children, the source of material is identi-fied, and one order of presentation is followed. Study of the thirty-two children revealed that they could be separ-ated into three broad groups on the basis of casework help needed and given. Seven very disturbed children were urgently in need of casework help. Of these seven children, some were receiving token casework help, and the rest were receiving no help at a l l . Nine very disturbed children were in need of some further casework help. Some of these nine children were receiving considerable casework assistance, but only minimum help was being given to others. The remaining sixteen children had very definite symptoms of emotional disturbance. With some of these children there had been a slight investigation of problems, but with many children no special attention had been given. The symptoms of emotional disturb-ance reported by the teachers would indicate that these sixteen children were as much in need of casework services as were any of the other children. Chapters five and six which follow deal with the children needing some casework help, and those whose needs for help are unknown. A closer study of the children urgently needing casework help is made in the present chapter. In a l l three chapters cases are presented roughly in order of urgency. 56 Children Receiving Token Casework Help Five children from four families were receiving only token casework help, and urgently needed further services. One boy is under the super-vision of the Hental Health Clinic, two boys are wards of the Children's Aid Society,- and two brothers are in a family receiving social assistance from the Social Welfare Branch. Virtually no casework help hab been given any of these children by persons.from the school. 1. George was reported to have continuous symptoms of general, mixed, and slight emotional disturbance. He is left out of play groups, bullies or shows cruelty, is bullied by his playmates, sucks his thumb, is a 'show-off, is always talking and making noises, cannot work with others without causing a disturbance, is restless or excitable, works far below eap.acity, daydreams far too much, has obsessive behavior, and has poor bowel or bladder control. No short-term symptoms of maladjustment were reported. George is nine years old and in grade four. . The teacher has met the mother; there is no evidence of neglect or inadequacy in the home. The teacher apparently has no idea why George behaves the way he does. Her comment was as follows: This child has been in this school about one year arid the other two teachers he has had say he has presented the same problems. Furthermore, reports from the school he attended previously state the same kind of behavior. The school progress card contains a description of behavior very similar to that given on the information sheet by the present teacher. It was noted that George has been referred to the Mental Health Clinic. The school health record also contains note or referral to the Clinic. The nurse provided the additional information that the teacher has 57 discussed George's behavior with the Clinic psychiatrist on two occasions, and i s trying to give the boy encouragement at school. Pre-Clinic investigation revealed that the mother and father are said to be happily married, and that there is no real financial worry. The father acts unconcerned over George's behavior. His motto-is, \"Live and let l i v e . \" The mother i s s t r i c t , but consistent. She punishes George by putting him to bed, or denying him privileges. He i s submissive at home, the very opposite of the way he behaves at school. The Mental Health Clinic recommended individual attention at own c l i n i c and general super-vision of the public health services for the multitude of presenting problems. A report of the C l i n i c a l findings was on f i l e with the school principal. This report i s quoted in f u l l i n order to show the great value and significance of the work being done. George and his mother were seen at your request on the 23rd. of January, 1951. The mother was over-anxious about her son's lack of acconplishment at school subjects as she has been since he started school in Scotland five years ago. She had taken him to the school psychologist in that location, and she sought the consultation bare also. George's teacher has remarked that he is resentful of school authority, unacceptable to the group, aggressive to his agemates and younger children, immature and noisy i n his attempts to attract the attention of strangers i n the school room;\" and this behavior i s worsening. An individual Stanford-Binet test was done. George was inscrutable, slow and unhappy about the test. His attitude was one of complete defeated resignation. The result was CA. 10 years, m . A. 9 years, 8 months, I. Q. 97. He l e f t the test room and greeted his mother with a smile, and gushed out that he had had a test and the teacher had said he had did well. This test situation i s an excellent demonstra-tion of the lad's deep feeling about learning. He i s blocked from trying for fear of failure, and i n great need of success at which level he expects adult approval. He has no conception of schooling for i t s own sake and his own satisfaction and edification. 58 The mother has been able to assimilate an tinder-standing of George's distressed and inefficient feeling about schooling. Her ability to act on her under-standing is open to question. She states her son is obedient and compliant to her standards and orders, but compensates for some of their rigid unpleasantness by daydreaming and a great attention to manual arts. In conference i t was agreed George's school behavior and slowness in learning were readily explic-able on this formulation. It is thought his lack of group adjustment is further aggravated by the fact that he stands out differently in this new cultural setting. It was thought that at school that i f an attempt was made to create in George some good feelings about himself, and some satisfaction from his academic efforts, and some explanation of his position in the group, that a core of initiative might be stirred which in turn would bring forth efficient use of his abilities. One wishes to see this mother again. This letter was written January 10. Three months later, when final information was secured from the school nurse, and the Mental Health Clinic, the mother had not yet returned to see the psychiatrist, and i t is hence doubtful whether the school nurse will be able to prevail on the mother to use Clinic services. In this instance, the school social worker or the social worker attached to the Mental Health Clinic dearly should be called into the case by the school nurse and asked to do case-work with the mother. 2. Dick's continuous symptoms f e l l in the general, mixed, slight, classification of emotional disturbance. He is continuously restless or excitable, bullies or shows cruelty, is a 'show off', works far below capacity, and is unaccountably stubborn. No short-term-symptoms were reported.- Dick is ten years old and in grade three; The teacher has met the foster mother, but does not know whether Dick received proper care at home. Commenting on the reason for Dick's behavior, the teacher, with 5 9 excellent understanding, wrote: I don't think he has any sense of security as he has been moved from one home to another. Also, the lack of affection i s very evident. He feels that no one really cares about him. y He has failed several times i n school which I know has given him an 'I don't care, I won't pass anyway' attitude. I think the reason for his failure i s that he has never been long enough in one school. The sense of failure is continually with him. He bullies the younger children, and has a very mean, nasty disposition quite frequently. I f e e l that i f something definite i s not done for him, that he w i l l turn into a juvenile delinquent. He has told me he was almost sent to a reform school. He also feels that he has been punished a great many times without a just chance to explain the reason for his behavior. I have t r i e d to be very understanding and patient with him. I have made i t very clear that I am his friend and helper, but at times he tries to take advan-tage of me. I have used a l l the psychological devices that I have studied at university and normal school, but this i s my f i r s t year teaching, and perhaps I have not had the necessary experience to help this boy. I do think that with the right kind of understanding and guidance he could become a normal, happy, well adjusted boy. No finer attitude could be entertained toward any student than this teacher has toward Dick. I t might make things easier for the teacher i f she knew more about the boy's background. She is giving him the best possible treatment, but she might fe e l easier in her own mind i f she had a l i t t l e more idea of why this boy behaves the way he does. The teacher should know that the child's failure to respond to treatment i s not an indictment of her method or attitude, but the result of the boy's trying circumstances at home, or i n his earlier l i f e . The school progres cards in use at this school have a space for comment. In June of 1950 i t was noted that the boy i s in a foster home, that he is a new pupil, that he i s repeating grade three, and that he is a poor, but willing student. In January of 1951 i t was noted that he has a \"poor attitude\". The school health'records for October, 1950 notes that the boy is living in a foster home, and that he is a \"very restless, difficult child\". Dick had not been referred to the school social worker or school nurse as having special problems. The mental health counsellor does not work in the school. Children's Aid Society records show that this boy was tragically neglected by hishparents as a child. The parents separated when the father returned from overseas. Both parents consistently refused to accept responsibility for their children, who often were left alone at night,, and forced to beg for food from passers by on the street. Dick had seen his mother in bed with different men, and he himself engaged in 'sex play' at an early age. The mother has received money from the father, as well as social assistance, but was unable to manage on the amount received. There is a brother a year younger, and a sister three years younger. Dick was bora in September, 1940, and admitted to the care of the Children's Aid Society in 1947. It is very hard to find a suitable home for seven year old boys. He was seen at the Child Guidance Clinic in April of 1949, when i t was found that he was very worried over his parents, that he steals compulsively, and has poor relations at school. There was a need for the teachers to build up his self esteem. Dick tested high in the slow normal group of general intelligence and i t was thought that with a better adjustment he would test low In the average group. At the C.G.C. again in May of 1950, his physical condition was good, but he was found to be in a disturbed emotional state. He was lacking in self-reliance, had. a poor sense of personal worth, and his attitude towards school was poor. He seemed unrealistic about; his,.own'J home, and not to have accepted a long-term separation. (This was four years after leaving home.) Play therapy was recommended. Dick was placed in a receiving home from his own home, and then in a foster home. However, this home proved to be unsatisfactory, mainly because the foster parents could not accept Dick's sex play. There were also problems of lying and stealing. Work was carried on with the mother during this period, since she showed 61 some interest in her son, but nothing came of i t . Dick did not get along well with these foster parents, who rejected him, and seemed unable to get along with other children, including his own brother and sister. In May of 1950 Dick was placed in his present foster home.. It was recognized as a temporary home from the beginning, but there was no other home avail-able for the boy. The present foster mother is a sixty year old widow, the mother of eleven children. A married daughter s t i l l lives at home (with her husband.) This foster mother did not wish to care for anyone exhibiting behavior problems such as Dick's. It is known that she is a l i t t l e on the strict side with the boy. However the Child Guidance Clinic recommended that he stay in the present home, and that the good relationship which existed between the worker and the child be continued. Workers from the Children's Aid Society have been to see school teachers and principals, although perhaps not in the present school, and have done much casework with the foster mother in an effort to help Dick. However, the foster mother is sixty years old, and there is no foster father to take an interest inthe boy, and set an example for him. If a more suitable home can be found, Dick will probably become a much better adjusted boy. 3. Tom displayed continuous symptoms classified in the general, mixed, and slight emotional disturbance group. The teacher reports that he is always very nervous when talked to, and that he is probably working far below capacity'. Once in a while he acts very timidly and is some-times left out of play groups. He has occasional poor bowel or bladder control. Tom is seven years old and in grade two. He belongs to a split-shift class comprised of grades one and two students. The teacher has met the foster mother, and reports that there is no evidence of inadequacy or neglect in the home. The teacher commented that: Treatment was supposed to have been poor before. Foster parents seem to be quite good with him. I've had him for grade one and now grade two and he has shown a slight improvement. School progress records show that Tom has a class standing of \"C\", and that he is of average intelligence. School health records note that he is a foster child, but contain- no comment on emotional disturbance. Tom has not been referred to the school social worker or to the school nurse for assistance. The mental health counsellor does not work in the school. Children's Aid Society records provide information about Tom's l i f e experience. Tom has been in the present foster home since he was,six months old. Foster parents have no children of their own. The foster mother is a tense, anxious person. In July of 1948 Tom was seen at the Child Guidance Clinic, and was found to have a low average I. Q.: By January i t was noticed that he was becoming more and more difficult to handle, having a general attitude of resentment. He was especially touchy about food, refusing to eat when he found out that this disturbed foster parents greatly. Tom had no friends, and was a poor sport. It was observed that the foster mother could not carry out suggestions about handling the: boy. C.G.C. re-examination in January of 1950 found Tom to test in the mid-average group of general i n t e l l i -gence. He had a good attitude towards school, but expressed resentment towards foster father, and other foster child in the home. The psychiatrist felt that the foster home was not meeting the child's needs, and recommended that the worker supervise the home very closely. In August of 1950 the foster-father reported that Tom was over-concerned with homework. In the same month a psychiatrist consultant urged very strongly that the foster daughter, whom Tom resented, be removed from the home. The consultant at that time expressed the opinion that not enough was known about Tom's relationships in the home to make any recommendation about his placement. 6 3 It is probable that Children's Aid Society workers have done every-thing possible in efforts to help the foster parents relax and show Tom more affection. Efforts failed, and because of the shortage of foster homes, and the knowledge that any unnecessary change in home is harmful to children, a new home was not found for Tom. At present there is a question about whether i t would disturb Tom more to remove him from the only home that he has ever known, or to leave him there. Psychiatric advice will likely be secured and followed in this instance, as in most others of a similar nature, but there is no likelihood of any immediate move to another home. In the meantime i t is important that the teacher at least be aware of the general home circumstances and maintain an under-standing and helpful attitude towards the boy. Comments of the present teacher indicate that she has a sufficient understanding of the boy, and is trying to help him. 4 . 5 . Ralph and Bob were reported by their different teachers as ''' displaying symptoms of maladjustment. The same method of description is used with these children as with the others, except that general informa-tion is given about each brother, followed by a summary, for both boys, of family circumstances. The elder brother is described f i r s t . Ralph was reported by his teacher to have continuous symptoms of aggressiveness. On a continuous basis he was described as being rest-less or excitable, and a 'show-off. On a short-term basis, he sulks. Ralph is ten years old, and in grade four. The teacher has not met either of the parents and reports that there is not any evidence of neglect. 64 The teacher made the following comment as to the reason for Ralph's behavior: I understand that this child has not continually lived with his mother because of his poor conduct. Apparently the father has been a very poor influence on the children, which no doubt accounts for the boy's strange behavior. School progress cards contain no written comments, but school health records contain much information. October, 1947. Home visit made re Ralph's aggressive behavior. Mdther said she would visit school to see teachers. December, 1949-.- Home visit . To be referred for mental - hygiene conference. Has been in trouble at school for stealing some money. Discussed possibility of mother coming to town to see nurse, and to see foster mother. January, 1951. Stayed with Uncle last year. Not taking cod liver o i l or enough milk. Advised skim milk powder. Apparently finances are limited. Father does, not see the children. Will request report from former school re mental hygiene. March, 1951. Home visit. Finally broke down and confided her side of the difficulties her family is in. Ralph is charged with theft of money from milk bottles. Suggested referral to Mental Health Clinic. Mother willing. Contacted social worker (Social Welfare Branch). Will await result of t r i a l for theft. The above records are very f u l l , much more f u l l than the average school nurse's records. This nurse is very interested in the problems of children. She provided the following history when asked for additional information: At the t r i a l Ralph was released on probation for two months. The parents are separated. The mother has an unsavoury reputation. —on social assistance— finances very limited. Ralph was taught to steal money out of his father's pants when he lay in a drunken stupor. Social worker is supervising the home, and so is probation officer. I am referring 65 the children to Psychiatric Clinic. These boys should live in a foster home and have a more normal l i f e . The mental health counsellor has discussed this boy's problems with the principal and the school nurse. He repeats the facts known to the school nurse, giving additional information. Major excerpts only are quoted from his notes: The mother appears to be living with another man, and seems to be interested chiefly in getting rid of the children. April 24, 1951. The school nurse reported that the mother has consented to accept clinical assistance for her children. When this case goes to clinic I shall follow my usual procedure (i.e.pre-clinical preparation of school staff and post-clinic interpretation in the school). The school social worker does not work in this school, and knows nothing about Ralph, or his brother Bob. Bob's continuous symptoms were reported to be those of aggressive-ness, as with his older brother. He is reported by the teacher to bully or show cruelty, to steal, to be a 'tattle tale', to be a 'show o f f , to be very restless or excitable, and to li e or t e l l ' t a l l tales'. No short-term symptoms of maladjustment were reported. Bob is seven years old and in grade two. The teacher has not met the mother, and does not know what treatment at home and home circumstances are like, except that the father is not at home. The teacher's comment as to the reason for Bob's maladjustment was a very general one: I believe that home conditions may have an influence on this child's actions. The school progress card contained no written comment, but school 66 health record had useful information in i t : May 1950. Teacher reports petty thieving, lying. Suggested Mental Health Clinic. Home visit revealed a 'painted' mother i l l in bed with a boil. Made an appointment for a visit in a week's time, but mother was not at home when visit was made. November, 1950. 'Jittery boy'. Cheats. Goes to bed at 8.00 P.M. Additional information provided by the nurse was that no thievery had been reported at school this year (1951). For activity of the mental health counsellor, see notes on Ralph, Bob's brother. Social Welfare Branch records more definitely indicate terrible home circumstances: The father is an alcoholic. He has on occasion sold the furniture for liquor. He showed no affection or interest in his children, or homej and finally deserted. The children became completely undisciplined and poorly cared for. Neighbours on several occasions reported the children as 'unmanageable' to Social Welfare Branch workers. The police knew one of the children 'slightly'. Ralph was privately placed in several foster homes. It was reported to Social Welfare Branch worker that one foster father who took Ralph did so 'to help him with his behavior problems', and did not ask for any board or maintenance money. The mother said she later learned that this man was extremely strict, had a vicious temper, and in order to get complete obedience from Ralph and from his own girls, beat them very severely. May, 1950. It was noted that the children were kept home from school because they had no clothing. In the same month Mr. 0. sued Mrs. 0. for divorce on the grounds of adultery. There was a severe experience in which a 'private detective' smashed down the door of the house in order to get evidence for divorce. Records contain much information about the incident, but make no mention of the effect on the children. There are fairly definite grounds for believing that the mother is prostituting herself, but no legal evidence, and for that reason the mother continues to receive Social Assistance. (For the same reason, pre-sumably, the children were not removed from the home.) 67 In March, 1951, the record states that Ralph returned to his own home 'sometime last f a l l ' . In March, also, he was brought before the Juvenile Court for stealing money from milk bottles. The mother was very unco-operative and unwilling to receive help, and nearly a l l the activity of the caseworkers consisted of administer-ing social assistance. The family moved several times in xhe three years that social assistance was provided, and much of the record-is taken up with arriving at decision as to which municipality was responsi-ble for paying assistance. The impression that the record leaves is that casework has been concerned mainly with financial matters, neglecting the welfare of the children. If conditions were as bad as they were said to be, the children might very probably have been removed from their home under the authority of The Protection of Children Act. It would not have been easy to find another home for the boys, but i t is possible that a suit-able home could have been found. No Assistance Being Given Two children urgently in need of casework help, were receiving no assistance at the time the survey was made. On one occasion the mother of one boy held a telephone conversation with a social worker at the Family Welfare Bureau, but did not keep appointments for interviews. The mother of the second boy had previously received some casework assistance from T. B. Social Service workers, but no help is presently being given. In 1947 the mother failed to keep an x-ray appointment, and has not been heard from since. It is the duty of the school nurse, 68 as part of her Metropolitan Health Committee services, to visit persons who f a i l to keep tuberculosis X-ray appointments, but there is no record of any visits ever being made for this purpose in this instance, 1. Gordon was classified by continuous symptoms as being withdrawn. His teacher reported that he is timid, works far below capacity, daydreams far too much, chews his fingernails, has poor bladder or bowel control, and has a speech defect. On a short-term basis, Gordon cries or is unhappy. He is six years old, and in grade one. His class was on split-shift when the survey was made. The teacher has met the mother, and reports no evidence of inadequacy or neglect in the home. The teacher's comment as to why Gordon behaves the way he does was as follows: Gordon is the fourth child in a family of five children. I feel he has had too much help, and has been babied a great deal. The school progress record contains no information at a l l , and the school health record no new information. Gordon has not been reported to the school social worker or school nurse as needing special help. The mental health counsellor does not work in the school. In March of 1949 Gordon's mother got in touch with the Family Wel-fare Bureau because her husband was drinking, worrying about \"various things\", and had an unsatisfactory job. An appointment was made by phone for an interview a week later. The mother did not keep the appointment, nor answer1 a follow-up letter offering another interview. Brief as the mother's acquaintance with the agency may be, i t is indicative of severe problems within the home, and there is no cause for wonder that Gordon is emotionally disturbed. Nevertheless, the social 69 worker f rom the F a m i l y W e l f a r e Bureau has no o p p o r t u n i t y t o do casework w i t h the p a r e n t s , s i n c e t h e r e has been no request f o r h e l p . The s c h o o l s o c i a l w o r k e r , on the o t h e r hand, i s i n a v e r y s t r o n g p o s i t i o n t o do casework w i t h the p a r e n t s . A l l he has t o do i s go t o the p a r e n t s , e x p l a i n t h a t he comes from t h e s c h o o l w i t h r e g a r d t o Gordon 's d i s t u r b a n c e , and would l i k e t o t a l k t h i n g s over and see what h e l p can be g i v e n the boy. Most people are i n t e r e s t e d i n t h e i r c h i l d r e n ' s progress at s c h o o l , o r are a f r a i d of the n o t o r i e t y t h a t would f o l l o w i f they r e f u s e d t o co-operate w i t h s c h o o l e f f o r t s t o he lp t h e i r c h i l d . I f t h e t e a c h e r had r e p o r t e d Gordon t o t h e s c h o o l s o c i a l worker as d i s p l a y i n g symptoms of maladjustment, and i f the s c h o o l s o c i a l worker had — p r o b a b l y t h r o u g h the S o c i a l S e r v i c e I n d e x — l e a r n e d of the mother ' s approach t o the F a m i l y Wel fare B u r e a u , the s c h o o l s o c i a l worker might then have v i s i t e d the p a r e n t s , assessed the home s i t u a t i o n i n the l i g h t of known problems, and g i v e n a l l p o s s i b l e casework h e l p . 2. Henry was c l a s s i f i e d by cont inuous symptoms as being wi thdrawn. He i s t i m i d , i s l e f t out of p l a y groups, works f a r below c a p a c i t y , i s unaccountably s t u b b o r n , i s a v e r y poor s p o r t , daydreams f a r too much, s u l k s , and a c t s l i s t l e s s and u n i n t e r e s t e d . No s h o r t - t e r m symptoms of e m o t i o n a l d i s t u r b a n c e were r e p o r t e d . Henry i s s i x years o l d and i n grade one. The t e a c h e r b e l i e v e s t h a t H e n r y ' s g e n e r a l h e a l t h i s not good. She has met the mother and there i s no evidence t h a t Henry i s n e g l e c t e d at home. There i s no i n f o r m a t i o n on t h e s c h o o l progress c a r d . The s c h o o l 70 medical card contains the information that the mother was in Tranquille T. B. sanitarium in 1943, and-that there are five children in the family. Henry has not been referred to the school social worker or the school nurseoas a special problem. The mental health counsellor does not work in Henry's school. Records from T. B. Social Service—part of Provincial Social Welfare Branch services—provided the only known information about Henry's home circumstances; Records are brief, but indicate that a l l is not well in Henry's home. The mother became a T.B. patient in March of 1943, and was discharged from hospital October 30th of the same year. The last X-ray was taken in 1947, at which time the mother was permitted to be up four hours a day.. She was supposed to have returned for further X-rays, but has not been seen since; Her present state of health is unknown. J Family relationships were known to be poor around 1943, but there is no up to date information. The father has taken l i t t l e or no responsibility for his children, and has not been faithful to his wife. His unfaithfulness contributed to his wife's worry, and affected her health before she contacted T. B. The family broke up after the mother went to hospital. Even i f the parents of Henry are reunited, i t is not likely, from past history, that they are happy. Their unhappiness is reflected in Henry's emotional disturbance. The \"public health (school) nurse from the Metropolitan Health Committee should have visited the mother when she failed to keep her X-ray appointment. However, for some reason, this v/as not done. It was known at the school that Henry's mother had been in hospital with tuberculosis. If the teacher had asked the school social worker for help at the first manifestation of Henry^s emotional 71 disturbance, the school social worker would undoubtedly have learned of the unfavourable family relationships, and the inadequate medical attention the mother was giving to her health. Appropriate casework help might then have been given the mother to enable her to look after her health, and assistance offered for possible marital or other problems. Summary Teachers had not attempted to secure casework help for four of these seven children urgently in need of i t . Two children were receiv-ing token assistance from Social Welfare Branch caseworkers, but were urgently in need of more intensive supervision. The school nurse had made very slight investigation into the affairs of the two children under supervision of the Social Welfare Branch, and another child, but no casework help was being given by the nurse, nor could she be expected to give any, not being a caseworker. None of the children had been called to the attention of the school social worker. There is need for a social worker to do casework with parents who resist Mental Health Clinic services. More social casework services might be helpful for some of the children under care of the Children's Aid Society. Most of the casework should be provided by Children's Aid Society caseworkers, of course, but a social worker from the school would be in a good position to stimulate agency services and co-operate in treatment insofar as help can be given at school. All seven children, or their families, have a history with a social 72 agency, and are therefore registered with the Social Service Index. Yet, so far as is known, only the boy who was examined at the Mental Health Clinic was cleared with the Social Service Index. Much useful information was gained in this instance, and equally useful information could have been learned about the other children by clearing them with the Index also, and approaching the respective social agencies. It would do l i t t l e good merely to learn of other agency activity however. The information would have to be used constructively in casework services to be of any value. For this reason, the school social worker is the logical person to make al l clearances with the Social Service Index, and teachers should refer emotionally disturbed children to the school social worker. Only seven children reported from the three schools were urgently in need of casework help when the sample survey was made. It is, however, possible to speculate that there are a considerable number of children in the other schools and grades of this particular school system who also need casework help urgently. 73 Chapter Five CHILDREN NEEDING SOME CASEWORK HELP: THREE SCHOOLS Nine very disturbed children were in need of some further casework help. Some of these nine children were receiving considerable case-work assistance, but only minimum help was being given to others. In no instance is there wilful neglect, but, because there are not enough caseworkers, or because there is no one to co-ordinate efforts and see that needed help is given, standard of services is low. Considerable Assistance Being Given Five children from four families were receiving considerable case-work assistance but there was some evidence that they needed more. Two children are wards of the Children's Aid Society, and the remaining three —two of them brothers—are mainly the responsibility of the Social Welfare Branch. 74 1. Hilda was classified by continuous symptoms as being withdrawn. She is timid, is left out of play groups, and is restless or excitable. On a short-term basis she cries or is unhappy. She is six years old and in grade one. The teacher has met the foster mother and reports that Hilda was \" i l l treated in her former home.\" The school progress card contained no written comments, but achieve-ment in an intelligence test was below average. School health records contain the information that Hilda is \"very immature—cries a lot.\" The nurse supplied the additional information that Hilda was referred by the teacher because of crying, and timid, nervous, behavior. The nurse knows that Hilda is a ward of the children's aid society, and has been in several foster homes. The teacher and the nurse have attempted to gain the child's confidence. The child has been given a chance to see the dentist and doctor at her own will, rather than being forced to go. The teacher is said to have been very understanding and patient. The nurse believes that the child is \"improving and adjusting very well\" at school, and that the present foster home is an \"ideal\" one. In April of 1951 Hilda's supervisor from the Children's Aid Society informed the mental health counsellor that the g i r l would probably be having difficulty at school. The mental mental health counsellor volun-teered to get the school's impression of the gi r l , and hold a conference at a later date. Information from Children's Aid Society records amply accounts for Hilda's symptoms of maladjustment at school. Hilda was born in July of 1944. She was admitted to agency care in December of 1948 after having 75 been placed out privately for 'adoption' with people who proved unable to love the child, and turned her over to the Children*s Aid Society. Hilda was treated very poorly in her own home. She learned to call every woman 'mom' and every man 'daddy'. At f i r s t , when placed in a foster home, she would not return carresses or kisses, or show any affection. She was very fearful, and any loud noise or sudden movement would send her cowering and crying. Hilda became very settled and secure in her first foster home. However, the foster parents left town, and not wishing to adopt Hilda, could not take her with them. The change was a shock to the g i r l , but her next foster home, the present one, meets her needs for love and affection, and appears to be very satis-factory. Hilda started school in September of 1950 in spite of the principal's recommendation that she stay out for a year. The foster mother requested that Hilda be allowed to stay, and' has helped her a good deal with her school work. Hilda was seen at the Child Guidance Clinic in November of 1950. Her health was found to be satis-factory, but she rated below average in general intelligence. It will be noted that Hilda i 3 in her third foster home, but only her second one while in the care of the Children's Aid Society. Agency workers have given Hilda considerable supervision in her foster home. If the teacher were to ask the school social worker to report to the Children's Aid Society on Hilda's emotional disturbance, a better under-standing of the child might be gained at the Children's Aid Society and, through exchange of information, at school also. 2. Frank has continuous symptoms of general, mixed, and slight maladjustment. He is left out of play groups, is restless or excitable, has'obsessive' behavior, and disturbs others in the class. The teacher did not report any short-term symptoms of maladjustment. Frank is seven years old and in grade one. The teacher knows that he is a foster child, but has not met the mother, and does not know how the child is treated in his present home. The teacher commented that the child's difficulties were due to \"Lack of affection and care in early childhood.\" The school progress cards indicated that Frank is below average intelligence. The school health record contained the comment that: Frank is very immature. Children's Aid Society took him out of school. Going to kindergarten. The school nurse provided additional information: Frank has been in many foster homes, and with his low intelligence has found difficulty in adjusting. The foster-mother has been very understanding and co-operative. The teacher gained the child's confidence. She has taken time to help him with the result that his I. Q . (score) is improving. Frank has not been called to the attention of the mental health counsellor, and he is not within the geographical area having the services of the school social worker. However, Children's Aid Society records provide information about Frank's problems, and the help given him. The boy's mother never grew up emotionally and psychiatric examination disclosed that she 'was not a f i t person' to care for the baby. She was neglecting him almost completely. When nine months old, accordingly, Frank was admitted to care of the Society as a ward. He has remained in the one foster home since placement. Both foster parents have given security and affection, and the foster father has an especially good relationship with'Frank, and another foster son. Foster children are said to get along well together. At times the foster parents have had difficulty coping with the children's problems, but have always worked well with the.agency, At home, Frank has mainly been a problem because of stubbornness and 77 defiancy. For example, he takes his own time to dress, and do chores. Frank's supervisor had him to the Child Guidance Clinic in November of 1948, when he tested high in the moron group of general intelligence. The C.G.C. recommended that Frank be held back?- a year in school, and he consequently went to kindergarten for a year before starting school. At a retest in September of 1949, Frank tested low in the slow normal group of general intelligence, a beiter rating than before. It was recommended that he stay out of school another year, but he started that September. Frank's emotional disturbance is evidently deep seated, and compli-cated by a less than average intellectual ability. Close co-operation between the teacher, school social worker, and Children's Aid Society worker is imperative i f Frank is to make an optimum emotional adjustment. 3. Dolores had continuous symptoms of withdrawal. The teacher reported that she always works far below capacity, and that she daydreams, at timea very much more than the average student. Dolores is seven years old and in grade two. The class she attends was on split-shift at the time of ithe survey. The teacher has not met the parents, but reports there is evidence that the g i r l is being neglected at home. The teacher wrote that \"Home circumstances\" were responsible for the girl's symptoms of maladjustment. School progress cards and school health records contained no enlightening information, but the school nurse supplied the following additional information: This child is not specially known to me except as a member of a large family with-generally low intelligence. Brothers have attended the Mental Health Clinic for mental testing. Dolores has not been referred to the school social worker as emotion-ally disturbed. The mental health counsellor does not work in the school. 78 Family Welfare Bureau records indicate that the family has long been a problem, both in the U. S. A. and in Canada: Both parents formerly lived in the States. Mrs. D. was married previously, and divorced. She is believed to have an exceedingly low level of i n t e l l i -gence. The Family Welfare Bureau provided petty cash and help with budgeting as long ago as 1933. There was said at that time to be a good relationship between the parents. There has been some vacillation as to religion. In 1939 the parents reported themselves to be protestants. However, in 1946 i t was learned that they had been in 'bad odour with the cloth', but were again united with the Roman Catholic Church: Social Welfare Branch Records indicate further that the family have been a problem with everyone whereever they have lived. Economic status is poor, as also is health. A l l seven children are said to have bad eyesight. A Social Welfare Branch worker is actively engaged in supervising this family-?-insofar as time permits--because of the realiza-tion that the parents are inadequate and that the children therefore need special supervision. Casework first started with this family in March of 1950 with the illegitimate pregnancy of one of Dolores' sisters. It was seen that the relationships in the. family were not good and that extensive case-work would be necessary. Recording is scanty, but indicates that the Social Welfare Branch worker has been inntouch with school teachers and church authorities. Work was shared among a l l the children. It was reported that \"Dolores is healthy and appears to be doing the best of al l the children in her school showing.\" 8, and 9. B i l l and Mervyn Bill's continuous symptoms were those of aggressiveness. The teacher 79 reported that he continually steals, and that he lies or tells 'ta l l tales'.. On a short-term basis he truants, is a 'tattle tale', and stutters. B i l l is eight years old and his grade two class was on a split-shift at the time that the sample survey was made. The teacher has met the mother and reports that there is evidence that the children are neglected.' The teacher commented that B i l l behaves the way he does \"Because he does not receive proper care and attention at home.\" The teacher is aware that the father is no longer living. School record sheet for 1950 contained the information that B i l l was very poorly adjusted, had poor attendance, and needed to repeat grade one. In February of 1951 there was no comment. School health records contained much information: May, 1949. Child is a problem at school. Disobedient, and takes the belongings of others. Home visit . Mother willing to have the children seen at Mental Health Clinic. May. Father died suddenly of a heart attack. Will refer for social assistance. June, 1949. Seen at Mental Health Clinic. I.Q. to be done this September. December, 1949. Has settled down in school this year doing better work (repeating grade one). The nurse did not have any information about the family other than what is contained in the report for the Mental Health Clinic. B i l l has not been referred to the school social worker as needing help. The mental health counsellor does not work in the school. The pre-clinical home investigation uncovered the information that the family lives in an old and poorly kept five room house. There is l i t t l e money. B i l l is very disobedient, and defies his mother. For 80 punishment, she send him to bed. B i l l is reported to tremble when scolded. The mother has a very poor relationship with her children. At Mental Health Clinic examination in September of 1949 B i l l achieved an intelligence rating of eighty-six. At the Clinic the mother was given the suggestion that she needs to be friendly and con-sistent with her children, but i t was seen that she would require \"considerable reinforcing\" as most of her thinking \"is a fantasy about herself\". The clinic recommended that B i l l be kept out of school for a year. He was sent to school, but failed. On repeating grade one the next year he did better. It was reported by the nurse that the teacher understands the limitation of B i l l and his brother Mervyn, and is not \"pushing them\" too hard. As a result, B i l l has become much more conform-ing at school. Mervyn*s continuous symptoms were also those of aggressiveness. The teacher reported that he is continually a 'show o f f , steals, truants, and lies or tells 'ta l l tales'. On a short-term basis he has a nervous twitch. Mervyn is seven years old and in grade one. The teacher is aware of home circumstances, and her comment on the reason for Mervyn's behavior was, \"This child does not receive proper care at home\". School progress cards contain no written comment. School health records contain no information about maladjustment in class, but reveal that his physical health is poor, his teeth being particularly bad. The school nurse provided the additional information that the teacher under-stands Mervyn's limitations and is not working him too hard at school, and 81 also that when he first started school he could not tolerate any auth-ority at a l l , but as time went on he learned that he \"is happier when he obeys\", and he has become more conforming. Pre-clinical investigation threw more light on Mervyn's behavior: He plays much better with l i t t l e children than with his age-mates. Some of his stealing was from lunch kits. He also took books, toys, pencils, and other things that did not belong to him, and destroyedthem. At the Mental Health Clinic in September of 1949, i t was found that Mervyn had an intelligence quotient of eag hty-six. It was recommended that he stay out of school for a year, and nis behavior was discussed with nis mother. Information from Social Welfare Branch records reveal what a terrible struggle the mother has had with her two children. When the father died, the family was forced to apply for social assistance, which was granted. However, even before the father's death, a l l was not well in the home. Numerous visits have disclosed that this mother has a very poor relationship with her children. She often screams at them, or threatens them with physical punishment, and sometimes she punishes them with a stick, or sends them to bed. The father was able to earn only a very inadequate income during the twelve years of marriage, and the mother reported that they were too poor ever to go out and do anything together, or have any recreation. The children suffered emotional upset over their father's death, and the upset was aggravated by later presence of his ashes in an urn on the mantelpiece. Social Welfare Branch Records t e l l of much activity in nelping the mother meet her financial obligations and obtain medical care for her children. The social worker was aware of the school situation: 82 November 1950. Complaint from the School Board of fire-setting near school. Visit. Mother i l l . Later v i s i t . Talked over fire. Talked over possibility of sending boys to a Catholic school. Mother not ready to do anything herself but asked worker to see priest. December 1950. Police called to the home again because one of the boys had stolen a bicycle, and money from a local store. Police threatened to take 'drastic action' if nothing was done. The mother later became reconciled to her cnurch, but the priest suggested that the boys continue at public school since the boys are 'too much of a problem for a Catholic school'. December 1950. It was decided that an attempt should be made to interpret non-ward care to the mother. There is no subsequent record of activity. In this tangled situation i t is probable that the social worker did as much as possible to allev-iate difficult stresses. Work was of a necessity chieily with the mother. It is difficult to see what else could have been done with the resources available. Presumably the matter of non-ward foster home care will be followed up. Unless someone exercises close supervision, i t is almost inevit-able, considering their low ability, economic deprivation, and poor relationship with their mother, that these boys get into serious trouble. The Social Welfare Branch worker is the logical person to keep in touch with the family, since social assistance is being given. Minimum Assistance Being Given Four children in need of some casework help were receiving a minimum of service. One child is a ward of the Children's Aid Society; one has received assistance from the Family Welfare Bureau, the Social Welfare Branch and the Mental Health Clinic; and two other children are mainly 8 3 under the supervision of the Social Welfare Branch. 1. Mary had continuous symptoms of withdrawal, and habit disorders. The teacher reported that she continually cries or is unhappy, is left out of play groups, bullies or shows cruelty, works far below capacity, is a'tattle tale', is unaccountably stubborn, is a very poor sport, is very restless, daydreams far too much, and has poor bladder or bowel control. On a short-term basis she lies or tells ' ta l l tales'. Mary is eight years old and in grade two. The teacher has met the foster mother, and believes that the child is properly cared for. Commenting on the reason for Mary's symptoms of maladjustment, the teacher wrote: I understand this child has improved in this foster home. The mother and father are living, but seem incapable of looking after the children. School progress cards contain no written comment on Mary. School health records note that a home visit was made in March of 1949 because the teacher was concerned over the child's school progress and inattentive-ness. Considerable information was recorded on this visit: Conditions poor—no water in house. Six living in two rooms. Common law relationship. Man drinks considerably. Nutrition poor. In April, 1950 another notation was made: Children now wards of C.A.S. due to father's conviction as a sex pervert. Molesting his own daughter. The school nurse evidently knows about the foster home and the child's progress in school. The nurse provided the additional imormation that; C.A.S. placed the children in an ideal foster home where they are happy, loved, and well cared for. Teachers have been understanding, and have made an attempt to gain their confidence. Child needs confidence in herself, and to learn to mix with other girls. The school social worker does not work in this school. The mental health counsellor reported that Mary had been referred to him by the g i r l ' supervisor at the Children's Aid Society as 'disturbed', but no other information was given him. The counsellor volunteered to get the school' impression of Mary and report back. Children's Aid Society records give a more rounded picture of Mary's background, her foster home, and help given by agency workers. r Mary was born in 1942. In 1950, with her siblings she was admitted into care of the society. The father had been attempting sexual relations, and both parents were depriving the children of love and physical care. A l l three children were placed in the- present foster home four days after being taken into care. The foster mother has two sons who were seven and nine years old at the time. The home is looked on as a temporary one since there is no foster father. The foster mother is very religious, and- rigid and inflexible in many ways, but she appears to take good care of the children and give them affection. No permanent plans, have been made for these children, since the mother is s t i l l interested in them. However, Mary, at least, shows no wish to return to her mother. At present the children are seeing their mother about every six weeks. They appear to be happy and settled in their present foster home. The major problem, and one which the Children's Aid Society workers are well aware of, is to find a suitable foster home for Mary in which there is a father as well as a mother. Little other help is necessary. 2. Janet was classified on a continuous basis as being withdrawn and having habit disorders. She was reported by the teacher to be timid, 85 to be left out of play groups, to be bullied by playmates, to be rest-less or excitable, to have poor bowel or bladder control, and to have a nervous twitch. No short-term symptoms of maladjustment were reported. Janet is six years old and in grade one. At the time the survey was made her class was on split shift. The teacher has met the mother, and reported that there is no evidence that Janet is neglected at home. Comment as to the reason for Janet's behavior was as follows: I feel that this g i r l is a very 'slow learner'. Many of her problems are due to her immaturity. The school progress card contained no information at the time the study was made. The school health record contained the information that there were two children in the family and that the father was a 'sprinkler inspector'. The school nurse provided much additional information about the family; This g i r l refused to permit physical examination in September, and later on in October. Later in the year, when she was taken to the health room without her mother she appeared to enjoy the examination. Physical development is. normal so far as is known. An older brother was referred to the Mental Health Clinic in 1949. Janet adjusted to school rather slowly, but appears to be enjoying i t more now. Enuresis, a problem at f i r s t , is no longer present. A conference was held between nurse, teacher and social worker attached to Mental Health Clinic. The teacher was most understanding, and does excellent, work with Janet and children like her. The Clinic might be used for this child, but the father is unwill-ing to see that a problem exists, and the Clinic was not suggested. Janet has not been referred to the school social worker as a problem, and the mental health counsellor does not work in the school. The 86 family is known to many agencies, but little help has been given. The mother went to see a prominent Vancouver psychiatrist. She next approached the Child Guidance Clinic in an attempt to get help for her son, who was having difficulty at home- and at school. In line with the regular policy, the Child Guidance Clinic referred the mother to the Social Welfare Branch. Several interviews were held between- the mother and a worker at the Social Welfare Branch, and the casework super-visor there discussed the situation with the Director of the Family Welfare Bureau. The latter agency volunteered to attempt to help the mother, since there appeared to be a marital problem. Accordingly, the Social Welfare Branch worker talked things over with the mother, and suggested that she visit the Family Welfare Bureau. The Family Welfare Bureau worker wrote -the mother, explaining services available, and inviting her to use them. However, the mother never replied to the letter. Nine months later, Janet's brother was brought before the Juvenile Court for forging and cashing a check. A Social Welfare Branch worker again saw the mother at that time, and once more suggested that she visit the Family Welfare Bureau. However, the-mother did not follow the suggestion. A summary of family relationships and circumstances was gathered from all sources, chiefly Mental Health Clinic and Social Welfare Branch records. The couple eloped and were married in the States when he was twenty-three, and she was twenty. The father has worked at various occupations and is at present an up-coast salesman for a large wholesale house. He is said to be successful in his work, but is home only on weekends, when he behaves in a tired irritable, and touchy manner. The home is modern, and in a good neighbourhood. The father has never been fond of children, or interested in -ftiem. He is said to have a fairly good relationship with Janet, but he is critical of his son, and never speaks to him except when taking him to task. 87 He p u n i s h e s t h e b o y b y d e n y i n g h i m p r i v i l e g e s . F o r e x a m p l e , t h e boy i s o f t e n l e f t a t home when t h e r e s t of t h e f a m i l y goes for* a car r i d e . The f a t h e r i s s a i d t o have s o c i a l a s p i r a t i o n s . He s u f f e r s f r o m h e m o r r h o i d s and needs d e n t a l a t t e n t i o n , b u t . r e f u s e s t o have a m e d i c a l c h e c k - u p . J a n e t ' s b r o t h e r was seen a t t h e M e n t a l H e a l t h C l i n i c i n A p r i l of 1 9 4 9 , and f o u n d t o be of n o r m a l i n t e l l i g e n c e . H i s p r o b l e m was m a i n l y i n r e l a t i o n s h i p w i t h h i s f a t h e r . A d v i c e was g i v e n t o t h e m o t h e r , a t t e m p t s were t o be made t o a r r a n g e i n t e r v i e w s b e t w e e n t h e f a t h e r and C l i n i c d o c t o r . I n December o f 1950 t h e s c h o o l n u r s e r e p o r t e d t h a t t h e f a t h e r had had h i s t e e t h o u t and t h a t he was much more c o n c e r n e d w i t h h i s son a f t e r t h e b o y h a d b e e n c a l l e d b e f o r e t h e J u v e n i l e C o u r t . H o w e v e r , when i n f o r m a t i o n was s e c u r e d i n A p r i l o f 1 9 5 1 , no i n t e r v i e w s had b e e n a r r a n g e d b e t w e e n the' f a t h e r and t h e C l i n i c d o c t o r . I f h e r d i f f i c u l t i e s become s e v e r e e n o u g h , d o u b t l e s s v e r y much t h e same a t t e n t i o n w i l l be g i v e n J a n e t as w a s g i v e n h e r b r o t h e r . The c l e a r l y r e c o g n i z e d i m p e d i m e n t t o h e l p i n g J a n e t o r h e r b r o t h e r i s t h e f a c t t h a t t h e f a t h e r r e f u s e s —or p e r h a p s i s u n a b l e b e c a u s e of h i s work— t o see t h e d o c t o r a t t h e M e n t a l H e a l t h C l i n i c . I f t h e n u r s e c a n n o t s e c u r e more a c t i v e p a r t i c i p a t i o n f r o m t h e f a t h e r i n p l a n s t o h e l p t h e c h i l d r e n , t h e s c h o o l s o c i a l w o r k e r o r t h e s o c i a l w o r k e r a t t a c h e d t o t h e M e n t a l H e a l t h Clinic s h o u l d be a s k e d t o h e l p . The f a t h e r m i g h t r e s i s t t h e i r e f f o r t s a l s o , o f c o u r s e , b u t t h e a p p r o a c h m i g h t be d i f f e r -e n t f r o m t h a t u s e d b y t h e s c h o o l n u r s e , and m i g h t s u c c e e d . 3 . D o u g l a s was c l a s s i f i e d on t h e b a s i s o f h i s c o n t i n u o u s symptoms as b e i n g a g g r e s s i v e w i t h h a b i t d i s o r d e r s . He c o n t i n u a l l y b u l l i e s o r shows c r u e l t y , i s a ' t a t t l e t a l e ' , i s a ' show o f f , l i e s o r t e l l s ' t a l l t a l e s ' , and i s r e s t l e s s o r e x c i t a b l e ; He chews h i s f i n g e r n a i l s and p e n c i l s and e r a s e r s , , i s n e r v o u s and f u m b l i n g w i t h h i s h a n d s , h a s p o o r b o w e l o r b l a d d e r c o n t r o l , a n i ha s ' o b s e s s i v e ' b e h a v i o r . No s h o r t - t e r m symptoms of e m o t i o n a l d i s t u r b a n c e were r e p o r t e d by t h e t e a c h e r . D o u g l a s i s n i n e y e a r s o l d and i n g r a d e t h r e e . The t e a c h e r has met t h e m o t h e r and i s aware t h a t t h e boy has had o p e r a t i o n s f o r k i d n e y t r o u b l e . T h e r e i s no e v i d e n c e of n e g l e c t o r i n a d e q u a c y i n t h e home. Commenting on t h e r e a s o n f o r t h e b o y ' s b e h a v i o r t h e t e a c h e r w r o t e I u n d e r s t a n d t h a t he has s u f f e r e d f r o m k i d n e y t r o u b l e s i n c e c h i l d h o o d and h i s m o t h e r ha s b e e n a f r a i d t o d i s c i p l i n e h i m . S c h o o l p r p g r e s s c a r d s c o n t a i n no comments . S c h o o l h e a l t h r e c o r d s have some i n f o r m a t i o n ! A u g u s t , 1 9 4 9 . D o u g l a s has had two o p e r a t i o n s f o r o b s t r u c t i o n o f t h e r i g h t k i d n e y . N o v e m b e r , 1 9 5 0 . He i s h a v i n g r e g u l a r c h e c k - u p s f o r h i s k i d n e y t r o u b l e , and i s t o be r e f e r r e d t o eye . c l i n i c . D o u g l a s has n o t b e e n r e f e r r e d t o anyone i n t h e s c h o o l as n e e d i n g h e l p f o r h i s e m o t i o n a l d i s t u r b a n c e . H i s f a m i l y ha s r e c e i v e d h e l p f r o m t h e S o c i a l W e l f a r e B r a n c h , and t h e F a m i l y W e l f a r e B u r e a u . I n 1945 t h e f a m i l y a s k e d t h e F a m i l y W e l f a r e B u r e a u f o r h e l p w i t h a d e b t o f $ 3 0 0 . and a n e x p e c t e d d e b t of a n o t h e r s i m i l a r o r g r e a t e r amount f o r m e d i c a l e x p e n s e s . The f a m i l y was n o t g i v e n needed money, b u t a w o r k e r f r o m t h e F a m i l y W e l f a r e B u r e a u d i s c u s s e d t h e p r o b l e m . M o r e t h a n a y e a r l a t e r i t was l e a r n e d f r o m t h e S o c i a l W e l f a r e B r a n c h t h a t t h e f a t h e r was h o s p i t a l i z e d , and t h a t t h e f a m i l y was a p p l y i n g f o r s o c i a l a s s i s t a n c e . The f a t h e r had b e e n i l l s i n c e A u g u s t 1946 and was i n h o s p i t a l b e t w e e n November 1946 and J a n u a r y 1 9 4 7 . He had a s e r i o u s o p e r a t i o n , b u t made an u n u s u a l l y r a p i d r e c o v e r y and was a b l e , i n F e b r u a r y t o r e t u r n t o h i s w o r k as a m a c h i n i s t . The S o c i a l W e l f a r e B r a n c h p r o v i d e d s o c i a l a s s i s t a n c e t o t h e f a m i l y w h i l e t h e f a t h e r was i n t h e h o s p i t a l . A t t h e t i m e , i t was n o t e d t h a t a l t h o u g h t h e home was a v e r y 89 p o o r o n e , t h e r e a p p e a r e d t o be good f a m i l y r e l a t i o n s . I t was n o t e d t h a t D o u g l a s had b e e n u n u s u a l l y d e l i c a t e s i n c e b i r t h . T h e r e was no e v i d e n c e , i n t h i s i n s t a n c e , o f f a m i l y p r o b l e m s o t h e r t h a n t h e economic one f o r w h i c h h e l p was g i v e n . The w o r k e r f r o m t h e S o c i a l W e l f a r e B r a n c h c o u l d n o t b e e x p e c t e d — w i t h p r e s e n t heavy c a s e -l o a d s — t o r e v i s i t f a m i l i e s as a m a t t e r of r o u t i n e . Of c o u r s e , i f someone f r o m the s c h o o l h a d i n f o r m e d t h e S o c i a l W e l f a r e B r a n c h o f t h e e m o t i o n a l d i s t u r b a n c e o f D o u g l a s , f u r t h e r c a s e w o r k m i g h t have b e e n p o s s i b l e . I t i s more l i k e l y , h o w e v e r , t h a t i f a n y t h i n g f u r t h e r i s t o b e d o n e to. h e l p t h e boy a d j u s t b e t t e r a t s c h o o l , i t w i l l have t o be i n t h e f o r m of c a s e w o r k h e l p g i v e n by t h e s c h o o l s o c i a l w o r k e r . 4 . J a c k was c l a s s i f i e d as a g g r e s s i v e on 1he b a s i s o f h i s c o n t i n -uous symptoms o f e m o t i o n a l d i s t u r b a n c e . The t e a c h e r r e p o r t s t h a t he i s c o n t i n u o u s l y a ' t a t t l e t a l e ' and a ' s h o w o f f . O K a s h o r t - t e r m b a s i s he daydreams f a r t o o m u c h , and a l t e r n a t e l y a c t s t h e b u l l y and s u l k s . T h i s boy i s s e v e n y e a r s o l d and i n g r a d e o n e . H i s c l a s s was on a s p l i t s h i f t a t t h e t i m e t h e s u r v e y was made. The t e a c h e r h a s met t h e g r a a d m o t h e r and a u n t and s t a t e s t h e r e i s e v i d e n c e t h a t J a c k i s b e i n g n e g l e c t e d . T h e r e a r e two b r o t h e r s i n t h e same c l a s s — o n e a r e p e a t e r . The t e a c h e r made t h e f o l l o w i n g comment as t o J a c k ' s symptoms of m a l a d j u s t m e n t : T h i s i s a b r o k e n home w h e r e i n t h e g r a n d m o t h e r , a u n t , u n c l e , and f a t h e r a r e a l l b r i n g i n g t h e b o y s u p . I b e l i e v e t h e y a r e c o n f u s e d i n r e g a r d t o d i s c i p l i n e . They b o t h seem e m o t i o n a l l y i m m a t u r e . S c h o o l p r o g r e s s c a r d s c o n t a i n e d no comment b u t i n d i c a t e t h a t - J a c k 90 has a good average intelligence, but only an \"E\" average In hi& academic work. School health records contained the information that in June of 1950 a notice was sent to mother with regards to physical examination of the boys, but that neither child nor parent responded. Jack has not been referred to the' school nurse or the school social worker as needing help for disturbance. The mental health' counsellor does not operate in the school. Two social agencies, however* have been active with' the family. It may not appear that very much has been accomplished, but support and general supervision were given through very disturbing events. Information that follows was secured from the Family Welfare Bureau, and the Social Welfare Branch. The parents were sexually promiscuous before the marriage, which took place only because of the father's insistance. The father had very l i t t l e education, but was holding down a good job. However he was unable to secure adequate living accommodation for his family, and they were living in a shack when the mother finally deserted with the children. The mother began to show signs of mental break-down following the apparently accidental death by suffocation of her f i r s t child. She was in the psychopathic ward of the general hospital on several occasions, and spent time in the Provincial Mental Hospital. In June of 1949 she was diagnosed as 'inadequate psychopathic and schizoid', but was dis-charged from hospital care as improved. While in the hospital the mother met members of a fanatical religious sect, and\"when returned home she joined the sect and spent much of her time going about from door to door* taking the children with her. The father had been unable'to secure more adequate housing for his family, and when the mother deserted she applied for judicial separation and custody of the children; From June of 1949 until March* 1950, a worker from the Family Welfare Bureau held interviews with the father in an effort to help 91 him solve some of his problems. At the same time, Social Welfare Branch workers were busy keeping track\" of the mother and' seeing\" that the children were not grossly neglected. Family Welfare Bureau records end with notice of the court action for* judicial: separation and custody of children by the mother. There is no notice of what happened at the t r i a l . The Family Welfare Bureau worker might have, and certainly the Social Welfare Branch worker should have followed up to see what happened to the children. If the teacher had reported the child and the school social worker had cleared him with the Social Service Index and reported to the agencies Involved that he was-displaying symptoms of maladjustment at school, at least further investigation might have been made. Possibly further casework help might have been given in some way. Summary A l l nine children have had a very poor l i f e experience. Three are in families presently supervised by Social Welfare Branch workers* three are under the supervision of workers from the- Children's Aid Society, and three once received help from social agencies, but are not at the moment receiving any casework-services. Seven of the nine children could best be given further needed help by an improvement of the standard of services already offered. Raising the general level of services: is a long term problemj and there is every reason to believe that social agencies are doing the best they can with 92 present budgets. It may; be* however* that i f the school social workers were to keep in close touch with workers from social agencies, more help might be secured for particular children. The families of twc children-have been given assistance in -the past from the Social Welfare Branch, but when the::ian»diate problem^was over-come, help1 was terminated'. The* school social 1 worker^should^ visit the? homes of these children and either do any necessary casework, or refer the families to the Social Welfare Branch for further- assistance. Referral would be possible, of* course* onlyafter learnings.of;;the^assist-ance formerly given by the Social Welfare Branch. The most convenient way of discovering-casework:help: given to families by social agencies is through the Social Service Index; . A l l nine1 children are registered under their family names with the Social Service Index; If arrangements- are not made with the Index to clear the names of emotionally disturbed children, a major source of information and help is being overlooked. There is no wish to suggest, with these nine children* that toe school' social worker was negligent in not using the Index. The fact is that none of the- emotionally disturbed children were referred to him-by the teachers- as needing casework services., In -the past, school principals and* teachers? havegained :ulittlerelief from getting in touch with a social agency and saying, in effect: \"This child is an awful problem at school. Can you do> something for him?\". It is not yet to be expected that miracles will bejwrought. However* by close contact with* social agencies, the school social worker should be able to accomplish three things. In the first place, i t may be possible to stimulate social agency services. in the second place, information 93 learned from the social agency by the school social worker may, when . interpreted, be helpful to the teacher in understanding a child's problems and assisting him most effectively in the classroom. Finally, information gained will be of great value to the school social worker when doing casework with the parents.of emotionally disturbed children. A l l nine children in the sample survey who are receiving some case-work help but are in need of more, would benefit to greater or- lesser1 degree from the services of the school social worker. A corresponding proportion of the children in the grades and schools not touched by the sample are also probably in need of some casework help from the school social worker. 94 Chapter Six CHILDREN WHOSE NEEDS FOR CASEWORK HELP ARE UNKNOWN: THREE SCHOOLS The conditions causing emotional disturbance among half of the children in the sample survey group are largely unknown. The school nurses had conducted some investigation into the disturbance of five children, and the assistance of the mental health counsellor was secured for one child, but none of the sixteen children had been called to the attention of the school social worker as needing casework help, nor were social agency workers giving casework help to any of these sixteen children or their families. Yet, symptoms of maladjustment are sufficiently severe among a l l the sixteen children to warrant, i f not immediate intensivecasework* certainly Investigation by a trained social caseworker at the earliest possible moment. Some Ihvestigation of Circumstances Supervision received from the* school'nurses and, in the one instance, from-the* mental health counsellor,; can by-no; meansrhe-called thorough. It must be pointed out that while\" school nurses' and the mental health counsellor perform a worthwhile function in visiting' parents, and\"referring parents; and children- to others sources-of help, social casework techniques do not-appear to be used to any appreciable extent. Yet visiting-with1 the1 parents of emotionally-disturbed children-calls for-the' highest degree of social casework s k i l l , such as is possessed by a trained and experienced social worker; It is likely that the school social worker-, rather-than the mental health counsellor or school nurses, should be asked to visit the parents of emotionally disturbed:children*' 1. Alan was reported to have' only one continuous symptom of emotional disturbance--stuttering; On a short-term basis, he bullies or shows cruelty, is bullied by playmates, is a 'tattle tale' is a •showoff', is restless or excitable, and chews his fingernails. Alan-is ten years old and in grade four. The teacher has not met the mother. There is no evidence that'Alan is neglected at home; His speech defect is a very serious one. Commenting on why Alan behaves the way he does, the? teacher wrotes He seems afraid others are going to take advantage of him; always seems to be on the defensive. The school progress cards contained no comment-on Alan's maladjust-ment. Information from school health records indicates active attempts 96 by the school nurse to help the boy s October, 1950. Home visit made re speech defect. ^Mother to consider having him referred tohealth'elinic for consultation, but not anxious to do so. Alan has not been called to the attention of the school nurse or of the1 school social worker as having special behavior problems-; The mental health counsellor does not work in Alan's school. The family has no record with the Social Service Index. 2. Chuck'.s isymptoms of emotional disturbance were short-term only. On a short-term basis the teacher reported that he bullies 1 or shows cruelty, works far below capacity, is a 'tattle tale', is a 'show o f f , is a very poor sport\", lies or tells 'ta l l tales', and chews his fingernails. Chuck is seven years old and when the survey was made his grade two-class was- on split shift. The teacher has not-met the'parents but does not know how Chuck is being treated at home. Commenting on why Chuck behaves the way he does the teacher wrote: Started school too young. Mother gave wrong date of birth to get the child in school-The school progress card contained the information that Chuck took grade one at another school, and did start\"very early. However, after starting he was sent home for a year. School health records contained considerable information about Chuck. June, 1948. Formerly enuresis* but not for over a year. July, 1949. Occasional enuresis, especially i f overtired, or has a cold. Bites nails. February, 1950. In hospital for two weeks with left ear ache. 97 March, 1950. S t i l l trouble with ears. Both drums inflamed; November, 1950. Low arches. Referred to school medical officer re' ears. Chuck is not known to the nurse as a behavior problem, nor has he been reported to the school social worker; The mental health counsellor does not work in 'Chuck* s school. The family has no record with the Social Service Index. 3. Ed's continuous symptoms were- of general, mixed* and- slight emotional disturbance. The teacher reported that he cries or isrunhappy* and has 'obsessive' behavior. No short-term symptoms^ of maladjustment were reported. Ed is five years old and in grade one. The-teacher'has' met the mother, and reports there is no evidence that Ed is being neglected at home. However, he has very poor eyesight. Commenting on the reason for Ed's behavior, the teacher wrote that he is \"Too immature to do grade one work successfully.\" School progress card contained no written comments, but there was only a low achievement in an intelligence test. School health records contained no information which would help to explain Ed's maladjustment, but the school nurse supplied additional information: Teacher reported his low intelligence. I visited home re strabismus. Immaturity has caused the slight maladjustment found here; I advised mother to have his eye condition investigated, and he has since had a good correction by surgery. Ed has not been called to the attention of the mental health counsellor as a problem. The school social worker does not work in Ed's'school. Clearance with the Social Service Index indicated that the family 98 waa registered with the Family Welfare Bureau. Investigation revealed that during the war the Family Welfare Bureau acted for the Dependent's Board of Trustees in helping the mother pay confinement expenses for Ed. The father was on the way overseas: at the time and dependent's allowance had not yet been granted. A brief comment was made on the D.B.T. form, concerning the mother: \"Competency good.\" 5. Don was reported to have short-term symptoms of emotional disturbance only. He is aggressive, bullies or shows cruelty, is a 'show o f f , and has'obsessive' behavior. Don is eight years old, and his grade two class was operating on a split shift at the time the survey was made. The teacher reports that Don is hard of hearing and that he comes from a \"very poor, small home.\" The teacher has met the mother, and reports there is evidence- that Don is neglected at home. The school progress card contained no comment on Don's maladjustment, but his marks are very low, and his intelligence rating is slightly below average. Perhaps low marks and low intelligence rating are rather the result of poor hearing than any intellectual disability. School health records also Indicate that Don's home environment is not the most satis-factory» September, 1949. F e l l from tree and broke left arm. November, 1949. Broke-arm again. Home visit made. Mother works; older married sister does house-keeping at present. Father unemployed. Five children in family. Don had not been referred to the school nurse -or the school social worker as a problem; The mental health counsellor does not work in Don's school. The Family Welfare Bureau has given some help toihe family. In 1942 homemaking service was provided the mother when she was 99 unable to make plans-for the birth of her'child. The mother seemed disturbed over her situation and unable to make plans* 'not being very bright'. The family later paid for the services provided them. The children were well-behaved and- attractive. The family was co-operative'. Don's father was injured i n the f i r s t world war* and received a small pension. He was disfigured, and lost the use of one eye. During the depression he was able to earn 'seventy-five cents to one dollar a day' delivering wood, but the family has always been hard up financially. 5-ior Sid was classified by continuous symptoms as being[withdrawn1 and having habit disorders. The teacher reported that he is timid, and is left but of play groups'; is bullied by playmates, works far below capacity, daydreams far too much, chews his fingernails, and has 'obsessive' behavior; The teacher addedthe comments that he has , unsteady printing, and has few friends. No short-term symptoms of maladjustment were-reported; Sid is in grade two; His age was' not given, but he must be at least seven or eight years old. The teacher has met both the mother and the father* and states that there is evidence that Sid is neglected or inadequately cared for at home. The teacher 24 commented extensively on the reason for Sid's behavior. Relationships within the1 family, i f as reported by the teacher, are' extremely un-healthy. There was some evidence that the teacher was probing for infor-mation unnecessarily. Some of the information reported did not appear to be too reliable;' , The school progress record- contained nothing of help in understanding 24 See teacher's comment #1, and remarks, pp. 49-50 100 Sid's emotional disturbance. The school health record revealed that an intelligence test was'given in October of 1949. A low achievement was recorded, and Sid was \"put back into grade one\". October, 1949. Mother very co-operative. Wants\" son to get a good start. January, 1941. Home visits made re mental hygiene. Mother worried re Sid's poor progress in school and his poor social behavior. Appointment made for Mental Health Clinic. Mother a former social worker. Rather cool and unaffectionate. The school nurse-provided the additional information that the mother has not yet decided to attend Clinic, because \"The present teacher does not encourage this and the mother has left i t up to the teacher's decision. The school social worker does not work in Sid's school. The family is registered with the Social Service Index as: being-known to the Metro-politan Health Committee i However* a registration only has been made* There is no information about the family, since the mother has not yet taken her child to Mental Health Clinic. The mental health counsellor has been very actively working with Sid in efforts to help him overcome his problems* and his comments are11 printed in f u l l because they show co-operation between people helping Sid, and because they illustrate a fact well known to social workers — that much time and effort may be spent helping-a child, and; apparently very l i t t l e accomplished; Nevertheless, time\" is well expended, since ' a situation is never known until it\"is- investigated. December, 1950. Referred to me by school-nurse, who felt that Sid should be taken to the Metropolitan Health Committee Mental Hygiene Clinic, but she had been unable to get the mother's_consent. Sid was-not considered by his teacher as a problem in school, but the nurse, in home contacts, had come to the conclusion I that the mother needed help. The mother felt that other children were rough with Sid. She disapproved of his friends and seemed over-concerned about his relationships with age mates at school and in the neighbourhood. The-mother also felt that the boy had 'a mental block', since his progress at school is low (repeated grade one), and she-believes that he possesses average intelligence. January, 1951. I arranged for a socio-metric questionnaire to be given Sid's class. He received six votes (six classmates out of thirty-six received fewer than six). His chief attach? ment seemed to be with a boy of whom his mother does not approve. Sid did not indicate any choices for the question dealing with friends he1 would; like to entertain at his home. He was the only pupil who did not make any choice in this connection; February, 1951. I discussed the-above find-ings with Sid's principal and .teacher, and suggested that an attempt be made to encourage friendships shown by the sociometric. February 14. At the suggestion-of the nurse and school principal I visited the mother and dis-cussed with her the possibility of a clinic referral. Although friendly and reasonably co-operative, she showed decided reluctance in going ahead with the referral. She claimed that Sid had improved greatly in his relationships with other children, and she justified his quiet, rather withdrawn manner as being a family characteristic. She said that her husband is an introvert, and that both she and he have had few friends during their lives. She showed dissatis-faction with the type of people living in their-neighbourhood. In spite of her statement about Sid's recent improvement, she gave the impression-of being overconcerned about him. She appears to be an intelligent, well educated woman (qualified social worker). Her husband went part way through university and is employed as a radio-technician. February 15 and 19. Conference with teacher, principal, and school nurse. It was decided that, since the mother was not 'ready' for the Clinic, the matter be dropped for the time being. 21 February; I informed the mother of this decision, and suggested that she get in touch with me if any problems arise in Hie future. 102 The mental health counsellor said that he would like to keep in touch with the mother, if he has time, and'possibly at a later date help her to accept a clinic referral for Sid. Also* the counsellor feels that the child should be given another intelligence test, and that i f he s t i l l ranks low i t might possibly be helpful to interpret the results to the mother. In a l l probability the mother realizes her' son's low ability, but cannot admit i t , and therefore will hot give permission to have Sid attend Clinic where her suspicions might be confirmed. If the teacher actually has any influence over the mother* but will not exert i t to enable Sid to attend Clinic, then the voluminous information supplied by the teacher would have to be looked at in a more critical light. It may be that the teacher has an abnormal interest in Sid's emotional disturbance and i s trying to provide treatment herself rather than giving the task over to those more qualified to do so. The mother is evidently very disturbed. It is imperative, there-fore, that she visit the \"Mental Health Clinic i f at a l l possible. Whether she will yield to the persuasions of the mental\" health counsellor* i t is impossible to say. The school social worker might achieve more i f he were to talk over Sid's difficulties with the mother* but the school social worker does not at present work in Sid's school. No Special Attention Given Eleven emotionally disturbed children reported by teachers were not receiving casework help from any source, and no investigation of their circumstances had been made. Their symptoms of emotional disturbance 103 would certainly warrant the- school social worker*s~attention; However* none of the children- hiad beenreferredto the school---social worker;. 1. Fred- was reported- by his teacher as having continuous symptoms of withdrawal. It was stated that he works far below capacity, and;' that he