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Long-term dependency and maladjustment cases in a family service agency : an exploratory study of data and method. Marcuse, Berthold


So-called "hard core" cases have long been known to welfare agencies and to communities; but proper definition and understanding is still often lacking, while attention has not been sufficiently directed to the problems of adequate diagnosis, early recognition, treatment and prevention and the social or community aspects as well as the personal or single-agency implications. The present study is an exploratory analysis, examining data and methodology, of such groups in a particular but strategic setting - the family service agency. After (a) considering popular and more acceptable definitions of "hard core" cases, it (b) reviews briefly some of the statistical indications of long-term cases in the Family Service Agency of Greater Vancouver, and proceeds to (c) a detailed analysis of a small selected group who manifest all the characteristics of chronic dependency and maladjustment. The systematic exploration of all the complex elements in the pattern of multi-problems dependency is the main theme of this study. Despite gaps in information- it proved possible to list these factors within three subdivisions:- (a) Socio-economic factors and presenting problem, (b) physical and mental health, and (c) premarriage history. A significant number of common elements were shown to be operating within each family. These elements were studied in conjunction with family behaviour patterns and a further correlation between them and the behaviour patterns seemed apparent. In spite of the complex inter-relationship of personality and environmental factors, it is possible to advance the view that multi problem families and potentially chronic cases are susceptible of relatively early identification. This would be a major step towards more effective diagnosis and treatment planning for the multiproblem family. Effective treatment planning and possible preventive techniques however, raise the essential issue of adequate community and agency resources. A Family Mental Health Centre is one special medium, as are some of the environmental services developed in such countries as Sweden and Great Britain. The tentative conclusion favours a balance between the American "mental health" approach, and that of coordinated social and environment services. As an exploratory study, it does not minimize the urgent need for further research.

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