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The pre-clinical conference as a diagnostic screen in the child guidance setting : a preliminary survey of the use of the procedure in Canadian clinical practice, and an analysis of selected cases in the Child Guidance Clinic at Vancouver Chave, Estelle Christine

Abstract

The procedure known as the pre-clinical conference is used routinely as a diagnostic screen in certain child guidance clinics in the United States, with advantage to both clinic and client. This study surveyed in brief the extent of the use of the procedure in Canadian mental health clinics giving service to-children. In the Child Guidance Clinic at Vancouver, the procedure is used only infrequently. The study analyzed certain cases from the Vancouver Clinic - one group of cases in which the procedure was used, and another group in which it was not - to throw light on the purposes and results of the procedure. The background survey showed a wide variation in pre-clinical procedures in Canadian mental health clinics. A small minority used a conference of the full team, in all cases; a majority did not use the procedure at all; a small group used a partial team conference pre-clinically in selected cases. The purposes for which the pre-clinical conference was used were identified by each clinic, with results similar to those shown by the case analysis. Consideration of the use of this procedure is of concern to social, workers functioning as members of a clinical team, because of the growing emphasis placed by leaders in the field on the integration of professional skills and service. Conferencing is an important way in which this principle is implemented, and pre-clinical conferencing, an extension of the method, is a further possible means of translating this principle into practice. The first group of 12 cases in which pre-clinical conferencing was used, contained four sub-groups of three cases each, selected according to the reasons for the conferencing, and classified for convenience according to medical, psychiatric, psychological or multiple reasons respectively. The second group of cases, in which pre-clinical conferencing was indicated but not used, contained three representative cases. The case analysis identified the uses served by a pre-clinical conference (in the first group of cases), or the possible uses (in the second group). The uses included any or all of the following: (1) selection of cases-and intake; (2) referral to or from other agencies; (3) planning diagnostic study and exploration; (4) allocation of diagnostic responsibilities; and (5) delineation of a tentative treatment plan. The results identified by the analysis included facilitation of any or all of the following: (l) diagnostic process; (2) establishment of treatment goals and (5) economical use of staff time. While the routine use of pre-clinical conferencing for diagnostic screening is held to represent the ideal practice, it was seen to be unnecessary in some clinics, impracticable in others and inadvisable in others for specific reasons. In many clinics the need was met by use of the procedure in selected cases. This is the practice in the Vancouver Clinic, where it is employed at the discretion of the social worker. This places a serious responsibility on the professional skill of the social worker, necessitating alertness to indications for use of the procedure and awareness of the desirability of extending its use, where possible, in the interests of the wider application of the principle of integration.

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