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"This year, although a fruitful one, has been sad, in that we have lost the help of two valued workers, namely the
Play Therapist and an Educational Psychologist, both of whom have resigned in order to have their own families.
It is always sad when valued workers are lost, since this work depends so much on people who are fitted for it by
training and endowment.
There are, however, encouraging aspects on the Haringey scene, in that there are indications of greater cohesion in
the Social Services and greater communications between people working in the different fields. There is an
encouraging growth of awareness of the problems facing us, the new departments seem prepared to consider new
methods and approaches to increase the potential of the limited human resources at our disposal to deal with the
ever-growing pressure of social and psychiatric problems.
Regrettably, however, residential and educational amenities, although increasing, do not keep up with the evergrowing
need. The absence of a Day Maladjusted School in this area is very crippling indeed for the work of the
Child Guidance Clinic. The Tutorial Groups are valiantly trying to fill this gap, but without a doubt, we should
have a Day Maladjusted School in this area, where so many children are so very disturbed for so many reasons.
In this Clinic we continue to give a service as adequate as we can. One of the hopeful aspects has been
increasing responsibility that the Psychologists who have been with us some time, are able to take with their cases.
As a result the pressure on clinic referrals has fallen, and we are able to give more time and service to the very
disturbed ones who are eventually referred to us.
We have had 181 referrals: of these 6 were re-referrals; this we feel is not a bad percentage. Of the new referrals,
twenty-two cases were not proceeded with, either because there was improvement, or because the child was no
longer accessible to our care. There is, of course, a great deal of movement in this Borough, with families moving
out and some of our cases end in this way. In such circumstances we generally refer them to the new local
authority.
During the year we have colosed 175 cases, of which 106 improved as a result of help from the clinic; this makes
improvement reach sixty per cent. Of a further twelve cases of the 175, the mother reported improvement prior to
the children being seen, and another ten had moved away; the remainder were either those who were not
co-operative, did not respond to offered appointments, or had transferred to other agents, clinics, hospitals, etc.
Since the children we have had to deal with are the most disturbed ones (the less disturbed being taken over by
the School Psychological Service) we are increasingly using the services of hospital and in-patient units.
The Psychotherapist has treated thirty-four children intensively during this year, and the Psychiatric Social
Workers maintain contact with the families."
Dr. Graf reports as follows on the year's work at Tetherdown:—
"The scope of work in the Clinic has progressively expanded over the years and the establishment of all specialists
involved has increased except for the two psychiatric sessions, which have remained unaltered now for 21 years.
It is regrettable that as a result of the now definitely insufficient psychiatric establishment the Medical Director
has to delegate some of the work which falls within his competence to his non-medical colleagues in the clinic,
and that because of the lack of a medical assistant he has to spend much valuable time in routine work which
would not require consultant expertise and experience. In accordance with developing trends in community
medicine, more psychiatric time should be spent in extra-clinical activities by the consultant in Children's Homes,
schools, families, etc., but this has so far been impossible to arrange because of the extent of his intra-clinical
duties. In spite of the employment of two non-medical and two medically qualified sessional psychotherapists who
currently have 26 children in treatment, there is still a waiting list for psychotherapy of 24 children, which
although it is not excessive in comparison with other similar clinics, still re-emphasises the need for an increase in
the psychiatric and psychotherapy establishment. There are at present 58 children placed in boarding schools by
us.
The number of children referred for Child Guidance investigation in 1971 was 234. The majority (110) were
referred from schools through teachers, or by the parents themselves (30). The Chief Education Officer and
Educational Psychologists sent us 26 children, while 48 came through medical sources (family doctors, school
medical officers and hospital consultants). The remaining referrals reached us through the Social Services
Department (9), Probation Officers, Play Group Leaders and Citizens' Advice Bureaux.
It is very difficult to describe specific problems brought to the Clinic for advice, diagnosis and treatment, because
most children presented themselves with a multiplicity of symptoms and complaints for which there were usually
a whole constellation of causes responsible. It is very rare indeed in child psychiatry to find a case presenting with
a single symptom, such as bed-wetting, and equally there is nearly always more than one reason or cause for a
child's disturbed behaviour. In the majority of cases (86) it was impossible to describe any specific behaviour
which led to the referral, but the causes usually lay in circumstances within the family or the immediate
environment. Educational Problems (81) including learning difficulties and irregular school attendance, aggressive
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