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REPORT ON THE WORK OP THE WEST HAM CHILD GUIDANCE CLINIC.
by Dr. T.P. Riordan, M.D., B.Ch., D.P.M.
As the table of statistics amply illustrates the nature and extent of the activities
of the Child Guidance Clinic during the year 1949, it remains but to draw attention to
those special features of the year's experience which appeared of importance in determining
the effectiveness of the Clinic as an Instrument for the prevention and treatment
of child problems.
At the beginning of the year the Clinic was burdened by a large waiting list. This
was discouraging to all concerned and the inevitable delay of months between the development
of the behaviour problem and its investigation and treatment had many undesirable consequences.
Sometimes interest in procuring Child Guidance waned because a child made
transient improvement during the protracted waiting period. Often the delay seemed of
critical importance in determining the difficulties encountered during subsequent treatment.
The early reduction of the waiting list was, therefore, a matter of some urgency. At
first, by careful screening of cases with regard both to their urgency and need of full
Child Guidance Service and by increasing the number of psychiatric sessions, its harmful
effects were minimised. Later when the Child Guidance team was completed by the appointment
in May, 1949 of a part-time Psychiatric Social Worker (Mrs.Kelly) it was reduced substantially.
A waiting list of 75 on 1st January 1949 became 23 on the 31st December 1949.
A considerable wastage of treatment time was occasioned by failure of children to
keep psychiatric appointments. Some 26% of appointments made, failed. This figure seems far
in excess of the normal expectation of failures and may be partly related to the high
percentage of mothers in this area who go out to work. It may be possible to reduce it by
increasing the amount of time which the Psychiatric Social Worker may allot for home
visiting.
With regard to treatment, a larger number of cases was dealt with during the past
year than in previous years. This was in some measure due to the policy of treating every
case in which even minor degrees of improvement seemed possible. Many children whose
intellectual level was so low as to limit the effectiveness of psychotherapy came within
the treatment group. In fact the majority of the children whose intelligence was assessed
by the Educational Psychologist were below average in their intelligence rating. In consequence
any appraisal of the results of treatment had to take into consideration, the
limiting factor of native endowment, and also the presence of irremediable environmental
stresses in each case. Only time and careful follow up studies can confirm the clinical
impressions gathered during the year. In general it appeared that young children responded
more rapidly and favourably to treatment measures. Also the parents of young children
appeared to be able to co-operate more fully and understandingly in carrying out the
advice of the Clinic. On the other hand treatment of the 8 to 12 age group was often protracted
and unproductive. Usually there were more setbacks, and the parents of this group, despite
their determination to be helpful, often appeared to have great difficulty in appreciating
and fulfilling the emotional needs of their children. Group therapy was found to be of
great value for certain children, and was used at some stages in the treatment of many.
A number of play groups, covering different age groups, and ministering to known personality
needs, were organised by Miss Prankford during the year. They provided an invaluable
treatment measure.
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