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introducing techniques of preventive mental health into the maternity and child welfare
service and offers at the same time the advantage of facilities for expert consultation.
43. At regular case conferences in child welfare centres, cases will be presented by
centre doctors and health visitors and discussed between them and the psychiatrist and
psychiatric social worker from a child guidance clinic in such a way that the principles
of taking a psychiatric history, the technique of elucidating important factors and the
understanding of underlying patterns will gradually become established. In the normal
way neither psychiatrist nor psychiatric social worker will actually see mothers and
children but, by discussion of the problems, will guide the centre staff in their own
handling of the case. There is no reason, of course, why the psychiatrist should not
sometimes be asked to see a case himself at the centre, in order to assist the centre staff
in its further management without referral to the child guidance clinic.
44. Cases which are found to require closer attention and follow-up than can be
given by case consultation in the child welfare centre will be referred to the child
guidance clinic, but with the great advantage of continuity of information and attention,
both at the stage of referral from child welfare centre to child guidance clinic and later
on in the course of treatment and after its conclusion.
45. The scheme would allow the inclusion of non-attenders of our welfare centres
whose problems may be noticed by the health visitor in the course of home visits, and
who, though unwilling to take part in organised centre activities, may yet welcome
the health visitor into their own homes. The health visitor will find the method of case
discussion of great value in the handling of such problems.
46. We have already stressed that the scheme must in its early stages be limited to
a relatively small number of centres. If it is successful, it can gradually be extended to
cover them all. Approaches and techniques are bound to vary in different groups and
no attempt must be made to standardise them for some considerable time—if ever.
On the other hand, the pooling of experience gained by the different groups will
undoubtedly be of mutual benefit. At first the case conferences at the centres will have
to be held frequently, probably once a week, but as the child welfare team gains experience
and closer links between child guidance clinic and centre begin to be formed it
may be possible to reduce the frequency of organised meetings, and the child guidance
staff may then be able to extend their contacts to other centres. However, the personal
link between centre doctor and health visitor on the one hand and psychiatrist and
psychiatric social worker on the other will always be maintained, even when formal
meetings take place less frequently.
Administrative implications
47. Consideration must be given to the practical implementation of the suggestions
made in preceding sections. As far as medical and nursing staff entering the public
health service are concerned, it is to be hoped that the need for more intensive training
in the field of preventive mental health will be recognised in revised syllabuses for the
D.P.H., D.C.H., and Health Visitor Certificate courses.
48. A programme of orientational training for public health staff within the County's
service presents no great difficulty. It seems desirable, particularly in view of our proposals
for intensive training in the centres, to conduct orientational activities at the local level
as far as possible and thereby to establish contacts between public health field staff and
the local child guidance units which will facilitate the introduction of intensive training
schemes. For the planning of the latter, one of the limiting factors will be the number
of child guidance teams which are both willing and adequately staffed to accept such
training commitments. It may also be possible to establish closer ties between the two
child guidance clinics which already exist in maternity and child welfare centres in
Divisions 2 and 3 and the child welfare staffs working in these centres.
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