View report page

49. The arrangement of regular case conferences will not present major organisational
problems. It is not envisaged that these need occupy a full morning or afternoon
session; weekly meetings lasting from an hour to an hour and a half should be adequate
and can be fitted into the centre time-table without undue difficulty.
50. While the case conference will provide clinical guidance to the public health
staff, the actual management of the case will be in the hands of the centre medical officer
and health visitors in the course of their normal activities. At routine child welfare
sessions, however, a continuous flow of mothers and babies usually arrive for consultation
and this is not a suitable setting for intensive work. For such work, neither mother,
doctor nor health visitor must have the feeling of being pressed for time. Already
centre doctors often discuss 'special problems' by appointment, either towards the
beginning or end of their ordinary sessions, or during special sessions, e.g., at 'Toddler
Clinics'. Undoubtedly similar arrangements will have to be made for preventive
mental health work. In those child welfare centres where case conferences are introduced
the medical officer must have the opportunity of arranging special appointments so
that he can devote sufficient time for discussion with the mothers without disturbing
the routine work of the centre.
51. We refer in paragraph 36 to the formation of parents' discussion groups.
Mothercraft classes which are at present being conducted by health visitors in many
child welfare centres in the County form a useful nucleus, but they could be further
developed to allow for the attendance—at least at times—not only of the centre doctor
but also of members of the child guidance team. For afternoon meetings it would seem
possible to time such discussions so that they either precede or follow the regular case
conference. Evening meetings similar to those of parent-teacher associations should also
be arranged at not too infrequent intervals in order to give the father as well as the
mother an opportunity for discussion.
52. A programme conducted on these lines would cause least disturbance of existing
services. As training and consultation could proceed side by side the scheme would
provide for the extension of centre activities to include preventive mental health work
from its inception, though, of course, on a very limited scale at first. The scheme is
capable of modification and adaptation to local circumstances and of development in
the light of experience, and one of its great advantages is that it allows preventive
mental health work to be carried out as part of the normal activities of the child welfare
centre and by the centre staff themselves. Thus the mother will be advised by those who
may, in many instances, have assisted her already in the ante-natal period and in whom
she has gained confidence.
Summary of recommendations
53. (1) Preventive mental health is a proper field of development for the maternity
and child welfare services. A large measure of this work can be carried out by suitably
trained medical officers and health visitors. The need of including more intensive
training in preventive mental health in revised syllabuses for D.P.H., D.C.H., and Health
Visitor Certificate courses has been stressed. In-service training schemes for doctors and
health visitors employed at present on the maternity and child welfare services of the
County are recommended. These include:
(a) Broad orientation of all professional public health staff through seminars and
group discussions. Such training should be conducted at divisional level by the staff
of local child guidance clinics.
(b) Intensive training of a limited number of medical officers and health visitors.
Such training should also be conducted by the staff of local child-guidance clinics,
in the form of weekly case conferences during which problems of mental health arising
in the course of maternity and child welfare work are discussed on an individual
case basis and guidance is given on their management.
165