London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1956

[Report of the Medical Officer of Health for London County Council]

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The work of the P.S.W. in the day schools for maladjusted children is, like that of
the schools themselves, still growing and developing, but a certain pattern is emerging.
The fact that the child returns daily to the environment in which his troubles developed,
may mean that the period of overt disturbance lasts longer than if he were to go away
from home, but the very fact that his problems are, as it were, ' kept on the boil', means
that there is something for the P.S.W. and parents to tackle together.
In practically every case, the parents are anxious to be co-operative and, as a rule,
the child would not have been recommended for day school rather than a boarding
school unless it was felt that there was much that was positive about the home. Nevertheless,
deep problems do exist in many homes. The difficulties of parents and children are
usually intertwined in the most complicated way, and one cannot be tackled without
the other. Most, though not all, children come to the school through child guidance
clinics, and it is the P.S.W's job to see that co-operation between school clinic and other
social agencies is as close as possible. Only about one-third of the children attending day
schools for the maladjusted are actually receiving child guidance treatment.
In addition to this type of work, there are the more mundane, but equally necessary,
practical matters of clothes, holidays, free dinners, etc., to be dealt with. This side of
the work is undertaken by arrangement with the district care organiser (Education
Department), to avoid having too many visitors to the same family. Dental appointments,
incidentally, often provide plenty of scope for the P.S.W., owing to the anxieties they
arouse. There was the boy who felt it necessary to go to the dental clinic armed with a
large hammer hidden under his jacket—'just, in case . . . One of the joys of the
P.S.W's work at Gideon primary school is the fact that she has her office as part of the
school, and has constant informal contacts with both staff and children. This kind of
give and take is both fascinating and clearly valuable to her in her work.
At Bredinghurst, the only boarding school for maladjusted children within the
county boundary, the P.S.W. has been working since the beginning of 1950. She is
looked upon by the rest of the staff as a member of the team whose main concern is
with the parents and families. She spends a certain amount of time actually in the school,
where she has her own office, partly attending to correspondence, telephone calls and
record keeping but, more especially, in discussion with other members of the staff in a
two-way exchange of information and ideas. The P.S.W. attends the weekly staff
conference and is in day-to-day consultation with the resident staff, the headteacher and
the psycho-therapist who treats the children in the school. In the autumn and winter
terms, she leads a weekly evening discussion group of houseparents.
Unlike the children at the day schools, no children at Bredinghurst attend child
guidance clinics for regular treatment, though they sometimes visit their former clinic
in the holidays. This means that the P.S.W. carries the whole of the work normally done
by the P.S.W. at the clinic, and works in with other social agencies concerned with the
families.
Children at such boarding schools are separated temporarily from their families,
though they go home for weekends and holidays. This arouses special difficulties for
many parents. At first, there is the feeling of relief when the child who is a symptom of
the family disturbance is away from home. Sometimes, this feeling turns to one of anger
and resentment when other people are, apparently, dealing more successfully with the
child. The P.S.W. has to be willing to accept these changing attitudes and to help the
parents to bear them. Frequently, the removal of one child from a family uncovers
other problems. The P.S.W. is invited into family discussions with other children, whose
difficulties were ignored, or unseen, while the maladjusted child remained at home. The
results of a P.S.W's work are not often spectacular. Parents with years of practice at
being not very successful with their children are not going to change over night,
particularly when their own emotional problems are often so deepseated. The wonder is,
that so many of them can modify their own attitudes sufficiently so as to be a positive
help to their maladjusted children.
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