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where the father is the stable element in the household, the health visitor has made
contact with him in the evenings or at week-ends, but where the father has been
recalcitrant or sexual problems have arisen the need for a male worker has been apparent
and much assistance has been afforded in such instances by male workers of the
N.S.P.C.C. and the National Assistance Board. Furthermore, attempts have been
made in several ways to increase the contribution which can be made by the general
practitioner, for his influence can be immensely valuable, especially when an authoritative
approach to the father is required. If the general practitioner normally responsible
for the medical care of a problem family is unable to attend the meeting of the divisional
co-ordinating committee when that family is under discussion, there is consultation
between him and a senior member of the divisional medical staff or the health visitor
concerned will call on him to obtain his views and his active co-operation. The
co-operation of the general practitioner in this way is most helpful and is a development
which both the Council and the Local Medical Committee for the County of London
wish to see encouraged in every way.
Services available to problem families
The health
visitor
As has already been said, the health visitor now, as in the past, makes a major contribution
to the work of improving the standards of problem families and for many
years to come she must bear the burden of combating their inertia, apathy and resistance
to changed social conditions and opportunities. In addition to the social work that
she does in the home, she can use her special position to see that the appropriate
personal health services and those of other statutory and voluntary agencies (including
marriage guidance services) are brought to bear on any difficult family situation.
The personal health services are able to play a very important part in the preventive
and rehabilitation work with problem and potential problem families and they
can be used very effectively to avoid the break-up of families and to help the family
over times of difficulty when otherwise the children would have to be separated
from their parents. In Annex C is shown in tabular form the use made of the
personal health services during 1956 to avoid the need for children to be received
into the care of the Council. Whilst many of the children so helped would not
necessarily come from problem families the table does illustrate the value of the personal
health services in making practical help available in a family emergency. The services
used include the home nursing, home help, day nursery, child minder and recuperative
holiday services. The home help service also provides child helps to attend at night,
or whole-time, children in their own homes who are temporarily deprived of the care
of their parent or guardian ; and other home helps who will attend in the early morning
or in the evening and at week-ends where children have to be looked after during
the daytime only when their parents are at work or to fit in with day nursery and school
hours.
In recent years new techniques have been evolved and scope has been given for
experiment and for the implementation of new ideas. One approach to problem families
has been on the basis of instruction in the home, including the Council's scheme for
specially trained home helps ; the provision of mothercraft and home-making classes
for selected mothers, the use of family service units, all aided where appropriate by
the use of a scheme to relieve strain in the home by providing one or other of the parents
with a recuperative holiday where this might avoid a breakdown in health or lessen
friction in a family. Another approach has been on psycho-therapeutic lines through the
use of the services of psychiatric social workers in the Council's mental health service.
A third approach has been in the use of residential rehabilitation centres such as the
Brentwood recuperative centre, the Mayflower home, or Spofforth Hall. A brief
descriotion of these soecial services follows.
Special home
helps
Towards the end of 1955 a scheme was prepared for the training of selected home
helps to work with the health visitor in the homes of families thought to be in danger
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