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medical press. The percentage incidence of problem families in the nine divisions ranged
from 0.2 to 2.28 per cent. of all families with a child or children under five.
A disproportionate amount of the time of health visitors as well as of many other care
workers, both statutory and voluntary, was being taken up by socially handicapped
families. Their tendency to gravitate to the poorer housing areas has produced a gross
disproportion in the case load of individual health visitors—for as the survey has shown,
as many as 30 such families may live in the area of one health visitor while only one or
two, or perhaps none, may live in the area of another. The situation presented an
administrative problem which has not been easy to solve. The introduction of the
practice of grouping health visitors in teams, each team serving an area, has helped to a
limited extent to spread the case load. In addition, the Council in 1957 decided to appoint
for an experimental period four full-time and two part-time social case workers in the
public health department to work with problem families in three divisions of the
county. These social case workers are the key workers in the field work concerning
certain problem families selected by the divisional co-ordinating committees. The
function of these case workers is not necessarily to replace other statutory or voluntary
workers who may be concerned, but to co-operate with them and to know and consider
any major proposals that may affect the family. In the light of experience gained similar
appointments will be made in all divisions in the near future.
Family Service Units have carried out their invaluable work in several parts of the
County, namely, Kensington and Paddington; Islington, Finsbury and Holborn;
Stepney, Poplar and Bethnal Green; Southwark and the northern parts of Lambeth
and Bermondsey. In 1956 the Council provided a training course of two weeks for
selected home helps who were willing to undertake such arduous duties with problem
families under the direction of the health visitor.
Problem family mothers with their children under five years of age have been sent
for periods of two months to rehabihtation homes. From 1951 to 1954, 23 families
were sent to Spofforth Hall, or the Brentwood or Mayflower homes. The results
obtained have on the whole been disappointing for, in spite of constant support on
their return by health visitors and other social workers, many families tended to slip
back quickly. This has happened more especially if the father himself is unstable, if
housing conditions are intolerable, or if another pregnancy increases the stress on
the family. The inevitable, if temporary, break-up of the family was often in itself an
adverse factor. The mother, with or without reason, tended to become anxious about
the use her husband might make of his new-found freedom or the husband became
intolerant of his wife's absence. It became clear if families were to be sent away from
their own environment that they must be carefully selected for this purpose.
(b) Mental health—Child psychiatrists in the child guidance clinics set up to deal with
the maladjusted school child have pointed out that some emotional disturbances might
have been prevented or minimised had the case been seen earlier. A study group,
under the chairmanship of Dr. J. Bowlby of the Tavistock Clinic, was formed in
1953 to consider how mental health work might be brought into the maternity and
child welfare field. The group's conclusions were published in my annual report for
1954 and in the medical press. The Council accepted their recommendation that case
conferences of medical officers and health visitors with a child psychiatrist and psychiatric
social worker would provide a training for maternity and child welfare staff and at the
same time give an indirect service to mothers and children. Case conference groups were
formed in a number of divisions and are being continued. The relationship which has
arisen between maternity and child welfare and child guidance staffs has proved of great
value to both services. On the one hand, there is a better insight into mental health
problems which manifest themselves in the abnormal behaviour of young children; on
the other, psychiatrists have been brought into constant touch with behaviour problems
of more children younger than those normally brought to the child guidance centre. It is
possible that the original view of the study group that a succession of medical officers
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