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have referred families for consideration to these committees. Family and hospital doctors
seek help with their cases and often give active support to the co-ordinating committee.
In 1956, I reported on an enquiry made in 1955 into the number of families in the county
who required help on the lines suggested in Ministry of Health circular 27/54, which
dealt with the prevention of break-up of families. An approximate estimate of the number
and distribution of hard-core problem families was made. The survey revealed that there
was good co-operation between the health visiting service and other statutory and voluntary
bodies, but the distribution of problem families, who tend to be found in or drift
to areas of poorer housing, had resulted in some health visitors bearing a disproportionate
case-load.
There was considerable evidence that the health visitor was well placed to recognise the
early stages of family breakdown and that her continued support of the family was essential
when her special skills were needed to cope with health problems. On the other hand, it
appeared wrong to divert the health visitor from her normal duties to carry out intensive
time-consuming casework with these families. When four full-time and two part-time
social workers were appointed on an experimental basis in 1957 to do family casework in
some of the divisions, the divisional treatment organisers also acted as their consultants
and supervisors.
Families are selected for this intensive casework by the divisional co-ordinating committees.
Broadly the families fall into two main groups:
(a) those in which there is some inherent and permanent disability such as severe
sub-normality, mental illness or low mentality which limits the extent to which the
family is able to carry on without support;
(b) those where it can be assumed that, given intensive support, the family will in
time be enabled to become independent of the social caseworker, although still needing
support from the ordinary social services.
Early in 1959 an attempt was made to assess the work of the social caseworkers. Clearly
no exact method could be devised to measure its effectiveness, but the points system
introduced for the 1955 survey was employed for periodic assessment of the families under
review. It appeared that more than half the families referred to social caseworkers had
shown some definite improvement.
This pilot scheme showed that selected social workers with sufficient time for intensive
casework with these families could achieve encouraging results. Although the work was
difficult and demanding, social workers attached to the public health department were
able to tolerate the inevitable frustration and disappointment without undue strain. This
was important, as the link with a family might have to extend over a period of years if
lasting results were to be achieved. It was decided, therefore, to make the scheme permanent
and to extend it by the appointment of further workers to bring the total staff up
to fifteen in due course. By the end of the year there were eight full-time social workers
and one part-time worker in five of the nine divisions. Moreover, five of the children's care
organisers had been selected to do similar work on a part-time basis, working with two
or three families and continuing their former duties for the rest of the time.
Unmarried mothers—Social work for unmarried mothers is carried out by five moral
welfare associations which receive grants from the Council. The two Church of England
associations employ between them 28 moral welfare workers to cover the county. The two
Roman Catholic associations have four social workers but use the Council's health visiting
service or sometimes moral welfare workers of Church of England associations to undertake
visiting for them. The Jewish Board of Guardians employs two moral welfare workers.
Unmarried expectant mothers are referred to these associations by the National Council
for the Unmarried Mother and her Child, by the public health, welfare and children's
departments, by doctors and hospital almoners, clergy and church workers, voluntary
organisations and members of the public. About 40 per cent. of the mothers are admitted
to the fifteen voluntary mother and baby homes in the county.
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