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Students must receive their practical training under the guidance of field work instructors. These
members of the staff are specially qualified for this purpose and arrangements have been made for a fourth
health visitor to undergo a special course of instruction early in 1967. The Council for the Training of
Health Visitors recommend that a field work instructor should have a case load of 300 families, to enable
her to have adequate time to instruct, supervise and guide the student. In addition, the field work
instructor must be available to meet the tutors, both at the Training College and clinic to discuss the
progress of the student. Due to the shortage of training staff it has not been possible to reduce case
loads to the recommended number.
Two students sponsored by other local authorities who received practical experience and training
in Haringey were successful in obtaining the health visitors certificate.
CO-ORDINATING COMMITTEE FOR WORK IN CONNECTION WITH PROBLEM FAMILIES
The Chairmanship of the Committee changed by rotation from the Medical Officer of Health to the
Children's Officer on 1st April 1966, and the Committee continued to bring together the different officers
and their views on the smaII number of families who found life exceptionally difficult. The study of these
families and their wants and needs helps to reveal the weak links in the organisation of the Welfare State,
and the different officers looked at the problems through various coloured spectacles.
A common early sign of family breakdown is the threat of eviction for failure to pay the rent,
frequently complicated with additional financial stress, due to hire purchase commitments and resort to
money lenders, and the causative factors often noted are mental illness and subnormality. The problems
of a family are sometimes solved over a period of many years by varying types of support given to the
family through the child-rearing periods.
The variety of officers who attend theCo-ordinating Committee is an indication of the variations
possible in the approach to these problems, variations from permissive to authoritarian ana from emotional
to material depending on how the problem is seen through the eyes of differentdisciplines. In the Health
Department some, but not all, of us take a biological approach rather than a sociological approach and
we see first the material shortcomings and tend to offer authoritarian aavice gained by past experience,
rather than to travel with the family in its wretchedness along the road of trial and error, in the hope that
it will find its own road to success.
In an environment of deprivation emotional factors may be transferred from one generation to the
next and in recent years there has been a noticeable increase in the number of chilaren admitted to the day
nurseries from homes where the mother is mentally ill. The child derives considerable benefit from
association with other children. Does this mean that we are making progress by breaking some faulty
links between mother and child with better prospects for the child's future or, ominously, does it mean
that in our new freedom of approach to mental diseases we are encouraging family life in situations where
it was formerly impossible? The child of a mentally disturbed mother has a poor start in life.
Many families still suffer from the problem of poverty and it is still possible for a man and his
family to take the rake's progress so well depicted by Hogarth in the 18th century, and in households
where life is aominated by the principle of the "wage stop", the children will meet with real hardship if
the parents indulge in excessive smoking, alcoholism or the betting shop. The biological approach to
these families sees them living at a marginal level of subsistence and seeks first of all to remedy the
material shortcomings, and the following are indications of what takes place.
Food. The cost of food is important and food values must be explained so that a family at the subsistence
level is encouraged to feed the baby on bottled milk in preference to the more expensive forms of dried
tinned milk.
Hygiene. Families not only need to understand hygiene, but economies must be explained to them so that
instead of acting as did one family using the very convenient but expensive disposable paper nappies for
the baby they can be encouraged to use the traditional cheaper towel nappies instead.
Heating. Many families fail to appreciate the difference in costs for heating, depending on whether oil,
coal, gas or electricity is used, but a family on a low income cannot afford to heat by electricity, and when
such a family is housed in a modern all-electric home with an immersion heater the consequential electricity
bill strikes like an evil spirit.
Fertility. For some families fertility isagreat advantage, but for the family living at marginal subsistence
level it is often a handicap for which positive help must be offered.
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