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It seems likely that child-guidance clinics will not fall
directly within the province of the Regional Hospital Boards.
This seems desirable in that child guidance is much wider in
implication than child psychiatry. To quote the "Lancet"
(6th December, 1947) : " Modern child guidance comprises
work in maternity and child-welfare clinics; in schools, by
selection and grading of pupils and by special teaching methods;
in foster-homes, boarding homes and residential schools; in
children's hospitals, notably orthopaedic and fever; and, finally,
in diagnosis, disposal and treatment, at the clinic itself, in work
in the home, and in the provision of special hostels for treatment.
The authorities concerned in all this will include regional
hospital boards, local health authorities, local education authorities,
and the Home Office, and we should recognise that the
first-named has no pre-eminence of interest: indeed, the highest
common factor, as it were, is the local education authority,
which of all public bodies now has far the most intimate concern
for the mental and physical development of children between the
ages of 2 and 18. It seems logical, therefore, for the great
preventive mental-health service of childhood to remain an
integral part of that system, and there seems to be no paramount
administrative reason for changing the existing arrangements
by which child guidance is administered by the School Medical
Service, which is itself intermediate between the education and
the health interests. Thus placed, the child-guidance services
can be linked through the School Medical Service with hospitals
and specialists, and particularly with paediatrics; and there is
no reason why the psychiatrists employed in this work should
not be carried on the establishments of regional hospital
boards."
Results of treatment at the Clinic have been encouraging.
It would be ill-advised to use the term "cures" in relation to
child-guidance successes. It is our objective to help the child
to adapt and adjust itself to its own problems and to any
difficulties in the home and school environments. In the case of
the older child, the approach may be direct—i.e., an effort is
made to investigate the child's mind and, by discovering faulty
mental attitudes, aid the child to a reconstruction of its mental
life. In the case of young children, the approach is usually
through observation of its play activities. At present two play
groups are functioning under the direction of the psychologist.
Coincident with the treatment of the child is the approach to the
parents (usually the mother) by the psychiatric social worker.
The nature of the problem or maladjustment of the child is
explained to the mother, and she is given advice and help on
how best to cope with the management of the child. Any
specific educational difficulties are dealt with by the educational
psychologist. In this way the child-guidance "team" works,
and the considered judgment of the team is brought to bear on
each particular problem child. In a number of cases the home
situation has been found to be extremely difficult or irremediable.
In such cases, recommendation has been made to "board-out"
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