TRENDS
By JOHN P. HUBBARD,M.D., Contributing Editor
This and subsequent descriptions of events and trends are intended to be unbiased and factual, pre senting both sides of controversial matters so that conclusions may be formed from critical appraisal of things as they are. These statements do not necessarily reflect the opinion of the writer nor are ihey to be interpreted as official opinion of the Academy.
THE CHILDREN'S BUREAU LOOKS AHEAD
By KATHERINEBAIN, M.D.
P
ERHAPS instead of saying “The
Children's
Bureau looks ahead,―one might more
correctly say that the Children's Bureau looks around at what is happening and peers ahead into the fog. For though one can identify many problems arising out of the emergency, their outline, bulk and duration are still indistinct. Many of the words we are using today are those we learned to use 10 years ago—day care, civil defense, evacua tion. But the emergency of 1951 is far different from that of 1941. Then we were faced with a clearcut objective which could be mastered by rapid, all-out effort. We had before us something to be done quickly and finished. Today no such well-defined goal is visible. All one can say is that it looks like a long pull—not five years, but perhaps 15 or 20. In a quick dire emergency there is justification for abandoning some basic services. In view of the long pull ahead of us now, it would be suicidal to fail to meet basic needs of children. This country cannot afford to sacrifice one generation. In World War II our potential allies far outnumbered our enemies. Today our potential enemies far outnumber
our friends. Each individual American is an asset which needs to be conserved.
Though
the size of the emergency, its speed of build-up,
and its ultimate duration
are unpredictable at this moment, nevertheless we are in it, and planning has to take place. The Children's Bureau is faced with problems for which answers must be found. Emergency activities which bring back memories of 10 years ago are beginning to com pete with basic programs for staff time. Day care of children of working mothers is again a public issue. Manpower policies, now being formulated, may greatly influence the pressures for employment of women. The need for day care, though high-lighted by an emergency, is part of a long-time trend in this country toward increased employment of married women. Whatever one's personal views may be about women with children working, the practice has become wide-spread and is now part of our culture. In the past, public programs of nursery education have been developed primarily as an accommoda tion to adults—in the 30's to make work for unemployed women, and in the 40's to get
women into factories. Perhaps this time the needs of children will come first. In January
1951 the Children's Bureau and the Office of Education jointly called together a group
of educators and social workers to discuss the present situation, to review past experience, and to recommend policies in the management of day-care programs which would insure their serving children's needs as well as those of adults. The Maybank bill, Senate bill
Dr. Bain is Associate Chief for Program Development, Childrens Bureau, Social Security Admini
stration, FSA, Washington, D.C.
TRENDS 603
349, to provide aid for community facilities and services (in some ways like the Lanham
Act) has been introduced into the Congress. Under this bill, were it to pass, day care services could be provided. How great the need will be for these services still remains to be seen. The Children's Bureau, together with the Office of Education, is exploring needs and ways to meet them.
Civil defense is with us again, though in quite different terms from 1941. Its focus today is on emergency care in the event of bombing. Morale building through civilian participation in drives and in community activities is not part of the present civil defense program. The Children's Bureau has already helped the Federal Civil Defense Adminis tration to prepare guide materials for the use of State and local civil defense offices in laying plans for the protection of mothers and children in the event of enemy attack. Evacuation of children from danger areas, plans for which were so well elaborated last time, is not a major element in the present planning. The experience of Britain in World War II and the type of bombing to which we may be subjected in the future have changed the thinking. Though civilians may have to be moved, wholesale anticipatory evacuation of children from our large cities is not contemplated.
A new term has been added to our vocabulary, ‘‘claimant agency.' ‘Under an Execu tive Order, certain agencies of the Federal Government have been designated to act as spokesmen for civilian needs. The Federal Security Agency under this order is claimant agency for health, welfare, recreation and education. The Public Health Service has assigned staff to determine the needs of hospitals and institutions for construction ma terials, equipment and medical supplies. Children's Bureau staff is working with the Public Health Service on the special maternity and pediatric needs.
Community “sorespots― are beginning to appear just as they did in 1940 and 1941. The Savannah River project is creating great problems of sanitation, health, housing and education over a wide area involving several States. The new Paducah area project will bring on similar problems. The field staff of the Children's Bureau has contributed time to surveys of these areas and to planning for meeting the special needs of children who have migrated there with their families.
What of EMIC ? Inquiries are coming to the Bureau from doctors, from State health departments and from citizens about a revival of the Emergency Maternity and Infant Care program. Care of infants of service men seems not yet to be a great problem, but wives of service men are pregnant and doctors are asking who is to pay for their care. The Children's Bureau policy has been to keep its eyes open for evidence of need, to listen, and to be ready with the facts in case of need. At the present time (Feb. 1 5, 1951) no position for or against a new EMIC has been taken. The march of events will have to determine that position.
These and other emergency activities have been added to the work load of the Chil dren's Bureau staff, a load already increased by more funds for grants to State with no more funds for administration. In 1950 the Congress authorized a higher ceiling for grants, though it appropriated less than the amount authorized.
Funds for Grants-in-aid to States
1952 Presidents 1950 1951 Budget (now be
604 KATHERINE BAIN
States are planning to use the increased funds in a variety of ways. Programs for
children with epilepsy, with cerebral palsy, and with hearing defects are being started
or expanded in many States. Many of the States have registered two primary needs for
which some of the increased funds should go—training of personnel and evaluation of
services. Shortage of staff is the single greatest obstruction to the ‘‘extension and im
provement of services for mothers and children,' ‘the purpose for which the funds are
granted. At a recent advisory committee on training, the consultants stressed the need
for using increased amounts of MCH and CC funds for training. They placed the em
phasis on training medical personnel, rather than on nursing, medical-social or nutrition,
and especially on training in growth and development.
Second only to training is the increased interest in evaluating programs. Services are
provided year after year without enough thought about changing emphases. Are the
services being provided for children ‘‘good―? Do they accomplish the end for which they
are designed ? Perhaps no type of research is more difficult than program evaluation,
because the criteria of success are hard to define and the tools for measuring success are
poor indeed. In spite of difficulties we may anticipate that more States will be interested
in setting up studies to try to determine adequacy and effectiveness of what they are doing. At the close of the war it looked as though the Children's Bureau might push ahead
on its own research program. Legislation was introduced into the Congress by Sen. Paul
Douglas of Illinois for a program of grants to institutions and universities for research in child life. Though hearings were favorable, no action was taken. New bills along the
same line have been introduced into this Congress by Mr. Douglas, Rep. Richard Bolling
and Rep. Jacob K. Javits.
We came out of the last war a research-conscious people. One of the fundamental
differences between a dictatorship and a democracy is in the attitude toward investiga
tion. A dictatorship accepts the status quo as right, final, and not to be questioned. A democracy constantly questions, seeks new ways, hunts new knowledge. We learned the great value of basic and applied research in the physical and biologic sciences and to some extent in the social sciences. The layman knows now it is possible to study people and find out what makes them “tick.―With a long pull of many years ahead of us, it is unthinkable that we abandon or even curtail our search for knowledge.
The White House Conference in December 1950 was one stage in a movement which began two years ago in grass-root planning and which will go on with increased mo mentum in State and local action. In terms of the development of important fact-finding
material and mobilization of nationwide attention on children and youth, the Conference
has already made an important contribution to the children's field. As in the instance of the Academy of Pediatrics Study of Child Health Services, it is not yet possible to meas ure adequately the full effects of this great enterprize. But if citizen interest is an indica tion of impending action, communities will see real change.
Everything we do in any agency today needs to be looked at critically to determine its
