TRENDS
-By JOHN P. HUBBARD, M.D., Contributing Editor
This and subsequent descriptions of events and trends are intended to be unbiaed and factual, pre.
seating both sides of con.roz’ersial natters so that conclusions na be formed from critical appraisal
of things as they are. These .rtate7nents do not necescarilj reflect th opinion of the u-ri/er nor a. they to be interpreted as official opinion of the Academy.
MEETING
OF
CHILDREN’S
BUREAU
ADVISORY
COMMITTEE
T
HE following report, submitted by Dr. Clarence H. Webb, official liaison repre-sentative from the Academy to the Children’s Bureau, summarizes the highlights of the meeting of the Advisory Committee on Maternal and Child Health and Crippled Children’s Services at The Children’s Bureau, January 30 and 31, 1950.This general advisory committee, constituted in 1948, meets once or twice annually to advise with the Maternal and Child Health and Crippled Children’s Services concern-ing the policies and programs of these divisions of the Children’s Bureau. It is to be distinguished from smaller technical committees which study and give advice on specific technical problems. Academy members in attendance at the meeting were: Harry H. Gordon, Chairman of the Advisory Committee, Allan M. Butler, John P. Hubbard, Thomas F. Shaffer, Clarence H. Webb, James L. Wilson, Leona Baumgartner, Associate Chief of the Children’s Bureau, and Katherine Bain, Director of Division of Research in Child Development.
Dr. Edwin F. Daily reviewed important developments since the last committee meeting. Attention was directed to the Annual Report of the Children’s Bureau in the December issue of The Child, wherein significant increases in child population and changes in maternal and infant mortality rates are reviewed. Cooperative planning and action between the Children’s Bureau and voluntary agencies has been fruitful. The Bureau called a con-ference of state Crippled Children directors and the staff of the National Foundation for Infantile Paralysis for discussion of administrative problems and establishment of princi-ples for cooperative action. Other voluntary agencies with which planning conferences were held included the National Society for Crippled Children and Adults, National Epilepsy League, Physicians League against Epilepsy, American Heart Association, Amen-can Public Health Association, American Hospital Association and the Junior League.
The Children’s Bureau has requested the Blue Cross Commission to urge the extension of family contracts to cover the cost of care of newborn infants. It was reported that the new Interassociation Conference of voluntary agencies, including the American Public Health Association, American Medical Association, American Dental Association, Amen-can Hospital Association, American Public Welfare Association and the American Nursing Association, considered the maternal and child health and crippled children’s services as one of their first fields of study and recommendations.
Emphasis on assistance with training of professional personnel, previously recommended by the advisory committee, has proceeded in various fields. Financial support to training centers in various states, in the form of scholarships or grants-in-aid, has been applied in
900 CLARENCE H. WEBB
the fields of rheumatic fever, audiology, premature care, school health services, dental
services, maternity and pediatric nursing and postgraduate courses for physicians.
Dr. Arthur
J.
Lesser reviewed trends in the expansion of maternal and child health and crippled children’s programs, mentioning a number of problems which were referred to working subcommittees of the Advisory Committee. Reports from the various state agencies indicated that increased funds, if made available, would be used toward insti-tuting or expanding programs for care of premature infants, sight conservation, school health, dental programs, and the extension of crippled children’s services to include cere-bral palsy, epilepsy, hearing defects, orthodontia and neurosurgery.The Committee was informed that Children’s Bureau Funds for the Crippled Children’s program in Arizona had been withdrawn after a number of conferences because of the State’s policy of excluding Indian children from the service.
The Advisory Committee was divided into subcommittees on Rural Care, Long-Term Care, Education and Training, and Need for Special Services, which considered arid reported an problems in these special fields.
The Subcommittee on Rural Health, Dr. John P. Hubbard, Chairman, recommended
as follows:
(a) That the Children’s Bureau promote Rural Health Conferences, including
repre-sentatives of producers and consumers of health services, acting insofar as possible through existing organizations, such as state or county rural health councils, state agencies estab-lished under the Hospital Construction Programs, the Rural Committees of the American Medical Association, and the National Health Council and state commissions established for the White House Conference.
(b) That continuing attention be given to regional planning toward establishing closer affiliation between community hospitals and urban centers in order to extend medical, dental, nursing and other personnel to outlying communities, recognizing the important
position of the general practitioner in these rural areas in maintaining maternal and child health.
(c) That development of local health units is a matter of urgent priority in the im-provement of rural health services.
(d) That the Children’s Bureau explore the possibilities of meeting transportation costs when needed to carry patients living in rural areas to hospitals, clinics or doctors, or to transport professional personnel to isolated patients, as one method of bridging the gap between needed services in rural areas and available services in urban centers.
The Subcommittee on Long-Term Care, Dr. Herbert R. Kobes, Chairman, recom-mended:
(a) That the Children’s Bureau, with the United States Public Health Service and state agencies, develop planning relative to construction of convalescent facilities in close proximity to existing medical services.
(b) That the Bureau stimulate services to provide educational facilities for children confined by long-term medical care, recognizing the desirability of periodic evaluation of the medical and educational programs in order to fit the individual’s needs, especially for older children.
(c) That the field of custodial care be explored.
(d) That consideration be given, in planning for long-term care, to the relative
ad-vantages of care in the hospital, the convalescent home, on the child’s own home.
The Subcommittee on Education and Training, Dr. Edward Rogers, Chairman, recom-mended:
(a) That financial aid for education and training be continued through
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edu-cational stipends, at least some of which funds shOuld be made available to teaching institutions for grants to students not involving prior commitment to return to service
in any stipulated area or state, with extension of grants to all relevant fields of service (physical therapy, nursing, nutrition, etc.) and (2) grants-in-aid to educational pro-grams, largely channeled through state agency control, but with permissive direct grants to universities.
(b) That studies be made of the pyramiding of time and costs involved in training, especially in public health fields, giving consideration to the standards for administrative medical personnel in the Maternal and Child Health field in relation to the problem of
recruiting and holding competent persons in these positions. It was suggested that schools
of public health might organize orientation courses in pediatrics, obstetrics, orthopedics, psychology, etc., and that the Children’s Bureau should make permissive the granting of stipends for the necessary time to achieve competence in such training. Attention was
called to the American Medical Association’s current two year survey of medical education.
(c) That the Children’s Bureau encourage comprehensive program planning and
func-tion on a regional pattern, recognizing the potential opportunities to the student, the resident physician and the practicing physician inherent in a regional relationship be-tween a teaching center and the surrounding communities.
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d) That enrichment of curriculum content in relation to public health programs be encouraged by the collection and dispersement of relevant scientific information, by the establishment of a summer institute or a series of regional institutes to whichrepresenta-tives from all appropriate educational institutions would be invited, and by aid to
uni-versities in studies and programs of interdepartmental cooperation, looking toward improved curricula in the fields affecting maternal and child health.
The Subcommittee on Need for Special Services, Dr. Nathan Sinai, Chairman, recom-mended:
(a) That the Children’s Bureau, recognizing both the value and the limitations of unattached clinics and isolated services within a community, encourage as a long-term objective the integration of the existing special services within the communities with a
view of their consolidation for a total plan of services to mothers and children.
(b) That priority of services be directed toward those conditions about which some-thing can be done (examples: epilepsy, newborn care, prematurity) rather than emphasis on fields of neglect.
(c) That diffusion of effort through multiplication of programs without accompanying development of personnel be avoided.
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d) That the Children’s Bureau study the services available to mothers, infants and children in the medical and hospital plans now in operation.(e) That the Bureau appoint a working committee to suggest which of the family
service plans (for example, The Health Insurance Plan of New York City, Permanent)
now in operation should be analyzed critically to determine what is being done and what should be done toward affording satisfactory maternal and child care.
(f) That consideration be given to a pilot study of a single community concerning its organization, its resources, and the development of those resources in the field of health, especially as related to maternal and child health.
dis-902 CLARENCE H. WEBB
cussed by Miss Katherine Lenroot, Chief of the Bureau. A conference of approximately 4,000 is anticipated, to be held during the first week of December, with the focus directed toward the mental, emotional and spiritual development of the child. Unanimous approval was given to a motion by Dr. John P. Hubbard to the effect that the Children’s Bureau call to the attention of the White House Conference National Committee the potential usefulness of the Academy of Pediatrics’ Study of Child Health Services, and recommend that a meeting be held between representatives of the White House Conference Corn-mittee, the Academy of Pediatrics, the Children’s Bureau, the U. S. Public Health Serv-ice, the Council of Medical Services of the American Medical Association and the Child Health Committee of the American Public Health Association, to discuss the develop-ment of community resources in maternal and child health.
The present status of Federal legislation relating to maternal and child health was discussed by Dr. Leona Baumgartner, Associate Chief of the Children’s Bureau. There
is more legislation related to children at present than at any previous time, probably occasioned by the rapid increase in the child population (40% more children 0 to 5 years than in 1940) mounting costs, curtailment of Crippled Children and Maternal and Child Health programs in many states, and general interest in child health.
Of the general health measures, the “omnibus” health bill is not expected to pass the present Congress ; “splinters” from this bill appear separately : the bill for Federal aid to medical education is in process of revision after passage by the Senate ; the bill for
local health units also has passed the Senate and is being considered by the House; amendments to the Hospital Construction Act which was passed last year increased grants to the states from $75,000,000 to $150,000,000.
More directly applicable to child health are: the School Lunch bill, which has been passed ; several bills related to child research, now before the Senate Committee on Labor
and Public Welfare ; 5.2352 and similar bills now in the House which would increase the authorization for Maternal and Child Health and Crippled Children grants to the states from 18.5 million to 50 million dollars ; and the National School Health Services bill, providing 35 million dollars, passed by the Senate and now before the House Com-mittee on Interstate and Foreign Commerce. Numerous amendments have been proposed to the latter bill and the Association of State and Territorial Health officers has recom-mended instead ‘‘the enactment into law of the type of bill which provides more money
for general health services for children.”
The position of the American Medical Association in relation to the Bills for School Health Services and Aid to Medical Education was stated by Dr. Ernest Howard ; that
of the Academy of Pediatrics toward Aid to Medical Education by Drs. Webb, Hubbard and Butler. A motion that the Advisory Committee indorse the principle of Federal assistance to education of medical and allied personnel, introduced by Mr. Harry Read, representing the CIO, was passed by majority vote.
Following the meeting of the Advisory Committee, the undersigned, recently appointed
as Liaison representative from the Academy to the Children’s Bureau, spent an extra day
in the various divisions of the Bureau in order to develop acquaintance with the aims and methods of these divisions. Discussions of the relationships between the Bureau and the Academy were held with Drs. Baumgartner and Daily, also with Dr. Harry Ong, former liaison representative.
(signed) CLARENCE H. WEBB, M.D.
