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Clinical Organization CLINICALORGANIZATION FOR CHILDGUIDANCEWITHIN THESCHOOLS By ELISE H.MARTENS Senior Specialistin the Education ofExceptionalawry= 46. 4. / BULLETIN1939, No. 15 a UNWED STATESDIPAITIEWO TRZINTERIOR Harold L. Ickes,Secretary OmanOrEDUCATION s .. s J W. Studebaker,Commissioner Vamp SeamGovaasinurt PanrsusaOVVICIII.... ... 00.WAIIIIINOTONt190 Pat adoby lb. lisperisteadased Demommew lIssibises,D. C.. ....peke 111some 4. s. ; AS'11- .. 1:4.'Ft" , , r -t r.r. _ , s to:As_ tie 4:4-;:01," . J b. 4. 0' ... ip Its 4r. .84 k I/ t5-. CONTENTS Pate FOREWORD V CHAPTER I. THE PLACEOF CLINICAL SERVICEIN THE SCHOOL PROGRAM___ 1 Growth of the clinicalpoint of viewin educationTypesof clinical e. organizationThe clinicalstaffThelarger functionsof clinical service. CHAPTER II. SOME STATEANDCOUNTYPROGRAMS___ _ _ _ _ _________ _ 9 The Stateprogramin MassachusettaTheOregonplanThe Cali- fornia planThe MarylandStateprogram organizedon a county basisA tax-supportedcounty guidanceclinioAcountyprogram in CaliforniaOtherState andcounty plans. 411 CHAPTER III. THERESOURCESOFSMALL CITIES 25 A city serviceCityand universitycooperationCityand county orState cooperation-7-Aplan of jointcity servicewith countyor StatecooperationGeneralcommentsonsmall cityprograms. CHAPTER IV. PROGRAM/IINCITIESOFMODERATE SIZE 34 Psychiatric servicefrom the StatePsychiatricservice froma com- munityagencyPsychiatricservice withinthe schoolsystem Generalcommenta. , CHAPTER V. THZOPPORTUNITYOF THELARGE CITY _ _ 45 Providence, R. I.Portland,Oreg.Jersey City,N. J.Rochester, N. Y.Newark,N.J.Minneapolis,Minn.Detroit,Mich. New York, N.Y.Generalcomments. CHAPTER VI.A CONFERENCEAND A SUMMARY 68 SELECTEDREFERENCES 74 A GUIDETOSTATES, COUNTIES,CITIES,ANDCLINICALAGENCIES REFERRED TO IN THIS BULLETIN 77 FOREWORD There is nò communityservice which ha's showna morephenomenal growth during thepast quarter ofacentury than the organization of clinical facilities forthe adjustmentof ,behavior and personality problems of children.Theterms "child-guidance clinic," "psychi- atric clinic," "behaviorclinic," "mental-health Clinic,"and other termshavingasimilar connotationarefamiliarto all who have anyresponsibility for thediagnosis andtreatment of children's diffi- culties.In 1896 the fitstpsychologicalclinic in the United States wasestablishedat the University ofPennsylvania, and theyear 1909sawthe first psychiatricclinic for childrenorganized in Chi- cago.Since that time thenumber of communitiesserved bypsy- chiatric child-guidanceclinics has reachedamark that probablylies somewhere between650 and 700. Amongthe interested agenciesare, ofcourse,the schools,the guidancefunction of which . is outstanding. Yet the limitations of budgets,both in school andcommunity admin- istration, have alltoo often seemedtoprohibit thedevelopment of a programwhich hasbeen recognizedasdesirable. In May 1988 the Commission&of Education invitedto Washing- tona groupof specialists whowereactivelfiengagedin work ofa clinicalnature, with particular rilationto child-guidanceprograms in schoolsystems. Thepurposesand findings ofthat conferenceare presented in chapterVI of this bulletin.Among the serviceswhich the confereeesrequested that theOffice of Education takieundercon- siderationwasthe Keparation ofmaterial for publicationdescrib- ing thetypes of clidical organizationfor child guidanceunderway in communitiesand schoolsystems of various sizes: Suchapublica- tion, itwasthought, mightstimulate schooladministrators andother Civic leaders,in tommunities inwhichnodefinite fòrmof clinical organizationasyet exists, to seek possibilities for iervioein this field.Moreover, by showingtrends of organizationto date,one maypointout the direction which futuredevelopment islikely to take. -# This bulletin isanattempt tomeet therequest of the conference. It doesnot purport to makeacompletesurveyof clinical organist- dons in operation, butrather 'topresent illustrative practice, folind insomeof the States, counties,and cities in whichthe principlesof child guidancehave taken deeproot. It reflects the deliberations of v A e . t. 4 . A ,/,t :" . *4 I 4 4.; . ._ .Vv.i4'e 4, 4, ;1"1 v A". 4.,140r.. 4_, 1 S.; : Jerte 410`_. VI FOREWORD the confereesaswellasthe dataassembledby theOffice ofEduca- tion &roughtheuseofinquiryforms. Itshows,first, certainor- ganizationplansfollowedon aState-wideor a county-widebasis; then proceedsto the effortsbeing made insmallcommunities;next, to programsin cities ofmoderate size;and,finally,toa considera- tion oftheopportuniti..: ofalarge city.There hasbeennointent to describein detailmethodsofprocedureor types of diagnosisand treatment. Thesearetheresponsibilityof thespecialists incharge of the localprogramafter itis organized,and itis assumedthat those appointedwill becapable ofdischargingthatresponsibility. Only the broadlines oforganization andrelationshipsare sketched, in orderthat those whoareinterestedmay see howafoundationcan be laid forthedevelopment ofaneffectiveprogram. To all who havesuppliedinformationthroughconferences,re- sponseto inquiry forms,or correspondence, theOffice ofEducation extends gratefulappreciation. The citie's,counties, andStatesré-, ferredto in the successivechaptersconstitute onlyasmallpropor- tion of the total number-ofcommunitiesin whichclinicalservice for children is underway.It isbelieved,towever, thatthepro- gramspresentedareillustrative ofthe varioustypes thatarebeing operated withadirect relationshipto the schools ofthecommunity. BREI8 GOODYKOONTZI AssistantCommissionerofEducation. a O a. , - : I f_c . ;; 25' 'Or 4. < . t 4 .; 1, . '244. 1-*4- i."-s4" ; -.4,. - i 15,,1 ..tst -; M . ``.4A. .4ttlXIM'Irj% AtitLir!%. jo,e, t. CLINICALORGANIZATIONFORCHILD GUIDANCEWITHINTHESCHOOLS CHAPTERF THE PLACEOFCLINICALSERVICEIN THE SCHOOL PROGRAM HE TERMS"clinic" and"clinical"focusimmediateattention Tuponthe individualand hisproblem.Originallyappliedto medicine, theyhavenowbecome identified*withnumerousother fields in which effectiveservice isdependentupon aclose diagnosticrela- tionship betweenclient and theperson orpersonsqualifiedto give him expert advice. Thesuccessivesteps involved ingivingfull clinical servicetoanyindividualareexamination,diagnosis,andtreatment,- with thenecessaryfollow-upto check andto insure results. GROWTH OPTHE CLINICALPOINT OFVIIM INEDUCATION In theschools theemphasisuponclinicalservicehasemerged asthe result ofanumber ofinterlockingfactors.Alwayspresentto acertainextent inaconstructiverelationshipbetweenteacherand pupil, ithas receiveditsgreatest impetus duringthepastquarter of acentury. The inaugurationof theuseof mentaltests, the attendant discovery of thewiderangeand diversityof capacitiesamongschool children, and theintensive effortsto provide forindividualdifferences- and needshave inthemselvespartakenlargely ofthe clinicalap- proach ineducation.The widespreademphasisuponintelligentand sympatheticpupilguidanceas amajorfunction oftheschoolhas .contributedsubstantiallyto the furtheranceof clinicalmeasures. Theacceptance of theconcept of the "wholechild"asthe objectof attention, withall itsinextricablyinterwovenimplications,hasneces- skatedaclinical studyof individualcases.Classroomteachers have becomemoreconscious ofthe need ofmalcingadjustmentsfor specific pupils. teachers andspecialclassteacherstiave beenap- pointedto handle serious instrudionaldifficulties.Sc/Wolcounselors, visitingcounselors, andvisitingteachers withexperience hiboth edu- cation and socialwork havefoundaplace inthe schoolsystemto study andto assist inadjustingpupil problemswithparticularatten- tionto the interrelationshipof community,school,and home.Health lind medicalspepiaiiita,psychometrists,and psychologistshave been -4 "C' t* . 11 -4 (JS *": , . r . 4,-4*4 1"t1.71: 4.271" 'rt. 'k44411Aqift -s, r VW f.. *. }_ 1'4 .:14_*4 °'''41: _jef741410r- ; t..i.4**1 .4i4$4,¡Zi 2 CLINICALORGANIZATION FORCHILDGUIDANCE addedto the school staff.The servicesof allthese peoplehavebeen indicative ofthe increasingimportance placeduponthe clirOcal aspects of the educationalprogram. Situations arisingoutside theelementary andsecondaryschools have likewisebeen responsible for'the growthof clinicalassistanceto cihildren ofschoolage,and these havehad theirpart in stimulating dieschoolsto further action.dommunity,State, andnationalproj- ects have been undertakenwhicharedirectedtoward theprevention of crimeand psychosis.Widely publicizedresearch findingshave pointedto maladjustmentsin childhoodas,forerunners ofserious delinquenCyand personalitydisturbance&Authorities inmental, hygiene haveemphasized theimportance ofdetecting andadjusting incipientpropems ofbehavior and ofthus obviatingthe dangerof theirbecomingacute.Teacher-trairiinginstitutionshave begunto makestudents recognizethe importanceof mentalhealth jntheirown experiencesand in the livesof thitirpupils.Privateenterprisehas .subsidized clinicalprogramsin demonstrationcenters,some ona temporary basis, othersascontinuingagencies. Thus, coming h&c'both withinand withoutthe educationalranks, significant influenceshave beenat work toconcentrate attentionupon the clinical'point of viewsliduponclifficalpractice inthe schools. It isnotsurprising,therefore, thatschool administratOrsshould be lookingforwaysandmeans tomake betteruseof the Possibilitiesfor clinical servicewhich theymayalready havein theirmidstandto addto them other services inan ory:nized fashion. TYPES ,01? CLINICAL'ORGANIZATION The desireforanorganized planof workhas ledtoavarietyof .. programs designed specificallyto adjust behaviorproblem§ ofpupils andmoregenerallyto help teachersto apply the
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