r i Program / for Social and Health Work in Philadelphia SOCIAL AND HEALTH COMMITTEE of THE CHILD FEDERATION 200 SOUTH JUNIPER STREET PHILADELPHIA (Second Edition) Co-operating Agencies American Red Cross Pennsylvania and Delaware Division Southeastern Chapter—Home Service Babies Hospital *Babies’ Welfare Association Board of Public Education Bureau of Compulsory Education Physical Education and Recreation Public Schools School Nurses Catholic Children’s Bureau Child Federation Children’s Aid Society Children’s Bureau Children’s Bureau of the Emergency Aid Children’s Hospital Church Mission of Help Community Service Department of Health Division of Child Hygiene Division of Housing and Sanitation Division of Vital Statistics Department of Public Welfare Federation of Jewish Charities General Social Service Bureau Mount Sinai Hospital Jewish Hospital Jewish Maternity Girls’ Aid Home Missionary Society Howard Hospital Jefferson Hospital Jewish Children’s Bureau Juvenile Aid Society Mothers’ Assistance Fund *Has been merged with The Child Federation. Municipal Court Criminal Division Domestic Relations Juvenile Misdemeanants Neighborhood Center Northern Liberties Association Parenthood Conference Pennsylvania Hospital Pennsylvania School for Social Service Personal Service Bureau Philadelphia Association of Day Nurseries Philadelphia Hospital Philadelphia Housing Association Philadelphia Pediatric Society Philadelphia Tuberculosis Committee Phipps Institute Playgrounds Association Polyclinic Hospital Protestant Episcopal City Mission Public Charities Association of Pennsylvania Public Education and Child Labor Association Registration Bureau St. Vincent de Paul Society Salvation Army Settlement Association Seybert Institution Society for Organizing Charity Society for the Protection of Colored Women Society to Protect Children from Cruelty Starr Centre Association Travellers’ Aid Society Union Benevolent Association United Hebrew Charities University Hospital Visiting Nurse Society White Williams Foundation for Girls 3 Introduction This Program was drafted more than a year ago. Its purpose was to clarify our thinking as a necessary pre¬ requisite to effective action. Moreover, we had been think¬ ing chiefly in terms of individual agencies or of one line of work. This was an attempt to stimulate thinking in terms of the city of Philadelphia. After being approved by the members of the Social and Health Committee of The Child Federation—then representing twenty-five private and gov¬ ernmental agencies—it was submitted to the boards of these agencies. There it was the subject of many discus¬ sions but was finally approved by a majority, the others declining to commit themselves at the time The purpose of the Program was achieved, however, as the discussions compelled definite thinking on the prin¬ ciples involved. The result has been a notable develop¬ ment of public opinion which has found expression in the discussions of the Constitutional Revision Commission,* now in session, in the attitude of private agencies toward the administration of an emergency fund from the city treasury for the relief of widowed mothers, and in the atti¬ tude of certain private agencies which receive government subsidies or whose boards contained public officials The definite proposals have necessarily been consider¬ ably revised during the course of the year, for, as proph¬ esied, certain things have been accomplished, the emphasis on others has been changed. The new city charter has been adopted, adjustments between departments advocated a year ago are now being made or have been made, the greater efficiency in those municipal services which have to do with sanitation in order that homes and neighbor¬ hoods may be kept cleaner and more wholesome, is now happily under way The new city charter creates a new Department of Public Welfare, in whose success all the agencies are *The Public Charities Association is advocating such a change throughout the state. 4 deeply concerned. Its organization and effective function¬ ing will be one of the most important items on the local program during the coming year. Both governmental and private agencies have joined in a most promising effort to demonstrate the practicability of co-ordinated work as outlined under II Private Agencies, Co-ordination of Work, etc. They have selected one of the „ old wards as the Social and Health District. This ward, which contains a population of approximately 23,000, was selected because it is one of the oldest and most congested sections of the city where the technical difficulties to over¬ come are greatest and where there were already the largest number of active agencies. Coincident with this, func¬ tions are being definitely stated, methods improved and standards raised. Sixty-seven agencies are now co-operat¬ ing in this effort under the following groups: Public Health Nursing Agencies Case Work Social Agencies, with Reference to the Family I General II Protective III Child Caring IV Hospital Social Service Community Agencies February 1920 Program For Social and Health Work in Philadelphia The Social and Health Committee, composed of repre¬ sentatives of many agencies which deal with civic and social problems affecting the well-being of the children of Philadelphia and their families, after a year of co-operative effort which has brought these agencies to a better mutual understanding of each other’s aims and methods, believes that the most promising forward step now may be taken through the formulation and acceptance of a program that will be city-wide in its scope and will include all phases of social and health work. This program must be construct¬ ive. It must: State general principles which will serve as guides in formulating concrete proposals Formulate a series of concrete proposals dealing with the most pressing needs of the moment. This list, however, can not be made complete and will neces¬ sarily be subject to constant change as items on it are disposed of or as other needs become press¬ ing I STATEMENT OF PRINCIPLES TO SERVE AS GUIDES IN FORMULATING CONCRETE PROPOSALS Distinction Between Private and Official Agencies As the first item in such a program the committee makes the following general statement of belief: That there should be a clear distinction between private or citizens’ agencies and official or governmental agencies The former, it believes, are primarily for the purpose of study, experiment, demonstration and informing of pub¬ lic opinion. In general their functions are to study and report upon conditions; to initiate and try out new policies; to carry these on at least until their utility has been estab¬ lished, when they may or may not be taken over by gov¬ ernmental agencies; to maintain experimental enterprises 6 designed to demonstrate the value of social theories; to supplement the work of weak governmental agencies when necessary but only so long as necessary; to keep constantly in touch with the work of governmental agencies so that they may aid by constructive criticism and support; to carry on a constant campaign of information designed to interest and inform the general public as to needs and opportunities within their respective fields The latter, it believes, are primarily for the purpose of administration. Their chief function is to carry out with the greatest possible technical ability the duties imposed upon them by law. Certain governmental agencies are charged with experiment and the dissemination of information, but in general such work is limited to experi¬ mentation with processes and to the dissemination of facts and statistics in which propaganda or the expression of opinion is reduced to a minimum. The distinction here made, of course, would not in any way curtail the right of a governmental agency to adopt improved methods or to request enlarged powers or wider scope when its experience shows that they will increase its efficiency. Such initiative on the part of governmental agencies is to be encouraged. Nor should the distinction be interpreted to mean any cur¬ tailment of the right of governmental agencies definitely charged with this duty, to supervise private agencies which exercise any authority over the persons or property of others. Private child caring agencies, for example, should be under the closest supervision of governmental agencies. But the functions and responsibilities of each should be clearly distinguished. In this connection it should be stated that the governmental agencies in mind are the continuing departments or bureaus, not elected officials or legislators who are elected to carry out policies which have been put before the electorate or to frame such policies. The latter do not come within the purview of this program nor do the commissions or committees appointed by the admin¬ istration or the legislative body with power only to inves¬ tigate and report or advise In other words the private or citizens’ agency repre¬ sents a group of citizens who, because of special interest in 7 some matter of community importance, have associated themselves to study it more thoroughly than they could in their individual capacities, or to support such study, to demonstrate the validity or utility of proposals that they believe will promote the public welfare, to maintain a closer and more informed contact with those governmental activi¬ ties in which they are particularly interested than would be possible for them as individual citizens; and to place before their fellow citizens whose interest in these particular mat¬ ters is not so keen, their findings and recommendations as aids in the formation of a constructive public opinion On the other hand governmental agencies, which are supposed to represent, not a special group, but the whole electorate, cannot successfully originate policies or carry through those which have not received a large measure of popular support. Attempts to do so would not only arouse opposition on the score that they are seeking to exercise powers with which they have not been entrusted, but would lessen their efficiency by distracting them from their prime function* Close Co-operation But No Organic Connection Granted these distinctions between private or citizens 5 agencies and official or governmental agencies, it follows that while there should be the closest practicable co-opera¬ tion, that while consultations and conferences should be frequent and frank, there should be no organic connection between the two kinds of agencies. Representatives of one should not sit as members of boards of occupy offices that will give them authority in the other. Public funds should not be granted to private agencies, nor should private con¬ tributions be turned over for expenditure to governmental agencies *There has been some confusion of thought on this subject due to the wide-spread breaking down of distinctions between private and governmental agencies during the War or during a flood, conflagration or other local disaster when it was necessary to mobilize all the community’s resources for quick, decisive action. So, during the crisis of a disease, a man may save his life by taking a drug. But no one would argue from this that he should continue drug taking after he has recovered from the disease. Then he should build up his health by means less immediate but more permanent in their effects. 8 The committee feels it necessary to make this statement because there has grown up in Pennsylvania a system of interchange between private and official agencies, and of grants of public funds to private agencies, that has resulted in a lamentable confusion as to purpose and responsibility and this in turn has resulted in a lessened efficiency. Civic and social agencies, whether private or governmental, are not exempt from the rule that one can not serve two mas¬ ters. The private agency that accepts public funds, that must consider the wishes or necessities of a public official, is not free to blaze the way. Its liberty is curtailed, its find¬ ings and recommendations are subject to the suspicion of' being colored by motives of expediency. The governmental agency that carries on its work in part through the medium of a private agency or by the aid of private contributions, is subject to the suspicion that its actions are influenced by a desire to retain this support. Whatever influence a pri¬ vate agency may have upon a public agency should be exer¬ cised through persuasion, demonstration, securing legisla¬ tion or marshalling public opinion, not through reward in the forms of service or contributions That there may be no misunderstanding, it should be repeated that this clear distinction as between private and governmental agencies does not prevent the closest co-oper¬ ation, nor even the sharing of a field of work, provided each maintains its independence and states definitely just where its responsibility begins and ends. Nor does it prevent joint or representative membership on a commission or com¬ mittee the purpose of which is merely to investigate or study and report, or the purpose of which is purely for con¬ ference, not for execution or administration Investigation Should Precede Establishment of a New Agency The committee makes also the following statement of belief: That whenever it is proposed by any individual or group of citizens or by any governmental body to establish a new social or civic organization or department, there should be, precedent to such establishment, a careful survey 9 both of the existing situation, and of the lessons of experi¬ ence to the end that the new organization may meet a real need and may most effectively supplement, not duplicate, what is being done The committee is moved to this statement of belief because there has been duplication in the past; because new organizations, needed elsewhere, have been established where a similar work was being done; because new organ¬ izations or institutions have been so located that they can¬ not expand to full usefulness or even so that their imme¬ diate usefulness is seriously interfered with; and because the terms of the foundation in some instances have been so narrow as to prevent readjustment to meet changing conditions Philadelphia has many social and civic agencies. Yet it still leaves undone many things for which these agencies are created. The agencies are seeking earnestly to render efficient service. But some, under the terms of their char¬ ter, are confined to a lesser work when a greater work is urgently needed. Others are prevented from rendering the gratest possible service to the city because their terri¬ tories or their announced purposes overlap those of similar organizations We have passed the pioneer stage in social work when one or a group of public spirited citizens or an administra¬ tion inspired with the desire to serve the community could without misgiving and without inquiry decide just what it should do and where, confident that in the great urban wilderness its contribution will be an unqualified asset. We have reached the stage where we must consider what has been done before deciding what shall be added. There are sections of the city that probably contain enough agencies, especially if those were all functioning fully. There are others that have been overlooked or neglected. There are fields of social work occupied by agencies, capable, pro¬ gressive, energetic, but not adequately supported. There is work now being carried on by private agencies that should be turned over, in part at least, to governmental agencies, leaving these private agencies free to devote their io full energies to their proper and permanent purposes. What we need today is such a marshalling of our resources as will make evident where we are strong, where weak, in order that future efforts may count where they are most needed II SOME PROPOSALS DEALING WITH NEEDS OF THE • MOMENT A careful survey of the existing situation and confer¬ ences with those engaged in active work would, the com¬ mittee believes, assure greater efficiency in the future. Meanwhile the existing agencies are seeking a basis for co-operation which will eliminate overlapping and will in¬ crease to a maximum our use of our present social resources. To this end the committee submits the following under three heads. The first has to do with governmental, the second and third with private agencies Governmental Agencies 1. Insertion in the proposed new state constitution of provisions distinguishing between private and governmental agencies as in the Statement of Principles. When government subsidies are withdrawn from private agencies, either it should be done gradually, so as to allow a period for readjustment, or the work of the private agency should be taken over by the government 2. The co-ordination of the work of state agencies deal¬ ing with social and health matters. This can be accomplished partly through revision of the Con¬ stitution, partly through legislation. It involves a clear delimitation of the function of state agencies and definite statements as to the nature and extent of their co-operation with private agencies. At present there is overlapping and confusion 3. The organization of the Philadelphia Department of Public Welfare so that it may effectively fulfil its purposes n 4. An adequate system of mothers’ pensions. The pres¬ ent system is so inadequate that applications two years old have not yet been reached The committee endorses the policy adopted by the Mothers’ Assistance Fund of supplementing the income of widows with children up to the mini¬ mum adopted by the War Risk Insurance Board 5. Improvement and stricter enforcement of laws designed to protect children At present it is difficult to fix responsibility upon those who illegally employ minors; the respon¬ sibility for enforcing legislation relative to street trades is shifted from one department to another 6. Improvement in the schools While there are specific needs of the city’s school system that appeal with special force to certain members of the committee whose work has shown them the importance of these needs, the consensus of opinion is that the great need today is a thorough and comprehensive study of the whole system by competent, experienced admin¬ istrators and specialists, working in co-opera¬ tion with the Board of Education. Such a study should result in recommendations designed to meet adequately all the city’s educational needs. Pending such a study and recommendations efforts to secure piece-meal improvement, even in such important particulars as the erection of new buildings—except when the need is of an emergent character—is likely to postpone the day when Philadelphia will provide properly for the schooling of its children It will be noted that this program does not include pro¬ vision for more public institutions. Schools are not institu¬ tions in the sense in which the word is used here. Neither under the succeeding headings does it include provision for more private institutions. More institutions may be needed, but the need is not obvious. What is obvious is the need for better service, which may or may not call for better 12 facilities than those now available, for clearer definition, a more definite placing of responsibility, better co-ordination and higher standards Moreover the committee believes that the ultimate solu¬ tion of our problem is to be reached not by such expedients as removing children from their homes to institutions or by breaking up families, but by so strengthening family life, by so improving environmental and community conditions, that the need of institutions as places of refuge will be con¬ stantly diminished. In the committee’s view institutions, whether asylums, hospitals or jails are in large degree con¬ fessions of failure. They are necessary now. They will be necessary for a long time to come. So far as we can foresee some will always be needed for a small proportion of those now committed to them, who because of permanent disabilities can never be permitted to share in normal family and community life. For these we shall be forced to provide better institutions as our knowledge of their needs increases. But in increasing degree we shall regard institutions as means of meeting temporary and exceptional situations with which we are not yet equipped to deal in the best way. So the committee lays emphasis upon those services which aid in strengthening and building up the normal, wholesome life that centers in the family Private Agencies—Co-ordination of Work, Standardization of Methods The need for co-ordination has long been evident and considerable progress toward it has been made. Several years ago three child placing agencies agreed upon a plan which prevented much duplication. More recently the lead¬ ing day nurseries formed an association through which they have been able to increase their effectiveness and raise their standards. Other neighborhood agencies having a common purpose, as the settlements, have made a beginning of asso¬ ciation. At the same time groups of local agencies, diverse in immediate purpose but serving the same neighborhood, have been drawn together by their desire to work out a well co-ordinated social program for their particular section of the city. During the past three years this movement 13 affected the city wide agencies. There has been a more general acceptance of the truth that all are working on one great social problem, however far apart the points from which they attack it This acceptance makes it easier to secure acceptance of a policy of co-ordination that will reduce duplication and will show how much of the field is not now touched. But every step in the direction of co-ordinating social agencies must be taken with care lest we lose more than we gain. Anarchy is the opposite of socialism, but because we would avoid the one we need not embrace the other That we should secure better co-ordination is evident and for this purpose the committee has agreed to select a certain area in which each of the city wide and neighbor¬ hood agencies will seek to: 1. Bring its work up to the utmost efficiency. This may involve improvement of organization, per¬ sonnel standards or methods, or all of them 2. Develop thorough co-operation with other private and governmental agencies. This will involve a definite, clear cut statement or restatement of purpose or of function. At present some agencies are not themselves clear as to their exact func¬ tion, others have not stated their function so that co-operating agencies may know definitely what it is. Lack of such statement leads to vagueness, uncertainty and misunderstanding 3. Meet the needs of the community fully. We all real¬ ize that these needs are now only partially met, partly because our resources are not utilized to the utmost. By selecting a comparatively small district and in this district eliminating all waste and duplication it is hoped that each agency will there be able to develop its work until it applies the best standards and meets entirely the need in its field. This inevitably means an increase of personnel and of expenditure on the part of many agencies until the peak is reached, i. e., until the existing need is fully met. From that time, how- ever, the burden should grow lighter for instead of trailing behind we shall have gotten ahead of our task and have begun to reduce its causes. When experience in the selected area has demon¬ strated the practicability of any of our proposals they should be applied throughout the city as fast as means permit Obviously this is not a temporary experiment, but the beginning of careful, thorough constructive work which will take several years to reach its culmination and which, having proved itself, will continue Private Agencies—Facilities, Standards, Methods, Purposes Aside from work in the selected area it now appears evident that many city wide and neighborhood agencies could increase their usefulness by: 1. Improved facilities 2. Better trained workers 3. Better methods 4. Study of purposes and limitation of charters Many of our agencies should re-examine their charters, constitutions or statements of purposes to see if a reword¬ ing of these would not increase their usefulness without infringing on fields occupied by other agencies. But beyond this there appears to be especial need for improved facilities for A. Recreational work B. Constructive work with difficult boys, 14 years of age and older, similar to that done by the Girls’ Aid C. The temporary care of children who are separated from their families D. Child placing The last item is due to the fact that child placing is now in the hands of governmental agencies not specifically charged with such work or in those of agencies partly gov¬ ernmental, partly private. In accordance with preceding i5 statements, the committee believes that governmental work should be in the hands of one agency, the functions of which should be clearly defined. So only can responsibility be definitely placed. This agency should be supplemented by an independent private child placing agency, supervised by the proper government officials, but not subsidized by pub¬ lic funds or controlled by officers or board members who occupy public office Not only should facilities be improved, but in some cases better use should be made of those we now have. Higher standards and better methods are perpetual needs. Few if any agencies are now satisfied with their present standards or methods. The great majority are constantly seeking—and securing—improvement. A well planned co-ordination will make possible a more rapid progress and will bring up those now lagging behind. Meanwhile confer¬ ences between agencies of like kind and the work of such bodies as the Charities’ Endorsement Committee of the Chamber of Commerce—which is seeking to set minimum standards—should be encouraged The above program is supposed to cover only the most obvious immediate needs. If all the items on this program could be realized at once not only would our infant, child and general death rates be cut down, not only would the lives of all of us be made better worth living, but the next generation would be stronger, abler, better citizens and bet¬ ter workers than they will be Yet if this program were today realized in full it would but open the way for another program, for this deals with primary needs. In spirit it is constructive, for it lays little emphasis on the merely negative, on rescue and cure. With such negative work as is still necessary—and in volume it continues to be the heavy end of the burden—goes an in¬ creasing amount of constructive work. When the con¬ structive work becomes the heavy end of the burden, when because of it the negative work has been reduced to a minimum we shall have a new outlook on life. 16