TJ. 3. Department of Labor 
 Children’s Bureau 
 Washington 2R, D. C. 
 
 TEN TEARS OF SERVICES FOB CHILDREN 
 UNDER THE 
 
 * 
 
 SOCIAL SECURITY PROGRAM 
 August 1935—August 19^5 
 
 Part I 
 
 Maternal and Child Health 
 
 This summary of the work done toward the betterment of 
 the health of mothers and children during the first 10 
 years of the Social Security program Is one of a series 
 of three covering those activities in which the Children’s 
 Bureau, U. S. Department of Labor, has a special respon¬ 
 sibility. Fart II of this summary deals with the work 
 done on behalf of crippled children; Part III deals with 
 the aid given in establishing and extending child-welfare 
 services. These programs are all administered by State 
 agencies under plans approved by the Children 1 s Bureau. 
 
 This report is intended for use as background material by 
 newspaper editors and feature writers; radio program di¬ 
 rectors; and by organizations interested in the welfare 
 of children. The national story, In each instance, can be 
 related to the work done in the States and the localities. 
 

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 U. S. Department of Labor 
 Chi 1 dren's Bureau 
 Washington 25, D. C. 
 
 MAEERNAL AND CHILD HEALTH UDDER THE SOCIAL SECURITY ACT 
 
 1935—1945 
 
 11 Somewhere out on the prairies, in isolated mountain 
 districts, scattered over the desert, dorn along the 
 swarps, on the border, up hill and down dale, off 
 beaten paths were the children for when a paragraph 
 of legal language created a mechanism whereby govern¬ 
 ment would, attempt to provide a greater measure of 
 opportunity . 11 
 
 —Children’s Bureau 
 
 THE AUTHORITY 
 
 Title V, Part 1, of the Social Security Act, as amended: 
 n Por the purpose of enabling each State to extend and 
 improve, as far as practicable under the conditions 
 in such Stale, services for promoting the health of 
 mothers and children, especially in rural areas and in 
 areas suffering from economic distress, there is here¬ 
 by authorized to be appropriated for each fiscal year, 
 begiandng.-with - the fiscal year ending June 30 , 193^, 
 the sum of $5', 820,000. The sums made available under 
 this section shall be used for making payments to 
 States which have submitted, and had approved by the 
 Chief of the Children’s Bureau, State plans for such 
 services.” 
 
 By this appropriation the fact was recognized that Federal participation 
 was vital to the success of any comprehensive effort to better the health 
 of the mothers and children of this country. 
 
 Wheat was provided was a limited program. Neither by the language of the 
 act nor the amount of the appropriation was complete coverage of the 
 country contemplated, even in rural areas where most of the work was 
 to be done. What has been done, therefore, can only be regarded as a 
 beginning, but a beginning that has already affected the well-being not 
 of thousands, but of millions, everywhere in the United States. 
 
 THE BENEFICIARIES 
 
 mi 
 
 he people of the United States—for what benefits children benefits all. 
 
 Direct beneficiaries of this particular part of the Social Security Act 
 arc, for the most part, mothers and children who live :n the rural areas 
 of the United States. Many of then did not ordinarily see a doctor except 
 in times of serious illness or disaster, for doctors are few and far betweer 
 
2 
 
 in many parts of this country. Health services, including prenatal clinics, 
 child-health conferences, public-health nursing, school health examinations, 
 and the like, that in some parts of the country have long been token for 
 granted, mere scarcely known tc many of these people prior to the start of 
 this program, and in some planes, such services are still nonexistent. 
 
 In the days before Social Security, many, if not most, of the women who 
 are now being reached through prenatal clinics would have had no medical 
 care whatsoever prior to their baby 1 s birth, heath, under such circum¬ 
 stances, frequently took the mother—a human loss to be reckoned not only 
 in terms of the individual, but in the count of broken homes and of children 
 left motherless. 
 
 And the children—many of them, like their mothers, were seldom seen by 
 a doctor or by a nurse. They ’’took sick" — and were "ailing"—they died, 
 as if that were the natural order. As in the case of their mothers, 
 mortality rates were high, one out of ten in sor.fc groups dying in the 
 first year of life. 
 
 Those who survived grew up, and many are still growing up, not the robust 
 lot one pictures as being typical of American youth. They are more apt to 
 be hollow-eyed boys and girls, with bodies marked by malnutrition—youngsters 
 with bent shoulders, spindlelegs—the group from which come the young men 
 who were rejected in such great numbers when called up by Selective Service. 
 
 * * * ********* 
 
 These, then, arc the mothers and, children for whom health services under 
 the Social Security Act were specifically intended, and among then are 
 
 thousands and tons of thousands ’dio for the first ti me a.re being seen by 
 
 doctors and nurses, and who for the first time are benef i ting from the 
 
 medical and health knowledge of which their country has great measure. 
 
 Not all of these women and children, nor even a considerable part of those 
 in need of medical care and health services, have as yet been reached—a 
 fact that must be kept in mind when gains made under the Social Security pro¬ 
 gram care set forth in impressive figures such as those cited in this report. 
 
 THAT HAS SEEN DONE PGR THESE MOTHERS AND THEIR CHILDREN 
 UNDER THE SOCIAL SECURITY ACT 
 
 In those ten years, because of the assistance to the States made possible 
 by the use of Social Security funds, a basis has been laid for State-wide 
 health services to mothers and children through the establishment and 
 strengthening of maternal and child health divisions of State health depart¬ 
 ments, and the strengthening, too, of local health agencies. 
 
3 - 
 
 At the tine the Social Security Act was passed, almost half the States 
 Tiad no special funds or less than $10,000 for maternal and child health. 
 Fourteen spent less than $3,000 a year or nothing at all for this work. 
 Today, all of the States have maternal and child-health divisions in their 
 
 departnonts of health. Altogether in 1949 the States now “budget at least 
 $4,300,000 of their own and local money for maternal and child-health 
 services in addition to the money they got iron the Federal government. 
 
 sic*******#**:******** 
 
 In the period approximating that in which maternal and chi I d -health programs 
 have been in operation under the Social Security program, the infant 
 
 mortality rate has been reduced nearly one-third; the maternal mortality 
 
 rate more than one-half. 
 
 Among women in the lp- to 44-year ago group, the childbearing years, in 
 1935, death from causes related to childbirth ranked second, only tubercu¬ 
 losis accounting for a larger number. In 1942, the last year for which 
 these statistics are available, puerperal causes ranked fourth on the 
 list, preceded by tuberculosis, diseases of the heart and cancer. In 1935> 
 some 12,000 women died from causes related to childbirth; in 1942 the 
 number was 7,000. Then, some 56 babies out of every 1,000 died within 
 their first year of life; today, 40 out of 1,000 die. 
 
 Hot all the credit for that remarkable record, of course, goes to the 
 Social Security program, but it undoubtedly has been on important con¬ 
 tributing factor. Significantly, the greatest decline has taken place in 
 those States in which the work done under the Social Security program broke 
 new ground—the States that before there was a Social Security program had 
 the greatest health problems and had been able to do the least about them; 
 the States, broadly speaking, with a largo rural population and relatively 
 little money with which to roach their people with health services. 
 
 FEAT IS 32IHG- D0H3 
 
 In a single year (1342), under this program of health services, made possi¬ 
 ble with the use of Social Security funds, more than l60,000 mothers 
 received prenatal care. 
 
 One hundred eighty-five thousand babies and some 300,000 young children 
 
 were given health ch.eck-.ups at medical conferences. 
 
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 More than 1,600,000 schoo1-age children mere exa ni nod by ph ysic ians. 
 
 More than 2,000,000 children were vaccinated against snalloox; nore than 
 1,600,000 yore immunized against diphtheria. 
 
 Public-health nurses gave care to sone 1,500,000 mothers and children. 
 
 HO'7 THE WORK IS DONE 
 
 Funds nade available for maternal and child-health services by the Social 
 Security Act are administered by State health departments under plans 
 approved by the Children’s Bureau, U. S. Department of Labor. 
 
 A largo portion of the Federal money is allotted to the States on the 
 grant-in-aid principle. That is, the States natch the funds. Part of the 
 Federal allotment, however, is granted solely on the basis of need, and 
 this part of the funds is not matched by the State. 
 
 The procedure is this*. Each year the State agency submits to the Children’s 
 Bureau a plan of operation, setting forth what services dll be provided. 
 
 The Children’s Bureau reviews the plan to make sure that it is in accord 
 with the over-all objectives set in the Social Security Act and that 
 standards for services are satisfactory. Upon approval of that plan, 
 
 Federal funds are granted to the State. Programs provided in a State 
 plan are administered by the maternal and child-health division of the 
 State health departments. 
 
 ECU THE STATES USE THE MONET 
 
 Most of the money granted to the States under the Social Security program 
 is used, through the State health department, to pay for the services of 
 
 physicians, dentists, public-health nurses and nutritionists, to people 
 living, for the most part, in rural areas. 
 
 Those people arc being reached through prenatal clinics and well-baby 
 conferences hold in centers easily accessible to largo numbers of mothers 
 and children. Others arc reached through hone visits by public-health 
 nurses. S 0 nc few mothers and children are given medical and hospital 
 care, but the program has been primarily one of providing health services 
 rather than actual medical or hospital care. 
 
 Through these various programs mothers are being taught better ways for 
 caring for their own health and that of their children and these mothers 
 in turn teach others: a. significant contribution to better health for 
 the entire Nation. 
 
 Nursing care is provided through the services of public-health nurses in 
 clinics and schools, and by hone visits. Examinations of school children 
 by doctors and nurses are an important part of the program. 
 
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5 
 
 Besides the day-to-day Fork carried on by doctors and nurses 
 special projects are undertaken. (Sea page j) 
 
 :ne connuni ty, 
 
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 the money is us at 
 
 t<~-< 
 
 ■ e, tc pay the salaries of consultants on the 
 
 staffs of State health departments, and of the Children*s Bureau, -or 
 example, for a considerable period a Negro pediatrician•op the Children’s 
 Bureau staff Forked uith State health departments in improving the care 
 being given Negro groups. 
 
 Funds are also available for postgraduate courses for medical, dental, and 
 other personnel. For example, thousands of physicians have attended 
 SI refresher” courses in obstetrics and pediatrics. The use of Social Security 
 funds has also made possible the training of nurse-midvives, this training 
 being given in four specially-selected centers: Tuskegee, Ala.; Santa Fe, 
 h. M.; Hycten, Ky.; and lieu York City. Those r/orion, in turn, Fork as mem¬ 
 bers of the State and local health department staff in improving the care 
 given to the thousands of uomen mho must, under present circumstances, 
 depend upon a niduife*s service at delivery. 
 
 In some instances, these nurse—mi dpi ves train and direct* the nonprofessional 
 midrives. In others, they thornselves assist in the delivery, as is the prac¬ 
 
 tice in Kentucky, Maryland, Indiana, and Florida. 
 
 
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 OF SEF.YI 
 
 
 IF S WIVES AND BABIES 
 
 An uni oreseen outgromth of this program has been the care given to service¬ 
 
 men' s uives and babies 
 
 our i) 
 
 the Far. 
 
 When the need, of public provision for 
 tno maternity care of Fives of non in the armed forces and care for their 
 sick infants became apparent in the early days of the mar, the experience 
 gained in administering the maternity and child-health program Fas heavily 
 drayn upon in framing the emergency maternity and infant care program. Since 
 1943 Congress has provided special funds for this program mhich is adminis¬ 
 tered by State health departments through their maternal and child-health 
 divisions, in accord uith plans approved by the Children’s Bureau. As a 
 result, medical, hospital, and nursing care has been provided for nearly a 
 million Fives and infants of service-men (September 194-B)'; 
 
 HOW HELL IS Id 
 
 FIT) T'Cirfi 
 
 Impressive as the Fork has oeen under the Social Security prOrTram, it is 
 recognized as far from adequate. Although infant death rates for the Nation 
 are not: at the louest level ever reported—only one in 25 babies dies before 
 tne end ox the first year of life—Fide variations exist in States and in 
 racial and language groups. In one State, one baby out of ten ’dies; in 
 another, one out of 30. The death rate for Negro infants is J2. percent 
 higher than that for unite infants. 
 
 Many babies, perhans half of those uho die today, night have lived if ado* 
 
 quato medical and hospital care Fore available. 
 
6 
 
 Like the infant death rate, the maternal death rate varies greatly from 
 State to State and by racial and language groups. In some States it is 
 five times as high as in others. The mortality rate for Negro mothers 
 is t wo and "g-half that for vhi t- e no t x i.e rs. 
 
 Although the maternal death rate has keen reduced more than half in the 
 last decade, still J,QQC mothers die each year from causes associated 
 v;ith chil&birth. 
 
 Despite the gain already made, it is cst limited that s till another pO percent 
 
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 of the deaths of mothers in childbirth, night be prevented if all mothers 
 
 had, the core this corn try knows ho w to give. 
 
 Here than 200,000 babies annually are born without a doctor in attendance. 
 
 In 10-2, approximately three-fourths of the rural counties were still without 
 maternity clinic centers, and it is not likely that the situation has changed 
 for the better in the war usriod. 
 
 In the large cities health and medical services for yc 
 available, but of the small cities (10,000 to 20,000 j 
 have no child-health conferences. 
 
 srvices for young child -u' 0 ii C. V re usually 
 population), one-fourth 
 
 Two-thirds of the rural counties in this country still have no regularlj 
 
 conducted child-health conferenc es under t h e administratio n o f public-health 
 agencies. 
 
 A public-health-nursing program adequate to bring skilled care to all families 
 in the community, it is estimated, requires one nurse to every 2,000 of tho 
 population. The best ratio in any State is one to 0, -KX>. The poorest record 
 is one to 25,000. 
 
 forty-eight thou s and additional public-hea lth nurses, the Children*s Bureau 
 estimates, are neodod. 
 
 Bureau, 
 
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 11 give at 
 
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 least s 
 
 ome 
 
 insight 
 
 into 
 
 - •- 'g —- - - . ... 
 
 the huge problem facing this country 
 
 if good 
 
 medical i 
 
 end nurs 
 
 xng 
 
 care is 
 
 to b 
 
 e made available to all mothers and 
 
 children in the United States. 1 ’ 
 
 man is proposed 
 
 The National Commission on Children in Wartime, which is made up of outstand¬ 
 ing men and women interested in child-health and child-welfare, made a year’s 
 study of what was being done under these maternal and child-health programs 
 
A 
 
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 in comparison with the need. 
 
 As a result, the Commissioif proposes that an additional $50,000,000 he 
 appropriated immediately from Federal funds under the Social Security Act 
 for an extension of the maternal and chiId-health programs in the States, 
 with more funds to he granted later as the program expands. Such an appro¬ 
 priation would he expended as follows: 
 
 $25,000,000—for maternity care and care for infants and preschool 
 children. 
 
 $15,000,000—for preventive and curative health service for school- 
 age children. 
 
 $10,000,000—for dental care of young school children. 
 
 In such a major expansion of the program, as the Commission recommends, the 
 objective is to make available good maternity and infant care to all mothers 
 
 and children who chopse to make use of su ch services. This is to he done 
 
 without discrimination because of race, color, nati onal origin, or residence. 
 
 The health of children, the Commission states, no less than their education, 
 is a public responsibility and services should be made available as a matter 
 of right. 
 
 *The report of the Commission, which is entitled Buildin g the Future for 
 Children and Youth , can be obtained from the Children 1 s Bureau, U. S. 
 Department of Labor, Washington 2p, D. C. 
 
 HOW THE STORY CAN 3E LOCALIZED 
 
 Each State has its own story of what has boon accomplished under the Social 
 . Security program. In many, for instance, the decline in maternal and 
 infant mortality rates is even more striking than it is for the Nation. 
 
 In almost any State the program can be seen operating through prenatal clin¬ 
 ics, well-child conferences, classes for mothers: and in the round of visits 
 made by the public-health nurse. 
 
 In each State a story can be had of how the maternal and child-health divi¬ 
 sions have taken on the job of providing medical, hospital, and nursing care 
 for servicemen’s wives and infants under the emergency maternity and infant 
 care program. A magazine of national circulation, describing the work being 
 done in the States under this program, calls it the ”biggest public health 
 experiment over conducted in this country.” 
 
 Besides the programs that are common to all the States, there are those 
 adapted to the particular needs and resources of the State or community. 
 
 The range is wide: for instance, in Anne Arundel County (Annapolis), Md., 
 a demonstration project is in operation that gives as complete a maternal 
 and infant and child-health service as is to be found anywhere in the 
 
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 country; and in San Mateo, California, to cite another instance of a sig¬ 
 nificant step forward in the public health field, child guidance, including 
 psychiatric consultation, is now being included in health services provided 
 on a coniraunity-wide basis. In both instances, the work being carried on is 
 in the nature of a demonstration project. 
 
 Elsewhere in the country, to illustrate the adaptation of these programs to 
 local needs, a great deal of the health department's effort goes into im¬ 
 proving the care given by midwives, upon whom thousands of women in this 
 country, Negro mothers for the most part, are still dependent. 
 
 Another example illustrating how the work done under these programs reaches 
 the people for whom little hashcrctofore been available is in Tuskegee, Ala,. 
 Federal funds are used to maintain m part a training center for nurse mid¬ 
 wives. These women serve the women in the surrounding rural area. 
 
 In Alaska, to cite still another instance of the program’s adaptability, 
 a boat, acquired from the U. S. Army, has been outfitted as a clinic and 
 serves the island people of Southeastern Alaska who heretofore have had 
 little or no public-health or medical service. 
 
 As an example of how Social Security funds are used to provide health ser¬ 
 vices in '"areas of special need, 11 to quote the act, Federal funds are being 
 used to maintain in part the SLossfield Health Center, in Birmingham, Ala. 
 This center serves the Negro population of a wide area. 
 
 These examples are cited only as an indication of the work being done that 
 is out-of-the-ordinary under the maternal and child-health program. Each 
 State has its own special projects that are no less newsworthy. 
 
 Information about these programs can be obtained from State health depart¬ 
 ments, from county health officers, and from public-health nurses, including 
 nurse—midwives, and others participating in these undertakings. 
 
 (C3 46-l4l) 
 
U. S. Department of Labor 
 Children* s Bureau 
 Washington 25, D. C. 
 
 SEN YEARS CP SERVICES POR CHILDREN 
 UNDER TEE 
 
 SOCIAL SECURITY PROGRAM 
 August 1935—August 19^+5 
 
 Part II 
 
 Services for Crippled Children 
 
 This summary of the work done in providing care and 
 treatment for physically-handicapped children during 
 the first 10 years of the Social Security program is 
 one of a series of three covering those activities in 
 which the Children’s Bureau, U. S. Department of Labor, 
 has a special responsibility. Part I of this summary 
 deals with the work done toward the betterment of the 
 health of mothers and children; Part III deals with 
 the aid given in establishing and extending child-wel¬ 
 fare services. These programs are all administered by 
 State agencies under plans approved by the Children's 
 Bureau. 
 
 -This report is Intended for use as background material by 
 newspaper editors and feature writers; radio program di¬ 
 rectors; and by organizations interested in the welfare 
 of children. The national story, in each instance, ca.n be 
 related to the work done in the States and the localities. 
 

 
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U. S. Department of Labor 
 Children 1 s Bureau 
 Washington 25, D. C. 
 
 SERVICES FOR CRIPPLED CHILDREN UNDER THE SOCIAL SECURITY ACT 
 
 1935—1945 
 
 Find the Crippled Children and G-ive Them Care— 
 
 The Congress-'of the United States 
 
 THE AUTHORITY 
 
 Title V, Part 2, Sec. 5H of the Social Security Act, 
 as amended, reads: n For the purpose of enabling each 
 State to extend and improve (especially in rural areas 
 and in areas suffering from severe economic distress), 
 as far as practicable under the conditions in such 
 State, services for locating crippled children, and 
 for providing medical, surgical, corrective, and other 
 services and care , and facilities for diagnosis, 
 hospitalisation, and after care, for children who are 
 crippled or who are suffering from conditions which 
 
 lead to crippling , there is hereby authorized to be 
 appropriated for each fiscal year .... the sum of 
 $3,S70,000. The sums made available under this sec¬ 
 tion shall be used for making payments to States which 
 have submitted, and had approved by the Chief of the 
 Children’s Bureau, State plans for such services. n 
 
 Although 35 States were providing for the care of crippled children with 
 State funds at the time the Social Security Act was passed, in only a 
 relatively few was a State-wide program conducted providing diagnosis, 
 medical and surgical care, hospitalisation, and after-care services for 
 any substantial number of crippled children. In some of those 35 States 
 only a very small number of children were cared for, because appropria¬ 
 tions were so limited. 
 
 Within 18 months after Social Security funds were made available, all the 
 
 States, the District of Columbia, Alaska, and Hawaii, had designated a 
 
 State agency to carry on a program for the care of crippled children. 
 
 Subsequently Puerto Rico was added to the list. 
 
 Thus, because of the Social Security Act, and the support it gave to the 
 
 States in their efforts to reach crippled children, care has been made 
 
 possible for thousands of children who otherwise might have grown up 
 
 no edl c s s 1 y han di cape e d, 
 
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 THE BENEFICIARIES 
 
 •Today, over a third of a million crippled children, hoys and girls under 
 21 years of age, are listed on State registers. 
 
 Some of these children and young people have already been aided; some are 
 now getting care; and others are known to be in need of care. 
 
 Last year alone, more than 100,000 children received cane under these State 
 programs of service to crippled children. 
 
 These 100,000 children are children who were born with a harelip, or a 
 cleft palate, or a clubfoot, or some other congenital malformation; children 
 with bent backs and twisted bodies; children with tuberculosis of the bone, 
 arthritis, osteomyelitis, or poliomyelitis; children with cerebral palsy; 
 children with rheumatic fever and heart disease; children with diabetes; 
 children with eyes that are crossed, or eye conditions that require surgery— 
 all of them children who because of the care given through the St,ate crippled 
 children’s agencies may hope to lead happy and useful lives. 
 
 HOT? CASE IS BROUGHT TO THESE HOYS AND GIRLS 
 
 In each of the States, and in the District of Columbia, Alaska, Hawaii, and 
 Puerto Rico, there is a crippled children’s agency. 
 
 Sometimes it is a part of the State health or welfare department; sometimes 
 it is under the board of education; sometimes it is a separate agency or 
 commission. 
 
 Each year these agencies submit to the Children’s Bureau, U. S. Department 
 of Labor, plans of operation within the over-all objectives of the program 
 set by Congress. Upon approval of the plan by the Children’s Bureau., Social 
 Security funds are allotted to the State. 
 
 The programs vary greatly from State to State. All provide certain services, 
 as for instance, diagnosis for all children brought to the agency*s attention, 
 and treatment and care for specific groups, such as those suffering from 
 orthopedic and plastic conditions. Each State, however, adapts its pro¬ 
 gram to the special needs within the State, within the limitations of funds 
 and personnel available. 
 
 Por instance in an area of scattered population with few facilities for 
 specialized medical care, as in Wyoming, provision often has to be made for 
 bringing the children to the treatment center and for their boarding care 
 while in attendance. The Alaska agency sends many children to Seattle, 
 Washington, for care that is not to be had in the Territory. 
 
 A number of the States have rheumatic fever control programs. These pro¬ 
 grains are being operated in California, Connecticut, District of Columbia, 
 Iowa, Maine, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, 
 Oklahoma, Rhode Island, South Carolina, Utah, Virginia, Washington, and 
 Wisconsin. 
 
3 * 
 
 One State, Iowa, is caring for children with diabetes. Maryland and 
 Connecticut are undertaking the care of children with hearing defects. 
 
 All of the State agencies are on the alert in times of poliomyelitis epidemics, 
 not only taking special measures at the time of the epidemic, hut also in 
 providing services to the young victims for long periods afterward. This 
 work is done with the help of other agencies and organizations engaged in 
 the fight against infantile paralysis. 
 
 tic********#**#***:!:** 
 
 The State agencies all provide a variety of services and care, including 
 diagnosis, medical, surgical, and hospital care, care in a convalescent or 
 foster home when necessary, and after care to sec tha.t a satisfactory ad¬ 
 justment is made. Education and needed vocational training are also ar¬ 
 ranged for by the crippled children's agency. 
 
 Medical services are given by qualified orthopedic surgeons, pediatricians, 
 and other consultants. Public-health nursing and social services, so 
 necessary for the rehabilitation of a child who is crippled or has been 
 crippled, are usually given by local workers with advice and help from 
 nursing and medical-social consultants on the staff of the crippled children's 
 agency. 
 
 Many persons, institutions, and agencies may be concerned in one or another 
 aspects of the child's care. It is the job of the State agency to make sure 
 that a coordinated plan is being followed for the child's care and to pre¬ 
 vent interrupted and contradictory types of treatment. 
 
 * * * * **************** 
 
 The first step in the operation of this program, e.s set forth by Congress, 
 is to find the children . The injunction is unusual: The Federal govern¬ 
 ment is saying in effect, do not wait for these children who need care to 
 be brought to you; find them—wherever they may be—and bring them in. 
 
 Sometimes it is the parent or friend of the child who reports his case to 
 the agency; or a physician, public-health nurse, social worker, or school 
 official may direct the agency's attention to the crippled child. Other 
 individuals and groups likewise help in locating these crippled children. 
 
 Then, a diagnosis of the case is arranged for at a crippled children's 
 clinic. Some of these clinics are so-called ’’permanent" clinics held in 
 the same place—a hospital or health center—at regular intervals. Other 
 clinics are "itinerant”—the clinic staff goes into rural areas. If a 
 child is acutely ill, say with rheumatic fever or infantile paralysis, the 
 physician may go into the child’s home. 
 
 In all instances the diagnosis is made without charge and without regard 
 
 to the family's financial circumstances. 
 
 After it is known what care is needed and what it is likely to cost, then, 
 as the program is operated by the State, consideration may be given to the 
 ability of the family to pay for the recommended treatment. Ho child is 
 
 y 0 OF ILL L!B„ 
 

 
 
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4 . 
 
 denied care because of inability of the family to meet any part of the 
 cost of treatment. 
 
 HOW WELL IS TEE KEEL) MET 
 
 The Chief of the Children’s Bureau, at a recent hearing before a Congression¬ 
 al commi11ee, stated that ’’fewer than 10 percent of the Nation’s physically 
 handicapped children are receiving care through services developed under 
 
 the Social Security program. 11 
 
 The care now given is largely to those with orthopedic or plastic conditions. 
 
 yet State crippled children 1 s agencies a year ago had on their registers 
 some 1^,000 children for whom care could not be provided because funds were 
 not available. 
 
 Others do not get the care they need because they live where hospital facili¬ 
 ties are not available. In all States convalescent facilities arc inadequate, 
 but the lack is particularly serious as far as Negro children are concerned, 
 and serious, too, for adolescent boys and girls. 
 
 Besides these thousands of children with orthopedic or plastic conditions 
 who tire not getting care, an even larger group are neglected. They are to 
 be found among the half million with rheumatic fever; the thousands with 
 cerebral palsy, or diabetes, or epilepsy; the millions with visual or hearing 
 
 defects; the approximately half million with tuberculosis; the nearly a 
 
 million with congenital syphilis; and the more than a million with asthma. 
 
 Not all, of course, are without care, but a large proportion arc, particu¬ 
 larly those in rural areas and snail towns, and those in certain racial 
 or language groups. 
 
 These figures, when placed alongside the findings of Selective Service, be¬ 
 come even more tragic in their implications, for the handicaps of childhood 
 are the handicaps of young manhood, and often needlessly so. Among IS- and 
 19 -year-old registrants examined, 1 out of 10 had defective eyesight; 3 out 
 of 100 had defective hearing; approximately 1 out of 20 had a musculoskeletal 
 deformity, and an equal number relatively had defective feet; and 3 act of 
 100 had a heart condition, undoubtedly traceable in many instances to rheumatic 
 fever. These young men were in an age-group that night have been reached by 
 
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 the crippled children's program had it been able these last 10 years to 
 bring to all physically-handicapped children the care it is authorized by 
 law to provide. 
 
 ‘The record for those who are cared for is in bright contrast to those cited 
 in the previous paragraph. In Kansas, for instance, a survey showed that 
 a. large proportion of the boys and girls cared for Hinder its program are 
 now self-supporting young men and women, and some of the group were in the 
 armed forces. 
 
 NEXT STEPS 
 
 The National Commission on Children in Wartime*recommends that an additional 
 $ 25 , 000,000 be appropriated immediately to be used as follows: 
 
 $5,000,000—for ortnopedically crippled children including those with 
 cerebral palsy. 
 
 $5,000,000—for children with other physically handicapping conditions 
 including defects of vision and hearing, diabetes, allergy, 
 epilepsy, etc. 
 
 $ 15 , 000 , 000 —for children with rheumatic fever and heart disease—the 
 greatest killer of school-age children. Programs for 
 their care, under services for crippled children, are 
 operated in only 17 States and the District of Colombia, 
 end even in these States in only a few counties. 
 
 The objective of those administering these programs—and of those who 
 support them—is not only to get care, but to get the best care possible 
 to all crippled children in need, of it. 
 
 Information can be obtained from the State crippled, children's agency, 
 or from the State or local health departments, about what is being done 
 and what is pla.nned for crippled children under the Social Security program. 
 
 ^Copies of the report of the Commission, which is entitled Building the 
 Future for Children and. Youth , a.re available free upon request to the 
 Children's Bureau, U. S. Department of Labor, Washington 2a, D. C. 
 
 (CB 46~l4o) 
 

 
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 U. ST Department of Labor 
 Children '3 Bureau 
 Washington 25 , D. C. 
 
 TEN YEARS 0? SERVICES BOR CHILDREN 
 
 UUDER THE 
 
 SOCIAL SECURITY PROGRAM 
 
 August 1935—August 19^0 
 
 Part III 
 
 Child-Welfare Sor Tr icos 
 
 This summary of the work done in establishing and ex¬ 
 tending child-welfare services during the first 10 
 years of the Social Security program is one of a series 
 of three covering those activities in which the Chil¬ 
 dren' 3 Bur err., U. S. Department of Labor, has a special 
 responsibility. Part I of this summary deals ’ 
 
 170 rk done toward the betterment of the health < 
 
 /he 
 
 : mothers 
 
 and children; Part II deals with the work done on be¬ 
 half of crippled children. These programs are all ad¬ 
 ministered by State agencies under plans .approved by 
 the Children’s Bureau, 
 
 This report is intended for use as background material by 
 newspaper editors and fnature writers; radio program di¬ 
 rectors; and by organizations Interested in the welfare 
 of children. The national story, in each instance, can be 
 related to the work done in the States and the localities. 
 

 
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Children 1 s Bureau 
 Washington 25 , D. C. 
 
 CHILD USLYAP3 SERVICES 3IDIR IKE SOCIAL SECURITY ACT 
 
 1935—191+5 
 
 n gor every child his fair chance in the world—" 
 
 vulia Lathrop, first Chief of the Children*s 3ur( au 
 
 TEE AUTHORITY 
 
 Section ^21 (a) of the Social Security Act, as amended, 
 reads: ’’Bor the purpose of enabling the United States, 
 through the Children's Bureau, to cooperate with State 
 public-welfare agencies in establishing, extending,, 
 and strengthening, especially in predominantly rural 
 areas, public-weIfare services (hereinafter . . . 
 referred to as * chiId-weIfare services’) for the pro¬ 
 tection and care of homeless, dependent, and neglected 
 children, and children in danger of becoming delinquent, 
 
 there is hereby authorized to he appropriated for each 
 fiscal year . 4 . the sum of $1,310,000. Such amount 
 shall be allotted by the Secretary of Labor, for use 
 by cooperating State public-welfare agencies on the 
 basis of plans developed jointly by the State agency and 
 the Children’s Bureau . * . 
 
 -Y TET SOCIAL SECURITY A 
 
 SERVICES 
 
 In all States responsibility for chiId-welfare work was left largely to the 
 communities and to a great degree, to private agencies. The consequence was 
 that outside the large urban centers child-welfare services were practically 
 non-existent, except as the local authorities looked after children who were 
 in acute distress—those who were orphaned or abandoned; those who were being 
 grossly neglected and abused; and those who were court cases—or as State¬ 
 wide child—placing services, usually under private auspices, gave some ser¬ 
 vice limited to foster care. That there was need for services in behalf of 
 children who wore homeless, dependent, neglected, or in danger of becoming 
 delinquent, though these services were not generally provided, is abundant¬ 
 ly clear from testimony offered at the time the Social Security Act was 
 being considered by Congress. 
 
 Some 7,400,000 boys and girls under l6 years of age wore on the relief lists 
 with all that being "on relief" means in terms of family disintegration and 
 childhood frustration. 
 
o 
 CL y 
 
 Some 300,000 children were listed ms- dependent .and ..neglected. 
 
 Half of the localities authorized by law to provide mother’s pensions were not 
 doing so and even when State aid. was being granted funds were inadequate, so 
 that many children who otherwise could have been maintained in their own 
 homes had to he cared for in institutions. These institutions, on the other 
 hand, were having extreme difficulty in meeting the demands upon them for often 
 their budgets had been cut onc-third, and in some instances, one-half. Large 
 numbers of children, in those years, were being taken care of in almshouses. 
 
 ach year some 200,000 children came before the courts as delinquents and 
 
 many times tin 
 
 rm 
 
 number were living under conditions that lead to delinquency. 
 
 housands of children were in fails. 
 
 These figures are all indicative of the plight of not thousands, but millions, 
 of boys and girls in those depression years. They needed help, but services 
 that ordinarily would have been available to assist some of these children 
 were in many instances being curtailed, for funds everywhere wore limited. 
 
 The basic need, of course, was for jobs, Jobs for the parents end older 
 relatives of these boys and girls. Jobs, oven when they were to be found, 
 wore no -4 however, the whole answer. There was, besides, the need for the kind 
 of help that a skilled child-welfare worker can I 3.sJ j. T1 cl G sisting a child, 
 end his family, through difficult periods. 
 
 THAT HAS BLSIT LC1Z jFDIS tel social slcueity act 
 
 The money al l otted to Jt ho States from the ffecUml apt-ropriat 1 on, small as it 
 was in relation to the need, made possible the establishment of child-welfare 
 
 services in some States. 
 
 and the extension and strengthening of those ser¬ 
 
 vices 1 n other s. 
 
 Today, nearly all the States, not just half the States, have well-established 
 child-•'■elfare divisions within their departments of public welfare, and State 
 and local appropriations for such services arc being greatly increased over 
 the years. The federal appropriation, instead of ”drying-up” aid from local 
 and State sources, as was predicted by some 
 Act was under consideration, actually ha 
 vices, with the States and local communities bearing 
 share of the cost. 
 
 at the time 
 
 broucht ab out 
 
 the Social Security 
 an expansion of sor- 
 increasingly important 
 
 State and local funds, for example, arc being used to pay the salaries of 
 more than 1300 workers who give their full-time to children, and many of 
 these workers have boor, employed within the last 10 years. These are in addi¬ 
 tion to more than 400 child-welfare workers who arc paid in full or in part 
 from Federal funds. The number is not large; coverage is far from adequate— 
 four out of five counties have no full-time child-welfare worker; and more¬ 
 over, the majority of these 1700 workers are employed in urban areas: never¬ 
 theless, the employment 01 even so small a number is significant, for 10 
 years ago chiId-welfare workers so engaged were very few. 
 

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In Mississippi, for z. n s t an c 0 , no Sta te funds for child-weIfare services were 
 available in the first years of operation of the Social Security program. 
 Federal funds were used to establish the services. In 1942, however, a State 
 appropriation was made for child-welfare, and similar appropriations hove been 
 continued. In Delaware, to cite another example, State funds for child-welfare 
 services were increased threo-fold from 1939 to 1944. 
 
 The greatest stimulus from the use of Federal moneys has been experienced in 
 the rural areas, where, for the first time, in many instances, the services of 
 a trained child-welfare worker hav q seen mane available. Federal funds are 
 being used to pay the salaries of op! child-welfare workers, all except a few 
 of whom were working in rural counties. In addition to this aid, Federal 
 mone S’* IS 3/ Iso being used to provide child-welfare workers in areas of special 
 need, or specifically, pishes"where children are living under extremely 
 unfavorable conditions. 
 
 S o, what was done in t he first deca.de of t he Social Security ur ogram, as far 
 as child-welfare was concorned, was to establish and set in motion the govern- 
 
 mental machinery by which the greater resources of the Federal government were 
 
 brought to the assistance of the States, with whom the responsibility rests 
 
 Pi.Ml li lW HII I % 
 
 for the welfare of the children 
 
 
 There is no way of counting the children who benefit from what is done under 
 the child-welfare programs under the Social Security Act, for many whom the 
 child-welfare worker never secs are directly affected through advisory and 
 consultative work with State and local we If are departments. For instance, a 
 consultant may be asked to make a study of a homo for delinquent girls, and 
 the recommended ions made may be far-reaching in their consequences. The 
 chi1d-wo1faro worker may succeed in arousing community concern over disgrace¬ 
 ful conditions in jails in which children are being held. 
 
 Or less dramatically, the child-welfare worker may bring the community's 
 attention to the need for a. summer-day comp or for a recreation hall for chil¬ 
 dren. in an 'underprivileged neighborhood. 
 
 In short, one largo part of the child-welfare worker's task is to develop 
 community interest in what is happening to the children, for with that interest 
 once aroused, much can bo done for their protection and care. 
 
 As for those who arc served directly by child-welfare workers each year under 
 the State-Federal programs, they are, by and large, a hapless lot of youngsters. 
 
 Some are boys and girls for whom a foster home has to bo found ond the chila- 
 welfare worker's responsibility is not only to find the home but to soo that a 
 satisfactory l djustnont is made in it. 
 
 Some of the children are in difficult jij. 1£}gir own homes or in the neighbor¬ 
 hood. 
 
L. 
 
 
 1 x -. 
 
 A 
 
Sone are children in jails, end children are in jail" almost everywhere in 
 the country, for for States have as yet provided adequate detention facili¬ 
 ties for children; In many instances, they are quartered with adult of¬ 
 fenders for days, and sonetir.es for weeks. Tor these children the child- 
 welfare worker is the spokesman, arousing comuni ties to the need for making 
 other provision for their care. Sometimes, and more and more frequently 
 it happens, the child-welfare worker is called to the jail, to rake sone 
 other arrangement, when possible, for the child’s detention. 
 
 Others rhor. the chi Id-welfare ’~orker aids are children who are in institu-* 
 tions for the care of delinquents. Sone others are not yet in the jails or 
 the training schools, hut in the opinion of the corr.mnity ”they are headed 
 there.” for these hoys and girls, too, the child-welfare worker serves as 
 a friendly advocate. 
 
 Sene who are cared for are the nontally deficient for whom institutional or 
 foster-family care must he found. 
 
 An important group heir^ aided 'ey chili-wolf are workers arc ■'unmarried mothers 
 and their babies. Often the mothers are so young themselves as to cone 
 within the legal definition of a child. The chiId-welfare worker is one to 
 whom these girls can turn in confidence, and they do, and with the help of 
 the chiId-weXfare worker a plan is node for the care of the girl during 
 pregnancy and childbirth and for such tine after as she still needs profession¬ 
 al counsel. Should she decide to relinquish her baby for adoption, again 
 the ohild-welfr.ro worker helps in getting the chil' settled in a home whore 
 he will get the affectionate cure his mother wants for him. In other adoptions, 
 
 
 too, the err 
 
 .Id-welfare 
 
 T.ur 
 
 * 
 
 So the work 
 
 goes on in 
 
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 j. y >j 
 
 
 with a gain 
 
 hero and a , 
 
 gain 
 
 day-by-da.y routine, unobtrusively but courageously, 
 
 has been made known, children to whom the way is opened a little wider for 
 their fair chance in the world, 
 
 HOW TI-H PHQC-HA1: CFBEATSS 
 
 Each year the State public welfare agency submits to the Children’s Bureau 
 a plan describing how tine Pectoral money will be used in developing child- 
 welfare services for children within the State. Upon approval of that plan 
 by the Children’s Bureau, money is allotted to the State. 
 
 federal money, in larg. part, is used to pay the salaries of chiId-welfare 
 workers, and a high proportion of the total number of child-welfare workers 
 employed by certain States are so paid. 
 
 federal funds are used, too, to pay the salaries of consultants working in 
 and through the State offices. 
 
 Some .money is used for the training of personnel, one of the great needs. 
 
 Hone of the money is used for actual board and come; it is all used, in one 
 way or the other, to provide services to children. 
 
the child involved is cared for in 
 
 Significantly, in 70 percent of the cases, 
 
 his oral home, as would not have been tr i e, in many Instanc es , if the services 
 of a. child-welfare worker had not been available. 
 
 HOT; TELL IS THE SUED !3T 
 
 The need for those social services that would aid in assuring to ’’each child 
 his fair chance’ 1 is not being met, and for many reasons, in addition to the 
 lack of funds. Lack of skilled personnel is one of the most important of 
 those reasons. The public* s unawareness of that need is another. 
 
 The situation today is not what it was in 193o» neither so far as services 
 are concerned, for a good beginning has been made in providing them, nor so 
 far as the children themselves arc concerned. But a supposition that, be¬ 
 cause economic tension has boon lifted for many families who were living in 
 terrifying insecurity ten years ago, all children are appreciably better off 
 is contrary to the facts. 
 
 Today* s children, in great numbers, arc an uprooted lot,— children of families 
 that were first on the move in the depression years, then, in the war years, 
 on the move once more. Homos have been broken and reestablished and broken 
 again, in many, many instances. Thousands of children, too, have bad family 
 relationships threatened, and in some cases broken with the call of men to the 
 armed services. The insecurity of the times has in its hold not only the chil¬ 
 dren living in urban areas but also those living in the small towns and over 
 the countryside, and ahead of them is a now adjustment, Nation-wide, families 
 will need help, and children will need help if they are to have "their fair 
 chance" in the days to come. 
 
 To be measured against that need are these facts: 
 
 Federal funds are being used today to provide child-welfare workers in only 
 
 one out of seven counties in the United States. The number of full-time work- 
 ers paid from. Federal funds is an appreciable part—one out of five—of the 
 
 whole number employed by State or lo cal agencies. 
 
 Loss than 1,000 child-welfare* workers under public auspices are working out¬ 
 side the metropolitan centers, i.e., counties that have cities of 100,000 
 or more population. Yet most children live in the smaller cities and in 
 towns and the rural areas. 
 
 More than half of the child-welfare workers employed by public-welfare agenci e; 
 are working in 3 States—New York, Massachusetts, Minnesota, Indiana, Wash¬ 
 ington, Illinois, Ohio, and Connecticut, 
 
 Not only are they concentrated in a few States, but, they tend to be further 
 concentrated in counties in those States that have largo urban populations. 
 
 In many of those counties, moreover, the services are limited, wholly or in 
 large measure, to provision of foster care, with little or no service provided 
 under public auspices to children in their own homes (exclusive of the provi¬ 
 sion of general relief and special types of public assistance). Relatively 
 few places have well-rounded child-welfare services. 
 

 V 
 
 Thirty-two States rave fewer than 2p full-time chiId-welfare workers on 
 their staffs, and s one times of necessity, their services are "spread thirl. 
 
 The figures have oven more meaning when given, not in a State, out in a, 
 county tabulation. For example, this is the kind of picture obtained: 
 
 Cf the 
 
 102 counties in 
 
 one State, only J 
 
 have child—vcIfare workers 
 
 r* 
 
 to 
 
 s* 
 
 lo 
 
 114 in 
 
 another, 
 
 only 6 
 
 have chi1d-velfar 
 
 e workers; of 100 counties 
 
 in still 
 
 ano thcr 
 
 ■ State, 
 
 only Ip; 
 
 and so on. Some 
 
 other specialized services 
 
 to chil- 
 
 Aren may beavailable in those comities, but it is not likely. 
 
 Programs everywhere are admittedly operating under great handicaps. The 
 field is relatively new. Funds are limited, and—a nag or difficulty men¬ 
 tioned previously—men and women with the necessary professional skills 
 are nowhere near adequate in number to meet even a considerable part of 
 the need. A training urogram has to go hand in hand with an expansion of 
 
 services. 
 
 side 
 
 it 
 
 con. 
 
 be said 
 
 that the files, of State 
 
 and local public- 
 
 CClit'' 
 
 ein 
 
 the 
 
 stories 
 
 of thousands of children 
 
 and families 
 
 -t. 
 
 cf* 
 
 O 
 
 lie Ip 
 
 thornsel 
 
 ves because a worker was 
 
 near at hand 
 
 to "do something” when their ora social .and economic resources mere not enough 
 to carry them through the stress of a particular situation. And, as the 
 need of the individual child is mot, communities become am?,re of the need 
 of the hundreds and the thousands of children in similar circumstances, 
 the children who are being denied "their fair chance in the world.” 
 
 HEXT STEPS 
 
 Stating that "today hundreds of thousands of children are living under con¬ 
 ditions that, deprive them of the opportunities and privileges contributing 
 to good citizenship," the Hation.nl Commission on Cr i 1 dr o n m Hart imq* in 
 its recent prospectus, calls for an expansion of social services to help 
 meet the special needs of children whose "veil-being cannot be fully assured 
 by their families and by those community services that arc intended for 
 all children." 
 
 The Commission also states that the war has shorn clearly that State and 
 local public and private welfare agencies do not .have the necessary services 
 and facilities to meet the social needs of children. 
 
 To meet the needs more fully, the Commissi on proposes an expansion of child- 
 
 welfare services u n der the Social Security progran, ovor a 10-year period, 
 that would make coverage State-wide, so that individual guidance and service 
 
 —'*' — *■ » — —— w I«I I I » I >»-» mm ' -- » . . . »» *----- ‘ 
 
 would be available to every child in snocial need. 
 
 ♦Copies of this report—"Building the Future" are available free upon request 
 to the Children's Bureau, U. S. Department of Labor, Washington 2p> F. C. 
 

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 X 
 
 The Commission would have Fo&eral funds available to the States for the 
 f o 11 owi ng purpo s c s i 
 
 a. An extension of foster care for children, primarily in foster- 
 f an i1 ~~ homes. 
 
 h. Prevision for temporary -care of dependent, neglected, and delinquent 
 children in areas whore they night other,:!se he without adequate 
 protection and shelter, or mould he detained in jail. 
 
 c. An improvement of institutional care for children. 
 
 d. Day-care services for children whose mothers are employed or whose 
 homo conditions require such services. 
 
 Recognising that a basic need is for well-trained personnel the Commission 
 also asms that Federal funds -should ho made available to the States to 
 assist in training such nor sonne-1. 
 
 C hild-welfare services provided, under such T o& era l-Stat o p rog ra ms, fur ther- 
 m ore, would ho available witho ut discri mination because of color, race, 
 creed, nationa l or igin, or residence. 
 
 Federal funds, un.d e r the Cer r " 1 s s 1 oa- 1 s proposal ,_ would be all otted to th e 
 
 Stat es, not on the ir a bil ity t o na t ch the fund, i n whole or in part, but on 
 the basis of State and csmimnity needs and the resources canallable to meet 
 
 those needs. 
 
 HOW TIE STOAT CAT BP TOLD 
 What is being done in providing specialised services to children in your State 
 What change has taken place since Social Security funds were made available? 
 How many counties have child-welfare workers? 
 
 Are children being held in jails in year community? 
 
 What does the 
 
 cm j. a-veil. 
 
 The answers to 
 
 these and 
 
 story can be h 
 
 ,ad from th 
 
 county health 
 
 office. 
 
 public wolf are, or rr.