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.

?; >> n ' /

iu % y

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

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

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.

y QF SLA,, L!B,

• a

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.

Besides the day-to-day Fork carried on by doctors and nurses
special projects are undertaken. (Sea page j)

:ne connuni ty,

t 7

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.

n Hi

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.

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

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

v t. '

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

I •

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

O .

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.

(

,-4 '

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,

2 .

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„

(

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

5»

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)

•if 1

•i

'-.<i

boar?

Vi 3

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.

(

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

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.

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.

1 x -.

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

— 4* c

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.

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

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

con.

be said

that the files, of State

and local public-

CClit''

ein

the

stories

of thousands of children

and families

-t.

cf*

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.

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.