The Full Measure of Responsibility A PAPER read before the Children’s Section of the National Conference of Charities and Correction At Philadelphia, May 10, 1906. BY WILLIAM H. PEAR w Assistant Secretary, Boston Children’s Aid Society (Now General Agent Boston Provident Association) Worthy of a Second Pleading by Every Social Worker. Reprinted by the Russell Sage Foundation Department of Child-Helping. New York: 1909. The Full Measure of Responsibility A Paper Read Before the Children’s Section of the National Conference of Charities and Correction At Philadelphia, May 10, 1906. BY WILLIAM H. PEAR. The following paper was written in 1906 for the Children’s Committee of the National Conference of Charities and Correction by Mr. William H. Pear, now General Agent of the Provident Association of Boston, but at that time Assistant Secretary of the Boston Chil¬ dren’s Aid Society. This paper is, in my opinion, one of the most important recent contributions to the literature of philanthropy. While it was written, primarily, for workers in behalf of chil¬ dren, it is equally valuable to every one who undertakes to deal with suffering humanity. The spirit of the paper is expressed in the phrase, “the need of diagnosis.” The gist of the paper will be found in the “Essential Principles” on pages 4 and 5. The paper was sent, in advance of its public reading, to the writer, who, recognizing its merits, printed 1,000 copies for distribution at the Conference. These copies disappeared as if by magic. It was printed in the Proceedings of the Conference, and reprinted in pamphlet form. It was reprinted in the Children’s Home Finder (circulation 30,000). It has recently been reprinted by Children’s Charities (circulation 40,000), and we are now printing 5,000 copies for distribution. Single copies will be furnished free of charge. Larger numbers can be secured at cost. HASTINGS H. HART, 105 East 22nd St., New York, N. Y. / THE FULL MEASURE OF RESPONSIBILITY BY WILLIAM H. PEAR. Reprinted by Request from the Proceedings of the National Con¬ ference of Charities and Correction. 1906. Genuine help can be rendered to those in need only when full responsibility is realized and accepted, and when scientific inquiry—i. e., diagnosis of the need—is followed by assistance which aims to remove the cause of the need, or by relief that is adequate, so far as that is possible. How many of us who are engaged in work for children, in children’s aid societies, day nurseries and asylums, would find, by reviewing the individual cases dealt with, that they would stand the test of comparison with this standard? The fact that one has it in his power to oflfer a certain kind of assistance, is no reason why he cS should address himself simply to the question of giving or withholding that assistance; considering merely whether he can take the child as asked, instead of that vastly important consideration, should the child be taken from its fam¬ ily at all. THE NEED OF DIAGNOSIS. Many years ago a long advance step was taken in removing the dependent child from the almshouse, and the hos¬ pitable asylum rose to supply the need. Then the development of the placing-out system, came in some instances to re¬ place, and quite generally to supplement and modify the work of the asylum. During the past twenty years we have focussed our attention on the question, how best to care for the children; the relative merits of the placing-out and the institution methods have been d»s- * cussed. I wish to urge that we now turn our attention to this other very important phase of our work, the need of what may be called case diagnosis and its attendant responsibilities. Here is an obligation not to be shirked. It rests upon every agency at the moment when the individual child seeks admission to its care, for there is always a chance that there may be no other human agency to intervene between that child and want or even calamity. The responsibility at this point is yours and you must face it. These applicants are seldom far sighted. They are in distress, and they do not know what they really need. They have appeared at your door, but they may reach no other in season, except with your assistance. One of two things, therefore, must be done; you must either deal with the situation your¬ self or put the applicants in touch with the best service that your community affords. In any case there can be no such thing as proper and adequate as¬ sistance without careful diagnosis of the need; and if we regard the occa¬ sion as one in which we have merely to decide whether or not to receive the child into our institution, we have not struck the pace which present day standards require. Consider the situation for a moment from the point of view of the commun¬ ity. In the first place,- it must be ad¬ mitted that the social forces of any community are very inadequately or¬ ganized if there is not some place where the needs of a. child in want can be analyzed, and a remedy suggested and applied. If a child is ill, it is possible to have the case diagnosed speedily and prescribed for in a dispensary, or treated in a hospital clinic, by an in¬ dividual physician skilled in the work he is called upon to do. But if a child is in need, or if, as is often the case, family need is thought by relatives and friends to be child need, in how many places can the same skillful treatment be assured? It may perhaps be conceded that the most scientific and economically sound plan, in theory, would be to have a cen¬ tral bureau of inquiry and advice, where all cases of child need might be diag- r nosed, and to which all helping agencies might refer all applicants. With such a single bureau duplication of effort would be avoided at the outset. But it is obvious that such a plan only needs to be stated to reveal any number of practical difficulties. The very size of a city like New York, for example, as well as the definite classification of its organizations, no doubt makes the sin¬ gle bureau at once impracticable. Never¬ theless the two main features of such a plan are apparent and well worth not¬ ing for the purpose of seeing how far it may be possible to approximate them. I refer to (1) The elimination of waste effort, and (2) The intensification and wise di¬ rection of effort. a clearing house oe experts. Whether or not the first object is attained by the plan of a single bureau need not matter, provided there is ef¬ fective co-operation between agencies in their work. But the second and more important consideration, the thoroughness and skill with which the work is done, demands our earnest con¬ sideration. Such a bureau as I have referred to would be a sort of clearing house, officered by experts, whose ex¬ perience would constantly grow more valuable through the large number of cases with which they would deal. The agents should be shrewd and trained observers, with some clear understand¬ ing of the symptoms of mental and physical, as well as moral, defects or disorder, and they should be in close touch with consulting physicians. They should be men and women of character and trained intelligence; sympathetic, constructively imaginative, wise; with an understanding of human nature, and a wide knowledge of the community’s resources for help. And besides these qualities they should have this keen sense of their responsibility for the maintenance and development of the highest possible standards. Here we would have an agency which would re¬ semble, in its function, a combination of dispensary and hospital; ready to diagnose and to refer, as the need re¬ quired, to special agencies for expert work in special lines. For the purpose of outlining the var¬ ious stages through which the work of such a bureau should proceed, I wish to call attention to EIGHT ESSENTIAL PRINCIPLES. (1) Co-operation: Keeping in close touch with all agencies to prevent dup¬ lication of effort at the outset (an end best attained through a central regis¬ tration bureau, where all agencies make inquiry concerning each case before act¬ ing), or, it may be, uniting effectively with another agency in working out a plan agreed upon. (2) Diagnosis of the Need : The work of an expert investigator with constructive imagination to determine the underlying, not the apparent, cause of the need. (3) Decision as to the Remedy: The plan for attacking, and, so far as possible, removing the cause; involv¬ ing, besides a keen analysis of all the features of the case, the determination as to the precise conditions to be re¬ quired of all concerned; what measure of financial responsibility should be borne by relatives, etc. (4) Application of the Remedy : Making effective the decision. One of the most important considerations, its employment or its absence marking the distinction between effective effort and cheap advice. (5) Responsibility, Direct and In¬ direct, Upon Admission: That is to say, the direct responsibility for the proper care of the child, and the indirect re¬ sponsibility for observation, and, if necessary, for definite action, to enforce or assist in carrying out the conditions prescribed. This latter may involve some definite action, quite apart from the care of the child. (6) Investigation Before Dis¬ charge: In cases where the child has been taken, the necessary assurance that discharge is justified and proper; that conditions have been complied with; or it may be the discovery that further extension of care is imperative, if all that has been done is not to go for naught. (7) Subsequent Inquiry to Learn Results: That very necessary step by which to test the real value of our work, and, in many instances, the one instrument with which to make our work effective. (8) Tabulation of Results : The necessary statistical work by means of which the valuable record of our ex¬ perience is made serviceable for study and for future guidance. A topical in¬ dex of the important features of cases dealt with, and also of the character of the work done by other agencies with whom we have perhaps co-operated. how these: principles work. Now let me tell you a true story that will illustrate the working of these prin¬ ciples. About two years ago Mrs. Blank, a widow, asked the Children’s Aid So¬ ciety to take, for a few weeks, her two children, aged four and a half and three. She said that she was tired, and thought a few weeks’ freedom from the care of the little ones would be a great re¬ lief. Admitting the premise, which was evident, her conclusion was, after seeing the children, easy to reach. The woman was working in a shop for $4.50 per week, and living with her aged parents in one of the suburbs, the man not strong, but working some, and the old woman just able to do the housework. It was easy to see that all was not well with the mother physically. Inquiry at the registration bureau of the Associated Charities showed that they had no record of the family, nor had any inquiry concerning the woman or children been made by any other ag¬ ency. Note here the first step in co¬ operation. Investigation at the home confirmed the mother’s story, and also revealed the fact that she had a serious illness, for which a physician had long before advised an operation. It was clear, therefore, that simply to take the children for a few weeks, at first sight a kindly thing to do, would be no real help. She was at length persuaded, though only after repeated interviews, to allow our agent to accompany her to one of our consulting physicians, a woman, who confirmed the finding of the other physician. Diagnosis of the need : the mother’s health should be restored, if possible, so that she can stand some chance of continuing to support her children. Decision as to the remedy: she should be sent to a hospital for the operation, which will be performed by our physician, and in the meantime the children must be cared for without ex¬ pense to her. This definite decision is therefore given and recorded: “John and Sarah are to be boarded in a family at the expense of the Society. Case to be reconsidered in four weeks.” Now comes the application of the remedy. The appointed time for mother and children to come to the of¬ fice arrives, but they did not. She has decided that she “can’t do it, after all.” She will get along as she has. This our investigating agent discovered on going to look them up. Further argu¬ ment follows, and at length prevails, and the little family reaches the office in charge of the agent, who has not dared to leave the woman for fear she would not hold to her purpose. We now enter the fifth stage: Di¬ rect responsibility for the good care of the children, and indirect responsibility for the mother. She must be conducted to the very door of the hospital by the investigating agent, while the placing- out visitor takes the children to the fam¬ ily that she has carefully chosen. A slight suspicion regarding their physi¬ cal condition has, however, caused her to take them first to the Eye and Ear Infirmary, where adenoids are removed and an ear treated. As the case is to be reconsidered in four weeks, the investigating agent makes an entry on her daily calendar, and when the day arrives she learns from the doctor the mother’s condition: in other words, here is investigation before discharge. The doctor reports that the woman has made a good recov¬ ery but needs at least three weeks’ rest in the country before going to work. It is accordingly decided to extend the time and arrange for the woman to go to a convalescent home. Again the agent makes a note on the calendar, and again, when the day arrives, she learns the mother’s condition. This time it is found to be excellent, and accordingly they all return home. At the time of giving the decision to discharge the children, we have decided on a definite plan for subsequent in¬ quiry, to learn results: an inquiry in two weeks to be sure that the woman’s strength is proving sufficient to enable her to work. Another inquiry, made a year later, resulted in the woman’s call¬ ing to tell how she was getting on, and bringing with her a friend who was in trouble. “I have brought her,” she said, “because you make people do things that are good for them, whether they want to or not.” As to the eighth principle, the tabu¬ lation of results; the reason that this case is available for illustration is be¬ cause there is a card in our “topical index” headed, “Parents, work for— case of John and Sarah Blank.” TWO KINDS OF CASES. There are two kinds of cases which especially require the most careful and scientific dealing, and together they form a very large proportion of all that are received. First, those in which the separation of the children from their parents should be permitted only upon certain conditions which aim at recon¬ struction. The case just described is an example of this very large class. Simply to remove the children from the family as requested, would have been as purposeless and ineffectual as for a physician to treat symptoms instead of the disease. It was proper and neces¬ sary here to take the children, but the separation was only justified by the effort made to restore the mother’s health. Then there is another kind of case which comes in a great variety of forms and which may safely be said to include more than half of all that are presented to the Society which I represent; the case in which the separation of the child from the family is quite unnecessary and therefore improper. Take for ex¬ ample the case of a young Swedish couple, who recently asked to have their baby taken so that the woman could go out to work and add to the income. The man was earning $11.00 per week and nearly all went for food and rent. Here was a case for a friendly visitor who would go into the home and teach the young wife ordinary household economies, how to provide, how to cook, etc. To take a child away under such circumstances would be distinctly wrong; instead, the case was placed in the hands of the Associated Charities for visiting the home. WORK OF FIVE SOCIETIES. While it cannot be said that such work is done nowhere else, there-are but five of our large cities in which the children’s aid societies have organized special departments for this work of case diagnosis; for giving information and advice. Beginning here in Phila¬ delphia in the year 1882, with the or¬ ganization of the Children’s Aid So¬ ciety and Bureau of Information, the work soon proved of the greatest value. Miss Kerr, superintendent of the so¬ ciety, says of it today, “It is impossible to estimate the value of its personal service, involving often many days of investigation and study, which is freely given from this Bureau to every case where the interests of a child and a home are at stake.” The work was at first undertaken in Boston about twenty years ago by Mr. Birtwell. While considering applica¬ tions for the admission of boys to the training farm at that time maintained by the Boston Children’s Aid Society, he found himself confronted by cases presenting a variety of needs; cases wherein he could see that only wise advice was needed; others in which, to reach the root of the difficulty, he found it necessary to do something more than simply to take the child. Case by case these were met, and in 1888 the Children’s Aid Society com¬ mitted itself definitely to the work, es¬ tablishing its Bureau of Information, which, during the past eighteen years, has dealt with the application of more than 18,000 children, and is receiving about 1,300 annually. This department is now maintained at an annual expense of about $6,000.00; a sum equal to the entire expenditure of the Society twenty year ago but representing but 13 per cent of the total expenditure today. In 1898 three other children’s aid so¬ cieties established similar departments: the Henry Watson Children’s Aid So¬ ciety in Baltimore, the Brooklyn Chil¬ dren’s Aid Society, and the Children’s Home and Aid Society of Chicago. In announcing to the public the formation of the new bureau, the Baltimore so¬ ciety invited all other institutions to use it as a registration bureau. It is now investigating the application of about 350 children annually. The Bureau of Counsel, Relief and Investigation of the Brooklyn society received, last year, applications involving 700 children, and the “Aid Department” of the Chicago society received applications involving 1,600. PRACTICAL CO-OPERATION. But now we come to a very practi¬ cal question: What are the smaller in¬ dependent societies to do, with no such equipment possible as is possessed by the large agency? I want before clos¬ ing to give a brief description of one or two ways in which different societies in and near Boston have sought to solve the problem, for they may be suggestive to others. First as to the day nurseries. Some five years ago, several of the day nur¬ series entered into an agreement with the Children’s Aid Society by which they reported to the Society’s Bureau of Information every case in which they refused admission to the nurseries for any cause whatever. Thus they discharged their responsibility toward all who came to them. Later came the formation of a new admission committee in one of the nur¬ series. After requesting the Children’s Aid Society to do for them all work of investigation and admission, the manag¬ ers finally adopted this plan suggested by Mr. Birtwell: Besides employing a trained investigator, they formed a committee on admission, made up of the chairman and one other member of their Board, their matron, a member of the executive staff of the Associated Charities, and one from the Children’s Aid Society. Here you have a distinct and very suggestive effort to meet this responsibility on which I have laid such stress. A still further development along this line-is the experiment now being made, a joint case committee, representing in similar fashion several nurseries instead of one, and including in its membership representatives of the paid staffs of the Children’s Mis¬ sion, Children’s Friend Society and the Society for the Prevention of Cruelty to Children. Again, a Children’s Home in Cam¬ bridge has adopted the plan of seeking the advice of the Associated Charities on questions of admission. This is very suggestive of possibilities in other communities. Other interesting developments may be seen in the reorganization of the Boston Children’s Friend Society in 1900, and the Worcester Children’s Friend Society in 1903, where, besides changing from the institution to the placing-out method, consultation bu¬ reaus were established by means of which questions of admission should be decided and other valuable assistance given when needed; and a similar in¬ stance is that of the Children’s Mis¬ sion, where a trained agent has been for several years employed for this work of admission and advice. In all of these instances the agents had work¬ ed with the Boston Children’s Aid So¬ ciety. The Children’s Friend Society is receiving applications at the rate of about 600 children per year, and the Children’s Mission about 800. It should be understood that we have in Boston a very effective scheme of co¬ operation in the registration bureau of the Associated Charities, where all the leading agencies are accustomed to in¬ quire for information upon the receipt of each application. Without such fa- k cilities it is easy to see what complica¬ tions might arise, where several inde¬ pendent bureaus are dealing with such a large number of cases. a few CAUTIONS. Let me add here, in closing, a few cautions. 1. Do not have rules that will set limits to your work. Even general principles you must always hold sub¬ ject to exception. 2. No application should be consid¬ ered without inquiry to secure all the information about the case which the co-operative schemes of your com¬ munity afford. 3. An application to take a child may call for action as far removed as possible from that asked for. 4. It rarely happens that the simple act of taking and caring for a child, even when such action is desirable, is alone adequate to the need. 5. If you take children in an emer¬ gency, it is your duty to see them through that emergency. Have no rules that will make your methods so inelastic as to prevent this. 6. When children are taken, rela¬ tives should be required to contribute towards their support as far as possible. We have been taught to believe that two things were necessary in social work, namely: warm sympathy and sound judgment in happy combination. I venture to name a third essential, this professional sense, to which I have already referred; the sense of responsi¬ bility, which will give our work wise direction, definite standards and general effectiveness. SOCIAL PSYCHOLOGY. This will require of us all, if we wisfe to be tolerated, progressive, construe!! tive work: the constant measuring up t'| the highest standards. The quack, th«| unprofessional doctor, is no greatel menace to the community than the uni professional, paid charity-worker, an<| the sooner we cease to tolerate the latf ter, the better it will be for the comi munity. Now the pity of it is that th<| community does not yet require of u. c | certain standards of excellence, as isj does of the lawyer and physician; bub will anyone say that there is less need; of it; that the work which Dr. Cabot; dignifies by the name of Social Psy-j chology, is of less vital import than that) of the lawyer or doctor? We tinker: with the affairs, the very lives of peo-l pie; take a child out of its home, per-; haps change the whole plan of life of an entire family; and what about the wisdom of it all? One of our great teachers of the present day has recently said that the beginning of wisdom is the desire for discipline. Now neither sympathy with our client, nor the soundest judgment of the need that we have at the time, will bring us this dis¬ cipline. What we must have is the will¬ ingness of the man of science to sub¬ ject his methods and his thoughts to the test of comparison with the largest discoveries of the laboratory; the feel¬ ing of responsibility which will cause us to pursue our daily work with vigor and courage, but yet with serious con¬ cern and humility, keeping our minds receptive to the newest truth and being ever ready for the next forward step.