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What Social Work Has To Offer In The Field Of Mental Retardation
by Grace White, Consultant on Educational Services, Council on Social Work Education
A Presentation Delivered at the Eighty-Fourth Annual Meeting of the American Association on Mental Deficiency
Baltimore, Maryland, May 21, 1960
Editor’s Note: This entry was researched and transcribed by Ian Lewenstein.
Social work is making a contribution to the field of mental retardation but social workers are not giving the substantial services which are needed and which they have the competence to give. Along with other professions and the general public, social work failed for many years to give focused attention to the mentally retarded as a group in the population which needed their services. Lacking knowledge of ways to help the severely and moderately retarded, the social workers helped parents place their children if that seemed the best solution at that time. Other social services were given, but often they were fragmentary and somewhat isolated. What amounted to neglect rose more from frustration and lack of knowledge than from indifference.
A fair question is: What is social work currently offering to the mentally retarded and their families? In these programs, clinics and institutions which give emphasis to mental retardation, the contribution of social work can be examined. These diagnostic, research and service centers are the core of the field of mental retardation. As in all “fields,” a core program is clearly identified but the periphery is not clear. Much of the contribution of social work to the mentally retarded is made in the periphery, in social agencies and socials service departments of hospitals, courts, rehabilitation centers and in public schools.
If one attempted to count the numbers of persons served or to identify the services given specifically to the mentally retarded, one would be confronted with the fact that statistical records and analyses of social services would not be in terms of the impairments of the clients, such as diseases, handicaps or mental retardation. Rather, social diagnostic classifications would be used, such as problems of family relationships, child care, socially deviant behavior, personal maladjustments and dissatisfactions, financial needs and problems related to illness, handicap and impairment.
The mentally retarded are not only themselves a widely diverse group in the population but basically their needs are more like the needs of other persons than they are different. Their psychosocial needs are common human needs and would usually be so regarded in social agencies. On the other hand, many of the mentally retarded also have specific needs. Those of you who are working the “core programs” are rapidly identifying this configuration of “mental retardation problems” as you discover more and more the true nature of mental retardation, its courses and variations, and its relation to other impairments and functioning of individuals.
There seems to be general agreement in the literature on these facts: The large majority of those who are labeled as mentally retarded will not be so identified at all times through their lives. There is considerable movement in and out of the categories of retardation at various age levels, as well as classification within the retarded population. Categorizing a child or an adult as mentally retarded depends not only on the acuity of the measuring instruments employed but also on the standards expected at different age levels and the demands which different social situations, programs, agencies and institutions may make at any given time. A basic core (about 6% of the total group) are identifiable as mentally retarded throughout their lives.
The implication of these facts about identification of the mentally retarded and the nature of reports of social services is that we are not likely to know either in statistical terms or descriptively the full contribution of social work in the field of mental retardation. Nor are the social services in the several kinds of special programs fully recorded. The writer studied a number of case records and other material written by social workers in institutions and clinics. Further knowledge was gained as a participant, in June 1959, in a week’s conference which was devoted to the examination by practitioners and educators of social work practice in the mental retardation field and the implications for social work education. This experience and study of records resulted in the conviction on the part of the writer that, insofar as they exist, the social services are substantial and professional in nature but that they are insufficient to the need. In fact, they seem woefully limited in amount; woefully, because the nature of the needs are such that the competencies of social workers are strongly indicated. One could make a convincing case for their essentiality in every program now serving the mentally retarded if one thought there were hope for thorough programming and staffing at this time.
My colleagues in the field tell me that the need for social services is great and that social workers are pitifully few in number in the special programs; that social workers are still generally indifferent to the great need and possibilities in the field; that recruiting to the field is very difficult; and that the interest and help of the profession is essential in order to make the contribution of social work to the mental retardation field what it should be and could be. Pressing upon social work are many underdeveloped fields—corrections, aging, addictions, to name but three; only yesterday were there even greater pressures from the mental health and chronic disease fields. Too many fields have to capture social workers on a catch-as-catch can basis, a situation which does not make for sound development of social services. For some of these fields, mental health particularly, development is substantial as a result of broad scale planning and the support by the public of a full program and inclusive staffing.
Pondering this situation of uneven development, the thought which kept coming to the fore was: What could social work offer this rapidly developing field of mental retardation in the next decade with effort and well directed energy on the part of social workers and, also, on the part of those “significant others” who affect and in many ways control where social workers are and what they are doing? “Others” include the major disciplines working in the field, the administrators of programs, the financing agents and citizens who, in the last analysis, say yea or nay to the support of services. The well directed effort of the social workers is, however, the first essential in development of social work in the field.
Consideration of what could be rests on three “givens” and many significant “ifs.” The givens are: (1) the nature, as now understood, of mental retardation and the needs of the two to three percent of the population so characterized; (2) the nature of professional social work practice with its current knowledge, attitudes, values, and skills; (3) the long continued and dire shortage of social workers with the competition of social problems clamoring for attention and personnel. In attempting to identify the key spots where competent social workers should be and to spot the activities which seem to merit major attention in the next few years, the writer was guided by the thought, so well expressed by Oliver Wendell Holmes, that it is sometimes more important to emphasize the obvious than to elucidate the obscure.
No attempt is made to summarize or highlight the nature of mental retardations and the needs of the mentally retarded. To do so would be presumptuous on the part of the writer; further, this audience is familiar with the field and time had better be spent on the nature of social work practice which is less familiar to many of the persons who work in the mental retardation field. However, before turning to the nature of the services that social work might give, several primary questions should be considered.
Where are the mentally retarded and where and how are their needs presented, by themselves or others? Who identifies them? Where and by what route does the social worker meet the mentally retarded or come in touch with their problems and needs? Where are social workers now and where do they need to be in order to make an effective contribution? The mentally retarded are mostly in their homes; some children are in foster homes and some adults are in “protective” homes and institutions of several kinds; a significant number of the moderately and severely retarded are in institutions for the mentally retarded. Their needs will not usually be presented, first, by themselves or others, as problems of mental retardation. The majority of children will appear in the offices of physicians, pediatric or well baby clinics as problems of slow development or a severe physical disability, perhaps as a complex condition of mental and physical malfunctioning. Many retardates will appear in pre-school or day care programs and here their mental functioning as well as any related social inadequacy will be manifested to the alert eye. Many will appear in schools and the educational demands will begin to reveal the impairment in mental functioning. A number of adolescents and adults will be identified in courts and in employment agencies and rehabilitation programs. Some will appear in social agencies as problems of child care or other problems of social and personal needs.
In other than the social agencies, who identifies the social problems related to the mental and social malfunctioning? Are social workers part of the personnel in these various places where the problems of the mental retardate are being identified, and who refers the person or his family to a social worker or a social agency and for what?
Accepting that many will not be identified clearly as to their mental retardation, we come sharply to the question of acuity of the social worker, his alertness to symptomatology and his competence to take into consideration the full range of behavioral manifestations and their causes. All social workers need to have understanding not only of mental endowment and functioning but also of the effect of adverse environment and psychic disorders on mental functioning. In assessing the person in his social situation and in determining his need for social service, the degree to which special consideration must be given to the intellectual capacity is determined by the person’s adequacy to cope with the demands made of him. He may be only marginally independent; he may be able to cope providing the demands are not in excess of his ability and the stresses are not such that his capacity to cope is lessened.
We have reached our first peg on which to hang a vital question: Does the basic two-year program in schools of social work give sufficient attention to mental endowment, to the manifestation of impairment and to the relationship of endowment to social functioning? Does the content on practice give sufficient attention, in class and field, to the application of such knowledge provided? The curriculum content bears examination from this viewpoint. The specialized practitioner, biased correctly by his intense interest in the field, would render a sad verdict of inadequate content and learning experiences. The social work educator, focusing on the objectives of basic education in the two-year Master’s program, would render a different opinion. The ground work is laid in the courses on human growth and behavior, which emphasize normal growth and the manifestations and causes of deviant behavior. The content on mental endowment and functioning, and the relation to social functioning, is doubtless insufficient in most schools and should be strengthened. The strengthening will depend, in large part, on the identification of what you, as specialized workers, believe is essential for all social workers to have as part of their basic education for social work practice. The content may seem self-evident to the specialized person, but this is not so. What is needed for consideration is clarity of that content which is needed and “evidence” of the use of such content in social work practice, per se. The competition of content for “the curriculum hour” is heavy, indeed. The tricky problem, complicated and difficult to solve, is whether content on and pertinent to mental retardation has “an appropriate portion” of attention in the schools of social work. “Appropriate portion” must be related to the core content which is deemed essential and most effective in basic professional education for social work practice in many fields. From the moans from all fields of practice to the effect that graduates do not understand this field or that problem, it is unlikely that any curriculum will ever have “enough” of specific content to prepare persons for competent practice in any specific field.
This brings us to the second peg: what opportunities are afforded by the staff development programs in agencies and centers to augment the basic preparation? What help is given in attaining the knowledge, attitudes and skills that are essential for good practice in that field and what help is given in the use of knowledge necessary for effective service to the persons under care? The third peg is: what curiosity do social workers show about the phenomena they are encountering in their practice and what individual inquiry and study do they carry on in order to increase their understanding of these phenomena and the ways of dealing with them more effectively? Many of the colleagues of social workers, physicians and social scientists in particular, prod social workers a bit by challenging mildly the state of their “CQ,” curiosity quotient. Why this concern on the part of another discipline? Because there is general acknowledgment that social workers are keen observers; they are sensitive and able to establish relationships with people of such nature that they learn much about people which could be of value to other disciplines; social workers have skills in interviewing that are needed in order to secure such data. What then is missing? The case is made that social workers tend not to bring through their observations and impressions to the point of maximum usefulness to their own practice and do not analyze or publish their findings in a manner useful to others in the research or practice of other disciplines. As one social scientist put it, “You have a gold mine but you do not work it.” True or not, the challenge that our curiosity quotient is low or that we do not analyze our data effectively should not be evaded or sidestepped.
Recognition by social workers that they do not yet have sufficient understanding of mental endowment and functioning, and their relation to social functioning, does not relieve social workers of their responsibility to make at least a gross assessment of the capacity of the individual. A refined assessment of mental retardation calls for a combination of diagnostic skills. The social worker should be alert to the need for such refined assessment and make a referral to other disciplines as indicated, but also participate in the diagnostic process. The social worker and the social agency share with other disciplines, with the clinics, the courts and schools, the task of case finding and the provision of service as needed and when needed. Some of the social treatment will be amelioration of social conditions through the utilization of resources and help to the family in using such resources. In all instances, attention should focus on prevention of unnecessary burdens and unhealthy stress. Continued strain and conflicts on the part of parents are reflected in family life and have an adverse impact on family members as well as on the retardate. The toll may be problems that could have been partially or largely prevented by adequate social services at the right time. A second preventive service centers on the “good growing conditions” for the retardate himself so that further psychic and social impairment will not occur.
“Good growing conditions” are essentially the same for all children. Provision for most of their basic needs does not vary because a child is mentally retarded; however, the social worker needs to examine what is difficult or impossible for the parents to provide their own mentally retarded child. Some of the difficulties lie in the family more than in the child. Mental retardation is a condition of an individual but the problems resulting from mental retardation are largely family problems which often become community problems. The family problems have high variability. Knowing one situation well does not tell us what we can anticipate in another situation, but knowing many such situations helps us understand better the possible problems that confront parents in providing the live, care and environment conducive to the child’s best growth and maximum social functioning within his potential.
What parents face and what help parents need can best be learned from parents themselves. The parents have had to struggle hard to help us understand but now that they have organized in order to have a collective voice, they are finding many ways to tell us.
The radio program, “Eternal Light,” on May 8th, dramatized for the public most effectively the needs of Jonathan’s mother in telling the story of the beginning of the Miamonodes Center. Jonathan’s mother had to learn from Jonathan that, like the tree, the boy grows, but grows slowly. Her conflicts and searchings were a typical syndrome—searching for medical help to make Jonathan right, seeking widely for reassurance that he would grow normally, ambivalence in facing the reality of his condition, then searching for someone to educate him. She felt education was not only his right but education was essential to her culture and her concept of her son. She faced closed doors but finally with the creation of the Center there was a source of help. Slowly she accepted limited goals as she learned to accept her son as he was. Slowly she was able to give him recognition of small gains, to accept his love for her and to give to him the love which he needed to grow, even if slowly.
You in this audience know the parents’ efforts and need for help. A term frequently used is parent counselling, a service provided by a number of disciplines. Social casework service is not synomous with parent counselling, as frequently characterized, but social casework provides a means for counselling parents and for helping families deal with their problems.
It is important to note that while many persons who have contact with the family or are treating the person in some specific way will have awareness and understanding of the social problems, the social worker focuses on these toward the end of evaluating them in order to deal with them. Study and treatment of psychosocial problems is the essence of the social worker’s job. If a person or a family is to be given social treatment, there must be an analysis of the psychosocial situation and an evaluation of the capacity and the motivation of the family to move forward in trying to solve the problems. The evaluation also includes the contribution that the social caseworker can make to the total situation. Much is learned from others who are working with the person and his family but the social workers must make his own assessment of the aspects of the situation with which he will work with the family.
The social worker learns from the person how “it is with him” because only from and through him can he know how the person assesses the situation and himself. This means that time must be spent with the person and ways found to help him tell or show the social worker “how it is.” Plans must be made, not for, a person to move ahead in his situation. The social workers cannot help in this movement ahead until there is some clarification of what the person wants and is capable of doing. Since revealing what is in one’s heart and mind is a personal and intimate experience, a relationship of confidence must be established. The person must not only be assured of the social worker’s interest in him and his situation, but of the capacity to help him and the desire to do so. This building of a relationship which permits knowing the situation and permits treatment may take an hour, days, or even weeks for those persons whose life experiences have been such that they do not relate readily nor trust freely, nor look outside of themselves for help in personal matters.
The meaning of mental retardation to each family is as unique as is personality and life experience. The problems of having and caring for a mentally retarded child are different in each instance.
The social worker begins where the person is in his understanding and attitudes—his perception of his problem and himself may or may not seem “realistic” but the person is involved as he sees himself and others. The social worker permits and often helps the person express his anger, his resentments and his bitterness. Probably most important, the person is not only allowed but encouraged to talk about the things which concern him without trying to divert him from expressing his fears, his anxieties, his disheartenment. This is in contrast to the persons in his family, friends, relatives and others who find it difficult to allow him to be himself. Many persons are put in discomfort when a person shares his miseries. The too ready assurance or asking him to look on the more cheerful side may deny him the right to have problems or to share them. There is value to the person in sharing his problems with someone whom he will not burden emotionally.
In mental retardation, as in many impairments, part of the treatment is focused on helping the parents understand and accept what has to be faced. Acceptance is harder than understanding; it comes from mulling over ideas in relation to themselves and their lives. They must often be helped to get their stride before they can take first steps in constructive planning. An important part of treatment is to help the person or family recognize what resources they have within themselves and in their environment. Close to this is the mobilization and use of community resources. These present a wide variety from economic to spiritual. The situation may represent for some persons the first need to call on a resource outside of themselves, except for a doctor or perhaps a lawyer. They may have to work through feeling of inadequacy, dependency, fear of loss of control of their lives, or fear of criticism and misunderstanding. Helping a person accept referral and use a community resource is often necessary. The person is helped to know that the social worker will help him make decisions but will not remove from him either his privilege or responsibility for making decisions. What he cannot do for himself will be done for him, if possible, by the social worker or by others.
Social casework service has been described briefly because it is a process that seems difficult for many to understand and distinguish from the helping and therapeutic services given by other disciplines. In a program or field which involves so many disciplines, decisions must be made as to what personnel shall be made available in sufficient numbers to carry on the various phases of study and treatment believed essential to meet the objectives of the program. In addition to social casework service which is direct service to individuals or families, social work practice includes four other basic processes: social group work, community organization, social administration, social research.
How much social work is wanted and how much will be provided in the programs and institutions for the mentally retarded? This depends on two forces. The first is the original provision for social workers in the staffing pattern and the financing of the program. Social workers do not usually play the major role in these matters. Expansion and extension of social work comes in part from within social work but the original determination of whether social workers shall be employed is made by the planners of the program or agency administrators. Insofar as social workers are in positions of community organization, program planning and consultation to program planners, the social worker can bring to bear consideration of the need for and the use of social services in the program.
The second force is the third “given”—the long continued and dire shortage of social workers with the competition of social problems clamoring for attention. There will not be enough social workers with professional education to fill all the positions where they are needed, budgeted for, and wanted. We are often asked—what is the use in budgeting for a social worker? Can we get one or a second, as the case may be? This is a valid and practical question which cannot be answered accurately. From the experience in other fields, two factors have been influential. Social workers tend to accept employment in those fields and in individual programs or agencies within a field which provide possibilities for the practice of social work in a responsible manner and in keeping with professional practice. This means, in part, time and working conditions which permit such practice, as well as the nature of the responsibilities assigned. It is not only poor economy to use a social worker for tasks that do not call for his competence, but it is often not possible to attract or retain a competent social worker under such conditions.
A second telling point is that the most effective recruiting for any field comes from the efforts of those within the field to interest others, one by one, in employment in the field. Because of the dearth of social workers and the costs of professional education, trainee and scholarship grants have helped in recruitment for specific fields.
Granted that securing competent personnel in a developing field is uphill work, the major question becomes how the social work personnel available can best be deployed. What multiple functions must be carried on concurrently?
- Direct Service—social casework and social group work
Direct service must be sustained and increased in programs, clinics and centers where it now exists and also in other selected places of importance for demonstration. Competent practitioners must be employed and retained long enough to establish stability of the services in some key places. The importance of direct service lies, first, in the fact that such services are desperately needed by people. In addition, the direct practice produces knowledge and skills which underlie the effectiveness of all other functions carried by social workers.
Direct practice is the “feeder” not only to more effective practice and to teaching, but also the source of data for research, for community and program planning and effecting social change.
The plus to the basic knowledge and skills of social work in specific practice must be identified by analysis of that practice. Every specific practice brings a different configuration of needs and services. Competent practice in a specific field requires the acquisition of knowledge, attitudes and skill related to the problem area and the use of techniques and methods which are most effective in the field. The induction of the worker new to the field and staff development programs need to relate to the specifics as well as to help the worker gain more comprehension of basic knowledge, skill in application of principles and methods, and increased ability to utilize knowledge in different situations.
These are obvious points but bear stressing because deliberate and conscientious retention of competent persons in direct practice always involves conflict in an undermanned field. Moving too many experienced workers too quickly into other major functions can result in a dearth of competent practitioners and the feeder line is weakened.
- Documentation, analysis and planning
Conscientious and consistent effort is needed to provide the valid data so often essential to influence and effect change in planning, in provision of services, in policy changes, and improvement in procedures. Such data come from documentation and from analysis. The provision of evidence, as well as social points of view, requires consideration of the utility of data, the timing and form for effective use and the means of reaching persons or groups of influence. As one example, it becomes increasingly clear that the intake policies of some social agencies and social service departments are to give service as and when needed and most effectively given to the mentally retarded and their families. The workers in the field must produce the data that effects such changes.
Training centers need to be selected, strengthened and kept at a high level. The entire battery of educational programs, including individual study, must be considered in any attempt to improve the preparation of persons for a specific practice, or to increase the competence of social workers in any field of practice. These include:
- Bachelor’s degree program and Master’s degree program in schools of social work
- On the job learning: two types—individual, through self-study and experience, staff development programs and other methods employed by agencies toward that goal
- Short term institutes, workshops and refresher courses under a variety of auspices
- Advanced graduate study in schools of social work
Teaching materials, case records and other, must be produced for in-service training and for use in basic educational programs in schools. Much might be said about the ways in which practice and education work together. One such way is the work of the Committee on Teaching Materials of the CSWE. For a number of years this committee has succeeded in luring materials out of the hands and heads of the practitioners and into the hands and heads of the faculty. It takes a bit of doing to accomplish the first as well as the second. Both practitioners and educators serve on the committee which reviews material, case records and descriptive material. If accepted, the material is reproduced for wide distribution. The committee has never had an abundance of material to make available and records on mental retardation are not now available, to my knowledge, through this means. The interest of practice and education in producing good teaching material should be mutual. The teaching records must come from practice as must the identification of the knowledge content regarding mental retardation believed essential for all social workers.
- Research is a must for the improvement of practice and also for the contribution social workers can make to the body of knowledge pertaining to the relation of mental endowment and functioning, and social adequacy and functioning. In turn, research is the second feeder line back to practice and education. The research in the field is indeed encouraging but research, like all other functions, has to be provided for in the selection of persons and their assignments, and allowance of time for this function.
- Consultation service
It becomes quite evident that social workers in many settings will need consultation from social workers with special knowledge of mental retardation in order to serve the mental retardates and their families more effectively. Where such consultants might be located and how their services might be supplied at the time and place needed presents many practical problems. Further, consultation is needed by other disciplines just as social workers need consultation service from other disciplines. The whole question of consultation on special problems, among disciplines and among agencies and programs, is a community organization and planning matter of high order, but given little or no attention by central planning bodies.
This list of functions is incomplete but these seem to the writer to be the major ones for focused attention in the next decade. Selected programs and institutes will need to carry all these functions. Even isolated social workers involved in a direct service program need to carry more than one.
The tasks ahead are large, indeed, but the value of long range planning and coordinated effort of a central group seems clear. This Conference, with its Section on Social Work, seems to provide one means of coordinate effort. The federal programs provide another means for organized effort toward goals agreed upon by a professional group. It is in such fashion that progress in social work has moved in other fields where social workers practice.
The movement in the past decade of social work in the field of mental retardation has been substantial and encouraging. The breakthrough has been made. The programs of the Social Work Section in this Conference dealt with significant aspects of practice. Such opportunities to share problems in practice and get help and stimulation from each other are also steps in a coordinated approach.
If what has been said in this paper gives too much emphasis to the obvious to be of value, then it is clear that it is timely to move ahead another year to elucidation of the obscure. So, growth and change and movement come, from what has been clarified to what still needs clarification.
Source: Grace White Articles. Box 1. University of Minnesota, Twin Cities, Social Welfare History Archives. Minneapolis, MN.