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Frances Perkins, Secretary
C H ILD R E N ’S BUREAU • Katharine F. Lenroot, Chief

Care of Children
Coming to the United States for Safety
Under the Attorney General’s Order
of July 13, 1940
Standards Prescribed
by the Children s Bureau

Bureau Publication N o. 268

United States
Government Printing Office
Washington : 1941

For »ale by the Superintendent of Documents. Washington, D. C.
Federal Reserve Bank of St. Louis

Price 10 cent»
Federal Reserve Bank of St. Louis

Co n t e n t s
Care in family homes and in groups----------------------------- -------Standards of family-home care for children (for use of
foster parents)______________________________________
Group care of children--------------------------------- ---------------Standards for child-care agencies-----------------------------------------General policies governing the designation of child-care
agencies______________________ ______________________
Standards of foster care (for use of designated child-care
agencies)------------------------------------------------------------- —
Care in reception centers----------------------------------------------------General standards of care of children in reception centers.
Medical care of children-----------------------------------------------------Standards for medical care-------------------------------------------Program for medical care---------------------------------------Organization for medical care--------------------------------Appendix.— Forms used in the designation of agencies--------m
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F o r e wo r d



Early in June 1940 it became apparent that steps should be
taken, through governmental action and private effort, to
facilitate the entrance of children from European war zones
seeking refuge in the United States, and to assure proper care
for these children after arrival. Need for coordinating the
efforts of the many agencies and individuals in the United
States anxious to provide refuge in this country for such
children also became urgent.
The United States Committee for the Care of European
Children was organized in June 1940 and was incorporated
under the laws of the State of New York on July 3, 1940.
As stated in a bulletin of the Committee, the problem of
providing a refuge in this country for children from European
war zones involves, on the one hand, the overwhelming
sentiment of the American people to admit as many such
children as possible, and, on the other hand, the duty of the
American Government to make certain that every child who
enters will be properly cared for and will not become a
“ public charge.” The function of the Committee, as
described in the same bulletin, is (1) to clear the way for the
admission of children evacuated from war zones in large num­
bers, and (2) to assure their proper care during their stay.1
After conferences between representatives of the Com­
mittee and officials of the Department of State, the Depart­
ment of Justice, and the Department of Labor, the Depart­
ment of Justice and the Department of State adopted on
July 13, 1940, a simplified plan of procedure for the admission
of children for refuge from the dangers of war, on either im­
migration-quota visas 2 or visitor’s visas.
Arrangements may be made either (1) by an individual
who wishes to bring a specified child to the United States and
who furnishes a United States consul abroad with such affi1 So That the Children Can Come, p. 3. Bull. No. 4, United States Committee
for the Care of European Children, Inc., New York.
2 Permitting entrance for an indefinite or permanent stay.

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davits and guarantees as may be required under the law to
assure his ability to care for the child, or (2) by an organiza­
tion recognized by the Attorney General as qualified to give
corporate affidavits for specified children or for unspecified
children to be nominated by representatives of the organiza­
tion abroad, assuring their proper care in this country in
accordance with standards set by the Children’s Bureau of
the United States Department of Labor. The United States
Committee for the Care of European Children, Inc., has sub­
mitted to the Attorney General a plan for the care of children
which has received his approval, and corporate affidavits
submitted by the Committee are accepted by the Attorney
General and by United States consular officers as a basis for
the issuance of quota or visitor’s visas. The corporate
affidavit certifies for each child, specified in the affidavit or
unspecified, as follows:
1. That the child will not become a public charge.
2. That reception, placement, and care of the child will be in ac­
cordance with standards set by the Children’s Bureau of the Depart­
ment of Labor.
3. That the sum of $50 required by the Government has been set
aside as a safeguard against certain future contingencies, and that it
will be placed in a trust fund to be reserved for such purposes upon
the arrival of the child in the United States.

As a basis for its corporate assurance on these points the
United States Committee has secured, for the most part
through its affiliated local information committees, affi­
davits for individuals guaranteeing support, or support and
care in their own homes, and cash contributions. Affidavits
assuring home care must state that the child will be cared
for in accordance with the standards of the Children’s Bureau.
The Child Care Division of the Committee is responsible
for the care of the children from the time they arrive at the
port of entry. In the case of children coming through Canada
it cooperates with Canadian authorities in the reception and
care of children in transit. This division has set up centers
for reception care of children in New York, and is responsible
for the review of homes and the placement and supervision of
children through private child-caring agencies designated by
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the Children’s Bureau, in consultation with State departments
of public welfare.
A total of 184 child-caring agencies in 34 States were
designated provisionally by the Children’s Bureau, in con­
sultation with State welfare departments, for immediate
service in the placement and supervision of European children.
B y December 1940 the facilities of 221 agencies had been
carefully reviewed by both the State agencies and the Chil­
dren’s Bureau and 184 agencies in 40 States had received
final designations.3
Generous cooperation in the development of the program
has been given by State welfare agencies, State health officials,
Nation-wide organizations, and especially by local desig­
nated agencies and local information committees. Pro­
cedures and policies have been developed in cooperation with
the children’s committee of the State Council of Public
Assistance and Welfare Administrators; a committee of the
American Academy of Pediatrics, and a special advisory
group on medical care called together by the Children’s
Bureau, which included members of the Children’s Bureau
Advisory Committee on Pediatrics and representatives of the
United States Committee for the Care of European Children;
and the Advisory Committee to the Child Care Division of the
United States Committee for the Care of European Children.
In addition to maintaining relationships with official
State agencies in regard to the program, giving general
advisory service with reference to development and applica­
tion of standards, and designating child-care agencies for
service, the Children’s Bureau, with the assistance of the
Committee, is compiling and maintaining a central register
of all children coming to the United States for refuge from
the dangers of war, not arriving to join a parent already here
nor accompanied by both parents.4 Through the register,
State health and welfare agencies are notified of children
being cared for in their States.
3 See appendix, p. 28, for forms used in the designation of agencies.
4 The register contained on January 31, 1941, the names of 5,530 children,
slightly more than two-thirds of whom were destined to relatives living in this
country or were accompanied by relatives.
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On October 3, 1940, it was announced that because of the
dangers of ocean transportation, the British Government’s
encouragement of the evacuation of children overseas would
be withdrawn for the present. In accordance with this
decision the United States Committee for the Care of Euro­
pean Children released the following statement of policy:
In looking ahead to its function over the next few months the United
States Committee for the Care of European Children, Inc., has reached
several conclusions. First, it is not going out of business. It must
continue to take care of the children who have come here as its obliga­
tion and this the Committee will do to the fullest extent originally
Second, it will continue to give its advice and help in relation to
children who have come over under private auspices.
Third, while the Committee adheres to its conclusion that it will not
take the responsibility of assisting children now abroad to run the
risks of ocean passage at this time, it regards it as part of its essential
function to aid in any way possible children who do arrive here as
evacuees from the war stricken countries, and that function, too, will
be continued during the coming months.
Fourth, the Committee expresses the view that changing circum­
stances may require a revision of its program at any time.

The standards for the care of children adopted by the
Children’s Bureau have been based on the policies and prac­
tices that have been accepted and used by qualified agencies
in providing care for children in the United States, particu­
larly the standards for child-caring agencies and for medical
care developed by the Child Welfare League of America.5
This publication brings together all the standards that have
been issued for the use of foster parents, reception centers,
and child-caring agencies. In order of issuance these
standards are:
General Standards for Child-Caring Agencies Designated for
Service to European Children, June 28, 1940.
Standards of Family-Home Care for Children (for use of
foster parents), August 1, 1940.
Standards of Foster Care (for use of designated child-care
agencies), August 2, 1940.
8 Standards of Foster Care for Children in Institutions, 1937, and A Health
Program for Children in Foster Care, 1938. Child Welfare League of America,
New York.
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General Standards of Care of Children in Reception Centers,
August 14, 1940.
Standards for Medical Care of Children, August 28, 1940.
Memorandum Concerning Group Care of Children (issued
in tentative form September 20, 1940).

The standards are presented as first issued except for minor
editorial or interpretive changes. The order in which they
are given in this bulletin is not the same as the chronological
order of issuance.

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Care in Family H o m e s and in Groups
The Children’s Bureau and the United States Committee
for the Care of European Children have based their policies
regarding family-home care and group care of children coming
here for safety upon the following premise:
Children coming to the United States for refuge from the dangers
of war should be regarded as guests of the people of the Nation.
Deprived for the present of care in their own homes by their own
people, they should be assured the kind of care which those in the
United' States concerned with the welfare of children are seeking con­
stantly to make a reality.



It is recognized that children coming to the United States,
unlike the children in this country for whom child-caring
organizations assume special responsibility, have come for
the most part from normal homes representing an average
cross section of the family life of the nation whose citizens
they are. Some have had group care in the home country,
British parents are more inclined than American parents to
send their children to boarding schools. The loneliness of a
child in a strange land, the necessity for adaptation to differ­
ent customs in the new home and to a different school program
from that with which he is familiar, and the importance of
maintaining his sense of belonging to his own people and his
own country make it desirable, whenever possible, to keep
guest children in touch with one another. On the other hand,
the variations in background, temperament, and special needs
which characterize children everywhere suggest the supe­
riority, for many children at least, of individual care in an
individual home. This plan also offers greater possibility
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Children Coming to United States fo r S afety

than group care for participation in normal family and com­
munity relationships and activities. Moreover, many chil­
dren coming to the United States under the auspices of the
Committee, like those coming under consular affidavits, have
natural family ties through blood relationship or parental
friendship or acquaintance.
In the light of all these considerations, especially the gen­
erally recognized values inherent for growing children in home
and family life, the Committee in its policies and the Chil­
dren’s Bureau in the standards which it has developed as a
basis for Committee action have emphasized home care.
When groups of children who have known one another in
the home country can be placed in homes in a single com­
munity within a radius that will make possible continuing
contacts and participation in the same school and community
activities, many of the values of home and group care can
be combined. On the other hand, for children who have
lived together under group care in England and for whom a
plan of group care is developed in this country, the standards
provide for a combination of group care and the personal
interest of an individual sponsor for each child.
(For use of foster parents)
I s s u e d A u g u s t 1 , 1940

The general report of the 1940 White House Conference on Children
in a Democracy recognized the importance of home and family as
the first condition of life for the child. The contributions of the home
to the growth, development, and education are summarized by the
White House Conference as follows: 1
The child has food and shelter if his family has a home
and provides food.
He is content and happy if he is well, if he has parents
and others to love and be loved by.
Education begins in the home, where he learns to speak,
to walk, to handle things, to play, to demand, to give, to
‘ Children in a Democracy; general report adopted by the White House Confer­
ence on Children in a Democracy, January 19, 1940, p. 10. Children’s Bureau,
Washington, 1940.
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Care in Family Homes and in Groups


Keligious faith is imparted in the family long before he goes
to church.
Adventure and safety, contentment and rebellion, cooper­
ation, sharing, self-reliance, and mutual aid are family experi­
It is impossible to set down in words the qualities which assure to
a child a successful foster-home experience. The following standards
are intended as general guides and not as inflexible requirements.
I. T he community in which the family lives should offer:

A . Wholesome neighborhood influences.
B. Good health services and facilities jo r medical care.
C. Well-equipped schools.
D. Opportunities jo r church attendance and religious instruction.
E. Facilities jo r wholesome play and recreation.
F. Child-weljare and child-guidance service within the commu­
nity or available to it.





II. T he

house in which the family lives should provide:

A . Protection jrom fire, accident, and disease, in conformity
with local fire and sanitary ordinances; screening of windows; sani­
tary toilet and bathing facilities; safe water supply in accordance
with local health-department standards; provision for storage and
refrigeration of food; and clean and sanitary premises at all times.
B. Adequate light, ventilation, and heat.
C. Good sleeping quarters.
1. Separate sleeping rooms for children, used exclusively
for bedrooms, with outside light and ventilation; preferably
a separate bedroom for each child, but not more than two
children in a room except in unusual situations.
2. A separate bed for each child, with good springs, a
comfortable mattress, and sufficient, clean bedclothing.
D. Provision jo r outdoor and indoor play.
III. T he family offering its home to the child should provide:
A. A complete family group, except in unusual situations.
Both foster parents should be actively interested in caring for the
child, and should be of an age suitable to meet the needs of the
child whose care they are to undertake. All members of the
family should be in good physical and mental health. One person
in the family should have sufficient free time to give the necessary
care, supervision, and companionship to the child.
B. Economic security based on a regular and reasonably secure
income sufficient to provide for a comfortable living.
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Children Coming to United States fo r S afety
C. Opportunities for the preservation o f ties with parents. The
foster parents should understand that this is a temporary plan for
the child and that every avenue for the child to maintain his ties
with his parents and his homeland ought to be utilized.
D. A normal place in the fam ily. Consideration and affection
for the child should be shown. He should be treated at all times
as a member of the family with opportunity for full participation
in family and community life.

IV. T he care given the child should include:
A . Food, clothing, and accessories.
1. Wholesome, nutritious food properly prepared and suffi­
cient in quantity. Formulas for infants should be prescribed
by a physician.
2. Clean and attractive clothing, well-fitting and individu­
ally owned, kept in good condition, with sufficient changes
for cleanliness, and suitable for all weather conditions.
3. Individual toilet articles, including towels, wash cloths,
comb, and toothbrush.
B. Medical and dental care, including: Periodic health and
dental examinations at least once a year and oftener in the case
of children of preschool age; prompt correction of remediable
defects, essential immunizations against communicable disease,
and the services of a physician in the case of accident or illness,
with nursing service and hospitalization when necessary.
C. Education.
1. Opportunity for attendance at a good school at least
until the child reaches the age of 16 years. (Conformity with
the requirements of the immigration regulations forbids any
gainful employment of children under the age of 16 years,
or after that age if admitted on a visitor’s visa.)
2. Provision for attendance at church or Sunday school.
D. Home training.
1. Definite participation in home activities suitable to the
age and physical development of the child.
2. Training in good health habits and personal hygiene.
3. Reasonable allowance for spending money.
4. Provision for toys and personal possessions.
E. Outside contacts.
1. Opportunities for suitable companionship, friendship,
participation in community activities, and adequate and
suitable recreation.
2. Assistance in maintaining communication with rela­
tives and friends abroad.
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Care in Fam ily Homes and in Groups


T h e contacts of the family with the supervising child- care


A . Prompt notification oj the agency with regard to change of
address, illness, or any matters which may be detrimental to the
child’s health, welfare, or happiness.
B. Reports to the agency concerning the child’s progress in
home and school.
C. Readiness to consult the agency when any developments take
place that seem to present difficulties, and in any event whenever
any marked change in the home situation occurs.
D. Opportunity for contacts by representatives of the agency
with the child and foster parents.
M e m o r a n d u m i s s u e d S e p t e m b e r 2 0 , 1 9 4 0 , a s r e v is e d

Children coming to the United States as guests for group care have
the same basic needs for individualized consideration of their particular
problems, and for a feeling of belonging and of sharing interests with
other individuals, both adults and children, as those receiving care in
foster homes. One of the commonly accepted forms of group care of
children is the boarding school. Such a school provides group life
interspersed with periods of vacation during which times the children
return to the natural relationships and experiences found within a
family. Other forms of group care provide for school attendance at
community schools, thus facilitating acquaintance and friendship
with children outside the group.
The following statement interpreting the needs of children receiv­
ing group care emphasizes the value of family relationship for these
children and points out the necessity for basing all programs of group
care on accepted standards of child care and services.
The emphasis placed by the Children’s Bureau upon care in family
homes is based upon the desirability of giving children coming here for
safety an opportunity for home life and community contacts as nearly
normal as possible. It is believed that their stay in the United States
should provide both safeguards to assure the conservation of ties and
interests centering in their homeland, and opportunity for care in
accordance with individual needs, for formation of friendships, and for
participation in the general life of the people of the United States,
whose guests they are.
The objectives outlined above, it is believed, can be met under
certain circumstances through a combination of group and familyhome care. In all such cases there should be an individual family
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Children Coming to United States fo r Safety

responsible for the child in whose home he can spend vacations and
to whose members he can look in emergencies. In other words, there
must be an individual sponsor for each child. Preferably group care
should be confined to cases in which the children have lived together
as a group before coming to the United States.
All groups providing care for children should be organized and
conducted in accordance with the Children’s Bureau standards for
child-care agencies and for medical care, insofar as they apply to
group care. Specifically, the following points should be kept in mind:
1. The care provided should be under the immediate super­
vision of a child-care agency designated by the Children’s
Bureau for service to children, or when such an agency is not
available, under such direct supervision as may be approved
by the Children’s Bureau.
2. The plan should be approved by and in compliance
with the requirements of the State department of welfare
and subject to the supervision of the department.
3. If the plan includes provision for full-time education, the
educational facilities should be approved by the State
department of education in conformity with policies set up
by the United States Office of Education. All children of
school age should attend full-time school at least until they
reach the age of 16 years.
4. Provision should be made for wholesome recreation and
leisure-time activities.
5. The plan should include adequate provision for medi­
cal care and health supervision.
6. The children should be housed in small units.
7. The services of a sufficient number of qualified social
workers should be available, preferably through arrange­
ments with a designated child-care agency. One social
worker should not be expected to serve more than 50 chil­
dren. One of the functions of the social worker should be
to develop and maintain relationship with the families
sponsoring the children and to arrange for their care in
family homes when the plan seems desirable.
8. Records of all available information concerning each
child and his family and of the child’s progress while under
care should be maintained.
9. The plan for housing, staff, and program of activities
should be in conformity with accepted standards of group
care and should be subject at all times to review and ap­
proval by the Children’s Bureau.
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Standards f or C h i l d - C a r e A g e n c i e s


In designating— in consultation with State welfare depart­
ments— child-care agencies willing to take responsibility for
the review of homes and the placement and supervision of
children coming to the United States under the auspices of
the United States Committee for the Care of European
Children, the Children’s Bureau has been guided by general
standards for such agencies, issued June 28, 1940, and more
detailed standards of foster care, issued August 2, 1940.
These standards are to be regarded not as inflexible require­
ments but as general guides in the review of agencies and the
development of foster-care programs.
Designated agencies are responsible, in the areas they serve,
for visiting and reviewing family homes offering to care for
European children, for selecting homes suited to the particular
needs of the children assigned to the area by the United States
Committee, for placing children in these homes, and for ad­
vising the foster parents and giving general supervision as
to the ways in which the child’s needs may be met most fully.
They may also be responsible for reception care prior to
(For service to European children)
I s s u e d J u n e 2 8 , 1940


I. A dministration.

A . The agency should be approved by and should be under the
supervision of the State department of welfare of the State in
which it is located.
B. The agency should be fully qualified and equipped for child­
placing service or it should be one which can be so equipped under
1 For standards of reception care, see pp. 14-18, and for standards of medical
care, pp. 19-27.
287975 °
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Children Coming to United States fo r Safety
plans worked out with the United States Committee for the Care
of European Children. The resources of the agency should in­
clude a well-organized and professionally staffed social-service
department to select the foster homes and to provide the con­
tinuing supervision of care given to children in such homes.
The agency should maintain records of all available informa­
tion concerning each child and his own family and complete
reports of care given by the agency.

II. Service.
A . Temporary reception care, if provided, should be in con­
formity with the standards of the Children’s Bureau of the United
States Department of Labor.
B. All children received for care should be placed in family
homes of their own religious faith, immediately or after a brief
period of reception care, except when the child’s special needs
require other forms of care.2
C. Children received for care should be assured adequate medi­
cal care and health supervision, should attend school until at
least the age of 16 years, and should not be gainfully employed
prior to the age of 16 years, or after that age if admitted on a
visitor’s visa.
D. It is preferable that not more than two unrelated children
should be placed in one home, and, in any event, there should be
no more than four, except in the case of brothers and sisters.
E. The agency should retain responsibility for each child until
he reaches the age of at least 18 years or has been returned to a
parent or legal guardian, or transferred to other care with the
approval of the United States Committee for the Care of European
III. Supervision.
A . The agency should agree that the Children’s Bureau shall
at all times have access to all premises and facilities used for the
care of children and to all records of such children.
B. The agency should agree to make such periodic reports of
the whereabouts, status, and care of the children as may be pre­
scribed by the Children’s Bureau.
2 See Group Care of Children, p. 5.
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Standards fo r Child-Care Agencies


(For use of designated child-care agencies)
I s s u e d A u g u s t 2 , 1940

I. Standards for the foster home.

A . Neighborhood and home.
1. The foster home should be located in a community
offering wholesome neighborhood influences, facilities for
health service and medical care, and accessibility to churches,
desirable recreational facilities, and well-equipped schools.
2. A standard of living should be maintained by the foster
family which makes possible normal family life in healthful
and wholesome surroundings. There should be a homelike
3. The foster home should conform to the sanitary ordi­
nances of the city or town in which it is located. It should
be kept clean and in a sanitary condition. Windows and
doors should be screened.
4. There should be adequate fire protection consistent with State and local ordinances.
5. The home should have adequate light, heat, and venti­
lation, and should not be overcrowded.
6. Sleeping quarters should have ample fight and venti­
lation. All sleeping rooms for children should be outside
rooms. It is preferable that each child have a separate
bedroom; if this is not possible, no more than two children
should share a bedroom except in unusual situations. The
child’s bedroom should be exclusively for the use of the child
or children occupying it and should not be used as living
room, dining room, or for other purposes by other members of
the family. Each child should have a separate bed, provided
with good springs and a comfortable mattress. The bed
clothing should be sufficient in quantity and should be kept
clean and in good condition.
7. There should be adequate space for indoor play and a
yard, or some place other than the street, for outdoor play.
There should be provision in the home and in the neighbor­
hood for recreational activities for older children.
8. There should be proper facilities for bathing. The main­
tenance of a high standard of hygiene and personal cleanliness
should be expected in all foster homes.
9. The milk and water supply should conform to the stand­
ards set by the State and local health departments.
10. Adequate provision should be made for the storage and
refrigeration of food.
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Children Coming to United States fo r S afety
B. The foster fam ily.
1. The foster family should be a complete family group,
with both parents actively interested in caring for a foster
child. The homes of widowed, divorced, or single women
should be considered only on the basis of their special
qualifications in relation to individual situations.
2. Foster parents should be well-balanced and mature indi­
viduals who can offer examples to a child of wholesome,
adult relationships and who can exercise good judgment in
the handling of a child. They should be in good health,
both mental and physical. They should be capable of offer­
ing intellectual, spiritual, and moral guidance to the child.
3. The foster parents should be of an age suitable to meet
the needs of the child whose care they are to undertake.
4. Family relationships of all individuals in the foster
home should be wholesome and of such a nature that the
addition of a foster child can be accomplished without un­
desirable results.
5. It is preferable that there be no adult boarders or room­
ers in the foster home.
6. There should be an income sufficient to provide a com­
fortable living for the foster family, and to make possible
adequate recreation and a well-rounded family life. The
income should be regular and reasonably secure. Unless
fully adequate substitute care is provided, the foster mother
should not be employed outside the home.
7. All members of the foster family should be in good
health and free from communicable disease or any defect
that would affect a child adversely. The agency should
give consideration to the possibility of asking for physical
examinations of members of the foster family.

II. Standards

of care and service.

A . Care of the child in the foster home.
1. The child placed in the foster home should always be
considered a member of the foster family and should be
treated in all respects in the same manner as the foster
parents’ own children.
2. Foster parents should have a reasonable knowledge of
the principles governing the feeding of children. The food
supplied to the child should be of good quality, properly
prepared and sufficient in quantity. Formulas for infants
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Standards fo r Child-Gare Agencies


should be prescribed by a pediatrician, and the feeding of
young children should be supervised by a physician.
3. The child should not be left in the home without
adult supervision, particularly at night.
4. The child should be supplied with clean and attractive
clothes that fit and are individually owned. The clothing
should be kept in good condition, and there should be suf­
ficient changes for cleanliness and protection against in­
clement weather. As a general rule, the child, if he is old
enough, should have the privilege of selecting his own
clothing under supervision of the foster mother.
5. The child should have his own individual place for his
belongings, including clothing, toys, and other personal
6. The child should be provided with individual toilet
articles, including towels, wash cloths, comb, and toothbrush.
He should be taught good health habits and personal
7. The child should be provided with necessary medical
and dental care, which should include periodic health and
dental examinations at least once a year and more than
once a year in the case of a young child, prompt correction
of remediable defects, essential immunizations, the services
of a physician in case of illness or accident, and hospitaliza­
tion when necessary.
8. Provision should be made for the child to attend school
at least until the age of 16, and for each child of suitable
age to attend a church or Sunday school of his own religious
9. Gainful employment of children under the age of 16
years is not permitted under immigration regulations
governing admission of children to the United States.
A child above that age admitted on a visitor’s visa is not
permitted to seek employment.
10. The child should have definite duties in the home
which are suitable to his age and physical development,
and he should be held responsible for their accomplishment.
11. Adequate and suitable recreation should be provided.
12. The child should participate in community activities.
He should have an opportunity to make friends in natural
ways. Normal neighborhood contacts and wholesome
relationships between the sexes should be fostered.
Federal Reserve Bank of St. Louis


Children Coming to United States fo r S afety
.R Selection of the foster home.
1. There should be a thorough review of the prospective
foster home and a clear understanding between the foster
parents and the agency before the child is placed. It is
important that the foster parents know what is expected of
them and that the agency know what the foster parents have
to offer a child and also what these parents expect of the child
and of the agency.
2. So far as is possible the foster home should be selected
on the basis of its ability to meet the needs of a particular
child of a similar cultural background.
3. The child should be placed in a foster home of the same
religious faith as that of his parents. Adherence to this
principle will prevent the development of problems which
may arise when the attitudes of the foster family may be in
conflict with the child’s early experience.
4. The study of the foster home, its selection for a particu­
lar child, and the placement of the child in the home should
be made by a responsible person who has an understanding of
child-placing work.
C. Placement of the child in the foster home.
1. It is preferable that no more than two unrelated children
be placed in one home and, in any event, there should be
no more than four, except in the case of brothers and sisters.
2. Every effort should be made to place brothers and sisters
in the same foster home or, if this is not possible, in the same
3. Before a child is placed in the foster home the foster
parents should be given as much information as possible
concerning the background of the child and any suggestions
that might be helpful in the integration of the child into the
family group.
4. If at all possible, the worker should talk the plans over
with the child, describing the home and what is expected of
5. The adjustment will be made easier for both the child
and the foster family if arrangements can be made for them to
become acquainted before the child goes to the home to live.
Consideration should be given to the possibility of the child’s
visiting in the foster home prior to placement, and, on the
basis of this visit, participating in the decision as to whether
he is to live in the home.
Federal Reserve Bank of St. Louis


Standards fo r Child-Gare Agencies


D. Supervision of the child in the foster home.
1. There should be adequate supervision of the child in the
foster home after placement. The foster parents and the
social worker should counsel together regarding the child’s
care. The worker, through her experience in child placing,
will be able to interpret to the foster parents a probable basis
for the child’s reactions, and the foster parents, through their
observation of the child’s physical and emotional develop­
ment, may contribute to the worker’s understanding of the
child. Both the foster parents and the child should feel that
the worker is a person who will help them work out their
2. Both the worker and the foster parents should be aware
of the differences in background of European and American
children, and any problems arising should be considered and
dealt with in the light of these differences.
3. The worker should thoroughly understand any situation
that arises before she gives advice, and she should avoid
blaming either the foster parents or the child if problems
develop. Trouble may be due to the fact that the particular
child cannot adjust in the particular home because of the
background and previous experience of both, rather than to
any fault of either the child or the foster parents.
4. The agency should be ready at all times to make such
changes in plans as will be for the interests of the child, and
it should be constantly alert to the developing needs of the
E. Records.
1. The agency should keep case records that include all
necessary current information for each child placed in a
foster home and for each foster home.
2. The confidential nature of the records should be re­
spected by everyone having access to them.
Federal Reserve Bank of St. Louis





European children entering the United States usually need
a period of group care in reception centers for a sufficient
length of time to allow plans to be made for their placement
in family homes or in group care, and to determine their
general physical condition and any special needs which may
be significant with reference to plans for their placement.
For children who have been exposed to communicable disease
temporary care is especially important, both for their own
protection and in order to prevent spread of disease. A brief
period of reception care is usually necessary immediately
after debarkation from boat or train, and a longer period of
temporary care, frequently in the community to which the
child is assigned, may be necessary prior to placement in a
family home.
General standards of care of children in reception centers,
prescribed by the Children’s Bureau, relate specifically to
reception centers used for temporary care, either at the port
of debarkation or in the community to which the child is
assigned for placement. In many respects, however, they
are applicable to any form of group care.
I s s u e d A u g u s t 1 4 , 1940

I. G eneral equipment of the center.

The building or buildings selected for care of children for a tem­
porary period should be chosen with major consideration for safety,
sanitation, health, and comfort. Adequate space for both indoor and
outdoor recreation should be provided. Preference should be given
to the use of buildings in which children can be cared for in units
accommodating not more than 50 children. (Single rooms are
preferable to dormitories for most children of school age.) This
Federal Reserve Bank of St. Louis


Care in Reception Centers /,


'(; p ( | 15

policy would avoid the quarantining of large numbers of 'children
and would make space available for the admission of new Children
in the event that communicable disease should develop in one unit.
Local or State authorities should be consulted with regard to rules
and regulations relating to housing, fire hazards, sanitary equipment,
water supply, examination of food handlers, and other sanitary require­
A . Safety.
Provision for safety should include removal of all possible fire
hazards, such as accumulation of rubbish and defective electrical
wiring, and should include a sufficient number of safety exits, as
required by local fire prevention regulations. Precautions should
be taken to prevent accidents by providing night lights in halls
and toilets and over exits, screens or bars on windows, hand rails
on stairways, and gates across stairs where needed for the pro­
tection of small children.
B. Sanitary and health provisions.
1. Pure water with adequate facilities for drinking and
2. Sufficient toilet and bathing facilities for the number and
sex of children under care. Provision should be made for
individual towels, washcloths, tooth brushes, and combs,
with clear marks of identification.
3. Well-ventilated and sunny premises, particular attention
being given to sufficient window space in sleeping quarters.
4. Sanitary care of food as to refrigeration and storage,
preparation, and serving.
5. Proper laundering of linen and wearing apparel to reduce
the danger of spread of infection.
6. Facilities for keeping the entire building clean and sani­
tary, including the care of dishes, toilets, and baths according
to standards of the local health department.
C. Sleeping quarters.
1. Single rooms for children of school age, or separate
dormitories for boys and girls over 5 years of age. All rooms
and dormitories should have individual beds, well spaced,
with clean, adequate bedding. Arrangements should be
made for space for each child’s clothing and other personal
Federal Reserve Bank of St. Louis



^2 Ohildren\Ooming to United States for Safety

’ \X \ Night care, which should include supervision of all
children, lights in the rooms of young children, and easy
access to toilet facilities.
D. Space fo r special health and welfare services.
1. Separate rooms should be available for isolation and
care of sick children or those suspected of having a com­
municable disease until appropriate arrangements can be
made for other care. There should be a minimum of 4 beds
available for isolation of sick children for every 100 chil­
dren under care.
2. Special facilities should be available for newly arrived
children until through a medical examination assurance is
given that they can without danger join in activities with
resident children.
3. Space should be provided for examining rooms for phy­
sicians and for special conferences with individual children.
II. Program of the reception center.

A . Study of the children.
The time spent by children in a reception center provides an
opportunity to obtain some understanding of each child’s physical
and mental condition, and his need for medical, dental, or other
care. It also provides an opportunity to discover each child’s
previous school experience and educational needs, and to under­
stand his social background and special interests, and any
personality problems that must be taken into consideration in his
final placement. It is important that each reception center have
on its staff well-equipped persons who, with the assistance of
special consultants, can undertake a basic study of each child
and his needs.
B. Health protection.
1. There should be at least one nurse for every 50 well
2. Medical supervision should be continuous during the
time that children remain in residence and arrangements
should be made for hospital care or other special medical
services needed by children.
3. Special precautions should be taken to minimize the
danger of introduction of communicable disesases when new
children are admitted.
Federal Reserve Bank of St. Louis

Care in Reception Centers


Special attention should be paid to the nutritional
needs and food habits of children. It is desirable to have the
services of a nutritionist or dietician or opportunity for
consultation with one.
C. Other aspects of the program.
1. Guarding of identification is important, through careful
preservation of tags, personal effects, and records.
2. Children should be encouraged to maintain contact with
their families, relatives, and friends through correspondence.
3. The religious affiliation of the child or the child’s
family should be respected in arrangements for meeting the
religious needs of the children through utilizing the resources
of the religious groups in the community.
4. Kecreation programs requiring physical activity are
particularly important, since they relieve emotional strain,
develop new friendships, and help children to become ac­
quainted with various forms of play and recreation which
may be especially characteristic of their new environment.
Inexpensive equipment, such as toys, bats and balls, dolls,
radio, and books which help to illustrate child life and the
interests of children in this country should be provided.
Excursions to local points of interest should be arranged when
possible. Qualified group leaders should be available for
these programs.
5. The mental health of the child should be safeguarded
by recognition of his personality needs and by plans to meet
them through careful handling of his individual problems by
staff members, or by utilization of the child-guidance
resources of the community.
6. The special needs of children, particularly educational
or medical needs, should be met by the most advantageous
possible utilization of local resources.
III. T he


A . The superintendent or director.
The effectiveness of any program of group care of children is
vitally affected by the type of person appointed to direct, coor­
dinate, and develop its services. The position of superintendent
or director requires a person with skill in institutional manage­
ment, understanding of child care and the factors affecting the
development of children, and ability to deal effectively with
professional and nonprofessional members of the staff.
Federal Reserve Bank of St. Louis


Children Coming to United States fo r Safety
B. Professional staff.
The standards of education, training, and experience required
of persons employed to provide professional services should meet
the accepted standards established by recognized professional
organizations in the fields of pediatrics, psychiatry, nursing,
dietetics, and social work.
C. Persons in direct charge of the children.
Supervisors of units within the center should have the ability
to direct the care of children in groups, yet not lose sight of the
Federal Reserve Bank of St. Louis

M e d i c a l Care of C h i l d r e n

Arrangements for the care of any child should include
plans to meet his health needs. Standards for medical care
of children have been drawn up to assist in planning the
whole program of care to be given and services to be provided
at reception centers, and to serve as guides in organizing
the health program and medical services of the agencies
assuming responsibility for placement and supervision of the
children in foster homes. These standards outline a program
for the medical care each child should receive, the organiza­
tion of medical services necessary to provide such care, and
the qualifications needed for personnel giving health service.
I s s u e d A u g u s t 2 8 ,1 9 4 0

It is understood that the European children who are sent to the
United States for care will have been examined by physicians previous
to embarkation, and that only those considered physically and men­
tally sound will be sent to this country. The information available
in the United States regarding the past medical history or present
health of these children, however, may be very limited. In order to
facilitate proper placement, therefore, information must be obtained
regarding their physical, mental, and emotional status. This informa­
tion should be as complete as is possible without adding unduly to the
strain and tension which in some degree is unavoidable under the

P r o g r a m f or M e d i c a l Car e
The program for medical care is designed as a guide for determining
the special health needs of the children and providing for those needs
in such a way as to protect their own health and the health of other
children with whom they may come in contact. Many of the recom­
mendations for medical care have been adapted, with the permission
of the Child Welfare League of America, from its booklet, “ A Health
Program for Children in Foster Care.” 2
1 Prepared by the Children’s Bureau in consultation with an advisory group
(see p. v i i ) .
2 See footnote 5, p. vm .

Federal Reserve Bank of St. Louis


Children Coming to United States fo r Safety

A program for medical care of guest children should include plans
for appropriate care of any children who become ill previous to
placement, plans for medical examination of all children, and plans
for continued medical supervision of the children after placement.
I. Provision for medical care of sick children.

At all places where guest children are to be cared for, suitable
arrangements should be made in advance for adequate medical care
for any children who become ill. This will involve provision for a
physician to be on call at all times and for nursing care and hospital
facilities to be available when needed. If large numbers of children
are cared for at one time in a reception center, responsibility for
medical supervision of specific groups of not more than 50 to 100
children should be assigned to individual physicians. These physicians
should call daily at the center, while the children are in residence, to
examine any children whom they or others of the staff believe to be
in need of special attention. Arrangements made in advance for
hospitalization of sick children, especially those with communicable
disease, and for the consultant services of specialists if needed, will
avoid confusion and make the necessary care more promptly available
if emergencies arise.
II. E xaminations before placement.

A . Arrangements jo r examination in reception centers.
Centers in which appropriate facilities can be made available
should be used for the care of children during a period of observa­
tion preliminary to placement. Children known to have been
exposed to communicable disease should remain in these centers
until after the incubation period for the disease has expired.
The period of observation before the child is placed in a foster
home should be utilized to gain information regarding the child’s
health status. A complete medical examination should be made
as soon as possible after the child arrives at the center where he is
to remain for observation. This will give opportunity for any
follow-up examinations found necessary without, in most cases,
prolonging the stay in the center, and will make the information
acquired available promptly to those arranging placement.
The findings on examination should be recorded in triplicate
on a form provided for this purpose. Recommendations for
special examinations or treatment should be recorded and should
indicate whether the examination or treatment should be arranged
before or after the child is placed. After all examinations that
are to be made before placement have been completed, the
findings should be summarized briefly on the record, and any
Federal Reserve Bank of St. Louis

Medical Gare o f Children


recommendations with regard to placement of the child or medical
care after placement should be noted. One copy of this record
should be retained at the center where the examination is made,
one copy should go with the child to the placement agency, and
one should be sent to the United States Committee.
For children who present special health or emotional problems,
plans for placement should be made only after consultation be­
tween the physician, the child-welfare workers, and the psychi­
atrist (child-guidance worker).
B. The content of the medical examination.
1. Physical examination by pediatrician.
Note should be made of the following:
Eyes— Pupillary reaction.
Eye grounds.
Ears— Otoscopic.
T eeth— Condition.
Throat— Pharynx.

Secondary sex characteristics.
Posture and spine.
Signs of endocrine imbalance.
Signs of emotional instability.
Intellectual equipment (apparent).
Presence of smallpox-vaccination scar.

Special attention should be given to the child’s nutritional
status as determined by clinical evidence. Evidences of
undue emotional disturbance should be noted.
2. Laboratory examinations.
Urinalysis: tests for albumen and sugar; microscopic
examination. Blood examination: hemoglobin determina­
tion, examination of smear (cell counts desirable but not
Cultures, when indicated, of throat, and of any vaginal
discharge that might be infectious.
3. Tests.
Syphilis test.
Tuberculin test: Mantoux or Patch test (on left arm).
Should be read on third to seventh day.
Federal Reserve Bank of St. Louis


Children Coming to United States fo r S afety
Schick tests (on right arm). Should be read on fourth to
seventh day.
4. Follow-up examinations, immunizations, and treatment
when indicated for individual children.
The above examinations will reveal certain children for
whom additional examinations are indicated or who should
receive certain immunizations or treatment for some specific
condition. These additional procedures include :
a. Diphtheria immunization for children with positive
Schick test. First dose (0.5 cc.) of toxoid should be given
as soon as possible after Schick test is read, and two
additional doses (1.0 cc. each) should be given at inter­
vals of 3 to 4 weeks. Recommendation for adminis­
tration of remaining doses should accompany a child
who is transferred elsewhere before completion of im­
b. Smallpox vaccination for children who do not have
a vaccination scar.
c. X-ray of chest and abdomen for children who have
positive tuberculin test.
Other conditions may require other special examina­
tions, such as ophthalmologic examination, stool exam­
ination, basal-metabolism test, or fluoroscopic examina­
tion, and for some conditions treatment may be necessary
before the child is placed.
5. Dental examination and tests of vision and hearing.
These may be given either before or after placement (see
sec. Ill-A ).

III. M edical supervision after placement.
Certain tests may be given either before or after placement since in
most cases they can safely be postponed until after the child is placed.
They should be given before placement in cases of gross defects which
are noticed at the time of the general physical examination. If there
is question as to whether they can be arranged after placement, the
dental examination and tests of vision and hearing should be planned
as part of the examination before the child is placed.
A . Special examinations and immunization.
Dental examination by a dentist. This may be given
as part of the admission examination of the child or may be
given after placement, but it is important that complete
information regarding the condition of the teeth should be
Federal Reserve Bank of St. Louis

Medical Care o f Children


available to the placement agency at an early date in order
that arrangements for necessary dental care may be included
in plans made for the child.
2. Tests of vision, with dilatation of the pupils, by an
ophthalmologist, should be given before the child enters
3. Tests of hearing, with an audiometer if possible, should
be given before or shortly after admission to school. It may
be possible to arrange for the test to be given through the
4. For children placed in certain areas, physicians may
recommend typhoid immunization.
5. Psychiatric and psychological study are desirable for
children presenting difficulties of social or educational ad­
justment and development. Such study may be indicated
before placement, but ordinarily it would be of greater value
after the child has had some experience in the foster home.
B. Health examinations.
Children under 6 years of age should be given a health examina­
tion at least every 6 months; older children should have such an
examination at least once a year, preferably at the beginning of
the school year. For some children physicians may recommend
more frequent examinations.
The health examination should include a physical examination,
laboratory examinations, and follow-up examinations as outlined
under section II-B : 1, 2, and 4.
C. Other health services.
1. Dental examinations.
Each child should have an examination by a dentist every
6 months, with prophylaxis and with treatment if indicated.
2. Correction of remediable defects and treatment of other
abnormal conditions.
Any conditions found at the examination before place­
ment, or at later examinations, which may interfere with the
child’s health or well-being, should receive appropriate
3. Medical care during illness.
For every child in a foster home the services of a physician
should be available in case of illness. Hospital facilities
and the consultation services of specialists should be avail­
able when needed.
Federal Reserve Bank of St. Louis


Children Coming to United States fo r Safety

O r g a n i z a t i o n f or M e d i c a l Car e
I. Organization of medical services for centers providing

A . Direction and organization of medical services.
In any city in which children are to be cared for temporarily
before assignment to designated agencies or individuals, a medical
director should be appointed who will be responsible for the
organization and administration of all medical services for the
children while they are under temporary care.
In the preliminary organization of the medical services, con­
sultation with representatives of the State and local health de­
partments will facilitate coordination of effort in obtaining
maximum protection for the health of the guest children and of
others with whom they will come in contact.
B. Personnel fo r medical services.
1. The staff needed.
In addition to the medical director other physicians should
be appointed if needed to provide adequate medical super­
vision of the children in the centers. One physician should
be responsible for not more than 50 to 100 children. The
services of a dentist should be available for emergency dental
care. Nurses, who will preferably reside in the center,
should be appointed in the proportion of approximately 1
nurse for every 50 well children.
For medical examinations before placement the personnel
required will include physicians, nurses, laboratory tech­
nicians, and voluntary assistants. Dentists, ophthalmolo­
gists, and experts in audiometer testing will be needed if the
dental examination, vision testing, and examination of
hearing are to be given previous to placement. The number
of physicians and the total hours of physicians’ services
planned for admission examinations should be sufficient to
allow a minimum of 15 minutes for the examination of each
child, and to allow for necessary follow-up examinations, the
reading of Schick and tuberculin tests, giving immunizations,
and so forth.
The services of specialists should be available for consul­
tation if needed for diagnosis or treatment.1
1 The American Academy of Pediatrics, 636 Church Street, Evanston, 111.,
and other organized professional groups have expressed their readiness to assist
in the development of programs for medical care of these children. Through
consultation with the local representatives of such organizations it may be possible
for agencies to obtain assistance in the development of their medical programs
and the services of qualified personnel.
Federal Reserve Bank of St. Louis

Medicai Gare o f Children


2. Qualifications of personnel for health services.
a. Pediatricians.
Physicians selected to organize and direct medical
services and to give medical examinations, health super­
vision, and general medical care should be skilled in the
care of children. Whenever possible pediatricians
should be selected.
b. Other specialists.
Physicians called in consultation or those giving
special examinations, such as ophthalmological exami­
nations, should be recognized specialists in their fields,
with experience in the care of children. It is particu­
larly important that psychiatrists and psychologists
should have had training and experience in child
guidance and in the treatment of children’s problems.
c. Dentists.
Dentists should have experience in dental work for
d. Nurses.
Nurses should have had experience in the care of
children. Training and experience in public-health
nursing, in children’s clinics, and in care of well children,
as for example, in connection with camp programs, are
especially valuable. If several nurses are to be em­
ployed in one center, a nurse who has had supervisory
experience as well as experience in the care of children
should be appointed supervisor.
C. Preliminary arrangements.
Every effort should be made to create an environment provid­
ing an atmosphere of repose and giving the child a sense of
security, to keep him occupied with tasks or recreations which
interest him and to surround him with the affection which he
needs. Examination procedures should be kept as informal as
possible in order to avoid frightening children who are already
under the strain of adjustment to a new environment.
The assignment of individual responsibilities and duties as
definitely as possible will avoid confusion and duplication of
Preliminary arrangements should be made for hospitalization,
if needed, for sick children.
For centers at which admission examinations are to be given,
arrangements should also be made for medical supplies, including
Federal Reserve Bank of St. Louis


Children Coming to United States fo r Safety
materials for special tests, and for facilities for laboratory tests,
X-ray examinations, and so forth.

II. Organization

of medical services for children in foster


Each agency accepting European children for placement in foster
homes should have a well-organized program for medical care of
children under its supervision. The direct responsibility for medical
care may be retained by the agency or may be placed with foster
parents. In either case there should be a clear understanding be­
tween the agency and the foster parents regarding the policies with
respect to medical care.
The medical program should be administered by or in consultation
with a physician. It is desirable that agencies and foster homes
should have access to consultant services by specialists for children
presenting unusual problems. Consultation service to the staff of
the agency by a psychiatrist or psychologist regarding children
presenting special problems of adjustment will be particularly help­
ful. Qualifications of personnel responsible for the health program
should be the same as those outlined for personnel for health services
in reception centers.
A . Medical services provided by the agency directly or in coopera­
tion with community agencies.
The medical services should be under the direction of a phy­
sician and should include the services of a qualified nurse.
They should include provision for periodic medical and dental
examinations, special examinations when indicated, interpreta­
tion of findings to foster parents, and necessary correction of
defects. Physicians should be on call to visit sick children in
the home, and hospital facilities should be available wdien needed.
It is important that foster parents should know how to obtain
medical services or authorization for surgical operations during
hours when the agency offices are closed.
The agency should keep a complete health record for each
child, including the findings at medical or dental examinations,
medical or dental care given, defects corrected, note of illnesses
or operations, and so forth.
B. Medical services provided by foster parents.
When the direct responsibility for medical care is placed with
the foster parents, the agency should be responsible for general
supervision of the health program. In order to do this the
agency either should have a physician on its staff or should
have the consultation services of a physician. The agency
should require that the choice of physician and dentist by the
Federal Reserve Bank of St. Louis

Medical Care o f Children


foster parents be subject to its approval, and should keep in
sufficiently close touch with the foster parents to ascertain
whether the recommended health program is being carried out.
Public-health-nursing service through the agency or a cooperating
community agency should be available to all children requiring
such service.
It may be advisable under some circumstances for the agency
to retain responsibility for certain aspects of the medical care
which might be difficult for the foster parents to obtain, such
as audiometer testing or psychological study.
The foster parents should have a clear understanding of what
constitutes a good health program for children and should be
prepared to carry out such a program. They should also under­
stand how to obtain authorization for surgical operations if
Reports of examinations and treatment should be obtained by
the agency from the child’s physician and dentist, either directly
or through the foster parents, and complete health records should
be kept by the agency.
Federal Reserve Bank of St. Louis

Appendix.— Forms Used in the Designation of Agencies

By direction of Katharine F. Lenroot, Chief of the Children’s
Bureau, United States Department of Labor, you are hereby notified
that t h e _________________________________________________________
has been provisionally designated as an agency adequately equipped
to cooperate with the United States Committee for the Care of European Children in the investigation of foster homes and in the care and
supervision of children who are subsequently placed in these homes.
C. B. Form No. 1

R e p ly t o : 215 F o u rth A ve n u e ,
N ew Y ork, N . Y .



You are hereby notified that your agency_______________________

has been designated as an agency adequately equipped to cooperate
with the United States Committee for the Care of European Children
in the review of foster homes and in the care and supervision of children
who are subsequently placed in these homes.
K atharine F. L enroot, Chief.

C. B. Form No. 6


Federal Reserve Bank of St. Louis