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U. S. D E P A R T M E N T O F L A B O R
JAMES J. DAVIS, Secretary

C H I L D R E N ’S

BUREAU

GRACE ABBOTT, Chief

THE WORK OF
CHILD-PLACING AGENCIES
Part I.— A Social Study of Ten Agencies Oaring for
Dependent Children
By
K A T H A R IN E P . HEW INS
AND

L . JOSEPHIN E W E B S T E R

Part II.— Health Supervision of Children Placed in
Foster Homes
By
M A R Y L . E V A N S , M .D .

Bureau Publication N o. 171

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SINGLE COPIES OF THIS PUBLICATION MAY BE
OBTAINED FBEE UPON APPLICATION TO THE
CHILDREN'S BUREAU.

ADDITIONAL COPIES MAY

BE PROCURED FROM THE SUPERINTENDENT OF
DOCUMENTS, GOVERNMENT PRINTING OFFICE,
■WASHINGTON, D. C.
AT

35 CEN T S P EE COPY

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XLSftc-

vwo» nI

CONTENTS
Page
ix

Letter o f transmittal.

P ast I.

A Social Study

T en A gencies Caring
C hildren

for

D ependent

Introduction_____________________________________________
Purpose and method of study_______________ H H _ _ ____ r ~E
The 10 agencies studied____________________________
~__
Development of child placing in the United StateaZZZ___
Rural child placing______________________________________________
Field of work, development, and organization of the 10 agencies"
Field of work and types of children received________________
Conditions determining the field of work_____________I __ *
Division of field in the communities studied___________
Limitations with regard to ages of children___________ I"
Types of children received_______________________________
Protective work___________________________ ____
Affiliation with the Child-Welfare League of America_
„History and form of organization of the 10 agencies_________
Dates o f establishment___________________________ ________
Original purposes and development into present work__._
Development of state-wide and interstate work______
The managing boards___________________________ _________ _
The standing committees__________ ______________ _ H ______"
Organization and staff______ ’____ __________ __________ ZjL~
Salaries__________________________________
Office equipment______________________ ________________ _ I
Financing_________________________________
Methods of work of the 10 agencies-^________________ ]_______ H IH I
Terms of acceptance for placement____ _______ _____________
Methods of receiving children____________________ ___ ”
Parental status at time of reception______ ~__ Z_Z_____ I_I
Financial terms of acceptance__________________________
Procedure prior to acceptance_____________ I ____ I ____ I I ” ~I_
Investigating staffs________________________________ _IZZII__
Registration with social-service exchange.,____________
Investigations as revealed by the records______________ I
Steps in investigation_________
Difficulties o f long-range investigations______________ ____
Number o f applications assigned each visitor___________
Efforts to preserve the fam ily unit________________
Decision as to reception of c h ild re n __II_III_____I______
Provision for children not -accepted for placement________
Formulating the plan for a child’s care in a foster home____
Physical examinations_____________________ ___
Psychological study o f child before placement_Z___Z___ Z
H ow foster homes were found____________________
Home-finding staffs____________________ Z_ZZ_Z_Z________ ZZZ
Types o f foster homes________________ ____ Z___________ I
Methods by which foster homes were obtained___
Standards required in foster homes___________ Z_Z___Z_
Separate standards for different types o f home"
Procedure prior to approval_____________________ I I ________
Method by which home was approved_____ I ____ I _________
Standards of investigation________________________ _ _ I _ I ___
Rates of board paid________;_____ ______________
Recording the successes and failures of foster h o m e sIII

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CONTENTS

Methods of work of the 10 agencies— Continued.
Temporary provision for children awaiting placement------------------------Placement direct in foster homes-----------------------------------------------------Agencies maintaining receiving homes------------------------------------------Length of first placement in foster homes---------------------------------------Methods of placement in foster homes----------------------- v------ ---------------------Selection o f a foster home------------ __ ---------1---------------------------------------Placing brothers and sisters together------------------------------------------Number of unrelated children customarily placed in the same
family home_____________________________________________ — -----------Method of introducing a child to a foster home— ------------- --------Supervision of the foster home------------------------- ---------------------------------The supervising staff----------------------------------------------------------------- ;-------Separate standards o f supervision for boarding and free homes—
Frequency o f visits to children in foster homes----------------------------Relationship of the child, the visitor, and the foster mother------Forms used in recording visits to foster homes----------------------------Division of work among visitors____________________________________
Replacements_________________________________
Educational standards------------->Recreation__________________________________ ________,--------------------- —
Allow ances_________________________________________
Clothing______________
Correspondence and gifts between visitor and child------------------Discipline______________ _________________________________ ______________
Responsibility o f the foster parents_________________________ .— - —
Educating the foster home___________________________ ___________________j—
Contacts with the child’s own fam ily--------------------- --------------------------------Contact through fam ily support____________________________________
Personal contacts of the parents with the child and with the
society____________________________________________________
Follow-up of children returnedto parents_________________________
Supervision after discharge_______________________
Return of legal control to parents_________________________________
Policy with regard to adoptions_______________________________________
Proportion o f children discharged from care who were adopted__
Investigation prior to adoption_______ .______________________________
Length o f placement prior to adoption_______________
Supervision in cases o f adoption------------ --- -------— _______________
Frankness in. regard to the child’s heredity-----------------------------------Records and statistics________________________ .—
__________ _______ .____
Differences in record keeping among the agencies________________
Method o f filing_____________________________ - __________________ ____
Stenographic assistance__________________________ i ________________ __
Statistical methods in use__________________________________________
Follow-up and research— __________ ________ ._______________________
Educating the general public in methods of child care_________________
State supervision__________
St. Louis Children’s Aid Society_____________________ .____ —
The Children’s Bureau o f Philadelphia and the Pennsylvania
Children’s Aid Society_______________ _________________________ ___
The child-caring department o f the Society o f St. Vincent de
Paul o f Detroit and the Michigan Children’s Aid Society____
The Jewish Home-Finding Society of Chicago___ ______________ __
The Massachusetts societies_________________________________________
The Children’s Home Society of Florida______________________ *____
Descriptions o f the individual agencies______________________________________
The Boston Children’s Aid Society_____________________________________
History and form o f organization-_________________________________
Staff organization_______________ «.________________ ____________________
Finances_______________________________ ___________ 1___________________
Types of work undertaken__________________________________________
Terms o f acceptance__________
Investigation prior to acceptance------------- *_____________________ ____
Foster-home finding and placement____ 1_______________________j—
Foster-home visits___________________________________________________
Education___________ •_________________________________________________

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CONTENTS
Descriptions o f the individual agencies— Continued.
The Boston Children’s Aid Society— Continued.
Religious training_____________________________________________ ___
_
Allow ances_____________________ _________________________ 3__go
Recreation_________________________ f_______________ _________ ~___ ~ __
Clothing------------------------- ---------------------------- ----------|______ ___ 99
Hehlth supervision___________________________ ________________________
Responsibility o f the society______________________________~__ ______”
Visits by parents to children in foster homes_____________________
Family rehabilitation________________________________________________
Follow-up after return o f child to his own home____ I ____________
Children’s Mission to Children____________________________ _____________
History and form o f organization___________________
l l f ~~
Quarters occupied by the agency________________________________
Finances___________________________________________ ___ ________________
Types of work undertaken__________________________________
Foster-home finding and placement_______ __________ ________________
Replacements_______________________________ '______________________ ~ ~
Clothing----------------------------------------------------------------------------------Education and recreation________________________
Allow ances___________________________ ,________________________________
Contact o f child with his own fam ily_____________________ ________
Health supervision____________________________ __________________
New England Home for Little Wanderers_____________________ |_______
Finances_______________________________________________ _____ / _ ________
Field of work_______________________________________________
The headquarters and the branches____________________I__________
The institution building_____ __________________________ ______________
The staff of the institution__________________________________
Methods o f care in the institution_________________________________ _
Department o f social service________________ ____________________ _
Department of child study__________ ™__________________ ___________
1J___
Staff meetings__________________________________ _________ __L
The Children’s Aid Society of Pennsylvania________________ ____ ______
History and form of organization_____________________ ___ __________
The field covered_____ .___________ __ _ __________________ 118
Sources o f fu n d s-__________________________________ ___________|_____
Children received and types of placement_________________________
Division of work________________________¿j_________'__ ______ ________
The development of county agencies___________________ 4____ ______
Clothing_____________________________
1*_____ _________
Health supervision_____________________ ______________________________
The training of new workers-._____________________________________
Growth of the work_______________________________ ______________ ___
The Children’s Bureau of Philadelphia________________ L— .______ ____
History and development___________________ : __ A_— u -_____________
Sources of funds___ ________________ _______ ____________________ -j____
Division of work________________ ___________________ ,______________ _
Children received andtypes of placement_______________
Recreation___________________________________ - _______________________ _
Clothing_______________________________________________
Health supervision_______- ____________ ______ ________________________
Cooperation with Children’s Aid Society of Pennsylvania___ _
Discharges_____________________________________________________________
The Children’s Home Society of Florida_________
History and form of organization___ ________ _______________________
Finances and publicity_____________________________________
The staff___________________________ ___________________________________
Receiving homes of the society_____________________________________
W ork with families____ ______________________________ ________ _______
Children received and services rendered_______________________
Influence of the society on the social-service development of
Florida____________________________________
The Michigan Children’s Aid Society___________
History and form of organization___________________________________
Development and work o f the branch offices__________ T__________
Sources of funds______________________________________________________

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CONTENTS

Descriptions o f the individual agencies— Continued.
Page
The Michigan Children’s Aid Society— Continued.
146
Division of work-------------------------------------------------------------------■-----------146
Receiving homes---------------------------------------------------------------------------------147
Children received and methods of care------------------- ---------------------148
Health supervision----------------------------------------------------—
— , --------150
The Jewish Home-Finding Society of Chicago— --------------- ---------------150
History and form of organization-— - , — — — ----------------------151
Sources of funds--------------- — -------- --------------- ---------------------------------151
Division of work----------------- ---------------------------------------------------------------152
Children received--------------------------- h------------------------ - - — ------ --------158
Foster-home care----------------------------------------------------- — ----------------------154
Health supervision------------------------------------- —---------- ------------- -----------159
System of records------------------------------------ --------------------T T ""7 ,—
The child-caring department of the Society of St. Vincent de Paul ot
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Detroit_________________________________________— --------------------- —■—
160
History and form of organization-------- -----------------------------------— r 160
Sources of funds------------------- .----------—-------1— --------------------------------160
Division of work----------------------- ------------------------------------------ d— ------161
Children received--------------------------------------------------------------------------------162
Methods o f care------------------------------------ - - 2----------------------------- ---------163
Health supervision-------ILv---- ------------ --------------------------- |S-------- -—
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Cooperation with parish conference and other agencies— y - -----166
The St. Louis Children’s Aid Society------------------------------------------------166
History and form of organization,----------------------- ---------- — —
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Sources of funds----------------------- -----------------------— ------------------ -— ~
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Division of work---------------------------- ----------------------------— j-------- m------169
Methods of care— ----------- -— {--------------------------- -------------------- ~ ~ C — —
170
Children received— — -------- ----------------------------- ---------------------------------171
Clothing--------------------------------------------------------— --------- - 77—;— - - —
171
Health supervision------------------— — --------------------------------------------------175
Disposition of cases and follow-up work— --------- --------------- — —

P art II.— H ealth Supervision of C hildren P laced
H omes

F oster

Introduction'— S----------------------------------------- -— ------------------------- 1
'
Standards of health supervision----------------\-------- - r ------- ||------------- % - r ~ Agencies studied------------------------------------------- ---------- ---------------------------------Children accepted for care------------------- ----------------------------------*-------Program of health work---------------------------------- —----------------------------------------General outline----------— -------- ------------------ ----------------- -—
----------—?—
Departments o f health------------ ± . — ~ ---------------- ----------r— -------------- t —
Trained nurses----------------------------------------— —
— --------------------Medical supervision— — ----------------------- -— — ------------— ---------- f —
Mental examinations and child study— :--------------- -----------------------Clinic organization
------------------ - - - ----------- — ^-------------— ■ —
Routine health examination------------------------ -— -------- -------------------- -—
Children examined and time of examination— -------------------— Temporary care during period of examination and treatment—
Scope of physical examination and clinic procedure-------- — ------Report of physical examination-------------------- -------------------------Mental examination------------ --------------------------------— — ----------------------- —
Value of mental tests----------------------- * -------------------------—
Children exam ined------------------------------------------- ------------------Report o f mental examination— ----- — — ------------------------------------Corrective work and special treatment------------— ----- -------r~— -----------Clinical and hospital facilities------------------- i,----------------------------------Carry out of recommendations---------------------------------------------------------Health standards for foster homes---------k -------- -----------— - - r - ---------Physical equipment of the home---------- -------------- — ---------- --------Health o f the foster fam ily— — -------------- — ---------------- ------- -------—
Instructions to foster mothers-------------------------— ------------- — — —
Health supervision in the home—
-------------------------■------ —------ —
Cooperation with community health agencies------------ -------------- —
Coordination of medical and social w ork-— — ------------ l^ r^ r-------------Health records------------------------------------------------------------— — --------- —
Cost o f health work------------------------------ ------------------------------------ -------------

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CONTENTS

' VII
Page

Conclusions_______________________________________ ___________________________ __
Case histories_____________ *______________________ ____ 1________ ~_________ 209
Appendix A.— General Tables_____________________________________ __________
Appendix B.— The Church Home Society of Massachusetts and the Detroit
Children’s Aid Society__________ ____________________________________ _______

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GEN ERAL TABLES

Table 1.— Age when received of children under care o f eight child-placing
agencies during a six-month period___________________________
Table 2.— Person or agency from whom children under care of eight
child-placing agencies were received during a six-month
period_____________________________________ ________________________
Table 3.— Parental status when received of children under care of eight
child-placing agencies during a six-month period_____________
Table 4.— Source of support of children under care of eight child-placing
agencies during a six-month period___________________________
Table 5.— Number of replacements of children under care of eight child
placing agencies during a six-month period_________ __________
Table 6.— Type of first placement of children under care of eight child
placing agencies during a six-month period___________________
Table 7.— Duration of first placement of children under care of eight
child-placing agencies during a six-month period_____________
Table 8.— Type of placement at discharge or at end of period, o f children
under care of eight child-placing agencies during a six-month
period---------------------------------------------------------------------- ---------------------Table 9.— Disposition made o f children discharged from care Qf eight
child-placing agencies during a six-month perood_____________

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O R G A N IZA T IO N C H A R TS

The
The
The
i^he

New England Home for Little Wanderers— _____ ________________facing
Children’s Aid Society of Pennsylvania______________
facing
Michigan Children’s Aid Society___ ______________________
facing
St. Louis Children’s Aid Society_______ .________________ ________________

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M APS

— Map of Massachusetts showing territory assigned to each of the three
Massachusetts agencies included in the study and to other agencies
in the State__________________________ __________________________________
— Map of Michigan showing location of headquarters and branch ofiices
of Michigan Children’s Aid Society____________________________________

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9
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L E T T E R O F T R A N S M IT T A L

n it e d

S tates D

e p a r t m e n t of

abor,

C h i l d r e n ’s B

ureau,

Washington, October IS, 1926.
S ir : There is transmitted herewith a report on the work o f childplacing agencies, which includes in Part I a social study o f 10
agencies caring for dependent children and in Part I I a study o f the
health supervision o f children placed in foster homes.
The field work for the social study of the child-placing agencies
was done by L. Josephine Webster and Katharine P. Hewins during
the period from November, 1922, to April, 1923. Miss Hewins wrote
the general section o f Part I and the individual descriptions o f the
three Massachusetts agencies; Miss Webster wrote the descriptions of
the other seven agencies.
Part I I was written by Dr. Mary L. Evans, who also did the field
investigations of. health supervision. Eight of the agencies in
cluded in Part I I are the same as those included in Part I ; an out
line o f the two not included in the social study is given in an ap
pendix to the report.
The Children’s Bureau is indebted to the Church Home Society
for the Care o f Children o f the Protestant Episcopal Church and
the Vermont Children’s A id Society (Inc.) for releasing Miss Hewins
and Miss Webster for the work on this report and to the agencies
included in the study for making available the information on which
the report is based and for reviewing and bringing it up to date.
Respectfully submitted.
G r a c e A b b o t t , Chief.
Hon. J a m e s J. D a v i s ,
Secretary of Labor.
IX

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THE WORK OF CHILD-PLACING AGENCIES
Part I.—A SOCIAL STUDY OF TEN AGENCIES CAR
ING FOR DEPENDENT CHILDREN
IN T R O D U C T IO N 1
PURPOSE A N D M ETH OD OF STU D Y

The purpose o f this report is to set forth what was actually being
done in the held of child placing by 10 representative agencies. The
forms or organization, the methods o f attaining results, ways and
means o f support with distribution o f costs o f the different agencies
are outlined.
The material was gathered by means o f interviews with the executives and other staff members o f the 10 agencies, supplemented by the
reading of some 50 records in each agency, one-half of which were
selected as illustrative o f the work done, the other half being an un
selected group o f consecutive cases. Committee and staff meetings
were attended, and foster homes were visited. Consultations were
W1th representatives o f other agencies in the community.
r ^rou^Ilout the report emphasis has been placed intentionally on
tJi6 D6tt6r features o f the work o f each agency, though reference has
been made freely to the poorer work where constructive criticism
has been thought possible.
T H E 10 A G ENCIES STUDIED

Ten private child-caring agencies were selected as illustrating
methods employed under different conditions in the New England
Middle Atlantic, Southern, and Middle Western States. Two of
the agencies—the Michigan Children’s A id Society and the ChilHome Society o f Florida—were state-wide agencies. The
Childrens A id Society o f Pennsylvania had for its territory the
tho State. The St. Louis Children’s Aid Society and
the Children s Bureau o f Philadelphia practically worked within
C1„ty
The field o f the child-caring department of the Society
Vincent de Paul o f Detroit was the Roman Catholic diocese
o f Detroit, covering 29 counties in Michigan; in the city o f Detroit
the society served mainly Catholic children. The Jewish Homeinding Society o f Chicago dealt only with Jewish children of that
city. I he territories o f the three agencies having their headquarters

in text orPin footnotes thrZgh

ChangeS ta ° rganization are noted

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T H E WORK OP CHILD-PLACING AGENCIES

in Boston—the Boston Children’s Aid Society,2 the Children’s Mis
sion to Children, and the New England Home for Little Wander
ers— were less easily defined. The two former served mainly chil
dren from Greater Boston and near-by communities, although the
Children’s Mission rendered aid to a number of children from other
parts o f Massachusetts and to some from other States. The New
England Home for Little Wanderers received children from all
over New England, through its central office in Boston and its four
branches—two in Maine (at Waterville and Caribou), one in Massa
chusetts (at Pittsfield), and one in Connecticut (at B ridgeport); the
branches practically worked only within their own home counties.
Some of the agencies operated in fields where no public child
placing work had as yet developed, or where there was very little
other social-welfare organization. Others worked in highly organized
territory and offered opportunities for intensive concentration on
selected jproblems*
The attitude o f the agencies was that o f cordial reception and a de
sire to facilitate a searching evaluation o f their work.^ Despite their
excellent cooperation the marked differences in statistical methods
and terminology among them made an accurate comparison o f work
or figures practically impossible. Even with the exercise o f the
greatest care in this matter it is almost certain that errors have
occurred*
Uniformity o f terminology and accounting is much needed in the
field of child placing. A beginning in the matter o f a common
terminology has been made through the efforts of certain committees,
and the following definitions have been adopted from their sugges
tions for use in this report:
“ Child placing ” is defined as providing care for any child sepa
rated for a long or a short period from his blood relatives (other
than his brothers and sisters), and cared for in a foster home under
the supervision o f an agency, public or private, whether placed free,
at board, or for wages. A “ foster home ” is “ a private family home
other than his own or his relatives’ which has been investigated and
approved, in which a child is placed under supervision with or with
out payment o f board in money or service and for either temporary
or permanent care.”
#
.
An “ application” is “ a request for advice or assistance which
comes within the province o f the society approached.” A “ case ” is
“ a human problem which is under diagnosis and treatment by a social
agency. It centers in individuals, in their relationship to the family
and the community.” 4
. . ;
The term “ temporary care ” was used by the agencies in two differ
ent senses. Some used it with reference to a time period and con
trasted it with long-time care; others used it in relation to all chil
dren not formally committed to their care by court procedure on the
presumption that the term of their stay was of uncertain duration.
2 Since Apr. 1, 1923, affiliated with the Boston Society for the Care of Girls under the
name Children’s Aid Association. This report covers only the section of the work origi
nally done by the Boston Children’s Aid Society.
4 CommUtee* o^Ternâno'logy? Conference on Illegitimacy, Boston, M ass., 1 9 2 1 ; Bulletin
of Child-Welfare League of America, Nov. 15, 1923.

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PAET I.

SOCIAL STUDY— INTRODUCTION

A few agencies used the terms “ ward ” and “ aid cases,” giving the
former appellation to children legally committed to their care and
the latter term to the children who were with the society by consent
o f or arrangement with the parents, to whom in most instances they
were ultimately returned.
J
DEVELOPM ENT OF CHILD PLACING IN TH E U N ITE D STATES

Cldld Pacing is probably as ancient as the family itself.5 But it
is a tar cry from the methods o f a day when the act o f placing a child
ended the transaction to those o f the most advanced present-day
agencies with their continuous, friendly, and helpful oversight in
the new home. In the first organized work little or no effort was
made toward constructive work with parents or the reestablishment
o f a child sow n home. Once the child was separated from his home
the main effort was directed toward finding some family which would
keep him permanently as their own or with which he could be bound
out. Historically the use o f free and adoptive homes preceded
placement m homes where board was paid. It was not until the
inauguration o f the boarding system that placing out was extended
on anything like a liberal scale to physically handicapped and problem children and to normal children who because o f family conditions
^ rio d s ° ^ sePara^ed ^rom their parents for comparatively short
in 19°9 President Rooseveit called a conference at Washington to
consider the care o f dependent children. Briefly summarized, the
conclusions o f that conference relative to child care were as follows -7
5 01? e care: Children of worthy parents or deserving mothers should as a
rule, be kept with their parents at home.
a’ as a
.
Home finding: Homeless and neglected children, if normal, should be cared
for in families, when practicable.
’
u Cdxea

cwidr“

shonw

i“ OT-

care
Sh° ” 1'i ‘ nSPeCt the work o f a11
5. Facts and records: Complete histories o f dependent children and their
parents, based upon personal investigation and supervision, should be recorded
for guidance o f child-caring agencies.
u
J
o
earey' Ev.ery needy child should receive the best medical and sur
gical attention and be instructed In health and hygiene.
7. Cooperation: Local child-caring agencies should cooperate and establish
joint bureaus o f information.

No better pronouncement on the subject has appeared, and the
principles there enumerated have since been reaffirmed.8
The child-placing movement had its inception on the Atlantic
oeaboard and in the Middle "West, but in 1923 as many as 198
societies, located in every section o f the country and in all but nine
fetates, were reported as having placed children in family homes.
5 See “ The development of child placing in the United Statps ” hv TTnstino-c. w

H om ew are for Deplnde°nt (ffid r e n i* ^
SUbJeCt With extensive bibliography in Foster
7 For the conclusions of the conference see the Proceedings o f the Conferencp nn tho
^ r e of Dependent Children, pp. 8 -1 4 (Senate Document No. 721, 60th Cong. 2d sess
Washington, 1 9 0 9 ). See also Foster-Home Care for Dependent Children, pp. 1 9 5 -2 0 0
’
See
Care of dependent children; the conclusions of the W hite House conference__
be£ i £ ear>
8 a|.ter> by Hastings H. H art, in Standards of Child W e lfa r e : a report of the
Children’s Bureau Conferences, May and June, 1919, pp. 339-344 (u f S ^ C h ild ren ’ s
Bureau Publication No. 60, W ashington 1 9 1 9 ),
^u ’
^ uaren 8

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TH E WORK OF CHILD-PLACING AGENCIES

The placing o f children in foster homes is not confined to agencies
devoted exclusively or even primarily to this type o f work. Ma
ternity homes, infant asylums, family-welfare societies, juvenile
courts, societies for the prevention o f cruelty to children, and hos
pital social-service departments are among those agencies which
have added child placing to their other activities. Such agencies
have undertaken it most frequently because the children’s agencies
in the community have not been equipped to meet the child-placing
needs, but sometimes through a lack o f appreciation o f how special
ized and delicate a task is the selection o f the right foster home
for a child and his adjustment to it. Wherever such a situation
exists it is a challenge to child-placing societies so to equip them
selves for service in their particular field that there shall be no
occasion for agencies specializing in other forms o f work to attempt
this additional service.
R U RAL CHILD PLACING

Rural child-placing work presents its own difficulties, and experi
ence has shown that the neglected roots o f delinquency and depend
ency reach out to isolated sections in very special ways. Methods
have been developed more slowly for the rural sections o f the coun
try than for the larger urban centers, and it is only in the last
decade, perhaps since the W orld War, that interest has focused on
bringing social service to children handicapped by their very
isolation.

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F IE L D

W O RK , DEVELOPM ENT, AND
O F T H E 10 A G E N C I E S

O R G A N IZ A T IO N

FIE LD OF W O R K A N D T Y P E S OF CHILDREN RECEIVED

Since the term “ child placing ” has been used in such very differ
ent senses in various parts o f the United States it should be restated
that throughout this report it includes not only placement in free
and adoptive homes but placement for temporary as well as perma
nent care in boarding homes. Such a use broadens the field to in
clude work done with the families of placed-out children, commonly
known as children’s aid work.
Conditions determining the field of work.

The field o f work o f private child-placing agencies should be de
termined largely by local needs and conditions. Where public child
caring agencies exist the private society is released from certain
obligations otherwise resting upon it alone and is comparatively free
to specialize in certain types o f care as well as to demonstrate new
and untried methods. This freedom to venture into new fields is
possible especially where in addition to a public department other
private children’s organizations share the field. In such communi
ties it has been found possible by mutual agreement for each child
placing agency to define its intake and to give a refinement o f service
not practicable where the responsibility for all, or even most, of the
child placing has fallen upon one organization. Where no public
state-wide child-placing agency exists the private society commonly
aims to meet the requirements o f all children who stand in need o f
placement and almost o f necessity does a more diversified and fre
quently a less intensive kind o f work.
Other determining factors in marking off the field of an agency
have been the presence or absence o f adequate public aid for children
in their own homes, efficient family-welfare societies, good attendance
work, good juvenile courts and probation, institutional provision for
the feeble-minded, visiting teachers, day nurseries, and societies for
the prevention o f cruelty to children. In just the proportion in
which these agencies and others exist may the work of the child-plac
ing society be confined to its more legitimate sphere. Where they
are absent it is in duty bound to do more general child-welfare work.
In relation to their respective fields the tendency o f each of the
agencies studied seemed to be toward intelligent action based on
knowledge and sympathetic understanding o f the needs and facilities
o f the territory which each had undertaken to serve; and coopera
tive relations with the other public and private social agencies oper
ating in the same locality. As a result o f this knowledge and co
operation a fine appreciation o f the values inherent in good family
life was found to permeate the work o f all the agencies studied.
From a strong emphasis on adoptions and free-home permanent
placements all the agencies were increasingly stressing the preserva5

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ÏH

WORK

ô i?

ô h îl d

-P L a

c ïN ô

À G IÏÏC ÏË S

tion o f family ties. Where this was impossible at the outset com
paratively short-time placement o f children was arranged for with
a view to their ultimate return to the homes o f parents or relatives.
Division of field in the communities studied.

The Children's Home Society' of Florida.—No public state-wide
placing-out department had been established in the State o f Florida.
The State provided industrial schools for delinquent children of
both sexes, a colony for the feeble-minded and epileptic, and a school
for the blind and deaf, and since 1919 the counties had made appro
priations for a limited amount o f mothers’ aid. Through its local
board o f charities one county did some family-rehabilitation work.
A few private agencies did family-relief work. The Florida Chil
dren’s Home Society was the only child-placing agency in the State;
it received only white children, but did not otherwise limit intake.
No provision for negro children existed in the State, except through
one or two orphanages.
The Michigan Children’s Aid Society.—F ifty private institutions
and agencies had been licensed by the State of Michigan, and many
o f them did child placing. The city o f Detroit and its environs were
well provided with such facilities. The Michigan Children’s A id
Society, although its activities were state-wide and branch offices
were strategically placed throughout the State, aimed to supplement
and not duplicate the work undertaken by the agents o f the State
welfare commission and the State public school at Coldwater. The
school at Coldwater operated as a receiving institution for certain de
pendent children committed by the 83 probate courts in the State.
Through agents from the institution and the local county agents
under the supervision of the State welfare commission these chil
dren were placed in families, either for adoption or for indenture,
and were visited periodically. More recently the institution had been
used especially for the reception o f difficult and “ unplaceable ”
children, the more normal ones going direct to free homes. The
Michigan Children’s A id Society not only placed children in free
and adoptive homes but was doing a rapidly increasing work for
children whose homes were broken more or less temporarily. In
these cases its efforts centered around rehabilitative measures for the
families at the same time that the children were being supervised in
boarding foster homes.
The Children's Aid Society of Pennsylvania.— The Children’s Aid
Society o f Pennsylvania operated east o f the Allegheny Mountains,
western Pennsylvania being served by other agencies. The society
did general child-placing work in those eastern counties where no
other private local agencies existed. In one county where no agency
existed for the purpose it did prosecuting in cases o f neglect. Since
1883 the State has prohibited almshouse care for children.1
This act further requires those officials having charge o f the poor
to place all dependent children over 2 years o f age in their charge
in family homes or educational institutions. At the request o f such
i T his prohibition was first embodied in the laws of 1883 and reenacted in 1921. Under
its provision “ it shall he unlawful for the overseers or guardians or directors of the
poor * *
* to receive into, or retain in, any almshouse or poorhouse, an y child between 2 and 16 years of age, for a longer period than 60 days, unless such child shall
be an unteachable idiot, an epileptic, or a paralytic, or otherwise so disabled or deformed
as to render it incapable of labor or service,
(A ct of June 13, 1883, Law s o f 1883, F . L .
I l l : act of M ay 20, 1921, Laws of 1921, P. L. 1030, No. 370, sec. 2.)

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MELD OP WORK,

officials the Pennsylvania Children’s A id Society had placed chil
dren, the cost o f board being reimbursed by the county. In Phila
delphia the society divided the field with a large number o f agencies
featuring various forms o f child care, these organizations often be
ing seriously restricted in their intake by charter limitations. The
appropriations for mothers’ aid were so inadequate in Philadelphia
that applications in that city were frequently not acted upon for a
year, and many children o f widowed mothers became the responsi
bility o f placing-out agencies, solely by reason o f dependency.
The child-caring department of the Society of St. Vincent de Paul
of Detroit— The child-faring department o f the Society o f St. Vin
cent de Paul o f Detroit accepted applications for placement exclu
sively for children o f Roman Catholic parentage resident in the dio
cese o f Detroit, which covered 29 counties in the southern section
o f Michigan; in practice its service was confined almost wholly to
Detroit and the surrounding towns. This specialization was actuated
by a desire to cooperate with other child-placing agencies operating
in the same territory.
The Jewish Horne-Finding Society of Chicago.— The Jewish
Home-Finding Society o f Chicago dealt exclusively with children
o f Jewish parentage resident in that city at the time o f application.
Such specialization was practical in a city o f the size o f Chicago,
which, like Detroit, was well provided with social agencies.
The Children’s Bureau of Philadelphia.— The Children’s Bureau
o f Philadelphia was an example o f an agency whose policy was to
adapt its work to fill a definite need in a city program. Established
in a community with no less than 118 children’s institutions and
agencies, it had set itself the specific task o f demonstrating highgrade methods o f placing out for a carefully selected group com
posed chiefly o f infants, unmarried mothers, and problem children.
It also investigated applications for admission to certain institutions.
The St. Louis Childrens Aid Societys—The St. Louis Children’s
A id Society was another instance o f an agency which had
adapted its work to local needs. Before the establishment o f
the St. Louis Board o f Children’s Guardians in 1912 the society
handled practically all kinds o f cases; after the development
o f that public board a practical arrangement was entered into
whereby the functions o f each body were carefully defined. The
board o f guardians agreed to care for the wholly dependent cases
(both long and short time), and the aid society provided for the
partly dependent children in need o f foster-home care. The
children’s aid society often extended its services to wholly de
pendent babies and children who offered serious problems o f conduct
or health. The board o f children’s guardians gave aid in their own
homes to eligible mothers and their children whose fathers were dead
or in certain public institutions, and the aid society no longer gave
this relief, as had been its practice prior to the assumption o f this
form o f work by the public body.
n T n i Boston Children’s Aid Society and the Children’$ Mission to
Chudren.—Massachusetts had a fairly well-worked-out plan de
signed to cover the whole field o f child care, for the interrelation of
public departments and private agencies. The division o f child guard22070— 27----- 2

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T H E WORK OF .CHILD-PLACING AGENCIES

ianship o f the Massachusetts Department of Public Welfare cared
for neglected and delinquent children committed to its custody by
the courts and for certain dependent children received on application
o f parents, guardians, or friends, or committed to its care by the va
rious boards o f overseers o f the poor which operated in each city
and town in the State. The city o f Boston maintained a similar
organization for children having a legal settlement in that city.
Schools for the feeble-minded, blind, crippled, and delinquent chil
dren were provided by the State. Mothers’ aid was administered
jointly by the overseers o f the poor in the several towns and the
division o f aid and relief o f the Massachusetts Department o f Public
Welfare. Family-welfare agencies existed in all the large cities and
in many towns. The Massachusetts Society for the Prevention of
Cruelty to Children covered the State effectively through 16 dis
trict offices.
In addition to the public departments and agencies already men
tioned, the State had a number o f private children’s organizations—
both placing-out agencies and institutions—besides those under con
sideration in this study, all o f which were doing work o f a similar
nature. In order to dovetail their activities certain o f the placingout societies— among them the Boston Children’s A id Society and
the Children’s Mission to Children—had come to an understanding
with regard to a division o f work which had resulted in a territorial
assignment whereby each agency should hold itself responsible for
applications arising within a given district or area. Other organiza
tions agreed to take cases on the basis o f church connection or other
affiliation. By means o f this arrangement it was expected that the
whole State should be covered. In addition the agencies specialized
to a certain extent, cooperating for this service regardless o f the dis
trict plan. The Children’s Mission to Children, for example, while
giving preference to cases within its own territory, was willing to
consider children living in other sections o f the State who required
posthospital care or treatment o f bone lesions. The Boston Chil
dren’s A id Society would place an unmarried mother and her baby,
or a delinquent boy from the court. .
New England Home for Little Wanderers.— This agency, char
tered to work throughout the six New England States, cooperated in
Massachusetts in the plan just outlined, though it received into its
institution children for diagnostic study from places outside its
assignment in the State. In Maine the agency had a fertile and
pioneer field which it cultivated diligently through two branch
offices. Local children’s agencies were active in New Hampshire and
Vermont, and it had withdrawn from those States except to give
assistance in studying children sent to the institution as physical
or mental problems. No branch had been started in Rhode Island,
where child placing was in the initial stages. Connecticut had de
veloped its child-welfare work mainly through county institutions
but since 1921 had carried forward such work through the program
o f its bureau o f child welfare of the department o f public welfare.
Because o f the operations o f the Connecticut Children’s A id Society,
the New England Home for Little Wanderers was limiting its
activities in that State to Fairfield County, and was cooperating
in a state-wide division o f responsibility between public and private
agencies somewhat resembling the Massachusetts situation.

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T e r r it o r y assigned to C hildren’s
M ission to Chi fclren.
T e r r ito r y a s s ig n e d to B o s to n
C h iId re n ’s Aid S o c ie ty
T e r r ito r y assigned t o o th e r c h ild
c a r in g a g e n c ie s .

M A P O F MA SSA C H U SET TS S H O W I N G T E R R IT O R Y A S S IG N E D EACH OF T H E T H R E E M A S S A C H U S E T T S
A G E N C I E S I N C L U D E D IN T H E S T U D Y A N D T O O T H E R A G E N C I E S IN T H E S T A T E

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FIELD OF WORK, DEVELOPMENT, AND ORGANIZATION

T e r r ito r y assigned to New England
Home f o r L ittle W a n d e r e r s .

TH E WORK OF CHILD-PLACING AGENCIES

Limitations with regard to ages of children.

The maximum age limitation for children at reception varied
among the agencies from 14 to 20 years except for unmarried mothers.
When such mothers were accompanied by their babies several o f the
agencies considered them suitable subjects for intensive care at any
age. A t least four societies (The Boston Children’s A id Society, the
Philadelphia Children’s Bureau, the Jewish Home-Finding Society
o f Chicago, and the St. Louis Children’s A id Society) specialized in
the care o f infants; two (The Children’s Mission to Children and
the Pennsylvania Children’s A id Society) declined as a rule to
take infants since other agencies operating in the same field were
specializing in their care; one agency (the child-caring department
o f the Society of St. Vincent de Paul o f Detroit) did not as a rule
receive infants under 6 months o f age. A ll the agencies kept children
up to the legal age of majority, unless they were previously dis
charged through adoption, returned to their own families, or per
manently disposed of in other ways.
Types of children received.

Children horn out of wedlock.—A ll the agencies cared for children
o f illegitimate birth, a few taking the mothers also under care.
Children for adoption or hoarding care.—The practice regarding
adoptions varied among the agencies. The Michigan Children’s A id
Society, the Children’s Home Society o f Florida, and the Children’s
A id Society o f Pennsylvania gave greater attention to adoption cases,
and the other seven agencies emphasized boarding care.
Children with physical and mental health problems.—-AW. the
agencies handled health problems, but some emphasized this more
than others. Problems o f this sort were given special prominence
by the New England Home for Little Wanderers, the Children’s
Mission to Children, the St. JLouis Children’s A id Society, and the
Children’s Bureau o f Philadelphia. A ll the agencies dealt with con
duct and mentality problems; the Children’s A id Society of Pennsyl
vania, the Children’s Bureau of Philadelphia, and the New England
Home for Little Wanderers were especially equipped to give mental
examinations. Children with syphilis or gonorrhea were accepted
under certain conditions by most of the societies, usually only when
they showed no active symptoms.
Protective work.

Protective work involving the prosecution of adults responsible
for the neglect or for the delinquency o f children is ordinarily the
function o f societies for the prevention o f cruelty to children. When
such a society receives a case requiring placement it usually refers it
directly to a child-placing society, or arranges for the child’s com
mitment through the juvenile court. These courts investigate their
own cases through their probation officers or they refer cases to the
child-caring or protective societies, thus enabling these societies to
make investigation and recommendation with regard to the advisa
bility o f commitment by the court.
Since there was no state-wide society for the prevention o f cruelty
to children in either Florida or Michigan, the Children’s Home So
ciety o f Florida and the Michigan Children’s A id Society found it

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FIELD OP WORK, DEVELOPMENT, AND ORGANIZATION

desirable to do protective work. For a like reason the Children’s
A id Society of Pennsylvania furnished such service in one countv
o f that State.
Affiliation with the Child-Welfare League of America.

A ll the agencies included in the study were affiliated with the
Child-Welfare League o f America and through this connection
rendered valuable intercommunity services o f various sorts, thereby
linking distant parts o f the country in an effective manner.
H ISTO R Y A N D FORM OF O R G A N IZATIO N OF TH E 10 AGENCIES
Dates of establishment.

The three agencies having headquarters in Boston were the earliest
established 5 the Children’s Mission to Children began its work in
1849, and the two others within 15 years o f that date. The Children’s
A id Societies o f Pennsylvania and o f Michigan were instituted be
fore the beginning of the present century— in 1882 and 1891. The
other five agencies were organized within the last 25 years; the old
est o f this group— the Children’s Home Society of Florida—was es
tablished in 1902, and the youngest— the child-caring department of
the Society o f St. Vincent de Paul of Detroit—in 1912.
Original purposes and development into present work.

Those agencies which were established earliest grew out o f a
spontaneous desire to help a particular child or at the most a few
children. Their growth was an expression o f the charity of half a
century or more ago, individual and kindly. Apparently no thought
o f a comprehensive program for child care was in the minds o f the
founders. With the establishment o f the newer societies, however,
a wholly different note was struck—the note o f community respon
sibility. Thus the more recently incorporated agencies planned
their work on the basis o f the general need o f service to children,
rather than the relief of sporadic instances o f distress coming under
personal observation. Notwithstanding the haphazard beginnings
o f the older societies they had kept well abreast o f the times and were
not found lagging behind their younger companions. Adaptation
of work to current needs was the underlying principle of all the
agencies studied.
Some agencies developed their placing-out work from institutions,
or at least had an institution in the earlier days, notably, the Jewish
Home-Finding Society o f Chicago and the Children’s Mission to
Children in Boston. The Children’s A id Society o f Pennsylvania
was the direct outgrowth o f a need for child placing felt by the
Philadelphia Society for Organizing Charity. The children’s work
o f the Society o f St. Vincent de Paul o f Detroit and that o f the St.
Louis Children’s A id Society came in response to juvenile-court
needs. A survey o f children’s needs in a particular locality was the
foundation on which the Children’s Bureau o f Philadelphia was
built.
Beginning with an emphasis on free-home care and adoptions the
Children’s Home Society o f Florida, the Children’s Mission to Chil
dren, the New England Home for Little Wanderers, and the Michi-

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T H E WORK OP CHILD-PLACING AGENCIES

gan Children’s A id Society had made rapid strides in more recent
years in the development o f the boarding-home system. This method
o f child placement has been used more or less from the outset by the
other agencies, especially those which were more recently incor
porated.
Interest in the furthering o f child-welfare legislation was a feature
o f the work o f almost all these agencies. The appointment o f several
county probation officers in Florida was directly traceable to the
activities o f the Children’s Home Society, which a few years ago
made a survey o f the State’s social resources. This same society
had been active in furthering juvenile court, child labor', and com
pulsory school attendance legislation. The Children’s A id Society
o f Pennsylvania offered another example o f great activity in further
ing legislation. As early as 1883 it was instrumental in securing laws
to limit the use o f almshouses for the care o f young children, and
it had continued ever since to be interested in promoting childwelfare legislation.
Development of state-wide and interstate work.2

Four societies had developed centers of activity beyond the main or
headquarters office. The Michigan Children’s A id Society had 10
branches located at strategic points in the State (see map, p. 13),
most o f which were self-supporting and administered their own
local finances through a local board and treasurer. The Detroit
branch not only met its own expenses but contributed a substantial
amount each year to the state-wide work. The branches were auton
omous with regard to local policies, looking to the State headquarters
office for general supervision and advice. An eleventh branch was
under consideration at the time of the study.
The Children’s Aid Society o f Pennsylvania had three county
branches, each under a local committee and with very different
local problems, but all three definitely affiliated with the head office
at Philadelphia and under the general supervision o f one field
supervisor.3
The New England Home for Little Wanderers had its main office
in Boston and four active branches, two in Maine, one in Connecti
cut, and one in the central part o f Massachusetts.
Prior to the study the Children’s Home Society o f Florida had
maintained the West Florida branch with headquarters at a receiv
ing home at Pensacola, some 300 miles distant from the main office
at Jacksonville. Definite branch activities had been given up at
that point shortly before the present study because the work was
not being sufficiently supported locally and because long-range su
pervision involved difficulties. The branch work was under the
immediate direction o f a local board o f directors assisted by a ladies’
auxiliary which especially concerned itself with the receiving home.
Shortly before the time o f the study an executive had been stationed
at Pensacola; but at the time o f the inquiry her headquarters had
been removed to Jacksonville.
2 For a discussion of how such work may be developed see “ The work o f a state-wide
child-placing organization,” by Albert H . Stoneman, in Foster-Home Care for Dependent
Children, pp. 79—96.
.
* Since the study was completed the work has been extended to two other counties.

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FIELD OF WORK, DEVELOPMENT, AND ORGANIZATION

M A P OF M IC H IG A N S H O W I N G LO CA TIO N OF H E A D Q U A R T E R S A N D BRANCH
O F F I C E S O F M I C H I G A N C H I L D R E N ’S A I D S O C IE T Y

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$ H E WORK O f CHiLri-PLACiNG AGENCIES

The managing* boards.

The managing boards varied in membership from 13 to 39, the
number being 20 or less in each o f five societies. In all but one
instance the membership comprised both men and women. Lawyers,
bankers, and business men predominated among the men members,
and among women members persons o f leisure, social position, and
wealth were in the majority. In six agencies board members came
from the territory served; for the other four, the board members were
drawn almost exclusively from the city where the headquarters were
located and did not represent the territory as a whole. The Florida
Children’s Home Society and the Michigan Children’s A id Society,
both state-wide in their work, had been very successful in securing
board members from all over their territory. The St. Louis Chil
dren’s A id Society was especially representative o f the community
in its make-up, including persons from the city chamber o f com
merce, a university, the juvenile court, and the school of social econ
omy, in addition to the more usual representation o f business, pro
fessional, arid social interests. Most o f the boards met monthly,
except during the summer months. One met quarterly, and another
about every two months. In the main they initiated very little new
business, acting, as a rule, on committee recommendations.
The standing committees.

Each agency had an executive committee or its equivalent charged
with authority to act between meetings o f the managing boards.
The membership o f such committees varied from one to eight, five
being the usual number. In every instance this committee appeared
to be active, usually meeting monthly, initiating policies, and making
recommendations to the boards. In addition, each agency had from
one to eight standing committees, the usual ones being revenue and
case committees. The financial, or revenue, committee was respon
sible for the raising and investing o f funds. In the case o f the
Boston Children’s A id Society the appeals sent out by the revenue
committee were prepared by the financial secretary. The case com
mittees usually met every one or two weeks and passed upon prob
lem cases presented by members o f the staff. The St. Vincent de
Paul Society o f Detroit had a committee on foster homes, which met
monthly and considered foster-home applications; in this way the
board members were kept in touch with another phase o f the case
work. The case committee o f the St. Louis Children’s A id Society
included in its membership a few persons not members o f the board,
thus bringing many interests and opinions to bear on the special
problems o f the society. The case committee o f the Children’s A id
Society o f Pennsylvania had had signal success in raising funds for
scholarships for promising children. The Children’s Mission to
Children had a monthly combination “ board and staff ” meeting,
which though somewhat, analogous to the case committees conducted
by several o f the other societies was not confined to consideration of
cases but dealt with current events and served to democratize staff
and board relations. These meetings were presided over by different
staff members under the direction o f the general secretary.
Organization and staff.

An executive officer, or general secretary, directly responsible to the
managing board o f directors, supervised the rest o f the staff in all

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FIELD OF W ORK, DEVELOPMENT, AND ORGANIZATION

the agencies. W ith one exception the work was carried on through
departments. The qualifications and training o f the different staff
personnels varied greatly among the agencies. A ll the executives
(eight men and two women) had college education, professional
experience in some other field (as, for example, the ministry), or
special training and experience in some form o f social work (not
necessarily in the children’s field) prior to the assumption o f their
positions with the agencies studied. Several held graduate degrees;
others had taken courses in schools o f social work.
The assistant secretaries and supervisors were responsible to the
executive secretaries for the case workers who did the field work.
These supervisors and case workers, almost all o f whom were women,
ranged from quite inexperienced young women to college graduates
o f wide experience and special aptitude, who had received training
in professional schools o f social work. Certain agencies whose staffs
were very carefully chosen had among their workers, particularly as
supervisors, a high percentage o f persons o f long experience with
their own or other social agencies. Such supervisors and visitors
gave a stability and virility to the case work that could hardly be
overestimated. Although details were not available to make an
accurate statement, it is probable that a majority o f the workers in
the nine agencies reporting on the training and experience o f their
staffs were eligible for either full or junior membership in the
American Association o f Social Workers.
The American Association o f Social Workers is an organization
established to promote the professional status o f persons doing social
work. The following extract from the constitution of the American
Association o f Social Workers outlines the requirement for mem
bership :
1. Membership in the American Association of Social Workers is open to
men and women trained in social work who are or have been professionally
concerned with problems of social organization and adjustment, and whose
ethical standards of performance and character are in conformity with those
of this association.
2. A member shall hereafter, at the time of his admittance, meet the fol
lowing qualifications:
He must have had four years of practical experience in social organiza
tions of recognized standing and have demonstrated that he possesses an
educational background warranting expectation of success and progress in
the profession of social work. He must be not less than 25 years of age.
Graduation from a two-year course in an approved school of social work
and one year of experience may be accepted in lieu of four years’ experience;
completion of one year in an approved school of social work in lieu of one
year of experience; completion of one year or more of graduate work in
social science in an accredited college or university in lieu of one year of
experience; two or more years of experience in a closely related profession
in lieu of one year of experience. In no case shall a member have had at
the time of his admittance less than one year of practical experience in
social work.
3. A junior member shall, at the time of his admittance, meet the following
qualifications:
He must have had one year o f supervised experience in a social organiza
tion of recognized standing and have graduated from an accredited college
or university. He must be not less than 21 years of age.
Satisfactory completion of one year in an approved school of social work
may be accepted in lieu of one year of supervised experience. * * *

A very cordial attitude o f cooperation toward schools o f social

work Rnd social-work departments o f universities existed in all the

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THE

WORK

O F C H I L D -P L A C I N G

A G E N C IE S

agencies, and at some time or other in all but two o f the agencies
located near schools o f social work, students had received field
work training. One agency which had no students in training at
the time o f the inquiry stated quite frankly that because o f certain
changes in the staff it had temporarily felt itself not equipped to
give the necessary training and supervision and did not wish to
be in the position o f using a student to run its errands. This com
ment illustrated the serious attitude taken by the agencies in prof
fering their equipment as an aid to the schools. The general secre
taries o f the child-caring department o f the Society o f St. Vincent
de Paul and the Children’s Bureau o f Philadelphia gave courses
at schools o f social work and universities.
Attendance at the National and State Conferences o f Social Work
by the general secretary was considered essential by all 10 ^societies,
and as a rule one or more staff members were sent in addition. The
full expenses o f the general secretary were always paid; the ex
penses o f the staff members were sometimes paid in full, but more
often in part. It was customary for some o f the agencies to pro
vide a certain amount for this purpose in their budget, which after
the expenses of the ^general secretary were met, was distributed
among the visitors sent. A generous attitude was observed in plan
ning to give staff members time to attend local conferences and
lectures, both because o f their value to the worker and so to the
society and because o f the opportunity given to pass on to others
the agency’s experience. The agencies studied had_ a missionary
spirit toward more isolated and less favored communities.
In a few instances and under special conditions the expenses o f
workers were paid by the agency for extension courses at schools of
social work. Libraries containing standard and current literature,
books, magazines, and bulletins dealing with social subjects were
installed in some agencies, and the workers were encouraged to
use them.
Staff meetings were held at regular intervals, usually weekly
except during the summer months, and as a rule were presided over
by the general secretary. The meetings were found a useful medium
for the introduction o f new ideas, sometimes discussed informally,
sometimes presented by outside speakers. The subjects covered a
wide range o f interests immediately or more remotely related to
the technique o f the work.
Salaries.

The salaries paid varied not only as between different parts of
the country but among agencies in the same section and did not
always vary with the education, special preparation, or previous
experience o f the individual workers. The study o f these 10 agencies
led to the conclusion that no standardization o f salaries for social
workers in the children’s field, whether case workers, supervisors, or
executives, had been developed.
Executives' salaries.— The salaries o f the executives (seven men
and two women) were reported for nine societies. They ranged
from $2,400 to $7,500 a year.4 It would be difficult to determine the
basis for the difference in these salaries. The only general rule
i
Since the study the salary of one of these executives has been increased to $8,100.
The salary of one executive was not paid by the agency studied,# but was contributed
by another organization, and though included above doe® not appear m the budget o n p . 2 2 .

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FIELD 1 OF WORK, DEVELOPMENT, AND ORGANIZATION

seemed to be that the women’s salaries were the lowest. In the cases
o f the executives whose education and training were given, little re
lation seemed to exist between the range o f salary and the amount
o f professional preparation either in schools o f social work or
through previous experience in case-work agencies, nor was there
a very clear relationship between the salary and the budget, the
former varying from 2 per cent to 6 per cent o f the budget. Neither
did the extent o f the territory served nor the number o f cases handled, so far as those facts were obtainable and comparable, fur
nish the criterion for the salary. It is probable that the personal
equation was an important factor in each instance.
Supervisors’ salaries— Salaries were reported by 9 o f the 10
agencies for 35 assistant secretaries, branch secretaries, and super
visors ranging from $1,200 to $2,800, with a mean salary o f $1,800
(since the study material salary increases have been made in one
agency, which now pays a maximum supervisory salary o f $3,500).
A ll tli6S6 semiexecutive positions wcro hold by women. Except in
those agencies having a woman executive, the supervisors and assist
ant secretaries received, in every instance, less than half the salary
paid to the chief executive, and in one agency the assistant supermtendent’s salary was less than one-third the executive’s salary.
The positions that included maintenance, o f which there were a
few, are not included in this comparison.
Oase-workers1 salaries.— The same nine agencies reported salaries
for about 85 assistant supervisors, investigators, home finders, plac
ing-out visitors (o f whom 5 were men), and nurses ranging from
$840 to $2,400, with a mean salary o f $1,400. About one-third re
ceived from $1,500 to $1,700, nearly 30 per cent received below
$1,200, the numbers in this latter group being largely from a single
agency. On the whole a closer relationship was found to exist for
this group between salaries received and the education, training, and
experience o f the workers, than for the executive and supervisory
groups. In the main these persons were actively engaged in field
work though a few o f them were also doing a small amount o f
clerical work.
Office equipment.

The physical surroundings o f the workers were generally good,
except in the case o f four agencies, whose quarters were obviously
too crowded for efficient service and in the case o f three for ordinary
comfort. Plans were under way at the time o f the study for moving
these agencies into more commodious offices.5 Interviewing rooms
designed to provide privacy and to produce a restful and sympathetic atmosphere in keeping with the delicate task o f inducing con
fidences had demonstrated their value to those agencies which had
them.
The Jewish Home-Finding Society of Chicago had adequate office
space in a building occupied also by 12 other Jewish charities of
Chicago. The offices were a model o f simplicity and efficiency. The
rooms were small and afforded opportunity for private interviews,
A small reception room and an adjoining playroom for the children
were appropriately furnished.
BIn three of these agencies improvement has been effected since the study.

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TH E WORE OE CHILD-ELACING AGENCIES

The New England Home for Little Wanderers had its head
quarters on the first floor o f the Boston institution (see p. 114). The
space occupied was ample, and the offices were very attractively
furnished. Provision was made for separate interviewing rooms,
and consideration was given to the comfort and convenience of
applicants and staff alike. This society and the Children’s Mission
to Children, another well-equipped agency, had fireproof record
rooms or vaults— a most important provision if social case records
are to be given the care they merit.
A t least eight o f the agencies had one or more motor cars for
the use o f their workers. Adequate telephone facilities with switch
boards and desk telephones proved their economy, exactly as in any
business house, wherever they were installed.
Financing.

Income.—Nearly a million and a half dollars ($1,486,000) was
the annual combined income o f the 10 societies, the individual in
come ranging from less than $40,000 to more than $365,000. The
variety in methods o f accounting used by the societies at the time of
the study made accurate comparison impossible. Differences ex
isted even in the methods used by the headquarters and the branches
o f a single agency (in one instance this was caused by the require
ments o f different community-fund organizations). The following
statements, therefore, must be considered as only approximately
true estimates. The statements in the following table are based in
some instances on figures for the year preceding the study and in
others on estimates for the year o f the study. Wherever doubt ex
isted care has been exercised to understate rather than to overstate
the figures. Six societies netted a combined income o f $192,000
from endowments and capital funds, which was about 13 per cent
o f the total income o f the 10 societies.
Sources of the income of the 10 agencies studied
Percentage distribution from—
Agency

Income1

Com Reim
Endow- Contri- Public munity burse
ment butions funds
chest ment 2

4.3
Pennsylvania Children’s Aid Society.. More than $150,000___
St. Vincent de Paul Society---------------New England Home for Little Wan- $125,000 to $150,000___
] 47.2
l 52.1
Boston Children’s Aid Society............
Jewish Home-Finding Society of
Chicago__________ _______ - ............ . $100,000 to $125,000- —
Florida Children’s Home Society------Michigan Children’s Aid Society------Philadelphia Children’s Bureau— ----Children’s Mission to Children---------- Less than $100,000____
St. Louis Children’s Aid Society--------

0.8
.3

74.2
19.6

23.7
24.1

1.5
92.6
51.5
18.3
72.4

17.8
66.3

29.2
23.5
2 91.0

15.4
8.9

2.7
13.8

29.7

7.8
7.4
24.9
8.9
17.7
27.5

1 Figures relate to the year 1922 or 1923; from printed annual reports or from information obtained by
agents.
2 By parents, relatives, and agencies.
2 Through the Jewish Charities of Chicago.

Public subsidies and per capita payments from State, county, and
city sources formed the largest single source o f support, but more
than three-fourths o f this amount was received by the Pennsylvania
Children’s A id Society, the only public child-caring agency in Penn
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Federal Reserve Bank of St. Louis

FIELD OF W ORK, DEVELOPMENT, AND ORGANIZATION

Ì9

sylvania outside o f Philadelphia. The rest of the public-fund sup
port was divided among six other agencies (the Boston Children’s
A id Society, the New England Home for Eittle Wanderers, the
Children’s Bureau o f Philadelphia, the Florida Children’s Home
Society, the Michigan Children’s A id Society, and the child-caring
department o f the Society o f St. Vincent de Paul o f Detroit), two
o f which received such small amounts for per capita payments that
they practically might be excluded from this category. Three
societies (the Children’s Mission to Children, the Jewish HomeFinding Society o f Chicago, and the St. Louis Children’s A id
Society) received no funds from public sources.
Six agencies (the New England Home for Little Wanderers, the
Pennsylvania Children’s A id Society, the Children’s Bureau o f
Philadelphia, the Michigan Children’s A id Society, the Jewish
Home-Finding Society o f Chicago, the child-caring department o f
¡ ^ Society o f St. Vincent de Paul o f Detroit, and the St. Louis
Children s A id Society ) received assistance from community chests
or their equivalent 6 to the extent of some $300,000. The Jewish
Home-Finding Society o f Chicago was supported almost exclusively
by the Jewish Charities o f Chicago.
The total funds from contributions, donations, and subscriptions
was well over a quarter o f a million. The Florida Children’s Home
Society, which carried on an aggressive all-the-year program of
publicity, received from such sources nearly 95 per cent o f its total
income. The St. Louis Children’s A id Society, which also consistently brought its work to public notice, obtained nearly half its rev
enue from popular subscriptions.
The amount obtained by the agencies through reimbursements by
relatives and friends was more than $200,000. Once again attention
must be called to the difficulties encountered in interpreting figures.
For example, the financial statement of one society combined thè
moneys received from relatives and public sources 5 a few included
under reimbursement the sums received from other social agencies.
The amount o f reimbursement received by a society had a definite
relation to such factors as its policy in the selection of cases and its
equipment for follow-up o f delinquent parents. Where public
agencies were established the bulk o f the cases which showed evi
dence o f small reimbursement ability were turned over to them,
due care being exercised not to include among such children those’
for whom the public agency was not reasonably well equipped to
provide. As might be expected, the Children’s A id Society o f Penn
sylvania, the Children’s Bureau o f Philadelphia, and the Children’s
Home Society o f Florida, operating in territory which had no State
system o f care for children, showed relatively lower financial returns
from parents than did the two Massachusetts societies, the New
England Home for Little Wanderers, and the St. Louis Children’s
A id Society, all operating in territory offering excellent public pro
vision for children. In one community wholly dependent on private
child-caring agencies it was customary, even if the parents were able
to pay for a child’s support and gave every promise o f paying, to
take the child to court and have him committed to the agency with
« « Since the study was made the St. Louis Children’s Aid Society has entered into a
n •i3? ? 11
under the terms of which clubs, churches, and individuals, though
monger solicited by the society, are still accepted as sponsors. The amounts contributed
to it by these sponsors are deducted from its share of the community fund.

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TH E WORE OP CHILD-PLACING AGENCIES

one order on the county payable to the agency and another on the
parent payable to the county. In such cases failure to pay on the
part o f the parent was a loss to the county and not to the agency.
Subsidies in Pennsylvania and private contributions in Florida off
set lack o f reimbursement.
Comparison of expenditures.— Comparison o f the expenditures of
the agencies studied was as difficult as that of their income, because
o f the lack o f uniformity in the agencies’ use of terms. Figures
that might mean much within a given agency were valueless when
interpretation and comparison were attempted.
For example,
“ securing homes for children and funds ” was an item used by one
agency which in the classification o f other agencies covered two
distinct phases o f work—publicity and home finding. Again,
“ medical, dental, and surgical ” might or might not include salaries
as well as doctors’ fees, medicines, appliances, and travel. Expenses
o f receiving homes were seldom kept separate from work o f place
ment. Even within a given agency methods were found to vary,
especially where branches were concerned. One agency which main
tained several branches explained that the branch accounts were
kept in accordance with the forms prescribed by the various com
munity funds.
Recognizing the need o f more uniformity in financial and statis
tical reporting, Boston had made a beginning through a subcommittee
o f the children’s department o f the council o f social agencies. This
committee, after a study o f the needs o f the local agencies as well
as o f their reports, recommended an outline form o f report, which
had been adopted by several societies, among them the Boston Chil
dren’s A id Society and the Children’s Mission to Children. The
outline adopted by the Boston agencies was as follow s:
Outline for financial statement
RECEIPTS

Previous year
Month

Cumu
lative
Month

Current:
A. For service rendered—
B. Investments—

Capital:
A. Legacies—

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Federal Reserve Bank of St. Louis

Cumu
lative

F IE L D

WORK,

DEVELOPM ENT, AND

O R G A N IZ A T IO N

Outline for financial statement— C o n tin u e d
E X P E N D IT U R E S

Current:
I Direct service to children—
A. Department of advice and assistance—
1 . Salaries__
2. Travel_______I
3. Incidentals___
B. Department of home finding—
4. Salaries___
5. Travel_____
6. Advertising
7. Incidentals.._
C. Department of foster homes
8. Salaries__
9. T ravel...
10. Board_____
11. Clothing__
12. Health..
13. Legal__ __________
Tuition and school expense
15. Recreation___
16. Sundries.........
D. Home libraries—
17. Salaries___
18. Travel..
19. Sundries
II—Administrative—
20. Salaries.........
21. Rent_________
22. Insurance_______________
23. Telephone and telegraph'. _
24. Stationery, postage, and office'supplies”
25. Furniture and equipment
26. Travel..........................
2?' T sal-drepasftXboxSeS'’ *° include auditing,'bonding^and
28. Joint cooperative movements
29. Sundries.. .
ID —Department of research30. Salaries_______
31. Travel.........
32. ¡Sundries...____________
IV~Department of finance and publicity
33. Salaries............................. _
34. Printing, stationery, and postage
35. Annual report expense..
36. Sundries.____ _________
37. Advertising.......... --.1 .1 ” ' ” " ' .........§.............
Total current expenditures:..........................
Transferred to capital.............
Cash balance__
Capital:
...............
........ g—
38. Sundries___
39. Purchase of securities.. . . .................
40. Loans.......... .......... ............... .
.................
41• T ™nsfer to current expense'to meet'deficit” '
Total capital expenditures.........
Cash balance_____

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TH E WORK OE CHILD-PLACING AGENCIES

Considerably more than $1,000,000, or 80 per cent o f the total com
bined income o f the agencies, was spent for board, salaries, clothing,
traveling expenses, and health items. The remainder covered rent,
printing and postage, recreation, allowances, and miscellaneous ex
penses. The comparative expenditures o f the 10 agencies are shown
in the following table:
Comparative expenditures of the 10 agencies studied
Percentage distribution for—

¡■Agency

Income1

Pennsylvania Children’s Aid
Society.
Child-Caring Department of
the Society of St. Vincent de
Paul.
New England Home for Little
Wanderers.
Boston Children’s Aid Society..
Jewish Home-Finding Society
of Chicago.
Florida Children’s Home Society
Michigan Children’s Aid Society
Philadelphia Children’s Bureau.
Children's Mission to Children.
St. LouisChildren’s Aid Society.

More than $150,000___

Travel
Cloth
and
Board ing for auto Health Oth
Salaries of chil
er3
chil mobile items
dren
dren mainte
nance
21.6

50.6

11.8

8.8

3 3.6

' 14.7

70.9

7.9

1.9

1.6

2.9

4 45.7

22.0

«5.3

4.8

1.5

« 2 0 .1

33.7

40.4

6.0

4.1 '

23.8

48.3

7.9

1.5

38.5
41.2
P 33.6
29.1
■Less than $100,000____
35.8

8 4.8
26.9
37.6
45.1
41.7

$125,000 to $150,000___

$100,000 to $125,000___

1.5
3.7
18 9.5
0

(10)
7.5
3.2
4.1
2 .2

3.1

3 5.4

9.3

1.3

1.72

09)
» 12.8
1.3
(H)

«56.6
«23.6
9.1
10.7
20.5

1 Figures relate to 1922 or 1923 ; from printed annual reports.
2 This item includes expenses for rent, office equipment, printing, and postage, allow
ances and miscellaneous expenses. In some instances it may include expenses^ for cloth
ing, travel, and health where details for these item s were not given separately in the
annual reports.
,
. . . .
3 Includes salaries of physicians and psychologists.
4 Includes medical salaries..
5 Includes some supplies for the institution.
.
.
, ,
.
« Includes expenses of the receiving home or institution maintained hy the agency for
the care of children.
..................
, , . . ,, ,
_
,
7 Includes salaries of staff maintained at preventive clinic supported jointly by Boston
Children’s Aid Society, Boston Dispensary, and the Church Home Society.
8 Includes board paid for children in boarding schools.
9 Figures not available.
. . .
,
.
. .
10 Figures not available, but amount was very low, as railroad passes and reduced fares
were given the society.
, . ,
l t u ì ’J
11 Excludes general secretary’s salary, which was paid by Seybert Institute.
12 Includes cost of salaries connected with the maintenance of the Associated Medical
Clinic supported jointly by the Pennsylvania Children’s Aid Society, Philadelphia Chil
dren’ s Bureau, the Pennsylvania Society to Protect Children from Cruelty, the Society
for Organizing Charity, and the W hite-W illiam s Foundation ; and the maintenance of the
child-study department jointly supported by the Children s Bureau of Philadelphia and
the Children’s Aid Society of Pennsylvania.
13 Includes children’s spending money.
...
. . ____
Expenses for this item amounted to about $500 for appliances, medicines, and home
visits by physicians; other treatment obtained almost entirely free at clinics.

Expenditures for board of children.— The agencies spent annually
over $600,000—more than two-fifths o f their combined income—on
direct service to the children as expressed in terms o f board paid.
Since boarding care was emphasized in different degrees by the
various agencies there was an inevitable proportional variation in
the amount o f this item, ranging from only 4.8 per cent in the case
o f the Children’s Home Society o f Florida, whose placing work was
mainly in free or adoptive homes, to more than 70 per cent in the
case of the St. Vincent de Paul Society o f Detroit, which specialized
in boarding care (see p, 160),

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FIELD OF WORK, DEVELOPMENT, AND ORGANIZATION

Expenditures for salaries.—The second largest item o f expenditure
by the agencies was for salaries, amounting to $412,000, nearly onethird o f the combined income. In two instances (Boston Children’s
A id Society and the Philadelphia Children’s Bureau) this item did
not cover salaries to physicians, psychiatrists, and psychologists,
which were accounted for under health, and in one instance (the
Philadelphia Children’s Bureau) it did not cover the salary o f the
general secretary, which was otherwise provided. The rate which
salaries bore to the budget o f each agency showed only slight rela
tion to the quality o f their work. It was observed, however, that in
the main those agencies which appropriated the largest proportions
to this item were equipped with a larger number of trained and ex
perienced case workers and made relatively greater returns to the com
munity in terms o f service than did those which paid lower salaries.
Expenditures for clothing and travel.— Eight agencies reported a
total o f nearly $95,000 spent for clothing, the amounts varying con
siderably between agencies whose standards differed. Some agencies,
such as the Boston Children’s A id Society, had a centralized plan
o f providing clothing for all children; others left the planning large
ly to the foster parents; the remainder took part but not all of the
responsibility for seeing that its children were properly clothed.
The expenditures for travel ranged from 1.5 per cent to 8.8 per cent
o f their income in the case o f eight agencies. One state-wide agency
which reported no expenditures for travel had very generous priv
ileges extended to it through the courtesy o f the railroads—privi
leges which were granted to the other agencies to a much more
limited extent.
Expenditures for health.— The item o f expenditure for health
was one o f growing importance with the societies. It has been only
a few years since child-caring agencies depended exclusively on
gratuitous medical service. To-day the tendency is for agencies to
develop, either independently or cooperatively, effective physical and
mental health supervision for their wards. More than $40,000 was
spent during the year in connection with health items by 7 of the 10
agencies studied.
2207°— 27------3

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Federal Reserve Bank of St. Louis

M ETH ODS OF W O R K OF TH E

10 A G E N C I E S

TERMS OF ACC EPTAN C E FOR PLACEM ENT
Methods of receiving children.

Children were received for placement by the agencies m two ways.
(1) Through some form of legal commitment, by parental surrender,
or through guardianship procedure; or (2) through voluntary ap
plication on the part o f parent, relative friend, or other agency, no
transfer o f custody being made. More than half the children (2,7 ¿6)
in care o f eight of the agencies studied for which figures were
available were received with some form o f legal control. <J± this
number 96.5 per cent were thus received by three agencies. the
majority o f the children accepted for placement by the other agencies
'were received without transfer o f custody from the parents, this
was in accord with the trend among child-placing agencies toward
family rehabilitation and away from custodial care.
Commitment through juvenile and 'probate courts.— Commitments,
either temporary or permanent, were made by the committing courts
to eight o f the agencies (New England Home for Little Wanderers,
Children’s A id Societies, o f Pennsylvania, Michigan, and St. Louis,
the Children’s Bureau o f Philadelphia, the Children’s Home Society
o f Florida, the child-caring department of the Society of St. v incent
de Paul o f Detroit, and the Jewish Home-Finding Society ot Chi
cago) , but the number received in this manner varied from more than
half o f all the children under care in the case of the Children s Aid
Society o f Pennsylvania to only 10 children under care of the New
England Home for Little Wanderers and 8 under care o f the 1 hiladelphia Children’s Bureau. (See General Table 2, p. 215.) In two
cities commitment by the juvenile court did not convey permanent
custody to the agency, since the judge reserved to himself the power
to order children so committed returned to their parents. Without
very close cooperation between the court and the agency, such divided
responsibility might tend to hamper the usefulness of a society.
The Philadelphia Children’s Bureau favored a decreasing use ot
court „commitments and the substitution o f informal jurisdiction
partly on the ground that better cooperation was established with the
children’s families when persuasion rather than authority was used.
In Massachusetts, where the juvenile court had power to commit neg
lected and delinquent children .only to a public agency, children were
placed with private agencies during a court continuance, which might
be renewed from time to time. Custody in such cases remained with
the court, the child being nominally in charge o f the probation officer
who delegated temporary authority to the agency. Children were
accepted for temporary care from the courts by the two Michigan
agencies studied, such children remaining legal wards ot the court.
The Florida society received a few children on terms similar to those
in Michigan.
24

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Federal Reserve Bank of St. Louis

METHODS OP WORK

Guardianship.— Guardianship with custody but without power to
assent to adoption, granted by the probate court, was a form of con
trol used occasionally by the three Boston agencies, the St. Louis and
Michigan societies, and the Jewish Home-Finding Society of Chi
cago. W ith the Jewish Home-Finding Society, however, it was
used only in cases where there were questions o f property. In cases
o f guardianship the custody of a child was granted to an individual,
usually the general secretary, and not to the society itself. The
child-caring department o f the Society o f St. Vincent de Paul of
Detroit had worked out a plan by which certain trust companies
accepted guardianship in cases involving property belonging to its
wards.
Parental surrender.—-Children were received on parental surrender
by eight of the agencies though most of them received very few
children in this way and neither the Boston Children’s A id Society
nor the Children’s Mission to Children had received any during the
year o f the study. On the whole the tendency appeared to be away
from parental surrender at the time o f reception. An exception to
this was in cases where consent to adoption was likely to be ulti-*
mately desirable and where it was unwise or impossible to keep in
sufficient touch with the mother o f an illegitimate child to get her
signature at the actual time o f adoption. In these rather rare cases
consent to surrender by the mother was obtained at time o f reception.
Otherwise she was not asked to sign papers until the petition was
ready for court action.
Commitment by poor-law officials.—To only four agencies— oper
ating in territory where there was no public department to which
such children could be sent— were foundlings and other children
committed by city and county poor-law officials.
Other methods.—A s was previously stated nearly half the children
were received by the agencies without surrender o f custody, full
legal control remaining usually with the parent or less frequently
with the referring institution or agency. Some '44 per cent o f all
children received by eight agencies belonged in this group, the per
centage for individual agencies ranging from 95.9 per cent for the
Boston Children’s A id Society down to 16.7 per cent for the Chil
dren’s A id Society o f Pennsylvania. In only 77 instances (out of
4,887 in the eight agencies for which figures were available) no legal
control appeared to have been established (the children in these cases
were full orphans without known guardians and not under court con
trol). These figures bear evidence to the care exercised by the
agencies in definitely establishing responsibility for and authority
over all children who were received for placement.
Parental status at time of reception.

As children are entitled normally to a home with two parents, each
contributing to the child’s development, it is important to know the
parental status o f children cared for by children’s agencies, and such
knowledge should throw considerable light on the reasons why chil
dren are without homes o f their own. The erroneous notion has popu
larly been held that institutions and child-placing agencies deal
almost exclusively with full orphans. In view o f the prevalence o f
this belief, it is worth noting that o f the 4,887 children received by

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Federal Reserve Bank of St. Louis

T H E W ORK OF CHILD-PLACING AGENCIES

eight agencies, both parents o f only 223 children (5 per cent) were
known to be dead. Broken homes, however, were numerous. In
only 8 per cent o f the total cases were the parents living together m
the homes from which the children were taken; for the various
agencies the proportions varied widely, the percentage being as high
as 22 2 for the Children’s Mission to Children and as low as 3.6 tor
the Florida Children’s Home Society. The difference is, o f course,
largely explainable by the special type o f work undertaken by each
agency, whether there was specialization in providing for certain
kinds o f temporary need, etc.
,
Divorce as a cause o f removal o f children to the care ot cUiidplacing agencies demands more serious attention than has yet been
given it.7 W ith 118 actual cases of divorced parents and the parents
o f 803 other children separated, deserted, or living apart (exclusive
o f cases in which one parent was in a hospital or correctional insti
tution), the problem o f 19 per cent o f all children in care ot the
agencies studied can be traced wholly or in part to the disruption ot
the home because of marital difficulties o f one sort or another.
Children o f unmarried mothers formed a large group— 16.3 per
V n t o f the total number o f children in care o f the agencies—ranging
from 35.8 per cent for the Michigan Children’s A id Society to as low
as 2.3 per cent for the Children’s Mission to Children.
Homes broken through illness, physical and mental, o f one or both
parents, but especially o f the mother, contributed anothei large
group o f children in care o f the agencies—480 children (nearly 10
per cent o f the total number). O f the children in care o f the Chil
dren’s Bureau of Philadelphia, 28.3 per cent were reported as re
ceived for this reason.
One thousand and eighty-eight children (22.3 per cent) came
from homes in which the father was head o f the family, the mothers
o f more than half this number being dead. The problem o f the
widower, very unlike that o f the widow, has so far baffled attempts
at solution; the difficulties o f trying to make suitable provision lor
his children other than by foster-home care have been drawn atten
tion to in an inquiry recently made.8
3
.
The commendable development o f aid to children in their own
homes through mothers’ aid legislation was reflected in the figures,
since only 8.4 per cent o f the children received came from widowed
mothers; in Florida, where such legislation was less widely applied
than in the other States studied, the percentage was 9.9.
A study o f the sources from which children were received as com
pared with the parental status indicated that it was the need of the
individual child and not alone the status o f the parent that deter
mined how he should be receipted. The special policy o f each society
regarding court commitments and reception from the parents should
beb taken into consideration in a comparison o f the sources from
which children were received. (See General Table 2, p. 215.)_______
7 For a fuller discussion of this subject
“ The h o m e /’ by Alfred Newberry, in The
nn oqq—9 8 5 • see also “ Some aspects of
Hornell H art, in Proceedings of the Fourth

as it affects the dependency of children see
Living Church (Milwaukee) June 27 1925
the case method as applied to divorce,
hy
National Conference o f Social Workers of the

S l a v e s 1, LuUcil<h ChUdren^n Need of Special Care.
trial Union, Boston, M ass., 1923.

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W om en’s Educational and Indus

METHODS OF WORK

Financial terms of acceptance.

With the exception o f the Children’s Home Society o f Florida all
the agencies favored holding parents to as full responsibility for sup
port as was consistent with their financial condition. The amount
required o f parents by the agencies was based rather on what they
could afford to pay than on the cost o f the child’s care. The
parents own needs for maintaining health and a decent standard of
living as well as for reestablishing a home fit for the return o f the
cbdd were factors taken into consideration. None o f the agencies
made financial reimbursement for the child an essential feature o f
acceptance, and all were caring for some children without it.
ouch reimbursement was made more commonly for children whose
custody remained with the parents, but instances occurred o f repayments being ordered by courts which had taken jurisdiction over
tne children, borne children received for adoption were paid for
m whole or in part by the parents until they were placed in free
° r / i ° - Pi 1-ve il0mes-. The children’s aid societies o f Pennsylvania
Mid Michigan especially held to this last policy. On the other hand,
the Children s Home Society o f Florida considered it unfair to expect a parent to pay for a child who was never to be returned to
7 aS
Pla,c<rd for adoption; this society also bore any
additional cost for a child returned to its care when adoption was
not consummated.
Parents and other relatives contributed the whole or part o f the
support m 37 per cent o f the total number o f children cared for by
the eight agencies having figures available on this point. For the
different agencies the proportion o f children for whom some such
payment was made varied from 6 to 92 per cent. (See General
Table 4, p. 217.)
The following list shows the source o f support for the 3,657 chil
dren for whom some contribution was received by the eight agencies :
Children for whom some support was received
Source of support:
P aren ts__________________________
Other relatives_________________
Other individuals________ ______
Public agency___________________
Private agency___ ____
Self_________________________
O th er_________ ___________________
More than one of above sources
Not reported_____________________

“ III

1,281
78
40
- 1, 845
_
246
9

2
-

123
33

T o ta l-------------------------------------------------------------------------------------------------------- 3 ,6 57

Support was paid by relatives for about 7 per cent o f the children
being boarded temporarily with the plan o f ultimately returning to
their own families. The St. Louis Children’s A id Society had an
agreement with the board o f children’s guardians o f that city that
the society should take only partly dependent, children, though ex
ceptions were frequently made in cases o f problem children The
society received support from parents with whom custody remained
tor some 80 per cent o f the children in care for whom support was
reported; it also made a point o f enlisting the interest o f churches

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TH E WORK O f CHILD-PLACING AGENCIES

clubs, and private individuals to sponsor cases in which there were
no relatives able or willing to reimburse the society for the care
given— a method with a distinct educational as well as financial
V slll6 ^

The Boston Children’s Aid Society received some support for 89
per cent o f the children under care and the Children’s Mission to
children for 80 per cent. These two societies a n d the St. Louis
society received some support for the largest proportion of children
in care of the agencies studied. Since these three societies dealt
largely with children whom it was expected to return to their own
families and whose general custody remained with the family, those
percentages may be readily explained. The Children s Mission re
ceived no support for 20 per cent o f its children; the Boston Chil
dren’s A id Society for 11 per cent. The Philadelphia Childrens
Bureau, taking children of similar family status to these others but
operating under conditions where public care was not so available as
in St. Louis and Massachusetts, received children whom the other
societies would have left to public-agency care, but accepted sup
port for them from public sources even though the custody remained
with the parent. Forty-one per cent were paid for in this way, and
parents reimbursed the society in whole or in part for 36 per cent. ^
Forty-seven per cent o f the children in care of the Michigan Lmldren’s A id Society, most o f them committed for adoption, brought
no support. For some 81 per cent, whose custody remained with the
parents, the agency received reimbursement from relatives. . Ihe
New England Home for Little Wanderers gave free care to 27 per
cent o f the children in its care, about half of whom were surrendered
by parents or received through guardianship proceedings; custody
o f the remainder continued with the parents or was vested m the
agency referring the case. More than one-third o f the children under
care of this agency were paid for wholly or in part by parents.
Every agency except the Jewish Home-Finding Society and the
St Louis Children’s A id Society accepted per capita payments from
public funds, though for several agencies the number o f children
supported in this way was negligible. The Children’s A id Society
o f Pennsylvania, the Children’s Home Society o f Florida, and the
Michigan Children’s Aid Society also received lump-sum subsidies
from city, county, or State officials. The Children s A id Society o f
Pennsylvania received from public agencies support for 78 per cent
o f the children under its care, the commitments having been made
through court or poor-law officials. This society received support
from all sources for 93.8 per cent o f the children under its care. (See
General Table 4, p. 217.)
PROCEDURE PRIOR TO A CC E P TA N C E

The recognition that the normal environment for a child to grow
up in is his own home with his own father and mother is the basis
o f the best child-placing work to-day. That this was not so formerly
is evidenced by agencies still to be found that regard the tie of
9 qinrp the pq+ahlisliment o f a “ financial federation ” for the support of social-welfare
agencies in St. Louis there has been some curtailment in the use of this method (see

Pri67.)

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METHODS OF WORK

blood but lightly. Little or no effort is made by such agencies to
determine the real need, and a mother’s request to be relieved o f
her child is looked on as sufficient reason for accepting him. Grad
ually a change has been taking place, and children’s aid societies are
rapidly awakening to the significant fact that a very large propor
tion o f children for whom application is made need not be placed.
Indeed, the best interests o f the child are often served better when
family and neighborhood resources are organized to keep him in his
own home. Such a case was that of a delicate 14-year-old girl, whose
father and mother, though they were good parents, felt themselves
unequal to the task o f caring for her properly in her almost help
less condition. Medical examination undertaken by the agency to
which application had been made disclosed the presence o f a pro
gressive heart trouble, and gave the girl a prognosis o f four years
to live, with hospital care indicated at intervals. Instead o f plac
ing her in a foster home the society arranged for her to remain at
home under supervision and provided occupational therapy and
admission to a nutrition class. The girl was thus enabled to live
happily at home under comfortable conditions which prolonged her
life as much as could be reasonably expected in view o f the medical
diagnosis.
As we canvass the whole situation, the evils o f poor institutional care and
by the same token the evils o f poor child placement, the high cost o f adequate
care, whether in an institution or in a supervised private home, we are driven

aspects means ramny welfare, school welfare, church welfare, community
welfare.10

Slowly at first ^and more rapidly as humanitarian and commonsense methods gained attention, agency after agency has adopted a
system o f inquiry or investigation before acceptance, which method,
once it has become a recognized part o f an agency’s work, has, so
far as known, never been discontinued.11
i the motive behind this investigation being to insure
that so far as possible no child should be placed in a foster home un
less it were shown to be for the best good o f the child, his family
and the community for him to be so placed; and that where this
was not found to be the case some other plan should be made effective.1^ The actual way in which this inquiry was made varied not
only between agencies but also between cases observed in individual
agencies. Speaking in general terms, a superior investigation was
made by two societies and an excellent one by two others. The
records o f at least four gave indication o f a too meager inquiry in
most cases to rank their investigations as better than mediocre re-

-V

—

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uagc 1'uuuuauuil, flew xorK, iy J.Y ).

T H E WORK OP CHILD-PLACING AGENCIES

ception work. The work o f several societies was very uneven, some
o f it being o f much higher quality than the rest. This was especially
noticeable as between the work in the large cities which was usually
good, and that in the “more rural sections where for a variety o f
reasons the work often fell below standard.
Investigating staffs.

In order to make such a careful inquiry as is indicated in the
preceding paragraph the agencies aimed to have on their staffs
visitors who were experienced in securing social, medical, and mental
histories, and in developing community resources—recreational,
health, educational, and financial. The size o f the staff making the
initial inquiry varied not only in actual numbers o f persons employed
by the several agencies, but also in the ratio to applications handled,
the size o f the territory served, and the types o f cases dealt with.
More than any other single factor, it was the personal qualifications,
training, and experience o f the staff which determined the quality o f
the work done. Six agencies, all handling their work from head
quarters, had a supervisor (responsible to the general secretary)
who gave all her time to the general oversight o f the investigations:
One society which had branch offices vested responsibility for the
branch investigations in the assistant secretary but placed the stand
ardization o f central-office investigations in the hands o f the director
o f the department o f advice and assistance. This divided authority
tended to produce a somewhat different standard o f investigations
for rural as compared with city cases. In one state-wide society the
assistant superintendent was made responsible for the work o f four
visitors, who were expected to cover an area o f 54,861 square miles.
Obviously this society was understaffed and could not be expected
to make adequate investigations in its field.
The supervisors were responsible for the oversight o f one to seven
case workers. It is probable that the average supervisor can give
adequate attention to not more than four case workers, though under
exceptionally favorable circumstances when all the workers involved
are fully trained and of long experience the oversight o f one or two
more may be attempted without loss to the service. No evidence
existed to encourage the belief that more than six case workers
could be directed to advantage by one supervisor, no matter how
skilled she and they might be. Those agencies which provided
closest supervision for their case workers made the largest number
o f satisfactory adjustments through relatives and community re
sources and according to available figures, accepted for placement
the smallest number o f children in comparison with the number
o f applications received.
Nine societies had investigators whose time was devoted exclu
sively to this special task o f determining which children needed
placement in foster homes and o f developing the resources o f the
family, relatives, church, or community for those whose needs could
be met better by adjustments making it possible for them to remain
in their own homes. Except for work done in the branches and in
rural districts where specialization o f this sort was scarcely pos
sible, only two agencies (the Jewish Home-Finding Society o f Chi
cago and the Children’s Home Society of Florida) followed the
method o f having the same case worker do both investigating and

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METHODS OP WORK

supervising in foster homes.13 The Children’s Bureau o f Philadel
phia and the Boston Children’s A id Society had, in addition to their
held case workers, an office investigator who received all applica
tions and did the clearing-house work for them. In this way per
haps one-fourth to one-third o f all applications were disposed o f
without being made cases for investigation by the field workers.
Such cases were dealt with (1) by reference to another agency
already in touch with the situation or more adapted
to deal with the problem; (2) by telephone reference to an agency
not yet on the case; or (3) merely by helpful suggestions to the
applicant before she left the office. When the application could not
be disposed o f in any o f these ways it became an “ application
accepted for investigation,” and the office investigator (who did no
field work herself) referred it to afield investigator for full inquiry.
A t this point the application became a case (see -p. 2).
Registration with social-service exchange.

The confidential or social-service exchange now established in most
large cities and many smaller places has become the recognized
medium o f interchange between agencies. Its purpose is to prevent
duplication o f effort and to facilitate service to those in need.
.
agencies studied believed in the value o f an exchange, but
since not all o f the territory covered by four agencies (the New
England Home for Little Wanderers, Children’s A id Society o f
Pennsyivama, the Children’s Home Society o f Florida, and the
Michigan Children’s A id Society) was served by such exchanges,
these-societies were able to register only such cases as came from
territory covered by an exchange. The New England Home for
Little Wanderers registered all Massachusetts cases with the Boston
exchange, which accepted registration over a large area; it also reg
istered with the Boston exchange all cases accepted for study at the
institution, even though they came through branch offices located in
other States. In addition it registered locally those cases arising in
other cities or towns which had developed exchanges o f their own.
The Children’s A id Society o f Pennsylvania used the Philadelphia
6XCMiig6 for Philadelphia cases and other local exchanges wherever
they existed in its territory. The only exchange in Florida was at
Jacksonville, and the Children’s Home Society o f Florida registered
with it all cases from that city, but since this exchange did not
receive cases or inquiries from outside the city, its usefulness to the
society was limited.
The Michigan Children’s A id Society, in addition to maintaining
an exchange o f its own in which every case known to the society
through any o f its branches could be immediately identified regis
tered its cases in every city in the State where an exchange existed.
I he other six agencies registered all their cases, since the territory
which each served was in every case fully covered by an exchange
service.
&
ncei the completion of the study, the Children’s Mission to Children has inans-n
whereby a supervisor of case work is made responsible for all case workers
The various case workers specialize in investigating, home finding, or placing out hut
may he called upon for the other kinds of work. This supervisor of the whole case’ plan
ried out

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7 a direCt0F ° f Visit0rs wh0 sees that t h l details i r l car

T SE WORSC OF C H IlD -M A C m E AGENCIES

The great value o f the confidential exchange lies m the fact that
it enables the agency to which application has been made to get m
direct and immediate communication with any other agency that has
known the child or family and to ascertain what plans may already
S v e been made in his behalf. O f course, unless the agencies re
ported through the confidential exchange as previously knowing a
child are communicated with directly, the practical value o f r e g i tration is greatly minimized. Unfortunately a few of the agencies
failed at tfmes to follow up the clues; others communicated at once
with all the agencies which had had any prior contacts wit a gi
case.
Investigations as revealed by the records.

The investigations made by the vistors were undoubtedly better
than the records would indicate, but evaluation o f the work done
must necessarily be based quite largely on the; w t ft t e n t e v u W The
records o f two or three agencies were so full and clear as to leave
no doubt as to what had befn done, even though the visitor who made
the inquiry might be absent for the day or had long since left the
employ o /t h e society. In these records complete evaluation o f the
fects gathered, the impressions received, and the sources pf informa
tion le r e clearly indicated. In other words, a diagnosis had been
. made, and the steps leading to it were logically outlined.
Steps in investigation.

•

In connection with their investigation several o f the societies
studied made it a matter of routine to verify the births, marriages,
and deaths o f all members o f the family, and they interviewed rela
tives and former employers, landlords, and former neighbors; they
also examined carefully the heredity, education, and particularly
the personality o f those seeking help. The verification of the ap
plicant’s story through these and other sources is not done, how^
in any spirit o f routine, but rather to get a trm. picture^fAhe
needs—physical, mental, and m oral-based on the facts. W ith per
fectly honest intentions individuals in need are as unable to g i v e a
complete and unprejudiced history o f their own situations and
art ions as is a physician to diagnose and prescribe treatment for himl l f 1I t i s t h e n ? s much in the interest o f the clients to verify and
amplify their statements as it is to ascertain additional facts bearing
on their situations but often outside their range o f knowledge. The
policy o f the societies which used this sympathetic yet. scienti
approach to their problems was to take clients more and more into
full confidence, explaining to them quite frankly suchjointsi as (1)
What part relatives may play in throwing light on. them ^ i f f i c u l ^
as well as in giving moral and financial assistance; (2) why a school
teacher may lie expected to give a more intelligent statement than
they themselves as to school progress; and (3) why a physician is m
a position to make a truer statement of physical condition. The
importance of securing the cooperation of the applicants in working
out a sobS on o f their® particular problems was being mcreasmgly
stressed by the more progressive agencies.
The difference between the earlier and present investigating meth
ods o f one society waS brought out by a case known first m 1914.
At that time a mother made application to have her 9-year-old boy

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METHODS OF WORK

placed temporarily in the society’s care. No investigation was made,
and he was received for care; but shortly afterwards his mother
took him with her to her place o f employment at domestic service.
Three years later the mother again applied to the society, this time
for advice and help in finding a housekeeper to care for her child.
The record did not show what, if anything, was done at this time.
Apparently the matter was allowed to drop. In any event action
was not recorded. In 1920 application was again made for care o f
• e b°y) then 15 years old, this time for permanent placement, as the
mother had become insane. A t this juncture the investigator arj»aii§ei^
-to ^e. given a mental test. He was found to be
feeble-minded (his intelligence quotient was 54), and the examining
doctor recommended that he be committed to a school for the feeblei® ecause only the superficial requests had been considered
m the earlier applications, without regard for underlying causes and
ntf* v?
Naming and education which were this boy’s due and
which could be given only in such a school, had been withheld
through those years when he would have profited most by them.
One society made a distinction between its investigations for long
and short time care, giving more attention to the former than to the
latter. The value o f the work o f another society which made no such
distinction was illustrated by a case in which temporary care was
asked for one child while the widowed mother planned to keep
another with her. Careful investigation revealed a need o f rather
long-time care for both children. To take the one and leave the
other in this instance would have delayed the time when a home for
both could, be had with their mother, who meanwhile needed an
operation and prolonged convalescent care.
Difficulties of long-range investigations.

Unevenness in the work o f at least three o f the societies called atten
tion to the need o f a common standard of investigation and to the
difficulties encountered in rural communities hampered by the lack
o f city resources. Where a society endeavored to serve a large area
as was the case with the Michigan and Pennsylvania Children’s Aid’
Societies, the Florida Children’s Home Society, and the New England
Home for Little Wanderers, the best work was made possible through
the development o f local branches, general supervision o f standards
emanating from the parent’ office. The Florida society had no branch
office at the time o f the study (see p. 136).
Number of applications assigned to each visitor.

Cases were not handled so efficiently, nor were local conditions well
understood, if an investigator’s work extended more than 30 to 50
miles at most from her headquarters.
The Boston Children’s A id Society, which made very careful in
vestigations, made a standard monthly assignment o f not more than
12 new cases to each experienced visitor. This society acted upon
293 applications during one year; 174 o f these cases were from within
a iO-mile radiusland only 51 from territory over 30 miles distant.
1 he Childrens Mission to Children, which also made excellent in
vestigations, acted upon 192 applications during one fiscal year;
123 came from within a 10-mile radius, 49 from territory within a
20 to 30 mile radius, and only 20 came from more distant points.

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TH E WORK OP CHILD-PLACING AGENCIES

Under usual conditions this society made an assignment o f 12 to 15
cases a month to each visitor. The Children’s Bureau o f Philadel
phia, all its cases coming from one city and its environs, assigned
from 10 to 12 cases a month to each visitor; the character o f its in
vestigations entirely justified the small number. In contrast, another
society which drew its applications from a city area but which as
signed on an average from 25 to 30 new cases each month per worker,
made, as might be expected, comparatively inadequate investigations.
A good investigation may be completed in a few hours. More
often it covers several days, but an extreme case may take several
months, and there must be a sufficiently large staff i f situations are to
be met promptly. An emergency occasionally arises that may justify
a child’s being taken for care pending the completion of investiga
tion, but a wise holding back is often a kindness in disguise, though
it has been found that skillful investigators develop undreamed of
family and neighborhood resources that often prove veritable gold
mines o f cooperation. The following is an illustration o f an investi
gation that covered a long period o f tim e:
A young unmarried woman, pregnant at the time she was referred to one of
the agencies of the study, at the request of the agency was given confine
ment and convalescent care by a maternity home. Meanwhile the agency con
tinued its investigation; it was not until 11 months after she was first re
ferred to the investigating department that the mother and her baby were
placed at board by the society. From the outset the agency suspected fam ily
resources but for many weeks the girl persisted in denying their existence.
During this period the visitor made frequent calls upon the girl, and while to
outward appearance she marked time she was in reality gaining her confidence.
One day this bore unexpected fruit when the young mother admitted the baby’s
resemblance to her own sister. The reserve broken down she poured out the
whole story. N ot- at once even then was her permission gained to tell her
fam ily her story. But later her permission was obtained, the fam ily learned
about the baby, and it was only a short time before mother and baby were
installed in their comfortable home. Altogether many days were given to this
case.

One supervisor, connected with an agency that made careful social
investigations, reported that in her judgment good case work occa
sionally demanded a departure from thorough investigation, but she
promptly added that it was invariably regretted sooner or later.
This agency, however, made careful investigations wherever possible.
It followed up clues in a very thorough manner, though never in a
routine or perfunctory way.14 It accepted, as did most o f the
agencies, the facts reported as the result o f a previous investigation
by another agency, but always made further inquiries whenever such
a course seemed tor the best interests o f the client. An illustration
o f this elasticity o f method is afforded by the following story:
The baby of a well-educated unmarried mother was referred for adoption to
a child-placing agency by the physician who had attended the mother at con
finement. The mother, who was 40 years old and hhd plenty o f money at her
disposal, encouraged by the physician, had fully made up her mind in advance
to part with her baby. The society realizing that to delay action was to lose
touch with the mother, who, under the laws of the State in which she was
living, could easily dispose o f the baby through a newspaper advertisement,
promptly agreed to place the baby pending the making of a final plan. The
next step was to get the mother’s confidence, and, if possible, to change her
14 See Social Diagnosis, by M ary E , Richmond, pp. 3 4 2 -3 7 0 » (Russell Sage Foundation,
New York, 1 9 1 7 ).

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METHODS OF W ORK

attitude. To this end the influence of the mother’s physieian and lawyer (who
were themselves reeducated to a wholly different view toward the mother’s
responsibilities) was sought and obtained. One significant entry in the record,
indicative of the time as well as the effort expended to effect cooperation in
this case, showed that on one occasion the visitor entertained the mother a t
her own home for Sunday afternoon tea and that the interview was prolonged
for two or three hours. Plans were ultimately worked out whereby the mother
should take a special course that would qualify her for an important position,
for which she was fitted by training and general education.
She was also
assisted to prosecute the alleged father, whose name she persistently refused
to divulge for a long tim e ; as a result of the court action which followed he
was adjudicated the father of her child and ordered to pay $5 a week toward
its support. This woman came from a good family, and the individualized treat
ment accorded her was shown in the way the visitor met her on her own in
tellectual level. She not only invited her to her own home but attended con
certs and lectures with her on many occasions, at one time spending a week
end with her in an institution where she was holding quite a responsible posi
tion. The investigation in this case covered many months o f patient contact,
and though the ultimate result was the adoption of the baby that plan was
not entered into hastily nor accomplished without a fu ll appreciation on the
part of all concerned of what was being undertaken. Nor was it brought
about until the alleged father had been made to feel his responsibility and,
what is as important, not until his heredity and the mother’s had been fully
ascertained.

The following case shows how two agencies may work simultane
ously on a case; it is also an example o f how a sympathetically
directed investigation may result in a wise plan :
A 14-year-old unmarried mother and her 1-month-old baby were referred to
the child-placing society by the maternity home where the baby had been born.
The society accepted the investigation previously made by the referring institu
tion, supplementing that information with inquiries directed specifically toward
a determination of the mother’s fitness to care for the baby on the basis of her
mentality and the likelihood that she could profit by further education. The
mother and the baby remained at the rhaternity home meanwhile. A mental
examination of the girl was made, based on her fam ily history and school
record. The examination was summed up in the record of the society as fol
lows : “ Emotional difficulties seem to have some influence in the way of pro
ducing a low mental rating; (9 % years Stanford revision scale) a probable
moron. It is doubtful if she should be allowed the responsibility of her child
without constant supervision. Any further work should be along vocational
lines.” An investigation of the girl’s own home revealed a situation that made
it impossible to consider allowing the baby to go there, though it was felt that
the young mother might be allowed to return if given careful oversight. Her
father being financially able to pay for the baby’s board, it seemed a proper
thing for him to bear that responsibility. The conclusions of the investigation
w ere: “ Baby to be placed by society, grandfather to reimburse for board,
mother to return to her relatives under supervision of the society’s investi
gator.”

Efforts to preserve the family unit.

A ll the agencies studied were agreed as to the value o f preserving
the child’s own home whenever that end could be attained with
advantage to the child, and it was a cardinal principle with them
all that no child should be taken for placement before every effort
had been made to make his own home a desirable one for him, The
degree to which this principle was made effective depended greatly
on the existence and efficiency o f certain local agencies, such as
family-welfare societies, visiting teachers, and habit clinics, through
which material relief and oversight might be obtained. In the
absence o f such organizations the responsibility of filling the breach
usually devolved upon the children’s society itself. Without such
facilities families are bound to be broken up unnecessarily. The

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TH E WORK OF CHILD-PLACING AGENCIES

story told later in this report (see p. 139) o f the difficulties encoun
tered and overcome by an agency working at long range and in a
territory (Florida) which lacked such family organization is a strik
ing illustration o f this point.
. .
In areas which were covered by family-welfare societies or in
which county boards had developed methods o f dealing with family
situations it was the practice for the children’s agency to turn over
cases o f this sort to them. Exceptions were sometimes made in those
instances needing only slight adjustment, in which the introduction
o f a second agency might perhaps have worked a hardship. The
following case is illustrative of how a children’s agency kept in
mind its objective o f maintaining the child’s own home, even though
preliminary plans included two brief periods of care in a foster home:
A children’s hospital which had been treating a 2-year-old girl asked place
ment for her because the grandfather with whom the parents were then living
refused to allow the child to go to his home for convalescence. The society
placed the little girl temporarily, the father promising to pay her board. Soon
afterwards the grandfather died, and the child was at once returned to her
parents under supervision of the society, which continued to provide milk and
clothing for her. Later, when the mother became pregnant the child was
again placed in a foster home. Immediately upon her mother’s recovery she
was returned to her home, and both children remained under the supervision
of the child-placing society’s nurse.

Decision as to reception of children.

After the investigation was completed and the facts were all at
hand the next step was a decision as to a plan which might or might
not involve the reception o f a child for placement in a foster home.
In every society studied this decision was made through consul
tation. The only instances in which it was left to the judgment o f
one person were in the branch offices where the secretary in charge
often' had to make decisions unaided. The method generally ap
proved was for the person who had investigated the case and was
conversant with its details to make a recommendation to her super
visor, who in most cases passed final judgment. Where a question
o f policy was involved or a fine point was to be settled the general
secretary, case committee, or an individual board member was con
sulted. Where a case committee existed, in addition to the cases
brought to it for decision certain other cases which had already been
decided upon were laid before it so that the committee members
might be kept informed as to the numbers and types o f children
being received. It was found that an informal committee o f this
character was able to offer help and practical suggestions to the
staff on the one hand, and on the other to carry an intelligent opinion
to the other board members. Partly in consequence o f this experi
ence, the members o f such case committees were very likely to be
among the most forward-looking and active directors.
Provision for children not accepted for placement.

Since careful investigation as to the actual needs of each child
resulted in more than two-thirds o f them being provided for by
relatives, by other agencies, or in other ways, it is important to
ascertain when and under what conditions certain resources are
found to be most useful. Unfortunately, although all the agencies
studied had certain data on this subject, only six had kept such
records that any reasonable comparison o f their work in this re
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METHODS OE WORK

spect was possible. Even among these six no uniform definitions
o f terms had been adopted, and complete reliance could not be
placed on the figures. For example, in using the word “ case” it
was by no means always clear that families were meant and not
children; 15 and even when the figures were correct and uniform for
the several societies, deductions had to be made warily and careful
interpretation was necessary. For example, a large intake in pro
portion to applications received may mean that the applications
came from communities largely or wholly deficient in local re
sources, for whom, therefore, the only solution was placement. This
was true o f the New England Home for Little Wanderers and the
Michigan Children’s A id Society, both o f which had branch offices
serving such types o f community. Or it may indicate a better recog
nition by the public o f a society’s specialization, resulting in a high
percentage o f applications that came within its legitimate province
to accept for placement. On the other hand, the very low per
centage o f acceptance for placement in the case o f one society was
due, at least in part, to the location o f the office, which made it easy
to make applications o f a general nature regardless o f their suita
bility. In the three agencies (the Boston Children’s A id Society
the Children’s A id Society o f Pennsylvania, and the Children’s
Bureau o f Philadelphia) showing the lowest percentage o f intake
this result was traceable in part to the careful sifting o f applica
tions by a skilled social worker (for a discussion o f the function of
this staff position see p. 97).
Agencies are sometimes confronted by a difficult intake situation
when institutions and agencies as well as individuals (frequently
from other professions) prejudge a case and indicate at the time
it is referred just how they expect it to be treated. These wellmeaning but sometimes unwise persons and organizations miss the
point that it is the business o f the children’s society first to make a
diagnosis and then to prescribe treatment; they overlook the fact
that such prejudgments may create a difficulty in effecting cooper
ation with clients. It is beyond the scope o f this study to consider
how much the desire to please contributors, politicians, courts
clergymen, physicians, other social agencies, and even generally to
be agreeable, has delayed a better community understanding of the
intelligent limitation o f intake, but it is undoubtedly a factor in the
situation.
FOR M U LATIN G T H E P L A N FOR A CHILD’S CARE IN A FOSTER
HOM E

After the preliminary steps o f investigation have been taken, the
physical condition o f the child examined, a study o f his personality
made, when full evidence is obtained regarding the probable length
o f time he will be in the care o f the society, the amount o f reimburse
ment to be expected from the parents settled, and plans as to the
ultimate rehabilitation or permanent disruption o f his family have
been considered then, and not until then, is the society ready
seriously to formulate a plan for the child’s care in a foster home.
15
The practice o f publishing in their annual report statistics of “ cases ” and “ chilclear w ^ e r^ v e r^ sed 010™118’ a*ready adopte(i by several societies, makes this distinction

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TH E WORK ÓE CHILD-PLACING AGENCIES

A ll 10 agencies made such plans after a conference o f one sort
or'another. Six (the Boston Children’s A id Society, the Children’s
Mission to Children, the New England Home for Little Wanderers,
the Children’s Bureau of Philadelphia, the Pennsylvania Children’s
A id Society, and the St. Louis Children’s A id Society) had adopted
the method o f consultation on each particular case as it arose, be
tween the supervisors o f the departments o f investigation and plac
ing out, at which consultation the investigator who made the in
quiry and the visitor who was to supervise the child in his foster
home were also present, and the home finder. A t this conference the
whole situation was gone over in great detail (the record haying been
read in advance by all concerned), the investigator outlining the
situation. It was the endeavor to make the situation as real to
the placing-out visitor as it was to the investigator. W ith most
agencies the plan was for the investigator to drop out o f the case at
this point, except in a few rare cases where it seemed desirable for
her to continue her work for awhile with some knotty phase o f the
family situation. Before actually withdrawing from the case the
investigator was expected to bring about a personal meeting of the
child, his relatives, and the placing-out visitor, and to make the
transfer between departments an easy and natural transition and not
an abrupt termination of friendly relations. Great skill was often
shown by trained and sympathetic case workers in making these
introductions. Unless the transfer was effected with great care the
result was likely to be unsatisfactory and the best-laid plans to go
awry.
Physical examinations.

The method by which physical examination before acceptance was
given, its thoroughness, and the control which the agency had over it
differed among the agencies. They all agreed as to the value o f pre
liminary routine examinations o f all children before placement
and often children for whom plans other than acceptance for place
ment were in contemplation. A few agencies, including those with
branches where the complication of distance made uniformity a
serious problem, depended to a considerable extent upon local physi
cians, who were asked to make the physical examination in accord
ance with blank forms furnished by the central office o f the society.
Six agencies were especially thorough in their methods, examining
every child that came under care, and deserve special comment; but
since their work is described under the individual agencies it will be
given only brief mention here. The Children’s A id Society o f Bos
ton, the New England Home for Little Wanderers, the Pennsylvania
and St. Louis Children’s A id Societies, the Children’s Bureau of
Philadelphia, and the Jewish Home-Finding Society o f Chicago
provided for the routine physical examination o f every child usually
on the day he was received for foster-home care.16 The examination
was also extended to certain children whose applications were still
under investigation and for whom a plan had not been determined.
Not infrequently the acceptance o f a child was decided on the medi
cal findings.
16
A few months prior to the study the Children’ s Mission to Children established rou
tine examinations every six months for all children.

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m e t h o d s oe w o r k

Psychological study of child before placement.

With physical examinations firmly established as a necessary part
o f an intelligent program for child care, especially when the plan for
a child involves placement in some home other than his own, chil
dren’s agencies are learning the importance of knowing more about
the mental make-up o f their charges. The value o f personality
studies as an aid in the selection o f foster homes adapted to indi
vidual needs has gathered momentum in recent years. Formerly
mental examinations were sought only when mental disease or defect
was self-evident or suspected in the individual or noted in the
heredity. Mental hygienists now teach the value o f understanding
personality traits in the normal child, such an understanding leading
to greater conservation and development of latent qualities and point
ing the way to a fuller use of special abilities. Doctor Dunham says,
“ A ll child-placing agencies ought to require frequent investigations
o f intelligence and character organization as well as o f physical
vigor.” 17
Judgments differ as to the relative value o f studying children
under the controlled conditions o f an institution and the more
nearly normal one o f foster-home care. From conditions revealed
by the study it would apear that for the present at least both are
needed. Except in communities adjacent or fairly accessible to large
centers it is probably impracticable to contemplate intensive person
ality studies o f children in foster homes; for these sections the wellequipped institution meets a definite present need. (For description
o f child-study programs in certain agencies see pp. 121-132.)
H O W FOSTER HOMES W E R E FOUND
Home-finding staffs.

The success o f placing out depends to a very definite extent on
an adequate number o f suitable foster homes being available at a
given time. In view o f the importance o f this fact it is strange
that only within a comparatively recent period has foster-home find
ing been considered seriously as a job demanding a techinque o f its
own for which certain social workers might especially prepare them
selves. Formerly, it was thought that placing-out visitors whose
main business was the supervision o f placed-out children could
investigate applications from prospective foster families in their
odd moments. “ If ,” says Mr. Murphy, “ potential foster homes
are studied in exactly the same way that other families known to
social agencies are studied, the element o f chance is increasingly
eliminated, and then is there possible that adjusting o f particular
children to particular families which so many o f us have talked about
and so seldom realized.” 18
Eight o f the agencies studied had social case workers, termed
home finders, assigned for full-time duty to the discovery and inves
tigation o f foster homes.
17 Dunham Francis Lee, M. D . : “ Social interpretations o f mental estimates.”
Hos
pital Social Service (August, 1 9 2 3 ), p. 79. For discussion o f this matter see also “ The
handicap of the dependent child,” by Alberta S. B. Guibord, M . D. (The Survey, Ausrus*16, 1920, pp. 6 1 4 -6 1 6 ) .
18 Murphy, J. Prentice: “ The foster care of neglected and dependent children.”
An
nals of the American Auademy of Political and Social Science, May, 1918, p. 123.

2207°— 27------ 4

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t h e w o r k of c h il d - p l a c in g a g e n c ie s

The home finders o f four o f these.societies (The Boston Children’s
A id Society, the New England Home for Little Wanderers, the
Children’s Bureau of Philadelphia, and the child-caring depart
ment o f the Society of St. Vincent de Paul o f Detroit) were under
the direction o f the placing-out supervisor. Four other societies
(the Children’s Mission to Children (Boston), the Pennsylvania
Children’s 'A id Society, the Jewish Home-Finding Society o f Chi
cago, and the St. Louis Children’s A id Society) maintained sepa
rate home-finding departments which were coordinate with their
investigating and placing-out departments and under the direction
o f a separate supervisor.18
Types of foster homes.20

Adoptive homes.—A ll the agencies placed at least a few children
in adoptive homes, but the Children’s Home Society of Florida and
the Michigan Children’s A id Society specialized in this type of
care. It was impossible, however, to determine the full number of
children so placed because the reports o f three large societies com
bined such children with those placed in free homes. A total o f
546 children in adoptive homes during the period o f the study was
reported by the seven agencies giving separate data on this point.
The Boston Children’s A id Society needed very few adoptive homes,
and its home finder directed her efforts with frequent success toward
transferring prospective adoptive-home applicants to free or board
ing home foster parents.
Free homes.—This type o f home was used by all the agencies.
Since no distinction was made between free homes for children
obviously too young to give anything in return for their board, and
those for older boys and girls quite capable o f working in return for
their board, the statement that 991 o f the total 1,472 children had free
homes has very little significance. This is especially true inasmuch
as this total included the large number o f children in adoptive homes
from the three societies that did not report separately under that
heading.
Boarding homes.— The 10 agencies reported over 2,000 children
annually cared for in boarding homes, the Pennsylvania Children’s
A id Society alone providing for more than half this number (1,039).
With the exception o f the two agencies which placed many children
in adoptive homes (the Children’s Home Society o f Florida and the
Michigan Children’s A id Society), the agencies placed more chil
dren in boarding foster homes than in all other types o f foster homes
combined. The boarding-home work o f four agencies so far ex
ceeded all other forms o f placement as to make these other forms
all but negligible in their cases (the Boston Children’s Aid So
ciety, the Children’s Mission to Children, the Philadelphia Chil
dren’s Bureau, and the St. Louis Children’s A id Society).
Wage homes.—A boy or girl (generally a girl) employed in the
household, was classified as in a wage foster home. When the child
went out from the home to daily employment and paid board from
his earnings, he was said to be in a wage boarding home. Nine
19 Since the study the Children’s Mission to Children has abolished departmental lines,
the various steps in each case, from start to finish, being directed by a supervisor of case
work. . I he home finder, however, a person of wide experience, finds and classifies her
homes independent of direction. The final adaptation o f the fam ily to the child is done
m conference with the supervisor.
20 For definition of foster homes see p. 2.

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METHODS OF WORK

societies had placed some 300 children in wage foster homes; six had
provided for 150 in wage boarding homes. One society, which placed
large numbers o f the children in free homes, disapproved o f the use
o f both wage foster and wage boarding homes, fearing exploitation
o f the children. This fear was not shared by the other agencies,
which had demonstrated an ability to adjust wages and requirements
in accordance with the individual capacity o f each child, and by a
system o f close supervision to control the kind and amount o f work
done.
Methods by which foster homes were obtained.

The home finders spent a definite amount of their time in devising
ways and means o f stimulating requests from desirable applicants to
receive children into their homes.
Newspaper advertisements,
though bringing a large response, were looked upon as resulting in
a comparatively small number o f homes that met the test o f ap
proval. Radio talks and speeches before such bodies as women’s
clubs and church organizations were approved, but no large returns
could be traced to them. Homes suggested by other foster mothers
netted a high percentage o f approvals. The Michigan Children’s
A id Society reported that the society was so well known that many
applications came unsought, and added that a good placement
usually brought several applications from the neighborhood. A num
ber o f families boarding children for the Pennsylvania Children’s
Aid Society had inherited this service from their parents. The home
finders o f the various children’s agencies located in Boston had
formed an organization for the raising o f standards and the ex
change o f methods o f obtaining foster homes.
Several agencies reported more difficulty in finding enough board
ing homes for infants and boarding or free homes for older boys
than other types o f home. In most sections, notably New England
and the Middle Atlantic States, where placing work had been carried
on the longest and where the boarding work had reached its greatest
development, difficulties were encountered in getting enough homes
that met the ascending standards set by these agencies. The solution
o f such a situation appears to lie in two quite different but not con
flicting developments. The first is that there should be even greater
effort in the future than in the past to do preventive work with
families that will forestall the family breakdown. Perhaps the very
obstacles encountered in finding foster homes will be an indirect
means o f forcing attention to the need o f setting up better standards
o f family life than now exist, such as better health and housing
conditions, better-regulated employment, more supervised recreation,
more individualized education, and better social legislation. Such
strengthening of family life would reduce the need for foster homes
in the proportion that provision was made for keeping children in
their own homes. The second approach to a solution o f the problem
o f shortage o f foster homes may come through a franker recognition
than has yet been accorded the need o f seeking boarding foster
mothers who will accept this as a life job worthy o f careful prepa
ration.21 This will necessitate giving such foster mothers a compen
sation more nearly approximating the service rendered than has
21
The Simmons College School of Social W ork furnished two extension courses for
foster mothers, one during the spring, the other in the fall of 1924.
Seven agencies paid
tuition for foster mothers who attended these lectures.

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TH E WORK OF CHILD-PLACING AGENCIES

heretofore been contemplated, except in the rarest instances, even by
the most forward-looking agency.
Standards required in foster homes.

The evaluation of foster homes was made by the agencies from
various angles, both material and moral. Communities were studied
and their educational, recreational, and health facilities duly
weighed. Certain communities were excluded for placing purposes
for certain types o f children, because o f unsatisfactory conditions
such as unsupervised transportation to and from school, + inexperi
enced and underpaid teachers who are constantly being changed,”
“ lack o f organized recreation facilities for adolescent youth.” The
following points were considered in the physical equipment o f the
individual home: The number and location o f its rooms (especially
sleeping arrangements), the condition o f the cellar, water supply, and
toilet facilities, and o f the yard, garden, and livestock. A growing
practice with a few o f the agencies was the incorporation in the
record of a floor plan of each home. The personalities o f the
various members o f the family were given due regard, their educa
tion, religious affiliations, financial status, social position, and moral
character being covered. The underlying purpose o f the family in
wanting a child was carefully gone into and their plans for making
him one o f the family and furthering his religious training, educa
tion, and recreation.
Homes were not approved by agencies doing the best type of work
unless there was evidence of sterling moral character and apprecia
tion and understanding of child nature combined with a desire to be
o f service, nor unless there was sufficient income to insure a standard
distinctly above the poverty line. The Children’s Bureau o f Phila
delphia, which stressed the personality o f the household members,
always obtained a very complete history o f the early life of the
foster parents, and i f the family was childless was careful to in
quire into the reasons for this condition. The home finder for this
and other societies always discussed with the prospective foster
parents the general subjects o f discipline, recreation, and sex instruc
tion and aimed to select teachable foster parents.
The following instance o f a home that was disapproved finally is
illustrative o f the care taken in evaluation:
A brother and sister approximately 45 and 35 years of age had an unusually
attractive home and an unquestionably adequate income. The final disap
proval of the home was based on the anticipated lack of ability to cooperate
fully with the society.
This opinion was based o n : (1) Their refusal to
fill out the application blank; (2 ) their objection to giving references; (3)
the sister’s friction with the faculty while in college, and (4) the conclusion
that she was an “ egoist, lacking in humor, who would not look at things
from the child’s viewpoint; who would crush and not develop him.”
The
first-two objections were not given serious consideration until the home had
been very carefully investigated through seven independent references, most of
whom were seen, and after a. careful personal study of the brother and sister
had been made by an investigator of keen sensibilities and well-balanced
experience.

The requirement regarding formal education, as distinguished
from native intelligence, of foster parents varied from very little
education if the home was to be used for boarding infants or children
o f small mental capacity, to a high-school education or more if the
home was to be used for older children with good mentality, espe
cially when plans were under way for their higher education. Other

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METHODS OF WORK

things being equal, it was recognized that more than grammar-school
training was desirable in the foster parents, but it was not considered
essential except in the cases indicated. Practical and trained nurses,
former teachers, and dietitians were among those found to be caring
for children.
The acceptance o f a home by the Boston Children’s A id Society
depended very much upon the personalities o f the foster father ancl
mother, the purpose and spirit o f the family, their reasons for taking
a child, and their attitude toward his future education, religious
training, and educational needs. They must first be people o f char
acter, in good standing in their own community, and able to offer
a child, besides affection, a real home atmosphere and intelligent
training. These requirements being met, the following standards
were required: (1) Sufficient income for family needs without board
from children; (2) sufficient room to afford a separate bed for each
child if not a separate room (o f 280 children reported on, 124 were
occupying separate rooms and 156, separate b eds); (3) pure water
and sanitary conditions; (4) schools near, or transportation to them
by supervised bus or by the family conveyance; (5) a church connec
tion for the family with church privileges for the children; (6) a
doctor’s word that to his knowledge the general health of the family
is good; (7) a definite understanding as to the amount o f work that
will be required o f the children; and (8) some recreation offered.
In determining the fitness o f a home this agency recognized different
standards according to the needs o f the children under consideration.
For instance, a home for a baby would require that special emphasis
be placed on sanitary conditions, facilities for outdoor sleeping, and
the foster mother’s education for and experience in caring for infants.
For a child who presented a conduct problem, the intelligence and
especially the moral character of the foster parents, and the desir
ability o f the community from an educational and recreational point
o f view were considered o f special importance.
The homejinder of the Children’s Mission to Children stated that
given a right purpose and good personal characteristics in the family
and good physical surroundings she would place the emphasis on
religious influences and the character-building qualities o f the foster
mother, who should be essentially a home maker rather than a home
keeper. In at least one agency homes which were approved received
periodic write-ups which were appended to the original investiga
tion. These were o f value in making later placements in the same
home. Examples o f the entries on the records were as follows:
“ Family gave generous and sympathetic treatment to the boys and
were patient with them, dealing intelligently with their faults.”
“ Family took deep interest in boy and did all they could to help
him, and he gained physically and made a good start in the two
months he was in the home. Although the foster mother is somewhat
older than the average foster mother she is young in spirit and has
a way o f appealing to the boys.”
Crowded business and factory districts were not looked upon by
any o f the agencies as acceptable communities in which to place chil
dren. Isolated farm homes were used less frequently than formerly,
since however desirable the family itself, such homes were not likely
to afford either the educational or the recreational facilities needed
by growing boys and girls. Suburban homes with open spaces

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TH E WORK OF CHILD-PLACING AGENCIES

around them and good community facilities— such as supervised
playgrounds, libraries, and community centers—were the type most
approved. Such homes were also found easier to supervise than the
more distant farm homes. One society insisted on boarding children
under 3 years in homes having a sleeping porch. This same society
was very careful that every child’s sleeping room should be light
and airy, and occupied by not more than two. children, each with a
separate bed. It furnished cribs for the babies when the foster
parents were unable to do so.
A ll the agencies placed Catholic children in Catholic homes, Jewish
children in Jewish homes, and Protestant children in Protestant
homes, and earnest endeavor was made to have these families con
nected with the church o f their faith. The child-caring department
o f the Society o f St. Vincent de Paul o f Detroit required that its
foster parents be practical Catholics, including those with whom
babies were boarded. The Jewish Home-Finding Society o f Chi
cago, although insisting on Jewish homes for the older children,
placed infants up to 214 or 3 years o f age in non-Jewish homes,
partly because it found that the Jewish women had less experience
with bottle-fed babies than did the average non-Jewish mother. No
particular effort was made to have the Protestant children placed in
homes o f their own denomination, but for older boys and girls with
definite denominational affiliation, arrangements were made when
ever possible for attendance at the church o f their preference.
Separate standards for different types of home.

Most o f the agencies made a more thorough investigation o f an
adoptive home than o f any other type, going into more detail with
reference to its economic status and making much more effort to see
the adoptive father. The difference, however, was likely to be in
emphasis rather than in kind. In fact, with most agencies a foster
home could be classified (as adoptive, free, boarding, or wage) only
after' the investigation was completed. Numerous instances occurred
o f homes offered for one kind o f care being converted to use for
another kind, and in the course o f years, o f the same home taking
children on various terms; indeed a single foster home has been
known to have children on different terms at the same time. It seems
clear that the same standard o f investigation in every case would be
the safest plan, for too much can not be known about a home caring
for a child who is placed in it by an agency. Whatever may be the
financial terms o f his acceptance, the agency has the primary respon
sibility o f placing a child in a home where he is likely to grow
up or at least to live during the formative period.
A few agencies discriminated between investigations o f homes
for long and short time use, on the theory that it was not necessary
to be so particular in selecting homes for short-time care. One
agency which placed many children for adoption was sometimes
satisfied with a less intensive investigation than was considered essen
tial by the other agencies, as was indicated in the following quota
tion from a leaflet issued to invite attention of prospective adoptive
parents: “ The next step is for the foster mother and father to
apply in person or in writing * * * giving brief information
about the kind o f home they have, their ages, whether there are
other children in the family and whether they want to adopt a
boy or girl, and the age they prefer. Usually the agency will send

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METHODS OF WORK

á representative to the home, references are generally required, and
the agency and the family take whatever action may be necessary to
satisfy both.”
The Michigan Children’s A id Society may be cited as an example
o f the caution exercised in establishing facts relative to the fitness
o f foster homes. This society took the precaution not only to visit
every prospective home but to corroborate the impression thus
gained through correspondence and visits to persons acquainted with
the family life, the business reputation, and the standing o f the differ
ent members o f the household. Care was exercised to see persons
other than those suggested by the family itself as references, nor were
these inquiries limited to the immediate situation. Often persons were
sought out who had known the family when it was living in another
city or town, sometimes in a quite different section o f the State.
Procedure prior to approval.

As has been stated, the process o f investigating foster homes is
in its infancy as compared with that o f investigating applications
for the care o f children; it is, however, going through exactly the
same evolution and bids fair in time to be done equally well.
The social-service exchange.—The utility of the social-service ex
change in economizing time and service has long been recognized
in case work. It was used for foster-home applications by eight
agencies. O f the two agencies not registering with social-service
exchanges at the time o f the study, one had ceased doing so only be
cause other child-placing societies in the same city did not register
their homes and in the agency’s judgment there seemed to be little point
to its solitary registration. Interesting disclosures have come to light
since registration o f foster homes has become the practice with child
placing agencies, o f which the following case is an example:
The home of Mr. and Mrs. B was under investigation. The references,
including one from the fam ily doctor, all spoke highly o f both the man and
his w ife ; the visit to the home was highly satisfactory. I t was at this time
that the agency which heretofore had not registered with the social-service
exchange decided to inquire in a few cases and thus test its usefulness. This
home was submitted among others and the report returned that Mr. B was
known to the social-service department of a general hospital. Inquiry at that
department revealed what the fam ily physician did not know, namely, that Mr.
B was in an active syphilitic condition and would be a source of danger to
young children.

References.— References, both those given by the prospective fos
ter family and others sought independently by the investigator, were
considered essential. The number required varied from four to
six or more, and those o f relatives were not accepted. Clergymen,
doctors, librarians, teachers, and other persons o f official or recog
nized standing in the community were called upon to confirm or
supplement the information acquired. In doubtful cases the num
ber o f independent sources consulted was limited only by a clearing
up in one way or another o f the question in dispute. The most
progressive agencies were supplementing the use o f blank forms by
personal letters and by visits to references, especially where a writ
ten reference was doubtful or conditional. A ll but two o f the agen
cies had either made it their policy to visit two or more references,
or were equipping themselves to this end. Even in the case of the
two exceptions follow-up was made where the home finder felt
doubtful. One o f these two agencies always visited references when

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THE WORK OF CHILD-PLACING AGENCIES

adoption was contemplated. In interviewing family references the
home finders o f the Children’s Bureau o f Philadelphia were guided,
but not restricted, by the following items to be considered: Moral
integrity, domestic relations, health, disposition and temperament,
responsibility o f both man and woman toward home, care o f own
children, type o f housekeeping, education, spending o f leisure time,
interests in community, and earlier history. They were asked to
state always whether the prospective foster family’s or independent
references were being interviewed and to characterize references,
and if information was obtained under difficulty to make a state
ment to that effect.
Visit to the home.— The policy o f visiting the prospective home
was almost universally indorsed by the agencies studied, and with
one exception the home was always seen as a prerequisite to use.
The society making this exception did so only in cases where the
home was over 150 miles distant from the society’s home office, in
which case the recommendation o f a local official might be accepted in
lieu o f a visit by an accredited agent o f the society.
Policy in relation to seeing the foster father.—It was found that
foster fathers were not receiving their proper share o f attention so
far as being interviewed as a preliminary to the approval o f a home
was concerned. Practical difficulties were in the way o f such in
terviews. But as children’s agencies came to appreciate the im
portance o f the father as a member o f a household, greater effort
was being made to see them before the home was accepted for use,
or at the latest at the time o f a first placement. A special urgency
for interviewing the foster father was recognized when a home was
under consideration for an older boy or girl, and in the case o f adop
tions such an interview was the accepted policy.
Method by which home was approved.

The method o f approval followed by most o f the societies was the
same general procedure as was called for in the approval o f ap
plications. The majority o f the agencies vested the supervisors o f
home finding with authority to approve or disapprove o f homes,
questions o f policy being referred to the general secretary or the
case committee where one existed. O f 1,531 foster-home applica
tions considered during 1923 by the Boston Children’s A id Society,
which had a high standard o f investigation, 93 (only 6 per cent)
were approved for use— 1 for adoption, 9 for free homes, 11 for wage
homes, and 69 for boarding homes.
Standards of investigation.

An outline o f captions for foster-home records, which had been
adopted by several Boston agencies, had resulted in some write-ups
o f foster-home investigations, especially by the home finder o f the
New England Home for Little Wanderers, that were replete with
information. They gave such graphic pictures of the situation in
the homes that a visitor contemplating a home for a child, though
she had neither seen the home nor interviewed the foster parents*
could judge quite accurately concerning the physical surroundings
as well as the personal qualifications o f the family members, their
social and economic status, and their interest in the community ac
tivities. The outline adopted by the Boston agencies was as follow s:

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METHODS OP WORK

A P P L IC A T IO N : Source and object.
C O N F ID E N T IA L E X C H A N G E : Registrations given.
TO R E A C H : Directions for reaching home.
C O M M U N IT Y : Churches, schools, recreation, size and type o f town (indusN i r m 0nCR i n o i CIn e ) ’ flou ts, clubs> community interests, health, libraries.
N E IG H B O R H O O D : H ow thickly settled, type of homes, etc. Any distinctly
undesirable features in the neighborhood. W ater supply. Distance from
schools, chureh>car line, etc.
H O U S E : Exterior type, porches, screens, barn, condition o f repair, grounds
garden, flowers, animals kept, etc. Interior— house well built? Arranger00“ ^ foster child’s room, cleanliness, order, taste in arrangement
ot articles of furniture and decorations, magazines, books, pictures, musical
iceboxmentS and tyPe
music» sanitation, ventilation, heating, lighting,
F A M IL Y :
Personnel: Members and ages, and others in household.
H istory: Man of the fam ily— birthplace, home as a boy, education and
occupation before and after marriage, previous marriage, relatives.
W om an of the family— birthplace, home as a g ir l; and home, education
and occupation before marriage, previous marriage, if any, and first
marriage name, relatives. Children— those at home— occupations, educa
tion ; those away— married, occupations, education.
H ea lth : Past and present of all members o f the family.
Finances: Income, rent, mortgage, insurance.
Interests: Church and club activities, community interests, neighborliness
movies, home making.
&
’
Experience: W ith children.
CI£?Q
L£) i Fosfe.r mother’s motive and preference, child’s relation to family,
t o b e p a i d ^ 1* ^ S £u£ure’ term.
wage home, recreation allowed, wages
G^nd"ateeni[MPRESS]C0N' ° f home and community, members of fam ily seen
IN D E P E N D E N T _ R E F E R E N C E S : Reports
references obtained during home visit
R E C O M M E N D A T IO N : For use of home.

of interviews

with

independent
p

The following outline, although not expected to be used uniformly,
was recommended by the Children’s Bureau o f Philadelphia as a
guide to the points which should be kept in mind in the investigation
or a prospective foster home :
1. Community: T ype; character o f its social and civic life ; standing- its
Ibove s e r f a g e

° 1?

5 p0ssibilities £or ind»strial work for boys and ¡prX

Neighborhood: T y p e; character.
3. H om e: Exterior— grounds (garden, etc.) ; barns; drainage; water sunolv•
¿ en f ~ tyPf - / bouse; arrangement o f rooms, particularly sleeping rooms-’
pictures^et’c tldmeSS ’ taste and arrangement of furniture; possessions, books,’
4. H istory: Man o f the family— previous marriage, if an y; birthplace - home
as a boy and before m arriage; education; occupation. Woman of the fa’m ily^previous marriage, if a n y ; birthplace; home as a girl and b e f^ e marHage’ education; former occupation; children— those at home, occuim nonS’ those away, names, if married daughters; occupations.
5. Glimpse o f fam ily life which visit affords.
*
discuss.ion : In relation to home m aking; housekeeping; brineine
up of^children; outside interests; church, religion; use o f spare time hobbieseX7 e pp ?fa®
Philosophy o f life ; social service (in its broadest’ sense). ’
7. Personality o f woman as gathered during conversation; of man as given
X ™ W o 4 l 0/ b “ t h 6 w Z S . br the W° m an : 04 C h M reI ■ * * * » consciously or
liabilities!01’8 lnterpretation

E m ily ’s

qualifications;

its

assets

and

its

A striking illustration was cited o f the need o f visiting every
prospective home and not depending solely on references c
,
the references for a certain fam ily had been unusually favorable, includ
ing one from another child-placing society which some years back had used

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TH E WORK OF CHILE-PLACING AGENCIES

the home for several months. Their society’s representative admitted, how
ever, that the worker who had personal knowledge of the home was no longer
in its employ and that the record was meager. A visit from the home finder
of the New England Home for Little Wanderers revealed a well-meaning but
ignorant couple, quite obviously unequal to the task of bringing up children.
To quote the record, the home was “ disapproved because of crowded quarters,
crude home life, and lack of culture and refinement.”

An instance o f discriminating judgment and the recognition o f the
limited usefulness of certain homes is shown in the following from
the records o f the same society:
Visitor feels that if a definite schedule for feeding and habits of a child were
drawn up, she (the foster mother) would conscientiously follow them, but
that if left to her own judgment she would probably show the same lack o f
system that her housekeeping evidenced.

The record also went explicitly into the degree o f skill with which
the foster mother had brought up her own family, stating that
educational advantages had been obtained for them. It also related
in some detail the foster mother’s earlier experience in bringing up
younger brothers and sisters. The final recommendation was :
W ith careful guidance on the part of a child’s visitor Mrs. D would con
scientiously care for a young child (not over 5 years). W ould hesitate to
place an older child in the home for fear Mrs. D would not be firm enough.

Rates of board paid.

The following table gives the rates of board paid by each o f the
TO agencies for children under 2 years o f age and children 2 years
o f age and over, and indicates the maximum and the minimum board
paid for a child:
Rates of board paid bp 10 child-placing agencies for children under supervision
in foster homes
Bates of board paid for time unit indicated
Agency

Boston Children’s Aid Society...
The
Children’s Mission to
Children.
The New England Home for
Little Wanderers.
The Children’s Bureau of Phila
delphia.
Pennsylvania Children’s Aid
Society.2
The Children’s Home Society of
Florida.
The Michigan Children’s Aid
Society.
The child-caring department of
of the Society of St. Vincent de
Paul.
The
Jew ish Home-Finding
Society of Chicago.3
The St. Lotus Children’s Aid
Society.4

Children under
2 years of age

Children over
2 years of age

Minimum

$5 a week_______ $4.50 a week........ $3.50 a week____
____ do__________ $4 a week _____
$5 a week............

Maximum

$7-$14 a week.4
$10 a week.
$7 a week.

$4 a week_______

$10 a week--------- $5-$6 a week____ $5 a week_______ $12 a week.
$4 a w e e k .......... $3-$3.50 a week.. $2-$3.50 a week.. $4-$5 a week.
$4.50 a week____

$7-$12 a week.

$4.50 a week........ $3.50 a week____

$7-$10 a week.

$/> a week
$5 a week______

___ do
$20 a m o n th ..... $18 a month........ $8 a month_____

$6-$8 a week.
$40 a month.
$25 a month.

1 The higher rates were paid for care in special temporary foster homes in which children were boarded
JLUJL a GUUJL b .

2 The regular rate for temporary homes was $5 a week for children 2 years of age or over, and $7 a week
for children under 2 years. The maximum rate was $9 a week.
_
.
3 In the cases of an epileptic girl and a superior hut very difficult boy, $15 a week was paid by the Jewish
Home-Finding Society.
4 Five small Japanese children, one of them feeble-minded, were being boarded in one home for $80 a
month. A blind baby and a child with a 4-plus Wassermann reaction were being boarded for $20 a month
each. An extra service given freely by most of the foster mothers was taking children to and from the dis
pensary, which is located in the extreme western part of St. Louis.

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METHODS OF WORK

Recording the successes and failures o f foster homes.
O n e o f th e m o s t re c e n t d e v e lo p m e n ts in fo s t e r -h o m e w o r k is th e
r e c o r d in g o f th e e x p e rie n c e w it h a h o m e a ft e r it h a s b een u sed .
E ven
w it h th e m o s t c a r e fu l a n d p a in s ta k in g in v e s tig a t io n th e fin a l te st o f
a h o m e is its use.
M o r e o v e r , s itu a tio n s o ft e n c h a n g e , a n d a h o m e
t h a t is v e r y d e sira b le a t th e t im e o f a p p r o v a l m a y d e te r io r a te , o r , as
h a p p e n s ju s t as fr e q u e n t ly , m a y d e v e lo p u n s u sp e c te d q u a litie s o f
u se fu ln e s s .
F o r th e se r ea so n s it is v e r y v a lu a b le to h a v e p e r io d ic
w r it e -u p s o n b o th h o m e s in w h ic h c h ild r e n a re p la c e d p e r m a n e n t ly
a n d th ose w h e re th e ir s t a y is lim ite d to a fe w w eek s o r m o n th s .
A
sta te m e n t s h o u ld a lw a y s b e en tered o n th e r e c o r d a t t h e tim e o f a
c h ild ’s r e m o v a l a n d a t r e g u la r in te r v a ls w h e n a c h ild r e m a in s in a
h o m e f o r a lo n g p e rio d .
T h e J e w is h H o m e -F i n d i n g S o c ie t y o f C h ic a g o h a d in tr o d u c e d th e
f o ll o w in g score c a r d f o r r a t in g its fo s te r h o m e s w h e n th e h o m e w a s
first in v e s tig a t e d a n d a p p r o v e d , a n d e v e r y s ix m o n th s t h e r e a fte r so
lo n g as it w a s in u s e :
Standards required o f foster home
1. Personality of foster m other:
Consider personal appearance; ability to win child’s confidence and
friendship; temperamental peculiarities; m orality; her resources
and probable teachableness—
High ----------------------------------—I------------------------------------- 20
Middle
______________ _______________________________________________
15
Low ___ 1____________________________ ______________ ?_________ _________ 10
Lowest.____________________________________ ____________________________
5
2. H ousing:
Consider location ; convenience of approach ; primary home facilities ;
sanitation; ventilation; cleanliness and order; arrangements of
room s; proximity of play spaces; conditions o f the porch and
yard—
High-----------------------------------------------------------------------------------------------------20
Middle____________________________ ________ ________*______________•!____ 15
L o w -------------------------------------10
5
Lowest___________ ___ ________ _______-_______________ :________A '_____
3. Environment in the hom e:
Consider the income. Does it allow for social growth? Consider
social life o f fa m ily ; educational standards; spiritual qualifica
tions ; is the fam ily circle complete or incomplete—
High--------------------------------------------------------------------------------20
Middle_____ .___ ________ ’______________________________________________
15
L o w ------------------------10
Lowest____________ ___ _________ & ______ ____________________ _ ________
5
4. Child-caring practices:
Mother’s mental alertness in relation to the care of her own hom e;
the care of her own children ; the physical appearance of the foster
children, such as cleanliness of neck, ears, head, scalp, etc. The
regularity of habit of the fa m ily ; household rh yth m ; the adjust
ment o f foster child to the situation—
High— -----------------------------------20
Middle_________________ ._&$_______ _______________________________ ____
15
Low _______ ._____________________ _____ _____________ ________f________ 10
5
Lowest______________
5. Cooperation:
Consider the ability of woman to work in harmony with those around
her. Her understanding of her own children; her interest and
ability to cooperate with the organization; with the child’s own relatives; with outside social resources—
High— ------------------------------------JjL------ ---------------------------------------------- 20
Middle--------------------------------------------------------------------------------------------------- 15
L o w ------------------- :_______________ _________________________________ ____ 10
Lowest________________________________________ ________ ____' __________
5
a

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TH E WORK OF CHILD-PLACING AGENCIES

The following excerpts from the write-up o f a home used over a
period o f several years for different children supervised by different
visitors, are offered in illustration o f the value o f such records for
future placement:
Home used for Jennie and Rupert who received splendid care and training.
The foster mother unusually-cordial in welcoming parents to visit children, and
all children in this home are happy. “ Gives excellent care to babies in home
and to delicate children who have to receive constant hospital treatment.”
Foster mother and daughter kind, painstaking women; should, however, be
watched about quantity of milk children receive, also about sleeping arrange
ments, as Thomas, with a heavy plaster cast from thigh to ankle, was found
to be sleeping with Jacob, who had had an operation for empyema. Children
thrive in this home and are always happy.

TEM PORARY PROVISION FOR CHILDREN A W A IT IN G PLACEM ENT

What happens to children immediately they are received by plac
ing-out societies? Has the society a receiving home? Do the chil
dren go directly to their permanent foster homes? These are ques
tions frequently asked by inquirers regarding child-placing methods.
Experience teaches that many, perhaps most,, children may re
main with parents, relatives, or friends until suitable foster homes
are found for them. The number o f necessary emergency placements
is smaller than is generally supposed. The better the case work done
at the time o f application the fewer do such placements become. In
fact, the best children's workers are coming to feel that the real
emergency, the one that calls for immediate provision for a child,
is so rare as to be almost negligible. However, it is occasionally
necessary to make prompt provision for a child. Temporary care is
necessary also for the children who must be studied medically and
psychiatrically before they can be placed successfully in more per
manent foster homes.
Placement direct in foster home.

Seven o f the agencies studied placed every child immediately on
reception in a foster home. Three o f these (the Michigan Chil
dren’s A id Society, the Florida Children’s Home Society, and the
New England Home for Little Wanderers) kept certain foster
homes, termed temporary, almost exclusively for care following re
ception. Four (the Children’s Bureau of Philadelphia, the child
caring department o f the Society o f St. Vincent de Paul o f Detroit,
the Jewish Home-Finding Society o f Chicago, and the St. Louis
Children’s Aid Society) had neither a receiving home nor temporary
foster homes; they placed their children immediately on reception
in their regular boarding foster homes. The three societies which
maintained receiving homes sometimes used foster homes for im
mediate placement.
Agencies maintaining receiving homes.

Three agencies maintained homes for the reception o f children
before placement in adoption or boarding homes. The Michigan
Children’s A id Society conducted two such homes—one in conjunc
tion with State office headquarters at Lansing and the other at St.
Joseph. The Florida society had two receiving homes—one at Jacksonville and the other in the western part o f the State at Pensacola.

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METHODS OF WORK

Almost all children received for care by this society were placed in
one or the other o f these homes until they were placed for adoption
or in free boarding homes. The New England Home for Little
Wanderers used its institution in Boston for all children received
through the headquarters office and for problem children referred by
the branches. Other children received by the branches were placed
in local foster homes, usually homes that were expected to be per
manent.
Length of first placement in foster homes.

The following list shows the percentage o f replacements by the
various agencies three months after original placement and indicates
that the length o f the first placement in foster homes for all the
agencies was usually short :
Per cent

Children’s Mission to Children____________
Boston Children’s Aid Society____________
Children’s Bureau o f Philadelphia________
St. Louis Children’s Aid Society__________
Michigan Children’s Aid Society-^_______
Pennsylvania Children’s Aid Society_____
Children’s Home Society of Florida______
New England Home for Little Wanderers.

3 9 .0
4 6 .4
58 .1
5 7 .4

66.1
7 1 .6

n
(“ )

M ETH ODS OF P LA C EM EN T IN FO STER HOM ES
Selection of a foster home.

The Pennsylvania Children’s A id Society outlined their procedure
in selecting a home as follow s: The home finder being notified that
a certain child was to be received by the society conferred with the
reception department (and read the records o f investigation) the
child-study department, and the medical department, all three de
partments having already had contacts with the child or his family.
I f a child already in a foster home was to be changed to another
home she conferred with the supervisor and with the placing-out
visitor who had known the child in his former foster home. I f the
change o f homes involved a change o f visitor, then she interviewed
the prospective as well as the former visitor. In the last two cases
she also talked with the foster mother who had had the child. In
the case o f an older child she often had a personal talk with him also.
Thus the home finder gained first-hand intimate knowledge o f a
particular child’s needs and on it based her recommendation for the
foster home to which he was to go.
The procedure o f the Bo£tpn Children’s A id Society required
that the placing-out visitor to whom the child was assigned should
confer with the investigator and then with the home finder, the
record o f the investigation having been read by all concerned. At
this conference the needs o f the particular child were gone into—the
probable length o f his stay with the society, his relation to his own
folks, the necessity for visiting them, and his educational, health,
recreational, and employment needs. The visitor was particularly
concerned with the make-up o f the foster family and its tempera
mental assets in relation to the child’s liabilities. Arrangements were
22 O f 31 children 16 were replaced within the period.
23 O f 18 children 9 were replaced within the period.

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TH E WORK OF CHILD-PLACING AGENCIES

made at this time for the placing-out visitor to be introduced person
ally to the child who was from then on to be her responsibility, thus
making his transfer a human and natural affair. Subject to the ap
proval o f the placing-out supervisor a home was selected at this con
ference. I f the home-finding department could not supply a home
that reasonably approximated the one desired it was that depart
ment’s job to search further for such a home. Meanwhile the placingout visitor was privileged to hunt for one independently, on the theory
that it was her ultimate responsibility to provide a home for the child.
Any home that she selected had to receive the approval o f the home
finder. However, comparatively little home finding was done by the
placing-out visitors, who as a rule planned for children to remain
with their parents or to go to temporary foster homes until suitable
permanent homes became available.
Placing brothers and sisters together.

In line with their attitude toward the conservation o f family life
all agencies endeavored not to separate brothers and sisters. For
practical reasons, however, it was often beneficial that they should
be in separate homes, though not necessarily in different towns.
Where for reason o f health (which included feeding problems inci
dent to infancy), conduct, or mental disability it was found expe
dient to part brothers and sisters, the aim was to keep them in fre
quent communication during the period of separation and to reunite
them as soon as the particular difficulty had been removed.
That the spirit o f keeping related children in touch with each
other, though approved by all the agencies, was not always lived up
to was shown by the following incident o f a boy o f about 12 years,
who, while attending a medical clinic, eagerly asked an attendant
the name o f a little girl who had just gone o'ut, remarking that
she looked like his little sister whom he had not seen for two years
and whose whereabouts he did not know. Some excellent reason
probably existed why these two children were being allowed to
grow up in ignorance o f each other’s whereabouts, but such an
instance at least requires explanation.
The advantage which sometimes comes from separating brothers
and sisters is the other side o f this picture, which, is illustrated by
an experience o f the Boston Children’s A id Society: A family of
five children were first placed together. First an older girl, who
was having too much care o f the younger children, was taken away
and later, the baby— a delicate feeding problem needing the undi
vided attention o f a foster mother especially skilled in the care
o f infants. When his feeding was adjusted the baby was returned to
the family group.24 A t the time o f the study this society had 26
related children placed together and 21 related children placed in
different homes. In addition, nine unmarried mothers were in dif
ferent foster homes from their babies, and eight such mothers were
placed with their babies.
24
The director of the child-study department maintained by the Pennsylvania Chil
dren s Aid Society and the Children’s Bureau o f Philadelphia illustrates the same point
in a case which reveals the opposing needs of two sisters. See The Need for Psycho
logical Interpretation in the Placement of Dependent Children, by Jessie T a ft (Child
W elfare League of America, Bulletin No. 6, April, 1 9 2 2 ).

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METHODS OF WORK

Number of unrelated children customarily placed in the same family home.

The general policy o f the several agencies, except in cases of
adoptions, was to place not more than two or three unrelated chil
dren together. Exceptions to the rule were sometimes made in very
short-time placements, especially those o f younger children. The
Massachusetts law requires that any person who receives for com
pensation more than one infant under 2 years must obtain a license.25
Method of introducing a child to a foster home.

Recognizing the psychological importance to the child o f making
a happy and fayorable entrance into such a new and untried phase
o f his life as going to a foster home, the 10 agencies had adopted
the policy o f protection and preparation in introducing the child
to his foster home. By no society was he ever allowed to go to the
home unaccompanied. Rarely and only under special conditions,
did he meet his prospective foster mother at the office o f the society,
or, indeed, anywhere outside her own home. The great majority o f
the children were accompanied to their new homes by their visitor,
who made the introduction and transition as natural as possible.
Frequently the visitor remained an hour or more until the child
became a little accustomed to his surroundings. By preference the
agencies prepared for the child’s placement by a special visit to
the home in advance o f his going, thus interpreting the child and
his needs to the foster parents. And conversely the new home was
talked oyer with the child if he was old enough to be given an
explanation.
SUPERVISION OF TH E FOSTER HOM E

I f foster-home care is to be properly evaluated certain questions
o f vital importance to the children and to society at large must be
answered. What happens to children while they are in foster
homes ? What kind o f care do they receive from the foster parents ?
What are their relations to other children and families living in
the same community? How much and what kind o f oversight is
maintained by the societies which place them in these homes ? What
o f their schooling and recreation? Many agencies still exist in the
United States that know little or nothing o f the after-life o f chil
dren whom they have placed in foster homes. They go on the
assumption that having found a good home for-the child, they can
safely leave his upbringing to the foster family and the community.
Other organizations hold themselves to a strict accounting for every
detail o f the child’s life, his health, education, religious and moral
training, recreation, and all that relates itself to his ultimate de
velopment and happiness. Midway between these are those agencies
which give some, but not very complete, oversight and supervision
in the foster homes.
The supervising staff.

Supervision by means o f a paid staff has largely supplanted the
earlier method o f volunteer service by board members. Volunteer
service proved to be too irregular and unreliable to meet the needs,
especially in emergencies. In former years the visitors and agents
25 M ass., Gen, Laws 1921, ch, 119, sec, 6,

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work

c h il d -p l a c in g

a g e n c ie s

o f the societies who visited in the homes also did home finding and
investigating o f applications. Some societies, more especially the
smaller ones, continue this method, on the theory that continuity
o f service is assured when a particular child’s problem is handled
from beginning to end by one person. Gradually this practice has
changed with most o f the agencies, until at the present time the
tendency is in the direction o f specialization o f function. The argu
ment in favor o f this procedure is that different personal qualities
are called for by these three very different types o f service. A per
son who may be well qualified to make an excellent investigation,
and to evaluate a situation and prescribe treatment is often quite
unable to sustain long-time friendly and helpful relations. Ex
perience points to the conclusion that with rare exceptions individuals
are not endowed by nature to perform all these very different func
tions equally well. In rural sections, however, it is often expedient
for one worker to function in all three kinds o f work.
In three o f the agencies studied (the Boston Children’s A id
Society, the Children’s Mission to Children, and the Philadelphia
Children’s Bureau) the children were supervised in their foster homes
by visitors giving full time to this particular work. Each o f these
agencies maintained a separate department for this work with a
supervisor in charge. In at least five agencies the training and
experience o f most o f these visitors were up to the standard required
for membership in the American Association o f Social Workers (see
p. 15). The Boston Children’s A id Society, the New England Home
for Little Wanderers, the Children’s Bureau of Philadelphia, the
Michigan Children’s A id Society, the Jewish Home-Finding Society,
and the St. Louis Children’s A id Society had nurses on their super
vising staffs, most o f whom were graduates o f training schools and
some o f whom had had additional training in public-health work.
Supervision was combined with home finding in a number o f in
stances. The Children’s Home Society o f Florida and the Jewish
Home-Finding Society o f Chicago combined it also with investigat
ing. Supervision was invariably combined with investigating and
home finding in all branch offices, where specialization was more diffi
cult because o f the comparatively limited number o f cases handled.
Separate standards of supervision for boarding and free homes.

Some difference o f opinion exists as to the wisdom and feasibility
o f maintaining the same quality o f supervision in a foster home
where free care is given as in one where board is paid. It is con
tended on the one hand that it is not fair to the family giving a free
home to a child for the society to direct his upbringing in any de
tailed way, and, on the other hand, it is maintained that a society,
having made the placement in the first instance, has full responsi
bility for the outcome, regardless o f the financial agreement, and not
at least until legal adoption has been consummated should it feel
itself released from this obligation.
The three Massachusetts and the two Pennsylvania societies main
tained the same standard o f supervision for all types o f home. These
five societies placed very few children for adoption compared with
the number placed at board. Three o f them (the Boston Children’s
A id Society, the Children’s Mission to Children, and the Children’s
Bureau o f Philadelphia) had a negligible number of young children

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METHODS OF WORK

in free homes, and their supervision o f the older boys and girls in
free, wage, and wage-boarding foster homes was on a par with their
boarding-home supervision. The St. Louis Children’s A id Society
planned to supervise its boarding homes more closely than the homes
in which children were on trial for adoption, except that its over
sight o f the adoption group was very close for the first six weeks.
The supervision o f prospective adoptive homes by the Jewish HomeFinding Society o f Chicago and the child-caring department o f the
Society o f St. Vincent de Paul o f Detroit was also less intensive than
that o f their boarding homes. In the case o f the Jewish HomeFinding Society the adoptive homes were supervised chiefly by the
general secretary or a member o f the board, and the contacts partook
more o f a social nature. The Children’s Home Society o f Florida
and the Michigan Children’s A id Society, each doing extensive adop
tion and free-home placing, maintained a very different standard o f
supervision as between these homes and those where board was paid.
The field workers o f the Michigan Children’s A id Society super
vised their boarding homes very closely, the time between visits
varying from a few days to a few weeks. Children in prospective
adoptive homes throughout the State were often not seen for several
months, and in those sections o f the State where visiting was made
difficult because o f the absence o f a branch office, the adoptive homes
sometimes had to go unvisited for a year. Arrangements were later
completed enabling the adoptive children in the remote sections o f
the State to be visited as often as four times a year. The Detroit
branch had established the practice o f making monthly visits to all
children in trial-adoption homes and still more frequent visits to
boarding-home children. The Michigan society had the excellent
custom, not found elsewhere to anything like the same extent, o f
continuing a supervisory interest long after legal adoption had
taken place, and the records o f the society bore testimony that such
postadoption visits were often made for several years. Such an
oversight affords data for a judgment on the value o f adoptions that
in time should provide excellent material on which to base studies
and draw conclusions as to the results o f adoptions, a subject on
which at present there is very little actual knowledge and divers
opinions.26
Frequency of visits to children in foster homes.

In Florida the superintendent o f the children’s home society and
his assistant made it a practice annually to go over the list o f chil
dren in free homes and to grade the homes, indicating how often
they were to be visited during the coming year. Where the home
had been used satisfactorily for 5 to 10 years it was planned to visit
only once; other homes were to be visited every six months, and still
others quarterly. The children in boarding homes, on the other
hand, were visited every two weeks.
The infants cared for by the Boston Children’s A id Society, the
Children’s Bureau o f Philadelphia, the St. Louis Children’s A id
Society, the Jewish Home-Finding Society, and the child-caring
36 The first and only extensive study dealing with follow-up on the subject is How
Foster Children Turn Out, by Sophie van Sendeii Theis, published by the State Chari
ties Aid Association, New York, in 1924.

2207°— 27------ 5

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CHILD-PLACING

a g e n c ie s

department o f the Society o f St. Vincent de Paul were all under
the constant supervision o f nurse-visitors, who visited weekly m
some cases and every two weeks in others. A t each visit the babies
were weighed and charted, and a report was made every two weeks
by the nurse to the pediatrician in charge of the clinics o f the
respective agencies.
n . %
. . .
Most o f the agencies had no hard and fast rule o f visitation
for children o f preschool and school age. The agencies expected
that children would be visited within a few days, or at most within
two weeks, o f the original placement and as often thereafter as their
needs required, which meant irregular intervals averaging one to
two months. Three months was a long time for a child cared for by
any o f these agencies to go unvisited, though there were instances
where children who had been in the same foster homes for long
periods and who were placed at long range had not been seen for
five or six months. Such instances were comparatively rare and
when they existed were supplemented by such frequent correspond
ence and personal interviews at a clinic, in school, or in connection
with a shopping or recreational excursion arranged by the visitor
as to insure knowledge of the situation. But child after child was
found to have been visited with great frequency every week or 10
days, and often over long periods. The frequency o f visits was
determined largely by the need in the particular case. In any
event each child was carefully individualized, and the society kept
in close touch with the situation by telephone and letter as well as
by actual visitation.
The St. Louis Children’s A id Society required that its babies
be seen at least every two weeks and older children every six weeks.
The records bore testimony to the care with which these requirements
were carried out, the following being taken quite at random from
a group o f records: Baby visited May 21, 26, June 6, 18, 22, 23, 28;
blind baby— October 7, 8, 11, 13, 15, 17, 18, 21, 24, 29, 31, No
vember 9,14,19,21,25; E. H., 13 years old—March 7,15,17,20, April
20, 27, 30, May 5, 14, 16, 27, 28, June 5. The foster mothers showed
by their reactions when visited by the inquirer in company with
the society’s visitor that they were accustomed to frequent calls. One
visited on January 18 exclaimed “ What’s the matter? You haven’t
been to see me for a long time, not since before Christmas.”
Babies i-n care o f the Jewish Home-Finding Society were visited
by the nurses at least every two weeks, and at least once a month
by the social worker whose special function it was to make helpful
contacts between the foster parents and the child’s own family.
Children over 2 years o f age were seen each month by the social
, workers, with the exception o f some boys on farms who were visited
about once in six weeks. Each month the visitors gave their super
visor a list o f children whom they had not seen with their foster
mothers in the home during the preceding month. I f either child
or foster mother had been seen at the office that fact was noted but
not accepted in lieu o f a visit to the home.
The child-caring department of the Society o f St. Vincent de Paul
o f Detroit planned to see children over 2 years o f age every two
months. I f special medical care was thought necessary, the nurses.

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METHODS OF WORK

visited such children in the meanwhile. Babies placed in boarding
homes were visited weekly by nurses from the Detroit District Nurs
ing Association, who were detailed to this service through a coopera
tive arrangement. Older children in boarding homes were expected
to be visited every two months by a visitor from the staff o f the
society.
Relationship of the child, the visitor, and the foster mother.

The relationship o f the visitor, the foster mother, and the child
was an important one with all those agencies which kept in close
touch with the home. Any spirit o f espionage on the part o f a
visitor was frowned upon. On the contrary, she was expected to
establish a spirit o f comradery, with cooperation as the keynote.
The child was taught to turn to his foster mother for guidance, and
it was a point o f honor between visitor and foster mother that
he was never to learn of any difference, however slight, which they
might hold on questions o f policy as to his upbringing. The visitor
aimed to uphold the foster mother where she could do so without
serious harm. In the event o f a serious disagreement as to the child’s
care she would arrange for his transfer to another home. The foster
mothers were selected with a view to their willingness to accept
suggestions, to uphold the visitor, and above all never to use her as a
“ big s,tick ” to the child. The Children’s Mission to Children liked
to regard its foster mothers as an extension of .its staff, who would
be as loyal to the society as any other staff member.
Forms used in recording visits to foster homes.

Blank forms to be definitely followed in making home visits were
used only to a limited extent by four societies. One o f these had
discontinued them for some time past except for certain children,
and since supervisors and visitors were all in agreement that they
should be replaced by the running record form, it was likely,that
they would soon be discarded. Two o f the Massachusetts agencies,
the Boston Children’s Aid Society and the New England Home for
Little Wanderers, furnished each visitor with a copy o f the follow
ing detailed outline developed by a group o f Boston supervisors
and used by several near-by agencies:
O utline

fob

Supervisory V isits

C hildren P laced

F oster H omes

(Presupposes physical examination with medical oversight)
I. CONDITIONS

A . F a m ily : ( Social history of child’s fam ily must never be considered complete.
Visitor should be alert to changing conditions, following up both new
sources of information and those exhausted when child was admitted to
care.) Child’s contact with his own fam ily and their influence on him ’
B. Changes in foster home (for foster-home record) affecting its fitness for the
child.
C. H ea lth : Personal hygiene; dietary; appetite; amount and kind of exercise;
sleeping arrangements, hours, and soundness of sleep (crying out, sleep
walking). Does child enjoy using muscles? When he exerts himself in
any way, how quickly does he begin to seem tired? How much rest or
sleep does he seem to need before he is energetic again? W hen tired how
does he show it— by restlessness, irritability, depression, or sleeplessness?
Is he gaining in weight?

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TH E WORK OF CHILD-PLACING AGENCIES

D. Adjustment to foster home:
1. Family’s attitude.— W h at is fam ily’s attitude toward child? Does
he feel himself to be “ one of the fam ily? ” W hat is the child’s
attitude toward foster parents, brothers and sisters? Does he
talk freely with them about his school, his companions, his inter
ests? Does he turn to them with any little worries?
2. Discipline.— W hat methods are found to prevent the child’s- repeti
tion of an offense and what is child’s reaction to punishment?
W h o does the punishing?
3. Home duties:
(a ) Demands on h im : W h a t are his home duties? Are they
specific and regular, or haphazard? Is patience exer
cised in teaching child or is it assumed that he ought to
know? Are his good points commended as well as his
poor ones censured?
(b ) H is response: Are his duties performed willingly, well?
Does he grasp directions quickly and profit by them, or
do instructions have to be constantly repeated? H as he
an allowance? How does he use it? Is he guided in its
use? Savings? Keeping own account?
4. W ork—
(a ) Demands on h im : Does child work for pay or board in the
home? Outside the house? W h at are the exact nature
and requirements o f his work? Hours of work? W ages?
(b) H is response: In what ways is he successful and in what
ways unsuccessful? H ow does he conduct himself at
his work— reliability, painstakingness, ability to hold him
self to drudgery, enjoyment o f work?
5. Play—
(a ) Facilities: Is child encouraged to bring friends home? W hat
recreation do foster parents provide in the home— games,
toys, books, pets? W h a t recreation do fam ily and child
have together? W h at encouragement and assistance does
he get in the use of the library and by whom? W hat kind
o f books does he read?
(b ) H is response: Does he seek or dread solitude? W h a t are
his resources for entertainment when alone?
E. S e ^ : Is the child well developed physically? H as he matured and at what
age? Is he attractive in face, figure, manners? To what degree does he
appear to crave petting and contact? Does he prefer friends of his own
sex or otherwise? Are his friendships wholesome or feverish? Is he
showing an interest in the opposite sex earlier or more strongly than
usual? Masturbation? W hat is his information on sex hygiene? I f he
has none, who will give it to him? How is he reacting to it, vulgarly,
prudishly, sanely?
F. Adjustment to school:
(a ) Situation: W h a t grade is he in? I f he is held back a grade, why?
W h at course is he taking and what are plans for further train
ing? W hat is the attitude of teachers and pupils toward child?
(b ) Response: Is his attendance regular ; prom pt; is it willing? W hat
is his deportment? Does he dislike discipline or revolt against
school authority?
(c) Special abilities or disabilities: W hich subjects interest him, and
which does he dislike? Do any stir him to spontaneous activity
of thought or action? H as he shown talents for music, drawing,
manual work?
G. Organized activities:
(a ) Group contacts: W h at organized activities outside the home is he
encouraged to join— e. g., clubs, Scouts, Y . M. C. A .? Does he
engage in competition and does he play the same games as
other children his own age? Is he a member of a gang or
group?
(b ) How readily does he make friends among either adults or chil
dren? W h y ? W h a t kind of friends does he choose? O f what
age? W hat does he admire in people? W h at loyalty and per
manence does he show in friendship? Has he a chum? How
does he get on with other children in play? Is he a leader?

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METHODS OF WORK

G. Organized activities— Continued.
Does he readily conform to the standards o f the foster environ
ment in dress, manners, morals? In what particulars does he
rise above or fall below these standards? How is he affected
by the approval or disapproval o f others? By their happiness
or distress? B y what means does he adapt himself to people—*
by yielding to their wishes and ways, by evading issues (keep
ing quiet, turning the subject, keeping out o f the way when
he disagrees), by telling lies, or does he give up the attempt and
be disagreeable? Does he respect property rights? W h a t does
he take and under what conditions? W hat appears to be his
motive? Is he generous in sharing his own possessions?
H . Church: Does he attend church and Sunday school? O f what value is this
special Sunday school to the child? W hat is the attitude of the church
people towards child? W h at is child’s attitude toward church? Is he
interested? Does he enter into church activities?
II. PERSONALITY

A . Energy and w ill:
1. How long does he work energetically? How soon does he begin to
lose interest? How long does he play without loss of interest?
2. W hat are the child’s main interests? H ow permanent are they?
Does he concentrate on following them or is he at the mercy of
vagrant impulses? Is he resourceful in carrying out his interests?
H ow successfully can he postpone the gratification o f his desires?
3. How does he meet a difficult situation in work, in play, in social
relations? (B y persistence or by giving up? Amiably or with
anger? Courageously or by lying?) Is he a good loser?
4. How does he get what he wants out of people? By insistence, teas
ing, crying, persuasion, or making himself attractive?
B . Emotions and m oods:
1. To what type of emotion is child liable? Undue fear (w orry).
anger, joy, depression? In what ways, if any, does he seem to
feel at a disadvantage with other children? How does he show
it? B y criticism of others, by self-consciousness, by avoidance
o f others, by “ blues?” D o his moods and emotions fluctuate
easily according to health and circumstances? Does he have
periodic spells o f depression? W h at does he find disagreeable—
sounds, slights, smells, thwarted desires— and does he reaaet to
disagreeable things?
2. Are his emotions easily aroused? Illustrate by evidence. W h at
arouses them? How are they expressed? H ow long do they
last? Is there intensity out of proportion to the occasion?
3. W h at helps him most toward control of his emotions or his moods?
C. W ishful thinking:
Does he romance— as if he were realizing aspirations of one sort or
another in imagination? I f so, what kind of stories does he tell?
W hat ambitions or what purposes has he for which he has shown a
willingness to sacrifice his own comfort or pleasure? Are his aspira
tions such as point mainly to personal advantage or are they such
as include the well-being o f other people?

Division of work among visitors.

Basis of di/oision. There is a diversity o f opinion among those
doing child placing as to the relative merits o f assigning children for
supervision on a territorial or a type basis. In the early days of
placing out, the division was practically all territorial, and many
public and private agencies carry on their work along this line to
day. The argument for a territorial division is based largely on
expediency— with economy o f time and money. In addition such
concentration makes possible a very intimate knowledge on the part
o f the workers o f each district so covered, which constitutes a very
real advantage.
When distribution is made by type a child is assigned to a visitor
primarily because of that visitor’s training, expertness, or special

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TH E WORK OP CHILD-PLACING AGENCIES

aptitude in handling the particular type— such as infants, unmarried
mothers, adolescent girls or boys, or psychiatric problems. It is a
real advantage to the child to be visited consecutively by one person
on whom he may look as his friend, regardless o f the community in
which he may be placed. This continuous oversight must net him a
return in better understanding o f his peculiar needs than can result
under a system that means a transfer to a new visitor whenever for
any reason he is moved to a new foster home outside the jurisdiction
o f the first visitor. Human nature being as it is such a continuing
responsibility as is entailed in the type method must tend to en
courage a visitor to put forth more effort in behalf o f a child than is
likely under a system that offers relief from a troublesome respon
sibility more or less at will.
The Michigan Children’s Aid Society and the New England Home
for Little Wanderers in their branch work assigned children on the
territorial basis, as did also the Pennsylvania Children’s A id Society
outside o f Philadelphia. The expense o f visiting on any other basis
would have been almost prohibitive for these societies, working as
they did in such large areas and with a comparatively small number
o f visitors. The policy in Florida was to have a child visited, suc
cessively by different visitors, the object being to have one visitor
check the work o f another. Practically, however, this method was in
use in only one county in which about 20 children were placed in
free homes. For the rest o f the State the expense o f this checking
system made it undesirable to consider, since the railroads which
granted passes to certain individuals did not make them transferable.
The Jewish Home-Finding Society o f Chicago and the child-caring
department o f the Society o f St. Vincent de Paul o f Detroit also
followed the territorial method. An exception to this territorial
assignment was made in the visiting o f infants, all o f whom were
in charge o f nurses.
The Boston Children’s A id Society, the Children’s Mission to
Children, the Children’s Bureau o f Philadelphia, and the St. Louis
Children’s A id Society assigned children for supervision mainly
on the basis o f type without regard to territory. The New England
Home for Little Wanderers did the same for children in charge of
the Boston office, and the Pennsylvania Children’s A id Society did
this in a limited way for older boys and girls located in the city o f
Philadelphia or near by in Delaware and New Jersey. These so
cieties delegated men visitors to the supervision o f older boys, and
nurses to the supervision o f infants. The Boston Children’s Aid
Society intrusted its unmarried mothers to a visitor who had special
ized in the problem over a period o f years. Her expert work with
this group was an outstanding illustration of patient and skillful
handling o f a very difficult type. The Children’s Bureau o f Phila
delphia and the Pennsylvania Children’s A id Society each employed
a negro social worker who, because o f her understanding o f her
race, dealt intelligently and sympathetically with some o f the older
negro children in care o f the society.
Number of children assigned to each visitor.— As important as
the size o f the territory over which a visitor must travel in order
to visit her children is the number o f children for whom she is
responsible.
A ll child-placing agencies agree to the obvious

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METHODS OF WORK

proposition that more can be accomplished where a visitor has
comparatively few children than where her responsibility extends
over large numbers. Actual radius o f territory is not, o f course,
a true indicator of ease or difficulty o f transportation in a
particular section. Railroad facilities, ability to command auto
mobile service at will, seasonal weather conditions, are all important
factors in any territorial distribution. For those agencies making a
division by type o f case, allowances had to be made for the special
problems assigned and the comparative frequency o f visits demanded
by such extremes as a delicate baby or an adolescent delinquent and
a quiet, normal boy or girl, 5 to 10 years old.
Replacements.

The fact that a child remains over a long period o f years in the
same foster home, is, other things being equal, an indication of care
ful selection o f the foster home based on the needs o f the child. On
the other hand, conditions that can not always be foreseen at the
outset may make a home undesirable after a timev It is, therefore,
sometimes indicative of the most thoughtful kind o f work when
replacements are made. Too much emphasis must not be placed one
way or the other in respect to the number o f relocations. Further
more, length o f time in care as well as types o f children cared for
should be carefully correlated before any attempt at a just com
parison can be made.
Educational standards.

The importance o f good educational opportunities adapted to the
need o f the individual child was acknowledged by all the agencies.
Foster homes were selected on the whole with this factor in mind.
The standards o f Massachusetts schools were not uniform, and the
three Massachusetts societies took this into account in selecting com
munities in which to place children. High schools varied in the
courses offered, and this was kept carefully in mind in relation to
the individual needs o f older children. The accessibility o f the
school to the foster home, and when the means o f transportation had
to be provided adequate chaperonage by a teacher or other com
petent person were taken under advisement in each case.
The Pennsylvania Children’s A id Society took into account the
accessibility as well as the character and efficiency o f the schools in
making their placements. The policy o f the Pennsylvania State
Department o f Education tended toward the abolition o f the oneroom schoolhouse for younger children. This had been helpful in
developing as placing territory some towns that had previously been
excluded for all but preschool children. The society sought to fol
low the recommendations o f its child-study department in the place
ment o f children for whom special classes, high school, etc., were
recommended. It excluded from use rural communities where the
schools were overcrowded or where there was already a considerable
number o f their children. A conflicting interest which often made it
difficult to ^carry out this ^policy was the desirability of placing
children within easy visiting distance of Philadelphia when the
parents and relatives resided there. Since large numbers o f children
came from that city congestion o f foster-home placement was diffi
cult to avoid if they were to be within a visiting radius. This diffi-

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T H E WORK OF CHILD-PLACING AGENCIES

culty was met in part by sending children without relatives to more
remote sections of the State’, thus conserving the near-by homes
for the others.
The Society o f St. Vincent de Paul o f Detroit, which favored the
development of boarding-home centers, made the school one o f its
chief interests, placing only preschool children in sections where
the efficiency of the school was below the required standard. For
free and adoptive homes in which children were more likely to con
tinue from childhood to youth, special attention was given to ascer
taining school facilities beyond the eighth grade.
The Jewish Home-Finding Society o f Chicago, which placed all
but infants and a few older boys in Jewish homes, found the educa
tional problem simplified by the fact that for the most part Jewish
people live in metropolitan areas where school facilities are usually
very good.
Method of following the child's school 'progress.—Whether the
visitor or the foster mother' should visit the school is a question on
which authorities differ. Those who believe it to be the exclusive
function o f the visitor base their conviction on the need o f direct
contact for the purpose o f making certain the exact situation in all
its details. Foster mothers differ, so they argue, in intelligence
and therefore in ability to gather and interpret information. Those
who favor having the foster mother visit the school do so on the
theory that since the child is in her home it is natural for her
to make the contact, that it will cause less comment for her to do
so, and that it better guards the child’s position in the community,
saving him from the danger o f having his status as a society’s charge
made public.
But a middle ground on this question was taken by those agencies
studied that individualized each child most carefully. These had
the contact arranged in each case to suit the particular needs o f the
situation. Teachers and principals vary in their attitude toward
a society. Many o f them take a social point o f view and are glad
to cooperate with a visitor. This is especially likely to be the case
where visiting teachers have been introduced into the school system.
Because o f her daily contacts a teacher who appreciates the need
o f intelligently studying a child handicapped by reason o f depen
dency or neglect can be a wonderful ally to a visitor or foster
mother. Some teachers like best to be approached by the foster
mother, and in these cases it was usually thought advisable for
her to go to the school quite regularly.
Ideally the foster mother should make all the school contacts,
just as she should direct the other' activities o f the child, and under
ordinary conditions a skillful visitor can instruct her so that she
will get very satisfactory and specific reports o f the child’s progress
in his various studies as well as o f his reactions to his schoolmates
and teachers. However some foster mothers, though dealing very
wisely with a child within the home, never succeed in getting satis
factory reports o f the school progress. In such cases, whether due
to lack o f educational background, timidity, or other reason, it
is advisable for the visitor to go to the school herself, at least until
she has trained the foster mother to get the information. Even
with the most satisfactory relations established between the foster

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METHODS OP WORK

mother and the school there are times when decisions o f great impor
tance make it best for a visitor to go to the school herself ; Pfor
example, when there is a question as to whether a 14-year-old girl
or boy, about to leave school and go to work, should not rather
thr° Ugh1 hlgh scllool> and if so, whether he should have a
echmcal or academic course. I f the decision is made in favor o f
further schooling it may involve a large financial outlay for the
society, and the plan must be based on a detailed knowledge, not onlv
aca? T 1C St]and;ng1a1nd mentality o f the child, important as
they are, but on his health and physical endurance. The child’s
a3?d ambitions are to be considered, as well as his respon
sibilities to other members o f his own family— father and mother,
younger brothers and sisters. There are instances where foster
£ t ei T and foster fatheJ s> too—have gathered and evaluated skillully the necessary data for an intelligent decision on such a vital
i i i K nV As a ™le> however, this is brought about through careful
andihe v ifto r

part ° f the child’ the teacher>the fost^ mother,

One agency reported, “ It is the policy o f the society not to visit
schools except m special cases because it is felt it embarrasses the
children who are wards o f the society to be. known as such. In cer
tain cases where the children are not especially sensitive and where
there is no stigma attached to dependent children in the community
the visitor sometimes goes directly to the school, sees the child there’
and confers with the teacher.” The same thing may be done in
different ways. A visitor who makes it known to teacher and
pupils that she represents authority and in her official capacity is
visiting a particular child, is o f course placing that child in a con
spicuous and humiliating position. How such a situation can be
turned to good account is illustrated by the following incident which
occurred a number o f years ago in a remote district school:
S la?^tw i r I Ch0^ WiliCl\ ,nUmbered less than 20 PuPils> nearly one-half were
State wards. The teacher, a young, thoughtless girl, unconsciously assumpd
by S e othe? n u n u f
childre.n’ a Pat.r°nage which was reflected
. xr'Ljp 6
i f 1’, Pnpnf- Thls situation was in no wise bettered when the Statp
,
,cai le<3 a^ die school, and one by one her charges were called to the
teacher s desk and conferred with there. This condition of affairs reached the
questiona W1S6 supervisor who took an early occasion to visit the school in
Approaching the teacher and introducing herself, she asked permission to
|ddrA
es® tke f ch0.01- Permission being readily accorded, she a^ked all the
State wards to rise. This they did with considerable reluctance
She then
proceeded to address the whole school and to state that as a representative
° i i e g 0Vf-r1f1° r’
she named, she had been sent to look after the interests
of these children who as his wards were entitled to very special care
Before
she ceased talking these formerly despised “ State children ” were the envy of
all their mates and ever after ranked as their peers.
y

Formal written reports from the school, either monthlv or
bimoDthl^, were asked for by only three agencies (the Pennsylvania
Children’s A id Society, the Children’s Home Society o f Florida and
the Jewish Home-Finding Society o f Chicago). The New England
Home for Little Wanderers requested monthly reports in conductproblem cases covering grade, conduct, general dress and appear
ance, and child s attitude to teacher and mates. The other societies
depended on the personal interview with the teacher to bring out
the necessary information under these headings.

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TH E WORK OE CHILD-PLACING AGENCIES

Education beyond the minimum age required by law.— Education
beyond the eighth grade was given to promising children by prac
tically all the agencies. The Boston Children’s A id Society had 18
boys and girls 14 years o f age or over in high school, and 4 girls
were being assisted to go to college. Seven other children who were
14 or over were in trade school, continuation school, or school of
domestic science; one crippled girl was being tutored at home.
The Children’s Mission to Children had 9 children 14 years o l age
or over in the grades, 9 in high school, 2 in trade school, and 1 m
C 0 ll6 °*6.

The New England Home for Little Wanderers had 4 children 14
or over still in the grades, 2 children under 14 years and 26 children
14 or over in high school, 2 in trade school, 2 in business college, and
The Pmmsylvania Children’s Aid Society continued 256 children
14 years o f age or over in the grades, and had 78 such children in
high school, with 29 others pursuing trade or vocational courses; 8
o f its children were at college.
The Children’s Home Society o f Florida sent many children not
readily placeable in free or adoption homes to boarding schools,
convents, and institutions, the tuition, clothing, and other necessary
expenses being met by the society. These schools were located in
other States (eastern and southern) as well as Florida.
The Michigan Children’s A id Society tried to keep the older
children in school as long as they were ambitious and showed enough
mental ability to warrant the effort. Free homes were found for
some o f these children. One girl had taken a nurse’s training, and
a group o f interested people were sending another girl through the
university. A boy had been sent to business college.
The Jewish Home-Finding Society o f Chicago had 7 children in
high school, 4 in trade school, 7 in normal school, and 1 in college.
O f the entire group, 7 were being cared for free of expense to the
society and 11 were being boarded by the society at rates ranging
from $100 to $250 a year.
Religious education.—The religious upbringing o f the children
was always taken into consideration, and all the societies maintained
a standard o f placing with families who were o f the same general
faith as the parents—Jewish, Roman Catholic, or Protestant. The
foster parents were expected to have a church affiliation, and the
child was to attend church with them and go to Sunday school. The
child-caring department o f the Society o f St. Vincent de Paul of
Detroit sent most o f its children to parochial schools and gave strict
heed to their religious instruction, both in the foster home and at
Sunday school. The Jewish Home-Finding Society o f Chicago reg
istered all children 7 years o f age and over in some religious school,
orthodox or nonorthodox, according to the preference o f the parent,
and a plan was under way to obtain semiannual reports from these
Hebrew schools. A ll children 3 years of age and over were placed
in Jewish homes except a few boys placed in the country where it
was difficult to obtain such homes. These boys were visited monthly
by a rabbi for religious instruction.
One society included in its instructions to foster mothers a pro
vision that illness was the only excuse for absence from Sunday

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METHODS OP WORK

school, but the Pennsylvania Children’s A id Society was the only
agency making any definite attempt to follow up the actual amount
o f religious activity as indicated by church and Sunday school at
tendance. This society sent a form letter quarterly to the pastors o f
all the churches where its children had a connection. Other agencies
kept more or less in touch with the situation, but on the whole the
records were unfortunately silent on this feature o f the child’s
development.
Recreation.

Since educators and others have taught an appreciation of the
significance o f the play element in a symmetrically developed child,
it is important to know to what extent this is consciously planned
for in the program o f child-placing agencies.2611 Recreation is o f
various sorts. It may be had within the home circle in a simple,
unorganized way. The dolls and toys o f the little ones; the game
o f checkers or parcheesi on a long winter’s evening for those a
little older; the family picnic; the radio set made by the young lad
helped by the big brother or father— these are illustrations o f the
home recreations which when participated in by the elders as well
as by the children make for family solidarity o f the most wholesome
sort. For the older child recreation outside the home involves play
that is usually o f a more organized variety. Community contacts
may be made through such organizations as summer camps and the
many club and social activities offered through tl^e churches..
A t least four o f the agencies studied gave the matter o f family
recreation serious consideration. Their visitors took definite re
sponsibility for seeing that the foster parents were intelligently and
actively interested in the subject. Realizing the importance o f toys
and games in the child’s development these societies did not hesi
tate to furnish them, chiefly at Christmas and holiday times or as
birthday gifts, but only when the foster parents could not afford
to provide them. Skates, sleds, dancing and music lessons, with
their attendant costs, were considered legitimate expenses by these
same agencies, thus acknowledging the physical and moral value
o f play.
The Jewish Home-Finding Society had purchased 45 tickets to the
Chicago symphony concerts, which enabled every child over 8 or 9
years old to attend twice a month. When the children were sent to
motion pictures the seats obtained were in different picture houses
and were scattered through the house so that children attended in
small groups or with the foster mother and her own child. The St.
Louis Children’s Aid Society saw to it that every child o f suitable
age under its supervision was taken annually to the circus, pains
being taken that small groups should go at different times in order
that there might be no labeling o f them as “ charity children,” which
might easily happen if a large group were gathered together.
Those societies which expected one visitor, to supervise a large
number o f children did very little to insure recreation for the chil
dren. Such children depended on the good will o f the foster par
ents. Doubtless in many instances the foster parents planned for
all the recreation that could be desired and o f the right sort, but
28a See Play in Education, by Joseph Lee (The Macmillan Co., New York, 1 9 2 1 ).

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TH E WORK OF CHILD-PLACING AGENCIES

it is likely that there were cases where suggestions and follow-up
by the visitors would have meant a more intelligent and consistent
program o f play adapted to the age, physical condition, and tem
peramental needs o f each child than was assured when it was left
wholly to the initiative of the foster parents.
The case of a 16-year-old boy who was in charge o f a man visitor
having supervision o f less than 40 adolescent boys furnished an ex
ample o f intensive supervision illustrating what might be accom
plished by a society equipped with visitors of training and experi
ence, who were allotted few enough children to allow time for fre
quent visiting and follow-up o f their charges.
W hen first placed, Joseph had a mental conflict due to early sex experience,
which had resulted in stealing. The psychiatrist who examined him prior to
placement recommended “ that he be placed in a sympathetic environment
where his confidences would be encouraged and where the mental life of the
family would be commensurate with his good mental abilities.
H e further
advised that the foster parents be informed fully o f his early experiences; that
spending money be furnished, or, preferably, that he be given a chance to earn
money outside of school hours. A boarding foster home was found that meas
ured up to these requirements, and the boy was entered m high school. The
cooperation of the teacher was obtained through a careful explanation of
Joseph’s history, followed up by frequent calls at the school from the visitor
who meanwhile received detailed reports on marks in the various subjects as
well as comments from the principal as to how Joseph conducted himself with
his companions. Employment suited to his needs was found, and thus he was
supplied with the spending money which was so necessary a part of his social
treatment The visitor also arranged for him to join a boys club and otherwise
planned for his recreational needs. A t Christmas time Joseph was invited to
the visitor’s home and entertained there. The record of the case bore testimony
to an understanding of this boy’s temperament coupled with an ability to obtain
cooperative action from others; the result of this well-rounded program was
that a boy previously delinquent was on the road to becoming a useful citizen.

Allowances.

„

Closely akin to the question o f recreation and education is that o±
allowance for spending money. I f thriftlessness is a present-day
American characteristic, and surely it is a factor in dependency, it
becomes apparent that a duty incumbent on placing-out agencies is
the inculcation o f thrift in their young charges. This education in
the appreciation o f the dollar is acquired only by the direct handling
o f money.
, n .
...
The agencies that had anything like a definite policy relative to
this important subject— about half the number studied— took the
position that children 8 years of age and over should have a small
but stated amount of spending money. The allowance usually began
with 5 to 10 cents weekly and increased to 25 and 50 cents as the
child grew older, which money he was at liberty to spend, give away,
or save, as he pleased. For the children old enough to earn their
board in foster homes the usual plan was to arrange with the foster
mother to provide the allowance which was graduated into a small
wage as time went on. An instance was reported by one society of a
problem girl of 13 being boarded at $7 a week, whose foster mother
chanced to remark to the visitor that she was giving the child an
allowance. The visitor, knowing the limited circumstances o f the
family, instantly volunteered that the society would thereafter bear
this expense. Two societies tried to arrange that each child should
carefully budget his allowance, planning for church contributions,

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METHODS OF WORK

recreation, gifts, and savings. The records were noticeably incom
plete on the subject, and it is probable that the question o f systematic
allowance was left too much to the discretion o f the foster mothers
and not checked up so carefully as it should have been by the visitors
in their supervisory visits. One society formerly provided expense
books for children in wage homes (an excellent idea in itself) but
abandoned them because o f the amount o f work entailed. Since this
society was one o f those requiring each visitor to carry a heavy case
load, this could scarcely be wondered at, though it might well be
regretted.
Though not making a separate item o f this expense the Boston
Children’s A id Society, the Children’s Mission to Children, and the
Children’s Bureau o f Philadelphia included “ spending money ” and
“ allowances ” in their annual disbursements. General approval o f
the value o f savings accounts was indicated in that the records
showed that many children were encouraged to start such accounts.
Sometimes these accounts were in the child’s own name but more
often in that o f the foster mother, visitor, or other representative
o f the society, who acted as trustee.
Clothing.

The importance o f dress as a means o f character building through
the development o f self-respect was little appreciated in the early
days o f placing out. Second-hand clothes were a common heritage,
and the humiliation o f wearing a dress or suit that was obviously too
short in the sleeves or o f a vintage long past was thought o f as part
of the lot o f a dependent child and to be meekly borne. Recent
psychology has taught us that to be dressed as well as one’s associates
has an influence that is o f the highest importance in helping to offset
the too often disastrous effects o f “ not belonging ”—that dependency
complex so frequently found among placed-out children.
The agencies’ policies with regard to the clothing o f children in
free and prospective adoptive homes appeared to be one o f leaving
the matter almost exclusively to the foster parents, who dressed the
children in accordance with their own standards and at their own
expense. Some exceptions were made by a few societies which used
free homes for older children and which provided clothing where
free board was given in return for light duties. Such children were
usually 14 years o f age or over, many of them continuing in school.
Correspondence and gifts between visitor and child.

The degree o f friendly relations maintained between visitor and
child as exibited by gifts and correspondence was practically regu
lated by the number of children for whom a visitor was responsible
as well as by the attitude o f the society. Such contacts with, the
children placed for adoption and in free homes were on the whole
less frequent than with the boarded group.
One society, aiming to promote close relations between the child
and his foster parents, discouraged correspondence on the child’s
part and prohibited the visitors from writing to the children. Any
necessary formal correspondence between the children and the office
was carried on by the general secretary and his assistant. Two other
agencies, while not quite so strict, disapproved o f the exchange o f
letters between the visitor and the children or their foster parents

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TH E WORK OF CHILD-PLACING AGENCIES

except through the supervisor. These three agencies did a large
amount o f adoptive and free home placing.
#
The city-wide agencies naturally had little occasion tor corre
spondence, since the proximity of the children made frequent drop
in ” calls entirely possible.
The three Massachusetts societies encouraged free correspondence
between visitor and child. Many o f these letters were hand written
and usually on plain rather than official paper, thus conveying to
the child a spirit o f friendly, personal interest rather than one ot
officialdom. One record, illustrative o f this relationship, showed
that a visitor to a diffident older girl had written many times on her
personal letter paper, from her home and in her own time, thus
establishing in the girl’s mind the fact that her interest was a very
personal one quite apart from “ what she was paid to do, as the
girl had put it.
•
„
. ,,
I .,
Birthdays were recognized by a card or small gilt from the visitor
by the three Massachusetts societies, the Children’s Bureau o f Phila
delphia, and the St. Louis Children’s A id Society, though with two
or three exceptions no systematic method was in use by which this
was automatically assured. At the receiving home of the Michigan
Children’s A id Society birthdays were celebrated with cakes and
candles. It was a generally accepted custom by all agencies to recog
nize Christmas with toys, candy, and fruit for all except children
placed for adoption; such children were considered by all to be
sufficiently well looked after by their prospective adoptive parents.
Birthdays and holidays were recognized in a very personal way by
the visitors of the Boston Children’s A id Society through cards,
gifts, luncheon and theater parties, and excursions. The society
disapproved o f having its children participate in entertainments
labeled for “ charity ” or “ orphan,” but encouraged their participa
tion in all normal community events, church or civic Christmas trees,
and the like. A special memorial fund provided the means whereby
Christmas gifts, selected by the visitors in accordance with the de
sires o f each child, were provided.
The Children’s Bureau o f Philadelphia provided all its children
except the infants with Christmas presents costing from $1 to $1.50.
Occasionally- more was spent for children who had set their hearts
on some special thing. In addition every child over 2 years o f age
received a box o f hard candy. The visitors remembered each foster
mother with a Christmas card. Baskets o f goodies were sent to some
homes where children had been returned to their own families, and
- gifts were also given to some children living with their own families.
A special committee o f the Pennsylvania Children’s A id Society
provided Christmas gifts for all children in boarding homes, which
relieved the visitors of a good deal o f care but was not so likely to
result in providing a child with what he most needed or desired.
In the Michigan Children’s A id Society receiving home Christmas
trees, Santa Claus, and all that combines to make a real Christmas
were enjoyed by the children. In former years children boarded m
the vicinity o f the St. Joseph receiving home were invited there.
This custom was discontinued two years before the study in favor of
the more natural method o f providing gifts to be distributed by

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m e th o d s of w o r k

each foster mother according to the method o f her household which
th£ chlld m™e cl° sel7 with his foster Parents.
and often on other Jewish holidays the Jewish
Home-Fmding Society o f Chicago provided gifts for all the child r e ^ m a n y o f which were supplied by the Jewish congregations o f
the city. The society also had the pleasing custom f l S
remembrances to children as they graduated from grammar ¿ h o o f
1 tT p y f rTslx.sueh graduates each received a fountain pen.
i + j u k ° ms Childrens A id Society formerly provided gifts
selected by a committee o f the board, but more recently each visitor
had looked out for her own children and took pains to rive more
i f ®re ^ ^ s ^ r parents could not afford to be lavish with their
fnrf ; rS day schools and special individuals often provided money
and toys and sometimes sponsored special children. ^
y
A t uhanukah

Discipline.

The agencies very generally held that discipline should be admin
istered mainly by the foster parents, the visitors guiding them with
wlfnpal / Uf v ? ? 10nS* C°rporal punishment was discouraged if not
wholly forbidden except by permission from the office, and this was
given only m rare cases. Several societies found the psychiatrist
very helpful with advice as to how to handle questions o f petty thiev
ing evasion o f truth, running away, and other more of less usual
irodaaw ° f f ° ^ al malajustment. The record o f a chronic runaway
indicated intelligent treatment by the visitor, the child cooperating
« M
T S f
“ U" - Uly ^
by
them to b e T S h f
lelt an attack o f running away coming on. Though the records
^
°n % se T ^ tio n s the
Zen
was that where the visitors were m frequent communication with the
foster parents the visitors advice was both sought and followedwhere because o f large numbers o f children to a visitor or for other
reasons the supervision was more relaxed the discipline was left
laigely to the discretion o f the foster parents.
Responsibility of the foster parents.

It was recognized that the ultimate responsibility for the child
rested with the society, since it had assumed the obligation o f providmg for him, but decisions for the child’s physical, mental, and
moral development were delegated in cases o f adoption to the foster
parents, frequently at a very early period and sometimes right from
the start. The agencies felt that since the chances were that the
child was to become a permanent and legal member o f the foster
home, the sooner the society effaced itself the better for all con
cerned. This did not mean that contacts were not maintained and
advice given; it merely implied that the balance o f responsibility
was placed at an early date in the hands o f the adoptive parents.2®
In all other cases; whether boarded or free, the consensus o f
opinion was that final authority must be retained by the society and
not delegated to the foster parents, on the principle that the society
acting m loco parentis, was responsible for what happened to the’
28

aiE^rriJ r'er>?^

Eights,” which occurs in December.

Sendeh T h e i s ^ C o S s ^ t n l & d r l c h 011 ^ C M d V ^
So^
192Sl ° ) ial W ° rk’ Chlld W elfare Series, Monograph No. 2, New York School'of Sociafw ork^

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T H E WORK OP CHILD-PLAJING AGENCIES

child in a very special way since no legal transfer to the foster
parents was contemplated. The practical working out o f this prin
ciple was to give a free hand to the foster mother in minor details
so long as she conformed to the standards o f the society as enunci
ated by the visitor in her supervisory capacity. The more experi
enced the visitor, provided her group was small enough to enable
her really to know the motives and temperaments o f foster parents
and children, the more likely was there to be good team play and
less occasion for the exercise o f the authority which might lie
behind her suggestions.
The Children’s Mission to Children offered an example o f respon
sibility centered in the society and yet shared in a fine way by the
foster parents, who were looked upon as an extension of the staff
and who responded to this attitude with great loyalty and devotion.
The annual foster mothers’ meeting held by the society undoubtedly
contributed to this feeling o f solidarity. The St. Louis Children’s
A id Society also had an annual meeting o f foster mothers.
The best relations between visitors and foster parents existed in
those agencies that had established mutual feelings o f good will
and confidence, where no system of espionage by the visitor was
tolerated but where she was looked upon by the foster mothers as
one who through her special knowledge and experience could be
o f great assistance in helping them to solve specific difficulties.
ED U C A T IN G T H E FOSTER H OM E

Placing-out societies have met on the whole with generous response
to their appeals for foster homes, especially for free and adoptive
homes for permanent care. Mother love and a desire for children
in the home have caused an outpouring o f sympathy for homeless
children. Men as well as women have been lavish with their affec
tion. But a new set o f conditions and problems came to view with
the great increase in calls for boarding care for the temporary aid of
children. Such care is needed for children who are ultimately to go
back to their families, for those handicapped by physical or mental
conditions, and for those who are unavailable for free or adoptive
homes because o f their unattractiveness or age.
It is only within very recent times that serious attention has been
given to the training o f foster parents. Even now the possibilities
o f development in this field are only just emerging from the mists
o f sentimentality. It has been assumed that a woman’s instinctive
love o f children (now known to be an insufficient guide in the d if
ficult task o f rearing her own flesh and blood, not to think o f those
not so related) was justification for asking her to solve the intricate
problem o f making a good citizen out o f somebody else’s child—
a child usually with the handicap o f a bad start in life, who needed
to be pretty much made over both physically and in his whole
outlook on life. The most progressive children’s agencies to-day are
stressing training o f prospective and actual foster parents as part
o f their equipment for adequate foster-home care for children of
many sorts and conditions.
Though most o f the agencies studied depended largely on the week
to week or month to month contacts o f the visitors for setting before

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METHODS OF WORK

the foster mothers in a practical way the ideals o f the society, three
societies supplemented this education through literature giving de
tailed information on certain practical points. The following letter
was one o f a series issued to its foster mothers by the Detroit branch
o f the Michigan Children’s A id Society:
D ear F ellow W orkers : Do we trust our children enough? Or do we have
the kind of halting faith that is expressed in the old maxim, “ Trust God but
keep your powder d r y ” ?
One ° f our little folks proved to be meddlesome and destructive. Several
times the tiny fingers had broken flowers and branches from the house plants.
H is wise foster mother went to work to awaken his interest in the flowers—
their wonderful growth, the shape of leaves and flowers, the beautiful colors__
it was made his task to water them. Finally, having secured his promise to
help in the care of the pretty plants, this “ believing ” mother left the child
alone in the room to pick the dry, yellow leaves off the very plants he had
despoiled. And she sat down to chat without even a backward glance at her
cherished flowers. And of course, they were safe. W hat boy could fail in
such an atmosphere of confidence? .
The question was asked, “ Do you think you can trust h im ? ” and her reply
was “ I shall trust him. I f he fails I shall only lose a plant, but if I hurt him
by suspicion I may have warped a child’s soul.’’
Thank God for such women, and there are many of them who have opened
their hearts and homes to “ one o f these little ones.”
Think of i t ! How often do we say, “ I know I can trust you ” and then
show the child that they are mere words by a too frequent check-up whose
object he feels is to detect him in wrong-doing? How often do we say “ I
shall trust you,” then question his every statement, even flatly suggest to him
he is lying?
Two of our lads had a naughty habit o f nibbling at good things to eat on their
way home from the grocery. One another met her boy at the door on his
return with “ Did you touch anything? ” and her tone implied her belief that
he h ad ; and she hastily unwrapped the cake and inspected it for broken
edges seemingly sure of his disobedience, his untrustworthiness and determined
to find proof of it.
„ T
Th,^ 0i ? er mother ? reeted the little lad cheerily and then he said (not she)
I didnt touch a thing this time, m other”— and his tone, and still more his
sparkling eyes, spoke his confidence in her joy in the little victory he had
won over his greediness— she answered, “ W hy, o f course, I never thought
of such a thing, son— I had your promise.” Just think of the difference— no question o f his conduct— only an assurance
o f a continuing faith that could not help but inspire the boy with a deter
mination to prove worthy of it.
. This is not a plea for allowing children’s deceits to go uncorrected. There
is a time when the boy, in a kindly way, may need to be made to face his
deceptions— but it is a plea for encompassing our little folks in an atmosphere
of affectionate trust. Better to run the risk of being deceived once in a
while than to fail to give a child the solid backing that comes from your
confidence.
Once more, isn t it a question of character—r-our character, yours and mine ?
I f we can convince the child of our integrity and that our esteem and con
fidence are worth winning, our example worthy of imitation, he’ll just
go right he can t help it any more than the flower can help growing in the
sunshine. To grow up in an atmosphere of helpful trust is the right of everv
child.
J
Christ’s rule was to forgive, “ yea, unto seventy-seven times.” H as our con
fidence ever been tried literally to his length? And many a tried but “ believ
ing ’ boarding mother has loved and trusted one of our little ones into selfrespect and trustworthiness long ere the limit set by the Christ was reached.
Dear “ trusting” boarding parents—for the boarding fathers have shone
m this respect— let us hold fast our faith in these little folks— let them feel
our confidence in them, even in their mistakes. B y the way, why are we
so fearful of their mistakes? Can we not trust the child’s ability to learn
through his own mistakes?
2207°— 27------ 6

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TH E WORK OF CHILD-PLACING AGENCIES

And dear boarding parents, won’t some of you who know you have helped
some child by your trust, write us about it? W e can learn from each other’s
experience and our children will benefit as we learn. Words of censure seldom
help. Let us hold fast our faith.
Cordially yours,

r
C h i l d r e n 's

i d

S o c i e t y ,

C h U

d -C a r in g

1
D

e p a r t m

e n t .

The Children’s Mission to Children sent to each new approved
foster home a neatly printed leaflet advising the parents on certain
fundamental requirements, covering such points as health, schooling,
church attendance, and recreation. For many years this agency had
distributed at intervals leaflets published by the United States Chil
dren’s Bureau, the State department o f health, the National Child
Health Association, and the National Mental Hygiene Association.
Group meetings o f the foster mothers, either for recreation or for
instruction, had been held by a few agencies.29 The foster mothers’
meetings held annually by the Children’s Mission to Children for
many years were largely social, but usually included an instructive
talk on some subject o f common interest. The Simmons College
School o f Social Work in Boston had held courses for foster mothers
(see p. 41).
Once a year the board and staff members of the St. Louis Chil
dren’s A id Society held a meeting for their boarding mothers. The
younger children were allowed to come, and provision was made for
their care in a separate room, the meeting being held at a community
center. Following the meeting luncheon was served, after which
there were dancing, games, and community singing. Oil one o f these
occasions an illustrated talk on food values was given by a trained
nurse; at another time the president o f the board gave a general
talk on the work o f the society.
For its two blind babies the St. Louis Children’s A id Society gave
their foster mothers typed suggestions furnished by the Missouri
School for the Blind. Publications o f the United States Children’s
Bureau were given out at the dispensary. The society sometimes
loaned books on child care to the foster mothers, a practice also fol
lowed by the Boston Children’s A id Society.
Printed directions for the care o f infants and small children were
sent out by the Philadelphia Children’s Bureau through the Asso
ciated Medical Clinic, which also furnished diet slips for children of
different ages. The society circulated among a group o f foster
mothers a pamphlet entitled “ Mental-Health Hints to Parents,”
published by the mental-hygiene committee o f the Public Charities
Association o f Pennsylvania. Occasionally foster parents were in
vited to confer with the psychologist o f the bureau, in the interest
o f a problem child. In selecting its homes this society emphasized
the value o f sex instruction given by the foster mother and rejected
foster mothers not capable o f giving this information. A book deal
ing with the subject o f sex was recommended to some of the mothers.
^Attendance at child-study or parent-training classes now being organized in a good
many communities would be a means o f promoting the general education of foster
mothers and would have the added advantage of doing this on a community basis, thus
minimizing the gatherings of foster mothers a s such.

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M ETH ODS

WOBK

CONTACTS W IT H TH E CHILD’S O W N F A M IL Y

Except in the cases o f those children who are placed for adoption
or for whom there is no prospect o f reunion with their families,
child-placing agencies are coming more and more to an appreciation
o f the importance of maintaining and developing relationships be
tween the placed-out children and their own relatives. Such contact
is needed both for the child’s sake and for the parents’. It fosters
interest and keeps responsibility active; it preserves natural affec
tions and offers incentives for early reunion; it gives the child an
assurance that he is not forgotten by his own and encourages the
parent to keep up a relationship that will bridge what might other
wise prove to be an ever-widening chasm leading to permanent
separation. Annually or oftener every situation should be reviewed,
and i f necessary reinvestigated, to learn how conditions are and
whether the purpose for which the child was removed is being or
has been accomplished. This réévaluation should, of course, include
the condition o f the child’s family as thoroughly as that o f the child
himself, the two being inseparable in any thoroughgoing plan for the
child.
The following illustration was offered by a supervisor connected
with an agency that frankly admitted its lack o f equipment to do
follow-up work with the families and as frankly deplored that lack:
The society boarded for over a year three small children of foreign parentage.
The mother was dead and the father paid what he could toward their support.
They were difficult to adjust in a fam ily home because they knew nothing of
American ways and were at first regarded as “ heathen ” by the foster mother.
The society spent much time and patience in interpreting these children to the
foster parents and succeeded in arousing their interest for the special needs of
the children. Then one day the children’s father appeared and announced
that he was remarried and wished to have the children returned to him. In
vestigation showed that he had a suitable home already established, and the
children were returned. Several months afterwards the father reappeared,
asking the society to board the children. H is new wife, a foreigner unused to
American ways, had struggled with the same problems that had at first daunted
the foster mother, and she had been unaided in her efforts to adjust the chil
dren. Now, completely discouraged, she refused to stay at home unless the
children were removed, and no amount of persuasion could change her attitude.
The society again took over the care of thé children, fully realizing its mistake,
but too late, in not having done for the stepmother what it had done for the
foster mother.

A very different situation was that illustrated by the following
story taken from the records o f the Boston Children’s A id Society :
The parents of an unmarried mother of 16 years with a young baby were
bent on having her relieved of the care of her child and used the familiar
argument that she ought to have the opportunity to live her own life— as
though having gone through the experience of maternity, she could eradicate
its effects and live her life as if nothing had happened. The society saw the
situation as one where reeducation of the point of view of grandparents and
mother alike was the point at issue, and set about the delicate task by accept
ing not the baby alone but also his mother for supervision, keeping them in
the grandparents’ home. Ten months after the original application medical
care was still being given, the alleged father had been prosecuted and the case
adjudicated, and payments were coming from him. Gradually the attitude of
the fam ily had been changed, and the mother was growing daiiy fonder of
her child .80
30 For an illustration o f fam ily rehabilitation where the placement of children in
foster homes was incidental to a fam ily plan, see Case Study No. 1, Child W elfare League
o f America, August, 1923.

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TH E WOEK OF CHILD-PLACING AGENCIES

Cooperation with a family agency for the,supervision o f a child’s
family is another method o f keeping in touch with the situation.
This is particularly desirable in those cases already known to the
family agency which are referred,to the child-placing agency for
short-time service.
Contact through fam ily support.

A most natural and wholesome contact resulted from the require
ment o f parents to contribute, according to their ability, toward
their children’s support. The 10 agencies studied all required pay
ments for certain classes o f children; none, however, received reim
bursement for all children in their care. O f 4,887 children reported
by 8 agencies, 1,281 (26.2 per cent) were being supported in whole
or in part by parents. This proportion varied among the agencies
as follow s:
Agency

Per cent

Boston Children’s Aid Society__________________________________________________69. 9
St. Louis Children’s Aid Society_______________________ !______________________ 69 .1
Children’s Mission - to Children________________________________ _____________ _ 57.3
Michigan Children’s Aid Society________________ ____ _________________________ 4 1 .0
New England Home for Little Wanderers_________________ _________________ 39. l
Children’s Bureau of Philadelphia__________________________________________3 6 .9
Children’s Home Society o f Florida__________________________________________ 9 .5
Pennsylvania Children’s Aid Society________________________________________ 5 .4

O f these children 1,064 (83.1 per cent) were received direct from
the parents without surrender; 151 (11.8 per cent) were received
by surrender, court commitment, or court continuance.
A t the time o f the study six visitors o f the Boston Children’s Aid
Society were trying to collect on 48 different accounts, aggregating
nearly $7,500, in some cases continuing back over a long period o f
time. In each case the visitor, with the approval o f the supervisor,
was satisfied that the account was not ready for prosecution. At
the date o f the study 14 delinquent accounts had been referred to the
Legal A id Society, which agency cooperated on a pay basis in the
legal work o f the agency at a cost o f $600 a year. These 14 cases
covered long periods of time and involved large amounts o f money,
the aggregate being $3,297.76. In such cases the Legal A id Society
and the visitor conferred as to when, if at all, a case should be
brought into court, either for criminal prosecution under nonsup
port procedure if a child was still in a foster home, or under civil
procedure i f he had been returned to his parents or had otherwise
left the society’s care.
The placing-out visitor o f the Boston Children’s A id Society was
primarily responsible for the enforcement o f parental agreements.
It was she who notified the bookkeeping department when to send
bills and duns. She determined when abatements should be made
and when a visit rather than a dun or personal letter was likely to
bring better results.
One agency pursued the practice o f having children originally
received on application o f the parents committed by the court after
the parents had become delinquent in their voluntary payments.
This agency was operating in a territory that had no public child
caring organization. By applying to the courts two things were ac
complished; one the taking of control away from the parent who
might or might not be an unfit guardian o f his child; the other the

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METHODS OP WORK

safeguarding o f the finances o f the agency, which automatically
transferred support o f these children from its own funds to those
o f the county immediately they were committed by the court. The
alternative to this method, favored by most o f the agencies, was to
have such parents taken into court and compelled under nonsupport
proceedings to meet their rightful obligations. Where a public
agency existed the children of parents who could not be forced to
meet their obligations were usually transferred by court commit
ment to the public agency. In cases o f children received by court
or poor-law commitments responsibility for collections from parents
was sometimes, though not always, assumed by the committing
agency. Though without doubt this method had advantages, on the
other hand it sometimes deprived the agencies o f an occasion for a
direct contact and increased the difficulties of establishing relations
with the parents.
.
.
The same agency that employed court commitments in delinquent
cases charged the reception department with the collection o f pay
ments and with all family contacts. Such an arrangement was in
the nature o f a divided authority, and the custom did not admit o f
as direct relationships between the parent and child as where these
contacts were in the control o f the department of placing out; it
sometimes resulted in a miscarriage o f plans. The same danger was
conceivable when the children’s agencies left the responsibility o f
collections, and often o f other family contacts, to a family-welfare
or other referring society; though undeniably such a division o f re
sponsibility worked advantageously in certain cases, especially where
the referring agency had a previously established contact with the
family and was to continue with it after the child’s return to
his parents.
When a children’s agency is equipped with visitors inexperienced
in family work, who in addition have too many children in their
care to make it possible for them to do follow-up with the families
under any conditions, then it is quite likely, as a practical matter,
that follow-up o f the parents in matters of collection o f board and
other contacts will be done more successfully through some betterequipped agency. I f the best results are to be obtained through such
an agency, such condition should be allowed to continue only until
the children’s agency can properly man itself to do the job, prefer
ably through its placing-out visitors.
In the case o f one agency the collections were made successfully
through the department o f investigation, which kept all family
contacts and arranged for rehabilitation and discharge.
Personal contacts of the parents with the child and with the society.

The general tendency o f the agencies was to encourage frequent
personal contacts between children and their parents, though this
was planned in ways that would not interfere with the routine o f
the life in the foster home. Perhaps no greater skill is required in
any phase o f child placing than in making the proper adjustments
between a parent and a child whose home is for the time in some
family other than his own. The visitor must be mindful o f the
rights and feelings of the foster mother, the other member o f the
triangle to be consulted, whose cooperation must be obtained at the
outset if the relationships are to be mutually helpful.

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TH E WORK OF CHILD-PLACING AGENCIES

The degree to which the 10 agencies encouraged visiting and cor
respondence between parents and children was determined some
what by the demands o f the particular case, and in a measure by the
emphasis placed by the society on this phase o f the work. Children
received for adoption, as well as all others for whom it had been
determined that no family rehabilitation was feasible, were cut off
from former home ties. For those children who had relatives with
whom contacts should be maintained the principle was found to be
uniform that visits and correspondence should be encouraged, usually
without restrictions, unless the privilege was found to be abused.
Those agencies which concerned themselves most carefully with
the maintenance o f family contacts allowed for car fares and rail
road fares in planning family budgets, and one agency had paid
for parents’ meals and lodging with the foster mothers in rare in
stances where it was recognized that not to do so would have pro
hibited these visits or worked a hardship on the foster parents.
Though general permissions to visit were given through the offices
these rules were liberally interpreted, and when good relations had
been established between parents and foster parents they were often
allowed to make direct contacts with each other. However, the
societies protected themselves as well as their foster homes by having
regulations which could be invoked as occasion demanded.
The Boston Children’s A id Society often arranged for children
to visit their relatives over a holiday or week end and otherwise
encouraged close contacts. The child-caring department o f the So
ciety o f St. Vincent de Paul had established relations with the De
troit parish conferences of that society, composed o f laymen, who
often kept in touch with the families and helped to reestablish the
homes. Likewise the League o f Catholic Women o f Detroit worked
with some women and older girls.
Follow-up of children returned to parents.

Though the agencies admitted a certain responsibility for chil
dren who had been returned to their own homes, comparatively little
follow-up work was done directly by the societies themselves.
The St. Louis Children’s Aid Society tried to keep in friendly
touch for at least six months after a child’s return and sometimes
made many visits during that period. The Children’s Bureau o f
Philadelphia, which did little follow-up, believing that the super
vision o f children in their own homes was not the function o f a
children’s agency but rather one for the family-welfare society, visit
ing-nurse association, or other referring agency, did occasionally, as
in the case o f a delicate baby, allow its nurse to supervise the health
after a child’s return home. The Children’s Mission to Children
placed many returned children on what was known as their peren
nial-inquiry list, which insured follow-up at intervals determined
for each case on its merits. Thirty-eight such children were so listed
at the time o f inquiry, o f whom 31 had been under supervision from
six months to over four years. An additional 9 children were at
home on trial and. under full supervision of the agency.
The Boston Children’s Aid Society also took quite a definite posi
tion with regard to the agency’s responsibility for follow-up in the
child’s home. O f 342 children under care of this society, 52 had been
under supervision in their own homes during the time o f the study

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METHODS OF WOBK

and had been visited as systematically as though in foster homes. In
cases that had been previously under the care o f another agency the
aim o f this society was to turn over the home supervision to them
at the earliest time consistent with the best interests o f the child.
Supervision after discharge.

Because the agencies differed in their definition o f the time o f dis
charge it was difficult to secure data regarding aftercare supervision.
Several agencies continued to visit children long after their return
home, but did not discharge them officially at that time. Others
discharged them the moment they left foster-home care. The ques
tion o f whether aftercare was given had to be considered along
with another factor, namely, whether the child had actually been
supervised in his own home after his period o f foster-home care, and
also whether another agency was following the case. Since 30.6 per
cent o f the children discharged were under 3 years o f age at the
time o f discharge, careful follow-up, at least of the health, was
shown to be needed if the money expended in previous foster-home
care was to be justified.
i
O f the 815 children discharged by eight agencies during the period
covered by the study, 115 had been discharged because o f death,
marriage, reaching the age limit, becoming, self-supporting, or run
ning away, or for various reasons classified as u other ” ; and 124 had
been transferred to other agencies or to institutions. These 239,
except for the runaways, might very well have been considered as
under other supervision or as needing none. Eighty-seven children
had been adopted, 38 o f whom were under 2 years o f age. Only 45
o f the 87 were receiving definite agency supervision, and that from
only one agency, the Michigan Children’s A id Society. O f all dis
charged children, 485 (59.5 per cent) were returned to relatives and
friends; 130 o f this number were infants under 2 years o f age and
106 were adolescents, 12 years or older. In spite o f the obviously
delicate situations involved in reestablishing children o f this age m
homes that had previously been disrupted, only 46 were reported as
under supervision o f the agency discharging. Again it should be
stated that this number does not take into account the careful work
done by those agencies which did not formally discharge such chil
dren until they had been visited often over long periods in their
parents’ or relatives’ homes after the period o f foster-home care.
Return of legal control to parents.

Since the majority o f the children were received informally from
their parents, and since by far the largest number o f those received
through court commitment were for adoption or permanent separa
tion, the question of returning legal control to the parents was
numerically an unimportant one. However, some children received
by court commitment or guardianship proceedings were ultimately
returned to their own parents. In cases of juvenile-court commit
ment, except where the court order carried the right to adopt, the
children could be returned by permission o f the court. When adop
tion was ordered in the committed cases in Michigan, it became neces
sary to have the natural parents go through the form o f adopting
their own child, if for any reason he was returned to them.
When guardianship was obtained through the probate court, as in

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TH E WOBK OF CHILD-PLACING AGENCIES

Massachusetts, the policy o f the societies was to retain custody until
majority to guard against a possible recurrence of need o f invoking
the authority.
PO LICY W IT H REGARD TO A D O P TIO N S

Adoption is one o f the oldest forms o f child care and one whose
results are perhaps the most unexplored. It has been favored by
institutions and child-placing societies alike; many children have
been given for adoption direct by parents without agency interven
tion. Greatly exaggerated statements concerning the value o f adop
tion have been met by equally unfounded condemnation. The ideas
usually held are o f two diametrically opposite sorts. One is
that all adoptions turn out well, that the child is well placed and well
liked by his adopting parents and is invariably happy; that he is
absorbed into the family life, grows up in happy ignorance o f his
. srit&ge, and becomes a well-adjusted citizen. The other notion
is that all adoptions are lotteries and that most o f them are failures.
It is obvious that neither view can be entirely correct. What is
needed is the facts for a large enough number o f cases so that safe
conclusions may be drawn. Such a study would have to consider the
elrect o f adoption on the child, his own family, the adopting parents
and the community, and it would need to cover a sufficiently long
period o f time to insure a proper perspective.
Proportion of children discharged from care who were adopted.

„The Michigan Children’s A id Society, the Children’s Home Society
o f Florida, and the Children’s A id Society o f Pennsylvania placed
a good many children for adoption; the number so placed by the
seven agencies was very small. During the year o f the study
87 children (10.7 per cent o f those discharged from care in that
period by eight agencies) were legally adopted; 78 o f this number
were m the care o f the Pennsylvania and Michigan Children’s Aid
Societies and the Children s Home Society o f Florida. None o f the
¡ ^ d,ren ^leased from care by the Boston Children’s Mission to
Children was legally adopted. O f those discharged by the other
agencies the percentages legally adopted were: The Children’s Home
Society o f Florida, 20.3 per cent; the Michigan Children’s A id
Society, 19.8 per cent ; the Children’s A id Society o f Pennsylvania
10.8 per cent; the Boston Children’s A id Society, 6.8 per cent; the
ri\ -u 0U1® “
en s A id Society, 2.7 per cent; the Philadelphia
Childrens Bureau 1.7 per cent; and the New England Home for
j tl(T Wanderers, 1.1 per cent. More than half o f the 87 children
adopted were known to be o f legitimate birth, and 8 o f them
were foundlings.3^ O f 165 children placed on trial for adoption
by the Michigan Children s A id Society in a given period 60 per
cent were illegitimate.3121
^
1
o f legitim ate1and U legltim a te ^ h fld re rf^ p la c ^ ^ o ^ a d O D tio n ^ a ^ f1^ * 6 similar Percentag-es

s*« o s as

studied were legitimate and 39 ¿ r elnt l ll e g i t o a t e

and

pe£ Cent °*£ the chlldrel1

CWcago^'weref^ot^obtaiim cf'at*1? t l m p a<nfP
cb/ the Jewish Home: Finding Society of
found that the society placed two children i n ^ d o p t i ^ i n l m a f a ^ S ' “t o l S m 1 “ WaS

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METHODS OF W O BK

Investigation prior to adoption.

The general advance in methods o f social investigation naturally
has affected the attitude of social agencies toward adoptions, but the
importance o f careful investigation in every case has not been so gen
erally recognized by courts having jurisdiction in adoption proceed
ings.32 Minnesota, Oregon, and North Dakota have laws requiring
that in prospective adoptions the fitness both o f the child and o f the
-foster home shall be investigated.33 Other States have permissive
legislation to this effect but sometimes little or no machinery for get
ting at the facts. Provided no protest is offered, many judges are
still willing to allow adoptions even though in the possession o f very
few facts about a case. The final test in a thorough investigation in
an adoption case is the observation o f how the relationship between
the adopting parents and the child actually works out. For this
reason several State laws provide for a trial period o f 6 to 12 months
before the final decree may become effective. The value o f such leg
islation will depend on the provision made for obtaining adequate
supervision during this trial period and the attention paid by the
courts to the recommendations based on such supervision.
That communities are awakening to the importance o f careful
inquiry before adoptions are consummated is shown by the follow
ing quotation from a Chicago study o f that city’s needs made by a
subcommittee o f the children’s committee o f the Chicago Council
o f Social Agencies in 1924:
The placing of children in fam ily homes, either for temporary or permanent
care, is attended With the gravest dangers. These dangers are accentuated
when children are placed for adoption in the permanent care of others, when
there has been no substantial investigation to determine the desirability of
separating the child from, his parents, and the fitness or the adaptability o f the
adopting parents to the child.
The unfortunate mother in a maternity hospital is not, at that time, in a
physical or mental condition to know her own mind, and is ofttimes persuaded
by some irresponsible individual to surrender her child for the purpose of adop
tion. No investigation has been made to establish her actual identity; the
facts concerning the child’s paternity are unknown. The mother’s surrender
is accepted by some of the courts of jurisdiction as sufficient to justify the most
important transaction in which human beings can engage.
• As a result of the hasty manner in which infants are separated from their
mothers and deprived of their natural food, the mortality of such infants is
very high and the physical resistance o f those who survive is materially
weakened.
Some mothers who have been persuaded to give away their babies for adop
tion discover that it is as impossible for them to hide their secret as it is for
them to recover their child. Many of these mothers are making desperate but
futile efforts to secure the restoration o f their child.
Many o f these children who have now arrived at their m ajority are making
efforts to ascertain the facts concerning their parentage. The absence of any
investigation at the time of their adoption makes it practically impossible for
the securing of this information at a later date.
Persons who have been refused children by accredited agencies because of
their moral unfitness have had no difficulty in securing them through adoption
proceedings in courts which did not make use o f the available resources o f
information. In consequence the lives of some children have been needlessly
and hopelessly blighted.
82 For a discussion of this subject see Adoption Laws in the United States, by
Emelyn Foster Peck (U. S. Children’s Bureau Publication No. 148, W ashington, 1 9 2 5 ).
88 Minn., Gen. Stat. 1913, sec. 7152, as amended by Laws of 1917, ch, 2 2 2 ; Oreg.,
Laws of 1920, sec. 9766, as amended by Gen. Laws of 1921, ch. 2 1 5 ; N. Dak., Comp.
Laws 1913, sec. 4446, as amended by Laws of 1923, ch. 151.

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TH E WORK OF CHILD-PLACING AGENCIES

Families unknowingly adopt children of bad heredity who have later de
veloped insanity, epilepsy, or feeble-mindedness. Some adoptions have been
consummated when the adoptive parents do not know that the ^child is of a
different racial descent, and the tardy discovery of this fact imposes great
hardships on both fam ily and child.

Five o f the agencies studied made a more complete investigation o f
children who were to be placed for adoption than o f children received
for boarding care. That is to say, they went with special care into
their heredity and even in cases o f illegitimacy tried to get specific
data on this point in regard to both parents.
Before committing children for adoption to the Children’s Home
Society o f Florida it was customary for the juvenile court to allow
the society to make its own social investigation and report its findings
to the court. The Illinois law required investigation and approval
by the State board o f administration o f prospective adoption homes
receiving children from maternity homes; but this investigation did
not cover inquiries regarding the child’s history, nor did the law
include cases arising otherwise than in a maternity home. A recent
arrangement with the court was resulting in certain cases being re
ferred to some of the agencies for investigation and report. In
Michigan the law required that an investigation o f a prospective
adoptive home must be made by the county agent, his report going
to the probate court. This same agent visited the children until
legal adoption was consummated. Discretionary powers were lodged
in the Missouri courts in accordance with which an officer in the St.
Louis court investigated and reported to the court on the fitness o f
prospective adoptive parents. The court also accepted such investi
gations made by the St. Louis Children’s A id Society.34
The agencies were unanimous in their opinion that no child,
whether o f legitimate or o f illegitimate birth, should be placed for
adoption if there were decent, self-respecting parents or other family
connections who might later, i f not at the moment, provide a home
for him. The agencies also opposed making eligible for adoption
children either of whose parents was known to have any inheritable
mental abnormality or any transmissible venereal disease. Evi
dence was lacking as to any special provision whereby parents were
tested for such conditions, and it is probable that in practice this
admirable ideal was carried out only in those cases where the parents
were in institutions for epileptics, the feeble-minded, or the insane,
or where the conditions were so pronounced as to be readily observ
able. The agencies held that children ought not to be given for
adoption unless they were free from physical disability and mental
defect. Most o f the agencies required a Wassermann test as a pre
requisite to adoption.
.
.
The Children’s Bureau of Philadelphia and the Pennsylvania
Children’s A id Society had undertaken recently to have psychologi
cal tests made o f all their placed-out children and placed none for
adoption who seemed backward. This was making a great differ
ence in the numbers so placed. A 2-year-old boy, whose mother was
feeble-minded, and whom the Jewish Home-Finding Society o f Chi
cago had taken to the Illinois Institute for Juvenile Research before
placing for adoption, was pronounced seven months mentally re3* in
sm ith’s Rev. Stat. 1921, ch. 23, sec. 3 4 3 ; Mich., Comp. Laws 1915, sec. 1 9 9 3 ;
Mo., Rev. Stat, 1919, sec. 1096.

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METHODS OF WORK

tarded. A t the end o f six months the decision was that the child
was not fit for adoption, and later he began to show marked be
havior difficulties for a 3-year-old. In Michigan a State law re
quired Wassermann tests before children could be legally adopted
tA
h.e-rgP°Ft to g ° to the adopting parents. The Michigan Children’s
■u ^ociety. refused to place for adoption any child who had once
had a positive Wassermann reaction and for whom at least three
negative reactions had not since been reported.
Many unwise adoptions come to the attention o f child-placing
agencies, societies for the prevention o f cruelty to children, and
other social agencies. Frequently the children involved had been
adopted as infants when they presented an attractive appearance,
but later in life, as more unlovely traits appeared, became unwanted
children. It seemed to be quite generally conceded among the
agencies studied that where prospective adoptive parents earnestly
desired to adopt children ineligible for adoption according to the
agency standards, such adoptions should be allowed only after all the
facts and possible consequences had been presented to the pro
spective parents. One such case was that o f a 7-year-old feeble
minded child who had been in a free home for four years and o f
whom the foster parents had become so fond that they wished to
adopt her. In this case the society obtained in writing a statement
from the adopting parents and their family physician to the effect
that they were advised as to the child’s condition before the adop
tion and were willing to stand by the consequences.
Length of placement prior to adoption.

W ith a few exceptions, almost negligible in numbers, the agencies
studied expected a child to be placed in a home from one to two
years before adoption was finally consummated. O f 29 adoptions
consummated during the five years before the study by the New
England Home for Little Wanderers, 4 children had been in the
adoptive home from 10 to 15 years before adoption, all of these
being placed originally without thought o f adoption; 4 others had
been in the home where they were finally adopted from 5 to 10 years,
and o f this number only 1 was placed with the idea o f adoption; the
dther 21 had been in the home at least a year before adoption, and
most o f them for two or three years.
Supervision in cases of adoption.

During the trial period the agencies planned for close supervision
and based their judgment as to the wisdom o f allowing the child
to remain permanently with the family on the results. Three agen
cies stated that they gave less detailed supervision when a child had
been placed in a prospective adoption home. The theory on which
these three agencies acted— and they were advocates o f the closest
follow-up—was that the real test of an adoption placement was
an adjustment between the child and his foster parents that would
show the parents’ ability to proceed alone without further guidance
from the society once the adoption was consummated. The Michi
gan Children’s Aid Society formerly made it a rule to visit every
adopted child annually until he was 21 years o f age, but more
recently that ruling had been somewhat modified to meet individual
needs.
Instances were cited that showed the value o f a follow-up which
gave information concerning conditions, especially those arising

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T H E WORK OF CHILD-PLACING AGENCIES

after adoption, which would not have been discovered had contact
ceased immediately upon adoption. For example, adopting families
might become disrupted by death, divorce, or other causes, and rela
tives lacking the incentive to care for adopted children that would
have operated had they been natural children, refused to continue car
ing for them. Such children, who would otherwise have been likely to
fall into the hands o f undesirable guardians, were taken back into the
care of the society. The Boston Children’s A id Society, which placed
only a very few children for adoption, had plans for following them
indefinitely in a friendly way, and hoped to accumulate data on these
cases that would throw light on the whole question o f adoptions.
During the five years before the study 21 children had been adopted
through this agency; 3 of these were adopted by the mothers’ hus
bands who were not the children’s own fathers, and 7 were adopted
by the boarding foster mothers with whom the children had been
placed. The remaining 11 were placed in adoption foster homes.
The average length o f time these children were in the home before
actual adoption took place was a little over two years. In one in
stance the child was adopted by the paternal grandparents, and in
another by personal friends o f the mother, who was dying. Since
their legal adoption contacts had been maintained by the society
with the majority of these children, and letters, messages, and invita
tions for visits were received frequently by supervising agents. The
relationship in these cases had been o f such a personal nature that it
was not possible to substitute a second agent if the one who had
arranged the adoption had left the society. In all adoption cases
the records were kept in special folders, not to be opened except by
the general secretary, the supervisor, or the agent who had arranged
the adoption. Great care was taken to protect the interests and
guard the confidence o f the adoptive parents.
Frankness in regard to the child’s heredity.

In view o f the mental conflicts which have arisen in the minds o f
children who have suspected the fact o f their adoption, or have
learned of it inadvertently at a critical time in their lives,35 it was
encouraging to find that every agency studied had the definite policy
o f informing prospective adoptive parents with regard to the hered
ity of the child and that they further urged all such parents to ac
quaint the child with the facts of his adoption while still young,
before the information would come to him as a shock; The adopting
mother who explained to her tiny charge that she had been especially
fortunate in being able to select and adopt a child rather than
having to accept one that just came (which she carefully explained
to be the usual method) opened the way for a more detailed ex
planation when the child was old enough to grasp fully the meaning
o f the information; at the same time it forestalled any story that
might reach the child in unpleasant ways. The Pennsylvania
Children’s A id Society had recently gone a step further than the
others in refusing its consent to an adoption in cases where the
foster parents were unwilling to promise to tell the child o f his
adoption when he reached an age o f understanding.
SB See Mental Conflicts and Misconduct, by W illiam Healy, M . D ., pp. 7 3 -7 4
Brown & Co., Boston, 1 9 1 7 ).

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(Little,

METHODS OF WOHK

RECORDS A N D STATISTICS

The value o f keeping records has been accepted theoretically as
necessary to the efficient conduct o f a social agency. Their impor
tance as a means to the -better treatment o f the individual child was
the basis on which records were first established. Their value for
research purposes is now beginning to attract attention. The form
and content o f records in order to meet the twofold requirement o f
aid to the individual and to society as a whole are still in the de
batable stage. Quite obviously the form and content depend very
much on the relative value placed by agencies on these two purposes
and whether one or the other is emphasized. The aim, o f course,
should be to serve both. A practical consideration is the time avail
able for record planning and dictation and the amount o f steno
graphic and clerical assistance provided. Only as boards o f directors
and the general public become more impressed with their value will
the amount of time and money allowed for their development be
increased sufficiently to allow the making o f good records.
Differences in record keeping among the agencies.

A ll 10 agencies kept records o f investigation and placing out,
which included identifying data on what is known as the face sheet,
with a chronological running record. The running record varied
from such simple entries as “ visited (with date) and found boy
doing well ” to a careful analysis o f a situation covering a page or
more o f typewritten material under such specific headings as family
history, physical condition, education, recreation and employment,
relationship to foster parents, and personality traits. Such com
paratively full records contained concrete illustrations o f character
istics exhibited, and the reader was left in possession o f facts by
which to interpret what would otherwise be hazy and general terms
such as “ untruthful,” “ lazy,” “ ambitious,” “ self-opinionated,”
“ bad tempered,” and “ good natured.”
The foster-home records varied to much the same degree as did the
investigations o f applications. No more complete records o f foster
homes were read than those o f the New England Home for Little
Wanderers. These followed a well-developed outline and gave in
each case such a clear picture o f the home itself as well as o f the
character, education, and background o f the foster parents, that the
reader felt as if he really knew what manner o f people the appli
cants were and what kind o f child would be likely to fit into their
home. The foster-home records o f several o f the societies gave indi
cation o f the discrimination exercised in the selection and approval
o f such homes. A few agencies were content with a skeleton o f
recorded facts which in themselves were far from convincing as to
the value o f the home.
One o f the more recent developments in the matter o f records has
been the recording o f the subsequent history o f the foster home based
on actual use. (Seep. 49.) Some four or five agencies had developed
a more or less systematic method o f making periodic entries in the
running record as to the usefulness o f a home, its weaknesses and its
strengths. These supplemented the original investigation and pro
duced a complete picture very helpful in an evaluation* Uniformity

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TH E WORK OF CHILD-PLACING AGENCIES

between agencies in record keeping is becoming recognized as a
necessary basis for an intelligent comparison o f work.36
Method of filing.

One alphabetical card index including applications, foster homes,
and placed-out children cross-referenced from family to child and
vice versa, is the simplest as well as the most comprehensive basis
o f a complete record system for a child-placing agency. Such a
system is adaptable to a small as well as to a large unit. The
alphabetical card in each case (in addition to identifying informa
tion) carries a case number, which leads to the numerically filed
record kept in a fireproof locked file.
A study o f the filing systems o f the agencies revealed a tendency
toward making the family rather than the child the unit by which
records were filed. In those few instances where each child in care
was given a separate folder, the family history was usually filed with
that o f the oldest child received for placement. This system carried
the possibility o f the loss o f identity o f relationships and was not
commonly used by the societies doing the best case work.
Blank forms were used by a few agencies, but the chronological
running record supplementing a face sheet was favored by most as
resulting in the more human presentation and better organization o f
facts, especially when a topical outline was borne in mind but freely
interpreted and not too rigidly adhered to.
Stenographic assistance.

In most o f the agencies the general secretaries were provided with
private secretaries, though some shared that service with the assistant
secretary. About half of the agencies made a weekly time provision
for stenographic assistance to each case worker, varying from 1^2
to 4 hours. As a rule each stenographer was expected to take dicta
tion from two to four or more workers. Though there were excep
tions the,, value o f the records bore, as might be expected, a pretty
definite relation to the time allowed as well as to its regularity.
Other factors were the training and experience both for the stenog
raphers and o f the case workers. One agency spoke highly o f the
value o f the dictaphone and other mechanical labor-saving devices.
Ability to assemble and plan record material in advance o f the
actual dictation is an important element in good record writing.
Workers who were expected to write reports by hand, on trains or
after hours, and who were not encouraged to feel that the record
writing is as important to good case work as the field work, were
bound in the long run to do poorer case work for their charges
than were those who were given enough time, in quiet surroundings,
in which to think over their experiences and to cull out o f their
day’s work, for commitment to paper, those essential and salient facts
that go to make up a consecutive and purposeful record.37
Statistical methods in use.

Some o f the societies kept statistical account o f the number o f
visits made to children, the use of hospitals, and other more or less
detailed information as to how the visitors made use o f their time.
86 The Child W elfare League o f America has issued a set of record forms that have
been adopted by several placing-out agencies.
.
87 For a fuller discussion of the purpose and construction of records see The Social
Case History, by Ada E . Sheffield (Russell Sage Foundation, New York, 1 9 2 0 ).

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METHODS OF WORK

But the most profitable social statistics were those which gave the
numbers and types o f children cared for and showed what provi
sion was made for those not received for placement; which indicated
the geographical and other sources o f applications and placements;
which classified the factors and causes leading to applications; and
which gave the numbers o f children per visitor, ages o f children at
admission and discharge, length o f time in care, and types o f foster
home used.
The children’s department, Boston Council o f Social Agencies,
had adopted the following eight statistical tables which were being
used quite generally by the child-placing agencies in Massachusetts.
Their uniform use materially assisted comparison o f the work o f the
various agencies:
T a b l e

I .

—R

6 s u m

o f

o r k

f o r

t h e

y e a r

Number of
children

Helped by the department of advice and assistance only_______________________
Cared for by the department of foster-home care____________________
Helped by other departments____________________________ ______________
Total helped during the year______________________________________________
T a b l e

I I . —

A p p l i c a t i o n s

r e c e i v e d

Involving—
Children
Families

Number o f applications:
Pending at beginning of year_____________________
New applications______________ _______________________
Reapplications_______________________________________

___________
_________ __
____________

Total___________________________________________

________

___ ____

(Note.— The committee recommends that only the child for whom applica
tion is made shall be counted as a child involved. Others helped directly and
indirectly are not to be counted.)
T a b l e

I I I . —

i s p o s i t i o n

o f

a p p l i c a t i o n s

,.
Number of
Applications :
children
(a ) W ith d raw n ______________________________________________________
(&) D irected__________ _______________________ ___________ ____ _____ _
__~___
(c) Transferred to other agencies_________________________________
____
( d )
Accepted as cases_______________________________________________ _____
( e )
Pending______________________________________ _____________________
T a b l e

I V

. —

i s p o s i t i o n

o f

a c c e p t e d

c a s e s

f r o m

T a b l e

I I I

_
Number of
Cases :
children
Withdrawn_________________________________________________________
Adjusted___________________________________________________________ ~__ ____
U n adjusted________ ____________________________________________I I I H _ _ I __
Advised_______________________________________________________________
Transferred to other agencies______________________________________
___ _
Transferred to department of foster-home care_________ _________
Pending___________ ____________________________________________________
T a b l e

V .—

e p a r t m

e n t

o f

f o s t e r - h o m

c a r e

In care at beginning of the year__________ ______________________________
Accepted during the year______________ ___________________________________
Discharged________________________________________________________________
In care a t end of the year________________________________
Total number in care of department during year_____________________
Weeks of care________________________________________________________

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Number of
children

TH E WORK OF CHILD-PLACING AGENCIES
Table VI.— Analysis of children discharged during the year

(To be worked out according to preference of organization)
Table V II.— Analysis o f work o f foster-home department at end of year

Under supervision:
In boarding homes___ __________ __________________„__ '2_________j
In wage homes____________ _____________________________________
In wage boarding homes____________________ _____ ___,_________
In free homes_________________________________________________
With parent or other relative____________ i!i____________ ______
Otherwise placed________________ ______________________________

Number of
children
___ .____
________
_______ _
________
________

Number of
foster homes
Pending at beginning of year______________________ _________ _______ ________
New applications-------------------------------*_____ ;_______ ____________ ___ ________
Approved_____________________________________ , ____________ 1___________ _
Disapproved_______________ _______________ _____________ _____ _ ________
Unsuitable________________________ _____________ ______________ _ ________
Withdrawn_____________ _______ t______ ___________________ _____ ________
Pending_________________ __________________ «_____________ ______ ________
Ready for use at the end o f year___________________ __________ ________
Table V III.— Department of home finding

Follow-up and research.
I n sp ite o f th e ir e x p re sse d in terest in th e su b je ct, a n d a fe w sca t
te re d attem p ts t o ev a lu a te ce rta in fe a tu re s o f th e w o r k , n o n e o f th e
a g en cies stu d ie d h a d m a d e a n y lo n g -tim e o r c o m p re h e n siv e stu d y o f
its in tak e, treatm en t, a n d u ltim a te e ffe ct o f its w o r k su ch as w o u ld f u r
n ish c o n v in c in g d a ta o n w h ic h to base in te llig e n t a n d scie n tific ju d g
m en t as t o its u ltim a te w o r th t o a co m m u n ity . L a c k o f fin a n cia l
b a c k in g , becau se th e p u b lic co n scie n ce is n o t a rou sed to th e v a lu e o f
su ch in te rp re ta tio n , is p r o b a b ly th e e x p la n a tio n f o r th is situ a tion .
U n fo r t u n a te ly it is n o t lim ite d t o th e ag en cies stu d ie d b u t is q u ite
p re v a le n t th e c o u n tr y o v e r. S o fa r as is k n o w n th e o n ly tw o a t
tem p ts in th is d ir e c tio n b y c h ild r e n ’s a g en cies h a v e been m a d e b y th e
N e w Y o r k S ta te C h a ritie s A i d A s s o c ia tio n , w h ic h has c o u ra g e o u sly
so u g h t t o evalu a te its w o r k ,38 a n d th e C h ild r e n ’s M iss io n to C h ild r e n
o f B o s to n , w h ose case su p e rv is o r m a d e a stu d y o f the v a lu e o f th e
w o r k w h ich th e m issio n w as d o in g f o r h o sp ita ls.
EDUCATING THE GENERAL PUBLIC IN M ETH ODS OF CHILD CARE
, E d u c a tio n o f th e p u b lic in th e p r in c ip le s u n d e r ly in g c h ild care,
e n tire ly a p a rt fr o m th e m o n e y -r a is in g p r o b le m , is c o m in g to be
lo o k e d u p o n as an im p o r ta n t o b lig a tio n f o r a c h ild -p la c in g a g e n cy
t o assum e.
T h e m eth od s e m p lo y e d are v a rio u s. S o m e ag en cies e x p e c t th a t
w o rk e rs a lre a d y o v e rb u rd e n e d s h o u ld so m e h o w d o th is a d d itio n a l
w o r k in th eir o d d m om en ts. O th e rs h a v e a sp e c ia lly e q u ip p e d p u b
lic it y d ep a rtm en t. B o th m eth od s, th e tim e elem en t asid e, h a v e th e ir
a d v a n ta g e s ; b o th th e ir d a n gers.
T h e first m e th o d , th a t o f d r a ft in g m em b ers o f th e sta ff in to the
serv ice o f p u b lic ity , has th e u n d o u b te d a d v a n ta g e o f th e p e rso n a l
to u ch , e sp e cia lly w h ere s p e a k in g a n d w r it in g are d on e b y th ose w h o
asTheis, Sophie van Senden: How Foster Children Turn Out.
Charities Aid Association. New York, 1924.

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New York State

METHODS OF WORK

have first-hand knowledge o f the cases. But unless this also is care
fully safeguarded the work will be done either at the expense o f time
which should be given to the children, or quite as likely by the sac
rifice o f necessary leisure time o f the case worker. Furthermore
few case workers have such a variety o f gifts as to include in their
qualifications the ability to do writing or public speaking easily and
acceptably, even though it be on the subject with which they are
most vitally concerned. Where this method has been tried it has
usually reacted unfavorably on the child, who is best served by a
worker refreshed after a few hours of free time, and not jaded and
tired after an evening spent in talking about her day’s work or after
a holiday devoted to writing a newspaper story. This method also
lacks continuity, and can seldom result in that variety of approach
possible in a plan made by one whose chief job it is to gather data
and disseminate it by press, radio, magazine article, public platform
or personal interview—one who will know how to make use of
directors and staff, using each when because of social position, business affiliation, or spocial knowledge lie may fit best into the program
o f education at a given moment.
.
specially equipped publicity department implies a person spe
cially qualified by training or experience, preferably by both, to
curect the putting across ” o f the message in such a way that values
shall not be lost, and yet in so popular a form that the public will
stop, look, and listen.” To be successful it requires that he shall
be at least socially minded, at best socially trained and equipped
with stenographic and clerical assistance sufficient to meet the pro
gram. In addition it requires large enough appropriations to carry
out an adequate program over a sufficiently long period to justify
the experiment. It may, and usually does, include efforts at money
raising, but should not be confused with it. Unless very carefully
safeguarded, the purely educational features are liable to be sub
merged in the stress o f money getting—so insistent and so everconstant a factor in the career of a social agency.
O f the 10 agencies studied, 5 were affiliated with community chests
or their equivalent, yet all 5 felt an obligation to do their own inde
pendent educational work. The child-caring department o f the
Society o f St. Vincent de Paul o f Detroit, affiliated with the Detroit
Community Fund besides reaching its own particular constituency
contributed articles to the publicity bureau o f the Detroit Com
munity Union.39
The Michigan Children’s A id Society, connected with several
chests through its various branches, offered talks given by its field
representatives to local groups at which stereopticon slides illus
trative o f its work were shown. These pictures were also given
publicity through the courtesy of motion-picture houses.
The Children’s Bureau o f Philadelphia, a -member o f the Phila
delphia Community Chest, had. prepared six sets o f stereopticon
slides showing housing conditions under which their children had
lived in the city o f Philadelphia before placement, weight charts o f
89 See issue for March o f Community Fund News No. 16, “ Caring for dependent chil1923) • Y James Fitzgerald, General Secretary, Society St. Vincent de Paul (Detroit,

2207°— 27------ 7

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TH E WORK OF CHILD-PLACING AGENCIES

undernourished babies, the interiors and exteriors o f boarding homes
in use by the society, and other features pertaining to the organiza
tion o f the work. These slides had been shown at a National Con
férence o f Social W ork and on other occasions. A considerable part
o f the general secretary’s time was given to speaking in various parts
o f the country, a generous contribution on the part o f the board to
the general cause o f child welfare which could be obtained in no
more effective way.
Through its general secretary and other qualified members ox the
staff the Pennsylvania Children’s A id Society had done educational
work throughout that part o f Pennsylvania in which the society
operated. The society had been particularly influential with poorlaw officials and at the time o f the inquiry was actively engaged in
a campaign for a codification o f the child-welfare laws o f the State.
Lantern slides were used by the St. Louis Children’s A id Society
in an effective way in connection with talks to Sunday schools, clubs,
and other organizations. The Christmas carols (see p. 167) primarily
designed for raising money, served also in both their preparation
and^execution as a background for a good deal o f educational work.
The custom o f obtaining financial sponsors for individual children
and the news bulletins issued at intervals by the society were still
other excellent mediums for educational publicity.
.
The New England Home for Little Wanderers had a part-time
publicity person, and addresses were given by the general secretary
and other staff members before church organizations, parent teacher
associations, and other organizations. In 1914 (and continuing an
nually since that date) a tri-State annual conference o f a distinctly
educational character was organized under the auspices o f the so
ciety. During the two days o f its sessions each year social workers
and prominent laymen from the various New England States met
to consider better methods o f child welfare.
The Children’s Mission to Children had for many years used lan
tern slides in connection with its educational work. A t the time of
the study it had just released one o f its most experienced workers
from all other responsibilities to devote her time to publicity work.
Because o f her long-time connection with the society and familiarity
with the details o f its work this worker was in a favorable position
to get across to the public the more subtle aspects o f social case work
as applied to children.
The Boston Children’s A id Society had a publicity secretary on
part time with especially assigned clerical assistance and a definite
portion o f the budget allotted to the work. Bulletins, leaflets, news
paper articles, radio broadcasting, and money appeals were the basis
on which the work was developing.
,.
The Florida Children’s Home Society raised all but a modicum
o f its $110,000 budget by popular subscriptions obtained through let
ters o f appeal to a general mailing list o f more than 75,000 names,
which was very inclusive and representative o f all classes. There
were at the time of the study over 18,000 contributors from a State
having a population o f 968,470. The great bulk o f the support o f
this society came from small contributions. A blotter with an ap-.
propriate inscription sent to school children a few years ago brought
in $8,600. The appeal letters were sent out systematically during

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METHODS OF WORK

the year and were carefully timed. No contributor received a second
appeal during the year, but he was furnished with an annual report
and other literature telling about the work o f the society. News
paper publicity was resorted to as a supplement to the appeal letters.
Incidentally foster homes were sometimes obtained through this
method o f educating the public to give its money.
ST A T E SUPERVISION

The value o f State supervision over private child-caring agencies
needs only to be stated. A full discussion o f its development may be
found in Doctor Potter’s article u State supervision o f placing-out
agencies ” in Foster-Home Care for Dependent Children.40
St. Louis Children’s Aid Society.

The Missouri law required that all child-placing agencies not
under the auspices o f some well-known religious organization, and
all homes receiving two or more children under 3 years o f age for
board, be licensed by the State board o f charities and corrections.
It required further that the board should investigate the condition
o f the foster homes, prescribe and inspect the records, and make
monthly examination o f their officers and agents with power to re
voke licenses o f all organizations and individuals that failed to obey
the provisions o f the act or the rules made by the board. Very detailed rules and regulations governing the physical equipment o f
the homes, and the health, clothing, educational, and recreational
standards o f homes had been drawn up by the Missouri State board,
and these rules were being applied to all foster homes as thoroughly
as the personnel o f the State office allowed. The St. Louis Children’s
A id Society was licensed under these regulations; for lack o f facili
ties in its own office the State board was temporarily waiving the
licensing o f the foster homes.41
The Children’s Bureau of Philadelphia and the Pennsylvania Children’s Aid
Society.

The Pennsylvania State Department o f Welfare, established in
1921, had general supervision over all agencies to which children
were committed, with power to prescribe standards of care. Although
failure to comply with its requirements usually meant reduction
in State subsidies, applications for which were acted on by the
State assembly after investigation by the State department o f
welfare, the State department was aiming more and more to secure
friendly cooperation with the agencies. In this it was succeeding
through its intelligent and sympathetic approach.
The child-caring department of the Society of St. Vincent de Paul of Detroit
and the Michigan Children’s Aid Society.

These two societies were licensed annually by the State welfare
commission, a division o f the State welfare department. Placements,
transfers, and removals o f children were reported to this board.
Adoption homes had to be approved by a county agent, who was
required to visit annually every child in an adoption home. A ll
40 United States Children’s Bureau Publication No. 136, pp. 1 6 5 -1 9 1 . W ashington 1926
41 For rules and regulations of the Missouri board see rules and regulations for the
government o f boarding houses for infants, boarding homes for children and childplacing agents and agencies, adopted by the Missouri State Board o f Charities and Cor
rections, Aug. 18, 1922 (authorized by Missouri Laws of 1921, pp. 1 9 5 -1 9 2 ),

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T H E WORK OP CHILD-PLACING AGENCIES

boarding and free homes were licensed by the commission after in
vestigation by either a State or a county agent. The license stated
how many children each home was allowed to take, and except with
special permission no home was allowed to receive more than two
infants under 1 year old.
The Jewish Home-Finding Society of Chicago.

This agency was licensed annually by the Illinois State Department
o f Public Welfare, but only one inspection had been made m the five
years preceding the study, at which time all the boarding homes had
been visited. Quarterly reports were made to the State department
o f all newly approved and discontinued homes, and the agency was
required to report all placements. Under the law the State had
powers o f visitation and removal o f children when the placing agency
after receiving due notification had taken no action to this end.
The Massachusetts societies.

A ll incorporated agencies in Massachusetts are required by law
to make an annual report on blanks supplied by the department o±
public welfare. Failure to make such a return for two consecutive
years constitutes ground for a dissolution o f the trust by the Su
preme Court. Unlike the supervision provided for m the other
States represented in the study, the Massachusetts Department o±
Public Welfare exercised annual supervision and inspection only over
such incorporated charitable organizations as consented to this overS1^The New England Home for Little Wanderers (so far as its work
lav in Massachusetts), the Children’s Mission to Children, and the
Boston Children’s A id Society were all eager to further inspection o±
their work and made their records and foster homes accessible to the
State representative. This representative, at the time of the study,
was a college graduate, trained in social work and with a ripe social
experience. After study o f an agency’s work her report was sent
directly to the board o f directors and contained constructive and
helpful suggestions. Foster homes in Massachusetts were not subject
to license or inspection; but children o f under 2 years, who were
placed either free or for board, must be reported to the division ot
child guardianship o f the department o f public welfare, both by the
person or society placing and by the foster mother receiving them.
These children were thereafter subject to visitation by a representa
tive from that department (a graduate nurse). I f the home was not
giving the proper care they could.be removed by the State department.& None but a licensed home was allowed to take more than one
such baby, and then, with very rare exceptions, only two.
The New England Home for Little Wanderers, chartered to work
in the six New England States, was affected differently in the d if
ferent States. In Maine, where two branches existed, the society was
licensed annually by the State board of charities and corrections.
Homes in which more than two children were boarded were licensed
by the same board, these homes being visited annually or oftener by
a State representative. In Connecticut, where the society also had
established a branch, recent legislation just being put into operation
at the time o f the study required licensing of homes but not o± the

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METHODS OP WORK

placing organizations, though an annual report o f the organization
was to be filed with the bureau of child w elfare o f the State department o f public welfare.
The Children’s Home Society of Florida.

Florida had no State welfare department and no State super
tion o’f bnUtSt»t s^ lety w®s trying to obtain legislation for the crea
tion o f a State department o f public welfare, and hoped that this
r e ^ c ? d T c t S llShed thr°Ugh ^

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appointed*chil-

D E S C R IP T IO N S Ô F T H E IN D IV ID U A L A G E N C IE S 1
T H E B OSTON C H ILDREN’S A ID SOCIETY
History and form of organization.

The Boston Children’s A id Society was organized in 1863 and in
corporated in 1865 “ for the purpose o f providing temporary homes
for vagrant, destitute, and exposed children and those under crimi
nal prosecution o f tender age in the City o f Boston and its vicinity,
and o f providing for them such other or further relief as may be
advisable to rescue them from moral ruin.” Much o f the earlier
work was done because the State provided no facilities for giving
the necessary care.
. , ,
„ .
, .,
At one time the society maintained three small homes outside Bos
ton. One o f these was a small farm, purchased soon after the so
ciety was organized, in West Newton, known as Pme Farm. This
was a training farm for wayward boys, and during the 32 years ot
its existence took care annually o f from 20 to 25 delinquent and
truant boys, ranging from 10 to 14 years o f age. The staff at the
farm consisted o f the superintendent and his wife, a schoolmaster,
an assistant matron, and the farmer and his wife. As this was a
training school for the boys, the placing-out workers of the society
kept in close touch with them, and placement m foster homes was
made as soon as possible. In order that Pine Farm might not become
too large, a second farm known as Rock Lawn, m Foxboro, was pur
chased in 1896, and this continued in use until September, 1899. A
similar but smaller training farm was maintained at Weston tor a
brief period following March, 1888.
, ,
As the needs in the State changed and the State training schools
developed these homes were given up. A t the time o f the purchase
o f the West Newton farm commitments to the Deer Island House ot
Correction with older and hardened offenders was the only method
of dealing with wayward boys. Later the Berlin department for
vounger boys was established by the State as an adjunct to the in
dustrial school, and the city truant school was transferred from
Deer Island and established on a cottage plan under the name ot the
Parental School. In addition to these State measures making the
work on the farms unnecessary the preventive probation work by
visitors o f the society in cooperation with the court lessened the need
for the training schools, and the encroachment o f city developments
changed the suitability of the location o f the farms.
.
The Boston Children’s A id Society, always interested in proba
tion work for juveniles, was with other organizations instrumental
in having a special judge appointed from the Boston municipal
court for the hearing of juvenile cases. This resulted m the estab
lishment o f the Boston juvenile court in 1906. The society has
1 The sections on health supervision under eight o
fin d H o m e

f o ? L U r i l W a id e re fs and the Florida Children’ s Home Society was not

studied in detail.

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DESCRIPTIONS OF THE INDIVIDUAL AGENCIES

continued to show its interest in the delinquent child by providing
for the Boston juvenile court a group o f temporary detention
homes.2
The greater part o f the agency’s work for a long time had been
accomplished through the placing o f dependent, delinquent, and,
later, problem children in private families rather than in institutions.
In this work the society has earned a reputation as a pioneer.
In 1915 a trust fund, netting the society about $9,000 annually,
became available through the discontinuance o f the Gwynne Home,
an institution formerly maintained for temporary and emergency
care o f children. In 1916 the Massachusetts Babies Hospital was
merged with the society, the work o f the two agencies being similar
in many respects. Since 1915 the Huntington Institute, originally
designed to provide institutional care for orphaned children, has
functioned exclusively through this society.
Formerly confining its activities to children living in the city o f
Boston and its immediate vicinity, the society has expanded its field
o f work in response to the demands made upon it, until to-day
the territory served covers a large part o f Middlesex County and
extends to a few towns 30 miles or more away from Boston. This
extension o f service was largely influenced by a cooperative arrange
ment among some 8 or 10 child-placing societies located in Boston
and in other parts o f the State. Under the plan these societies held
themselves jointly responsible for the child needs o f every village
and hamlet, as well as the large cities in the State.
In the spring o f 1923 a federation was effected of the Boston Chil
dren’s A id Society and the Boston Society for the Care o f Girls, an
organization with a background o f 100 years o f institutional and
placing-out work in Massachusetts. The name o f the new organiza
tion is the Children’s A id Association. A t the time o f this study
the two societies were functioning separately, although a central
committee had been established and one general secretary was serv
ing the two agencies.8
Throughout its 60 years o f existence the Boston Children’s Aid
Society has had the deserved reputation o f being a leader in childwelfare movements, not only in Massachusetts but throughout the
country. Its board o f directors has always been ready to lend the
services o f its executive secretary or members o f the staff, as occasion
required, to help sister organizations develop and extend their work.
The president, vice president, treasurer, and clerk, together with
the honorary vice presidents and members o f the board o f directors
are elected annually by the corporation and form the governing body
o f the society. A t the time o f this study 11 men and 10 women were
on the board in the membership o f which Metropolitan Boston4
was.largely represented. Meetings o f the board of directors were
2 Durham, Elizabeth P. : “ Boston’s child system .”
The Survey, Voi. X L V , No. 7
(Nov. 13, 1 9 2 0 ), pp. 2 5 0 -2 5 1 ; Juvenile Courts at W ork, a study o f the organization and
methods of 10 courts, by Katharine F . Lenroot and Emma O. Lundberg, pp. 7 8 -8 7 .
U. S. Children’s Bureau Publication No. 141. Washington, 1925.
8 Since the study the two societies have combined their case-work functions and
operate under the name o f the association. The association has j'oined w ith two other
children’s societies in establishing offices in one building.
4 Metropolitan Boston includes the towns and cities outside the city proper which
are under the Metropolitan district commission in charge o f parks, water, and sewerage
for the territory (M ass., Laws o f 1919, ch. 350, sec. 1 2 3 ),

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TH E WORK OF CHILD-PLACING AGENCIES

held monthly except during July, August, and September, and special
meetings were called when occasion demanded.
The board was particularly active through the following commit
tees: (1) The revenue committee, charged with the raising o f the
money and the approval of appeals prepared by the financial secre
tary, met irregularly on call, and consisted o f two men and one
woman; (2) the finance committee, composed o f six men responsible
for the investment of the funds, met irregularly on call; (3) the
central committee, a very strong and important committee with a
membership o f eight (four men and four women), met monthly, and
oftener when occasion demanded, passing on special^ expenditures
and policies, subject to the board’s approval except in matters of
emergency, when it had authority to act; (4) the investigation com
mittee, which considered problem cases referred to it by the investi
gating department, met biweekly, and its membership consisted o f
two men and four women; (5) the piacing-out committee, which
functioned for the department o f placing out in the same manner
as the investigation committee for the investigating department, met
in alternate weeks and was composed o f three women and one man.
Staff organization.

The staff was organized under the direction o f the general secre
tary in three main divisions: (1) Department o f advice and assist
ance; (2) home-finding department; and (3) department o f foster
home supervision. Frequent interdepartmental consultations were
held in relation to particular problems, which produced well-directed
and coordinated plans for the care o f the children and their families.
These consultations were the more readily held because of the physi
cal proximity of the two departments, as well as the comparatively
small units dealt with. The spirit of the staff, hard to define, was
one o f the outstanding factors in the success of the organization; an
esprit de corps was superimposed on qualities o f character, fitness
for the job, and technical training that was evident to one who con
ferred with the staff members, read the records, and listened in on
informal conferences as the day-by-day problems arose.
Social education of workers.— The society cooperated with the
Simmons College School o f Social W ork in training students as
signed to it for their field work, which was planned by the three
departments of advice and assistance, home finding, and supervision
o f placed-out children. The work assigned to the students was se
lected on the basis o f their needs, and care was taken that they should
not be used to do errands or act merely as substitutes. The super
visors gave a good deal o f personal time to this work, discussing
policies and making effective correlation between the field and
the academic work.
The general secretary always, one supervisor generally, and
frequently one or two visitors were sent to National and State con
ferences o f social work, all expenses being paid by the society, which
looked -upon these occasions as an opportunity for staff development
and the strengthening of the society’s own work, as well as a chance
to pass on its own experience to other agencies.
Finances.

The income o f the society was derived in about equal amounts from
four main sources: (1) Endowment, inclusive o f the Gwynne Home

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DESCRIPTIONS OP THE INDIVIDUAL AGENCIES

and the Massachusetts Babies Hospital trust funds; (2) reimburse
ment from parents and relatives; (3) subscriptions and donations;
and (4) miscellaneous funds, the largest part being income from the
Huntington Institute funds.
The amounts received from subscriptions and donations were
obtained through a careful system o f follow-up o f contributors and
through general publicity o f an educational character under the
direction o f a paid publicity agent, who gave half time to the saciety.
O f the total disbursements o f $128,073.26 for the fiscal year 1922,
nearly $107,000 was spent in direct service to children (their board
alone cost about $51,700; clothing, $7,700; medical care, $6,800); and
the salaries o f visitors and nurses amounted to a little over $31,500.
Types of work undertaken.

The division between public and private agency care in Massa
chusetts is not absolute. In general the Boston Children’s Aid
Society took cases which the State was not equipped to handle,
through lack o f either statutory power or administrative machinery,
or which were o f an experimental nature. Long-time dependency
cases were refused usually unless some special physical, mental, or
social problem was involved requiring more money and supervision
than a public agency was prepared to invest.
The division o f work between this society and the other private
child-placing agencies was by (a) a territorial agreement whereby
the State was districted (see p. 8 ); (5) agreement with certain sec
tarian organizations—such as Jewish, Roman Catholic, and Protes
tant Episcopal—not to handle their cases except by special arrange
ment; and (c) specialization by the Boston Children’s A id Society
in the care o f infants, unmarried mothers, and older delinquent boys.
Placement in foster homes and children’s aid were the main types
o f work carried on by the society. By placement is meant all types
o f foster-home care, boarding, free, and wage homes being included
in the definition. By aid work is meant planning and assisting the
families o f children, not only of those received for placement but o f
those who are guided and advised, the latter constituting an im
portant part o f the work o f the bureau o f inquiry.
As a rule, girls 20 years o f age or over and boys 18 or over were
not received for placement or aid. This age restriction was set aside
in the cases o f unmarried mothers, one record showing very intensive
work done with a mother 40 years old. Definitely feeble-minded
children and bed patients needing hospital care were excluded.
Inquiries from child-caring agencies in other cities affiliated with
the Child Welfare League o f America were investigated by this
society on the district plan.
Two special features o f the work o f the society were court foster
homes, and home libraries.
Court homes.5— Eight court foster homes were maintained within
the city limits, largely for the use o f the Boston juvenile court.
These homes were carefully selected with a view to intelligent and
strict oversight o f children, either on continuance from the juvenile
court or being held for a hearing. A subsidy averaging $14 per

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TH E WORK OF CHILD-PLACING AGENCIES

month was paid to these homes, plus $2.50 per diem per child for the
first three days and $12 a week thereafter. The rate of subsidy
depended on the type o f service rendered as well as on the foster
family’s financial condition. Ordinarily the families were full^
self-supporting. In one case, however, a home in receipt o f mothers’
aid was used, and the society watched the budget with great care,
adjusting its subsidy from time to time to meet the situation. A
telephone had been installed and was paid for by the society in two
o f the homes. Clothing and medical attendance were provided. On
her side, the foster mother was selected because she was “ forceful,
resourceful, and understanding,” and agreed that some one would
always be on hand to receive a child, day or night. One child to a
home was the preference, and invariably every child was given a
separate room.
#
.
The- Boston juvenile court, which reimbursed the society tor this
service on a per capita basis for board and clothing but not for sub
sidy might place a child direct in one o f these homes, immediately
notifying the office o f such placement. The homes were also loaned
on occasion to other agencies for their temporary use, and a very
generous attitude o f cooperation was maintained in this respect.
During the fiscal year preceding the study, 156 children were in
these court homes a total o f 802 days. Ninety-six came from the
Boston juvenile court, 53 were wards o f the society, 7 were children
under supervision of other agencies. The total cost for this service,
exclusive o f medical care, clothing, and incidentals, but inclusive o f
subsidies and board, was $2,783.60. The experience o f the society
based on an extended use o f this type o f home indicated that better
individual care, protection, and individualization can be assured chil
dren in these families at less cost than where a detention home is
maintained.
t
Home libraries.— For 25 years the society has supported a library
service in lending books to children in their own homes. Small
clubs o f 8 or-10 children had been established in different sections
o f Boston. One child in each club was constituted librarian and
a selected number o f books placed in his home and from there lent
to neighbors. Once a week the children’s aid supervisor, either per
sonally or through a corps o f volunteers, met with these clubs to
direct their reading. Incidentally the supervisor made helpful con
tacts on the social side. The development of home recreations, which
were by no means always confined to reading, was the contribution
made by these home libraries’^clubs, in which mothers and older
brothers and sisters sometimes joined.
Terms of acceptance.

Since Massachusetts laws do not allow courts or overseers o f the
poor to commit children to private organizations, no children were
so received by the Boston Children’s A id Society. Children before
the juvenile court on charges o f neglect and delinquency were some
times placed with the society on court continuance. Beports were
then made at stated intervals to the court’s probation officer who
had the ultimate responsibility o f the child and could surrender
him to the court when occasion warranted.
A child rarely was received on parental surrender, which trans
fers from the parent to the society the right to consent to adoption.

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DESCRIPTIONS OP TH E INDIVIDUAL AGENCIES

More often guardianship was given through the probate court to a
representative o f the society, usually the general secretary. B y far
the largest number o f children in care came without transfer of legal
control from the parents.. In a few cases the control was vested in a
guardian other than a representative o f the society, or no control
might be established in the case o f full orphans, when, however, it
was customary in such cases to have a guardian appointed.
Financial reimbursement by parents or other guardian was not a
requirement, but it was given weight in connection with the accept
ance o f a child. Lump-sum payments, whether from parents or in
the form o f subsidies, were never received. Periodic payments from
parents and other relatives were encouraged. These were based
on a careful estimate o f the financial situation in every case. Occa
sionally a private agency, church, or club paid for a child in whom it
had a special interest. In the same way a few overseers o f the poor
reimbursed the society for the board o f children for whom they de
sired some special form o f care which could not be obtained through
the division o f child guardianship o f the Massachusetts Department
o f Public Welfare.
The placing-out visitor was responsible primarily for the enforce
ment o f these financial agreements. She determined when read
justments should be made, and when a visit rather than a dun or
a personal letter was likely to bring better results from delinquent
relatives. It was on her initiative, also, that accounts in arrears were
referred to the Legal A id Society, which agency cooperated for an
annual fee in the law work o f the children’s aid society. This visitor
conferred with the representative o f the Legal A id Society as to
when, i f at all, a case should be brought into court, either for criminal
prosecution under nonsupport procedure i f the child was still in a
foster home, or under civil procedure i f he had been returned to his
parents or had otherwise left the society’s care.
The full cost o f board was paid by the parents or other guardians
for 9 o f the 93 children received in 1922; for Q4 children part o f the
board was paid; and for 20 children the society received no reim
bursement. Fully one-quarter o f the total income o f the society
came from parents, relatives, and guardians.
Investigation prior to acceptance.

The investigating staff consisted o f a supervisor and five case
workers, four o f whom were assigned work in the field. The original
applications all passed first through the hands o f the fifth worker
who made such adjustments as could be effected through office inter
views and correspondence. The applications which could not be so
adjusted were then referred to the field investigators. The results
o f this course had proved very valuable, offering distinct advantages
over the methods in vogue in most agencies, where applicants are
first met and interviewed by a clerk without social-work training.
A feature of the thorough preliminary investigation was the definite
plan made when the child was received, and the precise way in
which this plan was entered on the record.
Agreements for board payments by the parents or relatives were
made in writing when a child was received, these being based on a
study o f the family income in relation to its budget. Such agree
ments were subject to change when conditions warranted.

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TH E WORK OF CHILD-PLACING AGENCIES

In the investigation emphasis was from the outset on the main
tenance or establishment o f good family life rather than the place
ment o f the child, and no reasonable effort was spared to keep or
place him with his own family provided a fair chance existed for him
to make good there. Such agencies as the Family Welfare Society,
Baby Hygiene Association, and other organizations working directly
with the family were called upon to supervise these adjusted cases.
In places outside o f Boston where no agency existed for the purpose
and no individual could be enlisted to supervise, the Boston Chil
dren’s Aid Society considered itself responsible not only for making
a plan but for carrying out the supervision.
Foster-home finding and placement.

Foster homes were sought out and investigated by three special
visitors working under a supervisor o f home finding. These four
workers devoted all their time to this work, thereby developing a
high degree o f skill in selecting the proper persons to act as foster
parents. Their energies were not diverted by pressure from problems
connected with the children themselves, as is likely to be the case
where the visitors have a dual responsibility o f home finding and
after-placement supervision.
The society had eight visitors in the child-placing department,
three o f whom were nurses.
A ll children accepted for placement by the society were placed
in foster homes. (For definition of foster homes as accepted by the
society see p. 2.) O f 342 children accepted within a given period
102 (29.8 per cent) were first placed in the special homes maintained
by the society, the others being placed at once in regular foster homes.
O f the 102 children 71 were relocated within a month; all but one
child left the special homes within five months, and that one stayed
between six months and one year.
The society had 17 instances o f two unrelated children in the same
foster home, 3 instances o f three unrelated children, and in 1 instance
four unrelated babies- (two under 2 years and two over 2) were in
one home. In some instances the society had placed as many as five
or six related children in one foster home.
Great care was exercised in introducing a child to this home, and
under no circumstances was he sent alone. Occasionally the foster
mother might call at the office for him, but generally his visitor took
the child personally to the home, having previously planned with the
family for his reception. Sometimes a visitor stayed several hours
to make the adjustment easy and natural.
Foster-home visits.

Children were usually revisited within a few days o f their place
ment, especially i f the foster home was one never before used. In
cases where difficult situations arose, visitors made repeated home
visits, as often as every week or 10 days, and sometimes over long
periods o f time. The need in each child’s case formed the basis for
decision, and no rule existed except that it was expected that children
would not go unvisited for more than two months. Children were
assigned to visitors because o f that visitor’s special abilities to handle
their type; any territorial considerations were subordinated to the
need ot continuous oversight by some one person who knew how to

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DESCRIPTIONS OF TH E INDIVIDUAL AGENCIES

handle the child. With the increase in care in the selection o f the
home in the first place, greater relaxation in routine visiting was
found possible, which with certain safeguards was beneficial to the
child.
Education.

The school was visited by either the visitor or the foster mother.
I f by the visitor, she took pains to safeguard the child’s position in
the community. Visits were not made at stated intervals, but the
teacher was seen several times during the school year, and much
oftener if a special educational problem was involved. The purpose
of the visitor’s report on the school progress of a child was to de
termine: (1) Whether the child’s adjustment was good, and if not,
why; (2) his strong and weak points, mentally; (3) future policy
with relation to the child’s particular educational needs.
The aim was to provide all the education that a child was capable
o f assimilating and o f the sort adapted to his mental make-up. Most
o f the children went through the grammar grades, many to high
school, and a few were being helped to go to college.
Religious training.

Children placed in foster homes were expected to attend the Sun
day school and church o f their own faith within the three major divi
sions—Jewish, Roman Catholic, and Protestant— and foster mothers
were urged to attend with them.
Allowances.

Younger children received allowances through the foster mothers,
who usually gave them in return for small duties performed by the
children. These were budgeted carefully for church, recreation,
gifts, and savings. When the foster mother was unable to provide
an allowance herself, it was charged to the society. Older children
earned spending money, which they were helped to budget by the
foster mothers as well as by the visitor.
Recreation.

The policy o f the society was to provide the child with wholesome
recreational opportunities within his own oommunity. In this mat
ter, as in others, the work was accomplished as far as possible through
the foster family, the society steering and advising in the back
ground. The therapeutic value o f play was recognized, and skates,
tennis rackets, and other equipment were provided when their need
was indicated.
Clothing.

The Boston Children’s A id Society, in collaboration with the
Bethesda Society and the Church Home Society, employed a cloth
ing purchaser. A joint stock room was maintained from which
children were originally outfitted with clothing suited to the season
and the social grade o f the foster home to which they were to go.
Semiannually the visitor inspected the child’s clothing with the aid
of the foster mother, and necessary replacements were made, out
grown articles in good condition being returned to the office. No
distinction was made between boarding and free homes in regard
to clothing, except in the case o f adoptive homes, where the responsi
bility for dressing the child was left with the foster parents. In
addition to being responsible for the stock room, the clothing pur
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100

T H E WORK OF CHILD-PLACING AGENCIES

chaser made selection o f articles not kept in stock that were needed
by the children. The system was elastic and did not interfere with
the visitor’s relation to her child. I f a visitor desired to shop per
sonally with an older child, this was specially arranged as in the
case o f the older boys who had a man visitor. Most o f the girls,
however, preferred to shop with the “ specialist,” as they called her,
and it was interesting to note that this purchasing agent, conversant
as she was with materials and styles, had gained the cooperation of
some o f the girls to a marked extent and had reeducated several in
matters o f dress.
Health supervision.

The staff o f the preventive clinic o f the Boston Dispensary 5a (sup
ported jointly by the Boston Children’s A id Society and the Church
Home Society), three registered nurses, a social worker, and a cleri
cal assistant did health work for the society. The society also paid
for the part-time service o f a physician from the Boston Dispensary
for physical examinations o f older boys; and a physician from the
Society for the Prevention o f Cruelty to Children made gynecologi
cal examinations in court cases and gave expert testimony before the
court when necessary. The three registered nurses were members o f
the staff o f the society (child-placing department), o f whom two were
engaged in the actual supervision o f children under 3 years o f age
in foster homes and the third acted as supervisor o f the medical work
in the office and did social work with the babies families. The super
vising nurse was a college graduate and had had 10 years’ experience
with the society and in hospitals; the two nurses engaged in visiting
babies had each been with the society three years, one o f them having
had additional experience in public-health work.
O f 93 children accepted for care by the society in the year ended
September 30, 1922, 16 were health problems and 10 behavior prob
lems (about 28 per cent). On M arch-31, 1923, o f 300 children in
care, 58 were health problems and 89 behavior problems (about 49
per cent).
Routine health, examinations.— On admission to the society every
child was given a complete physical examination by the preventive
clinic. Curable defects were given prompt attention, and the child
frequently was kept in a temporary foster home until important
corrections were made, especially if the selected permanent home
was at a distance from the clinic. Thereafter he was kept under
regular observation by the clinic, returning for examination every
four to six months or oftener if the need was indicated. The date
for reexamination rested with the pediatrician in charge of the
clinic. Babies were visited weekly in their foster homes by the nurses,
and their charts were presented to the physician at the clinic at a bi
weekly conference. The babies were brought to the clinic if the phy
sician so directed.
Mental examinations.—Mental examinations were not routine.
A ll the mental work for the society was done free o f charge by the
Judge Baker Foundation, the Boston Psychopathic Hospital, the
5a The director of the preventive clinic w as also superintendent of the children’ s
department of the Boston Dispensary.
A woman full-time physician on the staff of
the preventive clinic worked largely with the feeding problems of the babies o f the two
societies supporting the clinic.

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DESCRIPTIONS OF TH E INDIVIDUAL AGENCIES

101

Habit Clinics for Preschool Children, and the Waverly School for
the Feeble-minded. Owing to the fact that many o f the children
received presented delinquency or personality difficulties, mental tests
were given to a large number o f children over 4 years o f age. Fre
quently the examination was made before the child was placed in care
o f the society or while he was under observation in a foster home.
The society cooperated very closely with the Judge Baker Founda
tion, which referred many o f its problem children for placement by
the society and gave reciprocal service by testing difficult children
brought to the clinic by the society’s visitors. Unmarried mothers
were as a rule given careful personality study, usually by a psychol
ogist or psychiatrist.
Records.—A form signed by the parents or guardian when a child
was admitted to the society giving permission for hospital treat
ment, a form giving the family and personal history of the child
for use on the first visit to the preventive clinic, and the physicalexamination blank used at the clinic were filed with the child’s rec
ord. Visits to clinics or home visits by a physician were mentioned
usually in the record, and also notation o f visits to hospitals for op
erations, accounts o f interviews with and reports from psychiatrists,
written reports o f mental examinations, results o f examination and
diagnosis by the preventive clinic, with the dates for return o f child,
laboratory reports, and reports o f X -ray examinations were filed.
The reports from the clinic were filed in a small folder at the back
o f the case history; after a child had reached 3 years of age his
weight chart and clinical charts were filed with the case in a separate
folder.
Health standards for foster home.—In placing children the
problem o f health was given first consideration; recommendations
regarding placement made by the physicians at the clinic in view
o f the child’s physical condition were carried out always, and the
recommendations made by the Judge Baker Foundation and the
Psychopathic Hospital regarding problem children were carried out
as closely as possible. The society had two standards for boarding
homes, one for those in which babies were placed and one for homes
for older children. Babies could be placed in homes in the city if
there was a porch, and separate sleeping quarters were not required
if arrangements could be made for placing a crib in the sleeping
quarters o f the foster parents. The society furnished cribs when
necessary. The foster mother was required to be a woman o f in
telligence who could follow directions faithfully in regard to the
feeding and care o f the baby. An amount in addition to the board
paid was supplied for the purchase o f milk; special foods, if re
quired, and dextri-maltose for the preparation of the baby’s formula
were supplied by the society. These foster mothers were instructed
in regard to feeding, bathing, and general care of the baby by the
nurses who visited the homes each week.
A written copy o f the
formula for the baby was furnished. Each mother was asked to
visit the clinic so that the clinic physician might talk to her in regard
to her child.
Most older children were placed in homes in the suburbs, or in a
city house with a yard. A separate room was required in most in
stances, or in the case o f small children separate beds in the same room

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might be allowed. No arrangement was permitted whereby a child
would sleep in a dining room or a living room. Unless the house was
on a farm in the country, it was required to have inside plumbing and
a bathroom. The visitors instructed the foster mothers in the care
o f the older children and were responsible for seeing that the in
structions were carried out. The health o f the foster family was
inquired into carefully before the home was selected for placement
by the investigator, not only through the information obtained
from the family itself, but through a personal interview with the
family physician and through independent references.
Corrective work o/nd social treatment.—The corrections o f defects
and treatment to be given at the Boston Dispensary were arranged
for by the social worker o f the preventive clinic, and the dates for
the return o f children were given to the society’s visitor, who was
responsible for returning the child on the appointed date. The
preventive clinic also arranged for hospital care for all children
under 12 years o f age at the Boston Dispensary. Children over 12
requiring hospital care were entered at other hospitals, arrange
ments being made by the society’s visitor. The City Hospital, the
Homeopathic Hospital, and the Massachusetts General Hospital were
used most frequently. Each visitor was responsible for obtaining
the necessary treatment for each child in her care.
Children served by the preventive clinic were automatically given
treatment in the other clinics o f the Boston Dispensary under the
direction o f the head o f the preventive clinic.
A ll dental work for the society was done at the dental clinic o f
the Boston Dispensary. Children’s teeth were examined and put in
good condition upon admission and were reexamined at intervals of
six months thereafter. In the case o f a child living too far from
the clinic to be brought for treatment a local dentist was used, the
society paying the bill. A ll eye work, X-ray, and laboratory work
were done at the Boston Dispensary.
Children with active tuberculosis were not accepted by the society
but were referred to the State sanatorium. In suspected or arrested
cases children were placed in foster homes and given special super
vision with, special diet according to the recommendations o f the
clinic. Children with gonorrheal infection were placed in temporary
homes without other children and were treated under the direction
o f the clinic physician. I f hospital treatment was necessary, chil
dren with a city residence were sent to the Homeopathic Hospital
or to the City Hospital ; State cases were sent to the State institu
tion at Tewksbury. The society did not accept children showing
a positive Wassermann reaction with open lesions. Children with
out lesions were placed in foster homes and sent to the Boston
Dispensary for treatment.
Orthopedic cases were accepted, i f they were not bed cases, and
cared for at the Boston Dispensary. Neurological cases were cared
for at the dispensary, but mental cases were referred to the Judge
Baker Hospital or the Psychopathic Hospital. Cases o f contagious
disease were cared for at the City Hospital, at local hospitals, or in
the foster homes.
In cases of illness o f children in foster homes in the metropolitan
district the foster mother notified the society and the clinic physician

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visited the child, except in an emergency when the nearest physician
was called. Outside the district a local physician was used, the
foster mother reporting the illness immediately so that the clinic
physician might get in touch with the attending physician. Where
a child required nursing treatment and was too ill to be moved from
the foster home.* or in cases o f contagious disease, a nurse was provided
to care for the child or household help was provided for the foster
mother so that she might nurse the child. The society paid all
charges for outside medical attendance and nursing (the society’s
were used only for the care o f babies). Undernourished
children were placed in special types o f country homes, were given
special diets, were visited frequently, and were returned periodically
to the clinic for observation. The Visiting Nurses’ Association was
called on sometimes for nurses to visit children in foster homes.
Cost of health work.—The society paid a stated amount toward the
salaries o f the personnel o f the preventive clinic and the up-keep o f
the clinic physician’s automobile. The Boston Dispensary furnished
quarters, light, heat, telephone service, equipment, and supplies for
the clinic. Services o f all departments of the dispensary were fur
nished free with the exception o f dental, the society paying for parttime service o f the dentist. A ll laboratory work, X rays, and pre
scriptions were free with the exception o f a few special medicines
that were charged for at cost. Glasses were furnished at cost and
braces at reduced rates. The society paid for the material for Schick
tests and for toxiil-antitoxin. Children sent to the hospital of the
Boston Dispensary were paid for at the rate o f $7 a week; for tonsil
and adenoid operation, including two nights’ care, $6 was paid. Hos
pital care for children oyer 12 years o f age was sometimes obtained
free o f charge at the City Hospital, if a child was a resident of
Boston, or a free bed was sometimes obtained in other hospitals; if
free care was not available the society paid for the hospital care.
The expenses for medical work o f the society in the year 1921-22
was $6,868.54, of which $5,600 was for the maintenance o f the pre
ventive clinic, and the remainder for outside professional service,
hospital care, special medicines, glasses, etc. The supervising nurse
o f the society was paid $1,550 and the two other nurses, $1,500 each.
The per capita cost o f health work for the year was $16.50, with 416
children in care. Although this expenditure is higher than that of
many other agencies, the health supervision given by the Boston
Children’s A id Society is complete and satisfactory in every way
and the society feels that the cost is justified by the results obtained.
Responsibility of the society.

Final responsibility in all that pertained to the child’s welfare
rested with the society. An exception was made in the case o f pro
spective adoptions, where the society was in the habit of withdrawing
little by little, ultimately leaving the entire responsibility with the
adoptive parents. As boarding, free-home, and wage-home foster
parents became better known, more and more was left to their judg
ment, but this was done cautiously and only when their standard of
essentials was in accord with that o f the society. In minor matters
foster parents were allowed considerable leeway.
2207°— 27------ 8

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Visits by parents to children in foster homes.

Parents and. relatives were actively encouraged to keep in touch,
with both the child and the society. Carfares were allowed for visits,
and on rare occasions foster mothers had been paid for providing
meals and a lodging to parents living at a distance. Permission to
visit had to be obtained through the office, but the rules were elastic,
and when relations were well established between parents and foster
parents direct connections were often allowed. In cases where the
parents’ interest was lukewarm, special efforts were made to revive
it. Under right conditions children were allowed to visit parents for
week ends or holidays. Occasionally it was found that the ihfluence
o f the parents over a child, whether the visits were at the parent’s
home or the child’s foster home, was so destructive that the privilege
had to be withdrawn. This difficulty is more likely to arise in a prob
lem case than in any other.
Family rehabilitation.

From the moment the child was received, unless it was evident at
the outset that his own home should not be maintained, plans were
directed toward its rehabilitation. The placing-out visitor was re
sponsible for this reconstruction process as well as for the supervision
o f the child in his foster home. To this end all the resources o f the
community were called into play, and a very full use made o f other
social agencies.
Follow-up after return of child to his own home.

The society felt a definite obligation toward children returned to
their own homes and for this reason did not discharge them imme
diately they left the foster home. Usually they were continued under
supervision over a period o f several months, the parents’ home being
visited more or less often during that time. Only after reasonable
assurance was given that the situation was comparatively stable was
the child formally discharged. During the follow-up period efforts
were made to connect the child with local clubs and settlements, and
to leave some sort o f supervision over the family which should carry
on after the society had withdrawn.
CHILDREN’S MISSION TO CHILDREN 6b
History and form of organization.

The Children’s Mission to Children was established in 1849 and in
corporated in 1864. Its original purpose was to take children off the
streets and interest them in Sunday schools and evening classes, but
later it was found that placement in homes was a necessary part of
the work. The charter of the society as amended in 1918 states that
the object o f the society is “to institute such methods in behalf o f
exposed and otherwise needy children in the city o f Boston and
vicinity as will promote their welfare and lead to good citizenship.”
In the early period, before the Civil War, a lodging house was pro
vided for working boys, and the early reports o f the society state
that the “ agent walked the streets looking for suitable subjects.”
Bb Since the study was made the Children’ s Mission to Children has consolidated all the
case work o f the society in one department. According to the statement of the general
secretary this method of work furnishes greater continuity o f service and better under
standing by the workers o f all sides of each case. No worker feels that this or that item
is the responsibility of another department and does not concern her.

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Later on a temporary home for neglected and dependent children was
built. It was, however, never the purpose of the society to keep
children for long periods in the institution, but to send them out into
free foster homes as soon as such could be found. From this freehome system the present method o f boarding care was gradually
developed.
In 1924 the board o f directors consisted o f 15 members— 11 men
and 4 women. The men represented a wide range o f interests,
including members o f the legal and medical professions and o f the
ministry, as well as manufacturers, bankers, and stockbrokers.
The board acted on policies and felt a definite responsibility for
money raising as well as the management and investment o f the
funds o f the society. Regular monthly meetings were held except
during the three summer months. In addition, a monthly meeting
o f the board and staff was held which brought the directors into
close relation with the visitors. A t these meetings problem cases
were presented for discussion and advice. Weekly meetings o f the
staff attended by the general secretary, social workers, stenographers,
and clerks were held, at which matters o f general interest in the field
o f child welfare were presented, the members o f the staff taking
turns in being responsible for the conduct o f these meetings.
Quarters occupied by the agency.

The agency owned and occupied a six-story brick dwelling house,
which at the time o f the study had been in use about one year and
had been renovated to suit the needs. It was commodious, light,
airy, and very conveniently located. It was midway between the
two railroad terminals. A self-operating electric elevator connected
all floors. In the basement was a well-fitted room where physical
examinations were made. On this floor also were kept the clothing
supplies. The main office and reception room, and comfortable
space for stenographers and bookkeeper, occupied the first floor.
The general secretary had a room on the second floor which ad
joined the board room. On the second floor also was a small but
well-equipped rest room, where lunches could be prepared and eaten
by the staff. The rest o f the second and the whole o f the third floor
were given over to the departments o f advice and assistance and
placing out, with ample provision for interviewing. The fourth
and fifth floors were occupied by caretakers, a man and wife espe
cially selected on account o f their fitness to provide temporary care
for children staying short periods. During the period studied these
quarters were used for only seven children, all o f whom stayed less
than one month. Children held in the office for a few hours were
also cared for there. Two rooms on the fifth floor were kept
exclusively for this purpose. Separate toilet and bathing facilities
had been provided tor the children. The whole atmosphere o f the
building was agreeable and gave the applicants opportunity for
quiet and privacy, thus facilitating the work o f the office and making
for better social contacts.
Finances.

The Children’s Mission to Children was the special interest o f the
Unitarian churches in Boston, and about one-fourth o f its income
was contributed by Sunday schools and church societies. Educa
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TH E WOEK OP CHILD-PLACIN'G AGENCIES

tion o f children in benevolence through these organizations was a
prominent feature o f its work. The rest o f the income was derived
from endowment, from reimbursement from relatives, and from gen
eral subscriptions. No money was received from any public source.
Though financial reimbursement was not an essential feature of
the intake, it was important from the practical side, especially in
view o f a temporary restriction on intake. For more than onethird o f the children in care during the year prior to the study no
reimbursement whatever was received; one-half paid part board,
and less than one-sixth paid full board. During the year before
the study the agency had been obliged to curtail its intake and to
limit its service to cases previously known to the society or to those
children for whom no other provision could be made by any other
agency. The only other recourse would have been materially to re
duce the quality o f its work, and this the directors refused to do.
This intake limitation has since been abolished.
Types of work undertaken.

In addition to general child-placing work rendered to a prescribed
territory, under a plan o f cooperation entered into with a group o f
agencies doing a similar work (see p. 8), the agency rendered a
very special service through its “ medical homes ” ; into these homes
children were received from hospitals for posthospital care. This
specialty had been carried on for nine years and was duplicated
by no other agency. Plaster-cast recumbents, children with ambula
tory bone lesions, and other types needing frequent hospital observa
tion and treatment and lacking proper homes or living at a distance,
were cared for in these homes. (See p. 111.)
An occasional service was given out-of-town societies by caring
overnight for one o f their children in the temporary home main
tained on the fifth floor o f the administration building.
Children under 2 years o f age were not taken for foster-home earn
(another agency in the field specialized in children under that age)
unless they were members o f a family group, nor were feeble-minded
children received except in rare instances and then only as a step
toward institutional care. The agency made no age, sex, racial, or
sect limitation, but delicate children in casts, on crutches, in wheel
chairs, with heart, choreic, and other physical limitations were the
types specialized in by the society.
Foster-home finding and placement.

The care with which decisions were made in accepting children for
foster-home placement was exemplified by a case in which applica
tion was made for the placement of one child only, and the investi
gator recommended that all five children in the family be placed.
In another instance, where two months’ care was requested, 15
months’ care was given, showing the pains taken to see a case
through, once the responsibility was assumed. O f 667 applications
received in one year, 167, or 25 per cent, were accepted to place the
children in foster homes. Painstaking work on the other cases re
vealed the possibility o f adjustments that were better for the chil
dren, and which often meant establishment with parents or relatives.
.Children were placed on reception either in the temporary home
or directly in foster homes. Very few, however, went to the tempo-

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DESCRIPTIONS OP TH E INDIVIDUAL AGENCIES

§n

rary home. A ll children received during the six months prior to
the study period had gone directly to their foster homes.
Except in their special medical homes where as many as 10 unreM ed children were placed frequently, the Children’s Mission to
Children usually placed their unrelated children individually. A t
the time of the study this agency had three unrelated children each
in two homes and two each in three homes. The agency reported 41
related children in 17 homes as follows: Two children each in 13
homes, three children each in 2 homes, and four and five each in
2 others.
Foster homes were investigated by one visitor who gave her time
almost wholly to the work, though she supervised in addition a
group o f 13 placed-out children, largely to give perspective to her
major job. These homes were mostly boarding homes, with a very
±ew_adoptive, free, and wage homes. The free and wage types were
used almost exclusively for older boys and girls attending school, or
earning their own support.
The society has looked upon its foster parents as an extension
department o f its work, and by this means has called forth much
loyalty and devotion from them. An annual foster mothers’ meet
ing was a feature, and this tended to encourage a feeling o f fellow
ship on their part. The ultimate responsibility, however, has
always rested With the society, and the visitor was constantly re
minded that it was her obligation to guide the foster mothers.
Replacements.

Permanency in a foster home has always been recognized bv the
as
desirable; it has appreciated also that most o f the
children came with a problem which exacts very special provision
but that the problem was likely to change from time to time. A bov
with osteomyelitis, for example, required expensive care in a medical
home over a period o f years; at the age o f 16 he had come to the
point where he could go on crutches. His vocational needs were
then paramount and the society placed him in a city home where he
could attend a day school for crippled children. It was far better
for him to be thus relocated than for the statistics on replacements
to make a better showing at his expense.
The following table shows the number o f placements made in the
cases o f children who on June 23, 1923, had been under care for the
specified periods o f tim e:
P l a c e m

e n t s
t o

a d e

i n

C h i l d r e n

t h e
o n

c a s e s
J u n e

Time under care

Total children.
Less than 1 year____
1 year, less than 8___
8 years, less than 16..

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o f
2 3 ,

c h i l d r e n
1 9 2 3 ,

f o r

u n d e r
t h e

c a r e

s p e c i f i e d

Total

138
30
96
12

o f

t h e

C h i l d r e n 's

p e r i o d s

Still in
home in
which first
placed

o f

t i m

Replaced
1-2 times

i s s i o n

Replaced
3-9 times

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T H E WOBK OF CHILD-PLACING AGENCIES

Clothing*.

The Children’s Mission to Children kept on hand a stock o f under
clothing in a room devoted to the purpose. Much o f this was bought
at wholesale, though church organizations contributed their quotas.
Individual things such as dresses, suits, shoes, and hats, were bought
by either the visitor or the foster mother and paid for by the society.
The older children were usually accompanied by the visitor when
shopping.
Education and recreation.

Each visitor had an average o f from 25 to 40 children to supervise.
Close personal attention was possible in the matter o f educational de
velopment, and effort was directed to giving each child the amount
and kind o f training best adapted to his mental equipment. A good
proportion o f the children entered high school, and those with special
aptitude were helped to go to normal school and college. Girls had
been trained for nurses and stenographers, and boys had been taught
trades o f various sorts. One was given a special course in electrical
work, another was learning the plumbing trade, and two others
were being helped to attend law school in the evening.
In selecting the foster homes recreation facilities were borne in
mind, and the visitors were expected to meet individual needs in this
direction, even though it entailed expense to the society. I f music
lessons or membership in the Boy Scouts would help the child’s
career, the cost was not begrudged; it was results that were sought,
and quality rather than quantity o f work was the test applied. The
aim was to place each child in a foster home o f churchgoing people
o f the same general religious faith—Roman Catholic, Protestant,
Jewish—as his parents. Where a family had a strong sectarian pref
erence, this was given consideration in placing children in that
home.
Allowances.

Younger children received allowances through the foster mothers,
who usually gave them in return for small duties performed by the
children. These were carefully budgeted for church, recreation,
gifts, and savings. When the foster mother was unable to provide
an allowance herself, it was charged to the society-. Older children
earned spending money, which they were helped to budget by the
foster mothers as well as by the visitor.
Contact of child with his own family.

Relatives were encouraged to visit in the foster home without
restrictions, unless the privilege was abused. They were further
urged to keep in touch through correspondence with their children.
Except in cases referred by a hospital social-service department or
other social agencies, the society took the initiative in rehabilitating
the families o f the children. Children were not ordinarily dis
charged from care as soon as they were returned to their own fam
ilies, but were placed on a “ perennial inquiry ” list and were there
after followed up at irregular intervals, sometimes over a period o f
several years, to make sure that home conditions were stabilized.
Health supervision.

Two members o f the board o f directors were physicians—one a
surgeon and one a pediatrist. The agency employed a physician

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who came on call to the office to make physical examinations of
the children received for care and who visited children sick in foster
homes sometimes, though such attendance was often given by the
family physician o f the foster family i f it was approved by the
agency. Two visitors supervised the hospital children in their foster
homes and took the children back and forth to the clinics and hos
pitals for treatment and observation. One of these visitors was a
trained dietitian, but neither o f the two was a trained nurse or had
had previous medical experience. No member of the staff devoted his
whole time to health work.
The agency usually did not accept young infants requiring special
feeding, definitely feeble-minded children, children with active tuber
culosis, syphilis with open lesions (unless by special permission from
the pediatrist) or with gonorrheal infection, but accepted children
with any other type o f health problem. About 1914 the Children’s
Mission to Children began to specialize in the care o f hospital chil
dren; that is, children who have been treated in hospitals and whose
condition is such that they are able to leave and would be benefited
by a residence outside the hospital, but who still require more care
and attention than could be given them in their homes and who must
be returned to the hospital at intervals for observation and treatment
The hospital physician retains charge o f the case until it is closed.
This work has been continued and developed and is a special contri
bution to the child-caring work o f Boston.
Physical examination.—Routine physical examinations were given
to all children on reception except those referred direct from hos
pitals (in these cases the hospital furnished the information about
the child’s health required by the agency). The examination was
made by the agency’s physician in the examining room in the base
ment o f the administration building—height and weight were noted,
temperature taken, vision and hearing were tested, and teeth, nose,
and throat examined. Sometimes older girls were taken to the office
o f a woman physician for physical examination, especially when a
pelvic examination was required. Occasionally a hospital child who
could walk was brought into the office and examined before place
ment, but usually the information from the last general examination
made at the hospital was entered on the child’s record and the case
was well followed up with examinations in various clinics at frequent
intervals.
Mental examinations.—Mental examinations were not routine; they
were made usually by the Judge Baker Foundation or the Boston
Psychopathic Hospital. The need for such examinations was de
cided upon usually in conference between the visitor in charge o f
the child and the supervisor o f the foster home care department
based on indications o f backwardness in school, behavior problems,
or bad heredity. Such examinations were made in all adoption cases.
Records. Health items appeared under separate captions in the
case record o f each child; in addition to which a medical sheet was
filed m the record giving the family, personal, and medical his
tory o f the child filled in by the investigator,' on the back o f which
was a printed form for physical examination with diagnosis and
recommendations to be filled out by the examining physician. Ruled
sheets were attached for the notation o f subsequent physical examina-

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tions, treatment, clinic visits, report of X rays, etc. Written re
ports from the psychiatrist were filed with the correspondence in each
case, and reports of mental examinations were noted in the running
record. In the case of a child referred from a hospital the examina
tion blank was filled out by the hospital physician. Any subsequent
treatment ordered by the physician was copied into the record.
Records were well written and easy to follow and showed good fol
low-up in regard to frequent visiting and returns to hospitals.
Health standards for foster homes.—Before a foster home was ac
cepted by the agency a statement from the family physician with re
gard to the various members o f the household was required, and the
visitor reported on the location, surroundings, comfort, and sanita
tion o f the house. An effort was made to obtain separate rooms for
each child. Unless a home was in the country an inside bathroom
was required. Most children were placed in the suburbs in detached
houses, unless it was necessary to place a child near a clinic or hos
pital when a city house or even an apartment house was sometimes
used. In placing children health problems were given first consid
eration, and the recommendations o f physician or psychiatrist were
followed as closely as possible.
Instructions to foster mothers in regard to the physical care o f
children, their diet, hours o f sleep, and general hygiene were given by
the visitor, who also gave them instructions received from the physi
cian in regard to children who were health problems. Where a
child needed massage or special manipulation the foster mother went
to the dispensary and received detailed instructions from the physi
cian. Printed diet slips were furnished by the hospitals for special
cases.
Corrective work and special treatment.—When children had been
examined by the agency physician and recommendations made for
corrections or special treatment they were referred to various clinics
and hospitals or to one of the consulting physicians on the staff of
the agency. The visitor was responsible for arranging that the
child have the necessary treatment, for obtaining reports from the
clinics and hospitals giving the diagnosis and recommendations for
treatment, and for transporting the child to and from the hospitals
and clinics.
Dental work was done at the Forsyth Dental College, where the
agency paid only for materials used, or at the dental clinics of the
dispensaries to which the children went, or by a staff o f consulting
dentists who did the agency’s work at reduced prices. Eye work for
the agency was done at the Eye and Ear Infirmary o f the Massachu
setts General Hospital. X -ray pictures were made wherever the
child was being treated; blood counts and urinary examinations
were made by the agency’s physician; and vaginal smears and throat
cultures were done at the laboratory of the city department o f health.
Surgical work and orthopedic surgery were usually done at the
Massachusetts General Hospital.
The agency did not accept children with active tuberculosis, but
referred them to the State sanatorium. Suspected cases were placed
in special homes under special supervision. Children with venereal
diseases were not accepted; however children showing positive Wassermann reactions without open lesions were placed in foster homes,

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111

the foster parents first being informed o f their condition, and
were sent to the Massachusetts General Hospital for treatment.
Neurological work was done at the Massachusetts General Hospital
and mental examinations were made by the Judge Baker Foundation
or the Boston Psychopathic Hospital.
I f a child became ill in a foster home the agency was notified when
ever possible by the foster mother and the visitor arranged for the
child to be visited by the agency physician or some other physician
known to the society. The agency called on the Visiting Nurse Asso
ciation for nursing service for children ill in foster homes or for
special treatment in foster homes.
Medical homes.— The Children’s Mission to Children used two
homes for hospital children, bed cases, or other children needing very
special attention. The homes were not subsidized by the agency, but
an effort was made to keep them as nearly filled to capacity as pos
sible. The board paid for these children ranged from $6 to $10
a week. One home was about 15 miles outside Boston. The foster
mother, a middle-aged unmarried woman, owned her own home and
was devoted to the children in her care. During the summer months
this foster mother rented her house and obtained a cottage on the
shore so that her children might have the benefits o f the sea air.
This home was used almost entirely for orthopedic cases, both bed
and ambulatory cases. A t the time o f the visit to the home (the
summer cottage) six children—five orthopedic cases and one medical
case— were being cared for in addition to a 15-year-old girl. The
orthopedic children were taken back and forth to the hospital for
necessary treatment, and the local physician attended the children
in the home if there was need.
The second home was about 5 miles from Boston. The foster
mother was a trained nurse, whose husband and sister, a capable
woman, lived with her. The home was equipped to care for 10
children. A t the time o f the visit to the home 7 children were
under care, all orthopedic cases, in addition to one child being
boarded for a private family. The house had an open porch at the
back on the first floor overlooking the children’s playground, which
was fitted with a play house, a slide, and swings. On the second
floor at the back o f the house was an inclosed sleeping porch with a
sunny exposure. This home was used for children needing trained
nursing care. Children showing positive Wassermann reactions with
open lesions when accepted by the agency were usually sent to this
home.
Cost of health work.— No clinic fees were charged the agency by
the clinics to which the children were sent, nor were X rays charged
for if ordered by the clinics. In other cases the agency paid for this
work. The agency usually paid for medicines prescribed, for braces,
crutches, or other apparatus for children whose parents could not
afford such expense. Usually the agency obtained free beds for its
children requiring hospital care. Contagious cases were sent to the
city hospital or to the nearest local hospital, and the expense was
charged to the child’s legal settlement. Visits to children ill in
foster homes by the agency or local physician were paid for by the
agency. A n automobile with a driver was hired two days a week at

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TH E WORK OP CHILD-PLACING AGENCIES

a cost o f $15 per day for the transporting of children to the hospitals
and clinics.
N E W E N G LA N D HOM E FOR LITT LE W A N D E R E R S 8
History.

The New England Home for Little Wanderers had its inception
in a mission opened on Ann Street (since called North Street) in
North Boston in 1852 or 1853. As the mission grew, Dr. O. S .
Sanders, a physician prominent in the work o f the mission, estab
lished a free dispensary in connection with it. From his contact
with those who came to the dispensary for treatment, Doctor
Sanders became interested in their home conditions. As a result, the
mission workers began a special investigation and a meeting was
called by Doctor Sanders in 1863 for the purpose of organizing
a charity to care for destitute and homeless children on a nonsectarian
basis. A committee was sent to New Y ork City to study the work
o f the Howard Street Mission as a model, and following its report,
a charter for the new institution was drawn up and granted by the
State legislature in March, 1865. The society was incorporated under
the name o f the Baldwin Place Home for Little Wanderers, as it
was found impossible to incorporate under the original name o f the
Union Mission and Home for Little Wanderers. An old church
property at Baldwin Place, Boston, was acquired, remodeled, and
finally dedicated on May 23, 1865. Some years later the name was
changed to New England Home for Little Wanderers.
The purpose o f the society as stated by the charter was “ rescuing
children from want and shame, providing them with food and clothing, giving them instruction in mind and heart, and placing them
with the consent of their parents or guardians in Christian homes.”
For several years before the granting o f the charter the society had
been taking children for placement in free homes in the Western
States as well as in New England. In addition to accepting children
for permanent and temporary placements, the society operated a day
school “ for children who were too poor, or whose parents were too
degraded to send them to public schools.” A id in food and clothing
was also given to destitute families in their own homes.
In 1887 the society acquired property on West Newton Street,
Boston, for the erection of a new home, which was dedicated on April
28, 1889. Additional space made possible the introduction shortly
after this date o f a kindergarten and o f a girls’ industrial school.
This home was occupied until the erection o f the present institution
on South Huntington Avenue in 1915.7
Finances.

Nearly half the income o f the society came from endowment;
reimbursement from relatives and donations and subscriptions were
the two chief sources of the remainder. W ith the exception o f a few
children for whose care reimbursement was made by overseers o f the
poor, no money was received from any public source.
«T h e health supervision of the New England Home io r Little Wanderers was not
studied by Doctor Evans.
> _
. .
,
,
. ..
7The foregoing account was furnished by Cheney C. Jones, superintendent o f the
society.

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DESCRIPTIONS OP TH E INDIVIDUAL AGENCIES

113

Field of work.

The New England Home for Little Wanderers occupied a unique
position in the field of child care because of the peculiar conditions
under which it was chartered to work. Chartered to operate over
approximately 62,000 square miles in the six New England States,
the geographical area was hardly greater than that of some agencies
functioning in a single State. The noteworthy fact was that, unlike
any other society studied, it had worked under the varying laws or
six different States, dealing with local situations arising in all the
New England States.
The headquarters and the branches.

The headquarters o f the society were at the institution in Boston.
Here applications were received and supervision in foster homes
was arranged for all children in any part o f New England not served
by a branch.
*
.
,
Four branches were in active operation on April 1, 1923, one each
in Connecticut and Massachusetts and two in Maine. A ll the
branches were working toward the goal o f self-support. The central
office encouraged local autonomy in matters o f policy, but directed
general supervision and standardization o f treatment. T o this end
local agents were given preliminary training at the central office.
State of Maine branch.—About 1914 a local committee on child
care was organized at Portland, but shortly abandoned its efforts,
believing that its work was made unnecessary by the establishment
o f a State board o f charities and correction. It was soon found,
however, that need still existed for a private organization, and m
May, 1915, the State o f Maine Branch was formally opened at Waterville, where it has functioned ever since. For six months its agent
was joint agent for the Waterville Associated Charities,' helping to
organize that society. The branch was organized to serve the whole
State; in actual practice it met the needs o f a limited area. A good
deal o f very excellent volunteer service was employed at the State
o f Maine branch. One such person acted as purchasing agent, buy
ing all clothing for the placed-out children, besides giving regular
time to take children to the various physicians, to verify vital
statistics, and to interview employers. A number o f private socie
ties, some local and others state-wide, were in friendly cooperative
relations with the branch though no well-defined plan o f division o f
cases had been worked out.
.
Aroostoch County branch.—This branch, established at Caribou,
Me., in October, 1918, was a direct outgrowth o f the State o f Maine
branch activities and came in response to a local demand. Though
a wealthy farming district, this section had many social problems,
among which illegitimacy was conspicuous. Except for a publichealth nurse doing antitubercular work, the county had few social
resources, and the agent was forced to do general social work for the
countryside. An automobile had been added to the equipment o f this
county branch shortly before the period o f the study resulting in a
saving o f money and time in comparison with the previous year
when long trips were made laboriously by team.
Fair-field County (Conn.) branch.— In October, 1914, a branch was
established at Bridgeport, Conn., planned to serve all Fairfield
County except the city o f Stamford, already covered by its own

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T H E WORK O f CHILO-RLAGING AGENCIES

children’s aid society. The city o f Bridgeport, to which a large part
o f the service o f this branch was given, had a financial federation,
or community chest, o f which the branch was a membef and through
which it received a substantial part o f its support. The other sources
o f support o f the Connecticut branch were beneficiaries, contributors
in the county, and a substantial sum from the central office. This
branch owned a Ford car.
Berkshire County (Mass.) branch.—The oldest* branch, located at
Pittsfield, Mass., was established in 1912 and had been active ever
since. It originally served a territory covering southern Vermont
and the western halves o f Massachusetts and Connecticut. During
its early years it worked in close cooperation with the Massachusetts
Society for the Prevention o f Cruelty to Children, one agent serving
both societies. This plan proved unsatisfactory, and for several
years before the period o f the study each society had maintained its
distinct organization and offices. As Vermont and Connecticut de
veloped their own local organizations and another society in Massa
chusetts assumed obligations for part o f the field in that State, the
work o f this branch was gradually restricted to children resident in
Berkshire County, where at the time o f the study it did a general
children’s aid and foster-home work. Excellent physical and mental
health facilities had been developed in the city o f Pittsfield and else
where in the county in conjunction with hospitals and physicians.
Besides the four branches described above, branches had been main
tained in New Hampshire, Vermont, and at Greenfield, Mass., for
varying lengths o f time, but were withdrawn as local children’s
societies developed to cover the field.
The institution building.

The office and headquarters o f the society occupied an attractive,
modern, fireproof building located in the outskirts o f Boston on the
edge o f the park system: The institution was equipped to care for
50 children. A well-furnished jflayground was adjacent and there
were several acres o f recreation space nearby which made possible
close oversight by the governesses detailed to watch the children at
their play.
The first floor was devoted mainly to the executive offices o f the
society for which ample and attractive space was provided Con
sideration was given to the comfort o f the staff, and to the need for
interviewing rooms free from interruption and away from the
machinery ”, o f the office. The superintendent and each o f the two
investigators and the supervisor o f branches had a commodious and
even more important, quiet room in which applicants and callers
could feel at ease in the telling o f their stories. The schoolroom and
kindergarten were on this floor also ; the dinin°" room was in the
basement.
The second floor was occupied by the dormitories; the boys and
girls were housed at either end o f the building, with the living
quarters o f the matrons making an effective division between them
Each group had its own recreation room, well stocked with toys and
games and pleasantly furnished with center table, reading lamp, and
comfortable chairs. The larger dormitories contained six and nine
beds; others provided for two to four children each. Isolation rooms
were provided to meet special needs.

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O R G A N IZ A T IO N C H A R T O F T H E N E W E N G L A N D H O M E F O R L IT T L E W A N D E R E R S
[April, 1925]

BOARD O F M A N A G ER S

BRAN CH O F F IC E S

G E N E R A L O F F IC E
BOSTON

SU PEF {V ISO R
C)F
BRAN IC H ES
O F F IC E S T A F F
Collector and pur
chasing agent
Cashier and book
keeper
Secretary to the
superintendent
5 stenographers
2 publicity agents
(2 part-time)

SO CIALS E R V IC E
D EPARTM EN T

DEPARTMENT OF
ADVICE AND
ASSISTANCE

DEPARTMENT OF
FOSTER-HOME
CARE

Chief
investigator
Investigator

Director
5 visitors

C H IL D -S T U D Y
D EPARTM EN T

M E D IC A L
D EPARTM EN T

Secretary
3 psychiatrists
1 psychologist
1 pediatrician
1 teacher
3 kindergarten
assistants
1 drawing teacher

Medical director
Woman physician
Physician’s as
sistant (student
resident)
Physicians and
surgeons
2 surgeons
laryngologists
aurist
dentist
orthopedic sur
geon
oculist
Head nurse
3 attendants
1 night nurse
Occupational
therapist
Corrective mas
seuse

HOME-FINDING
DEPARTMENT

Home finder

H O U SE S T A F F
Matron
Assistant matron
Teacher
2 governesses and
substitute gov
erness
Wardrobe m i s
tress and seam
stress
Engineer
Janitor
Janitor assistant
Cook
Cook’s assistant
3 laundresses
4 maids

LO C A L BOARDS
OF
M AN AG ERS

B E R K S H IR E
CO U N TY
(M A S S .)

F A IR F IE L D
CO U N TY
(CO N N .)

STA TE OF
MAI NE
BRAN CH

A R O O STO O K
C O U N TY
(M E .) BRA N CH

Agent in charge,
visitor,
office assistant

Agent in charge,
visitor,
publicity agent,
office assistant

Agent in charge,
office assistant

[all part time]

2207°— 27.

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(F a ce p. 114.)

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DESCRIPTIONS OF THE INDIVIDUAL AGENCIES

115

On the third floor were the hospital and isolation rooms, where
all children were placed in quarantine on arrival, and where they
remained until laboratory tests were reported on. A small, wellappointed operating room, a dental room, and a diet kitchen were
also conveniently located on this floor, and a glassed-in playroom
made an ideal place for ambulatory or bed patients who could be
wheeled directly from the hospital room. The hospital itself was
made attractive by flowering plants and bowls o f gold fish.
The staff of the institution.

The staff o f the institution was divided in two main divisions:
(1) Physicians, psychologists, nurses, and attendants connected with
the hospital; (2) matrons, teachers, and governesses, detailed for
oversight o f the daily life o f the nonhospital children (see p. 114).
Every child on admission was assigned to a visitor in the placingout department, whose duty it was to place him in a foster home
when he was ready to leave the institution. Meanwhile, the visitor
was expected to keep in close touch with those persons in the insti
tution who were coming in intimate contact with his everyday life,
and who could best advise her as to his progress and the time when
he would be likely to be ready for a foster home.
The New England Home for Little Wanderers used its institution
for all children received through the headquarters office and for
problem children referred by the branches. O f the 309 children re
ceived 270 (87.3 per cent) went to the institution on reception. O f
these 270 children, 28.1 per cent stayed less than one month, and 89.3
per cent were there less than six months.
Methods of care in the institution.

Practically all children received through the central office were
examined and studied at the institution before being placed in foster
homes (free or for board as the case might be). O f the cases origi
nating in the branches, only problem children—physical or mental—
were sent to the institution for diagnostic purposes; the majority
were given immediate foster-home care.
The New England Home for Little Wanderers provided an outfit
and kept children furnished with clothing suited to the standard o f
the home and community in which they were placed. Except for a
small stock o f underclothing maintained at the institution in Boston,
all clothing was purchased by the visitor with or for the child, or
by the foster mother, as the circumstances might require.
Thirty-eight children were in the institution on April 1, 1923; 27
came through the central office, 6 from branches, and 5 from other
societies with headquarters in New Hampshire and Vermont. The
11 last-named children were baffling mental, conduct, or health prob
lems; they had been at the institution from one to five months un
dergoing scientific study from the physical, social, and mental
angles. These children were ultimately to go back to the referring
sources, and would carry with them specific recommendations for
treatment. The 27 children who came through the central office
represented a much wider classification than these 11 children.
The 38 children fell roughly into three main divisions : (1) Mental
or conduct, 14; (2) physical, 9; (3) temporary care, 15. The third
group contained six infants under 2 years o f age, four o f whom were

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T H E WORK OF CHILD-PLACING AGENCIES

2 months old or less; all were in excellent physical condition. A ll
but one o f the infants were o f illegitimate birth, and in each case the
problem was a social one with the mother, for whom a plan was be
ing made by the social-service department. By special arrangement
with the Massachusetts Department o f Public Welfare, which ordi
narily restricts to two the number o f infants permitted in a foster
home,8 a license has been granted to the New England Home for
Little Wanderers to care in its institution for a maximum o f six
babies at any one time. Twenty-one children—more than half the
total number in the institution—were from 5 to 12 years old. Eight
children— five o f them girls—were adolescents, the oldest being a 19year-old girl with a physical disability not yet diagnosed.
Department of social service.

In addition to the work being carried on in the institution, the
New England Home for Little Wanderers was doing a general child
placing work analogous to that o f the other children’s aid societies op
erating in Massachusetts. In cooperation with these agencies, this
society held itself responsible for cases arising in certain sections
o f the State (see p. 8). For the other New England States the
society covered the territory described under the branch organiza
tions (see pp. 113-114) and accepted such other cases as could be
handled through the central office. The aim, however, was to develop
local responsibility in the various States and not to assume at the cen
tral office anything beyond the diagnostic services o f the institution.
The department o f social service was maintained at the central
office and had three divisions—investigation, home finding, and
placing out. Under the direction o f a supervisor o f training and
experience, the investigations were made with a thoroughness which
insured careful selection o f children eligible for placing-out service
or in need o f observation and study in the institution. This investi
gation furnished much o f the information needed by the psychol
ogist in her later study o f the children who came under her observa
tion. The records showed careful character delineation, not only o f
the children but of their parents as well, and often of other relatives.
The home-finding division, a more recently developed specialized
part o f the work, was being conducted efficiently. The standard o f
homes selected for use already showed improvement under the
method whereby one worker concentrated her energy on this pivotal
part o f the work o f placing out.
The supervision o f the children in foster homes was in charge of
the division o f placing out, the standards o f which were high.
Health, education, recreation, church connection, the attitude o f the
foster parents to the child in each case, and his adaptability to the
home and the community were among the points kept in mind by the
visitors.
8 “ Whoever receives under his care or control, and whoever places under the care or
control o f another for compensation, an infant under 2 years of age, not related by
blood or marriage to the person receiving it, shall, within two days thereafter, give
notice thereof, and of the terms upon which such infant was received, to the department
[o f public w elfare], with the name, age, and residence of the infant, its parents, and the
persons from whom or by whom received; but if such infant was received from the over
seers of the poor o f any city or town or from the trustees for children of Boston, or
from any charitable institution incorporated in this Commonwealth, such notice may
state only the name and age of such infant and the name and location of the board or
institution from which it was received.”
(M ass., Gen. Law s 1921, ch. 119, sec. 6.)

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DESCRIPTION'S OF TH E INDIVIDUAL AGENCIES

117

Department of child study.

The child-study department was responsible for all correspondence
and investigations connected with out-of-State cases other than those
referred to the institution by the branch offices. It accepted the in
vestigation o f other societies, requiring as far as practicable that
their summaries should follow an outline furnished by the depart
ment, covering details o f family history, physical condition, char
acteristics, delinquencies, school record, etc.
Fifty-eight children were received in the institution in the year o f
the study through this department; 43 came from the following sec
tions o f the territory for which the society was chartered: Maine, 2 ;
New Hampshire, i f ; Vermont, 16; Massachusetts, 15; Connecticut,
6. The other 15 children were from New York City.9
Staff meetings.

Weekly staff meetings, presided over by the superintendent, were
held at the institution at which the problems o f the children under
care were discussed. Reports were received from the nurses, teach
ers, governesses, and matron as to details o f a child’s conduct under
the various stimuli of school, companionship, and sleep. The re
ports o f the psychologist, psychiatrist, and physicians were pre
sented, and the placing-out visitor gave account o f the social con
tributory factors. After all the evidence concerning a child was in,
the discussion was crystallized into a recommendation; and i f the
child was ready for a foster home it became the responsibility of
the social-service department to put the recommendation into effect.
The staff meetings had a. highly educational value and were con
ducted in a very professional way.
T H E CHILDREN’S A ID SO C IETY O F P E N N S Y L V A N IA
History and form of organization.

The Children’s A id Society o f Pennsylvania was organized in
1882. For several years before that time the Philadelphia Society
for Organizing Charity had realized the need of an agency to place
dependent and neglected children in family homes and had discussed
the matter in its ward committees. It had done some child placing,
but considered that this type o f work properly belonged to a separate
society. Some o f its board members visited New York, Boston, and
London, and brought back reports o f the work o f the child-placing
agencies of those cities. The interest thus aroused resulted in the
establishment o f the Children’s A id Society o f Pennsylvania.
When the society was established, the dependent children o f the
State were being cared for in almshouses.10 One of its first activities
was to work for a law prohibiting the reception and detention of
children in almshouses, and providing for their care in “ respectable
private families,” child-caring institutions, or industrial schools or
homes. After the passage o f such a law in 1883, the society offered
its services to the poor-law officials in placing in family homes the
children from the almshouses and other children for whom care
9 See L ittle Wanderer’s Advocate, June, 1923, p. 17.
10 See The Care of Destitute, Neglected, and Delinquent Children, hy Homer Folks,
pp. 4, 2 3 -2 9 , 77, 159—162 (The Macmillan Co., New York, 1911) ; “ Child saving,” pp.
133—134 (Report o f the Committee on Child-Saving W ork presented to the Twentieth
National Conference of Charities and Correction, 1 8 9 3 ),

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TH E WORK OF CHILD-PLACING AGENCIES

might be needed. It was agreed that the officials should pay what
they considered a reasonable amount for the children’s board, but
that the society’s services of home finding and supervision should
be donated. Free foster homes were to be found whenever possible.
The State association of directors of the poor indorsed the plan o f
the children’s aid society, and many o f the local poor boards took
advantage of the offer. The society has ever since continued to
work in close touch with the poor-law officials o f the State, and is the
principal agency through which the city o f Philadelphia and many
counties o f the State provide foster-home care for dependent children.
In the period from 1883 to 1889 about 45 county committees were
organized throughout the State in accordance with the original plan
o f the founders of the society. In 1889 the Children’s A id Society
o f Western Pennsylvania, with headquarters at Pittsburgh, was
organized and incorporated. The committees o f the western counties
then became affiliated with that society. The county committee in a
few counties in the eastern part of the State took out charters and
became separate organizations; six such county societies were active
at the time o f the study.
In 1907 the Children’s A id Society o f Pennsylvania entered into
an agreement with the Seybert Institution of Philadelphia to finance
with that organization a children’s bureau in Philadelphia (see p.
126) which would serve as a joint reception and investigation agency
for the children’s aid society and several child-caring organizations of
Philadelphia. This arrangement was continued until 1920, when
the children’s bureau was reorganized, and the children’s aid society
established -its own reception and investigation department.11
The board of directors o f the society consisted o f 26 men and
women, the majority of whom were from the metropolitan area of
Philadelphia. The board was elected at the annual meeting and
served for one year; it functioned principally through the following
committees: Executive, finance, auditing, advice and supervision (a
case committee), older boys, older girls, clothing, and a State ad
visory council.
The field covered.

The Children’s A id Society o f Pennsylvania had its headquarters
in Philadelphia and covered all o f Pennsylvania east o f the
Allegheny Mountains— a territory including 44 counties with a popu
lation o f approximately 5,500,000. Pennsylvania had no public childplacing agencies with the exception o f poor boards and juvenile
courts, many o f which placed children in family homes.
Sources of funds.

The society received its funds from the following sources:
(1) Reimbursements from the department o f public welfare o f
the city o f Philadelphia, which paid $4.25 a week for each dependent
child placed by it in the care o f the society; (2) reimbursements
from poor-law officials for children received from almshouses; (3)
reimbursements from counties for the care o f children committed by
the juvenile courts (Philadelphia County paid $4.25 a week for each
child so committed, and the other counties paid varying amounts) ;
11
McCoy, Helen I . : “ The Philadelphia plan of a central bureau of inquiry and
specialized care.” . Proceedings of the National Conference o f Social W ork, 1922, pp.
1 4 5 -1 5 0 .

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DESCRIPTION'S OF THE INDIVIDUAL AGENCIES

(4) reimbursement from relatives, other individuals, and societies *
(5) a lump-sum subsidy from the State; (6) interest on invested5
, funds; (7) contributions from outside Philadelphia (a source of
support that was being developed); (8) appropriation from the
Welfare Federation o f Philadelphia.
Children received and types of placement.

Children from infancy to the age o f 16 years were received from all
parts o f Pennsylvania east o f the Allegheny Mountains. Seven
counties had local and unaffiliated children’s aid societies which co
operated with the State society. On request the State society received
children from them for observation and diagnosis. It made no limi
tations as to sex, race, religion, physical condition, or nationality.
Ihe^ society specialized in long-time placements. Children were
received by commitment from the juvenile courts, from the Depart
ment o f Public Welfare o f Philadelphia, and from the directors o f
the poor o f various towns and counties o f the State; others were
accepted informally from their parents or other individuals and
from private societies. O f 1,970 children in the care o f the societv
on December 31, 1922, 1,149 had been committed by the juvenile
courts and 507 had been received from poor-law officials; the others
had come through private agencies and individuals. The following
lists show the types o f placement and the types of district used for
placement:
Type of placement:
Children under care
Boarding in private families_________
_________________________
In private families without payment of board. “
‘
Receiving wages in private families__________
" ____
Paying own board_________________ _________ __________ ~____ ~ _ ~
W ith parents and relatives under supervision__________
____ __
Boarding in temporary homes awaiting placem ent..
I I ___ H H
In institutions for temporary care— _ . . .
______ ~ ____ 07
In hospitals for treatment_________ ; _______________
_ “ ___
~
Addresses unknown 12__ _
' —.------------- .— ----------- („

40?
Z z z

~
24

Total-------------- -------------------------------------------------------------—
Type Of district:

Number of

In country districts on rural routes._______
__
C lldro?ft
In or near 115 villages having a population oFle7s“t t o n l o o r i i r i I I
202
In or near 18 villages having a population of 500, less than 1 ,0 0 0 .. ~
203
than^OOO55 t0WnS ° r boroughs haying a population o f 1,000, less
IUthann i2r0 W — ° WnS ° r _borougbs baving a Population of 4,000l~less

tS in

J S L 3?, Ci-ties bavinf a Population of lV.Oobrtess^ttmn 5oIoqoII~
In 10 cities having a population of 50,000 or over__________ I _____
Children placed in Pennsylvania___
____
_______
Children placed outside Pennsylvania___ 1-1.111111— 1111111111“

*52
645
7Q9
’ 42

Total___________________

Division of work.

1,834

tw S w S t ° I the f Udy* the. WOrk ? f the socieV was divided among
the following departments: Reception, temporary care and health
home finding, district supervision, older f o l d e r girls, child study!
“ Most of these children were from 16 to 21 years of asre
12‘ Includes only children in boarding, free, or wage tomes.
2207°—27---- 9

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county agency, and office management. The assistant secretary had
general supervision over the case work o f the society.
In the reception department a supervisor, three full-time workers,
and a part-time worker investigated applications for child care from
Philadelphia. Applications coming from outside Philadelphia were
usually referred to a local person for investigation. In a few places
the society entered into an arrangement with certain local persons
to investigate cases o f child need and paid them for the work on a
per diem basis. Occasionally investigations were made by the vis
itors o f the department o f district supervision. In counties where
the society had established county agencies all investigations were
made by the executives in charge, known as “ county agents.
A ll
these investigations, however made, were under the supervision of
the reception department. Contact with the families o f children m
care and investigation of applications for discharge from care were
made also by this department.
The society had organized a special department whose duty it was
to supervise 36 foster families living in the city of Philadelphia, to
whom children were sent as soon as received and where they stayed
during their physical and mental examinations and during any intro
ductory health work resulting from these examinations. These homes
were primarily for Philadelphia children, but children coming to the
city from other parts o f the State i o r health examinations or other
purposes were also received there. From $5 to $7 a week was paid
for each child’s care in these homes, the latter rate being for infants
under 2 years o f age.
.
O f 2,146 children under supervision of the society during the
period o f the study 727 (33.9 per cent) were sent to these special
homes as soon as they were received, where they were given special
physical and mental supervision. Most o f the other children went
directly to regular boarding homes; 163 were placed in free homes.
O f those going to the special homes 585 (80.5 per cent) left within a
month; 15 stayed six months or more, 1 o f whom remained between
two and three years.
The department o f temporary care and health was conducted by a
registered nurse assisted by four visitors, a caretaker for children
while in the office, and two transfer agents. Children received by
the society passed at once to the care of this department, which was
responsible for their temporary placement and for health work.
W ith the Children’s Bureau o f Philadelphia and the Pennsylvania
Society to Protect Children from Cruelty, the Children’s A id Soci
ety o f Pennsylvania was joint supporter o f the Philadelphia Asso
ciated Medical Clinic.13 A t this clinic thorough physical and dental
examinations were made o f all children on the day o f placement,
and recommendations for treatment and a date for the return o f
each child to the clinic were given by the physicians in charge to
the department of temporary care and health. It was then the duty
o f that department to see that the physician’s instructions were car
ried out. W ith the aid of a system o f checks, the department has
given excellent health supervision to the children in its care. * It was
IS For further information regarding the Philadelphia Associated Medical Clinic, see
p. 132. See also “ Safeguarding the dependent child’s physical and mental health.” by
Horace H . Jenks, M . D., in Foster-Home Care for Dependent Children, pp. 1 1 3 -1 3 4
(Ü . S. Children’s Bureau Publication No. 136, W ashington, 1 9 2 6 ),

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O R G A N IZ A T IO N C H A R T O F T H E C H IL D R E N ’ S A ID S O C IE T Y O F P E N N S Y L V A N IA
[April, 192 5 ]

BOARD O F D IR E C T O R S

G EN ERAL SEC R ETA R Y

B U S IN E S S M A N A G ER

C H ILD STU D Y
D EPARTM EN T

A S S IS T A N T
G EN ERAL SEC R ETA R Y

Director
Assistant psy
chologist
Office secretary
C L E R IC A L FO R C E
Stenographer to gen
eral secretary
7 stenographers
Registrar
Bookkeeper
Assistant bookkeeper
4 clerks
Office boy

R E C E P T IO N
D EPARTM EN T
Supervisor
4 investigators

D EPA RTM EN T
OF TEM PO RA RY
CARE
(Including health)
Supervisor
5 workers
1 part-time worker
1 play-room worker

D EPARTM EN T
O F HOME
FINDIN G
Supervisor ;
Assistant supervisor
1 part-time worker

D EPARTM EN T
O F D IS T R IC T
S U P ER V IS IO N
3 supervisors
20 visitors and
3 part-time workers

A S S O C IA T ED
M ED IC A L C L IN IC
(Connected with
Children’s Hospital)

D IR E C T O R
C O U N TYA G EN C Y
D EPARTM EN T

Physician in charge
Assistant physician
Consulting derm a
tologist
C o n s u ltin g pediatrician
Consulting psychi
atrist
A sso ci ate optha I mologist
Associate dentist
Associate surgeon
Associate b acteri
ologist
Clinic assistant
Stenographer

BERKS
COUNTY
AGENCY

B RADFO RD
COUNTY
AGENCY

DELAW ARE
COUNTY
AGENCY

L Y C O M IN G
COUNTY
AGENCY

M O NTG O M ERY
COUNTY
AGENCY

NORTHAMPTON
COUNTY
AGENCY

County secretary
1 stenographer

County secretary
Assistant
secretary
1 stenographer

County secretary
1 stenographer

2 2 0 7 °— 27.

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(Face p. 120. )

MBjiâ vUïëK i-ngì*!

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DESCRIPTION'S OF TH E INDIVIDUAL AGENCIES

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responsible also for taking children to the child-study department
for psychometric tests, which were given as a matter o f routine to
all children received who were 5 years o f age and over. In addition
to the health work, the department of temporary care and health
investigated and supervised all the temporary boarding homes used
by the society in Philadelphia.
The department o f home finding consisted o f a supervisor and an
assistant, who investigated prospective permanent foster homes in
Philadelphia and directed investigations o f homes made by district
visitors and county agents outside Philadelphia, and a part-time
worker. In 1922 the society received 960 applications from pros
pective foster parents, o f which 367 were approved.
The department o f district supervision was responsible for the
care o f all children placed in permanent homes, except for some of
the older children supervised by the older boys’ and older girls’ de
partments. In December, 1922, this department consisted of 2
supervisors, 17 full-time visitors, and 1 visitor on part time. In
addition, the county agents o f the society in Lycoming, Bradford
and Lancaster Counties supervised the children placed in their dis
tricts. The visitors went from Philadelphia to their respective dis
tricts the early part of each week, lived in the districts from three to
four days9 and. returned to the central office on Friday^ bringing to
the department for temporary care children to be replaced or in need
o f special care, and to their supervisors the problems encountered
during the week. Transportation facilities m the rural districts
were provided by the regular employment o f local drivers o f auto
mobiles, whose time and cars were placed at the disposal of the
visitors.
O f 83 unrelated children under the supervision o f one o f the
society’s visitors 33 were in individual homes, 28 homes had two
unrelated children each, 6 homes had three each, and 16 homes had
four each.
The departments for older boys and older girls were supervised
directly by the assistant secretary. They did intensive work with
older children placed in or near Philadelphia, many o f whom were
problem cases. In the older boys’ department the visitors were
men—two on full time and one on part time. In the older girls’
department there were two women visitors. In these departments
the almost daily contact with some o f the problem children o f ado
lescent age was bringing excellent results.
A t the time o f the study the Pennsylvania Children’s A id Society
and the Children’s Bureau o f Philadelphia jointly financed a childstudy department headed by a psychologist who was assisted by social
^T^bbed by training and experience. The Pennsylvania
Childrens A id Society had completed arrangements whereby all
children (including babies) received were given a routine mental
examination through this department. It was planning also a grad
ual study of all children in care who had given any evidence o f being
conduct problems. In addition to the routine psychometric testing,
which consisted o f thorough examinations by means o f various stand
ard mental tests, further personality study was made o f the children
who showed special idiosyncrasies, a psychiatrist being consulted
whenever there were neurological symptoms in evidence. Visitors

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and foster mothers consulted freely with members o f the child-study
department and received concrete suggestions as to the mental hy
giene needed by their charges.
Weekly conferences at which problem cases were discussed were
attended by the psychologist, supervisors, and visitors, and expres
sions o f appreciation o f the practical help which this department
rendered were received from the social workers whose children were
objects o f its care.14
Three hundred and forty-two children were examined by the childstudy department during 1921, o f whom 14 were under school age
and 40 were 16 years or over. They were referred by 18 agencies
including the Children’s Aid Society of Pennsylvania and the Chil
dren’s Bureau o f Philadelphia.
The development of county agencies.

In 1919 a committee (the State advisory council), which had been
appointed to develop local participation in the work o f the society
outside Philadelphia, called a conference on county work for chil
dren in eastern and central Pennsylvania. This conference resulted
in the formation o f a State advisory council as an auxiliary o f the
board o f directors of the Children’s A id Society o f Pennsylvania.
The council was composed o f residents o f the counties, whose duties
were to assist in work for homeless and neglected children in their
own counties and to bring together the needs o f these children and
the services o f the children’s aid society. A county-agency depart
ment o f the Children’s A id Society or Pennsylvania, with a field
supervisor in charge, was established to organize and to develop
county committees and to superyise branch offices throughout eastern
Pennsylvania. These branches were known as county agencies and
the executives as county agents.
The duties o f the supervisor o f the county-agency department
were to study different communities; to organize county agencies,
not after one pattern but according to the needs and resources o f
each community; to appoint the county agents, subject to the ap
proval o f the county committees; to develop local interest and finan
cial support; and to direct and standardize the work o f the agencies.
The general plan was for the county agents to cooperate closely
with the poor-law officials in their work for dependent and neglected
children, acting in some cases as their assistants, and thus to bring
to the local public care o f children the services o f trained social
workers. It was intended to establish in each agency resources for
care in boarding homes for children not to be permanently separated
from their parents, and to centralize all adoption work through the
Philadelphia office. The main office also offered specialized services,
such as expert medical diagnosis and treatment and psychological
study to communities without such resources.
A t the time o f the study three county agencies had been estab
lished, and plans were on foot to organize agencies in several other
counties.16
n Since the completion of the study, the child-study department has become a depart
ment of the Pennsylvania Children’s Aid Society, although the Children’s Bureau of
Philadelphia continues to assist in its support.
. . .
16 Since the study branch offices have been established also in Berks, Delaware, M ont
gomery, and Northampton Counties.

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Lycom ing County committee.—In Lycoming County a former
affiliated county children’s aid society was revived as the new Lvcomm g County committee o f the Children’s A id Society o f Pennsyl
vania. A t the request o f the local committee, the county furnished
the agency with an office, light, and heat at Williamsport, the county
?Sa t -Du-1heJ °ith1e^ exPenses o f the agency were to be divided between
the Philadelphia office and the local committee. The local com
mittee obtained the needed funds from the Williamsport community
chest, and an agent was placed in the field in March, 1922 Her
duties were: (1) The investigation for poor-law officials and others
o± complaints regarding neglected and dependent children in Lycommg County, and when possible the making o f plans other than*placement for these children; (2) the reinvestigation o f the families o f
children from Lycoming County who had been placed by the Childrens A id Society o f Pennsylvania; (3) the development o f a group
o f boarding homes for the temporary care o f children not to be pertvu'
i s.eParj?^ed from their families; (4) investigation for the
Philadelphia office o f prospective foster homes in Lycoming and
three neighboring counties, and supervision o f the wards o f the
society placed in these counties.
The need for a local worker was shown by the number o f requests
for service which were made almost immediately. In three months
an office assistant was added to the staff. A t the time o f this study
(when the agency was nine months old) the agent was working with
over 50 cases and was supervising 33 children in foster homes
Bradford County committee.— In Bradford County the county commissioners acting as directors o f the poor accepted the offer o f the
Childrens A id Society o f Pennsylvania to pay half the expenses o f
r , 2a!no§ency1 for a y®ar- An a£ ent beg an work in the county in
0 uly, 1922, and reported monthly to a committee composed o f the three
county commissioners and three representatives o f a local committee
0± tilecilllclren„s ai(b society. The agent’s first duty was to investi
gate the cases o f children in a small institution known as the Brown
ing Home, in which the dependent boys and girls o f the county were
being supported. As a result of her efforts the population o f the
home was reduced in five months from 60 children (both boys and
girls) to 17 boys; 16 children were returned to relatives, 9 were
placed m free homes, and others were boarded in foster homes at the
same rate o f board which had been paid for them in the institution.
In addition, the agent investigated new cases for the poor-law offi
cials, and investigated homes and made supervisory visits to children
for the Philadelphia office.
Lancaster County committee.— In Lancaster County the work de
veloped along somewhat different lines. Two workers reported to a
Lancaster County committee, but the agents’ salaries and expenses
were met by the central office. The directors o f the poor o f the
county delegated one o f the agents o f the children’s aid society as
their assistant m investigating cases o f dependent children in the
?•! 1 ancaster* The actual expenses for board and clothing o f
the children m care were paid by the public officials, and the Lancaster County committee supplied scholarships and recreational
facilities and met other needs for which public funds could not be
used.

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Clothing.

The clothing committee o f the board o f directors o f the Pennsyl
vania Children’s A id Society bought clothing at wholesale, having
found it more economical than the former method o f purchasing
materials, cutting and making undergarments for the children. A
seamstress was employed by the society at the time o f the study whose
duty it was to mend garments and keep the clothing room connected
with the main offices in order. In boarding foster homes the care
takers or foster mothers were often allowed to buy clothing for
which they were reimbursed by the office. Children going to foster
homes were given a good outfit o f new clothing.
HealtK supervision.

Routine physical and mental examinations were given to all chil
dren upon reception by the Children’s A id Society o f Pennsylvania.
(See p. 186.) Children in permanent placements received health
supervision by the visitors o f the society upon their visits to the
children in foster homes, at least every three months. Any health or
behavior problems arising among children in permanent care were
discussed at a weekly supervisors’ conference, and problems requiring
special attention were referred to the medical department.
Records.— The medical record o f each child in care gave in chrono
logical order the reports o f physical and mental examinations, to
gether with corrections made and treatment given. The health record
o f a child after placement was recorded only on the visitor’s reports
or in letters from the foster mother. The family history was entered
on the medical record.
Health standards fo r foster homes.— Country homes were used as
often as possible for the placement o f children. In investigating a
foster home before accepting it for placement o f children the visitor
inspected in accordance with an outlined system the grounds, barns,
drainage, water supply, the interior o f the house, with the arrange
ment o f rooms—particularly sleeping rooms— and their cleanliness
and tidiness.
.
.
i t .
The family physician o f the foster family was interviewed about
their health in writing unless it was felt that a special indication o f
a health problem required a personal interview. F oster mothers were
instructed in the care of children by the visitors who based their in
structions on the report from the medical clinic. Most o f the visitors
had had courses in health work and hygiene. Special rates were
paid in homes where children requiring extra milk or special feeding
were placed, or for children requiring unusual care or attention.
Corrective work and special treatment.-—The medical department
received all recommendations for corrections o f defects and special
treatment from the associated medical clinic and was responsible
for .seeing that such work was carried out. Outside Philadelphia
the visitor in charge o f a child was responsible for seeing that
necessary treatment, except in emergencies, was received and for
transporting a child to a clinic or dispensary. The clinic dentist did
all dental work for children in temporary care and for any children
under permanent placement who could be brought conveniently
to the clinic. Otherwise such work was done by a local dentist. Eye
work was done at the clinic. Tuberculous babies were sent to the
Children’s Hospital; older children with tuberculosis were referred

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DESCRIPTIONS OE THE INDIVIDUAL AGENCIES

125

to the State dispensary for diagnosis and for admission to the State
sanatorium. I f a child was not accepted at a State sanatorium he was
placed in the country with special directions from the medical clinic
about diet and hours o f rest, and a report o f his condition was sent
to the clinic at stated intervals. Undernourished children were also
placed in the country with abundant diet and rest. Children with
gonorrheal infection were sent to the Philadelphia General Hosiptal;
children under 12 years o f age showing a positive Wassermann reac
tion were sent to the Children’s Hospital for appropriate treatments
and older children to the Polyclinic Hospital. A few children with
these diseases were placed in homes outside Philadelphia and received
treatment at local hospitals. Orthopedic cases were referred to the
orthopedic surgeon o f the Children’s Hospital or to the surgical con
sultant o f the society, and the necessary operations were performed
or braces applied. Neurological cases were referred to the consulting
psychiatrist o f the society. Minor surgical corrections, such as tonsil
and adenoid operations or circumcisions, were performed at any
o f the first-class hospitals. Blood counts, urinalysis, vaginal smears,
and Wassermann blood tests were made by the pathologist at the
clinic; diphtheria cultures were made by the board o f health.
Foster parents were supposed to provide medical care for children
ill in foster homes, but they could always consult the society which
would send a physician. The clinic physician visited children ill in
free, boarding, or temporary homes. In placements outside Philadel
phia the visitors made use o f local physicians as far as possible.
Nurses from the Visiting Nurse Association in Philadelphia visited
children ill in foster homes in Philadelphia and children discharged
from hospitals after operations.
Cost o f health work.—The Children’s A id Society o f Pennsylvania
contributed $8,000 a year to the support o f the associated medical
clinic. In addition the society paid for all medical treatment o f
children outside Philadelphia.
The training of new workers.

The training o f new workers was a regular part o f the program
o f the Children’s A id Society of Pennsylvania, as all the new work
ers and many others who wished to attend belonged to a class which
was taught by the assistant secretary. This class, consisting o f 16
workers at the time o f the study, met l 1/^ hours each week and studied
the history and organization o f the society and methods o f case work,
with special reference to work for dependent and neglected children.
The course was planned in consultation with the Pennsylvania School
tor Social and Health Work, and those taking the course received
credit at the school. The course had proved an effective means o f
educating new members o f the staff and was to be continued another
year.16
Growth of the work.

The statistics o f the Children’s A id Society o f Pennsylvania for
the 10 years preceding the study showed a significant decrease in the
number o f children received into care, and an increase in the number
o i visits made in behalf of children, Although the society had not
., 18 September, 1923, a worker employed jointly by the children’s aid societv end
the cWld0ren’sVaid society?* *he SCh° o1, and supervised tbe students doing field work with

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THE

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c h il d -p l a c in g

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artificially limited its intake, better methods o f investigation involv
ing plans other than placement for many children reduced to almost
half the number o f annual admissions o f children to the care o f the
society. During the same period the number o f visits in be
half o f children had been more than tripled. This improvement in
the quality o f the service rendered, in keeping with advancing stand
ards o f child care, together with increased medical and psychological
facilities for intensive child study and the extension o f the countyagency system, indicated that the society was entering upon a period
o f even greater usefulness in its work for the dependent and neglected
children in Pennsylvania.
TH E CHILDREN’S B U R E A U OF P H IL A D E L P H IA
History and development.

The Children’s Bureau o f Philadelphia was organized in 1907,
largely as the result of a survey of children’s work in Philadelphia
made under the direction o f the Seybert Institution. As a result of
this inquiry the Seybert Institution for Boys and Girls and the Chil
dren’s A id Society o f Pennsylvania decided to organize a children’s
bureau which would act as a joint reception and case-investigating
agency for these two organizations in particular and for any other
children’s agencies in Philadelphia which desired to avail themselves
o f the bureau’s services. The bureau was to seek to be a center o f
information about methods o f work and functions o f all the child
caring agencies in the city, and to have such information available
for immediate use for anyone applying for it.
During the first 18 months o f the bureau’s history its entire operat
ing expenses were met by the Seybert Institution. A t the end o f
that period the Pennsylvania Society to Protect Children from
Cruelty became an important supporting member o f the bureau, and
until June 30, 1920, made definite and considerable financial contri
butions toward the bureau’s budget. Throughout most of this
period the Children’s A id Society o f Pennsylvania and the Seybert
Institution each contributed five-twelfths of the bureau’s income, the
society for the prevention o f cruelty to children contributing twotwelfths. Gradually new institution and agency members were
added to the bureau board. Their payments were purely nominal,
however, being approximately $10 a year for each, although they all
availed themselves freely o f the bureau’s services.
A ll children received by the children’s aid society from the county
o f Philadelphia, beginning with the organization'-of the bureau in
1907 and up to January 1, 1919, passed through the hands o f the
bureau. From January, 1919, the society started receiving an in
creasing number o f children without the use o f the bureau’s services,
these children coming chiefly from the juvenile court and the depart
ment o f public welfare. The service of the children’s bureau to the
Pennsylvania Society to Protect Children from Cruelty was ex
pressed entirely through use o f the bureau for the placement o f
children committed to that society in the course of its work. The
society to protect children from cruelty had conducted formerly
an extensive placing department, which according to the terms of
agreement with the children’s bureau and the children’s aid society
it was gradually to abolish.

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DESCRIPTIONS OE TH E INDIVIDUAL AGENCIES

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The types of case referred to the children’s bureau included chil
dren who were delinquency and conduct problems, children in heed
of temporary care because of the illness or other incapacity on the
part of their parents, and children in need o f semiconvalescent care.
A considerable number o f applications involved care for unmarried
mothers and their babies, the services required including placement
and supervision in families as well as reception work. A t the end
o f the first year o f the bureau’s activities it became evident that
special temporary-care facilities were needed by the bureau for
children passing through its hands. Emergency problems had been
referred which called for inquiry as well as immediate medical and
other care before any definite plan in the way o f long-time care
could be worked out. This temporary care was developed by the
use o f individual family homes in Philadelphia, the number o f such
homes and the number of children cared for in them gradually in
creasing until by 1915 the bureau was maintaining in its own families
an average of 100 children. The major portion o f the cost for the
care given in these temporary family homes was met by the Seybert
Institution.
The bureau from the very start laid the foundations for thorough
medical examination and treatment for all children passing through
its hands, although its organization along medical lines was very
simple and limited at the beginning. In 1917 the relations between
th.6 children s bureau, and its chief supporting agencies underwent
some reorganization, with the result that the whole task o f providing
medical examinations and treatment and temporary care for chil
dren passing through the bureau was taken over by the Seybert In
stitution, which in that year assumed charge o f the temporary shelter
and the foster-family homes which had formerly been used by the
bureau.
J
This plan continued until June 30,1920, when the bureau was com
pletely reorganized. A t that time the Children’s A id Society o f
Pennsylvania and the Pennsylvania Society to Protect Children from
Cruelty both withdrew as supporting members o f the bureau and
assumed the responsibility for providing temporary shelter for all
children coming into their care. It was felt that an organization as
large as the children’s aid society would be much better served i f it
were to maintain its own reception case-work department rather
than to follow the old plan o f having these inquiries made by the
bureau and then passed over at different stages to the children’s aid
society. It was also agreed that the wards o f the children’s aid
society suffered great losses under the old plan, as the contacts be
tween the visitors o f the children’s aid society and the children they
in care were being broken constantly during the periods that
the children were in the care o f another organization over which the
children’s aid had no responsibility or control. It was likewise
agreed that the cause o f children’s work in Philadelphia would be
better served if a number o f the important children’s agencies were
to specialize in the types o f children to be cared fo r; that so far as
possible each agency should maintain a high-grade reception-work
department o f its own, thus putting the task o f educating the com
munity upon the shoulders o f a great many workers and agencies
rather than concentrating it upon a few central organizations. The

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TH E WORK OF CHILD-PLACING AGENCIES

original scheme in organizing the bureau was that it should become
the reception agency for practically all of the children’s societies in
Philadelphia; but it had been found that this involved too imper
sonal and too large-scale a method for obtaining the best results.
With the reorganization o f the bureau in 1920, the Seybert Insti
tution 17 decided to use the bureau as its agent in the performance o f
all its work and with this understanding paid to the bureau in that
year a total of approximately $70,000. The bureau as a special
service to the Seybert Institution created a placing-out department
which was to care for babies, unmarried mothers and their babies,
children in need o f temporary care and not suitable for institutional
treatment, and also children presenting special conduct problems.
Through its reception department the bureau was to continue acting
as the case-work agency for as many institutions as desired its serv
ices. The reception department was to serve also as a general caseinvestigating agency for non-Jewish and non-Catholic applications
for the community at large. The program o f work as outlined in
volved a greater volume o f work than could be handled completely
by the bureau under its limited resources, so that careful limiting of
work from time to time has been necessary.
One o f the chief objects o f the bureau as reorganized was to co
operate with other agencies in demonstrating the importance o f care
ful reception case work, and the significance o f adequate foster care
for children thought to be suitable for placement in families. The
necessity for preserving family ties needed constant emphasizing, and
cordial agreement was had with the bureau proposition that a funda
mental way to build up greater protection o f family life was to reveal
the costs involved in adequate foster care.
The board o f directors of the children’s bureau originally consisted
o f two members from the board o f directors and the executive o f
each member agency. On July 1, 1920, this plan was abolished.
The bureau from that time on operated under its own board, without
any basis o f agency representation. Although the Seybert Institu
tion contributed more than half the total income o f the bureau it
did not have a majority membership on the reorganized board.
The salary o f the executive o f the children’s bureau was paid in full
by the Seybert Institution, the bureau executive also being the execu
tive director o f the institution.18
Sources of funds.

A t the time o f this study, the Children’s Bureau o f Philadelphia
obtained its funds from the following sources: (1) The Seybert
Institution; (2) reimbursement for care o f children from the city
and county o f Philadelphia—the city department o f public welfare
paid $4.25 a week for the care o f every child whom it placed with
the bureau, and the county of Philadelphia paid at the same rate
for children committed by the juvenile court; (3) reimbursement
from relatives of children (on December 15,1922, o f the 142 children
17 The Seyhert Institution, one of the chief supporting members of the bureau, began
its work in 1906 under the will of the late Henry Seybert, providing for the creation of
an institution for the care of needy boys and girls. The trustees had large powers in
developing institutional plans, so that they had the proper authority to close the institu
tion in 1917 because of the great amount of care which was available for children
through other institutional agencies.
18 The section on history and development was written by J . Prentice Murphy, secre
tary, the Children’s Bureau of Philadelphia.

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THE INDIVIDUAL AGENCIES

cared for in boarding homes, 54 were being partially supported by
their parents); (4) reimbursement from private agencies for services
rendered m investigating applications for admission to various
mstitutmns; and (5) appropriations from the Welfare Federation
o f Philadelphia.
Division of work.

In December, 1922, the work o f the bureau was divided between
a reception department and a placing department. In addition a
statistician was employed to study'the intake and the underlying
causes o f dependency o f the children coming into the care o f the
bureau.
Reception department.-^The reception department consisted o f a
cmer, an application secretary, and six case workers. The following
table, prepared by the chief, shows the work o f the department for
the year 1922. It will be noticed that out o f 1,378 children for whom
application for care was made, only 273—less than one-fifth—were
accepted either for institutional or foster-home care. The chil
dren s bureau definitely limited its intake to from 150 to 160 chil
dren in care at any one time, but its policy was to refer to other
agencies the children not accepted or to work out some other plan
o i care. In e thorough investigations o f the reception department
the unnecessary breaking o f family ties and kept many
children with their own relatives who might otherwise have become
the charges of child-caring agencies:
W

o r k

o f

t h e

r e c e p t i o n
f o r

t h e

d e p a r t m

y e a r

e n t

J a n u a r y

o f
1 ,

t h e
1 9 2 2 ,

C h i l d r e n 's
t o

e c e m

b e r

u r e a u
3 1 ,

Unmar
ried
mothers

Applications

Total received.
Applications to children’s bureau.
Applications to institutions______

o f

P h i l a d e l p h i a

1 9 2 2

119

Children Families

1,378

11,023

1,105
273

826
197

Total acted upon.

» 1,041

Applications advised, referred, or withdrawn from office without field
Applications investigated and adjusted'without uiacement..........................
Care assumed by:
--------------------Relatives other than parents______________
Other social agencies____________
Advice given_____ ________________
*
■—
Withdrawn during course ofTnvestigation 1111111...............
Applications accepted for placement by children’s bureau"............................
Applications accepted for institutional care.......................................................

a ^ ^ ^ l f a ^ n o t ^ o L T e d ^ s lew S S

426
427
25
109
164
192
153
120

111

ÌS dUe t0 CaS6S PendiDg adjustment on

department.— The work o f the placing department was
divided between home finding and home supervision. The whole
department was in charge o f a chief, who had under her two home
finders, four case-work visitors (two o f whom were registered
nurses), and one part-time negro visitor for negro children, devoting
part o f her time to supervision of children in foster homes and-part
to reception investigations, and two transfer assistants (one o f whom
was working on part time). The nurses were assigned to baby

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A G E N C IE S

cases; the transfer assistants were used in the transporting of infants
and other very young children to their foster homes and to the clinics.
Older children were always accompanied to their homes by one of the
visitors. In addition to supervision of children in care, the visitors
kept in touch with the children’s families, referring cases requiring
family rehabilitation to the Philadelphia Society for Organizing
Charity and other family agencies. It was also the policy to visit the
children after they had been returned by the bureau to their own
homes, for in this way the gains* made to the children while in foster
care were more easily protected.
Children received and types of placement.

The children’s bureau specialized in temporary care, especially
o f infants and children presenting health and conduct problems;
it also worked with a few unmarried mothers and planned to expand
this work as its budget increased. The type of health and con
duct problems accepted were o f children for whom the outlook was
favorable for a cure or a satisfactory adjustment within a period
o f two years. Most o f the children were received informally from
their parents, though the bureau also accepted children by commit
ment from the juvenile court and without court commitment from
the city department of public welfare. The intake o f the bureau
was not limited as to age, sex, religion, or race, but as a matter of
fact the children received were for the most part Protestant and
under adolescent age. O f unrelated children boarded by the bureau,
47 were in individual homes, 34 groups o f two children, 18 groups
o f three, 12 groups o f four, and 15 groups o f five children were in
homes. The following list shows the children in care o f the bureau
on December 31, 1922, by type of problem presented and placement:
Children, under care

Types of problems presented:
; Dec* 3*’ 1922
Children received for temporary care (no other special problem
involved)-------- ---------------------------------------------------------------------------- -----------Babies----------- i — - — — ■*------------------------------------------------------------------------- --------Conduct problems------- ----------------------------------------------------------------------------------Health problems— __ ----------------------------------— ------------ ---------------- -------------- “
Unmarried mothers------------------------------------------------------ *-------------------------------Other children------ ---------------------------------- ----------------------------------------------- -— ^•
Superior__________________________ — '---------------------------- 1
-----------------®
Children of unmarried mothers (not babies)------------- :-------- —
«
Children received for adoption----------------------------------------------.------3
Normal children placed prior to October, 1920--------------------— —
8
Total
Types of placements :
Boarding homes-----------------Free homes^— --------------------Prospective adoption homes.
W age homes-------------------------W age boarding homes— —
Hospitals-------------------------------

159

142
7
4
3

Total __________________________ — ------------------------------------------------------------ 159

No receiving or subsidized boarding home was used by the bureau,
and .an effort was made to place the children at once where they
would remain while under care. A ll the homes used by the bureau
were within a radius o f 50 miles o f Philadelphia, and the great ma
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131

jority were within the metropolitan area. The bureau spared no
pains to find the home suited to the needs of each child, and a search
ing investigation was made before any home was accepted for use.
The investigation o f boarding homes was made in the same manner
as that o f free and adoption homes. Independent references as well
as those given by the applicants were always interviewed, and a care
ful study o f the personalities o f the members o f the foster family was
made. The home finders were instructed to talk over with the pro
spective foster parents the matter o f discipline, recreation, and sex in
struction, and no women were accepted as foster mothers for chil
dren above the baby age who were unwilling to give sex instruction
in the home. Each home was evaluated as to its possibilities for
meeting special kinds of child need. Before the placement o f any
child above the baby age, a visitor discussed with the foster mother
the personality o f the child to be placed and the kind o f treatment
the bureau thought advisable for the best development o f the child.
Throughout the placement, the visitor felt it her task so to under
stand the child’s background, early history, and native tendencies
that she could interpret his behavior to the foster parents and work
out with them the best possible plan.
The price paid for board o f normal children was $6 a week ih
Philadelphia and $5 a week outside the city. Most o f the babies
were boarded for $7 a week, a rate of $10 being paid often during the
first few weeks o f care. From $7 to $12 was paid for older children
presenting special problems o f health or behavior.
Recreation.

The Children’s Bureau o f Philadelphia held itself responsible for
seeing that each child was provided with proper recreational facili
ties and supplied funds for this purpose where necessary. In addi
tion to connecting the older children with the clubs best suited to
their needs, an effort was made to bring all children into touch with
natural recreational interests, such as outdoor games, garden plots,
picnics, and excursions. One house was made over by a foster par
ent in order to provide a suitable place where the boys might entertain
their friends with games and theatricals. The policy o f the bureau
to give allowances to all children of adolescent age proved helpful,
especially for children with a tendency to steal.
Clothing.

•

The bureau believed in the use o f good clothing purchased to suit
each individual child. The older children were taken by their foster
mothers or visitors on shopping expeditions, just as a child from a
normal home would be taken by his mother. The outfits supplied
the babies were unusually dainty and attractive. Special equipment
such as cribs, high chairs, and baby carriages were supplied when
the outfit o f the foster home was insufficient. Most o f the special
equipment was donated to and refitted by the bureau. In the case
o f certain older children going into foster homes the bureau like
wise furnished part, and occasionally all, o f any special equipment
needed.
Health supervision.

The Children’s Bureau o f Philadelphia, in conjunction with the
Children’s A id Society o f Pennsylvania, and the Society to Protect

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Children from Cruelty, organized in the spring o f 1920, the associa
ted medical clinic.19 This clinic, affiliated with the Children’s Hos
pital o f Philadelphia, was financed jointly by the three societies,
but was used also by certain other agencies in the city. Since July
1, 1920, the major portion o f the clinic’s expenses had been met by
the children’s bureau. Through this clinic the cooperating societies
were able to obtain for their children thorough, systematic, and
effective health supervision. Within the year preceding the study
the clinic extended its services to the Philadelphia Society for Or
ganizing Charity; and 1,000 children and adults from that organiza
tion had been examined and where necessary treated by the clinic
staff.
In many instances children were examined at the clinic while their
cases were under investigation by the reception department o f the
bureau. The knowledge thus gained of their physical condition
helped in the forming o f proper plans and often made possible the
correction o f physical defects before placement so that the children
were able to adjust themselves more quickly in their new homes.
This service was being expanded so that the physical findings in all
new cases might be considered at the same time with the social
findings.
Physical examination.—All children accepted for care by the bu
reau were given a routine physical examination at the clinic by the
medical director or his assistant. No child was placed without such
an examination. Children accepted for institutional placement were
examined, and any recommendation made for correction or treat
ment was carried out before such placement was made. The clinic
made a written report on each child to the bureau, and the corrections
recommended were "handled by the reception department before
placement. For corrections made after placement the visitor o f the
placing department was responsible for seeing that the necessary
treatment was received. In case o f replacement a child was reex
amined at the clinic before going to his new home.
Mental excmiination.—The Children’s Bureau o f Philadelphia
jointly with the Children’s A id Society o f Pennsylvania supported
a child-study department,20 which made psychological studies o f
children presenting conduct difficulties and recommendations for
their treatment. Children needing the advice o f a psychiatrist were
referred to the consulting psychiatrist o f the associated medical
clinic. The children’s bureau stood out preeminently for its discrimi
nating study o f each individual child and o f the foster families
to which they were intrusted. In the records, as well as in the minds
o f the workers, each child was not merely a child to be placed, but
a distinct personality. Placements based on such knowledge had
brought about seeming miracles o f improved health and conduct.
O f a group of 90 children examined January 1,1921, for the Phila
delphia Children’s Bureau by Jessie Taft, psychologist, the examiner
wrote: “ Although the cases o f this clinic are far from being an un19 See “ Safeguarding the dependent child’s physical and mental health,” by Horace
H . .Jenks, M. D., director of the Associated Medical Clinic, Philadelphia, in Poster-Home
Care for Dependent Children, pp. 1 1 3 -1 3 4 (U. S. Children’s Bureau Publication No. 136,
Washington, 1 9 2 6 ).
20 In January, 1923, the child-study department became an integral part of the Chil
dren’s Aid Society of Pennsylvania, though the Children’s Bureau o f Philadelphia con
tinued to contribute to its support.

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selected group, yet there is some significance in the fact that out o f 90
children referred for various reasons, with only 14 suspected o f
mental defect, 45 per cent are o f such inferior intelligence as to re
quire special consideration on that account, and 30 per cent are prob
ably too defective to get along in the world without continuous super
vision.”
Mental examinations were not routine with the bureau. A t the
time o f the study children received presenting problems of behavior,
showing retardation in school, children o f psychopathic or feeble
minded parents, a few children o f exceptional ability, children re
ceived for adoption, and those for whom mental tests were recom
mended by the clinic were sent to the child-study department for
mental examination. It was being planned at that time to have a
r?M^lne Psychometric test made by the child-study department of all
children over 5 years o f age received by the bureau.
Records.—-The health record o f each child was incorporated in the
case history in chronological order. Reports from the medical clinic
were copied into the record. Reports from the child-study depart
ment and the psychiatric clinic were noted on the record and filed
with the correspondence.in each case. For babies the nurses kept a
special weight and record sheet which was copied into the record.
• Seatth standards for foster homes.—In an investigation o f foster
homes for "use by the bureau the health o f the foster family was
stressed; the family physician and other references were interviewed.
Tne nervous stability or the foster mother and the physical condition
o f her own children were given much weight. Any hospital record in
a family was obtained through the social-service exchange. Recent
illnesses and cause o f death in a family were studied, and homes had
been rejected because o f recent illness or death from tuberculosis. A
separate bed was required for each child, the bureau furnishing a bed
if the home did not have a sufficient number. Placement recom
mendations from the medical clinic were followed very closely and
health problems were given careful consideration in all placements.
Foster mothers were instructed by the nurses in the care o f infants.
A slip giving the milk formula and a weight chart with printed di
rections on the back for the care o f infants and young children were
given to the foster mother. The visitors gave instruction for the care
o f older children, and printed diet slips were given the foster mother
where special diets were needed. Whenever possible the foster mother
went to the clinic to talk with the physician and to discuss the health
problems o f the children. Because o f the very special health prob
lem handled by the children’s bureau the foster mothers had to be
o f an exceptionally intelligent and responsible type, and a high rate
o f board had to be paid in many instances. The bureau had four spedal homes—two for white children and two for negro children__in
which the foster mothers gave special nursing attention to their
charges. One semihospital home for white children was in charge of
a trained nurse, and one home for negro children was in charge o f a
practical nurse. Three o f these homes were visited at the time o f
the study. Five children under 2 years o f age were being cared for
m one o f the homes for white children. In one home for negro
children four girls under 2 i/2 years o f age were placed (one a baby
o f 8 months) 5in the other home for negro children five children were
placed, one an infant o f 6 weeks showing marked malnutrition. The

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T H E WORK OF CHILD-PLACING AGENCIES

children in the three homes were well cared for, the foster mothers
were intelligent and interested, and the homes were in good condition.
Three homes for emergency placement were visited also—two for
white children and one for negroes. The children in these homes ap
peared to be well cared for.
Corrective work and special treatment.—Medical attendance was
supplied by the bureau through the associated medical clinic. The
transfer agents took the babies and young children to and from the
clinic and the visitors took the older children. The nurses were not
responsible for any transportation. Dental, eye, and laboratory
work, including tests of urine, Wassermann blood tests, smears, etc.,
were made by the specialists at the clinic. For minor surgical treat
ment the children were placed in any o f the first-class hospitals in
Philadelphia, the visitor being responsible for their entrance. As a
rule, the most convenient hospital to the child’s residence was used
or the one in which entrance could be obtained the soonest.
A ll foster mothers were instructed to call the bureau in case o f
sickness in the home; in emergencies she was to call the nearest
physician, the bureau paying for such medical service.
Children with inactive gonorrheal infection not requiring hospi
tal care were placed in foster homes, with instructions given for their
treatment. Children showing positive Wassermann reactions without
open lesions were placed in foster homes and were sent to a dis
pensary or to the office of one o f the staff consultants for treatment.
A ll orthopedic cases not requiring hospital care were placed in spe
cial foster homes and sent for treatment to a dispensary or hospital.
Serious contagious diseases were sent to the municipal hospital; cases
o f chicken pox, mumps, or uncomplicated measles were cared for in
the foster homes.
A ll children were returned to the clinic for reexamination when
ever necessary.
Infant care.—The Children’s Bureau o f Philadelphia had devel
oped a very intensive and thorough system of infant care. In
accordance with the rule for all children, babies were examined,
weighed, and measured at the associated medical clinic on the day
o f placement, and a feeding formula was made out by the physician
in charge and sent with the child to the foster mother. A ll babies
were seen in the boarding homes by the registered nurses o f the staff
at least every two weeks, and delicate babies as often as necessary.
The nurses advised with the foster mothers, weighed the babies,
and plotted their gains or losses on a weight chart. Once every
week the chief o f the placing department and the nurses held a con
ference with the director of the clinic, who went over the chart of
each baby, suggested a change of formula where necessary, and
advised whether or not the child should be brought to the clinic.
In this way the health of the babies was carefully guarded without
the exposure which is inevitable in taking them constantly to and
from a clinic. It was a matter o f pride to the bureau and the foster
mother when a baby had reached the age of 2 years without having
to be returned to the clinic. The assistant medical director spent
half o f her time visiting children in foster homes and in special
cases the director would visit a child in his foster home.

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Cost of health work.— Over 13 per cent o f the budget o f the chil
dren’s bureau was spent in the maintenance of the associated medi
cal clinic and the child-study department (the 1923 budget contained
an item o f $10,600 for the clinic and one o f $2,980 for the childstudy department). In addition, milk and extra foods where needed
were provided for children in foster homes, emergency medical serv
ice was paid for, and two trained nurses were employed by the bu
reau to visit and supervise infants and children presenting health
problems in their foster homes. The high cost of such work, how
ever, was felt to be justified by the bureau as shown in the results
obtained through the methods o f care in use.
Cooperation with Children’s Aid Society of Pennsylvania.

An excellent piece of cooperation in infant care had been de
veloped between the bureau and the Children’s Aid Society o f Penn
sylvania. The bureau supervised the babies placed in foster homes
in Philadelphia by the children’s aid society, and the children’s
aid society received from the children’s bureau babies who had suc
cessfully passed beyond the difficult feeding stage and were ready
for permanent placement. The bureau also turned over to the chil
dren’s aid society some older children for whom permanent care was
needed. Since September 1, 1922, all foundlings formerly placed
by the children’s aid society had been given to the care of the chil
dren’s bureau by the Philadelphia Department o f Public Welfare.
Discharges.

Since the Philadelphia Children’s Bureau specialized in temporary
care for children, most of the children received were eventually
returned to their families. After their return the visitors made the
necessary visits to the home to assure themselves that all was going
well and to assist in the readjustment. Only in very exceptional
cases were children given in adoption. The policy of the bureau
was to keep children for their parents where this was at all possible.
The following list shows how large was the turnover o f the bureau
during the year 1922, and the disposition, made of the children dis
charged from care:
C h i l d r e n

i n

c a r e

Children in care during 1922:
Number
In care Jan. 1, 1922___________________1_____________________________________114
Received during year________________________________ ______________________ ^ 1 5 3
Total______________ ________ ;______________________ j!__________________________267
Children discharged during 1922 :
Returned to relatives______________________________ ,_____ ______ _____________
Transferred to other societies___________________________ _ _ _______________
Transferred to institutions or hospitals____________________ _______________
Adopted_______________ ________________________ _______________ _____ __________
D ie d _____________________________________ __________ ,_______________________ '_

74
17

Total---------------------------------- -------------- ----------------------------- .---------- ------------------- 108
Children in care Dec. 31, 1922_________________________________________________ 159
2207°— 27------ 10

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TH E CH ILDREN’S HOM E SO C IETY OF F L O R ID A 21
History and form of organization.

The Children’s Home Society o f Florida was incorporated in 1902
and in that year began its work o f placing “ homeless children in
childless homes.” The society at first was chiefly concerned with
placing babies and other small children in foster homes for adoption.
In 1909 a receiving home was opened in Jacksonville, to which needy
children were brought from all parts of Florida. After a period of
temporary care there these children were sent to permanent foster
homes.
The society gradually broadened the scope o f its work to include
service for children not permanently separated from their families.
At first, these children were placed with the other wards of the
society in the receiving home; but as the work grew, more room was
needed, and in 1918 a small institution known as the “ children’s
boarding home ” was opened in Jacksonville. This “ boarding home ”
had accommodations for 65 children and cared only for children not
permanently separated from their families. Two years later this
method o f temporary care was abandoned, and since that time the
society had used family homes in or near Jacksonville, or its receiv
ing home at Pensacola, for the care of most o f its children not received as permanent wards.
In 1920, upon the invitation o f the board o f directors of the Pearl
Egan Home, a small institution for children at Pensacola, the society
agreed to take over its management for a trial period o f three years.
The home was remodeled and its name changed to the West Florida
Receiving Home. In connection with this expansion of the work,
a branch office with an executive in charge was established at Pensa
cola, as headquarters for the work in the nine counties o f West
Florida. In September, 1922, this branch office was closed. There
after the work was carried on from the Jacksonville office, though
the receiving home at Pensacola continued to be used for the
children from that section o f the State.
The board o f directors of the Florida Children’s Home Society
consisted at the time o f the study o f 40 prominent men from various
parts of Florida. Members o f the board were elected annually, and
any contributor to the society, no matter how small his contribution,
was entitled to vote at the annual meeting. The board met at least
once every three months. An executive committee o f five members,
meeting on call, was authorized to act for the board in the interims
between its meetings. Upon the establishment o f the West Florida
branch and receiving home, a local board o f directors of 22 men was
organized to direct the work of the society in that section.
Early in the history o f the children’s home society, the board of
directors, feeling a need for the help o f women in the work, chose 25
women from Jacksonville to serve as a ladies’ auxiliary. This aux
iliary became a self-perpetuating body. It met as a case committee
every two weeks to discuss problem cases of entrance and discharge.
It also assisted the matron of the receiving home in the buying of
household supplies, visited the wards of the society in hospitals, was
interested in the individual children, and was influential in gaining
21 The health supervision of the Children’ s Home Society of Florida was not studied
by Doctor Evans.

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support for the work o f the society. West Florida also had its ladies’
auxiliary, which served as a case committee for that section of the
State, meeting with a visitor sent from Jacksonville. In the absence
o f the visitor, this auxiliary was empowered to investigate and to
receive at the home aid cases, or children received for temporary
care, from West Florida. It also gave much personal attention to
the management o f the West Florida Eeceiving'Home.21a
Finance and publicity.

Before 1910 when the present State superintendent began his work
with the Florida Children’s Home Society, the society obtained its
funds through two solicitors who received 40 per cent o f all collec
tions. A t the suggestion o f the new superintendent the board o f di
rectors changed the method of raising money from personal solicita
tion to letters o f appeal. During the first year under the new method
the number o f contributors increased from 155 to over 2,0.00 and the
increase in revenue was so marked that the society has continued to
depend for its support upon written appeals. No public money was
received by the society except a voluntary annual appropriation o f
$600 from the board o f county commissioners o f Polk County and
per capita payments from the juvenile court at Jacksonville for the
support o f children boarded for the court.
A t the time o f the study the society had acquired a mailing list o f
75,000 names,21^ including the names o f 19,275 people who had at
some time contributed to the work, and o f 4,000 regular subscribers. A
system had been worked out of follow-up appeals every few months
to those who had not subscribed during the fiscal year, which had
resulted in distributing the receipts throughout the year. The bulk
o f the support came from small contributors; no special appeal was
made to potential givers o f large amounts.
The letters o f appeal served a dual purpose o f bringing returns
both in money and in foster homes for the children. In the financial
reports o f the society the money invested for such publicity was
classified under the heading, “ securing homes for children and
funds.” Much newspaper publicity was used, and although a large
amount o f advertising was donated, the society has found it profit
able occasionally to pay for newspaper space, sometimes even for a
full page in the leading Florida papers. The investment of money
in letters o f appeal and in newspaper publicity had not only put the
society on a firm financial basis and brought in offers o f foster homes
for the children, but it had been an effective factor in educating the
general public in methods and ideals o f child care.
The staff.

A t the time o f the study the office and field staff o f the society
consisted o f the State superintendent, an assistant superintendent,
three State visitors, one city visitor for Jacksonville, a bookkeeper,
an office secretary and a clerk who together had charge o f the mail
ing lists, and two stenographers; the position o f special field repre
sentative (see p. 141) was temporarily vacant. The board of direc218In.
a receiving home and branch office— known as the Southeastern Branch—
w as established in Miami to serve the children of that rapidly growing section of the
state. A local board of directors and a ladies’ auxiliary serve in connection w ith this
branch, which is supported largely by the Miami Community Chest. The staff consists
p i ft district superintendent, a field worker, and an office secretary.
A t the present time the society has a mailing list of more than 125,000 names.

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tors had voted to obtain the services o f a psychologist, who it was
expected would soon be added to the staff.22 The visitors performed a
general child-caring work, investigating cases of child need, inspect
ing prospective foster homes, and supervising placed-out children.
The work was not definitely districted, except that the city visitor’s
duties were confined to Jacksonville and its suburbs and covered
mainly the investigation and supervision o f boarding homes and
health follow-up for children in both the boarding homes and the
receiving home. The case work o f the visitors was supervised by the
assistant superintendent.
A t the Jacksonville receiving home a matron, a trained nurse, six
assistant matrons, two teachers, a housekeeper, a seamstress, a cook,
three maids, two laundresses, one laundryman, and a man who com
bined the duties o f yardman and engineer, were employed.2241 A t the
West Florida home the staff consisted o f a matron, an assistant
matron, a nurse, a housekeeper, a cook, and a laundress.
Receiving homes of the society.

In 1911 the Florida Children’s Home Society purchased a twoand-a-half story frame building located in one o f the best residential
districts o f Jacksonville to take the place o f a smaller building which
for two years had been used as a receiving home. A n adjacent cot
tage was bought in 1918 for a special baby cottage, and a small openair schoolhouse was built. In 1921 the directors planned to erect a
new receiving home, as the buildings in use were inadequate for the
growing needs o f the society; but fortunately it was found that the
two substantial and homelike residences on either side o f the receiving
home could be purchased at a cost much less than would be required
for the erection o f a new home. These buildings were purchased in
1922 and have been well equipped. This had given the society an
attractive group o f five buildings, with facilities for classifying the
children by age and sex, and at the same time a homelike atmosphere
had been made possible. These five buildings were as follows: (1)
Administration building, which also had dining-room capacity tor
56 children and attendants seated at small tables, and a dormitory
for 19 girls between the ages o f 7 and 14; (2) a cottage for babies
with 10 beds in two dormitories and a sleeping porch; (8) an in
firmary with two wards, one for boys and one for girls, with a total
capacity o f 11 beds; (4) a school and sleeping accommodations for
boys, including 27 beds in four dormitories and two sleeping porches;
and (5) a nursery with beds for 26 children o f from 2 to 8 years, a
dining room, and a diet kitchen. The cottages were adequately and
tastefully equipped and were kept in excellent condition.2213 The Jacksonville receiving home had a capacity for 10 babies under 2 years o f
age and 72 other children. At the time o f the study 67 children were
in the home. A two-room school, in session throughout the year, was
maintained at the receiving home.
22 Since the time of the study the number o f State visitors has been increased to six
and of city visitors to three. The trained psychologist has been added to the staff, and
two assistant bookkeepers, two stenographers, and a trained registrar.
222The society now has 12 assistant matrons, or house mothers, at the receiving home in
Jacksonville.
®b In 1925 a reception cottage, in which all children received are isolated for two
weeks, and a four-room schoolhouse were added. A new site for a receiving home has
been purchased, within 10 minutes of the heart of the city, consisting of 12 acres of land,
on which a new modern cottage-plan receiving home with special school facilities will be
erected.

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The West Florida Receiving Home at Pensacola was a two-story
frame house with a capacity for 35 children. On January 1, 1923,
26 children, most o f whom were “ aid cases ” from west Florida, were
being cared for in this home. The children attended the public
school at Pensacola.
A ll children received by the society as permanent wards were
placed in one or the other o f these receiving homes until placed for
adoption or in free homes. A few exceptions were made for diffi
cult children or those needing special care, these being boarded in
family homes. Although the policy was to place all children re
ceived for short-time care (known as aid cases) in foster homes a few
went to the receiving homes, these being mostly in the district
covered by the West Florida home.
Ninety-two per cent o f the Florida Children’s Home Society’s
children went to the receiving homes on reception; 24.5 per cent
stayed in the homes less than a month and 77.9 per cent less than
six months. Exclusive o f the investment the per capita cost in the
receiving homes was figured as $7.70 a week in 1922 as against $5
(exclusive o f supervision) in a boarding home.
Work with families.

In carrying out its policy o f conserving the child’s own home, the
society found itself seriously handicapped by a lack in many places
o f local resources for work with families. Time and again the society
had been called upon to place children in permanent homes, when
what was needed were facilities to improve home conditions so that
the children could with safety be left with their own relatives. The
plan o f the society had been to develop under separate auspices local
resources for family work, rather than to undertake to do such work
itself, but in certain cases a lack o f such resources had forced it to
step into the breach. The following story illustrates the difficulties
o f undertaking family work in rural communities from State head
quarters :
A judge from a distant part of the State wrote to the children’s home
society asking that two children be placed for adoption. The visitor o f the
society who was sent to investigate the case left Jacksonville at 11 o’clock
m the morning, traveled 200 miles by train, and was forced to stop overnight
at a village 20 miles from her destination, which she finally reached by auto
mobile about noon the next day. There she found Mrs. A, a young mother
o f 19, and her two small children living with an aged uncle and aunt, whose
only means o f support was a Government pension o f $25 a month. The mother
who was devoted to her children, had written to the judge asking him to use
his influence to have her husband pardoned from serving his term at the
penitentiary, where he had been sent for stealing a heifer. The judge had
immediately referred the case to the children’s home society for permanent
placement o f the children.
After about two hours with the family, the visitor arranged for temporary
financial relief and returned to the village where she again had to spend the
mght. The next day a long train trip took her to the city where Mrs. A ’s
mother lived, but where there was no social agency equipped to make a proper
investigation. The grandmother promised help, which she later failed to g iv e :
she also disclosed the names of other relatives, and gave valuable information.
l h e
visitor then returned to Jacksonville. From there she wrote to the county
commissioners explaining the situation and asking for a regular allowance for
Mrs. A and to the superintendent o f the State penitentiary requesting an interview with the father. No answer was received from the county commissioners
although several other letters were written. In response to a favorable reply
from the superintendent of the penitentiary, the visitor made a trip to Talla-

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A G E N C IE S

hassee only to find that Mr. A had been transferred to another part o f the
State. She followed and finally succeeded in seeing him. The journey took
two days. A second trip was made to the town where Mrs. A lived, which
resulted in persuading some relatives living in the county to give financial
assistance; in interesting the civic association o f the locality, which promised
to provide clothing and a friendly v isitor; and in obtaining for the fam ily from
the board of county commissioners an allowance of $12 a month. This piece of
work, although expensive and tedious, resulted in saving two children for
their own family, and in the end was probably less costly in time and money
than would have been the permanent care of the children. It is evident, how
ever, that with a limited staff much work of this kind is impossible.

Children received and services rendered.

The Children’s Home Society o f Florida received white children
17 years o f age and under from all parts o f Florida without rela
tion to sex, religion, nationality, health, or mentality. Permanent
wards were received by commitment from the juvenile courts, and
occasionally by parental release. Children accepted for temporary
care were usually received informally from their parents.
The society specialized in children suitable for adoption, but by no
means limited itself to this type o f child. It provided a variety o f
services for children not accepted as permanent wards, such as tem
porary care in boarding homes, medical or surgical treatment, legal
aid and advicer putting their families in touch with other agencies;
in a few cases where local facilities were not available, it did the
work o f a family-welfare society.
The following lists from the annual report of the society for the
year 1922 show the disposition made of children coming to its atten
tion during the year, and the type o f placement o f children under
its care January 1, 1923 :
Children received

Disposition made o f children:
during 1922
Placed in foster homes for permanent care_________________________
131
Placed in selected fam ily boarding homes_________________ _________ ___
65
90
Given temporary relief in receiving homes________________ ___________
Sent to special training and industrial schools________________________
23
Sent to special hospitals_______ ._________________________________ _______
10
179
Given special material relief, legal aid, financial loans______________
Employment obtained________________ _____________________ _____________
9
Rescued from abuse I __________________________________________________
2
Referred to relief agencies, juvenile courts, etc___________ _________ _
183
Referred to other social agencies, both in and outside the State_____
163
Referred to fam ily boarding houses____________________ ______________
89
Referred to maternity and rescue homes— _ __________________ <,_______
12
Referred to special training schools____________________________________
34
Aided in other ways______ ________________________________ _____ _______
35
Total________________ ______________ ___________________________ ______ 2201,025
Children in care

Type o f placement:
on Jan. 1,1923
In free homes___________________________
219
In Jacksonville receiving home_________________________________________ L__55
In W est Florida receiving home_______________ L____ __________ :________ __ 26
In boarding homes-------- --------------------------------------------------------------------------------- 42
In special schools__________________________
35
Total___________________________________________________________________ ____ 377

The society had been unusually successful in placing together
children o f the satne family. Early in 1923 a special appeal for
homes for brothers and sisters resulted within a month in the finding,
220Does

not include two children who died in infancy.

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investigating, and approving o f a free home for four children o f
one family and prospective adoptive homes for four pairs o f chil
dren. The society never allowed twins to be separated. Several
unrelated children were sometimes placed together in an adoptive
home; in boarding homes the rule was to have six or less unrelated
children, and the society preferred not to place more than four
together.
The society outfitted its children sent to foster homes with an
extra suit and a change o f underwear. A feature o f its care
was the provision o f a new suitcase for every child sent to a free
or adoptive home. When shoes and other clothing that needed to be
fitted carefully were needed the children were taken individually to
the stores, usually by the special visitor.
Boarding schools for older cMldr&n.— The society believed that the
placing o f adolescent boys and girls in boarding schools or institu
tions for special care was the best solution o f the problem o f dealing
with older children who did not adapt themselves readily to fosterhome care. A special appeal for funds for this purpose made it pos
sible in 1922 to provide such care for 57 children. As the facilities
m Florida for the kind o f training needed were limited, the society
sent many o f its children to schools and institutions in neighboring
States and even to New York and Pennsylvania. On December 31,
1923, 24 children (16 girls and 8 boys) were in such boarding schools
and institutions. O f this number 12 were 14 years or over when so
placed, 11 were under 14 years o f age, and the age o f 1 child was
not reported. Before going to these schools these boys and girls
each spent consecutively, or in several periods, from 13 days to over
a year in the receiving homes o f the society and from 3 weeks to over
a year in free homes. Four o f the 12 children over 14 had been
ni two different schools. The length o f their stay was from 17 days
for two to 2 years and 10 months for one, the average time in school
the group being a little over 6 months. With the exception of
the child whose age was not reported, the other 12 were first sent
to boarding schools between the ages of 5 and 13, all but 2 o f them
being 10 years or over.23
Influence of the society on the social-service development of Florida.

The Children’s Home Society o f Florida had occupied an im
portant position in the social development o f the State. It had been
an influential factor in obtaining the passage of bills for a State
colony for feeble-minded and epileptic, an industrial school for girls
juvenile courts, a revised child labor law, and laws for mothers’ aid
and compulsory education.
In 1921 a special field representative was employed whose chief
duty was to make a survey o f the social resources o f the State and
t0 ° r? aniM€?’ where possible, local agencies to do constructive work
w1^*! :~anilh6s. Her method o f approach was to collect information
m different communities regarding the families o f children who had
been referred to the society for care where investigation had shown
that what was needed was work for the rehabilitation o f the family
. 23 Since the study the Florida Children’s Home Society has been left a beouest a m ^ . 7
m g to over .$ 75,000.w i t h the understanding that it should be used to esteblfsh t trafn'
in Florida for older boys and girls. Property was ^ u g M which when re'
referred to a b o y e ?8 US6d f ° r S° me ° f the cWldren now attending the b oard in g schools

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TH E WORK OF CHILD-PLACING AGENCIES

and not the removal of the children. As a result o f the activities
o f the special field representative several county probation officers
were appointed and interest in constructive family work was in
creased. The work o f county organization had been temporarily
suspended at the time o f the study pending the action o f the State
legislature in the matter o f establishing State and county boards o f
public welfare.
TH E M ICH IG AN CH ILDREN’S A ID SO C IE TY
History and form of organization.

The Michigan Children’s A id Society was organized as the Mich
igan Children’s Home Society in 1891 and incorporated in 1893.
Early in its history a receiving home was established at St. Joseph,
then the headquarters o f the organization. As the work grew, chil
dren from all over the State were brought to St. Joseph and sent out
from there to permanent foster homes. For the first 20 years the
work was largely confined to the placement o f children in free or in
prospective adoption homes, but during the 10 years previous to the
study the society had enlarged its activities to include what waS'
known as aid work or services to children not permanently separated
from their families. Ten branch offices were established with re
sources for work with children in their own homes and for temporary
care in local boarding homes, so that only children to be permanently
removed from their families were sent to State headquarters for
placement in free or prospective adoption homes.
How far the emphasis had shifted from the complete separation of
a child from his family to preserving the family tie where possible
is shown in the following figures: In 1922, the society cared for 769
children known as wards, that is, children permanently separated
from their families, and for 833 aid cases, most o f whom were in
boarding homes. In that same year only 217 o f the children re
ceived into care were received for permanent placement and 543 were
received for temporary care. In addition, 866 investigations were
made where the children were not accepted for foster-home care.
In many o f these cases conditions were so adjusted that the children
could be left safely in their own homes.
This change o f emphasis was reflected also in the action o f the
trustees in June, 1921, when the name o f the society was changed
from the Michigan Children’s Home Society to the Michigan Chil
dren’s A id Society. In the fall of 1922, headquarters were trans
ferred from St. Joseph to Lansing, a city more centrally located for
state-wide^ work, and where the society could be in direct touch with
State officials and organizations.
The history o f the Michigan Children’s A id Society shows a con
tinuous development in the number o f children helped, in the scope
o f the work, and in the quality of the service rendered. Although
handicapped by financial limitations, the society has been steadily
approaching its ideal o f bringing to the child o f the less-favored
community all o f the resources o f the most highly developed com
munity o f the State.
The State board of trustees of the society consisted o f 16 mem
bers, elected by the contributors o f the society, who served for a term
o f four years. The trustees elected their own officers annually and

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DESCRIPTIONS OP THE INDIVIDUAL AGENCIES

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met every three months. A small executive committee was empow
ered to act between the meetings. In localities where branch offices
had been established local boards o f directors were appointed. The
members of these branch boards were originally appointed by the
State superintendent o f the organization, after which the boards
became self-perpetuating. In addition to the State board and the
local branch boards, local advisory boards existed in 150 towns and
in 15 o f the northern counties. These advisory boards. referred
cases o f needy children to the State office and were called upon for
advice regarding local conditions.
Development and work of the branch offices.

The Michigan Children’s A id Society had established branch
offices m Detroit, Ann Arbor, Grand Rapids, Marquette, Battle
Creek, Lansing, Flint, Pontiac, Kalamazoo, and St. Joseph. In most
o f the branches the unit o f organization was the county. Each
branch had an executive, appointed by the superintendent of the
State organization subject to the approval of a local board of direc
tors. Nearly all the branch executives had clerical assistance, and
some of the branches had other case workers.
. The history o f the establishment of these 10 branches was a lesson
m vision, cooperation, and perseverance. No two branches were
established in the same way, nor had any two rendered exactly the
same service, for they differed as do the needs and resources o f each
community. The establishment of a branch was always preceded
* careful analysis o f the community, its social consciousness, its
child-caring resources, and its outstanding needs. Suspicion and
even antagonism were met with such a friendly spirit o f cooperation,
that eventually adjustments were made that led to a more compre
hensive plan o f child care for the community. Usuallv the branch
was at first carried financially by the State office; even in some of
the wealthiest communities the branch continued for years to be
partially dependent. A t the time o f the study nearly all the branches
not only were self-supporting but also contributed toward the
expense of the State organization.
An account o f the establishment and work o f the branches is
given below.23a
The Detroit branch.— The first branch was established in Detroit
m 1910. Four years afterwards the Detroit Society for the Preven
tion o f Cruelty to Children and one o f the local child-caring insti
tutions combined to form the Detroit Children’s A id Society. The
question o f adjustment o f work between the Detroit branch o f the
Michigan Children’s Home Society and the Detroit Children’s Aid
Society was amicably and satisfactorily settled in 1918 by an agreement that the positions o f general secretary o f the Detroit Children’s
A id Society and executive o f the Detroit branch o f the state-wide
society should be vested in one person and that a division o f work
ahouid be made on the basis o f the age o f the child to be assisted.
I he Detroit branch o f the state-wide society functioned where the
oldest child o f the family was under 3 years o f age, and the Detroit

tíonteN<^<3L36,

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TH E WORK OP CHILD-PLACING AGENCIES

Children’s A id Society where the oldest child or the majority o f the
children o f a family were 3 years of age or over. In addition the
State organization agreed to place in adoption homes some of the
wards o f the local society. As a matter o f fact, the cooperation
between the two societies was so well adjusted that the workers them
selves scarcely knew by which society they were employed. Both
the Detroit Children’s A id Society and the Detroit branch of the
Michigan Children’s A id Society were supported by the Detroit
Community Fund. In addition a sum o f $5,000 was appropriated
from this fund in 1923 for the state-wide work o f the Michigan
Children’s A id Society, a noteworthy example o f the expansion o f
local community interests to participation in the development o f the
social resources of less privileged sections of the State.
The Ann Arbor branch.— The second branch was established in
Ann Arbor in 1917. The location o f the university hospital at Ann
Arbor had led to two unusual types o f services for this branch. A
State law provided that children from any part o f Michigan who
needed hospital treatment which their parents were financially un
able to provide might be committed to the university hospital by the
probate courts, the expenses for transportation and hospital care
being met by the State. After a period o f hospital treatment many
o f these children needed convalescent care in a private home in the
vicinity, so that they might be returned to the hospital frequently
for further observation and treatment. To meet this need the Ann
Arbor branch o f the Michigan Children’s A id Society developed a
number o f boarding homes where such children were placed under
the supervision o f the society. The expense o f this care was met by
the State. In February, 1923, the branch was supervising 22 out
patients o f the children’s ward, whom it had placed in licensed
boarding homes in or near Ann Arbor. Another special service of
the Ann Arbor branch was work with infants o f illegitimate birth
born at the university hospital. Where social adjustments could not
be made to keep mother and child together, and where no mental or
physical taint was evident, these children were accepted for place
ment in prospective adoption homes.
The Grand Ravids branch.— The Grand Rapids branch also was
established in 1917. Because o f the existence in the city o f Blodgett
Home, a well-equipped institution for children, the need for a local
branch o f the Michigan Children’s A id Society was not felt generally
at first. However, the superintendent o f the Michigan Children’s
A id Society convinced the community that a Grand Rapids branch
was needed to perform four services not undertaken by the local
institution, namely, the care of children from the county outside
Grand Rapids, care o f negro and crippled children, and the provi
sion o f a state-wide field for the selection o f prospective adoption
homes. On these grounds the branch was financed by the Grand
Rapids Welfare Union, which worked out an agreement between
Blodgett Home and the Grand Rapids branch. By this agreement
Blodgett Home was to give temporary care to Grand Rapids chil
dren, including foster care in boarding homes; and the Grand Rapids
branch was to accept children from the city who were to be perma
nently placed, and all children from the remainder o f the county
who needed foster-home care o f any kind. In carrying out this
agreement, the Grand Rapids branch turned over to Blodgett Home

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DESCRIPTION'S OP TH E INDIVIDUAL AGENCIES

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over 60 licensed boarding homes, and it has used Blodgett Home as a
receiving home for most of its wards.
Other tranches.—Five o f the 10 branches were organized in
response to invitations from local organizations—the Girls’ Protec
tive Union in Battle Creek, the family-welfare societies in Lansing,
Flint, Pontiac, and the Civic Improvement League in Kalamazoo.
In some cases the branch functioned as a department o f the familywelfare society; in others it had organized its own board o f directors
and had become entirely separate from the family society, though
closely cooperating with it. The Upper Peninsula ¿ranch, with
headquarters at Marquette, covered 14 counties and did an extensive
pioneer work. When State headquarters were moved from St.
Joseph to Lansing, a branch office was established at the St. Joseph
receiving home to carry on the local work formerlv undertaken bv
the State office.
General work of the tranches.—Although the branches differed in
their special services and problems, all o f them performed four main
types o f work: (1) Investigation o f cases o f child need; (2) in
vestigation o f prospective boarding, free, and adoption homes; (3)
supervision o f wards o f the society placed in the territory covered
by the branch; and (4) so-called aid work in behalf o f children not
permanently separated from their families. This last service necessi
tated the development o f boarding homes in the locality of the
branch office, where children temporarily deprived o f their own
homes might be cared for near their relatives, thus preserving family
ties while the agent endeavored to reestablish the child’s home. This
important service, preventing the permanent disruption o f families,
was impossible to render to any considerable degree from a State
headquarters.
The branch executives were authorized to accept for foster-home
care both permanent wards and children who were to be boarded
temporarily, though they often asked the advice o f the State office
before receiving children for permanent care. Placement of children
m prospective adoption homes was made through the State office.
This policy not only provided a state-wide field from which to select
the foster home best suited to each child, but it insured the re
moval of the child from his own locality when he was handicapped
by his environment and undesirable relatives.
The educational advantage to a community o f a local worker and a
local board o f directors can not be overemphasized. The community
is given a demonstration o f case-work methods of child care and sees
family ties conserved instead o f disrupted; the local board o f direc
tors becomes a nucleus o f informed public opinion, and through the
contact with the State office the community becomes interested not
only in local problems but in State and national child-welfare move
ments.
Sources o f funds.

The main sources o f funds for the state-wide work were: (1)
Reimbursement for care o f children from relatives or friends,
and from the counties that made appropriations for this purpose;
(2) contributions from regular members o f the society, or in response
to letters o f appeal; and (3) collections made by two solicitors (these
solicitors were paid salaries and did not receive commissions).

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TH E WORK OF CHILD-PLACING AGENCIES

A t the time o f the study the expenses o f the branch offices were
usually met by local financial federations. The Lansing branch was
financed by public funds appropriated by the city and county. A
few o f the branches were still partly or wholly dependent for sup
port upon the State office. On the other hand, most o f them con
tributed to the main office a certain sum ranging from $5 a month
from one branch to $5,000 a year from Detroit. In addition, the
branches reimbursed the State office for the board of the children
sent to headquarters for permanent care. When, however, a ward
from a braijph office was placed in a prospective adoption home, the
branch paid the State office $25, the State office agreeing to assume
all further financial responsibility in behalf of the child.
Division of work.

The work of the society fell into two general divisions—work in
territory covered by branch offices, and work elsewhere in the State.
The work of the branches has been outlined. The remainder of the
State was served by field workers sent out from the State head
quarters at Lansing. A t the time the study was made the arrange
ment was that a field assistant to the superintendent and two field
investigators inspected possible foster homes and investigated appli
cations in behalf of children needing care. The field assistant also
visited the branches and conferred with the branch executives re
garding local problems. A home visitor supervised the children
placed in foster homes, and a transfer agent, designated as “ travel
ing nurse,” spent her whole time placing children or transferring
them from one home to another or to or from one of the receiving
homes. The case work of the State office was supervised by a chil
dren’s secretary, who also planned the placements o f all State wards.
A financial secretary had charge o f general publicity and letters of
appeal, interviewed county boards of supervisors, and kept track of
the work o f the bookkeeper and of the two field solicitors.
Receiving homes.

Early in its history the Michigan Children’s A id Society estab
lished a receiving home at St. Joseph. Later it disposed o f the first
building used and erected an attractive, three-story fireproof build
ing o f brick and concrete, located on the outskirts o f St. Joseph
near Lake Michigan. This home had a capacity for 12 infants, 11
girls, and 12 boys—a total of 35 children. In January, 1923, the
society entered into a three-year contract with the Social-Service
Bureau o f Lansing to take over a building formerly used by the
bureau as a temporary home for children. This gave the society a
receiving home at Lansing, its new headquarters. The capacity o f
the new home was 6 babies and 24 older children. The State office
agreed to care for children who formerly were provided for tempo
rarily by the Lansing Social-Service Bureau. To meet this need,
and also for temporary care of its wards, the State office at the time
o f the study was developing a group o f boarding homes in and near
Lansing. This was in addition to the boarding homes used by the
Lansing branch.
The St. Joseph home at the time of inquiry had under care 6 infants
and 29 boys and girls of all ages. The Lansing home had 30 inmates
at the time o f the study— 3 babies, 26 children (including 6 daynursery children and 1 feeble-minded older girl awaiting commit
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O R G A N IZ A T IO N C H A R T O F T H E M IC H IG A N C H IL D R E N ’ S A ID S O C IE T Y
[April, 1925]

S T A T E BOARD O F T R U S T E E S

E X E C U T IV E C O M M IT T E E

S T A T E S U P E R IN T E N D E N T

C H IL D R E N ’S S E C R E T A R Y

F IE L D A S S IS T A N T
TO S U P E R IN T E N D E N T
FIN A N CIA L S E C R E T A R Y

ST. JO S E P H ’S
R E C E IV IN G
HOM E
Matron (trained
nurse)
Trained nurse
2 practical
nurses
Cook
Dining-room girl
Cleaning woman
General assist
ant
Laundress
Janitor

FIN A N C IA L F O R C E
2 solicitors
1 bookkeeper
1 clerk

D E T R O IT
BRANCH
A ffiliated with
D etroit C hildren’s
Aid Society

E X E C U T IV E
9 A S S IS T A N T S
Supported by
D etroit
Community
Fund

E X E C U T IV E
C L E R IC A L
A S S IS T A N T
Supported by
Ann Arbor
County Chest
Association

E X E C U T IV E
C L E R IC A L
A S S IS T A N T
Supported by
Grand Rapids
W e lfa re Union

E X E C U T IV E
C L E R IC A L
A S S IS T A N T
Supported by
State headquarters
assisted by
Upper Peninsular
board

E X E C U T IV E
C LE R IC A L
A S S IS TA N T
Supported by
Battle Creek
W elfare Fund

E X E C U T IV E
C L E R IC A L
A S S IS T A N T
Supported by
Lansing W elfare
Fund and county
) board of
supervisor)
appropriations

E X E C U T IV E
F IE L D W O R K E R
Supported by
Flint
Community Chest

E X E C U T IV E
C L E R IC A L
A S S IS T A N T
Supported by
Pontiac W elfare
Fund, city funds,
and county
appropriations

E X E C U T IV E
Supported by
Kalam azoo
Association
C harity Fund

2 2 0 7 ° — 27.

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E X E C U T IV E
F IE L D W O R K E R
Supported by
headquarters,
assisted by
local board

( F ace p. 146. )

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DESCRIPTIONS OP THE INDIVIDUAL AGENCIES

147

ment, who was carefully kept apart from the children). Nearly
half (44.4 per cent) o f the children went to receiving homes on
reception; most o f the others (47.6 per cent o f the total) went to
boarding foster homes at the time o f reception. O f 457 children
going to the receiving home, 192 (42 per cent) stayed less than one
month; 217 others (47.5 per cent) stayed less than six months.
Children received and methods of care.

The Michigan Children’s A id Society received children under 14
years o f age from all parts o f Michigan without regard to sex, race,
religion, or nationality. Permanent wards were received through
commitment from the juvenile courts or by parental release; aid
cases were received informally from their parents, though a few had
been committed temporarily by the courts. Children accepted for
temporary care were placed in boarding homes in the locality from
which they came. Wards received for permanent placement were,
as a rule, sent to one of the receiving homes until a suitable perma
nent home could be found. Sometimes, however, they had been
cared for in the boarding homes o f the branches.
Each branch had its own group o f boarding homes. The usual
rate of board paid was $4.50 a week for older children and $5 for
babies; $3.50 a week was paid near St. Joseph for some homes that
had been in use for a long time.
A Christmas card sent from the State office to boarding mothers
in 1922 was a tribute to the devotion o f these women and showed
the esteem in which they were held by the society.
The Michigan Children’s A id Society expected that the children
placed for adoption or in free homes would be clothed by the foster
parents. The society furnished the clothing for boarded children
on requisition by the foster mother, in accordance with the need o f
the individual child. It was noted that a generous attitude prevailed
on the part o f the foster mothers in supplementing clothing, as well
as sewing for children. A few foster mothers were authorized to buy
the clothing for their children and charge it to the society, but most
o f the shopping was done by the visitors, a discount generally being
granted by the stores. Some things were purchased at wholesale
and kept at the receiving homes, and some secondhand supplies
were also kept there. Clubs and church societies did a good deal
o f sewing for the society.
The following list shows the classification o f the 886 children in
care on January 1, 1923:
_

„

Children in care

Form of care:
on Jan. l , 1923
In boarding homes or receiving homes__________________________________
444
Permanent department________ ___ ,____________________________
124
Temporary department_______________ ____ ____ ;_________________
320
In prospective adoptive homes______________________________________ ______ 442
Total.

886

In addition, the society was keeping on its list for supervision
678 children who had been adopted legally.
The society often placed two, sometimes three, and occasionally
four unrelated children in an adoptive home. The society sometimes
paid board over long periods before it found adoptive homes for
brothers and sisters together.

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Health supervision.

A ll children received for care by the society were examined before
acceptance by a local physician who certified that they did not
have a communicable disease. The society did not accept for per
manent care a definitely feeble-minded child, or for adoption a
child either o f whose parents was epileptic, insane, or feeble-minded ;
children with syphilis or with active tuberculosis were not accepted
for permanent care, though a child with inactive tuberculosis or a
syphilitic child without open lesions was accepted for temporary
boarding care. The preliminary examinations differed according
to the resources o f the communities and were in many cases super
ficial ; therefore, all children accepted for permanent care were re
examined carefully, usually while they were in one o f the receiving
homes. Remedial physical defects were then corrected before place
ment in permanent foster homes. Mental examinations were not
made before acceptance, but were made after a child had been under
observation for a time, if he showed marked school retardation, anti
social behavior, or had poor heredity. The State superintendent o f
the society and the children’s secretary decided which children
should have mental examinations.
Each branch developed its own health facilities, using local re
sources when possible. Where treatment was not available locally,
children could always be sent to the university hospital at Ann
Arbor (see p. 144).
Physical and mental examination.—A t St. Joseph a child specialist
on the staff o f the receiving home examined all children received.
A t Lansing examinations were made by private physicians upon
request, but a plan for physical and mental examinations and the
correction o f defects was being worked out at the time o f the study
by the State superintendent o f the society and the State department
o f health. In Detroit children were examined in the office o f the
Detroit Children’s A id Society, where a preventive clinic for chil
dren under 3 years o f age was held a half day each week. The
Grand Rapids branch used the Blodgett Home and its staff of
physicians for the physical examination of children. Children were
examined for evidence o f contagious disease on the day o f admission,
and the day following each child was given a thorough physical
examination, including a urinalysis. A t Ann Arbor the university
hospital, including its out-patient department, and the State psycho
pathic clinic were used for physical and mental examinations of
children received. No routine health examinations were made of
local-aid cases who were apparently well. In Ann Arbor and
Detroit all unmarried mothers coming to the society from the hos
pitals were given mental tests. In other sections, less happily sup
plied with facilities, the society was hampered in having tests made.
It was, however, moving in the direction o f careful personality
studies for children in its care, especially for the permanent wards.
A t Kalamazoo infants and young children were usually examined in
the inf ant-welfare clinic at the health center ; older children received
for temporary care were not given a routine physical examination.
A physician at the State hospital held a mental clinic once a month at
the juvenile court and saw children at the hospital by appointment;
he would examine any or all o f the society’s children upon request.

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In Flint, Pontiac, Battle Creek, and the Upper Peninsular branches
physical examinations were made by local physicians or through
local health facilities.
Records.— Records o f State cases—that is, children received for
ermanent care—and o f State-aid cases were filed in the office at
iansing. A medical-examination blank, Wassermann reports, lab
oratory reports, letters from physicians, reports from hospitals,
reports from psychiatrists and o f mental examinations were filed
with correspondence in chronological order. Records of temporaryaid cases in the branches were filed in the branch office.
Health standards for foster homes.—The State welfare commis
sion, which licensed all boarding homes in Michigan, prescribed cer
tain requirements regarding light, ventilation, and sanitation for
these homes. The society had no requirements with regard to a yard
or porch, but most o f the State homes were in the co’untry. Children
were not allowed to sleep with their foster parents, and a separate
room was required for older children. Separate beds were required
wherever possible, although two children might be allowed to sleep
together. The society stressed an investigation o f the health o f the
family. In placing a child, health problems were given first consid
eration and an effort was made to find a home suited to the needs of
the particular child. The visitors instructed the foster mothers in
matters pertaining to the health o f the child, such as diet, sleep, and
general hygiene. Written food formulas were furnished for infants.
A t St. Joseph printed diet slips prepared by the State department o f
health were used for the instruction o f the foster mother; in Detroit
three registered nurses assigned by the Visiting Nurse Association
visited and supervised all children under 3 years o f age in foster
homes. A t Grand Rapids the clinic for infant feeding was used by
the society for the supervision o f infants in boarding homes. This
clinic conducted four stations in different parts o f the city and held
clinics for infants under 2 years and for children from 2 to 5 years
o f age, a nutrition and a prenatal clinic. The nurses from the clinics
visited the homes and demonstrated the preparation o f feeding
formulas, the giving o f baths, and supplied nursing service for sick
babies and little children; the clinic distributed printed pamphlets
on infant care and feeding. The Ann Arbor branch developed
special types o f homes for children placed for the university hospital
(see p. 144).
Corrective work and special treatment.—Each visitor was respon
sible for obtaining the medical attention that might be necessary for
the children under her care. Ordinary corrections, such as tonsil and
adenoid operations and circumcisions, for children coming into per
manent earn were made usually while the child was in the receiving
home; a child transferred to a branch or a ^branch child transferred
to the permanent care o f the society carried a memorandum o f any
treatment prescribed which had not been carried out, and the respon
sibility for carrying out this treatment then became the responsibility
o f the visitor into whose care the child passed. The society made use
o f all public and private health agencies available at headquarters
and in all the branches in an endeavor to work out a satisfactory pro
gram o f health work at a minimum cost; child-welfare stations and
visiting-nurse associations were used wherever available, except in
Detroit, where the society had its own physicians and nursing staff;

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TH E WORK OF CHILD-PLACING AGENCIES

in Lansing, where the branch executive preferred to solicit the service
o f private physicians; in St. Joseph, where a physician was employed
at the receiving home; and at Ann Arbor, where health work was
carried out through the university hospital.
Cost of health work.—No figures were available for the cost o f the
health work that the society was doing. Practically all medical
service was free, except, for the salary o f the physician employed for
the receiving home at St. Joseph and that o f the physician at the
Detroit branch (paid by the Detroit Children’s Aid Society).
T H E JEW ISH H OM E-FIN D IN G SO C IE TY OF C H IC A G O 24
History and form of organization.

. The Jewish Home-Finding Society o f Chicago was organized in
1907 as an auxiliary o f the Home for Jewish Friendless and W ork
ing Girls o f Chicago, an institution for temporary care. It was
hoped that by placing some o f the children in family homes the con
gestion in the institution would be relieved and room would be made
for other applicants for admission. The articles of incorporation
give the object o f -the society as follow s:
To receive and care for dependent children who may be committed to its
ca re; and to furnish all needed medical treatment, food, shelter, and cloth
ing to the sam e; and to provide for the care, custody, and discipline and the
moral, intellectual, and physical culture of the sam e; and to teach them
useful trades and afford them such, employment as shall best tend to make
them self-supporting and independent, and to fit them for earning their own
livelihood, and for future usefulness in society. Also to provide for the
adoption, custody, or care of such children, whether previously committed to
the care o f said society or not, by a respectable person or persons. Also to
participate in and carry on any and all other general charitable work.

During the first year of its organization the home-finding society
investigated 51 applications for admission to the Home for Jewish
Friendless and Working Girls o f Chicago, and returned 20 chil
dren from the institution to their parents and other relatives, in
addition to its work of placing children in foster homes. As it
was soon found that it was better policy to support fatherless chil
dren in the homes of their mothers than to provide for them in
institutions, the society early began a system o f mothers’ aid. When
the county established a mothers’ aid division o f the juvenile court,
the society continued to give an allowance to families that were un
able to fulfill the requirements for public aid, and to supplement
inadequate county allowances. In January, 1922, these “ compen
sated cases ” were transferred from the home-finding society to the
Jewish Social-Service Bureau, the Jewish family-welfare society o f
Chicago.
Early in its history, the home-finding society extended its work
o f investigation for admission and discharge to the other two in
stitutions for Jewish children in the city, the Chicago Home for
Jewish Orphans, and the Marks Nathan Orphan Home. By 1917
the work of the society had proved that the Home for Jewish
Friendless and Working Girls o f Chicago was no longer necessary,
24 No attempt has been made in this summary, as in the case of the other societies, to
bring the information up to date. Changes in policies and organization have been made
which would necessitate a new study if an adequate picture of conditions as they now
exist were to be attempted. The information given relates to the years 1922 and 1923.

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DESCRIPTIONS OF TH E INDIVIDUAL AGENCIES

151

and accordingly the institution was closed, the children being either
returned to their families or placed in foster homes by the home
finding society.
The society at the time o f the study was occupying commodious
and well-planned quarters in a large, two-story brick building which
housed several organizations o f the Jewish charities o f the city A
research bureau, which was located in the building, acted as a con•XTi ? f c^lanf e1 f°.r all applications received, registered cases
with the city confidential exchange, and gave to the various organiza
tions o f the federated Jewish societies a detailed report of services
rendered m behalf o f each member of a family helped by any one o f
A t the time o f the inquiry, the board o f directors o f the society
consisted o f 18 men and women elected by the contributors to the
Jewish Charities of Chicago. The members o f the board served for
a term of three years, elected their own officers annually, and held
monthly meetings. A n advisory committee met twice a month and
passed on all cases. After each meeting o f the advisory committee,
its report was sent to every member o f the board o f directors, and its
decisions were typed into the case records of the children whose cases
were passed upon at the meetings. A medical, a purchasing, and a
finance committee met on call.
Sources of funds.

The society was supported by reimbursements from relatives, dona
tions, interest on endowment, and appropriations from the Jewish
Chanties o f Chicago. It was noteworthy that under the existing
laws o f Illinois no support could be paid from public funds for
dependent children committed by the juvenile court o f Cook
County ; this left with the child-caring agencies o f Chicago a heavy
financial burden, which in many States was carried, at least partly,
at public expense.25
*
J’
Division of work.

A t the time o f the study the work o f the society was carried on
by the four departments o f investigation, medical care, child placmg, and supervision. The superintendent o f the society was her
self directly supervising the department o f investigation, as the
position o f supervisor was temporarily vacant. Applicants who came
to the office were seen by an office interviewer. For field investiga
tions the city was divided into seven districts with a worker assigned
to each district. The duties o f these seven workers combined in
vestigation o f cases o f children needing care and supervision o f chilw ? Siac5d
he society in foster homes. They thus worked for
both the department o f investigation and the department o f supervision; their work o f investigation was directed by the superin
tendent o f the society and their work o f supervision by the assistant
ch5drenen^ent’ Wb° WRS *n c^ar^e
*he supervision of placed-out
The department o f investigation in the year 1922 worked on 314
applications for boarding care, involving 702 children; o f these,

e ? r ly SinW1924made aVailaWe *

2207°— 27----- -11

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T H E WORK OF CHILD-PLACING AGENCIES

340 children were placed by the society in foster homes. The
department also investigated 75 applications for admission to the
Chicago Home for Jewish Orphans and the Marks Nathan Orphan
Home, for whom it acted in the matter o f investigating applica
tions, involving 134 children. The work of the investigation de
partment was closely connected with that o f the Jewish SocialService Bureau. Any case requiring family treatment was referred
by the society to that bureau. When the social-service bureau felt
that the welfare o f the children demanded their removal from their
families, a conference between the two agencies was held, which
sometimes resulted in further efforts by ^the social-service bureau
to obtain proper care for the children in their own homes, and
sometimes in their placement in foster homes under the supervision
o f the home-finding society.
The work o f the medical department was carried on by two regis
tered nurses (seep. 155.)
.
A director and her assistant were in charge o f the child-placing
department. Their duties were to find and investigate foster homes,
and in conference with the visitor who knew the child to select
the home best suited to his needs. During the year 1922 the de
partment investigated 516 prospective foster homes and placed 340
children.
.
,
. . .
The department o f supervision was under the immediate direction
o f the assistant to the superintendent. Children in foster, homes
were visited by the seven field workers who also did the work o f the
investigation department for their districts. Babies were visited in
the foster homes by the nurses o f the staff at least once in every two
weeks and were visited as a rule once a month by the social workers
o f the department. Highly specialized supervision thus existed o f
all homes where children under 2 years o f age were placed. The
nurses’ supervision was to insure proper physical care o f the chil
dren, and the social workers were concerned with the standards o f
the homes themselves and with the contacts between the children’s
families and the foster homes. Rehabilitation o f the child’s own
family was not attempted by the home-finding society, but was left
with the Jewish Social-Service Bureau. The visitors, however, kept
in touch with the children’s families and in most cases encouraged
relatives to visit the children in the foster homes.
Children received.

A t the time o f this study the Jewish Home-Finding Society o f
Chicago received Jewish children from Chicago and its immediate
environs up to the age o f 18 years, with no limitations as to health,
mentality, or sex. I t specialized in the temporary foster-home care
o f children pending the rehabilitation o f the child’s own home, and
each year returned about 90 per cent o f its children to their own
homes. The society, however, had made some permanent placements
where there was no possibility o f a child’s ever receiving proper care
with his own relatives. The society was boarding in foster homes a
large group o f mentally defective children for whom institutional
care was not at the time possible or for whom it was hoped that
foster-home care might be beneficial. As a rule from 25 to 40 per
cent o f the children under care at any one time belonged to this

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group and presented a distinct problem. The society was also
caring for a comparatively large number o f children under 2 years
o f age.
The children were received by commitment from the juvenile court
or informally from their relatives; in rare cases guardianship o f
children had been accepted from the probate court. O f the 318 chil
dren in the care o f the society on February 1, 1923, 99 had been
received from the juvenile court, 6 from the probate court, and the
others from their parents. No parental surrenders were accepted,
but the children were received from their families informally for
temporary care. A general understanding with the court and with
the institutions provided that the children o f large families re
quiring care covering a long period o f time should be cared for in
the institutions and that the home-finding society should specialize
in temporary placements and permanent care, when necessary, o f
children o f small families.
In 1922 the society gave 108,927 days o f boarding care to 632
children. During the year it received 340 children and returned
321 to their parents or relatives, placed 45 with other organizations
for further care, and placed 2 children for adoption. The following
list shows the ages o f children accepted for care in 1922:
.
A ges:

Children received
Jan. 1 to Dec. 3 1 ,1 9 2 2

1 year and under___________________________________________________________

36
Over 1 year, less than 2---------------------------------------- --------------------------------------L
34
37
Over 2 years, less than 5___________________________________________________
5 years of age and over___________________________________________ _________ 233
T o ta l-------------------------------------------------------------------------- --------------------------------- 340

Foster-home care.

On February 1, 1923, the society was using 226 boarding homes
and 20 free homes (including free homes with relatives and wage
homes) ; the society had no prospective adoptive homes at that time.
A ll the 318 children under care on that date were in foster homes in
Chicago except 12 boys who were in farm homes located within a
radius o f 60 miles o f the city. The regulations o f the city o f Chicago
required a license for every home that boarded more than two chil
dren of different families at one time. The Jewish Home-Finding
Society o f Chicago did not use any licensed homes. Large families
o f children needing permanent care went by arrangement to institu
tions, and this practice reduced the number o f separations in families
too large for accommodation in one foster home. In cases o f neces
sary separation effort was made to keep brothers and sisters in contact
by keeping them in the same neighborhood and the same schools.
Often by placing such, children with foster mothers who were related
the family circle was kept intact.
Non-Jewish homes were used for children from infancy to 2y2 or
3 years o f age. The devotion o f these non-Jewish foster parents
to the children they had cared for during infancy often led them to
keep track of the children after they had been returned to their own
homes or transferred to Jewish foster homes. This interest which
brought people o f different races together in a new understanding

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TH E WORK OF CHILD-PLACING AGENCIES

was a valuable by-product of the work of the society, especially as
it often touched the lives o f newly arrived immigrants.
The society supplemented the outfits of the foster home by supply
ing cribs, toilet chairs, baby carriages, and other equipment when
necessary. When these articles were not in use, the two firms from
which they were purchased originally gave them free storage and
transferred them to and from the homes where they were needed.
Infants under 2 years of age were visited at least once in every
two weeks by a nurse, and once a month by a social worker. (See
p. 152.) Children o f 2 years of age or over in Chicago were visited
in the foster homes at least once a month by the visitors, and once
every six months by the director of supervision. A delinquent list
was given by each visitor to the director the first of each month, on
which were noted the names o f the children under her supervision
whom she had failed to see in the foster homes the preceding month.
The visit was not considered complete unless the foster mother was
also seen in the home, for office interviews or chance meetings were
not counted. A n exception was made o f the 12 boys placed in the
country, who were visited, as a rule, every .six weeks.
The society believed that recreational and educational advan
tages were o f benefit. Allowances were given all children over 12
years o f age, 15 children were receiving music lessons, semimonthly
tickets to the Chicago Symphony Orchestra concerts were given to
all children over 8 or 9 years o f age, and weekly tickets to selected
motion pictures. A special vocational study o f all children in the
eighth grade' was made regularly each year, and opportunities were
provided for high-school education or for technical training suited
to the ability, aptitude, and ambition o f each child. A t the time o f
the study seven children were in high school, four were receiving
technical training, and one boy was being sent to college.
The well-dressed appearance o f the wards o f the Jewish HomeFinding Society was a matter o f favorable comment. The society
felt that the purchase o f good clothing paid in dollars and cents as
well as in the added self-respect o f the wearers. The society had a
clothing room where enough clothing bought at wholesale was kept
to outfit newly admitted children. A n organization o f Jewish
women, known as the Infant’s Aid, furnished most o f the infant
outfits, which were especially dainty and attractive. The policy o f
the society was to give the children clothing of good quality on the
theory that it was an ultimate economy and that the children took
better care o f their clothes if taught to appreciate their value. It also
laid a good deal of stress on the moral value o f good clothing. In
about half the free homes the foster mothers furnished the clothing,
many o f them making the children’s clothing, the society paying for
the materials. One foster mother displayed with warrantable pride
an overcoat which her husband, a tailor, had made for a little 6-yearold boy and which had cost the society just $1. For children 12
years o f age and over the clothing was always purchased individu
ally, by either the visitors or the foster mothers, the children being
taken on shopping expeditions as a child in his own home would be.
Health supervision.

A medical committee was one o f the standing committees o f the
board o f directors of the society, meeting on call to consider all mat
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ters pertaining to the policy o f the society in regard to its health
program. The chairman o f this committee was one o f the eminent
pediatrists o f the country and was actively interested in the health
work o f the society.
The department o f medical care had as its head a trained nurse
who had had special training and experience in the care and feeding
o f infants. She had general supervision o f all matters pertaining
to the health o f all the children in care, o f the health records, and
also had under her personal supervision all infants under 2 years o f
age. A junior nurse, also on a full-time basis, gave her time exclu
sively to visiting children who were ill in foster homes. The society
provided an automobile for the use o f the department, which greatly'
facilitated the work done by the senior nurse.
The medical supervision o f the society was carried out through the
cooperation o f the Michael Reese Hospital and its out-patient de
partment, the Michael Reese Dispensary. The program of medical
supervision included a routine physical examination for every child
received, special examinations, treatment and correction o f remedi
able defects as indicated, and hospitalization o f all children who re
quired hospital treatment.
The society had engaged the services o f several physicians in each
district o f the city to visit children who became ill in foster homes.
These physicians were connected with the infant-welfare stations o f
the city and were specializing in work for children.
The plan o f medical supervision differed in its execution for babies
and older children. Infants under 18 months o f age were examined
at the Sarah Morris Hospital, the children’s department o f the
Michael Reese Hospital, by the resident physician and were returned
there for treatment if necessary. A ll breast-fed babies and those
presenting feeding problems were placed in the Sarah Morris Hos
pital for feeding adjustment before being placed in foster homes.
Children under 12 years o f age requiring hospital treatment were
admitted to the Sarah Morris Hospital.
The Michael Reese Dispensary was a member of the Federation o f
Jewish Charities o f Chicago but was nonsectarian in its activities.
The operating deficit o f the dispensary was carried by the Federated
Jewish Charities. The dispensary had 10 major and 12 special
clinics, including the tuberculosis, metabolic, cardiac, albuminuria,
serological, nutrition, and mental-hygiene clinics, an X -ray depart
ment, and a clinical laboratory, and was equipped to give all kinds o f
medical service. The clinical staff was composed principally of
members o f the staff o f the Michael Reese Hospital who served with
out compensation; a few paid clinicians were on the staff and the
heads o f the laboratory, X -ray department, and dental clinic were
all paid on a full-time basis.
The children’s examining clinic o f the dispensary was organized
in 1920 for the purpose o f examining and treating the children o f
the Jewish Home-Finding Society and the Jewish Social-Service
Bureau. A t the time o f this study the clinic was held two mornings
a week for the examination o f children o f the Jewish Home-Finding
^Society, and about 10 children were examined each morning. Occa
sionally older children were examined in the regular medical clinic
o f the dispensary.

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The staff o f the children’s examining clinic was composed o f a
pediatrist, a specialist assigned from the ear, nose, and throat depart
ment who also examined eyes, and a dentist from the dental clinic. A
volunteer social worker served in the clinic at the time this study was
made. The pediatrist o f the clinic staff was one o f the paid clinicians
o f the dispensary and served continuously throughout the year, giv
ing a continuity and standardization o f service which was most de
sirable for this work.
,
Physical examination.—Health examinations usually were made
early in the investigation so that for all children for whom there was
a probability o f acceptance necessary treatment or correction could
be made before placement. In the cases not accepted for care the
family was assisted in obtaining treatment for the child through the
social-service department o f the dispensary.
Children who were to be admitted to the orphan homes were
always examined at the children’s examining clinic and the respon
sibility for any treatment not completed was taken over by the
institution when it received the child.
A routine physical examination was made o f all children accepted
for care by the society. The examination was made with the child
stripped und included examination by the pediatrist, an examination
o f the eyes, ears, nose, and throat by the specialist assigned to the
clinic from the nose and throat department, and a thorough examina
tion o f the teeth by the dentist from the dental clinic. Height and
weight were taken and notation made o f relative over and under
weight. A ll children 7 per cent or more under weight were referred
automatically to the nutrition clinic. Temperature, pulse, and res
piration were taken and recorded. Urinalyses and throat culture,
which were required by the city department o f health for all'children
placed in foster homes, were made routinely and a vaginal smear
made by the clinic nurse was also a part o f the routine procedure in
the examination o f girls. Yon Pirquet tests were made only in thé
tuberculosis clinic to which children were referred if there was in
dication o f the disease. Wassermann tests were made in cases show
ing suspicious signs or clinical evidence of syphilis or when there
was a suspicious family history, and for children to be placed for
adoption.
Children who were examined and found to need special examina
tion or treatment were referred to the appropriate departments o f
the dispensary, where they were examined and treated as required.
This included the children who were referred to the dental clinic o f
-the dispensary for treatment. The program for health supervision
included a reexamination every six months, and these reexaminations
were carried out almost without exception.
The report o f the routine physical examination in the children’s
examining clinic was made to the society upon its own printed form,
which covered the examination in detail, the various items being
filled out by the social worker o f the clinic from the dictation o f the
examiner. In addition to the physical findings, the recommenda
tions in each case and the treatment prescribed were also given. The
reports o f special treatments or of laboratory work performed in th&
Michael Reese Dispensary were transmitted to the society by letter

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157

through the social-service department of the dispensary upon receipt
o f a written request for this information from the society.
Mental examinations.—A t the time o f the study mental examina
tions o f children coming into care were not a matter o f routine, and
few children were examined as a preliminary to acceptance. The
policy o f the Jewish Home-Finding Society o f Chicago was to have
the following types always examined mentally: Children presenting
behavior difficulties, those who were two to three years retarded in
school, those whose family histories presented mental abnormalities,
all who were to be placed for adoption, and all unmarried mothers.
These tests were made at the Illinois Institute for Juvenile Research,
where a thorough psychological and psychiatric study was made of
each child. The society also made a point o f studying carefully all
the boys and girls under its care who were in the last grade o f
grammar school, in order to plan intelligently for their future edu
cation, and when it was thought advisable this study included a
mental test.
A ll mental studies for the society were made by the Institute for
Juvenile Research. Owing to pressure of work the institute was
able to examine an average o f not more than 5 children a month for
the society. During 1922 approximately 60 examinations were made
by the institute for the home-finding society, 40 o f which were first
examinations and 20 reexaminations.
The Institute for Juvenile Research which was a part o f the divi
sion o f criminology, department o f public welfare o f the State, had a
highly trained staff of psychiatrists, psychologists, and psychiatric
social workers and a completely equipped clinical laboratory. It ex
amined children o f all ages. The study ofi each case included a
physical, psychological, psychiatric, and social examination with re
examination if necessary. A t the conclusion of the examination a
conference was held by all branches o f the examining staff for dis
cussion o f the case and suitable recommendations were transmitted to
the society in writing. The agency workers were also given oppor
tunity to confer with the examining psychiatrist or a member of the
social-service staff in regard to individual cases. In presenting a
case for examination the society summarized the social history o f
the child according to an outline furnished by the institute and stated
the problem presented and the reason why the examination was
desired.
Because of the special problem which the society was called upon
to meet in caring for a large group o f mentally defective children,
the board o f directors had recognized the urgency of the need for
more mental service than had been available heretofore, and was pre
pared, if necessary, to provide funds to develop a service which
would insure routine psychometric tests, for all children coming into
care.
Records.— The medical record o f each child was kept on a separate
sheet with the rest o f a child’s history. A ll health items were re
corded, including examination and treatments in the dispensary,
visits by physicians and nurses at home, and hospital residence.
Each time a child was examined or reexamined in the children’s
"examining clinic a card was filled out in a card file in the medical
department and flagged to indicate the treatment or corrections

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TH E WORK OF CHILD-PLACING AGENCIES

recommended, signals o f distinctive colors being used to show the
different conditions found. These cards were reflagged to show when
treatment had been begun or when it was completed.
For checking up the medical work to be done two books were
used— in one was entered the name o f each child for whom treatment
had been advised by the examining clinic, together with the clinic
or hospital to which he had been referred, and the date upon which
he was to be treated. The dates upon which he actually was treated
and the date upon which he was discharged from treatment were also
entered in this book. A second book was used, in which a page was
devoted to each special clinic o f the dispensary, such as nose and
throat, eye, dental, etc., and under each clinic were entered the names
o f all children referred to that clinic, with the dates o f examination,
treatment, and discharge from treatment. The entries in these books
were made by the medical-clerical worker from the reports o f visitors
and nurses, which were submitted upon a special form provided for
the purpose.
The flagging o f the examination cards and the entries in these
books were used as a double check upon medical work to be done, and
were used also for the compiling o f medical statistics.
Gorrecti/ve work and special treatments.—Responsibility for carry
ing out the recommendations o f the examining clinic rested with the
society. Each visitor arranged for the treatment of children under
her care. Practically all corrective work and special treatments were
carried out in the Michael Reese Dispensary or Michael Reese Hos
pital. Children who did not require hospitalization remained in
their foster homes during the period o f treatment.
Tonsil and adenoid operations were performed at the Michael
Reese Tonsil and Adenoid Hospital. This hospital, the gift o f a
philanthropic member o f the Board o f Federated Jewish Charities,
was devoted entirely to tonsil and adenoid operations. A small fee
was charged those who could afford to pay, but the major part o f the
expense o f operating the hospital was carried by the donor, and the
home-finding society was not asked to pay for the service it received.
The services o f the hospital were available to the municipal tuber
culosis clinics, school nurses, and private agencies, as well as to the
Michael Reese Dispensary.
„
Girls o f school age with gonorrhea or active syphilis were entered
at the Frances Juvenile Home, a private institution for the care and
treatment o f girls o f school age suffering with venereal disease. The
home employed its own physician and maintained a residential school
for children under treatment. It charged a moderate rate o f board
for the children in care which the society was glad to pay rather
than to send these girls to the Cook County hospital as was necessary
in the cases o f other children with active venereal disease.
The tuberculosis clinic o f the Michael Reese Dispensary acted as
the out-patient department o f the Winfield Tuberculosis Sanatorium,
which was also a member o f the Federated Jewish Charities, and
through the clinic children with incipient tuberculosis were admitted
to the sanatorium. Children with active tuberculosis were referred
to one o f the* city or county institutions for the treatment o f this
disease. Children with contagious diseases were hospitalized through
the city department o f health, which assigned these cases to one of
the three hospitals in the city for the treatment of contagious disease,

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DESCRIPTIONS OF TH E INDIVIDUAL AGENCIES

159

Children with scabies were usually cared for in foster homes, the
society paying an increased rate of board for their care.
The Michael Eeese Hospital provided free beds for children who
required ordinary medical or surgical treatment, and two convales
cent homes supported by two Jewish clubs provided for the children
o f the society who needed such care.
Health standards for foster homes.—Foster mothers were in
structed as to the physical care and general hygiene o f the older
children by the visitors. I f a child presented a special health prob
lem, the visitor obtained detailed instructions from the examining
physician in regard to the child’s régime, and transmitted these to
the foster mother.
The senior nurse who had personal supervision of infants under
2 years instructed the foster mothers in regard to the care and feed
ing o f infants. These instructions covered the general care and
hygiene o f the baby, with a demonstration o f the preparation o f
food. A written copy o f the baby’s formula was always provided,
and a complete equipment o f bottles for each feeding was supplied.
A ll babies on formulas were seen by the nurse once a week or oftener
if necessary, and older babies were visited less frequently—every two
or three weeks. The nurse carried a scale with her and the baby was
weighed at each visit and its weight accurately recorded. I f the
baby failed to make satisfactory gains, or if in the opinion o f the
nurse he needed medical attention, a private physician was called or
the child was admitted to the Sarah Morris Hospital for a period o f
observation and adjustment o f his feeding.
Every foster mother was provided with the names o f several phy
sicians in her district upon whom she might call in an emergency.
In an ordinary illness the foster mother communicated with the cen
tral office and a nurse visited the child immediately or a physician
was called according to the urgency of the case.
Cost of health work.—During the year 1922 the cost to the society
j carrying^
its program of health supervision, exclusive o f the
salaries o f its two nurses, was less than 1y2 per cent o f the total
expenditures for the year.
A ll service received from the Michael Eeese Hospital and Dis
pensary was given without cost, including examinations o f all kinds,
treatments, X rays, laboratory work, and everything prescribed by
the dispensary physicians, such as medicines, glasses, and braces.
F or convenience some o f the dental work was done by neighborhood
dentists and paid for by the society. This was always done in
emergencies.
System of records.

The Jewish Home-Finding Society o f Chicago had succeeded in
working out a system o f obtaining statistical information without
the use o f a large clerical staff. Each day the bookkeeper brought
up to date a census o f the children in care, classified by boarding
homes ond^ hospitals. The superintendent kept by her desk visible
indexes, with the cards arranged under the following heads: Chil
dren under legal guardianship, investigations on hand for orphan
Iiomes, children in hospitals, children and active cases for investi
gation assigned to each visitor. The director o f supervision kept a
card file of school children, flagged to show school grades and de
gree of retardation. The medical card file has already been de
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TH E WORK O F CHILD-PLACING AGENCIES

scribed. (See p. 157.) Statistics for the monthly reports regarding
source, cause, and disposition o f applications were readily available
from flagged cards.
THE

C H ILD-CAR ING D E P AR TM E N T OF T H E SO C IE TY
V IN C E N T D E P A U L OF DETROIT

ST.

History and form of organization.

The child-caring department o f the Society o f St. Vincent de
Paul o f Detroit was organized in 1912 by the Particular Council
o f Detroit.26 The immediate cause for its establishment was the
reluctance o f the juvenile court o f Wayne County to commit chil
dren to institutions. The object o f the department as given m its
articles of incorporation was the care, education, and protection
o f children and placing them in homes 5 to care for such boys and
girls as may come to its care by order o f any court in the exercise
o f its authority or by the parent, parents, or legal guardian of any
such child or children.”
Although the department was organized primarily for the care
o f dependent and neglected children committed to it by the court,
it had gradually enlarged its scope so that it had become a general
child-caring organization. Its chief service had been the placing
and supervision in family boarding homes o f children who were
temporarily deprived o f their own homes.
The managing board o f the child-caring department consisted
of a general committee o f 15 men which met monthly. The officers
and members of the general committee were appointed by the par
ticular council. This committee had the following subcommittees:
Case, finance, homes, and court. The court committee, which was
composed of five practicing attorneys, not all o f whom were mem
bers o f the general committee, was o f great help in legal matters.
A short time before the study was made, members o f the committee
represented the child-caring department before the Supreme Court
o f Michigan. It had also obtained the consent o f certain trust
companies to become guardians o f the estates of some o f the wards
o f the society.
Sources of funds.

-rr

The child-caring department o f the Society ox St. Vincent de
Paul o f Detroit obtained its funds from three sources: (1) Keimbursement from parents and other relatives; (2) reimbursement
from Wayne County for children committed by the juvenile court;
and (3) appropriation from the Detroit Community Fund. Ihe de
partment was a member o f the Detroit Community Union, from
which it received in 1922 nearly two-thirds of its entire yearly ex
penditure. The financial accounts o f the department were kept by
a member o f the general committee, who donated his services.26a
Division of work.

„

A t the time o f the study the work o f the department consisted o f
two general divisions—the case department and the homes departs
ment. The staff o f the case department consisted of a supervisor,
28 Kortptv of St Vincent de Paul is an international organization o f Catholic laymen
engaged in the personarvisitatiou and service of the poor., « s unit of organization is
the parish conference and the various conferences of a given diocese are united m a

pa26ta1T h|raccounts of the department are now kept by a salaried accountant.

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DESCRIPTIONS OF THE INDIVIDUAL. AGENCIES

four case workers, and a stenographer. The work o f this depart
ment included: (1) Investigation o f applications for the care o f
children; (2) the making o f adjustments within the child’s family
that might prevent removal from his own home; and (3) work to
reestablish his home when the child had been placed, so that he might
be returned to it as quickly as possible. The homes department
investigated and supervised foster homes. Its staff consisted o f a
supervisor (a position temporarily vacant during this study), a
home investigator, two visitors, three trained nurses, and two stenog
raphers. The three trained nurses were paid by the Visiting Nurse
Association o f Detroit and were assigned by that association to the
child-caring department of the Society o f St. Vincent de Paul.27
Children received.

The child-caring department o f the Society o f St. Vincent de
Paul o f Detroit received Roman Catholic children from the diocese
o f Detroit, which included 29 counties, although the great majority
o f the children came from the city o f Detroit and surrounding towns.
Children were accepted from infancy up to the age o f 16, but, as a
matter o f fact, the society received very few infants o f under 6
months. This was largely because o f the work with unmarried
mothers and their babies carried on by Providence Hospital and by
the Woman’s Hospital o f Detroit. The department made no limita
tion as to sex, race, or nationalitiy; a large proportion of the children
were o f foreign parentage, those o f Polish descent predominating.
In 1922 a little over half (191) o f the children received were com
mitted to the child-caring department by the juvenile court; most o f
the others were received informally from their parents. Only a very
few children were accepted through parental releases.
The department was liberal in accepting children who were phys
ically or mentally defective, the only limitations being that it did
not accept a child with a contagious disease or one so mentally handi
capped that he could not be cared for in a family home. Because
o f this policy on the part o f the child-caring department, the juvenile
court o f Wayne County rarely committed a Roman Catholic depend
ent or neglected child to the State public school for dependent chil
dren at Coldwater. Neither did the court as a rule commit a Roman
Catholic mentally defective child, unless he was o f very low grade,
to a State institution without first giving him an opportunity to de
velop in a family home through temporary commitment to the So
ciety o f St. Vincent de Paul.
The following list shows the type o f placement for the 725 children
in care o f the child-caring department on January 1, 1923:
T

In
In
In
In
In
In

y p e

o f

p l a c e m

e n t

a n d

n u m

b e r

o f

c h i l d r e n

i n

c a r e

o n

J a n u a r y

1 ,

1 9 2 3

boarding homes________________________________ ___________ ._________________ 425
free homes__________________________ _________
130
prospective adoption homes_______________________________________ __ _ ______ 86
institutions_______________________________________________________ ,_____ ______ 72
hospitals_______________
7
boarding school___________________
5
Total_______________ *_______________________________________________________ 725

27 A t the present time the staff of the department consists of a supervisor, 2 home
investigators, 5 visitors, 2 trained nurses, and 3 stenographers. The arrangement with
the Visiting Nurse Association of Detroit is no longer effective.

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TH E WORK OF CHILD-PLACING AGENCIES

Methods of care.

The principal work o f the child-caring department was the tempo
rary care o f children. On an average, four out o f every five children
received for care had been returned to their homes each year. Very
little adoption work had been done. In January, 1923, o f the total
725 children in care, 86 were in prospective adoption homes. In its 11
years o f service the child-caring department had given 190 o f its
wards in adoption. Its policy had been very liberal in keeping chil
dren for their own relatives. In the case o f a child o f an unmarried
mother, the department had not hesitated to pay full board, if neces
sary, rather than to give the child for adoption, provided the mother
showed a desire to live respectably and to do whatever she could for
the child.
The child-caring department had never used a receiving home, but
placed its children at once in boarding homes. Placement was
usually in the home in which it was intended that the child should
remain while in care. A ll boarding homes used by the society had
first been licensed by the State welfare commission, and all adoption
homes had been approved by the county agent o f the county in which
the homes were located. In addition to communicating with other
references, the indorsement o f the pastor of the parish in which the
home was located was required for all homes in which children were
placed.
During the early days o f the department, a large number o f the
children were cared for in institutions because o f the difficulty of
obtaining a sufficient number o f good foster homes. In 1919 an
intensive campaign was made to develop more homes, chiefly through
an appeal to the foster parents already known to the organization,
which resulted in obtaining many new homes, so that more of the
department’s wards were cared for outside of institutions.
Most o f the children received for care were placed in or near
the city o f Detroit. An interesting experiment had been the develop
ment o f a unit o f boarding homes at Mount Clemens, about 20 or
25 miles from Detroit. In March, 1923, the child-caring department
had in this unit 75 approved homes, most o f which were in use, with
125 children in care. One o f the visitors lived in Mount Clemens
and supervised the children in the district. A trained nurse was
assigned to this territory and went out every day from Detroit, and
a local physician was paid to care for the health o f the children.
Eighty-five o f the children attended the local parochial school.
As a rule, children who were to be in care for a long period of time
were selected for placement in the Mount Clemens unit.
Because o f the large number of children in care whose parents
were foreign born and o f various nationalities, the department had
had an unusually difficult problem o f adjustment. Its policv had
been to use only homes where American standards and speech pre
vailed.
. The Society o f St. Vincent de Paul o f Detroit sent its children
into homes with at least two changes o f clothing, thereafter fur
nishing replacements for all boarded children. The usual method
o f replacement was for the foster mother to send in a list o f needed
articles, which were furnished from the clothing room at the office
or through individual purchases at the stores.

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163

Health supervision.

The health supervision o f the child-caring department was carried
out through the pediatric clinic o f the out-patient department of
St. Mary’s Hospital, the infant-welfare clinic o f the Detroit Board
o f Health, and the three nurses assigned by the Visiting Nurse Asso
ciation o f Detroit to the department. The duties o f the nurses in
cluded the supervising o f children in boarding homes, accompanying
children to the clinics, and the recording o f the examination and
treatment recommended on the child’s record. Each nurse had her
own district— two working in Detroit and one in the Mount Clemens
district. (See p. 162.)
Physical examinations.—A routine physical examination was made
o f all children received for permanent care by the department; chil
dren received for short periods o f temporary care (from 10 to 15
days), who had been examined by the board o f health, were not
given further examination before placement. The examination of
children over 1 year of age was made in the pediatric clinic of the
out-patient department o f St. Mary’s Hospital; babies under 1 year
were examined in the infant-welfare clinic o f the board o f health. A
child received upon discharge from a hospital was not given a
physical examination, but information was obtained from the hos
pital to fill out the required medical record. Immediately upon com
ing into care the child was taken to the clinic for examination;
examination was made with the child stripped to the waist. The
child was weighed but height was not taken so that an accurate
estimate o f overweight or underweight was not made. The tempera
ture was taken in each case; nose and throat, teeth, lungs, heart, ex
tremities, and glandular enlargements were examined. Vision and
hearing were not tested routinely; urinalysis, throat cultures, and
vaginal smears were made only when they seemed necessary, and
Wassermann blood tests were made at the request o f the department
or if clinically indicated (such tests were not made without consent
o f the child’s relatives). Von Pirquet tests were made if there was
indication of tuberculosis. Vaccination for smallpox was done by
the board o f health clinics but not routinely. The nurses from
the child-caring department who accompanied a child to the clinic
assisted the physician during examination, and got the findings o f
the examination for entering on the child’s medical record.
Mental examinations.—Mental examinations were not made rou
tinely, but were made o f all children placed for adoption, o f children
showing retardation in school, o f behavior problems, o f children with
bad heredity, and o f a few children o f s'uperior ability. Children
committed by the juvenile court were examined in the Wayne County
Psychopathic Clinic and school children were given intelligence tests
at the psychological clinics of the department o f education.2741 In the
cases o f infants received for adoption who were too young for a
mental examination the department endeavored to get an examina
tion o f the mother.
Records.— The medical record of each child was kept on a separate
sheet, giving the details o f the routine physical examination and a
record o f visits to the dispensary for treatments and of house visits
378 At the present time the child-caring department has its own mental clinic, the staff
of which consists of a psychiatrist, a field worker, and a stenographer.

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164

the

work

c h il d -p l a c in g

a g e n c ie s

by the nurse. A report o f the mental examination, i f any, was filed.
This record was filed with the case history o f the child.
Health standards for foster homes.— The department did not re
quire porches or yards in the homes in which it placed children; in
Detroit it required bathrooms and inside toilets, but these were not
required outside the city. Children were allowed to sleep in the room
with other children i f in the opinion o f the investigator the room was
sufficiently ventilated. The department did not furnish beds for its
wards, except occasionally a basket for a baby. Health instructions
were given to foster mothers by the nurses. The nurse demonstrated
the preparation of food and the bathing and care o f the baby. A
written copy o f the food formula for the baby was given the foster
mother and a pamphlet on baby care issued by the department o f
health. The nurse also gave verbal instructions regarding the diet o f
older children and supervised their sleeping arrangements. The
nurse was responsible for giving instructions about the use o f a tooth
brush and seeing that the children’s teeth were cared for properly.
Corrective work and special treatment.—The nurses were respon
sible for arranging to have all children examined and for obtaining
appointments for the carrying out of recommendations made regard
ing corrections and special treatment. Dental work for preschool
children in Detroit was done at the dental clinic o f the board of
health; the work for school children was done at the school clinic;
The department o f health sent school nurses to parochial schools to
examine children’s teeth. Dental work in the Mount Clemens district
was done by a dentist who gave his services free one-half day a week.
Dental work in Detroit was entirely free. W ork for children outside
Detroit was done by local physicians, whose charge, if any, was very
little. Eye work was done at St. Mary’s dispensary and glasses were
furnished by an optician in Detroit free of charge. X -ray and labo
ratory work, such as urinalysis, blood counts, and smears, were made
at St. Mary’s Dispensary. Throat cultures were made by the board
o f health. Children suspected o f tuberculosis were referred to the
tuberculosis clinic o f the department o f health; from there they were
referred to the open-air schools in the city and placed in boarding
homes. Incipient cases were referred to the Northville Sanitarium
and more advanced cases were sent to the Herman Kiefer Hospital.
Children showing positive Wassermann reactions were referred to
the venereal clinic o f the department o f health; i f they had no open
lesions they were placed in boarding homes and returned to the clinic
for treatment. I f intensive treatment was needed the child was sent
to the university hospital at Ann Arbor. Children with gonorrheal
infection were sent to the Herman Kiefer Hospital, where they were
treated in the venereal ward for children.
All surgical work was done at St. Mary’s Hospital; contagious
diseases were sent to the Herman Kiefer Hospital. Children need
ing long hospitalization were sent to the university hospital at Ann
Arbor.
Orthopedic cases were treated at St. Mary’s Hospital and were
entered at the Kellie Leland School for Crippled Children. This
school was built by the board o f education for the treatment and
education o f crippled children, and school schedules were arranged
in accordance with the clinic attendance o f the patients.

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DESCRIPTIONS OF TH E ' INDIVIDUAL AGENCIES

165;

Undernourished children were usually placed in the country under
special supervision, and if they failed to gain in weight were brought
into the city for observation. The foster mothers were instructed to
call the child-caring department in the case o f the illness o f a child.
The nurse was sent to visit the child, and if necessary sent for a
physician. In an emergency the foster mother called a local physi
cian. In rural districts the local physicians were called and the
department notified. In Mount Clemens a local physician attended
children ill in the boarding homes (see p. 162).
Cost of health work.— The amount o f health work done by the
child-caring department was out o f proportion to its cost, as the
salaries o f the three nurses were paid by the Visiting Nurse Asso
ciation o f Detroit, and the cost o f work done by the out-patient
department of St. Mary’s Dispensary was borne by the dispensary.
As these agencies all belonged to the Detroit Community. Union,
the cost o f the work was borne ultimately by the community which
contributed the funds to the union.
Cooperation with parish conferences and other agencies.

A distinct feature of the child-caring department was its coopera
tion with the parish conferences o f the Society o f St. Vincent de
Paul. A t the time o f this study the parish conferences had 519
active members throughout Detroit. Many o f them had attended
classes in case work conducted by the general secretary o f the child
caring department. These men were active in visiting the poor o f
their parishes, giving relief and other assistance, and endeavoring to
adjust bad social conditions. Many children in need were referred
by the conferences to the child-caring department, and, on the other
hand, the department referred to the conferences many families
where it was thought possible to keep children in their own homes.
Often the conferences and the child-caring department worked out a
plan together. Where financial help in the home was needed it was
supplied by the conferences, except in some cases involving prolonged
care, which were referred to the Detroit Department o f Public
Welfare.28
The child-caring department was fortunate in its working rela
tions with the other social organizations of the city. It was a mem
ber o f the Detroit Community Union and a beneficiary of the Detroit
Community Fund. It had joined with the other child-placing mem
bers o f the Detroit Community Union—the Detroit branch o f the
Michigan Children’s A id Society, the Detroit Children’s A id So
ciety, the United Jewish Charities, and the Methodist Children’s
Home— in working out a friendly arrangement whereby applica
tions for foster care of children were referred to the society repre
senting the faith o f the child’s parents. So friendly were its rela
tions with the juvenile court that the child-caring department placed
in its boarding homes some of the delinquent wards o f the court,
who were supervised jointly by the visitors o f the child-caring de
partment and the probation officers o f the court. An unusual piece
o f cooperation was the assignment to the department for full-time
Detroit had no private nonsectarian relief society.

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duty o f three registered nurses paid by the Detroit Visiting Nurse
Association. This was typical o f the general spirit o f give and take
that pervaded the work of the social agencies of the community, and
which was an important factor in meeting the needs of the handi
capped children o f Detroit.
Through the efforts o f the case department and cooperation with
the parish conferences and other agencies in Detroit the needs of
many children had been met without separating them from their
families. In 1922 the cases o f 2,206 families, involving 6,609 child
ren, were referred to the child-caring department. O f these 432
families were referred by the department to the conferences and
164 to other agencies. The remaining 1,610 cases were handled by
the case department, and resulted in the acceptance o f only 377
children for foster-home care. The conferences also cooperated
with the child-caring department by working to reestablish the
homes o f children under care, and often by friendly visiting after
a child had been returned to his own family. The visiting of women
and girls was done sometimes by the League o f Catholic Women,
since the conference visitors were all men.
T H E ST. LOUIS CH ILDREN’S A ID SO C IE TY
History and form of organization.

The St. Louis Children’s A id Society was organized in 1909 and
incorporated in 1911. Its inception was due to the vision o f a
worker in the juvenile court of St. Louis, who became impressed
with the need o f a child-placing organization in the city. When the
society was organized she became its first general secretary, serving
without salary for a year. The object o f the society, as stated in
the articles o f agreement, is as follow s:
The object of this society shall be to improve the conditions o f the poor
and destitute children in the city of St. Louis, Mo., and to keep and care for
neglected, exposed, wayward, and destitute children, and fo r 1that purpose to
receive such children by surrender or otherwise, and to exercise oversight
and control over those who have been placed in fam ilies; and, further, to
conserve the home life of the children in cases where the fam ily has been
deprived o f support by death, desertion, or otherwise.

The society at first did a general child-placing work and also gave
a limited number o f mothers’ allowances. When the St. Louis
Board o f Children’s Guardians was created, much o f the child-plac
ing and aid work was taken over by the public organization. The
children’s aid society was then able to specialize in cases o f part
dependency and in health and conduct problems. A t one time the
society tended to become a central application bureau for the child
caring institutions o f St. Louis, but at the time o f this investigation
such service had been discontinued, except that the society still in
vestigated applications for admission and discharge for the Protes
tant Orphans’ Home.
The board o f directors consisted o f 39 men and women; they were
elected at the annual meeting o f the society, served for one year,
and selected their own officers. The board met monthly. A case
committee, a finance committee, and a committee on Christmas carols

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divided the work of the society. It was customary to have a lunch
eon m connection with the annual meeting, for which compli
mentary tickets were sent to representatives o f newspapers which
contributed publicity, and to ministers and other influential people
o f the city.
r
Sources of funds.

Before 1923 the society was supported by contributions, member
ship leeSj reimbursement from relatives, and money raised through
letters o f appeal and from carol singing at Christmas. In 1923 it
became a member o f the St. Louis Community Fund, a federation
recently organized to raise the budgets o f the affiliated organizations
which did not allow financial appeals by any of its members.
Since 1911 a picturesque and effective means o f obtaining funds
for the society had been the singing o f carols at Christmas. A carol
committee worked for weeks before the holidays, organizing bands
o f singers from churches, clubs, schools, and community groups.
Much publicity was given to the custom through the local news
papers and churches, and attractive posters were placarded asking
the people to place candles in their windows on Christmas Eve as an
invitation to the singers. A t luncheon and dinner on the day before
Christmas, society leaders acted as hostesses at hotels, clubs, and
restaurants welcoming the singers as they appeared. On Christmas
Eve, the carolers, costumed in scarlet and green, sang in the
churches, theaters, and under all the windows where a lighted candle
gave its invitation. In 1922, $8,627.86 was cleared in this way. Care
was taken not to solicit funds, but simply to offer an opportunity to
give. This custom was discontinued in 1923.28a
Division of work.

A t the time o f the study, the work o f the society was divided into
three departments: (1) Advice and investigation, (2) home finding
and (3) home supervision.29 The department o f advice and investiga
tion investigated all applications for admission to the society and the
applications for admission and discharge for the Protestant Orphans’
Home. It also worked with families to keep children in their own
homes, when all that was needed was a slight adjustment, or where
by intensive work a solution could be quickly reached. When ex
tensive family treatment was required the case was referred to one
o f the family-welfare agencies o f the city. The staff of this depart
ment consisted o f a supervisor, a full-time assistant, and a part-time
assistant.29a During the year 1922 the department investigated 407
cases. In addition 252 applications were handled at the office
without field investigation. In these cases advice was given, and
where other social agencies were better fitted to meet the need the
applications were referred to them.
?*a 1+
.fi16
Douis Christmas Carols Association (an organization entirelv
ses»o^e f? .m tbe childrens aid society) was formed to carry on this custom.
s7 u<ly ° i i
agency was made a mother and baby department has been
added, chiefly to handle the work for unmarried mothers. A letter from the society
1924, states that it is hoped to accomplish much in the way o f better
legislation and better care for the unmarried mother.
-

full time *assistant1*'
2207°— 27-

staff of this department consists of a supervisor and two

-12

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00

O R G A N IZ A T IO N C H A R T O F T H E S T . L O U IS C H IL D R E N ’ S A ID S O C IE T Y

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THE WORK OP CHILD-PLACING AGENCIES

[April, 1925]

169

DESCRIPTIONS OF THE INDIVIDUAL AGENCIES

The following table shows the disposition made of applications
for the care o f children by the St. Louis Children’s A id Society dur
ing 1922, by number of families and number o f children involved:
D

i s p o s i t i o n

C h i l d r e n ’s
c h i l d r e n

a d e
A

i d

o f

a p p l i c a t i o n s

S o c i e t y

d u r i n g

f o r
1 9 2 2 ,

t h e
b y

c a r e
n u m

o f
b e r

c h i l d r e n
o f

f a m

b y

i l i e s

t h e
a n d

S t .
n u m

L o u i s
b e r

o f

i n v o l v e d

Applications
Disposition made
Families Children
involved
T o t a l .,.................. ............. .......... ..................................................................

659

1,075

Family advised or case referred to other agency without field investigation.
Investigation made and case disposed of without placement.......................... .

252
302

445
469

26
22
12

85
157

44
39
14
142
230

105

161

Care of children assumed by:
Relatives other than parents................................................................... .
Other social agencies___ ______ ________________________________ ....
Institutions______ ___________________ _________________ §j________
Family advised after investigation....................... ......... ,_______________
Application withdrawn______ ________________________________________
Investigation made and children placed by society.

The home-finding department investigated prospective foster
homes. This department was directly supervised by the general sec
retary, who herself investigated all prospective adoptive homes. The
staff, in addition to the supervisor, consisted o f one full-time and one
part-time worker.30 The following list shows the applications han
dled by this department in 1922:
N

u m

b e r

o f

a p p l i c a t i o n s

h a n d l e d

J a n u a r y

t o

e c e m

b e r

3 1 ,

1 9 2 2

Type of home:
T o ta l____________________________________________________________ ________

81637

Boarding hom es___________________________________________________________
Free homes_________________________________________________________________
W age hom es,__________
Prospective adoptive homes_______________________________________________
Homes for mothers with children___________________ _____________________

370
87
32
127
21

The department o f supervision consisted o f a director, a full-time
visitor, a full-time registered nurse, and four additional workers
who gave most o f their time to the work o f other departments o f
the society.31a The director assisted the visitor with the most difficult
cases. The work o f this department included the visiting and super
vision o f children in foster homes; contacts with the children’s own
families; and follow-up, usually for a six months’ period, when the
children had been returned to their own homes.
Methods of care.

The St. Louis Children’s A id Society had no receiving home nor
special homes for temporary care. One o f the directors of the society
30 In November, 1924, the home-finding department had two full-time workers and an
extra worker in emergencies, and investigated adoptive homes as well as foster homes.
31 Seventy-seven of these applications were approved.

sla At the present time the staff of the department consists of a director, three full-time
visitors, and a full-time registered nurse.

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had taken several apparently unplaceable children into her own
home; after good physical care, training, and grooming had devel
oped them into attractive children they were placed by the society,
usually in free foster homes.
The following list shows how the children in the care o f the society
were placed on December 31,1922:
C h i l d r e n

i n

c a r e

e c e m

b e r

Type of foster hom e:
Total___________ ___________________________ m

S I ,

1 9 2 2

______ , _____________________190

Boarding homes___________ :_________________________________ — ------------------ 101
Prospective adoption homes-------- --------------------------------------s— -------- ------------ 22
Free homes_____________________ -------------------------------------------— — 20
Institutions for special care_________________________ ___________ ---------------20
W age boarding homes____________________________ .--¿4-------- --------------1
---------- 19
W age homes____ It,— 1-------------- ----------------------------------- 4 -,-------------- -------------6
Free homes with mother at work______________ _______,--------------------- 2

The society had been unusually successful in keeping together chil
dren o f the same family. Four sisters had been boarded uninter
ruptedly in a foster family for four years and were a vital and
integral part o f the family group. Five delicate Japanese brothers
and sisters, ranging in age from 17 months to 7 years, had been
placed with a big-hearted American woman, who mothered the whole
brood. Under her care, in a plain suburban home, rickets and tuber
culosis gave way to straight, firm backs and legs and to rosy, chubby
cheeks.
Unrelated children usually were placed separately, but the society
had three homes with three unrelated children in each.
Children received.

The St. Louis Children’s A id Society received children from
St. Louis and its vicinity with no limitations as to sex, religion, race,
or nationality up to 21 years o f age.31b It had specialized in the care
o f infants and in health and behavior problems. Most o f the chil
dren had been received for temporary care by private arrangements
with their parents, though a few had been committed to the society
by order o f the juvenile court. Parental surrenders had been ac
cepted occasionally, but according to the law o f Missouri each sur
render had to be approved by the juvenile court. A working
agreement with the St. Louis Board o f Children’s Guardians which
became effective January, 1923, provided that the children’s aid
society was to receive cases o f part dependency, that is, where some
reimbursement was made by the children’s relatives or friends, and
the children who were wholly dependent were to be cared for by
the public child-caring agency. As a matter o f fact, the children’s
aid society had accepted numbers of wholly dependent children who
were definite health or behavior problems. On January 25, 1923, out
o f a total o f 171 children in care, 29 were definite health problems, 26
were definite conduct problems, and 39 were infants under 2 years o f
816 Boys 16 years of age and over are no longer accepted by the society.

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age.32 Only two negro children were in the care o f the society, be
cause as a rule negro children in St. Louis who required foster care
were wholly dependent.33
Clothing.

The St. Louis Children’s Aid Society took pains to outfit children
according to the grade of home into which they were to go in order
that they should conform to the standards o f the particular home and
community. Some supplies were purchased by the society at whole
sale and kept in a clothing room at the office for first placements and
emergency use. This stock was added to by contributions from
church societies, which did a good deal o f sewing for the society. A
limited amount o f second-hand clothing, usually o f a better grade
than the society could afford to purchase, was used with discretion
for special children for whom the circumstances made it appropriate.
After the initial outfit, clothing supplies were usually bought at
retail, by either the visitor or the foster parent, with special regard to
the need o f the individual child.
Health supervision.

The society with the cooperation o f Washington University Dis
pensary and the Children’s Hospital had worked out a comprehen
sive plan for the medical supervision o f its children. This program
included a thorough physical examination o f all children in the
pediatric department o f the Washington University Dispensary;
special examinations and treatment of children referred by the pedi
atric to the other departments o f the dispensary, such as eye, nose
and throat, skin, etc.; the return o f infants to the Well-Baby
Clinic at stated intervals for medical supervision, weighing, and
change o f food formula; and hospitalization o f all children needing
hospital care in the Children’s Hospital (negro children were ex
amined and treated in the Washington University Dispensary, but
when in need o f hospital treatment were sent to the city hospital).
Children who were ill in foster homes and required medical at
tention were seen by a physician, who was a member o f the staff
o f the Washington University Dispensary and who was paid by
the society for each visit made.33a The society included as a regular
member o f its staff in the department o f supervision a trained nurse
who had in her care infants under 2 years o f age and delicate chil
dren requiring special health supervision. She also gave nursing
care to children who became ill in foster homes.
The Washington University Dispensary served as the out-patient
department o f the Barnes Hospital, the St. Louis Children’s Hos
pital, and the Jewish Hospital of St. Louis. As an activity o f the
32
,a bove classification, a child who was both a health and a conduct problem was
counted only as a health problem, on the assumption that the maladjustment might be
removed with the physical handicap.
33 in November, 1924, the work o f the society with problem children and among negro
ink!?
of
Tw& orphanages
J[t. Louis recently had asked the society to
° ^ <ir Problem cases, and the mother and baby department was consloering the handling o f negro as well as white children.
in
society has had its own physician, who visits children sick
m roster homes, makes examinations of all children before placement (referring them to
specialists when necessary), and examines all children under care periodically 8

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the

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Washington University it was under the administrative control o f the
executive faculty o f the Washington University School o f Medicine
and its operating defict was carried by Washington University.
The pediatric department o f the dispensary in which all children
o f the society under 15 years o f age were examined served as the
out-patient department o f the medical wards o f the St. Louis Chil
dren’s Hospital. The staff consisted o f 12 physicians; 5 o f them,
including the chief o f the clinic, his associate, and the resident
physician o f the children’s hospital, were members o f the faculty
o f the school o f medicine of the Washington University, and were on
a full-time university basis. The attendance o f these full-time physi
cians in the clinic insured regularity and continuity o f service with a
resulting standardization not possible with a changing personnel.
The social-service department o f the Washington University Dis
pensary was a large and important one, including a director, 14 social
workers, and 11 clinical secretaries, 9 o f whom were volunteers. Much
o f the service that the children’s aid society received from the dis
pensary was made available through the social-service department.
The health work done by the society was not confined to that for
children received for placement. During 1922 o f 200 cases investi
gated and disposed of without placement almost all the 44 children
whose care was assumed by relatives other than parents, were ex
amined at the Washington University Dispensary and treatment
carried out; all the 14 children whose care was assumed by institu
tions were examined; and in the cases where adjustment was made
through advice many o f the 142 children involved were examined
and treatment obtained for them.
The physical excmwnatiovi.—The routine physical examination was
made with the child stripped arid included the taking o f the tem
perature, height, and weight, as well as a general physical examina
tion. No laboratory work or special tests were included in the
routine examination, but examinations o f urine and blood, and Von
Pirquet tests were made where indication was shown of their need.
Wassermann tests were made in cases showing some clinical evidence
o f hereditary or acquired syphilis, where there was a suspicious
family history, and in cases in which the society requested that they
be made. Schick testing for diphtheria was done in selected cases.
Children of preschool age usually were given toxin-antitoxin with
out the test, the Schick test being used later to determine immunity.
Children who were ill or who needed medical observation in a hos
pital were admitted to the Children’s Hospital, where urine exami
nations, vaginal smears, and Von Pirquet tests were made routinely.
Wassermann tests were made in almost all cases admitted to the
hospital.
A special clinic was held in the pediatric department for intra
venous and intramuscular medication for syphilis. The work of
this clinic was carried on entirely by one physician. Antiluetic
treatment was continued in an infant for one year and in older
children for at least two years, regardless of what the Wassermann
reaction showed.
The children who were found upon examination to require special
examinations and treatment were referred to the appropriate de-

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partments o f the dispensary; all kinds o f medical service were avail
able within the dispensary through its various departments.
Children over 15 years of age were examined in the medical de
partment o f the dispensary and were hospitalized in the Barnes
Hospital.
A uniform history card was used in the various departments o±
the dispensary on which was recorded the medical history, the find
ings o f the physical examination, diagnosis, treatment, and notes
made at subsequent visits. In the pediatric clinic the physical ex
amination was recorded in the form of positive findings only. The
records o f the children of the St. Louis Children’s A id Society were
kept in the general files o f the dispensary. These records, however,
were always available to the society’s workers through the socialservice department.
The service o f the Washington University Dispensary was free to
the children’s aid society, except in the cases o f children whose
parents were able to pay the dispensary fees. The society paid a
nominal charge for X rays, salvarsan treatment, and for prescrip
tions filled at the dispensary pharmacy. The society paid the
Children’s Hospital for children admitted to the hospital ward the
same rate which the society received from the children’s families.
The hospital made no charge for wholly dependent children.
Usually children presenting health problems were examined physi
cally during the course o f the investigation, and i f necessary were
sent to the Children’s Hospital for feeding adjustment or observa
tion before placement. Children who were apparently well were
examined at the dispensary the day they were placed. Children
who presented behavior difficulties were placed at once in homes
which had been carefully selected to meet their special needs.
In the cases o f older girls where a gynecological examination was
indicated, such examinations were made by a woman physician at
her private office.
Mental examvinaiions.—Mental examinations were made only in
selected cases because of the limited facilities available for this type
o f service. Practically all such examinations were made in the neu
rological clinic of the Washington University Dispensary, but be
cause o f pressure o f work the clinic was able to examine only a
limited number o f cases for the society (23 during 1922). During
1922 the child-guidance clinic, one o f the demonstration clinics estab
lished under the Commonwealth program for the prevention o f
delinquency, examined a few children for the society.34
A t the time o f the study mental examinations were restricted to
those children for whom such examination was recommended by the
pediatric clinic o f the Washington University Dispensary, to chil
dren who had proved most difficult after a period o f observation in
foster homes, and to those children showing serious school retarda
tion. It was not possible to have all problem children examined
because o f the limited facilities.35
34 Anderson, V . V . : The Psychiatric Clinic in the Treatm ent of Conduct Disorders of
Children in the Prevention of Juvenile Delinquency. The National Committee for Mental
Hygiene. New York, 1923.
.
35 In November, 1924, the society reported that the municipal psychiatric clinic
organized in the spring of 1923 following the demonstration clinic established under the
Commonwealth Fund was functioning well, and was referring many cases to it for super
vision and placement.
The society hoped to obtain expert advice and aid from the
clinic in its care o f problem children.

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Records.— All health items were recorded in the child’s running
record in chronological order. No written reports o f examinations
made in the Washington University Dispensary were given to the
society. The nurse or visitor made notes o f information given her
by the physician or obtained from the clinic record, and wrote them
on a special form for filing immediately with the case history.
When written reports o f mental examinations were received they
were filed with the correspondence in the case.
Health standards for foster homes.—In the selection o f homes for
older children the society used homes in the suburban districts,
preferably separate houses with yards. Babies were placed in the
city as conveniently as possible to the Washington University Dis
pensary. Separate beds were required for each child, and when
necessary the society furnished beds in order that children might
sleep alone. It also furnished cribs and baby carriages for infants
where they were not included in the equipment o f the home.
The investigation o f the foster home included a careful inquiry
in regard to the health o f the various members of the foster family
and an interview with the family physician.
The* home-finding department made certain requirements in re
gard to the physical care to be given a child relative to diet, sleeping
arrangements, and general hygiene, and the agreement which the
foster mother signed when accepting a child into her home carried
specific items covering these points.
The nurse instructed the foster mothers in regard to the care o f
infants, including the diet—-a written copy o f the food formula was
always provided-preparation o f food, and matters of general hy
giene, and in detail as to the care o f delicate children or those under
special treatment. Wherever possible the foster mothers were asked
to bring children to the dispensary themselves, in order that they
might meet the physician and receive direct information and in
structions in regard to the children, in their care. The foster mothers
cooperated in this respect to a remarkable degree, and these per
sonal contacts with the physicians o f the clinic not only had a
distinct educational value for the foster mothers but served to stimu
late their interest in the health problems o f the children.
The social visitors were responsible for the health supervision o f
the older children and the instruction o f foster mothers as to proper
diet, hours o f sleep, care o f the teeth, and other matters o f personal
hygiene.
A ll babies on a food formula in charge o f the society were visited
every two weeks or oftener and on alternate weeks were taken
to the Well-Baby Clinic, held twice a week by the resident physician
o f the Children’s Hospital, where they were weighed and looked
over by the clinic physician. The nurse attended the Well-Baby
Clinic to receive instructions from the physician, and in this way
saw all the small infants at least once a week. Older babies were
taken to the clinic about once a month. I f a baby failed to gain
and a special feeding adjustment was necessary he was admitted to
the Children’s Hospital.
Corrective work and special treatment.—A ll corrective work and
special treatments were carried out in the various departments o f

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the Washington University Dispensary, to which children were
referred by the physicians o f the pediatric clinic. Children who
required hospital treatment—including children with contagious
disease— were admitted to the Children’s Hospital or the city hos
pital- During 1922 the 41 children who received hospital care were
all treated m the Children’s Hospital.
Dental work was done in the dental clinics o f the Washington
University or the University o f St. Louis. Practically all the work
done m these clinics was performed by students, and the society
paid only for the materials used.
The society had been particularly successful in carrying out the
recommendations o f the clinic as to treatment and correction o f
remedial defects. It had been able to do this in every instance
where the society had had custody o f the child. In occasional cases,
where permission for important operations had been refused by
parents, court action had been sought. The society had been suc
cessful also in the placement o f children presenting behavior prob
lems. In cases where these children had been studied by a psychiatric clinic the recommendations of the clinic as to placement were
carried out as closely
possible and every effort was made to de
velop homes to suit the special requirements laid down.
. @°st of health work.— Through the close cooperation o f the Wash
ington University Dispensary and the Children’s Hospital the
society had been able to carry out a very comprehensive health pro
gram at extremely low cost. During 1922 the expenditure for health
work, exclusive o f the nurse’s salary, was less than 1 ^ per cent o f
the total expenditure for the year. The interest and cooperation of
the physicians o f the dispensary and hospital and the cordial rela
tions existing between the society and the social-service department
o f the Washington University Dispensary had much to do with the
effectiveness o f the work. On the other hand, the children’s aid
society reciprocated in service so far as possible by placing children
for the hospital and dispensary. During 1922 the society placed 35
children for the hospital in foster homes and made plans other than
placement for 25 others.
Disposition of cases and follow-up work.

Most o f the children received by the St. Louis Children’s Aid
Society were returned to their own families. Since the wholly de
pendent child went as a rule to the St. Louis Board o f Children’s
Guardians, it followed that very few o f the children cared for by
the society were eligible for adoption. Five children were legally
adopted in 1922, and only IT children had been given in adoption
since the organization o f the society in 1909. A probation period
o f two years in the prospective adoptive home was always required,
during which time supervision was maintained by the general secre
tary o f the society.35a
When children were returned to their own homes the society con
tinued to show a friendly interest and to visit the home for at least
six months. Occasionally this follow-up was prolonged for a year
s5a This supervision is now maintained by the director of supervision.

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or more, and the children in the family other than the ones originally
cared for by the society also received the benefit o f this contact.
A n outstanding feature o f the St. Louis Children’s A id Society
was its willingness to grapple with any problem o f child care, no
matter how difficult or complicated. Children with active tuber
culosis, with venereal infections, blind babies, a deaf mute, psycho
pathic little incorrigibles, and border line feeble-minded children
had been received unhesitatingly as a part o f the day’s work. In
the same quiet, unostentatious manner, difficulties o f health and be
havior had been adjusted by careful, painstaking work.

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Part II.—HEALTH SUPERVISION OF CHILDREN
PLACED IN FOSTER HOMES 1
INTRODUCTION
It is axiomatic that an individual who is well and physically able
is a potential asset to society, and that an individual who is physically
unfit is at best a potential liability. It follows, therefore, that one
o f the greatest contributions that child-placing societies can make
as social agencies, is to give the children in their care the best health
possible. No child-caring agency can be said to discharge its full
duty to a child for whom it accepts responsibility if it does not obtain
for that child the best health possible for him under the circum
stances and maintain him in it.
The purposes o f this section o f the report are: ( 1) To present
the work o f a number o f private child-caring agencies carrying on
effective health supervision through well-organized and comprehen
sive programs, in order to show what can be done and is being done
to build and conserve the health o f the dependent child; (2) to
present the health programs o f these agencies in detail, that they
may be available to organizations engaged in working out programs
o f their own; (3) to present the subject o f health supervision as a
distinct phase o f the work o f these agencies in order to center atten
tion upon its importance; and (4) to stimulate the interest o f
workers actively engaged in the care o f dependent children in the
health side o f their problem.
S T A N D A R D S O F H E A L T H S U P E R V IS IO N

Standards o f health supervision for child-caring agencies have
been formulated by Dr. Horace H. Jenks based largely upon the
practice o f the Associated Medical Clinic o f Philadelphia.2
In preparing this report, the writer has had in mind the following
generally accepted principles of health supervision by child-placing
agencies:
1. A thorough physical examination, and, i f possible, a mental
examination for every child when he comes under care.
2. Reexamination at definitely stated intervals.
3. Prompt correction o f all remediable defects.
1 Eight of the child-placing agencies studied by Doctor EVans in this section o f the
report are the same as those studied in Part I ; the health programs of two agencies
included in Part I— the New England Home for Little Wanderers and the Florida
Children’s Home Society— were not studied, but instead the Church Home Society of
Boston and the Detroit Children’s Aid Society were included in the 10 agencies whose
health programs are presented in Part II (for a summary o f the two last-named agencies
see Appendix B, p. 2 2 ).
2 Jenks, Horace H ., M . D „ director, Associated Medical Clinic, P hiladelphia: “ Safe
guarding the dependent child’s physical and mental health.”
Foster-Home Care for
Dependent Children. U. S. Children’s Bureau Publication No. 136, pp. 1 1 3 -1 3 4 . W ash
ington, 1926.

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4. Placement o f each child in a home selected in accordance with
health needs and the recommendations o f the examining physician or
psychiatrist.
5. Supervision o f each child’s diet, rest, and all details o f his per
sonal hygiene, and o f the hygienic conditions o f the home by the
society’s visitors.
6. Supervision o f infants in foster homes by trained nurses.
The application o f these principles is affected by the financial
limitations which must be faced by many agencies in the organi
zation of their health program. Doubtless few, i f any, organiza
tions to-day would be satisfied with anything less than the best
in carrying out their health programs, if their budgets permitted.
Unfortunately, much too often funds are limited, and an agency
is forced to adapt the pattern o f its health program to its financial
cloth. To show what may be done by agencies with limited funds,
this report describes the work of agencies whose health programs
have been based primarily upon the medical resources of their com
munities which were available without cost, as well as the work
o f agencies which were able to provide facilities o f their own for
carrying on their work.
A G E N C IE S S T U D IE D

Ten agencies located in five States east o f the Mississippi River
were selected for the purposes of this study. These societies were
known to be following constructive programs in the health super
vision o f their children and to be giving varied service in the field
o f child placing by private agencies. The agencies studied were:
The Boston Children’s A id Society; the Children’s Mission to Chil
dren; the Church Home Society o f Massachusetts; the Children’s
A id Society of Pennsylvania; the Children’s Bureau of Philadel
phia; the Michigan Children’s A id Society; the Detroit Children’s
A id Society; the child-caring department o f the Society o f St.
Vincent de Paul o f Detroit; the Jewish Home-Finding Society of
Chicago; and the St. Louis Children’s A id Society.
The territory served by eight o f these agencies has been outlined
(see pp 6- 8) ; for the territory served by the Church Home Society
and the Detroit Children’s A id Society see Appendix B, page 221.
C H IL D R E N A C C E P T E D F O R C A R E

In determining their policies as to the acceptance of children pre
senting problems of health or mentality, the agencies were governed
largely by the position which they occupied in the child-caring field
in which they operated, and by agreements with other child-caring
agencies of their respective communities. The Children’s Aid Soci
ety o f Pennsylvania, by agreement with the Children’s Bureau of
Philadelphia, did not accept babies in the Philadelphia district, and
t!ie Children’s Bureau took over for the Children’s A id Society
the supervision of babies brought into Philadelphia from outside
districts. The Children’s Mission to Children referred applications
for care for young and delicate babies to the Boston Children’s Aid
Society.

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Five o f the agencies accepted children for placement irrespective
o f their condition of health, if necessary arranging for their care
and treatment in hospitals or institutions until they were in condition
to be placed in foster homes. One agency did not accept any child
requiring hospital care. Three did not accept children with active
venereal disease or active tuberculosis, and one o f these was not
prepared to provide convalescent care for children discharged from
hospitals. One did not receive for permanent care any child with
a positive Wassermann reaction, but did accept for temporary
care in boarding homes children with positive Wassermann reactions
but without open lesions..
None o f the agencies accepted definitely feeble-minded children
for long-time care. Seven, however, received mentally defective
children for temporary placement during the illness o f the mother
or while they were awaiting commitment to institutions. Three
did not accept definitely feeble-minded children even for temporary
care. The Michigan Children’s A id Society did not accept a child
for permanent care if one or both o f his parents were known to
be insane, epileptic, or feeble-minded.

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PROGRAM OF HEALTH W ORK
G E N E R A L O U T L IN E

The program o f health supervision carried on by the Boston Chil
dren’s A id Society and the Church Home Society was based upon
the work o f the preventive clinic o f the Boston Dispensary sup
ported financially by the two societies. The programs o f the Chil
dren’s Bureau o f Philadelphia and the Children’s A id Society o f
Pennsylvania were based similarly upon the work o f the associated
medical clinic and its staff o f paid consultants. Medical supervision
o f the St. Louis Children’s A id Society was carried on through the
cooperation o f Washington University Dispensary and the Chil
dren’s Hospital o f St. Louis.
The health program o f the Jewish Home-Finding Society of Chi
cago was based upon the facilities afforded by the children’s examin
ing clinic o f the Michael Reese Dispensary, which was organized for
the express purpose o f examining and treating children o f the
society, and by the Michael Reese Hospital. Both the dispensary
and the hospital were members o f the Federated Jewish Charities
o f Chicago.
The Children’s Mission to Children employed its own physician to
examine children and to visit those who were ill in foster homes,
but used the various dispensaries and hospitals o f the city for special
treatments and corrections and for the supervision o f its posthos
pital cases.
The child-caring department o f the Society o f St. Vincent de Paul
o f Detroit used one o f the inf ant-welfare stations o f Detroit for the
examination o f young infants, and depended upon the nursery de
partment o f Providence Hospital for their hospitalization. Chil
dren over 1 year o f age were examined and treated in the out-patient
department o f St. Mary’s Hospital, a member o f the Detroit Com
munity Union, and were hospitalized in St. Mary’s Hospital. The
hospital expenses o f children with Detroit residence were borne by
the city.
The Detroit Children’s A id Society and the Detroit branch o f the
Michigan Children’s A id Society maintained at their own expense a
weekly clinic for the examination and medical supervision o f in
fants. Older children were examined without cost in the out
patient department o f Harper Hospital, a member o f thé Detroit
Community Union, and children requiring hospital care were ad
mitted to Harper Hospital or to the Children’s Free Hospital o f
Detroit.
The medical work o f the Michigan Children’s) A id Society out
side Detroit and St. Joseph was based upon free service available
through various agencies o f the communities in which the branch
offices were located, and upon the cooperation o f private physicians, J
The children’s department o f the hospital o f the University of
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Michigan at Ann Arbor was available for the hospitalization of all
children throughout the State who might need special medical treat
ment.
Wherever a weakness existed in the health program o f the agencies
studied plans were being made to develop resources and to obtain
additional service in order to strengthen and extend the work in
accordance with accepted standards of health supervision.
Departments of health.

Two agencies had organized separate departments to handle health
work. The Children’s A id Society o f Pennsylvania had a depart
ment o f temporary care and health in charge o f a supervisor who
was a registered nurse and a trained social worker. This depart
ment had charge o f all examinations and medical treatment given
to children coming into care and to children who had been returned
to Philadelphia for medical treatment.
The Jewish Home-Finding Society o f Chicago had a medical
department in charge o f a registered nurse who had general super
vision o f the health work o f the society and who supervised per
sonally all infants. A second nurse employed by the society visited
older children who became ill. The head o f the medical depart
ment was available for consultation by the other workers upon any
problems relating to the health of older children.
The Detroit Children’s A id Society placed on a medical worker
(not a nurse), who was under the direction o f the department o f
child care, the responsibility for physical examinations and medical
treatment o f all children over 3 years o f age who were accepted for
care, and o f all children returned to Detroit for medical treatment.
The medical work for younger children was carried out under the
direction o f the trained nurses.
Trained nurses.

All the agencies with one exception had one or more trained nurses
as permanent members of the staff and eight employed nurses to
supervise directly children who had been placed in foster homes.
The salaries o f these nurses were paid by the agencies, except those
in Detroit. In that city the Visiting Nurses’ Association, as a mem
ber o f the Detroit Community Union, assigned nurses from its or
ganization to the Detroit Children’s A id Society, the Michigan Chil
dren’s A id Society, and the child-caring department o f the Society
of St. Vincent de Paul, also members of the community union, for
permanent full-time duty with these organizations. The Visiting
Nurses’ Association paid the salaries o f these nurses from its own
funds and required only that each nurse submit to the association a
monthly statistical report o f the work that she had done. This ar
rangement, which had been in operation for 3y2 yeaTs at the time
of the study, had proved entirely successful. No conflict o f au
thority had occurred, because the nurses’ interests were identified
entirely with those of the organizations to which they were assigned,
and no attempt was made by the Visiting Nurses’ Association to
direct their work in any way. Through this arrangement nurses
chosen because o f their special fitness for the work, through train
ing and experience, were supplied to the agencies without cost, and
the Visiting Nurses’ Association made a very definite and valuable
contribution to the nursing service of the community.

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TH E WORK OF C H IL D -P A C IN G AGENCIES

The duties o f the nurses varied in the different societies. The Chil
dren’s A id Society o f Pennsylvania had a registered nurse at the head
o f its department o f temporary care. Her duties were purely execu
tive, but so much medical work was involved that a nurse’s training
was considered indispensable for the person called upon to handle
the problems arising in connection with the work o f this department.
Where professional nursing was required for children in boarding
homes the Visiting Nurses’ Association was called upon for this
service.
The Children’s Bureau o f Philadelphia had two trained nurses
upon its staff engaged in the supervision o f infants and o f special
health problems.
The Boston Children’s A id Society had a nursing staff o f three
registered nurses, one acting in a supervisory capacity and two
actively engaged in work with infants.
The three trained nurses in the child-caring department o f the
Society o f St. Vincent de Paul Society o f Detroit had under their
direct supervision all children placed by the society in boarding
homes irrespective o f age.
Two o f the three nurses o f the staff o f the Detroit Children’s Aid
Society and the Michigan Children’s A id Society in Detroit were en
gaged in the supervision o f infants, and the third visited older chil
dren who were ill, and also visited all older children once in six
months to see whether they were in good health.
The two nurses o f the medical department o f the Jewish HomeFinding Society of Chicago were engaged in the supervision and
care o f infants and o f cases o f illness among older children.
The St. Louis Children’s A id Society and the Church Home So
ciety had one nurse each whose duty was the supervision o f all in
fants under 2 and o f older children who presented health problems.
The Michigan Children’s A id Society had a trained nurse in charge
o f each o f its two receiving homes who were responsible for the
health supervision o f the infants and older children in care.
The salaries paid to nurses varied from $120 to $175 a month. The
average salary for nurses engaged in active supervision o f children
was $133 a month.
The success o f the plan o f using trained nurses in the supervision
o f infants and delicate children and the distinct contribution made
to the work o f a child-placing agency by the professional training
o f a nurse was shown by the fact that nine o f the agencies employed
trained nurses and Jhat agencies not prepared to provide trainednurse supervision directly or in cooperation with other agencies did
not accept delicate or very young infants.
It has been demonstrated by Dr. Maynard Ladd, o f the Preventive
Clinic o f Boston, and by Dr. H. H. Jenks, o f the Associated Medical
Clinic o f Philadelphia., that the most difficult feeding cases can be
successfully and scientifically cared for in foster homes without re
turning the babies to the clinics through a system o f careful super
vision by trained nurses under the direction o f the clinic’s pedi
atrists.3
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PROGRAM OP H EALTH WORK

183

Although the cooperation given by the Visiting Nurses’ Associa
tion and by municipal nurses may be good, the question o f divided
responsibility usually enters into such arrangements, and the advan
tages o f having a nurse whose interests are primarily those o f the
agency with which she works are obvious (this question does not
enter into the arrangement in Detroit whereby nurses are assigned
by the Visiting Nurses’ Association for permanent duty with the
child-placing agencies).
The employment o f a trained nurse does not present a problem o f
added expense. The supervisory work done by the nurse would
have to be done by another worker whose salary would be comparable
to hers. Besides, where the agency does not^employ a full-time
physician, a nurse is often able to care for a case o f minor illness
and thus save the expense o f a visit by a physician.
Wherever an agency is using a clinic outside its own organization,
especially where it is using more than one clinic, it seems desirable
from the standpoint o f maximum cooperation that contacts between
the clinics and the agency be made through a trained nurse wherever
this is possible without too great a sacrifice o f her time. The train
ing o f a nurse is particularly valuable in making contacts with
physicians and other nurses and in adjusting the procedure o f the
agency to the routine o f the clinic; it enables her to assist in the
expeditious handling o f children during examinations and to receive
technical instructions from physicians and interpret them to foster
mothers and to other workers. This is, o f course, not possible where
the nurse is expected to accompany children to and from the clinics,
but only when their transportation can be arranged otherwise.
Medical supervision.

Four o f the 10 agencies carried on medical supervision through
clinics organized and financed by themselves for the examination
and treatment o f their children. The Boston Children’s A id Society
and the Church Home Society maintained the preventive clinic o f
the Boston Dispensary under the direction of Dr. Maynard Ladd,
with a woman full-time assistant physician, a social worker, and a
clerk. Doctor Ladd acted as medical director of the societies and
assumed the entire responsibility for tHeir medical Supervision. The
Children’s Bureau o f Philadelphia and the Children’s Aid Society
o f Pennsylvania, together with the Society for Prevention o f Cruelty
to Children o f Pennsylvania, supported the associated medical clinic
o f the department o f prevention o f disease o f the Children’s Hos
pital ; Dr. Horace H. Jenks acted as director o f the clinic and medical
director of the cooperating societies. He was assisted by a woman
full-time assistant physician. The staff included a clinic nurse and
an office force.3a
Outside o f Philadelphia the Children’s A id Society depended for
the medical care o f its children upon the clinical services o f various
communities and the services o f private physicians, returning to
Philadelphia those in need o f special treatment. The Children’s
Mission to Children o f Boston employed the part-time service o f a
1

*» Since the time of the study a man part-time physician has been added t o the staff o f
th e clinic.

2207°— 27------13

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TH E

work

c h il d -p l a c in g

a g e n c ie s

physician for the examination o f children coming into care, for
which they paid a lump sum yearly. The Children’s Mission re
ceived many applications from hospitals to place in foster homes
children who were to remain under the supervision o f the hospitals.
Whenever a question arose as to the advisability o f accepting these
cases for care the decision was made by the two medical members o f
the board o f trustees. (See p. 108.)
The Michigan Children’s A id Society paid a physician at St.
Joseph for part-time service to examine children coming into care,
and to give medical supervision to children in the receiving
home. In the Detroit branch in connection with the Detroit Chil
dren’s A id Society a pediatrist held weekly clinics fo r the examina
tion and supervision o f infants, being paid for each clinic period.
The physician was available for consultation upon all medical prob<lems which arose in connection with the work o f the two societies
in Detroit. For examination and supervision o f children elsewhere
than in St. Joseph and Detroit the Michigan Children’s A id Society
depended upon the clinical resources o f the communities and the
services o f private physicians.
The agencies in St. Louis and Chicago, and the Society o f St.
Vincent de Paul o f Detroit received without expense the advice and
assistance o f the physicians serving in the clinics in which their
children were examined.
Mental examinations and child study.

The Children’s Bureau o f Philadelphia and the Children’s A id
Society o f Pennsylvania supported jointly a child-study depart
ment which gave psychometric tests and made personality studies
o f children (see pp. 121, 132). The Church Home Society o f Massa
chusetts employed its own psychiatrist upon a part-time basis for
routine mental examinations o f all children o f suitable age coming
into care.
The other agencies depended for mental examinations upon what
ever service was available. In Boston and Detroit children who had
been received through commitment by the juvenile court had usu
ally been examined, by psychiatrists. Wherever' a child-placing
agency was dependent for mental examinations upon outside agencies
it was impossible to examine all the children who needed such exami
nation.
Clinic organization.

The organization of the clinics used by the various societies fo r
the examination and treatment o f their children has been described
with the work o f the individual societies. (See pp. 100, 124,132,148,
155, 163, 171.) As will be seen by these descriptions the clinics
varied in their organization and in the detail o f routine.
Agencies that sent children to the preventive clinic and the asso
ciated medical clinic, which had permanent staffs, were assured
standardization o f service, which was one o f the chief advantages o f
a clinic organized exclusively for the use o f child-caring agencies.
Clinic service was standardized also for the St. Louis Children’s
A id Society which sent its children to be examined in the pediatric
department o f the Washington University Hospital, where the head
of the department, his associate, and several other clinicians were in
constant attendance, and for the Jewish Home-Finding Society which

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had'continuous service in the child-examining clinic o f the Michael
Reese Dispensary by a physician engaged and paid by the dispensary.
Standardization o f service was possible for all those agencies which
employed the same physicians regularly for the examination o f their
children. It was not possible for a society obliged to use a large
clinic with a changing personnel, where the child was not always
seen by the same physician. When general clinics were used, an effort
was made by the workers to return children to the clinic upon days
when they could be seen by the physicians who originally examined
them. For example the child-caring department o f the Society o f
St. Vincent de Paul used an infant-welfare station attended always
by the same physician for the supervision o f its small infants, and the
pediatric clinic o f St. Mary’s out-patient department for older chil
dren sending them upon the same days each week.
Whenever an agency was able through its own resources or through
cooperation with other agencies to provide its own medical staff, it
was able to present to the examiner all phases o f a child’s problem
in a degree not possible when he passed through a large general clinic
merely as one patient among many others.
To get the maximum cooperation it is necessary that the agencies
using general clinics gain the interest o f the examining physicians in
their.children, not only as medical problems, but as individuals for
whom the present treatment and adjustment are o f the most vital im
portance in determining the future happiness and usefulness o f their
lives.
A ll child-placing agencies, especially those called upon to care for
numbers o f children presenting problems o f health and behavior,,
feel the need o f the advice and professional backing o f a physician
who is especially interested in their problems and who is acquainted
with their resources and limitations and takes these factors into
consideration in the recommendations for the conduct o f a case.
In the preventive clinic o f the Boston Dispensary and in the
Associated Medical Clinic o f Philadelphia, the clinic director acted
as medical director o f the cooperating societies; entire responsibility
for their medical work was centralized in him. The medical director
was called upon to decide as to the advisability of accepting cases
in which a problem o f health or mentality was involved. He was
responsible for the actual medical treatment of children while in
care, he recommended the type o f foster home best suited to a child’s
particular need, and he decided the length of time a child should re
main in care in order to get the best results o f treatment. A ll ques
tions in which the professional advice o f a physician was needed were
referred to him for decision.
In this connection should be mentioned the unusual degree o f
cooperation received by the St. Louis Children’s A id Society from
the head o f the department o f pediatrics o f the Washington Uni
versity Dispensary, who solely because o f his interest in the work
of the society and in solving its problems acted virtually as the
medical director o f the society.
There is sometimes a tendency on the part o f workers to ques
tion the decisions and recommendations o f a medical examiner.
When medical decisions are questioned a division o f responsibility
results, the worker takes responsibility which she is not well qualified
to assume, and a let-down results in the medical work o f the agency.

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TH E WORK OP CHILD-PLACING AGENCIES

To avoid this situation the agency should obtain the best medical
service available and accept the recommendations without reservation.
R O U TIN E H E A L T H E X A M IN A T IO N S
Children examined and time of examination.

A ll the agencies had all children coming into permanent care given
physical examinations. Eight had all children examined irrespective
o f the length o f time they were to remain. Two, however, did not
have children examined ir they were to be in care but a week or two
and if they had been examined by a physician before acceptance.
The procedure in having children examined differed in the various
agencies.
The children o f the Children’s Bureau o f Philadelphia and the
Children’s A id Society o f Pennsylvania were examined in the asso
ciated medical clinic. The children’s bureau had all children ex
amined in the clinic as early as possible in the investigation, and the
children’s aid society children were examined upon the day they
came into care; but the children accepted by both societies were
examined upon the day o f placement irrespective o f how recently
they had been examined by the clinic or court physicians.
Examination o f a child upon the day he was placed in a foster
home, irrespective o f previous examinations, proved most satisfac
tory. A t the associated medical clinic the routine followed included
examinations o f all children upon the day o f replacement also, irre
spective o f the condition o f health, the examination o f all children
following discharge from hospitals, and examination of all children
upon the day o f discharge from care.
Temporary care during1period of examination and treatment.

None o f the agencies, except the Michigan Children’s A id Society,
used a receiving home for the temporary care o f children during the
period o f medical examination and treatment; they placed chidren
immediately in boarding homes. Agencies that received problem
children had the physical and mental examinations made previous
to acceptance whenever possible and the child was placed at once in a
boarding home in which it was hoped to have him remain.
That by careful investigation and close supervision boarding homes
can be developed which are prepared to receive at short notice all
types o f problem children and to give them skilled and careful atten
tion has been demonstrated by societies such as the Bostom Children’s
A id Society, which in emergencies is called upon to place all types
o f problem children in its subsidized homes; by the Children’s A id
Society o f Pennsylvania, which receives its large intake in tempo
rary boarding homes; and by the Children’s Bureau o f Philadelphia,
which accepts many delicate infants and children who have health
problems for care in its semihospital homes.
The use by the Children’s Bureau o f Philadelphia and the Chil
dren’s A id Society o f Pennsylvania o f boarding homes instead of
the temporary shelter which was used by these societies for a num
ber o f years had been followed by the elimination o f scabies, except
for the few children who had it when admitted, and a marked de
crease in the incidence o f contagious disease.

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From the standpoint o f safeguarding the physical and mental
health o f children receiving homes present several distinct disad
vantages as compared to boarding homes. Among these are the
frequent incidence o f contagious disease on account o f the exposure
o f numbers o f children, the resulting quarantine, and the close asso
ciation o f normal children with difficult or perhaps#defective children,
with bad sex habits or other undesirable traits.
Besides, a worker who can return a child to a receiving home i f
he has not done well in a foster home, is sometimes tempted to do so
rather than try to adjust him to a new foster home, so that unless;
the utmost care is used a receiving home may become filled with diffi
cult or defective children who have proved troublesome in foster
homes.
The comparative per capita cost for children maintained in receiv
ing homes and in boarding homes does not properly enter into this;
discussion, which is not a study o f the cheapest way o f caring fo r
children. Definite figures as to the cost o f maintaining children in
receiving homes are not available for purposes o f comparison, but
information from various sources seems to show that the cost o f the
receiving-home plan is usually considerably higher than the cost o f
the boarding-home plan.
Scope of physical examination and clinic procedure.

Six agencies arranged for gynecological examinations by women
physicians. A t the Associated Medical Clinic o f Philadelphia and the
preventive clinic o f the Boston Dispensary the gynecological exami
nations were made by the assistant physician except that at the pre
ventive clinic court cases were examined by a woman experienced in
court work. This woman physician appeared in court when necessary
so that the work o f the clinic physician was not interrupted.
The St. Louis Children’s A id Society and the Children’s Mission,
to Children obtained the services o f women physicians for gyneco
logical examinations, and in addition the Children’s Mission fre
quently employed women physicians for routine physical examina
tion o f older girls. In the children’s examining clinic o f the Michael
Beese Dispensary routine vaginal smears were made by the clinic
nurse. In the associated medical clinic all boys over 12 as well as
infants under 3 were examined by the medical director, and at the
preventive clinic adolescent boys were examined by the resident
physician (a man) o f the Boston Dispensary.
In both the associated medical clinic and the preventive clinic
small children o f both sexes Rnd older girls were examined by a
woman physician. Examination of older girls by a woman physi
cian was found to be a desirable arrangement, as by her sympathetic
understanding she was able to gain the confidence and cooperation
o f these girls in a degree most helpful in the solution of their
problems.
As the thoroughness of the physical examination and the emphasis
placed upon its various phases vary with the training and interest o f
the examiner, routine examinations can be standardized only when
they are made by a permanent staff. It is obvious that more time
and attention can be given to children who are examined in clinics
devoted entirely to their interests by physicians engaged primarily

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work

c h il d - p l a c in g

a g e n c ie s

for that purpose, than to children who must take their turn with
other children in a large general clinic.
Because o f the pressure o f work, routine testing o f vision and hear
in g was not possible in the general clinics, and only children with
•obvious defects were referred to the special departments for ex
amination. Where» testing o f hearing and vision was not a part o f
the routine, the agencies relied upon school medical inspection to
find any defects in children who had not been examined in the
clinic.
Pulse and temperature were taken as part o f the routine in all
clinics except one where they were taken only if there appeared to
be some special reason for it.
Height and weight were taken as part o f all clinic examinations
except in one clinic where children were weighed but their height
not measured. Tables o f average weight and height measurements
at various ages were used for the purpose o f finding whether chil
dren were overweight or underweight.
Routine examinations did not include any laboratory work ex
cept in the children’s examining clinic o f the Michael Reese Hos
pital, where throat cultures, urinalyses, and vaginal smears were
made as part o f the routine examination, and the Children’s Mission to
Children which had vaginal smears made o f all girls coming into
care.
In the Associated Medical Clinic o f Philadelphia a blood count
was made for every child 10 per cent or more underweight and
also for every child who appeared to be suffering from anemia. At
the children’s examining clinic o f the Michael Reese Dispensary all
children 7 per cent or more underweight were referred to the nutri
tion clinic o f the dispensary for special feeding instructions and
observation. A t the pediatric clinic o f the out-patient department
o f Harper Hospital the children o f the Detroit Children’s A id So
ciety were weighed and measured by the dietitian o f the dispensary,
who took charge o f all undernourished children.
In Michigan a regulation o f the State welfare commission re
quired that every child released by a court to a child-caring or
child-placing agency should have a Wassermann blood test made at
the laboratory o f the State department o f health at Lansing, at
the time o f admission.
A t the time o f this study none o f the agencies was having a Was
sermann blood test for syphilis made as part o f the routine ex
amination for all children coming into care. The question o f the
desirability o f making this test a part o f the routine physical ex
amination remains unsettled.
The policy o f the Associated Medical Clinic o f Philadelphia and the
preventive clinic o f the Boston Dispensary has been to perform this
test only in selected cases, the percentage o f positive reactions being
so small (only about 2 per cent in selected cases in the associated
medical clinic) that it was considered inadvisable to subject all
children to the strain o f a Wassermann test as part o f the routine
o f a first examination, on account o f the danger o f frightening the
child and o f losing further contact with him.

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189

Except in the Boston and Philadelphia clinics the weight o f medi
cal opinion was in favor of a Wassermann test for all children, but
because o f the large numbers o f children to be examined it had not
been possible to make it part o f the routine procedure o f any clinic.
The children’s examining clinic o f the Michael Reese Dispensary
was arranging to provide this service for the Jewish Home-Finding
Society o f Chicago at an early date.
In general, Wassermann tests were given to the following classes
o f children:
1. Children showing clinical evidence or suspicious signs o f con
genital or acquired syphilis.
2. Children who were mentally defective, or who required psychi
atric study.
3. Children who had a suspicious sex history or whose parents had
been sexually promiscuous.
4. Children offered for adoption.
5. Children who were to be admitted to certain child-caring in
stitutions which required the test as a preliminary to acceptance.
The Society o f St. Vincent de Paul o f Detroit obtained special per
mission from the parents before having a Wassermann test per
formed.
A t the time o f this study the Schick test, to determine a child’s
immunity to diphtheria, had not been used by any society as a part
o f the routine examination.
The Associated Medical Clinic o f Philadelphia was performing
the Schick test and giving toxin-antitoxin to children from the
children’s aid society and the children’s bureau as a routine. Chil
dren under 6 years o f age were immunized and later tested. Chil
dren over 6 years were given the Schick test and then immunized
and were tested again six months later i f they were still under care.
The preventive clinic o f the Boston Dispensary had begun to
administer toxin-antitoxin to all children o f preschool age, expecting
to give a Schick test six months later to determine whether im
munity to diphtheria had been established. Schick tests were to be
given to all children o f school age who were not in the Boston public
schools.
Special permission was obtained from each child’s parents before
the procedure was carried out.
Report of physical examination.

A ll the agencies but one used a standard form for recording the
results o f the initial physical examination. W ith one exception all
o f these forms gave a printed outline with various headings to be filled
in by the examining physician. One clinic used a form upon which
was recorded only the positive findings o f the examination.
By the use o f a regular printed outline to be followed in making a
physical examination, a guide to the scope o f the examination de
sired was given to physicians examining children outside the clinics,
and though frequently items might be merely checked off without
comment, the headings served to prevent the overlooking o f any es
sential points in recording the examination.
When children were examined in large clinics, usually it was not
possible to have the agency’s blank filled out by the examining

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TH E WORK OF CHILD-PLACING AGENCIES

physician, and the blank was filled out by the agency’s nurse or
social worker from the clinic record or by the social worker o f the
clinic.
It is important that a complete and accurate family history and
previous medical history o f the child be obtained before he is pre
sented for a medical examination. A ll the agencies except those
using the associated medical clinic and the preventive clinic pro-'
vided a more or less adequate space for the recording o f this infor
mation upon their physical-examination blanks, and the visitors who
accompanied the child to the clinic gave the examining physician
supplementary information when possible. In some o f the agencies
the parents or other relatives were asked to bring the children for
the first examination i f this could be arranged.
The associated medical clinic and preventive clinic each used a
special form for recording the family history and the previous medi
cal history. These forms contained information which the physician
considered essential in making a first examination and were filled in
and given to the physician when the child was presented for ex
amination. Following are the forms used by the preventive clinic :
B oston D ispensary P reventive Clin ic
N o .-----------------Date ;•------------------N a m e -------------- ------------------------------------------------------------- ,1---------- ---------- .----------------------------Age---------------------------------------------------------------------------------------------------------------------- -----------Agency--------------------------------------------------- *----------------------- ------------------------------------------------Clinical history--------------------------------------------------------------------------------------------------------------PH YSIC AL EXAMINATION

Temperature________________ Pulse---------- ------------------- RespirationW eight___________________________________
Height________________________________ -___
Appearance______________________ - ______
Posture____ - _____________________________
Skin_______________ _______________________
Head______________________________________
Face______________________________________
Eyes______________________________________
E ars______________________________________
Lymph nodes____________________________
Pharnyx__________________________ !----------Nose______________________________________
Tonsils___________________________________
Adenoids----------------- -------------------------------- 1
Tongue___________________________________
Teeth_________________________ ______- ____
Genitals and rectum____________________
Extremities______________________________

Normal weight_____ -__
Normal height________
Deformities-----------------H eart-----------------------Lungs-----------------------Abdomen-----------------Special exam inations:
Vaccination-.-------Wassermann_____
Von Pirquet---------Urine--------------------Smears-----------------Blood count______
X ray---------------- -— ?----Diagnosis— --------------Recommendations__l__
Examining physician.
Additional data----------

T he B oston D ispensary P reventive C lin ic
Number —
S o c ie t y -----------------------------------------------------------------------------------------------------------D ate_____________________________ — ___ ____ Birth date______________ Age.
Birthplace----------------------------------------— ------------------ -------------------------------------- «¿3
Name — -------------------------------------------------- ------------------------ ------------------------------

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PROGRAM OP H EALTH WORK
Family data
Name

Nativity

Age

Occupation

Health

Children (of unmarried

Parents married__Pregnancies_________

Miscarriages_______

Stillbirths.

Illnesses (parents and other relatives)
Insanity_____
RheumatismEpilepsy—
TuberculosisSyphilis—
Wassermann.

Alcoholism________
Bleeder____________
Cancer------------------Diabetes___________
Feeble-mindedness.
Heart disease-------

PATIENT

Birth and in fan cy:
Full-term____ r______________________
Premature___________________________
Labor—
Normal__________________________
Prolonged______________________
Cesarean________________________
Breech__________________________
Forceps___________ _____________
Previous treatment :
Local doctor________________________
Institution___________ ______________ I
Hospital---------------------------------------------

Previous treatment— Continued.
Vaccination date____________
Wassermann date___________
Von Pirquet date____________
Other tests, date____________
Birth weight_______________ ______
Abnormalities at birth__________
Breast fed :
■
How long_____________---------W holly-----------------------------------Partly------------------------------------W h y weaned-------------------------

PREVIOUS ILLNESSES

Chicken-pox_____
Diphtheria_______
Measles__________
Mumps_._________
Scarlet fever-----Pneumonia______
Whooping cough.
Colds_________ 1—
Bronchitis_______
Sore throats_____
Rheumatic fever.

(GIVE DATES)

Heart trouble_____________
Choreal____________________
Gonorrhea_________________
Convulsions_______________
Typhoid-----------------------------Meningitis-------------------------Syphilis____________________
Tuberculosis_______________
Infantile paralysis_______
Accidents and operations.

GENERAL HEALTH AND HABITS

Appetite____ -----------------Sleep--------- -------------------Bowels__________________
Vomiting_______________
Mouth breathing______
Snoring-------------------------Headsweats------------------Earache________________
Menstruation__________
When established.
Regular___________
Date last period—

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Headaches--------------Psychopathic traits.
Sexual______________
Lying-----------------------Stealing_____________
Enuresis____________
Other habits-______
Present diet________
Gaining weight____
Present symptoms..

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T H E W OEK OF CHILD-PLACING AGENCIES

Are there any restrictions pertaining to medical examination, diagnosis and
treatment ? ________________________________ _________________ _____ ________ ____________
To whom shall message be sent in case of emergency?_____________________________
H as ether permit been obtained for any operation the physician thinks best
to perform ?__________________________________________________________________________
H as permission been obtained for removal of patient to a contagious hospital
in case of contagious disease?_________________________________________________ ___
W orker responsible?__________ ___________________________________________________*____
B rief social summary and plan (reason for admission, disposition o f other
members of family, home conditions, etc.)______________________________________

It is desirable that every worker should be impressed with the
importance to the physician o f a complete and accurate history, and
should recognize her responsibility to supply this information i f it
is obtainable. When a physician is asked to examine a child with an
inadequately recorded history he may well feel that the agency has
not carried out an important part o f its work.
MENTAL EXAMINATION

That the value o f giving a mental examination to every child o f
suitable age was appreciated was demonstrated by the fact that all
the executives but one expressed themselves in favor o f a routine
mental examination for every child coming into care. One executive
did not believe it necessary to examine every child but desired a paid
psychiatric service for the study o f problem children. One agency
with facilities for routine psychological examinations had not had
them given to every child.
In practice routine mental examinations were given only by those
societies which paid for this service.
Agencies dependent upon outside agencies or volunteer service
were restricted in their work, and all these were engaged with plans
by which their service might be extended. Not only was the ques
tion o f getting adequate service complicated by the expense involved
but also by the difficulty o f finding persons qualified by training and
experience to examine and study problem children. One of the
valuable contributions o f the demonstration clinics conducted by the
division o f the prevention of delinquency o f the National Committee
for Mental Hygiene is the training o f psychiatrists and psychologists
in approved methods o f examination and treatment o f problem
children.4
Value of mental tests.

Psychological examinations by means o f standardized tests are o f
value in measuring a child’s intellectual development (expressed in
terms o f mental age) and in establishing his special abilities and
disabilities. Because o f the fact that a mental age or intelligence
quotient when considered apart from the important factors o f per
sonality^ and special abilities and disabilities may be misinterpreted
to the disadvantage o f a child, at least one psychiatric clinic examin
ing children for the child-caring societies did not report a mental
age or intelligence quotient for children examined.
For a child with personality difficulties, one who does not get
along well with others or who presents definite conduct problems
^Anderson, V. V . : A Discussion o f the F irst Demonstration Clinic Conducted by the
(Mimeogra^ hetf Tentl° n ° f Delm<luency o f the National Committee for Mental Hygiene!

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PROGRAM OP HEARTH WORK

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such as truancy, lying, stealing, or sex delinquencies, a more inten
sive examination by a psychiatrist should be given with an inter
pretation o f all the factors entering into his problem, including
social history, physical findings, intellectual development, and inade
quacies o f personality.
It is unreasonable to expect that a mental examination o f itself
will serve as a cure for all problems o f difficult children. Some
workers forget that the purpose o f the examination is to interpret
the child and his problems and to recommend a plan o f treatment,
leaving much hard and painstaking work ahead o f the worker in
carrying out the treatment.
On the other hand some workers tend to minimize the value o f the
help which may be given by the psychiatrist and to view with
skepticism the recommendations made by him. However, this atti
tude does not prevail among the more experienced and highly
trained workers.
Children examined.

In cities where psychiatric clinics were working in close connec
tion with the juvenile courts,5 children coming into the care o f
agencies from the courts had been examined usually, and the agencies
had been able to have some children examined in these clinics beside
those who had been before the court.
Through the clinics many o f the most difficult children coming to
the agencies from the courts had been examined, but unless the
mental examination was to be made the basis o f acceptance, the
usual procedure had been to have children received from sources
other than the court examined only after a period o f observation
in the foster home (except for those agencies which had routine
mental examinations). Usually, decisions as to which children were
to be examined were made by the supervisor o f placing out, and
frequently it was a question o f selecting only the most urgent cases
on account o f the lack o f facilities for having children examined.
Children selected for mental examination were o f the following
classes: 1. Children referred by physicians from the examining clin
ics; 2. children showing marked school retardation; 3. children pre
senting behavior problems; 4. children with mentally defective or
psychopathic parents; 5. children offered for adoption; 6. children o f
exceptional ability.
Several o f the agencies did not have children examined mentally
as part o f the routine preliminary to adoption, believing that where
the child had been under close observation during the preadoption
period o f one to two years, a mental examination was not necessary.
On the other hand, a preliminary mental examination o f all chil
dren offered for adoption would establish at once the unsuitability
o f certain children for adoption. Wherever possible agencies which
accepted infants for adoption had mental examinations given to the
mothers.
Report of mental examination.

An adequate account o f the important facts o f the child’s heredity
and developmental history is essential for all children who are to be
5 W ayne County Psychopathic Clinic, D e tro it; Judge Baker Foundation, B o sto n ; and
Institute for Juvenile Research, Chicago.

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T H E WORK OF CHILD-PLACING AGENCIES

«examined mentally. In order that no important details might be
•omitted many o f the clinics examining children for the child-placing
agencies asked that the child’s history be summarized according to
ran outline furnished by the clinic, and this summary was presented
"with the child at the time o f examination.
The case summaries varied in detail, but all covered the essential
facts o f the child’s heredity and family history, home and family
background, physical history, habits, personality, and school history,
together with reports o f previous mental and physical examinations
and a statement o f the child’s problem from the agency’s standpoint.
W ith but one exception the psychiatrists who examined children
for the various agencies reported the results o f the examinations in
writing. These reports varied from brief and informal notes giving
the mental age and intelligence quotient, suggested diagnosis, and
some recommendations as to treatment, to full and comprehensive
reports, summarizing the case and covering the diagnosis, etiology,
prognosis, and treatment.
In addition to studying the written report which the examiner
submitted to the agency it was usually possible for the worker on a
case to discuss it with the examiner.
The psychiatrist o f the Church Home Society o f Boston furnished
a summary o f each case examined by her for the records o f the
preventive clin ic; and the Associated Medical Clinic o f Philadelphia
was provided with a report o f each case examined by the child-study
department o f the Children’s A id Society o f Pennsylvania and the
Children’s Bureau o f Philadelphia.
I f the examiner desired to study a case further, a date was usually
set, upon which the society was asked either to furnish a report o f
the child’s progress or to return the child.
The psychiatrist o f the Church Home Society was freely accessible
to the workers o f the society for consultation, and the director o f
the child-study department and her assistant were always available
fo r consultation by the workers o f the Children’s Bureau o f Phila
delphia and the Children’s A id Society o f Pennsylvania.
CORRECTIVE WORK AND SPECIAL TREATMENT

After the initial physical examination the treatment o f every
child who needed corrective work or special treatment became the
responsibility o f the agency, whether the examination had been
made as part o f the investigation or after the child had been taken
into care. I f the child had been given an examination as a pre
liminary to acceptance, whenever possible treatment was begun and
corrective operations carried out while he remained in his old situa
tion. A number o f agencies accepted children and i f necessary
placed them in hospitals until they were ready for placement in a
foster home, and also placed babies presenting special feeding prob
lems in hospitals until their feeding was adjusted. Ordinarily chil
dren were placed immediately in foster homes, and then they were
taken to the dispensary for treatment as often as necessary by the
worker or foster mother, but the children of the Michigan Children’s
A id Society who came into permanent care in Lansing or St. Joseph
were kept in receiving homes and if necessary treated while there.

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PROGRAM OF H EALTH WORK

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Clinical and hospital facilities.

Where the clinic in which children were examined was a part o f a
large general dispensary, as in the case o f the preventive clinic o f
the Boston Dispensary, or when children were examined in the
pediatric clinic o f a large dispensary, as in the Washington Uni
versity Dispensary o f St. Louis, the various special clinics o f these
dispensaries, such as the eye, nose, and throat, were available for
special examinations and treatments.
This insured closer coordination o f the medical work than is pos
sible if an outside dispensary must be consulted, and also saves much
time for the worker, who is responsible for seeing that the child is
treated. A t the preventive clinic in Boston the workers o f the
Boston Children’s A id Society and the Church Home Society were
responsible only for getting the children to the clinic and home
again, the clinic workers accompanying the children to the various
special clinics and departments, saving much time to the agency’s
workers.
A clinical affiliation with the dispensary o f a general hospital also
facilitates the hospitalization o f children, whether for corrective
operations or for other surgical or medical treatment.
The associated medical clinic included as part o f its regular staff,
on a part-time basis, an oculist, a pathologist, a dentist, and a surgi
cal consultant, to whom children were referred from the clinic fo r
examination and treatment. Children who required other kinds o f
special service were referred to the clinics o f the Children’s Hos
pital or to .other hospitals o f the city.
The agencies with hospital affiliations were able to obtain hospital
treatment for their children without cost, or by the payment o f
nominal rates, and those societies which entered children wherever
there was a vacancy usually could have the use o f free beds or could
arrange to pay the hospital the same rate which they received from
the parents for the child’s care.
The preventive clinic was charged a nominal daily rate for all
children treated in the hospital of* the Boston Dispensary, which also
made a small fixed charge for tonsil and adenoid operations.
In Detroit children with legal residence could be hospitalized
at the expense o f the city.
Dental work— Dental treatment was given in the clinics o f dental
colleges, where the work was done by students under the supervision
o f instructors, in clinics conducted by departments of health and
boards o f education, in the dental departments of the dispensaries
in which the children were examined, and in the offices ox private
dentists, their services being either free or part paid.
The Detroit Children’s A id Society provided an office and equip
ment in its own building, and the city department of health supplied
a dentist one-half day a week, who gave the routine dental examina
tions for the society.
/
In St. Joseph, Mich., a number o f private dentists did volunteer
work for the Michigan Children’s A id Society, in rotating service,
each serving for a month at a time.
The associated medical clinic employed its own dentist on a parttime basis, the work being done in the clinic building.

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The preventive clinic o f the Boston Dispensary paid part o f the
salary o f the head of the dental clinic o f the dispensary, and was
allotted four appointments daily.
Although a number o f the agencies received satisfactory service
through the various programs which provided dental treatment for
their children practically without cost, the service was not always
adequate to meet their full requirements. Only when children could
be referred by the examining clinic directly to the dental clinic was
maximum service possible, and only when physical reexaminations
were a matter o f routine was a systematic reexamination o f the teeth
by a physician or dentist assured, although several o f the agencies
which did not have routine reexaminations sent their children to a
dental clinic at more or less regular intervals.
The experience o f the agencies using clinics in which the work was
done by dental students shows that this service was not uniformly
satisfactory, and that it was not always as inexpensive as it seemed,
when the time o f the workers attending with the children was con
sidered, additional time being required because o f the slowness o f
the work and the frequent returns o f the children for inspection and
replacement o f fillings.
Ermresis.—-Many children with enuresis were brought into the
-examining clinics for treatment. As a rule these cases were rather
discouraging to the physician as well as to the social workers.
These children were examined carefully to determine whether
there was any underlying physical cause for the trouble, and when
ever such a cause was found it was eliminated as far as.possible by
appropriate treatment.
When no physical cause could be discovered, the best results were
-obtained by not allowing the child to drink any liquids after 4 p. m.,
and getting him up at night at regular intervals, when this could be
done through the cooperation o f the foster mother. Drugs were
used, often as much for their effect through suggestion as for their
therapeutic value. In several o f the clinics gland preparations were
used in the treatment o f these cases, but the number o f cases so
treated was small and the results inconclusive.
A ll successful methods o f treatment were based upon gaining the
»confidence and cooperation o f the child.
In Boston habit clinics conducted for preschool children by the
Massachusetts Department o f Mental Disease, under the direction o f
Dr. Douglas A. Thom, had reported gratifying results in the treat
ment o f cases o f enuresis, and these clinics were available for the
treatment o f children of the Boston agencies.6
Carrying out of recommendations.

Recommendations made by the examining clinics or physicians as
to treatment or corrective operations were carried out in practically
all cases by a majority o f the agencies. When this was not done it
was not becaus^of lack o f medical facilities. Two agencies which
«experienced the most difficulty in carrying out treatment and cor
rections for their children had ample medical facilities for having
the work done. The refusal by parents o f consent to corrective oper8 See Habit Clinics for the Child of Preschool Age, by D. A . Thom, M . D. (U S.
Children’s Bureau Publication No. 135, W ashington, 1924) ; and Enuresis (Leaflet 'No.
Division of M ental Hygiene, Massachusetts Department of M ental Diseases, B oston).

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ations and the early discharge o f children from care were two o f
the main factors which interfered with the carrying out o f treat
ment in all cases.
The refusal o f parental consent to operations was met with more
frequently by those agencies which worked largely with foreignborn parents, who, because o f their ignorance o f American institu
tions, were suspicious o f hospitals and fearful o f operations. I f an
operation was imperative and consent was withheld by the parents,
it was the policy of all the agencies but one to seek court action, in
order that the operation might be performed.
Three o f the agencies obtained from the parents signed permission
for hospitalization or operative treatment for a child when accept
ing him for care, and regarded this as sufficient authority for any
ordinary surgical procedure. The Jewish Home-Finding Society
had the parents sign an authorization for medical, dental, and surgi
cal treatment at the time o f acceptance, but in addition asked for
special written permission for any operation requiring an anesthetic.
The policy o f other agencies was to ask for signed permission for
any specific operation as the occasion arose.
Usually parents who wished to have their children cared for were
willing to grant permission for any necessary medical or surgical
treatment, and it was found most satisfactory to have an agreement
to this effect signed as a matter o f routine when accepting the child,
so that treatment o f all kinds might be obtained for him. It was,
however, not always advisable to insist on permission for surgical
treatment at once, especially with foreign-born parents, who might
prefer to make other arrangements for the care o f their children
rather than consent to an operation, even at a sacrifice o f the best
interests o f the children. Several o f the agencies that made many
temporary placements found it impossible because o f lack o f time
always to make corrections or to complete treatment before a child
was discharged from care. However, except when permission was
refused and the recommendations o f the examining physician were
not carried out, usually any failure was caused by a shortage o f
workers to attend to the carrying out o f the treatment prescribed.
It was the practice o f the majority o f the agencies when returning
a child to his parents before treatment had been completed to put
/ the family in contact with the clinic where he had been treated, so
that the treatment might be carried on without interruption, and
where a child had been treated in a large dispensary for any serious
condition the case was usually followed up by the social-service
department o f the dispensary.
The Detroit Children’s A id Society had a successful method o f
follow-up by which any child discharged from the child-caring
department before completion o f medical treatment was reported
back to the worker with whom the case originated, who kept in
touch with him until the medical work had been completed, when
the case was finally closed.
The recommendations o f the examining physicians as to the place
ment o f children presenting health problems were carried out by the
agencies in almost every instance, higher rates o f board being paid
when necessary in order to obtain homes o f the type recommended.

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TH E WORK OF CHILD-PLACING AGENCIES

Occasionally a worker might decide that a recommendation made
by the physician or the psychiatrist was not essential and would not
carry it out, but usually every effort was made to investigate and
develop homes approximating as nearly as possible the requirements
made by the examiner, the workers often showing unusual interest
and resourcefulness in developing homes for these difficult children.
When this was not done it was usually because o f a shortage o f
workers and not because o f lack o f interest on the part o f the
workers.
HEALTH STANDARDS FOR FOSTER HOMES

The selection o f foster homes is primarily a social problem, but
nowhere in the work o f child placing are the medical and the social
factors o f the case so closely related, and nowhere is closer coopera
tion required between social worker and physician than in the selec
tion o f the proper home for the individual child, for unless the
child is placed in a home which meets his particular needs, both as
to physical care and sympathetic understanding, much o f the benefit
derived from careful medical supervision will be lost.
This fact was accepted generally by the child-placing agencies, and
every effort was made by them to place children in accordance with
the recommendations o f the examining physician and the psychiat
rist and when homes approximating the requirements made by the
examiners were not available efforts were made to develop such
homes. Frequently extra rates o f board were paid for the care o f
children presenting problems o f health and behavior, in order that
these children might be placed in accordance with the recommenda
tions o f the examining physicians.
The success o f a society in developing suitable foster homes for its
problem children depended primarily upon three factors:
1. An adequate staff for the department o f home finding, so that
sufficient time might be devoted to the development o f these homes.
2. Professional training o f the workers to whom this work was
intrusted, which presupposes a knowledge o f and insistence upon
definite and accepted standards as applied to foster homes in regard
to sanitation, physical equipment, and other conditions affecting the
hygiene and physical care o f the child.
3. The payment o f rates o f board sufficiently liberal to enable the
society to obtain the special care and attention necessary for problem
cases.
To safeguard the mental and physical health o f a child it is necessary that frequent changes o f foster homes due to superficial investi
gation be avoided, and it is desirable that money be expended for
adequate and trained service in developing homes where children
may be placed with a fair assurance of permanency.
The purely sectarian societies used only foster homes o f their
religious affiliation, a practice which limited them in their selection
o f homes for problem children. The Jewish Home-Finding Society,
however, although it placed all older children in Jewish homes,
recognized the importance o f the role o f the foster mother in the
care o f infants, and used the best homes available in placing them
irrespective o f the religion o f the foster parents.

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A ll the agencies studied paid higher rates when necessary to ob
tain special care and attention for problem children. One agency
paid $10 a week for the care of delicate inf ants in semihospital homes.
This agency had paid, upon occasions, $12 a week for delicate infants,
which was the maximum rate paid by any society for any type of
foster-home care. A maximum of $10 a week was paid by several
agencies for the care o f posthospital cases, blind and epileptic chil
dren, and a few difficult behavior problems.
The St. Louis Children’s A id Society was particularly successful
not only in finding excellent homes for the care o f the most difficult
health problems but in engaging these homes at a moderate rate.
Physical equipment of the home.

The physical standards for the foster homes varied with the differ
ent agencies. The agencies that cared for infants in boarding homes
usually had different standards for infant homes and homes for
older children. For older children detached houses somewhat out
side the city with yards or provision for outdoor play, or country
placements, were preferred, whereas infants might be placed in the
city, provided there was a porch upon which the child might be
aired, in order to facilitate the closer health supervision required for
these younger children. It was the policy o f some o f the societies to
supplement the equipment o f infant homes, when necessary, with
cribs, baby carriages, and go-carts, and five o f the societies supplied
a complete equipment o f bo.ttles for the daily feeding o f infants.
Infants were never placed in the country, or in homes where close
supervision was not possible.
Six o f the agencies required separate beds for their children, and
older children were not permitted to sleep in the room with the
foster parents. Three o f the agencies required that their children
should occupy separate rooms, if possible. I f a separate bed was
prescribed the agency provided the beds whenever necessary.
In placing special health cases or behavior problems the agencies
followed as closely as possible the recommendations of the examining
clinic, such as country homes for anemic or undernourished children,
no stairs for heart cases, and separate rooms for chorea cases.
Several o f the agencies made specific requirements as to the
amount o f milk the child should receive as part o f his daily diet.
The limiting o f the number o f children in a foster home had an
important bearing upon their health. Each additional child adds
to the danger o f introducing contagious disease into the home, and
individual or almost individual care is essential i f a child is to over
come those handicaps to health and happiness with which the de
pendent child usually has started. Six o f the agencies did not place
more than two unrelated children in the same home, except for treat
ment or in an emergency. Unless there was some special reason
for doing otherwise one child in a home was preferred. This was
true particularly in the case o f infants, and only where the foster
mother was exceptionally efficient did the agencies place more than
one infant in a home.
It was usually necessary to subsidize homes prepared to give
professional nursing care or other types o f special service in order
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that the use o f these homes might be limited to children o f the
society.
Health of the foster family.

The investigation o f the health o f the foster family depended
largely upon the time devoted to the investigation o f a home and
upon the training o f the worker. Four of the agencies stressed this
side o f the foster-home investigation, and in addition to getting all
information obtainable from the family and through interviews
with all persons given by the family as references and with other
persons three o f the agencies interviewed the family physician and
obtained from him a statement as to whether the condition of health
o f any member o f the family was such as to make the home unsafe.
Special emphasis was placed upon-the nervous stability o f the foster
mother. Hospital residence or dispensary attendance o f any member
o f the family was investigated and careful inquiry was made in
regard to any recent illness or cause o f death o f any member o f the
family.
Other agencies wrote to the family physician or requested him
to fill out a blank form, and if a question arose in regard to the
health o f the family interviewed him personally or by telephone.
It would appear, however, that several o f the agencies did not give
to this phase o f the investigation o f the foster homes the attention
which its importance demands.
Instructions to foster mothers.

Foster mothers were instructed in regard to matters o f general
hygiene and the physical care o f children by the visitors (trained
nurses or social workers) engaged in the supervision o f children,
and it was the responsibility o f the supervisors of the department o f
child placing in each agency to see that a visitor was thoroughly
acquainted with the physical condition and special needs o f every
child in her care.
Where special health or behavior problems were involved the visi
tors received specific instructions from the examining physician or
psychiatrist, and transmitted them to the foster mothers. A num
ber o f the agencies encouraged foster mothers who were caring for
infants or delicate children to come to the clinic and meet the physi
cians, and talk with them directly about the health problems o f the
children in their charge. When children had been referred to a
nutrition clinic and a special diet had been prescribed foster mothers
were asked to attend the clinic for instruction in the preparation o f
special articles of food.
It was felt by the agencies using the preventive clinic and the asso
ciated medical clinic that the educational value to the foster mothers
o f these contacts with the physicians o f the clinic was one o f the dis
tinct contributions made by the clinic to the work.
Wherever trained nurses were employed in the supervision o f in
fants all instructions in regard to their care and feeding were given
by them to the foster mothers; a copy o f the infant’s food formula
was provided, the preparation of its food demonstrated, and full
directions were given regarding all points o f the infant’s care. In
addition to the verbal instructions by the nurses printed directions
as to the care o f infants and small children and the diets proper for
children o f various ages were given to the foster mothers. Each

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agency used the printed material issued by the clinic in which its
children were examined or material issued by the State or city
department o f health.
As foster mothers were instructed by the visitors in the physical
care and hygiene o f older children, including diet, hours o f sleep,
ventilation o f the sleeping room, care of the teeth, it was o f the
utmost importance that the visitors should have professional train
ing in order that they might be properly equipped to give, correct
and detailed information on these matters.
Health supervision in the home.

Visits of nurses and social workers.—Health supervision of older
children was carried out by the social workers o f the various agencies
as part o f the general supervision o f the children, except that the
trained nurses employed by the Society of St. Vincent de Paul were
responsible for the health supervision o f all children in boarding
homes. The practice in regard to supervision o f children presenting
health problems varied. Some o f the societies placed such children
in charge o f trained nurses, whereas others placed only infants under
the supervision o f nurses and assigned older children to the social
visitors, who returned them to the examining clinic for observa
tion as often as necessary.
Three of the six agencies in which this differentiation was made
assigned all children under 3 to the nurse, and the other agencies,
infants under 2. The agency that did not have a staff nurse did
not accept young inf ants or feeding cases; the two State societies did
not have their own trained nurses in their branches; and one agency
placed in the hands o f trained nurses the supervision of all children
in boarding homes.
The frequency o f the supervisory visits varied according to the
policy of the agency and the number o f children assigned to each
visitor, but all the agencies that accepted young infants or difficult
feeding cases supervised them very closely. These children were
visited by the nurses every week or two, and were returned to the
examining clinics for medical supervision at frequent intervals (from
two weeks to one month).
A t the preventive clinic and the associated medical clinic the
babies were not returned to the clinic regularly but were visited
weekly or biweekly by the nurses, who reported each case in detail to
the medical director o f the clinic at a weekly conference. From
these reports the director made necessary changes o f formula and
directed the conduct of the case, so that if an infant continued to
do well he was not brought to the clinic, and frequently these infants
were not seen by the physician for months. I f the infant did not do
well, the case was immediately reported, and the assistant physician
visited the infant in his home.
The importance o f close supervision o f the children o f preschool
age was recognized in a number o f the agencies and these children
were visited frequently, particular attention being paid to their
diet, hours o f sleep, bathing, and teeth. Problem children (both
health and behavior) were visited in accordance with the individual
requirements o f the case, the supervision o f these children being
directed by the examining physician.
Two agencies had no fixed policy as to visiting older children
who were normal, leaving this matter to the judgment o f the visitors,

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who were well trained and who were governed in the frequency o f
their visits by conditions relating to both the child and the home.
The other agencies adopted minimum requirements as to the fre
quency o f the visits to older children, in intervals varying from two
weeks to three or four months.
Here, again, in the matter o f effective health supervision o f chil
dren in foster homes, the personality and training o f the visitor
played the major role. It is not reasonable to expect that a worker
can direct intelligently the proper feeding of a child unless she her
self has at least a working knowledge o f dietetics, including the food
requirements o f a growing child. She must know what a child should
weigh for his height and age, the number o f hours o f sleep that he
requires, the importance o f the care o f the teeth, and the many other
details o f personal hygiene if she is to do really effective work; and
this knowledge she acquires through systematic courses o f study, by
much reading, and through actual experience with children. She
must know also something o f mental hygiene and o f the new psy
chology, so that she may have an intelligent understanding o f the
difficulties o f children who present behavior problems, and be able
to interpret these children to the foster mothers.
Routine reexcmiinations.— The value o f reexamination o f children
at stated intervals is obvious. It permits the medical examiner to
follow the growth and development o f a child and to detect promptly
signs or symptoms o f any serious physical defects. Also, it insures
regular and careful reexamination o f the teeth, which is important
and which otherwise might be neglected.
Unfortunately routine reexaminations for older children were
possible only for the societies using clinics operated solely for their
use or for those employing their own physicians, as the pressure o f
work in the pediatric clinics o f large dispensaries did not permit
their use for reexamination o f children who were apparently well.
Emergency treatment.—A ll the agencies instructed their foster
mothers to communicate at once with the office whenever possible in
case o f a child’s illness, and the office then arranged for medical
attendance. When this was not possible because of distance or in
an emergency, the foster mother was instructed to call a physician
immediately "and advise the society as soon as possible o f the child’s
illness.
Several o f the agencies issued printed instructions to foster
mothers in regard to notifying the office and calling a physician in
the event o f a child’s becoming ill, and the Boston Children’s A id
Society and the Children’s Bureau o f Philadelphia gave definite
printed directions to foster mothers as to the conditions for which
they were to call the nurse for babies in their care.
Each agency provided a nurse i f necessary for the care of children
seriously ill in a foster home, or obtained household help for the
foster mother in order that she might nurse the child herself.
Every agency was invariably responsible for having children
treated. In some o f the large dispensaries the social-service depart
ment arranged appointments in the various departments of the dis
pensary, and the agency’s worker saw that the child was present
at the appointed time. The usual method of checking up the dates
for return of children to the clinic was for the worker to enter

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all return dates in her daybook, or appointment calendar, keeping
herself informed in advance o f appointments. In several agencies
the supervisor also kept a record o f these dates.
Wherever children were examined in a clinic o f a large dispensary,
and special examinations and treatments were given in other depart
ments o f the same dispensary, these services were given without cost
to the agencies, except for occasional charges for the use o f the
X ray in diagnosis, salvarsan treatment, special medicines, or when
the parents were able to pay dispensary fees.
COOPERATION WITH COMMUNITY HEALTH AGENCIES

The cooperation which the child-caring agencies sought from the
health agencies o f the community varied with the program o f the
health work o f each society. Those which had examining clinics
devoted solely to the purposes o f their own work and had their
own staff nurses were able to carry on their health work with but
little assistance from outside sources. Other societies depended en
tirely upon infant-welfare stations and the Visiting Nurses’ Asso
ciation for the supervision of their infants and for nursing care for
sick children. Agencies that did not call upon these outside agencies
for assistance in their supervision o f children while in care frequently
referred cases to them for follow-up after the discharge o f the
children.
Four o f the agencies used inf ant-welfare stations for the medical
supervision o f their infants. These agencies, however, accepted
but few younger babies or feeding cases.
The child-caring department o f the Society of St. Vincent de
Paul used one o f the municipal infant-welfare stations for the medi
cal supervision o f infants under one year. This society had very
few infants under six months o f age in care.
The Michigan Children’s Aid Society, except in Detroit, Lansing,
and St. Joseph, and the Children’s A id Society o f Pennsylvania,
except in Philadelphia, depended on infant-welfare stations or pri
vate physicians and the Visiting Nurses’ Association and municipal
nurses for the supervision o f infants in boarding homes, and also
used the Visiting Nurses’ Association or municipal nurses for nursing
care for older children. The Children’s A id Society o f Pennsylvania
also called upon the Visiting Nurses’ Association in Philadelphia
for nursing care for older children.
The Children’s Mission to Children in Boston, which occasionally
accepted infants, used the infant-welfare stations and the Visiting
Nurses’ Association for their health supervision, and also called upon
the Visiting Nurses’ Association for nursing care when such care was
required for children in boarding homes.
The policy o f the agencies using infant-welfare stations was to use
the clinics upon the same days o f the week, so that their children
might have the attention o f the same physicians.
The advantages gained by an agency that uses its own examining
and nursing staff are obvious. Among them may be named the
centralization o f responsibility for medical work, the undivided in
terest o f the staff, and, the planning of the work solely in the interests
o f the agency.

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It has already been mentioned that in Detroit the nurses o f the
Society o f St. Vincent de Paul and the Detroit Children’s A id
Society were assigned to these societies for full-time service by the
Visiting Nurses’ Association, an arrangement which has proved emi
nently satisfactory. This arrangement resulted from the fact that
the child-caring department o f the Society of St. Vincent de Paul,
the Children’s A id Society, and the Visiting Nurses’ Association
were all members o f the Detroit Community Union. The clinical
service which the Society o f St. Vincent de Paul received without
cost from the out-patient department of St. Mary’s Hospital and
the Detroit Children’s A id Society received without cost from
Harper Hospital was made possible by participation o f the dispen
saries and societies in the Community Union.
The St. Louis Children’s A id Society and the Washington Uni
versity Dispensary were both members o f the St. Louis Community
Fund. The Jewish Home-Finding Society o f Chicago and the
Michael Reese Hospital and Dispensary, which supplied medical
supervision for the society, were both members o f the Chicago Fed
erated Jewish Charities, so that although the society did not pay
for this service, it was financed from the same source as the society.
A ll the agencies received the cooperation o f various hospitals o f
their communities in providing hospital care for children, without
cost or at nominal rates. The Children’s A id Society o f St. Louis,
the Jewish Home-Finding Society o f Chicago and the Society o f
St. Vincent de Paul o f Detroit were particularly fortunate in hos
pital affiliations which provided for practically all the children o f
each society who needed care in one hospital. The Boston Dis
pensary Hospital cared for practically all children o f the preventive
clinic under 12 years o f age requiring hospital treatment and the
Children’s Hospital o f Philadelphia received many children for the
associated medical clinic.
The Jewish Home-Finding Society was fortunate in having avail
able for use the Frances Juvenile Home for the treatment o f girls
o f school age with venereal disease (see p. 158). It is to be regretted
that there are not more institutions o f this character where children
with venereal disease who can not be placed in boarding homes may
be cared for and treated in favorable surroundings without interrup
tion o f schooling. City or county hospitals are usually the only hos
pitals which will admit venereal cases to their wards.
C O O R D IN A TIO N OF M E D IC A L A N D SO C IA L W O R K

It was possible for those agencies that supported their own examin
ing clinics to get the closest coordination o f medical and social work.
As these clinics were devoted solely to the purposes o f their work,
the details o f their routine were adapted to the convenience o f the
society for the purpose o f giving maximum service not only in the
examination and treatment o f children, but in the keeping o f records,
the forwarding o f reports, and the availability o f the physicians for
consultation by the workers.
Those agencies that carried on their health work through the co
operation o f outside medical agencies found it necessary to adapt
their work to the routine o f the dispensary or hospital used. Under

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these circumstances the personality o f the worker making contacts
in the clinic was an important factor in obtaining the fullest coop
eration o f the physicians and the social-service workers, an indi
vidual with tact and adaptability being given a degree o f coopera
tion not accorded to another not possessing these traits o f personality.
Eight o f the agencies held staff conferences at stated intervals
for the discussion o f problem cases, both o f health and behavior,
but these conferences were not attended by the examining physicians.
In the preventive clinic and the associated medical clinic the
physicians always were available for consultation especially to make
a decision involving a medical problem, and physicians o f the pedi
atric clinic o f the Washington University in St. Louis were accessible
to the workers o f the St. Louis society. The pediatrist o f the
Detroit Children’s A id Society acted as medical director o f the
society and could be called upon at any time to make decisions re
quiring medical opinion.
One o f the most important contributions which an examining
clinic has to make to the work o f a social agency is its educational
and inspirational value to the social worker; not only is her interest
stimulated in the health side o f her problems, but she is given to
feel that she has substantial backing in handling them, through the
interest and professional knowledge o f the clinic physicians.
H E A LT H RECORDS

-The coordination o f a child’s health record with the rest o f his
history so as to make it available for use by persons not acquainted
with the case was a problem which had not been solved successfully
by all the agencies. There was no uniformity in the keeping o f
health records, and no two societies kept their records in exactly the
same way. In some instances the form o f the reports made by the
clinics doing the medical work determined the method used.
When a separate medical sheet was used for the health record this
part o f the record was not coordinated with the rest o f the history,
which failed to give a complete picture o f the child and the problem
which he presented. On the other hand, when health items were
incorporated in the child’s narrative record, they were usually diffi
cult to find without reading the entire case, and in instances where
a worker had been delayed in dictating the record o f a case, the
latest items did not appear at all, although the worker herself might
be entirely familiar with the situation. When red captions were used
to denote entries in regard to health in a narrative record, it greatly
facilitated the following o f these items. It would seem that a medi
cal history can be presented best when the health items are made a
part o f the narrative record, and are marked with red captions in
order that they may be identified easily.
One society kept its records strictly up to date by means o f the
written reports o f visitors, which were filed daily in the case folders
until they could be copied into the record.
The agencies in Boston using the preventive clinic referred to all
examinations and treatments given at the clinic in the child’s running
record and in addition filed the reports received from the clinic all
together in a small separate folder at the back o f the case record,
making these reports available in the original form and avoiding

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chances o f error and the additional work required in transcribing
the reports into the record.
Two o f the agencies used a separate medical sheet, upon which
all health records were kept for the entire period o f time the child
remained in care. One agency used a separate medical record while
the child remained in temporary placement, which also included items
of the social investigation during this period. This medical record
was closed when the child was placed permanently, and health items
were then included in the visitors’ written reports. One agency kept
a medical sheet giving the records o f physical examination and treat
ment, and also included these items in the child’s running record.
Two agencies used a medical blank for the original physical exami
nation with entries in regard to health carried in the running record.
Two societies copied all health records into the child’s running
record, including reports from clinics and laboratories.
Mental examinations were referred to always in the child’s case
record and the report o f the examination was filed with the corre
spondence or the medical record.
No uniformity in the methods used for the keeping o f medical
statistics existed and no comparable figures were available for the
medical work done by the various societies.
The preventive clinic and the associated medical clinic kept complete statistical data for all medical work done in the examining
clinics and also in outside hospitals and dispensaries.
It was necessary for those societies using outside medical agencies
for their work to keep their own medical statistics, and as they were
not always given complete reports as to diagnosis and treatment, it
was difficult for them to do more than keep numerical count o f the
physical examinations, treatments, operations, hospital admissions,
and nursing visits, combining these figures in various ways in their
reports. Three agencies made medical reports including these figures,
and another (the Jewish Home-Finding Society) gave in addition
the medical diagnosis o f all cases treated. Two agencies did not
compile these figures or make any report o f their medical work.
COST OF H E A L T H W O R K

The estimated expenditure for the health programs o f the various
agencies for 1923 varied from l ;% per cent o f the total budget, which
covered the very excellent health program o f one society through
the cooperation o f a large dispensary, to 13% per cent o f the total
budget, which represented the contribution o f one agency to the main
tenance o f an examining clinic and child-study department. (For
the estimated cost o f health work in the various agencies see pp. 103
111, 125, 135, 150, 159, 165, 175.)
°’
Two o f the agencies did not carry on their books a separate item
for medical care, the expenditures usually appearing under this head
ing being distributed among the items o f salaries, maintenance, etc.
It was not possible to make a comparison o f the medical work done
by the various societies upon the basis o f cost, because the actual
amount o f money spent did not bear any relation to the volume of
work done. Thousands o f dollars worth of clinical service had been
contributed without cost through the cooperation o f outside clinics
and dispensaries.

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The contribution o f the Children’s Bureau o f Philadelphia to the
maintenance o f the associated medical clinic bore no relation to the
use made o f the clinic by that society. The clinic was used not only
by the other two cooperating societies (the Children’s A id Society
o f Pennsylvania and the Society for Prevention o f Cruelty to Chil
dren) but was open also to other agencies of the city which did not
contribute to its financial support. The contribution o f the Children’s
Bureau o f Philadelphia to the associated medical clinic represented
five-eights o f the clinic’s budget, whereas less than one-fifth o f the
total work o f the clinic was done for the children’s bureau. The
children’s bureau made this contribution to the associated medical
clinic as one o f the special services which it rendered in the child
caring field o f Philadelphia.
The cost o f medical supervision to those agencies that maintained
their own examining clinics was considerably higher than that o f
other agencies which received clinical service from outside
agencies. On the other hand, this increased cost was offset by ad
vantages to the agencies supporting their own clinics, such as centrali
zation o f medical responsibility (one person making all medical
decisions) ; standardization o f service and coordination o f the medical
and social work with consequent saving o f time, complete records,
and opportunity for medical consultation. It is to be remembered
also that in these central examining clinics general standards o f
health supervision by child-placing agencies had been worked out.
The cost o f mental service for those agencies that maintained a de
partment o f child study and psychiatry, whether on a full-time or
part-time basis, added appreciably to the cost o f the health program.
It was felt, however, that this expenditure was more than justified
by the assistance given by these departments in the interpretation o f
children and the treatment o f problem cases.

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C O N C L U S IO N S

The conclusions o f this section o f the report may be stated as
follow s:
One o f the most important contributions to social work that a
child-placing agency has to make is the careful supervision o f the
health o f its children.
The child-placing agencies included in this study accepted their
responsibility in the matter o f health supervision and were working
to strengthen their programs where weakness existed.
Medical supervision can be carried on most satisfactorily under
the direction o f a responsible medical head in a central examining
clinic maintained exclusively for such work. The work o f these
examining clinics is facilitated where they are included in the
organization o f a general dispensary with a hospital connection.
B y the expenditure o f additional time and effort and by adapt
ing its health policies to the facilities offered it is possible for a
child-placing society to carry on an effective health program at
minimum expense through the cooperation o f medical agencies o f
the community.
In order that a health program may be carried out most effec
tively there must be the closest cooperation between the examining
clinic and the child-placing agency.
Routine mental examinations for children coming under care
and adequate service for the study o f problem children were pos
sible only for those agencies that financed their own service.
Careful and intelligent health supervision for children in foster
homes is dependent upon an adequate staff o f trained visitors.
Agencies accepting infants for care recognized their care as an
added responsibility and met this responsibility by the employment
o f trained nurses to supervise the health o f these infants.
It is possible for child-placing agencies to develop foster homes,
with or without subsidy, prepared to receive and care for children
presenting special health problems.
Adequate rates o f board must be paid, with extra rates for special
service, in order that children may be given the care and attention
which they require.
Sufficient money and effort should be spent in investigating and
developing foster homes in order that children may be spared the
physical and mental strain o f replacements necessary because o f
the use o f foster homes with which the agencies are not properly
acquainted.
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C A SE H IS T O R IE S

The following cases illustrate the health problems o f children
placed in foster homes:
Jessie was 5 years old when placed by the St. Louis Children’s Aid Society
upon the application of the social-service department of the Children’s Hospi
tal. She had been admitted to the hospital with diphtheria when 8 months
old, and had remained there as a diphtheria carrier for more than four years.
Her father was dead, and while she was in the hospital she was deserted by her
mother. During her illness a tracheotomy was performed, which necessitated
the wearing of a silver tube in her throat. A t the time she was placed by
the society, this tube had to be removed and cleaned three times a day by
the foster mother, and the child required careful supervision while eating
because o f her difficulty in swallowing due to the presence o f the tube. She
spoke in a peculiar husky voice, and at times could scarcely make herself un
derstood, and she was subject to distressing fits o f coughing. The society
had had her in care for more than three years, her board being paid con
tinuously by the same sponsor. During this time she had been under the
observation o f the hospital physicians and had been returned to the hospital
several times for plastic operations. The surgeons expected to be able soon to
close the opening in her throat permanently, so that she would be able to go
without the tube. Jessie had developed normally, was well and happy, and
enjoyed school and play. As soon as the operative treatment was completed,
the society had arranged to place her with a stepgrandmother in another
State, who was willing and able to provide her with a good home. During the
three and one-half years she had been in care the child had been placed in
but two homes, and was being boarded for $14 a month.

Robert, aged 2, of illegitimate birth, was placed by the St. Louis Children’s
Aid Society at the request of the social-service department of the Children’s
Hospital. The child was completely blind as the result of a pneumococcie
infection of both eyes. He was placed in a foster home, where he was well
cared for, his mother paying $20 a month for his board. H e had been a very
delicate infant, and had been given the closest medical supervision in an
infant-welfare clinic. H e had been in residence at the hospital three times
and one eye had been removed. The other eye was to be operated upon later
in the hope of restoring some degree of vision, but the prognosis was doubtful.

Joseph, aged 18 months, was suffering from an organic nerve disease, and
was mentally defective. He cried almost continuously, and it was difficult to
persuade him to take food. Eventually he would require institutional care.
A t the time of the study he was being given excellent care in a foster home of
the St. Louis Children’s Aid Society, at the rate of $18 a month, of which
the mother paid $15.
Frank, aged 9 years, was placed by the St. Louis Children’s Aid Society at
the request of the social-service department of the Children’s Hospital. H e had
been in the hospital for a number of months, during which time several plastic
operations had been performed for the restoration of one side o f his face, which
had been blown off by a shotgun. H is family, living in another part o f the
State, were poor and irresponsible and unable to provide him with a proper
home between operations. A t the time he was first placed by the society his
appearance was very repulsive— one side of his face was lacerated, h alf of his
nose was gone, and his mouth drawn to one side. He was in very poor physical
condition generally. H e was placed in a foster home, and at first was returned
209

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Federal Reserve Bank of St. Louis

210

THE

WORK

C H I L D -P L A C I N G

A G E N C IE S

to the hospital every other day to have his face dressed. H e remained in the
foster home two months and then another plastic operation was performed
upon him. A month later he returned to his foster home and was entered in
school and Sunday school. H is general condition had improved greatly. H e
was taken to the hospital for another operation, and wa§ returned to his foster
home within a week or two. This boy was boarded at the rate o f $25 a month.

Mary, aged 5, was placed by the Children’s Mission to Children of Boston at
the request of the social-service department o f a hospital after an operation
for fibrous ankylosis of the jaw . The hospital asked to have the child placed
in order that the foster mother might see that the child took the prescribed
exercises and wore the special apparatus which had been devised for spread
ing her jaw . It was necessary for her to wear this apparatus constantly
except during the night and at meal time. Her own mother was careless and
ignorant, and could not be impressed with the importance o f carrying out the
surgeon’s instructions. The child was being treated in a dental clinic, to
which she was returned frequently for observation.

Jennie was born in July, 1917. She was placed by the Boston Children’s Aid
Society. She had had a series of convulsions during the period September,
1918, to May, 1919. An X -ray picture taken in December, 1918, showed an
enlarged thymus. In May, 1919, the child was admitted to the hospital because
of frequent convulsions. Five X -ray treatments were given at intervals of
five to seven days, and the child was discharged from the hospital in July,
1919, The thymus still showed some enlargement. A fter this treatment the
child was much improved, but had several spells o f cyanosis, and on M ay,
1920, after a convulsion, she was again given an X -ra y treatment and another
in September, 1920. In July, 1921, she showed no evidence o f enlarged thymus,
and had had no convulsions for 22 months.

W illiam was 16 years of age at the time of the study. W ith a younger
brother he came into care of the Detroit Children’s Aid Society November 1
1916, when 9 years old. H is father had deserted the fam ily and his mother
had died of tuberculosis. W illiam was sturdy and well, but had a congenitaL
malformation of his lower legs, which were amputated November 2, 1916
He was using his third pair of artificial legs. The stumps continued to give
trouble for two years, and a further amputation was necessary because of
bone infection. For a year and a half he had had very little trouble, because
he had learned to take care of the stumps and to know the kinds of exercise
he could indulge in safely. He walked with a slight limp, swam well, rode
a bicycle, and engaged in many activities, but could not take part in any
game where running was required. He was bright and happy, and was
well liked by his companions. He was being trained for office work. The
expense of his first pair of artificial legs had been borne by a member of the
board of directors, the second pair was furnished by a teacher of dancing
who was interested in the boy’s handicap, and the society had just met the
expense of the third pair.

Elsie was born while her mother was a patient at a tuberculosis hospital.
She was accepted for care by the Boston Children’s Aid Society at the age
of 4 months. A t that time she weighed 7 pounds 2 ounces, was an under
nourished, hypertonic baby, regurgitating practically all food. She was placed
in a boarding home which had been used for nine years, during which time
the foster mother had cared for 116 infants, most of them particularly difficult
feeding cases. This baby was visited by both nurse and physician, at first
practically every day. Her food formula was changed frequently, and she
was given the closest supervision. After several months the baby appeared
to be in excellent condition and weighed 11 pounds 4 ounces.

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Federal Reserve Bank of St. Louis

CASE

H I S T O R IE S

211

Albert, aged 16 years, an orphan, was placed by the Children’s Mission to
Children of Boston at the request of the social-service department of a general
hospital. H e had been in care two years. H is expenses were met by a ma
ternal aunt and uncle in another State. H e w as suffering from osteomyelitis
of the femur and spontaneous dislocation o f the left hip. A t first this boy
was in bed, but later* he was up and about on crutches and was going to
school. In addition, he was taking a course in cartoon drawing, fo r which
he showed special aptitude. H e was awaiting an operation on his hip, fol
lowing which the surgeons believed he would be able to walk. W h ile in
care he had been under observation in the out-patient department and had
been returned to the hospital several times
for treatment. This boy was
boarded originally for $9 a w eek; later for $6.50.

Edward, aged 9 years, had been in care o f the Children’s Mission to Chil
dren of Boston 27 months.
H is mother was dead, and his father paid
his board of $7 a week. H e had been placed upon application of the socialservice department o f a general hospital, where his case had been diagnosed
a s nephritis and double otitis media. This boy was under observation in the
medical clinic of the hospital from which he came, and he also attended a
posture clinic. W hile in care he had several attacks of acute illness, with
nausea, high temperature, and delirium, followed by a discharge from both
ears. H is kidney condition was cured and he was ready to be returned
to his father as soon as suitable arrangements could be made.

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Federal Reserve Bank of St. Louis

A P P E N D I X A .— G E N E R A L T A B L E S
G eneral T able 1.—

g e

p l a c i n g

h e n

r e c e i v e d

a g e n c i e s

o f

d u r i n g

c h i l d r e n
a

s i x - m

u n d e r

o n t h

c a r e

o f

e i g h t

c h i l d

p e r i o d

Wards of specified child-placing agencies

Age when received
Total

New
Boston
Boston
Florida
Chil
Chil
Chil England
dren’s
Home
dren’s
dren’s
for Little Mission
Aid
Wan to Chil Home
Society
Society
derers
dren

Total................... 14,887
Under 6 months_____
6 months, under 1 year
1 year, under 2............
2 years, under 3...........
3 years, under 4______
4 years, under 6______
5 years, under 6______
6 years, under 7______
7 years, under 8....... .
8 years, under 9 ..........
9 years, under 10....... 10 years, under 11____
11 years, under 12........
12 years, under 13........
13 years, under 14____
14 years, under 15____
15 years or over............
Not reported________

698
229
353
344
306
277
324
361
323
337
292
256
216
168
143
99
91
70

St.
Louis
Chil
dren’s
Aid
Society

Michi Pennsyl
Phila
gan
vania
delphia
Chil
Chil
Chil
dren’s
dren’s
dren’s '
Aid
Aid
Bureau
Society Society

342

309

171

443

249

1,029

2,146

198

60
32
27
15
13
12
18
23
12
20
11
25
12
17
10
14
19
2

14
8
25
17
19
16
21
16
20
26
26
19
18
12
16
13
22
1

2
2
8
10
9
22
10
15
8
14
11
13
13
11
9
7
6
1

42
13
18
14
25
24
29
43
41
36
30
34
21
23
19
13
8
10

40
22
36
24
18
10
15
14
9
13
6
10
7
3
7
8
5
2

398
64
67
50
41
39
47
52
53
45
37
26
23
18
14
15
9
31

111
67
149
194
165
146
176
191
174
170
162
121
111
83
58
27
18
23

31
21
23
20
16
8
8
7
6
13
9
8
11
1
10
2
4

1 Includes 2,688 boys, 2,181 girls, and 18 children whose sex was not reported.

G eneral T able 2.— P

e r s o n

c h i l d - p l a c i n g

o r

a g e n c i e s

a g e n c y
w

e r e

f r o m

r e c e i v e d

h o m

c h i l d r e n

d u r i n g

s i x - m

u n d e r
o n t h

c a r e

o f

e i g h t

p e r i o d

Wards of specified child-placing agencies

Person or agency from
whom received
Total

New
Boston
Boston England Chil
Florida
Chil
Chil
Home
dren’s
dren’s
dren’s
for Little Mission
Aid
Wan to Chil Home
Society
Society derers
dren

Total___________ 4,887
Own family without
surrender___________ 1,458
Own family with surrender______ _____
400
Other relative________
91
Other individual_____
111
Poor-law official!_____
611
Committing court____ 1,712
Hospital_______ ______
58
Private agency........ .
304
Institution___________
68
Other________________
68
Not reported_________
6

St.
Louis
Chil
dren’s
Aid
Society

342

309

171

443

249

286

173

146

11
5

34
13
9
7
10

7
1

69
21
62
203
3
13
10
1 13

14
1
4
21

8
2
1

Michi Pennsyl
Phila
gan
vania
delphia
Chil
Chil
Chil
dren’s
dren’s
dren’s
Aid
Aid
Bureau
Society Society
1,029

2,146

198

212

425

104

1
8
5

28fi
12
11
3
• 253
21
5
10

2
7

6
6
594
1,202
3
196
22
2
3

1 Includes 12 juvenile-court cases without commitment.

2207°— 27------15

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

215

3
13
12
7
8
28
45
18
1

216

TH E WORK OF CHILD-PLACING AGENCIES

G eneral T able 3.— P
e i g h t

a r e n t a l

c h i l d - p l a c i n g

s t a t u s

h e n

a g e n c i e s

r e c e i v e d

d u r i n g

o f

s i x - m

c h i l d r e n
o n t h

u n d e r

c a r e

o f

p e r i o d

Wards of specified child-placing agencies

Parental status when received

New
Boston
St.
Michi Penn
Boston Eng
Chil Florida
syl
Louis
gan
land
Chil
dren’s Chil
vania
Chil
Chil
Total dren’s Home
Mis
Chil
dren’s dren’s
for
dren’s
Aid
sion to Home
dren’s
Aid
Society Little
Chil Society Aid
Wan
Society Society Aid
dren
Society
derers

Total_____ _____________ 4,887

342

309

171

443

249

1,029

2,146

198

372
929

55
42

35
55

38
24

. 16
137

12
55

63
160

142
437

11
19

Father working out of city.
Father dead______________
Father deserted__________

1
268
291
54
24

1
13
7

11
15
13

10
9
1
1

12
15
10
3

28
64
17
2

149
151
10
12

9
6
1
2

Father in insane hospital .
Father in correctional in-

36
24
2
2
5
19

Parents living together in
home______________ _________
Mother head of fam ily_____ _

Phila
delphia
Chil
dren’s
Bureau

Father in almshouse______
Whereabouts of father not
reported..............................

71
2
2

38
2

210

Mother unmarried........... ......... 798
Father head of family------ ------- 1,088

63
126

30
85

4
55

29
77

47
82

369
108

211
425

45
70

566
170
17
261

59
14
4
43

39
5

33
9
12

37
10
1
32

65
28
8
43

254
96
2
46

25
3

54
5
2
7

Mother dead_____________
Mother deserted__________
Mother in hospital _____
Mother in insane hospital
or institution for feeble-

5
Mother in correctional in-

2
1

3
1

Whereabouts

of mother

3
10

Step-parental home__________

153

Father and stepmother-----

43
78
7
15

8
12

9
12

3
8

3
3

2
22

16
17
1
6

2
4
1

Not reported which parent
Not reported as to home—........
*

Parents not living together.
Mother dead.. __________

715

46
144
66
171
55
56

2
7

10
9
6
12
1
2

3
6
3
2
1

3
7

20
3
19
4
4

163

361

1
9

24
40
7
19
11
6

4
53
46
103
28
40

6
3

Father in correctional inMother

hospital

1
7
3

or
1

Mother in correctional institution________________
Father in hospital. _______
Parental status not reported___ _____________ _

104

N o home......................................

824

100

74'

525

Both parents dead________
Whereabouts of both unknown............ ........
Both parents in institution

223

122

Both parents in hospital__
Parents divorced.. ..........

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

9
6

3
2Ô
87
6
1

9
6

1
2

5
13

2
15
1
1

3
12
58
2

217

A P P E N D IX E S

G eneral T able 3.—
e i g h t

P a r e n t a l

c h i l d - p l a c i n g

s t a t u s

a g e n c i e s

h e n

d u r i n g

r e c e i v e d
a

s i x - m

o f

o n t h

c h i l d r e n

p e r i o d

u n d e r

c a r e

o f

— Continued

Wards of specified child-placing agencies
New
Boston Eng
land
Chil
Total dren’s Home
for
Aid
Society Little
Wan
derers

Parental status when received

No home—Continued
Father dead, mother de
serting.._____ ___________
Father dead, mother in

Boston
Chil
dren’s
Mis
sion to
Chil
dren

Michi Penn
St.
Florida
syl
Louis
gan
Chil
vania
Chil
Chil
Chil
dren’s
dren’s
Home dren’s
dren’s
Aid
Aid
Society
Aid
Society Society
Society

32
4

Phila
delphia
Chil
dren’s
Bureau

Father dead, mother in
4

Father deserting, mother
2

38
Father deserting, mother
Father deserting, mother

Father in correctional in
stitution, mother in hos-

Fâther in correctional inFather in correctional in
stitution, mother desertF ath er not reported,
F ath er not reported,

F ath er not reported,

20
F ath er not reported,

2
Father

away

working,
2

Father in hospital, mother

3
Father in hospital, mother

4
99
8

G eneral T able 4.—

S o u r c e

p l a c i n g

1
4
1

1
1

o f

s u p p o r t

a g e n c i e s

o f

d u r i n g

c h i l d r e n
a

s i x - m

u n d e r

o n t h

4
4

c a r e

o f

2
88
2

e i g h t

c h i l d

p e r i o d

Wards of specified child-placing agencies

Source of support
Total

New
Boston
Boston England Chil
Florida
Chil
Chil
Home
dren’s
dren’s for Little Mission dren’s
Aid
Aid
Wan to Chil
Society
Society derers
dren

St.
Louis
Chil
dren’s
Aid
Society

Michi Pennsyl
Phila
vania
gan
delphia
Chil
Chil
Chil
dren’s
dren’s
dren’s
Aid
Aid
Bureau
Society Society

Total___________ 4,887

342

309

171

443

249

1,029

2,146

Vo support............... . 1,230
Support from:
Parents.................... 1,281
Other relatives____
78
Other individual..
40
1,845
246
Private agency___
9
Self
2
More than one of
123
33

375

481

132

239
19
6
2
18
2
1

121
5
11
21
43
3

98
6
3
8
5
4

42
5
1
13
6

172
11
5
6

422
23
5
36
33

116
7
8
1,684
129

71
2
1
81
6

3
2

12
16

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1
1

56
14

198

218

THE

G eneral T able 5.—

w o r k

u m

b e r

o f

c h i l d - p l a c i n g

c h il d

-p

r e p l a c e m

a g e n c i e s

l a c in g

e n t s

d u r i n g

o f
a

a g e n c ie s

c h i l d r e n

s i x - m

o n t h

u n d e r

c a r e

o f

e i g h t

p e r i o d

Wards of specified child-placing agencies

Number

of replace
ments

New
Boston Florida
Boston England Chil
Chil
Chil
dren’s
Home
Total dren’s for Little Mission dren’s
Home
Aid
to
Chil
Wan
Society
Society
dren
derers

St.
Louis
Chil
dren’s
Aid
Society

171

443

249

58
33
23
12
12
11
5
8
2
1
3
2

113
141
50
53
26
25
11
9
4
6

74
50
50
23
11
21
9
5
2
2
1
1

342

4,887
1
................................
2.......... ............................
3 _______ ______ ______
4
______ ____ ___
5 __________ ________
6
____ __________
7 . ................................. .
R
Q
10
11
14

1,075
928
664
574
385
309
248
193
117
115
65
45
44
36
23
17
14
8
s

80
64
59
47
28
19
14
10
7
7
1
3
1
1
1

309
122
43
28
36
20
11
5
9
8
6
4
2
4
1
3
2
2
2

2
1
1
1

1,029
322
237
130
97
59
47
36
23
15
10
15
6
6
5
5
5
1
4
1
1

8
2
2

1
1
1
6

G eneral T able 6.—

Michi Pennsyl
Phila
vania
gan
delphia
Chil
Chil
Chil
dren’s
dren’s
dren’s
Aid
Aid
Bureau
Society Society

2,146

198

202
322
298
292
224
168
166
128
79
83
40
29
32
28
13
id
10
2
4
1
6
2
2

104
38
26
14
5
7
2
1

1
1
1
2

T y p e

o f

c h i l d - p l a c i n g

f i r s t

p l a c e m

a g e n c i e s

e n t

d u r i n g

o f
a

c h i l d r e n

s i x - m

u n d e r

o n t h

c a r e

o f

e i g h t

p e r i o d

Wards of specified child-placing agencies

Type of first place
ment
Total

Boston Florida
New
Boston England Chil
Chil
Chil
dren’s
Home
dren’s for Little Mission dren’s
Home
Aid
to
Chil
Wan
Society
Society derers
dren

St.
Louis
Chil
dren’s
Aid
Society

Michi Pennsyl
Phila
vania
gan
delphia
Chil
Chil
Chil
dren’s
dren’s
dren’s
Aid
Aid
Bureau
Society Society

4,887

342

309

171

443

249

1,029

2,146

198

Boarding home______ 2,554
Receiving or tempo
rary home...... ........... 1,971
275
Free home............. .......
Free home with par
22
ents or relatives____
19
10
6
Otherwise placed____
1
Wage hoarding home.
10

211

159

202

490

1,245

198

102
18

270
20

7
3

408
2

457
56

727
163

1
1

T o ta l................

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

2
2
2

11
16
4

11
1
3
1

1
1
1

219

APPENDIXES

G eneral T able 7.—

u r a t i o n

c h i l d - p l a c i n g

f i r s t

p l a c e m

e n t

a g e n c i e s

o f

d u r i n g

o f

c h i l d r e n

s i x - m

o n t h

u n d e r

c a r e

o f

e i g h t

p e r i o d

Wards of specified child-placing agencies
Duration of first
placement

New
Boston
Boston
Florida
Chil
Chil England
Chil
dren’s
Home
dren’s
dren’s
Mission
for
Little
Aid
Home
Wan to Chil
Society
Society
derers
dren

Total

St.
Louis
Chil
dren’s
Aid
Society

Michi Pennsyl
Phila
gan
vania
delphia
Chil
Chil
Chil
dren’s
dren’s
dren’s
Aid
Aid
Society Society Bureau

Total..................... 4,887

342

309

171

443

249

1,029

2,146

198

Less than 1 month____ 2,164
1 month, less than 2___ 801
2 months, less than 3 ._ 421
3 months, less than 4 . _ 261
4 months, less than 5. - 155
5 months, less than 6. _ 143
6 months, less than 1
year................. ............ 386
1 year, less than 2_____
232
2 years, less than 3........
121
3 years, less than 4........
53
4 years, less than 5____
30
5 years, less than 6........
19
6 years, less than 7____
21
7 years, less than 8........
14
8 years, less than 9____
11
9 years, less than 10___
3
10 years or over_______ . 45
Not reported..................
7

126
49
32
18
18
16

88
42
57
31
23
24

41
15
17
12
7
3

104
118
52
47
19
25

90
45
11
20
7
8

403
210
104
65
38
35

1,253
293
121
60
31
22

59
29
27
8
12
10

33
22
11
8

27
5
4

27
25
13
2
5
2
2

62
13
2

35
21
6
1
4

99
40
15
2
3
3
2
4
1

84
82
60
40
16
13
12
8
9
3
37
2

19
24
10

G eneral T able 8.— T
c h i l d r e n

u n d e r

c a r e

2
1
4
1
1
2

y p e
o f

o f

e i g h t

1
4
1
p l a c e m

e n t

a t

c h i l d - p l a y i n g

1
4

d i s c h a r g e
a g e n c i e s

o r

d u r i n g

a t
a

e n d
s i x - m

o f

p e r i o d

o n t h

o f

p e r i o d

Wards of specified child-placing agencies
New
Type of placement at
Boston
Chil England
discharge or at end
Home
of period
Total dren’s
for Little
Aid
Wan
Society
derers
Total..................... 4,887

Boston
Florida
Chil
Chil
dren’s
Mission dren’s
Home
to Chil
Society
dren

St.
Louis
Chil
dren’s
Aid
Society

Michi Pennsyl
Phila
gan
vania
delphia
Chil
Chil
Chil
dren’s
dren’s
dren’s
Aid
Aid
Bureau
Society Society

342

309

171

443

249

1,029

2,146

Discharged_____

815

227

176

Boarding home..............
Free hom e....................
Free home with parents or relatives _ . . .
Receiving or temporary home__________
Wage home .................
Wage boarding home..
Institution____________
Hospital..........................
Adopted..........................
C onvent.......................
Boarding school___ __
Otherwise placed
Ran away.____ ______
Not reported.................

371
178

3
5

9
18

20
34

128
47

85
71

198

156
19
7
16
12
4
2

3
2

71
1
2

12
1
2

3
1

Not discharged.. 4,072

268

220

124

374

174

802

1,970

140

Boarding home.............. 2,046
Free home____________ 1,362
Free home with parents or relatives_____ 104
Receiving or temporary home_______
186
Wage home......... ........... 134
Wage boarding home. _
79
Institution...................
48
Hospital..........................
14
Adopted.................. .......
12
Convent........................
17
Boarding school______
23
Otherwise placed..........
34
Ran away.....................
5
Not reported................
8

182
14

62
58

82
10

47
188

97
44

319
370

1,127
669

130
9

5
6
5

44
4
14

2
6
3

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Federal Reserve Bank of St. Louis

16
3

2
1

2
4

1
44

15
6

1
4
14

3
7
13
1

14
1

16
23

5
1

16
56
2
32

55
5

3
I

220

THE

G eneral T able 9.—

WORK

i s p o s i t i o n

c h i l d - p l a c i n g

C H I L D -P L A C I N G

a d e

a g e n c i e s

o f

c h i l d r e n

d w

i n g

A G E N C IE S

d i s c h a r g e d

s i x - m

o n t h

f r o m

c a r e

o f

e i g h t

p e r i o d

Wards of specified child-placing agencies
New
Boston
Disposition made of
Boston
Florida
children discharged Total
Chil England Chil
Chil
Home
dren’s
dren's
dren’s
for
Little
Mission
Aid
Home
Wan to Chil
Society
Society
derers
dren
Total....................
Returned to own family ~ ------------------------Placed with relatives..
Adopted______________
Transferred to institution or a g e n cy .____
Of age............... ..............
Married........................
Dead.................... ..........
Self-supporting.............
Ran away_______ ____
Other________________
Not reported...............

St.
¡¿Louis
Chil
dren’s
Aid
Society

Michi Pennsyl
Phila
gan
vania
delphia
Chil
Chil
Chil
dren’s
dren’s
dren’s
Aid
Aid
Society Society Bureau

815

227

176

443
42
87

52
4
5

43
3
1

31
2

17
11
14

41
6
2

162
7
45

59
7
19

38
2
1

124
29
22
10
5
1
48
4

29
6
2

11
1
1

16
22
14
2

3
2
1
1
2

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Federal Reserve Bank of St. Louis

1
1
2
1

3
1

2
2

2
3

A P P E N D I X B — T H E C H U R C H H O M E S O C IE T Y O F M A S S A
C H U S E T T S A N D T H E D E T R O IT C H IL D R E N ’S A ID SO
C IE T Y
TH E CHURCH HOM E SO C IE T Y
The Church Home Society was founded in 1855 and incorporated in 1858,
with institutional care of dependent children as its principal work. In 1913
its institution was closed, and child placing began to be the main feature o f
its work. In 1916 the name of the society was changed to the Church Home
Society for the Care of Children o f the Protestant Episcopal Church. The
society was a state-wide organization, but as it had no branch offices it mainly
served a territory within a radius o f 40 to 50 miles o f Boston. W ithin the
State, however, it held the responsibility of caring for all children of Episcopal
parentage who would come under the care of a private agency. The society
received such children from infancy to 21 years of age (a few girls over this
age, mostly unmarried mothers, were received), with no limitation regarding
sex, race, or nationality. Definitely feeble-minded children, those with active
tuberculosis, and children needing bed care after discharge from a hospital
were not received; children with venereal diseases were received for care in
foster homes. The society specialized in children suitable for placement t §
foster homes.
The managing board consisted of 21 members elected by the society and was
self-perpetuating; the president and honorary vice presidents were the bishops
of Massachusetts and of Western Massachusetts.
The board held monthly
meetings. The society had an executive committee, a committee on appeals,
a case committee, a nominating committee, and an auditing committee.
The staff consisted of the general secretary, a supervisor of case work, an
investigator, one home finder, three visitors, including a trained nurse, two
stenographers, a bookkeeper, a general and an assistant clerk. For its health
work the society employed in addition to the trained nurse, who had under
her supervision all infants and children presenting health problems, a psychi
atrist, who gave two mornings a week to the society, and the staff o f the
preventive clinic o f the Boston Dispensary, which was maintained in part by
the Church Home Society.
About half the support of the society was obtained from income on invest
ments and contributions from individuals and churches, one-fourth from
reimbursements of relatives or other persons for the care of children, and onefourth from diocesan funds. A t the time of the study the society paid onethird of the expenses of the staff of the preventive clinic.
The society did not use a receiving home, but used two subsidized homes
for emergency or temporary placements. Only foster homes in which the
foster parents were of the Episcopal faith were used by the society ; each child
was required to sleep in a separate bed, although in some instances two children
ware allowed to sleep in the same room. It was the policy of the society to
place brothers and sisters in the same home, irrespective o f the number; how
ever, with few exceptions it did not place more than two unrelated children
in one home. Detached homes in the suburbs w;ere preferred for placement,
and in placing^ babies it was required that there be a porch or some arrange
ment for sleeping in the open air. In placing a child, first consideration was
given to any health or behavior problem and the recommendation of the clinic
physician or psychiatrist was followed as closely as possible.
The foster
mothers were instructed in the care o f children by the nurse, the visitors, and
by means o f printed slips on diet, rest, and general hygiene. On May 1, 1923,
about 150 children were in care of the society, averaging aboùt 40 children to
a visitor. No fixed rule was made with regard to frequency o f visits, but
each case was decided according to the individual needs. The trained nurse
supervised the babies in their foster homes and also found homes for them.

221

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222

THE

WORK

OP C H I L D -P L A C I N G

A G E N C IE S

The usual rate of board for babies under 2 years of age was $5 , & w eek;
the maximum rate paid was $7. I f the society took a child into care it would
pay what was necessary for proper care, but the highest rate that it had ever
had to pay for any child was $10.
Physical examinations were made o f every child received for care by the
society at the preventive clinic o f the Boston Dispensary by the clinic physician,
except for boys over 12 who were examined by the house physician of the
dispensary. Girls requiring gynecological examinations were examined by a
woman physician who was prepared to give expert testimony in court if neces
sary. Mental examinations were given every child received for care who was
5 years o f age or over, or to younger children if a need was indicated. Cor
rective work and special treatment were made through the Boston Dispensary,
and hospitalization was obtained through the children’s hospital of the dis
pensary for children under 13 years of age. Children over that age were
sent to other hospitals in Boston. Each child was reexamined six months
after his entrance examination or sooner depending upon the recommendation
o f the clinic physician.
The health work o f the society cost considerably more than that of many
other agencies, but it was considered as correspondingly effective. The total
expenditures for the year 1922 amounted to $64,120.47, of which $3,675.48 was
expended for health work.

TH E D E TR O IT CHILDREN’S A ID SO C IE TY
The Detroit Children’s Aid Society functioned as one with the Detroit
branch of the Michigan Children’s Aid Society, the general secretary o f the
Detroit society acting as the branch secretary for the State society. The
Detroit society took care o f children 3 years o f age and over received for
care, and the branch office of the State society took care of children under 3
years of age. The Detroit society investigated, adjusted, and placed nonCatholic and non-Jewish children in Detroit and adjacent territory, with no
limitation as to sex, race, or nationality.
The board o f managers, consisting o f 39 members, served for both societies.
The society had a case committee, a foster-homes committee, an executive
committee, and a clothing committee.
The staff consisted o f the general
secretary and 33 members. A s for the other child-caring societies in Detroit,
three trained nurses were assigned for full-time duty with the society by
the Visiting Nurse Association, the association paying their salary but hav
ing no supervision of their work.
In addition to the three nurses seven
visitors were engaged in the supervising of children in their foster homes,
and a medical worker had charge of all children placed in special homes for
corrective work or treatment. On the health staff of the society also was
a medical supervisor, who was pediatrician on the staff of the W om an’s
Hospital and Infant’s Home and for the out-patient department o f Harper
Hospital.
The society was a member of the Detroit Community Union, which made up
its operating budget.
The agency had no receiving home, but used three subsidized homes, in
which it placed children coming into care until they had been examined physi
cally and until they were ready for permanent placement.
In selecting
foster homes special attention was paid to sanitation, source of water supply,
light, and ventilation. Very few homes were used unless' they had a yard or
porch. It was not required that children sleep alone, but children o f different
sexes were not permitted to sleep in the same room and children were not
allowed to sleep with adults. More than four unrelated children were never
placed in one home, but effort was made to keep children o f the same fam ily
together. Each child was placed in a home most nearly approaching the
requirements of the individual child as to both health and behavior, and
the recommendation o f the clinic physician was followed closely. The foster
mothers were instructed in the care of children by the visitors, and a monthly
letter emphasizing some special problem o f child care was sent to all boardinghome foster mothers. The usual rate o f board paid by the society was $4
a week. In the subsidized home a rate o f $5 was paid, and where special
diet or extra care was required a higher rate— $6 or $7— was paid.

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Federal Reserve Bank of St. Louis

A P P E N D IX E S

223

Children coming into care o f the society were given a physical examination
in the pediatric clinic or the medical clinic o f the out-patient department o f
the Harper Hospital by the clinic physician. Mental examinations were not
routine but were given to children who showed school retardation, those pre
senting behavior problems, those showing unusual ability, and all children to
be placed for adoption. The mental examinations were made at the agency
office by a psychiatrist who volunteered his services a half day each week.
The psychiatrist at the juvenile court examined all court cases. The medicai
worker was responsible for seeing that a ll corrective work and special treat
ment were carried out. Such work was usually done at the Harper Hospital
Dispensary or in the Harper Hospital, except dental work, which was done at
the dental clinic a t the society’s central office. Children requiring long-time
hospital care were sent to the University Hospital at Ann Arbor. No relation
existed between the cost o f medical work and the amount o f work done by the
society, as the salaries of the trained nurses were paid by the Visiting Nurse
Association and free medical treatment was given all children o f the society
by the Harper Hospital Dispensary. A s these agencies all belonged to the
Detroit Community Union, the cost o f work was borne ultimately by the com
munity which contributed the funds to the union.
The Detroit Children’s Aid Society used as a central office a separate building that belonged to the Home of the Friendless. A nursery and play room on
the second floor of the building was in charge o f a matron. Children when
fir? i i a5 eri.i ? to care were brought to the central office and were bathed and
outfitted with new clothing before placement. The clinic rooms on the second
floor were large and well lighted.

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Federal Reserve Bank of St. Louis

Full text of The Work of Child-Placing Agencies : Part I.—A Social Study of Ten Agencies Caring for Dependent Children, Part II.—Health Supervision of Children Placed in Foster Homes, Bureau Publication No. 171

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