412 LABORATORY PROGRAMS

develop a comprehensive clinical data-collection procedure intended to objectify the ordinary history recordings. This system, designed for computer processing, should facilitate the confirmation or rejection of specific clinical hypotheses, enabling us to focus much more sharply the criteria concerning short-term therapy. Results of this method will be presented in a future paper.

THE RESIDENTIAL TREATMENT CENTER AS A LABORATORY FOR COMMUNITY MENTAL HEALTH PROGRAMS

Howard J . Klapman Illinois State Pediatric Institute, Chicago, Illinois

This paper reports the establishment of a community-oriented residential center at the Illinois State Pediatric Institute. This center deals with children ages two to eight with developmental failures and manifestations of emotional illness and cultural deprivation. These children receive medical and psychological diagnostic studies as well as treatment.

In order to maintain a community orientation children were to be admitted for a period of one month to approximately one year. After the child's discharge he would be followed by a community school, day-care center or child guidance clinic.

Each child at the treatment center had a therapist who was either a psychiatrist, psychologist, social worker or public health nurse. The therapist treated the family and functioned as leader of the child's milieu therapy team. The family was en- couraged in many cases to work with various children in the treatment center milieu giving the therapist an extra dimension in evaluating and treating them.

In planning for the child's discharge the therapists coordinated meetings between treatment center staff and follow-up agency staff. The therapists also offered them- selves to the community agency as ongoing resource people who had intimate knowledge of various facets of the case. In some instances the therapists continued to see both child and family as outpatients.

It was hoped that a relationship would be founded between the treatment center and the community agency whereby principles could be worked out not only for dealing with the case in point but with similar cases that the community agency might deal with. To further this, community people were invited to attend treatment center meetings. A relatively open policy was fostered in the treatment center, and community people were invited to see and to discuss the program. This necessitated staff dealings with the problem of themselves and their work being exposed to a relatively large number of outsiders.

Seven children over a period of 14 months were placed in the community. In all cases community contact was afforded. In five of these cases close cooperation with community agencies was achieved. This program resulted in an exceptionally close tie between treatment center personnel and personnel at The Southwest School for the Retarded. This cooperation resulted in a special class for emotionally disturbed retarded children run by Southwest School and supervised by the chief psychiatrist of the treatment center. This class has since become a demonstration project and has stirred up the interest of others in the problems of the disturbed retarded.

LA BO RAT0 RY PROGRAMS 41 3

A MODEL OF RESEARCH FOR EMERGENT COMMUNITY MENTAL HEALTH PROGRAMS

William Guy, Gerard Hogarty and Martin Gross Springfield State Hospital, Sykesville, Maryland

Social psychiatry with its emphasis on social rehabilitation and community involvement tends to render obsolete the isolation of traditional inpatient treat- ment as well as the research designs formulated to assess outcome in these settings. This new treatment concept encompasses not only the reduction of manifest psycho- pathology but also avoids the separation of the patient from his family and com- munity. Simple prevention of deterioration as a treatment goal is superseded by treatment objectives which involve improved levels of social functioning and resumption of expected role activities. Therefore, the use of exposure to treatment and symptom reduction as measures of either immediate or long-range effects is inappropriate. Research models and the techniques of assessment must be broad enough to encompass the complex restoration to health toward which this new philosophy is striving.

Historically clinical practice has preceded evaluation with resultant problems in manipulating, changing or eliminating costly and ineffective programs. This need not be the heritage with which modern psychiatric programs are endowed. Retro- spective research programs can be replaced by those which combine treatment with concurrent research so that evaluation is germane to the program’s objectives.

The multidisciplinary approach which is prevalent in community mental health programs postulates that therapeutic intervention on many levels will be more effective in realizing the goal of restoration to the community. But therapeutic intervention on many levels dictates the need for structured research models so that changes in manifest psychopathology, therapeutic progress and the impact of family and community on the patient’s posttreatment adjustment can be iden- tified and evaluated.

Specifically a community mental health program which uses a psychiatric day center as its hub has been planned to meet the mental health needs of a rural- transitional county. The application of modern social psychiatric concepts to such a community represents a pioneering effort in nonmetropolitan areas. Further, the avoidance of chronic problems of overlapping and duplicated service so often present in complex urban areas can be achieved. While experience gained in evaluating an urban psychiatric day center study served as an excellent method- ological resource, it became clear that simple duplication of this design was im- possible since the social structure and treatment needs of a rural community were different. The transitional character of the community forced us to consider the expanded mental health needs and social changes inherent under conditions of a rapid population influx.

In both of these studies an orthopsychiatric treatment approach is used or con- templated. In order to evaluate these programs the decision was made to employ a multidimensional research design in which the unique contributions of various disciplines could be assessed by representatives of each profession at all levels

414 URBAN RENEWAL, MENTAL HEALTH, SOCIAL CHANGE

where treatment effects might appear. Further, it became evident that this assess- ment team had to function as an independent unit. The separation of treatment from evaluation is an attempt to control therapist bias in a treatment condition where double-blind procedures are inapplicable.

It is not suggested that traditional experimental designs be discarded. Rather it is proposed that designs be modified and altered to correspond with the modern focus on community mental health programs.

Panel 125: Urban Renewal, Menta l Heal th and Planned Social

C h a n g e 4 1

Chairman: Barney Rabinow

AND THE MICROCOSM

Morton fsler and Barney Rabinow Community Renewal Program, New York City Planning Commission, New York

Because of deficiencies in the city’s man-made physical environment which neither households, industry, commerce nor philanthropy by themselves have been able to remedy, an increasing number of publicly initiated, directed and coordinated programs are intended to involve both the private and public sectors planfully in corrective and preventive intervention. The two symposia on Urban Renewal, Social Change and Mental Health will present some of the problems, services and consequences (anticipated and unanticipated) when government, the market economy and voluntary agencies act to achieve “a decent home in a decent environment for every American family.” The topics will cover a few sociopsycho- logical inputs in city planning and urban renewal and their consequences rather than the legal, economic or administrative aspects of such programs.

Renewal compels the population within a geographical area to confront new change processes at a pace and in areas of experience to which they are unaccus- tomed. This acute obtrusion may result in a buoyant and zestful response when those affected feel that they can influence the change and that its consequences wiIl be a fuller realization of their preferences.

Planned change will have a negative mental health impact on those who cannot see advantages for themselves; who do not consider the benefits worth the effort, or who because of character structure, age or the depletion of psychic energies in life crises experience such change as ego dystonic and coercive. Cities need pro- fessionals with knowledge and skill so that the human processes in making the environment more suitable for human use are more consistent with current under- standings concerning positive mental health-not in the laboratory, not during the clinical hour, not in the relatively protected consultation with a school teacher about a troubled child-but in the open community, with residents, business people, government officials and other professionals.

SOME ISSUES IN POLICY PLANNING-THE MACROCOSM

URBAN RENEWAL, MENTAL HEALTH, SOCIAL CHANGE 415

Renewal compels an unavoidable encounter with hosts of neglected problems- ill health, child neglect and abuse, drug addiction, unemployment, marital diffi- culties, delinquency, psychosis-sometimes a number of these in the same family.

Renewal needs sociopsychological insights in both policy and detailed design planning. As an example of policy planning the following will serve. Let us assume that the households with greatest need for more adequate residential facilities are low-income families with three or more children. On examination we find that a considerable number of these households have one parent only, the mother. We could go from a count of households with three or more children inadequately housed to the determination of the quantity of new apartments which are needed to satisfy this group. However we might find that the large number of these house- holds with feminine heads are Negro households. An interesting question presents itself. About 30 per cent of out-of-wedlock white children remain with their mothers. About 80 per cent of out-of-wedlock Negro children remain with their mothers. Does this reflect a greater incidence of better rearing environments provided by biological mothers for out-of-wedlock Negro children than for out-of-wedlock white children? Does it reflect a more wholesome attitude to illegitimacy in the Negro community than in the white community? If so, should this value differential be nurtured? Or does it reflect the absence of adequate placement facilities for Negro children?

There seem to be three areas which need more attention from mental health professionals: primary prevention in the stewarding of change processes; secondary prevention in allocation of manpower and resources to the uncovered, largely neglected problems; sharing in policy and design planning.

Papers in these two sessions will touch on what to do with skid-rowers, use of group therapy technics in helping tenants to help themselves, problems of serving families to be relocated, adoptional stresses on a local agency when physical changes result in a new population and a new social structure in the neighborhood. Some of the problems of planning with and for people will be discussed. Achieve- ments and gaps in planning social and communal services for low-income families in public housing will be sketched. Finally we will close with a paper on the politics of urban change.

IMPLEMENTING PLANNED SOCIAL CHANGE THROUGH URBAN RENEWAL

Elizabeth E. Kempton Bureau of Community A flairs, Housing and Redevelopment Board, New York, New York

The paper will be concerned with the purposes for which the urban renewal program was created and the way in which the focus on socia1 goa t and social problems has been evolving. While there are many factors which have inff uenced the changing focus of the program, this paper will relate some of the changes to the urban renewal agency’s close and continuous contact with residents and leaders of urban renewal neighborhoods. It will be shown that out of this relationship,

416 URBAN RENEWAL, MENTAL HEALTH, SOCIAL CHANGE

comes a knowledge of neighborhood social problems and concerns to which the agency relates along with its attention to the physical improvement of the neighbor- hood‘s housing stock and community facilities. This will be defined as an attempt to minimize the disruption of community life and reduce the trauma associated with relocation while improving the housing and amenities necessary to healthy community life.

The paper will go on to describe concurrent programs and studies being instituted to discover ways in which the urban renewal program can deal with many of the severe social problems found in deteriorated neighborhoods. The objective is to use urban renewal to strengthen and stabilize some of the families and individuals who must be relocated out of renewal neighborhoods.

Some of the refinements and new approaches needed to further social objectives will be enumerated and emphasis laid on the need for further participation of experts in the sociological and psychiatric field.

PROVIDING SERVICES TO LOW-INCOME FAMILIES IN PUBLIC HOUSING

Preston David Department of Social and Community Services, New York City Housing Authority, New York

We need a new set of assumptions with regard to human services and public housing. The issue is much broader than the limited question: What does it take to make subsidized shelter work? Public housing stands at the very center of the enormous forces now shaping the new urban community. The physical buildings, in and of themselves, generate great power; properly integrated with a range of supporting human services, they can vastly benefit the surrounding neighborhoods and the city at large. Thus, housing’s potential must be seen within the context of the over-arching issues closing upon the urban complex.

‘These are some of the larger considerations: 1 . The future will produce a single urban belt on the eastern seaboard from

north of Boston to south of Washington. 2. The urban impulse in America and in the world has drawn and will continue

to draw rural dwellers from the land to the cities. 3. The rapid population growth taken alone poses problems for which municipal

governments are not ready. 4. The current mass migration has caused major population dislocation, largely

ethnic in character. 5 . The human service agencies are not geared to current needs. (The fields

represented by the Orthopsychiatric Association-social work, psychology, psychiatry-have paid inadequate attention to the problems of low-income people.)

6 . The job skills of today’s migrants are not suited to the needs of today’s indus- trial machine. Automation has demolished large areas of economic oppor- tunity for the untrained.