I U. S. DEPOSITORY APR 2 5 1978 'Alcohol, Drug Abuse, and Mental Health Administration National institute of Mental Health Denmark’s N ational Family Guidance Program: A Preventive Mental Health Program for Children and Families _ U. 8. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE Public Health Service Denmark's National Family Guidance Program: A Preventive Mental Health Program for Children and Families by Marsdenfigner, .D. Joint UCLA-University of Copenhagen Center for Studies of Health Programs U. 8. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National institute of Mental Health 5600 Fishers Lane Rockville, Maryland 20857 6/ fl7‘a713/ ACKNOWLEDGMENT The information contained in this report was gathered from a wide variety of disparate (written in Danish) sources, most of them unpublished, as well as from a large number of personal interviews. As a result it has not been possible, except when making a direct quote, to make reference to the multiple sources of the detailed information presented, as for example in the tables. It would be impossible for me to express adequately my appreciation for the extraordinary cooperation afforded me by my Danish colleagues during the course of this study. While the Danes have no wish to convince others of the merits of their programs, they nevertheless believe their family-guidance system to have been, for the most part, sound. They were able to speak openly and honestly to me about the strengths and weaknesses they found in their family-guidance system. Marsden Wagner, MD. Copenhagen, 1977 This report was prepared with financial assistance provided by National lnstitute of Mental Health Contract No. (278- 77-003). DHEW Publication No. (ADM) 77-512 Printed 1978 CONTENTS Acknowledgment ____________________________________________________ Foreword __-_-_____________-______-________________-________-_,____ Preface ____________________________________________________________ Introduction ____' ____________________________________________________ Background and Historical Development ________________________________ Service Program ____________________________________________________ Administrative Structure __________________________________________ Provision of Services ______________________________________________ . Sources of Cases ______________________________________________ . Intake ________________________________________________________ . Family Advisors ______________________________________________ . Supporting Team ______________________________________________ . Types of Services ______________________________________________ .‘Service Innovations -___-____________________; __________________ Program Evaluation ______________________________________________ Results __________________________________________________________ 1. Growth of Program ____________________________________________ 2. Source of Families and Types of Families ________________________ 3. The Families' Primary Reason for Needing Family Guidance ________ 4. Types of Assistance Given to Families ____________________________ 5. The Development of Family Advisors and Supporting Teams ________ CDUI-bODN-A Training Family Advisors ______________________________________________ Cost Analysis ______________________________________________________ Program Impact ____________________________________________________ ProbIems With Family Guidance ______________________________________ Lessons From the Danish Experience __________________________________ Appendix I ________________________________________________________ Appendix II ________________________________________________________ Appendix III ________________________________________________________ 2591 coco—r..< mummmmm 10 10 11 13 13 15 16 18 20 22 24 27 37 61 WI ,1 7%? ; 1 7 ‘ my PM :31; FOREWORD This booklet is the second National Institute of Mental Health-sponsored report by Dr. Marsden Wagner, a pediatrician and authority on health and mental health programs. The first report was entitled Sweden‘s Health Screening Program for Four-Year—O/d Children (DHEW Pub. No. (ADM)76-282. 1975). Widely circulated, it received an enthusiastic reception from Congressional staff, the Swedish Embassy, the White House, and professionals involved in health planning. Both the report on Sweden’s Health Screening Program and the present study result from an ongoing dialog between Dr. Wagner and Dr. S. P. Hersh, Assistant Director for Children and Youth, NIMH. it is their joint conviction that thoughtful examination of human service systems in other countries enriches our planning processes and enhances the possibilities for improving our unique service systems at both the national and States levels. I share their perspective and believe that this second report will prove at least as useful as the first. Francis N. Waldrop, MD. Acting Director National institute of Mental Health PREFACE Families, Government, and Our Need for Change At the request of the President, there will be, in the spring of 1979, a White House Conference on Families. The intention is for the Conference, currently in the planning stages, to be preceded by State conferences under the sponsorship of the respective State Governors. From each State conference, the principal issues identified as well as the recommended approaches to citizen-gov- ernment management of these issues will provide a major part of the content for the 1979 meeting in Washington. Central to these meetings lies a belief in the importance of the family as our society’s basic structural unit. Modifying this belief (and deliberately expressed in the Conference title) is the recognition that many forms of family are now found in the United States. Dr. Marsden Wagner presents in the following pages an allied country’s experience with a Na- tional Family Guidance Program. The Danish experience should contribute to discussions both during and derivative of the projected State con- ferences and White House Conference. Obviously, Denmark and the United States differ dramatically in size and history. However, we are close enough in culture and philosophy to usefully ”compare notes” on our approaches to human services. The questions raised by such comparison can enrich our own thinking. More- over, while Denmark and the United States share a similar regard for human life and individual freedom, we face the same challenges of limited manpower and monetary resources. , ironically, Dr. Wagner describes a program that was so successful it no longer exists. it was phased-out in 1976 in order to establish a service system for all families, whether or not they have children. The problem with this “evolution" is that it creates the potential for an actual decrease in services delivered to children: As resources be— come more limited, those who will get the most services are the adults because of their visibility, organizing ability, and vote. Such a situation, if it develops, will be a loss for Denmark with its history of action on behalf of children as a major economic and social resource. During the years of the program (1965-1975), Denmark designed a family—support system di- rected at improving family functioning. Sensitive to problems of stigmatization, they designed experi— ments with case-finding and outreach resulting in an emphasis on voluntary approach. Prevention and early intervention were promoted. While ideal- istic, they were pragmatic. The Danes recognized people’s greater responsiveness if a system is available in times of crisis. They accepted and worked with the reality that contact in the home and from a neighborhood/community base not only surmounts many barriers but is “cost-benefi- cial." They respected and accommodated to the heterogeneity of people, styles, and values. They made lawyers part of the family-support service teams. From responding to emergencies—decision of parents to separate, a sudden death or serious illness of a parent, an eviction notice, penal detention of a parent—they learned as we all do that families coming to our attention for such needs are often multiproblem families. The needs for coordination of services as well as the dra- matic preponderance of economic problems have familiar overtones?“ Community “hunger" for such a program is reflected in the utilization data presented. Crudely extrapolating from Dr. Wag- ner's data, one can envision for the United States a caseload in the area of over 500,000 families per year with a yearly National cost to operate of about $2.2 billion—a fraction of our current ex- penditure in Medicaid alone. I suggest that we wonder a bit about the Danish Family Guidance Program approach. Evi- dence continues to accumulate about the eco- nomic inefficiency and logarithmically expanding V costs of our present approaches to human serv- ices and medical care. Prevention and early . intervention are “siren calls" which perhaps we should heed with great attention. Indeed, strengthening families, family systems, and their competence and integrity should be seriously considered. Such strengthening, I believe. can be accomplished through relatively simple ap- proaches. For the Danes these included a volun- tary family-centered approach to human service vi delivery without predetermined categories for as- sistance. coordination of services or aid in such coordination, making cOntact available through neighborhoods and into homes. Our health and human service systems need to evolve beyond where they currently find them- selves. It is my hope that Dr. Wagner's report will stimulate dialog and perhaps behaviors that will move us toward an American experiment with community-wide family-guidance programs. S. P. Hersh, MD. Assistant Director for Children and Youth, NIMH INTRODUCTION in 1964 A new Child and Youth Welfare Act was passed by the Danish Parliament. This Act in many ways represented a dramatic new ap‘ proach to the provision of social services. One of the new approaches was the creation of a national family-guidance service. This program provided "preventive psychosocial services for children based on a family-support system. From the time the family-guidance system began in 1965 it grew rapidly until 1975. when a new social-service law became operative which phased it out as a separate service. This report will describe and analyze this 10-year experience in Denmark with what may be the only attempt to date to provide nationwide a wide variety of services to families in crisis so as to prevent or minimize the impact of the crisis on the development of the families’ children. BACKGROUND AND HISTORICAL DEVELOPMENT Social services for children in Denmark have evolved over a period of more than 200 years. (The first preventive-care program for children could perhaps be considered the law passed in ,1263, which decreed that the father of a child born out of wedlock is liable to contribute at least one-half of the costs incurred in supporting the child until he is 10 years of age. A further provision indicated that the State must assist the (mother with the collection of this support. In 1888 a law providing for automatic, compulsory super- visionof all foster children considerably expanded preventive care for children. This law also stipu- lated that anyone who cares for a child for pay (including day care) must be first approved by the municipality. in order to carry out these responsibilities for child supervision, there evolved. around the turn of the century, a system in which each local municipality designated a Child and Youth Committee. These municipal child and youth committees together form a local child advocacy system which has been operative for over 70 years in Denmark. Since the municipal Child and Youth Commit- tee was, among other things, responsible for the supervision of the family-guidance system to be described, it is important to understand how these committees are constituted. Every 4 years each municipality elects a "council" (equivalent to a city council or county board of supervisors in the United States). One of these elected officials who has a special intErest in children becomes the Chairman of the Child and Youth Committee. Then two (or three) more council members volun- teer for the Committee and are joined by two (or three) more Committee members chosen by the council from local citizens to form a Committee of five (or seven) members. There are several impor- tant features of this Committee to note: a majority (three of five or four of seven) are elected council members; all are lay people with interest in, but no special training for, this work; there must be both men and women on the Committee; there is no pay for this work (except expenses) and all are volunteering their time; and the Committee may likely be reconstituted every 4 years. The responsibility of these local Child and . Youth Committees gradually increased over time. 7 In 1923 their protective functions were extended {.to include automatic. compulsory supervision of all children born out of wedlock and all children from separated and divorced families if the father's or mother's support was paid in advance by the municipality. This program of compulsory supervision directed to specified types of families (i.e., guidance tied to the provision of economic help and directed primarily to the socially or economically needy family) continued until the 1 beginning of the 1960s when the Danes, for a number of reasons decided to reevaluate this program. This reevaluation revealed two serious prob- lems with the protective services for children. First/guidance and supervision to all families within a certain category (for example, out-of- wedlock families) resulted in much supervision of families who were in no real need of suCh supervision. At the same time many families in real need of guidance did not fit the specified categories and were unable to receive help. Secondly, because families in the specified cate- gories had to submit to the compulsory supervi- sion or guidance, there was a stigma attached to the service and frequent negative community attitudes toward the work. So, at the beginning of the 1960s, the Danes decided to try to answer the question "Is it worthwhile at all to provide supportive services to problem families with children or families in crisis with children?” In order to try to answer this question the Danish National Social Research Institute launched an experiment: ”The Family Center Study—an experiment providing suppor- tive services to problem families." One hundred forty families with at least two children under 18 years were selected from one of the poorest sections of Copenhagen. Their breadwinners were either married persons or single mothers. The families met at least one, and in most cases two, of the following five criteria within the previous 2 years: Public aid; problems with children such as school conflicts; contact with child-welfare authorities; treatment for alcoholism; application for induced abortion. The families were selected to consist of 70 pairs of families with the two families of each pair being identical "social twins" as to sex, age, education, number of children, and social problems of the family breadwinner. One family of each pair was then randomly selected for the experimental group and the other family entered the control group. All 140 families were interviewed, the experimental program was applied for 2 years, and then all the families were again interviewed. In addition the case files of all families were analyzed. The experimental intervention consisted of establishing a Family Center in this district staffed by social workers who would provide “family directed supportive activities” for the experimental group of 70 families. It is important to note that 2 these activities included home visiting for guid- ance, especially coordination of their dealings with other public agencies and assistance in solving their most pressing problems. it was decided from the beginning that their services would not include clinically oriented social case work or psychotherapy. The control group re- ceived aid only through the usual channels of existing public agencies. The results of this important social experiment are too numerous to report fully here and will be only briefly summarized. For the reader interested in more detail, an English translation of the summary and conclusions has been included in the Appendix. The families were found to have multiple problems, and the children presented many signs of living in a threatening situation. After 2 years the results were measured both with regard to movement, based on case material, and effect, based on measuring differences between the experimental and control group using the pretest and posttest questionnaires. With regard to movement, there was moderate positive move- ment (i.e., improvement) in all fields of family functioning (relations between adults, adult/child relations, etc.) with marked improvement in em— ployment and dwelling situations. With regard to effect, the experimental families showed a greater improvement than the control families. The differ— ences between the experimental and control groups were modest, and there is a 7 percent chance that they were due to random variation, but the researchers felt that the differences were real and might have been shown to be greater it better measurement criteria could have been found. The overall result of this study was that family-support services of this type can be shown to produce a certain net positive effect in family functioning, especially with regard to the chil- dren‘s threatened situation. The results of this study, combined with the reevaluation of the existing services discussed earlier, resulted in the drafting of new national social service legislation for children. Following parliamentary debate, the Children and Youth Act , was passed in 1964 and became operative April 1, 1965. An English translation of this law is included in the Appendix. The new law created “Familievejledning” or the Family Guidance Program. This program was a significant departure from previous services in two important respects. First, all automatic, com- pulsory supervision of children, other than foster children, was abolished and replaced by the new family-guidance program in which family partici-v pation was always voluntary. Second,/ the service was to be offered to all families with children in Denmark, regardless of social class. economic status, marital status. or any other criteria. It was hoped that by making the service voluntary and available to everyone, any stigma would be re- moved and the entire relationship between provi- ders and consumers would change and become more positive. . The acceptance of the new program, as will be described in subsequent sections of this report, was so rapid and of such magnitude that > an impact on the evolution of the overall . of human services in Denmark. After a few ' litifears of Family Guidance it became clear to the program planners that: families in Denmark want a support system; a “one_-d00r" source of assistance to families is important; and the assist— ance should be located in local neighborhoods. So by the beginning of the 19705 the Danes decided to revise their entire social-service sys- tem along the lines of the system for children and youth. A "Social Reform” law was passed and the Danes set about preparing a “B-day"—April t, 1975. (B stands for “Social Bistands Lov"-—Social Assistance Law). This law abolished Family Guid- ance as a separate service (rehabilitation, mother's assistance, and the Child and Youth Department were also abolished) and, instead, each neighborhood was to have a local “Social Center” where all families (with or without children) could go for all of their social services. The effect of this integrative approach on the support system for families with children will be discussed later. SERVICE PROGRAM Administrative Structure First. a brief review of the overall organization and administration of human services in Denmark will be given as it will reveal many similarities between this system and the organization of human services in the United States and will also help the reader to fit the Family Guidance pro- gram into the rest of the system. The administra- tive departments of the national government in Denmark are responsible for proposing legislation to the national parliament In the case of social services the administrative department is the Ministry of Social Affairs Legislative proposals are first considered by parliamentary committees and then debated by the entire parliament (one house only). The parliament is responsible, then, for passing laws outlining the type and scope of services .to be offered to the people. The laws also specify how the funding of these programs will be shared. The administrative departments of the national government, in turn, then interpret and expand on the laws by generating recom- mendations with regard to the details of running , such programs. These same national departments are then also respbnsible for monitoring the pro- grams and reporting back to the parliament. The running of the programs themselves, however, is entirely the responsibility of the local districts, or “Kommunes.” ("Kommune" is translated ”munici- pality” but the reader must understand that this local district may be rural as well as urban and contain only small towns.) There are 250 munici- palities in Denmark ranging from small rural areas of 10,000 people to Copenhagen Municipality with over a half million people. (Greater Copenhagen has over a million people but is divided into several municipalities.) Each municipality is re- sponsible for providing a wide variety of human services including all social services. The funding of these services is shared by the national govern- ment and the local municipality and the cost sharing varies among the different programs of- fered. With regard to the Family-Guidance program, the National Child and Youth Act of 1964 stated that ”the purpose of the child and youth welfare services shall be to ensure that children and young persons grow up under conditions promot- ing a sound mental and physical development." The law then stated that to accomplish this goal the Child and Youth Committee of every munici- 3 pality "shall be required to offer continuing guid- ance and support to families with children who are supposed to be in particular need thereof." The Act also specifies that the municipality may be reimbursed by the national government for 70 percent of the costs of these services provided that they meet standards to be determined by the National Ministry of Social Affairs. It is important to note that, while the law stipulates that every municipality must have a family-support system, it does not describe what the services must include but, at the same time, it allows for federal reim- bursement for only those municipalities which have an approved program providing the kinds of services which the Ministry of Social Affairs deter- mines to be adequate. Within the Ministry of Social Affairs, the Na- tional Department of Child and Youth Welfare was assigned the task of developing the guidelines for the Family-Guidance program. The guidelines set two conditions necessary for an approved local program to receive federal reimbursement. The , first condition was that the “family, advisors” who provide the primary care in this program must either be certified social workers or have a basic education in certain related fields combined with a special, brief but i ensive training course. The second condition as that the family advisors must have the support and supervision of a team consisting of a physician (often a psychiatrist), a psychologist, a lawyer, and a social worker. In' order to determine if local municipalities had met these criteria and could be approved for reimbursement and in order to assist the local municipalities in the development and manage- ment of their family-guidance programs, the Na- tional Department of Child and Youth Welfar divided Denmark into 14 regions. each with a consultant from the National Department. This national consultant played a difficult double role— monitoring the municipalities in his district to be certain they maintained their standards while at the same time offering assistance to the munici— palities in monitoring their programs and solving problems when they arose. Once a month, all 14 consultants met together with the leader of the National Department to review the programs in the various regions, solve common problems, and evaluate the overall progress of the family~guid- ance service. Since the law required every municipality to have a family-guidance program but did not 4 require that it be an approved one, there was considerable variation in the quantity and quality of this service over time and in different parts of Denmark. This variability reflected, first, differing rates of “tooling up" for this new service and differing rates bf"‘tooling down" as “Bvday” ap- proached. This variability also reflected the heter- ogeneity of the various regions of Denmark includ- ing the degree of urbanization, degree of industrialization, economic level, social customs and beliefs, availability of professional workers, etc. The law allowed for such local variation but, at the same time, provided incentive for improve- ment in services. it was entirely the responsibility .of the local municipal Child and Youth Committee to determine what their family guidance would include. In a small, rural, more conservativeqand less affluent municipality the Committee mafita‘ve simply chosen to assign one of its staff mét'nbers to include "guidance and support of families with children” in his duties. This municipality would then be one of the nonapproved ones. The local citizens, however, have the right to appeal what they feel are inadequate services. There were also differences among the municipalities with approved programs since the type and scope of the service offered depended on local needs. It was possible for smaller municipalities to join together in providing the service, and, in all except the largest urban areas, this preventive guidance service was closely associated with the other protective services for children. Thus a certified social worker may have been on the staff of the Child and Youth Committee and performed investigative functions for the Committee and. at the same time, supervised some workers who were concentrating on protective services and other workers who, as family advisors, were providing preventive guidance. ln Copenhagen municipality, however, the size of the family-guid- ance program necessitated a separation from the other child welfare services. Within the Depart- ment of Child and Youth Affairs in Copenhagen there was a Division of Family Guidance whose only responsibility was to provide this service. This Division was responsible to the director of the Department, who in turn was responsible to the Municipal Mayor and Council. This Division worked closely with the other divisions which were performing the promotive and protective functions for children, and all divisions were housed in one central building. Provision of Services Although the services provided varied among the municipalities in Denmark, the basic pattern was similar as it was laid down by the guidelines of the National Department of Child and Youth Welfare. Important local variations, changes, or innovations will be mentioned in the following sections: 1. Sources of Cases When the Family Guidance service began in 1965, one of the tasks was to familiarize the public with this new offer since the program was to be voluntary rather than compulsory. During the parliamentary debate of this program, it had received considerable attention in the public me- dia. After the program began, it received further publicity through articles in magazines and news- papers. Equally importantly, information concern- ing the service was given to all those working with children and/or their families including family doc— tors, home visiting nurses, teachers, school psy- chologists, daycare workers, etc., so that they might refer families to the program. In addition an attractive pamphlet, For Familien, which de- scribed the services available in simple language, was widely distributed. At the beginning of the program the most important source of referral was the local Child and Youth Committee, which was already in contact with families who had previ- ously received compulsory supervision. If the Committee felt that problems still existed in a family, they were referred to Family Guidance where, hopefully, they would receive continuing help on a voluntary basis. ”Preventive” case-finding was also consid- ered early in the program. The value of such case—finding was demonstrated in a small study in Copenhagen. A long-established routine was for other departments in the city to send a notice to the Copenhagen Department of Child and Youth Affairs if a divorce or separation had occurred In a family with children or if a parent had been sent to a mental hospital. The Family Guidance service collected 100 of these notices and contacted the families to offer their services. In 58 of the 100 families it was found that services were needed and the offer was taken up by the family and help provided. But the long—range goal of case-finding in Family Guidance was that there would be little or no need for finding cases if all families were aware of the services, considered the program as a positive offer, felt no stigma in availing them- selves of such help, and came on their own. The pattern and evaluation of sources of cases will be presented in the subsequent section on results. 2. Intake Since the program was designed to help families in crisis, it was important that they receive some type of assistance as quickly as possible. In most municipalities the families were seen on the same day they applied for help. The worker interviewed the family member at length and attempted to help resolve any acute problems at that time. In Copenhagen Municipality there were intake workers, all qualified social workers who remained in the central office, whose primary task was to do five or six initial evaluations on new cases each day. In most other municipalities the intake was conducted by one of the family advi- sors. Many cases could be resolved at the intake level without need for further help. If further help was necessary, the case was then referred to a “family advisor” who served the neighborhood where the family lived. Since it might be neces- sary for the family to wait 2 or 3 months before the family advisor could start his service, the intake worker also arranged for any needed interim help. Thus by seeing new families the same day they applied and arranging any neces- sary immediate help, this crisis intervention could result in immediate feelings of support and hope. Through proper initial help, screening, and refer- ral, it was possible in most municipalities to refer all families needing longer-term help to a family advisor within 3 months. 3. Family Advisors If necessary, the case was next picked up by the family advisor. Since this family advisor was the primary care giver and the central person in the Family Guidance system, and since there is no equivalent worker in the United States (nor was there in Denmark before this program began), the qualifications, training, and duties of this position will be presented. When Family Guidance began, the authori- ties, recognizing the serious shortage of certified social workers in Denmark to man the program, 5 decided the need could not wait and also de- cided that the talents of a social worker could be spread more broadly through the use of the concept of the paraprofessional. So, with the birth of Family Guidance, the family advisor was also born. While some of the family advisors were qualified social workers—in Copenhagen 20—30 percent but less in other areas of Denmark—the majority were not but rather had a basic education in another related field such as teacher, preschool teacher, youth-club worker, nurse, and so on. When openings were available for new family advisors, the positions were advertized in the mass media. There were always more applicants than openings, and it was difficult to select the best applicants. The selection usually took place through a written application and two interviews. It was their experience that no particular criteria, including success in a previous profession, guar- anteed success as a family advisor. Consequently there was a 10-month probationary period after hiring and, from time to time, it was necessary to dismiss a worker who was simply not able to adapt to this work. After an applicant had been accepted into the program he was immediately placed on the payroll. The salary was about 3,000 Danish Kroner (approximately $500) a month, which was a - competitive wage for this level of training and experience. If the applicant was not a qualified social worker, he was then given a 4-month training course. This training course, which was required of an approved program, will be de- scribed in a later section. Following the comple- tion of training, the family advisor was assigned to a neighborhood and was assigned new cases as they arose in his district. In Copenhagen each family advisor usually had no more than 20 active cases at one time, although in some other munic- ipalities the caseload sometimes went as high as 60. When a new case was assigned, the family advisor made a home visit and, following a thorough assessment of the problems, began to provide any needed services (services offered are described in a later section). From this point onward, the family helper was the only one from the agency who had direct contact with the family unless individual professional help was required. The contact was always either by home visit or, when this was impossible, by phone. The family helper usually spent from 6 months to 1 year 6 working with a family, and the case was closed when it was felt the family situation had stabilized. Every attempt was made to help the family to be able to take care of itself as soon as possible and to prevent the use of the program as a crutch. The family, however, could return at any time for further help if it felt it was necessary. Each week the family advisor usually spent about 3 1/2 days in his neighborhood making home visits and contacting other agencies or individuals and 1 ‘/2 days at the central office with other members of the team. ‘ Most family advisors were women. In Copen- hagen about one—fifth were men, but in the rest of Denmark there were fewer. While in general it was important for the family advisors to have cases «from their own neighborhood where they were well acquainted with the people, the living condi- tions, agencies, etc., from time to time cases might be traded or assigned to an advisor from another district for special reasons. Thus, for example, if a family had a father but no mother, and if it were judged appropriate, the case might te given to a male family advisor from another neighborhood. In special circumstances a case might be managed by a supervising social worker. . 4. Supportlng Team A supporting team, as mentioned earlier, was a necessary element in an approved (and there- fore federally reimbursed) family-guidance pro— gram. The team must have included, in addition to the family advisor, a physician (usually a psychiatrist), a psychologist, a lawyer, and a certified social worker. In the smaller municipali- ties where there were four or less family advisors, all advisors used the same support team, and in the smallest municipalities, with one or two family advisors, two or more municipalities were allowed to join together in using the same support team. In the larger municipalities there were several support teams, each serving its own group of family advisors. Several family advisors met together regularly with the four specialists for a team meeting. Each advisor presented a case and then there was a general discussion among the group. In this manner the advisors could get supervision of the case and the other advisors could also learn from the discussion. in addition to team meetings, the family advisors also met individually with their supervising social worker (i.e., the social worker on the team) to go into more details on each case. Frequent case conferences were also held in which all of the individuals or agencies in the community which were involved in the helping of one family met together to discuss the manage— ment of the family’s problem. The family may have been invited to attend this meeting also, if it was felt that it was capable of benefiting from such attendance. In addition to consulting with the family advi— sors, the members of the support team also had other responsibilities related to their particular professional capacity. The psychiatrists occasion— ally evaluated adults or children in families under care to determine whether they needed profes— sional help. These evaluations also served to give the family advisors more confidence when they were working with these stressed, and sometimes disturbed, family members. The psychologists occasionally gave psychological testing to individ- ual family members when it was indicated. They also directed some group-therapy programs and were active in the training of family advisors. The lawyers, in addition to consulting with the teams on the legal implications of a family’s problems or projected assistance, also provided legal advice to a family under care or to the family-guidance program itself. 5. Types of Services The services offered to families in family guidance were based on the principle that this program was intended primarily for families faced with an emergency. This emergency may have been a decision of the parents to separate, a sudden death or serious illness of a parent, an eviction notice because of inability to pay the rent, penal detention of a parent, etc. The assumption was that, without help, family disintegration with subsequent damage to the quality of the chil- dren’s environment would occur. With this aim in mind, there were three general types of services offered by family guidance. The first type of service was the guidance offered by the intake social worker and the family advisor. This individ- ual guidance included referral of family members ./for needed services. These services included the whole range of health, education, and welfare programs from a family physician to a University Hospital clinic, from after-school day care to full- time foster care, from a group—therapy program (see below) to placement in a mental hospital. In addition to making the referrals, the family advisor would also follow through to be certain that the contact was made and the service received. The advisor assisted in the coordination of all these services and, if indicated, arranged for a case conference. Equally, if not more, important, how- ever, was the emotional support which the family advisor provided on a continuing basis. These families were in acute distress; and the family advisor, by meeting with them in their own home, frequently, and in a relaxed and unhurried fashion, was able to give the family members the support and hope they needed in order to, for the most part, solve their own problems. The family advisor also was available to the family by phone at any time during a crisis period. The second type of service available to families in family guidance was economic assist- ance. It was the task of the lawyer on the team to decide if the family in question qualified for economic assistance according to the Child and Youth Law. There were five situations in which it was possible for family guidance to provide economic help: (1) The family may have been in need of money to pay somebody to look after the children—day-care, kindergarten (this is not pro- vided universally in Denmark), or a foster mother. (2) Recommendations to the parents with regard 'to the child's upbringing may have included youth clubs, special educational or vocational training, etc, which involved a fee. (3) There may have been a need for referral to a physician, psycholo- gist, or psychiatrist. (4) There may have been need for homemaker’s assistance. (5) There may have been need of help to cope with a transient economic problem. This involved emergency funds to buy food or pay the rent or utility bills either to relieve a momentary shortage before the underlying problems were tackled or to help in cases where it seemed that the relief of the immediate need was all that was necessary and that the family would be able to cope from there on. in all of these five situations Family Guidance could help to foot the bill provided that (according to the law) the economic assistance would help to preserve the integrity of the family setting so that placement of children outside their home could be avoided. In their guidelines, however, the Ministry of Social Affairs made it clear that these 7 _/ regulations should be broadly interpreted and that Family Guidance should give the financial help needed before the family had exhausted every resource available. The third type of service available to families in family guidance was ”group" services. During the winter parent groups were formed from among parents who were receiving help from a family advisor. In this way, a small group of parents would meet with their family advisor somewhere in the neighborhood in the morning or evening. Members of the group tended to be lonely parents who had few friends, little money, and were badly in need of social outlets. The groups were called “Parent Clubs," and the parents were asked what they would like to have in the way of programs. They chose for them- selves what they wished to discuss or hear, and frequently chose such topics as living-collectives in Denmark, narcotics, laws governing children, educational techniques with children, etc. They met once a week and there may have been a discussion led by the family advisor or an invited speaker. In addition to the social and educational value of these clubs, the workers also felt that they were of considerable psychotherapeutic value. During the summer months, Family Guid- ance provided summer camps for mothers and children. A mother and her children would be sent for 2 weeks to stay together at such a camp. Most of these mothers could not otherwise afford a vacation (a token payment was made for the camp). From 10 to 12 mothers would be at the camp at one time with usually 24 to 26 children. There were kindergarten teachers there who took care of the children during the day so that the mothers were free to relax, to have discussion groups, to take trips, and to rest. The family advisors were there to assist in any way they could. In addition to their recreational, social, and educational benefits, these camps were also credited with having psychotherapeutic value. 6. Service Innovations During the 10 years of the family-guidance program, a number of innovations were tried. Some of these changes proved of value and some were not successful. One innovation has already been described—the preventive case- finding program. Even though this particular ino— vation was successful in the sense that it identified 8 families in need of help, it was never used as a routine procedure because, as will be seen later, family guidance was soon so swamped with new cases that it could not afford to find more. An important innovation was the result of experience over a number of years. As described previously, in the largest municipalities qualified social workers did initial evaluation of new cases in a central office. Gradually, with the increasing number of new cases, this initial evaluation be— came a bottleneck because there were only a finite number of qualified social workers and they could do only five or six intake evaluations a day. So in 1974 the system for intake was changed. instead of a routine intake on all new families, an emergency service was created where families in crisis could come for immediate help. Duty on this emergency service was rotated among all family advisors in the program, not just the qualified social workers. If, after the crisis intervention at the emergency service had been completed, it was found that additional, long-range help was needed, the family advisor giving the emergency help could keep the case or pass it along to an advisor working in the neighborhood where the family lived. This innovation became permanent because it proved valuable for several reasons: It completely removed the intake bottleneck; it cre— ated a social emergency service similar to the already established medical emergency service; it removed any separation between the certified social workers in the office and the family advisors in the field. Another innovation related to providing family guidance to the guest workers families. The guest workers in Denmark are similar in many ways to some of the minority groups in the United States: They come from different countries (usually South- ern Europe or the Middle East) and have a different culture and language; they are at the bottom of the socioeconomic ladder; they experi- ence discrimination and often tend to live together in urban ghettos. Most guest-worker families in Denmark live in Copenhagen. When the family- guidance program began, announcements were made in the foreign worker’s newspapers, and a booklet describing the program in the four most common languages of these workers was distrib— uted. Very few of these families, however, came for help, and it was found that the main barrier. was language. Finding non-Danish family advisors was not a solution since the guest workers speak so many disparate languages—Serbo—Croatian, Turkish, Pakistani, etc. So the family-guidance program started to use a translation service for these families. This proved valuable because the translator was of the same cultural background as, the family and often acted as an advocate for the family and an important mediator. In addition, family guidance arranged for many'parents of the families to have Danish language lessons so that they could cope better in daily life. Another innovation with regard to the guest- workers’ families illustrates the value of having family advisors in the local neighborhood who are familiar with the local institutions and conditions. One elementary school in a poorer section of central Copenhagen was having problems with a number of children from Yugoslavian families living in that area. The local family advisor, who had close contact with this school, learned of this situation and discussed what to do about it with her team. As a result a special program was developed in that neighborhood for Yugoslavian families which inCluded a Yugoslavian Youth Club and a Yugoslavian Parent Club. Another innovation was much less success- ful. In 1970 in one of the largest municipalities, an experimental neighborhood family treatment pro- gram was initiated. One day a week two family advisors, a social worker from the Mothers Aid program and a consultant psychologist, were available to give guidance and help in a neigh- borhood office. The experiment proved unsuc- cessful and was discontinued because the serv- ice providers were not familiar with the families and agencies in that neighborhood and did not spend enough time there to become familiar or to provide the constant intensive support necessary in times of family crisis. Program Evaluation With most human-service programs in Den- mark, program evaluation is seen as the respon— sibility of the central government. As mentioned earlier, the National Department of Child and Youth Affairs of the Ministry of Social Affairs was responsible not only for developing guidelines for family guidance but also for monitoring the ongo- ing program. It was clearly understood that the purpose of such monitoring, in addition to check— ing on local compliance with the standards set in the guidelines, was to evaluate the progress of the program. On the basis of this evaluation, it was the further responsibility of this National Department to revise the guidelines from time to time in the light of their evaluations. The law (as with most human-service laws in Denmark) was written in a broad manner to allow for such evolution of services within the legal framework. If, after considerable experience with the program, the National Department found that further changes were desirable which would go beyond the law, then recommendations were made to the parliament for new legislation. The method of procedure for central program evaluation was as follows. Each month the 14 regional consultants met together with the central program directors to discuss problems and prog— ress. Based on these discussions, recommenda- tions for program change would evolve. This was clearly a qualitative, subjective process but, ac- cording to those involved, an effective and reliable one. In addition, from time to time the National Department would review the overall progress of the program through an analysis of certain statis- tics which each local municipality was asked to submit. These statistics included the number of family advisors, number of consultants on the team, number of families served, and number of team meetings. One such review was conducted by the National Department in 1973*. The National Department of Child and Youth Affairs also had a budget of 500,000 kroner each year for system- atic evaluation of their various programs. During the 10 years of family guidance this money was never used to investigate family guidance. The Director of this Department during the time of family guidance stated that this was because the program was too new and was still rapidly evolv— ing like all new programs. He said that if the family guidance had not been taken over after 10 years, he was certain that this money would have been used very soon to carefully study this program. In general, it was understood that the respon- sibility of the local municipality was to provide the service in family guidance, not to “do research.” * “Familievejledning—i972—73" cher, I., and Christen- sen, P. National Department of Child and Youth Affairs, Copenhagen, Denmark. This unpublished report has not been translated into English, but some of the materials have been translated and used in the later section on results. Indeed, in 1965, at the beginning of the program, one municipality asked permission to use a small percentage of their funds for systematic study of the new service and was refused. The request was made again 5 years later in 1970 and again was turned down. ‘ On‘the other hand, it was also expected that the municipalities would take note of their experi- ence and try to make adjustments in their serv- ices. In the smaller municipalities this process was done continuously on an informal basis whenever the team would meet. In addition to discussing individual cases, the team would also discuss problems in providing the service and suggest new ideas to try out. In the larger municipalities this process of local program eval— uation had to be more formalized. The supervising social workers, supervising consultants, and pro- gram leaders were responsible for encouraging continuous feedback from all personnel concern- ing problems in the services and ideas for im- provement. Occasionally a single municipality might, of its own accord, try to find out more about what it was doing. As an example, in 1969 the munici— pality of Copenhagen wished to have a better understanding of the characteristics of the families they were serving. 80 each of the 40 family advisors was asked to randomly select two fami- lies (using case numbers) and to complete a questionnaire on these two families. The results on these questionnaires were compiled by the leaders of family guidance in Copenhagen, pho- tocopied, and distributed to the personnel in their program. The results were for internal use only and were used as a stimulant to bring forth suggestions with regard to services to these families. These data, which were never before released or published, contain a wealth of infor- mation concerning the characteristics of families served by family guidance and have been trans- lated into English and included in the Appendix. Results 1. Growth of Program The phenominally rapid acceptance of this new voluntary program can be documented in several ways. First, each local municipality had to decide whether or not it wished to have a recognized program. Even though a recognized program could receive 70 percent Federal reim- 10 bursement, it still required 30 percent local funds as well as the necessity of recruiting family advisors, forming support teams. etc. A large number of municipalities elected to establish a recognized service from the beginning in 1965. Every year more and more municipalities joined the list of authorized family-guidance programs until, by March 31, 1973, 8 years after family guidance began, 265 of the 277 municipalities in Denmark had a recognized program, 1 munici- pality had an unrecognized program, and 11 municipalities had no real program.‘ Since the municipaliites wrthout a recognized program were all very small, ”next to all families in the country with children and with the need had the possibility to receive family guidance.”** A second way to document the growth of the family—guidance program is through reviewing the number of families receiving services each year. While nationwide figures are unavailable prior to 1969, the number of families served by family guidance in Copenhagen Municipality during the 10 years of its existence are available and are shown in table 1. TABLE 1. Number of Families Served by Family Guidance in Copenhagen Municipality, 1965—1975 YEAR FAMILIES SERVED 1965 609 1966 723 1967 1,009 1968 1 .352 1969 1,310 1970 1 .348 1971 1 ,094 1972 1 ,138 1973 1 ,1 1 1 1974 1 .053 This table shows the large number of families who received help during the first year of the program as well as the rapid growth of the service during the first 4 years. After 1969 the number of families served by this municipality plateaued and remained rather stable. *Although, by law, all municipalities must provide a family guidance service, these 11 municipalities had cir- cumvented the law by assigning this additional task to an existing staff person, and no real service existed. "* Borne og Ungdomsvaemenes. 1974 Department of Child and Youth Affairs, Ministry of Social Affairs. The family-guidance service for the entire country, however, continued to grow after 1969 because individual programs were expanding and because new programs were being estab- lished in additional municipalities. The growth of the program, nationwide, is shown in table 2. TABLE 2. Number of Families Served by Recognized Family-Guidance Programs in All of Denmark CHANGES FROM FISCAL YEAR FAMILIES SERVED PREVIOUS YEAR 1969/70 7,292 +11% 1970/71 11,082 +52% 1971/72 13,253 +20% 1972/73 12.615 — 5% 1973/74 13,033 + 3% This table shows that the family-guidance program continued to grow rapidly nationwide until 1973, at which time it leveled off. it should be added that by 1973 it was known that the new Social Assistance Act was soon to be imple- mented (hence the family guidance program would be discontinued as a separate service) and the motivation for further growth was lost. A third way to measure the growth of family guidance is through the number of family advisors working in the program. The number of family advisors working in three local municipalities is shown in table 3. TABLE 3. Number of Family Advisers Working in Three Municipalities FREDERICKS— YEAR COPENHAGEN BERG GENTOFTE 1965 26 ' ' 1966 38 " ‘ 1967 46 4 1 1968 47 5 a 1969 48 4 4 1970 49 5 5 1971 47 5 6 1972 54 9 6 1973 57 9 6 1974 58 9 6 *figures unavailable. In all three of these municipalities a recog- nized program began in 1965 and the number of TABLE 4. Number of Family Advisors in Denmark—1970 to 1974 NUMBER OF FAMILY YEAR ADVISORS 1970 404 1971 489 1972 596 1973 636 1974 645 families served each year had peaked by 1969. The number of family advisors, however, did not peak until three years later in 1972, which dem- onstrates that there was a contiuning attempt to upgrade services by adding new workers. in looking at the number of family advisors nationwide one finds the same phenomenon—a continuing increase in the number of workers after the number of families served had peaked. An earlier table showed a nationwide peaking of families served by 1973, but table 4 shows that the number of family advisors continued to in- crease right up to the last year of the program. 2. Source of Families and Types of Families The new family-guidance service, unlike pre- vious family-support services, was always to in— volve families on a voluntary basis. Thus, when- ever an individual or agency referred a family to Family Guidance, the program contacted the family and offered its services. At the same time it was hoped that gradually more and more families would come on their own and ask for help. Two ways of measuring public acceptance of this program is to look at the percent of families referred who accept the offer and the percent of families who come on their own. With regard to the number of families referred who accepted the offer, the results for all of Denmark during a 5-year period are shown in table 5. It is clear from this table that there was a high degree of acceptance of this family-support pro- gram by the families in need throughout Denmark. With regard to families who came on their own to ask for help, it is important to look at all sources of families coming to this program. During this period of time in Denmark, there was a highly developed complex network of human services, and all individuals and agencies in contact with 11 TABLE 5. Percent of Families in Denmark Referred to Family Guidance Who Accepted the Offer: 1969/ 70 to 1973/74 SINGLE- PARENT“ TWO-PARENT FISCAL FAMILIES FAMILIES YEAR ACCEPTING ACCEPTING 1969/70 91% 96% 1970/71 96% 98% 1971/72 98% 98% J 1972/73 98% 98% 1973/74 97% 97% “Includes unmarried, deserted, separated, divorced mother or father with children families with children were urged to refer families in crisis to Family Guidance. The resulting referrals for all of Denmark during a 5-year period are shown in table 6. Table 6 illustrates the steadily increasing self- referral of families in crisis. While it is clear that some families who brought themselves to the service may have come at the suggestion of other individuals or agencies already working with the family, the increasingly large proportion of self- referrals nevertheless demonstrates the increasing knowledge of, and acceptance of, this service by the families. This table also illustrates the wide range of social, health, and educational commu- nity agencies which referred families to Family Guidance. It is perhaps not surprising that the second largest source of referrals (after self-refer- ral) was the group of individuals who actually entered the homes of these families—home help- ers, public health nurses, etc. With regard to the types of families which received Family Guidance, there is no nationwide family data such as that generated by Copen- hagen Municipality (see appendix 3). The one family characteristic available both in Copen- hagen and nationwide is whether or not the family receiving help from Family Guidance was a sin- gle-parent family or a two-parent family. The nationwide distribution of these two types of families receiving this service is shown in table 7. This relatively high percent of single-parent fami- lies receiving family guidance is one indication that the families who received services through this program were in a social high-risk category. As might be expected, the percent of single- TABLE 6. Sources of Referral to Family Guidance in Denmark: 1969/70 to 1973/74 PERCENT OF ALL REFERRED FAMILIES COMING FROM THIS SOURCE IN THIS FISCAL YEAR SOURCE OF REFERRAL 1969/70 1970/71 1971/72 1972/73 1973/74 National Person Registry 1 1 1 1 1 Municipal Social Board, including homemaker aids, home helpers, infant home visiting nurses. public health nurses 20 17 17 12 10 Municipal Child & Youth Committee 11 8 6 6 5 Hospitals and physicians 8 6 7 7 7 Public schools 4 5 4 5 5 Police and the Danish Welfare organization 1 2 1 1 1 DayACare Centers, Youth Clubs, Child and Youth Homes, Social Work Centers 2 1 2 2 2 Health—Insurance Programs, Mother’s—Aid Program, Rehabilitation Centers, Centers for Handicapped (mental & physical) 4 4 4 3 3 Other municipal agencies 3 4 4 4 3 Private citizens 3 3 2 2 2 The families themselves (self-referral) 43 49 52 57 61 12 parent families receiving family guidance in cen- tral Copenhagen was even higher: In 1968/69, for example, it was 68 percent. 3. The Families’ Primary Reason for Needing Family Guidance Whenever a family is in crisis, there are almost certain to be multiple problems. There is usually, nevertheless, one particular problem TABLE 7. Percent of One-parent and Two-parent Families Receiving Family Guidance in Denmark: 1969/70 to 1973/74 PERCENT PERCENT ONE-PARENT TWO-PARENT FISCAL YEAR FAMILIES' FAMILIES 1969/70 43 57 1970/71 42 58 1971/72 41 59 1972/73 44 56 1973/74 44 56 “Includes unmarried, deserted, separated, divorced mother or father with children. which has precipitated the crisis or is preventing the family from resolving the crisis without outside assistance. While data, unfortunately, are not available on what the family itself saw as the single most important problem in their situation, nationwide data are available on what the family advisor recorded as the primary problem most urgently in need of attention. (For an indication of the disparity between what the family and the family advisor saw as necessary help, see appen- dix 3.) Table 8 shows what the primary problem was in the families receiving Family Guidance in Denmark during 1 year. As might be expected, the number-one cause of family crisis is economic and confirms the importance of including financial assistance in the service. The second leading reason—per- sonal disagreements among family members— includes adult adult disagreement and adult child disagreement and documents the difficult job facing the family advisor and the importance of providing guidance in the home. The other rea- sons are fairly evenly spread and demonstrate the need for family advisors to coordinate services among many community agencies. The differ- ences between one-parent families and two—par- ent families are what one might expect—for ex- ample, single parents have more occupational and child-caring problems. 4. Types of Assistance Given to Families In an earlier section the various types of assistance available in the family-guidance pro- gram were presented. While the Danes did not gather data on which type of assistance was given to the families served (this would require a sampling of case records), some data can be found which give some general picture of the types of assistance provided. The first type of assistance provided was the personal guidance which the family advisor gave to family members in their own homes. This guidance was, of course. central to the aims of TABLE 8. The Primary Reason for Offering Family Guidance to Families in Denmark: 1973/74 PRIMARY REASON NUMBER OF ONE- NUMBER OF TWO- PERCENT FOR OFFER PARENT FAMILIES PARENT FAMILIES TOTAL OF TOTAL Economic problems 2,317 3,050 5,367 41 Bad housing 448 352 800 6 Health problems 415 759 1,174 9 Occupational problems (including un- employment) 546 353 899 7 Child-care Problems 540 427 967 7 Child-rearing & school problems 624 1,016 1,640 13 Personal disagreements among family members 865 1,287 2,152 16 ' Other reasons 22 12 34 1 Total 5,777 7,256 13,033 13 TABLE 9. The Use of Community Services for Assistance With Family Guidance for All Denmark: Fiscal Year 1973/74 PERCENT SERVICE NUMBER OF REFERRALS OF TOTAL Physician (general practitioner, public health physician) 2,620 15 Psychiatrist 668 4 Psychologist 991 6 Lawyer 778 5 Social worker 749 4 Mothers-aid Institution 911 6 Rehabilitation Center 1,146 7 Social-Welfare Center 634 4 Day-Care Center and Public Schools 2,828 17 Public Employment Service 1,091 6 National Child and Youth Dept. Consultant 554 3 Police and Courts 602 3 Other health agencies 1,030 6 Other municipal agencies 2,031 12 Other 357 2 Total 16,990 the program, and, although there are no hard data on this type of assistance, there is every reason to believe that it was part of the assistance given to every family served by the program. In all of the interviews which the author had with family advisors and recipient families, the impor- tance and value of this personal guidance were stressed. The next type of assistance available was the referral to, coordination of, and followup on other services in the community for which there is some available information. Table 9 presents the num- ber of times during a 1-year period that all of the family-guidance programs in Denmark contacted various services about helping individual families. Since, in this same year, 13,033 families were served by family guidance, there was an average of 1.3 referrals for each case. This table also demonstrates the important coordination which family guidance provided for these families. One of the most common referrals was to day-care centers. Although Denmark has a nationwide network of government-authorized and govern- ment-subsidized day care in private homes and day-care centers, the supply does not meet the demand, and waiting lists exist. Families in special need, however, may receive high priority, and, in this same year (1973/74), family guidance placed 2,419 children in authorized day care. Another most important type of assistance available to families in family guidance was eco- 14 nomic help. An earlier section listed the five situations in which it was possible for family guidance to give financial assistance. Athough data are not available on the exact number of families who received any of these various sources of financial help, it is again possible to gain a general picture. The first condition for financial assistance was to pay for any form of child care. We have just seen how family guid- ance in 1 year placed 2,419 children in day care, and it is reasonable to assume that in most of these cases the program paid the cost. In the subsequent section on cost analysis it will be seen that the total amount spent in Denmark in 1 year for free day care was considerable. There is no information available on familes who received economic help for the second and third situations: Expenses for the child's upbringing (youth clubs, special education, vocational training, etc.) and for the services of physicians, psychologists, and psychiatrists. With regard to the fourth and fifth conditions for economic assistance (homemaker’s assistance, any general transient economic prob- lem), however, we have some hard data. This is fortunate since the fifth condition—any general transient economic problem—was the category which allowed the family advisor to bail the family out of an acute crisis by paying overdue rent, etc. In 1 year (fiscal year 1973/74) 6,225 families in Denmark received financial assistance for this reason. (See section 27, subsection 2, item 5 in the Child and Youth Law in appendix ll of this report for a description of the conditions for payment to these families.) Since in this same year 13,033 families in Denmark were involved in Family Guidance, very nearly half of these families received this particular type of economic help. When the other types of economic assistance are added to this, it is clear that a large majority of J families in family guidance had financial assist— ance as part of their services. 5. The Development of Family Advisors and Supporting Teams As mentioned earlier, the family advisor was a new type of worker created when family guid- ance began. Because of the shortage of trained social workers, family advisors were recruited from related disciplines. Thus, for example, when Copenhagen Municipality began its family guid- ance in 1965, it started with 26 family advisors, of whom only 6 were qualified social workers. As the program in Copenhagen expanded, more family advisors were recruited and the relative number of'trained social workers increased. This increase is evident in table 10, which shows the number of qualified social workers in the last 4 years of the program in Copenhagen. This same trend toward an increasing num- ber of qualified social workers in the family-advisor ranks was true nationwide in Denmark. Table 11, in addition to indicating the number of qualified social workers working as family advisors in all of Denmark, also indicates the number of workers coming from related backgrounds. From this table it can be seen that the percent of family advisors in Denmark who were qualified social workers increased from 18 per- TABLE 10. Family Advisors in Copenhagen Municipality, 1972 to 1975 QUALIFIED BACKGROUND TOTAL SOCIAL IN RELATED FAMILY YEAR WORKERS DISCIPLINE ADVISORS 1972 13 39 52 1973 18 38 56 1974 21 32 53 1975 24 32 56 cent in 1970 to 27 percent in 1974. There were probably several reasons for this influx of qualified social workers. Many young social workers just out of training were attracted to this work because of the excellent supervision available. Word spread among the social workers in Denmark that this work was satisfying and rewarding. In addition the municipalities, in thier recruiting of new family advisors, gave preference to qualified social work— ers when they were available. In spite of the increasing use of social workers as family advisors, in the author‘s inter- views with program directors, supervising social workers, and other team members, and the family advisors themselves, the opinion was unanimous that, in general, the family advisors who were not social workers functioned very well and were as effective as the qualified social workers. Everyone agreed that whether or not a family advisor functioned well was a very individual matter. The one important criterion repeatedly was that pre- vious experience with children was important. If a qualified social worker had no previous experi- ence working with children, she or he was likely to function less well than a former kindergarten teacher who had been through the special train- ing course. In this regard it was pointed out that a TABLE 11. Background of Family Advisors in Denmark, 1970 to 1974 1970 1971 1972 1 973 1974 Nurses and public Health Nurses 29 32 54 30 21 Preschool and Afterschool Teachers 36 45 35 47 47 Teachers including special education teachers 48 58 76 84 70 On-the-job-trained in municipal welfare office 24 28 28 46 57 Teachers of homemaker assistants 33 39 39 33 23 Other training or practical experience' 160 199 253 258 252 Qualified social workers 74 88 111 138 175 Total 404 489 596 636 645 “This included a wide variety of training or experience such as working as assistants in public schools, handicapped children’s programs, etc. 15 nonsocial worker who had experience with chil- dren combined with a lawyer who knew all the rules and regulations made a very good team. One of the key factors in the development of the system of family advisors was the caseload for each advisor. Data presented earlier showed that the number of family advisors in Denmark continued to increase right up to the end of the 10-year period of this program in spite of the fact that the number of families served peaked after the first 6 years. This was because of the case- load of the family advisors. In a report issued by the National Department of Child and Youth Affairs in 1972, the recommendation was made that a municipality should have “at /east one family advisor per 70,000 inhabitants." (Italics theirs.)* The experience with the program to that point indicated that this number of family advisors should result in an average of 20 “thick” cases per advisor. It was most difficult, and to some extent unreasonable, to try to fix the workload of an advisor in terms of number of cases because of the marked variability in the ”thickness" or complexity among cases. 80 the notion of a range was created—no more than 25 cases and no less than 10 cases per family advisor. Although the data are available on the average number of cases per family advisor for each of the 277 municipalities in Denmark with an authorized pro- gram in 1972, it is far too voluminous for inclusion here. In the largest municipalities the caseload tended to average close to 20. (In Copenhagen Municipality it was exactly 20.) In the smaller municipalities, however, the caseload was highly variable, ranging from a low of 6 to a high of 76 but it was very unusual to find a figure above 50 or below 10, and the caseload in the majority of municipalities clustered in the 20s and low 303. In spite of these heavy caseloads there was also agreement among those who worked in family guidance that the morale of the family advisors, in general, was excellent. The prevailing spirit was that they were involved in an exciting new program which was filling an important need and which was being welcomed by the families. There was also a positive impression of the value and effectiveness of the supporting team. The support provided by the team to the family advisor who was not a social worker was found to be a key ingredient in the successful development of the program. While every municipality with a recognized family—guidance service must have had a team, smaller municipalities could share a team. In reviewing the list of municipalities with shared teams, it is clear that, in general, munici- palities with less than 20,000 inhabitants shared teams and municipalities with more than 40,000 inhabitants had their own team. It appears that experience showed that one team could effec- tively support four family advisors serving a com- munity of 40,000 people. Thus, for example, Viborg Municipality in Western Denmark, with a 1972 population of 36,304, had four family advi- sors and one support team of its own. The national guidelines indicated that the support teams must hold regular meetings. The National Department of Child & Youth Affairs interpreted this to mean a team meeting at least once a month with each of its family advisors (singly or in a group). The National Department decided to set a minimal acceptable limit of team meetings at 10 per year. TRAINING FAMILY ADVISORS As described earlier, after new family advi— sors had been hired by a municipality and placed on the payroll, they were required to take a special training course if they were not qualified social workers. This course was organized by the National Department of Child & Youth Affairs and was 15 weeks in length. The course was a “traveling course"—that is, it was given at one of “'Familievejledning 1972.” Kjaer and Christensen. Unub— lished report. 16 the five Schools of Social Work scattered across Denmark, rotating from school to school so that the course was given in each area from time to time. The National Department notified all munici— palities in an area that the course was coming to their area on a certain date so that recruits could be hired in time for the course. The student recruits traveled to the school where the course was given and lived there for the duration of the course unless their home was within commuting distance. They were not allowed to have any other work while attending the course. Course lectures and discussions were given mornings and afternoons 5 days a week, and the students had a long list of required readings. Teachers for the course were drawn from three groups: Faculty from the School of Social Work where the course was given, staff from the National Department, and outside experts. Teach- ers included many professional disciplines—so- cial work, psychology, psychiatry, medicine, pub- lic health, law, education, business administration, and economics. The National Department of Child and Youth Affairs was responsible for the course curriculum and revised it from time to time. The curriculum of one of the last courses was as follows: Child and youth welfare 50 hours Social rights, including public rights, sick in- surance, child subsidy, adult subsidy, acci- dent insurance, work insurance 40 hours Law, including family law, criminal law, civil law, tax law, building law 62 hours Social medicine 20 hours Psychology 26 hours Adult psychiatry 18 hours Child psychiatry 10 hours Institutional services, including care of the handicapped, services for mothers, voca- tional guidance, mental retardation, alcohol- ism, drug users, rehabilitation, day institu- tions, residential institutions 52 hours Interview techniques and client management 54 hours Budget planning 8 hours Visits to institutions 58 hours Group work 20 hours Total 420 hours The 420 hours of instruction were given over 15 weeks—an intensive period of study. It is impor- tant to remember that this training course was seen by the Danes, not as basic education, but as an addition to an already basic education. If the family advisors satisfactorily completed the course, they returned to the municipality and began work. If after a 10-month probationary period their work was deemed satisfactory they then became qualified family advisors and were eligible to join the National Union of Family Advisors. The training of family advisors did not end with the basic training course and the inservice training provided by their supporting team. They were required to attend refresher courses, again at the expense of their municipality and again presented by the National Department. After 2 years of work the first refresher course was given: a 1-week live-in course which again rotated around Denmark. Two days of the week were devoted to bringing the family advisors up to date on guidelines and regulations. The remainder of the week was devoted to work with group dynam- ics. One year later, after 3 years of work, the family advisors were required to attend a 2—week live-in refresher course. Again 1 year later, after 4 years of work, another 2—week refresher course Nas required. in order to give a picture of the level of training of family advisors in Denmark, the exact situation which existed as of March 31, 1973, is presented as follows: 636 Family Advisers 138 Social Workers 498 not Social Workers 422 completed course 76 presently attending training course or wait- ing for next training course. A career ladder existed for this new field in Denmark. A trained family advisor who had per- formed well on the job could apply to attend one of the schools of social work in Denmark to become a qualified social worker. The usual prerequisites were, if necessary, waived as it was felt that this applicant had proved his ability to excel at this type of service. 17 COST ANALYSIS It is most difficult to perform a detailed cost analysis on the Family Guidance program in Denmark for several reasons. Although the Danes keep careful records on their public expenditures, the records are not categorized by item of service but rather by the section of the law which author- izes payment. In addition the costs for services are shared by the State (Federal) and the munici- pality, and the municipalities categorize expendi— tures differently from the State. A further problem was the necessity to express costs in this report in dollars rather than Danish kroner. Although the exchange rate between these two currencies fluctuated some during this period, the average figure of 6 kroner for $1 was used in all calcula- tions for this report. In spite of these difficulties it has been possible to accumulate information on the financing of this Family Guidance program. First the costs for Family Guidance for 1 year in Copenhagen Municipality will be analyzed. Copenhagen Municipality is the inner-city of greater Copenhagen and does not include any of the contiguous suburbs. The costs for Child and Youth Welfare services for Copenhagen Munici— pality for the fiscal year 1969/70 are shown in table 12. it is essential to understand what each serv- ice item in this table includes. Family Guidance (item 1) includes salaries for family advisors, salaries for the supporting teams, and travel expenses for the family advisors and teams. This category does not include economic support given to the families in Family Guidance nor the cost of services arranged for the families by Family Guidance. The next item, children placed outside the home, includes maintenance costs for children in full-time foster care or residential care in municipal or state institutions. This includes TABLE 12. Total Child & Youth Welfare Costs, Copenhagen Municipality, Fiscal Year 1969/70 SERVICE COST PERCENT 1. Family Guidance 2. Children placed outside own home $4,507,334 65.0 3. Preventive Welfare Services $1,866,667 26.9 $ 557,833 8.1 Total $6,931,834 18 children who could not be cared for in their own home but does not include children who received care in somatic hospitals, mental hospitals, or rehabilitation hospitals. The third item, preventive welfare services, includes all of the services and economic supports which Family Guidance could arrange for or provide to families and their chil- dren (see earlier sections of this report). They were called "preventive services” because their purpose was to prevent the placement of a child outside his home because of family crisis. While the labor and administrative costs of Family Guidance (item 1) were used entirely for this particular program, the preventive welfare services (item 3) could also have been ordered by other programs in the municipality, such as the Child & Youth Committee, and, unfortunately, there is no way to separate out what part of these costs were the result of the Family Guidance program although the great majority of these services (and hence costs) emanated from Family Guidance. Placing children outside their home was not within the purview of Family Guidance but rather was the responsibility of the Child and Youth Committees. These costs will now be placed within the framework of the Family Guidance program, the overall Child and Youth Welfare Program, and the total welfare program of Copenhagen Municipal- ity. During the same fiscal year (1969/70) Family Guidance in Copenhagen had 48 family advisors and served 1,348 families (28.1 cases per ad- visor). The population of the municipality at the time was 627,800 (1 family advisor per 13,063 inhabitants). The labor and administrative costs of Family Guidance (item 1) were therefore $414 per case, or $0.89 per capita. Although not all Preven- tive Welfare Service costs (item 3) were generated by Family Guidance, if it is assumed that they were and this cost is added to the labor and administrative costs (item 1), then the total ex- penditures for Family Guidance for that year in Copenhagen were $2,957,167, or $4.71 per cap— ita. The total child-welfare expenditures for that year (items 1,2, and 3) were $11 per capita. During the same year, the total welfare expendi- ture (all age groups) for Copenhagen Municipality was $300,183,333 or $478 per capita. Child and Youth welfare expenditures were 2.3 percent of alI welfare costs. The cost sharing for this $300 million welfare expenditure was: 66.2 percent reimbursement from federal funds, 30.1 percent Municipal funds, and 3.7 percent payment from service recipients. Next. a similar analysis of costs for Family Guidance for 1 year will be made for all of Denmark. Unfortunately for technical reasons it has not been possible to use the same year for this nationwide cost analysis and, as stated ear— lier, the cost categories are different at the na- tional level. Some national/local comparisons are nevertheless possible and will be presented later. The costs for child and youth welfare services for all of Denmark for the fiscal year 1972/73 are listed in table 13. Again each service item must be defined. Family Guidance (item 1) is identical with the same category in Copenhagen—salaries for fam- ily advisors' support teams and travel expenses for these workers. Item 2, free places in day care, includes publicly subsidized free places in pre- school day care, after-school day care, and youth clubs. Item 3, preventive welfare services, is the same as this category in Copenhagen except that it does not (as in Copenhagen) include free places in day care, supervising guardians, and aftercare. Supervising guardian (item 4) is the cost of providing a guardian who comes to visit a family frequently in their own home to be certain that the children are receiving adequate care. This item was also included in preventive welfare services in Copenhagen. Item 5, children placed outside their own home, is identical to this cate- gory in Copenhagen. The last item, aftercare for youth 18 to 21 years of age, is the cost of preventive welfare services for this special age group and was also included in preventive welfare services in Copenhagen. If items 2, 3, 4, and 6 are combined, as they are in Copenhagen, they account for 45.8 percent of costs. As was the case in Copenhagen, these combined preventive welfare services, which account for 45.8 percent of costs, come mostly, but not entirely, from Family Guidance programs. These nationwide costs will now be placed within the framework of the nationwide Family Guidance program and the overall national Child and Youth Welfare Program. During the same fiscal year (1972/73) Family Guidance in Denmark had an average number of 616 family advisors and served 12,615 families (20.4 cases per ad- visor). The population of Denmark at this time was 4,975,653 (1 family advisor per 8,077 inhabitants). The labor and administrative costs of Family Guidance (item 1) were therefore $733 per case, or $1.86 per capita. Although not all preventive welfare service costs (item 3) and free places in day care (item 2) were generated by Family Guidance, if it is assumed that they were and if these service costs are added to the labor and administrative costs (item 1), then the total ex- penditures for Family Guidance for that year in Denmark were $46,153, 517, or $9.28 per capita. The total child-welfare expenditures for that year (items 1 through 6) were $18 per capita. The cost-sharing for these child-welfare expenditures was 70 percent federal reimbursement and 30 percent municipal funds. Although direct comparisons between costs for child-welfare services in Copenhagen and all of Denmark are not possible, a few general observations are in order. The fact that Copen- hagen spent 65 percent of its funds on placing children outside their own homes, while in all of Denmark only 45 percent of its funds were spent for this purpose, is probably the result of the fact that in Copenhagen there is an unusual concen— tration of large metropolitan inner-city high-risk families, for whom all attempts to prevent family TABLE 13. Total Child and Youth Welfare Costs, All of Denmark, Fiscal Year 1972/73 SERVICE COST PERCENT' 1. Family Guidance $ 9,245,667 10.5 2. Free places in day care 26,506,667 30.0 3. Preventive Welfare Services 10,401,190 11.8 4. Supervising guardian (child in own home) 2,323,809 2.6 5. Children placed outside own home 39,709,524 44.9 6. ”Aftercare" for youth 18-21 years of age 1,271,428 1.4 *These percentages, for technical reasons, are approximate and rounded. 19 disintegration had been to no avail. in 1969/70, when the Copenhagen cost figures were gener- ated, the number of families served each year by Family Guidance had already peaked, but the service had not yet caught up with the demand; hence there are 28 cases per family advisor, one family advisor per 13,063 inhabitants, and a cost of $414 per case and $0.89 per capita. But, by 1972/73, when the nationwide cost figures were generated, the supply had caught up with the demand, and Denmark had achieved its goal of an average caseload of 20 and one family advisor for every 10,000 inhabitants. Indeed this particular year was probably the optimal year for this program since soon thereafter the ”tooling down” began for the new welfare reform. Thus in 1972/ 73 in Denmark we find 20.4 cases per family advisor, one family advisor per 8077 inhabitants, and a cost of $733 per case and $1.86 per capita. Focusing now on the nationwide cost analysis of Family Guidance in Denmark, several important observations emerge. First the staffing costs for such a program are not high (only about 10 percent of all child-welfare costs), and this pro— gram is seen to be service-intensive rather than labor-intensive. With regard to services, the single biggest cost item is public subsidized day care, and, at least in Denmark, the possibility of placing children in day care when a family is in crisis appears to be an essential ingredient in a family- support system. In looking at the overall pattern of costs for child-welfare services in Denmark one finds the following general picture: Cost to keep children in their own home—65 percent (labor 10 percent and services 45 percent); cost to maintain chil- dren outside their own home—45 percent. Thus the Danes, by 1972/73, were spending more child-welfare money to keep children in their own homes than they were spending to remove Chil- dren from their own homes. This appears to be desirable for several reasons: 1) it is infinitely more expensive to maintain one child outside his home than to provide supportive services within his own home and therefore the welfare dollar can be spread over a much larger segment of the population; 2) money spent to keep a child in his own home is usually spent earlier in a crisis before the family has disintegrated and therefore is more preventive in nature and more likely to save public money in the long run; 3) Danes believe that, all things being equal, the child is best off in his own home and therefore money spent on a family-support system is more desira- ble than money spent on foster care and residen- tial institutions for children. Since a primary goal of the Family-Guidance system was to prevent having to remove a child from a family in crisis, and since keeping one child at home through family support is much cheaper than maintaining that child outside the home, it would be logical to attempt a cost-benefit analysis of this program. Does supporting families in crisis reduce the number of children who must be placed outside their home and does this approach ”pay?" Unfor- tunately the Danes did not attempt to answer this question, nor have they collected their service data and their cost data in a way to facilitate such an analysis. Another observation which emerges from the cost analysis is that these services were not particularly expensive. The cost for the entire child-welfare service in Denmark during its most highly developed period was $18 per capita per year. This included the entire Family-Guidance program: staffing, administration, economic sup— port to families, purchase of services for families, as well as the remainder of the child-welfare services—Child and Youth Committees, mainte- nance of children outside their homes, etc. Child- welfare services appear particularly ”cheap” when put into the framework of all welfare services: The cost of all welfare services in Copenhagen in 1969/70 was $478 per capita, of which only 2.3 percent was spent on children and their families. PROGRAM IMPACT The impact of the Family-Guidance program on the overall system of human services in Denmark was profound. The enthusiasm with I which this program was received by the general 20 public was one of the important factors precipitat- ing the decision in Denmark to reform the entire welfare system. Three basic elements of the Family-Guidance program which were felt to be central to the success of this program were incorporated into the welfare reform. The first principle was the family-centered approach of- fered on a voluntary basis without requiring pre- determined categories for assistance. The impor- tance of this innovation in welfare service was discussed earlier and was extended under the new Welfare Assistance Law in Denmark so that any family (with or without children) can come for assistance when they themselves deem it neces- sary. The second element of Family Guidance incorporated into the welfare reform was the coordination of all services by one worker. Under the welfare reform there is one “Social Office" where the people go for all social services. This change involved merging a number of social programs and is the reason why Family Guidance ceased to exist as a separate service in 1975. The third element in Family Guidance included in ¢ the new welfare system in Denmark is the neigh- borhood approach. The new Social Office is located in the neighborhood where the workers are familiar with the problems and resources of that area and where the people live close to the source of help. This is in sharp contrast to some of the previous specialized social services in Denmark, which were much more centralized. For example the Mother‘s Aid Agency, which pro- vided a wide range of public subsidized social services for pregnant women and women with children under 2 years of age, had centralized offices, each serving several municipalities, and it was necessary for women to travel long distances for assistance. The Family-Guidance program also had a significant impact on service providers in Den- mark. The fact that this new social program changed the approach from that of ”controlling” certain categories of people defined as needing assistance to offering help on a voluntary basis to those who decided for themselves that they needed this help changed the attitude of those providing the service. At the beginning of the Family-Guidance program the need for this change in attitude of service providers was very apparent, and indeed it was found that not all of those who had worked in the earlier “control” system were capable of making this change. The Director of the Family-Guidance program in one municipality explained that when the new program began he had a difficult time trying to determine which members of the Child and Youth Committee staff were most likely to adapt to this new ap- praoch. Consequently staff selection for Family Guidance was not always successful—one family advisor interviewed told of a lawyer on her support team who had previously worked for 15 years for a Child and Youth Committee and ”had suspicion in his soul and was unable to get away from a punitive approach to families in crisis." As the Family—Guidance program developed over time, however, a process of natural selection took place among the workers so that, by the time the program ended, those still working in Family Guidance appear to have internalized the positive, nonblaming attitude toward families asking for help. Two incidents support this contention. When the new “social offices" opened in 1975 under the welfare reform they were staffed in large part by former family advisors. Within 6 months the clients in these new social offices who had not been clients in Family Guidance reported that they no longer felt bullied as they had under the old system. The second incident is that, when Family Guidance ceased to exist in 1975, many family advisors who had had neighborhood ”parent clubs" meeting in the evenings continued to meet with these groups on a voluntary basis and some of these clubs still exist at present. The Family-Guidance program also had an impact on the service consumers. This impact was similar to the impact on the service provi— ders—a change in attitude concerning asking for and receiving help. Shortly after Family Guidance began in Copenhagen, the program experi- mented with a case-finding method in which they contacted families reported by the municipality to have recently experienced separation or divorce to see if they wished assistance (see earlier section). One of the families contacted was from an upper-class neighborhood, and the father was the Director of a large private company. This father called the Director of Family Guidance in Copenhagen and angrily explained that his family was not “needy" and not ready to go on welfare. Ironically, after a long telephone discussion it came out that this man‘s wife had left him with the children, that one son was upset and in trouble at school, and after some assistance from Family Guidance the father’s attitude changed com- pletely. This rather dramatic factual example was not, of course. typical, and, in general, it took some time for the public to see Family Guidance as a positive offer without stigma. The significant 21 increase of self-referrals to the program seen in an earlier section is testimony to this changing attitude. By the 19703 this positive consumer attitude toward the program. appears to have become firmly established. During the interviews with families who had received Family Guidance, it was reported on a number of occasions that in their neighborhood it was something of a status symbol to be involved with Family Guidance while it was still a stigma to be involved with a Child and Youth Committee. It was this positive attitude of the general public toward Family Guidance which was, in part, the reason for the public acceptance of the new social-reform law. PROBLEMS WITH FAMILY GUIDANCE Any program such as Family Guidance will experience problems and difficulties. Some of the more specific problems, such as the bottleneck in Copenhagen, have already been discussed, and this section will review the more general problems when viewing the program as a whole. The Danes, during the interviews, brought up many of these problems, and, in addition, the author has added some from his own perspective. The first set of problems surrounded the issue of central versus local control of the program. The National Department of Child and Youth Affairs was highly motivated to develop quality programs, but the final decisions were definitely in the hands of the local municipalities. As a consequence, not every municipality had an approved'Family-Guidance program and at least a few families in Denmark who needed such services did not have them. The biggest hurdle in establishing an approved program was finding professionals for a qualified support team—a difficult task for the isolated rural municipalities. Another problem was that, except for reporting expenses, the municipalities were not required to report on their services to the central Department. This made it difficult for the Natioanl Department to monitor local programs. For example, since Family Guidance provided federal reimbursement for administrative costs while other social programs did not receive similar reimbursement, municipalities would sometimes use Family-Guidance administrative resources to help administer other social programs. The Na— tional Department was aware of this practice but decided it was best to ignore it since the money was being used for a good purpose and the Department wished to maintain geod rapport with the municipalities. Another difficulty with central/ local control concerned the consultants from the National Department. It was their job to bridge the central/local gap, but, as mentioned earlier, in 22 doing this they had to perform two roles simulta- neously—monitor (control) local programs and serve as advisors and assistants. The former Director of the National Department stated in an interview that he felt the best solution to this , central/local control problem was to have consid- erable central control at the beginning of such a program and then gradually turn over the reins to‘ the locals after a good program had been estab- lished. A second set of problems with Family Guid- ance was linked to scale. in a review of the experience with the program in the smaller munic- ipalities, it was clear that some of the success of the service was a function of small size. With only one or two family advisors and one support team, all the workers knew each other and their cases quite well and also knew their community, its services, and its people. in the largest municipal— ities, with large numbers of family advisors and several support teams, there were problems in communication and lack of knowledge of local conditions. There was also sometimes a tendency for the most highly trained and highly skilled workers to end up with supervisory positions where they remained in their offices while those with the least training and/or experience were performing what was perhaps the most difficult task requiring the greatest skill—working with the families in their own homes. The way in which one large municipality (Copenhagen) overcame this dilemma has already been described. One problem which was not mentioned by the Danes, but is seen by the author as at least a potential difficulty, is the fact that the services of this program, including emergency economic help, were tied to guidance. What if a family came to Family Guidance because they had no money to pay the rent and were to be evicted onto the street (a potentially traumatic experience for the Children) but did not wish anyone to “meddle in their private affairs"? This is a difficult dilemma because, while the integrity and self-confidence of the adults in the family need to be protected, it public funds are to be given to a family there is some concern that they will be used appropriately for the best welfare of the children. The way the Danes have resolved this dilemma is illustrated by the approach of the Family-Guidance program: The provider had the right to review the family's budget and make recommendations (i.e., give guidance), but if it was judged that the family needed economic help, it was always given as money and not in a form (such as coupons) which might have been construed as revealing lack of confidence in the judgment of the con- sumer. A difficulty which Family Guidance experi- enced, particularly early in the program, relates to the separation of preventive services for children from protective services. The preventive services in Family Guidance were always voluntary, but what if a family was in crisis and the children were suffering and in need of help but the family refused help? Because of such situations it was necessary to continue to maintain protective serv- ices (the Child and Youth Committee) even after preventive services had been established. But unless these two types of services were seen by the public as separate, families would not be willing to volunteer for the preventive services. In the smallest municipalities it was sometimes nec- essary for the same staff to perform both types of service, and, even in Copenhagen, where these two types of services were completely separate with separate staff, they were housed in the same building. The public appears to have been able to gradually distinguish between these disparate services. Another problem with the Family-Guidance program was, in the opinion of a number of workers interviewed, never satisfactorily resolved. Some of the data presented (see appendix Ill) make it clear that many of the families in this program were, “hard-core” deprived families. At- tempting to rehabilitate such families took consid- erable time and effort of the family advisors, leaving them less time for more stable families suffering from an acute but temporary crisis. Trying to achieve a balance in the distribution of resources (including manpower) between these two types of families was difficult. Some workers felt that too much effort had gone into the hard- core families, thus preventing a broader spread of services over a larger number of families. One solution suggested was to develop two different approaches to use with families: An intensive but short-term approach to the more stable families, which would allow more such families to be served; a less intensive but longer-range ap- proach for the hard-core families. Another problem in working with families was closely related to the previous problem. While one of the goals of Family Guidance was to help families to help themselves, this was particularly difficult with the more deprived families, and there was a tendency for families to. develop a depend- ency on the family advisor. The issue of the ”disabling professions" has begun to receive more attention recently, and Family Guidance did not escape this problem. Family advisors reported that it was sometimes difficult to close a case (exacerbating the case—load problem) and that the more support a family was given the more dependent it became. Even if a case was closed, the family was free to return if it felt it again could not cope, but unfortunately the Danes collected no data on recidivism. Family Guidance at- tempted to solve this particular problem by putting emphasis, in their training courses and continu- ing-education programs, on creating family self— sufficiency. One essentially unsolvable dilemma in Family Guidance was created by the neighborhood ap- proach. There were obvious advantages in having a family advisor in a small neighborhood where she knew the local conditions and resources. But what if “she" should have been a “he” i.e., what if the qualities of a family advisor did not match the characteristics and needs of a particular family in that neighborhood. As mentioned earlier, trading of cases to make a more suitable match of family advisors to families was a common practice, but if this was done the advantages of neighborhood approach were lost. Family Guidance decided always to use the neighborhood approach unless a services mismatch between family advisor and family developed. From the earlier section on program evalua- tion it is clear that the Danes took a basically empirical approach to the development of Family Guidance. The only program evaluation built into the program from the beginning was the monthly meeting of the National consultants. While this 23 method appears to have worked effectively in solving some problems as they arose and in bringing about necessary revisions in the guide- lines from time to time, the author feels that the program evaluation would have been strength- ened if there had been a more adequate system for continuously collecting a systematic data base. If, for example, a sample of case records had been collected and analyzed, it would have been possible to get information on such impor- tant questions as the success of the program in resolving particular types of family crises, the rate of recidivism, etc. In addition, if the cost account- ing for the program had been more service- related or even case-related it would have been possible to gather more information on the cost benefit of Family Guidance. While it is beyond the purview of this report to discuss the new Social Assistance program in Denmark which replaced Family Guidance in 1975, several comments based on the early experience with this social reform are perhaps in order. Indeed the Danes are at present so in- volved in this new program and so anxious to discuss its problems that it was sometimes diffi- cult to get them to talk about their experiences with Family Guidance. Any discussion of this new social reform must begin with the fact that, coincidentally, the reform went into effect at a time when Denmark was feeling the effects of the worldwide recession. As a result, funds were in many cases not adequate and at the same time the increasing unemployment was putting greater demands on available funds and manpower. Two effects of this limitation of resources on the family- support system in Denmark need mentioning. First, in a climate of limited resources it is often the children who get short—changed. As already mentioned, the social reform expands the services previously offered in Family Guidance to all fami- lies rather than just families with children. One result of this change has been that so many families without children have applied that families with children are sometimes unable to receive help. Unless funds are earmarked for children, it is likely that the more powerful adults will consume the funds. Secondly, in a climate of limited re- sources, preventive services are often the first to disappear. Thus the local social offices have found themselves so swamped with providing assiétance to the unemployed that they do not have the time or money for such “luxuries" as guidance. In spite of these problems, most Danes feel that the principles behind the social reform are sound, and this interesting experiment in social service deserves attention in the future. v LESSONS FROM THE DANISH EXPERIENCE The 10—year Danish experience with Family Guidance has resulted in a number of valuable lessons. While any country which might establish a similar family—support system for its children would need, of course, to adapt the system to local conditions, the general principles which have emerged from the Danish experience would almost certainly apply. Many practical facts have evolved and are too numerous to recapitulate here. This final section, however, will summarize a number of overall lessons which, in the eyes of the Danes as well as this author, have evolved from this program. 1. A very effective way to provide preventive mental health services to children is to develop a family—support system which will help families in times of crisis. This family-oriented approach will help the families to maintain a quality environment for their children. 24 2. The family—support system should be voluntary and offered to all families. Categorical programs miss families in crisis and create serv— ice-connected stigma. The best case-finding is self-referral in a voluntary program where all stigma has been removed. 3. A family-support system needs to include a broad base of services including personal guidance, emergency financial assistance, referral to and support for other services such as home- makers and day care, and group programs for parents. 4. A family-support system should operate primarily in the families’ own homes through home visiting. 5. The support given to families in crisis should be in the nature of practical guidance on r a continuous, intensive basis. Families should not be defined as “sick" and in need of “treatment"?n the form of, for example. weekly therapy in a clinical setting. 6. The primary care provider in a family- support system should have had training for and experience with children together with training in the skills related to social work. If qualified social workers are not available in sufficient numbers, those with a relevant background can, after a short intensive training, work effectively in such a program. The primary care given should have a supporting professional team. 7. One effective way to organize a family- support system is through central planning and «monitoring and local administration and service delivery. 8. Family-support services should emanate from the neighborhood so that workers are familiar with local conditions and resources. Larger cities must be divided into local neighborhoods and the program decentralized to these neighborhoods. 9. A family-support system should have an emergency service through which families in crisis can be assisted on the same day they apply. 10. Guidance to a family in a family-support system should be discontinued as sOon as possi- ble, and every attempt should be made to help the family become independent and self-suffi- cient. 11. The family-support system must be adapted to meet the special characteristics and needs of minority groups. 12. A family-support system is not costly. The system in Denmark costs under $10, per/year per capita‘to operate and totaled only_1 ,to,_.2_.perc_ent of all welfare. costs. Unless funds are earmarked for a family-support system, they may be used for purposes which are not child-directed and not preventive in nature. 13. Perhaps the single most important lesson > to be learned from the Danish experience is that . a nationwide support system for families with ; children is feasible—it can be done and it works. Furthermore such a system is comparatively cheap and can have a high degree of accept- ance both from the providers and the consumers of the service. 25 I, APPENDIX I English translation of the Summary and Conclusions from: “The Family Center Study—an Experiment Providing Supportive Services to Problem Families” Danish Social Research Institute Publication Number 35 SUMMARY AND CONCLUSIONS A study of an experimental program of spe- cial aid to multiprob/em families in a low-income area of Copenhagen has been performed. Under the program, 70 families have been assisted by social workers who coordinated the benefits they received from various social agencies and gave advice on pressing problems without offering therapy. The experiment was conducted by a private group, but financed by the City of Copen- hagen. The institute has followed the experimental group and a control group with a view to evalua— tion of the experiment. The institute has recorded in a systematic way the total process through which the families passed and the outcome of the . social casework. One main finding of the present investigation is that the 70 families who received coordinated support through the Family Center were to a certain extent, and in almost all respects, in better condition after this treatment than before it. Be- sides showing this absolute movement in a posi- tive direction, the families receiving this coordi- nated support improved more than a corresponding control group of 70 families. The difference found between social adjustment of the supported group and the control group at the end of the supportive period leads to the conclusion that the Family Center has obtained a certain, although modest, net effect with the supported families. The 140 families included in the investigation were selected so that they all had at least two children under 18 years of age. Their breadwin- ners were either married persons or single moth- ers. Moreover the families met at least one, and in most cases two, of the following five selection criteria: A record of previous public aid or sup- port, problems with children such as school conflicts, contact with the child welfare authorities, cases of treatment for alcoholism, or cases of application for induced abortion—these criteria having been fulfilled within the latest 2 years before the start of the investigation. In this way 28 families were selected which definitely had social problems and could be expected to need support in order to be able to utilize the help offered by the already existing agencies in the society. It turned out that a relatively few of the sampling characteristics made it possible to predict which of the families would have a number of other social and personal problems. The families to be studied were selected in such a way, furthermore, as to consist of 70 pairs of families with the two families of each pair being identical, ”social twins” as to sex, age, education, number of children, and social problems (selec— tion criteria) of the family breadwinner. It also turned out, as expected, that the families of the so—called ”matched-pairs" also differed very little in a number of other respects and consequently the two groups selected were rather uniform. As a first step, information for the experimen- tal investigation was obtained by interviewing all 140 families (see the questionnaire in appendix A) before the Center contacted any of them. One of the families of each pair of "social twins" was then selected at random (by lot) to be offered support from the Family Center. The other family of the pair was included in the control group of families which, as before the start of this study, continued to receive social support only through the ordinary channels. All 140 families were interviewed a second time after about 2 years by interviewers using identical questionnaires, but working independ- ently of the Family Center, the social workers of the Family Center, or the information which in the meantime had been collected about the 70 fami- lies receiving supportive care from the Family Center. The hypothesis of the experiment was that the families receiving special support would man— age better and make greater progress than the control group. The family center which was established with special reference to this investigation was pre- pared to perceive and help each family as a group, as a whole. The principle of family-directed supportive activities breaks with the traditional general prac- tice relying on specialized institutions which help individual family members in difficult situations. During these first years of the family center’s existence this holistic principle has been built into a new law concerning family counseling in con- nection with the child welfare authorities. The law aims at coordination, trying the holistic approach of harmonizing activities of and contact between various public institutions and relevant private persons such as employers and landlords. The family center directed a sociopedagogical effort at each family, aiming at activating family mem- bers and teaching them a problemsolving proc- ess involving new social norms and roles. Part of this effort aimed at changing some attitudes, values, and prejudices of the families. The aim of the investigation has been to register the effects of the coordinating, stimulating, and attitude—changing supportive activity of the Family Center. The investigation has not con- cerned itself either with the causes of the social deviations in question or the working methods of the Family Center. These various working meth- ods of the Family Center ev‘entually coalesced into a plastic, generalized system of influence, and an investigation of the functional value of the single working methods would necessarily have to be carried through by means other than the methods of this study. However, the Family Cen- ter's working methods are touched upon in con— nection with mention of its activities and in con— nection with the development process of the families during the investigation period. We have termed the task of the Center's social workers ”supportive activity," by which we mean helpful guidance of the activities of the families, especially coordination of their dealings with other social agencies and the solution of their most pressing problems. We have, however, es- pecially avoided the word “treatment," partly be- cause it was decided from the beginning that the Family Center’s proper task was not clinical work, much less psychotherapy. Two of the theoretical ideas used here, the idea of the family as a whole and deviance theory, are briefly explained in the following: Within the behavioral sciences. field theory and Gestalt psychology have formulated regulari- ties concerning the interdependence of forces within total systems. in this investigation the nu- clear family has been considered the relevant unit, constituting at the same time a whole all by itself and also a component in larger social patterns. The family is kept together as a group by forces resulting partly from the fact that the individual members depend on the family group because it can meet a number of their basic needs. For another, the group structure in itself has a tendency to cohesion through the distribu- tion of increasingly differentiated roles which are interdependent. This family group functions as a living dy- namic unit, the members of which are in continual interaction. The consequence of these forces for any contemplated supportive activity is that any attempt at solving problems of one family member has to be adapted to the demands of the family as a whole. According to the general theory of deviance, which is formulated in chapter 3H and appendix A, people are usually perceived as deviating more or less within various fields of behavior. Both positive and negative deviations from an average midpoint exist. All human beings deviate in at least some fields of behavior. and this is accepted by other people as long as socially negative deviations are compensated for by socially positive deviations. Only a person with a surplus of socially unwanted features or char- acteristics will be perceived of as a negative deviant. The consequence of this to practical supportive activity is that the situation of a socially negative deviant may be improved by a reduction of his negative deviations or a strengthening of his positive deviations. The latter procedure will sometimes even be the easier one to carry through. Of course, deviations can only be estimated on the basis of generally accepted norms of the community in the various fields of behavior. De- mands for less negative deviation from a norm appear in the form of moral pressure exercised, in the interest of the community. by various units within it. The findings of the investigation are summed up in the following sections, the sections set off from each other by italicizing the most important distinguishing words. First, all 140 families are described on the basis of the initial interviews of them in their homes, supplemented by information from the public institutions which had had some 29 contact with the families. Next follow descriptions of the 70 families which thereafter received sup— portive care from the Family Center. The descrip- tion of these 70 families includes, first, some general features of a small number of selected cases; then the results are given, for the 70 supported families, of a before-and-after compar- ison of their functioning and social adjustment. This method gives a picture of the absolute movement (in most cases a social improvement), without any reference to a control group. The last section sums up the statistical analysis of the movements of all 140 families—their progress or deterioration, within single fields of function and generally—with an analysis of differences be- tween the movements of the supported group and the control group. It should be noted that the female breadwin- ners are considered the principal subjects in the analyzed material in‘ order to make it possible to subdivide the families into mutually exclusive groups of single, married, and cohabiting moth— ers. One specific finding of the investigation is a description of all 140 sampled families at the beginning of the project. This description gives a picture of social problems in an urban slum area. The sampled families are not representative of the pOpulation of the area, as they are specially selected according to contact with the child welfare authorities, children's school conflicts, a record of having received public assistance or of abortion cases, and, to a certain extent, alcohol- ism. That is, the 140 families were selected for symptoms of maladjustment or socially negative deviation. On the other hand it is reasonable to assume that the selected families represent those with especially acute problems and that a great number of families in about the same situation may be found in similar slum areas. The average age of the female principal subjects was 34 years, that of the adult males associated with them 36 years. About two-fifths of the women were married at the beginning of the investigation, and a little more than half of them had previously been married, whereas only 6 percent were single. Half of the families had two children, and one-third of them and three children. A few of them had four or five children under 18 years old and living at home. However, there were several families in which one, two, or three of their 30 children under 18 were not actually living with the family. In most cases they had been removed by the child welfare authorities, 22 percent of the families did not have all the children under 18 at home. Very often the children of a family did not have the same father: thus the children inn 44 percent of the families were not all full brothers and sisters. This may be a reflection of the short period of matrimony (reckoned by date of civil certificate), which for half of the families was 3 years or less and which was for only 17 percent more than 10 years. The average age of the children was 8 years. The unemployment rate of the breadwinners in the sample was not very high at the start of the investigation in 1962, and the average income of the families was on the same level as that of a section of the population of Copenhagen with the same composition as to sex and occupation. Only one-fifth of the whole sample received public assistance, but many of them were in arrears with taxes and installment payments; nine—tenths had at an earlier date been in contact with the public assistance offices and the child welfare authorities and half of them had had abortions. The quality of the families’ dwellings was poor—more than half of them lived in slum buildings and the rest not much better. Moreover, the flats were small and overcrowded but, all the same, to a great extent clean and well kept. Here we define a “slum building" as one with low-standard maintenance and sanitary facilities and with a shortage of sunlight and fresh air. The family life of the sample was often characterized by conflicts. ln half of the cases there were conflicts between the adults; in one- fourth of the families the conflicts were between the adults and the children; and in one—seventh of all the families there were problems with alcohol- ism. This mainly applied to the men, of whom one-fourth were alcoholics. The criminality rate was high: 46 percent of the men (as against 8 percent of the total male population of Denmark) had been in prison, and of these 33 percent were recidivists. Even more noteworthy was, that 13 percent of the females had been imprisoned, and of these 5 percent repeatedly. Psyhcologically, the female subjects were characterized by stress symptoms, lack of self-confidence and lack of mental balance. The children presented many signs of living in a threatening situation. Their school relation- T. ‘09"... m .131, ships were rather poor for half of the children, and their relations to playmates were poor for one- fourth of the children. One-third played truant or were often absent from school, and one-fourth displayed various kinds of antisocial behavior. Within just the last 12 months one-fourth had displayed antisocial behavior registered by the authorities. The attitude of the families toward the social welfare agencies was to a great extent suspicious and aggressive, especially toward the public assistance office and only a little less so toward the child welfare authorities. Social welfare agen- cies will probably never escape a certain amount of distrust and resentment from their clientele, partly because the institutions are not always able to meet the demands of the clientele, partly because to ask for public aid may be perceived as humiliating, and finally because part of their clientele is psychologically unbalanced and very easily hurt. It was found that in 42 percent of the cases in the sample investigated here, the princi- pal subject had an unfriendly or hostile attitude toward the public assistance office and in 28 percent of the cases toward the child welfare office, whereas about 25 percent had an indiffer- ent attitude toward both offices. However, it is also noteworthy that among these families, who do not constitute the most compliant part of the institution clientele, there was a positive attitude toward cooperation with the public assistance office in one-third of the cases and toward the child welfare office in half of the cases. A little more than two—thirds of the families had a positive attitude toward the Mothers’ Aid Center. Toward the interviewers, who came from a neutral re- search institution, the families’ attitudes were chiefly positive and cooperative. By sampling a clientele with serious prob- lems—such as record of public assistance, prob- lems with children, alcoholism, and applications for induced abortion—contact was actually estab- lished with families who also had problems in other fields of behavior, such as a rather unstable family life and many conflicts between family members, a high criminality rate, and maladjust- ment problems. Society offered the families, in- cluding the single mothers, only very poor dwell- ing conditions. The Fami/y Center's activity, covering 70 of these families, consisted chiefly of visits to their homes over a period of 2 years. The average frequency of these visits was once per month. Also on an average of once per month inquiries were made to the various other institu— tions involved with these families, but this activity varied widely depending on the family, and for a small part of the clientele the amount of activity was rather large. The kinds of problems most actively attacked were (1) the changing of atti- tudes toward institutions and toward the children of the families, and (2) the practical problems concerning the labor market, health services, and institutions available, e.g., day-care institutions to take care of small children during the working hours of the female breadwinner. The activities of the Family Center are thus an example of organized practical work in accord- ance with social-psychological theories. Of course these fields could be remedied quite differently. through another planning of the work. According to the immediate experience of the research leader, the Family Center‘s activity was impeded by the fact that in the experimental period the Center was new and quite unknown. Especially at the beginning, there was a considerable amount of scepticism toward the Family Center on the part of the existing institutions. Originally it was intended that the statistical and case analyses should supplement each other. This proved not as possible as we had wanted. In editing the Family Center's records one could only pick out illustrative cases, because the records did not contain sufficiently detailed information to conduct a dynamic analysis. No doubt, it is difficult to combine counseling activities, which must be as good as possible, and systematic registration. Evaluations, expectations, and the actual events had to be written down rather pedantically if the material was to be further analyzed later on. The case descriptions demonstrate the het- erogeneous combinations of problems which the clientele of the Family Center had. They also show how the Family Center tried to support the fami- lies, and that this was done with somewhat uneven success. Owing to the favorable employ- ment conditions in the society as a whole at the time of the investigation, the economic conditions of some of the families were relatively good, but in spite of this there were found examples of deep material poverty, and very poor dwelling condi- tions, which should be quite unacceptable to a welfare state. The abortion legislation in force and administration of it does in some cases lead to social collapse for young women who give birth 31 to several illegitimate children before they, for health reasons, become eligible for a legal in- duced abortion. Likewise the cases demonstrate a crying need in such vital fields as institutions for children, which could give the children pedagog- ical care during the daily work of the breadwin- ners, as well as a need for clinics and treatment homes for the psychologically injured children and adults. Psychological deviations which de- mand either social-psychological support or psy- chiatric therapy may be difficult even for experts to treat, and for counseling institutions like the Family Center it has been still more difficult, since sufficient professional help is not available. Rela— tionships between the social workers and the clients are threatened if the legislation and the institutional services of the community, about which expectations are easily aroused during the supportive work, do not fulfill these expectations. Some examples show that successful im- provement of dwelling, institutional, or employ- ment conditions can essentially change the total situation of a family, but there are also cases demonstrating that some multiproblem families will need continued support in order to prevent a complete collapse and dissolution of the family. Furthermore, there are features in the case descriptions which show that the support to the families in question has to be given in a very flexible and individual way, paying due regard to the total situation of the family. Sometimes support must be given beyond what would be justifiable from a strictly legal point of view. Each individual case to be solved by social case work necessitates collection of information, which in turn involves a lot of work and is dependent on the availability of qualified person- nel. That a case is thoroughly examined does not mean, however, that it will be easier for the case worker to find a solution. Thus, there have been a few cases where detailed information was not collected or, when collected, was ignored in favor of a formally correct decision on the solution to a case. When a preference for formal correctness causes social agencies to make demands on clients for formally correct behavior, for instance that the clients correctly fill our applications, the difficulties of the clients are sometimes made unnecessarily worse. The persons concerned are often untrained in expressing themselves in writ- ing or in filling out the forms. To such persons, these forms are written in a strange, incomprehen- 32 sible language. If the case worker’s familiarity with the situation of the clients and their perception of the situation is insufficient, the unfamiliarity may easily lead to conflicts and irritation on both sides. No doubt many of the clients tend to behave awkwardly as a consequence of their suspicion and aggressiveness, and the negative influence - of this behavior on the case worker may set in motion a vicious cycle of hostile interaction. On the basis of records kept by the Family Center concerning the 70 supported families, an analysis was made of the functioning of these supported families in a number of fields of behav— ior. This analysis deals partly with the psychologi- cal and emotional interaction within the family and partly with the families’ external relations to agen— cies, to work, and to the owners of their dwellings. Evaluations of functioning were made for 11 such fields according to defined criteria, both at the beginning and at the end of the investigation. With these data it was possible to register the families' progress or regression in each of these fields of behavior. The results of this part of the investigation were as follows: The situation was unchanged for one-half to three-fourths of the families after the supportive period. This lack of change was most marked as far as psychological problems and relationships of the adults to the children were concerned. It was also true to a somewhat smaller degree with employment and dwelling situations. However, only a small percent of the families have undergone a change for the worse, and the results as a whole show a clearly positive tend- ency. The conditions for about 20 percent of the families have become somewhat improved and for about 8 percent much improved. A moderate improvement evenly spread over all function fields of the families has been noted, whereas an important improvement is only found in employment and dwelling situations. Evaluation of the need of the families for public institutions shows that about one—third of the families must be considered under-supplied. The situation in this respect was improved for only one-fourth of the families. For the single mothers, especially, the progress was very modest, which partly reflects the lack of day—care institutions for children. The relations between adults in the families were often bad, but the Family Center has dealt with these problems, and changes for the better occurred. This is presumed to be important for ‘4‘)» " - 1‘- kn: vr it, the children, since a correlation has been found between poor relations between the adults and poor relations between the adults and the chil- dren. At the beginning ‘of the investigation the children were in a rather threatening situation, but according to the evaluations of functions an improvement has taken place in about one-fourth of the cases. This was in accordance with the aims of the Family Center. For the single mothers it was found, as a general tendency, that progress was somewhat less than that for the married and cohabiting women; e.g., almost no improvement with a view to dwelling conditions was noted. The readiness of the single mothers to cooperate was good, but their attitude toward social institutions became more negative during the supportive period. There is some indication that the relatively small prog- ress of the single mothers was due to the fact that they were stuck in circumstances which were very difficult for the Family Center to change, and this brought about some bitterness and defeatism. At the beginning of the project, the families functioned best in work and housekeeping, whereas at that time they functioned worst with respect to the psychological and emotional har- mony of the family. These findings are in accord- ance with corresponding research elsewhere. A connection has been found between prog- ress in quality of dwelling and improvements in employment and income conditions, housekeep- ing, physical and psychological state of the family, and relations between adults and children. This is interesting, but no conclusions can be drawn as to the causal relationship. The chance that supportive activities will lead to a positive change for the better, according to the present analysis seems to be dependent on age, since persons under 30 years of age had the greatest relative improvement. Among the families of the control group it turned out that even without support from the Family Center the younger persons made relatively greater prog- ress, which means that youth as such, even in the absence of support, increases the possibilities of improvement. The initial situation seems to have influenced the extent of the improvement, since there is a tendency to a greater improvement, the worse the starting point was. One may interpret this finding to mean that although families with the poorest conditions may be difficult to treat, nevertheless support to these cases can be given a reasonable chance of positive effect. There was also found a systematic relation between the activity intensity of the social workers and the total movement in all function fields of the families. A very intense supportive activity had a greater positive effect in families with adults of low intelligence than in other families, whereas low activity effected a very small improvement in the same families. As one might guess from the findings above on youth, the younger the woman or the married couple was, the closer was the connection between activity intensity and positive movement. These observations seem to indicate that there will be a chance of success in socially weak and immature families if the work is intensified. If one wishes to estimate the importance of the Family Center‘s supportive efforts, looking at the progress registered during the supportive period is not enough, since this progress might be due to other factors in the community. Of relevance here is the fact that in the period of the experiment there was a high and increasing employment rate. These favorable possibilities for earning a living presumably benefitted especially that part of the labor force which under worse conditions would have difficulty in getting and keeping a job. As mentioned the sampled 140 families were divided into two groups of 70 families each, in order to make it possible to find out whether the supportive activity of the Family Center had an effect in itself. The control group received aid only through the usual channels of the already existing social agencies. The other group of 70 families received, besides the usual means of aid, also support from the Family Center, which kept con— tact with each family for 2 years. The two subgroups were matched so that they were identical in certain respects. The high degree of homogeneity between the control and the experi- mental group at the start of the investigation was necessary in order to demonstrate possible differ— ences between the two groups at the end of the experimental period. It was found at the end of this period that both the supported families and the control group had improved their situations, but that the families which had had contact with the Family Center showed greater improvement. However, the differences are modest, and there is a certain risk (7 percent) that the difference may 33 be due entirely to random variations although, statistically, this risk is rather small. As stated at the beginning of the summary, the main findings of statistical analysis are that an actual improvement in the general social condi- tions of the supported families has taken place. The results can be interpreted, so as to indicate that the Family Center has obtained a certain. although modest, net effect with the supported families as compared with the control group. However, the apparent modest size of the effect of the Family Center may be artificially decreased by the difficulties involved in measuring the varia— bles concerned. We could presume that there was actually greater progress with the supported families than was apparent, but that it was partly veiled by the relatively uncertain methods of measuring. The stated conclusion may also be expressed thus: A net positive effect of the supportive activity of the Family Center has been found, but it has proved to be very strong. The statistical findings are based exclusively on questionnaire material, in distinction to the daily work records of the Family Center previously described. Findings will be given here both about all 140 families as a whole and about the sup- ported and control families separately in cases where the two groups differ. Most of the families stayed in the same dwelling during the study and only 7 percent moved to the suburbs. One-fourth of the families obtained a better dwelling and in this respect there is no difference between the two subgroups. However, the supported families moved away from slums to a somewhat greater extent. This mainly applies to the married couples. The average yearly income of the families increased from 13,500 Danish kroner to 19,200 Danish kroner, and in this respect there is not much difference between the two subgroups. This increase of almost 50 percent was partly due to inflation and partly an indication of a better standard of living. The average income assess- ment in the same 2-year period in Copenhagen showed an increase of 13 percent. However, if the increase in income for the part of the Copen- hagen population which occupationally corre- sponds to the investigated persons is reckoned separately. an increase of 24 percent will be found for these occupational groups. While the Copenhagen population as a whole had thus increased their income 13 percent during the 2 34 years in question, the increase for the economi- cally lower group was 24 percent and for those in the poorest economic conditions it was 42 per- cent. Thus there seems to be a clear trend for a period of full employment in this society to be mainly in favor of those in the socially poorest situations, partly because they have their periods of unemployment reduced. The relative improve- ment in income has made itself especially felt for the single mothers. This is to some extent a consequence of specific increases in the hourly rates of pay for women during this period. The above increases in income are substantial and indicate a real improvement in the standard of living and they have, as mentioned, been to the benefit of both groups. The social vulnerability which is characteristic of the families concerned becomes less decisive in periods of progress, and the families in question have proved them- selves able to profit from the period of general prosperity and become more like those who have so far been better off economically than them- selves. Conflict symptoms such as alcoholism and aggressive personal relations between the adults of the families have shown a change for the better in the supported group. it is also noteworthy that a substantial improvement has been found in the relations between parents and children in the supported families as compared with the control families. Furthermore, the chil- dren’s absence from school has decreased dur— ing the experimental period, and this effect was especially marked in the supported families, al- though also present among the control families. These relative improvements in the two family groups indicate that the efforts of the Family Center can hardly be said to have exercised any important influence on the employment and in- come conditions, but that, on the other hand, the Center's efforts toward improvement of the human relations within the families have had some suc- cess. This may be a consequence of the general improvement in social conditions, but economic progress in itself has not been able to bring forth corresponding effects in the control families. As far as the psychological characteristics are con— cerned, there was little difference between the initial and final situations but, on the other hand, no actual psychotherapeutic effect was intended. It turned out, in fact, that the women of the supported families in their psychological charac- teristics during the supportive period deteriorated, especially in respect to depressive tendencies. This may be a consequence of the fact that a number of sensitive problems have been touched upon, of which the person in question had not previously been aware. Even when there was actually some progress in the total situation of the family concerned, the conscious work to find solutions to the problems sometimes aroused expectations which were not fulfilled and probably caused frustration. The nature and the extent of the empirical results of the Family Center, as described above, could only be measured through an investigation with an experimental setup which made it possi— ble to see the actual progress in relation to the progress in the control families and which proba- bly would also have occurred in the supported families without intervention on the part of the Family Center. This was an attempt to break with the common practice in agency and institutional investigations, in which only the absolute progress of the experimental group is recorded, without the use of any control group. Corresponding American investigations car- ried through in the same period have shown a similar picture of modest progress in a number of fields of behavior rather than great progress in single fields. An investigation of families with severe problems, in which a control group was included, found very little difference between the experimental and the control families, and the changes were described as neither statistically significant nor professionally satisfactory. Another project experimented with various methods of family treatment. A greater positive change was found in better utilization of the personnel as compared with reduction in the number of cases per social worker. In this latter research there was no nontreated control group. Finally we shall mention an American experi- ment with three groups of maladjusted girls at about the age of puberty. Two of the groups received intensive care from social workers, one group through case work and one group through psychiatric treatment, whereas a third control group was not offered any treatment. The conclu- sion was that no strong effect resulted from any of the treatments, and that the results must be described as disappointing, especially consider- ing the very intensive work which had been made by qualified social workers. in comparison with these American investi- gations the result of the present piece of experi- mental research is rather positive, since there was a tendency toward greater progress in the sup- ported families than in the others, especially in such a delicate field as conflicts between the family members. Regarding conclusions which might be drawn concerning similar welfare efforts, it should be mentioned that, according to the experience and opinions of the research leaders. the Family Center would have functioned better if time had permitted it to become known as an agency available before the experimental period started. The net result of the experiment has been described as modest, but this must be seen in relation to the expectations one could realistically have for the sampled clientele. These families had many social and personal difficulties, and their confidence and willingness to cooperate had to be revived continually during the supportive proc- ess. This in itself was a difficult task and to some extent it was counteracted by the fact that the aggressive suspicion of the clientele could only be confirmed by the inability of the Family Center to procure day-care institutions for children, treat- ment institutions for psychological problems, and, last but not least, good dwellings at moderate prices. in some cases the existing abortion legis- lation made a real rehabilitation of the families difficult. Certain families were in such a situation that an actual improvement could hardly be expected, but on the other hand stabilization at a modest level was in itself a relative advantage compared to the complete social collapse other- wise possible. The possibility cannot be excluded that eco- nomic prosperity during the experimental period paradoxically may have been responsible for the net progress attributed to the supportive activity, because the control group also had good possi- bilities of improving their social situation and actually did so. On the other hand the usual, and contrary, argument must also be considered, that favorable social conditions in the community are necessary for all social rehabilitation work. Em- ployment of the most socially vulnerable part of the labor force would be more difficult during a depression or other periods of high unemploy- ment, and the Family Center might be powerless to find work for its clientele. it can, however. be assumed that in a period with certain, but not 35 insurmountable, difficulties there might be differ- ences with regard to employment and income between the families which were supported by a family center and the families which had to manage their problems themselves. Since the Family Center was established with the explicit main task of helping families whose children were in a threatening situation. it must be emphasized that the sociopedagogical attitude- changing therapy of the family as an entity has brought about improvements in the personal rela- tions within it. Both the frequent tension between the adults in the families and the negative atti- tudes on the part of the adults toward the children were improved, which was reflected by the fact, among others, that the children came to better terms with their schools. These results are likely to reduce the amount of threat previously existing in the situations of a great part of the children. The findings also indicate that very young, immature, and multiproblem families are susceptible to influ- ence in favorable directions by supportive activi- ties, when especially intensive efforts are made. The investigation offers arguments for contin- uing with the described supportive activity quite apart from the humane and ethical reasons for social work and from regard for the security of people who are doing well at the moment, but who might get into difficulties of the sort dis- cussed here later on. 36 Practically speaking, the Family Center ran into difficulties and delays created by the poor coordination between the diverse other institutions dealing with the social problems of these families. Better results, in future, of supportive activities for multiproblem families depend on obtaining more adequate coverage by various institutions and also sufficient access to experts. However, these prerequisites must be so organized as to facilitate communication and coordination be- tween them. Furthermore, a real improvement in the situation of these families is essentially de- pendent on better dwelling conditions. All this has to be coordinated with a family-oriented supportive activity, and this condition must take place not only within the Family Center and within the family guidance office, but also within all social agencies involved. A more thorough un- derstanding of social deviance on the part of agency personnel will be necessary to promote the realistic and unsentimental attitude toward clientele of the agencies. With knowledge avail- able of the previous life of the families and their internal dynamics, smooth planning and unor- thodox administration of the supportive activity can be established. This effort must incorporate in its perspective the importance of developing the socially strong characteristics of the family group in compensation for its weak points. \ .44.‘ .Q‘ t 4‘ Vs... APPENDIX ll English translation of: “The Child and Youth Act” passed by the Danish Parliament in 1964. .‘u v— " .. f‘ T 44% ”W4- CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER (003me 10 11 12 13 14 15 16 17 18 CONTENTS Purpose and Organization ________________________ Purpose ______________________________________ The Authorities, etc, Exercising the Care __________ Central Authorities ______________________________ Child and Youth Welfare Committees ________________ Outside Copenhagen __________________________ In Copenhagen ________________________________ Co-optation ____________________________________ Family Guidance ________________________________ Special Child Care Measures ______________________ Duty of Notification, etc. ________________________ inquiries ______________________________________ Supporting Measures __________________________ Supervising Guardian ____________________________ Exercise of Care Apart From Parents ________________ Termination of Supporting Measures ________________ After Care ______________________________________ Review of Resolutions on Supporting Measures, etc. -_ National Council of Child and Youth Welfare Services Directorate of Child and Youth Welfare Services ____ Review by the Courts __________________________ Child Guidance Centers __________________________ Day Care, Day—Care institutions. etc _________________ Private Day Care ______________________________ Day-Care institutions, etc., Eligible for Grants ______ Rules Governing Payment of Grants ______________ Other Day-Care Institutions, etc ___________________ Supervision ____________________________________ Permission to Receive Children into Care ____________ Homes for Children and Young Persons ____________ Certified Homes ________________________________ Rules Governing Payment of Grants ______________ Other Homes for Children and Young Persons ______ Supervision ____________________________________ Payment for the Care of Children and Young Persons Societies for the Care of Children and Young Persons Reimbursement and Auditing, etc ___________________ Penal Clauses __________________________________ Transitional and Final Provisions ____________________ SECTIONS 1-7 1 2-3 4-7 8-1 7 8-9 10-13 14-1 7 18—1 9 20—36 20-22 23-26 27-36 37 38—44 45-49 50-51 52-60 52—55 56 57—60 61 ~63 64—77 64 65-68 69-75 76 77 78—82 83-97 83-89 90—95 96 97 98-100 101-103 104-109 110-114 115 39 THE CHILDREN AND YOUNG PERSONS ACT, 1964 CHAPTER 1 PURPOSE AND ORGANIZATION 1. (1) The purpose of the Child and Youth Welfare Services shall be to ensure that children and young persons grow up under conditions which promote sound mental and physical devel- opment. (2) The care shall be exercised by local child and youth welfare committees, child guidance centers, day-care institutions, and homes for chil- dren and young persons, as well as by voluntary societies for the care of children and young persons, and shall be supported by the state through the central child and youth welfare au- thorities. The Authorities, eta, Exercising the Care 2. (1) it shall be the duty of the Child and Youth Welfare Committee, in cooperation with other authorities and with institutions and voluntary societies, to attend to the care of children and young persons in their area by supervising the conditions under which children and young per— sons live, supporting parents in the upbringing and care of their children, granting assistance to children and young persons who are in need of support, and ensuring the existence of the nec- essary day-care institutions and socio-educational recreation facilities. (2) The local authority shall be required to provide and run the necessary institutions it the duties are not otherwise discharged. 3. The institutions and the voluntary societies shall separately attend to socio—educational func- tions, as specified in their rules. Central Authorities 4. The Minister of Social Affairs shall be the supreme administrative authority for the care of 40 children and young persons. The Minister shall make general regulations as to how the care shall be exercised and the administration organized. 5. (1) The Directorate of Child and Youth Welfare Sen/ices shall directly or through child care advisers give guidance and support to the local child and youth welfare committees in their activities and see to it that the care is carried out in the most expedient manner. (2) The Directorate shall provide for the necessary number of homes for children and young persons and of child care training colleges to be available. They shall coordinate the .estab- lishment and running of child and youth welfare institutions and give them educational guidance. (3) The Directorate shall inspect homes for children and young persons at least twice a year and day-care institutions normally twice a year and may, as necessary. inspect other premises where children and young persons are accomo— dated. (4) The Directorate shall check the economy and accounts of the institutions and attend to the administration of financial arrangements and of state institutions under this Act. (5) The Directorate shall have power to request information from child and youth welfare committees, certified institutions, and registered societies with a view to carrying out supervision and compiling annual statistics. (6) Besides, the Directorate may be author- ized by the Minister of Social Affairs to exercise powers conferred on the Minister under this Act. 6. (1) Any complaints against resolutions about child-care arrangements, etc, may in pur— suance of the provisions of this Act be brought before the National Council of Child and Youth Welfare Services. ”-6 " (2) The National Council shall be composed of: (i) a chairman appointed by the Crown and satisfying the general conditions governing ap- pointment to the office of High Court judge; (ii) the Director of Child and Youth Welfare Services; (iii) a member appointed by the Minister of Social Affairs; and (iv) two mem- bers elected by Parliament. (3) For each of the members referred to in paragraphs (i) to (iii) of subsection (2) of this section the Minister of Social Affairs shall appoint a substitute member, and Parliament shall elect a substitute member for each of the members referred to in paragraph (iv) of subsection (2) of this section. The substitute member for the chair- man shall satisfy the general conditions for appointment to the office of High Court judge. (4) Appointment and election of the members and substitute members referred to in paragraphs (iii) and (iv) of subsection (2) of this section shall be for a term of 4 years, corresponding to the local electoral term: Provided that a member or substitute member shall retire on the expiration of the month in which he attains the age of 70. (5) Any resolution passed by the National Council of Child and Youth Welfare Services shall be valid if no less than three members vote for it. 7. (1) The Educational Board of the Child and Youth Welfare Services shall give their opinion to the Ministry of Social Affairs on questions relating to the organization of the care of children and young persons and the institutions concerned, on the educative work, instruction, and training pro- vided by the institutions, and on other educational matters. (2) The Board shall be composed of up to 10 members representing expert knowledge within institutional care, the work of the child and youth welfare committees, the central authorities, the National Health Service, and any other special expert knowledge. (3) The Economic Board of the Child and Youth Welfare Services shall give their opinion to the Ministry of Social Affairs on matters relating to the financing of child and youth care, including institutional care, on matters connected with build- ings, and on any other matters of an economic nature relating to the care of children and young persons. (4) The Board shall be composed of up to 12 members, of whom one shall be an economic expert, one a building expert, and the other members shall be representatives of the central and local authorities and of the child and youth welfare organizations. (5)The members of the child and youth welfare boards shall be appointed by the Minister of Social Affairs for a term of 4 years, correspond— ing to the local electoral term. The Minister shall appoint one of the members as chairman. (6)The Minister of Social Affairs may fix the rules of procedure of the boards. The boards shall meet for joint consideration of questions of educational as well as economic relevance. CHAPTER 2 CHILD AND YOUTH WELFARE COMMITTEES 8. (1) In the local-authority areas outside Copenhagen, the care of children and young persons shall be exercised by a child and youth welfare committee consisting of five or seven members. For each member there shall be a substitute member who shall take the place of the member in case the latter is prevented from attending a meeting. The committee shall be composed of both men and women. (2) The Chairman of the Social Welfare Com- mittee shall be elected as a member of the Child and Youth Welfare Committee. The other mem- bers and substitute members shall be elected by the local council for the local electoral term from among the inhabitants of the area who have experience in the care of children and young persons and are eligible for election to the local council. (3) The Child and Youth Welfare Committee shall elect their own chairman and one or two vice—chairmen; provided that, where the duties of the Social Welfare Committee are discharged by a corporation, the burgomaster or alderman who is responsible for the care of children and young persons shall be Chairman of the Child and Youth Welfare Committee. 41 (4) The members of the Child and Youth Welfare Committee shall receive subsistence and traveling allowances, as well as a special allow- ance for absence from theirplace of residence under the rules applying to members of the local council. 9. (1) The Minister of Social Affairs may direct that a large local authority area be divided into several child care districts. (2) Further, the Minister of Social Affairs may approve, regarding child and youth welfare com- mittees serving large areas, that certain aspects of the care be exercised by the chairman: Pro- vided that decisions on child-care arrangements may be made by the chairman only with the consent of the person having the parental rights over the child or young person, or, if the young person is no longer subject to custody, the young person himself or his guardian. A decision about removal from home may be made by the chair- man only where such step is taken solely because the child or young person has no one to provide for him, or the breadwinner is incapable of caring for him in a proper manner. In Copenhagen 10. (1) The care of children and young persons in the Copenhagen area shall be the responsibility of the Copenhagen Child and Youth Welfare Committee in accordance with rules to be approved by the Minister of Social Affairs. (2) The rules may provide for certain aspects of the care to be carried out by the Corporation of Copenhagen: Provided that a resolution about removal from home may be passed by the Corporation only where such step is taken solely because the child or young person has no one to provide for him or the breadwinner is incapable of caring for him in a proper manner. 11. The Child and Youth Welfare Committee shall be composed of: (i) the burgomaster in charge of the division of the Corporation that is responsible for the care of children and young persons, as chairman; (ii) two vice-chairman who shall be nominated by the Corporation and shall satisfy the general 42 conditions governing appointment to the office of judge; (iii) six or eight other members. 12. (1) The City of Copenhagen shall be divided into child care districts whose number and delimitation shall be specified in the rules. (2) For each district there shall be elected a prescribed number of district guardians and sub- stitutes who should have knowledge of the condi- tions of the district for which they are elected. (3) The members of the Child and Youth Welfare Committee referred to in paragraph (iii) of section 11 of this Act, as well as the district guardians, shall be elected by the City Council under specified rules from among persons who have experience in the care of children and young persons and who are eligible for election to the local council. They shall be elected for a term of 4 years starting with the first June following the end of a local electoral term. 13. (1) in the consideration of matters relating to supporting measures under the provisions of chapter 4 of this Act or to resolutions passed under section 43, chapter 7, section 50 and section 81 of this Act, two district guardians shall be co-opted to the Child and Youth Welfare Committee, including at least one of the guardians serving the relevant district. (2) The matter may, however, be considered by an ad hoc subcommittee consisting of no less than five members, including one of the vice chairmen, two other members of the child and youth welfare committee, and one of the guardi- ans of the relevant district. Co-optalion 14. (1) The judge of the local inferior court shall be co-opted to the Child and Youth Welfare Committee outside Copenhagen in the consider- ation of cases relating to: (i) the application of subsection (1) or (2) of section 28 of this Act concerning removal from home of a child or young person; (ii) the committal of a child or young person in care to the psychiatric department of a hospital or to a mental hospital in the cases set out in subsection (2) of section 43 of this Act; 5 -5» (iii) an order prohibiting the person who has the parental rights from taking a child home from a foster home (of. s. 81 of this Act). (2) At the committee’s request, the judge shall further be co—opted to the committee in the consideration of cases relating to: (i) refusal to meet an application for return to parents, either indefinitely or for a trial period, of a child or young person who is maintained in an institution; (ii) reception back into care of a child or young person after tentative return to parents; (iii) retention of a child or young person in care in the psychiatric department of a hospital or in a mental hospital; and (iv) maintaining a prohibition of taking home foster children. (3) in case there are several judges in a judicial area, the Minister of Justice shall decide who shall discharge the function. (4) The judge shall guide the committee on the construction and application of this Act and on the evaluation of any available evidence. He shall preside over the discussion and see that the necessary inquiries are made and that the assist— ance of the medical officer of health and of other special experts is enlisted, as necessary. 15. (1) in the cases referred to in subsection (1) of section 14 of this Act a psycho-educational adviser to be nominated by the Minister of Social Affairs for the local electoral term shall be cc- opted to the Child and Youth Welfare Committee. The assistance of the adviser may be enlisted in other cases, too. (2) In the light of an evaluation of the avail- able data on the personality and family environ- ment of the child or young person, the adviser shall guide the committee on what measures must be considered most likely to promote the devel- opment of the child or young person in each particular case. If further investigations are deemed necessary for throwing light on these questions, he shall make recommendations to that effect. (3) The Minister of Social Affairs may approve that the provision of subsection (1) of this section shall not apply to local authorities which have otherwise ensured the committee the necessary guidance in this field. 16. The Child and Youth Welfare Committee may request the medical officer of health to attend meetings or otherwise give assistance through a medical evaluation of the matter in hand. 17. (1) The delegates referred to in sections 14 to 16 of this Act shall attend the meetings of the Child and Youth Welfare Committee without any right of voting. In case their views differ from those of the members, a note to that effect shall be entered in the record of proceedings of the Committee and a transcript be sent without delay to the National Council of Child and Youth Welfare Services. (2) The Minister of Social Affairs shall make regulations governing payment of fees to the judge, the psycho—educational adviser and the medical officer of health for their services in matters relating to child care. The expenses shall be defrayed by the state. CHAPTER 3 FAMILY GUIDANCE 18. (1) The Child and Youth Welfare Commit- tee may offer families with children continuing guidance and support and shall be required to make such offer to families who are supposed to be in particular need thereof. (2) The Minister of Social Affairs may make regulations on the organization of family guidance and on the duty of notification on the part of authorities and individual persons. 19. (1) Family guidance may be approved by the Minister of Social Affairs so that the expenses are reimbursed under the rules governing child- care expenses, subject to the condition that the family guidance officers are persons who by virtue of their training or previous occupation are spe- cially qualified for such work and that the ex- penses are capable of separation from the other administrative expenses of the Child and Youth Welfare Committee. (2) Family guidance may be provided and approved as a common service to several areas. 43 CHAPTER 4 SPECIAL CHILD CARE MEASURES 20. The Child and Youth Welfare Committee shall be required, in cooperation with other au- thorities and institutions, etc., to keep informed of the conditions under which children and young persons in their area live so as to be able, as early as possible, to become aware of cases where special support is needed. 21. Any person who while exercising a public office or function becomes aware of matters requiring supporting measures in pursuance of this Act shall be required to notify the Child and Youth Welfare Committee. 22. (1) Any person who becomes aware that a child or young person under 18 years of age is exposed to neglect or degrading treatment on the part of parents or other educators or lives under conditions which are liable to seriously imperil his mental or physical health or development shall be required to notify the Child and Youth Welfare Committee. (2) Also, any person shall be entitled to inform the Committee of matters which in his opinion require intervention by the Committee. Inquiries 23. (1) Where a child or young person under 18 years of age is supposed to be in need of special support, the Child and Youth Welfare Committee shall see that an inquiry is made into the circumstances of the child or young person. The Minister of Social Affairs shall make detailed regulations on such inquiry. (2) The inquiry shall be made by persons being specially qualified for such work. Where deemed necessary, the Committee shall enlist the assistance of the child care adviser and other experts. 24. (1) Any public authority and any individ- ual may be asked for a statement on his knowl- edge of the child or young person and of the conditions under which he lives. (2) Those who have made statements and any other persons believed to have knowledge of the conditions may be summoned to appear 44 before the Child and Youth Welfare Committee if they are staying in the area served by the Committee. Persons outside that area may be requested to make a statement before the appro- priate committee. (3) As regards the right to request information under the provisions of subsections (1) and (2) of this section and the duty to give such information, the legislative limitations on the taking of evidence shall apply mutatis mutandr's. 25. (1) The assistance of the police may be enlisted if in the view of the Child and Youth Welfare Committee the necessary information cannot be otherwise provided. Further, the Com- mittee may require the taking of evidence before a court in pursuance of subsection (1) of section 1018 of the Administration of Justice Act. (2) The execution of any necessary certifi— cates and transcripts may be requested from the appropriate authorities, free of charge. 26. Where the child or young person has no guardian, it shall be the duty of the Child and Youth Welfare Committee to arrange for a guard- ian to be appointed. Supporting Measures 27. (1) It shall be the duty of the Child and Youth Welfare Committee to give guidance to the person having the parental rights over the child or young person or to the person who actually has the care of him, where it appears from the available evidence: (i) that the child or young person has no one to provide for him; (ii) that the breadwinner is unable to provide for the child or young person in a proper manner; (iii) that the child or young person has difficulty in adjusting himself to his daily environ- ment, his school, or the community; (iv) that the child or young person is not properly brought up or cared for; or (v) that the child or young person does not live under satisfactory conditions. (2) in the cases referred to in subsection (1) of this section the Child and Youth Welfare Committee may resolve: (i) to give directions or orders for the care, upbringing, education, training or employment of the child or young person, e.g., that a child shall attend a day-care institution, or the like, or that a young person shall attend a school, a youth club, or the like; (ii) to appoint a supervising guardian; (iii) to have the child or young person exam- ined and treated by a physician or examined and guided by a psychologist; (iv) to make grants toward expenses directly involved by the directions or orders given; (v) to make grants toward the expenses of domestic help in the event of parents' illness or to meet temporary difficulties in order to obviate the need of removing the child from home; and (vi) to arrange for the child or young person to be accommodated and maintained apart from his parents in a foster home, a boarding school or in other private care, in a home for children and young persons, in a hospital or in any other treatment institution. (3) A resolution for the taking of supporting measures may be passed only where required in the interests of the welfare of the child or young person. They shall, as far as possible, be taken in cooperation with the person having the parental rights over the child or young person and with any other persons who in actual fact exercise the parental rights, and every effort should be made to keep the child or young person in his home. The Social Welfare Committee shall be informed of any payment of financial assistance under paragraphs (iv) and (v) of subsection (2) of this section. 28. (1) Without the consent of the person having the parental rights over the child or young person, the latter’s removal from home may be resolved only where this is required in his inter- ests: (i) because the child or young person has shown considerable difficulties in adjusting him- self to his daily environment, his school or the community in general, and his parents are unable to cope with his upbringing; (ii) because the child or young person lives under such conditions that his mental or physical health or development is seriously injured or imperiled; (iii) because the parents fail to arrange for the child or young person to be committed to the necessary special care or other necessary treat- ment of mental or physical disorders. (2) Irrespective of the fact that the person having the parental rights over the child or young person consents to the latter being maintained apart from his parents, the Child and Youth Welfare Committee may resolve, on the conditions set out in subsection (1) of this section and if warranted by the circumstances, that the child or young person shall not be returned to his parents as long as public care is required. 29. (1) Supporting measures may be taken with respect to children and young persons under 18 years of age who are resident in this country. (2) Where a resolution for appointment of a supervising guardian or for removal from home has not been finally rescinded when the child reaches the age of 18, such measures may be changed to or combined with other measures also after that time in pursuance of sections 27 and 28 of this Act. Where a resolution for removal from home has been made with the consent of the person having the parental rights in respect to the young person, a resolution in pursuance of subsection (2) of section 28 of this Act may be made also after his attainment of 18 years of age. (3) In other cases, supporting measures may under special circumstances be taken in respect to young persons over the age of 18. subject to the consent of the young person and his guard- ian. » 30. (1) No resolution may be passed in pursuance of subsection (1) or subsection (2) of section 28 of this Act, unless the person having the parental rights over the child or young person or, in case his whereabouts in this country are unknown, the one who in actual fact exercises the parental rights has been requested at a suitable notice by registered mail to make a statement before the child and youth welfare committee. The same shall apply to the guardian of a young person who is no longer subject to custody. The summons shall call attention to the provision of subsection (4) of section 31 of this Act. (2) Any young person over 15 years of age shall be given the opportunity to make a state- ment in the cases referred to in subsection (1) of this section. 45 31. (1) Subject to the provisions of subsection (2) of section 9 and subsection (2) of section 10 of this Act, the taking of supporting measures shall be resolved by a meeting of the Child and Youth Welfare Committee. Subject to Subsection (2) of section 13 of this Act, at least one-half of the members shall be present. (2) The passing of a resolution in pursuance of subsection (1) or subsection (2) of section 28 of this Act requires that at least two-thirds of the members of the committee vote in favor of the resolution. In Copenhagen it is required that at least two-thirds of the members and district guardians of the committee (cf. 8. 13 (1)) or two- thirds of an ad hoc subcommittee in pursuance of subsection (2) of section 13 of this Act vote in favor of the resolution. (3) The meetings shall be held in camera. (4) The parents may seek the assistance of a third party, who may appear before the commit- tee. 32. Any resolution that may be brought before the National Council shall be communi- cated by registered mail to those entitled to lodge a complaint. unless they have renounced such communication. At the same time the latter shall be informed of the right to bring the matter before the National Council and of the time wthin which this shall be done. 33. (1) Where the available evidence is not sufficient, or where for any other reason a resolu— tion cannot yet be finally made, such arrange- ments as cannot be postponed without prejudice to the welfare of the child may be taken on a provisional basis. If the Child and Youth Welfare Committee is not sitting, provisional arrangements may be taken by the chairman or, in his absence or by his authority, by the vice-chairman (vice- chairmen). (2) The matter shall as soon as possible be submitted to the Committee for final resolution. Any accommodation and maintenance of a child or young person apart from his parents by virtue of a provisional resolution must not exceed a period of 2 months. (3) A resolution made under subsection (1) of this section shall not be capable of being brought before any higher administrative authority. 46 34. The Child and Youth Welfare Committee may, if necessary, enlist the assistance of local authorities serving other areas or of the police for the enforcement of resolutions. 35. The provisions of the National Assistance Act on payment of assistance to persons who are not Danish nationals, on notification and reim— bursement of expenses toward the payment of such assistance, and on the possible repatriation of the persons concerned shall apply mutatis mutand/ to any assistance awarded under this Act to children and young persons who are not Danish nationals. 36. (1) The care provided under this Chapter shall be exercised by the Child and Youth Welfare Committee in whose area the person having the parental rights over the child or young person or the person who in actual fact exercises the parental rights is resident. in case the place of residence in this country of such person is un— known, the care shall be exercised by the local authority in whose area the child or young person is resident. The latter authority shall be required to give the necessary assistance until the care may be taken over by the appropriate Child and Youth Welfare Committee. (2) Where the person having the parental rights over the child or young person or the person who in actual fact exercises the parental rights takes up his residence in an area other than that served by the committee which has commenced the taking of supporting measures, the file may be transmitted to the committee of the new area for further action. Any resolution that has been passed shall apply until it may be rescinded by the new committee under the provi— sions of chapter 7. (3) Any doubt as to which committee is the appropriate committee shall be decided by the Directorate of Child and Youth Welfare Services. CHAPTER 5 SUPERVISING GUARDIAN 37. (1) The supervising guardian shall assist the family with advice and guidance and follow the development of the child or young person through continuing personal contact. _.‘4 (2) The supervising guardian shall be ap— pointed in writing by the Child and Youth Welfare Committee responsible for the care or, at the request of that Committee, by the Child and Youth Welfare Committee in whose area the supervision is to be carried out. (3) As supervising guardians shall be ap- pointed persons with special qualifications for carrying out such work. (4) The Minister of Social Affairs shall make regulations for the appointment of supervising guardians and for reimbursement of expenses on the remuneration, etc. of supervising guardians. Further, the Minister of Social Affairs shall make regulations governing the general duties of the supervising guardian; a copy of these regulations shall be handed over to each supervising guard- ian. (5) The Child and Youth Welfare Committee may decide that the earnings of a young person shall be paid to the supervising guardian for the benefit of the young person. CHAPTER 6 EXERCISE OF CARE APART FROM PARENTS 38. When it has been resolved to accommo- date and maintain a child or young person apart from his parents under the provisions of chapter 4 of this Act, it shall be the duty of the Child and Youth Welfare Committee to decide where he shall be placed and to see to his care, upbring- ing, education or training, and to decide on his personal affairs to the extent required by the care. The Committee shall, as far as possible, take the necessary decisions in cooperation with the per- son having the parental rights over the child or young person. 39. (1,) In the choice of accommodation the Child and Youth Welfare Committee shall see to it that the child or young person is placed under conditions likely to promote his mental and physi- cal development and to provide facilities for a training suited to his abilities and aptitudes. (2) If the care is not supposed to be of quite short duration and the necessary treatment or special circumstances of the parents do not otherwise require, children shall as far as possible be boarded out in family care. (3) The Minister of Social Affairs shall make regulations as a guide for determining terms of payment for receiving a child into care. 40. (1) So long as a child or young person is in care, the Child and Youth Welfare Committee shall keep informed of his conditions through contact with the foster parents, with the person in charge of the institution, or with the place of training, and decide, as necessary, on change of accommodation, training, treatment, etc. (2) The committee may authorize a person, an institution or a registered society to exercise the day-to-day care of the child or young person. Where the latter has been placed in a certified home for children and young persons or in a “special care" institution, the care shall be exer- cised on behalf of the committee by the person in charge of the institution so long as the child or young person is being maintained there or is subject to its supervision. (3) Persons in charge of homes for children and young persons may require the question concerning change of accommodation to be submitted to the Directorate of Child and Youth Welfare Services. 41. Unless regard for the welfare of the child or young person militates against it in the particu- lar case, it shall be the duty of the Child and Youth Welfare Committee, in consultation with those who are in charge of the day—to—day care, to see to it that the connection between the child or young person and his home is maintained and to try to enable his return to his parents. 42. Prior to the placing of a child or young person otherwise than in a certified institution, the premises shall be examined by the local Child and Youth Welfare Committee: Provided that the Minister of Social Affairs may permit a committee to examine premises situated in areas served by other local authorities. 43. (1) The Child and Youth Welfare Commit- tee may decide, with the concurrence of the medical superintendent of the hospital, to commit 47 a child or young person to the psychiatric depart- ment of a hospital or to a mental hospital, even where the general conditions under the legislation on hospitalization of mental cases are not satis- fied. The stay may continue so long as this is deemed necessary by the committee with the concurrence of the medical superintendent. (2) Where the person having the parental rights over the child or young person or, if the latter is no longer subject to custody, the young person or his guardian objects to such committal, the resolution may be passed only subject to the provisions of section 30, subsections (2) to (4) of section 31, and section 32 of this Act. 44. Where the child or young person is not maintained in a certified home for children and young persons, the supervision shall be exercised in pursuance of regulations to be made by the Minister of Social Affairs. CHAPTER 7 TERMINATION OF SUPPORTING MEASURES 45. Supporting measures under chapter 4 of this Act shall end when their purpose has been achieved or such measures are no longer re- quired, or the young person has attained the age of 21. 46. (1) Termination of supporting measures shall be resolved by the Child and Youth Welfare Committee responsible for the care of the child or young person concerned: Provided that, if the person having the parental rights in respect of the child or young person is resident in the area of another local authority, the committee serving that area shall be consulted before any resolution is passed. (2) Before a resolution is passed about refusing to meet an application for return to parents, either indefinitely or for a trial period, the person having the parental rights in respect of the child or young person or, if the latter is no longer subject to custody, the guardian shall be given an opportunity to be heard. They shall be notified of the decision by registered mail and of the right to bring the question before the National Council 48 of Child and Youth Welfare Services. Young persons who are no longer subject to custody shall be given an opportunity to make a state- ment. 47. (1) The Child and Youth Welfare Commit- tee may resolve that a child or young person who is maintained apart from his parents be tentatively returned to the latter so as to permit of his being received back into care within a period of 2 years, if deemed necessary. (2) Where the person having the parental rights in respect of a child or young person or, if the latter is no longer subject to custody, the young person or his guardian objects to recom— mittal to care, this may take place only if the resolution of receiving the child or young person into care was passed in pursuance of section 28 of this Act. (3) The provisions of subsection (1), (3), and (4) of section 31 of this Act shall apply mutatis mutandis to resolutions on recommittal to care. The same shall apply to the provisions of section 30, subsection (2) of section 31, and section 32 of this Act, if recommittal to care is resolved in pursuance of subsection (2) of this section. 48. (1) Where the continuation of care in pursuance of section 28 of this Act in respect of a young person is deemed impracticable for the time being, eg. by reason of manifest opposition to cooperation on the part of the young person or his parents, the Child and Youth Welfare Commit- tee may resolve that the care be confined to the committee's keeping informed of the development of the young person so that supporting measures are instituted, if deemed expedient and practica— ble. The resolution shall be communicated without delay to the Directorate of Child and Youth Welfare Services. (2) Where in special cases such restricted care is deemed to serve no useful purpose, then, on the recommendation of the committee respon- sible for the care of the young person or the person in charge of the institution in which the young person is maintained, the National Council may resolve that the young person shall go finally out of care. (3) The care by the child and youth welfare authorities shall cease if the young person is sentenced to youth prison. 49. Where a child or young person has been placed under section 28 of this Act in a home for children and young persons, or in special care, or with foster parents, either indefinitely or for a trial period, may be passed only with the concurrence of the person in charge of the home or the institution, or of the society, unless the resolution is approved by the National Council. CHAPTER 8 AFTER CARE 50. (1) In the event of return of a child or young person to his parents, either indefinitely or for a trial period, attention shall be given to his being placed under satisfactory conditions. (2) For up to 2 years after his return, contri- butions may be made toward his maintenance, training, etc. 51. Grants toward after—care may be made by the state. The Minister of Social Affairs shall make regulations for the exercise of such care. CHAPTER 9 REVIEW OF RESOLUTIONS ON SUPPORTING MEASURES, ETC. 52. (1) The below resolutions passed by the Child and Youth Welfare Committee may be brought before the National Counci/ of Child and Youth Welfare Services: (i) resolutions on supporting measures passed under chapter 4 of this Act; (ii) refusal to meet an application for cessa— tion of supporting measures or for tentative return to parents; (iii) resolutions on recommittal to care of a child or young person following tentative return; (iv) resolutions for placing or retaining a child or young person in the psychiatric department of a hospital or in a mental hospital; (v) refusal to meet a request for application of the facilities provided by this Act. (2) The right to bring a question before the National Council shall be available to the person having the parental rights in respect of the child or young person, or the person who in actual fact exercises the parental rights, and, if the young person is no longer subject to custody, the latter or his guardian. 53. (1) The matter shall be brought before the National Council within 1 month of receipt of the communication of the resolution passed by the Child and Youth Welfare Committee. (2) Those decisions of the National Council that may be brought before a court (cf. section 57 of this Act) shall be made before the expiration of 2 months. While communicating the decision to the person who brought the case before the Council, the National Council shall inform him of his right to file a petition for the case to be heard by a court and of the time within which such a petition shall be filed. (3) The bringing of a case before the National Council does not prevent institution of the meas- ures resolved by the Child and Youth Welfare Committee: Provided that, in very special circum- stances, the chairman of the National Council may direct that a resolution shall not be enforced until the Council has decided the case. 54. (1) Where a matter has been brought before the National Council or the Council other- wise becomes aware of matters likely to require the taking of supporting measures, the National Council may order the Child and Youth Welfare Committee to make the necessary inquiries or make such inquiries itself. (2) If the committee does not accordingly take the necessary measures, the National Coun- cil may make a resolution to that effect and order the Committee to enforce the resolution. (3) The chairman of the National Council may order the taking of such provisional measures it interests in the welfare of the child cannot be postponed. 55. The decisions of the National Council cannot be brought before any other administrative authority: Provided that decisions on a Child and Youth Welfare Committee's refusal to meet a request for the application of the facilities pro- 49 vided by this Act may be brought before the Minister of Social Affairs within 1 month by any of the persons referred to in subsection (2) of section 52 of this Act. 56. Where as a condition in a suspended sentence or a dismissal of charge it is prescribed that a young person shall be received into care or remain in care and be placed as specified in the sentence or the Letter of Dismissal of Charge, and where, after the young person has been received into care, the Child and Youth Welfare Committee does not pass a resolution on his accommodation in accordance with the condition, the Directorate of Child and Youth Welfare Sen/- ices shall decide where the young person shall be placed. Review by the Courts 57. (1) Any of the persons referred to in subsection (2) of section 52 of this Act may within 4 weeks by application to the National Council demand the following decisions made by the Council to be brought before the competent High Court of Justice: (i) resolutions passed under paragraph (i) of subsection (1) of section 52 or under section 54 of this Act concerning removal of a child or young person from his home; (ii) refusal to meet an application for return of a child or young person to his parents, either indefinitely or for a trial period; (iii) refusal to meet an application for approval under section 49 of this Act of return of a child or young person to his parents, either indefinitely or for a trial period; (iv) resolutions for recommittal to care of a child or young person following tentative return to parents; (v) resolutions for placing or retaining a child or young person in the psychiatric department of a hospital or in a mental hospital. (2) ln the event of confirmation by a court of a resolution passed by the National Council, another review by the court cannot be demanded until after the expiration of 6 months, unless a shorter time has been fixed by the court. 58. (1) In its hearing of cases relating to the care of children and young persons. the High Court shall be joined by one judge experienced 50 in child care and one judge experienced in child psychiatry or in psychology. (2) The cases shall otherwise be heard in conformity with the general rules of the Adminis- tration of Justice Act governing civil cases (cf. chapter 43a of that Act), subject to the modifica- tions stated below. (3) Where the case concerns a child or young person under 18 years of age, the latter may attend the court sittings only with the permis— sion of the court. (4) The court may decide that the court sittings shall be held in camera. (5) By public report of the court proceedings or the judgment, the name, occupation, or resi- dence of any of the persons involved in the case must not be stated without the permission of the court. Any contravention of the prohibition shall be liable to be punished by a fine. (6) The provision of paragraph (iii) of subsec— tion (1 ) of section 218 of the Administration of Justice Act shall not apply to the hearing of these cases before a High Court of Justice. 59. The decision of the High Court may be brought before the Supreme Court only where, as a rare exception, the Minister of Justice so per- mits. Any petition for permission to make an appeal shall be filed within 12 months in the case of a judgment and within 6 months in the case of a court order. 60. (1) The judges referred to in section 58 of this Act shall be appointed by the Minister of Justice after consultation with the Minister of Social Affairs. He shall determine their number and decide on fees and traveling allowances. Those appointed shall be of age, of good char- acter, and trustworthy. (2) The judges shall be appointed for a term of 4 years: Provided that a judge shall retire at the end of the month in which he attains 70 years of age. (3) No person who satisfies the prescribed conditions may decline to accept appointment unless he is over 65 years of age or he is able to adduce any other ground for exemption that is deemed acceptable by the Minister of Justice. (4) Selection for the individual case among the judges appointed shall be made by the President of the competent High Court. No person who under sections 60 and 62 of the Administra- tion of Justice Act would be precluded from acting as a judge in the case shall be eligible for selection. CHAPTER 10 CHILD GUIDANCE CENTERS 61. (1) A child guidance center for the care of children and young persons may be recog- nized by the Minister of Social Affairs as eligible for public grants, provided it is run as an inde- pendent institution, or by one or more local authorities, or by one or more registered societies for the care of children and young persons. (2) The recognition shall be subject to the condition that the person in charge of the institu- tion, as well as its rules and premises, is approved by the Minister of Social Affairs and that a board of supervision, whose members shall be ap- pointed by the Minister of Social Affairs, is set up. 62. (1) The child guidance centers shall assist in the examination and treatment of children and young persons whose behavior is disturbed, primarily on the recommendation of a Child and Youth Welfare Committee, a certified institution or a registered society for the care of children and young persons. (2) The Minister of Social Affairs shall make regulations for the layout, conduct, and running of the centers, and for salaries, pensions, and other conditions of employment of the staff. 63. (1) Rent and other property expenses of recognized child guidance centers shall be paid in full by the state, while the centers shall be grant-aided for 90 percent of the other running expenses. (2) The grant shall be paid in advance on the basis of a budget approved by the Directorate of Child and Youth Welfare Services. The final settle- ment of accounts shall take place after the expiration of the financial year. (3) Besides, aid may be granted under the provisions of subsection (4) of section 71, of section 73 and of section 74 of this Act. Aid in pursuance of section 74 may be granted as to 90 percent of the expenses referred to in the provi— sion. CHAPTER 11 DAY-CARE, DAY-CARE INSTITUTIONS, ETC. Private day care 64. (1) No one may receive more than two children under 14 years of age into day care for payment without the previous permission of the local Child and Youth Welfare Committee, which shall see that the conditions are satisfactory in regard to upbringing and health. (2) Permission may be granted for particular children or for a particular number of changing children. The maximum number of children to be received into day care by any one person shall be seven. * (3) The committee shall supervise private day care for which a permission is required. If on the basis of an investigation they find that supervision is not required, the committee may decide to terminate it. (4) If they become aware that the conditions of a family render the home unfit for receiving children into day care, the committee may, on the basis of an inquiry into the conditions, decide that the family shall not be allowed to receive any children into day care. (5) Any person whose application for permis- sion to receive children into day care has been refused, or whose permission has been with- drawn, may within 1 month, bring the matter before the National Council of Child and Youth Welfare Services under the provisions of sections 53 to 55 of this Act. The same shall apply to any person for whom a decision has been made under the provision of subsection (4) of this section. Day-care institutions, etc., eligible for grants 65. (1) The following day—care institutions and recreational facilities may be recognized by the 51 Minister of Social Affairs as eligible for public grants: (i) day nurseries; (ii) nursery schools; (iii) recreation centers and all-day schools; (iv) recreation clubs not certifiable as part of general education; (v) youth clubs whose primary aim is that of social education or which form part of a multi— branch institution; (vi) playgrounds; (vii) other recreational facilities having a so- cio-educational purpose. (2) In addition, arrangement of private day care may be recognized as part of the activities of a day nursery, a nursery school or a recreation center, or as an independent institution. 66. (1) The institutions may be run as inde- pendent institutions, or by local authorities, or by registered societies for the care of children and young persons: Provided that institutions not de- signed to receive more than 20 children may be otherwise run and, in special cases, this may be permitted by the Minister of Social Affairs also in respect of institutions capable of receiving more than 20 children. (2) Recognition shall be subject to the condi- tion that the governing body of the institution, the person in charge of it, as well as its rules and premises, are approved by the Minister of Social Affairs. (3) Prior to recognition, a statement shall be obtained through the local council from the Child and Youth Welfare Committee and, in the case of youth clubs, also from the Youth Board. (4) The establishment or alteration of an institution shall be subject to prior approval by the Minister of Social Affairs of the plans for the layout and activities of the institution. 67. (1) The Minister of Social Affairs shall make regulations on: (i) the layout, conduct, and running of the institutions; (ii) the educative work to be carried out in the institutions; (iii) medical attention and dental care; and (iv) salaries, pensions, and other conditions 52 of employment for persons in charge of institutions and members of staff. (2) The rules governing remuneration of per- sons in charge of institutions and members of staff shall be determined in conformity with the principles of the Civil Servants Act. The recogni- tion of an institution shall be subject to the condition that the staff are paid in conformity with those rules. 68. Institutions eligible for grants shall primar- ily receive children whose admission is particularly required for social and educational reasons. Rules governing payment of grants 69. (1) A charge shall be levied under rules to be determined by the Minister of Social Affairs for the use of institutions, etc., eligible for grants. (2) The Child and Youth Welfare Committee may, under rules to be determined by the Minister of Social Affairs, pay the cost of wholly or partially free places for children of parents who are not able to pay the charge themselves. The cost shall be defrayed as a child care expense. 70. (1) Institutions eligible for grants shall be fully reimbursed for expenses on rent, payment of interest and installments on mortgage loans ap- proved by the Minister of Social Affairs, and on taxes, duties, insurance and maintenance relating to real property. The state shall pay four-sevenths and the local authority three-sevenths of the expenses. The same shall apply to the special transport expenses of outlying nursery schools. (2) The cost of maintenance must not over a 3 year period exceed 41/2 percent of the ap- proved fire insurance sum (for institutions in rented premises, a corresponding amount): Pro- vided that, for institutions whose need for mainte- nance is particularly large by reason of the age of buildings, type of clientele, etc, the Minister of Social Affairs may, for 3- or 6-year periods, allow expenses of up to 2 percent per annum. (3) The cost of medical attention and dental care shall be paid by the state. 71. (1 ) Institutions for Children of preschool age shall be grant-aided for the other running A—nr ‘ g .‘__ expenses as to 40 percent by the state and as to 30 percent by the local authority. (2) Institutions for children and young per- sons attending school or above school-leaving age shall be grant-aided for the other running expenses as to 45 percent by the state and as to 35 percent by the local authority. (3) Grants under subsections (1) and (2) of this section and subsections (1) and (2) of section 70 of this Act shall be paid in advance on the basis of a budget approved by the Directorate of Child and Youth Welfare Services. Final settlement of accounts shall take place after the expiration of the financial year. (4) A special grant may be paid to institutions run at a loss out of an annual sum made available for such purpose. 72. (1) Institutions which by reason of quite special circumstances are not capable of being run under the ordinary grant arrangements may be eligible for full payment of running expenses, after deduction of receipts, within the limits of a budget previously approved by the Directorate of Child and Youth Welfare Services. Four—sevenths of the grant shall be paid by the state and three- sevenths by the local authority. (2) Permission shall be granted by the Minis- ter of Social Affairs after consultation with the Minister of Finance It may be granted only to institutions run as independent institutions, or by local authorities, or by registered societies for the care of children and young persons. (3) A board of supervision, whose members shall be appointed by the Minister of Social Affairs, shall be set up for each institution. 73. Grants may be paid for special mainte— nance purposes out of an annual sum made available for such purposes and corresponding to 1/2 percent of the approved fire insurance sums on the buildings of all recognised institutions, and corresponding amounts for institutions in rented premises. 74. (1) Grants may be paid out of an annual sum made available for new or existing institu— tions, etc, for the purchase and erection of real property, for payment of share, etc, for the layout of premises and for furniture, at the rate of up to 50 percent of the proportion of the expenses that cannot be covered by maximum mortgage loans from public funds or loans under the legislation on grant—aided building activities. (2) The state grant may be subject to the condition that the local authority makes a grant of up to the same amount. For nonmunicipal institu— tions, however, the total grants must not exceed 70 percent of the expenses. 75. (1) Grants for the payment of installments in loans and payments out of the sum made available in pursuance of section 74 of this Act may be made by way of loans pursuant to regulations made by the Minister of Social Affairs after consultation with the Minister of Finance. (2) Regulations shall be made by the Minister of Social Affairs after consultation with the Minister of Finance about the application of any surplus after receipt of grants in pursuance of section 71 of this Act. Other day-care institutions, etc. 76. Day-care institutions and similar facilities which are not recognized under section 65 of this Act or as part of general education, but admit children under 14 years of age for payment, may be established and run only with the permission of the Directorate of Child and Youth Welfare Services. The permission shall be granted with a particular person in charge and for particular premises. Supervision 77. The local Child and Youth Welfare Com- mittee shall supervise recognized or permitted day-care institutions and similar facilities through a person designated for the purpose: Provided that, as far as recognized institutions are con— cerned, the Committee may instead designate a member of the governing body or the board of supervision. CHAPTER 12 PERMISSION TO RECEIVE CHILDREN INTO CARE 78. (1) No person may receive a child under 14 years of age into private family care without the previous written permission of the local Child 53 and Youth Welfare Committee, who shall see that the conditions are satisfactory in regard to up- bringing and health, and that the placement is in the interest of the welfare of the child. (2) It shall not be permitted to receive more than four children into care, unless they are siblings. (3) The permission may be withdrawn when the conditions prior to the permission are no longer present. 79. (1) The Child and Youth Welfare Commit- tee shall supervise children under 14 years of age who are boarded out for payment in their area. (2) Where on the basis of an investigation they find that supervision is not required, the Committee shall decide to terminate it: Provided that supervision of family care of a commercial character shall not be capable of termination. 80. (1) Any person who boards out or assists in boarding out a child shall be required to verify that the home has been granted the necessary permission. (2) Any person who has been granted per— mission to receive a child into care shall notify the Child and Youth Welfare Committee when the child has been received, when the care termi- nates or changes in character, and when there is a change of address. (3) If the foster parents move to the area of another local authority, the committee serving the previous area shall inform the committee serving the new area of the care, whether or not supervi- sion has been terminated. 81. (1) The Child and Youth Welfare Commit- tee may decide that a child or young person under 18 years of age must not be removed from a foster home without good cause. The Commit- tee may also decide that a child or young person must not be returned to his parents if this would be in substantial conflict with his interests. (2) The provisions of section 30. subsections (2) to (4) of section 31, and section 32 of this Act shall apply to resolutions passed in pursuance of subsection (1) of this section. 82. (1) Any person whose application for 54 permission to receive a child into care has been refused, or whose permission has been with- drawn, may within 1 month bring the matter before the National Council of Child and Youth Welfare Services under the provisions of sections 53 to 55 of this Act. The same shall apply to any person who has been ordered not to change his place of residence or not to take home a foster child. (2) The person concerned may make an appeal to the courts from the decision of the National Council prohibiting the taking home of a child under the provisions of sections 57 to 60 of this Act. CHAPTER 13 HOMES FOR CHILDREN AND YOUNG PERSONS Certified homes 83. (1) Homes for children may be certified by the Minister of Social Affairs as eligible for grants as: (i) day nurseries; (ii) children’s homes for short-term or long- term stays; (iii) observation homes for temporary obser- vation; (iv) school homes for children in need of special support in regard to education and up- bringing; (v) treatment homes for children whose be- havior disorders require a particularly thorough psycho—educational treatment; (vi) homes for other special purposes. (2) The certification of the homes referred to in paragraph (ii) of subsection (1) of this section may be limited to cover short-term stays only. School homes may be certified for the particular purpose of receiving children of subnormal intelli- gence and retarded development. 84. (1) Homes for young persons may be certified by the Minister of Social Affairs as eligible for grants as: (1) youth homes for short-term or long-term stays; (ii) observation homes for temporary obser- vation; ”2—4,-"- (iii) treatment homes for young persons whose behavior disorders require a particularly thorough psycho-educational treatment; (iv) hostels for young persons in need of special support during training or occupational adjustment; (v) homes for other special purposes. (2) The certification of the homes referred to in paragraph (i) of subsection (1) of this section may be limited to cover short—term stays only. Homes of that type may also be certified for the particular purpose of receiving young persons of subnormal intelligence and retarded develop- ment. 85. In connection with homes for children and young persons particularly suited for the purpose, the Minister of Social Affairs may ap- prove foster-home arrangements as eligible for grants. 86. (1 ) Homes for children and young per- sons may be run by the state, or as independent institutions, or by local authorities, or by registered societies for the care of children and young persons: Provided that, in special cases, homes run otherwise may be certified. _ (2) The certification shall be subject to the condition that the governing body (the board of supervision) of the institution, the person in charge of it, as well as its rules and premises, are approved by the Minister of Social Affairs. (3) Prior to certification a statement shall be obtained from the Child and Youth Welfare Com- mittee through the local council. (4) The establishment or alteration of an institution shall be subject to previous approval of the plans relating to the layout and activities of the home. 87. The Minister of Social Affairs shall make regulations on: (i) the layout, conduct, and running of homes for children and young persons; (ii) the educative work to be carried out by the institutions; (iii) medical attention, medical treatment, and dental care; (iv) salaries, housing, pensions, training, and other conditions of employment for persons in charge of homes and members of staff. The rules governing salaries shall be determined on the principles of the Civil Servants Act. 88. (1) The general education of the clientele of homes for children and young persons shall preferably take place in the ordinary primary school or other state or municipal school. (2) The Minister of Social Affairs shall, after consultation with the Ministry of Education, ap— prove the curricula of the instruction provided by homes for children and young persons. The instruction must not be inferior to any other similar public instruction. 89. (1) Certified homes for children and young persons shall be required to accept chil- dren or young persons whom the Child and Youth Welfare Committee want to be accommodated and maintained in the home, provided its capacity so permits and such placing is in accordance with the rules of the institution, and the conditions of the home do not militate against it. Any disagreement between committee and institution about the accommodation shall be decided by the Directorate of Child and Youth Welfare Serv- ices. (2) Homes established by the state or run on the account of the state, and homes whose deficit is covered by the state, apart from day nurseries, may accept admissions only with the previous permission of the Directorate. Rules governing payment of grants 90. (1) The Child and Youth Welfare Commit- tee responsible for the care of a child or young person accommodated and maintained in a certi- fied home shall pay a grant at a specified rate per day: Provided that, for persons over 16 years of age, the grant shall be paid by the state. (2) The rate of the grant shall be fixed every year in the month of March for the coming financial year by the Minister of Social Affairs after consultation with the Minister of Finance. (3) Similarly, the Minister of Social Affairs shall determine the rate to be charged for private placings in certified homes for children and young persons. The governing body or board of super- vision of a home may depart from that rate, if 55 warranted by the circumstances in the particular case. 91. (1) Certified homes for children and young persons not run by the state shall be fully reimbursed by the state for payment of interest and installments on mortgage loans approved by the Minister of Social Affairs and for payment of taxes, duties, insurance, and maintenance relating to real property, and rent. (2) The cost of maintenance of each home cannot normally over a 3—year period exceed 41/2 percent of the approved fire insurance sum of the buildings. For buildings which are not insured against fire, the cost of maintenance shall be similarly fixed on the basis of a special assess- ment approved by the Minister of Social Affairs: Provided that, in the case of homes whose need for general maintenance is particularly large by reason of the clientele of the home, the age, type, etc., of buildings, the Minister may, for 3- or 6— year periods, allow maintenance expenses of up to 2 percent per annum of the fire-insurance sum or the specially assessed sum. (3) The state also pays the expenses on medical and dental attention as well as medical, dental, and hospital treatment. 92. (1) For observation homes, treatment homes, school homes, and youth homes referred to in paragraphs (iii) to (v) of subsection (1) of section 83 and paragraphs (i) to (iii) of subsection (1) of section 84 of this Act, the state shall fully reimburse the homes for other running expenses after deduction of receipts within the limits of a budget previously approved by the Directorate of Child and Youth Welfare Services. Homes other than those mentioned may, as decided by the Minister of Social Affairs after consultation with the Minister of Finance, benefit from these arrange- ments, if indicated for special reasons. (2) Any institution in receipt of grants in pursuance of subsection (1) of this section shall be run as an independent institution, or by a registered society for the care of children and young persons, or by one or more local authori- ties. (3) A board of supervision, whose members shall be appointed by the Minister of Social Affairs, shall be set up for each institution. 56 93. (1) Certified homes for children and young persons which are not covered by the grant arrangements referred to in section 92 of this Act shall be grant-aided by the state at a percentage (to be fixed every year for each type of institution) of the running expenses after deduc- tion of the expenses referred to in section 91 of this Act and the receipts of the institution, aside from grants paid in proportion to the number of children. The procedure set out in subsection (2) of section 90 of this Act shall be applied in the determination of the percentage. (2) Grants payable in pursuance of subsec- tion (1) of this section and section 91 of this Act shall be paid in advance on the basis of a budget approved by the Directorate of Child and Youth Welfare Services. The final settlement of accounts shall take place after the expiration of the ac- counting year. (3) Special grants may be paid to institutions run at a loss out of an annual sum made available for such purpose. 94. (1) Grants may be paid for special maintenance purposes out of an annual sum made available for such purposes and corre- sponding to 1/2 percent of the approved building fire—insurance sums of all certified institutions. (2) Payments toward the improvement of existing homes for children and young persons, inter alia for necessary alterations, extensions. and sewage, water supply, and roads, as well as for the establishment of new institutions, may be made out of an annual sum made available for such purposes. Such payments may be made only where the work costs will not exceed 50,000 kr. That maximum sum shall be regulated by the Minister of Social Affairs according to the trend of officially registered building costs. Major building projects may be carried out only after consultation with the authority empowered to make grants. (3) Payments toward the installation of new homes and for the purchase of furniture of a more permanent value and of technical equipment for existing homes may be made out of an annual sum made available for such purposes. 95. (1) Regulations may be made by the Minister of Social Affairs, after consultation with the Minister of Finance, for aid in pursuance of section 91 of this Act for the payment of install- ments on loans and grants paid out of the special sums referred to in subsections (2) and (3) of section 94 of this Act to be made as a loan. (2) Regulations shall be made by the Minister of Social Affairs, after consultation with the Minister of Finance, for the application of any surplus after receipt of grants under section 93 of this Act. Other homes for children and young persons 96. (1) Homes for children and young per- sons and any similar institutions capable of receiv- ing five or more children under 18 years of age and not certified as eligible for grants shall be required to obtain previous permission from the Directorate of Child and Youth Welfare Services for their establishment and operation. (2) Permission shall be given for a particular person to be in charge of the institution and for particular premises. (3) Prior to the first permission, a statement shall be obtained from the local Child and Youth Welfare Committee. (4) The Minister of Social Affairs shall make regulations about medical attention and about the layout and conduct of the institutions. Supervision 97. Homes for children and young persons shall be subject to supervision by the Child and Youth Welfare Committee in whose area the institution is situated: Provided that this shall not apply to institutions run by a local authority but situated outside their area, nor to homes having a board of supervision appointed by the Minister of Social Affairs. CHAPTER 14 PAYMENT FOR THE CARE OF CHILDREN AND YOUNG PERSONS 98. (1) Where children and young persons under 18 years of age are maintained apart from their parents by the intervention of a Child and Youth Welfare Committee, the persons having the parental rights over the particular child or young person shall be required to meet, wholly or in part, the expenses involved. The payment shall be fixed by the Committee having regard to the financial conditions of the person liable to pay under rules of guidance to be laid down by the Minister of Social Affairs. (2) If warranted by the circumstances, the Committee may, wholly or in part, exempt parents from paying or remit any payment due. (3) A decision about payment may be varied by the Committee in the event of change of circumstances. (4) Regarding collection and recovery, etc, of the payment, the rules governing the collection of personal taxes shall apply. Payment may also be recovered through distraint under the provi- sions of chapter 54 of the Administration of Justice Act. 99. (1) A child or young person who is maintained apart from his parents by the interven- tion of a Child and Youth Welfare Committee may be ordered to pay for his maintenance according to his means. The Minister of Social Affairs shall make regulations governing the determination, securing, and application of the payment. (2) The provisions of subsections (2) and (3) of section 98 of this Act shall apply mutatis mutandis. 100. The decisions of the Child and Youth Welfare Committee on payment by parents and on the application of the child’s or young person’s capital or income from securities, etc, may, within 1 month, be brought before the National Council of Child and Youth Welfare Services by the parents or the guardian. The decision of the National Council shall not be subject to appeal to any other administrative authority. CHAPTER 15 SOCIETIES FOR THE CARE OF CHILDREN AND YOUNG PERSONS 101. Voluntary societies may be registered by the Minister of Social Affairs as entitled to carry out activities in the field of child and youth care, inter alia relating to the boarding-out of children under this Act, to the supervision of foster chil- 57 dren, to the care of children and young persons away from their homes, and to aftercare. A society may at any time be removed from the register. 102. (1) The Minister of Social Affairs shall make regulations on the direction, accounting, auditing, and annual reporting of registered soci- etles. (2) The activities of voluntary societies shall be carried out in accordance with rules approved by the Minister of Social Affairs in respect to each society. The approval shall, as far as possible, take account of the characteristics of each soci— ety. 103. Registered societies may be eligible for state grants under rules to be laid down by the Minister of Social Affairs. Grants paid to recog- nized institutions provided or run by the societies shall be made under the provisions of chapters 10, 11, and 13 of this Act. CHAPTER 16 REIMBURSEMENT AND AUDITING, ETC. 104. (1) Any' expenses defrayed by a local authority in connection with payment of assistance under this Act (child care expenses) shall be reimbursed by the state as to three-tenths, while four-tenths shall be subject to inter-municipal reimbursement under the relevant provisions of the National Assistance Act. The remaining part. viz., three-tenths. shall be borne by the local authority itself. ' (2) Provided that expenses on assistance to young persons over 16 years of age who, with the consent of the Directorate, have been accom- modated in school homes, youth homes, or treat- ment homes. shall be fully reimbursed by the Exchequer. 105. (1) Office expenses and similar admin- istrative expenses shall not be subject to reim- bursement. This shall apply also to expenses on family guidance under the provisions of chapter 3 of this Act, if not approved under section 19 of this Act. (2) As for expenses on day-care institutions 58 and similar institutions, as well as homes for children and young persons, the local authority may, aside from grants paid under chapters 11 and 13 of this Act to institutions run by the local authority, claim reimbursement only in proportion to the charges fixed for the institutions. The same shall apply to hospital expenses. (3) Any questions of doubt as to which expenses may be approved as child-care ex- penses shall be decided by the Directorate of Child and Youth Welfare Services. 106. (1) Any reimbursement on the part of a local authority (other than the authority in whose area the care is exercised) of the proportion of the child care expenses to be borne by a local authority shall be subject to similar rules to those of the National Assistance Act governing reim- bursement from a local authority in whose area the recipient formerly resided. as regards other public assistance. (2) The local authority liable for children maintained apart from their parents under this Act shall, as long as they remain in care. be the same authority that was liable at the commencement of the care. (3) Any doubt as to which localauthority is liable shall be decided by the Directorate of Child and Youth Welfare Services. 107. (1) The state shall make the necessary grants toward the training of persons to be in charge of child and youth care institutions and of members of staff. . (2) The state shall .make grants to the Child Care Pension Fund in accordance with the rules of the Fund, which shall be approved by the Minister of Social Affairs after consultation with the Minister of Finance. 108. ( 1) Of state expenditure on: (i) grants under the second sentence of subsection (1) of section 90 of this Act; (it) grants payable to homes for children and young persons under sections 91 to 94 of this Act; (iii) training of persons to be in charge of institutions and of members of staff under subsec- tion (1) of section 107 of this Act; (iv) the Child Care Pension Fund under subsection (2) of section 107 of this Act; and (v) after care under section 51 of this Act; three—twentieths shall be charged to the local authorities of the country under the rules govern- ing inter-municipal reimbursement of the National Assistance Act. (2) Four-tenths of the state expenditure on child and youth guidance centers under section 63 of this Act shall be charged under the same rules. 109. Calculation and payment of reimburse- ment to the local authorities, as well as auditing of local authority accounts on expenses under this Act, shall be made in pursuance of the provisions of the National Assistance Act. CHAPTER 17 PENAL CLAUSES 110. Any contravention of the provision of subsection (1) of section 22 of this Act shall be liable to be punished by a fine or simple deten- tion. 111. (1) Any person who, for the examination of cases under this Act, makes untrue or mislead- ing statements shall, unless a more severe penalty is incurred under the Civil Criminal Code, be liable to a fine or, in aggravating circumstances, to simple detention for a term not exceeding 3 months. (2) The same penalty shall apply to any person who: (i) fails to comply with an order made in pursuance of section 27 of this Act; or (ii) acts in contravention of an order not to visit a child accommodated by the Child and Youth Welfare Committee. 112. Any person who prompts or helps a child or young person who is maintained apart from his parents in pursuance of this Act to escape or harbors the escaped shall be liable to simple detention or to imprisonment for any term not exceeding 2 years or, in extenuating circum— stances, to a fine. 113. (1) Any person who, contrary to the provisions of this Act, places or receives a child into care, removes a child from its foster-home, or fails to make such notification as is required under regulations made in pursuance of subsection (2) of section 18 of this Act shall be liable to a fine. (2) The same penalty shall apply to any person who, contrary to the provisions of section 76 or section 96 of this Act, establishes or maintains day—care institutions and similar institu— tions or homes for children and young persons, or acts in contravention of the rules made under those provisions. 114. (1) Any person who takes part in the administration of this Act shall be bound to secrecy as to what comes to his knowledge in the examination of cases relating to children and young persons. (2) The provisions of the Civil Criminal Code on offences committed while exercising a public office or function shall apply, even though the function is subject to public election. CHAPTER 18 TRANSITIONAL AND FINAL PROVISIONS 115. (1) This Act shall come into force on April 1, 1965. (2) At the same time, the Children and Young Persons Act, No. 170, of May 31, 1961 shall be repealed: Provided that the provision of subsec- tion (3) of section 93 of that Act about the payment by a local authority of the school teach- ing of a child outside the area in which he resides shall remain in force until March 31, 1968. The payment shall be fixed for the last time under the prescribed rules for the financial year 1964—65. The following years the payment shall be reduced each year by 25 percent of that amount. (3) Any arrangements for the care of children and young persons under the Act repealed and under the National Assistance Act of May 20, 1933 shall remain in force until they are terminated in pursuance of this Act. (4) This Act shall not extend to the Faroe Islands or Greenland. 59 “4,. w APPENDIX III A Survey of the Characteristics of 80 Families in the Family-Guidance Program in Copenhagen Municipality in 1969. LIVING SITUATION OF THE CHILDREN 55 living with both parents 106 living with mother alone 3 living with father alone 1 living with father and stepmother 18 living with mother and stepfather 3 living with other guardians 186 Total LIVING SITUATION OF THE PARENTS 25 parents living together (stepfathers & step— mothers included) 53 mothers alone 2 fathers alone 80 families total PARENTS’ AGE Fathers Mothers under 20 0 under 20 2 2024 3 20-24 14 25-29 6 25-29 17 30-34 4 30-34 22 35-39 6 35-39 6 40-44 3 40-44 3 45-49 2 45-49 3 50-54 1 50-54 5 55—59 1 55 and over 0 60 and over 0 no information 6 no information 1 PARENTS” CHRONIC ILLNESSES Father Bad nerves Depression Schizophrenia Alcoholism Migraine Headaches Bad kidneys Back problems No information 62 A-A-L—L—LN—L—Lm _.| Mother Bad nerves Nervous symptoms Internal female problems Eczema Back problems Varicose veins Inflammation of the veins Inflammation of the nervesI Overweight Respiratory diseases Irritation of the large intestine Heart defects Rheumatoid arthritis Kidney problems No information PARENTS’ COMBINED INCOME Weekly Salary N w-A-L-L-A-LM‘ANQQQOAO (A) Under $1 7 $1 7-$34 $34-$51 $51 -$68 $68-$85 $85-$102 $102-$1 19 $1 1 9—$136 $136-$1 53 $153-$1 70 over $1 70 OCO—tww—BGJCDNNO Total Monthly Salary (.0 N Under $1 36 $1 36-$204 $204—$272 $272-$304 $340—$408 $408—$4 76 $476—$544 $544-$631 2 over $612 ONO—‘AV—‘UIO Total _A \I ' $55; ' ’ ’ 17-“? Other Income Children's allowance Home allowance Widow's allowance Taxi rides Home helper Craftsman in periods Cleaning in periods Lose work - N—L—L—A—LN—Ao Total PARENTS’ PROFESSION Fathers A. CD Unskilled laborer Construction worker Chauffeur Semi-skilled worker Dock worker Printing worker Printer Warehouse worker Office clerk Ship steward Artist Dairy worker Building super. Photographer's assis. Apprenticeship Re-education No information Mothers O)_L_L_L_A—L_.L_L_L—_A._L_L_L_mew Cleaning woman Housewife Factory worker Office clerk Home helper Hospital worker Cafeteria worker Pre-professional training Switchboard operator Sandwich lady Draftsman Librarian Bookkeeper Child care No information CO—‘A—‘AANNNNACDGJGJO M PARENTS’ EDUCATION Father 9th grade , 1 10th grade" 11th‘grade Middle school No information @4440) Mother 7th grade 8th grade 9th grade 4 10th grade 11th grade 12th grade Middle school High school J'r. college Non-accredited course No information (DUI—t—‘MN-k-hCOCO—F EARLIER MARRIAGES Father Mother .1. NCO l: 2: 6 3. PARENTS’ RECREATIONAL ACTIVITIES Father TV Family Car drives Animals Aquarium fish Fishing Painting No information co-a-a—‘amcom ..L Mother TV 1 Family Parents‘ club Reading Car drives ' Animals Drawing and painting ma—nwmmm 63 Art 1 Music 1 Ceramics 1 Lamps 1 Sex 1 Boyfriend 1 No information 36 CHILDREN’S AGES Boys Girls 0-3 23 0-3 20 3-6 26 4-6 25 7-9 19 7-9 18 10-12 17 10—12 13 13-15 13 13-15 9 1818 4 16-18 5 over 18 1 over 18 1 Total 1 03 Total 91 CHILDREN’S EDUCATION Nursery school 2 3rd Grade 20 4th Grade 7 5th Grade 12 6th Grade 8 7th Grade 7 8th Grade 6 91h Grade 11 10th Grade 6 11th Grade 1 High School Diploma 4 Extra help/reading 10 Non-accredited/post graduate 2 Technical school 2 DAY TIME INSTITUTIONS Infant Day Care 8 Private Day Care 15 Nursery School 28 After-School Day Care 37 After-School Club 4 Youth Club 64 CHILDREN’S CHRONIC ILLNESSES Enuresis Bad nerves Epilepsy Bronchitis Asthma Cough Chronic colds Thyroid Overweight Ear infections Kidney disease Bladder infection Psoriasis Heart disease Poor vision Hernia Club foot Mental retardation Drug abuse Criminality No information REMARKS CONCERNING CHILDREN (o—A—L—L—Jd—‘d—‘waw—‘V—‘wamm _L (.0 On waiting list for a day institution Behavioral problems Criminality Spoiled Very active Harmonious Children’s hospital Home teacher (because of illness) Boy/Girl Scouts Pre-apprenticeship position Children’s Home child School difficulties Trusting Trainee in a nursery school Educated by Mother’s Aid Diagnostic Center A bit over-protected Weak character AA—A—L—Addd—A—A—A—Amwwwwm FAMILY GUIDANCE’S EVALUATION OF THE FAMILY’S TOTAL SITUATION ABOVE BELOW TOTAL EXCELLENT AVERAGE AVERAGE AVERAGE POOR FAMILIES Intelligence 1 14 45 14 0 74 Cohesiveness 13 25 23 12 1 74 School & work stability 11 18 22 18 1 70 Living conditions 16 22 1O 16 9 73 Adjustments to public 12 26 23 12 2 75 institutions Economic status 4 1O 21 24 12 71 Ability to administer economy 12 21 21 10 7 71 FAMILY REQUESTS ASSESSMENT OF NEEDS BY FAMILY ADVISOR Financial assistnace 17 Financial assistance 7 Assistance in budget planning 5 Assistance in budget planning 4 Place in institution 13 Place in institution 12 Assistance in finding new housing 13 Assistance in finding new housing 10 Entrance to educational program 12 Entrance to educational program 10 Stabilization of working situation 7 Stabilization of working situation 5 Rehabilitation 2 Rehabilitation 9 Continue education (return to school) 2 Continue education (return to school) 1 Ongoing supportive contact 7 Ongoing supportive contact 7 Child-rearing advice 5 Child—rearing advice 14 Assistance in dealing with public authorities 3 Assistance in dealing with public authorities 1 Marriage counseling 2 Marriage counseling 1 Payment for day care 2 Payment for day care 2 Language club 1 Language club 1 Accommodation of children 1 Accommodation of children 2 Psychological support to fatherless children 1 Psychological support to fatherless children 2 Narcotics problem 1 Narcotics problem 1 Communicaion problem 1 Family counseling 3 Counseling on children and housekeeping 1 Assistance with invalid pension 1 Parent Club 1 Preventive removal (of child) 2 Satisfied 1 Evaluation of children 1 Did not think there was a need for family Observation of mother and child 1 counseling 2 No requests 3 Socially adapted 1 Scaling down 3 7% US. GOVERNMENT PRINTING OFFICE: 1978 0—248—202 65 v DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION National Institute of Mental Health 5600 FISHERS LANE ROCKVILLE, MARYLAND 20857 POSTAGE AND FEES PAID OFFICIAL BUSINESS ”'8' DEPAEEVVEgg OF H'E'W' Penalty for private use, $300 THI R D CLASS BU L K RATE NOTICE OF MAILING CHANGE El Check here if you wish to discontinue receiving this type of publication. E1 Check here if your address has changed and you wish to continue receiving this type of publication. (Be sure to furnish your complete address including zip code.) Tear off cover with address label still affixed and send to: Alcohol, Drug Abuse, and Mental Health Administration Printing and Publications Management Section 5600 Fishers Lane (Rm. 6-105) Rockville, Maryland 20857 DHEW Publication No. (ADM) 77-512 Printed 1978 U.C. BERKELEY LIBRARIES mm ”III CDHSH7033u