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Report on academy study
The Academy Study of Child Health Services REPORT
ON
ACADEMY
STUDY
Under title of The Social Aspects of Medicine in the March issue of the JOURNAL, Dr. Park has thrown an aura of suspicion over the true parentage of the Academy's war baby-now more respectfully known as ~ T h e Study of Child Health Servi,~es." Partly in order to forestall the appointment of ~'another committee to investigate," Mthough there is nothing to hide, those of us concerned with rearing this child wish to clarify for Dr. Park and his readers ~ t h i s mysterious affair.'~ More particularly, however, we ~re eager to describe the extent to which many friends of the Academy have supported this infant prodigy and have once more demonstrated their faith in the activities of the Academy.
Relationship of tke United States Public Health Service and Children's Bureau.--l~ is apparent that there still exists considerable doubt and misgiving arising from the fact that the United States Public Health Service and the Children's Bureau have been asked to assist in the organization and conduct of this Study. This action was taken in accordance with a recommendation presented to the Academy membership at its annual meeting in November, 1944: " T h a t the American Academy of Pediatrics requests the United States Public Kealth Service and Children's Bureau to undertake with the Academy a survey in every state to determine . . . information concerning the present situation and extension of personnel and facilities needed in each state to meet the objectives as s t a t e d . " Those who wish to refer to the full report will find it published in the JOURNAL (J. Pediat. 25: 625, December, 1944). This recommendation having been unanimously approved in open meeting, it naturally followed that Dr. Parran and Dr. Martha Eliot were asked to cooperate with the Academy in this Study. Both responded with wholehearted support, contributing the full-time services of expert medicM and statistical personnel and equipment. Cooperative planning was begun and at the same time it was made clear that the control of the project was to remain in the hands of the Academy. Thus there has been established an effective and happy working relationship wherein the authority of the Academy has at no time been questioned. In view of the desirability of working in close proximity to the two cooperating government agencies, a Central Office was set up in Washington to serve as headquarters for the Director and Executive Staff. Washington was chosen for the Central Office with some hesitation since this location might be interpreted by some as indicating that the Study is a government project. I t very definitely is not a government project. The l)ireetor is paid by and answerable to the Academy of Pediatrics; the personnel who are on loan from the government agencies are under his direction. The responsibility for the success of the undertaking belongs to the Academy. Instead of viewing with suspicion and misgiving the intentions of those who recommended this cooperation they should be commended for a step without which the Academy would now find itself in an embarrassing plight. I t is fair to state that these planners wrought better than they knew. No one at the outset appreciated the enormous mass of statistical data to be collected or the labor involved in adequate analyses. The Academy does not have at its disposal the necessary statistical facilities or in fact the personnel or experience to undertake a task of such broad scope. Even we at the Central Office appreMute that we do not yet fully visualize all that is involved in drawing together, coding, and tabulating information frmn all hospitals, medical schools, health services, and physicians throughout the country. 756
ACADEMY STUDY OF CHILD HEALTH SERVICES
757
Questions have also been raised with regard to who is to interpret the information and the purpose to which the results of the Study will be put. The function of the Study as it is now organized is to obtain factual material. Much confusion will be avoided i f it is kept clearly in mind that this Study is to be considered only as the first step toward the attainment of the Academy's objective which, briefly stated, is to make available throughout the country improved and more evenly distributed medical care for children. At the close of the Study the material will be presented in a report which will be available to all who care to use it. This report will be limited to a presentation of factual data ,lad will not include broad interpretations or recommendations. A program of action resulting from this report will be a responsibility of the Academy at a later date. Only after the facts are known can a fair estimate be made of the interpretations and opinions that may arise from them. In addition to publishing an over-all report, information gathered through the State Programs now under way will be returned to State chairmen of the Academy in tabular form broken down to State, County, or Metropolitan levels. I t is hoped thereby to stimulate local groups to evaluate the services within their own communities as a basis for local planning. The responsibility for collecting and reporting the desired information and also the relationship between the American Academy of Pediatrics, the United States Public Health Service and the Children's Bureau have been repeatedly described at many meetings of the Academy. However, there are many who have been unable to attend these meetings and have not had the opportunity to become fully informed, of whom some still seem to be suspicious of the motives of the government agencies, partieuarly the Children's Bureau. So again in order to allay any lingering misgivings it is worth reiterating that there is no intention on the part of anyone to use this Study for any dire motive. If, after the facts are gathered wad the Academy has drawn up a program based upon them, there are tho~e who wish to oppose that p r o g r a m - - a n d it is hard to believe that such will not be the c a s e - then pediatricians themselves will be able to support their cause by a background of factual data which is now lacking.
National Foundation for Infantile Paralysls.--When the Study was first undertaken not only was its scope underestimated but also its cost. At the outset the Academy appropriated $8,000 from its reserve fund. More recently it has added another $10,000 to its appropriation which altogether represents a large proportion of its total reserve fund. This is clear evidence of the earnestness with which the Academy is meeting its own commitment. But even so this is a relatively small proportion of the total expense. I t was apparent that grants of major proportions would be needed to help the Academy in this project. The National Foundation for Infanti'_e Paralysis was one of the first sources to which the Academy looked for help. This Foundation is particularly concerned with improving the resources for one aspect of pediatric care and showed immediate interest in the Academ y ' s Study. A f t e r a detailed examination of the proposed plan the Foundation has made a grant of $116,000 for a two-year period. I t is intended that this grant should cover the expenses involved in maintaining the large staff for which the Academy is responsible in the Central Office, salaries and expenses of Regional Directors, cost of preparing and printing questionnaire schedules and publicity material, and general operating expenses of the Central Office. This grant, although generous, is not expected to take care of the cost of State programs throughout the country. However, at the State level the National Foundation for Infantile Paralysis has again come to our support. A memorandum has been sent from the National Headquarters of the Foundation to all their field representatives urging them to encourage County Chapters to give not only moral support but also financial assistance to State programs when asked to do so by the State Chairmen of the Academy. Whether or not financial support is obtained at the State level from the National Foundation it is considered desirable from the point of view of the mutual interests of the Foundation and the Academy that their field representatives and other persons interested in the
758
THE JOURNAL
OF PEDIATRICS
County Chapter activities should cooperate in accepting appointments to the Academy State Advisory Committees. The Central Office of the Study has already received word from many States demonstrating the willingness of the Foundation to offer generous support to State chairmen.
Further Fi~mncial S~pport.--In order to stand on as broad a basis as possible in financing this major effort, the Academy has sought support from several of the larger Foundations and also from several of the commercial firms which have special pediatric interest. The Kellogg Foundation has expressed its approval of the Study and has offered to appoint one or more of its trained field workers to assist in the collection of data. A letter has recently been received from the Executive Vice-President of the Field Foundation stating that tile Directors of this Foundation have voted a contribution, the amount of which has not yet been specified. The services of the Executive Director of the New York State Study have been contributed by the Metropolitan Life Insurance Company. Generous supi)ort has been received from Mead Johnson and Company, M and R Dietetic Laboratories, Carnation Company, the Pet Milk Company. Leder]e Laboratories, Inc., has also stated that they would make a contribution which has not yet been received. I n addition to these grants received by the Central Office, State Chairmen who are responsible for financing State Programs from within each State have received financial contributions from many different sources. So far it appears evident that they have been able to do so without undue difficulty. Support at the State level from the National Foundation for Infantile Paralysis has already been described. I n many cases the State Health Department has met part or all of the expenses of the State program by funds available under Title V of the Social Security Act. A few States have sought and received grants from local ]~oundations. In certain areas contributions have been requested of the pediatricians themselves. The American Academy of Pediatrics is indeed fortunate in the number of friends who may always be counted upon to come forward and assist its activities. The happy relationships which this Study is promoting throughout the country are well demonstrated by the following quotation from a recent letter of Dr. Theodore E. Allen~ Executive Secretary for the Metropolitan New York area: ~ T h e response to our never ending letters asking for sponsorship for this Study has continued to be a very happy one. I t is a pleasure to open the mail in the morning and see in how many d~fferent way~ agencies and individuals can say they are pleased to help our p r o j e c t . " JOHN P. HUBBARD. M.]).
ON
ACADEMY
STUDY
Under title of The Social Aspects of Medicine in the March issue of the JOURNAL, Dr. Park has thrown an aura of suspicion over the true parentage of the Academy's war baby-now more respectfully known as ~ T h e Study of Child Health Servi,~es." Partly in order to forestall the appointment of ~'another committee to investigate," Mthough there is nothing to hide, those of us concerned with rearing this child wish to clarify for Dr. Park and his readers ~ t h i s mysterious affair.'~ More particularly, however, we ~re eager to describe the extent to which many friends of the Academy have supported this infant prodigy and have once more demonstrated their faith in the activities of the Academy.
Relationship of tke United States Public Health Service and Children's Bureau.--l~ is apparent that there still exists considerable doubt and misgiving arising from the fact that the United States Public Health Service and the Children's Bureau have been asked to assist in the organization and conduct of this Study. This action was taken in accordance with a recommendation presented to the Academy membership at its annual meeting in November, 1944: " T h a t the American Academy of Pediatrics requests the United States Public Kealth Service and Children's Bureau to undertake with the Academy a survey in every state to determine . . . information concerning the present situation and extension of personnel and facilities needed in each state to meet the objectives as s t a t e d . " Those who wish to refer to the full report will find it published in the JOURNAL (J. Pediat. 25: 625, December, 1944). This recommendation having been unanimously approved in open meeting, it naturally followed that Dr. Parran and Dr. Martha Eliot were asked to cooperate with the Academy in this Study. Both responded with wholehearted support, contributing the full-time services of expert medicM and statistical personnel and equipment. Cooperative planning was begun and at the same time it was made clear that the control of the project was to remain in the hands of the Academy. Thus there has been established an effective and happy working relationship wherein the authority of the Academy has at no time been questioned. In view of the desirability of working in close proximity to the two cooperating government agencies, a Central Office was set up in Washington to serve as headquarters for the Director and Executive Staff. Washington was chosen for the Central Office with some hesitation since this location might be interpreted by some as indicating that the Study is a government project. I t very definitely is not a government project. The l)ireetor is paid by and answerable to the Academy of Pediatrics; the personnel who are on loan from the government agencies are under his direction. The responsibility for the success of the undertaking belongs to the Academy. Instead of viewing with suspicion and misgiving the intentions of those who recommended this cooperation they should be commended for a step without which the Academy would now find itself in an embarrassing plight. I t is fair to state that these planners wrought better than they knew. No one at the outset appreciated the enormous mass of statistical data to be collected or the labor involved in adequate analyses. The Academy does not have at its disposal the necessary statistical facilities or in fact the personnel or experience to undertake a task of such broad scope. Even we at the Central Office appreMute that we do not yet fully visualize all that is involved in drawing together, coding, and tabulating information frmn all hospitals, medical schools, health services, and physicians throughout the country. 756
ACADEMY STUDY OF CHILD HEALTH SERVICES
757
Questions have also been raised with regard to who is to interpret the information and the purpose to which the results of the Study will be put. The function of the Study as it is now organized is to obtain factual material. Much confusion will be avoided i f it is kept clearly in mind that this Study is to be considered only as the first step toward the attainment of the Academy's objective which, briefly stated, is to make available throughout the country improved and more evenly distributed medical care for children. At the close of the Study the material will be presented in a report which will be available to all who care to use it. This report will be limited to a presentation of factual data ,lad will not include broad interpretations or recommendations. A program of action resulting from this report will be a responsibility of the Academy at a later date. Only after the facts are known can a fair estimate be made of the interpretations and opinions that may arise from them. In addition to publishing an over-all report, information gathered through the State Programs now under way will be returned to State chairmen of the Academy in tabular form broken down to State, County, or Metropolitan levels. I t is hoped thereby to stimulate local groups to evaluate the services within their own communities as a basis for local planning. The responsibility for collecting and reporting the desired information and also the relationship between the American Academy of Pediatrics, the United States Public Health Service and the Children's Bureau have been repeatedly described at many meetings of the Academy. However, there are many who have been unable to attend these meetings and have not had the opportunity to become fully informed, of whom some still seem to be suspicious of the motives of the government agencies, partieuarly the Children's Bureau. So again in order to allay any lingering misgivings it is worth reiterating that there is no intention on the part of anyone to use this Study for any dire motive. If, after the facts are gathered wad the Academy has drawn up a program based upon them, there are tho~e who wish to oppose that p r o g r a m - - a n d it is hard to believe that such will not be the c a s e - then pediatricians themselves will be able to support their cause by a background of factual data which is now lacking.
National Foundation for Infantile Paralysls.--When the Study was first undertaken not only was its scope underestimated but also its cost. At the outset the Academy appropriated $8,000 from its reserve fund. More recently it has added another $10,000 to its appropriation which altogether represents a large proportion of its total reserve fund. This is clear evidence of the earnestness with which the Academy is meeting its own commitment. But even so this is a relatively small proportion of the total expense. I t was apparent that grants of major proportions would be needed to help the Academy in this project. The National Foundation for Infanti'_e Paralysis was one of the first sources to which the Academy looked for help. This Foundation is particularly concerned with improving the resources for one aspect of pediatric care and showed immediate interest in the Academ y ' s Study. A f t e r a detailed examination of the proposed plan the Foundation has made a grant of $116,000 for a two-year period. I t is intended that this grant should cover the expenses involved in maintaining the large staff for which the Academy is responsible in the Central Office, salaries and expenses of Regional Directors, cost of preparing and printing questionnaire schedules and publicity material, and general operating expenses of the Central Office. This grant, although generous, is not expected to take care of the cost of State programs throughout the country. However, at the State level the National Foundation for Infantile Paralysis has again come to our support. A memorandum has been sent from the National Headquarters of the Foundation to all their field representatives urging them to encourage County Chapters to give not only moral support but also financial assistance to State programs when asked to do so by the State Chairmen of the Academy. Whether or not financial support is obtained at the State level from the National Foundation it is considered desirable from the point of view of the mutual interests of the Foundation and the Academy that their field representatives and other persons interested in the
758
THE JOURNAL
OF PEDIATRICS
County Chapter activities should cooperate in accepting appointments to the Academy State Advisory Committees. The Central Office of the Study has already received word from many States demonstrating the willingness of the Foundation to offer generous support to State chairmen.
Further Fi~mncial S~pport.--In order to stand on as broad a basis as possible in financing this major effort, the Academy has sought support from several of the larger Foundations and also from several of the commercial firms which have special pediatric interest. The Kellogg Foundation has expressed its approval of the Study and has offered to appoint one or more of its trained field workers to assist in the collection of data. A letter has recently been received from the Executive Vice-President of the Field Foundation stating that tile Directors of this Foundation have voted a contribution, the amount of which has not yet been specified. The services of the Executive Director of the New York State Study have been contributed by the Metropolitan Life Insurance Company. Generous supi)ort has been received from Mead Johnson and Company, M and R Dietetic Laboratories, Carnation Company, the Pet Milk Company. Leder]e Laboratories, Inc., has also stated that they would make a contribution which has not yet been received. I n addition to these grants received by the Central Office, State Chairmen who are responsible for financing State Programs from within each State have received financial contributions from many different sources. So far it appears evident that they have been able to do so without undue difficulty. Support at the State level from the National Foundation for Infantile Paralysis has already been described. I n many cases the State Health Department has met part or all of the expenses of the State program by funds available under Title V of the Social Security Act. A few States have sought and received grants from local ]~oundations. In certain areas contributions have been requested of the pediatricians themselves. The American Academy of Pediatrics is indeed fortunate in the number of friends who may always be counted upon to come forward and assist its activities. The happy relationships which this Study is promoting throughout the country are well demonstrated by the following quotation from a recent letter of Dr. Theodore E. Allen~ Executive Secretary for the Metropolitan New York area: ~ T h e response to our never ending letters asking for sponsorship for this Study has continued to be a very happy one. I t is a pleasure to open the mail in the morning and see in how many d~fferent way~ agencies and individuals can say they are pleased to help our p r o j e c t . " JOHN P. HUBBARD. M.]).