PEDIATRICS Vol. 46 No. 5 November 1970, pp. 803-807
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UTILIZATION OF A PEDIATRICIAN IN A COMMUNITY CHILD GUIDANCE CLINIC

I. Low-income Community

William Ackerly M.D.1

1 Department of Psychiatry, Tufts Medical School, and Director, Somerville Child Guidance Clinic, Somerville, Massachusetts

Today's symposium focuses on the use of the pediatrician in a community child guidance clinic. My discussion of that subject will be extended to include the broader subject of total comprehensive care for low-income families. The concept of such care seems to me the most important topic for discussion by physicians engaged in family medicine, whether as independent pediatricians, psychiatrists, general practitioners, or internists, or in neighborhood clinics. I would like to present certain philosophical notions as well as the hard facts in relation to this concept, particularly from my viewpoint as Director of a Community Child Guidance Clinic in a low-income area.

In the philosophical view, comprehensive care is a wish fulfillment and an ideal. In reality, as physicians we do not provide anywhere near the total care for most of the families that we see, particularly in a lowincome area. For example, a teen-ager in the average multiproblem family that comes to our clinic may be a school failure, intoxicated on drugs, consuming alcohol, truant, and delinquent. He probably has come in contact with school guidance counselors, police officers, settlement house workers, family doctors, and now our mental health team, not to mention the agencies which follow this family (e.g., welfare workers, family service, medical clinics, and, maybe, Alcoholics Anonymous). For this teen-ager and his family we must develop a model with both a philosophy and the resources to begin to approach the reality and the ideal of comprehensive care.

At the present time, we only scratch the surface in providing the leadership, coordination, and service necessary to implement what any of us would consider to be true comprehensive care–a myth only approximated even in the wealthier communities.




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W. Kleinberg, P. A. O'Connor, and E. Denhoff
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